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The Science of the Total Environment Nov 2022Environmental factors have been associated with adverse health effects in epidemiological studies. The main exposure variable is usually determined via prior knowledge...
BACKGROUND
Environmental factors have been associated with adverse health effects in epidemiological studies. The main exposure variable is usually determined via prior knowledge or statistical methods. It may be challenging when evidence is scarce to support prior knowledge, or to address collinearity issues using statistical methods. This study aimed to investigate the importance level of environmental variables for the under-five mortality in Malaysia via random forest approach.
METHOD
We applied a conditional permutation importance via a random forest (CPI-RF) approach to evaluate the relative importance of the weather- and air pollution-related environmental factors on daily under-five mortality in Malaysia. This study spanned from January 1, 2014 to December 31, 2016. In data preparation, deviation mortality counts were derived through a generalized additive model, adjusting for long-term trend and seasonality. Analyses were conducted considering mortality causes (all-cause, natural-cause, or external-cause) and data structures (continuous, categorical, or all types [i.e., include all variables of continuous type and all variables of categorical type]). The main analysis comprised of two stages. In Stage 1, Boruta selection was applied for preliminary screening to remove highly unimportant variables. In Stage 2, the retained variables from Boruta were used in the CPI-RF analysis. The final importance value was obtained as an average value from a 10-fold cross-validation.
RESULT
Some heat-related variables (maximum temperature, heat wave), temperature variability, and haze-related variables (PM10, PM10-derived haze index, PM10- and fire-derived haze index, fire hotspot) were among the prominent variables associated with under-five mortality in Malaysia. The important variables were consistent for all- and natural-cause mortality and sensitivity analyses. However, different most important variables were observed between natural- and external-cause under-five mortality.
CONCLUSION
Heat-related variables, temperature variability, and haze-related variables were consistently prominent for all- and natural-cause under-five mortalities, but not for external-cause.
Topics: Air Pollutants; Air Pollution; Environmental Exposure; Hot Temperature; Malaysia; Mortality; Particulate Matter; Weather
PubMed: 35839873
DOI: 10.1016/j.scitotenv.2022.157312 -
Disaster Medicine and Public Health... Dec 2020
Topics: COVID-19; History, 19th Century; History, 20th Century; History, 21st Century; History, Medieval; Humans; Mortality; Pandemics
PubMed: 32854810
DOI: 10.1017/dmp.2020.307 -
Journal of Epidemiology and Community... Sep 2023Public health research increasingly acknowledges the influence of built environments (BE) on health; however, it is uncertain how BE change is associated with better...
BACKGROUND
Public health research increasingly acknowledges the influence of built environments (BE) on health; however, it is uncertain how BE change is associated with better population health and whether BE change can help narrow health inequalities. This knowledge gap is partly due to a lack of suitable longitudinal BE data in most countries. We devised a method to quantify BE change longitudinally and explored associations with mortality. The method is replicable in any nation that captures BE vector map data.
METHODS
Ordnance Survey data were used to categorise small areas as having no change, loss or gain, in buildings, roads, and woodland between 2015 and 2019. We examined individual mortality records for 2012-2015 and 2016-2019, using negative binomial regression to explore associations between BE change and all-cause and cause-specific mortality, adjusting for income deprivation.
RESULTS
BE change varied significantly by deprivation and urbanicity. Change in the BE and change in mortality were not related, however, areas that went on to experience BE change had different baseline mortality rates compared with those that did not. For example, areas that gained infrastructure already had lower mortality rates.
CONCLUSION
We provide new methodology to quantify BE change over time across a nation. Findings provide insight into the health of areas that do/do not experience change, prompting critical perspectives on cross-sectional studies of associations between BE and health. Methods and findings applied internationally could explore the context of BE change and its potential to improve health in areas most in need beyond the UK.
Topics: Humans; Built Environment; Cause of Death; Cross-Sectional Studies; Income; Mortality; Public Health
PubMed: 37369593
DOI: 10.1136/jech-2023-220681 -
BMC Cancer Dec 2020Breast cancer (BC) is the most common malignancy in Latin American women, but with a wide variability with respect to their mortality. This study aims to estimate the...
BACKGROUND
Breast cancer (BC) is the most common malignancy in Latin American women, but with a wide variability with respect to their mortality. This study aims to estimate the mortality rates from BC in Peruvian women and to assess mortality trends over 15 years.
METHODS
We calculated BC age-standardized mortality rate (ASMR) per 100,000 women-years using the world standard SEGI population. We estimated joinpoint regression models for BC in Peru and its geographical areas. The spatial analysis was performed using the Moran's I statistic.
RESULTS
In a 15-year period, Peru had a mortality rate of 9.97 per 100,000 women-years. The coastal region had the highest mortality rate (12.15 per 100,000 women-years), followed by the highlands region (4.71 per 100,000 women-years). In 2003, the highest ASMR for BC were in the provinces of Lima, Arequipa, and La Libertad (above 8.0 per 100,000 women-years), whereas in 2017, the highest ASMR were in Tumbes, Callao, and Moquegua (above 13.0 per women-years). The mortality trend for BC has been declining in the coastal region since 2005 (APC = - 1.35, p < 0.05), whereas the highlands region experienced an upward trend throughout the study period (APC = 4.26, p < 0.05). The rainforest region had a stable trend. Spatial analysis showed a Local Indicator of Spatial Association of 0.26 (p < 0.05).
CONCLUSION
We found regional differences in the mortality trends over 15 years. Although the coastal region experienced a downward trend, the highlands had an upward mortality trend in the entire study period. It is necessary to implement tailored public health interventions to reduce BC mortality in Peru.
Topics: Breast Neoplasms; Female; Humans; Mortality; Peru
PubMed: 33261561
DOI: 10.1186/s12885-020-07671-x -
Journal of Sleep Research Apr 2024Both short (< 6 hr) and long (> 8 hr) sleep are associated with increased mortality. We here investigated whether the association between sleep duration and...
Both short (< 6 hr) and long (> 8 hr) sleep are associated with increased mortality. We here investigated whether the association between sleep duration and all-cause, cardiovascular disease and cancer mortality differs between men and women. A cohort of 34,311 participants (mean age and standard deviation = 50.5 ± 15.5 years, 65% women), with detailed assessment of sleep at baseline and up to 20.5 years of follow-up (18 years for cause-specific mortality), was analysed using Cox proportional hazards model to estimate HRs with 95% confidence intervals. After adjustment for covariates, all-cause, cardiovascular disease and cancer mortalities were increased for both < 5 hr and ≥ 9 hr sleep durations (with 6 hr as reference). For all-cause mortality, women who slept < 5 hr had a hazard ratio = 1.54 (95% confidence interval = 1.32-1.80), while the corresponding hazard ratio was 1.05 (95% confidence interval = 0.88-1.27) for men, the interaction being significant (p < 0.05). For cardiovascular disease mortality, exclusion of the first 2 years of exposure, as well as competing risk analysis eliminated the originally significant interaction. Cancer mortality did not show any significant interaction. Survival analysis of the difference between the reference duration (6 hr) and the short duration (< 5 hr) during follow-up showed a gradually steeper reduction of survival time for women than for men for all-cause mortality. We also observed that the lowest cancer mortality appeared for the 5-hr sleep duration. In conclusion, the pattern of association between short sleep duration and all-cause mortality differed between women and men, and the difference between men and women increased with follow-up time.
Topics: Male; Humans; Female; Cardiovascular Diseases; Sleep; Proportional Hazards Models; Sleep Wake Disorders; Neoplasms; Risk Factors; Mortality
PubMed: 37192602
DOI: 10.1111/jsr.13931 -
BMJ Mental Health May 2023Bipolar disorder (BD) is associated with increased mortality, but evidence on cause-specific mortality is limited.
BACKGROUND
Bipolar disorder (BD) is associated with increased mortality, but evidence on cause-specific mortality is limited.
OBJECTIVE
To investigate cause-specific premature excess mortality in BD.
METHODS
Finnish nationwide cohort study of individuals with and without a diagnosis of BD who were aged 15-64 years during 2004-2018. Standardised mortality ratios (SMRs) with 95% CIs were calculated for BD using the mortality rates in the Finnish general population without BD as weights. Causes of death were defined by the International Classification of Diseases, 10th revision codes.
FINDINGS
Of the included 47 018 individuals with BD, 3300 (7%) died during follow-up. Individuals with BD had sixfold higher mortality due to external causes (SMR: 6.01, 95% CI: 5.68, 6.34) and twofold higher mortality due to somatic causes (SMR: 2.06, 95% CI: 1.97, 2.15). Of the deaths due to external causes, 83% (1061/1273) were excess deaths, whereas 51% (1043/2027) of the deaths due to somatic causes were excess. About twice the number of potential years of life were lost in excess due to external causes than due to somatic causes. Alcohol-related causes contributed more to excess mortality than deaths due to cardiovascular disease.
CONCLUSION
External causes of death contributed more to the mortality gap than somatic causes after controlling for age-specific background general population mortality.
CLINICAL IMPLICATION
A balanced consideration between therapeutic response, different treatment options and risk of cause-specific mortality is needed to prevent premature mortality in BD and to reduce the mortality gap.
Topics: Humans; Bipolar Disorder; Cohort Studies; Cause of Death; Cardiovascular Diseases; Mortality, Premature
PubMed: 37463759
DOI: 10.1136/bmjment-2023-300700 -
Cancer Epidemiology, Biomarkers &... Jul 2021This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and...
BACKGROUND
This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and premature cancer mortality by cancer types.
METHODS
Using multiple databases, cancer mortality was linked to SES and other county characteristics. The outcome measure was cancer mortality among adults ages 25-64 years in 3,028 U.S. counties, from 1999 to 2018. Socioeconomic inequalities in mortality were calculated as a concentration index (CI) by income (annual median household income), educational attainment (% with bachelor's degree or higher), and unemployment rate. A hierarchical linear mixed model and dominance analyses were used to investigate SES associated with county-level mortality. The analyses were also conducted by cancer types.
RESULTS
CIs of SES factors varied by cancer types. Low-SES counties showed increasing trends in mortality, while high-SES counties showed decreasing trends. Socioeconomic inequalities in mortality among high-SES counties were larger than those among low-SES counties. SES explained 25.73% of the mortality. County-level cancer mortality was associated with income, educational attainment, and unemployment rate, at -0.24 [95% (CI): -0.36 to -0.12], -0.68 (95% CI: -0.87 to -0.50), and 1.50 (95% CI: 0.92-2.07) deaths per 100,000 population with one-unit SES factors increase, respectively, after controlling for health care environment and population health.
CONCLUSIONS
SES acts as a key driver of premature cancer mortality, and socioeconomic inequalities differ by cancer types.
IMPACT
Focused efforts that target socioeconomic drivers of mortalities and inequalities are warranted for designing cancer-prevention implementation strategies and control programs and policies for socioeconomically underprivileged groups.
Topics: Adult; Aged; Female; Geography; Health Status Disparities; History, 20th Century; History, 21st Century; Humans; Male; Middle Aged; Mortality, Premature; Neoplasms; Social Determinants of Health; Socioeconomic Factors; United States
PubMed: 33947656
DOI: 10.1158/1055-9965.EPI-20-1534 -
Population Health Metrics Jan 2022The mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without...
BACKGROUND
The mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without high functioning vital registration systems could benefit from estimates of age- and cause-specific mortality to inform health programming, however, to date the causes of under-five death have only been described for broad age categories such as for neonates (0-27 days), infants (0-11 months), and children age 12-59 months.
METHODS
We adapt the log quadratic model to mortality patterns for children under five to all-cause child mortality and then to age- and cause-specific mortality (U5ACSM). We apply these methods to empirical sample registration system mortality data in China from 1996 to 2015. Based on these empirical data, we simulate probabilities of mortality in the case when the true relationships between age and mortality by cause are known.
RESULTS
We estimate U5ACSM within 0.1-0.7 deaths per 1000 livebirths in hold out strata for life tables constructed from the China sample registration system, representing considerable improvement compared to an error of 1.2 per 1000 livebirths using a standard approach. This improved prediction error for U5ACSM is consistently demonstrated for all-cause as well as pneumonia- and injury-specific mortality. We also consistently identified cause-specific mortality patterns in simulated mortality scenarios.
CONCLUSION
The log quadratic model is a significant improvement over the standard approach for deriving U5ACSM based on both simulation and empirical results.
Topics: Cause of Death; Child; Child Mortality; Child, Preschool; China; Humans; Infant; Infant Mortality; Infant, Newborn; Life Tables
PubMed: 35012587
DOI: 10.1186/s12963-021-00277-w -
International Journal of Oral and... Jan 2021Survival rates for oral squamous cell carcinoma (OSCC) has remained stagnant in recent years and improving surgical mortality could be an avenue to enhance outcomes....
Survival rates for oral squamous cell carcinoma (OSCC) has remained stagnant in recent years and improving surgical mortality could be an avenue to enhance outcomes. This systematic review aims to identify the causes of mortalities, determine both the modifiable and non-modifiable factors involved and target a reduction in postoperative 30-day mortality. In May 2019, a comprehensive search of key databases including PubMed, EMBASE, Cochrane Library was conducted. Blinded selection by two researchers identified papers that included participants who received oral squamous cell carcinoma resection and suffered an in-hospital or 30-day mortality. Selection identified two relevant papers that meet the inclusion criteria. One study had one death in its population sample but only had the cause of death described. Another study had an overall surgical mortality rate of 1% in a population of 21,681. Patients with multiple factors had the highest mortality rates; 4.6% in patients >85 years old and have a T4 diagnosis, 3.9% in patients with a Comorbidity Index ≥1 and a T4 diagnosis. These studies did not determine relationships between factors and causes of death. There are significant knowledge gaps in the literature, that can be addressed through further population analysis studies.
Topics: Aged, 80 and over; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Mouth Neoplasms; Squamous Cell Carcinoma of Head and Neck; Survival Rate
PubMed: 32773113
DOI: 10.1016/j.ijom.2020.07.011 -
Environmental Science and Pollution... Jan 2022The present research aims to investigate the impact of air pollution on the number of mortalities caused by COVID-19 per Pakistani province. To do so, for each...
The present research aims to investigate the impact of air pollution on the number of mortalities caused by COVID-19 per Pakistani province. To do so, for each independent area of Pakistan, the observed mortality due to COVID-19 has been standardized over the entire population using standard age groups ranging from 0 to 4, 5 to 9, 10 to 14,…, 65, and above years, supported by the 2017 state people census. The impact of air pollution and COVID-19 transience among Pakistani areas, Islamabad Capital Territory (ICT), and the Federally Administered Tribal Region (FATA) was analyzed by a multiple-linear regression model, while the broad collection of attributes was observed by the resources of local spatial autocorrelation indicators, including the spatial portion of COVID-19 association. The result indicates that the observed mortality rate is much higher than predicted in certain provinces, namely, the Khyber Pakhtunkhwa and Punjab provinces, and the prevalence of PM was independently linked to mortality due to the corona virus. Additionally, the results of the local spatial autocorrelation indicators on the standardized mortality rate and PM define a collection of very higher ideologies in the broad range of KPK and the southern part of Punjab province, respectively, with a definite degree of connection between the two distributions in the Khyber Pakhtunkhwa region. In brief, this research seems to find a justification for confirming the existence of a correlation between the possibility of COVID-19 mortality and air pollution, more precisely considering air pollutants (i.e., particulate (PM) and land take-over. To this end, the need to mediate in favor of measures aimed at eliminating emissions in the environment will be reiterated by speeding up current proposals and policies aimed at all causes of atmospheric pollution: urbanization, water and manufacturing, home heating, and transportation.
Topics: Air Pollutants; Air Pollution; COVID-19; Humans; Infant, Newborn; Mortality; Pakistan; Particulate Matter; SARS-CoV-2
PubMed: 34363580
DOI: 10.1007/s11356-021-15654-z