Lung Cancer Resection at Hospitals With High vs Low Mortality Rates.

PubMed

Grenda, Tyler R; Revels, Sha'Shonda L; Yin, Huiying; Birkmeyer, John D; Wong, Sandra L

2015-11-01

Wide variations in mortality rates exist across hospitals following lung cancer resection; however, the factors underlying these differences remain unclear. To evaluate perioperative outcomes in patients who underwent lung cancer resection at hospitals with very high and very low mortality rates (high-mortality hospitals [HMHs] and low-mortality hospitals [LMHs]) to better understand the factors related to differences in mortality rates after lung cancer resection. In this retrospective cohort study, 1279 hospitals that were accredited by the Commission on Cancer were ranked on a composite measure of risk-adjusted mortality following major cancer resections performed from January 1, 2005, through December 31, 2006. We collected data from January 1, 2006, through December 31, 2007, on 645 lung resections in 18 LMHs and 25 HMHs. After adjusting for patient characteristics, we used hierarchical logistic regression to examine differences in the incidence of complications and "failure-to-rescue" rates (defined as death following a complication). Rates of adherence to processes of care, incidence of complications, and failure to rescue following complications. Among 645 patients who received lung resections (441 in LMHs and 204 in HMHs), the overall unadjusted mortality rates were 1.6% (n = 7) vs 10.8% (n = 22; P < .001) for LMHs and HMHs, respectively. Following risk adjustment, the difference in mortality rates was attenuated (1.8% vs 8.1%; P < .001) but remained significant. Overall, complication rates were higher in HMHs (23.3% vs 15.6%; adjusted odds ratio [aOR], 1.79; 95% CI, 0.99-3.21), but this difference was not significant. The likelihood of any surgical (aOR, 0.73; 95% CI, 0.26-2.00) or cardiopulmonary (aOR, 1.23; 95% CI, 0.70-2.16) complications was similar between LMHs and HMHs. However, failure-to-rescue rates were significantly higher in HMHs (25.9% vs 8.7%; aOR, 6.55; 95% CI, 1.44-29.88). Failure-to-rescue rates are higher at HMHs, which may

Geographic trends in prostate cancer mortality: an application of spatial smoothers and the need for adjustment.

PubMed

Kafadar, K

1997-01-01

Prostate cancer mortality among whites and nonwhites in U.S. counties are analyzed for geographic effects. To better visualize geographical effects, the data are smoothed with a bivariate smoother using age-specific rates. Among nonwhites, an important explanatory variable is the proportion of African Americans. A relationship between the mortality rate and this variable is derived, and the data are adjusted for this variable using this relationship. When the rates are adjusted for age only, among whites there is a north-south gradient: rates are higher in the north, lower in the south. Among nonwhites, the gradient runs east to west: higher in the east, lower in the west. The latter gradient disappears when the rates are further adjusted for African Americans. The study reveals the importance of both smoothing the data to visualize patterns in geography and adjusting the data for an important variable to identify underlying patterns. The additional adjustment permits the identification of other areas of the country with elevated or depressed rates.

External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China

PubMed Central

Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

2016-01-01

Background and Purpose A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. Methods The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson’s correlation coefficient. Results The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79–0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81–0.84). Excellent calibration was reported in the two models with Pearson’s correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). Conclusions The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke. PMID:27846282

External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

PubMed

Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

2016-01-01

A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient. The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84). Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

A comparison of administrative and physiologic predictive models in determining risk adjusted mortality rates in critically ill patients.

PubMed

Enfield, Kyle B; Schafer, Katherine; Zlupko, Mike; Herasevich, Vitaly; Novicoff, Wendy M; Gajic, Ognjen; Hoke, Tracey R; Truwit, Jonathon D

2012-01-01

Hospitals are increasingly compared based on clinical outcomes adjusted for severity of illness. Multiple methods exist to adjust for differences between patients. The challenge for consumers of this information, both the public and healthcare providers, is interpreting differences in risk adjustment models particularly when models differ in their use of administrative and physiologic data. We set to examine how administrative and physiologic models compare to each when applied to critically ill patients. We prospectively abstracted variables for a physiologic and administrative model of mortality from two intensive care units in the United States. Predicted mortality was compared through the Pearsons Product coefficient and Bland-Altman analysis. A subgroup of patients admitted directly from the emergency department was analyzed to remove potential confounding changes in condition prior to ICU admission. We included 556 patients from two academic medical centers in this analysis. The administrative model and physiologic models predicted mortalities for the combined cohort were 15.3% (95% CI 13.7%, 16.8%) and 24.6% (95% CI 22.7%, 26.5%) (t-test p-value<0.001). The r(2) for these models was 0.297. The Bland-Atlman plot suggests that at low predicted mortality there was good agreement; however, as mortality increased the models diverged. Similar results were found when analyzing a subgroup of patients admitted directly from the emergency department. When comparing the two hospitals, there was a statistical difference when using the administrative model but not the physiologic model. Unexplained mortality, defined as those patients who died who had a predicted mortality less than 10%, was a rare event by either model. In conclusion, while it has been shown that administrative models provide estimates of mortality that are similar to physiologic models in non-critically ill patients with pneumonia, our results suggest this finding can not be applied globally to

The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates.

PubMed

Grant, William B; Garland, Cedric F

2006-01-01

Solar ultraviolet B (UVB) irradiance and vitamin D are associated with reduced cancer mortality rates. However, the previous ecologic study of UVB and cancer mortality rates in the U.S. (Grant, 2002) did not include other risk factors in the analysis. An ecologic study was performed using age-adjusted annual mortality rates for Caucasian Americans for 1950-69 and 1970-94, along with state-averaged values for selected years for alcohol consumption, Hispanic heritage, lung cancer (as a proxy for smoking), poverty, degree of urbanization and UVB in multiple regression analyses. Models were developed that explained much of the variance in cancer mortality rates, with stronger correlations for the earlier period. Fifteen types of cancer were inversely-associated with UVB. In the earlier period, most of the associations of cancer death rates with alcohol consumption (nine), Hispanic heritage (six), the proxy for smoking (ten), urban residence (seven) and poverty (inverse for eight) agreed well with the literature. These results provide additional support for the hypothesis that solar UVB, through photosynthesis of vitamin D, is inversely-associated with cancer mortality rates, and that various other cancer risk-modifying factors do not detract from this link. It is thought that sun avoidance practices after 1980, along with improved cancer treatment, led to reduced associations in the latter period. The results regarding solar UVB should be studied further with additional observational and intervention studies of vitamin D indices and cancer incidence, mortality and survival rates.

Antipsychotics and mortality: adjusting for mortality risk scores to address confounding by terminal illness.

PubMed

Park, Yoonyoung; Franklin, Jessica M; Schneeweiss, Sebastian; Levin, Raisa; Crystal, Stephen; Gerhard, Tobias; Huybrechts, Krista F

2015-03-01

To determine whether adjustment for prognostic indices specifically developed for nursing home (NH) populations affect the magnitude of previously observed associations between mortality and conventional and atypical antipsychotics. Cohort study. A merged data set of Medicaid, Medicare, Minimum Data Set (MDS), Online Survey Certification and Reporting system, and National Death Index for 2001 to 2005. Dual-eligible individuals aged 65 and older who initiated antipsychotic treatment in a NH (N=75,445). Three mortality risk scores (Mortality Risk Index Score, Revised MDS Mortality Risk Index, Advanced Dementia Prognostic Tool) were derived for each participant using baseline MDS data, and their performance was assessed using c-statistics and goodness-of-fit tests. The effect of adjusting for these indices in addition to propensity scores (PSs) on the association between antipsychotic medication and mortality was evaluated using Cox models with and without adjustment for risk scores. Each risk score showed moderate discrimination for 6-month mortality, with c-statistics ranging from 0.61 to 0.63. There was no evidence of lack of fit. Imbalances in risk scores between conventional and atypical antipsychotic users, suggesting potential confounding, were much lower within PS deciles than the imbalances in the full cohort. Accounting for each score in the Cox model did not change the relative risk estimates: 2.24 with PS-only adjustment versus 2.20, 2.20, and 2.22 after further adjustment for the three risk scores. Although causality cannot be proven based on nonrandomized studies, this study adds to the body of evidence rejecting explanations other than causality for the greater mortality risk associated with conventional antipsychotics than with atypical antipsychotics. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States.

PubMed

Chen, Han-Yang; Chauhan, Suneet P; Ananth, Cande V; Vintzileos, Anthony M; Abuhamad, Alfred Z

2011-06-01

To examine the association between electronic fetal heart rate monitoring and neonatal and infant mortality, as well as neonatal morbidity. We used the United States 2004 linked birth and infant death data. Multivariable log-binomial regression models were fitted to estimate risk ratio for association between electronic fetal heart rate monitoring and mortality, while adjusting for potential confounders. In 2004, 89% of singleton pregnancies had electronic fetal heart rate monitoring. Electronic fetal heart rate monitoring was associated with significantly lower infant mortality (adjusted relative risk, 0.75); this was mainly driven by the lower risk of early neonatal mortality (adjusted relative risk, 0.50). In low-risk pregnancies, electronic fetal heart rate monitoring was associated with decreased risk for Apgar scores <4 at 5 minutes (relative risk, 0.54); in high-risk pregnancies, with decreased risk of neonatal seizures (relative risk, 0.65). In the United States, the use of electronic fetal heart rate monitoring was associated with a substantial decrease in early neonatal mortality and morbidity that lowered infant mortality. Copyright © 2011 Mosby, Inc. All rights reserved.

Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates.

PubMed

Xian, Ying; Holloway, Robert G; Pan, Wenqin; Peterson, Eric D

2012-06-01

Public reporting efforts currently profile hospitals based on overall stroke mortality rates, yet the "mix" of hemorrhagic and ischemic stroke cases may impact this rate. Using the 2005 to 2006 New York state data, we examined the degree to which hospital stroke mortality rankings varied regarding ischemic versus hemorrhagic versus total stroke. Observed/expected ratio was calculated using the Agency for Healthcare Research and Quality Inpatient Quality Indicator software. The observed/expected ratio and outlier status based on stroke types across hospitals were examined using Pearson correlation coefficients (r) and weighted κ. Overall 30-day stroke mortality rates were 15.2% and varied from 11.3% for ischemic stroke and 37.3% for intracerebral hemorrhage. Hospital risk-adjusted ischemic stroke observed/expected ratio was weakly correlated with its own intracerebral hemorrhage observed/expected ratio (r=0.38). When examining hospital performance group (mortality better, worse, or no different than average), disagreement was observed in 35 of 81 hospitals (κ=0.23). Total stroke mortality observed/expected ratio and rankings were correlated with intracerebral hemorrhage (r=0.61 and κ=0.36) and ischemic stroke (r=0.94 and κ=0.71), but many hospitals still switched classification depending on mortality metrics. However, hospitals treating a higher percent of hemorrhagic stroke did not have a statistically significant higher total stroke mortality rate relative to those treating fewer hemorrhagic strokes. Hospital stroke mortality ratings varied considerably depending on whether ischemic, hemorrhagic, or total stroke mortality rates were used. Public reporting of stroke mortality measures should consider providing risk-adjusted outcome on separate stroke types.

A new casemix adjustment index for hospital mortality among patients with congestive heart failure.

PubMed

Polanczyk, C A; Rohde, L E; Philbin, E A; Di Salvo, T G

1998-10-01

Comparative analysis of hospital outcomes requires reliable adjustment for casemix. Although congestive heart failure is one of the most common indications for hospitalization, congestive heart failure casemix adjustment has not been widely studied. The purposes of this study were (1) to describe and validate a new congestive heart failure-specific casemix adjustment index to predict in-hospital mortality and (2) to compare its performance to the Charlson comorbidity index. Data from all 4,608 admissions to the Massachusetts General Hospital from January 1990 to July 1996 with a principal ICD-9-CM discharge diagnosis of congestive heart failure were evaluated. Massachusetts General Hospital patients were randomly divided in a derivation and a validation set. By logistic regression, odds ratios for in-hospital death were computed and weights were assigned to construct a new predictive index in the derivation set. The performance of the index was tested in an internal Massachusetts General Hospital validation set and in a non-Massachusetts General Hospital external validation set incorporating data from all 1995 New York state hospital discharges with a primary discharge diagnosis of congestive heart failure. Overall in-hospital mortality was 6.4%. Based on the new index, patients were assigned to six categories with incrementally increasing hospital mortality rates ranging from 0.5% to 31%. By logistic regression, "c" statistics of the congestive heart failure-specific index (0.83 and 0.78, derivation and validation set) were significantly superior to the Charlson index (0.66). Similar incrementally increasing hospital mortality rates were observed in the New York database with the congestive heart failure-specific index ("c" statistics 0.75). In an administrative database, this congestive heart failure-specific index may be a more adequate casemix adjustment tool to predict hospital mortality in patients hospitalized for congestive heart failure.

Cancer incidence and mortality rates in Bermuda.

PubMed

Dallaire, F; Dewailly, E; Rouja, P

2009-09-01

To describe cancer and mortality rates in Bermuda and to compare such rates to those of the United States of America (U.S.A.). Age-adjusted race-specific cancer incidence rates for Bermuda were calculated using the Bermuda Cancer Registry. These rates were then compared to U.S.A. cancer rates published by the National Cancer Institute. Overall age-adjusted incidence rate was 495 cases per 100,000 for Blacks and 527 cases per 100,000 for Whites. Incident cases were more frequent among men than women in both races. For Blacks, the highest incidences were prostate for men and breast for women, followed by colon/rectum and lung cancer. For Whites, if we exclude benign skin cancers, the picture was similar with the notable exception of lung cancer being more frequent than colon/rectum in White males. When Bermuda's rates were compared to those of the U.S.A., overall cancer rates were similar in both countries. Rates in Bermuda were higher for cancer of the mouth, ovarian cancer (Black women), melanoma (Whites), colorectal cancer (White women) and breast cancer (White women). Lung and colorectal cancers were less frequent in Bermuda's Black population. Further epidemiological studies are needed to identify potential risk factors that could contribute to these differences. Screening and prevention strategies could be adjusted accordingly.

Geographic disparity in chronic obstructive pulmonary disease (COPD) mortality rates among the Taiwan population.

PubMed

Chan, Ta-Chien; Chiang, Po-Huang; Su, Ming-Daw; Wang, Hsuan-Wen; Liu, Michael Shi-yung

2014-01-01

Chronic obstructive pulmonary disease (COPD) causes a high disease burden among the elderly worldwide. In Taiwan, the long-term temporal trend of COPD mortality is declining, but the geographical disparity of the disease is not yet known. Nationwide COPD age-adjusted mortality at the township level during 1999-2007 is used for elucidating the geographical distribution of the disease. With an ordinary least squares (OLS) model and geographically weighted regression (GWR), the ecologic risk factors such as smoking rate, area deprivation index, tuberculosis exposure, percentage of aborigines, density of health care facilities, air pollution and altitude are all considered in both models to evaluate their effects on mortality. Global and local Moran's I are used for examining their spatial autocorrelation and identifying clusters. During the study period, the COPD age-adjusted mortality rates in males declined from 26.83 to 19.67 per 100,000 population, and those in females declined from 8.98 to 5.70 per 100,000 population. Overall, males' COPD mortality rate was around three times higher than females'. In the results of GWR, the median coefficients of smoking rate, the percentage of aborigines, PM10 and the altitude are positively correlated with COPD mortality in males and females. The median value of density of health care facilities is negatively correlated with COPD mortality. The overall adjusted R-squares are about 20% higher in the GWR model than in the OLS model. The local Moran's I of the GWR's residuals reflected the consistent high-high cluster in southern Taiwan. The findings indicate that geographical disparities in COPD mortality exist. Future epidemiological investigation is required to understand the specific risk factors within the clustering areas.

Association of heart rate at hospital discharge with mortality and hospitalizations in patients with heart failure.

PubMed

Habal, Marlena V; Liu, Peter P; Austin, Peter C; Ross, Heather J; Newton, Gary E; Wang, Xuesong; Tu, Jack V; Lee, Douglas S

2014-01-01

Heart failure (HF) is associated with a high burden of morbidity and mortality. Hospital discharge is an opportunity for identification of modifiable prognostic factors in the transition to chronic HF. We examined the association of discharge heart rate with 30-day and 1-year mortality and hospitalization outcomes in a cohort of 9097 patients with HF discharged from hospital. Discharge heart rate was categorized into predefined groups: 40 to 60 (n=1333), 61 to 70 (n=2170), 71 to 80 (n=2631), 81 to 90 (n=1700), and >90 bpm (n=1263). There was a significant increase in all-cause 30-day mortality with adjusted odds ratios of 1.59 (95% confidence interval [CI], 1.18-2.14; P=0.003) for discharge heart rates 81 to 90 bpm and 1.56 (95% CI, 1.13-2.16; P=0.007) for heart rates>90 bpm when compared with the reference group (heart rates, 61-70 bpm). Cardiovascular death risk at 30 days was also higher with adjusted odds ratio 1.59 (discharge heart rates, 81-90 bpm; 95% CI, 1.09-2.33; P=0.017) and 1.65 (discharge heart rates, >90 bpm; 95% CI, 1.09-2.48; P=0.017). One-year all-cause mortality (adjusted odds ratio, 1.41; 95% CI, 1.16-1.72; P<0.001) and cardiovascular death (adjusted odds ratio, 1.47; 95% CI, 1.12-1.92; P=0.005) were higher with discharge heart rates>90 bpm when compared with the reference group (heart rates, 40-60 bpm). Readmissions for HF (adjusted hazard ratio, 1.26; 95% CI, 1.04-1.54; P=0.021) and cardiovascular disease (adjusted hazard ratio, 1.29; 95% CI, 1.08-1.54; P=0.004) within 30 days were also higher with discharge heart rates>90 bpm. Higher discharge heart rates were associated with greater risk of all-cause and cardiovascular mortality≤1-year follow-up and an elevated risk of 30-day readmission for HF and cardiovascular disease.

Black/white differences in very low birth weight neonatal mortality rates among New York City hospitals.

PubMed

Howell, Elizabeth A; Hebert, Paul; Chatterjee, Samprit; Kleinman, Lawrence C; Chassin, Mark R

2008-03-01

We sought to determine whether differences in the hospitals at which black and white infants are born contribute to black/white disparities in very low birth weight neonatal mortality rates in New York City. We performed a population-based cohort study using New York City vital statistics records on all live births and deaths of infants weighing 500 to 1499 g who were born in 45 hospitals between January 1, 1996, and December 31, 2001 (N = 11 781). We measured very low birth weight risk-adjusted neonatal mortality rates for each New York City hospital and assessed differences in the distributions of non-Hispanic black and non-Hispanic white very low birth weight births among these hospitals. Risk-adjusted neonatal mortality rates for very low birth weight infants in New York City hospitals ranged from 9.6 to 27.2 deaths per 1000 births. White very low birth weight infants were more likely to be born in the lowest mortality tertile of hospitals (49%), compared with black very low birth weight infants (29%). We estimated that, if black women delivered in the same hospitals as white women, then black very low birth weight mortality rates would be reduced by 6.7 deaths per 1000 very low birth weight births, removing 34.5% of the black/white disparity in very low birth weight neonatal mortality rates in New York City. Volume of very low birth weight deliveries was modestly associated with very low birth weight mortality rates but explained little of the racial disparity. Black very low birth weight infants more likely to be born in New York City hospitals with higher risk-adjusted neonatal mortality rates than were very low birth weight infants, contributing substantially to black-white disparities.

39 CFR 3010.25 - Limitation on unused rate adjustment authority rate adjustments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Limitation on unused rate adjustment authority rate adjustments. 3010.25 Section 3010.25 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL REGULATION OF RATES FOR MARKET DOMINANT PRODUCTS Rules for Applying the Price Cap § 3010.25 Limitation on...

Amniotic fluid embolism mortality rate.

PubMed

Benson, Michael D

2017-11-01

The objective of this study was to determine the mortality rate of amniotic fluid embolism (AFE) using population-based studies and case series. A literature search was conducted using the two key words: 'amniotic fluid embolism (AFE)' AND 'mortality rate'. Thirteen population-based studies were evaluated, as well as 36 case series including at least two patients. The mortality rate from population-based studies varied from 11% to 44%. When nine population-based studies with over 17 000 000 live births were aggregated, the maternal mortality rate was 20.4%. In contrast, the mortality rate of AFE in case series varies from 0% to 100% with numerous rates in between. The AFE mortality rate in population-based studies varied from 11% to 44% with the best available evidence supporting an overall mortality rate of 20.4%. Data from case series should no longer be used as a basis for describing the lethality of AFE. © 2017 Japan Society of Obstetrics and Gynecology.

Epidemiologic evidence for different roles of ultraviolet A and B radiation in melanoma mortality rates.

PubMed

Garland, Cedric F; Garland, Frank C; Gorham, Edward D

2003-07-01

The action spectrum of ultraviolet radiation mainly responsible for melanoma induction is unknown, but evidence suggests it could be ultraviolet A (UVA), which has a different geographic distribution than ultraviolet B (UVB). This study assessed whether melanoma mortality rates are more closely related to the global distribution of UVA or UVB. UVA and UVB radiation and age-adjusted melanoma mortality rates were obtained for all 45 countries reporting cancer data to the World Health Organization. Stratospheric ozone data were obtained from NASA satellites. Average population skin pigmentation was obtained from skin reflectometry measurements. Paradoxically, melanoma mortality rates decreased with increasing UVB in men (r = -0.48, p < 0.001), and women (r = -0.57, p < 0.001), and with increasing UVA in both sexes. By contrast, rates were positively associated with increasing UVA/UVB ratio in men (r = + 0.49, p < 0.001) and women (r = + 0.55, p < 0.001). After multiple adjustment that included controlling for skin pigmentation, only UVA was associated with melanoma mortality rates in men (p < 0.02) with a suggestive but non-significant trend present in women (p = 0.12). UVA radiation was associated with melanoma mortality rates after controlling for UVB and average pigmentation. The results require confirmation in observational studies.

Variability in the measurement of hospital-wide mortality rates.

PubMed

Shahian, David M; Wolf, Robert E; Iezzoni, Lisa I; Kirle, Leslie; Normand, Sharon-Lise T

2010-12-23

Several countries use hospital-wide mortality rates to evaluate the quality of hospital care, although the usefulness of this metric has been questioned. Massachusetts policymakers recently requested an assessment of methods to calculate this aggregate mortality metric for use as a measure of hospital quality. The Massachusetts Division of Health Care Finance and Policy provided four vendors with identical information on 2,528,624 discharges from Massachusetts acute care hospitals from October 1, 2004, through September 30, 2007. Vendors applied their risk-adjustment algorithms and provided predicted probabilities of in-hospital death for each discharge and for hospital-level observed and expected mortality rates. We compared the numbers and characteristics of discharges and hospitals included by each of the four methods. We also compared hospitals' standardized mortality ratios and classification of hospitals with mortality rates that were higher or lower than expected, according to each method. The proportions of discharges that were included by each method ranged from 28% to 95%, and the severity of patients' diagnoses varied widely. Because of their discharge-selection criteria, two methods calculated in-hospital mortality rates (4.0% and 5.9%) that were twice the state average (2.1%). Pairwise associations (Pearson correlation coefficients) of discharge-level predicted mortality probabilities ranged from 0.46 to 0.70. Hospital-performance categorizations varied substantially and were sometimes completely discordant. In 2006, a total of 12 of 28 hospitals that had higher-than-expected hospital-wide mortality when classified by one method had lower-than-expected mortality when classified by one or more of the other methods. Four common methods for calculating hospital-wide mortality produced substantially different results. This may have resulted from a lack of standardized national eligibility and exclusion criteria, different statistical methods, or

Methods of adjusting the stable estimates of fertility for the effects of mortality decline.

PubMed

Abou-Gamrah, H

1976-03-01

Summary The paper shows how stable population methods, based on the age structure and the rate of increase, may be used to estimate the demographic measures of a quasi-stable population. After a discussion of known methods for adjusting the stable estimates to allow for the effects of mortality decline two new methods are presented, the application of which requires less information. The first method does not need any supplementary information, and the second method requires an estimate of the difference between the last two five-year intercensal rates of increase, i.e. five times the annual change of the rate of increase during the last ten years. For these new methods we do not need to know the onset year of mortality decline as in the Coale-Demeny method, or a long series of rates of increase as in Zachariah's method.

39 CFR 3010.28 - Maximum size of unused rate adjustment authority rate adjustments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Maximum size of unused rate adjustment authority rate adjustments. 3010.28 Section 3010.28 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL REGULATION OF RATES FOR MARKET DOMINANT PRODUCTS Rules for Applying the Price Cap § 3010.28 Maximum size of...

Severity-Adjusted Mortality in Trauma Patients Transported by Police

PubMed Central

Band, Roger A.; Salhi, Rama A.; Holena, Daniel N.; Powell, Elizabeth; Branas, Charles C.; Carr, Brendan G.

2018-01-01

Study objective Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia. Methods This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index. Results Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police. Conclusion We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care. PMID:24387925

Maryland's high cancer mortality rate: a review of contributing demographic factors.

PubMed

Freedman, D M

1999-01-01

For many years, Maryland has ranked among the top states in cancer mortality. This study analyzed mortality data from the National Center for Health Statistics (CDC-Wonder) to help explain Maryland's cancer rate and rank. Age-adjusted rates are based on deaths per 100,000 population from 1991 through 1995. Rates and ranks overall, and stratified by age, are calculated for total cancer mortality, as well as for four major sites: lung, breast, prostate, and colorectal. Because states differ in their racial/gender mix, race/gender rates among states are also compared. Although Maryland ranks seventh in overall cancer mortality, its rates and rank by race and gender subpopulation are less high. For those under 75, white men ranked 26th, black men ranked 20th, and black and white women ranked 12th and 10th, respectively. Maryland's overall rank, as with any state, is a function of the rates of its racial and gender subpopulations and the relative size of these groups in the state. Many of the disparities between Maryland's overall high cancer rank and its lower rank by subpopulation also characterize the major cancer sites. Although a stratified presentation of cancer rates and ranks may be more favorable to Maryland, it should not be used to downplay the attention cancer mortality in Maryland deserves.

Comparison of pediatric cardiac surgical mortality rates from national administrative data to contemporary clinical standards.

PubMed

Welke, Karl F; Diggs, Brian S; Karamlou, Tara; Ungerleider, Ross M

2009-01-01

Despite the superior coding and risk adjustment of clinical data, the ready availability, national scope, and perceived unbiased nature of administrative data make it the choice of governmental agencies and insurance companies for evaluating quality and outcomes. We calculated pediatric cardiac surgery mortality rates from administrative data and compared them with widely quoted standards from clinical databases. Pediatric cardiac surgical operations were retrospectively identified by ICD-9-CM diagnosis and procedure codes from the Nationwide Inpatient Sample (NIS) 1988-2005 and the Kids' Inpatient Database (KID) 2003. Cases were grouped into Risk Adjustment for Congenital Heart Surgery, version 1 (RACHS-1) categories. In-hospital mortality rates and 95% confidence intervals were calculated. A total of 55,164 operations from the NIS and 10,945 operations from the KID were placed into RACHS-1 categories. During the 18-year period, the overall NIS mortality rate for pediatric cardiac surgery decreased from 8.7% (95% confidence interval, 8.0% to 9.3%) to 4.6% (95% confidence interval, 4.3% to 5.0%). Mortality rates by RACHS-1 category decreased significantly as well. The KID and NIS mortality rates from comparable years were similar. Overall mortality rates derived from administrative data were higher than those from contemporary national clinical data, The Society of Thoracic Surgeons Congenital Heart Surgery Database, or published data from pediatric cardiac specialty centers. Although category-specific mortality rates were higher in administrative data than in clinical data, a minority of the relationships reached statistical significance. Despite substantial improvement, mortality rates from administrative data remain higher than those from clinical data. The discrepancy may be attributable to several factors: differences in database design and composition, differences in data collection and reporting structures, and variation in data quality.

Is the high ischemic heart disease mortality rate in New York State just an urban effect?

PubMed Central

McNutt, L A; Strogatz, D S; Coles, F B; Fehrs, L J

1994-01-01

To determine whether New York State's high ischemic heart disease mortality rate was due primarily to an urban effect, rates for regions in the State were compared with each other and with national data. New York State mortality rates for the period 1980-87 were highest for New York City (344.5 per 100,000 residents), followed by upstate urban and rural areas (267.1-285.1), and New York City suburbs (272.5). However, the overall 1986 age-adjusted rate for the New York State region with the lowest mortality rate (265.7) exceeded that of 42 States. New York State's number one ischemic heart disease mortality ranking reflects the need for statewide intervention programs, because even regions with relatively low mortality rates are high when they are compared with national rates. PMID:8041858

Adjusting for overdispersion in piecewise exponential regression models to estimate excess mortality rate in population-based research.

PubMed

Luque-Fernandez, Miguel Angel; Belot, Aurélien; Quaresma, Manuela; Maringe, Camille; Coleman, Michel P; Rachet, Bernard

2016-10-01

In population-based cancer research, piecewise exponential regression models are used to derive adjusted estimates of excess mortality due to cancer using the Poisson generalized linear modelling framework. However, the assumption that the conditional mean and variance of the rate parameter given the set of covariates x i are equal is strong and may fail to account for overdispersion given the variability of the rate parameter (the variance exceeds the mean). Using an empirical example, we aimed to describe simple methods to test and correct for overdispersion. We used a regression-based score test for overdispersion under the relative survival framework and proposed different approaches to correct for overdispersion including a quasi-likelihood, robust standard errors estimation, negative binomial regression and flexible piecewise modelling. All piecewise exponential regression models showed the presence of significant inherent overdispersion (p-value <0.001). However, the flexible piecewise exponential model showed the smallest overdispersion parameter (3.2 versus 21.3) for non-flexible piecewise exponential models. We showed that there were no major differences between methods. However, using a flexible piecewise regression modelling, with either a quasi-likelihood or robust standard errors, was the best approach as it deals with both, overdispersion due to model misspecification and true or inherent overdispersion.

Distribution of cancer mortality rates by province in South Africa.

PubMed

Made, Felix; Wilson, Kerry; Jina, Ruxana; Tlotleng, Nonhlanhla; Jack, Samantha; Ntlebi, Vusi; Kootbodien, Tahira

2017-12-01

Cancer mortality rates are expected to increase in developing countries. Cancer mortality rates by province remain largely unreported in South Africa. This study described the 2014 age standardised cancer mortality rates by province in South Africa, to provide insight for strategic interventions and advocacy. 2014 deaths data were retrieved from Statistics South Africa. Deaths from cancer were extracted using 10th International Classification of Diseases (ICD) codes for cancer (C00-C97). Adjusted 2013 mid-year population estimates were used as a standard population. All rates were calculated per 100 000 individuals. Nearly 38 000 (8%) of the total deaths in South Africa in 2014 were attributed to cancer. Western Cape Province had the highest age standardised cancer mortality rate in South Africa (118, 95% CI: 115-121 deaths per 100 000 individuals), followed by the Northern Cape (113, 95% CI: 107-119 per 100 000 individuals), with the lowest rate in Limpopo Province (47, 95% CI: 45-49 per 100 000). The age standardised cancer mortality rate for men (71, 95% CI: 70-72 per 100 000 individuals) was similar to women (69, 95% CI: 68-70 per 100 000). Lung cancer was a major driver of cancer death in men (13, 95% CI: 12.6-13.4 per 100 000). In women, cervical cancer was the leading cause of cancer death (13, 95% CI: 12.6-13.4 per 100 000 individuals). There is a need to further investigate the factors related to the differences in cancer mortality by province in South Africa. Raising awareness of risk factors and screening for cancer in the population along with improved access and quality of health care are also important. Copyright © 2017 Elsevier Ltd. All rights reserved.

Associations between perinatal interventions and hospital stillbirth rates and neonatal mortality.

PubMed

Joyce, R; Webb, R; Peacock, J L

2004-01-01

Previous studies suggest that high risk and low birthweight babies have better outcomes if born in hospitals with level III neonatal intensive care units. Relations between obstetric care, particularly intrapartum interventions and perinatal outcomes, are less well understood, however. To investigate effects of obstetric, paediatric, and demographic factors on rates of hospital stillbirths and neonatal mortality. Cross sectional data on all 65 maternity units in all Thames Regions, 1994-1996, covering 540 834 live births and stillbirths. Hospital level analyses investigated associations between staffing rates (consultant/junior paediatricians, consultant/junior obstetricians, midwives), facilities (consultant obstetrician/anaesthetist sessions, delivery beds, special care baby unit, neonatal intensive care unit cots, etc), interventions (vaginal births, caesarean sections, forceps, epidurals, inductions, general anaesthetic), parental data (parity, maternal age, social class, deprivation, multiple births), and birthweight standardised stillbirth rates and neonatal mortality. Unifactorial analyses showed consistent negative associations between measures of obstetric intervention and stillbirth rates. Some measures of staffing, facilities, and parental data also showed significant associations. Scores for interventional, organisational, and parental variables were derived for multifactorial analysis to overcome the statistical problems caused by high intercorrelations between variables. A higher intervention score and higher number of consultant obstetricians per 1000 births were both independently and significantly associated with lower stillbirth rates. Organisational and parental factors were not significant after adjustment. Only Townsend deprivation score was significantly associated with neonatal mortality (positive correlation). Birthweight adjusted stillbirth rates were significantly lower in units that took a more interventionalist approach and in those with

Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals.

PubMed

Rasmussen, Thomas Bøjer; Ulrichsen, Sinna Pilgaard; Nørgaard, Mette

2018-01-01

Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM) chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes. The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses. We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations. Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals' estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54). In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease. The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most Danish hospitals. Together with descriptive analyses, it was possible to use an alarm from a risk-adjusted CUSUM chart to identify potential performance problems.

Three-year mortality rate of suicide attempters in consultation-liaison service.

PubMed

Chen, Hong-Ming; Hung, Tai-Hsin; Chou, Shih-Yong; Tsai, Ching-Shu; Su, Jian-An

2016-11-01

Suicide attempters might be sent to the emergency room for urgent medical intervention. Some with more severe physical morbidity may be hospitalised, and psychiatrists might be consulted for suicide evaluation. The aim of our study was to investigate the three-year all-cause mortality rate of hospitalised suicide attempters with regard to the effect of consultation-liaison services, and to identify any risk factors associated with mortality. Between 2002 and 2006, 196 inpatients from medical or surgical wards in a general hospital who had consulted psychiatrists because of suicide attempts were collected consecutively. We traced their mortality incidence during a three-year period, and calculated the mortality rate and time (days) to death. Three-year all-cause mortality was 20.4%, and there was a higher risk of mortality in the first two years after the index suicide attempt. In the adjusted Cox regression model, associated risks included male gender, older age, diagnosis of depressive disorders and lack of psychiatric follow-up. We found that hospitalised suicide attempters had higher all-cause mortality after discharge, and determined that psychiatric follow-up is helpful. More attention should be paid to those with potential risk factors, and timely intervention is suggested in order to reduce mortality.

Cancer mortality in central Serbia.

PubMed

Markovic-Denic, Ljiljana; Cirkovic, Andia; Zivkovic, Snezana; Stanic, Danica; Skodric-Trifunovic, Vesna

2014-01-01

Cancer is the one of the leading cause of death worldwide. The aim of this study was to examine cancer mortality trends in the population of central Serbia in the period from 2002 to 2011. The descriptive epidemiological method was used. The mortality from all malignant tumors (code C00-C96 of the International Disease Classification) was registered. The source of mortality data was the published material of the Cancer Registry of Serbia. The source of population data was the census of 2002 and 2011 and the estimates for inter-census years. Non-standardized, age-adjusted and age-specific mortality rates were calculated. Age adjustment of mortality rates was performed by the direct method of standardization. Trend lines were estimated using linear regression. During 2002-2011, cancer caused about 20% of all deaths each year in central Serbia. More men (56.9%) than women (43.1%) died of cancer. The average mortality rate for men was 1.3 times higher compared to women. A significant trend of increase of the age-adjusted mortality rates was recorded both for males (p<0.001) and for females (p=0.02). Except gastric cancer, the age-adjusted mortality rates in men were significantly increased for lung cancer (p=0.02), colorectal cancer (p<0.05), prostate cancer (p=0.01) and pancreatic cancer (p=0.01). Age-adjusted mortality rates for breast cancer in females were remarkably increased (p=0.01), especially after 2007. In central Serbia during the period from 2002 to 2011, there was an increasing trend in mortality rates due to cancers in both sexes. Cancer mortality in males was 1.3-fold higher compared to females.

Increased Mortality Rates During Resident Handoff Periods and the Effect of ACGME Duty Hour Regulations.

PubMed

Denson, Joshua L; McCarty, Matthew; Fang, Yixin; Uppal, Amit; Evans, Laura

2015-09-01

Medical errors occur following handoff-related miscommunication. Data regarding the effect on patient-centered outcomes, specifically mortality, are lacking. Our objective was to investigate handoff-related mortality and the effect of duty-hour regulations. Retrospective cohort study of adult medical patients at a public, university-affiliated hospital from 2010 to 2012. Patients were divided into 2 cohorts: handoff group (discharged within 7 days following a change in resident physician team) vs control group (discharged the 3 weeks of each 4-week rotation before resident service change). The primary outcome was unadjusted and adjusted hospital mortality rate. As a secondary prespecified analysis, we examined the effect of 2011 Accreditation Council for Graduate Medical Education (ACGME) duty-hour changes. Among 23,736 patients, unadjusted hospital mortality during the handoff group was higher than the control group (2.68% vs 2.08%, respectively; P = .007; odds ratio [OR] 1.30; 95% confidence interval [CI], 1.08-1.57). Following adjustment, this association remained statistically significant (adjusted OR 1.34; P = .003; 95% CI, 1.10-1.62). Similarly, pre-duty-hour unadjusted hospital mortality was higher in the handoff group vs control group (2.87% vs 2.01%, respectively; P = .006; OR 1.44; 95% CI, 1.11-1.86), which remained statistically significant following adjustment (adjusted OR 1.50; P = .002; 95% CI, 1.16-1.95). However, this association lost statistical significance following duty-hour revision with respect to both unadjusted (2.48% vs 2.15%, respectively; P = .30; OR 1.16; 95% CI, 0.88-1.53) and adjusted mortality (OR 1.18; P = .26; 95% CI, 0.89-1.56). Resident transition in care was significantly associated with an increase in unadjusted and adjusted hospital mortality. Although improved by 2011 ACGME duty-hour amendments, a trend toward higher mortality remained following resident handoff. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study.

PubMed

Chen, Chien-Min; Yang, Yao-Hsu; Chang, Chia-Hao; Chen, Pau-Chung

2017-12-01

To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. Retrospective cohort study. Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. None. Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age <45y; adjusted HR, 3.62), being a man (adjusted HR, 1.49), having ischemic stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI score<10; adjusted HR, 2.68), and comorbidity (Charlson-Deyo Comorbidity Index [CCI] score≥3, compared with CCI score=0; adjusted HR, 4.23). First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Trends in systemic lupus erythematosus mortality rates in the state of Sao Paulo, Brazil from 1985 to 2004.

PubMed

Souza, D C C; Santo, A H; Sato, E I

2010-01-01

To estimate mortality rates and mortality trends from SLE in the state of São Paulo, Brazil. The official data bank was used to study all deaths occurred from 1985 to 2004 in which SLE was mentioned as the underlying cause of death. Besides the overall mortality rate, the annual gender- and age-specific mortality rates were estimated for each calendar year by age bracket (0-19 years, 20-39 years, 40-59 years and over 60 years) and for the sub-periods 1985-1995 (first) and 1996-2004 (second), by decades. Chi-square test was used to compare the mortality rates between the two periods, as well the mortality rates according to educational level considering years of study. Pearson correlation coefficient test was used to analyse mortality trends. The crude rates were adjusted for age by the direct method, using the standard Brazilian population in 2000. A total of 2,601 deaths (90% female) attributed to SLE were analysed. The mean age at death was significantly higher in the second than in the first sub-period (36.6+/-15.6 years vs. 33.9+/-14.0 years; p<0.001). The overall adjusted mortality rate was 3.8 deaths/million habitants/year for the entire period and 3.4 deaths/million inhabitants/year for the first and 4.0 deaths/million inhabitants/year for the second sub-period (p<0.001). In each calendar year, the mortality rate was significantly lower for the better educated group. Throughout the period, there was a significant increase in mortality rates only among women over 40. SLE patients living in the state of São Paulo still die at younger ages than those living in developed countries. Our data do not support the theory that there was an improvement in the SLE mortality rate in the last 20 years in the state of Sao Paulo. Socio-economic factors, such as the difficulty to get medical care and adequate treatment, may be the main factors to explain the worst prognosis for our patients.

Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

PubMed

Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

2006-02-01

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of

Patterns of mortality rates in Darfur conflict.

PubMed

Degomme, Olivier; Guha-Sapir, Debarati

2010-01-23

Several mortality estimates for the Darfur conflict have been reported since 2004, but few accounted for conflict dynamics such as changing displacement and causes of deaths. We analyse changes over time for crude and cause-specific mortality rates, and assess the effect of displacement on mortality rates. Retrospective mortality surveys were gathered from an online database. Quasi-Poisson models were used to assess mortality rates with place and period in which the survey was done, and the proportions of displaced people in the samples were the explanatory variables. Predicted mortality rates for five periods were computed and applied to population data taken from the UN's series about Darfur to obtain the number of deaths. 63 of 107 mortality surveys met all criteria for analysis. Our results show significant reductions in mortality rates from early 2004 to the end of 2008, although rates were higher during deployment of fewer humanitarian aid workers. In general, the reduction in rate was more important for violence-related than for diarrhoea-related mortality. Displacement correlated with increased rates of deaths associated with diarrhoea, but also with reduction in violent deaths. We estimated the excess number of deaths to be 298 271 (95% CI 178 258-461 520). Although violence was the main cause of death during 2004, diseases have been the cause of most deaths since 2005, with displaced populations being the most susceptible. Any reduction in humanitarian assistance could lead to worsening mortality rates, as was the case between mid 2006 and mid 2007. Copyright 2010 Elsevier Ltd. All rights reserved.

75 FR 41876 - Disclosure of Adjustable Rate Mortgages (ARMs) Rates

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... Rate Mortgages (ARMs) Rates AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notice..., an annual disclosure is required to reflect any adjustment to the interest rate and monthly mortgage... lists the following information: Title of Proposal: Disclosure of Adjustable Rate Mortgages (ARMs) Rates...

Neighborhood poverty rate and mortality in patients receiving critical care in the academic medical center setting.

PubMed

Zager, Sam; Mendu, Mallika L; Chang, Domingo; Bazick, Heidi S; Braun, Andrea B; Gibbons, Fiona K; Christopher, Kenneth B

2011-06-01

Poverty is associated with increased risk of chronic illness but its contribution to critical care outcome is not well defined. We performed a multicenter observational study of 38,917 patients, aged ≥ 18 years, who received critical care between 1997 and 2007. The patients were treated in two academic medical centers in Boston, Massachusetts. Data sources included 1990 US census and hospital administrative data. The exposure of interest was neighborhood poverty rate, categorized as < 5%, 5% to 10%, 10% to 20%, 20% to 40% and > 40%. Neighborhood poverty rate is the percentage of residents below the federal poverty line. Census tracts were used as the geographic units of analysis. Logistic regression examined death by days 30, 90, and 365 post-critical care initiation and in-hospital mortality. Adjusted ORs were estimated by multivariable logistic regression models. Sensitivity analysis was performed for 1-year postdischarge mortality among patients discharged to home. Following multivariable adjustment, neighborhood poverty rate was not associated with all-cause 30-day mortality: 5% to 10% OR, 1.05 (95% CI, 0.98-1.14; P = .2); 10% to 20% OR, 0.96 (95% CI, 0.87-1.06; P = .5); 20% to 40% OR, 1.08 (95% CI, 0.96-1.22; P = .2); > 40% OR, 1.20 (95% CI, 0.90-1.60; P = .2); referent in each is < 5%. Similar nonsignificant associations were noted at 90-day and 365-day mortality post-critical care initiation and in-hospital mortality. Among patients discharged to home, neighborhood poverty rate was not associated with 1-year-postdischarge mortality. Our study suggests that there is no relationship between the neighborhood poverty rate and mortality up to 1 year following critical care at academic medical centers.

Explaining mortality rate plateaus

PubMed Central

Weitz, Joshua S.; Fraser, Hunter B.

2001-01-01

We propose a stochastic model of aging to explain deviations from exponential growth in mortality rates commonly observed in empirical studies. Mortality rate plateaus are explained as a generic consequence of considering death in terms of first passage times for processes undergoing a random walk with drift. Simulations of populations with age-dependent distributions of viabilities agree with a wide array of experimental results. The influence of cohort size is well accounted for by the stochastic nature of the model. PMID:11752476

Is outdoor work associated with elevated rates of cerebrovascular disease mortality? A cohort study based on iron-ore mining.

PubMed

Björ, Ove; Jonsson, Håkan; Damber, Lena; Burström, Lage; Nilsson, Tohr

2016-01-01

A cohort study that examined iron ore mining found negative associations between cumulative working time employed underground and several outcomes, including mortality of cerebrovascular diseases. In this cohort study, and using the same group of miners, we examined whether work in an outdoor environment could explain elevated cerebrovascular disease rates. This study was based on a Swedish iron ore mining cohort consisting of 13,000 workers. Poisson regression models were used to generate smoothed estimates of standardized mortality ratios and adjusted rate ratios, both models by cumulative exposure time in outdoor work. The adjusted rate ratio between employment classified as outdoor work ≥25 years and outdoor work 0-4 years was 1.62 (95 % CI 1.07-2.42). The subgroup underground work ≥15 years deviated most in occurrence of cerebrovascular disease mortality compared with the external reference population: SMR (0.70 (95 % CI 0.56-0.85)). Employment in outdoor environments was associated with elevated rates of cerebrovascular disease mortality. In contrast, work in tempered underground employment was associated with a protecting effect.

Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study.

PubMed

Larsen, Robert; Bäckström, Denise; Fredrikson, Mats; Steinvall, Ingrid; Gedeborg, Rolf; Sjoberg, Folke

2018-04-03

The interpretation of changes in injury-related mortality over time requires an understanding of changes in the incidence of the various types of injury, and adjustment for their severity. Our aim was to investigate changes over time in incidence of hospital admission for injuries caused by falls, traffic incidents, or assaults, and to assess the risk-adjusted short-term mortality for these patients. All patients admitted to hospital with injuries caused by falls, traffic incidents, or assaults during the years 2001-11 in Sweden were identified from the nationwide population-based Patient Registry. The trend in mortality over time for each cause of injury was adjusted for age, sex, comorbidity and severity of injury as classified from the International Classification of diseases, version 10 Injury Severity Score (ICISS). Both the incidence of fall (689 to 636/100000 inhabitants: p = 0.047, coefficient - 4.71) and traffic related injuries (169 to 123/100000 inhabitants: p < 0.0001, coefficient - 5.37) decreased over time while incidence of assault related injuries remained essentially unchanged during the study period. There was an overall decrease in risk-adjusted 30-day mortality in all three groups (OR 1.00; CI95% 0.99-1.00). Decreases in traffic (OR 0.95; 95% CI 0.93 to 0.97) and assault (OR 0.93; 95% CI 0.87 to 0.99) related injuries was significant whereas falls were not during this 11-year period. Risk-adjustment is a good way to use big materials to find epidemiological changes. However after adjusting for age, year, sex and risk we find that a possible factor is left in the pre- and/or in-hospital care. The decrease in risk-adjusted mortality may suggest changes over time in pre- and/or in-hospital care. A non-significantdecrease in risk-adjusted mortality was registered for falls, which may indicate that low-energy trauma has not benefited for the increased survivability as much as high-energy trauma, ie traffic- and assault related

76 FR 42140 - Rate Adjustment Remand

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-18

... POSTAL REGULATORY COMMISSION [Docket No. R2010-4R; Order No. 757] Rate Adjustment Remand AGENCY... the causation standard in exigent rate adjustments. This notice provides information on legal... of the Commission's September 30, 2010 order denying a Postal Service request for an exigent rate...

The effect of peer review on mortality rates.

PubMed

Krahwinkel, W; Schuler, E; Liebetrau, M; Meier-Hellmann, A; Zacher, J; Kuhlen, R

2016-10-01

Lowering of mortality rates in hospitals with mortality rates higher than accepted reference values for acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia, stroke, mechanical ventilation (MV) and colorectal surgery by using an external peer review process that identifies areas requiring rectification and implements protocols directed at improving these areas. Retrospective, observational, quality management study using administrative data to compare in-hospital mortality rates (pre and post an external peer review process that included adoption of improvement protocols) with reference values. German general hospitals of a large, private group. Hospitals with mortality rates higher than reference values. Peer review of medical records by experienced, outside physicians triggered by in-hospital mortality rates higher than expected. Inadequacies were identified, improvement protocols enforced and mortality rates subsequently re-examined. Mortality rates 1 year before and 1 year after peer review and protocol use. For AMI, CHF, pneumonia, stroke, MV and colorectal surgery, the mortality rates 1 year post-peer review were significantly decreased as compared to pre-peer review mortality rates. The standardized mortality ratio for all of the above diagnoses was 1.45, 1 year before peer review, and 0.97, 1 year after peer review. The absolute risk reduction of 7.3% translates into 710 deaths in this population which could have been prevented. Peer review triggered and conducted in the manner described here is associated with a significant lowering of in-hospital mortality rates in hospitals that previously had higher than expected mortality rates. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis.

PubMed

Nitsch, Dorothea; Grams, Morgan; Sang, Yingying; Black, Corri; Cirillo, Massimo; Djurdjev, Ognjenka; Iseki, Kunitoshi; Jassal, Simerjot K; Kimm, Heejin; Kronenberg, Florian; Oien, Cecilia M; Levey, Andrew S; Levin, Adeera; Woodward, Mark; Hemmelgarn, Brenda R

2013-01-29

To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. Random effects meta-analysis using pooled individual participant data. 46 cohorts from Europe, North and South America, Asia, and Australasia. 2,051,158 participants (54% women) from general population cohorts (n=1,861,052), high risk cohorts (n=151,494), and chronic kidney disease cohorts (n=38,612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥ 50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (mg/g). Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (P(interaction)<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (P(interaction)<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk. Both sexes face increased risk of all

Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis

PubMed Central

Nitsch, Dorothea; Grams, Morgan; Sang, Yingying; Black, Corri; Cirillo, Massimo; Djurdjev, Ognjenka; Iseki, Kunitoshi; Jassal, Simerjot K; Kimm, Heejin; Kronenberg, Florian; Øien, Cecilia M; Levin, Adeera; Woodward, Mark; Hemmelgarn, Brenda R

2013-01-01

Objective To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. Design Random effects meta-analysis using pooled individual participant data. Setting 46 cohorts from Europe, North and South America, Asia, and Australasia. Participants 2 051 158 participants (54% women) from general population cohorts (n=1 861 052), high risk cohorts (n=151 494), and chronic kidney disease cohorts (n=38 612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m2) and urinary albumin-creatinine ratio (mg/g). Results Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (Pinteraction<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (Pinteraction<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal

Ozone and daily mortality rate in 21 cities of East Asia: how does season modify the association?

PubMed

Chen, Renjie; Cai, Jing; Meng, Xia; Kim, Ho; Honda, Yasushi; Guo, Yue Leon; Samoli, Evangelia; Yang, Xin; Kan, Haidong

2014-10-01

Previous studies in East Asia have revealed that the short-term associations between tropospheric ozone and daily mortality rate were strongest in winter, which is opposite to the findings in North America and Western Europe. Therefore, we investigated the season-varying association between ozone and daily mortality rate in 21 cities of East Asia from 1979 to 2010. Time-series Poisson regression models were used to analyze the association between ozone and daily nonaccidental mortality rate in each city, testing for different temperature lags. The best-fitting model was obtained after adjustment for temperature in the previous 2 weeks. Bayesian hierarchical models were applied to pool the city-specific estimates. An interquartile-range increase of the moving average concentrations of same-day and previous-day ozone was associated with an increase of 1.44% (95% posterior interval (PI): 1.08%, 1.80%) in daily total mortality rate after adjustment for temperature in the previous 2 weeks. The corresponding increases were 0.62% (95% PI: 0.08%, 1.16%) in winter, 1.46% (95% PI: 0.89%, 2.03%) in spring, 1.60% (95% PI: 1.03%, 2.17%) in summer, and 1.12% (95% PI: 0.73%, 1.51%) in fall. We found significant associations between short-term exposure to ozone and higher mortality rate in East Asia that varied considerably from season to season with a significant trough in winter. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

National mortality rates: the impact of inequality?

PubMed

Wilkinson, R G

1992-08-01

Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates.

Reduced mortality rates in a cohort of long-term underground iron-ore miners.

PubMed

Björ, Ove; Jonsson, Håkan; Damber, Lena; Wahlström, Jens; Nilsson, Tohr

2013-05-01

Historically, working in iron-ore mines has been associated with an increased risk of lung cancer and silicosis. However, studies on other causes of mortality are inconsistent and in the case of cancer incidence, sparse. The aim of this study was to examine the association between iron-ore mining, mortality and cancer incidence. A 54-year cohort study on iron-ore miners from mines in northern Sweden was carried out comprising 13,000 workers. Standardized rate ratios were calculated comparing the disease frequency, mortality, and cancer incidence with that of the general population of northern Sweden. Poisson regression was used to evaluate the association between the durations of employment and underground work, and outcome. Underground mining was associated with a significant decrease in adjusted mortality rate ratios for cerebrovascular and digestive system diseases, and stroke. For several outcomes, elevated standardized rate ratios were observed among blue-collar workers relative to the reference population. However, only the incidence of lung cancer increased with employment time underground (P < 0.001). Long-term iron-ore mining underground was associated with lower rates regarding several health outcomes. This is possibly explained by factors related to actual job activities, environmental exposure, or the selection of healthier workers for long-term underground employment. Copyright © 2013 Wiley Periodicals, Inc.

Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals

PubMed Central

Stukel, Therese A.; Fisher, Elliott S.; Alter, David A.; Guttmann, Astrid; Ko, Dennis T.; Fung, Kinwah; Wodchis, Walter P.; Baxter, Nancy N.; Earle, Craig C.; Lee, Douglas S.

2012-01-01

Context The extent to which better spending produces higher-quality care and better patient outcomes in a universal health care system with selective access to medical technology is unknown. Objective To assess whether acute care patients admitted to higher-spending hospitals have lower mortality and readmissions. Design, Setting, and Patients The study population comprised adults (> 18 years) in Ontario, Canada, with a first admission for acute myocardial infarction (AMI) (n=179 139), congestive heart failure (CHF) (n=92 377), hip fracture (n=90 046), or colon cancer (n=26 195) during 1998–2008, with follow-up to 1 year. The exposure measure was the index hospital’s end-of-life expenditure index for hospital, physician, and emergency department services. Main Outcome Measures The primary outcomes were 30-day and 1-year mortality and readmissions and major cardiac events (readmissions for AMI, angina, CHF, or death) for AMI and CHF. Results Patients’ baseline health status was similar across hospital expenditure groups. Patients admitted to hospitals in the highest- vs lowest-spending intensity terciles had lower rates of all adverse outcomes. In the highest- vs lowest-spending hospitals, respectively, the age- and sex-adjusted 30-day mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF; fully adjusted relative 30-day mortality rates were 0.93 (95% CI, 0.89–0.98) for AMI, 0.81 (95% CI, 0.76–0.86) for CHF, 0.74 (95% CI, 0.68–0.80) for hip fracture, and 0.78 (95% CI, 0.66–0.91) for colon cancer. Results for 1-year mortality, readmissions, and major cardiac events were similar. Higher-spending hospitals had higher nursing staff ratios, and their patients received more inpatient medical specialist visits, interventional (AMI cohort) and medical (AMI and CHF cohorts) cardiac therapies, preoperative specialty care (colon cancer cohort), and postdischarge collaborative care with a

National mortality rates: the impact of inequality?

PubMed Central

Wilkinson, R G

1992-01-01

Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates. PMID:1636827

Applying the compound Poisson process model to the reporting of injury-related mortality rates.

PubMed

Kegler, Scott R

2007-02-16

Injury-related mortality rate estimates are often analyzed under the assumption that case counts follow a Poisson distribution. Certain types of injury incidents occasionally involve multiple fatalities, however, resulting in dependencies between cases that are not reflected in the simple Poisson model and which can affect even basic statistical analyses. This paper explores the compound Poisson process model as an alternative, emphasizing adjustments to some commonly used interval estimators for population-based rates and rate ratios. The adjusted estimators involve relatively simple closed-form computations, which in the absence of multiple-case incidents reduce to familiar estimators based on the simpler Poisson model. Summary data from the National Violent Death Reporting System are referenced in several examples demonstrating application of the proposed methodology.

Trauma, comorbidity, and mortality following diagnoses of severe stress and adjustment disorders: a nationwide cohort study.

PubMed

Gradus, Jaimie L; Antonsen, Sussie; Svensson, Elisabeth; Lash, Timothy L; Resick, Patricia A; Hansen, Jens Georg

2015-09-01

Longitudinal outcomes following stress or trauma diagnoses are receiving attention, yet population-based studies are few. The aims of the present cohort study were to examine the cumulative incidence of traumatic events and psychiatric diagnoses following diagnoses of severe stress and adjustment disorders categorized using International Classification of Diseases, Tenth Revision, codes and to examine associations of these diagnoses with all-cause mortality and suicide. Data came from a longitudinal cohort of all Danes who received a diagnosis of reaction to severe stress or adjustment disorders (International Classification of Diseases, Tenth Revision, code F43.x) between 1995 and 2011, and they were compared with data from a general-population cohort. Cumulative incidence curves were plotted to examine traumatic experiences and psychiatric diagnoses during the study period. A Cox proportional hazards regression model was used to examine the associations of the disorders with mortality and suicide. Participants with stress diagnoses had a higher incidence of traumatic events and psychiatric diagnoses than did the comparison group. Each disorder was associated with a higher rate of all-cause mortality than that seen in the comparison cohort, and strong associations with suicide were found after adjustment. This study provides a comprehensive assessment of the associations of stress disorders with a variety of outcomes, and we found that stress diagnoses may have long-lasting and potentially severe consequences. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Resting heart rate is a risk factor for mortality in chronic obstructive pulmonary disease, but not for exacerbations or pneumonia.

PubMed

Warnier, Miriam J; Rutten, Frans H; de Boer, Anthonius; Hoes, Arno W; De Bruin, Marie L

2014-01-01

Although it is known that patients with chronic obstructive pulmonary disease (COPD) generally do have an increased heart rate, the effects on both mortality and non-fatal pulmonary complications are unclear. We assessed whether heart rate is associated with all-cause mortality, and non-fatal pulmonary endpoints. A prospective cohort study of 405 elderly patients with COPD was performed. All patients underwent extensive investigations, including electrocardiography. Follow-up data on mortality were obtained by linking the cohort to the Dutch National Cause of Death Register and information on complications (exacerbation of COPD or pneumonia) by scrutinizing patient files of general practitioners. Multivariable cox regression analysis was performed. During the follow-up 132 (33%) patients died. The overall mortality rate was 50/1000 py (42-59). The major causes of death were cardiovascular and respiratory. The relative risk of all-cause mortality increased with 21% for every 10 beats/minute increase in heart rate (adjusted HR: 1.21 [1.07-1.36], p = 0.002). The incidence of major non-fatal pulmonary events was 145/1000 py (120-168). The risk of a non-fatal pulmonary complication increased non-significantly with 7% for every 10 beats/minute increase in resting heart rate (adjusted HR: 1.07 [0.96-1.18], p = 0.208). Increased resting heart rate is a strong and independent risk factor for all-cause mortality in elderly patients with COPD. An increased resting heart rate did not result in an increased risk of exacerbations or pneumonia. This may indicate that the increased mortality risk of COPD is related to non-pulmonary causes. Future randomized controlled trials are needed to investigate whether heart-rate lowering agents are worthwhile for COPD patients.

42 CFR 416.172 - Adjustments to national payment rates.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Adjustments to national payment rates. 416.172... Adjustments to national payment rates. (a) General rule. Contractors adjust the payment rates established for...; or (2) The geographically adjusted payment rate determined under this subpart. (c) Geographic...

42 CFR 416.172 - Adjustments to national payment rates.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Adjustments to national payment rates. 416.172... Adjustments to national payment rates. (a) General rule. Contractors adjust the payment rates established for...; or (2) The geographically adjusted payment rate determined under this subpart. (c) Geographic...

7 CFR 4287.112 - Interest rate adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Interest rate adjustments. 4287.112 Section 4287.112... Loans § 4287.112 Interest rate adjustments. (a) Reductions. The borrower, lender, and holder (if any) may collectively initiate a permanent or temporary reduction in the interest rate of the guaranteed...

The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program

PubMed Central

WIEBE, DOUGLAS J.; HOLENA, DANIEL N.; DELGADO, M. KIT; McWILLIAMS, NATHAN; ALTENBURG, JULIET; CARR, BRENDAN G.

2018-01-01

Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance. PMID:28541852

The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program.

PubMed

Wiebe, Douglas J; Holena, Daniel N; Delgado, M Kit; McWilliams, Nathan; Altenburg, Juliet; Carr, Brendan G

2017-05-01

Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance.

Liver cancer mortality rate model in Thailand

NASA Astrophysics Data System (ADS)

Sriwattanapongse, Wattanavadee; Prasitwattanaseree, Sukon

2013-09-01

Liver Cancer has been a leading cause of death in Thailand. The purpose of this study was to model and forecast liver cancer mortality rate in Thailand using death certificate reports. A retrospective analysis of the liver cancer mortality rate was conducted. Numbering of 123,280 liver cancer causes of death cases were obtained from the national vital registration database for the 10-year period from 2000 to 2009, provided by the Ministry of Interior and coded as cause-of-death using ICD-10 by the Ministry of Public Health. Multivariate regression model was used for modeling and forecasting age-specific liver cancer mortality rates in Thailand. Liver cancer mortality increased with increasing age for each sex and was also higher in the North East provinces. The trends of liver cancer mortality remained stable in most age groups with increases during ten-year period (2000 to 2009) in the Northern and Southern. Liver cancer mortality was higher in males and increase with increasing age. There is need of liver cancer control measures to remain on a sustained and long-term basis for the high liver cancer burden rate of Thailand.

Past and Present ARDS Mortality Rates: A Systematic Review.

PubMed

Máca, Jan; Jor, Ondřej; Holub, Michal; Sklienka, Peter; Burša, Filip; Burda, Michal; Janout, Vladimír; Ševčík, Pavel

2017-01-01

ARDS is severe form of respiratory failure with significant impact on the morbidity and mortality of critical care patients. Epidemiological data are crucial for evaluating the efficacy of therapeutic interventions, designing studies, and optimizing resource distribution. The goal of this review is to present general aspects of mortality data published over the past decades. A systematic search of the MEDLINE/PubMed was performed. The articles were divided according to their methodology, type of reported mortality, and time. The main outcome was mortality. Extracted data included study duration, number of patients, and number of centers. The mortality trends and current mortality were calculated for subgroups consisting of in-hospital, ICU, 28/30-d, and 60-d mortality over 3 time periods (A, before 1995; B, 1995-2000; C, after 2000). The retrospectivity and prospectivity were also taken into account. Moreover, we present the most recent mortality rates since 2010. One hundred seventy-seven articles were included in the final analysis. General mortality rates ranged from 11 to 87% in studies including subjects with ARDS of all etiologies (mixed group). Linear regression revealed that the study design (28/30-d or 60-d) significantly influenced the mortality rate. Reported mortality rates were higher in prospective studies, such as randomized controlled trials and prospective observational studies compared with retrospective observational studies. Mortality rates exhibited a linear decrease in relation to time period (P < .001). The number of centers showed a significant negative correlation with mortality rates. The prospective observational studies did not have consistently higher mortality rates compared with randomized controlled trials. The mortality trends over 3 time periods (before 1995, 1995-2000, and after 2000) yielded variable results in general ARDS populations. However, a mortality decrease was present mostly in prospective studies. Since 2010, the

76 FR 7883 - Postal Service Rate Adjustment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-11

... POSTAL REGULATORY COMMISSION [Docket No. R2011-4; Order No. 663] Postal Service Rate Adjustment AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request concerning a Type 2 rate adjustment. This notice addresses procedural steps...

[Mortality due to pesticide poisoning in Colombia, 1998-2011].

PubMed

Chaparro-Narváez, Pablo; Castañeda-Orjuela, Carlos

2015-08-01

Poisoning due to pesticides is an important public health problem worldwide due its morbidity and mortality. In Colombia, there are no exact data on mortality due to pesticide poisoning. To estimate the trend of mortality rate due to pesticide poisoning in Colombia between 1998 and 2011. We carried out a descriptive analysis with the database reports of death as unintentional poisoning, self-inflicted intentional poisoning, aggression with pesticides, and poisoning with non-identified intentionality, population projections between 1998 and 2011, and rurality indexes. Crude and age-adjusted mortality rates were estimated and trends and Spearman coefficients were evaluated. A total of 4,835 deaths were registered (age-adjusted mortality rate of 2.38 deaths per 100,000 people). Mortality rates were higher in rural areas, for self-inflicted intentional poisoning, in men and in age groups between 15 and 39 years old. The trend has been decreasing since 2002. Municipality mortality rates due to unintentional poisoning and aggression correlated significantly with the rurality index in less rural municipalities. Mortality rates due to pesticide poisoning presented a mild decrease between 1998 and 2011. It is necessary to adjust and reinforce the measures conducive to reducing pesticide exposure in order to avoid poisoning and reduce mortality.

Adjusting for reverse causation to estimate the effect of obesity on mortality after incident heart failure in the Atherosclerosis Risk in Communities (ARIC) study.

PubMed

Shakiba, Maryam; Soori, Hamid; Mansournia, Mohammad Ali; Nazari, Seyed Saeed Hashemi; Salimi, Yahya

2016-01-01

The lower mortality rate of obese patients with heart failure (HF) has been partly attributed to reverse causation bias due to weight loss caused by disease. Using data about weight both before and after HF, this study aimed to adjust for reverse causation and examine the association of obesity both before and after HF with mortality. Using the Atherosclerosis Risk in Communities (ARIC) study, 308 patients with data available from before and after the incidence of HF were included. Pre-morbid and post-morbid obesity were defined based on body mass index measurements at least three months before and after incident HF. The associations of pre-morbid and post-morbid obesity and weight change with survival after HF were evaluated using a Cox proportional hazard model. Pre-morbid obesity was associated with higher mortality (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04 to 2.49) but post-morbid obesity was associated with increased survival (HR, 0.57; 95% CI, 0.37 to 0.88). Adjusting for weight change due to disease as a confounder of the obesity-mortality relationship resulted in the absence of any significant associations between post-morbid obesity and mortality. This study demonstrated that controlling for reverse causality by adjusting for the confounder of weight change may remove or reverse the protective effect of obesity on mortality among patients with incident HF.

18 CFR 154.403 - Periodic rate adjustments.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Periodic rate adjustments. 154.403 Section 154.403 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.403 Periodic rate adjustments. (a) This section applies to the passthrough, on a periodic...

18 CFR 154.403 - Periodic rate adjustments.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Periodic rate adjustments. 154.403 Section 154.403 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.403 Periodic rate adjustments. (a) This section applies to the passthrough, on a periodic...

18 CFR 154.403 - Periodic rate adjustments.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Periodic rate adjustments. 154.403 Section 154.403 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.403 Periodic rate adjustments. (a) This section applies to the passthrough, on a periodic...

18 CFR 154.403 - Periodic rate adjustments.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Periodic rate adjustments. 154.403 Section 154.403 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.403 Periodic rate adjustments. (a) This section applies to the passthrough, on a periodic...

Association between gender inequality index and child mortality rates: a cross-national study of 138 countries.

PubMed

Brinda, Ethel Mary; Rajkumar, Anto P; Enemark, Ulrika

2015-03-09

Gender inequality weakens maternal health and harms children through many direct and indirect pathways. Allied biological disadvantage and psychosocial adversities challenge the survival of children of both genders. United Nations Development Programme (UNDP) has recently developed a Gender Inequality Index to measure the multidimensional nature of gender inequality. The global impact of Gender Inequality Index on the child mortality rates remains uncertain. We employed an ecological study to investigate the association between child mortality rates and Gender Inequality Indices of 138 countries for which UNDP has published the Gender Inequality Index. Data on child mortality rates and on potential confounders, such as, per capita gross domestic product and immunization coverage, were obtained from the official World Health Organization and World Bank sources. We employed multivariate non-parametric robust regression models to study the relationship between these variables. Women in low and middle income countries (LMICs) suffer significantly more gender inequality (p < 0.001). Gender Inequality Index (GII) was positively associated with neonatal (β = 53.85; 95% CI 41.61-64.09), infant (β = 70.28; 95% CI 51.93-88.64) and under five mortality rates (β = 68.14; 95% CI 49.71-86.58), after adjusting for the effects of potential confounders (p < 0.001). We have documented statistically significant positive associations between GII and child mortality rates. Our results suggest that the initiatives to curtail child mortality rates should extend beyond medical interventions and should prioritize women's rights and autonomy. We discuss major pathways connecting gender inequality and child mortality. We present the socio-economic problems, which sustain higher gender inequality and child mortality in LMICs. We further discuss the potential solutions pertinent to LMICs. Dissipating gender barriers and focusing on social well-being of women may augment the survival of

Completeness and underestimation of cancer mortality rate in Iran: a report from Fars Province in southern Iran.

PubMed

Marzban, Maryam; Haghdoost, Ali-Akbar; Dortaj, Eshagh; Bahrampour, Abbas; Zendehdel, Kazem

2015-03-01

The incidence and mortality rates of cancer are increasing worldwide, particularly in the developing countries. Valid data are needed for measuring the cancer burden and making appropriate decisions toward cancer control. We evaluated the completeness of death registry with regard to cancer death in Fars Province, I. R. of Iran. We used data from three sources in Fars Province, including the national death registry (source 1), the follow-up data from the pathology-based cancer registry (source 2) and hospital based records (source 3) during 2004 - 2006. We used the capture-recapture method and estimated underestimation and the true age standardized mortality rate (ASMR) for cancer. We used log-linear (LL) modeling for statistical analysis. We observed 1941, 480, and 355 cancer deaths in sources 1, 2 and 3, respectively. After data linkage, we estimated that mortality registry had about 40% underestimation for cancer death. After adjustment for this underestimation rate, the ASMR of cancer in the Fars Province for all cancer types increased from 44.8 per 100,000 (95% CI: 42.8 - 46.7) to 76.3 per 100,000 (95% CI: 73.3 - 78.9), accounting for 3309 (95% CI: 3151 - 3293) cancer deaths annually. The mortality rate of cancer is considerably higher than the rates reported by the routine registry in Iran. Improvement in the validity and completeness of the mortality registry is needed to estimate the true mortality rate caused by cancer in Iran.

Difficulties with Regression Analysis of Age-Adjusted Rates.

DTIC Science & Technology

1982-09-01

variables used in those analyses, such as death rates in various states, have been age adjusted, whereas the predictor variables have not been age adjusted...The use of crude state death rates as the outcome variable with crude covariates and age as predictors can avoid the problem, at least under some...should be regressed on age-adjusted exposure Z+B+ Although age-specific death rates , Yas+’ may be available, it is often difficult to obtain age

Mortality Differences Between Traditional Medicare and Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data

PubMed Central

Beveridge, Roy A.; Mendes, Sean M.; Caplan, Arial; Rogstad, Teresa L.; Olson, Vanessa; Williams, Meredith C.; McRae, Jacquelyn M.; Vargas, Stefan

2017-01-01

Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the MA data set. The mortality model adjusted for clinical conditions and demographic factors. Model development considered the effect of potentially greater coding intensity in the MA population. Further analysis calculated ratios for subpopulations. Predicted, risk-adjusted mortality was lower in the MA population than in FFS Medicare. However, the ratio of actual-to-predicted mortality (0.80) suggested that the individuals in the MA data set were less likely to die than would be predicted had those individuals been enrolled in FFS Medicare. Differences between actual and predicted mortality were particularly pronounced in low income (dual eligibility), nonwhite race, high morbidity, and Health Maintenance Organization (HMO) subgroups. After controlling for baseline clinical risk as represented by claims diagnosis data, mortality differences favoring MA over FFS Medicare persisted, particularly in vulnerable subgroups and HMO plans. These findings suggest that differences in morbidity do not fully explain differences in mortality between the 2 programs. PMID:28578605

Impact of heart rate in atrial fibrillation versus sinus rhythm on mortality in octogenarian patients with acute coronary syndrome

PubMed Central

Li, Shijun; Barywani, Salim; Fu, Michael

2017-01-01

Introduction Association of heart rate (HR) with mortality in patients with acute coronary syndrome (ACS) and aged ≥ 80 years are underrepresented in clinical trials. We therefore aimed to investigate the association of HR in atrial fibrillation (AF) versus sinus rhythm (SR) with all-cause mortality in octogenarian patients with ACS. Methods A total of 336 patients with ACS patients and aged ≥ 80 years were enrolled into the current study. The end point of interest was death from any cause. Association of HR in AF versus SR with mortality was analyzed by Kaplan-Meier curve following log-rank test and multivariable Cox regression analysis. Results In total, 63 (87.5%) of patients with AF were dead and 147 (59.8%) of patients with SR were dead during the follow-up period. The best cut-off was 80 bpm, with a sensitivity of 62% and specificity of 66%. HR ≤ 80 bpm in SR but not in AF was associated with better outcome as compared with HR > 80 bpm (Chi-Square = 26.55, Log rank P < 0.001). In SR subgroup, the hazard ratios of HR ≤ 80 bpm were 0.51(95% CI 0.37-0.70, P < 0.001) adjusted for age, 0.46 (95%CI 0.33-0.63, P < 0.001) adjusted for gender, 0.62 (95%CI 0.42- 0.93, P = 0.020) adjusted for multivariables respectively. In AF subgroup, the hazard ratios of HR ≤ 80 bpm were 0.83(95% CI 0.49-1.38, P = 0.464) adjusted for age, 0.96 (95%CI 0.59-1.58, P = 0.882) adjusted for gender, 0.72(95% CI 0.41-1.26, P = 0.249) adjusted for multivariables respectively. Conclusion The current study demonstrates that heart rate is an independent prognostic predictor for all-cause mortality, and HR ≤ 80 bpm is associated with improved outcome in SR but not in AF in octogenarian patients with ACS. PMID:29255559

Impact of heart rate in atrial fibrillation versus sinus rhythm on mortality in octogenarian patients with acute coronary syndrome.

PubMed

Li, Shijun; Barywani, Salim; Fu, Michael

2017-01-01

Association of heart rate (HR) with mortality in patients with acute coronary syndrome (ACS) and aged ≥ 80 years are underrepresented in clinical trials. We therefore aimed to investigate the association of HR in atrial fibrillation (AF) versus sinus rhythm (SR) with all-cause mortality in octogenarian patients with ACS. A total of 336 patients with ACS patients and aged ≥ 80 years were enrolled into the current study. The end point of interest was death from any cause. Association of HR in AF versus SR with mortality was analyzed by Kaplan-Meier curve following log-rank test and multivariable Cox regression analysis. In total, 63 (87.5%) of patients with AF were dead and 147 (59.8%) of patients with SR were dead during the follow-up period. The best cut-off was 80 bpm, with a sensitivity of 62% and specificity of 66%. HR ≤ 80 bpm in SR but not in AF was associated with better outcome as compared with HR > 80 bpm (Chi-Square = 26.55, Log rank P < 0.001). In SR subgroup, the hazard ratios of HR ≤ 80 bpm were 0.51(95% CI 0.37-0.70, P < 0.001) adjusted for age, 0.46 (95%CI 0.33-0.63, P < 0.001) adjusted for gender, 0.62 (95%CI 0.42- 0.93, P = 0.020) adjusted for multivariables respectively. In AF subgroup, the hazard ratios of HR ≤ 80 bpm were 0.83(95% CI 0.49-1.38, P = 0.464) adjusted for age, 0.96 (95%CI 0.59-1.58, P = 0.882) adjusted for gender, 0.72(95% CI 0.41-1.26, P = 0.249) adjusted for multivariables respectively. The current study demonstrates that heart rate is an independent prognostic predictor for all-cause mortality, and HR ≤ 80 bpm is associated with improved outcome in SR but not in AF in octogenarian patients with ACS.

Measured glomerular filtration rate does not improve prediction of mortality by cystatin C and creatinine.

PubMed

Sundin, Per-Ola; Sjöström, Per; Jones, Ian; Olsson, Lovisa A; Udumyan, Ruzan; Grubb, Anders; Lindström, Veronica; Montgomery, Scott

2017-04-01

Cystatin C may add explanatory power for associations with mortality in combination with other filtration markers, possibly indicating pathways other than glomerular filtration rate (GFR). However, this has not been firmly established since interpretation of associations independent of measured GFR (mGFR) is limited by potential multicollinearity between markers of GFR. The primary aim of this study was to assess associations between cystatin C and mortality, independent of mGFR. A secondary aim was to evaluate the utility of combining cystatin C and creatinine to predict mortality risk. Cox regression was used to assess the associations of cystatin C and creatinine with mortality in 1157 individuals referred for assessment of plasma clearance of iohexol. Since cystatin C and creatinine are inversely related to mGFR, cystatin C - 1 and creatinine - 1 were used. After adjustment for mGFR, lower cystatin C - 1 (higher cystatin C concentration) and higher creatinine - 1 (lower creatinine concentration) were independently associated with increased mortality. When nested models were compared, avoiding the potential influence of multicollinearity, the independence of the associations was supported. Among models combining the markers of GFR, adjusted for demographic factors and comorbidity, cystatin C - 1 and creatinine - 1 combined explained the largest proportion of variance in associations with mortality risk ( R 2  = 0.61). Addition of mGFR did not improve the model. Our results suggest that both creatinine and cystatin C have independent associations with mortality not explained entirely by mGFR and that mGFR does not offer a more precise mortality risk assessment than these endogenous filtration markers combined. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Short-Term Effect of Coarse Particles on Daily Mortality Rate in A Tropical City, Kaohsiung, Taiwan.

PubMed

Tsai, Shang-Shyue; Weng, Yi-Hao; Chiu, Ya-Wen; Yang, Chun-Yuh

2015-01-01

Many studies examined the short-term effects of air pollution on frequency of daily mortality over the past two decades. However, information on the relationship between exposure to levels of coarse particles (PM(2.5-10)) and daily mortality rate is relatively sparse due to limited availability of monitoring data and findings are inconsistent. This study was undertaken to determine whether an association exists between PM(2.5-10) levels and rate of daily mortality in Kaohsiung, Taiwan, a large industrial city with a tropical climate. Daily mortality rate, air pollution parameters, and weather data for Kaohsiung were obtained for the period 2006-2008. The relative risk (RR) of daily mortality occurrence was estimated using a time-stratified case-crossover approach, controlling for (1) weather variables, (2) day of the week, (3) seasonality, and (4) long-term time trends. For the single-pollutant model without adjustment for other pollutants, PM(2.5-10) exposure levels showed significant correlation with total mortality rate both on warm and cool days, with an interquartile range increase associated with a 14% (95% CI = 5-23%) and 12% (95% CI = 5-20%) rise in number of total deaths, respectively. In two-pollutant models, PM(2.5-10) exerted significant influence on total mortality frequency after inclusion of sulfur dioxide (SO(2)) on warm days. On cool days, PM(2.5-10) induced significant elevation in total mortality rate when SO(2) or ozone (O(3)) was added in the regression model. There was no apparent indication of an association between PM(2.5-10) exposure and deaths attributed to respiratory and circulatory diseases. This study provided evidence of correlation between short-term exposure to PM(2.5-10) and increased risk of death for all causes.

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data.

PubMed

Ye, J; Zhang, J; Mikolajczyk, R; Torloni, M R; Gülmezoglu, A M; Betran, A P

2016-04-01

Caesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality. Ecological study using longitudinal data. Worldwide country-level data. A total of 159 countries were included in the analyses, representing 98.0% of global live births (2005). Nationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio-economic development by means of human development index (HDI) using fractional polynomial regression models. Maternal mortality ratio and neonatal mortality rate. Most countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5-10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%. Although caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality. The caesarean section rate of around 10% may be the optimal rate to achieve the lowest mortality. © 2015 The Authors

Long-term association between the intensity of cosmic rays and mortality rates in the city of Sao Paulo

NASA Astrophysics Data System (ADS)

Vieira, C. L. Z.; Janot-Pacheco, E.; Lage, C.; Pacini, A.; Koutrakis, P.; Cury, P. R.; Shaodan, H.; Pereira, L. A.; Saldiva, P. H. N.

2018-02-01

Human beings are constantly exposed to many kinds of environmental agents which affect their health and lifespan. Galactic cosmic rays (GCRs) are the main source of ionizing radiation in the lower troposphere, in which secondary products can penetrate the ground and underground layers. GCRs affect the physical-chemical properties of the terrestrial atmosphere, as well as the biosphere. GCRs are modulated by solar activity and latitudinal geomagnetic field distribution. In our ecological/populational retrospective study, we analyzed the correlation between the annual flux of local secondary GCR-induced ionization (CRII) and mortality rates in the city of Sao Paulo, Brazil, between 1951-2012. The multivariate linear regression analyses adjusted by demographic and weather parameters showed that CRII are significantly correlated with total mortality, infectious disease mortality, maternal mortality, and perinatal mortality rates (p < 0.001). The underlying mechanisms are still unclear. Further cross-sectional and experimental cohort studies are necessary to understand the biophysical mechanisms of the association found here.

Dizziness and death: An imbalance in mortality.

PubMed

Corrales, C Eduardo; Bhattacharyya, Neil

2016-09-01

To determine if dizziness is an independent risk factor for mortality among adults in the United States. Cross-sectional analysis using the National Health Interview Survey (NHIS). Adult respondents in the 2008 NHIS were evaluated. Demographic information (gender, race, ethnicity, education level), prevalence of dizziness, mortality rates, and leading causes of death (cardiovascular disease, cancer, diabetes, cerebrovascular disease) were collected and analyzed. The association between dizziness and subsequent mortality was determined adjusting for demographic and other disease factors. Among 213.6 ± 3.5 million adult Americans, 23.8 ± 0.7 million reported dizziness in the past 12 months (11.1% ± 0.3%; mean age, 45.9 ± 0.2 years; 51.7% ± 0.5% female). The mortality rate among the group without dizziness in the preceding 12 months was 2.6% ± 0.1%, compared to the dizzy group at 9.0% ± 0.7%. After adjusting for gender and age, there was a statistically significant association between dizziness and mortality (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.8-2.8). After adjusting for all covariates including age, ethnicity, race, gender, diabetes, cardiovascular, cerebrovascular disease, cancer, and grade level, dizziness remained an independent predictor of increased mortality (adjusted OR: 1.7, 95% CI: 1.36-2.18). Approximately 11% of adult Americans reported dizziness or balance problems in the preceding 12 months. Adults with dizziness have a greater mortality rate than nondizzy adults. Even after adjusting for covariates, there was a significant association between dizziness and mortality. Screening for dizziness as a risk factor for mortality may be warranted. 2b Laryngoscope, 126:2134-2136, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Hurricane Sandy (New Jersey): Mortality Rates in the Following Month and Quarter.

PubMed

Kim, Soyeon; Kulkarni, Prathit A; Rajan, Mangala; Thomas, Pauline; Tsai, Stella; Tan, Christina; Davidow, Amy

2017-08-01

To describe changes in mortality after Hurricane Sandy made landfall in New Jersey on October 29, 2012. We used electronic death records to describe changes in all-cause and cause-specific mortality overall, in persons aged 76 years or older, and by 3 Sandy impact levels for the month and quarter following Hurricane Sandy compared with the same periods in earlier years adjusted for trends. All-cause mortality increased 6% (95% confidence interval [CI] = 2%, 11%) for the month, 5%, 8%, and 12% by increasing Sandy impact level; and 7% (95% CI = 5%, 10%) for the quarter, 5%, 8%, and 15% by increasing Sandy impact level. In elderly persons, all-cause mortality rates increased 10% (95% CI = 5%, 15%) and 13% (95% CI = 10%, 16%) in the month and quarter, respectively. Deaths that were cardiovascular disease-related increased by 6% in both periods, noninfectious respiratory disease-related by 24% in the quarter, infection-related by 20% in the quarter, and unintentional injury-related by 23% in the month. Mortality increased, heterogeneous by cause, for both periods after Hurricane Sandy, particularly in communities more severely affected and in the elderly, who may benefit from supportive services.

Early mortality experience in a large military cohort and a comparison of mortality data sources

PubMed Central

2010-01-01

Background Complete and accurate ascertainment of mortality is critically important in any longitudinal study. Tracking of mortality is particularly essential among US military members because of unique occupational exposures (e.g., worldwide deployments as well as combat experiences). Our study objectives were to describe the early mortality experience of Panel 1 of the Millennium Cohort, consisting of participants in a 21-year prospective study of US military service members, and to assess data sources used to ascertain mortality. Methods A population-based random sample (n = 256,400) of all US military service members on service rosters as of October 1, 2000, was selected for study recruitment. Among this original sample, 214,388 had valid mailing addresses, were not in the pilot study, and comprised the group referred to in this study as the invited sample. Panel 1 participants were enrolled from 2001 to 2003, represented all armed service branches, and included active-duty, Reserve, and National Guard members. Crude death rates, as well as age- and sex-adjusted overall and age-adjusted, category-specific death rates were calculated and compared for participants (n = 77,047) and non-participants (n = 137,341) based on data from the Social Security Administration Death Master File, Department of Veterans Affairs (VA) files, and the Department of Defense Medical Mortality Registry, 2001-2006. Numbers of deaths identified by these three data sources, as well as the National Death Index, were compared for 2001-2004. Results There were 341 deaths among the participants for a crude death rate of 80.7 per 100,000 person-years (95% confidence interval [CI]: 72.2,89.3) compared to 820 deaths and a crude death rate of 113.2 per 100,000 person-years (95% CI: 105.4, 120.9) for non-participants. Age-adjusted, category-specific death rates highlighted consistently higher rates among study non-participants. Although there were advantages and disadvantages for each data source

Observational intensity bias associated with illness adjustment: cross sectional analysis of insurance claims

PubMed Central

Staiger, Douglas O; Sharp, Sandra M; Gottlieb, Daniel J; Bevan, Gwyn; McPherson, Klim; Welch, H Gilbert

2013-01-01

Objective To determine the bias associated with frequency of visits by physicians in adjusting for illness, using diagnoses recorded in administrative databases. Setting Claims data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design Cross sectional analysis. Participants 20% sample of fee for service Medicare beneficiaries residing in the United States in 2007 (n=5 153 877). Main outcome measures The effect of illness adjustment on regional mortality and spending rates using standard and visit corrected illness methods for adjustment. The standard method adjusts using comorbidity measures based on diagnoses listed in administrative databases; the modified method corrects these measures for the frequency of visits by physicians. Three conventions for measuring comorbidity are used: the Charlson comorbidity index, Iezzoni chronic conditions, and hierarchical condition categories risk scores. Results The visit corrected Charlson comorbidity index explained more of the variation in age, sex, and race mortality across the 306 hospital referral regions than did the standard index (R2=0.21 v 0.11, P<0.001) and, compared with sex and race adjusted mortality, reduced regional variation, whereas adjustment using the standard Charlson comorbidity index increased it. Although visit corrected and age, sex, and race adjusted mortality rates were similar in hospital referral regions with the highest and lowest fifths of visits, adjustment using the standard index resulted in a rate that was 18% lower in the highest fifth (46.4 v 56.3 deaths per 1000, P<0.001). Age, sex, and race adjusted spending as well as visit corrected spending was more than 30% greater in the highest fifth of visits than in the lowest fifth, but only 12% greater after adjustment using the standard index. Similar results were obtained using the Iezzoni and the hierarchical condition categories conventions for measuring comorbidity. Conclusion The

An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients.

PubMed

Bratzler, Dale W; Normand, Sharon-Lise T; Wang, Yun; O'Donnell, Walter J; Metersky, Mark; Han, Lein F; Rapp, Michael T; Krumholz, Harlan M

2011-04-12

Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998-2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998-2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25(th), 50(th), and 75(th) percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model.

Mortality rates among 15- to 44-year-old women in Boston: looking beyond reproductive status.

PubMed

Katz, M E; Holmes, M D; Power, K L; Wise, P H

1995-08-01

Mortality rates were examined for Boston women, aged 15 to 44, from 1980 to 1989. There were 1234 deaths, with a rate of 787.8/100,000 for the decade. Leading causes were cancer, accidents, heart disease, homicide, suicide, and chronic liver disease. After age adjustment, African-American women in this age group were 2.3 times more likely to die than White women. Deaths at least partly attributable to smoking and alcohol amounted to 29.8% and 31.9%, respectively. Mortality was found to be related more directly to the general well-being of young women than to their reproductive status, and many deaths were preventable. African-American/White disparities were most likely linked to social factors. These findings suggest that health needs of reproductive-age women transcend reproductive health and require comprehensive interventions.

Evoked Death-Related Thoughts in the Aftermath of Terror Attack: The Associations Between Mortality Salience Effect and Adjustment Disorder.

PubMed

Ring, Lia; Lavenda, Osnat; Hamama-Raz, Yaira; Ben-Ezra, Menachem; Pitcho-Prelorentzos, Shani; David, Udi Y; Zaken, Adi; Mahat-Shamir, Michal

2018-01-01

ICD-11 has provided a revised definition for adjustment disorder (AjD). The current study examined whether mortality salience effect, a possible consequence of a terror attack, may serve as a significant predictor associated with each of the AjD subscales. Using an online survey, 379 adult participants were recruited and filled out self-reported questionnaires dealing with adjustment disorder symptoms as well as mortality salience effect. Findings revealed that mortality salience effect was a significant predictor of all AjD subscales. The importance of mortality salience effect for AjD is discussed in light of terror management theory.

39 CFR 3010.14 - Contents of notice of rate adjustment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Contents of notice of rate adjustment. 3010.14... Adjustments) § 3010.14 Contents of notice of rate adjustment. (a) General. The Postal Service notice of rate... sources; (4) The amount of new unused rate authority, if any, that will be generated by the rate...

Factors associated to inpatient mortality rates in type-2-diabetic patients: a cross-sectional analytical study in three Peruvian hospitals.

PubMed

Atamari-Anahui, Noé; Martinez-Ninanqui, Franklin W; Paucar-Tito, Liz; Morales-Concha, Luz; Miranda-Chirau, Alejandra; Gamarra-Contreras, Marco Antonio; Zea-Nuñez, Carlos Antonio; Mejia, Christian R

2017-12-05

Diabetes mortality has increased in recent years. In Peru, there are few studies on in-hospital mortality due to type 2 diabetes in the provinces. To determine factors associated to hospital mortality in patients with diabetes mellitus type 2 in three hospitals from Cusco-Peru. An analytical cross-sectional study was performed. All patients with diabetes mellitus type 2 hospitalized in the city of Cusco during the 2016 were included. Socio-educational and clinical characteristics were evaluated, with "death" as the variable of interest. The crude (cPR) and adjusted (aPR) prevalence ratios were estimated using generalized linear models with Poisson family and log link function, with their respective 95% confidence intervals (95% CI). The values p <0.05 were considered significant. A total of 153 patients were studied; 33.3% (51) died in the hospital. The mortality rate increased when the following factors were associated: age of the patients increased the mortality rate by one-year increments (aPR: 1.02; CI95%: 1.01-1.03; p<0.001); to have been admitted by the emergency service (aPR: 1.93; CI95%: 1.34-2.77; p<0.001); being a patient who is readmitted to the hospital (aPR: 2.01; CI95%: 1.36-2.98; p<0.001); and patients who have had a metabolic in-hospital complication (aPR: 1.61; CI95%: 1.07-2.43; p=0.024) or renal in-hospital complications (aPR: 1.47; CI95%: 1.30-1.67; p<0.001). Conversely, the mortality rate was reduced when admission was due to a urinary tract infection (aPR: 0.50; CI95%: 0.35-0.72; p<0.001); adjusted by seven variables. A third of hospitalized diabetes mellitus type 2 patients died during the study period. Mortality was increased as age rises, patients admitted through emergency rooms, patients who were readmitted to the hospital, and patients who had metabolic or renal complications. Patients admitted for a urinary tract infection had a lower mortality rate.

Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography

PubMed Central

Jacklyn, Gemma; Glasziou, Paul; Macaskill, Petra; Barratt, Alexandra

2016-01-01

Background: Women require information about the impact of regularly attending screening mammography on breast cancer mortality and overdiagnosis to make informed decisions. To provide this information we aimed to meta-analyse randomised controlled trials adjusted for adherence to the trial protocol. Methods: Nine screening mammography trials used in the Independent UK Breast Screening Report were selected. Extending an existing approach to adjust intention-to-treat (ITT) estimates for less than 100% adherence rates, we conducted a random-effects meta-analysis. This produced a combined deattenuated prevented fraction and a combined deattenuated percentage risk of overdiagnosis. Results: In women aged 39–75 years invited to screen, the prevented fraction of breast cancer mortality at 13-year follow-up was 0.22 (95% CI 0.15–0.28) and it increased to 0.30 (95% CI 0.18–0.42) with deattenuation. In women aged 40–69 years invited to screen, the ITT percentage risk of overdiagnosis during the screening period was 19.0% (95% CI 15.2–22.7%), deattenuation increased this to 29.7% (95% CI 17.8–41.5%). Conclusions: Adjustment for nonadherence increased the size of the mortality benefit and risk of overdiagnosis by up to 50%. These estimates are more appropriate when developing quantitative information to support individual decisions about attending screening mammography. PMID:27124337

Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates.

PubMed

Souza-Oliveira, Ana Carolina; Cunha, Thúlio Marquez; Passos, Liliane Barbosa da Silva; Lopes, Gustavo Camargo; Gomes, Fabiola Alves; Röder, Denise Von Dolinger de Brito

2016-01-01

Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14-70%). This study evaluated factors influencing mortality of patients with Ventilator-associated pneumonia (VAP), including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy. This retrospective study included 120 cases of Ventilator-associated pneumonia admitted to the adult adult intensive care unit of the Federal University of Uberlândia. The chi-square test was used to compare qualitative variables. Student's t-test was used for quantitative variables and multiple logistic regression analysis to identify independent predictors of mortality. De-escalation of antibiotic therapy and resistant bacteria did not influence mortality. Mortality was 4 times and 3 times higher, respectively, in patients who received an inappropriate antibiotic loading dose and in patients whose antibiotic dose was not adjusted for renal function. Multiple logistic regression analysis revealed the incorrect adjustment for renal function was the only independent factor associated with increased mortality. Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations. Copyright © 2016. Published by Elsevier Editora Ltda.

7 CFR 1421.102 - Adjustment of basic loan rates.

Code of Federal Regulations, 2011 CFR

2011-01-01

... be adjusted or not adjusted as follows: (1) For farm-stored commodities, except for peanuts, that... rate. (3) With respect to commodities harvested, excluding silage or hay, as other than grain and... basic county loan rate shall not be adjusted to reflect the protein content. (5) With respect to...

Encephalitis Hospitalization Rates and Inpatient Mortality in the United States, 2000-2010

PubMed Central

George, Benjamin P.

2014-01-01

Background Encephalitis rates by etiology and acute-phase outcomes for encephalitis in the 21st century are largely unknown. We sought to evaluate cause-specific rates of encephalitis hospitalizations and predictors of inpatient mortality in the United States. Methods Using the Nationwide Inpatient Sample (NIS) from 2000 to 2010, a retrospective observational study of 238,567 patients (mean [SD] age, 44.8 [24.0] years) hospitalized within non-federal, acute care hospitals in the U.S. with a diagnosis of encephalitis was conducted. Hospitalization rates were calculated using population-level estimates of disease from the NIS and population estimates from the United States Census Bureau. Adjusted odds of mortality were calculated for patients included in the study. Results In the U.S. from 2000–2010, there were 7.3±0.2 encephalitis hospitalizations per 100,000 population (95% CI: 7.1–7.6). Encephalitis hospitalization rates were highest among females (7.6±0.2 per 100,000) and those <1 year and >65 years of age with rates of 13.5±0.9 and 14.1±0.4 per 100,000, respectively. Etiology was unknown for approximately 50% of cases. Among patients with identified etiology, viral causes were most common (48.2%), followed by Other Specified causes (32.5%), which included predominantly autoimmune conditions. The most common infectious agents were herpes simplex virus, toxoplasma, and West Nile virus. Comorbid HIV infection was present in 7.7% of hospitalizations. Average length of stay was 11.2 days with mortality of 5.6%. In regression analysis, patients with comorbid HIV/AIDS or cancer had increased odds of mortality (odds ratio [OR]  = 1.70; 95% CI: 1.30–2.22 and OR = 2.26; 95% CI: 1.88–2.71, respectively). Enteroviral, postinfectious, toxic, and Other Specified causes were associated with lower odds vs. herpes simplex encephalitis. Conclusions While encephalitis and encephalitis-related mortality impose a considerable burden in the U.S. in the 21st

Alternative Measures of Self-Rated Health for Predicting Mortality Among Older People: Is Past or Future Orientation More Important?

PubMed

Ferraro, Kenneth F; Wilkinson, Lindsay R

2015-10-01

The purpose of this study was to compare the prognostic validity of alternative measures of health ratings, including those that tap temporal reflections, on adult mortality. The study uses a national sample of 1,266 Americans 50-74 years old in 1995, with vital status tracked through 2005, to compare the effect of 3 types of health ratings on mortality: conventional indicator of self-rated health (SRH), age comparison form of SRH, and health ratings that incorporate temporal dimensions. Logistic regression was used to estimate the odds of mortality associated with alternative health ratings while adjusting for health conditions, lifestyle factors, and status characteristics and resources. Self-rated health was a consistent predictor of mortality, but the respondent's expected health rating-10 years in the future-was an independent predictor. Future health expectations were more important than past (recalled change) in predicting mortality risk: People with more negative expectations of future health were less likely to survive. The findings reveal the importance of future time perspective for older people and suggest that it is more useful to query older people about their future health expectations than about how their health has changed. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Excess mortality in winter in Finnish intensive care.

PubMed

Reinikainen, M; Uusaro, A; Ruokonen, E; Niskanen, M

2006-07-01

In the general population, mortality from acute myocardial infarctions, strokes and respiratory causes is increased in winter. The winter climate in Finland is harsh. The aim of this study was to find out whether there are seasonal variations in mortality rates in Finnish intensive care units (ICUs). We analysed data on 31,040 patients treated in 18 Finnish ICUs. We measured severity of illness with acute physiology and chronic health evaluation II (APACHE II) scores and intensity of care with therapeutic intervention scoring system (TISS) scores. We assessed mortality rates in different months and seasons and used logistic regression analysis to test the independent effect of various seasons on hospital mortality. We defined 'winter' as the period from December to February, inclusive. The crude hospital mortality rate was 17.9% in winter and 16.4% in non-winter, P = 0.003. Even after adjustment for case mix, winter season was an independent risk factor for increased hospital mortality (adjusted odds ratio 1.13, 95% confidence interval 1.04-1.22, P = 0.005). In particular, the risk of respiratory failure was increased in winter. Crude hospital mortality was increased during the main holiday season in July. However, the severity of illness-adjusted risk of death was not higher in July than in other months. An increase in the mean daily TISS score was an independent predictor of increased hospital mortality. Severity of illness-adjusted hospital mortality for Finnish ICU patients is higher in winter than in other seasons.

Cancer mortality in Yukon 1999–2013: elevated mortality rates and a unique cancer profile

PubMed Central

Simkin, Jonathan; Woods, Ryan; Elliott, Catherine

2017-01-01

ABSTRACT Background: Although cancer is the leading cause of death in Canada, cancer in the North has been incompletely described. Objective: To determine cancer mortality rates in the Yukon Territory, compare them with Canadian rates, and identify major causes of cancer mortality. Design: The Yukon Vital Statistics Registry provided all cancer deaths for Yukon residents between 1999-2013. Age-standardised mortality rates (ASMRs) were calculated using direct standardisation and compared with Canadian rates. Standardised mortality ratios (SMRs) were calculated using indirect standardisation relative to age-specific rates from Canada, British Columbia (BC), and three sub-provincial BC administrative health regions : Interior Health (IH), Northern Health (NH) and Vancouver Coastal Health (VCH). Trends in smoothed ASMRs were examined with graphical methods. Results: Yukon’s all-cancer ASMRs were elevated compared with national and provincial rates for the entire period. Disparities were greatest compared with the urban VCH: prostate (SMRVCH=246.3, 95% CI 140.9–351.6), female lung (SMRVCH=221.2, 95% CI 154.3–288.1), female breast (SMRVCH=169.0 95% CI, 101.4–236.7), and total colorectal (SMRVCH=149.3, 95% CI 101.8–196.8) cancers were significantly elevated. Total stomach cancer mortality was significantly elevated compared with all comparators. Conclusions: Yukon cancer mortality rates were elevated compared with national, provincial, urban, and southern-rural jurisdictions. More research is required to elucidate these differences. PMID:28598269

5 CFR 536.305 - Adjusting an employee's retained rate when a pay schedule is adjusted.

Code of Federal Regulations, 2010 CFR

2010-01-01

... conversion under § 536.303(b) or any other simultaneous pay action. The retained rate adjustment under... new retained rate must be determined under the geographic conversion rule in § 536.303(b). (4... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Adjusting an employee's retained rate...

An Administrative Claims Model for Profiling Hospital 30-Day Mortality Rates for Pneumonia Patients

PubMed Central

Bratzler, Dale W.; Normand, Sharon-Lise T.; Wang, Yun; O'Donnell, Walter J.; Metersky, Mark; Han, Lein F.; Rapp, Michael T.; Krumholz, Harlan M.

2011-01-01

Background Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998–2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998–2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25th, 50th, and 75th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). Conclusions/Significance An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model. PMID:21532758

Evaluation of cardiac surgery mortality rates: 30-day mortality or longer follow-up?

PubMed

Siregar, Sabrina; Groenwold, Rolf H H; de Mol, Bas A J M; Speekenbrink, Ron G H; Versteegh, Michel I M; Brandon Bravo Bruinsma, George J; Bots, Michiel L; van der Graaf, Yolanda; van Herwerden, Lex A

2013-11-01

The aim of our study was to investigate early mortality after cardiac surgery and to determine the most adequate follow-up period for the evaluation of mortality rates. Information on all adult cardiac surgery procedures in 10 of 16 cardiothoracic centres in Netherlands from 2007 until 2010 was extracted from the database of Netherlands Association for Cardio-Thoracic Surgery (n = 33 094). Survival up to 1 year after surgery was obtained from the national death registry. Survival analysis was performed using Kaplan-Meier and Cox regression analysis. Benchmarking was performed using logistic regression with mortality rates at different time points as dependent variables, the logistic EuroSCORE as covariate and a random intercept per centre. In-hospital mortality was 2.94% (n = 972), 30-day mortality 3.02% (n = 998), operative mortality 3.57% (n = 1181), 60-day mortality 3.84% (n = 1271), 6-month mortality 5.16% (n = 1707) and 1-year mortality 6.20% (n = 2052). The survival curves showed a steep initial decline followed by stabilization after ∼60-120 days, depending on the intervention performed, e.g. 60 days for isolated coronary artery bypass grafting (CABG) and 120 days for combined CABG and valve surgery. Benchmark results were affected by the choice of the follow-up period: four hospitals changed outlier status when the follow-up was increased from 30 days to 1 year. In the isolated CABG subgroup, benchmark results were unaffected: no outliers were found using either 30-day or 1-year follow-up. The course of early mortality after cardiac surgery differs across interventions and continues up to ∼120 days. Thirty-day mortality reflects only a part of early mortality after cardiac surgery and should only be used for benchmarking of isolated CABG procedures. The follow-up should be prolonged to capture early mortality of all types of interventions.

Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality.

PubMed

Pezzi, Christopher M; Mallin, Katherine; Mendez, Andres Samayoa; Greer Gay, Emmelle; Putnam, Joe B

2014-11-01

To evaluate 30-day and 90-day mortality after major pulmonary resection for lung cancer including the relationship to hospital volume. Major lung resections from 2007 to 2011 were identified in the National Cancer Data Base. Mortality was compared according to annual volume and demographic and clinical covariates using univariate and multivariable analyses, and included information on comorbidity. Statistical significance (P<.05) and 95% confidence intervals were assessed. There were 124,418 major pulmonary resections identified in 1233 facilities. The 30-day mortality rate was 2.8%. The 90-day mortality rate was 5.4%. Hospital volume was significantly associated with 30-day mortality, with a mortality rate of 3.7% for volumes less than 10, and 1.7% for volumes of 90 or more. Other variables significantly associated with 30-day mortality include older age, male sex, higher stage, pneumonectomy, a previous primary cancer, and multiple comorbidities. Similar results were found for 90-day mortality rates. In the multivariate analysis, hospital volume remained significant with adjusted odds ratios of 2.1 (95% confidence interval [CI], 1.7-2.6) for 30-day mortality and 1.3 (95% CI, 1.1-1.6) for conditional 90-day mortality for the hospitals with the lowest volume (<10) compared with those with the highest volume (>90). Hospitals with a volume less than 30 had an adjusted odds ratio for 30-day mortality of 1.3 (95% CI, 1.2-1.5) compared with those with a volume greater than 30. Mortality at 30 and 90 days and hospital volume should be monitored by institutions performing major pulmonary resection and benchmarked against hospitals performing at least 30 resections per year. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Suicide mortality rates in Louisiana, 1999-2010.

PubMed

Straif-Bourgeois, Susanne; Ratard, Raoult

2012-01-01

This report is a descriptive study on suicide deaths in Louisiana occurring in the years 1999 to 2010. Mortality data was collected from death certificates from this 12-year period to describe suicide mortality by year, race, sex, age group, and methods of suicide. Data were also compared to national data. Rates and methods used to commit suicide vary greatly according to sex, race, and age. The highest rates were observed in white males, followed by black males, white females, and black females. Older white males had the highest suicide rates. The influence of age was modulated by the sex and race categories. Firearm was the most common method used in all four categories. Other less common methods were hanging/strangulation/suffocation (HSS) and drugs/alcohol. Although no parish-level data were systematically analyzed, a comparison of suicide rates post-Katrina versus pre-Katrina was done for Orleans Parish, the rest of the Greater New Orleans area, and a comparison group. It appears that rates observed among whites, particularly males, were higher after Katrina. Data based on mortality do not give a comprehensive picture of the burden of suicide, and their interpretation should be done with caution.

Alternatives for using multivariate regression to adjust prospective payment rates

PubMed Central

Sheingold, Steven H.

1990-01-01

Multivariate regression analysis has been used in structuring three of the adjustments to Medicare's prospective payment rates. Because the indirect-teaching adjustment, the disproportionate-share adjustment, and the adjustment for large cities are responsible for distributing approximately $3 billion in payments each year, the specification of regression models for these adjustments is of critical importance. In this article, the application of regression for adjusting Medicare's prospective rates is discussed, and the implications that differing specifications could have for these adjustments are demonstrated. PMID:10113271

Chronic cardiovascular disease mortality in mountaintop mining areas of central Appalachian states.

PubMed

Esch, Laura; Hendryx, Michael

2011-01-01

To determine if chronic cardiovascular disease (CVD) mortality rates are higher among residents of mountaintop mining (MTM) areas compared to mining and nonmining areas, and to examine the association between greater levels of MTM surface mining and CVD mortality. Age-adjusted chronic CVD mortality rates from 1999 to 2006 for counties in 4 Appalachian states where MTM occurs (N = 404) were linked with county coal mining data. Three groups of counties were compared: MTM, coal mining but not MTM, and nonmining. Covariates included smoking rate, rural-urban status, percent male population, primary care physician supply, obesity rate, diabetes rate, poverty rate, race/ethnicity rates, high school and college education rates, and Appalachian county. Linear regression analyses examined the association of mortality rates with mining in MTM areas and non-MTM areas and the association of mortality with quantity of surface coal mined in MTM areas. Prior to covariate adjustment, chronic CVD mortality rates were significantly higher in both mining areas compared to nonmining areas and significantly highest in MTM areas. After adjustment, mortality rates in MTM areas remained significantly higher and increased as a function of greater levels of surface mining. Higher obesity and poverty rates and lower college education rates also significantly predicted CVD mortality overall and in rural counties. MTM activity is significantly associated with elevated chronic CVD mortality rates. Future research is necessary to examine the socioeconomic and environmental impacts of MTM on health to reduce health disparities in rural coal mining areas. © 2011 National Rural Health Association.

Fine-particulate Air Pollution from Diesel Emission Control and Mortality Rates in Tokyo: A Quasi-experimental Study.

PubMed

Yorifuji, Takashi; Kashima, Saori; Doi, Hiroyuki

2016-11-01

Evidence linking air pollution with adverse health outcomes is accumulating. However, few studies have adopted a quasi-experimental design to evaluate whether decline in air pollution from regulatory action improves public health. We evaluated the effect of a diesel emission control ordinance introduced in 2003 on mortality rates in 23 wards of the Tokyo metropolitan area, Japan, from October 2000 to September 2012, taking into account change in mortality rates in a reference population (Osaka) with a introduction of such a regulation in 2009. We obtained daily counts of all-cause and cause-specific mortality and concentrations of nitrogen dioxide (NO2) and particulate matter less than 2.5 μm in diameter (PM2.5) during the study period. We employed interrupted time-series analysis to analyze the data. Decline in NO2 during the study period was similar in the two areas, while decline in PM2.5 and the improvement in age-standardized mortality rates were greater in Tokyo's 23 wards compared with Osaka. Even after adjusting for age-standardized mortality rates in Osaka, percent changes in mortality between the first 3-year interval (October 2000 to September 2003) and the last 3-year interval (October 2009 to September 2012) were -6.0% for all causes, -11% for cardiovascular disease, -10% for ischemic heart disease, -6.2% for cerebrovascular disease, -22% for pulmonary disease, and -4.9% for lung cancer. We did not observe a decline in mortality from other causes. This quasi-experimental study in Tokyo suggests that emission control was associated with improvements in both air quality and health outcomes.

International Ranking of Infant Mortality Rates: Taiwan Compared with European Countries.

PubMed

Liang, Fu-Wen; Lu, Tsung-Hsueh; Wu, Mei-Hwan; Lue, Hung-Chi; Chiang, Tung-Liang; Huang, Ya-Li; Chen, Lea-Hua

2016-08-01

Rankings of infant mortality rates are commonly cited international comparisons to assess the health status of individual countries. We compared the infant mortality rate of Taiwan with those of European countries for 2004 according to two definitions. First, the countries were ranked on the basis of crude infant, neonatal, and postneonatal mortality rates. The countries were then ranked according to the mortality rates calculated after exclusion of live births with a known birth weight of <1000 g, which is the definition set by the World Health Organization. Taiwan was ranked 11(th), 12(th), and 15(th) among 26 high-income countries for crude infant, neonatal, and postneonatal mortality rates, respectively. The ranks were 12(th), 16(th), and 15(th), respectively, for mortality rates, excluding live births with a birth weight of <1000 g. However, in only seven, four, and 10 countries were the mortality rate ratios statistically significantly lower than Taiwan in infant, neonatal, and postneonatal mortality, respectively, according to the second definition. The ranking of Taiwan was similar (11(th) vs. 12(th)) according the two definitions. However, after consideration of the confidence interval, only six countries (Sweden, Finland, Czech Republic, Belgium, Austria, and Germany) had infant mortality rates statistically significantly lower than those of Taiwan in 2004. Copyright © 2015. Published by Elsevier B.V.

10 CFR 436.22 - Adjusted internal rate of return.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Methodology and Procedures for Life Cycle Cost Analyses § 436.22 Adjusted internal rate of return. The adjusted internal rate of return is the overall rate of return on an energy or water conservation measure... yearly net savings in energy or water and non-fuel or non-water operation and maintenance costs...

Differences in trapping mortality rates of northern flying squirrels

Treesearch

D.K. Rosenberg; R.G. Anthony

1993-01-01

We described trapping mortality rates of northern flying squirrel (Glaucomys sabrinus) populations in western Oregon, U.S.A., and evaluated the effects of sex, age, body mass, and number of times an individual was recaptured on these rates. Although the overall trapping mortality rates were relatively low (7%) during 16-21 day trapping sessions, we...

Variation in hospital mortality in an Australian neonatal intensive care unit network.

PubMed

Abdel-Latif, Mohamed E; Nowak, Gen; Bajuk, Barbara; Glass, Kathryn; Harley, David

2018-07-01

Studying centre-to-centre (CTC) variation in mortality rates is important because inferences about quality of care can be made permitting changes in practice to improve outcomes. However, comparisons between hospitals can be misleading unless there is adjustment for population characteristics and severity of illness. We sought to report the risk-adjusted CTC variation in mortality among preterm infants born <32 weeks and admitted to all eight tertiary neonatal intensive care units (NICUs) in the New South Wales and the Australian Capital Territory Neonatal Network (NICUS), Australia. We analysed routinely collected prospective data for births between 2007 and 2014. Adjusted mortality rates for each NICU were produced using a multiple logistic regression model. Output from this model was used to construct funnel plots. A total of 7212 live born infants <32 weeks gestation were admitted consecutively to network NICUs during the study period. NICUs differed in their patient populations and severity of illness.The overall unadjusted hospital mortality rate for the network was 7.9% (n=572 deaths). This varied from 5.3% in hospital E to 10.4% in hospital C. Adjusted mortality rates showed little CTC variation. No hospital reached the +99.8% control limit level on adjusted funnel plots. Characteristics of infants admitted to NICUs differ, and comparing unadjusted mortality rates should be avoided. Logistic regression-derived risk-adjusted mortality rates plotted on funnel plots provide a powerful visual graphical tool for presenting quality performance data. CTC variation is readily identified, permitting hospitals to appraise their practices and start timely intervention. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Geographic Variations in Cardiovascular Disease Mortality Among Asian American Subgroups, 2003-2011.

PubMed

Pu, Jia; Hastings, Katherine G; Boothroyd, Derek; Jose, Powell O; Chung, Sukyung; Shah, Janki B; Cullen, Mark R; Palaniappan, Latha P; Rehkopf, David H

2017-07-12

There are well-documented geographical differences in cardiovascular disease (CVD) mortality for non-Hispanic whites. However, it remains unknown whether similar geographical variation in CVD mortality exists for Asian American subgroups. This study aims to examine geographical differences in CVD mortality among Asian American subgroups living in the United States and whether they are consistent with geographical differences observed among non-Hispanic whites. Using US death records from 2003 to 2011 (n=3 897 040 CVD deaths), age-adjusted CVD mortality rates per 100 000 population and age-adjusted mortality rate ratios were calculated for the 6 largest Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and compared with non-Hispanic whites. There were consistently lower mortality rates for all Asian American subgroups compared with non-Hispanic whites across divisions for CVD mortality and ischemic heart disease mortality. However, cerebrovascular disease mortality demonstrated substantial geographical differences by Asian American subgroup. There were a number of regional divisions where certain Asian American subgroups (Filipino and Japanese men, Korean and Vietnamese men and women) possessed no mortality advantage compared with non-Hispanic whites. The most striking geographical variation was with Filipino men (age-adjusted mortality rate ratio=1.18; 95% CI, 1.14-1.24) and Japanese men (age-adjusted mortality rate ratio=1.05; 95% CI: 1.00-1.11) in the Pacific division who had significantly higher cerebrovascular mortality than non-Hispanic whites. There was substantial geographical variation in Asian American subgroup mortality for cerebrovascular disease when compared with non-Hispanic whites. It deserves increased attention to prioritize prevention and treatment in the Pacific division where approximately 80% of Filipinos CVD deaths and 90% of Japanese CVD deaths occur in the United States. © 2017 The Authors

18 CFR 154.403 - Periodic rate adjustments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Changes § 154.403 Periodic rate adjustments. (a) This section applies to the passthrough, on a periodic... its rates to reflect changes in transportation and compression costs paid to others: (i) The changes... pre-dating the effectiveness of the tariff language setting forth the periodic rate change mechanism...

[Global self-rated health and mortality in older people].

PubMed

Moreno, Ximena; Huerta, Martín; Albala, Cecilia

2014-01-01

To explore the association between global self-rated health and mortality in older people. A systematic review was performed. The inclusion criteria were longitudinal studies that assessed self-rated health with a single general question and samples of community-dwelling persons aged 60 years or more. Electronic databases were searched and references were reviewed. We selected 18 studies published between 1993 and 2011. Six out of seven studies that analyzed men and women found a higher risk of dying among persons who rated their health as poor; the most frequent covariables were age, gender, chronic diseases, and functional status. Half of the studies that analyzed only men or women found a significant association. The effect of self-reported health on mortality was observed among people younger than 75 years. Results were not dependent on the length of follow-up. The results confirm previous findings suggesting that a negative self-rating of general health predicts mortality. The mechanisms through which this indicator may predict mortality among older people could differ in men and women and need to be elucidated. The role of depression should be investigated, considering that the effect of self-rated health on mortality was not present when depression was included. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Incidence and mortality rates of colorectal cancer in Malaysia.

PubMed

Abu Hassan, Muhammad Radzi; Ismail, Ibtisam; Mohd Suan, Mohd Azri; Ahmad, Faizah; Wan Khazim, Wan Khamizar; Othman, Zabedah; Mat Said, Rosaida; Tan, Wei Leong; Mohammed, Siti Rahmah Noor Syahireen; Soelar, Shahrul Aiman; Nik Mustapha, Nik Raihan

2016-01-01

This is the first study that estimates the incidence and mortality rate for colorectal cancer (CRC) patients in Malaysia by sex and ethnicity. The 4,501 patients were selected from National Cancer Patient Registry-Colorectal Cancer data. Patient survival status was cross-checked with the National Registration Department. The age-standardised rate (ASR) was calculated as the proportion of CRC cases (incidence) and deaths (mortality) from 2008 to 2013, weighted by the age structure of the population, as determined by the Department of Statistics Malaysia and the World Health Organization world standard population distribution. The overall incidence rate for CRC was 21.32 cases per 100,000. Those of Chinese ethnicity had the highest CRC incidence (27.35), followed by the Malay (18.95), and Indian (17.55) ethnicities. The ASR incidence rate of CRC was 1.33 times higher among males than females (24.16 and 18.14 per 100,000, respectively). The 2011 (44.7%) CRC deaths were recorded. The overall ASR of mortality was 9.79 cases, with 11.85 among the Chinese, followed by 9.56 among the Malays and 7.08 among the Indians. The ASR of mortality was 1.42 times higher among males (11.46) than females (8.05). CRC incidence and mortality is higher in males than females. Individuals of Chinese ethnicity have the highest incidence of CRC, followed by the Malay and Indian ethnicities. The same trends were observed for the age-standardised mortality rate.

Treatment of patent ductus arteriosus and neonatal mortality/morbidities: adjustment for treatment selection bias.

PubMed

Mirea, Lucia; Sankaran, Koravangattu; Seshia, Mary; Ohlsson, Arne; Allen, Alexander C; Aziz, Khalid; Lee, Shoo K; Shah, Prakesh S

2012-10-01

To examine the association between treatment for patent ductus arteriosus (PDA) and neonatal outcomes in preterm infants, after adjustment for treatment selection bias. Secondary analyses were conducted using data collected by the Canadian Neonatal Network for neonates born at a gestational age ≤ 32 weeks and admitted to neonatal intensive care units in Canada between 2004 and 2008. Infants who had PDA and survived beyond 72 hours were included in multivariable logistic regression analyses that compared mortality or any severe neonatal morbidity (intraventricular hemorrhage grades ≥ 3, retinopathy of prematurity stages ≥ 3, bronchopulmonary dysplasia, or necrotizing enterocolitis stages ≥ 2) between treatment groups (conservative management, indomethacin only, surgical ligation only, or both indomethacin and ligation). Propensity scores (PS) were estimated for each pair of treatment comparisons, and used in PS-adjusted and PS-matched analyses. Among 3556 eligible infants with a diagnosis of PDA, 577 (16%) were conservatively managed, 2026 (57%) received indomethacin only, 327 (9%) underwent ligation only, and 626 (18%) were treated with both indomethacin and ligation. All multivariable and PS-based analyses detected significantly higher mortality/morbidities for surgically ligated infants, irrespective of prior indomethacin treatment (OR ranged from 1.25-2.35) compared with infants managed conservatively or those who received only indomethacin. No significant differences were detected between infants treated with only indomethacin and those managed conservatively. Surgical ligation of PDA in preterm neonates was associated with increased neonatal mortality/morbidity in all analyses adjusted for measured confounders that attempt to account for treatment selection bias. Copyright © 2012 Mosby, Inc. All rights reserved.

Rural/urban mortality differences in England and Wales and the effect of deprivation adjustment.

PubMed

Gartner, Andrea; Farewell, Daniel; Roach, Paul; Dunstan, Frank

2011-05-01

Perceptions that rural populations are inevitably healthier and live longer than urban populations are increasingly being challenged. But very few publications have investigated the extent to which these putative differences can be explained by variation in area composition. Existing publications have tended to use conventional deprivation measures, often thought to mask rural deprivation by favourable averages. Further, they have typically been based on large and variably-sized geographical units, or confined to studies of a single region or cause of death. This study examines differences in mortality between rural and urban areas in the entire population of England and Wales for 2002-2004. It uses the most up-to-date small geographical units of similar size and homogeneity of population together with the recently-introduced Rural and Urban Area Classification, and adjusts for five different deprivation measures (including modern composite indices). The causes of death investigated were all-cause mortality, cancer, lung cancer, respiratory disease, circulatory disease, suicide and accidents. Particular points of focus for the study were the potential for interaction between deprivation and rurality, and the importance of choice of deprivation measure in quantifying the relationships between mortality, rurality and deprivation. Choice of deprivation measure was not found to alter the substantive conclusions of any analysis, and little evidence for differential effects of deprivation in rural and urban areas was uncovered. Differences between rural and urban areas in all-cause, circulatory disease and cancer mortality could largely be accounted for by adjusting for deprivation. For these causes of death, therefore, rural populations were not found to be inherently healthier than their urban counterparts. However, substantial residual differences between rural and urban areas were found in comparisons of mortality from lung cancer and respiratory disease, mortality

Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe.

PubMed

Brück, Katharina; Jager, Kitty J; Zoccali, Carmine; Bello, Aminu K; Minutolo, Roberto; Ioannou, Kyriakos; Verbeke, Francis; Völzke, Henry; Arnlöv, Johan; Leonardis, Daniela; Ferraro, Pietro Manuel; Brenner, Hermann; Caplin, Ben; Kalra, Philip A; Wanner, Christoph; Castelao, Alberto Martinez; Gorriz, Jose Luis; Hallan, Stein; Rothenbacher, Dietrich; Gibertoni, Dino; De Nicola, Luca; Heinze, Georg; Van Biesen, Wim; Stel, Vianda S

2018-06-01

The incidence of renal replacement therapy varies across countries. However, little is known about the epidemiology of chronic kidney disease (CKD) outcomes. Here we describe progression and mortality risk of patients with CKD but not on renal replacement therapy at outpatient nephrology clinics across Europe using individual data from nine CKD cohorts participating in the European CKD Burden Consortium. A joint model assessed the mean change in estimated glomerular filtration rate (eGFR) and mortality risk simultaneously, thereby accounting for mortality risk when estimating eGFR decline and vice versa, while also correcting for the measurement error in eGFR. Results were adjusted for important risk factors (baseline eGFR, age, sex, albuminuria, primary renal disease, diabetes, hypertension, obesity and smoking) in 27,771 patients from five countries. The adjusted mean annual eGFR decline varied from 0.77 (95% confidence interval 0.45, 1.08) ml/min/1.73m 2 in the Belgium cohort to 2.43 (2.11, 2.75) ml/min/1.73m 2 in the Spanish cohort. As compared to the Italian PIRP cohort, the adjusted mortality hazard ratio varied from 0.22 (0.11, 0.43) in the London LACKABO cohort to 1.30 (1.13, 1.49) in the English CRISIS cohort. These results suggest that the eGFR decline showed minor variation but mortality showed the most variation. Thus, different health care organization systems are potentially associated with differences in outcome of patients with CKD within Europe. These results can be used by policy makers to plan resources on a regional, national and European level. Copyright © 2018 International Society of Nephrology. All rights reserved.

Widespread increase of tree mortality rates in the Western United States

USGS Publications Warehouse

van Mantgem, P.J.; Stephenson, N.L.; Byrne, J.C.; Daniels, L.D.; Franklin, J.F.; Fule, P.Z.; Harmon, M.E.; Larson, A.J.; Smith, Joseph M.; Taylor, A.H.; Veblen, T.T.

2009-01-01

Persistent changes in tree mortality rates can alter forest structure, composition, and ecosystem services such as carbon sequestration. Our analyses of longitudinal data from unmanaged old forests in the western United States showed that background (noncatastrophic) mortality rates have increased rapidly in recent decades, with doubling periods ranging from 17 to 29 years among regions. Increases were also pervasive across elevations, tree sizes, dominant genera, and past fire histories. Forest density and basal area declined slightly, which suggests that increasing mortality was not caused by endogenous increases in competition. Because mortality increased in small trees, the overall increase in mortality rates cannot be attributed solely to aging of large trees. Regional warming and consequent increases in water deficits are likely contributors to the increases in tree mortality rates.

Quantifying and Adjusting for Disease Misclassification Due to Loss to Follow-Up in Historical Cohort Mortality Studies.

PubMed

Scott, Laura L F; Maldonado, George

2015-10-15

The purpose of this analysis was to quantify and adjust for disease misclassification from loss to follow-up in a historical cohort mortality study of workers where exposure was categorized as a multi-level variable. Disease classification parameters were defined using 2008 mortality data for the New Zealand population and the proportions of known deaths observed for the cohort. The probability distributions for each classification parameter were constructed to account for potential differences in mortality due to exposure status, gender, and ethnicity. Probabilistic uncertainty analysis (bias analysis), which uses Monte Carlo techniques, was then used to sample each parameter distribution 50,000 times, calculating adjusted odds ratios (ORDM-LTF) that compared the mortality of workers with the highest cumulative exposure to those that were considered never-exposed. The geometric mean ORDM-LTF ranged between 1.65 (certainty interval (CI): 0.50-3.88) and 3.33 (CI: 1.21-10.48), and the geometric mean of the disease-misclassification error factor (εDM-LTF), which is the ratio of the observed odds ratio to the adjusted odds ratio, had a range of 0.91 (CI: 0.29-2.52) to 1.85 (CI: 0.78-6.07). Only when workers in the highest exposure category were more likely than those never-exposed to be misclassified as non-cases did the ORDM-LTF frequency distributions shift further away from the null. The application of uncertainty analysis to historical cohort mortality studies with multi-level exposures can provide valuable insight into the magnitude and direction of study error resulting from losses to follow-up.

Race Matters: Analyzing the Relationship between Colorectal Cancer Mortality Rates and Various Factors within Respective Racial Groups.

PubMed

Veach, Emma; Xique, Ismael; Johnson, Jada; Lyle, Jessica; Almodovar, Israel; Sellers, Kimberly F; Moore, Calandra T; Jackson, Monica C

2014-01-01

Colorectal cancer (CRC) is the third leading cause of mortality due to cancer (with over 50,000 deaths annually), representing 9% of all cancer deaths in the United States (1). In particular, the African-American CRC mortality rate is among the highest reported for any race/ethnic group. Meanwhile, the CRC mortality rate for Hispanics is 15-19% lower than that for non-Hispanic Caucasians (2). While factors such as obesity, age, and socio-economic status are known to associate with CRC mortality, do these and other potential factors correlate with CRC death in the same way across races? This research linked CRC mortality data obtained from the National Cancer Institute with data from the United States Census Bureau, the Centers for Disease Control and Prevention, and the National Solar Radiation Database to examine geographic and racial/ethnic differences, and develop a spatial regression model that adjusted for several factors that may attribute to health disparities among ethnic/racial groups. This analysis showed that sunlight, obesity, and socio-economic status were significant predictors of CRC mortality. The study is significant because it not only verifies known factors associated with the risk of CRC death but, more importantly, demonstrates how these factors vary within different racial groups. Accordingly, education on reducing risk factors for CRC should be directed at specific racial groups above and beyond creating a generalized education plan.

Cohort-specific trends in stroke mortality in seven European countries were related to infant mortality rates.

PubMed

Amiri, M; Kunst, A E; Janssen, F; Mackenbach, J P

2006-12-01

To assess, in a population-based study, whether secular trends in cardiovascular disease mortality in seven European countries were correlated with past trends in infant mortality rate (IMR) in these countries. Data on ischemic heart disease (IHD) and stroke mortality in 1950-1999 in the Netherlands, England & Wales, France, and four Nordic countries were analyzed. We used Poisson regression to describe trends in mortality according to birth cohort, for the cohorts born between 1860 and 1939. Pearson correlation coefficients were calculated to determine associations between IMR and IHD, or stroke mortality. IHD mortality increased for successive cohorts up to 1900, and then started to decline. Stroke mortality levels were virtually stable among birth cohorts up to 1880, but declined rapidly among later cohorts. A strong positive association was found between cohort-specific IMR levels and stroke mortality rates. There were no strong cohort-wise associations between IMR and IHD mortality. These results support other studies in suggesting that living conditions in early childhood may influence population levels of stroke mortality. Future studies should determine the contribution of specific early life factors to the mortality decline in IHD and especially stroke.

The relation between resting heart rate and cancer incidence, cancer mortality and all-cause mortality in patients with manifest vascular disease.

PubMed

van Kruijsdijk, Rob C M; van der Graaf, Yolanda; Bemelmans, Remy H H; Nathoe, Hendrik M; Peeters, Petra H M; Visseren, Frank L J

2014-12-01

Previous studies suggest that elevated resting heart rate (RHR) is related to an increased risk of cancer mortality. The aim of this study was to evaluate the relation between RHR and cancer incidence and mortality in patients with vascular disease. Patients with manifest vascular disease (n=6007) were prospectively followed-up for cancer incidence and mortality. At baseline, RHR was obtained from an electrocardiogram. The relation between RHR and cancer incidence, cancer mortality and total mortality was assessed using competing risks models. During a median follow-up of 6.0 years (interquartile range: 3.1-9.3) 491 patients (8%) were diagnosed with cancer and 907 (15%) patients died, 248 (27%) died from cancer. After adjustment for potential confounders, the hazard ratio (HR) for incident cancer per 10 beats/min increase in RHR was 1.00 (95% confidence interval [CI]: 0.93-1.07). There was a trend toward an increased risk of colorectal cancer in patients with higher RHR (HR 1.15, 95% CI 0.97-1.36). The risk of all-cause mortality was increased in patients in the highest quartile of RHR compared to the lowest quartile (HR 1.86, 95% CI 1.53-2.27), but no effect of RHR on cancer mortality was observed (HR 1.01, 95% CI 0.70-1.46). In patients with manifest vascular disease, elevated RHR was related to a higher risk of premature all-cause mortality, but this was not due to increased cancer mortality. RHR was not related to risk of overall cancer incidence, although a relation between elevated RHR and incident colorectal cancer risk could not be ruled out. Copyright © 2014 Elsevier Ltd. All rights reserved.

Age, period, and birth cohort-specific effects on cervical cancer mortality rates in Japanese women and projections for mortality rates over 20-year period (2012-2031).

PubMed

Uchida, Hiroyuki; Kobayashi, Mizuki; Hosobuchi, Ami; Ohta, Ayano; Ohtake, Kazuo; Yamaki, Tutomu; Uchida, Masaki; Odagiri, Youichi; Natsume, Hideshi; Kobayashi, Jun

2014-01-01

We aimed to determine the effects of age, period, and birth cohort on cervical cancer mortality rate trends in Japanese women, by age-period-cohort (APC) analysis. Additionally, we analyzed projected mortality rates. We obtained data on the number of cervical cancer deaths in Japanese women from 1975-2011 from the national vital statistics and census population data. A cohort table of mortality rate data was analyzed on the basis of a Bayesian APC model. We also projected the mortality rates for the 2012-2031 period. The period effect was relatively limited, compared with the age and cohort effects. The age effect increased suddenly from 25-29 to 45-49 years of age and gently increased thereafter. An analysis of the cohort effect on mortality rate trends revealed a steep decreasing slope for birth cohorts born from 1908-1940 and a subsequent sudden increase after 1945. The mortality rate projections indicated increasing trends from 40 to 74 years of age until the year 2031. The age effect increased from 25-29 years of age. This could be attributable to the high human papilloma virus (HPV) infection risk and the low cervical cancer screening rate. The cohort effect changed from decreasing to increasing after the early 1940s. This might be attributable to the spread of cervical cancer screening and treatment before 1940 and the high HPV infection risk and reduced cervical cancer screening rate after 1945. The projected mortality rate indicated an increasing trend until the year 2031.

Incidence trends and mortality rates of gastric cancer in Israel.

PubMed

Lavy, Ron; Kapiev, Andronik; Poluksht, Natan; Halevy, Ariel; Keinan-Boker, Lital

2013-04-01

Gastric cancer is the fourth most common malignancy worldwide. The incidence trends and mortality rates of gastric cancer in Israel have not been studied in depth. The aim of our study was to try and investigate the aforementioned issues in Israel in different ethnic groups. This retrospective study is based on the data of The Israel National Cancer Registry and The Central Bureau of Statistics. Published data from these two institutes were collected, summarized, and analyzed in this study. Around 650 new cases of gastric cancer are diagnosed yearly in Israel. While we noticed a decline during the period 1990-2007 in the incidence in the Jewish population (13.6-8.9 and 6.75-5.42 cases per 100,000 in Jewish men and women, respectively), an increase in the Arab population was noticed (7.7-10.2 and 3.7-4.2 cases per 100,000 in men and women, respectively). Age-adjusted mortality rates per 10,000 cases of gastric cancer decreased significantly, from 7.21 in 1990 to 5.46 in 2007, in the total population. The 5-year relative survival showed a slight increase for both men and women. There is a difference in the incidence and outcome of gastric cancer between the Jewish and Arab populations in Israel. The grim prognosis of gastric cancer patients in Israel is probably due to the advanced stage at which gastric cancer is diagnosed in Israel.

10 CFR 903.17 - Informal public meetings for minor rate adjustments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Informal public meetings for minor rate adjustments. 903..., Southwestern, and Western Area Power Administrations § 903.17 Informal public meetings for minor rate adjustments. In lieu of public information or comment forums in conjunction with a minor rate adjustment...

10 CFR 903.17 - Informal public meetings for minor rate adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Informal public meetings for minor rate adjustments. 903..., Southwestern, and Western Area Power Administrations § 903.17 Informal public meetings for minor rate adjustments. In lieu of public information or comment forums in conjunction with a minor rate adjustment...

Incidence and mortality rates of colorectal cancer in Malaysia

PubMed Central

2016-01-01

OBJECTIVES This is the first study that estimates the incidence and mortality rate for colorectal cancer (CRC) patients in Malaysia by sex and ethnicity. METHODS The 4,501 patients were selected from National Cancer Patient Registry-Colorectal Cancer data. Patient survival status was cross-checked with the National Registration Department. The age-standardised rate (ASR) was calculated as the proportion of CRC cases (incidence) and deaths (mortality) from 2008 to 2013, weighted by the age structure of the population, as determined by the Department of Statistics Malaysia and the World Health Organization world standard population distribution. RESULTS The overall incidence rate for CRC was 21.32 cases per 100,000. Those of Chinese ethnicity had the highest CRC incidence (27.35), followed by the Malay (18.95), and Indian (17.55) ethnicities. The ASR incidence rate of CRC was 1.33 times higher among males than females (24.16 and 18.14 per 100,000, respectively). The 2011 (44.7%) CRC deaths were recorded. The overall ASR of mortality was 9.79 cases, with 11.85 among the Chinese, followed by 9.56 among the Malays and 7.08 among the Indians. The ASR of mortality was 1.42 times higher among males (11.46) than females (8.05). CONCLUSIONS CRC incidence and mortality is higher in males than females. Individuals of Chinese ethnicity have the highest incidence of CRC, followed by the Malay and Indian ethnicities. The same trends were observed for the age-standardised mortality rate. PMID:26971697

43 CFR 38.3 - Administration of adjusted rates of pay.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Administration of adjusted rates of pay. 38.3 Section 38.3 Public Lands: Interior Office of the Secretary of the Interior PAY OF U.S. PARK POLICE-INTERIM GEOGRAPHIC ADJUSTMENTS § 38.3 Administration of adjusted rates of pay. (a) An employee is...

Socioeconomic factors and cervical cancer mortality in Spain during the period 1989-1997.

PubMed

Morales Suarez-Varela, M M; Jiménez-López, M C; Llópis-González, A

2004-01-01

A study was made of cervical cancer (CC) mortality trends in Spain during the period 1989-1997 at National, Autonomous Community and Provincial levels, in relation to different socioeconomic factors. Data were obtained from the Spanish National Institute of Statistics (Instituto Nacional de Estadística, INE). The crude mortality rates were age-adjusted using the indirect method and Gross Domestic Product (GDP) as socioeconomic status (SES) indicator. National CC age-adjusted mortality rates have increasing slightly, varying from 3.09 deaths/100000 women in 1989 to 3.42 in 1996. The highest age-adjusted mortality rates corresponded to Seville, Palencia and Orense, with 4.13, 4.06 and 3.98 cases/100000 women, respectively. The lowest mortality rates were found in Las Palmas, Cantabria and Alicante with 2.63, 2.77 and 2.80 deaths/100000 women, respectively. A relative risk (RR) of 1.14 (95%CI: 0.98-1.32) ( P=0.048) was observed between the provinces with the lowest SES and highest mortality rate, and those with the highest SES and lowest mortality rate. The results of our study show a slight increasing trend in CC mortality rates in Spain during the period 1989-1997, and suggest that the variations among provinces and Autonomous Communities could be due to CC risk factors (SES related to human papillomavirus, parity, diet, etc.) and differences in early diagnosis.

Emotional disturbance assessed by the Self-Rating Depression Scale test is associated with mortality among Japanese Hemodialysis patients.

PubMed

Kazama, Sakumi; Kazama, Junichiro James; Wakasugi, Minako; Ito, Yumi; Narita, Ichiei; Tanaka, Motoko; Horiguchi, Fumi; Tanigawa, Koichi

2018-04-17

Emotional disturbance including depression is associated with increased mortality among dialysis patients. The Self-Rating Depression Scale (SDS) is a simple tool for assessing emotional disturbance. This study investigated the relationship between emotional conditions as assessed with the SDS test and mortality among 491 hemodialysis patients. At baseline, 183 (37.3%), 180 (36.7%), 108 (22.0%), and 20 (4.1%) were classified as normal, borderline depression, depression, and severe depression, respectively. During the two years of observation period, 57 of 491 (11.6%) died. The SDS scores in the non-survivors were significantly higher than those in the survivors (p<0.0001). Logistic analyses showed that the diagnoses made by the SDS test were associated with significantly greater risks for all-cause mortality (99%CI: 1.905-3.698 for that without adjustment, 1.999-4.382 for that with full adjustment). When the SDS score = 50 was selected as the cut off value, the test screened two-year all cause death with sensitivity = 57.9% and the specificity = 78.1%. In conclusion, hemodialysis patients had high prevalence of emotional disturbance assessed by the SDS test, and high SDS score was significantly associated with all-cause mortality. These findings underscore the importance of screening for emotional conditions using the SDS test among hemodialysis patients.

Development and Evaluation of an Automated Machine Learning Algorithm for In-Hospital Mortality Risk Adjustment Among Critical Care Patients.

PubMed

Delahanty, Ryan J; Kaufman, David; Jones, Spencer S

2018-06-01

Risk adjustment algorithms for ICU mortality are necessary for measuring and improving ICU performance. Existing risk adjustment algorithms are not widely adopted. Key barriers to adoption include licensing and implementation costs as well as labor costs associated with human-intensive data collection. Widespread adoption of electronic health records makes automated risk adjustment feasible. Using modern machine learning methods and open source tools, we developed and evaluated a retrospective risk adjustment algorithm for in-hospital mortality among ICU patients. The Risk of Inpatient Death score can be fully automated and is reliant upon data elements that are generated in the course of usual hospital processes. One hundred thirty-one ICUs in 53 hospitals operated by Tenet Healthcare. A cohort of 237,173 ICU patients discharged between January 2014 and December 2016. The data were randomly split into training (36 hospitals), and validation (17 hospitals) data sets. Feature selection and model training were carried out using the training set while the discrimination, calibration, and accuracy of the model were assessed in the validation data set. Model discrimination was evaluated based on the area under receiver operating characteristic curve; accuracy and calibration were assessed via adjusted Brier scores and visual analysis of calibration curves. Seventeen features, including a mix of clinical and administrative data elements, were retained in the final model. The Risk of Inpatient Death score demonstrated excellent discrimination (area under receiver operating characteristic curve = 0.94) and calibration (adjusted Brier score = 52.8%) in the validation dataset; these results compare favorably to the published performance statistics for the most commonly used mortality risk adjustment algorithms. Low adoption of ICU mortality risk adjustment algorithms impedes progress toward increasing the value of the healthcare delivered in ICUs. The Risk of Inpatient Death

Determinants of self-rated health: could health status explain the association between self-rated health and mortality?

PubMed

Murata, Chiyoe; Kondo, Takaaki; Tamakoshi, Koji; Yatsuya, Hiroshi; Toyoshima, Hideaki

2006-01-01

The purpose of this study was to investigate factors related to self-rated health and to mortality among 2490 community-living elderly. Respondents were followed for 7.3 years for all-cause mortality. To compare the relative impact of each variable, we employed logistic regression analysis for self-rated health and Cox hazard analysis for mortality. Cox analysis stratified by gender, follow-up periods, age group, and functional status was also employed. Series of analysis found that factors associated with self-rated health and with mortality were not identical. Psychological factors such as perceived isolation at home or 'ikigai (one aspect of psychological well-being)' were associated with self-rated health only. Age, functional status, and social relations were associated both with self-rated health and mortality after controlling for possible confounders. Illnesses and functional status accounted for 35-40% of variances in the fair/poor self-rated health. Differences by gender and functional status were observed in the factors related to self-rated health. Overall, self-rated health effect on mortality was stronger for people with no functional impairment, for shorter follow-up period, and for young-old age group. Although, illnesses and functional status were major determinants of self-rated health, economical, psychological, and social factors were also related to self-rated health.

Avian growth and development rates and age-specific mortality: the roles of nest predation and adult mortality.

PubMed

Remes, V

2007-01-01

Previous studies have shown that avian growth and development covary with juvenile mortality. Juveniles of birds under strong nest predation pressure grow rapidly, have short incubation and nestling periods, and leave the nest at low body mass. Life-history theory predicts that parental investment increases with adult mortality rate. Thus, developmental traits that depend on the parental effort exerted (pre- and postnatal growth rate) should scale positively with adult mortality, in contrast to those that do not have a direct relationship with parental investment (timing of developmental events, e.g. nest leaving). I tested this prediction on a sample of 84 North American songbirds. Nestling growth rate scaled positively and incubation period duration negatively with annual adult mortality rates even when controlled for nest predation and other covariates, including phylogeny. On the contrary, neither the duration of the nestling period nor body mass at fledging showed any relationship. Proximate mechanisms generating the relationship of pre- and postnatal growth rates to adult mortality may include increased feeding, nest attentiveness during incubation and/or allocation of hormones, and deserve further attention.

Differential mortality in New York City (1988-1992). Part One: excess mortality among non-Hispanic blacks.

PubMed

Fang, J; Madhavan, S; Cohen, H; Alderman, M H

1995-01-01

To determine the distribution of mortality for non-Hispanic blacks and non-Hispanic whites in New York City, death certificates issued in New York City during 1988 through 1992, and the relevant 1990 US census data for New York City, have been examined. Age-adjusted death rates for blacks and whites by gender and cause of death were computed based on the US population in 1940. Also, standard mortality ratios and excess mortality were calculated using the New York City mortality rate as reference. The results showed that New York City blacks had higher age-adjusted death rates than whites regardless of cause, including stroke, AIDS, homicide, and diabetes. The rate for New York City blacks was also higher than the US total for both genders. Using New York City mortality rates as a reference, more than 80% of excess deaths in blacks occurred before age 65. Injury/poisoning was the leading cause of excess death (20.1%) in black males, while in black females, cardiovascular disease was the largest single cause of excess deaths (24.8%). The higher death rates, especially premature death, of blacks in New York City are related to conditions such as violence, substance abuse, and AIDS, for which prevention rather than medical care is the more likely solution, as well as to cardiovascular diseases, where both prevention through behavioral change, and health and medical care, can influence outcome.

Dietary restriction of rodents decreases aging rate without affecting initial mortality rate -- a meta-analysis.

PubMed

Simons, Mirre J P; Koch, Wouter; Verhulst, Simon

2013-06-01

Dietary restriction (DR) extends lifespan in multiple species from various taxa. This effect can arise via two distinct but not mutually exclusive ways: a change in aging rate and/or vulnerability to the aging process (i.e. initial mortality rate). When DR affects vulnerability, this lowers mortality instantly, whereas a change in aging rate will gradually lower mortality risk over time. Unraveling how DR extends lifespan is of interest because it may guide toward understanding the mechanism(s) mediating lifespan extension and also has practical implications for the application of DR. We reanalyzed published survival data from 82 pairs of survival curves from DR experiments in rats and mice by fitting Gompertz and also Gompertz-Makeham models. The addition of the Makeham parameter has been reported to improve the estimation of Gompertz parameters. Both models separate initial mortality rate (vulnerability) from an age-dependent increase in mortality (aging rate). We subjected the obtained Gompertz parameters to a meta-analysis. We find that DR reduced aging rate without affecting vulnerability. The latter contrasts with the conclusion of a recent analysis of a largely overlapping data set, and we show how the earlier finding is due to a statistical artifact. Our analysis indicates that the biology underlying the life-extending effect of DR in rodents likely involves attenuated accumulation of damage, which contrasts with the acute effect of DR on mortality reported for Drosophila. Moreover, our findings show that the often-reported correlation between aging rate and vulnerability does not constrain changing aging rate without affecting vulnerability simultaneously. © 2013 John Wiley & Sons Ltd and the Anatomical Society.

Inequality in income and mortality in the United States: analysis of mortality and potential pathways.

PubMed

Kaplan, G A; Pamuk, E R; Lynch, J W; Cohen, R D; Balfour, J L

1996-04-20

To examine the relation between health outcomes and the equality with which income is distributed in the United States. The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. Age adjusted mortality from all causes. There was a significant correlation (r = -0.62 [corrected], P < 0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.

Post-exercise heart rate recovery independently predicts mortality risk in patients with chronic heart failure.

PubMed

Tang, Yi-Da; Dewland, Thomas A; Wencker, Detlef; Katz, Stuart D

2009-12-01

Post-exercise heart rate recovery (HRR) is an index of parasympathetic function associated with clinical outcomes in populations with and without documented coronary heart disease. Decreased parasympathetic activity is thought to be associated with disease progression in chronic heart failure (HF), but an independent association between post-exercise HRR and clinical outcomes among such patients has not been established. We measured HRR (calculated as the difference between heart rate at peak exercise and after 1 minute of recovery) in 202 HF subjects and recorded 17 mortality and 15 urgent transplantation outcome events over 624 days of follow-up. Reduced post-exercise HRR was independently associated with increased event risk after adjusting for other exercise-derived variables (peak oxygen uptake and change in minute ventilation per change in carbon dioxide production slope), for the Heart Failure Survival Score (adjusted HR 1.09 for 1 beat/min reduction, 95% CI 1.05-1.13, P < .0001), and the Seattle Heart Failure Model score (adjusted HR 1.08 for one beat/min reduction, 95% CI 1.05-1.12, P < .0001). Subjects in the lowest risk tertile based on post-exercise HRR (>or=30 beats/min) had low risk of events irrespective of the risk predicted by the survival scores. In a subgroup of 15 subjects, reduced post-exercise HRR was associated with increased serum markers of inflammation (interleukin-6, r = 0.58, P = .024; high-sensitivity C-reactive protein, r = 0.66, P = .007). Post-exercise HRR predicts mortality risk in patients with HF and provides prognostic information independent of previously described survival models. Pathophysiologic links between autonomic function and inflammation may be mediators of this association.

39 CFR 3010.26 - Calculation of unused rate adjustment authority.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Calculation of unused rate adjustment authority. 3010.26 Section 3010.26 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL REGULATION OF RATES FOR MARKET DOMINANT PRODUCTS Rules for Applying the Price Cap § 3010.26 Calculation of unused rate adjustment...

Geographic distribution of dementia mortality: elevated mortality rates for black and white Americans by place of birth.

PubMed

Glymour, M Maria; Kosheleva, Anna; Wadley, Virginia G; Weiss, Christopher; Manly, Jennifer J

2011-01-01

We hypothesized that patterns of elevated stroke mortality among those born in the United States Stroke Belt (SB) states also prevailed for mortality related to all-cause dementia or Alzheimer Disease. Cause-specific mortality (contributing cause of death, including underlying cause cases) rates in 2000 for United States-born African Americans and whites aged 65 to 89 years were calculated by linking national mortality records with population data based on race, sex, age, and birth state or state of residence in 2000. Birth in a SB state (NC, SC, GA, TN, AR, MS, or AL) was cross-classified against SB residence at the 2000 Census. Compared with those who were not born in the SB, odds of all-cause dementia mortality were significantly elevated by 29% for African Americans and 19% for whites born in the SB. These patterns prevailed among individuals who no longer lived in the SB at death. Patterns were similar for Alzheimer Disease-related mortality. Some non-SB states were also associated with significant elevations in dementia-related mortality. Dementia mortality rates follow geographic patterns similar to stroke mortality, with elevated rates among those born in the SB. This suggests important roles for geographically patterned childhood exposures in establishing cognitive reserve.

Trends in twin neonatal mortality rates in the United States, 1989 through 1999: influence of birth registration and obstetric intervention.

PubMed

Ananth, Cande V; Joseph Ks, K s; Smulian, John C

2004-05-01

We sought to evaluate the contributions of changes in birth registration, labor induction, and cesarean delivery on trends in twin neonatal mortality rates. We conducted a population-based, retrospective cohort study of twin live births, using linked birth-infant death data in the United States (1989-1999). Relative risks and 95% confidence intervals that quantified changes in neonatal (0-27 days) mortality rates were derived from ecologic logistic regression models that were fit after aggregation of the data by each state in the United States. The frequency of live born twins who weighed <500 g increased 72%, from 0.7% in 1989 to 1.2% in 1999, of live born twins who weighed 500 to 749 g and 750 to 999 g increased by 55% and 28%, respectively, between 1989 and 1999. Preterm birth rates increased by 19%, from 46.2% in 1989 to 57.2% in 1999. The rate of labor induction increased from 5.8% to 13.9%, and the cesarean delivery rate increased from 49.8% to 56.3%. Between 1989 to 1991 and 1997 to 1999, the crude neonatal mortality rates among twins who weighed >or=500 g declined by 37% (95% CI, 35%-40%) from 21.5 to 13.6 per 1000 twin live births. Adjustments for preterm labor induction, preterm cesarean delivery, term labor induction, term cesarean delivery, and sociodemographic factors had little influence on neonatal mortality rate trends. Increases in preterm birth because of obstetric intervention among twins have not led to increases in twin neonatal mortality rates in the United States.

Distinct Age and Self-Rated Health Crossover Mortality Effects for African Americans: Evidence from a National Cohort Study

PubMed Central

Roth, David L.; Skarupski, Kimberly A.; Crews, Deidra C.; Howard, Virginia J.; Locher, Julie L.

2016-01-01

The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may “crossover” at about 75 to 80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality

Distinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study.

PubMed

Roth, David L; Skarupski, Kimberly A; Crews, Deidra C; Howard, Virginia J; Locher, Julie L

2016-05-01

The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may "crossover" at about 75-80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality

Exercise heart rate gradient: a novel index to predict all-cause mortality.

PubMed

Duarte, Carlos Vieira; Myers, Jonathan; de Araújo, Claudio Gil Soares

2015-05-01

Although substantial evidence relates reduced exercise heart rate (HR) reserve and recovery to a higher risk of all-cause mortality, a combined indicator of these variables has not been explored. Our aim was to combine HR reserve and recovery into a single index and to assess its utility to predict all-cause mortality. Retrospective cohort analysis. Participants were 1476 subjects (937 males) aged between 41 and 79 years who completed a maximal cycle cardiopulmonary exercise test while not using medication with negative chronotropic effects or having an implantable cardiac pacemaker. HR reserve (HR maximum - HR resting) and recovery (HR maximum - HR at 1-min post exercise) were calculated and divided into quintiles. Quintile rankings were summed yielding an exercise HR gradient (EHRG) ranging from 2 to 10, reflecting the magnitude of on- and off-HR transients to exercise. Survival analyses were undertaken using EHRG scores and HR reserve and recovery in the lowest quintiles (Q1). During a mean follow up of 7.3 years, 44 participants died (3.1%). There was an inverse trend for EHRG scores and death rate (p < 0.05) that increased from 1.2% to 13.5%, respectively, for scores 10 and 2. An EHRG score of 2 was a better predictor of all-cause mortality than either Q1 for HR reserve (<80 bpm) or HR recovery alone (<27 bpm): age-adjusted hazard ratios: 3.53 (p = 0.011), 2.52 (p < 0.05), and 2.57 (p < 0.05), respectively. EHRG, a novel index combining HR reserve and HR recovery, is a better indicator of mortality risk than either response alone. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Social life factors affecting the mortality, longevity, and birth rate of total Japanese population: effects of rapid industrialization and urbanization.

PubMed

Araki, S; Uchida, E; Murata, K

1990-12-01

To expand upon the findings that lower mortality was found in Japanese urban areas in contrast to the Western model where in the US and Britain the risk of death was higher in metropolitan areas and conurbations, 22 social life indicators are examined among 46 prefectures in Japan in terms of their effect on age specific mortality, life expectancy, and age adjusted marriage, divorce, and birth rates. The effects of these factors on age adjusted mortality for 8 major working and nonworking male populations, where also analyzed. The 22 social life factors were selected from among 227 indicators in the system of Statistical Indicators on Life. Factor analysis was used to classify the indicators into 8 groups of factors for 1970 and 7 for 1975. Factors 1-3 for both years were rural or urban residence, low income and unemployment, and prefectural age distribution. The 4th for 1970 was home help for the elderly and for 1975, social mobility. The social life indicators were classified form 1 to 8 as rural residence in 1970 and 1975, urban residence, low income, high employment, old age, young age, social mobility, and home help for the elderly which moved from 8th place in 1970 to 1st in 1975. Between 1960-75, rapid urbanization took place with the proportion of farmers, fishermen, and workers declining from 43% in 1960 to 19% in 1975. The results of stepwise regression analysis indicate a positive relationship of urban residence with mortality of men and women except school-aged and middle-aged women, and the working populations, as well as life expectancy at birth for males and females and ages 20 and 40 years for males. Rural residence was positively associated with the male marriage rate, whereas the marriage rate for females was affected by industrialization and urbanization. High employment and social mobility were positively related to the female marriage rate. Low income was positively related to the divorce rate for males and females. Rural residence and high

Evaluation of trauma care using TRISS method: the role of adjusted misclassification rate and adjusted w-statistic.

PubMed

Llullaku, Sadik S; Hyseni, Nexhmi Sh; Bytyçi, Cen I; Rexhepi, Sylejman K

2009-01-15

Major trauma is a leading cause of death worldwide. Evaluation of trauma care using Trauma Injury and Injury Severity Score (TRISS) method is focused in trauma outcome (deaths and survivors). For testing TRISS method TRISS misclassification rate is used. Calculating w-statistic, as a difference between observed and TRISS expected survivors, we compare our trauma care results with the TRISS standard. The aim of this study is to analyze interaction between misclassification rate and w-statistic and to adjust these parameters to be closer to the truth. Analysis of components of TRISS misclassification rate and w-statistic and actual trauma outcome. The component of false negative (FN) (by TRISS method unexpected deaths) has two parts: preventable (Pd) and non-preventable (nonPd) trauma deaths. Pd represents inappropriate trauma care of an institution; otherwise nonpreventable trauma deaths represents errors in TRISS method. Removing patients with preventable trauma deaths we get an Adjusted misclassification rate: (FP + FN - Pd)/N or (b+c-Pd)/N. Substracting nonPd from FN value in w-statistic formula we get an Adjusted w-statistic: [FP-(FN - nonPd)]/N, respectively (FP-Pd)/N, or (b-Pd)/N). Because adjusted formulas clean method from inappropriate trauma care, and clean trauma care from the methods error, TRISS adjusted misclassification rate and adjusted w-statistic gives more realistic results and may be used in researches of trauma outcome.

Variability in case-mix adjusted in-hospital cardiac arrest rates.

PubMed

Merchant, Raina M; Yang, Lin; Becker, Lance B; Berg, Robert A; Nadkarni, Vinay; Nichol, Graham; Carr, Brendan G; Mitra, Nandita; Bradley, Steven M; Abella, Benjamin S; Groeneveld, Peter W

2012-02-01

It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. Adult patients with IHCA. Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; P<0.0001). Case-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.

Colorectal cancer among Koreans living in South Korea versus California: incidence, mortality, and screening rates.

PubMed

Ryu, So Yeon; Crespi, Catherine M; Maxwell, Annette E

2014-08-01

This study compared trends in colorectal cancer (CRC) incidence and mortality rates among Koreans in South Korea and Korean Americans and non-Hispanic whites in California between 1999 and 2009, and examined CRC screening rates and socio-demographic correlates of CRC screening in the two Korean populations. Age-standardized CRC incidence and mortality rates of Koreans in South Korea and Korean Americans and non-Hispanic whites in California for the years 1999-2009 were obtained from annual reports of cancer statistics and modeled using joinpoint regression. Using 2009 data from the Korean National Health and Nutrition Examination Survey and the California Health Interview Survey, we estimated and compared CRC screening rates and test modalities. We used multiple logistic regression to examine socio-demographic correlates of completion of CRC screening according to the guidelines among the two Korean populations. CRC incidence and mortality rates among South Koreans increased during 1999-2009 but more slowly during the late 2000s. In California, CRC incidence increased among Korean American females but decreased among non-Hispanic whites. About 37% of South Koreans and 60% of Korean Americans reported completion of CRC screening according to guidelines in 2009. Among South Koreans, married status, higher income, and private health insurance were associated with CRC screening, adjusting for other factors. Among Korean Americans, having health insurance was associated with CRC screening. Despite almost identical CRC screening guidelines in South Korea and the USA and substantially higher screening rates among Korean Americans as compared to South Koreans, disparities remain in both populations with respect to CRC statistics. Thus, efforts to promote primary and secondary prevention of CRC in both Korean populations are critically important in both countries.

Remarkable rates of lightning strike mortality in Malawi.

PubMed

Mulder, Monique Borgerhoff; Msalu, Lameck; Caro, Tim; Salerno, Jonathan

2012-01-01

Livingstone's second mission site on the shore of Lake Malawi suffers very high rates of consequential lightning strikes. Comprehensive interviewing of victims and their relatives in seven Traditional Authorities in Nkhata Bay District, Malawi revealed that the annual rate of consequential strikes was 419/million, more than six times higher than that in other developing countries; the rate of deaths from lightning was 84/million/year, 5.4 times greater than the highest ever recorded. These remarkable figures reveal that lightning constitutes a significant stochastic source of mortality with potential life history consequences, but it should not deflect attention away from the more prominent causes of mortality in this rural area.

25 CFR 175.12 - Procedures for adjusting electric power rates except for adjustments due to changes in the cost...

Code of Federal Regulations, 2010 CFR

2010-04-01

... adjustments due to changes in the cost of purchased power or energy. 175.12 Section 175.12 Indians BUREAU OF... adjustments due to changes in the cost of purchased power or energy. Except for adjustments to rates due to changes in the cost of purchased power or energy, the Area Director shall adjust electric power rates...

Rate of change in renal function and mortality in elderly treated hypertensive patients.

PubMed

Chowdhury, Enayet K; Langham, Robyn G; Ademi, Zanfina; Owen, Alice; Krum, Henry; Wing, Lindon M H; Nelson, Mark R; Reid, Christopher M

2015-07-07

Evidence relating the rate of change in renal function, measured as eGFR, after antihypertensive treatment in elderly patients to clinical outcome is sparse. This study characterized the rate of change in eGFR after commencement of antihypertensive treatment in an elderly population, the factors associated with eGFR rate change, and the rate's association with all-cause and cardiovascular mortality. Data from the Second Australian National Blood Pressure study were used, where 6083 hypertensive participants aged ≥65 years were enrolled during 1995-1997 and followed for a median of 4.1 years (in-trial). Following the Second Australian National Blood Pressure study, participants were followed-up for a further median 6.9 years (post-trial). The annual rate of change in the eGFR was calculated in 4940 participants using creatinine measurements during the in-trial period and classified into quintiles (Q) on the basis of the following eGFR changes: rapid decline (Q1), decline (Q2), stable (Q3), increase (Q4), and rapid increase (Q5). A rapid decline in eGFR in comparison with those with stable eGFRs during the in-trial period was associated with older age, living in a rural area, wider pulse pressure at baseline, receiving diuretic-based therapy, taking multiple antihypertensive drugs, and having blood pressure <140/90 mmHg during the study. However, a rapid increase in eGFR was observed in younger women and those with a higher cholesterol level. After adjustment for baseline and in-trial covariates, Cox-proportional hazard models showed a significantly greater risk for both all-cause (hazard ratio, 1.28; 95% confidence interval, 1.09 to 1.52; P=0.003) and cardiovascular (hazard ratio, 1.40; 95% confidence interval, 1.11 to 1.76; P=0.004) mortality in the rapid decline group compared with the stable group over a median of 7.2 years after the last eGFR measure. No significant association with mortality was observed for a rapid increase in eGFR. In elderly persons with

Racial Difference in Sarcoidosis Mortality in the United States

PubMed Central

Machado, Roberto F.; Schraufnagel, Dean; Sweiss, Nadera J.; Baughman, Robert P.

2015-01-01

BACKGROUND: The clinical presentation and outcome of sarcoidosis varies by race. However, the race difference in mortality outcome remains largely unknown. METHODS: We studied mortality related to sarcoidosis from 1999 through 2010 by examining data on multiple causes of death from the National Center for Health Statistics. We compared the comorbid conditions between sarcoidosis-related deaths with deaths caused by car accidents (previously healthy control subjects) and rheumatoid arthritis (chronic disease control subjects) in both African Americans and Caucasians. RESULTS: From 1999 through 2010, sarcoidosis was reported as an immediate cause of death in 10,348 people in the United States with a combined overall mean age-adjusted mortality rate of 2.8 per 1 million person-years. Of these, 6,285 were African American and 3,984 Caucasian. The age-adjusted mortality rate for African Americans was 12 times higher than for Caucasians. African Americans died at an earlier age than Caucasians. African Americans living in the District of Columbia and North Carolina and Caucasians living in Vermont had higher mortality rates. Although the total sarcoidosis age-adjusted mortality rate had not changed over the 12 year period studied, this rate increased for Caucasians (R = 0.747, P = .005) but not for African Americans. Compared with the control groups, pulmonary hypertension was significantly more common in individuals with sarcoidosis. CONCLUSIONS: This nationwide population-based study exposes a significant difference in ethnicity and sex among people dying of sarcoidosis in the United States. Pulmonary hypertension investigation should be considered in all patients with sarcoidosis, especially African Americans. PMID:25188873

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

PubMed Central

Haagsma, Juanita A; Graetz, Nicholas; Bolliger, Ian; Naghavi, Mohsen; Higashi, Hideki; Mullany, Erin C; Abera, Semaw Ferede; Abraham, Jerry Puthenpurakal; Adofo, Koranteng; Alsharif, Ubai; Ameh, Emmanuel A; Ammar, Walid; Antonio, Carl Abelardo T; Barrero, Lope H; Bekele, Tolesa; Bose, Dipan; Brazinova, Alexandra; Catalá-López, Ferrán; Dandona, Lalit; Dandona, Rakhi; Dargan, Paul I; De Leo, Diego; Degenhardt, Louisa; Derrett, Sarah; Dharmaratne, Samath D; Driscoll, Tim R; Duan, Leilei; Petrovich Ermakov, Sergey; Farzadfar, Farshad; Feigin, Valery L; Gabbe, Belinda; Gosselin, Richard A; Hafezi-Nejad, Nima; Hamadeh, Randah Ribhi; Hijar, Martha; Hu, Guoqing; Jayaraman, Sudha P; Jiang, Guohong; Khader, Yousef Saleh; Khan, Ejaz Ahmad; Krishnaswami, Sanjay; Kulkarni, Chanda; Lecky, Fiona E; Leung, Ricky; Lunevicius, Raimundas; Lyons, Ronan Anthony; Majdan, Marek; Mason-Jones, Amanda J; Matzopoulos, Richard; Meaney, Peter A; Mekonnen, Wubegzier; Miller, Ted R; Mock, Charles N; Norman, Rosana E; Polinder, Suzanne; Pourmalek, Farshad; Rahimi-Movaghar, Vafa; Refaat, Amany; Rojas-Rueda, David; Roy, Nobhojit; Schwebel, David C; Shaheen, Amira; Shahraz, Saeid; Skirbekk, Vegard; Søreide, Kjetil; Soshnikov, Sergey; Stein, Dan J; Sykes, Bryan L; Tabb, Karen M; Temesgen, Awoke Misganaw; Tenkorang, Eric Yeboah; Theadom, Alice M; Tran, Bach Xuan; Vasankari, Tommi J; Vavilala, Monica S; Vlassov, Vasiliy Victorovich; Woldeyohannes, Solomon Meseret; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa Z; Yu, Chuanhua; Murray, Christopher J L; Vos, Theo

2016-01-01

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made. PMID:26635210

Improving estimates of tree mortality probability using potential growth rate

USGS Publications Warehouse

Das, Adrian J.; Stephenson, Nathan L.

2015-01-01

Tree growth rate is frequently used to estimate mortality probability. Yet, growth metrics can vary in form, and the justification for using one over another is rarely clear. We tested whether a growth index (GI) that scales the realized diameter growth rate against the potential diameter growth rate (PDGR) would give better estimates of mortality probability than other measures. We also tested whether PDGR, being a function of tree size, might better correlate with the baseline mortality probability than direct measurements of size such as diameter or basal area. Using a long-term dataset from the Sierra Nevada, California, U.S.A., as well as existing species-specific estimates of PDGR, we developed growth–mortality models for four common species. For three of the four species, models that included GI, PDGR, or a combination of GI and PDGR were substantially better than models without them. For the fourth species, the models including GI and PDGR performed roughly as well as a model that included only the diameter growth rate. Our results suggest that using PDGR can improve our ability to estimate tree survival probability. However, in the absence of PDGR estimates, the diameter growth rate was the best empirical predictor of mortality, in contrast to assumptions often made in the literature.

Levels and trends of child and adult mortality rates in the Islamic Republic of Iran, 1990-2013; protocol of the NASBOD study.

PubMed

Mohammadi, Younes; Parsaeian, Mahboubeh; Farzadfar, Farshad; Kasaeian, Amir; Mehdipour, Parinaz; Sheidaei, Ali; Mansouri, Anita; Saeedi Moghaddam, Sahar; Djalalinia, Shirin; Mahmoudi, Mahmood; Khosravi, Ardeshir; Yazdani, Kamran

2014-03-01

Calculation of burden of diseases and risk factors is crucial to set priorities in the health care systems. Nevertheless, the reliable measurement of mortality rates is the main barrier to reach this goal. Unfortunately, in many developing countries the vital registration system (VRS) is either defective or does not exist at all. Consequently, alternative methods have been developed to measure mortality. This study is a subcomponent of NASBOD project, which is currently conducting in Iran. In this study, we aim to calculate incompleteness of the Death Registration System (DRS) and then to estimate levels and trends of child and adult mortality using reliable methods. In order to estimate mortality rates, first, we identify all possible data sources. Then, we calculate incompleteness of child and adult morality separately. For incompleteness of child mortality, we analyze summary birth history data using maternal age cohort and maternal age period methods. Then, we combine these two methods using LOESS regression. However, these estimates are not plausible for some provinces. We use additional information of covariates such as wealth index and years of schooling to make predictions for these provinces using spatio-temporal model. We generate yearly estimates of mortality using Gaussian process regression that covers both sampling and non-sampling errors within uncertainty intervals. By comparing the resulted estimates with mortality rates from DRS, we calculate child mortality incompleteness. For incompleteness of adult mortality, Generalized Growth Balance, Synthetic Extinct Generation and a hybrid of two mentioned methods are used. Afterwards, we combine incompleteness of three methods using GPR, and apply it to correct and adjust the number of deaths. In this study, we develop a conceptual framework to overcome the existing challenges for accurate measuring of mortality rates. The resulting estimates can be used to inform policy-makers about past, current and

Case mix adjusted variation in cesarean section rate in Sweden.

PubMed

Mesterton, Johan; Ladfors, Lars; Ekenberg Abreu, Anna; Lindgren, Peter; Saltvedt, Sissel; Weichselbraun, Marianne; Amer-Wåhlin, Isis

2017-05-01

Cesarean section (CS) rate is a well-established indicator of performance in maternity care and is also related to resource use. Case mix adjustment of CS rates when performing comparisons between hospitals is important. The objective of this study was to estimate case mix adjusted variation in CS rate between hospitals in Sweden. In total, 139 756 deliveries in 2011 and 2012 were identified in administrative systems in seven regions covering 67% of all deliveries in Sweden. Data were linked to the Medical birth register and population data. Twenty-three different sociodemographic and clinical characteristics were used for adjustment. Analyses were performed for the entire study population as well as for two subgroups. Logistic regression was used to analyze differences between hospitals. The overall CS rate was 16.9% (hospital minimum-maximum 12.1-22.6%). Significant variations in CS rate between hospitals were observed after case mix adjustment: hospital odds ratios for CS varied from 0.62 (95% CI 0.53-0.73) to 1.45 (95% CI 1.37-1.52). In nulliparous, cephalic, full-term, singletons the overall CS rate was 14.3% (hospital minimum-maximum: 9.0-19.0%), whereas it was 4.7% for multiparous, cephalic, full-term, singletons with no previous CS (hospital minimum-maximum: 3.2-6.7%). In both subgroups significant variations were observed in case mix adjusted CS rates. Significant differences in CS rate between Swedish hospitals were found after adjusting for differences in case mix. This indicates a potential for fewer interventions and lower resource use in Swedish childbirth care. Best practice sharing and continuous monitoring are important tools for improving childbirth care. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Study of colorectal mortality in the Andalusian population.

PubMed

Cayuela, A; Rodríguez-Domínguez, S; Garzón-Benavides, M; Pizarro-Moreno, A; Giráldez-Gallego, A; Cordero-Fernández, C

2011-06-01

to provide up-to-date information and to analyze recent changes in colorectal cancer mortality trends in Andalusia during the period of 1980-2008 using joinpoint regression models. age- and sex-specific colorectal cancer deaths were taken from the official vital statistics published by the Instituto de Estadística de Andalucía for the years 1980 to 2008. We computed age-specific rates for each 5-year age group and calendar year and age-standardized mortality rates per 100,000 men and women. A joinpoint regression analysis was used for trend analysis of standardized rates. Joinpoint regression analysis was used to identify the years when a significant change in the linear slope of the temporal trend occurred. The best fitting points (the "join-points") are chosen where the rate significantly changes. mortality from colorectal cancer in Andalusia during the period studied has increased, from 277 deaths in 1980 to 1,227 in 2008 in men, and from 333 to 805 deaths in women. Adjusted overall colorectal cancer mortality rates increased from 7.7 to 17.0 deaths per 100,000 person-years in men and from 6.6 to 9.0 per 100,000 person-years in women Changes in mortality did not evolve similarly for men and women. Age-specific CRC mortality rates are lower in women than in men, which imply that women reach comparable levels of colorectal cancer mortality at higher ages than men. sex differences for colorectal cancer mortality have been widening in the last decade in Andalusia. In spite of the decreasing trends in age-adjusted mortality rates in women, incidence rates and the absolute numbers of deaths are still increasing, largely because of the aging of the population. Consequently, colorectal cancer still has a large impact on health care services, and this impact will continue to increase for many more years.

Prediction of mortality rates using a model with stochastic parameters

NASA Astrophysics Data System (ADS)

Tan, Chon Sern; Pooi, Ah Hin

2016-10-01

Prediction of future mortality rates is crucial to insurance companies because they face longevity risks while providing retirement benefits to a population whose life expectancy is increasing. In the past literature, a time series model based on multivariate power-normal distribution has been applied on mortality data from the United States for the years 1933 till 2000 to forecast the future mortality rates for the years 2001 till 2010. In this paper, a more dynamic approach based on the multivariate time series will be proposed where the model uses stochastic parameters that vary with time. The resulting prediction intervals obtained using the model with stochastic parameters perform better because apart from having good ability in covering the observed future mortality rates, they also tend to have distinctly shorter interval lengths.

Income inequality and cause-specific mortality during economic development.

PubMed

Lau, Elaine W; Schooling, C Mary; Tin, Keith Y; Leung, Gabriel M

2012-04-01

Life expectancy is strongly related to national income, whether there is an additional contribution of income inequality is unclear. We used negative binomial regression to examine the association of neighborhood-level Gini, adjusted for age, sex, and income, with mortality rates in Hong Kong from 1976 to 2006. The association of neighborhood Gini with all-cause mortality varied over time (p-value for interaction < .01). Neighborhood Gini was positively associated with nonmedical mortality in 1976 to 1986; incident rate ratio (IRR) 1.09, 95% confidence interval (95% CI) 1.02-1.16 per 0.1 change and in 1991 to 2006, IRR 1.24, 95% CI 1.13-1.36, adjusted for age, sex and absolute income. Similarly adjusted, Gini was not associated with all-cause mortality in 1976 to 1986 (IRR 0.96, 95% CI 0.93-1.00) but was in 1991 to 2006 (IRR 1.25, 95% CI 1.20-1.29), when Gini was also positively associated with death from cardiovascular diseases, respiratory diseases and some cancers. Independent of income, income inequality was positively associated with nonmedical mortality rates at a low level of spatial aggregation, indicating the consistent harms of social disharmony. However, the impact on medical mortality was less consistent, suggesting the relevance of contextual factors. Copyright © 2012 Elsevier Inc. All rights reserved.

Lithium in drinking water and suicide mortality.

PubMed

Kapusta, Nestor D; Mossaheb, Nilufar; Etzersdorfer, Elmar; Hlavin, Gerald; Thau, Kenneth; Willeit, Matthäus; Praschak-Rieder, Nicole; Sonneck, Gernot; Leithner-Dziubas, Katharina

2011-05-01

There is some evidence that natural levels of lithium in drinking water may have a protective effect on suicide mortality. To evaluate the association between local lithium levels in drinking water and suicide mortality at district level in Austria. A nationwide sample of 6460 lithium measurements was examined for association with suicide rates per 100,000 population and suicide standardised mortality ratios across all 99 Austrian districts. Multivariate regression models were adjusted for well-known socioeconomic factors known to influence suicide mortality in Austria (population density, per capita income, proportion of Roman Catholics, as well as the availability of mental health service providers). Sensitivity analyses and weighted least squares regression were used to challenge the robustness of the results. The overall suicide rate (R(2) = 0.15, β = -0.39, t = -4.14, P = 0.000073) as well as the suicide mortality ratio (R(2) = 0.17, β = -0.41, t = -4.38, P = 0.000030) were inversely associated with lithium levels in drinking water and remained significant after sensitivity analyses and adjustment for socioeconomic factors. In replicating and extending previous results, this study provides strong evidence that geographic regions with higher natural lithium concentrations in drinking water are associated with lower suicide mortality rates.

Motor neuron disease mortality rates in New Zealand 1992-2013.

PubMed

Cao, Maize C; Chancellor, Andrew; Charleston, Alison; Dragunow, Mike; Scotter, Emma L

2018-05-01

We determined the mortality rates of motor neuron disease (MND) in New Zealand over 22 years from 1992 to 2013. Previous studies have found an unusually high and/or increasing incidence of MND in certain regions of New Zealand; however, no studies have examined MND rates nationwide to corroborate this. Death certificate data coded G12.2 by International Classification of Diseases (ICD)-10 coding, or 335.2 by ICD-9 coding were obtained. These codes specify amyotrophic lateral sclerosis, progressive bulbar palsy, or other motor neuron diseases as the underlying cause of death. Mortality rates for MND deaths in New Zealand were age-standardized to the European Standard Population and compared with rates from international studies that also examined death certificate data and were age-standardized to the same standard population. The age-standardized mortality from MND in New Zealand was 2.3 per 100,000 per year from 1992-2007 and 2.8 per 100,000 per year from 2008-2013. These rates were 3.3 and 4.0 per 100,000 per year, respectively, for the population 20 years and older. The increase in rate between these two time periods was likely due to changes in MND death coding from 2008. Contrary to a previous regional study of MND incidence, nationwide mortality rates did not increase steadily over this time period once aging was accounted for. However, New Zealand MND mortality rate was higher than comparable studies we examined internationally (mean 1.67 per 100,000 per year), suggesting that further analysis of MND burden in New Zealand is warranted.

Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries.

PubMed

Raj, Anita; Boehmer, Ulrike

2013-04-01

This study was designed to assess associations between national rates of girl child marriage and national rates of HIV and maternal and child health (MCH) concerns, using national indicator data from 2009 United Nations reports. Current analyses were limited to the N = 97 nations (of 188 nations) for which girl child marriage data were available. Regression analyses adjusted for development and world region demonstrate that nations with higher rates of girl child marriage are significantly more likely to contend with higher rates of maternal and infant mortality and nonutilization of maternal health services, but not HIV.

Trends In State-Level Child Mortality, Maternal Mortality, And Fertility Rates In India.

PubMed

Munshi, Vidit; Yamey, Gavin; Verguet, Stéphane

2016-10-01

Trends in child mortality, maternal mortality, and fertility in India reveal wide variation across states. As a whole, India performs worse than many other low- and middle-income countries, although its rates of improvement have recently increased. Differences in health systems and adopted policies may account for some of the variation across Indian states. Published by Project HOPE—The People-to-People Health Foundation, Inc.

Risk-adjusted performance evaluation in three academic thoracic surgery units using the Eurolung risk models.

PubMed

Pompili, Cecilia; Shargall, Yaron; Decaluwe, Herbert; Moons, Johnny; Chari, Madhu; Brunelli, Alessandro

2018-01-03

The objective of this study was to evaluate the performance of 3 thoracic surgery centres using the Eurolung risk models for morbidity and mortality. This was a retrospective analysis performed on data collected from 3 academic centres (2014-2016). Seven hundred and twenty-one patients in Centre 1, 857 patients in Centre 2 and 433 patients in Centre 3 who underwent anatomical lung resections were analysed. The Eurolung1 and Eurolung2 models were used to predict risk-adjusted cardiopulmonary morbidity and 30-day mortality rates. Observed and risk-adjusted outcomes were compared within each centre. The observed morbidity of Centre 1 was in line with the predicted morbidity (observed 21.1% vs predicted 22.7%, P = 0.31). Centre 2 performed better than expected (observed morbidity 20.2% vs predicted 26.7%, P < 0.001), whereas the observed morbidity of Centre 3 was higher than the predicted morbidity (observed 41.1% vs predicted 24.3%, P < 0.001). Centre 1 had higher observed mortality when compared with the predicted mortality (3.6% vs 2.1%, P = 0.005), whereas Centre 2 had an observed mortality rate significantly lower than the predicted mortality rate (1.2% vs 2.5%, P = 0.013). Centre 3 had an observed mortality rate in line with the predicted mortality rate (observed 1.4% vs predicted 2.4%, P = 0.17). The observed mortality rates in the patients with major complications were 30.8% in Centre 1 (versus predicted mortality rate 3.8%, P < 0.001), 8.2% in Centre 2 (versus predicted mortality rate 4.1%, P = 0.030) and 9.0% in Centre 3 (versus predicted mortality rate 3.5%, P = 0.014). The Eurolung models were successfully used as risk-adjusting instruments to internally audit the outcomes of 3 different centres, showing their applicability for future quality improvement initiatives. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Remarkable Rates of Lightning Strike Mortality in Malawi

PubMed Central

Borgerhoff Mulder, Monique; Msalu, Lameck; Caro, Tim; Salerno, Jonathan

2012-01-01

Livingstone's second mission site on the shore of Lake Malawi suffers very high rates of consequential lightning strikes. Comprehensive interviewing of victims and their relatives in seven Traditional Authorities in Nkhata Bay District, Malawi revealed that the annual rate of consequential strikes was 419/million, more than six times higher than that in other developing countries; the rate of deaths from lightning was 84/million/year, 5.4 times greater than the highest ever recorded. These remarkable figures reveal that lightning constitutes a significant stochastic source of mortality with potential life history consequences, but it should not deflect attention away from the more prominent causes of mortality in this rural area. PMID:22253708

Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

PubMed

Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

2015-08-01

When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

Association between an Internet-Based Measure of Area Racism and Black Mortality.

PubMed

Chae, David H; Clouston, Sean; Hatzenbuehler, Mark L; Kramer, Michael R; Cooper, Hannah L F; Wilson, Sacoby M; Stephens-Davidowitz, Seth I; Gold, Robert S; Link, Bruce G

2015-01-01

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the "N-word" in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004-2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to

Association between an Internet-Based Measure of Area Racism and Black Mortality

PubMed Central

Chae, David H.; Clouston, Sean; Hatzenbuehler, Mark L.; Kramer, Michael R.; Cooper, Hannah L. F.; Wilson, Sacoby M.; Stephens-Davidowitz, Seth I.; Gold, Robert S.; Link, Bruce G.

2015-01-01

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the “N-word” in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004–2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study

Per-Capita Medicare Expenditures, Primary Care Access, Mortality Rates, and the Least Healthy Cities in America.

PubMed

Weeks, William B; Weinstein, James N

2017-01-01

To determine whether several measures of health care expenditures, access, and outcomes for the 25 recently identified "least healthy cities in America" differed from those in the rest of America. For 2004 and 2013, we obtained publicly available price-, age-, sex-, and race-adjusted hospital service area per-capita Medicare expenditures; age-, sex-, and race-adjusted Medicare mortality rates; and 2 indicators of primary care access: the proportion of enrollees having at least one ambulatory visit to a primary care clinician and the per-capita discharge rate for ambulatory care sensitive conditions. Using population weighting, we used Student t test for expenditure data and the chi-squared test for access and outcomes data to compare results of the 25 least healthy cities in aggregate to the rest of America. In both years examined, the 25 least healthy cities had substantially (about $500 per capita per year) and statistically significantly higher total per-capita Medicare Part A and Part B expenditures than the rest of America: about 4/5 of this difference was due to higher hospital and skilled nursing facility expenditures; physician expenditures were modestly lower in the 25 least healthy cities. While a greater proportion of Medicare beneficiaries in the least healthy cities had a primary care clinician both years, mortality and ambulatory care sensitive condition admission rates were substantially higher in the least healthy cities. Policymakers and health system executives should work together to determine the best asset allocation across determinants of health that maximizes value creation from a community health perspective. Copyright © 2016 Elsevier Inc. All rights reserved.

The influence of interpregnancy interval on infant mortality.

PubMed

McKinney, David; House, Melissa; Chen, Aimin; Muglia, Louis; DeFranco, Emily

2017-03-01

In Ohio, the infant mortality rate is above the national average and the black infant mortality rate is more than twice the white infant mortality rate. Having a short interpregnancy interval has been shown to correlate with preterm birth and low birthweight, but the effect of short interpregnancy interval on infant mortality is less well established. We sought to quantify the population impact of interpregnancy interval on the risk of infant mortality. This was a statewide population-based retrospective cohort study of all births (n = 1,131,070) and infant mortalities (n = 8152) using linked Ohio birth and infant death records from January 2007 through September 2014. For this study we analyzed 5 interpregnancy interval categories: 0-<6, 6-<12, 12-<24, 24-<60, and ≥60 months. The primary outcome for this study was infant mortality. During the study period, 3701 infant mortalities were linked to a live birth certificate with an interpregnancy interval available. We calculated the frequency and relative risk of infant mortality for each interval compared to a referent interval of 12-<24 months. Stratified analyses by maternal race were also performed. Adjusted risks were estimated after accounting for statistically significant and biologically plausible confounding variables. Adjusted relative risk was utilized to calculate the attributable risk percent of short interpregnancy intervals on infant mortality. Short interpregnancy intervals were common in Ohio during the study period. Of all multiparous births, 20.5% followed an interval of <12 months. The overall infant mortality rate during this time was 7.2 per 1000 live births (6.0 for white mothers and 13.1 for black mothers). Infant mortalities occurred more frequently for births following short intervals of 0-<6 months (9.2 per 1000) and 6-<12 months (7.1 per 1000) compared to 12-<24 months (5.6 per 1000) (P < .001 and <.001). The highest risk for infant mortality followed interpregnancy intervals of 0

Longitudinal Predictors of Self-Rated Health and Mortality in Older Adults

PubMed Central

Short, Jerome L.

2014-01-01

Introduction Few studies have compared the effects of demographic, cognitive, and behavioral factors of health and mortality longitudinally. We examined predictors of self-rated health and mortality at 3 points, each 2 years apart, over 4 years. Methods We used data from the 2006 wave of the Health and Retirement Study and health and mortality indicators from 2006, 2008, and 2010. We analyzed data from 17,930 adults (aged 50–104 y) to examine predictors of self-rated health and data from a subgroup of 1,171 adults who died from 2006 through 2010 to examine predictors of mortality. Results Time 1 depression was the strongest predictor of self-rated health at all points, independent of age and education. Education, mild activities, body mass index, delayed word recall, and smoking were all associated with self-rated health at each point and predicted mortality. Delayed word recall mediated the relationships of mild activity with health and mortality. Bidirectional mediation was found for the effects of mild activity and depression on health. Conclusion Medical professionals should consider screening for depression and memory difficulties in addition to conducting medical assessments. These assessments could lead to more effective biopsychosocial interventions to help older adults manage risks for mortality. PMID:24901793

Mortality rates and cause-of-death patterns in a vaccinated population.

PubMed

McCarthy, Natalie L; Weintraub, Eric; Vellozzi, Claudia; Duffy, Jonathan; Gee, Julianne; Donahue, James G; Jackson, Michael L; Lee, Grace M; Glanz, Jason; Baxter, Roger; Lugg, Marlene M; Naleway, Allison; Omer, Saad B; Nakasato, Cynthia; Vazquez-Benitez, Gabriela; DeStefano, Frank

2013-07-01

Determining the baseline mortality rate in a vaccinated population is necessary to be able to identify any unusual increases in deaths following vaccine administration. Background rates are particularly useful during mass immunization campaigns and in the evaluation of new vaccines. Provide background mortality rates and describe causes of death following vaccination in the Vaccine Safety Datalink (VSD). Analyses were conducted in 2012. Mortality rates were calculated at 0-1 day, 0-7 days, 0-30 days, and 0-60 days following vaccination for deaths occurring between January 1, 2005, and December 31, 2008. Analyses were stratified by age and gender. Causes of death were examined, and findings were compared to National Center for Health Statistics (NCHS) data. Among 13,033,274 vaccinated people, 15,455 deaths occurred between 0 and 60 days following vaccination. The mortality rate within 60 days of a vaccination visit was 442.5 deaths per 100,000 person-years. Rates were highest in the group aged ≥85 years, and increased from the 0-1-day to the 0-60-day interval following vaccination. Eleven of the 15 leading causes of death in the VSD and NCHS overlap in both systems, and the top four causes of death were the same in both systems. VSD mortality rates demonstrate a healthy vaccinee effect, with rates lowest in the days immediately following vaccination, most apparent in the older age groups. The VSD mortality rate is lower than that in the general U.S. population, and the causes of death are similar. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine

24 CFR 203.49 - Eligibility of adjustable rate mortgages.

Code of Federal Regulations, 2010 CFR

2010-04-01

... corresponding to changes in the interest rate index. (d) Frequency of interest rate changes. (1) The interest...) Interest-rate index. Changes in the interest rate charged on an adjustable rate mortgage must correspond either to changes in the one-year London Interbank Offered Rate (LIBOR) or to changes in the weekly...

Trends in Hospitalization Rates and Outcomes of Endocarditis among Medicare Beneficiaries

PubMed Central

Bikdeli, Behnood; Wang, Yun; Kim, Nancy; Desai, Mayur M.; Quagliarello, Vincent; Krumholz, Harlan M.

2015-01-01

Objectives To determine the hospitalization rates and outcomes of endocarditis among older adults. Background Endocarditis is the most serious cardiovascular infection and is especially common among older adults. Little is known about recent trends for endocarditis hospitalizations and outcomes. Methods Using Medicare inpatient Standard Analytic Files, we identified all Fee-For-Service beneficiaries aged ≥65 years with a principal or secondary diagnosis of endocarditis from 1999-2010. We used Medicare Denominator Files to report hospitalizations per 100,000 person-years. Rates of 30-day and 1-year mortality were calculated using Vital Status Files. We used mixed-effects models to calculate adjusted rates of hospitalization and mortality and to compare the results before and after 2007, when the American Heart Association revised recommendations for endocarditis prophylaxis. Results Overall, 262,658 beneficiaries were hospitalized with endocarditis. The adjusted hospitalization rate increased from 1999-2005, reaching 83.5 per 100,000 person-years in 2005, and declined during 2006-2007. After 2007, the decline continued, reaching 70.6 per 100,000 person-years in 2010. Adjusted 30-day and 1-year mortality rates ranged from 14.2% to 16.5% and from 32.6% to 36.2%, respectively. There were no consistent changes in adjusted rates of 30-day and 1-year mortality after 2007. Trends in rates of hospitalization and outcomes were consistent across demographic subgroups. Adjusted rates of hospitalization and mortality declined consistently in the subgroup with principal diagnosis of endocarditis. Conclusions Our study highlights the high burden of endocarditis among older adults. We did not observe an increase in adjusted rates of hospitalization or mortality associated with endocarditis after publication of the 2007 guidelines. PMID:23994421

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013.

PubMed

Haagsma, Juanita A; Graetz, Nicholas; Bolliger, Ian; Naghavi, Mohsen; Higashi, Hideki; Mullany, Erin C; Abera, Semaw Ferede; Abraham, Jerry Puthenpurakal; Adofo, Koranteng; Alsharif, Ubai; Ameh, Emmanuel A; Ammar, Walid; Antonio, Carl Abelardo T; Barrero, Lope H; Bekele, Tolesa; Bose, Dipan; Brazinova, Alexandra; Catalá-López, Ferrán; Dandona, Lalit; Dandona, Rakhi; Dargan, Paul I; De Leo, Diego; Degenhardt, Louisa; Derrett, Sarah; Dharmaratne, Samath D; Driscoll, Tim R; Duan, Leilei; Petrovich Ermakov, Sergey; Farzadfar, Farshad; Feigin, Valery L; Franklin, Richard C; Gabbe, Belinda; Gosselin, Richard A; Hafezi-Nejad, Nima; Hamadeh, Randah Ribhi; Hijar, Martha; Hu, Guoqing; Jayaraman, Sudha P; Jiang, Guohong; Khader, Yousef Saleh; Khan, Ejaz Ahmad; Krishnaswami, Sanjay; Kulkarni, Chanda; Lecky, Fiona E; Leung, Ricky; Lunevicius, Raimundas; Lyons, Ronan Anthony; Majdan, Marek; Mason-Jones, Amanda J; Matzopoulos, Richard; Meaney, Peter A; Mekonnen, Wubegzier; Miller, Ted R; Mock, Charles N; Norman, Rosana E; Orozco, Ricardo; Polinder, Suzanne; Pourmalek, Farshad; Rahimi-Movaghar, Vafa; Refaat, Amany; Rojas-Rueda, David; Roy, Nobhojit; Schwebel, David C; Shaheen, Amira; Shahraz, Saeid; Skirbekk, Vegard; Søreide, Kjetil; Soshnikov, Sergey; Stein, Dan J; Sykes, Bryan L; Tabb, Karen M; Temesgen, Awoke Misganaw; Tenkorang, Eric Yeboah; Theadom, Alice M; Tran, Bach Xuan; Vasankari, Tommi J; Vavilala, Monica S; Vlassov, Vasiliy Victorovich; Woldeyohannes, Solomon Meseret; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa Z; Yu, Chuanhua; Murray, Christopher J L; Vos, Theo

2016-02-01

The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Rate of Change in Renal Function and Mortality in Elderly Treated Hypertensive Patients

PubMed Central

Langham, Robyn G.; Ademi, Zanfina; Owen, Alice; Krum, Henry; Wing, Lindon M.H.; Nelson, Mark R.; Reid, Christopher M.

2015-01-01

Background and objectives Evidence relating the rate of change in renal function, measured as eGFR, after antihypertensive treatment in elderly patients to clinical outcome is sparse. This study characterized the rate of change in eGFR after commencement of antihypertensive treatment in an elderly population, the factors associated with eGFR rate change, and the rate’s association with all-cause and cardiovascular mortality. Design, setting, participants, & measurements Data from the Second Australian National Blood Pressure study were used, where 6083 hypertensive participants aged ≥65 years were enrolled during 1995–1997 and followed for a median of 4.1 years (in-trial). Following the Second Australian National Blood Pressure study, participants were followed-up for a further median 6.9 years (post-trial). The annual rate of change in the eGFR was calculated in 4940 participants using creatinine measurements during the in-trial period and classified into quintiles (Q) on the basis of the following eGFR changes: rapid decline (Q1), decline (Q2), stable (Q3), increase (Q4), and rapid increase (Q5). Results A rapid decline in eGFR in comparison with those with stable eGFRs during the in-trial period was associated with older age, living in a rural area, wider pulse pressure at baseline, receiving diuretic-based therapy, taking multiple antihypertensive drugs, and having blood pressure <140/90 mmHg during the study. However, a rapid increase in eGFR was observed in younger women and those with a higher cholesterol level. After adjustment for baseline and in-trial covariates, Cox-proportional hazard models showed a significantly greater risk for both all-cause (hazard ratio, 1.28; 95% confidence interval, 1.09 to 1.52; P=0.003) and cardiovascular (hazard ratio, 1.40; 95% confidence interval, 1.11 to 1.76; P=0.004) mortality in the rapid decline group compared with the stable group over a median of 7.2 years after the last eGFR measure. No significant association

Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer.

PubMed

Rocha, Thiago Augusto Hernandes; Thomaz, Erika Bárbara Abreu Fonseca; da Silva, Núbia Cristina; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Barbosa, Allan Claudius Queiroz; Thumé, Elaine; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Vissoci, João Ricardo Nickenig; Staton, Catherine Ann; Facchini, Luiz Augusto

2017-10-30

Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables. An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002-2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%). The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = -0.01; p < 0.006) and PHC financing (β = -0.52 -9 ; p = 0.014). In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We

5 CFR 9701.322 - Setting and adjusting rate ranges.

Code of Federal Regulations, 2010 CFR

2010-01-01

... MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Setting and Adjusting Rate Ranges... operational reasons, these adjustments will become effective on or about the date of the annual General...

Explaining large mortality differences between adjacent counties: a cross-sectional study.

PubMed

Schootman, M; Chien, L; Yun, S; Pruitt, S L

2016-08-02

Extensive geographic variation in adverse health outcomes exists, but global measures ignore differences between adjacent geographic areas, which often have very different mortality rates. We describe a novel application of advanced spatial analysis to 1) examine the extent of differences in mortality rates between adjacent counties, 2) describe differences in risk factors between adjacent counties, and 3) determine if differences in risk factors account for the differences in mortality rates between adjacent counties. We conducted a cross-sectional study in Missouri, USA with 2005-2009 age-adjusted all-cause mortality rate as the outcome and county-level explanatory variables from a 2007 population-based survey. We used a multi-level Gaussian model and a full Bayesian approach to analyze the difference in risk factors relative to the difference in mortality rates between adjacent counties. The average mean difference in the age-adjusted mortality rate between any two adjacent counties was -3.27 (standard deviation = 95.5) per 100,000 population (maximum = 258.80). Six variables were associated with mortality differences: inability to obtain medical care because of cost (β = 2.6), hospital discharge rate (β = 1.03), prevalence of fair/poor health (β = 2.93), and hypertension (β = 4.75) and poverty prevalence (β = 6.08). Examining differences in mortality rates and associated risk factors between adjacent counties provides additional insight for future interventions to reduce geographic disparities.

Chronic Cardiovascular Disease Mortality in Mountaintop Mining Areas of Central Appalachian States

ERIC Educational Resources Information Center

Esch, Laura; Hendryx, Michael

2011-01-01

Purpose: To determine if chronic cardiovascular disease (CVD) mortality rates are higher among residents of mountaintop mining (MTM) areas compared to mining and nonmining areas, and to examine the association between greater levels of MTM surface mining and CVD mortality. Methods: Age-adjusted chronic CVD mortality rates from 1999 to 2006 for…

Antidepressant prescribing and changes in antidepressant poisoning mortality and suicide in England, 1993-2004.

PubMed

Morgan, Oliver; Griffiths, Clare; Majeed, Azeem

2008-03-01

In England, the impact of increased use of antidepressant medications is unclear. We examine associations between antidepressant use, suicide and antidepressant poisoning mortality, adjusted for important covariates. Data on suicide and antidepressant poisoning mortality were provided by the Office for National Statistics. Prescription data were provided by the Department of Health. Age- and sex-specific prescribing rates were estimated from The Health Improvement Network primary care data. We measured the association between prescribing, suicide and poisoning mortality after adjusting for age, sex, calendar year, prescribing rates and use of newer antidepressants drugs. The prevalence of antidepressant treatment increased during the 1990s for all age and sex groups. Treatment prevalence remained constant from 2002 but declined among children and adolescents. Between 1993 and 2004, age-standardized rates for suicide decreased from 98.2 to 81.3 per million populations and for antidepressants from 9.2 to 7.4 per million populations. Before adjustment, increased antidepressant prescribing was associated with a decrease in suicide (r(s) = -0.90, P < 0.001) and antidepressant poisoning mortality rates (r(s) = -0.65, P = 0.023). This association disappeared after adjustment. In England, at a population level, there does not appear to be an association between antidepressant prescribing and antidepressant poisoning mortality or suicide.

Causes and rates of mortality of swift foxes in western Kansas

USGS Publications Warehouse

Sovada, M.A.; Roy, C.C.; Bright, J.B.; Gillis, J.R.

1998-01-01

Knowledge of mortality factors is important for developing strategies to conserve the swift fox (Vulpes velox), a species being considered for listing under the Endangered Species Act, but available information about swift fox mortality is inadequate. We used radiotelemetry techniques to examine the magnitude and causes of mortality of swift fox populations in 2 study areas in western Kansas. One study area was predominantly cropland, the other rangeland. Mortality rates, calculated using Kaplan-Meier estimation techniques in a staggered entry design, were 0.55 ?? 0.08 (5 ?? SE) for adult and 0.67 ?? 0.08 for juvenile swift foxes. We did not detect differences between study areas in mortality rates for adults or juveniles. Predation by coyotes (Canis latrans) was the major cause of mortality for adult and juvenile swift foxes in both study areas, and vehicle collision was an important mortality factor for juveniles in the cropland study area. No mortality was attributed to starvation or disease.

Fiscal decentralisation and infant mortality rate: the Colombian case.

PubMed

Soto, Victoria Eugenia; Farfan, Maria Isabel; Lorant, Vincent

2012-05-01

There is a paucity of research analysing the influence of fiscal decentralisation on health outcomes. Colombia is an interesting case study, as health expenditure there has been decentralising since 1993, leading to an improvement in health care insurance. However, it is unclear whether fiscal decentralisation has improved population health. We assess the effect of fiscal decentralisation of health expenditure on infant mortality rates in Colombia. Infant mortality rates for 1080 municipalities over a 10-year period (1998-2007) were related to fiscal decentralisation by using an unbalanced fixed-effect regression model with robust errors. Fiscal decentralisation was measured as the locally controlled health expenditure as a proportion of total health expenditure. We also evaluated the effect of transfers from central government and municipal institutional capacity. In addition, we compared the effect of fiscal decentralisation at different levels of municipal poverty. Fiscal decentralisation decreased infant mortality rates (the elasticity was equal to -0.06). However, this effect was stronger in non-poor municipalities (-0.12) than poor ones (-0.081). We conclude that decentralising the fiscal allocation of responsibilities to municipalities decreased infant mortality rates. However, this improved health outcome effect depended greatly on the socio-economic conditions of the localities. The policy instrument used by the Health Minister to evaluate municipal institutional capacity in the health sector needs to be revised. Copyright © 2012 Elsevier Ltd. All rights reserved.

Ethnicity and mortality from systemic lupus erythematosus in the US.

PubMed

Krishnan, E; Hubert, H B

2006-11-01

To study ethnic differences in mortality from systemic lupus erythematosus (lupus) in two large, population-based datasets. We analysed the national death data (1979-98) from the National Center for Health Statistics (Hyattsville, Maryland, USA) and hospitalisation data (1993-2002) from the Nationwide Inpatient Sample (NIS), the largest hospitalisation database in the US. The overall, unadjusted, lupus mortality in the National Center for Health Statistics data was 4.6 per million, whereas the proportion of in-hospital mortality from the NIS was 2.9%. African-Americans had disproportionately higher mortality risk than Caucasians (all-cause mortality relative risk adjusted for age = 1.24 (women), 1.36 (men); lupus mortality relative risk = 3.91 (women), 2.40 (men)). Excess risk was found among in-hospital deaths (odds ratio adjusted for age = 1.4 (women), 1.3 (men)). Lupus death rates increased overall from 1979 to 98 (p<0.001). The proportional increase was greatest among African-Americans. Among Caucasian men, death rates declined significantly (p<0.001), but rates did not change substantially for African-American men. The African-American:Caucasian mortality ratio rose with time among men, but there was little change among women. In analyses of the NIS data adjusted for age, the in-hospital mortality risk decreased with time among Caucasian women (p<0.001). African-Americans with lupus have 2-3-fold higher lupus mortality risk than Caucasians. The magnitude of the risk disparity is disproportionately higher than the disparity in all-cause mortality. A lupus-specific biological factor, as opposed to socioeconomic and access-to-care factors, may be responsible for this phenomenon.

Are infant mortality rate declines exponential? The general pattern of 20th century infant mortality rate decline

PubMed Central

Bishai, David; Opuni, Marjorie

2009-01-01

Background Time trends in infant mortality for the 20th century show a curvilinear pattern that most demographers have assumed to be approximately exponential. Virtually all cross-country comparisons and time series analyses of infant mortality have studied the logarithm of infant mortality to account for the curvilinear time trend. However, there is no evidence that the log transform is the best fit for infant mortality time trends. Methods We use maximum likelihood methods to determine the best transformation to fit time trends in infant mortality reduction in the 20th century and to assess the importance of the proper transformation in identifying the relationship between infant mortality and gross domestic product (GDP) per capita. We apply the Box Cox transform to infant mortality rate (IMR) time series from 18 countries to identify the best fitting value of lambda for each country and for the pooled sample. For each country, we test the value of λ against the null that λ = 0 (logarithmic model) and against the null that λ = 1 (linear model). We then demonstrate the importance of selecting the proper transformation by comparing regressions of ln(IMR) on same year GDP per capita against Box Cox transformed models. Results Based on chi-squared test statistics, infant mortality decline is best described as an exponential decline only for the United States. For the remaining 17 countries we study, IMR decline is neither best modelled as logarithmic nor as a linear process. Imposing a logarithmic transform on IMR can lead to bias in fitting the relationship between IMR and GDP per capita. Conclusion The assumption that IMR declines are exponential is enshrined in the Preston curve and in nearly all cross-country as well as time series analyses of IMR data since Preston's 1975 paper, but this assumption is seldom correct. Statistical analyses of IMR trends should assess the robustness of findings to transformations other than the log transform. PMID:19698144

Aggregate level beverage specific effect of alcohol sale on myocardial infarction mortality rate.

PubMed

Razvodovsky, Yury Evgeny

2009-01-01

The pronounced fluctuations in cardiovascular mortality in the countries of the former Soviet Union over the past decades have attracted considerable interest. The mounting evidence suggests that binge drinking pattern is a potentially important contributor to higher cardiovascular mortality rate in the former Soviet republics. There is assumption that if occasional heavy drinking of strong spirits increases the risk of cardiovascular mortality, countries where this is predominant drinking pattern should display positive association between spirits consumption and cardiovascular mortality at the aggregate level. To estimate the aggregate level beverage specific effect of alcohol sale on myocardial infarction mortality rate in drinking culture, which combine a higher level of spirits consumption per capita with the explosive drinking pattern. Trends in beverage specific alcohol sale per capita and myocardial infarction mortality rate from 1970 to 2005 in Belarus were analyzed employing ARIMA time series analysis. The results of time series analysis suggest positive relation between strong spirits (vodka) sale per capita and myocardial infarction mortality rate. The analysis suggests that a 1 liter increase in vodka sale per capita would result in a 7.2% increase in myocardial infarction mortality rate (8.2% increase in male mortality and 6.8% increase in female mortality). the results of the present study suggest a positive relation between vodka sale and myocardial infarction mortality rate at aggregate level and support the hypothesis that binge drinking of strong spirits is a risk factor of myocardial infarction at the individual level. Thus, from a public policy point of view, the outcome of this study suggests that cardiovascularrelated mortality prevention programs should put more focus on addressing alcohol consumption structure.

Trends in under-5 mortality rates and the HIV/AIDS epidemic.

PubMed Central

Adetunji, J.

2000-01-01

INTRODUCTION: The prevalence of human immunodeficiency virus (HIV) among adults and mortality rates among under-5-year-olds have increased or stagnated in many countries. The objective of this study was to investigate whether there is a link between under-5 mortality trends and the prevalence of HIV among adults and, if so, to assess the magnitude of the effect of adult HIV prevalence on under-5 mortality rates. METHOD: Data from Demographic and Health Surveys were used to establish the trends in under-5 mortality rates for 25 countries for which there are data for at least two points in time. Countries were ranked according to the most recent adult HIV prevalence data and grouped in three categories: those with very high HIV prevalence (> or = 5%); those with moderately high prevalence (1-4.9%); and those with low prevalence (< 1%). A mathematical model was fitted to obtain an estimate of the contribution of HIV/AIDS to the level of under-5 mortality in each country. RESULTS: Under-5 mortality rates showed an increase in most countries with high adult HIV prevalence, but a decrease in almost every country with moderately high or low prevalence. The estimated contribution of adult HIV prevalence to the observed level of under-5 mortality was highest (up to 61%) in Zimbabwe (where HIV prevalence was highest) and tended to decrease with the level of HIV prevalence. DISCUSSION: The contribution of HIV/AIDS to childhood mortality therefore appears to be most noticeable in settings where the epidemic is most severe. PMID:11100615

Influenza-related mortality trends in Japanese and American seniors: evidence for the indirect mortality benefits of vaccinating schoolchildren.

PubMed

Charu, Vivek; Viboud, Cécile; Simonsen, Lone; Sturm-Ramirez, Katharine; Shinjoh, Masayoshi; Chowell, Gerardo; Miller, Mark; Sugaya, Norio

2011-01-01

The historical Japanese influenza vaccination program targeted at schoolchildren provides a unique opportunity to evaluate the indirect benefits of vaccinating high-transmitter groups to mitigate disease burden among seniors. Here we characterize the indirect mortality benefits of vaccinating schoolchildren based on data from Japan and the US. We compared age-specific influenza-related excess mortality rates in Japanese seniors aged ≥65 years during the schoolchildren vaccination program (1978-1994) and after the program was discontinued (1995-2006). Indirect vaccine benefits were adjusted for demographic changes, socioeconomics and dominant influenza subtype; US mortality data were used as a control. We estimate that the schoolchildren vaccination program conferred a 36% adjusted mortality reduction among Japanese seniors (95%CI: 17-51%), corresponding to ∼1,000 senior deaths averted by vaccination annually (95%CI: 400-1,800). In contrast, influenza-related mortality did not change among US seniors, despite increasing vaccine coverage in this population. The Japanese schoolchildren vaccination program was associated with substantial indirect mortality benefits in seniors.

Assessing predicted age-specific breast cancer mortality rates in 27 European countries by 2020.

PubMed

Clèries, R; Rooney, R M; Vilardell, M; Espinàs, J A; Dyba, T; Borras, J M

2018-03-01

We assessed differences in predicted breast cancer (BC) mortality rates, across Europe, by 2020, taking into account changes in the time trends of BC mortality rates during the period 2000-2010. BC mortality data, for 27 European Union (EU) countries, were extracted from the World Health Organization mortality database. First, we compared BC mortality data between time periods 2000-2004 and 2006-2010 through standardized mortality ratios (SMRs) and carrying out a graphical assessment of the age-specific rates. Second, making use of the base period 2006-2012, we predicted BC mortality rates by 2020. Finally, making use of the SMRs and the predicted data, we identified a clustering of countries, assessing differences in the time trends between the areas defined in this clustering. The clustering approach identified two clusters of countries: the first cluster were countries where BC predicted mortality rates, in 2020, might slightly increase among women aged 69 and older compared with 2010 [Greece (SMR 1.01), Croatia (SMR 1.02), Latvia (SMR 1.15), Poland (SMR 1.14), Estonia (SMR 1.16), Bulgaria (SMR 1.13), Lithuania (SMR 1.03), Romania (SMR 1.13) and Slovakia (SMR 1.06)]. The second cluster was those countries where BC mortality rates level off or decrease in all age groups (remaining countries). However, BC mortality rates between these clusters might diminish and converge to similar figures by 2020. For the year 2020, our predictions have shown a converging pattern of BC mortality rates between European regions. Reducing disparities, in access to screening and treatment, could have a substantial effect in countries where a non-decreasing trend in age-specific BC mortality rates has been predicted.

What Pertussis Mortality Rates Make Maternal Acellular Pertussis Immunization Cost-Effective in Low- and Middle-Income Countries? A Decision Analysis

PubMed Central

Russell, Louise B.; Pentakota, Sri Ram; Toscano, Cristiana Maria; Cosgriff, Ben; Sinha, Anushua

2016-01-01

Background. Despite longstanding infant vaccination programs in low- and middle-income countries (LMICs), pertussis continues to cause deaths in the youngest infants. A maternal monovalent acellular pertussis (aP) vaccine, in development, could prevent many of these deaths. We estimated infant pertussis mortality rates at which maternal vaccination would be a cost-effective use of public health resources in LMICs. Methods. We developed a decision model to evaluate the cost-effectiveness of maternal aP immunization plus routine infant vaccination vs routine infant vaccination alone in Bangladesh, Nigeria, and Brazil. For a range of maternal aP vaccine prices, one-way sensitivity analyses identified the infant pertussis mortality rates required to make maternal immunization cost-effective by alternative benchmarks ($100, 0.5 gross domestic product [GDP] per capita, and GDP per capita per disability-adjusted life-year [DALY]). Probabilistic sensitivity analysis provided uncertainty intervals for these mortality rates. Results. Infant pertussis mortality rates necessary to make maternal aP immunization cost-effective exceed the rates suggested by current evidence except at low vaccine prices and/or cost-effectiveness benchmarks at the high end of those considered in this report. For example, at a vaccine price of $0.50/dose, pertussis mortality would need to be 0.051 per 1000 infants in Bangladesh, and 0.018 per 1000 in Nigeria, to cost 0.5 per capita GDP per DALY. In Brazil, a middle-income country, at a vaccine price of $4/dose, infant pertussis mortality would need to be 0.043 per 1000 to cost 0.5 per capita GDP per DALY. Conclusions. For commonly used cost-effectiveness benchmarks, maternal aP immunization would be cost-effective in many LMICs only if the vaccine were offered at less than $1–$2/dose. PMID:27838677

Mortality rates in OECD countries converged during the period 1990-2010.

PubMed

Bremberg, Sven G

2017-06-01

Since the scientific revolution of the 18th century, human health has gradually improved, but there is no unifying theory that explains this improvement in health. Studies of macrodeterminants have produced conflicting results. Most studies have analysed health at a given point in time as the outcome; however, the rate of improvement in health might be a more appropriate outcome. Twenty-eight OECD member countries were selected for analysis in the period 1990-2010. The main outcomes studied, in six age groups, were the national rates of decrease in mortality in the period 1990-2010. The effects of seven potential determinants on the rates of decrease in mortality were analysed in linear multiple regression models using least squares, controlling for country-specific history constants, which represent the mortality rate in 1990. The multiple regression analyses started with models that only included mortality rates in 1990 as determinants. These models explained 87% of the intercountry variation in the children aged 1-4 years and 51% in adults aged 55-74 years. When added to the regression equations, the seven determinants did not seem to significantly increase the explanatory power of the equations. The analyses indicated a decrease in mortality in all nations and in all age groups. The development of mortality rates in the different nations demonstrated significant catch-up effects. Therefore an important objective of the national public health sector seems to be to reduce the delay between international research findings and the universal implementation of relevant innovations.

Trends in hospitalization rates and outcomes of endocarditis among Medicare beneficiaries.

PubMed

Bikdeli, Behnood; Wang, Yun; Kim, Nancy; Desai, Mayur M; Quagliarello, Vincent; Krumholz, Harlan M

2013-12-10

The aim of this study was to determine the hospitalization rates and outcomes of endocarditis among older adults. Endocarditis is the most serious cardiovascular infection and is especially common among older adults. Little is known about recent trends for endocarditis hospitalizations and outcomes. Using Medicare inpatient Standard Analytic Files, we identified all fee-for-service beneficiaries age ≥65 years with a principal or secondary diagnosis of endocarditis from 1999 to 2010. We used Medicare Denominator Files to report hospitalizations per 100,000 person-years. Rates of 30-day and 1-year mortality were calculated using Vital Status Files. We used mixed-effects models to calculate adjusted rates of hospitalization and mortality and to compare the results before and after 2007, when the American Heart Association revised their recommendations for endocarditis prophylaxis. Overall, 262,658 beneficiaries were hospitalized with endocarditis. The adjusted hospitalization rate increased from 1999 to 2005, reaching 83.5 per 100,000 person-years in 2005, and declined during 2006 to 2007. After 2007, the decline continued, reaching 70.6 per 100,000 person-years in 2010. Adjusted 30-day and 1-year mortality rates ranged from 14.2% to 16.5% and from 32.6% to 36.2%, respectively. There were no consistent changes in adjusted rates of 30-day and 1-year mortality after 2007. Trends in rates of hospitalization and outcomes were consistent across demographic subgroups. Adjusted rates of hospitalization and mortality declined consistently in the subgroup with a principal diagnosis of endocarditis. Our study highlights the high burden of endocarditis among older adults. We did not observe an increase in adjusted rates of hospitalization or mortality associated with endocarditis after publication of the 2007 guidelines. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Stroke mortality rates vary in local communities in a metropolitan area: racial and spatial disparities and correlates.

PubMed

Hunt, Bijou R; Deot, Deepa; Whitman, Steven

2014-07-01

For the past decade, stroke has held steady as one of the top 4 leading causes of death in the United States. Aggregated data provide information about how the country or individual states are faring with respect to stroke mortality, but disaggregation provides data that may facilitate targeted interventions and community engagement. We analyzed deaths from stroke to residents of Chicago to calculate age-adjusted stroke mortality rates (AASMRs). We calculated AASMRs for Chicago by race/ethnicity, sex, and community area. We also examined the correlation between AASMR and (1) racial/ethnic composition of a community area and (2) median household income. The AASMR for Chicago (44.9 per 100,000 population) was significantly higher than the national rate (42.2). Within both the United States and Chicago, the highest AASMRs were found among non-Hispanic blacks, followed by non-Hispanic whites, and then Hispanics. There was a strong, positive correlation between the proportion of black residents in a community area and the AASMR (0.58). There was a strong, negative relationship between household income and the AASMR for the entire city (-0.56) and for the predominantly black community areas (-0.47). These data provide insight into where the worst stroke mortality problems reside in Chicago. We anticipate that the data can be used to work toward the development of solutions to the high stroke mortality rates observed in several of Chicago's community areas and in similar communities throughout the United States. © 2014 American Heart Association, Inc.

The Relationship Between Child Mortality Rates and Prevalence of Celiac Disease.

PubMed

Biagi, Federico; Raiteri, Alberto; Schiepatti, Annalisa; Klersy, Catherine; Corazza, Gino R

2018-02-01

Some evidence suggests that prevalence of celiac disease in the general population is increasing over time. Because the prognosis of celiac disease was a dismal one before discovering the role of gluten, our aim was to investigate a possible relationship between children under-5 mortality rates and prevalence rates of celiac disease. Thanks to a literature review, we found 27 studies performed in 17 different countries describing the prevalence of celiac disease in schoolchildren; between 1995 and 2011, 4 studies were performed in Italy. A meta-analysis of prevalence rates was performed. Prevalence was compared between specific country under-5 mortality groups, publication year, and age. In the last decades, under-5 mortality rates have been decreasing all over the world. This reduction is paralleled by an increase of the prevalence of celiac disease. The Spearman correlation coefficient was -63%, 95% confidence interval -82% to -33% (P < 0.001). So, the higher the mortality rate, the lower the prevalence of CD. This finding is confirmed by the meta-analysis of the 4 studies conducted in Italy over time. The under-5 mortality rate seems to influence the prevalence of celiac disease in the general population. In the near future, the number of patients with celiac disease will increase, thanks to the better environmental conditions that nowadays allow a better survival of children with celiac disease.

Comparing self-reported health status and diagnosis-based risk adjustment to predict 1- and 2 to 5-year mortality.

PubMed

Pietz, Kenneth; Petersen, Laura A

2007-04-01

To compare the ability of two diagnosis-based risk adjustment systems and health self-report to predict short- and long-term mortality. Data were obtained from the Department of Veterans Affairs (VA) administrative databases. The study population was 78,164 VA beneficiaries at eight medical centers during fiscal year (FY) 1998, 35,337 of whom completed an 36-Item Short Form Health Survey for veterans (SF-36V) survey. We tested the ability of Diagnostic Cost Groups (DCGs), Adjusted Clinical Groups (ACGs), SF-36V Physical Component score (PCS) and Mental Component Score (MCS), and eight SF-36V scales to predict 1- and 2-5 year all-cause mortality. The additional predictive value of adding PCS and MCS to ACGs and DCGs was also evaluated. Logistic regression models were compared using Akaike's information criterion, the c-statistic, and the Hosmer-Lemeshow test. The c-statistics for the eight scales combined with age and gender were 0.766 for 1-year mortality and 0.771 for 2-5-year mortality. For DCGs with age and gender the c-statistics for 1- and 2-5-year mortality were 0.778 and 0.771, respectively. Adding PCS and MCS to the DCG model increased the c-statistics to 0.798 for 1-year and 0.784 for 2-5-year mortality. The DCG model showed slightly better performance than the eight-scale model in predicting 1-year mortality, but the two models showed similar performance for 2-5-year mortality. Health self-report may add health risk information in addition to age, gender, and diagnosis for predicting longer-term mortality.

Health Risk or Resource? Gradual and Independent Association between Self-Rated Health and Mortality Persists Over 30 Years

PubMed Central

Bopp, Matthias; Braun, Julia; Gutzwiller, Felix; Faeh, David

2012-01-01

Background Poor self-rated health (SRH) is associated with increased mortality. However, most studies only adjust for few health risk factors and/or do not analyse whether this association is consistent also for intermediate categories of SRH and for follow-up periods exceeding 5–10 years. This study examined whether the SRH-mortality association remained significant 30 years after assessment when adjusting for a wide range of known clinical, behavioural and socio-demographic risk factors. Methods We followed-up 8,251 men and women aged ≥16 years who participated 1977–79 in a community based health study and were anonymously linked with the Swiss National Cohort (SNC) until the end of 2008. Covariates were measured at baseline and included education, marital status, smoking, medical history, medication, blood glucose and pressure. Results 92.8% of the original study participants could be linked to a census, mortality or emigration record of the SNC. Loss to follow-up 1980–2000 was 5.8%. Even after 30 years of follow-up and after adjustment for all covariates, the association between SRH and all-cause mortality remained strong and estimates almost linearly increased from “excellent” (reference: hazard ratio, HR 1) to “good” (men: HR 1.07 95% confidence interval 0.92–1.24, women: 1.22, 1.01–1.46) to “fair” (1.41, 1.18–1.68; 1.39, 1.14–1.70) to “poor”(1.61, 1.15–2.25; 1.49, 1.07–2.06) to “very poor” (2.85, 1.25–6.51; 1.30, 0.18–9.35). Persons answering the SRH question with “don't know” (1.87, 1.21–2.88; 1.26, 0.87–1.83) had also an increased mortality risk; this was pronounced in men and in the first years of follow-up. Conclusions SRH is a strong and “dose-dependent” predictor of mortality. The association was largely independent from covariates and remained significant after decades. This suggests that SRH provides relevant and sustained health information beyond classical risk factors or medical history and

Reduced Lung Cancer Mortality With Lower Atmospheric Pressure.

PubMed

Merrill, Ray M; Frutos, Aaron

2018-01-01

Research has shown that higher altitude is associated with lower risk of lung cancer and improved survival among patients. The current study assessed the influence of county-level atmospheric pressure (a measure reflecting both altitude and temperature) on age-adjusted lung cancer mortality rates in the contiguous United States, with 2 forms of spatial regression. Ordinary least squares regression and geographically weighted regression models were used to evaluate the impact of climate and other selected variables on lung cancer mortality, based on 2974 counties. Atmospheric pressure was significantly positively associated with lung cancer mortality, after controlling for sunlight, precipitation, PM2.5 (µg/m 3 ), current smoker, and other selected variables. Positive county-level β coefficient estimates ( P < .05) for atmospheric pressure were observed throughout the United States, higher in the eastern half of the country. The spatial regression models showed that atmospheric pressure is positively associated with age-adjusted lung cancer mortality rates, after controlling for other selected variables.

Implications of prescription drug monitoring and medical cannabis legislation on opioid overdose mortality.

PubMed

Phillips, Elyse; Gazmararian, Julie

To determine whether specific state legislation has an effect on opioid overdose mortality rates compared to states without those types of legislation. Ecological study estimating opioid-related mortality in states with and without a prescription drug monitoring program (PDMP) and/or medical cannabis legislation. Opioid-related mortality rates for 50 states and Washington DC from 2011 to 2014 were obtained from CDC WONDER. PDMP data were obtained from the National Alliance for Model State Drug Laws, and data on medical cannabis legislation from the National Organization for the Reform of Marijuana Laws. The relationship between PDMPs with mandatory access provisions, medical cannabis legislation, and opioid-related mortality rates. Multivariate repeated measures analysis performed with software and services. Medical cannabis laws were associated with an increase of 21.7 percent in mean age-adjusted opioid-related mortality (p < 0.0001). PDMPs were associated with an increase of 11.4 percent in mean age-adjusted opioid-related mortality (p = 0.005). For every additional year since enactment, mean age-adjusted opioid-related mortality rate increased by 1.7 percent in states with medical cannabis (p = 0.049) and 5.8 percent for states with a PDMP (p = 0.005). Interaction between both types of legislation produced a borderline significant decrease of 10.1 percent (p = 0.055). For every year states had both types of legislation, interaction resulted in a 0.6 percent decrease in rate (p = 0.013). When combined with the availability of medical cannabis as an alternative analgesic therapy, PDMPs may be more effective at decreasing opioid-related mortality.

10 CFR 903.11 - Advance announcement of rate adjustment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and... advertisement, and/or by Federal Register publication. Written comments relevant to rate policy and design and...

10 CFR 903.11 - Advance announcement of rate adjustment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and... advertisement, and/or by Federal Register publication. Written comments relevant to rate policy and design and...

10 CFR 903.11 - Advance announcement of rate adjustment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and... advertisement, and/or by Federal Register publication. Written comments relevant to rate policy and design and...

10 CFR 903.11 - Advance announcement of rate adjustment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and... advertisement, and/or by Federal Register publication. Written comments relevant to rate policy and design and...

American-Indian diabetes mortality in the Great Plains Region 2002–2010

PubMed Central

Kelley, Allyson; Giroux, Jennifer; Schulz, Mark; Aronson, Bob; Wallace, Debra; Bell, Ronny; Morrison, Sharon

2015-01-01

Objective To compare American-Indian and Caucasian mortality rates from diabetes among tribal Contract Health Service Delivery Areas (CHSDAs) in the Great Plains Region (GPR) and describe the disparities observed. Research design and methods Mortality data from the National Center for Vital Statistics and Seer*STAT were used to identify diabetes as the underlying cause of death for each decedent in the GPR from 2002 to 2010. Mortality data were abstracted and aggregated for American-Indians and Caucasians for 25 reservation CHSDAs in the GPR. Rate ratios (RR) with 95% CIs were used and SEER*Stat V.8.0.4 software calculated age-adjusted diabetes mortality rates. Results Age-adjusted mortality rates for American-Indians were significantly higher than those for Caucasians during the 8-year period. In the GPR, American-Indians were 3.44 times more likely to die from diabetes than Caucasians. South Dakota had the highest RR (5.47 times that of Caucasians), and Iowa had the lowest RR, (1.1). Reservation CHSDA RR ranged from 1.78 to 10.25. Conclusions American-Indians in the GPR have higher diabetes mortality rates than Caucasians in the GPR. Mortality rates among American-Indians persist despite special programs and initiatives aimed at reducing diabetes in these populations. Effective and immediate efforts are needed to address premature diabetes mortality among American-Indians in the GPR. PMID:25926992

A gigawatt level repetitive rate adjustable magnetic pulse compressor.

PubMed

Li, Song; Gao, Jing-Ming; Yang, Han-Wu; Qian, Bao-Liang; Li, Ze-Xin

2015-08-01

In this paper, a gigawatt level repetitive rate adjustable magnetic pulse compressor is investigated both numerically and experimentally. The device has advantages of high power level, high repetitive rate achievability, and long lifetime reliability. Importantly, dominate parameters including the saturation time, the peak voltage, and even the compression ratio can be potentially adjusted continuously and reliably, which significantly expands the applicable area of the device and generators based on it. Specifically, a two-stage adjustable magnetic pulse compressor, utilized for charging the pulse forming network of a high power pulse generator, is designed with different compression ratios of 25 and 18 through an optimized design process. Equivalent circuit analysis shows that the modification of compression ratio can be achieved by just changing the turn number of the winding. At the same time, increasing inductance of the grounded inductor will decrease the peak voltage and delay the charging process. Based on these analyses, an adjustable compressor was built and studied experimentally in both the single shot mode and repetitive rate mode. Pulses with peak voltage of 60 kV and energy per pulse of 360 J were obtained in the experiment. The rise times of the pulses were compressed from 25 μs to 1 μs and from 18 μs to 1 μs, respectively, at repetitive rate of 20 Hz with good repeatability. Experimental results show reasonable agreement with analyses.

Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births.

PubMed

Chughtai, Abrar A; Wang, Alex Y; Hilder, Lisa; Li, Zhuoyang; Lui, Kei; Farquhar, Cindy; Sullivan, Elizabeth A

2018-02-01

Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births? Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births. Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births. This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples. All births (≥20 weeks of gestation and/or ≥400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death. Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P < 0.01). Overall perinatal mortality rate was significantly higher for ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (<32 weeks' gestation) and moderate to late preterm births (32-36 weeks' gestation) (AOR 0.61, 95% CI 0.53-0.70 and AOR 0.61, 95% CI 0.53-0.70, respectively) compared to non-ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group. Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian

Adjusted hospital death rates: a potential screen for quality of medical care.

PubMed

Dubois, R W; Brook, R H; Rogers, W H

1987-09-01

Increased economic pressure on hospitals has accelerated the need to develop a screening tool for identifying hospitals that potentially provide poor quality care. Based upon data from 93 hospitals and 205,000 admissions, we used a multiple regression model to adjust the hospitals crude death rate. The adjustment process used age, origin of patient from the emergency department or nursing home, and a hospital case mix index based on DRGs (diagnostic related groups). Before adjustment, hospital death rates ranged from 0.3 to 5.8 per 100 admissions. After adjustment, hospital death ratios ranged from 0.36 to 1.36 per 100 (actual death rate divided by predicted death rate). Eleven hospitals (12 per cent) were identified where the actual death rate exceeded the predicted death rate by more than two standard deviations. In nine hospitals (10 per cent), the predicted death rate exceeded the actual death rate by a similar statistical margin. The 11 hospitals with higher than predicted death rates may provide inadequate quality of care or have uniquely ill patient populations. The adjusted death rate model needs to be validated and generalized before it can be used routinely to screen hospitals. However, the remaining large differences in observed versus predicted death rates lead us to believe that important differences in hospital performance may exist.

Variation in ICU Utilization and Mortality After Blunt Splenic Injury

PubMed Central

Kaufman, Elinore J.; Wiebe, Douglas J.; Martin, Niels D.; Pascual, Jose L.; Reilly, Patrick M.; Holena, Daniel N.

2016-01-01

Background While trauma patients are frequently cared for in the ICU, admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. Materials and Methods We conducted a retrospective cohort study of patients treated for blunt splenic injuries at 30 level I and II Pennsylvania trauma centers, 2011–2014. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman’s rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement, between high- and low-ICU-utilization centers. Results Of 2,587 patients with blunt splenic injuries, 63.9% (1,654) were admitted to the ICU. Median injury severity score (ISS) was 17 overall, 13 for non-ICU patients and 17 for ICU patients (p < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9% to 87.3%. Risk-adjusted mortality rates ranged from 1.2% to 9.6%. There was no correlation between O:E ratios for ICU utilization and mortality (rs = −0.2595, p=0.2103). Proportionately fewer ICU patients at high-utilization centers received critical care procedures than at low-utilization centers. Conclusions Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality. PMID:27363642

US County-Level Trends in Mortality Rates for Major Causes of Death, 1980-2014.

PubMed

Dwyer-Lindgren, Laura; Bertozzi-Villa, Amelia; Stubbs, Rebecca W; Morozoff, Chloe; Kutz, Michael J; Huynh, Chantal; Barber, Ryan M; Shackelford, Katya A; Mackenbach, Johan P; van Lenthe, Frank J; Flaxman, Abraham D; Naghavi, Mohsen; Mokdad, Ali H; Murray, Christopher J L

2016-12-13

County-level patterns in mortality rates by cause have not been systematically described but are potentially useful for public health officials, clinicians, and researchers seeking to improve health and reduce geographic disparities. To demonstrate the use of a novel method for county-level estimation and to estimate annual mortality rates by US county for 21 mutually exclusive causes of death from 1980 through 2014. Redistribution methods for garbage codes (implausible or insufficiently specific cause of death codes) and small area estimation methods (statistical methods for estimating rates in small subpopulations) were applied to death registration data from the National Vital Statistics System to estimate annual county-level mortality rates for 21 causes of death. These estimates were raked (scaled along multiple dimensions) to ensure consistency between causes and with existing national-level estimates. Geographic patterns in the age-standardized mortality rates in 2014 and in the change in the age-standardized mortality rates between 1980 and 2014 for the 10 highest-burden causes were determined. County of residence. Cause-specific age-standardized mortality rates. A total of 80 412 524 deaths were recorded from January 1, 1980, through December 31, 2014, in the United States. Of these, 19.4 million deaths were assigned garbage codes. Mortality rates were analyzed for 3110 counties or groups of counties. Large between-county disparities were evident for every cause, with the gap in age-standardized mortality rates between counties in the 90th and 10th percentiles varying from 14.0 deaths per 100 000 population (cirrhosis and chronic liver diseases) to 147.0 deaths per 100 000 population (cardiovascular diseases). Geographic regions with elevated mortality rates differed among causes: for example, cardiovascular disease mortality tended to be highest along the southern half of the Mississippi River, while mortality rates from self-harm and

Trends in mortality from COPD among adults in the United States.

PubMed

Ford, Earl S

2015-10-01

COPD imposes a large public health burden internationally and in the United States. The objective of this study was to examine trends in mortality from COPD among US adults from 1968 to 2011. Data from the National Vital Statistics System from 1968 to 2011 for adults aged ≥ 25 years were accessed, and trends in mortality rates were examined with Joinpoint analysis. Among all adults, age-adjusted mortality rate rose from 29.4 per 100,000 population in 1968 to 67.0 per 100,000 population in 1999 and then declined to 63.7 per 100,000 population in 2011 (annual percentage change [APC] 2000-2011, -0.2%; 95% CI, -0.6 to 0.2). The age-adjusted mortality rate among men peaked in 1999 and then declined (APC 1999-2011, -1.1%; 95% CI, -1.4 to -0.7), whereas the age-adjusted mortality rate among women increased from 2000 to 2011, peaking in 2008 (APC 2000-2011, 0.4%; 95% CI, 0.0-0.9). Despite a narrowing of the sex gap, mortality rates in men continued to exceed those in women. Evidence of a decline in the APC was noted for black men (1999-2011, -1.5%; 95% CI, -2.1 to -1.0) and white men (1999-2011, -0.9%; 95% CI, -1.3 to -0.6), adults aged 55 to 64 years (1989-2011, -1.0%; 95% CI, -1.2 to -0.8), and adults aged 65 to 74 years (1999-2011, -1.2%; 95% CI, -1.6 to -0.9). In the United States, the mortality rate from COPD has declined since 1999 in men and some age groups but appears to be still rising in women, albeit at a reduced pace.

Risk adjustment as basis for rational benchmarking: the example of colon carcinoma.

PubMed

Ptok, Henry; Marusch, Frank; Schmidt, Uwe; Gastinger, Ingo; Wenisch, Hubertus J C; Lippert, Hans

2011-01-01

The results of resection of colorectal carcinoma can vary greatly from one hospital to another. However, this does not necessarily reflect differences in the quality of treatment. The purpose of this study was to compare various tools for the risk-adjusted assessment of treatment results after resection of colorectal carcinoma within the context of hospital benchmarking. On the basis of a data pool provided by a multicentric observation study of patients with colon cancer, the postoperative in-hospital mortality rates at two high-volume hospitals ("A" and "B") were compared. After univariate comparison, risk-adjusted comparison of postoperative mortality was performed by logistic regression analysis (LReA), propensity-score analysis (PScA), and the CR-POSSUM score. Postoperative complications were compared by LReA and PScA. Although postoperative mortality differed significantly (P = 0.041) in univariate comparison of hospitals A and B (2.9% vs. 6.4%), no significant difference was found by LReA or PScA. Similarly, the observed mortality at these did not differ significantly from the mortality estimated by the CR-POSSUM score (hospital A, 2.9%/4.9%, P = 0.298; hospital B, 6.4%/6.5%, P = 1.000). Significant differences were seen in risk-adjusted comparison of most postoperative complications (by both LReA and PScA), but there were no differences in the rates of relaparotomy or anastomotic leakage that required surgery. For the hard outcome variable "postoperative mortality," none of the three risk adjustment procedures showed any difference between the hospitals. The CR-POSSUM score can be regarded as the most practicable tool for risk-adjusted comparison of the outcome of colon-carcinoma resection in clinical benchmarking.

5 CFR 530.307 - OPM review and adjustment of special rate schedules.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... 5305(d), special rate schedule adjustments made by OPM have the force and effect of statute. (d)(1) For... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false OPM review and adjustment of special rate... REGULATIONS PAY RATES AND SYSTEMS (GENERAL) Special Rate Schedules for Recruitment and Retention General...

Cross-National Trends in Mortality Rates among the Elderly.

ERIC Educational Resources Information Center

Myers, GeorgeC.

1978-01-01

An examination of death rates among the elderly and trends over the period 1950-1975 and 1970-1975 for selected developed nations provides evidence of continued strong mortality declines for females and somewhat mixed results for males. Implications of these trends for forecasting the mortality component of U.S. population projections are…

Evaluation of the DAVROS (Development And Validation of Risk-adjusted Outcomes for Systems of emergency care) risk-adjustment model as a quality indicator for healthcare

PubMed Central

Wilson, Richard; Goodacre, Steve W; Klingbajl, Marcin; Kelly, Anne-Maree; Rainer, Tim; Coats, Tim; Holloway, Vikki; Townend, Will; Crane, Steve

2014-01-01

Background and objective Risk-adjusted mortality rates can be used as a quality indicator if it is assumed that the discrepancy between predicted and actual mortality can be attributed to the quality of healthcare (ie, the model has attributional validity). The Development And Validation of Risk-adjusted Outcomes for Systems of emergency care (DAVROS) model predicts 7-day mortality in emergency medical admissions. We aimed to test this assumption by evaluating the attributional validity of the DAVROS risk-adjustment model. Methods We selected cases that had the greatest discrepancy between observed mortality and predicted probability of mortality from seven hospitals involved in validation of the DAVROS risk-adjustment model. Reviewers at each hospital assessed hospital records to determine whether the discrepancy between predicted and actual mortality could be explained by the healthcare provided. Results We received 232/280 (83%) completed review forms relating to 179 unexpected deaths and 53 unexpected survivors. The healthcare system was judged to have potentially contributed to 10/179 (8%) of the unexpected deaths and 26/53 (49%) of the unexpected survivors. Failure of the model to appropriately predict risk was judged to be responsible for 135/179 (75%) of the unexpected deaths and 2/53 (4%) of the unexpected survivors. Some 10/53 (19%) of the unexpected survivors died within a few months of the 7-day period of model prediction. Conclusions We found little evidence that deaths occurring in patients with a low predicted mortality from risk-adjustment could be attributed to the quality of healthcare provided. PMID:23605036

Mortality in the Vertebroplasty Population

PubMed Central

McDonald, Robert J.; Achenbach, Sara; Atkinson, Elizabeth; Gray, Leigh A.; Cloft, Harry J.; Melton, L. Joseph; Kallmes, David F.

2011-01-01

Purpose Vertebroplasty is an effective treatment for painful compression fractures refractory to conservative management. Since there are limited data regarding the survival characteristics of this patient population, we compared the survival of a treated to an untreated vertebral fracture cohort to determine if vertebroplasty affects mortality rates. Materials and Methods The survival of a treated cohort, comprising 524 vertebroplasty recipients with refractory osteoporotic vertebral compression fractures, was compared to a separate, historical cohort of 589 subjects with fractures not treated by vertebroplasty who were identified from the Rochester Epidemiology Project. Mortality was compared between cohorts using Cox proportional hazard models adjusting for age, gender, and Charlson indices of co-morbidity. Mortality was also correlated with pre-, peri-, and post-procedural clinical metrics (e.g., cement volume utilization, Roland-Morris Disability Questionnaire score, analog pain scales, frequency of narcotic use, and improvements in mobility) within the treated cohort. Results Vertebroplasty recipients demonstrated 77% of the survival expected for individuals of similar age, ethnicity, and gender within the US population. When compared to individuals with both symptomatic and asymptomatic untreated vertebral fractures, vertebroplasty recipients retained a 17% greater mortality risk. However, when compared to symptomatic untreated vertebral fractures, vertebroplasty recipients had no increased mortality following adjustment for differences in age, sex and co-morbidity (HR 1.02; CI 0.82–1.25). In addition, no clinical metrics used to assess the efficacy of vertebroplasty were predictive of survival. Conclusion Vertebroplasty recipients have mortality rates similar to individuals with untreated symptomatic fractures but worse mortality compared to those with asymptomatic vertebral fractures. PMID:21998109

Differences between Men and Women in Time Trends in Lung Cancer Mortality in Spain (1980-2013).

PubMed

Martín-Sánchez, Juan Carlos; Clèries, Ramon; Lidón-Moyano, Cristina; González-de Paz, Luis; Martínez-Sánchez, Jose M

2016-06-01

The main risk factor for lung cancer is smoking, a habit that varies according to age and sex. The objective of this study was to explore trends in lung cancer mortality by sex and age from 1980 to 2013 in Spain. We used lung cancer mortality (International Classification of Diseases code 162 for the 9th edition, and codes C33 and C34 for 10th edition) and population data from the Spanish National Statistics Institute. Crude, truncated, age-adjusted mortality and age-specific mortality rates were assessed through joinpoint regression to estimate the annual percent change (APC). Age-adjusted mortality rate significantly increased from 1980 to 1991 among men (APC=3.12%) and significantly decreased between 2001 and 2013 (APC=-1.53%), a similar pattern was observed in age-specific rates. Among women, age-adjusted mortality rate increased from 1989 (APC 1989-1997=1.82%), with the greatest increase observed from 1997 until the end of the study in 2013 (APC=4.41%). Diverging trends in the prevalence of smoking could explain the increase in the rate of lung cancer-related mortality among Spanish women since the early 1990s. Public health policies should be implemented to reduce tobacco consumption in women and halt the increase in lung cancer mortality. Copyright © 2016 SEPAR. Published by Elsevier Espana. All rights reserved.

Trends in oral cavity, pharyngeal, oesophageal and gastric cancer mortality rates in Spain, 1952-2006: an age-period-cohort analysis.

PubMed

Seoane-Mato, Daniel; Aragonés, Nuria; Ferreras, Eva; García-Pérez, Javier; Cervantes-Amat, Marta; Fernández-Navarro, Pablo; Pastor-Barriuso, Roberto; López-Abente, Gonzalo

2014-04-11

Although oral cavity, pharyngeal, oesophageal and gastric cancers share some risk factors, no comparative analysis of mortality rate trends in these illnesses has been undertaken in Spain. This study aimed to evaluate the independent effects of age, death period and birth cohort on the mortality rates of these tumours. Specific and age-adjusted mortality rates by tumour and sex were analysed. Age-period-cohort log-linear models were fitted separately for each tumour and sex, and segmented regression models were used to detect changes in period- and cohort-effect curvatures. Among men, the period-effect curvatures for oral cavity/pharyngeal and oesophageal cancers displayed a mortality trend that rose until 1995 and then declined. Among women, oral cavity/pharyngeal cancer mortality increased throughout the study period whereas oesophageal cancer mortality decreased after 1970. Stomach cancer mortality decreased in both sexes from 1965 onwards. Lastly, the cohort-effect curvature showed a certain degree of similarity for all three tumours in both sexes, which was greater among oral cavity, pharyngeal and oesophageal cancers, with a change point in evidence, after which risk of death increased in cohorts born from the 1910-1920s onwards and decreased among the 1950-1960 cohorts and successive generations. This latter feature was likewise observed for stomach cancer. While the similarities of the cohort effects in oral cavity/pharyngeal, oesophageal and gastric tumours support the implication of shared risk factors, the more marked changes in cohort-effect curvature for oral cavity/pharyngeal and oesophageal cancer could be due to the greater influence of some risk factors in their aetiology, such as smoking and alcohol consumption. The increase in oral cavity/pharyngeal cancer mortality in women deserves further study.

Changes in mental health services and suicide mortality in Norway: an ecological study

PubMed Central

2011-01-01

Background Mental disorders are strongly associated with excess suicide risk, and successful treatment might prevent suicide. Since 1990, and particularly after 1998, there has been a substantial increase in mental health service resources in Norway. This study aimed to investigate whether these changes have had an impact on suicide mortality. Methods We used Poisson regression analyses to assess the effect of changes in five mental health services variables on suicide mortality in five Norwegian health regions during the period 1990-2006. These variables included: number of man-labour years by all personnel, number of discharges, number of outpatient consultations, number of inpatient days, and number of hospital beds. Adjustments were made for sales of alcohol, sales of antidepressants, education, and unemployment. Results In the period 1990-2006, we observed a total of 9480 suicides and the total suicide rate declined by 26%. None of the mental health services variables were significantly associated with female or male suicide mortality in the adjusted analyses (p > 0.05). Sales of antidepressants (adjusted Incidence Rate Ratio = 0.98; 95% CI = 0.97-1.00) and sales of alcohol (adjusted IRR = 1.41; 95% CI = 1.18-1.72) were significantly associated with female suicide mortality; education (adjusted IRR = 0.86; 95% CI = 0.79-0.94) and unemployment (adjusted IRR = 0.91; 95% CI = 0.85-0.97) were significantly associated with male suicide mortality. Conclusions The adjusted analyses in the present study indicate that increased resources in Norwegian mental health services in the period 1990-2006 were statistically unrelated to suicide mortality. PMID:21443801

Lower Mortality Rate in Elderly Patients With Community‐Onset Pneumonia on Treatment With Aspirin

PubMed Central

Falcone, Marco; Russo, Alessandro; Cangemi, Roberto; Farcomeni, Alessio; Calvieri, Camilla; Barillà, Francesco; Scarpellini, Maria Gabriella; Bertazzoni, Giuliano; Palange, Paolo; Taliani, Gloria; Venditti, Mario; Violi, Francesco

2015-01-01

Background Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. Methods and Results Consecutive patients admitted to the University‐Hospital Policlinico Umberto I (Rome, Italy) with community‐onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow‐up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; P<0.001) were aspirin nonusers. Overall, nonfatal CVEs occurred in 7% of patients, 8.3% in nonaspirin users, and 4.9% in aspirin users (odds ratio, 1.77; 95% confidence interval, 1.03 to 3.04; P=0.040). The Cox regression analysis showed that pneumonia severity index (PSI), severe sepsis, pleural effusion, and PaO2/FiO2 ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P=0.029) for total mortality. Conclusions This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia. PMID:25564372

Do Mortality Rates in Eating Disorders Change over Time? A Longitudinal Look at Anorexia Nervosa and Bulimia Nervosa

PubMed Central

Franko, Debra L.; Keshaviah, Aparna; Eddy, Kamryn T.; Krishna, Meera; Davis, Martha C.; Keel, Pamela K.; Herzog, David B.

2014-01-01

Objective Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. Method Beginning in 1987, 246 treatment-seeking women with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. Results Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 [95% CI=2.4-7.3] for lifetime anorexia nervosa and 2.33 [95% CI=0.3-8.4] for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among women with lifetime anorexia nervosa peaked within the first 10 years of follow-up resulting in a standardized mortality ratio of 7.7 [95% CI=3.7-14.2]. The standardized mortality ratio varied by duration of illness and was 3.2 [95% CI=0.9-8.3] for women with lifetime anorexia nervosa for 0-15 years (4/119 died), and 6.6 [95% CI=3.2-12.1] for women with lifetime anorexia nervosa for >15-30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse (p<0.0001), low body mass index (p=0.0005), and poor social adjustment (p=0.0090). Conclusions These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and/or poor psychosocial functioning raise the risk for mortality in anorexia nervosa. PMID:23771148

Comparing Self-Reported Health Status and Diagnosis-Based Risk Adjustment to Predict 1- and 2 to 5-Year Mortality

PubMed Central

Pietz, Kenneth; Petersen, Laura A

2007-01-01

Objectives To compare the ability of two diagnosis-based risk adjustment systems and health self-report to predict short- and long-term mortality. Data Sources/Study Setting Data were obtained from the Department of Veterans Affairs (VA) administrative databases. The study population was 78,164 VA beneficiaries at eight medical centers during fiscal year (FY) 1998, 35,337 of whom completed an 36-Item Short Form Health Survey for veterans (SF-36V) survey. Study Design We tested the ability of Diagnostic Cost Groups (DCGs), Adjusted Clinical Groups (ACGs), SF-36V Physical Component score (PCS) and Mental Component Score (MCS), and eight SF-36V scales to predict 1- and 2–5 year all-cause mortality. The additional predictive value of adding PCS and MCS to ACGs and DCGs was also evaluated. Logistic regression models were compared using Akaike's information criterion, the c-statistic, and the Hosmer–Lemeshow test. Principal Findings The c-statistics for the eight scales combined with age and gender were 0.766 for 1-year mortality and 0.771 for 2–5-year mortality. For DCGs with age and gender the c-statistics for 1- and 2–5-year mortality were 0.778 and 0.771, respectively. Adding PCS and MCS to the DCG model increased the c-statistics to 0.798 for 1-year and 0.784 for 2–5-year mortality. Conclusions The DCG model showed slightly better performance than the eight-scale model in predicting 1-year mortality, but the two models showed similar performance for 2–5-year mortality. Health self-report may add health risk information in addition to age, gender, and diagnosis for predicting longer-term mortality. PMID:17362210

Forecasting the mortality rates using Lee-Carter model and Heligman-Pollard model

NASA Astrophysics Data System (ADS)

Ibrahim, R. I.; Ngataman, N.; Abrisam, W. N. A. Wan Mohd

2017-09-01

Improvement in life expectancies has driven further declines in mortality. The sustained reduction in mortality rates and its systematic underestimation has been attracting the significant interest of researchers in recent years because of its potential impact on population size and structure, social security systems, and (from an actuarial perspective) the life insurance and pensions industry worldwide. Among all forecasting methods, the Lee-Carter model has been widely accepted by the actuarial community and Heligman-Pollard model has been widely used by researchers in modelling and forecasting future mortality. Therefore, this paper only focuses on Lee-Carter model and Heligman-Pollard model. The main objective of this paper is to investigate how accurately these two models will perform using Malaysian data. Since these models involves nonlinear equations that are explicitly difficult to solve, the Matrix Laboratory Version 8.0 (MATLAB 8.0) software will be used to estimate the parameters of the models. Autoregressive Integrated Moving Average (ARIMA) procedure is applied to acquire the forecasted parameters for both models as the forecasted mortality rates are obtained by using all the values of forecasted parameters. To investigate the accuracy of the estimation, the forecasted results will be compared against actual data of mortality rates. The results indicate that both models provide better results for male population. However, for the elderly female population, Heligman-Pollard model seems to underestimate to the mortality rates while Lee-Carter model seems to overestimate to the mortality rates.

Widespread increase of tree mortality rates in the western United States

Treesearch

Phillip J. van Mantgem; Nathan L. Stephenson; John C. Byrne; Lori D. Daniels; Jerry F. Franklin; Peter Z. Fule; Mark E. Harmon; Andrew J. Larson; Jeremy M. Smith; Alan H. Taylor; Thomas T. Veblen

2009-01-01

Persistent changes in tree mortality rates can alter forest structure, composition, and ecosystem services such as carbon sequestration. Our analyses of longitudinal data from unmanaged old forests in the western United States showed that background (noncatastrophic) mortality rates have increased rapidly in recent decades, with doubling periods ranging from 17 to 29...

Forecasting the mortality rates of Indonesian population by using neural network

NASA Astrophysics Data System (ADS)

Safitri, Lutfiani; Mardiyati, Sri; Rahim, Hendrisman

2018-03-01

A model that can represent a problem is required in conducting a forecasting. One of the models that has been acknowledged by the actuary community in forecasting mortality rate is the Lee-Certer model. Lee Carter model supported by Neural Network will be used to calculate mortality forecasting in Indonesia. The type of Neural Network used is feedforward neural network aligned with backpropagation algorithm in python programming language. And the final result of this study is mortality rate in forecasting Indonesia for the next few years

Causes and implications of the correlation between forest productivity and tree mortality rates

USGS Publications Warehouse

Stephenson, Nathan L.; van Mantgem, Philip J.; Bunn, Andrew G.; Bruner, Howard; Harmon, Mark E.; O'Connell, Kari B.; Urban, Dean L.; Franklin, Jerry F.

2011-01-01

For only one of these four mechanisms, competition, can high mortality rates be considered to be a relatively direct consequence of high NPP. The remaining mechanisms force us to adopt a different view of causality, in which tree growth rates and probability of mortality can vary with at least a degree of independence along productivity gradients. In many cases, rather than being a direct cause of high mortality rates, NPP may remain high in spite of high mortality rates. The independent influence of plant enemies and other factors helps explain why forest biomass can show little correlation, or even negative correlation, with forest NPP.

Risk Adjustment for a Children's Capitation Rate

PubMed Central

Newhouse, Joseph P.; Sloss, Elizabeth M.; Manning, Willard G.; Keeler, Emmett B.

1993-01-01

Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual outpatient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping. PMID:10133708

Risk adjustment for a children's capitation rate.

PubMed

Newhouse, J P; Sloss, E M; Manning, W G; Keeler, E B

1993-01-01

Few capitation arrangements vary premiums by a child's health characteristics, yielding an incentive to discriminate against children with predictably high expenditures from chronic diseases. In this article, we explore risk adjusters for the 35 percent of the variance in annual out-patient expenditure we find to be potentially predictable. Demographic factors such as age and gender only explain 5 percent of such variance; health status measures explain 25 percent, prior use and health status measures together explain 65 to 70 percent. The profit from risk selection falls less than proportionately with improved ability to adjust for risk. Partial capitation rates may be necessary to mitigate skimming and dumping.

Captive Reptile Mortality Rates in the Home and Implications for the Wildlife Trade

PubMed Central

Robinson, Janine E.; St. John, Freya A. V.; Griffiths, Richard A.; Roberts, David L.

2015-01-01

The trade in wildlife and keeping of exotic pets is subject to varying levels of national and international regulation and is a topic often attracting controversy. Reptiles are popular exotic pets and comprise a substantial component of the live animal trade. High mortality of traded animals raises welfare concerns, and also has implications for conservation if collection from the wild is required to meet demand. Mortality of reptiles can occur at any stage of the trade chain from collector to consumer. However, there is limited information on mortality rates of reptiles across trade chains, particularly amongst final consumers in the home. We investigated mortality rates of reptiles amongst consumers using a specialised technique for asking sensitive questions, additive Randomised Response Technique (aRRT), as well as direct questioning (DQ). Overall, 3.6% of snakes, chelonians and lizards died within one year of acquisition. Boas and pythons had the lowest reported mortality rates of 1.9% and chameleons had the highest at 28.2%. More than 97% of snakes, 87% of lizards and 69% of chelonians acquired by respondents over five years were reported to be captive bred and results suggest that mortality rates may be lowest for captive bred individuals. Estimates of mortality from aRRT and DQ did not differ significantly which is in line with our findings that respondents did not find questions about reptile mortality to be sensitive. This research suggests that captive reptile mortality in the home is rather low, and identifies those taxa where further effort could be made to reduce mortality rates. PMID:26556237

Captive Reptile Mortality Rates in the Home and Implications for the Wildlife Trade.

PubMed

Robinson, Janine E; St John, Freya A V; Griffiths, Richard A; Roberts, David L

2015-01-01

The trade in wildlife and keeping of exotic pets is subject to varying levels of national and international regulation and is a topic often attracting controversy. Reptiles are popular exotic pets and comprise a substantial component of the live animal trade. High mortality of traded animals raises welfare concerns, and also has implications for conservation if collection from the wild is required to meet demand. Mortality of reptiles can occur at any stage of the trade chain from collector to consumer. However, there is limited information on mortality rates of reptiles across trade chains, particularly amongst final consumers in the home. We investigated mortality rates of reptiles amongst consumers using a specialised technique for asking sensitive questions, additive Randomised Response Technique (aRRT), as well as direct questioning (DQ). Overall, 3.6% of snakes, chelonians and lizards died within one year of acquisition. Boas and pythons had the lowest reported mortality rates of 1.9% and chameleons had the highest at 28.2%. More than 97% of snakes, 87% of lizards and 69% of chelonians acquired by respondents over five years were reported to be captive bred and results suggest that mortality rates may be lowest for captive bred individuals. Estimates of mortality from aRRT and DQ did not differ significantly which is in line with our findings that respondents did not find questions about reptile mortality to be sensitive. This research suggests that captive reptile mortality in the home is rather low, and identifies those taxa where further effort could be made to reduce mortality rates.

39 CFR 3010.26 - Calculation of unused rate adjustment authority.

Code of Federal Regulations, 2011 CFR

2011-07-01

... authority for each class is equal to the difference between the maximum allowable percentage change in rates under the applicable rate limitation and the actual percentage change in rates for that class. (c) When... rate adjustment leading to its computation. ...

Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission.

PubMed

Meacock, Rachel; Anselmi, Laura; Kristensen, Søren Rud; Doran, Tim; Sutton, Matt

2017-01-01

weekend days than weekdays (35.9 vs. 80.8). The mortality rate was significantly higher at weekends amongst direct admissions (risk-adjusted OR: 1.212) due to the proportionately greater reduction in admissions relative to deaths. Conclusions There are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted. The reduced availability of primary care services and the higher Accident and Emergency admission threshold at weekends mean fewer and sicker patients are admitted at weekends than during the week. Extending services in hospitals and in the community at weekends may increase the number of emergency admissions and therefore lower mortality, but may not reduce the absolute number of deaths.

[Morbidity and mortality rates in relation to the "surgeon factor" after duodenopancreatectomy].

PubMed

Targarona, Javier; Pando, Elizabeth; Garatea, Rafael; Vavoulis, Alexandra; Montoya, Eduardo

2007-10-01

The present study was designed to determine whether the surgeon factor has an independent effect on morbidity and mortality rates after duodenopancreatectomy. Between October 2002 and December 2006, we performed a study of 119 patients who underwent duodenopancreatectomy. The surgeons were divided into 3 groups according to the number of interventions they performed each year: a low volume group (three Whipple procedures per year), a medium volume group (four to 10 Whipple procedures per year) and a high volume group (> 10 Whipple procedures per year). The morbidity rate was higher in the low volume group (82%) than in the high volume group (35%). Length of hospital stay was clearly longer in the low and medium volume groups (27 days, and 21 days) than in the high volume group (17 days). Comparison of the results of the 3 groups revealed that the group performing three or less interventions per year (low volume) had the highest mortality rate (47%), while the group performing more than 10 interventions per year (high volume) had a very low mortality rate (4%). We found that the volume-to-surgeon ratio was inversely proportional to morbidity, length of hospital stay, return to oral intake, and mortality rates. Therefore, increasing surgical volume could improve morbidity and mortality rates.

The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis.

PubMed

Tørring, N; Sanghani, S N; Petrides, G; Kellner, C H; Østergaard, S D

2017-05-01

Electroconvulsive therapy (ECT) remains underutilized because of fears of cognitive and medical risks, including the risk of death. In this study, we aimed to assess the mortality rate of ECT by means of a systematic review and pooled analysis. The study was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The ECT-related mortality rate was calculated as the total number of ECT-related deaths reported in the included studies divided by the total number of ECT treatments. Fifteen studies with data from 32 countries reporting on a total of 766 180 ECT treatments met the inclusion criteria. Sixteen cases of ECT-related death were reported in the included studies yielding an ECT-related mortality rate of 2.1 per 100 000 treatments (95% CI: 1.2-3.4). In the nine studies that were published after 2001 (covering 414 747 treatments), there was only one reported ECT-related death. The ECT-related mortality rate was estimated at 2.1 per 100 000 treatments. In comparison, a recent analysis of the mortality of general anesthesia in relation to surgical procedures reported a mortality rate of 3.4 per 100 000. Our findings document that death caused by ECT is an extremely rare event. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009.

PubMed

Singh, Gopal K; Siahpush, Mohammad

2014-04-01

This study examined trends in rural-urban disparities in all-cause and cause-specific mortality in the USA between 1969 and 2009. A rural-urban continuum measure was linked to county-level mortality data. Age-adjusted death rates were calculated by sex, race, cause-of-death, area-poverty, and urbanization level for 13 time periods between 1969 and 2009. Cause-of-death decomposition and log-linear and Poisson regression were used to analyze rural-urban differentials. Mortality rates increased with increasing levels of rurality overall and for non-Hispanic whites, blacks, and American Indians/Alaska Natives. Despite the declining mortality trends, mortality risks for both males and females and for blacks and whites have been increasingly higher in non-metropolitan than metropolitan areas, particularly since 1990. In 2005-2009, mortality rates varied from 391.9 per 100,000 population for Asians/Pacific Islanders in rural areas to 1,063.2 for blacks in small-urban towns. Poverty gradients were steeper in rural areas, which maintained higher mortality than urban areas after adjustment for poverty level. Poor blacks in non-metropolitan areas experienced two to three times higher all-cause and premature mortality risks than affluent blacks and whites in metropolitan areas. Disparities widened over time; excess mortality from all causes combined and from several major causes of death in non-metropolitan areas was greater in 2005-2009 than in 1990-1992. Causes of death contributing most to the increasing rural-urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer's disease. Residents in metropolitan areas experienced larger mortality reductions during the past four decades than non-metropolitan residents, contributing to the widening gap.

Heart rate is an independent predictor of all-cause mortality in individuals with type 2 diabetes: The diabetes heart study.

PubMed

Prasada, Sameer; Oswalt, Cameron; Yeboah, Phyllis; Saylor, Georgia; Bowden, Donald; Yeboah, Joseph

2018-01-15

To assess the association of resting heart rate with all-cause and cardiovascular disease (CVD) mortality in the Diabetes Heart Study (DHS). Out of a total of 1443 participants recruited into the DHS, 1315 participants with type 2 diabetes who were free of atrial fibrillation and supraventricular tachycardia during the baseline exam were included in this analysis. Heart rate was collected from baseline resting electrocardiogram and mortality (all-cause and CVD) was obtained from state and national death registry. Kaplan-Meier (K-M) and Cox proportional hazard analyses were used to assess the association. The mean age, body mass index (BMI) and systolic blood pressure (SBP) of the cohort were 61.4 ± 9.2 years, 32.0 ± 6.6 kg/m 2 , and 139.4 ± 19.4 mmHg respectively. Fifty-six percent were females, 85% were whites, 15% were blacks, 18% were smokers. The mean ± SD heart rate was 69.8 (11.9) beats per minute (bpm). After a median follow-up time of 8.5 years (maximum follow-up time is 14.0 years), 258 participants were deceased. In K-M analysis, participants with heart rate above the median had a significantly higher event rate compared with those below the median (log-rank P = 0.0223). A one standard deviation increase in heart rate was associated with all-cause mortality in unadjusted (hazard ratio 1.16, 95%CI: 1.03-1.31) and adjusted (hazard ratio 1.20, 95%CI: 1.05-1.37) models. Similar results were obtained with CVD mortality as the outcome of interest. Heart rate is an independent predictor of all-cause mortality in this population with type 2 diabetes. In this study, a 1-SD increase in heart rate was associated with a 20% increase in risk suggesting that additional prognostic information may be gleaned from this ubiquitously collected vital sign.

Surgical volume and postoperative mortality rate at a referral hospital in Western Uganda: Measuring the Lancet Commission on Global Surgery indicators in low-resource settings.

PubMed

Anderson, Geoffrey A; Ilcisin, Lenka; Abesiga, Lenard; Mayanja, Ronald; Portal Benetiz, Noralis; Ngonzi, Joseph; Kayima, Peter; Shrime, Mark G

2017-06-01

The Lancet Commission on Global Surgery recommends that every country report its surgical volume and postoperative mortality rate. Little is known, however, about the numbers of operations performed and the associated postoperative mortality rate in low-income countries or how to best collect these data. For one month, every patient who underwent an operation at a referral hospital in western Uganda was observed. These patients and their outcomes were followed until discharge. Prospective data were compared with data obtained from logbooks and patient charts to determine the validity of using retrospective methods for collecting these metrics. Surgical volume at this regional hospital in Uganda is 8,515 operations/y, compared to 4,000 operations/y reported in the only other published data. The postoperative mortality rate at this hospital is 2.4%, similar to other hospitals in low-income countries. Finding patient files in the medical records department was time consuming and yielded only 62% of the files. Furthermore, a comparison of missing versus found charts revealed that the missing charts were significantly different from the found charts. Logbooks, on the other hand, captured 99% of the operations and 94% of the deaths. Our results describe a simple, reproducible, accurate, and inexpensive method for collection of the Lancet Commission on Global Surgery variables using logbooks that already exist in most hospitals in low-income countries. While some have suggested using risk-adjusted postoperative mortality rate as a more equitable variable, our data suggest that only a limited amount of risk adjustment is possible given the limited available data. Copyright © 2017 Elsevier Inc. All rights reserved.

Racial disparities in stage-specific colorectal cancer mortality rates from 1985 to 2008.

PubMed

Robbins, Anthony S; Siegel, Rebecca L; Jemal, Ahmedin

2012-02-01

Since the early 1980s, colorectal cancer (CRC) mortality rates for whites and blacks in the United States have been diverging as a result of earlier and larger reductions in death rates for whites. We examined whether this mortality pattern varies by stage at diagnosis. The Incidence-Based Mortality database of the Surveillance, Epidemiology, and End Results (SEER) Program was used to examine data from the nine original SEER regions. Our main outcome measures were changes in stage-specific mortality rates by race. From 1985 to 1987 to 2006 to 2008, CRC mortality rates decreased for each stage in both blacks and whites, but for every stage, the decreases were smaller for blacks, particularly for distant-stage disease. For localized stage, mortality rates decreased 30.3% in whites compared with 13.2% in blacks; for regional stage, declines were 48.5% in whites compared with 34.0% in blacks; and for distant stage, declines were 32.6% in whites compared with 4.6% in blacks. As a result, the black-white rate ratios increased from 1.17 (95% CI, 0.98 to 1.39) to 1.41 (95% CI, 1.21 to 1.63) for localized disease, from 1.03 (95% CI, 0.93 to 1.14) to 1.30 (95% CI, 1.17 to 1.44) for regional disease, and from 1.21 (95% CI, 1.10 to 1.34) to 1.72 (95% CI, 1.58 to 1.86) for distant-stage disease. In absolute terms, the disparity in distant-stage mortality rates accounted for approximately 60% of the overall black-white mortality disparity. The black-white disparities in CRC mortality increased for each stage of the disease, but the overall disparity in overall mortality was largely driven by trends for late-stage disease. Concerted efforts to prevent or detect CRC at earlier stages in blacks could improve the worsening black- white disparities.

Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality

PubMed Central

Matsushita, Kunihiro; Sang, Yingying; Ballew, Shoshana H; Appel, Lawrence J.; Arima, Hisatomi; Chadban, Steven J.; Cirillo, Massimo; Djurdjev, Ognjenka; Green, Jamie A; Heine, Gunnar H; Inker, Lesley A; Irie, Fujiko; Ishani, Areef; Ix, Joachim H.; Kovesdy, Csaba P.; Marks, Angharad; Ohkubo, Takayoshi; Shalev, Varda; Shankar, Anoop; Wen, Chi Pang; de Jong, Paul E.; Iseki, Kunitoshi; Stengel, Benedicte

2014-01-01

Importance The established chronic kidney disease (CKD) progression endpoint, end-stage renal disease (ESRD) or doubling of serum creatinine (corresponding to a change in estimated glomerular filtration rate (eGFR) of −57% or greater) is a late event, limiting feasibility of nephrology clinical trials. Objective To characterize the association of decline in eGFR with subsequent progression to ESRD, with implications for using lesser declines in eGFR as potential alternative endpoints for CKD progression. Since most people with CKD die before reaching ESRD, we also investigated mortality risk. Data Sources Individual meta-analysis of up to 1.7 million participants with 12,344 ESRD events and 223,944 deaths from 35 cohorts. Study Selection Cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine over 1-3 years and outcome data. Data Extraction and Synthesis Transfer of individual participant data or standardized analysis of outputs for random effects meta-analysis took place between July 2012 and September 2013 with baseline eGFRs during 1975-2012. Main Outcomes and Measures ESRD (initiation of dialysis or transplantation) or all-cause mortality risk related to percent change in eGFR over 2 years adjusted for potential confounders and first eGFR. Results The adjusted hazard ratios (HR) of ESRD and mortality were exponentially higher with larger eGFR decline. Among participants with baseline eGFR <60 ml/min/1.73m2, the adjusted HRs for ESRD were 32.1 (95% CI 22.3-46.3) and 5.4 (4.5-6.4) for −57% and −30% eGFR changes, respectively. However, changes of −30% or greater were much more common than changes of −57% (6.9% (6.4-7.4%) vs. 0.79% (0.52-1.06%) in the whole consortium). This association was strong and consistent across length of baseline (1 or 3 years), baseline eGFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD for eGFR changes of −57%, −40%, −30% and 0% were 99% (95-100%), 83% (71-93%), 64

A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals

PubMed Central

Devereaux, P.J.; Choi, Peter T.L.; Lacchetti, Christina; Weaver, Bruce; Schünemann, Holger J.; Haines, Ted; Lavis, John N.; Grant, Brydon J.B.; Haslam, David R.S.; Bhandari, Mohit; Sullivan, Terrence; Cook, Deborah J.; Walter, Stephen D.; Meade, Maureen; Khan, Humaira; Bhatnagar, Neera; Guyatt, Gordon H.

2002-01-01

Background Canadians are engaged in an intense debate about the relative merits of private for-profit versus private not-for-profit health care delivery. To inform this debate, we undertook a systematic review and meta-analysis of studies comparing the mortality rates of private for-profit hospitals and those of private not-for-profit hospitals. Methods We identified studies through an electronic search of 11 bibliographical databases, our own files, consultation with experts, reference lists, PubMed and SciSearch. We masked the study results before determining study eligibility. Our eligibility criteria included observational studies or randomized controlled trials that compared private for-profit and private not-for-profit hospitals. We excluded studies that evaluated mortality rates in hospitals with a particular profit status that subsequently converted to the other profit status. For each study, we calculated a relative risk of mortality for private for-profit hospitals relative to private not-for-profit hospitals and pooled the studies of adult populations that included adjustment for potential confounders (e.g., teaching status, severity of illness) using a random effects model. Results Fifteen observational studies, involving more than 26 000 hospitals and 38 million patients, fulfilled the eligibility criteria. In the studies of adult populations, with adjustment for potential confounders, private for-profit hospitals were associated with an increased risk of death (relative risk [RR] 1.020, 95% confidence interval [CI] 1.003–1.038; p = 0.02). The one perinatal study with adjustment for potential confounders also showed an increased risk of death in private for-profit hospitals (RR 1.095, 95% CI 1.050–1.141; p < 0.0001). Interpretation Our meta-analysis suggests that private for-profit ownership of hospitals, in comparison with private not-for-profit ownership, results in a higher risk of death for patients. PMID:12054406

The role of gender in the association between self-rated health and mortality among older adults in Santiago, Chile: A cohort study

PubMed Central

Moreno, Ximena; Albala, Cecilia; Lera, Lydia; Sánchez, Hugo; Fuentes-García, Alejandra; Dangour, Alan D.

2017-01-01

Background Previous studies on the role of gender in the association between self-rated health and mortality have shown contrasting results. This study was aimed to determine the importance of gender in the association between self-rated health and mortality among older people in Santiago, Chile. Methods A 10 year follow-up of 1066 people aged 60 or more, from the Chilean cohort of the Study of Health, Ageing and Well-Being. Self-rated health was assessed in face to face interviews through a single general question, along with socio-demographic and health status information. Cox proportional hazards and flexible parametric models for survival analyses were employed. Results By the end of follow-up, 30.7% of women and 39.4% of men died. Adjusted hazard ratio of poor self-rated health, compared to good self-rated health, was 1.92(95% CI 1.29–2.86). In models stratified by gender, an increased risk of mortality was observed among women who rated their health as poor (HR = 2.21, 95% CI 1.43–3.40), but not among men (HR = 1.04, 95% CI 0.58–1.86). Age was associated with mortality in both groups; for men, functional limitation and underweight were also risk factors and obesity was a protective factor. Conclusions Compared to older women who rated their health as good, older women who rated their health as poor had a 2 fold increased risk of mortality over the subsequent 10 years. These findings stress the importance of considering a gender perspective into health programmes, including those focused on older people, in order to address the different elements that increase, on the long run, the risk of dying among older women and men. PMID:28719627

Body size and mortality rates in coral reef fishes: a three-phase relationship.

PubMed

Goatley, Christopher Harry Robert; Bellwood, David Roy

2016-10-26

Body size is closely linked to mortality rates in many animals, although the overarching patterns in this relationship have rarely been considered for multiple species. A meta-analysis of published size-specific mortality rates for coral reef fishes revealed an exponential decline in mortality rate with increasing body size, however, within this broad relationship there are three distinct phases. Phase one is characterized by naive fishes recruiting to reefs, which suffer extremely high mortality rates. In this well-studied phase, fishes must learn quickly to survive the many predation risks. After just a few days, the surviving fishes enter phase two, in which small increases in body size result in pronounced increases in lifespan (estimated 11 d mm -1 ). Remarkably, approximately 50% of reef fish individuals remain in phase two throughout their lives. Once fishes reach a size threshold of about 43 mm total length (TL) they enter phase three, where mortality rates are relatively low and the pressure to grow is presumably, significantly reduced. These phases provide a clearer understanding of the impact of body size on mortality rates in coral reef fishes and begin to reveal critical insights into the energetic and trophic dynamics of coral reefs. © 2016 The Author(s).

Body size and mortality rates in coral reef fishes: a three-phase relationship

PubMed Central

Bellwood, David Roy

2016-01-01

Body size is closely linked to mortality rates in many animals, although the overarching patterns in this relationship have rarely been considered for multiple species. A meta-analysis of published size-specific mortality rates for coral reef fishes revealed an exponential decline in mortality rate with increasing body size, however, within this broad relationship there are three distinct phases. Phase one is characterized by naive fishes recruiting to reefs, which suffer extremely high mortality rates. In this well-studied phase, fishes must learn quickly to survive the many predation risks. After just a few days, the surviving fishes enter phase two, in which small increases in body size result in pronounced increases in lifespan (estimated 11 d mm–1). Remarkably, approximately 50% of reef fish individuals remain in phase two throughout their lives. Once fishes reach a size threshold of about 43 mm total length (TL) they enter phase three, where mortality rates are relatively low and the pressure to grow is presumably, significantly reduced. These phases provide a clearer understanding of the impact of body size on mortality rates in coral reef fishes and begin to reveal critical insights into the energetic and trophic dynamics of coral reefs. PMID:27798308

Occupational risks for idiopathic pulmonary fibrosis mortality in the United States.

PubMed

Pinheiro, Germania A; Antao, Vinicius C; Wood, John M; Wassell, James T

2008-01-01

Metal and wood dust exposures have been identified as possible occupational risk factors for idiopathic pulmonary fibrosis (IPF). We analyzed mortality data using ICD-10 code J84.1--"Other interstitial pulmonary diseases with fibrosis," derived age-adjusted mortality rates for 1999-2003, and assessed occupational risks for 1999, by calculating proportionate mortality ratios (PMRs) and mortality odds ratios (MORs) using a matched case-control approach. We identified 84,010 IPF deaths, with an age-adjusted mortality rate of 75.7 deaths/million. Mortality rates were highest among males, whites, and those aged 85 and older. Three industry categories with potential occupational exposures recognized as risk factors for IPF were identified: "Wood buildings and mobile homes" (PMR = 4.5, 95% confidence interval (CI) 1.2-11.6 and MOR = 5.3, 95% CI 1.2-23.8), "Metal mining" (PMR = 2.4, 95% CI 1.3-4.0 and MOR = 2.2, 95% CI 1.1-4.4), and "Fabricated structural metal products" (PMR = 1.9, 95% CI 1.1-3.1 and MOR = 1.7, 95% CI 1.0-3.1). Workers in these industry categories may benefit from toxicological studies and improved surveillance for this disease.

Temporal Trends in Mortality from Ischemic and Hemorrhagic Stroke in Mexico, 1980-2012.

PubMed

Cruz, Copytzy; Campuzano-Rincón, Julio César; Calleja-Castillo, Juan Manuel; Hernández-Álvarez, Anaid; Parra, María Del Socorro; Moreno-Macias, Hortensia; Hernández-Girón, Carlos

2017-04-01

Over the past decades, the decline in mortality from stroke has been more pronounced in high-income countries than in low- and middle-income countries. We evaluated changes in temporal stroke mortality trends in Mexico according to sex and type of stroke. We assessed stroke mortality from Mexico's National Health Information System for the period from 1980 to 2012. We analyzed age-adjusted mortality rates by sex, type of stroke, and age group. The annual percentage change and the average annual percentage change (AAPC) in the slopes of the age-adjusted mortality trends were determined using joinpoint regression models. The age-adjusted mortality rates due to stroke decreased between 1980 and 2012, from 44.55 to 33.47 per 100,000 inhabitants, and the AAPC (95% confidence interval [CI]) was -.9 (-1.0 to -.7). The AAPC for females was -1.1 (-1.5 to -.7) and that for males was -.7 (-.9 to -.6). People older than 65 years showed the highest mortality throughout the period. Between 1980 and 2012, the AAPC (95% CI) for ischemic stroke was -3.8 (-4.8 to -2.8) and was -.5 (-.8 to -.2) for hemorrhagic stroke. For the same period, the AAPC for intracerebral hemorrhage (ICH) was -.7 (-1.6 to .2) and that for subarachnoid hemorrhage (SAH) was 1.6 (.4-2.8). The age-adjusted mortality rates of all strokes combined, ischemic stroke, hemorrhagic stroke, and ICH, decreased between 1980 and 2012 in Mexico. However, the increase in SAH mortality makes it necessary to explore the risk factors and clinical management of this type of stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Age and sex of surgeons and mortality of older surgical patients: observational study

PubMed Central

Jena, Anupam B; Orav, E John; Blumenthal, Daniel M; Tsai, Thomas C; Mehtsun, Winta T; Jha, Ashish K

2018-01-01

Abstract Objective To investigate whether patients’ mortality differs according to the age and sex of surgeons. Design Observational study. Setting US acute care hospitals. Participants 100% of Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries between 2011 and 2014. Main outcome measure Operative mortality rate of patients, defined as death during hospital admission or within 30 days of the operative procedure, after adjustment for patients’ and surgeons’ characteristics and indicator variables for hospitals. Results 892 187 patients who were treated by 45 826 surgeons were included. Patients’ mortality was lower for older surgeons than for younger surgeons: the adjusted operative mortality rates were 6.6% (95% confidence interval 6.5% to 6.7%), 6.5% (6.4% to 6.6%), 6.4% (6.3% to 6.5%), and 6.3% (6.2% to 6.5%) for surgeons aged under 40 years, 40-49 years, 50-59 years, and 60 years or over, respectively (P for trend=0.001). There was no evidence that adjusted operative mortality differed between patients treated by female versus male surgeons (adjusted mortality 6.3% for female surgeons versus 6.5% for male surgeons; adjusted odds ratio 0.97, 95% confidence interval 0.93 to 1.01). After stratification by sex of surgeon, patients’ mortality declined with age of surgeon for both male and female surgeons (except for female surgeons aged 60 or older); female surgeons in their 50s had the lowest operative mortality. Conclusion Using national data on Medicare beneficiaries in the US, this study found that patients treated by older surgeons had lower mortality than patients treated by younger surgeons. There was no evidence that operative mortality differed between male and female surgeons. PMID:29695473

Militarism and mortality. An international analysis of arms spending and infant death rates.

PubMed

Woolhandler, S; Himmelstein, D U

1985-06-15

Examination of data from 141 countries showed that infant mortality rates for 1979 were positively correlated with the proportion of gross national product devoted to military spending (r = 0.23, p less than 0.01) and negatively correlated with indicators of economic development, health resources, and social spending. In a multivariate analysis controlling for per caput gross national product, arms spending remained a significant positive predictor of infant mortality rate (p less than 0.0001), while the proportion of the population with access to clean water, the number of teachers per head, and caloric consumption per head were negative predictors. The multivariate model accounted for much of the observed variance in infant mortality rate (R2 = 0.78, p less than 0.0001), and showed good fit to similar data for the year 1972 (R2 = 0.80, p less than 0.0001). The model was also predictive of infant mortality rates in subgroup analysis of underdeveloped, middle developed, and developed nations. Analysis of time trends confirmed that an increase in military spending presages a poor record of improvement in infant mortality rate. These findings support the hypothesis that arms spending is causally related to infant mortality.

Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study.

PubMed

Sharma, Praveen; Dietrich, Thomas; Ferro, Charles J; Cockwell, Paul; Chapple, Iain L C

2016-02-01

Periodontitis may add to the systemic inflammatory burden in individuals with chronic kidney disease (CKD), thereby contributing to an increased mortality rate. This study aimed to determine the association between periodontitis and mortality rate (all-cause and cardiovascular disease-related) in individuals with stage 3-5 CKD, hitherto referred to as "CKD". Survival analysis was carried out using the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data. Cox proportional hazards regression was employed to assess the association between periodontitis and mortality, in individuals with CKD. This association was compared with the association between mortality and traditional risk factors in CKD mortality (diabetes, hypertension and smoking). Of the 13,784 participants eligible for analysis in NHANES III, 861 (6%) had CKD. The median follow-up for this cohort was 14.3 years. Adjusting for confounders, the 10-year all-cause mortality rate for individuals with CKD increased from 32% (95% CI: 29-35%) to 41% (36-47%) with the addition of periodontitis. For diabetes, the 10-year all-cause mortality rate increased to 43% (38-49%). There is a strong, association between periodontitis and increased mortality in individuals with CKD. Sources of chronic systemic inflammation (including periodontitis) may be important contributors to mortality in patients with CKD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Trends in oral cavity, pharyngeal, oesophageal and gastric cancer mortality rates in Spain, 1952–2006: an age-period-cohort analysis

PubMed Central

2014-01-01

Background Although oral cavity, pharyngeal, oesophageal and gastric cancers share some risk factors, no comparative analysis of mortality rate trends in these illnesses has been undertaken in Spain. This study aimed to evaluate the independent effects of age, death period and birth cohort on the mortality rates of these tumours. Methods Specific and age-adjusted mortality rates by tumour and sex were analysed. Age-period-cohort log-linear models were fitted separately for each tumour and sex, and segmented regression models were used to detect changes in period- and cohort-effect curvatures. Results Among men, the period-effect curvatures for oral cavity/pharyngeal and oesophageal cancers displayed a mortality trend that rose until 1995 and then declined. Among women, oral cavity/pharyngeal cancer mortality increased throughout the study period whereas oesophageal cancer mortality decreased after 1970. Stomach cancer mortality decreased in both sexes from 1965 onwards. Lastly, the cohort-effect curvature showed a certain degree of similarity for all three tumours in both sexes, which was greater among oral cavity, pharyngeal and oesophageal cancers, with a change point in evidence, after which risk of death increased in cohorts born from the 1910-1920s onwards and decreased among the 1950–1960 cohorts and successive generations. This latter feature was likewise observed for stomach cancer. Conclusions While the similarities of the cohort effects in oral cavity/pharyngeal, oesophageal and gastric tumours support the implication of shared risk factors, the more marked changes in cohort-effect curvature for oral cavity/pharyngeal and oesophageal cancer could be due to the greater influence of some risk factors in their aetiology, such as smoking and alcohol consumption. The increase in oral cavity/pharyngeal cancer mortality in women deserves further study. PMID:24725381

Tree mortality rates and tree population projections in Baltimore, Maryland, USA

Treesearch

David J. Nowak; Miki Kuroda; Daniel E. Crane

2004-01-01

Based on re-measurements (1999 and 2001) of randomly-distributed permanent plots within the city boundaries of Baltimore, Maryland, trees are estimated to have an annual mortality rate of 6.6% with an overall annual net change in the number of live trees of -4.2%. Tree mortality rates were significantly different based on tree size, condition, species, and Land use....

Urban poverty and infant mortality rate disparities.

PubMed

Sims, Mario; Sims, Tammy L; Bruce, Marino A

2007-04-01

This study examined whether the relationship between high poverty and infant mortality rates (IMRs) varied across race- and ethnic-specific populations in large urban areas. Data were drawn from 1990 Census and 1992-1994 Vital Statistics for selected U.S. metropolitan areas. High-poverty areas were defined as neighborhoods in which > or = 40% of the families had incomes below the federal poverty threshold. Bivariate models showed that high poverty was a significant predictor of IMR for each group; however, multivariate analyses demonstrate that maternal health and regional factors explained most of the variance in the group-specific models of IMR. Additional analysis revealed that high poverty was significantly associated with minority-white IMR disparities, and country of origin is an important consideration for ethnic birth outcomes. Findings from this study provide a glimpse into the complexity associated with infant mortality in metropolitan areas because they suggest that the factors associated with infant mortality in urban areas vary by race and ethnicity.

Baseline fatty acids, food groups, a diet score and 50-year all-cause mortality rates. An ecological analysis of the Seven Countries Study.

PubMed

Menotti, Alessandro; Kromhout, Daan; Puddu, Paolo Emilio; Alberti-Fidanza, Adalberta; Hollman, Peter; Kafatos, Anthony; Tolonen, Hanna; Adachi, Hisashi; Jacobs, David R

2017-12-01

This analysis deals with the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in 16 cohorts of the Seven Countries Study. A dietary survey was conducted at baseline in cohorts subsamples including chemical analysis of food samples representing average consumptions. Ecologic correlations of dietary variables were computed across cohorts with 50-year all-cause mortality rates, where 97% of men had died. There was a 12-year average age at death population difference between extreme cohorts. In the 1960s the average population intake of saturated (S) and trans (T) fatty acids and hard fats was high in the northern European cohorts while monounsaturated (M), polyunsaturated (P) fatty acids and vegetable oils were high in the Mediterranean areas and total fat was low in Japan. The 50-year all-cause mortality rates correlated (r= -0.51 to -0.64) ecologically inversely with the ratios M/S, (M + P)/(S + T) and vegetable foods and the ratio hard fats/vegetable oils. Adjustment for high socio-economic status strengthened (r= -0.62 to -0.77) these associations including MAI diet score. The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets. KEY MESSAGES We aimed at studying the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in the Seven Countries Study. The 50-year all-cause mortality rates correlated (r = -0.51 to -0.64) ecologically inversely with the ratios M/S [monounsaturated (M) + polyunsaturated (P)]/[saturated (S) + trans (T)] fatty acids and vegetable foods and the ratio hard fats/vegetable oils. After adjustment for high socio-economic status, associations with the ratios strengthened (r = -0.62 to -0.77) including also the MAI diet score

Mortality rates by occupation in Korea: a nationwide, 13-year follow-up study

PubMed Central

Lee, Hye-Eun; Kim, Hyoung-Ryoul; Chung, Yun Kyung; Kang, Seong-Kyu; Kim, Eun-A

2016-01-01

Objective The present study sought to identify inequalities in cause-specific mortality across different occupational groups in Korea. Methods The cohort included Korean workers enrolled in the national employment insurance programme between 1995 and 2000. Mortality was determined by matching death between 1995 and 2008 according to a nationwide registry of the Korea National Statistical Office. The cohort was divided into nine occupational groups according to the Korean Standard Occupational Classification (KSOC). Age-standardised mortality rates of each subcohort were calculated. Results The highest age-standardised mortality rate was identified in KSOC 6 (agricultural, forestry and fishery workers; male (M): 563.0 per 100 000, female (F): 206.0 per 100 000), followed by KSOC 9 (elementary occupations; M: 499.0, F: 163.4) and KSOC 8 (plant, machine operators and assemblers; M: 380.3, F: 157.8). The lowest rate occurred in KSOC 2 (professionals and related workers; M: 209.1, F: 93.3). Differences in mortality rates between KSOC 2 and KSOC 9 (M: 289.9, F: 70.1) and the rate ratio of KSCO9 to KSCO2 (M: 2.39, F: 1.75) were higher in men. The most prominent mortality rate difference was observed in external causes of death (M: 96.9, F: 21.6) and liver disease in men (38.3 per 100 000). Mental disease showed the highest rate ratio (M: 6.31, F: 13.00). Conclusions Substantial differences in mortality rates by occupation were identified. Main causes of death were injury, suicide and male liver disease. Development of policies to support occupations linked with a lower socioeconomic position should be prioritised. PMID:26920855

Trend in infant mortality rate in Argentina within the framework of the Millennium Development Goals.

PubMed

Finkelstein, Juliana Z; Duhau, Mariana; Speranza, Ana

2016-06-01

Infant mortality rate (IMR) is an indicator of the health status of a population and of the quality of and access to health care services. In 2000, and within the framework of the Millennium Development Goals, Argentina committed to achieve by 2015 a reduction by two thirds of its 1990 infant mortality rate, and to identify and close inter-jurisdictional gaps. The objective of this article is to describe the trend in infant mortality rate in Argentina and interjurisdictional gaps, infant mortality magnitude and causes, in compliance with the Millennium Development Goals. A descriptive study on infant mortality was conducted in Argentina in 1990 and between 2000 and 2013, based on vital statistics data published by the Health Statistics and Information Department of the Ministry of Health of Argentina. The following reductions were confirmed: 57.8% in IMR, 52.6% in neonatal mortality rate and 63.8% in post-neonatal mortality rate. The inter-provincial Gini coefficient for IMR decreased by 27%. The population attributable risk decreased by 16.6% for IMR, 38.8% for neonatal mortality rate and 51.5% for post-neonatal mortality rate in 2013 versus 1990. A significant reduction in infant mortality and its components has been shown, but not enough to meet the Millennium Development Goals. The reduction in IMR gaps reached the set goal; however, inequalities still persist. Sociedad Argentina de Pediatría.

A Novel Lung Disease Phenotype Adjusted for Mortality Attrition for Cystic Fibrosis Genetic Modifier Studies

PubMed Central

Taylor, Chelsea; Commander, Clayton W.; Collaco, Joseph M.; Strug, Lisa J.; Li, Weili; Wright, Fred A.; Webel, Aaron D.; Pace, Rhonda G.; Stonebraker, Jaclyn R.; Naughton, Kathleen; Dorfman, Ruslan; Sandford, Andrew; Blackman, Scott M.; Berthiaume, Yves; Paré, Peter; Drumm, Mitchell L.; Zielenski, Julian; Durie, Peter; Cutting, Garry R.; Knowles, Michael R.; Corey, Mary

2011-01-01

SUMMARY Genetic studies of lung disease in Cystic Fibrosis are hampered by the lack of a severity measure that accounts for chronic disease progression and mortality attrition. Further, combining analyses across studies requires common phenotypes that are robust to study design and patient ascertainment. Using data from the North American Cystic Fibrosis Modifier Consortium (Canadian Consortium for CF Genetic Studies, Johns Hopkins University CF Twin and Sibling Study, and University of North Carolina/Case Western Reserve University Gene Modifier Study), the authors calculated age-specific CF percentile values of FEV1 which were adjusted for CF age-specific mortality data. The phenotype was computed for 2061 patients representing the Canadian CF population, 1137 extreme phenotype patients in the UNC/Case Western study, and 1323 patients from multiple CF sib families in the CF Twin and Sibling Study. Despite differences in ascertainment and median age, our phenotype score was distributed in all three samples in a manner consistent with ascertainment differences, reflecting the lung disease severity of each individual in the underlying population. The new phenotype score was highly correlated with the previously recommended complex phenotype, but the new phenotype is more robust for shorter follow-up and for extreme ages. A disease progression and mortality adjusted phenotype reduces the need for stratification or additional covariates, increasing statistical power and avoiding possible distortions. This approach will facilitate large scale genetic and environmental epidemiological studies which will provide targeted therapeutic pathways for the clinical benefit of patients with CF. PMID:21462361

Postnatal growth rates covary weakly with embryonic development rates and do not explain adult mortality probability among songbirds on four continents.

PubMed

Martin, Thomas E; Oteyza, Juan C; Mitchell, Adam E; Potticary, Ahva L; Lloyd, Penn

2015-03-01

Growth and development rates may result from genetic programming of intrinsic processes that yield correlated rates between life stages. These intrinsic rates are thought to affect adult mortality probability and longevity. However, if proximate extrinsic factors (e.g., temperature, food) influence development rates differently between stages and yield low covariance between stages, then development rates may not explain adult mortality probability. We examined these issues based on study of 90 songbird species on four continents to capture the diverse life-history strategies observed across geographic space. The length of the embryonic period explained little variation (ca. 13%) in nestling periods and growth rates among species. This low covariance suggests that the relative importance of intrinsic and extrinsic influences on growth and development rates differs between stages. Consequently, nestling period durations and nestling growth rates were not related to annual adult mortality probability among diverse songbird species within or among sites. The absence of a clear effect of faster growth on adult mortality when examined in an evolutionary framework across species may indicate that species that evolve faster growth also evolve physiological mechanisms for ameliorating costs on adult mortality. Instead, adult mortality rates of species in the wild may be determined more strongly by extrinsic environmental causes.

Postnatal growth rates covary weakly with embryonic development rates and do not explain adult mortality probability among songbirds on four continents

USGS Publications Warehouse

Martin, Thomas E.; Oteyza, Juan C.; Mitchell, Adam E.; Potticary, Ahva L.; Lloyd, P.

2016-01-01

Growth and development rates may result from genetic programming of intrinsic processes that yield correlated rates between life stages. These intrinsic rates are thought to affect adult mortality probability and longevity. However, if proximate extrinsic factors (e.g., temperature, food) influence development rates differently between stages and yield low covariance between stages, then development rates may not explain adult mortality probability. We examined these issues based on study of 90 songbird species on four continents to capture the diverse life-history strategies observed across geographic space. The length of the embryonic period explained little variation (ca. 13%) in nestling periods and growth rates among species. This low covariance suggests that the relative importance of intrinsic and extrinsic influences on growth and development rates differs between stages. Consequently, nestling period durations and nestling growth rates were not related to annual adult mortality probability among diverse songbird species within or among sites. The absence of a clear effect of faster growth on adult mortality when examined in an evolutionary framework across species may indicate that species that evolve faster growth also evolve physiological mechanisms for ameliorating costs on adult mortality. Instead, adult mortality rates of species in the wild may be determined more strongly by extrinsic environmental causes.

Exploring geographic variation in US mortality rates using a spatial Durbin approach

PubMed Central

Yang, Tse-Chuan; Noah, Aggie; Shoff, Carla

2015-01-01

Previous studies focused on identifying the determinants of mortality in US counties have examined the relationships between mortality and explanatory covariates within a county only, and have ignored the well-documented spatial dependence of mortality. We challenge earlier literature by arguing that the mortality rate of a certain county may also be associated with the features of its neighboring counties beyond its own features. Drawing from both the spillover (i.e., same direction effect) and social relativity (i.e., opposite direction effect) perspectives, our spatial Durbin modeling results indicate that both theoretical perspectives provide valuable frameworks to guide the modeling of mortality variation in US counties. Our empirical findings support that mortality rate of a certain county is associated with the features of its neighbors beyond its own features. Specifically, we found support for the spillover perspective in which the percentage of the Hispanic population, concentrated disadvantage, and the social capital of a specific county are negatively associated with the mortality rate in the specific county and also in neighboring counties. On the other hand, the following covariates fit the social relativity process: health insurance coverage, percentage of non-Hispanic other races, and income inequality. Their direction of the associations with mortality in the specific county is opposite to that of the relationships with mortality in neighboring counties. Methodologically, spatial Durbin modeling addresses the shortcomings of traditional analytic approaches used in ecological mortality research such as ordinary least squares, spatial error, and spatial lag regression. Our results produce new insights drawn from unbiased estimates. PMID:25642156

Cancer mortality disparities among New York City's Upper Manhattan neighborhoods.

PubMed

Hashim, Dana; Manczuk, Marta; Holcombe, Randall; Lucchini, Roberto; Boffetta, Paolo

2017-11-01

The East Harlem (EH), Central Harlem (CH), and Upper East Side (UES) neighborhoods of New York City are geographically contiguous to tertiary medical care, but are characterized by cancer mortality rate disparities. This ecological study aims to disentangle the effects of race and neighborhood on cancer deaths. Mortality-to-incidence ratios were determined using neighborhood-specific data from the New York State Cancer Registry and Vital Records Office (2007-2011). Ecological data on modifiable cancer risk factors from the New York City Community Health Survey (2002-2006) were stratified by sex, age group, race/ethnicity, and neighborhood and modeled against stratified mortality rates to disentangle race/ethnicity and neighborhood using logistic regression. Significant gaps in mortality rates were observed between the UES and both CH and EH across all cancers, favoring UES. Mortality-to-incidence ratios of both CH and EH were similarly elevated in the range of 0.41-0.44 compared with UES (0.26-0.30). After covariate and multivariable adjustment, black race (odds ratio=1.68; 95% confidence interval: 1.46-1.93) and EH residence (odds ratio=1.20; 95% confidence interval: 1.07-1.35) remained significant risk factors in all cancers' combined mortality. Mortality disparities remain among EH, CH, and UES neighborhoods. Both neighborhood and race are significantly associated with cancer mortality, independent of each other. Multivariable adjusted models that include Community Health Survey risk factors show that this mortality gap may be avoidable through community-based public health interventions.

Self-Rated Health Changes and Oldest-Old Mortality

PubMed Central

2014-01-01

Objectives. This study explores how 2 measures of self-rated health (SRH) change are related to mortality among oldest-old adults. In doing so, it also considers how associations between SRH and mortality may depend on prior SRH. Method. Data come from the Asset and Health Dynamics survey—the oldest-old portion of the Health and Retirement Study—and follow 6,233 individuals across 13 years. I use parametric hazard models to examine relationships between death and 2 measures of short-term SRH change—a computed measure comparing SRH at time t–1 and t, and a respondent-provided retrospectively reported change. Results. Respondents who demonstrate or report any SRH change between survey waves died at a greater rate than those with consistent SRH. After controlling for morbidity, individual characteristics, and SRH, those who changed SRH categories between survey waves and those who retrospectively reported an improvement in health continue to have a greater risk of death, when compared with those with no change. Discussion. These findings suggest that the well-established associations between SRH status and mortality may understate the risk of death for oldest-old individuals with recent subjective health improvements. PMID:24589929

10 CFR 436.22 - Adjusted internal rate of return.

Code of Federal Regulations, 2013 CFR

2013-01-01

... adjusted internal rate of return is the overall rate of return on an energy or water conservation measure... attributable to the proposed energy or water conservation measure. The denominator of the ratio is the present... proposed energy or water conservation measure. [61 FR 32651, June 25, 1996] ...

10 CFR 436.22 - Adjusted internal rate of return.

Code of Federal Regulations, 2014 CFR

2014-01-01

... adjusted internal rate of return is the overall rate of return on an energy or water conservation measure... attributable to the proposed energy or water conservation measure. The denominator of the ratio is the present... proposed energy or water conservation measure. [61 FR 32651, June 25, 1996] ...

10 CFR 436.22 - Adjusted internal rate of return.

Code of Federal Regulations, 2011 CFR

2011-01-01

... adjusted internal rate of return is the overall rate of return on an energy or water conservation measure... attributable to the proposed energy or water conservation measure. The denominator of the ratio is the present... proposed energy or water conservation measure. [61 FR 32651, June 25, 1996] ...

10 CFR 436.22 - Adjusted internal rate of return.

Code of Federal Regulations, 2012 CFR

2012-01-01

... adjusted internal rate of return is the overall rate of return on an energy or water conservation measure... attributable to the proposed energy or water conservation measure. The denominator of the ratio is the present... proposed energy or water conservation measure. [61 FR 32651, June 25, 1996] ...

Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

PubMed Central

Ou, Lixin; Chen, Jack; Assareh, Hassan; Hollis, Stephanie J.; Hillman, Ken; Flabouris, Arthas

2014-01-01

Background Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. Methods We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics. Results The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. Conclusions The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the

Elevated cardiac troponin T is associated with higher mortality and amputation rates in patients with peripheral arterial disease.

PubMed

Linnemann, Birgit; Sutter, Thilo; Herrmann, Eva; Sixt, Sebastian; Rastan, Aljoscha; Schwarzwaelder, Uwe; Noory, Elias; Buergelin, Karlheinz; Beschorner, Ulrich; Zeller, Thomas

2014-04-22

The aim of the present study was to evaluate whether elevated cardiac troponin T (cTnT) was independently associated with an increased all-cause mortality or risk of cardiovascular events and amputation among patients with peripheral arterial disease (PAD). PAD patients often have impaired renal function, and the blood concentration of cardiac troponin often increases with declining glomerular filtration rate. The cohort consisted of 1,041 consecutive PAD patients (653 males, 388 females, age 70.7 ± 10.8 years, Rutherford stages 2 to 5) undergoing endovascular peripheral revascularization. At baseline, measurable cTnT levels (≥0.01 ng/ml) were detected in 21.3% of individuals. Compared with patients who had undetectable cTnT levels, those with cTnT levels ≥0.01 ng/ml had higher rates for mortality (31.7% vs. 3.9%, respectively; p < 0.001), myocardial infarction (4.1% vs. 1.1%, respectively; p = 0.003), and amputation (10.1% vs. 2.4%, respectively; p < 0.001) during a 1-year follow-up. In adjusted Cox regression models, cTnT levels ≥0.01 ng/ml were associated with increased total mortality (hazard ratio [HR]: 8.14; 95% confidence interval [CI]: 3.77 to 17.6; p < 0.001) and amputation rates (HR: 3.71; 95% CI: 1.33 to 10.3; p = 0.012). cTnT is frequently elevated in PAD patients and is associated with higher event rates in terms of total mortality and amputation. Even small cTnT elevations predict a markedly increased risk that is independent of an impaired renal function. (Troponin T as Risk Stratification Tool in Patients With Peripheral Arterial Occlusive Disease; NCT01087385). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Risk adjusted surgical audit in gynaecological oncology: P-POSSUM does not predict outcome.

PubMed

Das, N; Talaat, A S; Naik, R; Lopes, A D; Godfrey, K A; Hatem, M H; Edmondson, R J

2006-12-01

To assess the Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and its validity for use in gynaecological oncology surgery. All patients undergoing gynaecological oncology surgery at the Northern Gynaecological Oncology Centre (NGOC) Gateshead, UK over a period of 12months (2002-2003) were assessed prospectively. Mortality and morbidity predictions using the Portsmouth modification of the POSSUM algorithm (P-POSSUM) were compared to the actual outcomes. Performance of the model was also evaluated using the Hosmer and Lemeshow Chi square statistic (testing the goodness of fit). During this period 468 patients were assessed. The P-POSSUM appeared to over predict mortality rates for our patients. It predicted a 7% mortality rate for our patients compared to an observed rate of 2% (35 predicted deaths in comparison to 10 observed deaths), a difference that was statistically significant (H&L chi(2)=542.9, d.f. 8, p<0.05). The P-POSSUM algorithm overestimates the risk of mortality for gynaecological oncology patients undergoing surgery. The P-POSSUM algorithm will require further adjustments prior to adoption for gynaecological cancer surgery as a risk adjusted surgical audit tool.

Examining mortality risk and rate of ageing among Polish Olympic athletes: a survival follow-up from 1924 to 2012

PubMed Central

Lin, Yuhui; Gajewski, Antoni; Poznańska, Anna

2016-01-01

Objectives Population-based studies have shown that an active lifestyle reduces mortality risk. Therefore, it has been a longstanding belief that individuals who engage in frequent exercise will experience a slower rate of ageing. It is uncertain whether this widely-accepted assumption holds for intense wear-and-tear. Here, using the 88 years survival follow-up data of Polish Olympic athletes, we report for the first time on whether frequent exercise alters the rate of ageing. Design Longitudinal survival data of male elite Polish athletes who participated in the Olympic Games from year 1924 to 2010 were used. Deaths occurring before the end of World War II were excluded for reliable estimates. Setting and participants Recruited male elite athletes N=1273 were preassigned to two categorical birth cohorts—Cohort I 1890–1919; Cohort II 1920–1959—and a parametric frailty survival analysis was conducted. An event-history analysis was also conducted to adjust for medical improvements from year 1920 onwards: Cohort II. Results Our findings suggest (1) in Cohort I, for every threefold reduction in mortality risk, the rate of ageing decelerates by 1%; (2) socioeconomic transitions and interventions contribute to a reduction in mortality risk of 29% for the general population and 50% for Olympic athletes; (3) an optimum benefit gained for reducing the rate of ageing from competitive sports (Cohort I 0.086 (95% CI 0.047 to 0.157) and Cohort II 0.085 (95% CI 0.050 to 0.144)). Conclusions This study further suggests that intensive physical training during youth should be considered as a factor to improve ageing and mortality risk parameters. PMID:27091824

10 CFR 903.11 - Advance announcement of rate adjustment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Advance announcement of rate adjustment. 903.11 Section 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in... announcement may be through direct contact with customers, at public meetings, by press release, by newspaper...

Population health and the economy: Mortality and the Great Recession in Europe.

PubMed

Tapia Granados, José A; Ionides, Edward L

2017-12-01

We analyze the evolution of mortality-based health indicators in 27 European countries before and after the start of the Great Recession. We find that in the countries where the crisis has been particularly severe, mortality reductions in 2007-2010 were considerably bigger than in 2004-2007. Panel models adjusted for space-invariant and time-invariant factors show that an increase of 1 percentage point in the national unemployment rate is associated with a reduction of 0.5% (p < .001) in the rate of age-adjusted mortality. The pattern of mortality oscillating procyclically is found for total and sex-specific mortality, cause-specific mortality due to major causes of death, and mortality for ages 30-44 and 75 and over, but not for ages 0-14. Suicides appear increasing when the economy decelerates-countercyclically-but the evidence is weak. Results are robust to using different weights in the regression, applying nonlinear methods for detrending, expanding the sample, and using as business cycle indicator gross domestic product per capita or employment-to-population ratios rather than the unemployment rate. We conclude that in the European experience of the past 20 years, recessions, on average, have beneficial short-term effects on mortality of the adult population. Copyright © 2017 John Wiley & Sons, Ltd.

Incorporating Comorbidity Within Risk Adjustment for UK Pediatric Cardiac Surgery.

PubMed

Brown, Katherine L; Rogers, Libby; Barron, David J; Tsang, Victor; Anderson, David; Tibby, Shane; Witter, Thomas; Stickley, John; Crowe, Sonya; English, Kate; Franklin, Rodney C; Pagel, Christina

2017-07-01

When considering early survival rates after pediatric cardiac surgery it is essential to adjust for risk linked to case complexity. An important but previously less well understood component of case mix complexity is comorbidity. The National Congenital Heart Disease Audit data representing all pediatric cardiac surgery procedures undertaken in the United Kingdom and Ireland between 2009 and 2014 was used to develop and test groupings for comorbidity and additional non-procedure-based risk factors within a risk adjustment model for 30-day mortality. A mixture of expert consensus based opinion and empiric statistical analyses were used to define and test the new comorbidity groups. The study dataset consisted of 21,838 pediatric cardiac surgical procedure episodes in 18,834 patients with 539 deaths (raw 30-day mortality rate, 2.5%). In addition to surgical procedure type, primary cardiac diagnosis, univentricular status, age, weight, procedure type (bypass, nonbypass, or hybrid), and era, the new risk factor groups of non-Down congenital anomalies, acquired comorbidities, increased severity of illness indicators (eg, preoperative mechanical ventilation or circulatory support) and additional cardiac risk factors (eg, heart muscle conditions and raised pulmonary arterial pressure) all independently increased the risk of operative mortality. In an era of low mortality rates across a wide range of operations, non-procedure-based risk factors form a vital element of risk adjustment and their presence leads to wide variations in the predicted risk of a given operation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Effects of education and other socioeconomic factors on middle age mortality in rural Bangladesh.

PubMed

Hurt, L S; Ronsmans, C; Saha, S

2004-04-01

To examine socioeconomic gradients in mortality in adult women and their husbands in Bangladesh, paying particular attention to the independent effects of the educational status of each spouse. Historical cohort study. Matlab, a rural area 60 km south east of Dhaka, the capital of Bangladesh. 14803 married women aged 45 or over and their husbands who were resident in the Matlab Demographic Surveillance area between 30 June 1982 and 31 December 1998. Mortality was lower in women with formal or Koranic education compared with those with none (adjusted rate ratio for formal education = 0.68, 95% CI 0.53 to 0.86; adjusted rate ratio for Koranic schooling = 0.82, 95% CI 0.66 to 1.00). After adjusting for her own education, the husband's level of education or occupation did not have an independent effect on a woman's survival. Men who had attended formal education had lower mortality than those without any education (adjusted rate ratio = 0.84, 95% CI 0.75 to 0.93), but men whose wives had been educated had an additional survival advantage independent of their own education and occupation (adjusted rate ratio = 0.76, 95% CI 0.67 to 0.87). Mortality in both sexes was also significantly associated with marital status and the percentage of surviving children, and in men was associated with the man's occupation, religion, area of residence. The data suggest that socioeconomic status has a strong influence on mortality in adults in Bangladesh. They also illustrate how important the continued promotion of education, particularly for women, may be for the survival of both women and men in rural Bangladesh.

Mortality rates by occupation in Korea: a nationwide, 13-year follow-up study.

PubMed

Lee, Hye-Eun; Kim, Hyoung-Ryoul; Chung, Yun Kyung; Kang, Seong-Kyu; Kim, Eun-A

2016-05-01

The present study sought to identify inequalities in cause-specific mortality across different occupational groups in Korea. The cohort included Korean workers enrolled in the national employment insurance programme between 1995 and 2000. Mortality was determined by matching death between 1995 and 2009 according to a nationwide registry of the Korea National Statistical Office. The cohort was divided into nine occupational groups according to the Korean Standard Occupational Classification (KSOC). Age-standardised mortality rates of each subcohort were calculated. The highest age-standardised mortality rate was identified in KSOC 6 (agricultural, forestry and fishery workers; male (M): 563.0 per 100 000, female (F): 206.0 per 100 000), followed by KSOC 9 (elementary occupations; M: 499.0, F: 163.4) and KSOC 8 (plant, machine operators and assemblers; M: 380.3, F: 157.8). The lowest rate occurred in KSOC 2 (professionals and related workers; M: 209.1, F: 93.3). Differences in mortality rates between KSOC 2 and KSOC 9 (M: 289.9, F: 70.1) and the rate ratio of KSCO9 to KSCO2 (M: 2.39, F: 1.75) were higher in men. The most prominent mortality rate difference was observed in external causes of death (M: 96.9, F: 21.6) and liver disease in men (38.3 per 100 000). Mental disease showed the highest rate ratio (M: 6.31, F: 13.00). Substantial differences in mortality rates by occupation were identified. Main causes of death were injury, suicide and male liver disease. Development of policies to support occupations linked with a lower socioeconomic position should be prioritised. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Variation in intensive care unit utilization and mortality after blunt splenic injury.

PubMed

Kaufman, Elinore J; Wiebe, Douglas J; Martin, Niels D; Pascual, Jose L; Reilly, Patrick M; Holena, Daniel N

2016-06-15

Although trauma patients are frequently cared for in the intensive care unit (ICU), admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. We conducted a retrospective cohort study of patients treated for blunt splenic injuries from 2011-2014 at 30 level I and II Pennsylvania trauma centers. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman's rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement between high and low-ICU-utilization centers. Of 2587 patients with blunt splenic injuries, 63.9% (1654) were admitted to the ICU. Median injury severity score was 17 overall, 13 for non-ICU patients and 17 for ICU patients (P < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization and mortality (Spearman's rho = -0.2595, P = 0.2103). Proportionately fewer ICU patients received critical care procedures at high-utilization centers than at low-utilization centers. Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Newborn calf welfare: a review focusing on mortality rates.

PubMed

Uetake, Katsuji

2013-02-01

Calf mortality control is vitally important for farmers, not only to improve animal welfare, but also to increase productivity. High calf mortality rates can be related to larger numbers of calves in a herd, employee performance, severe weather, and the neonatal period covering the first 4 weeks of life. Although the basic premise of preventing newborn calf mortality is early detection and treatment of calves at risk for failure of passive transfer of immunoglobulins, calf mortality due to infectious diseases such as acute diarrhea increases in the presence of these physical and psychological stressors. This suggests that farmers should not ignore the effects of secondary environmental factors. For prevention rather than cure, the quality of the environment should be improved, which will improve not only animal welfare but also productivity. This paper presents a review of the literature on newborn calf mortality and discusses its productivity implications. © 2012 Japanese Society of Animal Science.

76 FR 80191 - Adjustments of Certain Rates of Pay

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

... Order 13594 of December 19, 2011 Adjustments of Certain Rates of Pay By the authority vested in me as... Appropriations and Surface Transportation Extensions Act, 2011 (Public Law 111-322), which freezes certain pay... full applicable locality pay rates in non-foreign areas pursuant to the Non-Foreign Area Retirement...

75 FR 81817 - Adjustments of Certain Rates of Pay

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

... Order 13561 of December 22, 2010 Adjustments of Certain Rates of Pay By the authority vested in me as..., it is hereby ordered as follows: Section 1. Statutory Pay Systems. Pursuant to the Continuing... ``Continuing Appropriations Act''), the rates of basic pay or salaries of the statutory pay systems (as defined...

Increased Heart Rate Is Associated With Higher Mortality in Patients With Atrial Fibrillation (AF): Results From the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF)

PubMed Central

Steinberg, Benjamin A; Kim, Sunghee; Thomas, Laine; Fonarow, Gregg C; Gersh, Bernard J; Holmqvist, Fredrik; Hylek, Elaine; Kowey, Peter R; Mahaffey, Kenneth W; Naccarelli, Gerald; Reiffel, James A; Chang, Paul; Peterson, Eric D; Piccini, Jonathan P

2015-01-01

Background Most patients with atrial fibrillation (AF) require rate control; however, the optimal target heart rate remains under debate. We aimed to assess rate control and subsequent outcomes among patients with permanent AF. Methods and Results We studied 2812 US outpatients with permanent AF in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation. Resting heart rate was measured longitudinally and used as a time-dependent covariate in multivariable Cox models of all-cause and cause-specific mortality during a median follow-up of 24 months. At baseline, 7.4% (n=207) had resting heart rate <60 beats per minute (bpm), 62% (n=1755) 60 to 79 bpm, 29% (n=817) 80 to 109 bpm, and 1.2% (n=33) ≥110 bpm. Groups did not differ by age, previous cerebrovascular disease, heart failure status, CHA2DS2-VASc scores, renal function, or left ventricular function. There were significant differences in race (P=0.001), sinus node dysfunction (P=0.004), and treatment with calcium-channel blockers (P=0.006) and anticoagulation (P=0.009). In analyses of continuous heart rates, lower heart rate ≤65 bpm was associated with higher all-cause mortality (adjusted hazard ratio [HR], 1.15 per 5-bpm decrease; 95% CI, 1.01 to 1.32; P=0.04). Similarly, increasing heart rate >65 bpm was associated with higher all-cause mortality (adjusted HR, 1.10 per 5-bpm increase; 95% CI, 1.05 to 1.15; P<0.0001). This relationship was consistent across endpoints and in a broader sensitivity analysis of permanent and nonpermanent AF patients. Conclusions Among patients with permanent AF, there is a J-shaped relationship between heart rate and mortality. These data support current guideline recommendations, and clinical trials are warranted to determine optimal rate control. Clinical Trial Registration URL: http://clinicaltrials.gov/. Unique identifier: NCT01165710. PMID:26370445

Increased Heart Rate Is Associated With Higher Mortality in Patients With Atrial Fibrillation (AF): Results From the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF).

PubMed

Steinberg, Benjamin A; Kim, Sunghee; Thomas, Laine; Fonarow, Gregg C; Gersh, Bernard J; Holmqvist, Fredrik; Hylek, Elaine; Kowey, Peter R; Mahaffey, Kenneth W; Naccarelli, Gerald; Reiffel, James A; Chang, Paul; Peterson, Eric D; Piccini, Jonathan P

2015-09-14

Most patients with atrial fibrillation (AF) require rate control; however, the optimal target heart rate remains under debate. We aimed to assess rate control and subsequent outcomes among patients with permanent AF. We studied 2812 US outpatients with permanent AF in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation. Resting heart rate was measured longitudinally and used as a time-dependent covariate in multivariable Cox models of all-cause and cause-specific mortality during a median follow-up of 24 months. At baseline, 7.4% (n=207) had resting heart rate <60 beats per minute (bpm), 62% (n=1755) 60 to 79 bpm, 29% (n=817) 80 to 109 bpm, and 1.2% (n=33) ≥110 bpm. Groups did not differ by age, previous cerebrovascular disease, heart failure status, CHA2DS2-VASc scores, renal function, or left ventricular function. There were significant differences in race (P=0.001), sinus node dysfunction (P=0.004), and treatment with calcium-channel blockers (P=0.006) and anticoagulation (P=0.009). In analyses of continuous heart rates, lower heart rate ≤65 bpm was associated with higher all-cause mortality (adjusted hazard ratio [HR], 1.15 per 5-bpm decrease; 95% CI, 1.01 to 1.32; P=0.04). Similarly, increasing heart rate >65 bpm was associated with higher all-cause mortality (adjusted HR, 1.10 per 5-bpm increase; 95% CI, 1.05 to 1.15; P<0.0001). This relationship was consistent across endpoints and in a broader sensitivity analysis of permanent and nonpermanent AF patients. Among patients with permanent AF, there is a J-shaped relationship between heart rate and mortality. These data support current guideline recommendations, and clinical trials are warranted to determine optimal rate control. URL: http://clinicaltrials.gov/. Unique identifier: NCT01165710. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Association of Race With Mortality and Cardiovascular Events in a Large Cohort of US Veterans.

PubMed

Kovesdy, Csaba P; Norris, Keith C; Boulware, L Ebony; Lu, Jun L; Ma, Jennie Z; Streja, Elani; Molnar, Miklos Z; Kalantar-Zadeh, Kamyar

2015-10-20

In the general population, blacks experience higher mortality than their white peers, attributed in part to their lower socioeconomic status, reduced access to care, and possibly intrinsic biological factors. Patients with kidney disease are a notable exception, among whom blacks experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with equal or similar access to health care. We compared all-cause mortality, incident coronary heart disease, and incident ischemic stroke using multivariable-adjusted Cox models in a nationwide cohort of 547 441 black and 2 525 525 white patients with baseline estimated glomerular filtration rate ≥ 60 mL·min⁻¹·1.73 m⁻² receiving care from the US Veterans Health Administration. In parallel analyses, we compared outcomes in black versus white individuals in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. After multivariable adjustments in veterans, black race was associated with 24% lower all-cause mortality (adjusted hazard ratio, 0.76; 95% confidence interval, 0.75-0.77; P<0.001) and 37% lower incidence of coronary heart disease (adjusted hazard ratio, 0.63; 95% confidence interval, 0.62-0.65; P<0.001) but a similar incidence of ischemic stroke (adjusted hazard ratio, 0.99; 95% confidence interval, 0.97-1.01; P=0.3). Black race was associated with a 42% higher adjusted mortality among individuals with estimated glomerular filtration rate ≥ 60 mL·min⁻¹·1.73 m⁻² in NHANES (adjusted hazard ratio, 1.42; 95% confidence interval, 1.09-1.87). Black veterans with normal estimated glomerular filtration rate and equal access to healthcare have lower all-cause mortality and incidence of coronary heart disease and a similar incidence of ischemic stroke. These associations are in contrast to the higher mortality experienced by black individuals in the general US population. © 2015 American Heart Association, Inc.

Growth rate predicts mortality of Abies concolor in both burned and unburned stands

USGS Publications Warehouse

van Mantgem, Phillip J.; Stephenson, Nathan L.; Mutch, Linda S.; Johnson, Veronica G.; Esperanza, Annie M.; Parsons, David J.

2003-01-01

Tree mortality is often the result of both long-term and short-term stress. Growth rate, an indicator of long-term stress, is often used to estimate probability of death in unburned stands. In contrast, probability of death in burned stands is modeled as a function of short-term disturbance severity. We sought to narrow this conceptual gap by determining (i) whether growth rate, in addition to crown scorch, is a predictor of mortality in burned stands and (ii) whether a single, simple model could predict tree death in both burned and unburned stands. Observations of 2622 unburned and 688 burned Abies concolor (Gord. & Glend.) Lindl. (white fir) in the Sierra Nevada of California, U.S.A., indicated that growth rate was a significant predictor of mortality in the unburned stands, while both crown scorch and radial growth were significant predictors of mortality in the burned stands. Applying the burned stand model to unburned stands resulted in an overestimation of the unburned stand mortality rate. While failing to create a general model of tree death for A. concolor, our findings underscore the idea that similar processes may affect mortality in disturbed and undisturbed stands.

Mortality among patients with hypertension from 1995 to 2005: a population-based study

PubMed Central

Tu, Karen; Chen, Zhongliang; Lipscombe, Lorraine L.

2008-01-01

Background We have reported that the prevalence of diagnosed hypertension increased by 60% from 1995 to 2005 in Ontario. In the present study, we asked whether this increase is explained by a decrease in the mortality rate. Methods We performed a population-based cohort study using linked administrative data for Ontario, a Canadian province with over 12 million residents. We identified prevalent cases of hypertension using a validated case-definition algorithm for hypertension, and we examined trends in mortality from 1995 to 2005 among adults aged 20 years and older with hypertension. Results The age-and sex-adjusted mortality among patients with hypertension decreased from 11.3 per 1000 people in 1995 to 9.6 per 1000 in 2005 (p < 0.001), which is a relative reduction of 15.5%. We found that the relative decrease in age-adjusted mortality was higher among men than among women (–22.2% v. –7.3%, p < 0.001). Interpretation Mortality rates among patients with hypertension have decreased. Along with an increasing incidence, decreased mortality rates may contribute to the increased prevalence of diagnosed hypertension. Sex-related discrepancies in the reduction of mortality warrant further investigation. PMID:18490639

Mortality among patients with hypertension from 1995 to 2005: a population-based study.

PubMed

Tu, Karen; Chen, Zhongliang; Lipscombe, Lorraine L

2008-05-20

We have reported that the prevalence of diagnosed hypertension increased by 60% from 1995 to 2005 in Ontario. In the present study, we asked whether this increase is explained by a decrease in the mortality rate. We performed a population-based cohort study using linked administrative data for Ontario, a Canadian province with over 12 million residents. We identified prevalent cases of hypertension using a validated case-definition algorithm for hypertension, and we examined trends in mortality from 1995 to 2005 among adults aged 20 years and older with hypertension. The age- and sex-adjusted mortality among patients with hypertension decreased from 11.3 per 1000 people in 1995 to 9.6 per 1000 in 2005 (p < 0.001), which is a relative reduction of 15.5%. We found that the relative decrease in age-adjusted mortality was higher among men than among women (-22.2% v. -7.3%, p < 0.001). Mortality rates among patients with hypertension have decreased. Along with an increasing incidence, decreased mortality rates may contribute to the increased prevalence of diagnosed hypertension. Sex-related discrepancies in the reduction of mortality warrant further investigation.

5 CFR 9901.312 - Maximum rates of base salary and adjusted salary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Maximum rates of base salary and adjusted salary. 9901.312 Section 9901.312 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES....312 Maximum rates of base salary and adjusted salary. (a) Subject to § 9901.105, the Secretary may...

Racial segregation, income inequality, and mortality in US metropolitan areas.

PubMed

Nuru-Jeter, Amani M; LaVeist, Thomas A

2011-04-01

Evidence of the association between income inequality and mortality has been mixed. Studies indicate that growing income inequalities reflect inequalities between, rather than within, racial groups. Racial segregation may play a role. We examine the role of racial segregation on the relationship between income inequality and mortality in a cross-section of US metropolitan areas. Metropolitan areas were included if they had a population of at least 100,000 and were at least 10% black (N = 107). Deaths for the time period 1991-1999 were used to calculate age-adjusted all-cause mortality rates for each metropolitan statistical area (MSA) using direct age-adjustment techniques. Multivariate least squares regression was used to examine associations for the total sample and for blacks and whites separately. Income inequality was associated with lower mortality rates among whites and higher mortality rates among blacks. There was a significant interaction between income inequality and racial segregation. A significant graded inverse income inequality/mortality association was found for MSAs with higher versus lower levels of black-white racial segregation. Effects were stronger among whites than among blacks. A positive income inequality/mortality association was found in MSAs with higher versus lower levels of Hispanic-white segregation. Uncertainty regarding the income inequality/mortality association found in previous studies may be related to the omission of important variables such as racial segregation that modify associations differently between groups. Research is needed to further elucidate the risk and protective effects of racial segregation across groups.

Mortality in American Veterans with the HLA-B27 gene.

PubMed

Walsh, Jessica A; Zhou, Xi; Clegg, Daniel O; Teng, Chiachen; Cannon, Grant W; Sauer, Brian

2015-04-01

To compare survival in American veterans with and without the HLA-B27 (B27) gene. Mortality was evaluated in a national cohort of veterans with clinically available B27 test results between October 1, 1999, and December 31, 2011. The primary outcome was the mortality difference between B27-positive and B27-negative veterans, adjusted for age, sex, race, and diagnoses codes for diseases that may have influenced both B27 testing and mortality, including psoriasis, inflammatory bowel disease, spondyloarthritis (SpA), and other types of inflammatory arthritis. The secondary outcomes were the adjusted mortality HR for B27+ and B27- veterans, in subgroups with and without SpA. Among veterans with available B27 test results, 27,652 (84.7%) were B27- and 4978 (15.3%) were B27+. The mean followup time was 4.6 years. Mortality was higher in the B27+ group than in the B27- group (HR 1.15, 95% CI 1.03-1.27). Mortality was also higher in the B27+ subgroups with SpA (HR 1.35, 95% CI 1.06-1.72) and without SpA (HR 1.11, 95% CI 0.99-1.24), but the difference was significant only in the subgroup with SpA. B27 positivity was associated with an increased mortality rate in a cohort of veterans clinically selected for B27 testing, after adjustment for SpA. In the subgroup with SpA, the mortality rate was associated with B27 positivity, and in the subgroup without SpA, there was a nonsignificant association between B27+ and mortality.

39 CFR 3010.27 - Application of unused rate adjustment authority.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MARKET DOMINANT PRODUCTS Rules for Applying the Price Cap § 3010.27 Application of unused rate adjustment..., then the difference between the percentage change in rates for the class and the price cap shall be...

5 CFR 9701.337 - Treatment of employees whose rate of pay falls below the minimum adjusted rate of their band.

Code of Federal Regulations, 2011 CFR

2011-01-01

... falls below the minimum adjusted rate of their band. 9701.337 Section 9701.337 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.337 Treatment of employees whose rate of pay falls... (including a locality or special rate supplement) falls below the minimum adjusted rate of his or her band as...

5 CFR 9701.337 - Treatment of employees whose rate of pay falls below the minimum adjusted rate of their band.

Code of Federal Regulations, 2012 CFR

2012-01-01

... falls below the minimum adjusted rate of their band. 9701.337 Section 9701.337 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.337 Treatment of employees whose rate of pay falls... (including a locality or special rate supplement) falls below the minimum adjusted rate of his or her band as...

5 CFR 9701.337 - Treatment of employees whose rate of pay falls below the minimum adjusted rate of their band.

Code of Federal Regulations, 2014 CFR

2014-01-01

... falls below the minimum adjusted rate of their band. 9701.337 Section 9701.337 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.337 Treatment of employees whose rate of pay falls... (including a locality or special rate supplement) falls below the minimum adjusted rate of his or her band as...

5 CFR 9701.337 - Treatment of employees whose rate of pay falls below the minimum adjusted rate of their band.

Code of Federal Regulations, 2013 CFR

2013-01-01

... falls below the minimum adjusted rate of their band. 9701.337 Section 9701.337 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.337 Treatment of employees whose rate of pay falls... (including a locality or special rate supplement) falls below the minimum adjusted rate of his or her band as...

[The health gap in Mexico, measured through child mortality].

PubMed

Gutiérrez, Juan Pablo; Bertozzi, Stefano M

2003-01-01

To estimate the health gap in Mexico, as evidenced by the difference between the observed 1998 mortality rate and the estimated rate and the estimated rate for the same year according to social and economic indicators, with rates from other countries. An econometric model was developed, using the 1998 child mortality rate (CMR) as the dependent variable, and macro-social and economic indicators as independent variables. The model included 70 countries for which complete data were available. The proposed model explained over 90% of the variability in CMR among countries. The expected CMR for Mexico was 22% lower that the observed rate, which represented nearly 20,000 excess deaths. After adjusting for differences in productivity, distribution of wealth, and investment in human capital, the excess child mortality rate suggested efficiency problems in the Mexican health system, at least in relation to services intended to reduce child mortality. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Brazil's conditional cash transfer program associated with declines in infant mortality rates.

PubMed

Shei, Amie

2013-07-01

Conditional cash transfer programs are innovative social safety-net programs that aim to relieve poverty. They provide a regular source of income to poor families and are "conditional" in that they require poor families to invest in the health and education of their children through greater use of educational and preventive health services. Brazil's Bolsa Família conditional cash transfer program, created in 2003, is the world's largest program of its kind. During the first five years of the program, it was associated with a significant 9.3 percent reduction in overall infant mortality rates, with greater declines in postneonatal mortality rates than in mortality rates at an earlier age and in municipalities with many users of Brazil's Family Health Program than in those with lower use rates. There were also larger effects in municipalities with higher infant mortality rates at baseline. Programs like Bolsa Família can improve child health and reduce long-standing health inequalities. Policy makers should review the adequacy of basic health services to ensure that the services can respond to the increased demand created by such programs. Programs should also target vulnerable groups at greatest risk and include careful monitoring and evaluation.

Global Prostate Cancer Incidence and Mortality Rates According to the Human Development Index.

PubMed

Khazaei, Salman; Rezaeian, Shahab; Ayubi, Erfan; Gholamaliee, Behzad; Pishkuhi, Mahin Ahmadi; Khazaei, Somayeh; Mansori, Kamyar; Nematollahi, Shahrzad; Sani, Mohadeseh; Hanis, Shiva Mansouri

2016-01-01

Prostate cancer (PC) is one of the leading causes of death, especially in developed countries. The human development index (HDI) and its dimensions seem correlated with incidence and mortality rates of PC. This study aimed to assess the association of the specific components of HDI (life expectancy at birth, education, gross national income per 1000 capita, health, and living standards) with burden indicators of PC worldwide. Information of the incidence and mortality rates of PC was obtained from the GLOBOCAN cancer project in year 2012 and data about the HDI 2013 were obtained from the World Bank database. The correlation between incidence, mortality rates, and the HDI parameters were assessed using STATA software. A significant inequality of PC incidence rates was observed according to concentration indexes=0.25 with 95% CI (0.22, 0.34) and a negative mortality concentration index of -0.04 with 95% CI (-0.09, 0.01) was observed. A positive significant correlation was detected between the incidence rates of PC and the HDI and its dimensions including life expectancy at birth, education, income, urbanization level and obesity. However, there was a negative significant correlation between the standardized mortality rates and the life expectancy, income and HDI.

Six-year mortality in a street-recruited cohort of homeless youth in San Francisco, California.

PubMed

Auerswald, Colette L; Lin, Jessica S; Parriott, Andrea

2016-01-01

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004. Methods. Using data collected from a longitudinal, venue-based sample of street youth 15-24 years of age, we calculated age, race, and gender-adjusted mortality rates. Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3-18.9]). Gender specific SMRs were 16.1 (95% CI [3.3-47.1]) for females and 9.4 (95% CI [4.0-18.4]) for males. Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the state's general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population.

Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin.

PubMed

Falcone, Marco; Russo, Alessandro; Cangemi, Roberto; Farcomeni, Alessio; Calvieri, Camilla; Barillà, Francesco; Scarpellini, Maria Gabriella; Bertazzoni, Giuliano; Palange, Paolo; Taliani, Gloria; Venditti, Mario; Violi, Francesco

2015-01-06

Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; P<0.001) were aspirin nonusers. Overall, nonfatal CVEs occurred in 7% of patients, 8.3% in nonaspirin users, and 4.9% in aspirin users (odds ratio, 1.77; 95% confidence interval, 1.03 to 3.04; P=0.040). The Cox regression analysis showed that pneumonia severity index (PSI), severe sepsis, pleural effusion, and PaO(2)/FiO(2) ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P=0.029) for total mortality. This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Heart rate turbulence predicts all-cause mortality and sudden death in congestive heart failure patients.

PubMed

Cygankiewicz, Iwona; Zareba, Wojciech; Vazquez, Rafael; Vallverdu, Montserrat; Gonzalez-Juanatey, Jose R; Valdes, Mariano; Almendral, Jesus; Cinca, Juan; Caminal, Pere; de Luna, Antoni Bayes

2008-08-01

Abnormal heart rate turbulence (HRT) has been documented as a strong predictor of total mortality and sudden death in postinfarction patients, but data in patients with congestive heart failure (CHF) are limited. The aim of this study was to evaluate the prognostic significance of HRT for predicting mortality in CHF patients in New York Heart Association (NYHA) class II-III. In 651 CHF patients with sinus rhythm enrolled into the MUSIC (Muerte Subita en Insuficiencia Cardiaca) study, the standard HRT parameters turbulence onset (TO) and slope (TS), as well as HRT categories, were assessed for predicting total mortality and sudden death. HRT was analyzable in 607 patients, mean age 63 years (434 male), 50% of ischemic etiology. During a median follow up of 44 months, 129 patients died, 52 from sudden death. Abnormal TS and HRT category 2 (HRT2) were independently associated with increased all-cause mortality (HR: 2.10, CI: 1.41 to 3.12, P <.001 and HR: 2.52, CI: 1.56 to 4.05, P <.001; respectively), sudden death (HR: 2.25, CI: 1.13 to 4.46, P = .021 for HRT2), and death due to heart failure progression (HR: 4.11, CI: 1.84 to 9.19, P <.001 for HRT2) after adjustment for clinical covariates in multivariate analysis. The prognostic value of TS for predicting total mortality was similar in various groups dichotomized by age, gender, NYHA class, left ventricular ejection fraction, and CHF etiology. TS was found to be predictive for total mortality only in patients with QRS > 120 ms. HRT is a potent risk predictor for both heart failure and arrhythmic death in patients with class II and III CHF.

Time trend and age-period-cohort effect on kidney cancer mortality in Europe, 1981-2000.

PubMed

Pérez-Farinós, Napoleón; López-Abente, Gonzalo; Pastor-Barriuso, Roberto

2006-05-03

The incorporation of diagnostic and therapeutic improvements, as well as the different smoking patterns, may have had an influence on the observed variability in renal cancer mortality across Europe. This study examined time trends in kidney cancer mortality in fourteen European countries during the last two decades of the 20th century. Kidney cancer deaths and population estimates for each country during the period 1981-2000 were drawn from the World Health Organization Mortality Database. Age- and period-adjusted mortality rates, as well as annual percentage changes in age-adjusted mortality rates, were calculated for each country and geographical region. Log-linear Poisson models were also fitted to study the effect of age, death period, and birth cohort on kidney cancer mortality rates within each country. For men, the overall standardized kidney cancer mortality rates in the eastern, western, and northern European countries were 20, 25, and 53% higher than those for the southern European countries, respectively. However, age-adjusted mortality rates showed a significant annual decrease of -0.7% in the north of Europe, a moderate rise of 0.7% in the west, and substantial increases of 1.4% in the south and 2.0% in the east. This trend was similar among women, but with lower mortality rates. Age-period-cohort models showed three different birth-cohort patterns for both men and women: a decrease in mortality trend for those generations born after 1920 in the Nordic countries, a similar but lagged decline for cohorts born after 1930 in western and southern European countries, and a continuous increase throughout all birth cohorts in eastern Europe. Similar but more heterogeneous regional patterns were observed for period effects. Kidney cancer mortality trends in Europe showed a clear north-south pattern, with high rates on a downward trend in the north, intermediate rates on a more marked rising trend in the east than in the west, and low rates on an upward trend

Cancer incidence rate and mortality rate in sickle cell disease patients at Howard University Hospital: 1986-1995.

PubMed

Dawkins, F W; Kim, K S; Squires, R S; Chisholm, R; Kark, J A; Perlin, E; Castro, O

1997-08-01

The incidence of cancer in patients with sickle cell disease (SCD) is not known. The 10-year follow-up data on 696 patients with SCD was analyzed at our institution in order to determine the cancer incidence and cancer mortality rates. The age range was 18 to 79 years, with a mean age of 28.8 years. There were 377 females and 319 males. The median follow-up was 3 years. Five patients developed cancer during this period. The cancer incidence rate was 5/2,864 or 1.74 per 1,000 patient years. The 95% CI was 0.64 to 4.32 per 1,000 patient years. There were 68 deaths with 3 being due to cancer. The cancer mortality rate was 3/2,873 or 1.04 cases per 1,000 patient years. Our data represent the first published paper that the authors are aware of, where the cancer incidence and mortality rates have been calculated for any group of patients with SCD.

Decrease in mortality rate and hospital admissions for acute myocardial infarction after the enactment of the smoking ban law in São Paulo city, Brazil.

PubMed

Abe, Tania M O; Scholz, Jaqueline; de Masi, Eduardo; Nobre, Moacyr R C; Filho, Roberto Kalil

2017-11-01

Smoking restriction laws have spread worldwide during the last decade. Previous studies have shown a decline in the community rates of myocardial infarction after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in hospitality venues. To evaluate whether the 2009 implementation of a comprehensive smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction. We performed a time-series study of monthly rates of mortality and hospital admissions for acute myocardial infarction from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modelled by environmental variables and atmospheric pollutants to evaluate the effect of smoking ban law in mortality and hospital admission rate. We also used Interrupted Time Series Analysis (ITSA) to make a comparison between the period pre and post smoking ban law. We observed a reduction in mortality rate (-11.9% in the first 17 months after the law) and in hospital admission rate (-5.4% in the first 3 months after the law) for myocardial infarction after the implementation of the smoking ban law. Hospital admissions and mortality rate for myocardial infarction were reduced in the first months after the comprehensive smoking ban law was implemented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Hispanic mortality advantage and ethnic misclassification on US death certificates.

PubMed

Arias, Elizabeth; Eschbach, Karl; Schauman, William S; Backlund, Eric L; Sorlie, Paul D

2010-04-01

We tested the data artifact hypothesis regarding the Hispanic mortality advantage by investigating whether and to what degree this advantage is explained by Hispanic origin misclassification on US death certificates. We used the National Longitudinal Mortality Study, which links Current Population Survey records to death certificates for 1979 through 1998, to estimate the sensitivity, specificity, and net ascertainment of Hispanic ethnicity on death certificates compared with survey classifications. Using national vital statistics mortality data, we estimated Hispanic age-specific and age-adjusted death rates, which were uncorrected and corrected for death certificate misclassification, and produced death rate ratios comparing the Hispanic with the non-Hispanic White population. Hispanic origin reporting on death certificates in the United States is reasonably good. The net ascertainment of Hispanic origin is just 5% higher on survey records than on death certificates. Corrected age-adjusted death rates for Hispanics are lower than those for the non-Hispanic White population by close to 20%. The Hispanic mortality paradox is not explained by an incongruence between ethnic classification in vital registration and population data systems.

Does raking basal duff affect tree growth rates or mortality?

Treesearch

Erin Noonan-Wright; Sharon M. Hood; Danny R. Cluck

2010-01-01

Mortality and reduced growth rates due to raking accumulated basal duff were evaluated for old, large-diameter ponderosa and Jeffrey pine trees on the Lassen National Forest, California. No fire treatments were included to isolate the effect of raking from fire. Trees were monitored annually for 5 years after the raking treatment for mortality and then cored to measure...

Use of life course work-family profiles to predict mortality risk among US women.

PubMed

Sabbath, Erika L; Guevara, Ivan Mejía; Glymour, M Maria; Berkman, Lisa F

2015-04-01

We examined relationships between US women's exposure to midlife work-family demands and subsequent mortality risk. We used data from women born 1935 to 1956 in the Health and Retirement Study to calculate employment, marital, and parenthood statuses for each age between 16 and 50 years. We used sequence analysis to identify 7 prototypical work-family trajectories. We calculated age-standardized mortality rates and hazard ratios (HRs) for mortality associated with work-family sequences, with adjustment for covariates and potentially explanatory later-life factors. Married women staying home with children briefly before reentering the workforce had the lowest mortality rates. In comparison, after adjustment for age, race/ethnicity, and education, HRs for mortality were 2.14 (95% confidence interval [CI] = 1.58, 2.90) among single nonworking mothers, 1.48 (95% CI = 1.06, 1.98) among single working mothers, and 1.36 (95% CI = 1.02, 1.80) among married nonworking mothers. Adjustment for later-life behavioral and economic factors partially attenuated risks. Sequence analysis is a promising exposure assessment tool for life course research. This method permitted identification of certain lifetime work-family profiles associated with mortality risk before age 75 years.

Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality.

PubMed

Coresh, Josef; Turin, Tanvir Chowdhury; Matsushita, Kunihiro; Sang, Yingying; Ballew, Shoshana H; Appel, Lawrence J; Arima, Hisatomi; Chadban, Steven J; Cirillo, Massimo; Djurdjev, Ognjenka; Green, Jamie A; Heine, Gunnar H; Inker, Lesley A; Irie, Fujiko; Ishani, Areef; Ix, Joachim H; Kovesdy, Csaba P; Marks, Angharad; Ohkubo, Takayoshi; Shalev, Varda; Shankar, Anoop; Wen, Chi Pang; de Jong, Paul E; Iseki, Kunitoshi; Stengel, Benedicte; Gansevoort, Ron T; Levey, Andrew S

2014-06-25

The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of −57% or greater) is a late event. To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. Individual meta-analysis of 1.7 million participants with 12,344 ESRD events and 223,944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data. Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012. End-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR. The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3-46.3) for changes of −57% in estimated GFR and 5.4 (95% CI, 4.5-6.4) for changes of −30%. However, changes of −30% or greater (6.9% [95% CI, 6.4%-7.4%] of the entire consortium) were more common than changes of −57% (0.79% [95% CI, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2

Agricultural Chemical Use and White Male Cancer Mortality in Selected Rural Farm Counties.

ERIC Educational Resources Information Center

Stokes, C. Shannon; Brace, Kathy D.

A study of 1,497 nonmetropolitan counties was conducted to test the possible contribution of agricultural chemical use to cancer mortality rates in rural counties. The dependent variables were 20-year age-adjusted mortality rates for 1950 to 1969 for five categories of cancer: genital, urinary, lymphatic, respiratory, and digestive. Because sex…

Decreases in Smoking-Related Cancer Mortality Rates Are Associated with Birth Cohort Effects in Korean Men.

PubMed

Jee, Yon Ho; Shin, Aesun; Lee, Jong-Keun; Oh, Chang-Mo

2016-12-05

Background: This study aimed to examine trends in smoking-related cancer mortality rates and to investigate the effect birth cohort on smoking-related cancer mortality in Korean men. Methods: The number of smoking-related cancer deaths and corresponding population numbers were obtained from Statistics Korea for the period 1984-2013. Joinpoint regression analysis was used to detect changes in trends in age-standardized mortality rates. Birth-cohort specific mortality rates were illustrated by 5 year age groups. Results: The age-standardized mortality rates for oropharyngeal decreased from 2003 to 2013 (annual percent change (APC): -3.1 (95% CI, -4.6 to -1.6)) and lung cancers decreased from 2002 to 2013 (APC -2.4 (95% CI -2.7 to -2.2)). The mortality rates for esophageal declined from 1994 to 2002 (APC -2.5 (95% CI -4.1 to -0.8)) and from 2002 to 2013 (APC -5.2 (95% CI -5.7 to -4.7)) and laryngeal cancer declined from 1995 to 2013 (average annual percent change (AAPC): -3.3 (95% CI -4.7 to -1.8)). By the age group, the trends for the smoking-related cancer mortality except for oropharyngeal cancer have changed earlier to decrease in the younger age group. The birth-cohort specific mortality rates and age-period-cohort analysis consistently showed that all birth cohorts born after 1930 showed reduced mortality of smoking-related cancers. Conclusions: In Korean men, smoking-related cancer mortality rates have decreased. Our findings also indicate that current decreases in smoking-related cancer mortality rates have mainly been due to a decrease in the birth cohort effect, which suggest that decrease in smoking rates.

Cancer mortality rates in Appalachia: descriptive epidemiology and an approach to explaining differences in outcomes.

PubMed

Blackley, David; Behringer, Bruce; Zheng, Shimin

2012-08-01

Cancer is a leading cause of death in the Appalachian region of the United States. Existing studies compare regional mortality rates to those of the entire nation. We compare cancer mortality rates in Appalachia to those of the nation, with additional comparisons of Appalachian and non-Appalachian counties within the 13 states that contain the Appalachian region. Lung/bronchus, colorectal, female breast and cervical cancers, as well as all cancers combined, are included in analysis. Linear regression is used to identify independent associations between ecological socioeconomic and demographic variables and county-level cancer mortality outcomes. There is a pattern of high cancer mortality rates in the 13 states containing Appalachia compared to the rest of the United States. Mortality rate differences exist between Appalachian and non-Appalachian counties within the 13 states, but these are not consistent. Lung cancer is a major problem in Appalachia; most Appalachian counties within the 13 states have significantly higher mortality rates than in-state, non-Appalachian counterparts. Mortality rates from all cancers combined also appear to be worse overall within Appalachia, but part of this disparity is likely driven by lung cancer. Education and income are generally associated with cancer mortality, but differences in the strength and direction of these associations exist depending on location and cancer type. Improving high school graduation rates in Appalachia could result in a meaningful long term reduction in lung cancer mortality. The relative importance of household income level to cancer outcomes may be greater outside the Appalachian regions within these states.

Effects of education and other socioeconomic factors on middle age mortality in rural Bangladesh

PubMed Central

Hurt, L; Ronsmans, C; Saha, S

2004-01-01

Study objective: To examine socioeconomic gradients in mortality in adult women and their husbands in Bangladesh, paying particular attention to the independent effects of the educational status of each spouse. Design: Historical cohort study. Setting: Matlab, a rural area 60 km south east of Dhaka, the capital of Bangladesh. Participants: 14 803 married women aged 45 or over and their husbands who were resident in the Matlab Demographic Surveillance area between 30 June 1982 and 31 December 1998. Main results: Mortality was lower in women with formal or Koranic education compared with those with none (adjusted rate ratio for formal education = 0.68, 95% CI 0.53 to 0.86; adjusted rate ratio for Koranic schooling = 0.82, 95% CI 0.66 to 1.00). After adjusting for her own education, the husband's level of education or occupation did not have an independent effect on a woman's survival. Men who had attended formal education had lower mortality than those without any education (adjusted rate ratio = 0.84, 95% CI 0.75 to 0.93), but men whose wives had been educated had an additional survival advantage independent of their own education and occupation (adjusted rate ratio = 0.76, 95% CI 0.67 to 0.87). Mortality in both sexes was also significantly associated with marital status and the percentage of surviving children, and in men was associated with the man's occupation, religion, area of residence. Conclusions: The data suggest that socioeconomic status has a strong influence on mortality in adults in Bangladesh. They also illustrate how important the continued promotion of education, particularly for women, may be for the survival of both women and men in rural Bangladesh. PMID:15026446

Examining mortality risk and rate of ageing among Polish Olympic athletes: a survival follow-up from 1924 to 2012.

PubMed

Lin, Yuhui; Gajewski, Antoni; Poznańska, Anna

2016-04-18

Population-based studies have shown that an active lifestyle reduces mortality risk. Therefore, it has been a longstanding belief that individuals who engage in frequent exercise will experience a slower rate of ageing. It is uncertain whether this widely-accepted assumption holds for intense wear-and-tear. Here, using the 88 years survival follow-up data of Polish Olympic athletes, we report for the first time on whether frequent exercise alters the rate of ageing. Longitudinal survival data of male elite Polish athletes who participated in the Olympic Games from year 1924 to 2010 were used. Deaths occurring before the end of World War II were excluded for reliable estimates. Recruited male elite athletes N=1273 were preassigned to two categorical birth cohorts--Cohort I 1890-1919; Cohort II 1920-1959--and a parametric frailty survival analysis was conducted. An event-history analysis was also conducted to adjust for medical improvements from year 1920 onwards: Cohort II. Our findings suggest (1) in Cohort I, for every threefold reduction in mortality risk, the rate of ageing decelerates by 1%; (2) socioeconomic transitions and interventions contribute to a reduction in mortality risk of 29% for the general population and 50% for Olympic athletes; (3) an optimum benefit gained for reducing the rate of ageing from competitive sports (Cohort I 0.086 (95% CI 0.047 to 0.157) and Cohort II 0.085 (95% CI 0.050 to 0.144)). This study further suggests that intensive physical training during youth should be considered as a factor to improve ageing and mortality risk parameters. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Is patriarchy the source of men's higher mortality?

PubMed Central

Stanistreet, D; Bambra, C; Scott-Samuel, A

2005-01-01

Objective: To examine the relation between levels of patriarchy and male health by comparing female homicide rates with male mortality within countries. Hypothesis: High levels of patriarchy in a society are associated with increased mortality among men. Design: Cross sectional ecological study design. Setting: 51 countries from four continents were represented in the data—America, Europe, Australasia, and Asia. No data were available for Africa. Results: A multivariate stepwise linear regression model was used. Main outcome measure was age standardised male mortality rates for 51 countries for the year 1995. Age standardised female homicide rates and GDP per capita ranking were the explanatory variables in the model. Results were also adjusted for the effects of general rates of homicide. Age standardised female homicide rates and ranking of GDP were strongly correlated with age standardised male mortality rates (Pearson's r = 0.699 and Spearman's 0.744 respectively) and both correlations achieved significance (p<0.005). Both factors were subsequently included in the stepwise regression model. Female homicide rates explained 48.8% of the variance in male mortality, and GDP a further 13.6% showing that the higher the rate of female homicide, and hence the greater the indicator of patriarchy, the higher is the rate of mortality among men. Conclusion: These data suggest that oppression and exploitation harm the oppressors as well as those they oppress, and that men's higher mortality is a preventable social condition, which could be tackled through global social policy measures. PMID:16166362

Is 30-day Posthospitalization Mortality Lower Among Racial/Ethnic Minorities?: A Reexamination.

PubMed

Lin, Meng-Yun; Kressin, Nancy R; Paasche-Orlow, Michael K; Kim, Eun Ji; López, Lenny; Rosen, Jennifer E; Hanchate, Amresh D

2018-06-05

Multiple studies have reported that risk-adjusted rates of 30-day mortality after hospitalization for an acute condition are lower among blacks compared with whites. To examine if previously reported lower mortality for minorities, relative to whites, is accounted for by adjustment for do-not-resuscitate status, potentially unconfirmed admission diagnosis, and differential risk of hospitalization. Using inpatient discharge and vital status data for patients aged 18 and older in California, we examined all admissions from January 1, 2010 to June 30, 2011 for acute myocardial infarction, heart failure, pneumonia, acute stroke, gastrointestinal bleed, and hip fracture and estimated relative risk of mortality for Hispanics, non-Hispanic blacks, non-Hispanic Asians, and non-Hispanic whites. Multiple mortality measures were examined: inpatient, 30-, 90-, and 180 day. Adding census data we estimated population risks of hospitalization and hospitalization with inpatient death. Across all mortality outcomes, blacks had lower mortality rate, relative to whites even after exclusion of patients with do-not-resuscitate status and potentially unconfirmed diagnosis. Compared with whites, the population risk of hospitalization was 80% higher and risk of hospitalization with inpatient mortality was 30% higher among blacks. Among Hispanics and Asians, disparities varied with mortality measure. Lower risk of posthospitalization mortality among blacks, relative to whites, may be associated with higher rate of hospitalizations and differences in unobserved patient acuity. Disparities for Hispanics and Asians, relative to whites, vary with the mortality measure used.

Among nonagenarians, congruence between self-rated and proxy-rated health was low but both predicted mortality.

PubMed

Vuorisalmi, Merja; Sarkeala, Tytti; Hervonen, Antti; Jylhä, Marja

2012-05-01

The congruence between self-rated global health (SRH) and proxy-rated global health (PRH), the factors associated with congruence between SRH and PRH, and their associations with mortality are examined using data from the Vitality 90+ study. The data consist of 213 pairs of subjects--aged 90 years and older--and proxies. The relationship between SRH and PRH was analyzed by chi-square test and Cohen's kappa. Logistic regression analysis was used to find out the factors that are associated with the congruence between health ratings. The association between SRH and PRH with mortality was studied using Cox proportional hazard models. The subjects rated their health more negatively than the proxies. Kappa value indicated only slight congruence between SRH and PRH, and they also predicted mortality differently. Good self-reported functional ability was associated with congruence between SRH and PRH. The results imply that the evaluation processes of SRH and PRH differ, and the measures are not directly interchangeable. Both measures are useful health indicators in very old age but SRH cannot be replaced by PRH in analyses. Copyright © 2012 Elsevier Inc. All rights reserved.

A 5-trial adjusting delay discounting task: Accurate discount rates in less than 60 seconds

PubMed Central

Koffarnus, Mikhail N.; Bickel, Warren K.

2014-01-01

Individuals who discount delayed rewards at a high rate are more likely to engage in substance abuse, overeating, or problem gambling. Findings such as these suggest the value of methods to obtain an accurate and fast measurement of discount rate that can be easily deployed in variety of settings. In the present study, we developed and evaluated the 5-trial adjusting delay task, a novel method of obtaining discount rate in less than one minute. We hypothesized that discount rates from the 5-trial adjusting delay task would be similar and correlated with discount rates from a lengthier task we have used previously, and that four known effects relating to delay discounting would be replicable with this novel task. To test these hypotheses, the 5-trial adjusting delay task was administered to 111 college students six times to obtain discount rates for six different commodities, along with a lengthier adjusting amount discounting task. We found that discount rates were similar and correlated between the 5-trial adjusting delay task and the adjusting amount task. Each of the four known effects relating to delay discounting was replicated with the 5-trial adjusting delay task to varying degrees. First, discount rates were inversely correlated with amount. Second, discount rates between past and future outcomes were correlated. Third, discount rates were greater for consumable rewards than with money, although we did not control for amount in this comparison. Fourth, discount rates were lower when zero amounts opposing the chosen time point were explicitly described. Results indicate that the 5-trial adjusting delay task is a viable, rapid method to assess discount rate. PMID:24708144

A 5-trial adjusting delay discounting task: accurate discount rates in less than one minute.

PubMed

Koffarnus, Mikhail N; Bickel, Warren K

2014-06-01

Individuals who discount delayed rewards at a high rate are more likely to engage in substance abuse, overeating, or problem gambling. Such findings suggest the value of methods to obtain an accurate and fast measurement of discount rate that can be easily deployed in variety of settings. In the present study, we developed and evaluated the 5-trial adjusting delay task, a novel method of obtaining a discount rate in less than 1 min. We hypothesized that discount rates from the 5-trial adjusting delay task would be similar and would correlate with discount rates from a lengthier task we have used previously, and that 4 known effects relating to delay discounting would be replicable with this novel task. To test these hypotheses, the 5-trial adjusting delay task was administered to 111 college students 6 times to obtain discount rates for 6 different commodities, along with a lengthier adjusting amount discounting task. We found that discount rates were similar and correlated between the 5-trial adjusting delay task and the adjusting amount task. Each of the 4 known effects relating to delay discounting was replicated with the 5-trial adjusting delay task to varying degrees. First, discount rates were inversely correlated with amount. Second, discount rates between past and future outcomes were correlated. Third, discount rates were greater for consumable rewards than with money, although we did not control for amount in this comparison. Fourth, discount rates were lower when $0 amounts opposing the chosen time point were explicitly described. Results indicate that the 5-trial adjusting delay task is a viable, rapid method to assess discount rate. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Forecasting the mortality rates of Malaysian population using Heligman-Pollard model

NASA Astrophysics Data System (ADS)

Ibrahim, Rose Irnawaty; Mohd, Razak; Ngataman, Nuraini; Abrisam, Wan Nur Azifah Wan Mohd

2017-08-01

Actuaries, demographers and other professionals have always been aware of the critical importance of mortality forecasting due to declining trend of mortality and continuous increases in life expectancy. Heligman-Pollard model was introduced in 1980 and has been widely used by researchers in modelling and forecasting future mortality. This paper aims to estimate an eight-parameter model based on Heligman and Pollard's law of mortality. Since the model involves nonlinear equations that are explicitly difficult to solve, the Matrix Laboratory Version 7.0 (MATLAB 7.0) software will be used in order to estimate the parameters. Statistical Package for the Social Sciences (SPSS) will be applied to forecast all the parameters according to Autoregressive Integrated Moving Average (ARIMA). The empirical data sets of Malaysian population for period of 1981 to 2015 for both genders will be considered, which the period of 1981 to 2010 will be used as "training set" and the period of 2011 to 2015 as "testing set". In order to investigate the accuracy of the estimation, the forecast results will be compared against actual data of mortality rates. The result shows that Heligman-Pollard model fit well for male population at all ages while the model seems to underestimate the mortality rates for female population at the older ages.

Mortality rates among children and teenagers living in Inuit Nunangat, 1994 to 2008.

PubMed

Oliver, Lisa N; Peters, Paul A; Kohen, Dafna E

2012-09-01

Because Vital Statistics data do not include information on Inuit identity in all jurisdictions, mortality rates cannot be calculated specifically for Inuit. However, Inuit in Canada are geographically concentrated--78% live in Inuit Nunangat, and 82% of the area's total population identify as Inuit. While there are limitations, geographic approaches can be employed to calculate mortality for the population of that area. The Vital Statistics Database (1994 to 2008) and population estimates were used to calculate age-standardized mortality rates (ASMRs) in five-year intervals around the 1996 and 2006 Census years. Mortality rates were calculated for 1- to 19-year-olds living in Inuit Nunangat and those living elsewhere in Canada. The ASMR in 2004-2008 for 1- to 19-year-olds in Inuit Nunangat was 188.0 deaths per 100,000 person-years at risk, five times the rate (35.3) elsewhere in Canada. The disparity had not narrowed over the previous decade. In Inuit Nunangat, injuries were responsible for 64% of deaths of children and teenagers, compared with 36% in the rest of Canada. The persistently high mortality rates for children and teenagers living in Inuit Nunangat, compared with the rest of Canada, are important in understanding the health and socio-economic situation of residents of this region.

Fertility and mortality in India during 1951-1971.

PubMed

Sinha, U P

1976-03-01

Statistical corrections found necessary to draw up a set of life tab les for the International Institute for Population Studies are discussed . The 1971 Census of India enumerated 547,949,809 persons, 13 million short of the estimate by the Census Actuary. Although the fluid migration situation may have complicated the figures, the real problem seems to be overestimation of the drop in death rates and underestimation of the adoption of family planning. Also, the Census Actuary borrowed infant mortality rates observed by the National Sample Survey without adjusting for underestimation of vital events. This results in underestimation of childhood mortality. The smoothed age distributions of 1961 seem different from the ones of 1951. There is a 2% difference in the proportion of children below 5 years of age, a figure that does not seem possible due to mortality decline alone in the 10-year period. Population projections using the method derived have been very close to enumerated populations and the vital rates are close to estimates of other authors and surveys. It is possible the Sample Re gistration Scheme did not make adjustments for events missed by the enumerator and, subsequently, by the supervisor.