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Asian Pacific Journal of Cancer... Jun 2020Mechanics are exposed to known human carcinogens. This study aimed to compare mortality from selected cancers between male mechanics and the general population of the...
INTRODUCTION
Mechanics are exposed to known human carcinogens. This study aimed to compare mortality from selected cancers between male mechanics and the general population of the South and Southeast regions of Brazil.
METHODS
Data on deaths, occurred between 2006-2017, among male mechanics and the general population, were obtained from the Mortality Information System. Occupations were classified using the Brazilian Classification of Occupations. Mortality Odds Ratio (MOR) and confidence intervals (95%) for selected cancers among mechanics, stratified by age (30-49, 50-69 years), race, and education compared to the general population, were estimated using logistic regression models.
RESULTS
In general, mechanics showed higher mortality from oropharynx, hypopharynx, larynx, lung and bladder cancers, but lower mortality for all leukemias. Oropharynx and larynx cancer mortality risk was slightly higher among older mechanics, while hypopharynx cancer mortality was more noticeable among the youngest. Lower mortality from all leukemias was observed only among younger mechanics. Mortality by oropharynx and larynx cancers were higher among white mechanics. They were also the only ones to experience higher mortality by hypopharynx cancer, while lung cancer mortality were increased only among non-white ones. Mechanics of all educational levels were more likely to die by the oropharynx cancer. Those with 1-7 and 8 or more years of schooling also showed excess of death by the cancers of larynx and all leukemias. Significantly higher mortality by pancreas cancer was only observed among mechanics with no education, while those with 1-7 years of schooling showed higher risk to die by lung and bladder cancers. Those with 8 or more years of schooling show increased mortality risk for hypopharynx cancer. Increased mortality risk for myeloid leukemia was only observed when stratified by region of residence.
CONCLUSION
Results of our study suggest a positive association between mechanic occupation and some specific cancers.
.Topics: Adult; Aged; Automobiles; Educational Status; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Mortality; Neoplasms; Occupational Diseases; Occupational Exposure; Prognosis; Risk Factors; Survival Rate
PubMed: 32592378
DOI: 10.31557/APJCP.2020.21.6.1779 -
Scandinavian Journal of Public Health Feb 2022All-cause mortality is a global indicator of the overall health of the population, and its relation to the macro economy is thus of vital interest. The main aim was to...
All-cause mortality is a global indicator of the overall health of the population, and its relation to the macro economy is thus of vital interest. The main aim was to estimate the short-term and the long-term impact of macroeconomic change on all-cause mortality. Variations in the unemployment rate were used as indicator of temporary fluctuations in the economy. We used time-series data for 21 OECD countries spanning the period 1960-2018. We used four outcomes: total mortality (0+), infant mortality (<1), mortality in the age-group 20-64, and old-age mortality (65+). Data on GDP/capita were obtained from the Maddison Project. Unemployment data (% unemployed in the work force) were sourced from Eurostat. We applied error correction modelling to estimate the short-term and the long-term impact of macroeconomic change on all-cause mortality. We found that increases in unemployment were statistically significantly associated with decreases in all mortality outcomes except old-age mortality. Increases in GDP were associated with significant lowering long-term effects on mortality.
Topics: Humans; Economic Recession; Mortality; Unemployment
PubMed: 34666579
DOI: 10.1177/14034948211049979 -
Journal of Biomedical Informatics Aug 2020Healthcare data continues to flourish yet a relatively small portion, mostly structured, is being utilized effectively for predicting clinical outcomes. The rich...
Healthcare data continues to flourish yet a relatively small portion, mostly structured, is being utilized effectively for predicting clinical outcomes. The rich subjective information available in unstructured clinical notes can possibly facilitate higher discrimination but tends to be under-utilized in mortality prediction. This work attempts to assess the gain in performance when multiple notes that have been minimally preprocessed are used as an input for prediction. A hierarchical architecture consisting of both convolutional and recurrent layers is used to concurrently model the different notes compiled in an individual hospital stay. This approach is evaluated on predicting in-hospital mortality on the MIMIC-III dataset. On comparison to approaches utilizing structured data, it achieved higher metrics despite requiring less cleaning and preprocessing. This demonstrates the potential of unstructured data in enhancing mortality prediction and signifies the need to incorporate more raw unstructured data into current clinical prediction methods.
Topics: Hospital Mortality
PubMed: 32592755
DOI: 10.1016/j.jbi.2020.103489 -
Frontiers in Public Health 2021Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. This study aimed to evaluate the effectiveness of a multi-component...
Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. This study aimed to evaluate the effectiveness of a multi-component intervention on the pediatric health system over two different periods in Guangzhou. Based on the World Health Organization (WHO) "six building blocks" model and Donabedian's "Structure-Process-Outcomes" framework, an intervention package was developed to increase financial and human resouce investment to strengthen basic health care and strive for a better quality of pediatric care. This multi-component intervention package was conducted in Guangzhou to improve the pediatric service delivery during two stages (2011-2014 and 2016-2019). The main outcome indicators were the changes in the allocation of pediatricians and pediatric beds, pediatric service efficiency, and the impact of pediatricians on child mortality. We found that pediatricians per 1,000 children (PPTC) and pediatric beds per 1,000 children (PBPTC) increased from 1.07 and 2.37 in 2010 to 1.37 and 2.39 in 2014, then to 1.47 and 2.93 in 2019, respectively. Infant mortality rate (IMR) and under-5 mortality rate (U5MR) dropped from 5.46‰ and 4.04‰ in 2010 to 4.35‰ and 3.30‰ in 2014 then to 3.26‰ and 2.37‰ in 2019. The Gini coefficients of PPTC and PBPTC decreased from 0.48 and 0.38 in 2010, to 0.35 and 0.28 in 2014, then to 0.35 and 0.22 in 2019, respectively, representing the improvement of pediatric resources distribution according to service population. However, equalities in the spatial distribution were not improved much. The average efficiency of pediatric service fluctuated from 2010 to 2019. A unit increase in PPTC was associated with an 11% reduction in IMR and a 16% reduction in U5MR. Findings suggest this multi-component intervention strategy is effective, particularly on the reduction of child mortality. In future, more rigorous and multi-faceted indicators should be integrated in a comprehensive evaluation of the intervention.
Topics: Child; Humans; Child Mortality; Delivery of Health Care; Infant Mortality; Infant, Newborn; Infant; Child, Preschool
PubMed: 34671589
DOI: 10.3389/fpubh.2021.760124 -
Journal of Racial and Ethnic Health... Apr 2024In Chicago in 2018, the average life expectancy (ALE) for NH Blacks was 71.5 years, 9.1 fewer years than for NH Whites (80.6 years). Inasmuch as some causes of death...
BACKGROUND
In Chicago in 2018, the average life expectancy (ALE) for NH Blacks was 71.5 years, 9.1 fewer years than for NH Whites (80.6 years). Inasmuch as some causes of death are increasingly recognized products of structural racism, in urban areas, such causes may have potential for reducing racial inequities through public health intervention. Our purpose is to allocate racial inequities in ALE in Chicago to differentials in cause-specific mortality.
METHODS
Using multiple decrement processes and decomposition analysis, we examine cause-specific mortality in Chicago to determine the causes of death that contribute to the gap in life expectancy between NH Blacks and NH Whites.
RESULTS
Among females, the racial difference in ALE was 8.21 years; for males, it was 10.53 years. We find that cancer and heart disease mortality account for 3.03 years or 36% of the racial gap in average life expectancy among females. Differences in homicide and heart disease mortality rates comprised over 45% of the disparity among males.
CONCLUSIONS
Strategies for improving inequities in life expectancy should account for differences between males and females in cause-specific mortality rates. In urban areas with high levels of segregation, reducing inequities in ALE may be possible by dramatically reducing mortality rates from some causes.
CONTRIBUTION
This paper illustrates the state of inequities in ALE between NH Blacks and NH Whites in Chicago for the period just prior to the onset of the COVID-19 pandemic, using a well-established method of decomposing mortality differentials for sub-populations.
Topics: Male; Female; Humans; Cause of Death; Chicago; Pandemics; Life Expectancy; Heart Diseases; Mortality
PubMed: 36973497
DOI: 10.1007/s40615-023-01566-w -
American Journal of Public Health Sep 2021To evaluate changes in mortality in US counties along the US-Mexico border in which there was substantial new border wall construction after the Secure Fence Act of...
To evaluate changes in mortality in US counties along the US-Mexico border in which there was substantial new border wall construction after the Secure Fence Act of 2006 relative to border counties in which there was no such border wall construction. Using complete 1990 to 2017 mortality microdata and a quasi-experimental difference-in-differences design, we evaluated changes in overall (all-cause) mortality, mortality from drug overdose, and mortality from homicide in the 10 counties with substantial new border wall construction and 11 counties with no such construction. We fit a linear model, adjusting for population characteristics and county and year fixed effects, with Bonferroni adjustments for multiple comparisons. Sensitivity analyses included the addition of adjacent inland counties and modifications to the statistical model. Relative to counties without substantial new border wall construction, counties in which a substantial amount of new border wall was constructed exhibited a nonsignificant 0.02-percentage-point increase (95% confidence interval [CI] = -0.06, 0.10; > .99) in overall mortality after construction. Border wall construction was not associated with changes in either deaths from overdose or deaths from homicide. Wall construction along the US-Mexico border after the Secure Fence Act of 2006 was not associated with discernible changes in mortality.
Topics: Cause of Death; Emigrants and Immigrants; Humans; Mexico; Mortality; Socioeconomic Factors; United States
PubMed: 34197717
DOI: 10.2105/AJPH.2021.306329 -
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 -
The Cochrane Database of Systematic... Mar 2020The United Nations' Sustainable Development Goals (SDGs) include reducing the global maternal mortality rate to less than 70 per 100,000 live births and ending... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The United Nations' Sustainable Development Goals (SDGs) include reducing the global maternal mortality rate to less than 70 per 100,000 live births and ending preventable deaths of newborns and children under five years of age, in every country, by 2030. Maternal and perinatal death audit and review is widely recommended as an intervention to reduce maternal and perinatal mortality, and to improve quality of care, and could be key to attaining the SDGs. However, there is uncertainty over the most cost-effective way of auditing and reviewing deaths: community-based audit (verbal and social autopsy), facility-based audits (significant event analysis (SEA)) or a combination of both (confidential enquiry).
OBJECTIVES
To assess the impact and cost-effectiveness of different types of death audits and reviews in reducing maternal, perinatal and child mortality.
SEARCH METHODS
We searched the following from inception to 16 January 2019: CENTRAL, Ovid MEDLINE, Embase OvidSP, and five other databases. We identified ongoing studies using ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform, and searched reference lists of included articles.
SELECTION CRITERIA
Cluster-randomised trials, cluster non-randomised trials, controlled before-and-after studies and interrupted time series studies of any form of death audit or review that involved reviewing individual cases of maternal, perinatal or child deaths, identifying avoidable factors, and making recommendations. To be included in the review, a study needed to report at least one of the following outcomes: perinatal mortality rate; stillbirth rate; neonatal mortality rate; mortality rate in children under five years of age or maternal mortality rate.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane Effective Practice and Organisation of Care (EPOC) group methodological procedures. Two review authors independently extracted data, assessed risk of bias and assessed the certainty of the evidence using GRADE. We planned to perform a meta-analysis using a random-effects model but included studies were not homogeneous enough to make pooling their results meaningful.
MAIN RESULTS
We included two cluster-randomised trials. Both introduced death review and audit as part of a multicomponent intervention, and compared this to current care. The QUARITE study (QUAlity of care, RIsk management, and TEchnology) concerned maternal death reviews in hospitals in West Africa, which had very high maternal and perinatal mortality rates. In contrast, the OPERA trial studied perinatal morbidity/mortality conferences (MMCs) in maternity units in France, which already had very low perinatal mortality rates at baseline. The OPERA intervention in France started with an outreach visit to brief obstetricians, midwives and anaesthetists on the national guidelines on morbidity/mortality case management, and was followed by a series of perinatal MMCs. Half of the intervention units were randomised to receive additional support from a clinical psychologist during these meetings. The OPERA intervention may make little or no difference to overall perinatal mortality (low certainty evidence), however we are uncertain about the effect of the intervention on perinatal mortality related to suboptimal care (very low certainty evidence).The intervention probably reduces perinatal morbidity related to suboptimal care (unadjusted odds ratio (OR) 0.62, 95% confidence interval (CI) 0.40 to 0.95; 165,353 births; moderate-certainty evidence). The effect of the intervention on stillbirth rate, neonatal mortality, mortality rate in children under five years of age, maternal mortality or adverse effects was not reported. The QUARITE intervention in West Africa focused on training leaders of hospital obstetric teams using the ALARM (Advances in Labour And Risk Management) course, which included one day of training about conducting maternal death reviews. The leaders returned to their hospitals, established a multidisciplinary committee and started auditing maternal deaths, with the support of external facilitators. The intervention probably reduces inpatient maternal deaths (adjusted OR 0.85, 95% CI 0.73 to 0.98; 191,167 deliveries; moderate certainty evidence) and probably also reduces inpatient neonatal mortality within 24 hours following birth (adjusted OR 0.74, 95% CI 0.61 to 0.90; moderate certainty evidence). However, QUARITE probably makes little or no difference to the inpatient stillbirth rate (moderate certainty evidence) and may make little or no difference to the inpatient neonatal mortality rate after 24 hours, although the 95% confidence interval includes both benefit and harm (low certainty evidence). The QUARITE intervention probably increases the percent of women receiving high quality of care (OR 1.87, 95% CI 1.35 - 2.57, moderate-certainty evidence). The effect of the intervention on perinatal mortality, mortality rate in children under five years of age, or adverse effects was not reported. We did not find any studies that evaluated child death audit and review or community-based death reviews or costs.
AUTHORS' CONCLUSIONS
A complex intervention including maternal death audit and review, as well as development of local leadership and training, probably reduces inpatient maternal mortality in low-income country district hospitals, and probably slightly improves quality of care. Perinatal death audit and review, as part of a complex intervention with training, probably improves quality of care, as measured by perinatal morbidity related to suboptimal care, in a high-income setting where mortality was already very low. The WHO recommends that maternal and perinatal death reviews should be conducted in all hospitals globally. However, conducting death reviews in isolation may not be sufficient to achieve the reductions in mortality observed in the QUARITE trial. This review suggests that maternal death audit and review may need to be implemented as part of an intervention package which also includes elements such as training of a leading doctor and midwife in each hospital, annual recertification, and quarterly outreach visits by external facilitators to provide supervision and mentorship. The same may also apply to perinatal and child death reviews. More operational research is needed on the most cost-effective ways of implementing maternal, perinatal and paediatric death reviews in low- and middle-income countries.
Topics: Child; Child Mortality; Child, Preschool; Clinical Audit; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Perinatal Mortality; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Stillbirth
PubMed: 32212268
DOI: 10.1002/14651858.CD012982.pub2 -
Global Health Action Dec 2023Half of global under-five mortalities is neonatal. The highest rates are found in low-income countries such as Ethiopia. Ethiopia has made progress in reducing...
BACKGROUND
Half of global under-five mortalities is neonatal. The highest rates are found in low-income countries such as Ethiopia. Ethiopia has made progress in reducing under-five mortality, but neonatal mortality remains high. Evidence collected continuously at the community level is crucial for understanding the trends and causes of neonatal mortality.
OBJECTIVES
To analyse the trends and causes of neonatal mortality at the Kilte-Awlelo Health and Demographic Surveillance System (KAHDSS) site in Ethiopia from 2010 to 2017.
METHODS
A descriptive study was conducted using data from neonates born between 2010 and 2017 at the KAHDSS site. Data were collected using interviewer-administered questionnaires. Causes of death were examined, and neonatal mortality trends were described using simple linear regression.
RESULTS
The overall average neonatal mortality rate was 17/1000 live births (LBs). The rate increased from 12 per 1000 LBs in 2010 to 15 per 1000 LBs in 2017. The majority of neonatal deaths occurred during the first week of life, and more than one-half died at home. The leading causes were sepsis, pre-term birth (including respiratory distress), disease related to the perinatal period, birth asphyxia, and neonatal pneumonia.
CONCLUSIONS
The high neonatal mortality in Ethiopia requires urgent attention and action. Sepsis, preterm birth, perinatal diseases, asphyxia, and neonatal pneumonia are the leading causes of death in neonates. Facility- and community-based health services should target the leading causes of neonatal deaths.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Perinatal Death; Ethiopia; Asphyxia; Cause of Death; Premature Birth; Infant Mortality; Sepsis; Pneumonia
PubMed: 38126362
DOI: 10.1080/16549716.2023.2289710 -
Science (New York, N.Y.) Feb 2022India’s national COVID death totals remain undetermined. Using an independent nationally representative survey of 0.14 million (M) adults, we compared COVID mortality...
India’s national COVID death totals remain undetermined. Using an independent nationally representative survey of 0.14 million (M) adults, we compared COVID mortality during the 2020 and 2021 viral waves to expected all-cause mortality. COVID constituted 29% (95%CI 28-31%) of deaths from June 2020-July 2021, corresponding to 3.2M (3.1-3.4) deaths, of which 2.7M (2.6-2.9) occurred in April-July 2021 (when COVID doubled all-cause mortality). A sub-survey of 57,000 adults showed similar temporal increases in mortality with COVID and non-COVID deaths peaking similarly. Two government data sources found that, when compared to pre-pandemic periods, all-cause mortality was 27% (23-32%) higher in 0.2M health facilities and 26% (21-31%) higher in civil registration deaths in ten states; both increases occurred mostly in 2021. The analyses find that India’s cumulative COVID deaths by September 2021 were 6-7 times higher than reported officially.
Topics: Adult; COVID-19; Cause of Death; Family Characteristics; Female; Health Facilities; Hospital Mortality; Humans; India; Male; Mortality
PubMed: 34990216
DOI: 10.1126/science.abm5154