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JAMA Network Open Jan 2021To address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of... (Comparative Study)
Comparative Study
IMPORTANCE
To address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of government. However, few or no all-cause mortality data are available at the local level to motivate and guide city-level actions for health equity within the country's biggest cities.
OBJECTIVES
To provide city-level data on all-cause mortality rates and racial inequities within cities and to determine whether these measures changed during the past decade.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used mortality data from the National Vital Statistics System and American Community Survey population estimates to calculate city-level mortality rates for the non-Hispanic Black (Black) population, non-Hispanic White (White) population, and total population from January 2016 to December 2018. Changes from January 2009 to December 2018 were examined with joinpoint regression. Data were analyzed for the United States and the 30 most populous US cities. Data analysis was conducted from February to November 2020.
EXPOSURE
City of residence.
MAIN OUTCOMES AND MEASURES
Total population and race-specific age-standardized mortality rates using 3-year averages, mortality rate ratios between Black and White populations, excess Black deaths, and annual average percentage change in mortality rates and rate ratios.
RESULTS
The study included 26 295 827 death records. In 2016 to 2018, all-cause mortality rates ranged from 537 per 100 000 population in San Francisco to 1342 per 100 000 in Las Vegas compared with the overall US rate of 759 per 100 000. The all-cause mortality rate among Black populations was 24% higher than among White populations nationally (rate ratio, 1.236; 95% CI, 1.233 to 1.238), resulting in 74 402 excess Black deaths annually. At the city level, this ranged from 6 excess Black deaths in El Paso to 3804 excess Black deaths every year in Chicago. The US rate remained constant during the study period (average annual percentage change, -0.10%; 95% CI, -0.34% to 0.14%; P = .42). The racial inequities in rates for the US decreased between 2008 and 2019 (annual average percentage change, -0.51%; 95% CI, -0.92% to -0.09%; P =0.02). Only 14 of 30 cities (46.7%) experienced improvements in overall mortality rates during the past decade. Racial inequities increased in more cities (6 [20.0%]) than in which it decreased (2 [6.7%]).
CONCLUSIONS AND RELEVANCE
In this study, mortality rates and inequities between Black and White populations varied substantially among the largest US cities. City leaders and other health advocates can use these types of local data on the burden of death and health inequities in their jurisdictions to increase awareness and advocacy related to racial health inequities, to guide the allocation of local resources, to monitor trends over time, and to highlight effective population health strategies.
Topics: Black or African American; Cause of Death; Cross-Sectional Studies; Female; Humans; Male; Mortality; Mortality, Premature; United States; White People
PubMed: 33471116
DOI: 10.1001/jamanetworkopen.2020.32086 -
Journal of Alzheimer's Disease : JAD 2021The increasing prevalence of Alzheimer's disease (AD), along with the associated burden on healthcare systems, presents a substantial public health challenge.
BACKGROUND
The increasing prevalence of Alzheimer's disease (AD), along with the associated burden on healthcare systems, presents a substantial public health challenge.
OBJECTIVE
This study aimed to investigate trends in AD mortality and the relevant burden across the United States (U.S.) from 1999 to 2018 and to predict mortality trends between 2019 and 2023.
METHODS
Data on AD-related deaths between 1999 and 2018 were collected from the WONDER database administered by the U.S. Centers for Disease Control and Prevention (CDC). The Joinpoint Regression Program was used to analyze mortality trends due to AD. Years of life lost (YLL) were calculated to explore the burden of AD deaths. An autoregressive integrated moving average (ARIMA) model was employed to forecast mortality trends from 2019 to 2023.
RESULTS
Over a recent 20-year period, the number of AD deaths in the U.S. increased from 44,536 (31,145 females and 13,391 males) to 122,019 (84,062 females and 37,957 males). The overall age-adjusted mortality rate increased from 16.5/100,000 in 1999 to 30.5/100,000 in 2018. AD mortality is projected to reach 42.40/100000 within the year 2023. Overall, AD resulted in 322,773.00 YLL (2.33 per 1000 population) in 1999 and 658,501.87 YLL (3.68 per 1000 population) in 2018.
CONCLUSION
Our findings demonstrate an increase in AD mortality in the U.S. from 1999 to 2018 as well as a rapid increase from 2019 to 2023. The high burden of AD deaths emphasizes the need for targeted prevention, early diagnosis, and hierarchical management.
Topics: Aged; Alzheimer Disease; Cause of Death; Cost of Illness; Female; Health Services Needs and Demand; Humans; Life Expectancy; Male; Mortality; Prevalence; United States
PubMed: 34092643
DOI: 10.3233/JAD-210225 -
NCHS Data Brief Jan 2022Perinatal mortality (late fetal deaths at 28 completed weeks of gestation or more and early neonatal deaths under age 7 days) can be an indicator of the quality of...
Perinatal mortality (late fetal deaths at 28 completed weeks of gestation or more and early neonatal deaths under age 7 days) can be an indicator of the quality of health care before, during, and after delivery, and of the health status of the nation (1,2). The U.S. perinatal mortality rate declined 30% from 1990 to 2011, but was stable from 2011 through 2016 (1,3,4). This report presents trends in perinatal mortality as well as its components, late fetal and early neonatal mortality, for 2017 through 2019. Also shown are perinatal mortality trends by mother's age, race and Hispanic origin, and state for 2017-2019.
Topics: Child; Female; Fetal Mortality; Hispanic or Latino; Humans; Infant Mortality; Infant, Newborn; Perinatal Death; Perinatal Mortality; Pregnancy; Prenatal Care; United States
PubMed: 35072603
DOI: No ID Found -
Environmental Pollution (Barking, Essex... May 2023Black carbon (BC) is a product of incomplete or inefficient combustion and may be associated with a variety of adverse effects on human health. The objective of this... (Meta-Analysis)
Meta-Analysis Review
Black carbon (BC) is a product of incomplete or inefficient combustion and may be associated with a variety of adverse effects on human health. The objective of this study was to analyze the association between various mortalities and long-/short-term exposure to BC as an independent pollutant. In this systematic review, we searched 4 databases for original research in English up to 6 October 2022, that investigated population-wide mortality due to BC exposure. We pooled mortality estimates and expressed them as relative risk (RR) per 10 μg/m increase in BC. We used a random-effect model to derive the pooled RRs. Of the 3186 studies identified, 29 articles met the eligibility criteria, including 18 long-term exposure studies and 11 short-term exposure studies. In the major meta-analysis and sensitivity analysis, positive associations were found between BC and total mortality and cause-specific disease mortalities. Among them, the short-term effects of BC on total mortality, cardiovascular disease mortality, respiratory disease mortality, and the long-term effects of BC on total mortality, ischemic heart disease mortality, respiratory disease mortality and lung cancer mortality were found to be statistically significant. The heterogeneity of the meta-analysis results was much lower for short-term studies than for long-term. Few studies were at a high risk of bias in any domain. The certainty of the evidence for most of the exposure-outcome pairs was moderate. Our study showed a significantly positive association between short-/long-term BC exposure and various mortalities. We speculate that BC has a higher adverse health effect on the respiratory system than on the cardiovascular system. This is different from the effect of PM. Therefore, more studies are needed to consider BC as a separate pollutant, and not just as a component of PM.
Topics: Humans; Cause of Death; Air Pollutants; Environmental Pollutants; Soot; Carbon; Environmental Exposure; Particulate Matter; Air Pollution
PubMed: 36649881
DOI: 10.1016/j.envpol.2023.121086 -
Nursing Research 2020Although prior studies of inpatient maternal mortality in the United States provide data on the overall rate and trend in inpatient maternal mortality, there are no...
BACKGROUND
Although prior studies of inpatient maternal mortality in the United States provide data on the overall rate and trend in inpatient maternal mortality, there are no published reports of maternal mortality data stratified by timing of its occurrence across the pregnancy continuum (antepartum, intrapartum, and postpartum).
OBJECTIVE
The study objective was to determine whether the maternal mortality rate, trends over time, self-reported race/ethnicity, and associated factors vary based on the timing of the occurrence of death during pregnancy.
METHODS
We conducted a cross-sectional analysis of the Nationwide Inpatient Sample database to identify pregnancy-related inpatient stays stratified by timing. Among women in the sample, we determined in-hospital mortality and used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify comorbidities and behavioral characteristics associated with mortality, including alcohol, drug, and tobacco use. Joinpoint regression was used to calculate rates and trends of in-hospital maternal mortality.
RESULTS
During the study period, there were 7,411 inpatient maternal mortalities among an estimated 58,742,179 hospitalizations of women 15-49 years of age. In-hospital maternal mortality rate stratified by race showed that African Americans died at significantly higher rates during antepartum, intrapartum, and postpartum periods compared to hospitalizations for Whites or Hispanics during the same time period. Although the postpartum hospitalization represents only 2% of pregnancy-related hospitalizations among women aged 15-49 years, hospitalization during this time period accounted for 27.2% of all maternal deaths during pregnancy-related hospitalization.
DISCUSSION
Most in-hospital maternal mortalities occur after hospital discharge from child birth (postpartum period). Yet, the postpartum period continues to be the time period with the least maternal healthcare surveillance in the pregnancy continuum. African American women experience three times more in-hospital mortality when compared to their White counterparts.
Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Forecasting; Hospital Mortality; Humans; Maternal Mortality; Middle Aged; Pregnancy; Pregnancy Complications; Time Factors; United States; Young Adult
PubMed: 31609900
DOI: 10.1097/NNR.0000000000000397 -
Epidemiologia E Prevenzione 2020This Monograph aims to provide the scientific community and the Regional Healthcare Service an up-to-date Atlas of mortality for the Campania Region (Southern Italy).... (Review)
Review
OBJECTIVES
This Monograph aims to provide the scientific community and the Regional Healthcare Service an up-to-date Atlas of mortality for the Campania Region (Southern Italy). The Atlas shows an overview of mortality through comparisons with national data and with intraregional macroareas. Maps presenting risk measures with municipal details are also provided.
MATERIALS AND METHODS
Both overall and cause-specific mortality data for the period 2006-2014 referred to people residing in Campania Region are analysed in this Atlas. Twenty-nine death causes (major causes and specific cancers) are studied; for each of them, it has been provided: • direct standardised rates (standard population EU 2013) referred to Italy, Campania Region, and the seven regional Local Health Units (LHUs); • standardised mortality ratios (SMRs), estimated on a regional basis, referred to every LHU; • years of life lost (number and rate) both on a regional and on LHU basis; • mortality rate trends for the period 2006-2014, including annual percentage changes (APCs) for Italy, Campania Region, and every LHU; • for every death cause, regional maps are provided also with municipal details for Relative Risks (RRs) and risk posterior probabilities (PPs) estimated through a Bayesian hierarchical model. Risk estimates are presented both crude and adjusted by socioeconomic deprivation index resulted from the 2011 Census of the Italian National Institute fo Statistics.
RESULTS
In Campania Region, standardised mortality ratios (per 100,000; IC95%) higher than the national average have been recorded for the following causes: all causes of death: M: 1,233.3 (IC95% 1,227.9-1,238.9) vs 1,093.8 (IC95% 1,092.5-1,095.1); F: 826.1 (IC95% 822.6-829.7) vs 722.8 (IC95% 721.9-732.6); digestive system diseases: M: 51.2 (IC95% 50.2-52.3) vs 44.2 (IC95% 44.0-44.5); F: 35.8 (IC95% 35.1-36.6) vs 29,2 (IC95% 29.0-29.4); circulatory system diseases: M: 493.1 (IC95% 489.6-496.8) vs 404.3 (IC95% 403.5-405.1); F: 388.5 (IC95% 386.1-390.9) vs 296.5 (IC95% 295.9-297.0); genitourinary system diseases: M: 27.2 (IC95% 26.4-28.1) vs 21.9- (IC95% 21.7-22.1); F: 18.2 (IC95% 17.7-18.7) vs 13.7- (IC95% 13.5-13.8); endocrine and metabolic diseases: M: 60.0 (IC95% 58.8-61.2) vs 43.8 (IC95% 43.5-44.0); F: 60.7 (IC95% 59.8-61.7) vs 36.6 (IC95% 36.4-36.8); myocardial infarction: M: 71.1 (IC95% 69.8-72.4) vs 60.9 (IC95% 60.6-61.2); F: 38.2 (IC95% 37.4-39.0) vs 30.2-(IC95% 30.0-30.4); diabetes: M: 52.6 (IC95% 51.5-53.8) vs 35.1 (IC95% 34.9-35.3); F: 53.8 (IC95% 52.9-54.7) vs 28.6 (IC95% 28.4-28.8). On the other hand, mortality rates comparable to or lower than the national average are observed for the remaining causes of death, with different differences for gender. Mortality for cancer causes in Campania Region presents rates higher than the rates observed at national level in males for the following causes: all cancers: 380.4 (IC95% 377.5-383.3) vs 356.5 (IC95% 355.8-357.2); lung cancer: 112.5 (IC95% 110.9/114.0) vs 93.0 (IC95% 92.6-93.3);larynx cancer: 7.6 (IC95% 7.2-8.0) vs 5.5 (IC95% 5.4-5.6);bladder cancer: 25.1 (IC95% 24.4-25.9) vs 17.3 (IC95% 17.1-17.4); in females for the following causes: liver cancer: 3.8 (IC95% 3.6-4.1) vs 3.3 (IC95% 3.2-3.4);bladder cancer:: 3.5 (IC95% 3.3-3.7) vs 3.0 (IC95% 2.9-3.0). In Campania Region, mortality rates comparable to or lower than the national average are observed for the remaining cancer causes both in females and in males. For almost all the death causes, the highest mortality rates are observed in the three LHUs of Naples (Naples centre, Naples 2 North, Naples 3 South); for some death causes, also the Province of Caserta presents the highest mortality rates. It is worth noting that these areas are characterised by the highest urbanisation and regional population density, and by exposures to possible environmental risks. Time trend analyses highlight that regional and national trends are similar for almost all the examined death causes. In Campania Region, males present decreasing trends for all-cause mortality; for respiratory system, circulatory system, and digestive system diseases; for all malignant cancers; for lung, prostate, and stomach cancers; for leukaemias. On the other hand, an increasing trend is shown for liver cancer. Trends for genitourinary system and nervous system diseases are almost unchanged; the same is for blood diseases and haemolymphopoietic system cancers. In females, there is a decreasing mortality trend for all causes, for circulatory system and digestive system diseases; for haemolymphopoietic system and stomach cancers; on the contrary, an increasing trend is highlighted for communicable diseases and lung and liver cancer, mirroring the national situation. Trends for respiratory system, genitourinary system, nervous system diseases; blood diseases; all malignant cancers; kidney and breast cancers; leukaemias are almost unchanged. The analysis of mortality data on municipal basis reported that the most excesses in mortality risk occur in the municipalities included in the area with the highest urban development of Naples and, partly, in the municipalities of the Caserta Province. The distribution of the excesses at municipal level is not homogeneous in Campania Region, but there are relevant intermunicipal differences related to the considered causes of death. This heterogeneity in the distribution of excess risk is a characteristic also of the area called Terra di fuochi (Land of fires), both for overall mortality and for mortality by gender.
CONCLUSIONS
Mortality data are a valuable support to the analysis of the population health conditions. Excesses in general mortality and for some specific causes found in Campania Region vs Italy in 2006-2014 suggest that in this region there is a need to implement more strict intervention in terms both of primary prevention (for individuals and the environment) and of management of the whole care and clinical pathway of some pathologies, bearing in mind the burden of regional structural and economic factors on these excesses. The highest excesses in mortality in Campania Region have been found in the areas with the highest degree of urbanisation: this confirms the national data of a different distribution of diseases - and mortality - in the areas characterised by high urban development compared to rural areas. Finally, cause-specific mortality maps at municipal level, extended to the whole region, could enable to identify possible critical issues which may need epidemiological studies focused on possible local factors of environmental pressure.
Topics: Cause of Death; Cities; Humans; Italy; Mortality
PubMed: 33565290
DOI: 10.19191/EP20.1.S1.P001.003 -
Nutrients Jan 2022Little is known about the effect of milk intake on all-cause mortality among Chinese adults. The present study aimed to explore the association between milk intake and...
BACKGROUND
Little is known about the effect of milk intake on all-cause mortality among Chinese adults. The present study aimed to explore the association between milk intake and all-cause mortality in the Chinese population.
METHODS
Data from 1997 to 2015 of the China Health and Nutrition Survey (CHNS) were used. A total of 14,738 participants enrolled in the study. Dietary data were obtained by three day 24-h dietary recall. All-cause mortality was assessed according to information reported. The association between milk intake and all-cause mortality were explored using Cox regression and further stratified with different levels of dietary diversity score (DDS) and energy intake.
RESULTS
11,975 (81.25%) did not consume milk, 1341 (9.10%) and 1422 (9.65%) consumed 0.1-2 portions/week and >2 portions/week, respectively. Milk consumption of 0.1-2 portions/week was related to the decreased all-cause mortality (HR: 0.59, 95% CI: 0.41-0.85). In stratified analysis, consuming 0.1-2 portions/week was associated with decreased all-cause mortality among people with high DDS and energy intake.
CONCLUSIONS
Milk intake is low among Chinese adults. Consuming 0.1-2 portions of milk/week might be associated with the reduced risk of death among Chinese adults by advocating health education. Further research is required to investigate the relationships between specific dairy products and cause-specific mortality.
Topics: Adult; Animals; Cause of Death; China; Diet; Female; Humans; Male; Middle Aged; Milk; Mortality; Nutrition Surveys; Proportional Hazards Models; Prospective Studies
PubMed: 35057475
DOI: 10.3390/nu14020292 -
Przeglad Epidemiologiczny 2021We study patterns and developments in sex differences in alcohol-attributable mortality (AAM) in Poland over the years 2002-2018. Sex gap and sex-specific mortality...
We study patterns and developments in sex differences in alcohol-attributable mortality (AAM) in Poland over the years 2002-2018. Sex gap and sex-specific mortality patterns according to age, educational level and urbanrural settlements are contrasted with findings for other developed countries. Premature AAM of the population 20-64 years old is quantified with age-standardized alcohol-attributable mortality rates (AASMR) by sex and selected characteristics. For the age pattern, we study the gender gap in alcohol-attributable crude death rates for 10-year age groups. Data comes from the World Health Organization database or directly from the Polish Central Statistical Office. In 2002, in Poland, men died 9-times more often than women from causes attributable to alcohol consumption. As a result of faster growth in AASMR among women, the relative sex gap halved between 2002 and 2018. However, this relative change was accompanied by an increase in the absolute gap, resulting from a larger increase in the total number of deaths attributed to alcohol consumption among men than women. Due to the substantially higher alcohol consumption and mortality among men, differences in AAM according to age, education and place of residence, and their changes over the study years, are much more pronounced for men than women. Polish men and women are characterized by similar patterns and developments of alcohol-attributable mortality in the study years. Different from that observed for other developed countries narrowing the sex gap, we observe in Poland perseverance of male elevated AAM. An important contribution of the study is the evidence that to understand differences between men and women in AAM and their developments, we need to study both relative and absolute sex gaps.
Topics: Adult; Alcohol Drinking; Cause of Death; Female; Humans; Male; Middle Aged; Mortality; Mortality, Premature; Poland; Sex Characteristics; Sex Distribution; World Health Organization; Young Adult
PubMed: 34696561
DOI: 10.32394/pe.75.22 -
Sleep Health Apr 2024To identify longitudinal trajectories of sleep duration and quality and estimate their association with mild cognitive impairment, frailty, and all-cause mortality.
OBJECTIVES
To identify longitudinal trajectories of sleep duration and quality and estimate their association with mild cognitive impairment, frailty, and all-cause mortality.
METHODS
We used data from three waves (2009, 2014, 2017) of the WHO Study on Global Aging and Adult Health in Mexico. The sample consisted of 2722 adults aged 50 and over. Sleep duration and quality were assessed by self-report. Sleep trajectories were determined by applying growth mixture models. Mixed-effects logistic (mild cognitive impairment) and ordinal logistic (frailty), and Cox proportional hazards (all-cause mortality) models were fitted.
RESULTS
Three classes for sleep duration ("optimal-stable," "long-increasing," and "short-decreasing") and quality ("very good-increasing," "very good-decreasing," and "moderate/poor stable") were identified. Compared to the optimal-stable group, the long-increasing trajectory had greater odds for mild cognitive impairment (odds ratio=1.68, 95% CI: 1.01-2.78) and frailty (odds ratio=1.66, 95% CI: 1.13-2.46), and higher risk for all-cause mortality (hazard ratio=1.91, 95% CI: 1.14-3.19); and the short-decreasing class had a higher probability of frailty (odds ratio=1.83, 95% CI: 1.26-2.64). Regarding the sleep quality, the moderate/poor stable trajectory had higher odds of frailty (odds ratio=1.71, 95% CI: 1.18-2.47) than very good-increasing group.
CONCLUSIONS
These results have important implications for clinical practice and public health policies, given that the evaluation and treatment of sleep disorders need more attention in primary care settings. Interventions to detect and treat sleep disorders should be integrated into clinical practice to prevent or delay the appearance of alterations in older adults' physical and cognitive function. Further research on sleep quality and duration is warranted to understand their contribution to healthy aging.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Cause of Death; Cognitive Dysfunction; Frailty; Longitudinal Studies; Mexico; Mortality; Sleep Duration; Sleep Quality; Time Factors
PubMed: 38238122
DOI: 10.1016/j.sleh.2023.12.002 -
International Journal of Health... Jan 2021This population-based study compares U.S. effectiveness with 20 Other Western Countries (OWC) in reducing mortality 1989-1991 and 2013-2015 and, responding to criticisms...
This population-based study compares U.S. effectiveness with 20 Other Western Countries (OWC) in reducing mortality 1989-1991 and 2013-2015 and, responding to criticisms of Britain's National Health Service, directly compares U.S. with U.K. child (0-4), adult (55-74), and 24 global mortality categories. World Health Organization Age-Standardized Death Rates (ASDR) data are used to compare American and OWC mortality over the period, juxtaposed against national average percentages of Gross Domestic Product (GDP) Expenditure on Health (%GDPEH) drawn from World Bank data. America's average %GDPEH was highest at 13.53% and Britain's the lowest at 7.68%. Every OWC had significantly greater ASDR reductions than America. Current U.S. child and adult mortality rates are 46% and 19% higher than Britain's. Of 24 global diagnostic mortalities, America had 16 higher rates than Britain, notably for Circulatory Disease (24%), Endocrine Disorders (70%), External Deaths (53%), Genitourinary (44%), Infectious Disease (65%), and Perinatal Deaths (34%). Conversely, U.S. rates were than Britain's for Neoplasms (11%), Respiratory (12%), and Digestive Disorder Deaths (11%). However, had America matched the United Kingdom's ASDR, there would have been 488,453 fewer U.S. deaths. In view of American %GDPHE and their mortality rates, which were significantly higher than those of the OWC, these results suggests that the U.S. health care system is the least efficient in the Western world.
Topics: Adult; Child; Communicable Diseases; Female; Health Expenditures; Humans; Mortality; Pregnancy; State Medicine; United Kingdom; United States; World Health Organization
PubMed: 33059529
DOI: 10.1177/0020731420965130