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Journal of General Internal Medicine Apr 2024
Topics: Humans; Social Determinants of Health; Morbidity; Mortality; Congresses as Topic; Healthcare Disparities; Health Status Disparities; Health Inequities
PubMed: 38243108
DOI: 10.1007/s11606-024-08616-x -
JAMA Network Open Feb 2024In resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
In resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based interventions can increase newborn survival by improving health care practices.
OBJECTIVES
To develop and evaluate the effectiveness of a community-based maternal and newborn care services package to reduce perinatal and neonatal mortality in rural Pakistan.
DESIGN, SETTING, AND PARTICIPANTS
This cluster randomized clinical trial was conducted between November 1, 2012, and December 31, 2013, in district Rahim Yar Khan in the province of Punjab. A cluster was defined as an administrative union council. Any consenting pregnant resident of the study area, regardless of gestational age, was enrolled. An ongoing pregnancy surveillance system identified 12 529 and 12 333 pregnancies in the intervention and control clusters, respectively; 9410 pregnancies were excluded from analysis due to continuation of pregnancy at the end of the study, loss to follow-up, or miscarriage. Participants were followed up until the 40th postpartum day. Statistical analysis was performed from January to May 2014.
INTERVENTION
A maternal and newborn health pack, training for community- and facility-based health care professionals, and community mobilization through counseling and education sessions.
MAIN OUTCOMES AND MEASURES
The primary outcome was perinatal mortality, defined as stillbirths per 1000 births and neonatal death within 7 days per 1000 live births. The secondary outcome was neonatal mortality, defined as death within 28 days of life per 1000 live births. Systematic random sampling was used to allocate 10 clusters each to intervention and control groups. Analysis was conducted on a modified intention-to-treat basis.
RESULTS
For the control group vs the intervention group, the total number of households was 33 188 vs 34 315, the median number of households per cluster was 3092 (IQR, 3018-3467) vs 3469 (IQR, 3019-4075), the total population was 229 155 vs 234 674, the mean (SD) number of residents per household was 6.9 (9.5) vs 6.8 (9.6), the number of males per 100 females (ie, the sex ratio) was 104.2 vs 103.7, and the mean (SD) number of children younger than 5 years per household was 1.0 (4.2) vs 1.0 (4.3). Altogether, 7598 births from conrol clusters and 8017 births from intervention clusters were analyzed. There was no significant difference in perinatal mortality between the intervention and control clusters (rate ratio, 0.86; 95% CI, 0.69-1.08; P = .19). The NMR was lower among the intervention than the control clusters (39.2/1000 live births vs 52.2/1000 live births; rate ratio, 0.75; 95% CI, 0.58-0.95; P = .02). The frequencies of antenatal visits and facility births were similar between the 2 groups. However, clean delivery practices were higher among intervention clusters than control clusters (63.2% [2284 of 3616] vs 13.2% [455 of 3458]; P < .001). Chlorhexidine use was also more common among intervention clusters than control clusters (55.9% [4271 of 7642] vs 0.3% [19 of 7203]; P < .001).
CONCLUSIONS AND RELEVANCE
This pragmatic cluster randomized clinical trial demonstrated a reduction in NMR that occurred in the background of improved household intrapartum and newborn care practices. However, the effect of the intervention on antenatal visits, facility births, and perinatal mortality rates was inconclusive, highlighting areas requiring further research. Nevertheless, the improvement in NMR underscores the effectiveness of community-based programs in low-resource settings.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01751945.
Topics: Pregnancy; Child; Male; Infant, Newborn; Female; Humans; Infant Mortality; Family; Parturition; Perinatal Death; Perinatal Mortality
PubMed: 38372998
DOI: 10.1001/jamanetworkopen.2023.56609 -
Frontiers in Public Health 2023Under-five mortality rate (U5MR) and maternal mortality rate (MMR) are important indicators for evaluating the quality of perinatal health and child health services in a...
INTRODUCTION
Under-five mortality rate (U5MR) and maternal mortality rate (MMR) are important indicators for evaluating the quality of perinatal health and child health services in a country or region, and are research priorities for promoting maternal and infant safety and maternal and child health. This paper aimed to analysis and predict the trends of U5MR and MMR in China, to explore the impact of social health services and economic factors on U5MR and MMR, and to provide a basis for relevant departments to formulate relevant policies and measures.
METHODS
The JoinPoint regression model was established to conduct time trend analysis and describe the trend of neonatal mortality rate (NMR), infant mortality rate (IMR), U5MR and MMR in China from 1991 to 2020. The linear mixed effect model was used to assess the fixed effects of maternal health care services and socioeconomic factors on U5MR and MMR were explored, with year as a random effect to minimize the effect of collinearity. Auto regressive integrated moving average models (ARIMA) were built to predict U5MR and MMR from 2021 to 2025.
RESULTS
The NMR, IMR, U5MR and MMR from 1991 to 2020 in China among national, urban and rural areas showed continuous downward trends. The NMR, IMR, U5MR and MMR were significantly negatively correlated with gross domestic product (GDP), the proportion of the total health expenditure (THE) to GDP, system management rate, prenatal care rate, post-natal visit rate and hospital delivery rate. The predicted values of national U5MR from 2021 to 2025 were 7.3 ‰, 7.2 ‰, 7.1 ‰, 7.1 ‰ and 7.2 ‰ and the predicted values of national MMR were 13.8/100000, 12.1/100000, 10.6/100000, 9.6/100000 and 8.3/100000.
CONCLUSION
China has made great achievements in reducing the U5MR and MMR. It is necessary for achieving the goals of Healthy China 2030 by promoting the equalization of basic public health services and further optimizing the allocation of government health resources. China's experience in reducing U5MR and MMR can be used as a reference for developing countries to realize the SDGs.
Topics: Infant; Infant, Newborn; Child; Pregnancy; Female; Humans; Child Mortality; Maternal Mortality; Infant Mortality; Socioeconomic Factors; China
PubMed: 37927855
DOI: 10.3389/fpubh.2023.1198356 -
Journal of the National Cancer Institute Jan 2024Few studies have examined cancer-related mortality overall, never mind select cancer types, during the COVID-19 pandemic. Data on cancer-related mortality (any mention...
Few studies have examined cancer-related mortality overall, never mind select cancer types, during the COVID-19 pandemic. Data on cancer-related mortality (any mention in death certificates, multiple causes of death approach) was extracted from the US Centers for Disease Control and Prevention WONDER database. Changes in trends for age-standardized mortality rates through 1999-2021 were assessed by Joinpoint analysis. In total, 1 379 643 cancer-related deaths were registered in 2020-2021, with cancer selected as the underlying cause in 88%. After 2 decades of decline, age-standardized cancer-related mortality increased from 2019 to 2021 for all cancers (annual percentage change = 1.6%, 95% confidence interval = 0.6% to 2.6%), especially for prostate cancer (annual percentage change = 5.1%, 95% confidence interval = 2.2% to 8.2%) and hematologic cancers (annual percentage change = 4.8%, 95% confidence interval = 3.1% to 6.6%). Sharp peaks in cancer-related deaths for many cancer sites were observed during pandemic waves in both 2020 and 2021, mostly attributed to COVID-19 as the underlying cause. Multiple causes of death analyses are warranted to fully assess the impact of the pandemic on cancer-related mortality.
Topics: Male; Humans; United States; Pandemics; COVID-19; Prostatic Neoplasms; Hematologic Neoplasms; Databases, Factual; Cause of Death; Mortality
PubMed: 37688577
DOI: 10.1093/jnci/djad191 -
BMC Public Health Apr 2024Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant...
BACKGROUND
Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic.
METHODS
The associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017-2022 were explored, using linear regression models.
RESULTS
The higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020-2022).
CONCLUSIONS
Life in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies.
Topics: Female; Humans; Infant; Infant, Newborn; Male; Pregnancy; COVID-19; Ethnicity; Infant Mortality; Perinatal Mortality; Roma; Slovakia; Socioeconomic Disparities in Health; Socioeconomic Factors
PubMed: 38658885
DOI: 10.1186/s12889-024-18645-0 -
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 -
Nephrology, Dialysis, Transplantation :... May 2024
Topics: Humans; Hemodiafiltration; Kidney Failure, Chronic; Survival Rate; Cause of Death
PubMed: 38183294
DOI: 10.1093/ndt/gfae003 -
Journal of Epidemiology and Community... Sep 2023Previous studies undertaken in New Zealand using generic rurality classifications have concluded that life expectancy and age-standardised mortality rates are similar... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
Previous studies undertaken in New Zealand using generic rurality classifications have concluded that life expectancy and age-standardised mortality rates are similar for urban and rural populations.
METHODS
Administrative mortality (2014-2018) and census data (2013 and 2018) were used to estimate age-stratified sex-adjusted mortality rate ratios (aMRRs) for a range of mortality outcomes across the rural-urban spectrum (using major urban centres as the reference) for the total population and separately for Māori and non-Māori. Rural was defined according to the recently developed Geographic Classification for Health.
RESULTS
Mortality rates were higher overall in rural areas. This was most pronounced in the youngest age group (<30 years) in the most remote communities (eg, all-cause, amenable and injury-related aMRRs (95% CIs) were 2.1 (1.7 to 2.6), 2.5 (1.9 to 3.2) and 3.0 (2.3 to 3.9) respectively. The rural:urban differences attenuated markedly with increasing age; for some outcomes in those aged 75 years or more, estimated aMRRs were <1.0. Similar patterns were observed for Māori and non-Māori.
CONCLUSION
This is the first time that a consistent pattern of higher mortality rates for rural populations has been observed in New Zealand. A purpose-built urban-rural classification and age stratification were important factors in unmasking these disparities.
Topics: Life Expectancy; Humans; Urban Population; Rural Population; New Zealand; Mortality; Age Distribution; Male; Female; Adolescent; Adult; Middle Aged; Aged; Aged, 80 and over
PubMed: 37295927
DOI: 10.1136/jech-2023-220337 -
Health Economics Sep 2023The government of Peru amended its constitution to increase compulsory education from six to 11 years in 1993. This constitutional amendment provides a natural...
The government of Peru amended its constitution to increase compulsory education from six to 11 years in 1993. This constitutional amendment provides a natural experiment to investigate the impact of maternal education on child mortality. Exploiting differences in the reform exposure by age, I find that mothers who were exposed to the reform were less likely to experience the death of a child. There is also evidence that the reform caused a decline in infant mortality. These results are not driven by the age difference between mothers who were treated by the reform and those who were not treated. Additional analyses reveal that the reform increased age at first birth, decreased desired fertility, reduced smoking, and improved economic opportunities for women. The results demonstrate that compulsory schooling may be a useful policy tool to improve women's education, which can, in turn, enhance the survival of their children.
Topics: Infant; Child; Female; Humans; Child Mortality; Peru; Educational Status; Infant Mortality; Mothers; Mortality; Socioeconomic Factors
PubMed: 37182225
DOI: 10.1002/hec.4696 -
European Journal of Clinical... Jan 2024Depression has been associated with nonalcoholic fatty liver disease (NAFLD). Data addressing the impact of depression on NAFLD-related mortality are evolving. We aim to...
BACKGROUND
Depression has been associated with nonalcoholic fatty liver disease (NAFLD). Data addressing the impact of depression on NAFLD-related mortality are evolving. We aim to study the association of depression in NAFLD and all-cause/cause-specific mortality in the United States.
METHODS
A total of 11,877 individuals with NAFLD in the 2007-2016 National Health and Nutrition Examination Survey with the availability of linked mortality through 2019 were analysed. NAFLD was defined by utilizing the hepatic steatosis index in the absence of known causes of chronic liver disease. Depression and functional impairment due to depression were assessed using the Patient Health Questionnaire.
RESULTS
During the median follow-up of 7.6 years, individuals with depression among individuals with NAFLD had a 35% higher all-cause mortality than those without depression (hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.03-1.75) after adjusting for demographic, lifestyle and clinical risk factors. NAFLD with functional impairment due to depression had a 62% higher all-cause mortality than NAFLD without functional impairment (HR: 1.62, 95% CI: 1.10-2.39). Depression in NAFLD was associated with an approximately 50% increase in the risk for cardiovascular mortality, with a 2-fold higher cardiovascular mortality in those with functional impairment compared to those without (HR: 2.07, 95% CI: 1.30-3.30). However, there was no significant difference in cancer- and accident-related mortalities in NAFLD with or without depression.
CONCLUSIONS
Depression among individuals with NAFLD was associated with a higher risk for all-cause and cardiovascular mortality in the United States.
Topics: Humans; United States; Non-alcoholic Fatty Liver Disease; Nutrition Surveys; Cause of Death; Depression; Cardiovascular Diseases
PubMed: 37638383
DOI: 10.1111/eci.14087