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The Lancet. Public Health Sep 2023Social inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify...
BACKGROUND
Social inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify social, including educational, inequalities in mortality among adults in Mexico City.
METHODS
The Mexico City Prospective Study recruited 150 000 adults aged 35 years and older from two districts of Mexico City between 1998 and 2004. Participants were followed up until Jan 1, 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 years associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors.
FINDINGS
Among 143 478 participants aged 35-74 years, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 1·84; 95% CI 1·71-1·98), equivalent to approximately 6 years lower life expectancy, with an RR of 1·78 (1·67-1·90) among participants with incomplete primary, 1·62 (1·53-1·72) with complete primary, and 1·34 (1·25-1·42) with secondary education. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 3·65; 95% CI 3·05-4·38 for no education vs tertiary education) and from infectious diseases (2·67; 2·00-3·56), but there was an apparent higher rate of death from all specific causes studied with lower education, with the exception of cancer for which there was little association. Lifestyle factors (ie, smoking, alcohol drinking, and leisure time physical activity) and related physiological correlates (ie, adiposity, diabetes, and blood pressure) accounted for about four-fifths of the association of education with premature mortality.
INTERPRETATION
In this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality.
FUNDING
Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit.
Topics: Adult; Humans; Prospective Studies; Cause of Death; Mexico; Educational Status; Mortality, Premature
PubMed: 37633676
DOI: 10.1016/S2468-2667(23)00153-6 -
BMC Cancer Jul 2020The incidence of thyroid cancer is increasing worldwide. This is not accompanied by a corresponding increase in mortality. In contrast, in most populations' thyroid...
BACKGROUND
The incidence of thyroid cancer is increasing worldwide. This is not accompanied by a corresponding increase in mortality. In contrast, in most populations' thyroid cancer mortality has been decreasing in recent decades, although there are some notable exceptions. Relatively few studies focus on mortality and in Latin America we do not find evidence on the temporal trend of mortality. The study of the epidemiology of the thyroid cancer should be approached with a suitable methodology and with data based on the population. Trends should be expressed as an annual percentage of change and/or average annual rate of change. An appropriate method for analyzing trends in thyroid cancer mortality rates is the Joinpoint regression analysis. Previously published findings are described, and the methodology used is compared.
SHORT CONCLUSION
At the global level, Ecuador is one of the countries with the highest incidence rate of thyroid cancer. However, mortality data are scarce and not rigorous. It is important to raise awareness of updated and reliable population-based data on the trend of thyroid cancer mortality in Eccuador.
Topics: Ecuador; Humans; Incidence; Mortality; Registries; Survival Rate; Thyroid Neoplasms
PubMed: 32646384
DOI: 10.1186/s12885-020-07137-0 -
American Family Physician Jul 2020
Review
Topics: Adult; Cardiovascular Diseases; Cause of Death; Dietary Supplements; Humans; Mortality; Neoplasms; Treatment Outcome; Vitamin D; Vitamins
PubMed: 32603077
DOI: No ID Found -
NCHS Data Brief Dec 2021This report presents final 2020 U.S. mortality data on deaths and death rates by demographic and medical characteristics. These data provide information on mortality...
This report presents final 2020 U.S. mortality data on deaths and death rates by demographic and medical characteristics. These data provide information on mortality patterns in U.S. residents by variables such as sex, age, race and Hispanic origin, and cause of death. Life expectancy estimates, age-adjusted death rates, age-specific death rates, 10 leading causes of death, and 10 leading causes of infant death were analyzed by comparing 2020 and 2019 final data (1).
Topics: Cause of Death; Humans; Infant; Infant Mortality; Life Expectancy; Mortality; Sex Distribution; United States
PubMed: 34978528
DOI: No ID Found -
Global Health, Science and Practice Aug 2019Accessible, affordable, and high-quality postabortion care (PAC) can prevent maternal death and disability and provides an important opportunity to prevent future...
Accessible, affordable, and high-quality postabortion care (PAC) can prevent maternal death and disability and provides an important opportunity to prevent future unintended pregnancies. This supplement offers learnings on PAC provision from the community of partners around the world, including service delivery and community engagement models, approaches to support facility-based providers, best practices in pre- and post-procedure counseling, and approaches to institutionalize PAC in public- and private-sector health systems.
Topics: Abortion, Induced; Abortion, Spontaneous; Adolescent; Aftercare; Age Factors; Birth Intervals; Child Mortality; Child, Preschool; Family Planning Services; Female; Humans; Infant; Infant Mortality; Maternal Mortality; Postnatal Care; Pregnancy; United States; United States Agency for International Development
PubMed: 31455618
DOI: 10.9745/GHSP-D-19-00262 -
Journal of Public Health (Oxford,... Nov 2023Cardiovascular and cancer mortality are the two leading causes of death in the developed world including the USA. However, mortality trends for these diseases are highly...
BACKGROUND
Cardiovascular and cancer mortality are the two leading causes of death in the developed world including the USA. However, mortality trends for these diseases are highly dynamic, and the geographic landscape is in transition. We analyze patterns of mortality improvement at county level during recent decades focusing on mortality decline and geographic diversity.
METHODS
We grouped age-adjusted mortality rates of cardiovascular and cancer diseases from CDC WONDER for 2959 US counties into 3-year time periods to improve reliability. We calculated percent mortality decrease between 1981-83 and 2016-19 for both causes to quantify mortality improvements for counties.
RESULTS
Using standard deviation as an index of disparities, place-based cancer mortalities were 68% larger than cardiovascular disparities. Significantly, 566 US counties had same or higher rates of cancer mortality in 2019 as in 1981. The geographic distribution of mortality improvement in either cause tends to favor largely populated areas along coasts. Less-populated, rural places in the interior and southeastern regions were experiencing less improvement.
CONCLUSIONS
At the county level, large place-based disparities exist for both causes of death with the magnitude of disparities being substantially larger for the reduction in cancer deaths. Put differently, place matters, more for cancer than cardiovascular mortality.
Topics: Humans; Mortality; Neoplasms; Reproducibility of Results; United States; Cardiovascular Diseases; Geography
PubMed: 37395175
DOI: 10.1093/pubmed/fdad089 -
The Lancet. Public Health May 2024Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities.
METHODS
We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374.
FINDINGS
Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ=0·28, I=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types.
INTERPRETATION
Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health.
FUNDING
National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.
Topics: Humans; Disabled Persons; Life Expectancy; Mortality
PubMed: 38702095
DOI: 10.1016/S2468-2667(24)00054-9 -
European Heart Journal Jun 2021Since dietary sodium intake has been identified as a risk factor for cardiovascular disease and premature death, a high sodium intake can be expected to curtail life... (Observational Study)
Observational Study
AIMS
Since dietary sodium intake has been identified as a risk factor for cardiovascular disease and premature death, a high sodium intake can be expected to curtail life span. We tested this hypothesis by analysing the relationship between sodium intake and life expectancy as well as survival in 181 countries worldwide.
METHODS AND RESULTS
We correlated age-standardized estimates of country-specific average sodium consumption with healthy life expectancy at birth and at age of 60 years, death due to non-communicable diseases and all-cause mortality for the year of 2010, after adjusting for potential confounders such as gross domestic product per capita and body mass index. We considered global health estimates as provided by World Health Organization. Among the 181 countries included in this analysis, we found a positive correlation between sodium intake and healthy life expectancy at birth (β = 2.6 years/g of daily sodium intake, R2 = 0.66, P < 0.001), as well as healthy life expectancy at age 60 (β = 0.3 years/g of daily sodium intake, R2 = 0.60, P = 0.048) but not for death due to non-communicable diseases (β = 17 events/g of daily sodium intake, R2 = 0.43, P = 0.100). Conversely, all-cause mortality correlated inversely with sodium intake (β = -131 events/g of daily sodium intake, R2 = 0.60, P < 0.001). In a sensitivity analysis restricted to 46 countries in the highest income class, sodium intake continued to correlate positively with healthy life expectancy at birth (β = 3.4 years/g of daily sodium intake, R2 = 0.53, P < 0.001) and inversely with all-cause mortality (β = -168 events/g of daily sodium intake, R2 = 0.50, P < 0.001).
CONCLUSION
Our observation of sodium intake correlating positively with life expectancy and inversely with all-cause mortality worldwide and in high-income countries argues against dietary sodium intake being a culprit of curtailing life span or a risk factor for premature death. These data are observational and should not be used as a base for nutritional interventions.
Topics: Global Health; Humans; Infant, Newborn; Life Expectancy; Middle Aged; Mortality; Mortality, Premature; Noncommunicable Diseases; Sodium, Dietary
PubMed: 33351135
DOI: 10.1093/eurheartj/ehaa947 -
The Lancet. Global Health Jan 2022Sierra Leone's child and maternal mortality rates are among the highest in the world. However, little is known about the causes of premature mortality in the country. To...
BACKGROUND
Sierra Leone's child and maternal mortality rates are among the highest in the world. However, little is known about the causes of premature mortality in the country. To rectify this, the Ministry of Health and Sanitation of Sierra Leone launched the Sierra Leone Sample Registration System (SL-SRS) of births and deaths. Here, we report cause-specific mortality from the first SL-SRS round, representing deaths from 2018 to 2020.
METHODS
The Countrywide Mortality Surveillance for Action platform established the SL-SRS, which involved conducting electronic verbal autopsies in 678 randomly selected villages and urban blocks throughout the country. 61 surveyors, in teams of four or five, enrolled people and ascertained deaths of individuals younger than 70 years in 2019-20, capturing verbal autopsies on deaths from 2018 to 2020. Centrally, two trained physicians independently assigned causes of death according to the International Classification of Diseases (tenth edition). SL-SRS death proportions were applied to 5-year mortality averages from the UN World Population Prospects (2019) to derive cause-specific death totals and risks of death nationally and in four Sierra Leone regions, with comparisons made with the Western region where Freetown, the capital, is located. We compared SL-SRS results with the cause-specific mortality estimates for Sierra Leone in the 2019 WHO Global Health Estimates.
FINDINGS
Between Sept 1, 2019, and Dec 15, 2020, we enrolled 343 000 people and ascertained 8374 deaths of individuals younger than 70 years. Malaria was the leading cause of death in children and adults, nationally and in each region, representing 22% of deaths under age 70 years in 2020. Other infectious diseases accounted for an additional 16% of deaths. Overall maternal mortality ratio was 510 deaths per 100 000 livebirths (95% CI 483-538), and neonatal mortality rate was 31·1 deaths per 1000 livebirths (95% CI 30·4-31·8), both among the highest rates in the world. Haemorrhage was the major cause of maternal mortality and birth asphyxia or trauma was the major cause of neonatal mortality. Excess deaths were not detected in the months of 2020 corresponding to the peak of the COVID-19 pandemic. Half of the deaths occurred in rural areas and at home. If the Northern, Eastern, and Southern regions of Sierra Leone had the lower death rates observed in the Western region, about 20 000 deaths (just over a quarter of national total deaths in people younger than 70 years) would have been avoided. WHO model-based data vastly underestimated malaria deaths and some specific causes of injury deaths, and substantially overestimated maternal mortality.
INTERPRETATION
Over 60% of individuals in Sierra Leone die prematurely, before age 70 years, most from preventable or treatable causes. Nationally representative mortality surveys such as the SL-SRS are of high value in providing reliable cause-of-death information to set public health priorities and target interventions in low-income countries.
FUNDING
Bill & Melinda Gates Foundation, Canadian Institutes of Health Research, Queen Elizabeth Scholarship Program.
Topics: Adolescent; Adult; Aged; COVID-19; Cause of Death; Child; Child Mortality; Child, Preschool; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Malaria; Male; Maternal Mortality; Middle Aged; Mortality, Premature; Sierra Leone
PubMed: 34838202
DOI: 10.1016/S2214-109X(21)00459-9 -
International Journal of Environmental... Jun 2021Despite the implementation of social and health policies that positively affected the health of the populations in Brazil, since 2009 the country has experienced a... (Review)
Review
Despite the implementation of social and health policies that positively affected the health of the populations in Brazil, since 2009 the country has experienced a slower decline of infant mortality. After an economic and political crisis, Brazil witnessed increases in infant mortality that raised questions about what are the determinants of infant mortality after the implementation of such policies. We conducted a scoping review to identify and summarize those determinants with searches in three databases: LILACS, MEDLINE, and SCIELO. We included studies published between 2010 and 2020. We selected 23 papers: 83% associated infant mortality with public policies; 78% related infant mortality with the use of the health system and socioeconomic and living conditions; and 27% related to individual characteristics to infant mortality. Inequalities in the access to healthcare seem to have important implications in reducing infant mortality. Socioeconomic conditions and health-related factors such as income, education, fertility, housing, and the . Program coverage was pointed out as the main determinants of infant mortality. Likewise, recent changes in infant mortality in Brazil are likely related to these factors. We also identified a gap in terms of studies on a possible association between employment and infant mortality.
Topics: Brazil; Educational Status; Government Programs; Humans; Income; Infant; Infant Mortality; Mortality; Socioeconomic Factors
PubMed: 34203770
DOI: 10.3390/ijerph18126464