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Population Trends in All-Cause Mortality and Cause Specific-Death With Incident Atrial Fibrillation.Journal of the American Heart... Oct 2020BACKGROUND Limited studies have evaluated population-level temporal trends in mortality and cause of death in patients with contemporary managed atrial fibrillation....
BACKGROUND Limited studies have evaluated population-level temporal trends in mortality and cause of death in patients with contemporary managed atrial fibrillation. This study reports the temporal trends in 1-year overall and cause-specific mortality in patients with incident atrial fibrillation. METHODS AND RESULTS Patients with incident atrial fibrillation presenting to an emergency department or hospitalized in Ontario, Canada, were identified in population-level linked administrative databases that included data on vital statistics and cause of death. Temporal trends in 1-year all-cause and cause-specific mortality was determined for individuals identified between April 1, 2007 (fiscal year [FY] 2007) and March 31, 2016 (FY 2015). The study cohort consisted of 110 302 individuals, 69±15 years of age with a median congestive heart failure, hypertension, age (≥75 years), diabetes mellitus, stroke (2 points), vascular disease, age (≥65 years), sex category (female) score of 2.8. There was no significant decline in the adjusted 1-year all-cause mortality between the first and last years of the study period (adjusted mortality: FY 2007, 8.0%; FY 2015, 7.8%; P for trend=0.68). Noncardiovascular death accounted for 61% of all deaths; the adjusted 1-year noncardiovascular mortality rate rose from 4.5% in FY 2007 to 5.2% in FY 2015 (P for trend=0.007). In contrast, the 1-year cardiovascular mortality rate decreased from 3.5% in FY 2007 to 2.6% in FY 2015 (P for trend=0.01). CONCLUSIONS Overall 1-year all-cause mortality in individuals with incident atrial fibrillation has not improved despite a significant reduction in the rate of cardiovascular death. These findings highlight the importance of recognizing and managing concomitant noncardiovascular conditions in patients with atrial fibrillation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Cause of Death; Female; Humans; Incidence; Male; Middle Aged; Mortality; Ontario; Risk Factors; Young Adult
PubMed: 32924719
DOI: 10.1161/JAHA.120.016810 -
International Journal of Epidemiology Feb 2024Attempts at assessing heterogeneity in countries' mortality profiles often rely on measures of cause of death (CoD) diversity. Unfortunately, such indicators fail to...
BACKGROUND
Attempts at assessing heterogeneity in countries' mortality profiles often rely on measures of cause of death (CoD) diversity. Unfortunately, such indicators fail to take into consideration the degree of (dis)similarity among pairs of causes (e.g. 'transport injuries' and 'unintentional injuries' are implicitly assumed to be as dissimilar as 'transport injuries' and 'Alzheimer's disease')-an unrealistic and unduly restrictive assumption.
DEVELOPMENT
We extend diversity indicators proposing a broader class of heterogeneity measures that are sensitive to the similarity between the causes of death one works with. The so-called 'CoD inequality' measures are defined as the average expected 'dissimilarity between any two causes of death'. A strength of the approach is that such measures are decomposable, so that users can assess the contribution of each cause to overall CoD heterogeneity levels-a useful property for the evaluation of public health policies.
APPLICATION
We have applied the method to 15 low-mortality countries between 1990 and 2019, using data from the Global Burden of Disease project. CoD inequality and CoD diversity generally increase over time across countries and sex, but with some exceptions. In several cases (notably, Finland), both indicators run in opposite directions.
CONCLUSIONS
CoD inequality and diversity indicators capture complementary information about the heterogeneity of mortality profiles, so they should be analysed alongside other population health metrics, such as life expectancy and lifespan inequality.
Topics: Humans; Cause of Death; Life Expectancy; Longevity; Finland; Alzheimer Disease; Mortality
PubMed: 38365965
DOI: 10.1093/ije/dyae016 -
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 -
Journal of Global Health 2021Expanding social protection programme is a major target of the Sustainable Development Goals. Previous studies provided evidence for the relationship of social...
BACKGROUND
Expanding social protection programme is a major target of the Sustainable Development Goals. Previous studies provided evidence for the relationship of social protection programme to greater use of health services and some improved health outcomes for children. Yet, its impact on child mortality has not been clearly revealed. In this study, we examined the association between social protection programmes and child mortality.
METHODS
We obtained child mortality data from 379 nationally representative surveys involving 101 low- and middle-income countries (LMICs). We included five child mortality outcomes in the study, which were neonatal mortality rate (NMR), post-neonatal mortality rate (PMR), childhood mortality rate (CMR), infant mortality rate (IMR), and under-5 mortality rate (U5MR). We extracted data on social protection programmes from multiple data sources (eg, Atlas of Social Protection Indicators of Resilience and Equity). Social protection and labour programme (SPL) was the major type of social protection we included. We also included four subtypes of SPL - social assistance, cash transfer, social insurance, and labour market protection. Both unadjusted and adjusted regressions were conducted to measure the associations between characteristics of social protection programmes and child mortality, as well as inequalities in child mortality.
RESULTS
Among the 101 countries, the median coverage rate of SPL was 28.5%, with an interquartile range between 6.5% and 55.2%. Using the adjusted model, we found a one-percentage-point increase in SPL coverage is associated with a reduction of 0.09 (95% confidence interval (CI) = 0.04, 0.14) per 1000 live births in NMR, 0.11 (95% CI = 0.04, 0.18) in PMR, and 0.25 (95% CI = 0.11, 0.38) in CMR. Social assistance programme was the only subtype of SPL to be significantly associated with lower mortality rates. A higher SPL coverage was associated with better equity in child mortality - as the coverage of SPL increased by one percentage point, the concentration index of CMR would increase by 0.08 (95% CI = 0.03, 0.13) in the adjusted model, suggesting an improvement in equity.
CONCLUSIONS
The strong association between social protection programme and child mortality suggests that to achieve the SDG targets of universal social protection and to reduce child mortality, LMICs shall consider prioritizing the expansion of social protection programmes.
Topics: Child; Child Mortality; Developing Countries; Humans; Infant; Infant Mortality; Infant, Newborn; Poverty; Sustainable Development
PubMed: 34737867
DOI: 10.7189/jogh.11.04067 -
Asian Pacific Journal of Cancer... Feb 2022Although it is known that cancer mortality rate varies depending on occupations in Japan, differences in female cancer mortality rate depending on occupational classes...
BACKGROUND
Although it is known that cancer mortality rate varies depending on occupations in Japan, differences in female cancer mortality rate depending on occupational classes have not been analyzed using the Vital Statistics in Japan. In this study, we analyzed the Vital Statistics data in Japan from 1995 to 2015, and revealed differences in cancer mortality rate depending on occupational classes among Japanese women.
METHODS
The Vital Statistics data by occupations from 1995 to 2015 were obtained from the "Report of Vital Statistics : Occupational and Industrial Aspects" in Japan, and data on mortality for cancer in all sites, colorectal cancer, liver cancer, gallbladder and extrahepatic bile duct cancer, pancreatic cancer, lung cancer, breast cancer, and uterine cancer were used. We classified main occupation categories into non-manual workers and manual workers, and calculated age-standardized mortality rate for each of the occupational class, year, age group, and type of cancer and its annual percent change.
RESULTS
Age-standardized mortality rates for non-manual workers (222.0 per 100,000 persons in 1995 and 143.8 per 100,000 persons in 2015) were higher in cancer in all sites than those for manual workers (127.6 per 100,000 persons in 1995 and 103.7 per 100,000 persons in 2015) throughout the years. However, age-standardized mortality rates showed a significant decreasing trend between 1995 and 2015 for non-manual workers, and the absolute value of annual percent change was higher in non-manual workers than in manual workers. As a result, a difference in age-standardized mortality rates for cancer in all sites between the two types of occupational classes decreased throughout the years.
CONCLUSION
A further study investigating differences in physical or behavioral characteristics of female non-manual and manual workers is needed in order to understand the key factors for the higher cancer mortality rate in non-manual workers.
Topics: Adult; Female; Humans; Japan; Middle Aged; Mortality; Neoplasms; Occupational Diseases; Occupational Health; Occupations; Women's Health
PubMed: 35225459
DOI: 10.31557/APJCP.2022.23.2.475 -
Arquivos Brasileiros de Cardiologia Feb 2020In many cities around the world, the mortality rate from cancer (CA) has exceeded that from disease of the circulatory system (DCS).
BACKGROUND
In many cities around the world, the mortality rate from cancer (CA) has exceeded that from disease of the circulatory system (DCS).
OBJECTIVES
To compare the mortality curves from DCS and CA in the most populous capital cities of the five regions of Brazil.
METHODS
Data of mortality rates from DCS and CA between 2000 and 2015 were collected from the Mortality Information System of Manaus, Salvador, Goiania, Sao Paulo and Curitiba, and categorized by age range into early (30-69 years) and late (≥ 70 years), and by gender of the individuals. Chapters II and IX of the International Classification of Diseases-10 were used for the analysis of causes of deaths. The Joinpoint regression model was used to assess the tendency of the estimated annual percentage change of mortality rate, and the Monte Carlo permutation test was used to detect when changes occurred. Statistical significance was set at 5%.
RESULTS
There was a consistent decrease in early and late mortality from DCS in both genders in the cities studied, except for late mortality in men in Manaus. There was a tendency of decrease of mortality rates from CA in São Paulo and Curitiba, and of increase in the rates from CA in Goiania. In Salvador, there was a decrease in early mortality from CA in men and women and an increase in late mortality in both genders.
CONCLUSION
There was a progressive and marked decrease in the mortality rate from DCS and a maintenance or slight increase in CA mortality in the five capital cities studied. These phenomena may lead to the intersection of the curves, with predominance of mortality from CA (old and new cases).
Topics: Adult; Age Distribution; Age Factors; Aged; Brazil; Cardiovascular Diseases; Cause of Death; Cities; Female; Humans; Male; Middle Aged; Monte Carlo Method; Mortality; Neoplasms; Sex Distribution; Sex Factors; Time Factors
PubMed: 32215484
DOI: 10.36660/abc.20180304 -
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 -
BMJ Open Apr 2022To investigate all-cause and cause-specific mortality risks, including deaths from external, cardiovascular and cancer causes, among deployed Nordic military veterans in...
OBJECTIVES
To investigate all-cause and cause-specific mortality risks, including deaths from external, cardiovascular and cancer causes, among deployed Nordic military veterans in comparison to the general population in each country.
DESIGN
Pooled analysis.
SETTING
Denmark, Norway, Finland and Sweden.
PARTICIPANTS
Military veterans deployed between 1990 and 2010 were followed via nationwide registers and compared with age-sex-calendar-year-specific rates in the general population using pooled standardised mortality ratios (SMRs).
MAIN OUTCOMES
All-cause and cause-specific mortality retrieved from each country's Causes of Death Register, including deaths from external, cardiovascular and cancer causes.
RESULTS
Among 83 584 veterans 1152 deaths occurred of which 343 were from external causes (including 203 suicides and 129 traffic/transport accidents), 134 from cardiovascular causes and 297 from neoplasms. Veterans had a lower risk of death from any cause (pooled SMR 0.58, 95% CI 0.52 to 0.64), external causes (0.71, 95% CI 0.64 to 0.79), suicide (0.77, 95% CI 0.67 to 0.89), cardiovascular causes (0.54, 95% CI 0.46 to 0.64) and neoplasms (0.78, 95% CI 0.70 to 0.88). There was no difference regarding traffic/transport accidents for the whole period (1.10, 95% CI 0.92 to 1.31) but the pooled point estimate was elevated, though not statistically significant, during the first 5 years (1.17, 95% CI 0.89 to 1.53) but not thereafter (1.01, 95% CI 0.77 to 1.34). For all other causes of death, except suicide, statistically significantly lower risk among veterans was observed both during the first 5 years and thereafter. For suicide, no difference was observed beyond 5 years. Judged from the country-specific SMR estimates, there was a high degree of consistency although statistically significant heterogeneity was found for all-cause mortality.
CONCLUSIONS
Nordic military veterans had lower overall and cause-specific mortality than the general population for most outcomes, as expected given the predeployment selection process. Though uncommon, fatal traffic/transport accidents were an exception with no difference between deployed military veterans and the general population.
Topics: Cause of Death; Humans; Mortality; Neoplasms; Risk; Suicide; Veterans
PubMed: 35414543
DOI: 10.1136/bmjopen-2021-052313 -
Journal of Epidemiology and Global... Sep 2019Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in...
Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in 2016 to provide data for preventive measures of maternal and child health. In this study, we aim to determine the incidence of perinatal mortality, assess the distribution of stillbirths and early neonatal deaths, and to determine the major causes of perinatal mortality in Georgia. Data sources were the Georgian Birth Registry and the vital registration system for the year 2017. Causes of early neonatal deaths were assigned into five categories, using the Wigglesworth classification with the Neonatal and Intrauterine deaths Classification according to Etiology modification. The study used descriptive statistics only, specifically counts, means, proportions, and rates, using the statistical software STATA version 15.0. (StataCorp, College Station, TX, USA). In 2017, 489 stillbirths and 238 early neonatal deaths were recorded, resulting in a perinatal mortality rate of 13.6 per 1000 births. About 80% of stillbirths had an unknown cause of death. The majority of stillbirths occurred before the start of labor (85%), and almost one-third were delivered by caesarean section (28%). Prematurity (58%) and congenital malformations (23%) were the main causes of early neonatal deaths, and 70% of early neonatal deaths occurred after the first day of life. The perinatal mortality rate in Georgia remained high in 2017. The major causes of early neonatal deaths were comparable to those of many high-income countries. Contrary to global data, most early neonatal deaths occurred after the first day of life.
Topics: Cause of Death; Female; Georgia (Republic); Humans; Incidence; Infant; Infant Mortality; Infant, Newborn; Male; Perinatal Death; Perinatal Mortality; Stillbirth
PubMed: 31529933
DOI: 10.2991/jegh.k.190818.001