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

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.

Mortality rates among Arab Americans in Michigan.

PubMed

Dallo, Florence J; Schwartz, Kendra; Ruterbusch, Julie J; Booza, Jason; Williams, David R

2012-04-01

The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.

Mortality Rates Among Arab Americans in Michigan

PubMed Central

Schwartz, Kendra; Ruterbusch, Julie J.; Booza, Jason; Williams, David R.

2014-01-01

The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population. PMID:21318619

Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries.

PubMed

Bellizzi, Saverio; Sobel, Howard; Betran, Ana Pilar; Temmerman, Marleen

2018-06-01

Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies. We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs. Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1.3; 95% CI = 1.0-1.8) and

Premorbid (early life) IQ and later mortality risk: systematic review.

PubMed

Batty, G David; Deary, Ian J; Gottfredson, Linda S

2007-04-01

Studies of middle-aged and particularly older-aged adults found that those with higher scores on tests of IQ (cognitive function) had lower rates of later mortality. Interpretation of such findings potentially is hampered by the problem of reverse causality: such somatic diseases as diabetes or hypertension, common in older adults, can decrease cognitive function. Studies that provide extended follow-up of the health experience of individuals who had their (premorbid) IQ assessed in childhood and/or early adulthood minimize this concern. The purpose of the present report is to systematically locate, evaluate, and interpret the findings of all such studies. We systematically identified individual-level studies linking premorbid IQ with later mortality by using four approaches: search of electronic databases (MEDLINE, EMBASE, and PSYCHINFO); scrutiny of the reference sections of identified reports; search of our own files; and contact with researchers in the field. Study quality was assessed by using predefined criteria. Nine cohort studies met the inclusion criteria. Overall, study quality was moderate. All reports showed an inverse IQ-mortality relation; i.e., higher IQ scores were associated with decreased mortality risk. The nature of this relation (i.e., dose-response or threshold) and whether it differs by sex was unclear. The IQ-mortality association did not appear to be explained by reverse causality or selection bias. Confounding by other early-life factors also did not seem to explain the association, although some studies were not well characterized in this regard. Adult socioeconomic position appeared to mediate the IQ-mortality association in some studies, but this was not a universal finding. In all studies, higher IQ in the first two decades of life was related to lower rates of total mortality in middle to late adulthood. Some plausible mechanistic pathways exist, but further examination is required. The precise nature of the IQ-mortality relation

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

Early life mortality and height in Indian states

PubMed Central

Coffey, Diane

2014-01-01

Height is a marker for health, cognitive ability and economic productivity. Recent research on the determinants of height suggests that postneonatal mortality predicts height because it is a measure of the early life disease environment to which a cohort is exposed. This article advances the literature on the determinants of height by examining the role of early life mortality, including neonatal mortality, in India, a large developing country with a very short population. It uses state level variation in neonatal mortality, postneonatal mortality, and pre-adult mortality to predict the heights of adults born between 1970 and 1983, and neonatal and postneonatal mortality to predict the heights of children born between 1995 and 2005. In contrast to what is found in the literature on developed countries, I find that state level variation in neonatal mortality is a strong predictor of adult and child heights. This may be due to state level variation in, and overall poor levels of, pre-natal nutrition in India. PMID:25499239

Does shared family background influence the impact of educational differences on early mortality?

PubMed

Søndergaard, Grethe; Mortensen, Laust H; Nybo Andersen, Anne-Marie; Andersen, Per Kragh; Dalton, Susanne Oksbjerg; Madsen, Mia; Osler, Merete

2012-10-15

The mechanisms behind social differences in mortality rates have been debated. The authors examined the extent to which shared family background and health in early life could explain the association between educational status and all-cause mortality rates using a sibling design. The study was register-based and included all individuals born in Denmark between 1950 and 1979 who had at least 1 full sibling born in the same time period (n = 1,381,436). All individuals were followed from 28 years of age until death, emigration, or December 2009. The authors used Cox regression analyses to estimate hazard ratios for mortality according to educational level. Conventional cohort and intersibling analyses were carried out and conducted separately for deaths occurring before and after the age of 45 years, respectively. The cohort analyses showed an inverse association between educational status and all-cause mortality that was strongest for males, increased with younger birth cohorts, and tended to be strongest in the analyses of death before 45 years of age. The associations were attenuated slightly in the intersibling analyses and after adjustment for serious health conditions in early life. Hence, health selection and confounding by factors shared by siblings explained only a minor part of the association between educational level and all-cause mortality.

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.

Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries

PubMed Central

Bellizzi, Saverio; Sobel, Howard; Betran, Ana Pilar; Temmerman, Marleen

2018-01-01

Background Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies. Methods We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs. Results Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1

High early life mortality in free-ranging dogs is largely influenced by humans

PubMed Central

Paul, Manabi; Sen Majumder, Sreejani; Sau, Shubhra; Nandi, Anjan K.; Bhadra, Anindita

2016-01-01

Free-ranging dogs are a ubiquitous part of human habitations in many developing countries, leading a life of scavengers dependent on human wastes for survival. The effective management of free-ranging dogs calls for understanding of their population dynamics. Life expectancy at birth and early life mortality are important factors that shape life-histories of mammals. We carried out a five year-long census based study in seven locations of West Bengal, India, to understand the pattern of population growth and factors affecting early life mortality in free-ranging dogs. We observed high rates of mortality, with only ~19% of the 364 pups from 95 observed litters surviving till the reproductive age; 63% of total mortality being human influenced. While living near people increases resource availability for dogs, it also has deep adverse impacts on their population growth, making the dog-human relationship on streets highly complex. PMID:26804633

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.

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

Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003-15.

PubMed

Gesesew, Hailay Abrha; Ward, Paul; Woldemichael, Kifle; Mwanri, Lillian

2018-01-01

Several studies reported that the majority of deaths in HIV-infected people are documented in their early antiretroviral therapy (ART) follow-ups. Early mortality refers to death of people on ART for follow up period of below 24 months due to any cause. The current study assessed predictors of early HIV mortality in Southwest Ethiopia. We have conducted a retrospective analysis of 5299 patient records dating from June 2003- March 2015. To estimate survival time and compare the time to event among the different groups of patients, we used a Kaplan Meir curve and log-rank test. To identify mortality predictors, we used a cox regression analysis. We used SPSS-20 for all analyses. A total of 326 patients died in the 12 years follow-up period contributing to 6.2% cumulative incidence and 21.7 deaths per 1000 person-year observations incidence rate. Eighty-nine percent of the total deaths were documented in the first two years follow up-an early-term ART follow up. Early HIV mortality rates among adults were 50% less in separated, divorced or widowed patients compared with never married patients, 1.6 times higher in patients with baseline CD4 count <200 cells/μL compared to baseline CD4 count ≥200 cells/μL, 1.5 times higher in patients with baseline WHO clinical stage 3 or 4 compared to baseline WHO clinical stage 1 or 2, 2.1 times higher in patients with immunologic failure compared with no immunologic failure, 60% less in patients with fair or poor compared with good adherence, 2.9 times higher in patients with bedridden functional status compared to working functional status, and 2.7 times higher with patients who had no history of HIV testing before diagnosis compared to those who had history of HIV testing. Most predictors of early mortality remained the same to the predictors of an overall HIV mortality. When discontinuation was assumed as an event, the predictors of an overall HIV mortality included age between 25-50 years, base line CD4 count, developing

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.

Effect of prenatal care on infant mortality rates according to birth-death certificate files.

PubMed

Poma, P A

1999-09-01

Infant mortality has decreased nationwide; however, our national rates still log behind those of other industrialized countries, especially the rates for minority groups. This study evaluates the effect of prenatal care and risk factors on infant mortality rates in Chicago. Using linked infant birth and death certificates of Chicago residents for 1989-1995, a total of 5838 deaths occurring during the first year of life were identified. Birth certificate variables, especially prenatal care, were reviewed. Variables were compared by stratified analysis. Pearson chi 2 analysis and odd ratios (ORs) were computed. Infant mortality rate (IMR) in Chicago decreased from 17 in 1989 to 12.6 in 1995 (P < .0001). Some factors increased IMR several fold: prematurity (OR 17.43), no prenatal care (OR 4.07), inadequate weight gain (OR 2.95), African-American ethnicity (OR 2.55), and inadequate prenatal care (OR 2.03). Compared with no care, prenatal care was associated with lower IMR; however, early care was associated with higher IMR and ORs than later care. These results demonstrate prenatal care is associated with lower IMR; however, compared with late prenatal care, early care does not improve IMR. Further studies should evaluate whether improving the quality of care improves IMRs.

Early-Life Origins of the Race Gap in Men's Mortality

ERIC Educational Resources Information Center

Warner, David F.; Hayward, Mark D.

2006-01-01

Using a life course framework, we examine the early life origins of the race gap in men's all-cause mortality. Using the National Longitudinal Survey of Older Men (1966-1990), we evaluate major social pathways by which early life conditions differentiate the mortality experiences of blacks and whites. Our findings indicate that early life…

Early mortality of alcoholic hepatitis: a review of data from placebo-controlled clinical trials.

PubMed

Yu, Chao-Hui; Xu, Cheng-Fu; Ye, Hua; Li, Lan; Li, You-Ming

2010-05-21

To investigate the early mortality of placebo-treated alcoholic hepatitis patients. Mortality data about alcoholic hepatitis patients who participated in randomized placebo-controlled trials were searched from PubMed, EMBASE, and Cochrane Library, extracted and analyzed. A total of 661 placebo-treated patients in 19 trials were included. The overall mortality rate was 34.19% with a median observation time of 160 d (range 21-720 d). Hepatic failure, gastrointestinal bleeding and infection were the three main causes of death, accounting for 55.47%, 21.17% and 7.30% of all deaths, respectively. One-month mortality data about 324 placebo-treated alcoholic hepatitis patients in 10 trials were reported with a pooled mortality rate of 20.37%. The one-month mortality rate of patients with moderate to severe alcoholic hepatitis tended to be higher than that of general patients (22.69% vs 10.93%, P < 0.05), whereas no significant difference was observed between the patients from North America or Europe (22.43% vs 18.45%, P > 0.05), neither any difference was found between the studies published before and after 1990 (18.18% vs 21.88%, P > 0.05). Alcoholic hepatitis is a severe liver disease with a high mortality rate, and hepatic failure, gastrointestinal bleeding and infection are the three main causes of death.

Detection of early warning signals of forest mortality in California

NASA Astrophysics Data System (ADS)

Liu, Y.; Kumar, M.; Katul, G. G.; Porporato, A. M.

2017-12-01

Massive forest mortality was observed in California during the most recent drought. Owing to complex interactions of physiological mechanisms under stress, prediction of climate-induced forest mortality using dynamic global vegetation models remains fraught with uncertainty. Given that forest ecosystems approaching mortality tend to exhibit reduction in resilience, we evaluate the time-varying resilience from time series of satellite images to detect early warning signals (EWSs) of mortality. Four metrics of EWSs are used: (1) low greenness, (2) high empirical autocorrelation of greenness, (3) high autocorrelation inferred using a Bayesian dynamic linear model considering the influence of seasonality and climate conditions, and (4) low recovery rate inferred from the drift term in the Langevin equation describing stochastic dynamics. Spatial accuracy and lead-time of these EWSs are evaluated by comparing the EWSs against observed mortality from aerial surveys conducted by the US Forest Service. Our results show that most forested areas in California that underwent mortality exhibit a EWS with a lead time of three months to two years ahead of observed mortality. Notably, EWS is also detected in some areas without mortality, suggesting reduced resilience during drought. Furthermore, the influence of the previous drought (2007-2009) may have propagated into the recent drought (2012-2016) through reduced resilience, hence contributing to the massive forest mortality observed recently. Methodologies developed in this study for detection of EWS will improve the near-term predictability of forest mortality, thus providing crucial information for forest and water resource management.

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

In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis.

PubMed

Lalani, Tahaniyat; Chu, Vivian H; Park, Lawrence P; Cecchi, Enrico; Corey, G Ralph; Durante-Mangoni, Emanuele; Fowler, Vance G; Gordon, David; Grossi, Paolo; Hannan, Margaret; Hoen, Bruno; Muñoz, Patricia; Rizk, Hussien; Kanj, Souha S; Selton-Suty, Christine; Sexton, Daniel J; Spelman, Denis; Ravasio, Veronica; Tripodi, Marie Françoise; Wang, Andrew

2013-09-09

.2% vs 37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P = .007) quintiles of surgical propensity. Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort. Further studies are needed to define the effect and timing of surgery in patients with PVE who have indications for surgery.

Early and late mortality of spontaneous hemorrhagic transformation of ischemic stroke.

PubMed

D'Amelio, Marco; Terruso, Valeria; Famoso, Giorgia; Di Benedetto, Norma; Realmuto, Sabrina; Valentino, Francesca; Ragonese, Paolo; Savettieri, Giovanni; Aridon, Paolo

2014-04-01

Hemorrhagic transformation (HT), a complication of ischemic stroke (IS), might influence patient's prognosis. Our aim is to evaluate, in a hospital-based series of patients not treated with thrombolysis, the relationship between HT and mortality. We compared mortality of individuals with spontaneous HT with that of individuals without. Medical records of patients diagnosed with anterior IS were retrospectively reviewed. Outcome measures were 30- and 90-day survival after IS onset. Kaplan-Meier estimates were used to construct survival curves. Cox proportional hazards model was used to estimate hazard ratio (HR) for the main outcome measure (death). HT was stratified in hemorrhagic infarction and parenchymal hematoma (PH). We also evaluated the relationship between HT and the main mortality risk factors (gender, age, premorbid status, severity of stroke, and radiological features). Thirty days from stroke onset, 8.1% (19 of 233) of patients died. At multivariate analysis, PH (HR: 7.7, 95% confidence interval [CI]: 2.1, 27.8) and low level of consciousness at admission (HR: 5.0, 95% CI: 1.3, 18.6) were significantly associated with death. At 3-month follow-up, mortality rate was 12.1% (28 of 232). At multivariate analysis, large infarct size (HR: 2.7, 95% CI: 1.2, 6.0) and HT (HR: 2.3, 95% CI: 1.0, 5.4) were independent risk factors for mortality. Parenchymal hematoma was, however, the strongest predictor of late mortality (HR: 7.9, 95% CI: 2.9, 21.4). Neurological status and infarct size play a significant role, respectively, in early and late mortality after IS. Parenchymal hematoma independently predicts both early and late mortality. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Changes in mortality rates and humanitarian conditions in Darfur, Sudan 2003-2007.

PubMed

Garfield, Richard; Polonsky, Jonny

2010-01-01

The Darfur region of Sudan has been an intense focus of humanitarian concern since rebellions began there early in 2003. In 2004, the US Secretary of State declared that conflict in Darfur represented genocide. Since 2003, many sample surveys and various mortality estimates for Darfur have been made. Nonetheless, confusion and controversy surrounding mortality levels and trends have continued. For this project, results were reviewed from the highest quality field surveys on mortality in Darfur conducted between 2003 and 2008. Trend analysis demonstrated a dramatic decline in mortality over time in Darfur. By 2005, mortality levels had fallen below emergency levels and have continued to decline. Deaths directly due violence have declined as a proportion of all of the deaths in Darfur. Declining mortality in Darfur was not associated with other proximate improvements in well-being, such as improved nutrition. Without large-scale, humanitarian intervention, continuing high rates of mortality due to violence likely would have occurred. If mortality had continued at the high rate documented in 2004, by January 2009, there would have been 330,000 additional deaths. With the humanitarian assistance provided through the United Nations and non-governmental organizations, these people are alive today. A focus on excess deaths among noncombatants may draw attention away from other needs, such as establishing better security, improving service delivery to the displaced, and advocating for internally displaced persons to be reached today and to re-establish their lives and livelihoods tomorrow.

Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California.

PubMed

Ho, Gwendolyn; Wun, Ted; Muffly, Lori; Li, Qian; Brunson, Ann; Rosenberg, Aaron S; Jonas, Brian A; Keegan, Theresa H M

2018-05-01

To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML). Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute-designated cancer center (NCI-CC). Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ≤60 days from diagnosis). Of the 7007 patients with AML, 1762 (25%) were treated at an NCI-CC. Patients with AML who were treated at NCI-CCs were more likely to be aged ≤65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI-CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38-0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non-NCI-CCs. The initial treatment of adult patients with AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938-45. © 2018 American Cancer Society. © 2018 American Cancer Society.

All-cancers mortality rates approaching diseases of the heart mortality rates as leading cause of death in Texas.

PubMed

Wyatt, Stephen W; Maynard, William Ryan; Risser, David R; Hakenewerth, Anne M; Williams, Melanie A; Garcia, Rebecca

2014-01-01

Diseases of the heart and malignant neoplasms (all-cancers) are the leading causes of death in the United States. The gap between the two has been closing in recent years. To assess the gap status in Texas and to establish a baseline to support evaluation efforts for the Cancer Prevention Research Institute of Texas, mortality data from 2006 to 2009 were analyzed. Immediate cause of death data in Texas for the years 2006-2009 were analyzed and rates developed by sex, race/ethnicity, and four metropolitan counties. Overall, for the years 2006-2009, the age-adjusted mortality rates (AARs) among Texas residents for both diseases of the heart and all-cancers decreased; however, during this time frame, there was greater improvement in diseases of the heart AARs as compared with all-cancers AARs. For the four large metropolitan counties of Bexar, Dallas, Harris, and Travis, data were analyzed by sex and race/ethnicity, and 11 of the 12 largest percent mortality rate decreases were for diseases of the heart. Age-adjusted mortality rates among Texas residents from diseases of the heart are showing improvement as compared with the rates for all-cancers.

Early mortality and complications in hospitalized adult Californians with acute myeloid leukaemia.

PubMed

Ho, Gwendolyn; Jonas, Brian A; Li, Qian; Brunson, Ann; Wun, Ted; Keegan, Theresa H M

2017-06-01

Few studies have evaluated the impact of complications, sociodemographic and clinical factors on early mortality (death ≤60 days from diagnosis) in acute myeloid leukaemia (AML) patients. Using data from the California Cancer Registry linked to hospital discharge records from 1999 to 2012, we identified patients aged ≥15 years with AML who received inpatient treatment (N = 6359). Multivariate logistic regression analyses were used to assess the association of complications with early mortality, adjusting for sociodemographic factors, comorbidities and hospital type. Early mortality decreased over time (25·3%, 1999-2000; 16·8%, 2011-2012) across all age groups, but was higher in older patients (6·9%, 15-39, 11·4%, 40-54, 18·6% 55-65, and 35·8%, >65 years). Major bleeding [Odds ratio (OR) 1·5, 95% confidence interval (CI) 1·3-1·9], liver failure (OR 1·9, 95% CI 1·1-3·1), renal failure (OR 2·4, 95% CI 2·0-2·9), respiratory failure (OR 7·6, 95% CI 6·2-9·3) and cardiac arrest (OR 15·8, 95% CI 8·7-28·6) were associated with early mortality. Higher early mortality was also associated with single marital status, low neighbourhood socioeconomic status, lack of health insurance and comorbidities. Treatment at National Cancer Institute-designated cancer centres was associated with lower early mortality (OR 0·5, 95% CI 0·4-0·6). In conclusion, organ dysfunction, hospital type and sociodemographic factors impact early mortality. Further studies should investigate how differences in healthcare delivery affect early mortality. © 2017 John Wiley & Sons Ltd.

Mortality throughout early childhood for Michigan children born with congenital anomalies, 1992-1998.

PubMed

Berger, Katherine H; Zhu, Bao-Ping; Copeland, Glenn

2003-09-01

Congenital anomalies are a leading cause of infant deaths, accounting for almost a fifth of all infant deaths. Few studies have researched the survival experience of infants born with congenital anomalies past the infant stage. Using birth and death files routinely linked to the Michigan Birth Defects Registry, we identified all singleton infants during calendar years 1992 through 1998 with reportable congenital anomalies for our study. A comparative file of children born without congenital anomalies during the same time period was developed using linked birth and death files. The mortality data were assessed by age at death (through age six) and race to determine mortality rates, relative risks, hazard ratios, and survival trends. Throughout early childhood, children born with congenital anomalies had a high risk of mortality compared with all other children. The overall 7-year hazard ratio comparing children with congenital anomalies with all other children was 7.2. Overall mortality rates for black children were significantly higher than white children through the age of seven, irrespective of whether they had congenital anomalies. Among children with congenital anomalies, this disparity disappeared after adjusting for birth weight, sex, mother's age, mother's education, and number of organ systems affected. Compared with children without congenital anomalies, children born with congenital anomalies had a higher risk of mortality well beyond the infant period. Racial disparities in mortality rates among children with congenital anomalies were due to confounding factors.

Early mortality syndrome in Great Lakes salmonines

USGS Publications Warehouse

Honeyfield, Dale C.; Brown, Scott B.; Fitzsimons, John D.; Tillitt, Donald E.

2005-01-01

Early mortality syndrome (EMS) is the termused to describe an embryonic mortality affectingthe offspring of salmonines (coho salmonOnco-rhynchus kisutch, Chinook salmonOncorhynchustshawytscha, steelhead [anadromous rainbow troutOncorhynchus mykiss], brown troutSalmo trutta,and lake trout,Salvelinus namaycush) in LakesMichigan and Ontario and, to a lesser extent, LakesHuron and Erie (Marcquenski and Brown 1997).Clinical signs of EMS include loss of equilibrium,a spiral swimming pattern, lethargy, hyperexcit-ability, hemorrhage, and death between hatch andfirst feeding. Early mortality syndrome was ob-served as far back as the 1960s in Great Lakessalmonines (Marcquenski and Brown 1997; Fitz-simons et al. 1999) and is of concern because mor-tality has been high in recent years (Wolgamoodet al. 2005; all 2005 citations are this issue). Stocksof Atlantic salmonSalmo salarfrom the FingerLakes and the Baltic Sea also exhibit a similarearly life stage mortality, called Cayuga syndrome(Fisher et al. 1995) and M74 (Bo ̈ rjeson and Norr-gren 1997), respectively. Low egg thiamine levelsand enhanced survival following thiamine treat-ments are common characteristics of EMS, CayugaSyndrome, and M74 (Fitzsimons et al. 1999). Be-cause the deficiency does not appear to be the re-sult of inadequate dietary thiamine (Fitzsimons and Brown 1998), investigators have hypothesizedthat the presence of some thiaminolytic factors inthe diet may reduce the bioavailability of thiamine,either by destroying it or converting it to an in-active analog or thiamine antagonist (Fisher et al.1996; Fitzsimons et al. 1999).

Verbal memory and search speed in early midlife are associated with mortality over 25 years' follow-up, independently of health status and early life factors: a British birth cohort study.

PubMed

Davis, Daniel; Cooper, Rachel; Terrera, Graciela Muniz; Hardy, Rebecca; Richards, Marcus; Kuh, Diana

2016-08-01

Cognitive capabilities in childhood and in late life are inversely associated with mortality rates. However, it is unclear if adult cognition, at a time still relatively free from comorbidity, is associated with subsequent mortality, and whether this explains the associations of early life factors with adult mortality. We used data from the MRC National Survey of Health and Development, a birth cohort study prospectively assessing 5362 participants born in 1946. The present analysis includes participants followed up from age 43 and undergoing cognitive assessment (verbal memory and search speed). Mortality outcomes were notified through linkage with a national register. Cox regression was used to estimate mortality hazards in relation to cognitive performance at age 43, adjusting for early life factors, socioeconomic position and health status. Data were available on 3192 individuals. Univariable analyses indicated that adult verbal memory and search speed, parental factors, childhood cognition and educational attainment were associated with mortality. However, multivariable models showed that the mortality associations with earlier life factors were explained by adult cognitive capability. A standard deviation increase in verbal memory and search speed scores was associated with lower mortality rates [hazard ratio (HR) = 0.86, 95% confidence interval (CI) 0.77-0.97, P = 0.02; HR = 0.88, 95% CI 0.78-1.00, P = 0.05, respectively), after adjustment for adult health. Cognitive capability in early midlife was inversely associated with mortality rates over 25 years and accounted for the associations of family background, childhood cognitive ability and educational attainment with mortality. These findings, in a nationally representative cohort with long-term follow-up, suggest that building cognitive reserve may improve later life health and survival chances. © The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological

Variation in hospital mortality rates with inpatient cancer surgery.

PubMed

Wong, Sandra L; Revels, ShaʼShonda L; Yin, Huiying; Stewart, Andrew K; McVeigh, Andrea; Banerjee, Mousumi; Birkmeyer, John D

2015-04-01

To elucidate clinical mechanisms underlying variation in hospital mortality after cancer surgery : Thousands of Americans die every year undergoing elective cancer surgery. Wide variation in hospital mortality rates suggest opportunities for improvement, but these efforts are limited by uncertainty about why some hospitals have poorer outcomes than others. Using data from the 2006-2007 National Cancer Data Base, we ranked 1279 hospitals according to a composite measure of perioperative mortality after operations for bladder, esophagus, colon, lung, pancreas, and stomach cancers. We then conducted detailed medical record review of 5632 patients at 1 of 19 hospitals with low mortality rates (2.1%) or 30 hospitals with high mortality rates (9.1%). Hierarchical logistic regression analyses were used to compare risk-adjusted complication incidence and case-fatality rates among patients experiencing serious complications. The 7.0% absolute mortality difference between the 2 hospital groups could be attributed to higher mortality from surgical site, pulmonary, thromboembolic, and other complications. The overall incidence of complications was not different between hospital groups [21.2% vs 17.8%; adjusted odds ratio (OR) = 1.34, 95% confidence interval (CI): 0.93-1.94]. In contrast, case-fatality after complications was more than threefold higher at high mortality hospitals than at low mortality hospitals (25.9% vs 13.6%; adjusted OR = 3.23, 95% CI: 1.56-6.69). Low mortality and high mortality hospitals are distinguished less by their complication rates than by how frequently patients die after a complication. Strategies for ensuring the timely recognition and effective management of postoperative complications will be essential in reducing mortality after cancer surgery.

Radiation Exposure and Mortality from Cardiovascular Disease and Cancer in Early NASA Astronauts.

PubMed

Elgart, S Robin; Little, Mark P; Chappell, Lori J; Milder, Caitlin M; Shavers, Mark R; Huff, Janice L; Patel, Zarana S

2018-05-31

Understanding space radiation health effects is critical due to potential increased morbidity and mortality following spaceflight. We evaluated whether there is evidence for excess cardiovascular disease or cancer mortality in early NASA astronauts and if a correlation exists between space radiation exposure and mortality. Astronauts selected from 1959-1969 were included and followed until death or February 2017, with 39 of 73 individuals still alive at that time. Calculated standardized mortality rates for tested outcomes were significantly below U.S. white male population rates, including all-cardiovascular disease (n = 7, SMR = 33; 95% CI, 14-65) and all-cancer (n = 7, SMR = 43; 95% CI, 18-83), as anticipated in a healthy worker population. Space radiation doses for cohort members ranged from 0-78 mGy. No significant associations between space radiation dose and mortality were found using logistic regression with an internal reference group, adjusting for medical radiation. Statistical power of the logistic regression was <6%, remaining <12% even when expected risk level or observed deaths were assumed to be 10 times higher than currently reported. While no excess radiation-associated cardiovascular or cancer mortality risk was observed, findings must be tempered by the statistical limitations of this cohort; notwithstanding, this small unique cohort provides a foundation for assessment of astronaut health.

Risk factors for early infant mortality in Sarlahi district, Nepal.

PubMed Central

Katz, Joanne; West, Keith P.; Khatry, Subarna K.; Christian, Parul; LeClerq, Steven C.; Pradhan, Elizabeth Kimbrough; Shrestha, Sharada Ram

2003-01-01

OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. METHODS: Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy. PMID:14758431

Does early functional outcome predict 1-year mortality in elderly patients with hip fracture?

PubMed

Dubljanin-Raspopović, Emilija; Marković-Denić, Ljiljana; Marinković, Jelena; Nedeljković, Una; Bumbaširević, Marko

2013-08-01

Hip fractures in the elderly are followed by considerable risk of functional decline and mortality. The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures. A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables. Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5-520.1) for men and 301.6 (95% CI, 212.4-391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture. Functional level at discharge is the main

Association between mild intellectual disability and early mortality in men and women: evidence from a population-based cohort study

PubMed Central

Maenner, Matthew J; Greenberg, Jan S; Mailick, Marsha R

2016-01-01

Lower (versus higher) IQ scores have been shown to increase the risk of early mortality, however, the underlying mechanisms are poorly understood and previous studies underrepresent individuals with intellectual disabilities and women. This study followed one-third of all senior-year students (approximately aged 17) attending public high school in Wisconsin, USA in 1957 (n=10,317) until 2011. Men and women with mild intellectual disabilities had increased rates of mortality compared to people with the highest IQs, particularly for cardiovascular disease. Importantly, when educational attainment was held constant, people with intellectual disabilities did not have higher mortality by age 70 than people with higher IQs. Individuals with intellectual disabilities likely experience multiple disadvantages throughout life that contribute to increased risk of early mortality. PMID:25928436

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

Migration and health: a study of effects of early life experiences and current socio-economic situation on mortality of immigrants in Sweden.

PubMed

Klinthäll, Martin; Lindström, Martin

2011-12-01

Previous research has demonstrated mortality differences between immigrants and natives living in Sweden. The aim of this study is to investigate the effects of early life conditions in the country of birth and current socio-economic conditions in adult life in Sweden on cardiovascular, cancer, all other cause and total mortality among immigrants and natives in Sweden. The cohort data concerning individual demographic characteristics and socio-economic conditions stems from the Swedish Longitudinal Immigrant Database (SLI), a register-based representative database, and consists of individuals from 11 countries of birth, born between 1921 and 1939, who were residents in Sweden between 1980 and 2001. The associations between current socio-economic conditions as well as infant mortality rates (IMR) and Gross Domestic Product (GDP) per capita in the year and country of birth, and total, cardiovascular, cancer and 'all other' mortality in 1980-2001 were calculated by survival analysis using Cox proportional hazards regression to calculate hazard rate ratios. The effects of current adult life socio-economic conditions in Sweden on mortality are both stronger and more straightforward than the effects of early life conditions in the sense that higher socio-economic status is significantly associated with lower mortality in all groups of diagnoses; however, we find associations between infant mortality rates (IMR) in the year and country of birth, and cancer mortality among men and women in the final model. Socioeconomic conditions in Sweden are more strongly associated with mortality than early life indicators IMR and GDP per capita in the year of birth in the country of origin. This finding has health policy and other policy implications.

Signs of eclampsia during singleton deliveries and early neonatal mortality in low- and middle-income countries from three WHO regions.

PubMed

Bellizzi, Saverio; Sobel, Howard L; Ali, Mohamed M

2017-10-01

To determine the prevalence of eclampsia symptoms and to explore associations between eclampsia and early neonatal mortality. The present secondary analysis included Demographic and Health Surveys data from 2005 to 2012; details of signs related to severe obstetric adverse events of singleton deliveries during interviewees' most recent delivery in the preceding 5 years were included. Data and delivery history were merged for pooled analyses. Convulsions-used as an indicator for having experienced eclampsia-and early neonatal mortality rates were compared, and a generalized random effect model, adjusted for heterogeneity between and within countries, was used to investigate the impact of presumed eclampsia on early neonatal mortality. The merged dataset included data from six surveys and 55 384 live deliveries that occurred in Colombia, Bangladesh, Indonesia, Mali, Niger, and Peru. Indications of eclampsia were recorded for 1.2% (95% confidence interval [CI] 1.0-1.3), 1.7% (95% CI 1.5-2.1), and 1.7% (95% CI 1.5-2.1) of deliveries reported from the American, South East Asian, and African regions, respectively. Pooled analyses demonstrated that eclampsia was associated with increased risk of early neonatal mortality (adjusted risk ratio 2.1 95% CI 1.4-3.2). Increased risk of early neonatal mortality indicates a need for strategies targeting the early detection of eclampsia and early interventions. © 2017 International Federation of Gynecology and Obstetrics.

Early Infectious Diseases Specialty Intervention Is Associated with Shorter Hospital Stays and Lower Readmission Rates: A Retrospective Cohort Study.

PubMed

Schmitt, Steven; MacIntyre, Ann T; Bleasdale, Susan C; Ritter, J Trees; Nelson, Sandra B; Berbari, Elie F; Burdette, Steven D; Hewlett, Angela; Miles, Matthew; Robinson, Philip A; Siddiqui, Javeed; Trotman, Robin; Martinelli, Lawrence; Zeitlin, Gary; Rodriguez, Andrés; Smith, Mark W; McQuillen, Daniel P

2018-06-13

Intervention by infectious diseases (ID) physicians improves outcomes for inpatients in Medicare, but patients with other insurance types could fare differently. We assessed whether ID involvement leads to better outcomes among privately insured patients under age 65 hospitalized with common infections. We performed a retrospective analysis of administrative claims data from community hospital and post-discharge ambulatory care. Patients were privately insured individuals under 65 years old with an acute-care stay in 2014 for selected infections, classed as having early (by day 3) or late (after day 3) ID intervention, or none. Key outcomes were mortality, cost, length of the index stay; readmission rate, mortality and total cost of care over the first 30 days after discharge. Patients managed with early ID involvement had shorter length of stay, lower spending, and lower mortality in the index stay than those patients managed without ID involvement. Relative to late, early ID involvement was associated with shorter length of stay and lower cost. Individuals with early ID intervention during hospitalization had fewer readmissions and lower healthcare payments after discharge. Relative to late, those with early ID intervention experienced lower readmission, lower spending, and lower mortality. Among privately insured patients under 65 years old, treated in a hospital, early intervention with an ID physician was associated with lower mortality rate and shorter length of stay. Patients who received early ID intervention during their hospital stay were less likely to be readmitted after discharge and had lower total healthcare spending.

Long-Term Mortality Effect of Early Pacemaker Implantation After Surgical Aortic Valve Replacement.

PubMed

Greason, Kevin L; Lahr, Brian D; Stulak, John M; Cha, Yong-Mei; Rea, Robert F; Schaff, Hartzell V; Dearani, Joseph A

2017-10-01

The need for pacemaker implantation is a well-described complication of aortic valve replacement. Not so well described is the effect such an event has on long-term outcome. This study reviewed a 21-year experience at the Mayo Clinic (Rochester, Minnesota) with aortic valve replacement to understand the influence of early postoperative pacemaker implantation on long-term mortality rates more clearly. This study retrospectively reviewed the records of 5,842 patients without previous pacemaker implantation who underwent surgical aortic valve replacement from January 1993 through June 2014. The median age of these patients was 73 years (range, 65 to 79 years), the median ejection fraction was 62% (range, 53% to 68%), 3,853 patients were male (66%), and coronary artery bypass graft operation was performed in 2,553 (44%) of the patients studied. Early pacemaker implantation occurred in 146 patients (2.5%) within 30 days of surgical aortic valve replacement. The median follow-up of patients was 11.1 years (range, 5.8 to 16.5 years), and all-cause mortality rates were 2.4% at 30 days, 6.4% at 1 year, 23.1% at 5 years, 48.3% at 10 years, and 67.9% at 15 years postoperatively. Early pacemaker implantation was associated with an increased risk of death after multivariable adjustment for baseline patients' characteristics (hazard ratio, 1.49; 95% confidence interval, 1.20, 1.84; p < 0.001). Early pacemaker implantation as a complication of surgical aortic valve replacement is associated with an increased risk of long-term death. Valve replacement-related pacemaker implantation rates should be important considerations with respect to new valve replacement paradigms, especially in younger and lower-risk patients. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

[The value of coexisting pneumonia and British Thoracic Society CURB-65 score in predicting early mortality rate in patients with acute exacerbation of chronic obstructive pulmonary disease].

PubMed

Zhang, Mei; Zhao, Yun-feng; Luo, Yi-min; Wang, Xi-hua; Yang, Yuan; Lin, Yong

2013-04-01

To investigate the value of coexisting pneumonia and British Thoracic Society CURB-65 score in predicting early mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In this prospective study, 483 consecutive in-patients with AECOPD were recruited between January 2010 and September 2012, including 295 males and 188 females. The patients were aged 45 to 92 years. They were divided into 2 groups: non-pneumonia (npAECOPD) and with pneumonia (pAECOPD). The start point of this study was the date when the patients were admitted into the respiratory ward, and the endpoint was the 30 day mortality. Clinical and demographic data were collected for all the patients, and the value of coexisting pneumonia and CURB-65 in predicting in-hospital mortality and 30 day mortality were assessed and compared. According to the inclusion/exclusion criteria, eventually 457 patients were included in this research, with 278 males and 179 females, and an average age of (75 ± 9) years. Of the 457 patients, 120 (26.3%) patients were in the pAECOPD group and 337 (73.7%) patients in the npAECOPD group. The in-hospital mortality, the 30 day mortality and the assisted ventilation rate were significantly higher in the pAECOPD group as compared to the npAECOPD group 18.3% (22/120) vs 4.7% (16/337), 21.7% (26/120) vs 7.4% (25/337); 49.2% (59/120) vs 27.0% (91/337), χ(2) = 18.1 - 21.4, all P < 0.05, respectively. Furthermore, the in-hospital mortality of the pAECOPD patients with CURB-65 score < 2, = 2 and > 2 was 4.4% (2/45), 15.2% (7/46) and 44.8% (13/29), respectively, while that of the npAECOPD patients was 0.9% (1/113), 3.4% (4/119) and 10.5% (11/105), respectively. The 30 day mortality of the pAECOPD patients with CURB-65 score < 2, = 2 and > 2 was 4.4% (2/45), 19.6% (9/46) and 51.7% (15/29), respectively, while that of the npAECOPD patients was 0.9% (1/113), 5.0% (6/119) and 17.1% (18/105), respectively. Stratified by CURB-65 Score, the in

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.

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.

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...

Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia

PubMed Central

Lohela, Terhi J.; Campbell, Oona M. R.; Gabrysch, Sabine

2012-01-01

Background Globally, approximately 3 million babies die annually within their first month. Access to adequate care at birth is needed to reduce newborn as well as maternal deaths. We explore the influence of distance to delivery care and of level of care on early neonatal mortality in rural Zambia and Malawi, the influence of distance (and level of care) on facility delivery, and the influence of facility delivery on early neonatal mortality. Methods and Findings National Health Facility Censuses were used to classify the level of obstetric care for 1131 Zambian and 446 Malawian delivery facilities. Straight-line distances to facilities were calculated for 3771 newborns in the 2007 Zambia DHS and 8842 newborns in the 2004 Malawi DHS. There was no association between distance to care and early neonatal mortality in Malawi (OR 0.97, 95%CI 0.58–1.60), while in Zambia, further distance (per 10 km) was associated with lower mortality (OR 0.55, 95%CI 0.35–0.87). The level of care provided in the closest facility showed no association with early neonatal mortality in either Malawi (OR 1.02, 95%CI 0.90–1.16) or Zambia (OR 1.02, 95%CI 0.82–1.26). In both countries, distance to care was strongly associated with facility use for delivery (Malawi: OR 0.35 per 10km, 95%CI 0.26–0.46). All results are adjusted for available confounders. Early neonatal mortality did not differ by frequency of facility delivery in the community. Conclusions While better geographic access and higher level of care were associated with more frequent facility delivery, there was no association with lower early neonatal mortality. This could be due to low quality of care for newborns at health facilities, but differential underreporting of early neonatal deaths in the DHS is an alternative explanation. Improved data sources are needed to monitor progress in the provision of obstetric and newborn care and its impact on mortality. PMID:23300599

[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.

Early detection strategy and mortality reduction in severe sepsis.

PubMed

Westphal, Glauco Adrieno; Feijó, Janaína; Andrade, Patrícia Silva de; Trindade, Louise; Suchard, Cezar; Monteiro, Márcio Andrei Gil; Martins, Sheila Fonseca; Nunes, Fernanda; Caldeira Filho, Milton

2009-06-01

To evaluate the impact of implementing an institutional policy for detection of severe sepsis and septic shock. Study before (stage I), after (stage II) with prospective data collection in a 195 bed public hospital.. Stage I: Patients with severe sepsis or septic shock were included consecutively over 15 months and treated according to the Surviving Sepsis Campaign guidelines. Stage II: In the 10 subsequent months, patients with severe sepsis or septic shock were enrolled based on an active search for signs suggesting infection (SSI) in hospitalized patients. The two stages were compared for demographic variables, time needed for recognition of at least two signs suggesting infection (SSI-Δt), compliance to the bundles of 6 and 24 hours and mortality. We identified 124 patients with severe sepsis or septic shock, 68 in stage I and 56 in stage II. The demographic variables were similar in both stages. The Δt-SSI was 34 ± 54 hours in stage I and 7 ± 8.4 hours in stage II (p <0.001). There was no difference in compliance to the bundles. In parallel there was significant reduction of mortality rates at 28 days (54.4% versus 30%, p <0.02) and hospital (67.6% versus 41%, p <0.003). The strategy used helped to identify early risk of sepsis and resulted in decreased mortality associated with severe sepsis and septic shock.

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.

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

Scaling up implementation of ART: Organizational culture and early mortality of patients initiated on ART in Nairobi, Kenya.

PubMed

Ayah, Richard

2018-01-01

Scaling up the antiretroviral (ART) program in Kenya has involved a strategy of using clinical guidelines coupled with decentralization of treatment sites. However decentralization pushes clinical responsibility downwards to health facilities run by lower cadre staff. Whether the organizational culture in health facilities affects the outcomes despite the use of clinical guidelines has not been explored. This study aimed to demonstrate the relationship between organizational culture and early mortality and those lost to follow up (LTFU) among patients enrolled for HIV care. A stratified sample of 31 health facilities in Nairobi County offering ART services were surveyed. Data of patients enrolled on ART and LTFU for the 12 months ending 30th June 2013 were abstracted. Mortality and LTFU were determined and used to rank health facilities. In the facilities with the lowest and highest mortality and LTFU key informant interviews were conducted using a tool adapted from team climate assessment measurement questionnaire and competing value framework tool to assess organizational culture. The strength of association between early mortality, LTFU and organizational culture was tested. Half (51.8%) of the 5,808 patients enrolled into care in 31 health facilities over the 12-month study period were started on ART. Of these 48 (1.6% 95% CI 0.8%-2.4%) died within three months of starting treatment, while a further 125 (4.2% 95% CI 2.1%-6.6%) were LTFU giving an attrition rate of 5.7% (95% CI 3.3%-8.6%). Tuberculosis was the most common comorbidity associated with high early mortality and high LTFU. Organizational culture, specifically an adhocratic type was found to be associated with low early mortality and low LTFU of patients enrolled for HIV care (P = 0.034). The use of ART clinical guidelines in a decentralized health systems are not sufficient to achieve required service delivery outcomes. The attrition rate above would mean 85,000 Kenyans missing care based on current

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.

Association Between Low IQ Scores and Early Mortality in Men and Women: Evidence From a Population-Based Cohort Study.

PubMed

Maenner, Matthew J; Greenberg, Jan S; Mailick, Marsha R

2015-05-01

Lower (versus higher) IQ scores have been shown to increase the risk of early mortality, however, the underlying mechanisms are poorly understood and previous studies underrepresent individuals with intellectual disability (ID) and women. This study followed one third of all senior-year students (approximately aged 17) attending public high school in Wisconsin, U.S. in 1957 (n  =  10,317) until 2011. Men and women with the lowest IQ test scores (i.e., IQ scores ≤ 85) had increased rates of mortality compared to people with the highest IQ test scores, particularly for cardiovascular disease. Importantly, when educational attainment was held constant, people with lower IQ test scores did not have higher mortality by age 70 than people with higher IQ test scores. Individuals with lower IQ test scores likely experience multiple disadvantages throughout life that contribute to increased risk of early mortality.

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

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.

A Two-Center Randomized Trial of an Additional Early Dose of Measles Vaccine: Effects on Mortality and Measles Antibody Levels.

PubMed

Fisker, Ane B; Nebie, Eric; Schoeps, Anja; Martins, Cesario; Rodrigues, Amabelia; Zakane, Alphonse; Kagone, Moubassira; Byberg, Stine; Thysen, Sanne M; Tiendrebeogo, Justin; Coulibaly, Boubacar; Sankoh, Osman; Becher, Heiko; Whittle, Hilton C; van der Klis, Fiona R M; Benn, Christine S; Sie, Ali; Müller, Olaf; Aaby, Peter

2018-05-02

In addition to protecting against measles, measles vaccine (MV) may have beneficial nonspecific effects. We tested the effect of an additional early MV on mortality and measles antibody levels. Children aged 4-7 months at rural health and demographic surveillance sites in Burkina Faso and Guinea-Bissau were randomized 1:1 to an extra early standard dose of MV (Edmonston-Zagreb strain) or no extra MV 4 weeks after the third diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine. All children received routine MV at 9 months. We assessed mortality through home visits and compared mortality from enrollment to age 3 years using Cox proportional hazards models, censoring for subsequent nontrial MV. Subgroups of participants had blood sampled to assess measles antibody levels. Among 8309 children enrolled from 18 July 2012 to 3 December 2015, we registered 145 deaths (mortality rate: 16/1000 person-years). The mortality was lower than anticipated and did not differ by randomization group (hazard ratio, 1.05; 95% confidence interval, 0.75-1.46). At enrollment, 4% (16/447) of children in Burkina Faso and 21% (90/422) in Guinea-Bissau had protective measles antibody levels. By age 9 months, no measles-unvaccinated/-unexposed child had protective levels, while 92% (306/333) of early MV recipients had protective levels. At final follow-up, 98% (186/189) in the early MV group and 97% (196/202) in the control group had protective levels. Early MV did not reduce all-cause mortality. Most children were susceptible to measles infection at age 4-7 months and responded with high antibody levels to early MV. NCT01644721.

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.

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.

Results of concurrent radio-chemotherapy for the treatment of head and neck squamous cell carcinoma in everyday clinical practice with special reference to early mortality

PubMed Central

2013-01-01

Background Randomized controlled trials have established concurrent chemo-radiotherapy as the preferred treatment option for inoperable local-regionally advanced head and neck squamous cell carcinomas (HNSCCs). Because many patients have multiple co-morbidities and would not fulfill the eligibility criteria of clinical trials, the results need to be re-evaluated in daily clinical practice with special reference to early mortality. Methods 167 consecutive patients with HNSCC who received concurrent chemo-radiotherapy at the Basel University Hospital between 1988 and 2006 were analyzed retrospectively with a special focus on early deaths and risk factors for an unfavorable outcome. Results In our cohort, the 3- and 5-year overall survival rates were 54% and 47%, respectively. The therapy was associated with relevant toxicity and an early mortality rate of 5.4%. Patients dying early were analyzed individually for the cause of death. Patients with elevated white blood cell counts (HR: 2.66 p = 0,016) and vascular co-morbidities (HR: 5.3, p = 0,047) showed significantly worse survival rates. The same factors were associated with a trend toward increased treatment-related mortality. The 3-year survival rate improved from approximately 43% for patients treated before the year 2000 to 65% for patients treated after the year 2000 (Fisher’s exact test p = 0.01). Conclusions Although many patients who received concurrent chemo-radiotherapy would not have qualified for clinical trials, the outcome was favorable and has significantly improved in recent years. However the early mortality was slightly worse than what is described in the literature. PMID:24373220

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.

Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital.

PubMed

Ersdal, Hege Langli; Mduma, Estomih; Svensen, Erling; Perlman, Jeffrey

2012-05-01

Early neonatal mortality within the first 24 hours contributes substantially to overall neonatal mortality rates. The definition of birth asphyxia (BA) is imprecise, and reliable cause-specific mortality data are limited; thus the estimated proportion of BA-related deaths globally remains questionable. The objective was to determine the presumed causes of neonatal death within the first 24 hours in a rural hospital in Northern Tanzania. This is a prospective descriptive observational study conducted in the delivery room and adjacent neonatal area. Research assistants were trained to observe and record events related to labor, neonatal resuscitation, and 24-hour postnatal course. BA was defined as failure to initiate spontaneous respirations and/or 5-minute Apgar score <7, prematurity as gestational age <36 weeks, and low birth weight (LBW) as birth weight <3rd centile for gestational age. Data were analyzed with χ(2) and Student's t tests. Over 1 year, 4720 infants were born and evaluated. Of these, 256 were admitted to the neonatal area. Forty-nine infants died secondary to BA (61%), prematurity (18%), LBW (8%), infection (2%), congenital abnormalities (8%), and unclear reason (2%). The 5-minute Apgar score was ≥7 in 50% of the infants who died secondary to BA. Most cases of early neonatal mortality were related to BA, and prematurity and LBW are additional important considerations. Reducing perinatal mortality requires a multifaceted approach with attention to issues related to BA, potential complications of prematurity, and LBW. The 5-minute Apgar score is a poor surrogate of BA.

Five-year all-cause mortality rates across five categories of substantiated elder abuse occurring in the community.

PubMed

Burnett, Jason; Jackson, Shelly L; Sinha, Arup K; Aschenbrenner, Andrew R; Murphy, Kathleen Pace; Xia, Rui; Diamond, Pamela M

2016-01-01

Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N = 1,670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical abuse, emotional abuse, financial exploitation, and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates, underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical management of community-dwelling elder abuse victims.

Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar.

PubMed

Garchitorena, Andres; Miller, Ann C; Cordier, Laura F; Rabeza, Victor R; Randriamanambintsoa, Marius; Razanadrakato, Hery-Tiana R; Hall, Lara; Gikic, Djordje; Haruna, Justin; McCarty, Meg; Randrianambinina, Andriamihaja; Thomson, Dana R; Atwood, Sidney; Rich, Michael L; Murray, Megan B; Ratsirarson, Josea; Ouenzar, Mohammed Ali; Bonds, Matthew H

2018-01-01

The Sustainable Development Goals framed an unprecedented commitment to achieve global convergence in child and maternal mortality rates through 2030. To meet those targets, essential health services must be scaled via integration with strengthened health systems. This is especially urgent in Madagascar, the country with the lowest level of financing for health in the world. Here, we present an interim evaluation of the first 2 years of a district-level health system strengthening (HSS) initiative in rural Madagascar, using estimates of intervention coverage and mortality rates from a district-wide longitudinal cohort. We carried out a district representative household survey at baseline of the HSS intervention in over 1500 households in Ifanadiana district. The first follow-up was after the first 2 years of the initiative. For each survey, we estimated maternal, newborn and child health (MNCH) coverage, healthcare inequalities and child mortality rates both in the initial intervention catchment area and in the rest of the district. We evaluated changes between the two areas through difference-in-differences analyses. We estimated annual changes in health centre per capita utilisation from 2013 to 2016. The intervention was associated with 19.1% and 36.4% decreases in under-five and neonatal mortality, respectively, although these were not statistically significant. The composite coverage index (a summary measure of MNCH coverage) increased by 30.1%, with a notable 63% increase in deliveries in health facilities. Improvements in coverage were substantially larger in the HSS catchment area and led to an overall reduction in healthcare inequalities. Health centre utilisation rates in the catchment tripled for most types of care during the study period. At the earliest stages of an HSS intervention, the rapid improvements observed for Ifanadiana add to preliminary evidence supporting the untapped and poorly understood potential of integrated HSS interventions on

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

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.

Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

PubMed

Noyez, L; Biemans, I; Verkroost, M; van Swieten, H

2013-10-01

This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery. Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Corpus Christi Heart Project questionnaire concerning physical activity (PA). Based on this questionnaire, 1815 patients were classified as active and 1335 patients were classified as sedentary. The endpoints of the study were hospital mortality and early mortality. The study population had a mean age of 69.7 ± 10.1 (19-95) years and a mean logistic EuroSCORE risk of 5.1 ± 5.6 (0.88-73.8). Sedentary patients were significantly older (p = 0.001), obese (p = 0.001), had a higher EuroSCORE risk (p = 0.001), and a higher percentage of complications. Hospital mortality (1.1 % versus 0.4 % (p = 0.014)) and early mortality (1.5 % versus 0.6 % (p = 0.006)) were significantly higher in the sedentary group compared with the active group. However, a sedentary lifestyle was not identified as an independent predictor for hospital mortality (p = 0.61) or early mortality (p = 0.70). Sedentary patients were older, obese and had a higher EuroSCORE risk. They had significantly more postoperative complications, higher hospital mortality and early mortality. Despite these results, sedentary behaviour could not be identified as an independent predictor for hospital or early mortality.

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.

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.

Seasonal Variation in Solar Ultra Violet Radiation and Early Mortality in Extremely Preterm Infants.

PubMed

Salas, Ariel A; Smith, Kelly A; Rodgers, Mackenzie D; Phillips, Vivien; Ambalavanan, Namasivayam

2015-11-01

Vitamin D production during pregnancy promotes fetal lung development, a major determinant of infant survival after preterm birth. Because vitamin D synthesis in humans is regulated by solar ultraviolet B (UVB) radiation, we hypothesized that seasonal variation in solar UVB doses during fetal development would be associated with variation in neonatal mortality rates. This cohort study included infants born alive with gestational age (GA) between 23 and 28 weeks gestation admitted to a neonatal unit between 1996 and 2010. Three infant cohort groups were defined according to increasing intensities of solar UVB doses at 17 and 22 weeks gestation. The primary outcome was death during the first 28 days after birth. Outcome data of 2,319 infants were analyzed. Mean birth weight was 830 ± 230 g and median gestational age was 26 weeks. Mortality rates were significantly different across groups (p = 0.04). High-intensity solar UVB doses were associated with lower mortality when compared with normal intensity solar UVB doses (hazard ratio: 0.70; 95% confidence interval: 0.54-0.91; p = 0.01). High-intensity solar UVB doses during fetal development seem to be associated with risk reduction of early mortality in preterm infants. Prospective studies are needed to validate these preliminary findings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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.

[Prognostic factors of early 30-day mortality in elderly patients admitted to an emergency department].

PubMed

Morales Erazo, Alexander; Cardona Arango, Doris

The main aim of this study was to identify the variables related to early mortality in the elderly at the time of admission to the emergency department. Using probability sampling, the study included patients 60 years old or older of both genders who were admitted for observation to the emergency department of the University Hospital of Nariño, ¿Colombia? in 2015. Using a questionnaire designed for this study, some multidimensional features that affect the health of the elderly were collected (demographic, clinical, psychological, functional, and social variables). The patients were then followed-up for 30 days in order to determine the mortality rate during this time. Univariate and multivariate logistic regressions and survival analysis were performed. Data were collected from 246 patients, with a mean age of 75.27 years and the majority female. The 30-day mortality rate was 15%. The variables most associated with death were: being female, temperature problems, initial diagnosis of neoplasia, and unable to walk independently in the emergency department. It is possible to determine the multidimensional factors present in the older patient admitted to an emergency department that could affect their 30-day mortality prognosis. and which should be intervened. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

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.

Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PRospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study

PubMed Central

Rahbar, Elaheh; Fox, Erin E.; del Junco, Deborah J.; Harvin, John A.; Holcomb, John B.; Wade, Charles E.; Schreiber, Martin A.; Rahbar, Mohammad H.; Bulger, Eileen M.; Phelan, Herb A.; Brasel, Karen J.; Alarcon, Louis H.; Myers, John G.; Cohen, Mitchell J.; Muskat, Peter; Cotton, Bryan A.

2013-01-01

Background The classic definition of MT, ≥10 units red blood cells (RBCs) in 24 hours, has never been demonstrated as a valid surrogate for severe hemorrhage and can introduce survival bias. In addition, the definition fails to capture other products that the clinician may have immediately available during the initial resuscitation. Assuming that units of resuscitative fluids reflect patient illness, our objective was to identify a rate of resuscitation intensity (RI) that could serve as an early surrogate of sickness for patients with substantial bleeding post-injury. Methods Adult patients surviving at least 30 minutes post-admission and receiving ≥1 RBC within 6 hours of admission from ten US Level 1 trauma centers were enrolled in the PRospective Observational Multicenter Major Trauma Transfusion study. Total fluid units were calculated as the sum of the number of crystalloid units (1 L=1 unit), colloids (0.5 L=1 unit) and blood products (1 RBC=1 unit, 1 plasma=1 unit, 6 pack platelets=1 unit). Univariable and multivariable logistic regressions were used to evaluate associations between RI and 6-hour mortality, adjusting for age, center, penetrating injury, weighted Revised Trauma Score, and Injury Severity Score. Results 1096 eligible patients received resuscitative fluids within 30 minutes, including 620 transfused with blood products. Despite varying products utilized, the total fluid RI was similar across all sites (3.2±2.5 units). Patients who received ≥4 units of any resuscitative fluid had a 6-hour mortality rate of 14.4% vs. 4.5% in patients who received <4 units. The adjusted odds ratio of 6-hour mortality for patients receiving ≥4 units within 30 minutes was 2.1 (95% Confidence Interval: 1.2–3.5). Conclusions Resuscitation with ≥4 units of any fluid was significantly associated with 6-hour mortality. This study suggests that early RI regardless of fluid type can be used as a surrogate for sickness and mortality in severely bleeding

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

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.

Pneumonectomy for lung cancer: contemporary national early morbidity and mortality outcomes.

PubMed

Thomas, Pascal A; Berbis, Julie; Baste, Jean-Marc; Le Pimpec-Barthes, Françoise; Tronc, François; Falcoz, Pierre-Emmanuel; Dahan, Marcel; Loundou, Anderson

2015-01-01

The study objective was to determine contemporary early outcomes associated with pneumonectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database (EPITHOR). After discarding inconsistent files, a group of 4498 patients who underwent elective pneumonectomy for primary lung cancer between 2003 and 2013 was selected. Logistic regression analysis was performed on variables for mortality and major adverse events. Then, a propensity score analysis was adjusted for imbalances in baseline characteristics between patients with or without neoadjuvant treatment. Operative mortality was 7.8%. Surgical, cardiovascular, pulmonary, and infectious complications rates were 14.9%, 14.1%, 11.5%, and 2.7%, respectively. None of these complications were predicted by the performance of a neoadjuvant therapy. Operative mortality analysis, adjusted for the propensity scores, identified age greater than 65 years (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-2.9; P < .001), underweight body mass index category (OR, 2.2; 95% CI, 1.2-4.0; P = .009), American Society of Anesthesiologists score of 3 or greater (OR, 2.310; 95% CI, 1.615-3.304; P < .001), right laterality of the procedure (OR, 1.8; 95% CI, 1.1-2.4; P = .011), performance of an extended pneumonectomy (OR, 1.5; 95% CI, 1.1-2.1; P = .018), and absence of systematic lymphadenectomy (OR, 2.9; 95% CI, 1.1-7.8; P = .027) as risk predictors. Induction therapy (OR, 0.63; 95% CI, 0.5-0.9; P = .005) and overweight body mass index category (OR, 0.60; 95% CI, 0.4-0.9; P = .033) were protective factors. Several risk factors for major adverse early outcomes after pneumonectomy for cancer were identified. Overweight patients and those who received induction therapy had paradoxically lower adjusted risks of mortality. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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

Being born under adverse economic conditions leads to a higher cardiovascular mortality rate later in life: evidence based on individuals born at different stages of the business cycle.

PubMed

van den Berg, Gerard J; Doblhammer-Reiter, Gabriele; Christensen, Kaare

2011-05-01

We connect the recent medical and economic literatures on the long-run effects of early-life conditions by analyzing the effects of economic conditions on the individual cardiovascular (CV) mortality rate later in life, using individual data records from the Danish Twin Registry covering births since the 1870s and including the cause of death. To capture exogenous variation of conditions early in life, we use the state of the business cycle around birth. We find significant negative effects of economic conditions around birth on the individual CV mortality rate at higher ages. There is no effect on the cancer-specific mortality rate. From variation within and between monozygotic and dizygotic twin pairs born under different conditions, we conclude that the fate of an individual is more strongly determined by genetic and household-environmental factors if early-life conditions are poor. Individual-specific qualities come more to fruition if the starting position in life is better.

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.

The relationship between admission heart rate and early prognosis in patients with ST-elevation myocardial infarction.

PubMed

Salwa, Paweł; Gorczyca-Michta, Iwona; Wożakowska-Kapłon, Beata

2015-01-01

Heart rate (HR) is a basic cardiovascular parameter. The relationship between HR and cardiovascular mortality and morbidity has been indicated in clinical trials and epidemiological studies. The evaluation of the relationship between HR upon hospital admission and the in-hospital prognosis in a group of patients with ST-elevation myocardial infarction (STEMI). The medical records of 927 patients were subject to retrospective analysis. The patients were classified on the basis of HR upon hospital admission: < 60 bpm (n = 75), 60-69 bpm (n = 169), 70-79 bpm (n = 245), 80-89 bpm (n = 172), 90-99 bpm (n = 134), and ≥ 100 bpm (n = 132). A group of patients with HR of 60-69 bpm on hospital admission (n = 169) constituted a reference group. Patients with atrioventricular blocks and arrhythmias were excluded from the analysis. Early mortality and co-existing diseases were evaluated in the study population. Patients with HR ≥ 90 bpm demonstrated heart failure symptoms considerably more often than patients with HR of 60-69 bpm (p = 0.0010). In-hospital mortality was significantly higher in patients with a HR of more than 90 bpm and bradycardia. The relationship between HR and cardiovascular mortality is shown with a J-shaped curve. HR is strictly correlated with early cardiovascular mortality in a population of patients with STEMI. The relationship between HR and early mortality is demonstrated by a J-shaped curve.

Air pollution in early life and adult mortality from chronic rheumatic heart disease.

PubMed

Phillips, David I W; Osmond, Clive; Williams, Martin L; Jones, Alexander

2017-08-01

Chronic rheumatic heart disease (RHD) remains a globally important cause of heart disease. The reasons for the continuing high prevalence of this disease are obscure, but it may have its origins in the poor social and economic conditions with which the disease has been consistently and strongly linked. Mortality studies from the UK have suggested the importance of adverse environmental factors in early life; these studies demonstrated specific geographical associations between high rates of chest infection during infancy and subsequent RHD. They raised the possibility that early air pollution, which is known to be strongly linked with chest infection during infancy, may predispose to RHD. We related estimates of air pollution and social conditions developed by Daly in 1951-52 for 78 urban areas in England and Wales to their subsequent RHD mortality rates at ages 35-74 in men and women during 1993-2012. There were strong relationships between domestic air pollution and RHD [relative risk per standard deviation (SD) increase in pollution 1.168, 95% confidence interval (CI): 1.128 to 1.210, P < 0.001). Inclusion of published data on social class, education, crowding and population density in multiple regression analyses showed that the air pollution association was independent of these; only overcrowding was separately linked with RHD. We present the first evidence of an association between air pollution in early life and RHD. Although there are several limitations to this study, the strength and consistency of the results, together with their biological plausibility, suggest a causal link. This deserves attention because it may have important consequences for the control of RHD in resource-poor countries where widespread use of biomass fuels and domestic pollution remain a problem. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

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.

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

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.

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.

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.

Morbidity and Mortality Rates after Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

PubMed Central

Passeri, Luis A.; Choi, James G.; Kaban, Leonard B.; Lahey, Edward T.

2016-01-01

Purpose To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. Patients and Methods Patients with OSA who underwent maxillomandibular advancement with genial advancement (MMA), at Massachusetts General Hospital Department of Oral and Maxillofacial Surgery, from December 2002 to June 2011, were matched to patients with DFD undergoing similar maxillofacial procedures during the same time period. They were compared with regards to demographic variables, medical comorbidities, perioperative management, intraoperative, early and late postoperative complications and mortality. Results A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9±12.5 vs. 21.7±8.6years), had a higher ASA classification (2.0±0.5 vs. 1.3±0.6) and BMI (29.6±4.7 vs. 23.0±3.1kg/m2). They also had a greater number of medical comorbidities (2.4±2.3 vs. 0.7±1.0). More OSA than DFD patients had complications (28, 100% vs.19, 73%, p=0.003) and the total number of complications in the OSA group was higher (108 vs. 33, p<0.001). In the OSA group, 13.9% and in the DFD group 3.0% of the complications were classified as major. The absolute risk of a complication for the OSA group was 3.9 vs . 1.3 for the DFD group. The relative risk of complications in OSA compared to DFD was 3.0. No difference in mortality was found. Conclusions OSA patients were older, had more comorbidities and ultimately had a greater number of early, late, minor and major complications than those in the DFD group. The incidence of mortality in both groups was zero. MMA appears to be a safe procedure with regards to mortality but OSA patients should be counseled preoperatively regarding the relative increased risk of complications. PMID:27181624

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.

Estimation of birth population-based perinatal-neonatal mortality and preterm rate in China from a regional survey in 2010.

PubMed

Sun, L; Yue, H; Sun, B; Han, L; Qi, M; Tian, Z; Lu, S; Shan, C; Luo, J; Fan, Y; Li, S; Dong, M; Zuo, X; Zhang, Y; Lin, W; Xu, J; Heng, Y

2013-11-01

To estimate birth population-based perinatal-neonatal mortality and preterm rate in China from a regional survey in 2010. Data of total births in 2010 obtained from 151 level I-III hospitals in Huai'an, Jiangsu, were prospectively collected and analyzed. From 61,227 birth registries (including 60,986 live births and 241 stillbirths), we derive a birth rate of 11.3‰ (of 5.4 million regional population), a male-to-female ratio of 116:100 and valid data from 60,615 newborns. Mean birth weight (BW) was 3441 ± 491 g with 13.6% macrosomia. Low BW was 2.8% (1691/60,372) with 8.83% mortality. Preterm rate was 3.72% (2239/60,264) with 7.61% mortality. Cesarean section rate was 52.9% (31,964/60,445), multiple pregnancy 1.8% (1088/60,567) and birth defects 6.7‰ (411/61,227). There were 97.4% healthy newborns and 2.2% (1298) requiring hospitalized after birth. The perinatal mortality was 7.7‰ (471/61,227, including 241 stillbirths, 230 early neonatal deaths). The neonatal mortality was 4.4‰ (269/60,986). The main causes of neonatal death were birth asphyxia (24.5%), respiratory diseases (21.5%), prematurity related organ dysfunction (18.5%) and congenital anomalies (7.7%), whereas incidence of congenital heart disease and respiratory distress syndrome was 8.6‰ and 6.1‰, respectively. This regional birth population-based data file contains low perinatal-neonatal mortality rates, associated with low proportion of LBW and preterm births, and incidences of major neonatal disease, by which we estimate, in a nationwide perspective, in 16 million annual births, preterm births should be around 800,000, perinatal and neonatal mortality may be 128,000-144,000 and 80,000-96,000, respectively, along with 100,000 respiratory distress syndrome.

[VIABILITY OF MYOCAROIUM AS RISK FACTOR FOR MORTALITY IN EARLY AND LATE PERIOD AFTER BYPASS SURGERY OF CORONARY ARTERIES IN PATIENTS WITH CORONARY HEART DISEASE AND SEVERE LEFT VENTRICULAR DYSFUNCTION].

PubMed

Todurov, B M; Zelenchuk, V; Kuzmich, I M; Ivanyuk, N B; Nikolaichuk, M V

2015-06-01

In coronary heart disease and low ejection fraction of the left ventricle (LV) in patients after coronary artery bypass surgery tend mortality and complication rate higher than preserved LV systolic function. Significant preoperative predictors of early mortality and remote in these patients, and the incidence of complications in the early postoperative period were reveald.

State infant mortality: an ecologic study to determine modifiable risks and adjusted infant mortality rates.

PubMed

Paul, David A; Mackley, Amy; Locke, Robert G; Stefano, John L; Kroelinger, Charlan

2009-05-01

To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR's were standardized and states were compared with the United States adjusted rates. Models for IMR in individual states in 2001 (r2 = 0.66, P < 0.01) and 2002 (r2 = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are

Variations in mortality rates among Canadian neonatal intensive care units

PubMed Central

Sankaran, Koravangattu; Chien, Li-Yin; Walker, Robin; Seshia, Mary; Ohlsson, Arne; Lee, Shoo K.

2002-01-01

Background Most previous reports of variations in mortality rates for infants admitted to neonatal intensive care units (NICUs) have involved small groups of subpopulations, such as infants with very low birth weight. Our aim was to examine the incidence and causes of death and the risk-adjusted variation in mortality rates for a large group of infants of all birth weights admitted to Canadian NICUs. Methods We examined the deaths that occurred among all 19 265 infants admitted to 17 tertiary-level Canadian NICUs from January 1996 to October 1997. We used multivariate analysis to examine the risk factors associated with death and the variations in mortality rates, adjusting for risks in the baseline population, severity of illness on admission and whether the infant was outborn (born at a different hospital from the one where the NICU was located). Results The overall mortality rate was 4% (795 infants died). Forty percent of the deaths (n = 318) occurred within 2 days of NICU admission, 50% (n = 397) within 3 days and 75% (n = 596) within 12 days. The major conditions associated with death were gestational age less than 24 weeks (59 deaths [7%]), gestational age 24–28 weeks (325 deaths [41%]), outborn status (340 deaths [42%]), congenital anomalies (270 deaths [34%]), surgery (141 deaths [18%]), infection (108 deaths [14%]), hypoxic–ischemic encephalopathy (128 deaths [16%]) and small for gestational age (i.e., less than the third percentile) (77 deaths [10%]). There was significant variation in the risk-adjusted mortality rates (range 1.6% to 5.5%) among the 17 NICUs. Interpretation Most NICU deaths occurred within the first few days after admission. Preterm birth, outborn status and congenital anomalies were the conditions most frequently associated with death in the NICU. The significant variation in risk-adjusted mortality rates emphasizes the importance of risk adjustment for valid comparison of NICU outcomes. PMID:11826939

Interactions between hatch dates, growth rates, and mortality of Age-0 native Rainbow Smelt and nonnative Alewife in Lake Champlain

USGS Publications Warehouse

Parrish, Donna; Simonin, Paul W.; Rudstam, Lars G.; Pientka, Bernard; Sullivan, Patrick J.

2016-01-01

Timing of hatch in fish populations can be critical for first-year survival and, therefore, year-class strength and subsequent species interactions. We compared hatch timing, growth rates, and subsequent mortality of age-0 Rainbow Smelt Osmerus mordax and Alewife Alosa pseudoharengus, two common open-water fish species of northern North America. In our study site, Lake Champlain, Rainbow Smelt hatched (beginning May 26) almost a month earlier than Alewives (June 20). Abundance in the sampling area was highest in July for age-0 Rainbow Smelt and August for age-0 Alewives. Late-hatching individuals of both species grew faster than those hatching earlier (0.6 mm/d versus 0.4 for Rainbow Smelt; 0.7 mm/d versus 0.6 for Alewives). Mean mortality rate during the first 45 d of life was 3.4%/d for age-0 Rainbow Smelt and was 5.5%/d for age-0 Alewives. Alewife mortality rates did not differ with hatch timing but daily mortality rates of Rainbow Smelt were highest for early-hatching fish. Cannibalism is probably the primary mortality source for age-0 Rainbow Smelt in this lake. Therefore, hatching earlier may not be advantageous because the overlap of adult and age-0 Rainbow Smelt is highest earlier in the season. However, Alewives, first documented in Lake Champlain in 2003, may increase the mortality of age-0 Rainbow Smelt in the summer, which should favor selection for earlier hatching.

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

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…

Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

PubMed Central

Alleman, Brandon W.; Li, Lei; Dagle, John M.; Smith, P. Brian; Ambalavanan, Namasivayam; Laughon, Matthew M.; Stoll, Barbara J.; Goldberg, Ronald N.; Carlo, Waldemar A.; Murray, Jeffrey C.; Cotten, C. Michael; Shankaran, Seetha; Walsh, Michele C.; Laptook, Abbot R.; Ellsbury, Dan L.; Hale, Ellen C.; Newman, Nancy S.; Wallace, Dennis D.; Das, Abhik; Higgins, Rosemary D.

2013-01-01

OBJECTIVE: To examine factors affecting center differences in mortality for extremely low birth weight (ELBW) infants. METHODS: We analyzed data for 5418 ELBW infants born at 16 Neonatal Research Network centers during 2006–2009. The primary outcomes of early mortality (≤12 hours after birth) and in-hospital mortality were assessed by using multilevel hierarchical models. Models were developed to investigate associations of center rates of selected interventions with mortality while adjusting for patient-level risk factors. These analyses were performed for all gestational ages (GAs) and separately for GAs <25 weeks and ≥25 weeks. RESULTS: Early and in-hospital mortality rates among centers were 5% to 36% and 11% to 53% for all GAs, 13% to 73% and 28% to 90% for GAs <25 weeks, and 1% to 11% and 7% to 26% for GAs ≥25 weeks, respectively. Center intervention rates significantly predicted both early and in-hospital mortality for infants <25 weeks. For infants ≥25 weeks, intervention rates did not predict mortality. The variance in mortality among centers was significant for all GAs and outcomes. Center use of interventions and patient risk factors explained some but not all of the center variation in mortality rates. CONCLUSIONS: Center intervention rates explain a portion of the center variation in mortality, especially for infants born at <25 weeks’ GA. This finding suggests that deaths may be prevented by standardizing care for very early GA infants. However, differences in patient characteristics and center intervention rates do not account for all of the observed variability in mortality; and for infants with GA ≥25 weeks these differences account for only a small part of the variation in mortality. PMID:23753096

Early mortality in multiple myeloma: the time-dependent impact of comorbidity: A population-based study in 621 real-life patients.

PubMed

Ríos-Tamayo, Rafael; Sáinz, Juan; Martínez-López, Joaquín; Puerta, José Manuel; Chang, Daysi-Yoe-Ling; Rodríguez, Teresa; Garrido, Pilar; de Veas, José Luís García; Romero, Antonio; Moratalla, Lucía; López-Fernández, Elisa; González, Pedro Antonio; Sánchez, María José; Jiménez-Moleón, José Juan; Jurado, Manuel; Lahuerta, Juan José

2016-07-01

Multiple myeloma is a heterogeneous disease with variable survival; this variability cannot be fully explained by the current systems of risk stratification. Early mortality remains a serious obstacle to further improve the trend toward increased survival demonstrated in recent years. However, the definition of early mortality is not standardized yet. Importantly, no study has focused on the impact of comorbidity on early mortality in multiple myeloma to date. Therefore, we analyzed the role of baseline comorbidity in a large population-based cohort of 621 real-life myeloma patients over a 31-year period. To evaluate early mortality, a sequential multivariate regression model at 2, 6, and 12 months from diagnosis was performed. It was demonstrated that comorbidity had an independent impact on early mortality, which is differential and time-dependent. Besides renal failure, respiratory disease at 2 months, liver disease at 6 months, and hepatitis virus C infection at 12 months, were, respectively, associated with early mortality, adjusting for other well-established prognostic factors. On the other hand, the long-term monitoring in our study points out a modest downward trend in early mortality over time. This is the first single institution population-based study aiming to assess the impact of comorbidity on early mortality in multiple myeloma. It is suggested that early mortality should be analyzed at three key time points (2, 6, and 12 months), in order to allow comparisons between studies. Comorbidity plays a critical role in the outcome of myeloma patients in terms of early mortality. Am. J. Hematol. 91:700-704, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Risk factors of early and late mortality after thoracic endovascular aortic repair for complicated stanford B acute aortic dissection.

PubMed

Ruan, Zhong-Bao; Zhu, Li; Yin, Yi-Gang; Chen, Ge-Cai

2014-07-01

The risk factors associated with death in complicated Stanford B acute aortic dissection (AAD) after thoracic endovascular aortic repair (TEVAR) are poorly understood. The aim of this study was to evaluate the early and late events and mortality of complicated Stanford B AAD associated with TEVAR. Sixty-two patients with complicated Stanford B AAD undergoing TEVAR were included in this study. Primary technical success of TEVAR was achieved in 61 (98.39%) cases. The early mortality rate was 9.68%. Procedural type I endoleak (p = 0.007, OR = 7.71, 95% CI: 1.75-34.01) and cardiac tamponade (p = 0.010, OR = 8.86, 95% CI: 1.70-4 6.14) were the significant predictors of early death in the multivariate model. The late mortality was 16.07%. Cox regression analysis revealed rupture of false lumen (p = 0.001, hazard ratio = 21.96, 95% CI: 3.02-82.12), postoperative myocardial infarction (p = 0.001, hazard ratio = 9.86, 95% CI: 2.12-39.64), and acute renal failure (p = 0.024, hazard ratio = 3.98, 95% CI: 1.26-12.11) to be independent risk factors of late mortality. Type I procedural endoleak and cardiac tamponade were the significant predictors of early death in patients of complicated Stanford B AAD undergoing TEVAR. Rupture of false lumen, postoperative myocardial infarction, and acute renal failure were the independent risk factors for late death after TEVAR. © 2014 Wiley Periodicals, Inc.

Tree mortality from fire and bark beetles following early and late season prescribed fires in a Sierra Nevada mixed-conifer forest

USGS Publications Warehouse

Schwilk, Dylan W.; Knapp, Eric E.; Ferrenberg, Scott; Keeley, Jon E.; Caprio, Anthony C.

2006-01-01

Over the last century, fire exclusion in the forests of the Sierra Nevada has allowed surface fuels to accumulate and has led to increased tree density. Stand composition has also been altered as shade tolerant tree species crowd out shade intolerant species. To restore forest structure and reduce the risk of large, intense fires, managers have increasingly used prescription burning. Most fires prior to EuroAmerican settlement occurred during the late summer and early fall and most prescribed burning has taken place during the latter part of this period. Poor air quality and lack of suitable burn windows during the fall, however, have resulted in a need to conduct more prescription burning earlier in the season. Previous reports have suggested that burning during the time when trees are actively growing may increase mortality rates due to fine root damage and/or bark beetle activity. This study examines the effects of fire on tree mortality and bark beetle attacks under prescription burning during early and late season. Replicated early season burn, late season burn and unburned control plots were established in an old-growth mixed conifer forest in the Sierra Nevada that had not experienced a fire in over 120 years. Although prescribed burns resulted in significant mortality of particularly the smallest tree size classes, no difference between early and late season burns was detected. Direct mortality due to fire was associated with fire intensity. Secondary mortality due to bark beetles was not significantly correlated with fire intensity. The probability of bark beetle attack on pines did not differ between early and late season burns, while the probability of bark beetle attack on firs was greater following early season burns. Overall tree mortality appeared to be primarily the result of fire intensity rather than tree phenology at the time of the burns. Early season burns are generally conducted under higher fuel moisture conditions, leading to less fuel

Early hospital mortality prediction of intensive care unit patients using an ensemble learning approach.

PubMed

Awad, Aya; Bader-El-Den, Mohamed; McNicholas, James; Briggs, Jim

2017-12-01

Mortality prediction of hospitalized patients is an important problem. Over the past few decades, several severity scoring systems and machine learning mortality prediction models have been developed for predicting hospital mortality. By contrast, early mortality prediction for intensive care unit patients remains an open challenge. Most research has focused on severity of illness scoring systems or data mining (DM) models designed for risk estimation at least 24 or 48h after ICU admission. This study highlights the main data challenges in early mortality prediction in ICU patients and introduces a new machine learning based framework for Early Mortality Prediction for Intensive Care Unit patients (EMPICU). The proposed method is evaluated on the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database. Mortality prediction models are developed for patients at the age of 16 or above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU). We employ the ensemble learning Random Forest (RF), the predictive Decision Trees (DT), the probabilistic Naive Bayes (NB) and the rule-based Projective Adaptive Resonance Theory (PART) models. The primary outcome was hospital mortality. The explanatory variables included demographic, physiological, vital signs and laboratory test variables. Performance measures were calculated using cross-validated area under the receiver operating characteristic curve (AUROC) to minimize bias. 11,722 patients with single ICU stays are considered. Only patients at the age of 16 years old and above in Medical ICU (MICU), Surgical ICU (SICU) or Cardiac Surgery Recovery Unit (CSRU) are considered in this study. The proposed EMPICU framework outperformed standard scoring systems (SOFA, SAPS-I, APACHE-II, NEWS and qSOFA) in terms of AUROC and time (i.e. at 6h compared to 48h or more after admission). The results show that although there are many values missing in the first few hour of ICU admission

Lactate clearance cut off for early mortality prediction in adult sepsis and septic shock patients

NASA Astrophysics Data System (ADS)

Sinto, R.; Widodo, D.; Pohan, H. T.

2018-03-01

Previous lactate clearance cut off for early mortality prediction in sepsis and septic shock patient was determined by consensus from small sample size-study. We investigated the best lactate clearance cut off and its ability to predict early mortality in sepsis and septic shock patients. This cohort study was conducted in Intensive Care Unit of CiptoMangunkusumo Hospital in 2013. Patients’ lactate clearance and eight other resuscitationendpoints were recorded, and theoutcome was observed during the first 120 hours. The clearance cut off was determined using receiver operating characteristic (ROC) analysis, and its ability was investigated with Cox’s proportional hazard regression analysis using other resuscitation endpoints as confounders. Total of 268 subjects was included, of whom 70 (26.11%) subjects died within the first 120 hours. The area under ROC of lactate clearance to predict early mortality was 0.78 (95% % confidence interval [CI] 0.71-0.84) with best cut off was <7.5% (sensitivity and specificity 88.99% and 81.4% respectively). Compared with group achieving lactate clearance target, group not achieving lactate clearance target had to increase early mortality risk (adjusted hazard ratio 13.42; 95%CI 7.19-25.07). In conclusion, the best lactate clearance cut off as anearly mortality predictor in sepsis and septic shock patients is 7.5%.

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.

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.

[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.

Strategies to reduce infant mortality rate in India.

PubMed

Ghai, O P

1985-01-01

As a systems approach is needed to develop strategies to reduce the infant mortality rate (IMR), it is appropriate to analyze the present situation in India, reasons for low IMR in some Indian states vis-a-vis others, the status in some neighboring countries, and the cost effectiveness of various available technological interventions and their organizational constraints. A 1981 survey revealed 1) a low IMR for the state of Kerala, one which was comparable with Western nations, despite the fact that nearly half of the population in Kerala lived below the poverty line; 2) a very high IMR for the state of Uttar Pradesh, even though the number of people living below the poverty line was not significantly by different from the state of Kerala; and a moderate IMR reduction in the state of Punjab, even though only 15% of the population was below the poverty line. Favorable factors for low IMR appear to be a high female literacy rate, good medical and educational facilities close to the place of residence, and an excellent transportation and communication system. To significantly reduce IMR in a short period of time, it is necessary to adopt certain immediate measures. Nearly 55% of infant deaths occur in the 1st month of life, and these generally are not amenable to general measures and technological interventions. The problem is difficult, but a solution can be found by reaching a broad consensus among professionals and administrators. The major recommendations of a seminar on the Strategies for Reducing infant Mortality in India, held during January 1984, were: provide antenatal care to 100% of pregnant women; work for early registration of pregnancy and identification of high risk pregnancies; immunize 100% of pregnant women with tetanus toxoid; make available intrapartum care for all pregnant women; delineate anticipated job requirements, duties, and functions of village level health workers; make presterilized packaged delivery kits available to all female health

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

Socio-economic patterning in early mortality of patients aged 0-49 years diagnosed with primary bone cancer in Great Britain, 1985-2008.

PubMed

Blakey, Karen; Feltbower, Richard G; James, Peter W; Libby, Gillian; Stiller, Charles; Norman, Paul; Gerrand, Craig; McNally, Richard J Q

2018-04-01

Studies have shown marked improvements in survival between 1981 and 2000 for Ewing sarcoma patients but not for osteosarcoma. This study aimed to explore socio-economic patterning in early mortality rates for both tumours. The study analysed all 2432 osteosarcoma and 1619 Ewing sarcoma cases, aged 0-49 years, diagnosed in Great Britain 1985-2008 and followed to 31/12/2009. Logistic regression models were used to calculate risk of dying within three months, six months, one year, three years and five years after diagnosis. Associations with Townsend deprivation score and its components were examined at small-area level. Urban/rural status was studied at larger regional level. For osteosarcoma, after age adjustment, mortality at three months, six months and one year was associated with higher area unemployment, OR = 1.05 (95% CI 1.00, 1.10), OR = 1.04 (95% CI 1.01, 1.08) and OR = 1.04 (95% CI 1.02, 1.06) respectively per 1% increase in unemployment. Mortality at six months was associated with greater household non-car ownership, OR = 1.02 (95% CI 1.00, 1.03). For Ewing sarcoma, there were no significant associations between mortality and overall Townsend score, nor its components for any time period. For both tumours increasing mortality was associated with less urban and more remote rural areas. This study found that for osteosarcoma, early mortality was associated with residence at diagnosis in areas of higher unemployment, suggesting risk of early death may be socio-economically determined. For both tumours, distance from urban centres may lead to greater risk of early death. Copyright © 2018 Elsevier Ltd. All rights reserved.

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.

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.

Gaming in risk-adjusted mortality rates: effect of misclassification of risk factors in the benchmarking of cardiac surgery risk-adjusted mortality rates.

PubMed

Siregar, Sabrina; Groenwold, Rolf H H; Versteegh, Michel I M; Noyez, Luc; ter Burg, Willem Jan P P; Bots, Michiel L; van der Graaf, Yolanda; van Herwerden, Lex A

2013-03-01

Upcoding or undercoding of risk factors could affect the benchmarking of risk-adjusted mortality rates. The aim was to investigate the effect of misclassification of risk factors on the benchmarking of mortality rates after cardiac surgery. A prospective cohort was used comprising all adult cardiac surgery patients in all 16 cardiothoracic centers in The Netherlands from January 1, 2007, to December 31, 2009. A random effects model, including the logistic European system for cardiac operative risk evaluation (EuroSCORE) was used to benchmark the in-hospital mortality rates. We simulated upcoding and undercoding of 5 selected variables in the patients from 1 center. These patients were selected randomly (nondifferential misclassification) or by the EuroSCORE (differential misclassification). In the random patients, substantial misclassification was required to affect benchmarking: a 1.8-fold increase in prevalence of the 4 risk factors changed an underperforming center into an average performing one. Upcoding of 1 variable required even more. When patients with the greatest EuroSCORE were upcoded (ie, differential misclassification), a 1.1-fold increase was sufficient: moderate left ventricular function from 14.2% to 15.7%, poor left ventricular function from 8.4% to 9.3%, recent myocardial infarction from 7.9% to 8.6%, and extracardiac arteriopathy from 9.0% to 9.8%. Benchmarking using risk-adjusted mortality rates can be manipulated by misclassification of the EuroSCORE risk factors. Misclassification of random patients or of single variables will have little effect. However, limited upcoding of multiple risk factors in high-risk patients can greatly influence benchmarking. To minimize "gaming," the prevalence of all risk factors should be carefully monitored. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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

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.

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.

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

Effects of prenatal micronutrient and early food supplementation on maternal hemoglobin, birth weight, and infant mortality among children in Bangladesh: the MINIMat randomized trial.

PubMed

Persson, Lars Åke; Arifeen, Shams; Ekström, Eva-Charlotte; Rasmussen, Kathleen M; Frongillo, Edward A; Yunus, Md

2012-05-16

Nutritional insult in fetal life and small size at birth are common in low-income countries and are associated with serious health consequences. To test the hypothesis that prenatal multiple micronutrient supplementation (MMS) and an early invitation to food supplementation would increase maternal hemoglobin level and birth weight and decrease infant mortality, and to assess whether a combination of these interventions would further enhance these outcomes. A randomized trial with a factorial design in Matlab, Bangladesh, of 4436 pregnant women, recruited between November 11, 2001, and October 30, 2003, with follow-up until June 23, 2009. Participants were randomized into 6 groups; a double-masked supplementation with capsules of 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, was combined with food supplementation (608 kcal 6 days per week) randomized to either early invitation (9 weeks' gestation) or usual invitation (20 weeks' gestation). Maternal hemoglobin level at 30 weeks' gestation, birth weight, and infant mortality. Under 5-year mortality was also assessed. Adjusted maternal hemoglobin level at 30 weeks' gestation was 115.0 g/L (95% CI, 114.4-115.5 g/L), with no significant differences among micronutrient groups. Mean maternal hemoglobin level was lower in the early vs usual invitation groups (114.5 vs 115.4 g/L; difference, -0.9 g/L; 95% CI, -1.7 to -0.1; P = .04). There were 3625 live births out of 4436 pregnancies. Mean birth weight among 3267 singletons was 2694 g (95% CI, 2680-2708 g), with no significant differences among groups. The early invitation with MMS group had an infant mortality rate of 16.8 per 1000 live births vs 44.1 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid (hazard ratio [HR], 0.38; 95% CI, 0.18-0.78). Early invitation with MMS group had an under 5

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

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

The role of marriage in the causal pathway from economic conditions early in life to mortality.

PubMed

van den Berg, Gerard J; Gupta, Sumedha

2015-03-01

This paper analyzes the interplay between early-life conditions and marital status, as determinants of adult mortality. We use individual data from Dutch registers (years 1815-2000), combined with business cycle conditions in childhood as indicators of early-life conditions. The empirical analysis estimates bivariate duration models of marriage and mortality, allowing for unobserved heterogeneity. Results show that conditions around birth and school going ages are important for marriage and mortality. Men typically enjoy a protective effect of marriage, whereas women suffer during childbearing ages. However, having been born under favorable economic conditions reduces female mortality during childbearing ages. Copyright © 2014 Elsevier B.V. All rights reserved.

Early mortality in adults initiating antiretroviral therapy (ART) in low- and middle-income countries (LMIC): a systematic review and meta-analysis.

PubMed

Gupta, Amita; Nadkarni, Girish; Yang, Wei-Teng; Chandrasekhar, Aditya; Gupte, Nikhil; Bisson, Gregory P; Hosseinipour, Mina; Gummadi, Naveen

2011-01-01

We systematically reviewed observational studies of early mortality post-antiretroviral therapy (ART) initiation in low- and middle-income countries (LMIC) in Asia, Africa, and Central and South America, as defined by the World Bank, to summarize what is known. Studies published in English between January 1996 and December 2010 were searched in Medline and EMBASE. Three independent reviewers examined studies of mortality within one year post-ART. An article was included if the study was conducted in a LMIC, participants were initiating ART in a non-clinical trial setting and were ≥15 years. Fifty studies were included; 38 (76%) from sub-Saharan Africa (SSA), 5 (10%) from Asia, 2 (4%) from the Americas, and 5 (10%) were multi-regional. Median follow-up time and pre-ART CD4 cell count ranged from 3-55 months and 11-192 cells/mm(3), respectively. Loss-to-follow-up, reported in 40 (80%) studies, ranged from 0.3%-27%. Overall, SSA had the highest pooled 12-month mortality probability of 0.17 (95% CI 0.11-0.24) versus 0.11 (95% CI 0.10-0.13) for Asia, and 0.07 (95% CI 0.007-0.20) for the Americas. Of 14 (28%) studies reporting cause-specific mortality, tuberculosis (TB) (5%-44%), wasting (5%-53%), advanced HIV (20%-37%), and chronic diarrhea (10%-25%) were most common. Independent factors associated with early mortality in 30 (60%) studies included: low baseline CD4 cell count, male sex, advanced World Health Organization clinical stage, low body mass index, anemia, age greater than 40 years, and pre-ART quantitative HIV RNA. Significant heterogeneity in outcomes and in methods of reporting outcomes exist among published studies evaluating mortality in the first year after ART initiation in LMIC. Early mortality rates are highest in SSA, and opportunistic illnesses such as TB and wasting syndrome are the most common reported causes of death. Strategies addressing modifiable risk factors associated with early death are urgently needed.

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/

Time trends and epidemiological patterns of perinatal lamb mortality in Norway.

PubMed

Holmøy, Ingrid Hunter; Waage, Steinar

2015-09-30

Perinatal mortality is a major cause of loss in the sheep industry. Our aim was to explore time trends in crude population stillbirth and neonatal mortality rates in Norway. We used data on 6,435,715 lambs from flocks enrolled in the Norwegian Sheep Recording System (NSRS) from 2000 through 2010 for descriptive analysis of trends. Longitudinal patterns of mortality rates were compared for lambs within different levels of variables suspected to be associated with perinatal loss. There was an approximately linear increase in the annual proportion of stillborn lambs during the study period, from 3.3 % in 2000 to 4.7 % in 2010. In the same time period, average litter size of ewes in NSRS flocks increased from 2.00 to 2.19. However, a steady rise in stillbirth rate was observed within each litter size group, suggesting a gradually increasing impact on stillbirth risk of other, yet unidentified, factors. Average flock size increased during the study period. The highest stillbirth rates were found in the largest and smallest flocks. Early neonatal mortality rates (0-5 days of life) varied from year to year (minimum 2.2 %, maximum 3.2 %) and were invariably higher among triplets and quadruplets than among singletons and twins. Annual fluctuations were parallel within the various litter sizes. A significant overall decreasing trend was present within all litter sizes with the exception of singletons. Weather data for the prime lambing months (April and May) 2000-2010 indicated a relationship between low temperatures and high neonatal mortality rates. At the flock level, there was a significant positive correlation between stillbirths and early neonatal mortality rates (r = 0.13), between stillbirth rates in two consecutive years (r = 0.43) and between early neonatal mortality rates in two consecutive years (r = 0.40). The substantial increase in ovine stillbirth rate in recent years in Norway was to some extent related to a corresponding increase in the

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.

[Clinical characteristics, complications and mortality in 506 patients with infective endocarditis and determinants of survival rate at 10 years].

PubMed

Oyonarte, Miguel; Montagna, Rodrigo; Braun, Sandra; Rojo, Pamela; Jara, José L; Cereceda, Mauricio; Morales, Marcelo; Nazzal, Carolina; Nazal, Carolina; Alonso, Faustino

2012-12-01

Rates of morbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylococcus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% of patients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome.

Predicting Early Mortality After Hip Fracture Surgery: The Hip Fracture Estimator of Mortality Amsterdam.

PubMed

Karres, Julian; Kieviet, Noera; Eerenberg, Jan-Peter; Vrouenraets, Bart C

2018-01-01

Early mortality after hip fracture surgery is high and preoperative risk assessment for the individual patient is challenging. A risk model could identify patients in need of more intensive perioperative care, provide insight in the prognosis, and allow for risk adjustment in audits. This study aimed to develop and validate a risk prediction model for 30-day mortality after hip fracture surgery: the Hip fracture Estimator of Mortality Amsterdam (HEMA). Data on 1050 consecutive patients undergoing hip fracture surgery between 2004 and 2010 were retrospectively collected and randomly split into a development cohort (746 patients) and validation cohort (304 patients). Logistic regression analysis was performed in the development cohort to determine risk factors for the HEMA. Discrimination and calibration were assessed in both cohorts using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow goodness-of-fit test, and by stratification into low-, medium- and high-risk groups. Nine predictors for 30-day mortality were identified and used in the final model: age ≥85 years, in-hospital fracture, signs of malnutrition, myocardial infarction, congestive heart failure, current pneumonia, renal failure, malignancy, and serum urea >9 mmol/L. The HEMA showed good discrimination in the development cohort (AUC = 0.81) and the validation cohort (AUC = 0.79). The Hosmer-Lemeshow test indicated no lack of fit in either cohort (P > 0.05). The HEMA is based on preoperative variables and can be used to predict the risk of 30-day mortality after hip fracture surgery for the individual patient. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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.

Prognostic indices for early mortality in ischaemic stroke - meta-analysis.

PubMed

Mattishent, K; Kwok, C S; Mahtani, A; Pelpola, K; Myint, P K; Loke, Y K

2016-01-01

Several models have been developed to predict mortality in ischaemic stroke. We aimed to evaluate systematically the performance of published stroke prognostic scores. We searched MEDLINE and EMBASE in February 2014 for prognostic models (published between 2003 and 2014) used in predicting early mortality (<6 months) after ischaemic stroke. We evaluated discriminant ability of the tools through meta-analysis of the area under the curve receiver operating characteristic curve (AUROC) or c-statistic. We evaluated the following components of study validity: collection of prognostic variables, neuroimaging, treatment pathways and missing data. We identified 18 articles (involving 163 240 patients) reporting on the performance of prognostic models for mortality in ischaemic stroke, with 15 articles providing AUC for meta-analysis. Most studies were either retrospective, or post hoc analyses of prospectively collected data; all but three reported validation data. The iSCORE had the largest number of validation cohorts (five) within our systematic review and showed good performance in four different countries, pooled AUC 0.84 (95% CI 0.82-0.87). We identified other potentially useful prognostic tools that have yet to be as extensively validated as iSCORE - these include SOAR (2 studies, pooled AUC 0.79, 95% CI 0.78-0.80), GWTG (2 studies, pooled AUC 0.72, 95% CI 0.72-0.72) and PLAN (1 study, pooled AUC 0.85, 95% CI 0.84-0.87). Our meta-analysis has identified and summarized the performance of several prognostic scores with modest to good predictive accuracy for early mortality in ischaemic stroke, with the iSCORE having the broadest evidence base. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Spatial analysis of neonatal mortality in the state of São Paulo, 2006-2010].

PubMed

Almeida, Milena Cristina Silva; Gomes, Camila Moraes Santos; Nascimento, Luiz Fernando Costa

2014-12-01

The aim of this study was to identify spatial patterns of distribution of overall, early, and late neonatal mortality rates in São Paulo state. An ecological and exploratory study was carried in micro-regions of São Paulo sate. Mortality rates per 1,000 live births (LB) were calculated using data on overall, early, and late neonatal mortality in São Paulo between 2006 and 2010; these data were obtained from Information System and Information Technology Department of the Brazilian National Healthcare System (DATASUS). The global Moran's indices (I) were calculated for rates and thematic maps were built with these rates. Micro-regions with a high priority for intervention were identified by the box map. The software TerraView 4.2.1 was used for spatial analysis. The rates of early and late neonatal mortality were 6.2 per thousand LB and 2.5 per thousand LB, respectively. The global Moran's indexes (I) were I=0.13, I=0.15, and I=0.26 for overall, early, and late neonatal mortality rates, respectively; all global Moran's indices showed p-values <0.05. Thematic maps showed clusters of micro-regions with high rates located in the southwest and east of the state. The results presented in this study allow the implementation of policies by health managers, aiming to reduce neonatal mortality. Copyright © 2014 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

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.

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...

Natural selection and sex differences in morbidity and mortality in early life.

PubMed

Wells, J C

2000-01-07

Both morbidity and mortality are consistently reported to be higher in males than in females in early life, but no explanation for these findings has been offered. This paper argues that the sex difference in early vulnerability can be attributed to the natural selection of optimal maternal strategies for maximizing lifetime reproductive success, as modelled previously by Trivers and Willard. These authors theorized that males and females offer different returns on parental investment depending on the state of the environment. Natural selection has therefore favoured maternal ability to manipulate offspring sex in response to environmental conditions in early life, as shown in variation in the sex ratio at birth. This argument can be extended to the whole period of parental investment until weaning. Male vulnerability in response to environmental stress in early life is predicted to have been favoured by natural selection. This vulnerability is most evident in the harsh conditions resulting from pre-term birth, but can also be seen in term infants, and manifests as greater morbidity and mortality persisting into early childhood. Malnutrition, interacting with infection after birth, is suggested as the fundamental trigger mechanism. The model suggests that whatever improvements are made in medical care, any environmental stress will always affect males more severely than females in early life. Copyright 2000 Academic Press.

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

Predictors of early mortality after rabbit antithymocyte globulin as first-line treatment in severe aplastic anemia.

PubMed

Atta, Elias H; Lima, Carlos B L; Dias, Danielle S P; Clé, Diego V; Bonduel, Mariana M; Sciuccati, Gabriela B; Medeiros, Larissa A; Oliveira, Michel M; Salvino, Marco A; Garanito, Marlene P; Blum Fonseca, Patricia B; Saad, Sara Teresinha O; Calado, Rodrigo T; Scheinberg, Phillip

2017-11-01

Despite being recommended as first-line immunosuppressive therapy in severe aplastic anemia (SAA), horse antithymocyte globulin (ATG) is still unavailable in many countries outside the USA. Rabbit ATG is more lymphocytoxic than horse ATG, and this might result in a higher incidence of severe infections and early mortality. This study was designed to identify the risk factors for early mortality and overall survival (OS) after rabbit ATG in patients with SAA. We retrospectively reviewed 185 patients with SAA who underwent rabbit ATG and cyclosporine. The incidence of death in 3 months following rabbit ATG therapy was 15.1% (28/185). Early mortality was mainly related to infectious complications, despite adequate antibiotic and/or antifungal treatment. Age > 35 years (odds ratio [OR] 5.06, P = 0.001) and baseline absolute neutrophil count (ANC) ≤ 0.1 × 10 9 /L (OR 7.64, P < 0.001) were independent risk factors for early mortality after immunosuppressive therapy with this agent. Hematological response at 6 months was observed in only 29.7% of all patients. OS at 1 year after rabbit ATG was 75.3%; and age > 35 years (OR 1.88, P = 0.03), baseline ANC ≤ 0.1 × 10 9 /L (OR 2.65, P < 0.001), and lack of response to rabbit ATG (OR 11.40, P < 0.001) were independently associated with mortality. Alternative strategies are needed for the treatment of SAA patients in countries were horse ATG is unavailable, particularly for those at high risk for early mortality after rabbit ATG due to a higher age and very low pre-treatment neutrophil count.

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.

A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE.

PubMed

Di Mauro, Michele; Dato, Guglielmo Mario Actis; Barili, Fabio; Gelsomino, Sandro; Santè, Pasquale; Corte, Alessandro Della; Carrozza, Antonio; Ratta, Ester Della; Cugola, Diego; Galletti, Lorenzo; Devotini, Roger; Casabona, Riccardo; Santini, Francesco; Salsano, Antonio; Scrofani, Roberto; Antona, Carlo; Botta, Luca; Russo, Claudio; Mancuso, Samuel; Rinaldi, Mauro; De Vincentiis, Carlo; Biondi, Andrea; Beghi, Cesare; Cappabianca, Giangiuseppe; Tarzia, Vincenzo; Gerosa, Gino; De Bonis, Michele; Pozzoli, Alberto; Nicolini, Francesco; Benassi, Filippo; Rosato, Francesco; Grasso, Elena; Livi, Ugolino; Sponga, Sandro; Pacini, Davide; Di Bartolomeo, Roberto; De Martino, Andrea; Bortolotti, Uberto; Onorati, Francesco; Faggian, Giuseppe; Lorusso, Roberto; Vizzardi, Enrico; Di Giammarco, Gabriele; Marinelli, Daniele; Villa, Emmanuel; Troise, Giovanni; Picichè, Marco; Musumeci, Francesco; Paparella, Domenico; Margari, Vito; Tritto, Francesco; Damiani, Girolamo; Scrascia, Giuseppe; Zaccaria, Salvatore; Renzulli, Attilio; Serraino, Giuseppe; Mariscalco, Giovanni; Maselli, Daniele; Foschi, Massimiliano; Parolari, Alessandro; Nappi, Giannantonio

2017-08-15

The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE). From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers). Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2mg/dl, presence of abscess, number of treated valve/prosthesis (with respect to one treated valve/prosthesis) and the isolation of Staphylococcus aureus, Fungus spp., Pseudomonas Aeruginosa and other micro-organisms, while Streptococcus spp., Enterococcus spp. and other Staphylococci did not affect early mortality, as well as no micro-organisms isolation. LVEF was found linearly associated with outcomes while non-linear association between mortality and age was tested and the best model was found with a categorization into four classes (AUC=0.851). The following study provides a logistic risk model to predict early mortality in patients with heart valve or prosthesis infective endocarditis undergoing surgical treatment, called "The EndoSCORE". Copyright © 2017. Published by Elsevier B.V.

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.

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.

[Necrotizing fasciitis: study of 17 cases presenting a low mortality rate].

PubMed

Kibadi, K; Forli, A; Martin Des Pallieres, T; Debus, G; Moutet, F; Corcella, D

2013-04-01

Necrotizing fasciitis is a hypodermis, muscular fascia then dermis necrotizing infection. The originality of this study is to present a series of necrotizing fasciitis treated and followed these last five years, and to compare the therapeutic results with those of the literature. We led a retrospective study on the patients treated for necrotizing fasciitis between 2005 and 2009 by bringing together the demographic and clinical data, the bacteriological examinations and the results of management. Follow-up data from these patients during period of study (five years) were notified. Seventeen patients were treated (11 men and six women). The average age of the patients was 52 years (ranging from 28 to 82 years). Risk factors of necrotizing fasciitis for our patients were: nonsteroidal anti-inflammatory drugs (82.2%), cutaneous wound (76.4%), obesity (29.4%), oto-rhino-laryngologic diseases (23.5%), alcoholic and drug addicts (23.5%), and diabetis (11.7%). The most isolated and responsible germ was Streptococcus pyogenes in 75.5% of cases. Culture of specimens collected before antibiotic treatment showed that the bacterium was sensible to the antibiotics being administered (clindamycin in 70.5% of cases). The surgical management was early done with an average delay of 2.7 days (ranging from 1 to 15 days). We observed a low mortality rate (11.7%). One patient died during the period of follow-up after one year (average follow-up of 2.0 years; 1-3 years). Contrary to the data from the literature, this study presents a decrease of the mortality in necrotizing fasciitis with an early treatment and an adequate management. The precocity and the quality of surgical procedures as well as the presence of an underlying disease are determining factors for successful management of necrotizing fasciitis. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

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

PubMed Central

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

2016-01-01

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. PMID:27929405

Long-term mortality rates and spatial patterns in an old-growth forest

Treesearch

Emily J. Silver; Shawn Fraver; Anthony W. D' Amato; Tuomas Aakala; Brian J. Palik

2013-01-01

Understanding natural mortality patterns and processes of forest tree species is increasingly important given projected changes in mortality owing to global change. With this need in mind, the rate and spatial pattern of mortality was assessed over an 89-year period in a natural-origin Pinus resinosa (Aiton)-dominated system to assess these processes...

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

Temperature-dependent rate models of vascular cambium cell mortality

Treesearch

Matthew B. Dickinson; Edward A. Johnson

2004-01-01

We use two rate-process models to describe cell mortality at elevated temperatures as a means of understanding vascular cambium cell death during surface fires. In the models, cell death is caused by irreversible damage to cellular molecules that occurs at rates that increase exponentially with temperature. The models differ in whether cells show cumulative effects of...

Correlations for number of sunspots, unemployment rate, and suicide mortality in Japan.

PubMed

Otsu, Akiko; Chinami, Masanobu; Morgenthale, Stephan; Kaneko, Yoshihiro; Fujita, Daisuke; Shirakawa, Taro

2006-04-01

We studied the correlations among sunspot numbers, business cycles, and suicide mortalitites. Based on data from Japan between 1971 and 2001, a significant negative correlation between sunspot numbers and unemployment rate was found, R= -.17. The correlation between suicide mortality and unemployment rate was positive for males (R=.46) and negative for females (R =-.69). Both are statistically significant. The hypothesis that variation of sun activity may affect the economy and the unemployment rate and hence increase the male suicide mortality is raised.

Self-rated health changes and oldest-old mortality.

PubMed

Vogelsang, Eric M

2014-07-01

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. 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. 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. 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. © The Author 2014. 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.

Early embryo mortality in natural human reproduction: What the data say

PubMed Central

Jarvis, Gavin E.

2017-01-01

How many human embryos die between fertilisation and birth under natural conditions? It is widely accepted that natural human embryo mortality is high, particularly during the first weeks after fertilisation, with total prenatal losses of 70% and higher frequently claimed. However, the first external sign of pregnancy occurs two weeks after fertilisation with a missed menstrual period, and establishing the fate of embryos before this is challenging. Calculations are additionally hampered by a lack of data on the efficiency of fertilisation under natural conditions. Four distinct sources are used to justify quantitative claims regarding embryo loss: (i) a hypothesis published by Roberts & Lowe in The Lancet  is widely cited but has no practical quantitative value; (ii) life table analyses give consistent assessments of clinical pregnancy loss, but cannot illuminate losses at earlier stages of development; (iii) studies that measure human chorionic gonadotrophin (hCG) reveal losses in the second week of development and beyond, but not before; and (iv) the classic studies of Hertig and Rock offer the only direct insight into the fate of human embryos from fertilisation under natural conditions. Re-examination of Hertig’s data demonstrates that his estimates for fertilisation rate and early embryo loss are highly imprecise and casts doubt on the validity of his numerical analysis. A recent re-analysis of hCG study data concluded that approximately 40-60% of embryos may be lost between fertilisation and birth, although this will vary substantially between individual women. In conclusion, natural human embryo mortality is lower than often claimed and widely accepted. Estimates for total prenatal mortality of 70% or higher are exaggerated and not supported by the available data. PMID:28580126

Early Mortality in Adults Initiating Antiretroviral Therapy (ART) in Low- and Middle-Income Countries (LMIC): A Systematic Review and Meta-Analysis

PubMed Central

Gupta, Amita; Nadkarni, Girish; Yang, Wei-Teng; Chandrasekhar, Aditya; Gupte, Nikhil; Bisson, Gregory P.; Hosseinipour, Mina; Gummadi, Naveen

2011-01-01

Background We systematically reviewed observational studies of early mortality post-antiretroviral therapy (ART) initiation in low- and middle-income countries (LMIC) in Asia, Africa, and Central and South America, as defined by the World Bank, to summarize what is known. Methods and Findings Studies published in English between January 1996 and December 2010 were searched in Medline and EMBASE. Three independent reviewers examined studies of mortality within one year post-ART. An article was included if the study was conducted in a LMIC, participants were initiating ART in a non-clinical trial setting and were ≥15 years. Fifty studies were included; 38 (76%) from sub-Saharan Africa (SSA), 5 (10%) from Asia, 2 (4%) from the Americas, and 5 (10%) were multi-regional. Median follow-up time and pre-ART CD4 cell count ranged from 3–55 months and 11–192 cells/mm3, respectively. Loss-to-follow-up, reported in 40 (80%) studies, ranged from 0.3%–27%. Overall, SSA had the highest pooled 12-month mortality probability of 0.17 (95% CI 0.11–0.24) versus 0.11 (95% CI 0.10–0.13) for Asia, and 0.07 (95% CI 0.007–0.20) for the Americas. Of 14 (28%) studies reporting cause-specific mortality, tuberculosis (TB) (5%–44%), wasting (5%–53%), advanced HIV (20%–37%), and chronic diarrhea (10%–25%) were most common. Independent factors associated with early mortality in 30 (60%) studies included: low baseline CD4 cell count, male sex, advanced World Health Organization clinical stage, low body mass index, anemia, age greater than 40 years, and pre-ART quantitative HIV RNA. Conclusions Significant heterogeneity in outcomes and in methods of reporting outcomes exist among published studies evaluating mortality in the first year after ART initiation in LMIC. Early mortality rates are highest in SSA, and opportunistic illnesses such as TB and wasting syndrome are the most common reported causes of death. Strategies addressing modifiable risk factors associated with early

Leukapheresis do not improve early death rates in acute myeloid leukemia patients with hyperleukocytosis.

PubMed

Malkan, Umit Yavuz; Ozcebe, Osman Ilhami

2017-12-01

Hyperleukocytosis (HL) is defined as the clinical condition when the white blood cell (WBC) count is above 100,000/mm 3 in peripheral blood. It has been already shown in the literature that leukapheresis, a conventional technique to decrease the serum WBC level, is ineffective for long-term survival in cases of hyperleukocytotic acute myeloid leukemia (AML) with leukostasis. However, the effect of leukapheresis on early mortality is still unclear. In this study, we aimed to evaluate the effect of leukapheresis on early mortality of patients with AML who have HL. Twenty-eight de novo patients with AML, diagnosed with HL between 2002 and 2015 at the Hacettepe Hematology Department, were analyzed retrospectively. Leukapheresis was performed in 10 patients, and the mean WBC decrease with leukapheresis was 57.4×10 3 /μl which accounts for 31% of the initial WBC count. The indications for leukapheresis were hyperviscosity and prophylaxis in four and six patients, respectively. In the group of patients who received leukapheresis, three of four patients who had hyperviscosity symptoms died, and three of six patients died who did not have symptoms. In our study, we observed that the leukapheresis procedure is highly effective in reducing plasma WBC levels. However, although it is statistically insignificant, our findings also revealed that there is a much higher rate of death in patients who were treated with leukapheresis. Therefore we conclude that leukapheresis does not lower rates of early death; nevertheless, this finding should be confirmed by prospective studies with larger cohorts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association between Proximity to a Health Center and Early Childhood Mortality in Madagascar

PubMed Central

Kashima, Saori; Suzuki, Etsuji; Okayasu, Toshiharu; Jean Louis, Razafimahatratra; Eboshida, Akira; Subramanian, S. V.

2012-01-01

Objective To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance. Methods From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia. Results Compared with those who lived >1.5–3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0–10.0 km away from a health center were 1.36 (95% CI: 0.92–2.01) and 1.42 (95% CI: 1.06–1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status. Conclusions Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better

Time series models on analysing mortality rates and acute childhood lymphoid leukaemia.

PubMed

Kis, Maria

2005-01-01

In this paper we demonstrate applying time series models on medical research. The Hungarian mortality rates were analysed by autoregressive integrated moving average models and seasonal time series models examined the data of acute childhood lymphoid leukaemia.The mortality data may be analysed by time series methods such as autoregressive integrated moving average (ARIMA) modelling. This method is demonstrated by two examples: analysis of the mortality rates of ischemic heart diseases and analysis of the mortality rates of cancer of digestive system. Mathematical expressions are given for the results of analysis. The relationships between time series of mortality rates were studied with ARIMA models. Calculations of confidence intervals for autoregressive parameters by tree methods: standard normal distribution as estimation and estimation of the White's theory and the continuous time case estimation. Analysing the confidence intervals of the first order autoregressive parameters we may conclude that the confidence intervals were much smaller than other estimations by applying the continuous time estimation model.We present a new approach to analysing the occurrence of acute childhood lymphoid leukaemia. We decompose time series into components. The periodicity of acute childhood lymphoid leukaemia in Hungary was examined using seasonal decomposition time series method. The cyclic trend of the dates of diagnosis revealed that a higher percent of the peaks fell within the winter months than in the other seasons. This proves the seasonal occurrence of the childhood leukaemia in Hungary.

Apparent climatically induced increase of tree mortality rates in a temperate forest

USGS Publications Warehouse

van Mantgem, P.J.; Stephenson, N.L.

2007-01-01

We provide a first detailed analysis of long-term, annual-resolution demographic trends in a temperate forest. After tracking the fates of 21 338 trees in a network of old-growth forest plots in the Sierra Nevada of California, we found that mortality rate, but not the recruitment rate, increased significantly over the 22 years of measurement (1983-2004). Mortality rates increased in both of two dominant taxonomic groups (Abies and Pinus) and in different forest types (different elevational zones). The increase in overall mortality rate resulted from an increase in tree deaths attributed to stress and biotic causes, and coincided with a temperature-driven increase in an index of drought. Our findings suggest that these forests (and by implication, other water-limited forests) may be sensitive to temperature-driven drought stress, and may be poised for die-back if future climates continue to feature rising temperatures without compensating increases in precipitation. ?? 2007 Blackwell Publishing Ltd/CNRS.

Early mortality and morbidity after total hip arthroplasty in patients with femoral neck fracture

PubMed Central

Hailer, Nils P; Garland, Anne; Rogmark, Cecilia; Garellick, Göran; Kärrholm, Johan

2016-01-01

Background and purpose — Early postoperative mortality is relatively high after total hip arthroplasty (THA) that has been performed due to femoral neck fracture. However, this has rarely been investigated after adjustment for medical comorbidity and comparison with the mortality in an age-matched population. We therefore assessed early mortality in hip fracture patients treated with a THA, in the setting of a nationwide matched cohort study. Patients and methods — 24,699 patients who underwent THA due to a femoral neck fracture between 1992 and 2012 were matched with 118,518 controls. Kaplan-Meier survival analysis was used to calculate cumulative unadjusted survival, and Cox regression models were fitted to compute hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for age, sex, comorbidity, and socioeconomic background. Results — 90-day survival was 96.3% (95% CI: 96.0–96.5) for THA cases and 98.7% (95% CI: 98.6–98.8) for control individuals, giving an adjusted HR of 2.2 (95% CI: 2.0–2.4) for THA cases compared to control individuals. Comorbidity burden increased in THA cases over time, but the adjusted risk of death within 90 days did not differ statistically significantly between the time periods investigated (1992–1998, 1999–2005, and 2006–2012). A Charlson comorbidity index of 3 or more, an American Society of Anesthesiologists (ASA) grade of 3 and above, male sex, an age of 80 years and above, an income below the first quartile, and a lower level of education were all associated with an increased risk of 90-day mortality. Interpretation — The adjusted early mortality in femoral neck fracture patients who underwent THA was about double that in a matched control population. Patients with femoral neck fracture but with no substantial comorbidity and an age of less than 80 years appear to have a low risk of early death. Patients older than 80 years and those with a Charlson comorbidity index of more than 2 have a high

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.

Mortality of Youth Offenders Along a Continuum of Justice System Involvement.

PubMed

Aalsma, Matthew C; Lau, Katherine S L; Perkins, Anthony J; Schwartz, Katherine; Tu, Wanzhu; Wiehe, Sarah E; Monahan, Patrick; Rosenman, Marc B

2016-03-01

Black male youth are at high risk of homicide and criminal justice involvement. This study aimed to determine how early mortality among youth offenders varies based on race; gender; and the continuum of justice system involvement: arrest, detention, incarceration, and transfer to adult courts. Criminal and death records of 49,479 youth offenders (ages 10-18 years at first arrest) in Marion County, Indiana, from January 1, 1999, to December 31, 2011, were examined. Statistical analyses were completed in November 2014. From 1999 to 2011 (aggregate exposure, 386,709 person-years), 518 youth offender deaths occurred. The most common cause of death was homicide (48.2%). The mortality rate of youth offenders was nearly 1.5 times greater than that among community youth (standardized mortality ratio, 1.48). The youth offender mortality rate varied depending on the severity of justice system involvement. Arrested youth had the lowest rate of mortality (90/100,000), followed by detained youth (165/100,000); incarcerated youth (216/100,000); and youth transferred to adult court (313/100,000). A proportional hazards model demonstrated that older age, male gender, and more severe justice system involvement 5 years post-arrest predicted shorter time to mortality. Youth offenders face greater risk for early death than community youth. Among these, black male youth face higher risk of early mortality than their white male counterparts. However, regardless of race/ethnicity, mortality rates for youth offenders increase as youth involvement in the justice system becomes more protracted and severe. Thus, justice system involvement is a significant factor to target for intervention. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Forecasting selected specific age mortality rate of Malaysia by using Lee-Carter model

NASA Astrophysics Data System (ADS)

Shukri Kamaruddin, Halim; Ismail, Noriszura

2018-03-01

Observing mortality pattern and trend is an important subject for any country to maintain a good social-economy in the next projection years. The declining in mortality trend gives a good impression of what a government has done towards macro citizen in one nation. Selecting a particular mortality model can be a tricky based on the approached method adapting. Lee-Carter model is adapted because of its simplicity and reliability of the outcome results with approach of regression. Implementation of Lee-Carter in finding a fitted model and hence its projection has been used worldwide in most of mortality research in developed countries. This paper studies the mortality pattern of Malaysia in the past by using original model of Lee-Carter (1992) and hence its cross-sectional observation for a single age. The data is indexed by age of death and year of death from 1984 to 2012, in which are supplied by Department of Statistics Malaysia. The results are modelled by using RStudio and the keen analysis will focus on the trend and projection of mortality rate and age specific mortality rate in the future. This paper can be extended to different variants extensions of Lee-Carter or any stochastic mortality tool by using Malaysia mortality experience as a centre of the main issue.

Social capital in a changing society: cross sectional associations with middle aged female and male mortality rates.

PubMed

Skrabski, A; Kopp, M; Kawachi, I

2003-02-01

Social capital has been linked to self rated health and mortality rates. The authors examined the relations between measures of social capital and male/female mortality rates across counties in Hungary. Cross sectional, ecological study. 20 counties of Hungary. 12,640 people were interviewed in 1995 (the "Hungarostudy II" survey), representing the Hungarian population according to sex, age, and county. Social capital was measured by three indicators: lack of social trust, reciprocity between citizens, and help received from civil organisations. Covariates included county GDP, personal income, education, unemployment, smoking, and alcohol spirit consumption. Gender specific mortality rates were calculated for the middle aged population (45-64 years) in the 20 counties of Hungary. All of the social capital variables were significantly associated with middle age mortality, but levels of mistrust showed the strongest association. Several gender differences were observed, namely male mortality rates were more closely associated with lack of help from civic organisations, while female mortality rates were more closely connected with perceptions of reciprocity. There are gender differences in the relations of specific social capital indicators to mortality rates. At the same time, perceptions of social capital within each sex were associated with mortality rates in the opposite sex.

Early loss to follow-up and mortality of HIV-infected patients diagnosed after the era of antiretroviral treatment scale up: a call for re-invigorating the response in Iran.

PubMed

Badie, Banafsheh Moradmand; Nabaei, Ghaemeh; Rasoolinejad, Mehrnaz; Mirzazadeh, Ali; McFarland, Willi

2013-12-01

In Iran, the HIV/AIDS epidemic is growing during an era of scaling up the national surveillance system and antiretroviral therapy programs. We examined the early loss to follow-up and mortality rates in a retrospective cohort of 1495 HIV-infected patients by survival proportional hazard Cox model. We also conducted a data abstraction sub-study in a systematic random sample of 147 patients to assess the association between mortality and predictor factors. Overall, 17.3% patients were not seen after their first visit and 17.4% more were lost by 6 months. The overall mortality rate was 7.0 (95% CI 6.1-8.1) per 100 person-years. Moreover, crude mortality rate was higher in men (8.6) than in women (1.7), with an age-adjusted hazard ratio for men compared to women of 4.55 (95% CI 2.31-8.93). Lastly, history of tuberculosis and not being on antiretroviral therapy were significantly associated with higher mortality in the patient sub-sample.

Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients: The EPOCH Randomized Clinical Trial.

PubMed

Parshuram, Christopher S; Dryden-Palmer, Karen; Farrell, Catherine; Gottesman, Ronald; Gray, Martin; Hutchison, James S; Helfaer, Mark; Hunt, Elizabeth A; Joffe, Ari R; Lacroix, Jacques; Moga, Michael Alice; Nadkarni, Vinay; Ninis, Nelly; Parkin, Patricia C; Wensley, David; Willan, Andrew R; Tomlinson, George A

2018-03-13

There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years). Participating hospitals had continuous physician staffing and subspecialized pediatric services. Patient enrollment began on February 28, 2011, and ended on June 21, 2015. Follow-up ended on July 19, 2015. The BedsidePEWS intervention (10 hospitals) was compared with usual care (no severity of illness score; 11 hospitals). The primary outcome was all-cause hospital mortality. The secondary outcome was a significant clinical deterioration event, which was defined as a composite outcome reflecting late ICU admission. Regression analyses accounted for hospital-level clustering and baseline rates. Among 144 539 patient discharges at 21 randomized hospitals, there were 559 443 patient-days and 144 539 patients (100%) completed the trial. All-cause hospital mortality was 1.93 per 1000 patient discharges at hospitals with BedsidePEWS and 1.56 per 1000 patient discharges at hospitals with usual care (adjusted between-group rate difference, 0.01 [95% CI, -0.80 to 0.81 per 1000 patient discharges]; adjusted odds ratio, 1.01 [95% CI, 0.61 to 1.69]; P = .96). Significant clinical deterioration events occurred during 0.50 per 1000 patient-days at hospitals with BedsidePEWS vs 0.84 per 1000 patient-days at hospitals with usual care (adjusted between-group rate difference, -0.34 [95% CI, -0.73 to 0.05 per 1000 patient

Geographical trends in infant mortality: England and Wales, 1970-2006.

PubMed

Norman, Paul; Gregory, Ian; Dorling, Danny; Baker, Allan

2008-01-01

At national level in England and Wales, infant mortality rates fell rapidly from the early 1970s and into the 1980s. Subnational areas have also experienced a reduction in levels of infant mortality. While rates continued to fall to 2006, the rate of reduction has slowed. Although the Government Office Regions Yorkshire and The Humber, the North West and the West Midlands and the Office for National Statistics local authority types Cities and Services and London Cosmopolitan have experienced relatively large absolute reductions in infant mortality, their rates remained high compared with the national average. Within all regions and local authority types, a strong relationship was found between ward level deprivation and infant mortality rates. Nevertheless, levels of infant mortality declined over time even in the most deprived areas with a narrowing of absolute differences in rates between areas. Areas in which the level of deprivation eased have experienced greater than average reductions in levels of infant mortality.

Exploring the relationship between nursing hours per patient day and mortality rate of hospitalised patients in Taiwan.

PubMed

Chang, Yu-Chun; Yen, Miaofen; Chang, Sheng-Mao; Liu, Ya-Ming

2017-03-01

To investigate the relationship between nursing hours per patient day and the inpatient mortality rate in Taiwan. Nursing hours per patient day has been associated with better patient outcomes. The literature is inconclusive on the relationship between nursing hours per patient day and the inpatient mortality rate, and no studies have yet examined this issue in Taiwan. A retrospective longitudinal study analysed data from the 'Nursing Utilization of Resources, Staffing and Environment on Outcome Study: NURSE-outcome study'. Hierarchical regression estimated the relationship between nursing hours per patient day and in-hospital mortality rate after controlling for confounding variables. The mean nursing hours per patient day in Taiwan was 2.3, while the mean inpatient mortality rate was 0.73% higher nursing hours per patient day was associated with a lower inpatient mortality rate after controlling for confounding variables. The total explained variance of this study in inpatient mortality rate was 19.9%. Significant relationships to inpatient mortality were found in levels of hospitals, seasonal variation and nurses' work experience. Nursing hours per patient day affects the mortality rate among hospitalised patients in Taiwan. According to the results, we suggested the government and managers in Taiwan double the nursing hours per patient day so that the inpatient mortality rate will decline by 1.1%. This might be the optimal nurse configuration that could provide a balance between cost-effectiveness and patient safety. © 2016 John Wiley & Sons Ltd.

Cross-temporal and cross-national poverty and mortality rates among developed countries.

PubMed

Fritzell, Johan; Kangas, Olli; Bacchus Hertzman, Jennie; Blomgren, Jenni; Hiilamo, Heikki

2013-01-01

A prime objective of welfare state activities is to take action to enhance population health and to decrease mortality risks. For several centuries, poverty has been seen as a key social risk factor in these respects. Consequently, the fight against poverty has historically been at the forefront of public health and social policy. The relationship between relative poverty rates and population health indicators is less self-evident, notwithstanding the obvious similarity to the debated topic of the relationship between population health and income inequality. In this study we undertake a comparative analysis of the relationship between relative poverty and mortality across 26 countries over time, with pooled cross-sectional time series analysis. We utilize data from the Luxembourg Income Study to construct age-specific poverty rates across countries and time covering the period from around 1980 to 2005, merged with data on age- and gender-specific mortality data from the Human Mortality Database. Our results suggest not only an impact of relative poverty but also clear differences by welfare regime that partly goes beyond the well-known differences in poverty rates between welfare regimes.

Cross-Temporal and Cross-National Poverty and Mortality Rates among Developed Countries

PubMed Central

Fritzell, Johan; Kangas, Olli; Bacchus Hertzman, Jennie; Blomgren, Jenni; Hiilamo, Heikki

2013-01-01

A prime objective of welfare state activities is to take action to enhance population health and to decrease mortality risks. For several centuries, poverty has been seen as a key social risk factor in these respects. Consequently, the fight against poverty has historically been at the forefront of public health and social policy. The relationship between relative poverty rates and population health indicators is less self-evident, notwithstanding the obvious similarity to the debated topic of the relationship between population health and income inequality. In this study we undertake a comparative analysis of the relationship between relative poverty and mortality across 26 countries over time, with pooled cross-sectional time series analysis. We utilize data from the Luxembourg Income Study to construct age-specific poverty rates across countries and time covering the period from around 1980 to 2005, merged with data on age- and gender-specific mortality data from the Human Mortality Database. Our results suggest not only an impact of relative poverty but also clear differences by welfare regime that partly goes beyond the well-known differences in poverty rates between welfare regimes. PMID:23840235

No evidence of nonlinear effects of predator density, refuge availability, or body size of prey on prey mortality rates.

PubMed

Simkins, Richard M; Belk, Mark C

2017-08-01

Predator density, refuge availability, and body size of prey can all affect the mortality rate of prey. We assume that more predators will lead to an increase in prey mortality rate, but behavioral interactions between predators and prey, and availability of refuge, may lead to nonlinear effects of increased number of predators on prey mortality rates. We tested for nonlinear effects in prey mortality rates in a mesocosm experiment with different size classes of western mosquitofish ( Gambusia affinis ) as the prey, different numbers of green sunfish ( Lepomis cyanellus ) as the predators, and different levels of refuge. Predator number and size class of prey, but not refuge availability, had significant effects on the mortality rate of prey. Change in mortality rate of prey was linear and equal across the range of predator numbers. Each new predator increased the mortality rate by about 10% overall, and mortality rates were higher for smaller size classes. Predator-prey interactions at the individual level may not scale up to create nonlinearity in prey mortality rates with increasing predator density at the population level.

Global Incidence and Mortality Rates of Stomach Cancer and the Human Development Index: an Ecological Study.

PubMed

Khazaei, Salman; Rezaeian, Shahab; Soheylizad, Mokhtar; Khazaei, Somayeh; Biderafsh, Azam

2016-01-01

Stomach cancer (SC) is the second leading cause of cancer death with the rate of 10.4% in the world. The correlation between the incidence and mortality rates of SC and human development index (HDI) has not been globally determined. Therefore, this study aimed to determine the association between the incidence and mortality rates of SC and HDI in various regions. In this global ecological study, we used the data about the incidence and mortality rate of SC and HDI from the global cancer project and the United Nations Development Programme database, respectively. In 2012, SCs were estimated to have affected a total of 951,594 individuals (crude rate: 13.5 per 100,000 individuals) with a male/female ratio of 1.97, and caused 723,073 deaths worldwide (crude rate: 10.2 per 100,000 individuals). There was a positive correlation between the HDI and both incidence (r=0.28, <0.05) and mortality rates of SC (r=0.13, P = 0.1) in the world in 2012. The high incidence and mortality rates of SC in countries with high and very high HDI is remarkable which should be the top priority of interventions for global health policymakers. In addition, health programs should be provided to reduce the burden of this disease in the regions with high incidence and mortality rates of SC.

Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial

PubMed Central

2013-01-01

Background Early rapid fluid resuscitation (boluses) in African children with severe febrile illnesses increases the 48-hour mortality by 3.3% compared with controls (no bolus). We explored the effect of boluses on 48-hour all-cause mortality by clinical presentation at enrolment, hemodynamic changes over the first hour, and on different modes of death, according to terminal clinical events. We hypothesize that boluses may cause excess deaths from neurological or respiratory events relating to fluid overload. Methods Pre-defined presentation syndromes (PS; severe acidosis or severe shock, respiratory, neurological) and predominant terminal clinical events (cardiovascular collapse, respiratory, neurological) were described by randomized arm (bolus versus control) in 3,141 severely ill febrile children with shock enrolled in the Fluid Expansion as Supportive Therapy (FEAST) trial. Landmark analyses were used to compare early mortality in treatment groups, conditional on changes in shock and hypoxia parameters. Competing risks methods were used to estimate cumulative incidence curves and sub-hazard ratios to compare treatment groups in terms of terminal clinical events. Results Of 2,396 out of 3,141 (76%) classifiable participants, 1,647 (69%) had a severe metabolic acidosis or severe shock PS, 625 (26%) had a respiratory PS and 976 (41%) had a neurological PS, either alone or in combination. Mortality was greatest among children fulfilling criteria for all three PS (28% bolus, 21% control) and lowest for lone respiratory (2% bolus, 5% control) or neurological (3% bolus, 0% control) presentations. Excess mortality in bolus arms versus control was apparent for all three PS, including all their component features. By one hour, shock had resolved (responders) more frequently in bolus versus control groups (43% versus 32%, P <0.001), but excess mortality with boluses was evident in responders (relative risk 1.98, 95% confidence interval 0.94 to 4.17, P = 0.06) and 'non

Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial.

PubMed

Maitland, Kathryn; George, Elizabeth C; Evans, Jennifer A; Kiguli, Sarah; Olupot-Olupot, Peter; Akech, Samuel O; Opoka, Robert O; Engoru, Charles; Nyeko, Richard; Mtove, George; Reyburn, Hugh; Brent, Bernadette; Nteziyaremye, Julius; Mpoya, Ayub; Prevatt, Natalie; Dambisya, Cornelius M; Semakula, Daniel; Ddungu, Ahmed; Okuuny, Vicent; Wokulira, Ronald; Timbwa, Molline; Otii, Benedict; Levin, Michael; Crawley, Jane; Babiker, Abdel G; Gibb, Diana M

2013-03-14

Early rapid fluid resuscitation (boluses) in African children with severe febrile illnesses increases the 48-hour mortality by 3.3% compared with controls (no bolus). We explored the effect of boluses on 48-hour all-cause mortality by clinical presentation at enrolment, hemodynamic changes over the first hour, and on different modes of death, according to terminal clinical events. We hypothesize that boluses may cause excess deaths from neurological or respiratory events relating to fluid overload. Pre-defined presentation syndromes (PS; severe acidosis or severe shock, respiratory, neurological) and predominant terminal clinical events (cardiovascular collapse, respiratory, neurological) were described by randomized arm (bolus versus control) in 3,141 severely ill febrile children with shock enrolled in the Fluid Expansion as Supportive Therapy (FEAST) trial. Landmark analyses were used to compare early mortality in treatment groups, conditional on changes in shock and hypoxia parameters. Competing risks methods were used to estimate cumulative incidence curves and sub-hazard ratios to compare treatment groups in terms of terminal clinical events. Of 2,396 out of 3,141 (76%) classifiable participants, 1,647 (69%) had a severe metabolic acidosis or severe shock PS, 625 (26%) had a respiratory PS and 976 (41%) had a neurological PS, either alone or in combination. Mortality was greatest among children fulfilling criteria for all three PS (28% bolus, 21% control) and lowest for lone respiratory (2% bolus, 5% control) or neurological (3% bolus, 0% control) presentations. Excess mortality in bolus arms versus control was apparent for all three PS, including all their component features. By one hour, shock had resolved (responders) more frequently in bolus versus control groups (43% versus 32%, P <0.001), but excess mortality with boluses was evident in responders (relative risk 1.98, 95% confidence interval 0.94 to 4.17, P = 0.06) and 'non-responders' (relative risk 1

Adjusting Expected Mortality Rates Using Information From a Control Population: An Example Using Socioeconomic Status.

PubMed

Bower, Hannah; Andersson, Therese M-L; Crowther, Michael J; Dickman, Paul W; Lambe, Mats; Lambert, Paul C

2018-04-01

Expected or reference mortality rates are commonly used in the calculation of measures such as relative survival in population-based cancer survival studies and standardized mortality ratios. These expected rates are usually presented according to age, sex, and calendar year. In certain situations, stratification of expected rates by other factors is required to avoid potential bias if interest lies in quantifying measures according to such factors as, for example, socioeconomic status. If data are not available on a population level, information from a control population could be used to adjust expected rates. We have presented two approaches for adjusting expected mortality rates using information from a control population: a Poisson generalized linear model and a flexible parametric survival model. We used a control group from BCBaSe-a register-based, matched breast cancer cohort in Sweden with diagnoses between 1992 and 2012-to illustrate the two methods using socioeconomic status as a risk factor of interest. Results showed that Poisson and flexible parametric survival approaches estimate similar adjusted mortality rates according to socioeconomic status. Additional uncertainty involved in the methods to estimate stratified, expected mortality rates described in this study can be accounted for using a parametric bootstrap, but this might make little difference if using a large control population.

Early kit mortality and growth in farmed mink are affected by litter size rather than nest climate.

PubMed

Schou, T M; Malmkvist, J

2017-09-01

We investigated the effects of nest box climate on early mink kit mortality and growth. We hypothesised that litters in warm nest boxes experience less hypothermia-induced mortality and higher growth rates during the 1st week of life. This study included data from 749, 1-year-old breeding dams with access to nesting materials. Kits were weighed on days 1 and 7, dead kits were collected daily from birth until day 7 after birth, and nest climate was measured continuously from days 1 to 6. We tested the influences of the following daily temperature (T) and humidity (H) parameters on the number of live-born kit deaths and kit growth: T mean, T min, T max, T var (fluctuation) and H mean. The nest microclimate experienced by the kits was buffered against the ambient climate, with higher temperatures and reduced climate fluctuation. Most (77.0%) live-born kit deaths in the 1st week occurred on days 0 and 1. Seven of 15 climate parameters on days 1 to 3 had significant effects on live-born kit mortality. However, conflicting effects among days, marginal effects and late effects indicated that climate was not the primary cause of kit mortality. Five of 30 climate parameters had significant effects on kit growth. Few and conflicting effects indicated that the climate effect on growth was negligible. One exception was that large nest temperature fluctuations on day 1 were associated with reduced deaths of live-born kit (P<0.001) and increased kit growth (P=0.003). Litter size affected kit vitality; larger total litter size at birth was associated with greater risks of kit death (P<0.001) and reduced growth (P<0.001). The number of living kits in litters had the opposite effect, as kits in large liveborn litters had a reduced risk of death (P<0.001) and those with large mean litter size on days 1 to 7 had increased growth (P=0.026). Nest box temperature had little effect on early kit survival and growth, which could be due to dams' additional maternal behaviour. Therefore, we

Early Lung Cancer Diagnosis by Biosensors

PubMed Central

Zhang, Yuqian; Yang, Dongliang; Weng, Lixing; Wang, Lianhui

2013-01-01

Lung cancer causes an extreme threat to human health, and the mortality rate due to lung cancer has not decreased during the last decade. Prognosis or early diagnosis could help reduce the mortality rate. If microRNA and tumor-associated antigens (TAAs), as well as the corresponding autoantibodies, can be detected prior to clinical diagnosis, such high sensitivity of biosensors makes the early diagnosis and prognosis of cancer realizable. This review provides an overview of tumor-associated biomarker identifying methods and the biosensor technology available today. Laboratorial researches utilizing biosensors for early lung cancer diagnosis will be highlighted. PMID:23892596

Did the Great Recession affect mortality rates in the metropolitan United States? Effects on mortality by age, gender and cause of death.

PubMed

Strumpf, Erin C; Charters, Thomas J; Harper, Sam; Nandi, Arijit

2017-09-01

Mortality rates generally decline during economic recessions in high-income countries, however gaps remain in our understanding of the underlying mechanisms. This study estimates the impacts of increases in unemployment rates on both all-cause and cause-specific mortality across U.S. metropolitan regions during the Great Recession. We estimate the effects of economic conditions during the recent and severe recessionary period on mortality, including differences by age and gender subgroups, using fixed effects regression models. We identify a plausibly causal effect by isolating the impacts of within-metropolitan area changes in unemployment rates and controlling for common temporal trends. We aggregated vital statistics, population, and unemployment data at the area-month-year-age-gender-race level, yielding 527,040 observations across 366 metropolitan areas, 2005-2010. We estimate that a one percentage point increase in the metropolitan area unemployment rate was associated with a decrease in all-cause mortality of 3.95 deaths per 100,000 person years (95%CI -6.80 to -1.10), or 0.5%. Estimated reductions in cardiovascular disease mortality contributed 60% of the overall effect and were more pronounced among women. Motor vehicle accident mortality declined with unemployment increases, especially for men and those under age 65, as did legal intervention and homicide mortality, particularly for men and adults ages 25-64. We find suggestive evidence that increases in metropolitan area unemployment increased accidental drug poisoning deaths for both men and women ages 25-64. Our finding that all-cause mortality decreased during the Great Recession is consistent with previous studies. Some categories of cause-specific mortality, notably cardiovascular disease, also follow this pattern, and are more pronounced for certain gender and age groups. Our study also suggests that the recent recession contributed to the growth in deaths from overdoses of prescription drugs in

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.

Hazard Regression Models of Early Mortality in Trauma Centers

PubMed Central

Clark, David E; Qian, Jing; Winchell, Robert J; Betensky, Rebecca A

2013-01-01

Background Factors affecting early hospital deaths after trauma may be different from factors affecting later hospital deaths, and the distribution of short and long prehospital times may vary among hospitals. Hazard regression (HR) models may therefore be more useful than logistic regression (LR) models for analysis of trauma mortality, especially when treatment effects at different time points are of interest. Study Design We obtained data for trauma center patients from the 2008–9 National Trauma Data Bank (NTDB). Cases were included if they had complete data for prehospital times, hospital times, survival outcome, age, vital signs, and severity scores. Cases were excluded if pulseless on admission, transferred in or out, or ISS<9. Using covariates proposed for the Trauma Quality Improvement Program and an indicator for each hospital, we compared LR models predicting survival at 8 hours after injury to HR models with survival censored at 8 hours. HR models were then modified to allow time-varying hospital effects. Results 85,327 patients in 161 hospitals met inclusion criteria. Crude hazards peaked initially, then steadily declined. When hazard ratios were assumed constant in HR models, they were similar to odds ratios in LR models associating increased mortality with increased age, firearm mechanism, increased severity, more deranged physiology, and estimated hospital-specific effects. However, when hospital effects were allowed to vary by time, HR models demonstrated that hospital outliers were not the same at different times after injury. Conclusions HR models with time-varying hazard ratios reveal inconsistencies in treatment effects, data quality, and/or timing of early death among trauma centers. HR models are generally more flexible than LR models, can be adapted for censored data, and potentially offer a better tool for analysis of factors affecting early death after injury. PMID:23036828

Comparison of Glasgow Coma Scale, Full Outline of Unresponsiveness and Acute Physiology and Chronic Health Evaluation in Prediction of Mortality Rate Among Patients With Traumatic Brain Injury Admitted to Intensive Care Unit

PubMed Central

Hosseini, Seyed Hossein; Ayyasi, Mitra; Akbari, Hooshang; Heidari Gorji, Mohammad Ali

2016-01-01

Background Traumatic brain injury (TBI) is a common cause of mortality and disability worldwide. Choosing an appropriate diagnostic tool is critical in early stage for appropriate decision about primary diagnosis, medical care and prognosis. Objectives This study aimed to compare the Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) and acute physiology and chronic health evaluation (APACHE II) with respect to prediction of the mortality rate of patients with TBI admitted to intensive care unit. Patients and Methods This diagnostic study was conducted on 80 patients with TBI in educational hospitals. The scores of APACHE II, GCS and FOUR were recorded during the first 24 hours of admission of patients. In this study, early mortality means the patient death before 14 days and delayed mortality means the patient death 15 days after admitting to hospital. The collected data were analyzed using descriptive and inductive statistics. Results The results showed that the mean age of the patients was 33.80 ± 12.60. From a total of 80 patients with TBI, 16 (20%) were females and 64 (80%) males. The mortality rate was 15 (18.7%). The results showed no significant difference among three tools. In prediction of early mortality, the areas under the curve (AUCs) were 0.92 (CI = 0.95. 0.81 - 0.97), 0.90 (CI = 0.95. 0.74 - 0.94), and 0.96 (CI = 0.95. 0.87 - 0.9) for FOUR, APACHE II and GCS, respectively. In delayed mortality, the AUCs were 0.89 (CI = 0.95. 0.81-0.94), 0.94 (CI = 0.95. 0.74 - 0.97) and 0.90 (CI = 0.95. 0.87 - 0.95) for FOUR, APACHE II and GCS, respectively. Conclusions Considering that GCS is easy to use and the FOUR can diagnose a locking syndrome along same values of subscales. These two subscales are superior to APACHI II in prediction of early mortality. Conversation APACHE II is more punctual in the prediction of delayed mortality. PMID:29696116

Estimating freshwater turtle mortality rates and population declines following hook ingestion.

PubMed

Steen, David A; Robinson, Orin J

2017-12-01

Freshwater turtle populations are susceptible to declines following small increases in the mortality of adults, making it essential to identify and understand potential threats. Freshwater turtles ingest fish hooks associated with recreational angling, and this is likely a problem because hook ingestion is a source of additive mortality for sea turtles. We used a Bayesian-modeling framework, observed rates of hook ingestion by freshwater turtles, and mortality of sea turtles from hook ingestion to examine the probability that a freshwater turtle in a given population ingests a hook and subsequently dies from it. We used the results of these analyses and previously published life-history data to simulate the effects of hook ingestion on population growth for 3 species of freshwater turtle. In our simulation, the probability that an individual turtle ingests a hook and dies as a result was 1.2-11%. Our simulation results suggest that this rate of mortality from hook ingestion is sufficient to cause population declines. We believe we have identified fish-hook ingestion as a serious yet generally overlooked threat to the viability of freshwater turtle populations. © 2017 Society for Conservation Biology.

Effectiveness of early detection on breast cancer mortality reduction in Catalonia (Spain)

PubMed Central

2009-01-01

Background At present, it is complicated to use screening trials to determine the optimal age intervals and periodicities of breast cancer early detection. Mathematical models are an alternative that has been widely used. The aim of this study was to estimate the effect of different breast cancer early detection strategies in Catalonia (Spain), in terms of breast cancer mortality reduction (MR) and years of life gained (YLG), using the stochastic models developed by Lee and Zelen (LZ). Methods We used the LZ model to estimate the cumulative probability of death for a cohort exposed to different screening strategies after T years of follow-up. We also obtained the cumulative probability of death for a cohort with no screening. These probabilities were used to estimate the possible breast cancer MR and YLG by age, period and cohort of birth. The inputs of the model were: incidence of, mortality from and survival after breast cancer, mortality from other causes, distribution of breast cancer stages at diagnosis and sensitivity of mammography. The outputs were relative breast cancer MR and YLG. Results Relative breast cancer MR varied from 20% for biennial exams in the 50 to 69 age interval to 30% for annual exams in the 40 to 74 age interval. When strategies differ in periodicity but not in the age interval of exams, biennial screening achieved almost 80% of the annual screening MR. In contrast to MR, the effect on YLG of extending screening from 69 to 74 years of age was smaller than the effect of extending the screening from 50 to 45 or 40 years. Conclusion In this study we have obtained a measure of the effect of breast cancer screening in terms of mortality and years of life gained. The Lee and Zelen mathematical models have been very useful for assessing the impact of different modalities of early detection on MR and YLG in Catalonia (Spain). PMID:19754959

Heart rate recovery, exercise capacity, and mortality risk in male veterans.

PubMed

Kokkinos, Peter; Myers, Jonathan; Doumas, Michael; Faselis, Charles; Pittaras, Andreas; Manolis, Athanasios; Kokkinos, John Peter; Narayan, Puneet; Papademetriou, Vasilios; Fletcher, Ross

2012-04-01

Both impaired heart rate recovery (HRR) and low fitness are associated with higher mortality risk. In addition, HRR is influenced by fitness status. The interaction between HRR, mortality, and fitness has not been clearly defined. Thus, we sought to evaluate the association between HRR and all-cause mortality and to assess the effects of fitness on this association. Treadmill exercise testing was performed in 5974 male veterans for clinical reasons at two Veterans Affairs Medical Centers (Washington, DC and Palo Alto, CA). HRR was calculated at 1 and 2 min of recovery. All-cause mortality was determined over a mean 6.2-year follow-up period. Mortality risk was significantly and inversely associated with HRR, only at 2 min. A cut-off value of 14 beats/min at 2 min recovery was the strongest predictor of mortality for the cohort (hazard ratio = 2.4; CI 1.6-3.5). The mortality risk was overestimated when exercise capacity was not considered. When both low fitness and low HRR were present (≤6 metabolic equivalents and ≤14 beats/min), mortality risk was approximately seven-fold higher compared to the High-fit + High-HRR group (>6 metabolic equivalents and >14 beats/min). HRR at 2 min post exercise is strongly and inversely associated with all-cause mortality. Exercise capacity affects HRR-associated mortality substantially and should be considered when applying HRR to estimate mortality.

Trends in cancer mortality in Mexico, 1981-2007.

PubMed

Bosetti, Cristina; Rodríguez, Teresa; Chatenoud, Liliane; Bertuccio, Paola; Levi, Fabio; Negri, Eva; La Vecchia, Carlo

2011-09-01

The objective of this study was to provide information on recent trends in cancer mortality in Mexico. We analyzed data provided by the World Health Organization, using joinpoint analysis to detect changes in trends between 1981 and 2007. For most cancers, mortality was upward but started to decline in the late 1980's/early 1990's for both sexes. Overall cancer mortality was 75.53/100 000 men, world standard, and 69.2/100 000 women in 2005-2007. Mortality from uterine cancer declined by approximately 2.5% per year in the 1990s, and by approximately 5% per year in the last decade, but its rates remained exceedingly high (9.7/100 000 in 2005-2007). Other major declines over recent years were those of stomach cancer (approximately 2.5% per year, with rates of 6.6/100 000 in men and 4.9/100 000 in women in 2005-2007) and lung cancer (2-2.5% per year, 11.0/100 000 in men and 4.5/100 000 in women in 2005-2007). Mortality leveled off only since the early 1990s for breast and prostate, and since the late 1990s for colorectal cancer. Death rates from cancer in Mexico remained low on a worldwide scale and showed favorable trends over more recent calendar years. Mortality from (cervix) uterine cancer still represents a major public health priority in this country.

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.

Detecting early warning signals of tree mortality in boreal North America using multiscale satellite data.

PubMed

Rogers, Brendan M; Solvik, Kylen; Hogg, Edward H; Ju, Junchang; Masek, Jeffrey G; Michaelian, Michael; Berner, Logan T; Goetz, Scott J

2018-06-01

Increasing tree mortality from global change drivers such as drought and biotic infestations is a widespread phenomenon, including in the boreal zone where climate changes and feedbacks to the Earth system are relatively large. Despite the importance for science and management communities, our ability to forecast tree mortality at landscape to continental scales is limited. However, two independent information streams have the potential to inform and improve mortality forecasts: repeat forest inventories and satellite remote sensing. Time series of tree-level growth patterns indicate that productivity declines and related temporal dynamics often precede mortality years to decades before death. Plot-level productivity, in turn, has been related to satellite-based indices such as the Normalized difference vegetation index (NDVI). Here we link these two data sources to show that early warning signals of mortality are evident in several NDVI-based metrics up to 24 years before death. We focus on two repeat forest inventories and three NDVI products across western boreal North America where productivity and mortality dynamics are influenced by periodic drought. These data sources capture a range of forest conditions and spatial resolution to highlight the sensitivity and limitations of our approach. Overall, results indicate potential to use satellite NDVI for early warning signals of mortality. Relationships are broadly consistent across inventories, species, and spatial resolutions, although the utility of coarse-scale imagery in the heterogeneous aspen parkland was limited. Longer-term NDVI data and annually remeasured sites with high mortality levels generate the strongest signals, although we still found robust relationships at sites remeasured at a typical 5 year frequency. The approach and relationships developed here can be used as a basis for improving forest mortality models and monitoring systems. © 2018 John Wiley & Sons Ltd.

Increased mortality rate and suicide in Swedish former elite male athletes in power sports.

PubMed

Lindqvist, A-S; Moberg, T; Ehrnborg, C; Eriksson, B O; Fahlke, C; Rosén, T

2014-12-01

Physical training has been shown to reduce mortality in normal subjects, and athletes have a healthier lifestyle after their active career as compared with normal subjects. Since the 1950s, the use of anabolic androgenic steroids (AAS) has been frequent, especially in power sports. The aim of the present study was to investigate mortality, including causes of death, in former Swedish male elite athletes, active 1960-1979, in wrestling, powerlifting, Olympic lifting, and the throwing events in track and field when the suspicion of former AAS use was high. Results indicate that, during the age period of 20-50 years, there was an excess mortality of around 45%. However, when analyzing the total study period, the mortality was not increased. Mortality from suicide was increased 2-4 times among the former athletes during the period of 30-50 years of age compared with the general population of men. Mortality rate from malignancy was lower among the athletes. As the use of AAS was marked between 1960 and 1979 and was not doping-listed until 1975, it seems probable that the effect of AAS use might play a part in the observed increased mortality and suicide rate. The otherwise healthy lifestyle among the athletes might explain the low malignancy rates. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

[EARLY IN-HOSPITAL MORTALITY IN INTERNAL MEDICINE WARDS (WITHIN 24 HOURS): A POTENTIAL QUALITY INDICATOR OR A VARIABLE AFFECTED BY MULTIPLE FACTORS?

PubMed

Niv, Yaron; Berkov, Evgeny; Kanter, Pazit; Abrahmson, Evgeny; Gabbay, Uri

2017-04-01

To evaluate in-hospital mortality rate within 24 hours in internal medicine wards and to evaluate if it may be used as quality indicator. In-hospital mortality rate is an outcome measure which apparently reflects quality of care. There are debates on whether it may be considered a quality indicator since it is difficult to compare different case-mixes between hospitals. Research on mortality within 24 hours had not been published. An historical prospective study was conducted including the entire internal wards admissions to the Rabin Medical Center between 1/7/14 and 30/6/15. We evaluated inhospital deaths and 7 days post discharge deaths. We focused on deaths within 24 hours, patients' characteristics, the primary diagnosis (which we assumed is the cause of death) and co-morbidity. The analysis includes descriptive statistics and mortality rates performed with SPSS version 22. Overall, 25,414 patients were admitted to internal wards during the study period. There were 1,620 in-hospitals deaths (6.37%) among which 164 deaths occurred within 24 hours (0.65%), which is 10.1% of in-hospital deaths. These patients were very old (median 82), many were residents of nursing homes and nearly all were brought to the hospital by ambulance. The most frequent primary diagnoses were sepsis (24%), pneumonia (22%), metastatic cancer (10%) and acute neurologic event (5%). The results exclude excessive inhospital mortality within 24 hours. The patients' characteristics enable researchers to assume that these deaths were expected and not preventable. There is no excessive mortality within 24 hours, the deaths were expected and a seasonal modifying effect was evident. All this and the different case mix in between hospitals suggest that early in-hospital mortality seems inadequate as a quality measure.

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study.

PubMed

Agri, Fabio; Bourgeat, Mylène; Becce, Fabio; Moerenhout, Kevin; Pasquier, Mathieu; Borens, Olivier; Yersin, Bertrand; Demartines, Nicolas; Zingg, Tobias

2017-11-09

Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures. Single-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed. The present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates. Tile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and

Birth rates among male cancer survivors and mortality rates among their offspring: a population-based study from Sweden.

PubMed

Tang, Siau-Wei; Liu, Jenny; Juay, Lester; Czene, Kamila; Miao, Hui; Salim, Agus; Verkooijen, Helena M; Hartman, Mikael

2016-03-08

With improvements in treatment of cancer, more men of fertile age are survivors of cancer. This study evaluates trends in birth rates among male cancer survivors and mortality rates of their offspring. From the Swedish Multi-generation Register and Cancer Register, we identified 84,752 men ≤70 years with a history of cancer, for which we calculated relative birth rates as compared to the background population(Standardized Birth Ratios, SBRs). We also identified 126,696 offspring of men who had cancer, and compared their risks of death to the background population(Standardized Mortality Ratio, SMRs). Independent factors associated with reduced birth rates and mortality rates were estimated with Poisson modelling. Men with a history of cancer were 23 % less likely to father a child compared to the background population(SBR 0.77, 95 % Confidence Interval[CI] 0.75-0.79). Nulliparous men were significantly more likely to father a child after diagnosis (SBR 0.81, 95 % CI 0.79-0.83) compared to parous men (SBR 0.68, 95 % CI 0.66-0.74). Cancer site(prostate), onset of cancer during childhood or adolescence, parity status at diagnosis(parous), current age(>40 years) and a recent diagnosis were significant and independent predictors of a reduced probability of fathering a child after diagnosis. Of the 126,696 children born to men who have had a diagnosis of cancer, 2604(2.06 %) died during follow up. The overall mortality rate was similar to the background population(SMR of 1.00, 95 %CI 0.96-1.04) and was not affected by the timing of their birth in relation to father's cancer diagnosis. Male cancer survivors are less likely to father a child compared to the background population. This is influenced by cancer site, age of onset and parity status at diagnosis. However, their offspring are not at an increased risk of death.

Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006.

PubMed

Krumholz, Harlan M; Wang, Yun; Chen, Jersey; Drye, Elizabeth E; Spertus, John A; Ross, Joseph S; Curtis, Jeptha P; Nallamothu, Brahmajee K; Lichtman, Judith H; Havranek, Edward P; Masoudi, Frederick A; Radford, Martha J; Han, Lein F; Rapp, Michael T; Straube, Barry M; Normand, Sharon-Lise T

2009-08-19

During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Observational study using administrative data and a validated risk model to evaluate 3,195,672 discharges in 2,755,370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Hospital-specific 30-day all-cause RSMR. At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation.

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.

Linking egg thiamine and fatty acid concentrations of Lake Michigan lake trout with early life stage mortality.

PubMed

Czesny, Sergiusz; Dettmers, John M; Rinchard, Jacques; Dabrowski, Konrad

2009-12-01

The natural reproduction of lake trout Salvelinus namaycush in Lake Michigan is thought to be compromised by nutritional deficiency associated with inadequate levels of thiamine (vitamin B1) in their eggs. However, mortality driven by thiamine deficiency (commonly referred to as early mortality syndrome [EMS]) is not the only significant cause of low lake trout survival at early life stages. In this study, we sought to better understand the combined effects of variable levels of thiamine and fatty acids in lake trout eggs on prehatch, posthatch, and swim-up-stage mortality. We sampled the eggs of 29 lake trout females from southwestern Lake Michigan. The concentrations of free thiamine and its vitamers (e.g., thiamine monophosphate [TMP] and thiamine pyrophosphate [TPP]) as well as fatty acid profiles were determined in sampled eggs. Fertilized eggs and embryos were monitored through the advanced swim-up stage (1,000 degree-days). Three distinct periods of mortality were identified: prehatch (0-400 degree-days), immediately posthatch (401-600 degree-days), and swim-up (601-1,000 degree-days). Stepwise multiple regression analysis revealed (1) that cis-7-hexadecenoic acid in both neutral lipids (NL) and phospholipids (PL) correlated with prehatch mortality, (2) that docosapentaenoic acid in PL and docosahexaenoic acid in NL correlated with posthatch mortality, and (3) that total lipids, TPP, and palmitoleic acid in NL, linoleic acid, and palmitic acid in PL correlated with the frequency of EMS. These results indicate the complexity of early life stage mortality in lake trout and suggest that inadequate levels of key fatty acids in eggs, along with variable thiamine content, contribute to the low survival of lake trout progeny in Lake Michigan.

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.

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.

The importance of early life family factors in the association between cardiovascular risk factors and early cardiovascular mortality.

PubMed

Kjøllesdal, Marte K R; Ariansen, Inger; Mortensen, Laust H; Næss, Øyvind

2017-01-01

To explore the importance of early life factors shared by siblings, such as parental socioeconomic position, parental practices, housing and neighbourhood, for the association between cardiovascular disease (CVD) risk factors and mortality from CVD, ischaemic heart disease (IHD) and cerebrovascular disease. Norwegian health surveys (1974-2003) were linked with data from the Norwegian Family Based Life Course Study and the Cause of Death Registry. Participants with at least one full sibling among survey participants (n=2 71 643) were included. Data on CVD risk factors, body mass index (BMI), height, systolic blood pressure (SBP) and total cholesterol (TC) were stratified into 'low', 'medium' and 'high' risk, and smoking to 'daily smoking' and 'not daily smoking'. Mean age of participants was 41 years, mean follow-up time was 19 years and during follow-up 2512 died from CVD. For each category of increased risk factor level, the per step HR of CVD mortality was increased by 1.91 (95% CI 1.78 to 2.05) for SBP, 1.67 (1.58 to 1.76) for TC, 1.44 (1.36 to 1.53) for BMI, 1.26 (1.18 to 1.35) for height and 2.89 (2.66 to 3.14) for smoking. In analyses where each sibship (groups of full siblings) had a group-specific baseline hazard, these associations were attenuated to 1.74, 1.51, 1.29, 1.18 and 2.63, respectively. The associations between risk factors and IHD mortality followed the same pattern. Early life family factors explained a small part of the association between risk factors and mortality from CVD and IHD in a relatively young sample.

Infant and fetal mortality among a high fertility and mortality population in the Bolivian Amazon

PubMed Central

Gurven, Michael

2012-01-01

Indigenous populations experience higher rates of poverty, disease and mortality than non-indigenous populations. To gauge current and future risks among Tsimane Amerindians of Bolivia, I assess mortality rates and growth early in life, and changes in risks due to modernization, based on demographic interviews conducted Sept. 2002–July 2005. Tsimane have high fertility (Total Fertility Rate = 9) and infant mortality (13%). Infections are the leading cause of infant death (55%). Infant mortality is greatest among women who are young, monolingual, space births close together, and live far from town. Infant mortality declined during the period 1990–2002, and a higher rate of reported miscarriages occurred during the 1950–1989 period. Infant deaths are more frequent among those born in the wet season. Infant stunting, underweight and wasting are common (34%, 15% and 12%, respectively) and greatest for low-weight mothers and high parity infants. Regression analysis of infant growth shows minimal regional differences in anthropometrics but greater stunting and underweight during the first two years of life. Males are more likely to be underweight, wasted, and spontaneously aborted. Whereas morbidity and stunting are prevalent in infancy, greater food availability later in life has not yet resulted in chronic diseases (e.g. hypertension, atherosclerosis and diabetes) in adulthood due to the relatively traditional Tsimane lifestyle. PMID:23092724

Homicide mortality rates in Canada, 2000-2009: Youth at increased risk.

PubMed

Basham, C Andrew; Snider, Carolyn

2016-10-20

To estimate and compare Canadian homicide mortality rates (HMRs) and trends in HMRs across age groups, with a focus on trends for youth. Data for the period of 2000 to 2009 were collected from Statistics Canada's CANSIM (Canadian Statistical Information Management) Table 102-0540 with the following ICD-10-CA coded external causes of death: X85 to Y09 (assault) and Y87.1 (sequelae of assault). Annual population counts from 2000 to 2009 were obtained from Statistics Canada's CANSIM Table 051-0001. Both death and population counts were organized into five-year age groups. A random effects negative binomial regression analysis was conducted to estimate age group-specific rates, rate ratios, and trends in homicide mortality. There were 9,878 homicide deaths in Canada during the study period. The increase in the overall homicide mortality rate (HMR) of 0.3% per year was not statistically significant (95% CI: -1.1% to +1.8%). Canadians aged 15-19 years and 20-24 years had the highest HMRs during the study period, and experienced statistically significant annual increases in their HMRs of 3% and 4% respectively (p < 0.05). A general, though not statistically significant, decrease in the HMR was observed for all age groups 50+ years. A fixed effects negative binomial regression model showed that the HMR for males was higher than for females over the study period [RRfemale/male = 0.473 (95% CI: 0.361, 0.621)], but no significant difference in sex-specific trends in the HMR was found. An increasing risk of homicide mortality was identified among Canadian youth, ages 15-24, over the 10-year study period. Research that seeks to understand the reasons for the increased homicide risk facing Canada's youth, and public policy responses to reduce this risk, are warranted.

Early detection of emerging zoonotic diseases with animal morbidity and mortality monitoring.

PubMed

Bisson, Isabelle-Anne; Ssebide, Benard J; Marra, Peter P

2015-03-01

Diseases transmitted between animals and people have made up more than 50% of emerging infectious diseases in humans over the last 60 years and have continued to arise in recent months. Yet, public health and animal disease surveillance programs continue to operate independently. Here, we assessed whether recent emerging zoonotic pathogens (n = 143) are known to cause morbidity or mortality in their animal host and if so, whether they were first detected with an animal morbidity/mortality event. We show that although sick or dead animals are often associated with these pathogens (52%), only 9% were first detected from an animal morbidity or mortality event prior to or concurrent with signs of illness in humans. We propose that an animal morbidity and mortality reporting program will improve detection and should be an essential component of early warning systems for zoonotic diseases. With the use of widespread low-cost technology, such a program could engage both the public and professionals and be easily tested and further incorporated as part of surveillance efforts by public health officials.

Penetrating abdominal injuries during the Syrian war: Patterns and factors affecting mortality rates.

PubMed

Arafat, Shawqi; Alsabek, Mhd Belal; Ahmad, Mousa; Hamo, Iman; Munder, Eskander

2017-05-01

A large number of innocent Syrians were injured or killed during the years of war. This retrospective study investigates the differences in patterns of injury and factors affecting the mortality rate in 324 patients coming to Damascus Hospital with penetrating abdominal trauma, and illustrates the difficulties of diagnosis and decision making in crisis situations. A retrospective study was registered from patient's records between October 2012 and June 2013 in Damascus Hospital. All victims were injured either by explosions or gunshots. A total of 325 patients: 183 by explosion; 56.3%, 141 by gunshot; 43.3%, and one patient by other means; 0.3% were reviewed. The study focused on the two large groups with a total of 324 patients. Males were predominant (82.1%; n=266) and the majority of patients were between 19 and 35 years old. Patients suffering from multi abdominal organ injury were more common in gunshot group (n=72, 51.1%) compared to the explosion group (n=83, 45.3%). 264 patients (81.5%) underwent surgical operations and only 22 (8.3%) had normal laparotomy. The inpatient mortality rate was (17.0%; n=55), and there was no difference in mortality rate between the two groups. More than the half of deaths (n=42; 76.4%) had a P.A.T.I score≥25 where the death rate was 35.6% which is higher compared to 6.3% in those with a P.A.T.I<25. In the ICU 33 patients died, of these (87.9%; n=29) died after immediate admission to the ICU which is higher compared with a later admission (12.1%; n=4). The need for massive blood transfusion affected the mortality rate. Efforts must be directed toward training of medical staff to deal with crisis incidents. The need for massive blood transfusion and ICU admissions can affects mortality. P.A.T.I was found to be an effective predictor of mortality. Clinical experience in this field can produce better health care and faster judgments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Early Childbearing, Marital Status, and Women's Health and Mortality after Age 50

ERIC Educational Resources Information Center

Henretta, John C.

2007-01-01

This article examines the relationship between a woman's childbearing history and her later health and mortality, with primary focus on whether the association between them is due to early and later socioeconomic status. Data are drawn from the Health and Retirement Study birth cohort of 1931-1941. Results indicate that, conditional on reaching…

[Maternal mortality rate in the Aurelio Valdivieso General Hospital: a ten years follow up].

PubMed

Noguera-Sánchez, Marcelo Fidias; Arenas-Gómez, Susana; Rabadán-Martínez, Cesar Esli; Antonio-Sánchez, Pedro

2013-01-01

In México, the maternal mortality rate has been diminishing in the country in the last decades, except in the state of Oaxaca. Oaxaca is located amongst the entities with the highest ratios of maternal mortality. To analyze the behavior and epidemiological tendencies of maternal mortality over 10 years at the Dr. Aurelio Valdivieso General Hospital. In a retrospective, descriptive, and transverse analysis, we reviewed the maternal mortality files from the gynecology and obstetrics division. Three sets of variables were designed: social, obstetrical and circumstantial. We used general and descriptive statistical tools. From January first to December 31th of 2009 there were registered 109 maternal deaths. Excluding 2 non-obstetrical deaths, ths results in 107 maternal deaths. Divided into 75 direct maternal deaths and 32 indirect maternal deaths, the maternal mortality rate was 172.14 × 100,000 livebirths. Eighty-nine maternal deaths were foreseeable (83%) and 18 were not foreseeable (17%) as was stated by the Ad Hoc Committee within the Dr. Aurelio Valdivieso General Hospital. Pregnancy-related hypertension accounts for the highest pathology in relation to maternal deaths, the low literacy and puerperium correlated to a higher risk. Low human development index and low literacy were the variables that accounted for higher mortality risk. Also, we found that the higher occurrence of maternal deaths appeared during the puerperium and within hospital wards. The maternal mortality rate founded was the higher amongst the various areas of the country.

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.

Dampening effects of long-term experimental drought on growth and mortality rates of a Holm oak forest.

PubMed

Barbeta, Adrià; Ogaya, Romà; Peñuelas, Josep

2013-10-01

Forests respond to increasing intensities and frequencies of drought by reducing growth and with higher tree mortality rates. Little is known, however, about the long-term consequences of generally drier conditions and more frequent extreme droughts. A Holm oak forest was exposed to experimental rainfall manipulation for 13 years to study the effect of increasing drought on growth and mortality of the dominant species Quercus ilex, Phillyrea latifolia, and Arbutus unedo. The drought treatment reduced stem growth of A. unedo (-66.5%) and Q. ilex (-17.5%), whereas P. latifolia remained unaffected. Higher stem mortality rates were noticeable in Q. ilex (+42.3%), but not in the other two species. Stem growth was a function of the drought index of early spring in the three species. Stem mortality rates depended on the drought index of winter and spring for Q. ilex and in spring and summer for P. latifolia, but showed no relation to climate in A. unedo. Following a long and intense drought (2005-2006), stem growth of Q. ilex and P. latifolia increased, whereas it decreased in A. unedo. Q. ilex also enhanced its survival after this period. Furthermore, the effect of drought treatment on stem growth in Q. ilex and A. unedo was attenuated as the study progressed. These results highlight the different vulnerabilities of Mediterranean species to more frequent and intense droughts, which may lead to partial species substitution and changes in forest structure and thus in carbon uptake. The response to drought, however, changed over time. Decreased intra- and interspecific competition after extreme events with high mortality, together with probable morphological and physiological acclimation to drought during the study period, may, at least in the short term, buffer forests against drier conditions. The long-term effects of drought consequently deserve more attention, because the ecosystemic responses are unlikely to be stable over time.Nontechnical summaryIn this study, we

Mortality Rates After Emergent Posterior Fossa Decompression for Ischemic or Hemorrhagic Stroke in Older Patients.

PubMed

Puffer, Ross C; Graffeo, Christopher; Rabinstein, Alejandro; Van Gompel, Jamie J

2016-08-01

Cerebellar stroke causes major morbidity in the aging population. Guidelines from the American Stroke Association recommend emergent decompression in patients who have brainstem compression, hydrocephalus, or clinical deterioration. The objective of this study was to determine 30-day and 1-year mortality rates in patients >60 years old undergoing emergent posterior fossa decompression. Surgical records identified all patients >60 years old who underwent emergent posterior fossa decompression. Mortality rates were calculated at 30 days and 1 year postoperatively, and these rates were compared with patient and procedure characteristics. During 2000-2014, 34 emergent posterior fossa decompressions were performed in patients >60 years old. Mortality rates at 30 days were 0%, 33%, and 25% for age deciles 60-69 years, 70-79 years, and ≥80 years. Increasing age (alive at 30 days 75.2 years ± 1.7 vs. deceased 81.1 years ± 1.7, P = 0.01) and smaller craniectomy dimensions were associated with 30-day mortality. Mortality rates at 1 year were 0%, 50%, and 67% for age deciles 60-69 years, 70-79 years, and ≥80 years. Increasing age was significantly associated with mortality at 1 year (alive at 1 year 72.3 years ± 2.0 vs. deceased 81.1 years ± 1.2, P < 0.01). Type of pathology, side of pathology, volume of bleed/infarct, and placement of an external ventricular drain were not associated with mortality. Age was independent of admission Glasgow Coma Scale score as a predictor of mortality at 30 days, 90 days, and 1 year postoperatively. Increasing age and smaller craniectomy size were significantly associated with mortality in patients undergoing emergent posterior fossa decompression. Among patients ≥80 years old, one-quarter were dead within 1 month of the operation, and more than two-thirds were dead within 1 year. Copyright © 2016 Elsevier Inc. All rights reserved.

Spatial variations in mortality in pelagic early life stages of a marine fish (Gadus morhua)

NASA Astrophysics Data System (ADS)

Langangen, Øystein; Stige, Leif C.; Yaragina, Natalia A.; Ottersen, Geir; Vikebø, Frode B.; Stenseth, Nils Chr.

2014-09-01

Mortality of pelagic eggs and larvae of marine fish is often assumed to be constant both in space and time due to lacking information. This may, however, be a gross oversimplification, as early life stages are likely to experience large variations in mortality both in time and space. In this paper we develop a method for estimating the spatial variability in mortality of eggs and larvae. The method relies on survey data and physical-biological particle-drift models to predict the drift of ichthyoplankton. Furthermore, the method was used to estimate the spatially resolved mortality field in the egg and larval stages of Barents Sea cod (Gadus morhua). We analyzed data from the Barents Sea for the period between 1959 and 1993 when there are two surveys available: a spring and a summer survey. An individual-based physical-biological particle-drift model, tailored to the egg and larval stages of Barents Sea cod, was used to predict the drift trajectories from the observed stage-specific distributions in spring to the time of observation in the summer, a drift time of approximately 45 days. We interpreted the spatial patterns in the differences between the predicted and observed abundance distributions in summer as reflecting the spatial patterns in mortality over the drift period. Using the estimated mortality fields, we show that the spatial variations in mortality might have a significant impact on survival to later life stages and we suggest that there may be trade-offs between increased early survival in off shore regions and reduced probability of ending up in the favorable nursing grounds in the Barents Sea. In addition, we show that accounting for the estimated mortality field, improves the correlation between a simulated recruitment index and observation-based indices of juvenile abundance.

Contribution of Early Detection and Adjuvant Treatments to Breast Cancer Mortality Reduction in Catalonia, Spain

PubMed Central

Vilaprinyo, Ester; Puig, Teresa; Rue, Montserrat

2012-01-01

Background Reductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia. Methodology/Principal Findings A stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975–2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30–69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%. Conclusions/Significance Screening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods. PMID:22272292

High adult mortality among Hiwi hunter-gatherers: implications for human evolution.

PubMed

Hill, Kim; Hurtado, A M; Walker, R S

2007-04-01

Extant apes experience early sexual maturity and short life spans relative to modern humans. Both of these traits and others are linked by life-history theory to mortality rates experienced at different ages by our hominin ancestors. However, currently there is a great deal of debate concerning hominin mortality profiles at different periods of evolutionary history. Observed rates and causes of mortality in modern hunter-gatherers may provide information about Upper Paleolithic mortality that can be compared to indirect evidence from the fossil record, yet little is published about causes and rates of mortality in foraging societies around the world. To our knowledge, interview-based life tables for recent hunter-gatherers are published for only four societies (Ache, Agta, Hadza, and Ju/'hoansi). Here, we present mortality data for a fifth group, the Hiwi hunter-gatherers of Venezuela. The results show comparatively high death rates among the Hiwi and highlight differences in mortality rates among hunter-gatherer societies. The high levels of conspecific violence and adult mortality in the Hiwi may better represent Paleolithic human demographics than do the lower, disease-based death rates reported in the most frequently cited forager studies.

Differential Neonatal and Postneonatal Infant Mortality Rates across US Counties: The Role of Socioeconomic Conditions and Rurality

ERIC Educational Resources Information Center

Sparks, P. Johnelle; McLaughlin, Diane K.; Stokes, C. Shannon

2009-01-01

Purpose: To examine differences in correlates of neonatal and postneonatal infant mortality rates, across counties, by degree of rurality. Methods: Neonatal and postneonatal mortality rates were calculated from the 1998 to 2002 Compressed Mortality Files from the National Center for Health Statistics. Bivariate analyses assessed the relationship…

Exceptionally high mortality rate of the 1918 influenza pandemic in the Brazilian naval fleet

PubMed Central

Schuck‐Paim, Cynthia; Shanks, G. Dennis; Almeida, Francisco E. A.; Alonso, Wladimir J.

2012-01-01

Please cite this paper as: Schuck‐Paim et al. (2012) Exceptionally high mortality rate of the 1918 influenza pandemic in the Brazilian naval fleet. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00341.x. Background  The naval experience with the 1918 pandemic during World War I remains underexplored despite its key role on the pandemic’s global diffusion and the epidemiological interest of isolated and relatively homogeneous populations. The pandemic outbreak in the Brazilian naval fleet is of particular interest both because of its severity and the fact that it was the only Latin American military force deployed to war. Objectives  To study the mortality patterns of the pandemic in the Brazilian fleet sent to patrol the West African coast in 1918. Method  We investigated mortality across vessels, ranks, and occupations based on official population and mortality records from the Brazilian Navy Archives. Results  The outbreak that swept this fleet included the highest influenza mortality rate on any naval ship reported to date. Nearly 10% of the crews died, with death rates reaching 13–14% on two destroyers. While overall mortality was lower for officers, stokers and engineer officers were significantly more likely to die from the pandemic, possibly due to the pulmonary damage from constant exposure to the smoke and coal dust from the boilers. Conclusions  The fatality patterns observed provide valuable data on the conditions that can exacerbate the impact of a pandemic. While the putative lack of exposure to a first pandemic wave may have played a role in the excessive mortality observed in this fleet, our results indicate that strenuous labor conditions, dehydration, and exposure to coal dust were major risk factors. The unequal death rates among vessels remain an open question. PMID:22336427

Clinical and demographic risk factors associated with mortality during early adulthood in a population-based cohort of childhood-onset type 1 diabetes.

PubMed

Cooper, M N; de Klerk, N H; Jones, T W; Davis, E A

2014-12-01

To calculate standardized mortality ratios and to assess the association between paediatric clinical factors and higher risk of mortality during early adulthood in a population-based cohort of subjects with Type 1 diabetes. Subjects with Type 1 diabetes were identified through the Western Australian Children's Diabetes Database and clinical data for those who reached 18 years of age (n = 1309) were extracted. An age- and sex-matched (without diabetes) comparison cohort (n = 6451) was obtained from the birth registry. Mortality records were obtained from the death registry. Participants were followed up until 31 January 2012. Associations of clinical factors (from clinic visits before 18 years of age) with mortality were assessed using Cox proportional hazard models. The standardized mortality ratio for all-cause mortality was 1.7 (95% CI 0.7-3.3) for male and 10.1 (95% CI 5.2-17.7) for female subjects with Type 1 diabetes (median age at end of study 25.6 years). The adjusted hazard ratio was 1.5 (95% CI 1.1-2.1) for a 1% increase in mean paediatric HbA1c level, 3.8 (95% CI 0.9-15.3) for four episodes of severe hypoglycaemia relative to zero episodes, and 6.21 (95% CI 1.4-28.4) for a low-level socio-economic background relative to a high-level background. People with childhood-onset Type 1 diabetes have higher mortality rates in early adulthood. At particularly high risk are women, those with a history of poor HbA1c levels, those with recurrent severe hypoglycaemia during paediatric management, and those from a low socio-economic background. These groups may benefit from intensified management during transition from paediatric to adult care facilities. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

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

Long-term mortality rates (>8-year) improve as compared to the general and obese population following bariatric surgery.

PubMed

Telem, Dana A; Talamini, Mark; Shroyer, A Laurie; Yang, Jie; Altieri, Maria; Zhang, Qiao; Gracia, Gerald; Pryor, Aurora D

2015-03-01

Sparse data are available on long-term patient mortality following bariatric surgery as compared to the general population. The purpose of this study was to assess long-term mortality rates and identify risk factors for all-cause mortality following bariatric surgery. New York State (NYS) Planning and Research Cooperative System (SPARCS) longitudinal administrative data were used to identify 7,862 adult patients who underwent a primary laparoscopic bariatric surgery from 1999 to 2005. The Social Security Death Index database identified >30-day mortalities. Risk factors for mortality were screened using a univariate Cox proportional hazard (PH) model and analyzed using a multiple PH model. Based on age, gender, and race/ethnicity, actuarial projections for NYS mortality rates obtained from Centers of Disease Control were compared to the actual post-bariatric surgery mortality rates observed. The mean bariatric mortality rate was 2.5 % with 8-14 years of follow-up. Mean time to death ranged from 4 to 6 year and did not differ by operation (p = 0.073). From 1999 to 2010, the actuarial mortality rate predicted for the general NYS population was 2.1 % versus the observed 1.5 % for the bariatric surgery population (p = 0.005). Extrapolating to 2013, demonstrated the actuarial mortality predictions at 3.1 % versus the bariatric surgery patients' observed morality rate of 2.5 % (p = 0.01). Risk factors associated with an earlier time to death included: age, male gender, Medicare/Medicaid insurance, congestive heart failure, rheumatoid arthritis, pulmonary circulation disorders, and diabetes. No procedure-specific or perioperative complication impact for time-to-death was found. Long-term mortality rate of patients undergoing bariatric surgery significantly improves as compared to the general population regardless of bariatric operation performed. Additionally, perioperative complications do not increase long-term mortality risk. This study did identify specific patient

Health Human Capital in Sub-Saharan Africa: Conflicting Evidence from Infant Mortality Rates and Adult Heights

PubMed Central

Akachi, Yoko; Canning, David

2011-01-01

We investigate trends in cohort infant mortality rates and adult heights in 39 developing countries since 1960. In most regions of the world improved nutrition, and reduced childhood exposure to disease, have lead to improvements in both infant mortality and adult stature. In Sub-Saharan Africa, however, despite declining infant mortality rates, adult heights have not increased. We argue that in Sub-Saharan Africa the decline in infant mortality may have been due to interventions that prevent infant deaths rather than improved nutrition and childhood morbidity. Despite declining infant mortality, Sub-Saharan Africa may not be experiencing increases in health human capital. PMID:20634153

The importance of early life family factors in the association between cardiovascular risk factors and early cardiovascular mortality

PubMed Central

Kjøllesdal, Marte K R; Ariansen, Inger; Mortensen, Laust H; Næss, Øyvind

2017-01-01

Objective To explore the importance of early life factors shared by siblings, such as parental socioeconomic position, parental practices, housing and neighbourhood, for the association between cardiovascular disease (CVD) risk factors and mortality from CVD, ischaemic heart disease (IHD) and cerebrovascular disease. Methods Norwegian health surveys (1974–2003) were linked with data from the Norwegian Family Based Life Course Study and the Cause of Death Registry. Participants with at least one full sibling among survey participants (n=2 71 643) were included. Data on CVD risk factors, body mass index (BMI), height, systolic blood pressure (SBP) and total cholesterol (TC) were stratified into ‘low’, ‘medium’ and ‘high’ risk, and smoking to ‘daily smoking’ and ‘not daily smoking’. Results Mean age of participants was 41 years, mean follow-up time was 19 years and during follow-up 2512 died from CVD. For each category of increased risk factor level, the per step HR of CVD mortality was increased by 1.91 (95% CI 1.78 to 2.05) for SBP, 1.67 (1.58 to 1.76) for TC, 1.44 (1.36 to 1.53) for BMI, 1.26 (1.18 to 1.35) for height and 2.89 (2.66 to 3.14) for smoking. In analyses where each sibship (groups of full siblings) had a group-specific baseline hazard, these associations were attenuated to 1.74, 1.51, 1.29, 1.18 and 2.63, respectively. The associations between risk factors and IHD mortality followed the same pattern. Conclusion Early life family factors explained a small part of the association between risk factors and mortality from CVD and IHD in a relatively young sample. PMID:28878947

Causes of mortality in early infantile epileptic encephalopathy: A systematic review.

PubMed

Radaelli, Graciane; de Souza Santos, Francisco; Borelli, Wyllians Vendramini; Pisani, Leonardo; Nunes, Magda Lahorgue; Scorza, Fulvio Alexandre; da Costa, Jaderson Costa

2018-06-12

Early infantile epileptic encephalopathy syndrome (EIEE), also known as Ohtahara syndrome, is an age-dependent epileptic encephalopathy syndrome defined by clinical features and electroencephalographic findings. Epileptic disorders with refractory seizures beginning in the neonatal period and/or early infancy have a potential risk of premature mortality, including sudden death. We aimed to identify the causes of death in EIEE and conducted a literature survey of fatal outcomes. We performed a literature search in MEDLINE, EMBASE, and Web of Science for data from inception until September 2017. The terms "death sudden," "unexplained death," "SUDEP," "lethal," and "fatal" and the medical subject heading terms "epileptic encephalopathy," "mortality," "death," "sudden infant death syndrome," and "human" were used in the search strategy. The EIEE case report studies reporting mortality were included. The search yielded 1360 articles. After screening for titles and abstracts and removing duplicate entries, full texts of 15 articles were reviewed. After reading full texts, 11 articles met the inclusion criteria (9 articles in English and 2 in Japanese, dated from 1976 to 2015). The review comprised 38 unique cases of EIEE, 17 of which had death as an outcome. In all cases, the suppression-burst pattern on electroencephalographies (EEGs) was common. Most cases (55%) involved male infants. The mean (standard deviation [SD]) age at onset of seizure was 19.6 ± 33 days. The mean (SD) age at death was 12.9 ± 14.1 months. Most infants (58.8%) survived less than one year. The cause of death was described only in eight (47%) patients; the cause was pneumonia/respiratory illness or sudden unexpected death in epilepsy (SUDEP). The results show EIEE as a severe disease associated with a premature mortality, evidenced by a very young age at death. Increasing interest in the detection of new molecular bases of EIEE is leading us to a better understanding of this severe

Does adversity early in life affect general population suicide rates? A cross-national study.

PubMed

Shah, Ajit; Bhandarkar, Ritesh

2011-01-01

Adversity early in life has been suggested as a protective factor for elderly suicides. However, studies examining this relationship in general population suicide rates are scarce. The relationship between general population suicide rates and four proxy measures of adversity earlier in life was examined using data from the World Health Organization and the United Nations data banks. General population suicide rates were negatively correlated with the percentage of children under the age of 5 years who were underweight, the percentage of children under the age of 5 years who were under height, the percentage of infants with low birth weight babies, and the percentage of the general population that was undernourished. The only independent predictor general population suicide rates in both sexes, on multiple regression analysis, was the Gini coefficient (a measure of income inequality). Income inequality may lead to low birth weight, undernourishment, underweight and under height because income inequality results in poor access to healthcare and nutrition. These adversities may increase child mortality rates and reduce life expectancy. Those surviving into adulthood in countries with greater adversity early in life may be at reduced risk of suicide because of selective survival of those at reduced risk of suicide due to constitutional or genetic factors and development of greater tolerance to hardship in adulthood. ‎

Comparison of crude and adjusted mortality rates from leading causes of death in northeastern Brazil.

PubMed

França, Elisabeth; Rao, Chalapati; Abreu, Daisy Maria Xavier de; Souza, Maria de Fátima Marinho de; Lopez, Alan D

2012-04-01

To present how the adjustment of incompleteness and misclassification of causes of death in the vital registration (VR) system can contribute to more accurate estimates of the risk of mortality from leading causes of death in northeastern Brazil. After estimating the total numbers of deaths by age and sex in Brazil's Northeast region in 2002-2004 by correcting for undercount in the VR data, adjustment algorithms were applied to the reported cause-of-death structure. Average annual age-standardized mortality rates were computed by cause, with and without the corrections, and compared to death rates for Brazil's South region after adjustments for potential misdiagnosis. Death rates from ischemic heart disease, lower respiratory infections, chronic obstructive pulmonary disease, and perinatal conditions were more than 100% higher for both sexes than what was suggested by the routine VR data. Corrected cause-specific mortality rates were higher in the Northeast region versus the South region for the majority of causes of death, including several noncommunicable conditions. Failure to adjust VR data for undercount of cases reported and misdiagnoses will cause underestimation of mortality risks for the populations of the Northeast region, which are more vulnerable than those in other regions of the country. In order to more reliably understand the pattern of disease, all cause-specific mortality rates in poor populations should be adjusted.

Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation.

PubMed

Gaba, Ron C; Couture, Patrick M; Bui, James T; Knuttinen, M Grace; Walzer, Natasha M; Kallwitz, Eric R; Berkes, Jamie L; Cotler, Scott J

2013-03-01

To compare the performance of various liver disease scoring systems in predicting early mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. In this single-institution retrospective study, eight scoring systems were used to grade liver disease in 211 patients (male-to-female ratio = 131:80; mean age, 54 y) before TIPS creation from 1999-2011. Scoring systems included bilirubin level, Child-Pugh (CP) score, Model for End-Stage Liver Disease (MELD) and Model for End-Stage Liver Disease sodium (MELD-Na) score, Emory score, prognostic index (PI), Acute Physiology and Chronic Health Evaluation (APACHE) 2 score, and Bonn TIPS early mortality (BOTEM) score. Medical record review was used to identify 30-day and 90-day clinical outcomes. The relationship of scoring parameters with mortality outcomes was assessed with multivariate analysis, and the relative ability of systems to predict mortality after TIPS creation was evaluated by comparing area under receiver operating characteristic (AUROC) curves. TIPS were successfully created for variceal hemorrhage (n = 121), ascites (n = 72), hepatic hydrothorax (n = 15), and portal vein thrombosis (n = 3). All scoring systems had a significant association with 30-day and 90-day mortality (P<.050 in each case) on multivariate analysis. Based on 30-day and 90-day AUROC, MELD (0.878, 0.816) and MELD-Na (0.863, 0.823) scores had the best capability to predict early mortality compared with bilirubin (0.786, 0.749), CP (0.822, 0.771), Emory (0.786, 0.681), PI (0.854, 0.760), APACHE 2 (0.836, 0.735), and BOTEM (0.798, 0.698), with statistical superiority over bilirubin, Emory, and BOTEM scores. Several liver disease scoring systems have prognostic value for early mortality after TIPS creation. MELD and MELD-Na scores most effectively predict survival after TIPS creation. Copyright © 2013. Published by Elsevier Inc.

Survival rates, mortality causes, and habitats of Pennsylvania white-tailed deer fawns

USGS Publications Warehouse

Vreeland, J.K.; Diefenbach, D.R.; Wallingford, B.D.

2004-01-01

Estimates of survival and cause-specific mortality of white-tailed deer (Odocoileus virginianus) fawns are important to population management. We quantified cause-specific mortality, survival rates, and habitat characteristics related to fawn survival in a forested landscape and an agricultural landscape in central Pennsylvania. We captured and radiocollared neonatal (0.05). Predation accounted for 46.2% (95% Cl = 37.6-56.7%) of 106 mortalities through 34 weeks. We attributed 32.7% (95% Cl = 21.9-48.6%) and 36.7% (95% Cl = 25.5-52.9%) of 49 predation events to black bears (Ursus americanus) and coyotes (Canis latrans], respectively. Natural causes, excluding predation, accounted for 27.4% (95% Cl = 20.1-37.3) of mortalities. Fawn survival in Pennsylvania was comparable to reported survival in forested and agricultural regions in northern portions of the white-tailed deer range. We have no evidence to suggest that the fawn survival rates we observed were preventing population growth. Because white-tailed deer are habitat generalists, home-range-scale habitat characteristics may be unrelated to fawn survival; therefore, future studies should consider landscape-related characteristics on fawn survival.

Sex differences in US mortality rates for stroke and stroke subtypes by race/ethnicity and age, 1995-1998.

PubMed

Ayala, Carma; Croft, Janet B; Greenlund, Kurt J; Keenan, Nora L; Donehoo, Ralph S; Malarcher, Ann M; Mensah, George A

2002-05-01

Ischemic stroke accounts for 70% to 80% of all strokes, but intracerebral and subarachnoid hemorrhagic strokes have greater fatality. Age-standardized death rates from overall stroke are higher among men than women, but little is known about sex differences in stroke subtype mortality by race/ethnicity. We analyzed 1995 to 1998 national death certificate data to compare sex-specific age-standardized death rates (per 100 000) for ischemic stroke (n=507 256), intracerebral hemorrhagic stroke (n=98 709), and subarachnoid hemorrhagic stroke (n=27 334) among whites, blacks, American Indians/Alaska Natives, Asians/Pacific Islanders, and Hispanics. We calculated rate ratios and 95% CIs comparing women with men within age and racial/ethnic groups. Age-specific rates of ischemic and intracerebral hemorrhagic stroke deaths were lower for women than for men aged 25 to 44 and 45 to 64 years but were higher for ischemic stroke among older women, aged > or =65 years. Only among whites did women have higher age-standardized rates of ischemic stroke. Age-standardized death rates for intracerebral hemorrhagic stroke among women were lower than or similar to those among men in all racial/ethnic groups. Women had higher risk of death from subarachnoid hemorrhagic; this sex differential increased with age. The female-to-male mortality ratio differs for stroke subtypes by race/ethnicity and age. A primary public health effort should focus on increasing the awareness of stroke symptoms, particularly among people at high risk, to decrease delay in early detection and effective stroke treatment.

Female Literacy Rate is a Better Predictor of Birth Rate and Infant Mortality Rate in India.

PubMed

Saurabh, Suman; Sarkar, Sonali; Pandey, Dhruv K

2013-01-01

Educated women are known to take informed reproductive and healthcare decisions. These result in population stabilization and better infant care reflected by lower birth rates and infant mortality rates (IMRs), respectively. Our objective was to study the relationship of male and female literacy rates with crude birth rates (CBRs) and IMRs of the states and union territories (UTs) of India. The data were analyzed using linear regression. CBR and IMR were taken as the dependent variables; while the overall literacy rates, male, and female literacy rates were the independent variables. CBRs were inversely related to literacy rates (slope parameter = -0.402, P < 0.001). On multiple linear regression with male and female literacy rates, a significant inverse relationship emerged between female literacy rate and CBR (slope = -0.363, P < 0.001), while male literacy rate was not significantly related to CBR (P = 0.674). IMR of the states were also inversely related to their literacy rates (slope = -1.254, P < 0.001). Multiple linear regression revealed a significant inverse relationship between IMR and female literacy (slope = -0.816, P = 0.031), whereas male literacy rate was not significantly related (P = 0.630). Female literacy is relatively highly important for both population stabilization and better infant health.

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

Why do child mortality rates fall? An analysis of the Nicaraguan experience.

PubMed Central

Sandiford, P; Morales, P; Gorter, A; Coyle, E; Smith, G D

1991-01-01

A comprehensive review of available sources of mortality data was undertaken to document the changes that have occurred in infant mortality in Nicaragua over the last three decades. It was found that a rapid fall in infant mortality commenced in the early 1970s and has continued steadily since. Trends in several different factors which might have led to this breakthrough were examined including: income, nutrition, breastfeeding practices, maternal education, immunizations, access to health services, provision of water supplies and sanitation, and anti-malarial programs. Of these, improved access to health services appears to have been the most important factor. At a time when the number of hospital beds per capita was dropping, increasing numbers of health care professionals, particularly nurses, were becoming available to staff primary health care facilities built in the 1960s. These were provided at least partly in response to the growing political turmoil enveloping the nation at that time. Certain Nicaraguan cultural attributes may have added to the impact of the reforms. Efforts in the field of public health made since the 1979 insurrection appear to have maintained the decline in child mortality. PMID:1983913

Regional variations in mortality rates in England and Wales: an analysis using multi-level modelling.

PubMed

Langford, I H; Bentham, G

1996-03-01

Mortality rates in England and Wales display a persistent regional pattern indicating generally poorer health in the North and West. Some of this is simply a reflection of regional differences in the extent of social deprivation which is known to exert a profound influence on health. Part of the pattern may also be the result of regional differences in urbanization which also affect mortality rates. However, there may be important regional differences over and above these compositional effects. This study attempts to establish the magnitude of such independent regional differences in mortality rates by using the techniques of multi-level modelling. Standardized mortality rates (SMRs) for males and females under 65 for 1989-91 in local authority districts are grouped into categories using the ACORN classification scheme. The Townsend Index is included as a measure of social deprivation. Using a cross-classified multi-level model, it is shown that region accounts for approximately four times more variation in SMRs than is explained by the ACORN classification. Analysis of diagnostic residuals show a clear North-South divide in excess mortality when both regional and socio-economic classification of districts are modelled simultaneously, a possibility allowed for by the use of a multi-level model.

Variation in the mortality rate of turkeys during transport to the slaughterhouse with travel distance and month.

PubMed

Voslárová, Eva; Rubesová, Lenka; Vecerek, Vladimír; Pisteková, Vladimíra; Malena, Milan

2006-01-01

Failure to comply with animal welfare requirements during the transport of turkeys to the slaughterhouse increases stress in animals, which is manifested by increased mortality rate during transport. The numbers of turkeys that died during transport or soon after arrival may serve as an important parameter to indicate the level of animal welfare during transport of turkeys. The number of turkeys that died during transport to slaughterhouses in the Czech Republic in the period from 1997 to 2004 was investigated. The mortality rate found was 0.28% +/- 0.06% but varied with travel distance. The lowest mortality rate was found in case of travel distance below 50 km (0.18% +/- 0.08%) while long travel distances resulted in considerable increase in the mortality rates of turkeys (between 0.28% +/- 0.07 and 0.37% +/- 0.10%). The mortality rate of transported turkeys was also affected by the particular month of the year. Thus, the highest overall mortality rate occurred at long travel distances during winter months, i.e. in December (0.34% +/- 0.18%), January (0.32% +/- 0.06%), and February (0.36% +/- 0.07%). The comparison of individual years has shown a long-term trend towards a decrease in turkeys' mortality during transportation to slaughterhouses from 0.32% in 1998 to 0.20% in 2004. The decrease was statistically significant (Spearman's rank correlation coefficient r = -0.86, p < 0.01). This trend can be evaluated as positive.

Mortality and recurrence rate after pressure ulcer operation for elderly long-term bedridden patients.

PubMed

Kuwahara, Masamitsu; Tada, Hideyuki; Mashiba, Kumi; Yurugi, Satoshi; Iioka, Hiroshi; Niitsuma, Katsunori; Yasuda, Yukiko

2005-06-01

We operated on 16 sacral pressure ulcers in elderly and long-term residential patients who were immobile as a result of cerebral vascular disease. The mean age of patients was 76 years. Eight ulcers were treated with local fascial flaps and 8 by simple closure. The follow-up period was from 1 to 4 years. Recurrence and mortality rates were examined retrospectively. In the 16 patients, recurrence occurred in 37.5%, and 43.8% died without recurrence. The recurrence rate was 37.5% for local fascial flaps and 37.5% for simple closure. Overall mortality was 68.8% in the follow-up period. Because postoperative death was common, we should not only focus on reducing local pressure but also pay attention to any underlying disease. Because of this high mortality rate, the least invasive procedure possible should be used. Because the recurrence rate of simple closure was the same as for local fascial flaps, simple closure should be considered as a reconstructive method.

Heart rate profile during exercise in patients with early repolarization.

PubMed

Cay, Serkan; Cagirci, Goksel; Atak, Ramazan; Balbay, Yucel; Demir, Ahmet Duran; Aydogdu, Sinan

2010-09-01

Both early repolarization and altered heart rate profile are associated with sudden death. In this study, we aimed to demonstrate an association between early repolarization and heart rate profile during exercise. A total of 84 subjects were included in the study. Comparable 44 subjects with early repolarization and 40 subjects with normal electrocardiogram underwent exercise stress testing. Resting heart rate, maximum heart rate, heart rate increment and decrement were analyzed. Both groups were comparable for baseline characteristics including resting heart rate. Maximum heart rate, heart rate increment and heart rate decrement of the subjects in early repolarization group had significantly decreased maximum heart rate, heart rate increment and heart rate decrement compared to control group (all P < 0.05). The lower heart rate increment (< 106 beats/min) and heart rate decrement (< 95 beats/min) were significantly associated with the presence of early repolarization. After adjustment for age and sex, the multiple-adjusted OR of the risk of presence of early repolarization was 2.98 (95%CI 1.21-7.34) (P = 0.018) and 7.73 (95%CI 2.84-21.03) (P < 0.001) for the lower heart rate increment and heart rate decrement compared to higher levels, respectively. Subjects with early repolarization have altered heart rate profile during exercise compared to control subjects. This can be related to sudden death.

Mortality and recurrence rates among systemically untreated high risk breast cancer patients included in the DBCG 77 trials.

PubMed

Jensen, Maj-Britt; Nielsen, Torsten O; Knoop, Ann S; Laenkholm, Anne-Vibeke; Balslev, Eva; Ejlertsen, Bent

2018-01-01

Following loco-regional treatment for early breast cancer accurate prognostication is essential for communicating benefits of systemic treatment. The aim of this study was to determine time to recurrence and long-term mortality rates in high risk patients according to patient characteristics and subtypes as assigned by immunohistochemistry panels. In November 1977 through January 1983, 2862 patients with tumors larger than 5 cm or positive axillary nodes were included in the DBCG 77 trials. Archival tumor tissue from patients randomly assigned to no systemic treatment was analyzed for ER, PR, Ki67, EGFR and HER2. Intrinsic subtypes were defined as follows: Luminal A, ER or PR >0%, HER2-negative, PR >10% and Ki67 < 14%; Luminal B, ER or PR >0%, (PR ≤10% or HER2-positive or Ki67 ≥ 14%); HER2E, ER 0%, PR 0%, HER2 positive; Core basal, ER 0%, PR 0%, HER2 negative and EGFR positive. Multivariate categorical and fractional polynomials (MFP) models were used to construct prognostic subsets by clinicopathologic characteristics. In a multivariate model, mortality rate was significantly associated with age, tumor size, nodal status, invasion, histological type and grade, as well as subtype classification. With 35 years of follow-up, in this population of high-risk patients with no systemic therapy, no subgroup based on a composite prognostic score and/or molecular subtypes could be identified without excess mortality as compared to the background population.

Investigation of thiamine and PCB association with early life stage fry mortality in lake trout from northwestern Lake Michigan in 1996-1998

USGS Publications Warehouse

Honeyfield, Dale C.; Beltman, Dong; Holey, Mark; Edsall, Carol C.

2005-01-01

Lake trout (Salvelinus namaycush) eggs were collected from 72 females near Sturgeon Bay, WI in northwestern Lake Michigan from 1996, 1997, and 1998 to determine the relationships between egg thiamine and polychlorinated biphenyl (PCB) concentrations with egg fertilization and hatch, prevalence of abnormal fry, and fry mortality. Fry mortality consistent with early mortality syndrome (EMS) was observed in eggs from 33% of the females in 1996, 25% in 1997, and 28% in 1998. Among egg lots exhibiting EMS, fry mortality averaged 95% in 1996, 63% in 1997 and 77% in 1998 compared to 2% or less in lots that did not exhibit EMS. Expression of EMS was strongly correlated with egg thiamine concentrations; egg lots with less than approximately 1 nmol/g total thiamine consistently exhibited high rates of EMS, whereas egg batches with greater than 1.5 nmol/g showed little or no incidence of EMS among swim-up fry. Egg thiamine concentration was not related to fertilization rate, egg hatch, or the prevalence of abnormal fry. There was no relationship between egg concentrations of PCBs or tetrachlorinated dibenzo-p-dioxin (TCDD) equivalents (from PCBs, dioxins, and furans) and any of the egg or fry viability measurements, including EMS. We concluded that fry mortality observed in Lake Michigan lake trout in 1996-1998 was not caused by the toxicity of PCBs, dioxins, and furans, but is due to low egg thiamine concentrations.

How can mortality increase population size? A test of two mechanistic hypotheses.

PubMed

McIntire, Kristina M; Juliano, Steven A

2018-05-03

Overcompensation occurs when added mortality increases survival to the next life-cycle stage. Overcompensation can contribute to the Hydra Effect, wherein added mortality increases equilibrium population size. One hypothesis for overcompensation is that added mortality eases density-dependence, increasing survival to adulthood ("temporal separation of mortality and density dependence"). Mortality early in the life cycle is therefore predicted to cause overcompensation, whereas mortality later in the life cycle is not. Another hypothesis for overcompensation is that threat of mortality (e.g., from predation) causes behavioral changes that reduce overexploitation of resources, allowing resource recovery, and increasing production of adults ("prudent resource exploitation"). Behaviorally active predation cues alone are therefore predicted to cause overcompensation. We tested these predictions in two experiments with larvae of two species of Aedes. As predicted, early mortality yielded greater production of adults, and of adult females, and greater estimated rate of population increase than did later mortality. Addition of water-borne predation cues usually reduced browsing on surfaces in late-stage larvae, but contrary to prediction, resulted in neither significantly greater production of adult mosquitoes nor significantly greater estimated rate of increase. Thus we have strong evidence that timing of mortality contributes to overcompensation and the Hydra effect in mosquitoes. Evidence that predation cues alone can result in overcompensation via prudent resource exploitation is lacking. We expect the overcompensation in response to early mortality will be common in organisms with complex life cycles, density dependence among juveniles, and developmental control of populations. This article is protected by copyright. All rights reserved. This article is protected by copyright. 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.

[Demographic characteristics and mortality among indigenous peoples in Mato Grosso do Sul State, Brazil].

PubMed

Ferreira, Maria Evanir Vicente; Matsuo, Tiemi; Souza, Regina Kazue Tanno de

2011-12-01

The present study aimed to assess mortality rates and related demographic factors among indigenous peoples in the State of Mato Grosso do Sul, Central-West Brazil, compared to the State's general population. Mortality rates were estimated based on data obtained from the Health Care Database for Indigenous Peoples and monthly patient care records as well as demographic data from the Brazilian Unified National Health System (SUS) and mortality data from the SUS Mortality Database. Compared to the overall population, among indigenous peoples there were proportionally more individuals under 15 years of age and fewer elderly, besides higher mortality rates at early ages and from infectious and parasitic diseases. Indigenous men showed significantly higher mortality rates from external causes and respiratory and infectious diseases, while among women the mortality rates from external causes and infectious diseases were higher. Suicide rates among young indigenous individuals were also particularly alarming. Indigenous people's health conditions are worse than those of the general population in Mato Grosso do Sul.

A 2-fold higher rate of intraventricular hemorrhage-related mortality in African American neonates and infants.

PubMed

Qureshi, Adnan I; Adil, Malik M; Shafizadeh, Negin; Majidi, Shahram

2013-07-01

Despite the recognition of racial or ethnic differences in preterm gestation, such differences in the rate of intraventricular hemorrhage (IVH), frequently associated with preterm gestation, are not well studied. The authors performed the current study to identify racial or ethnic differences in the incidence of IVH-related mortality within the national population of the US. Using the ICD-10 codes P52.0, P52.1, P52.2, P52.3, and P10.2 and the Multiple Cause of Death data from 2000 to 2009, the authors identified all IVH-related mortalities that occurred in neonates and infants aged less than 1 year. The live births for whites and African Americans from the census for 2000-2009 were used to derive the incidence of IVH-related mortality for whites and African Americans per 100,000 live births. The IVH rate ratio (RR, 95% confidence interval [CI]) and annual percent change (APC) in the incidence rates from 2000 to 2009 were also calculated. A total of 3249 IVH-related mortality cases were reported from 2000 to 2009. The incidence rates of IVH were higher among African American infants (16 per 100,000 live births) than among whites (7.8 per 100,000 live births). African American infants had a 2-fold higher risk of IVH-related mortality compared with whites (RR 2.0, 95% CI 1.2-3.2). The rate of increase over the last 10 years was less in African American infants (APC 1.6%) than in white infants (APC 4.3%). The rate of IVH-related mortality is 2-fold higher among African American than white neonates and infants. Further studies are required to understand the underlying reasons for this prominent disparity in one of the most significant causes of infant mortality.

POVERTY, INFANT MORTALITY, AND HOMICIDE RATES IN CROSS-NATIONAL PERPSECTIVE: ASSESSMENTS OF CRITERION AND CONSTRUCT VALIDITY*

PubMed Central

Messner, Steven F.; Raffalovich, Lawrence E.; Sutton, Gretchen M.

2011-01-01

This paper assesses the extent to which the infant mortality rate might be treated as a “proxy” for poverty in research on cross-national variation in homicide rates. We have assembled a pooled, cross-sectional time-series dataset for 16 advanced nations over the 1993–2000 period that includes standard measures of infant mortality and homicide and also contains information on two commonly used “income-based” poverty measures: a measure intended to reflect “absolute” deprivation and a measure intended to reflect “relative” deprivation. With these data, we are able to assess the criterion validity of the infant mortality rate with reference to the two income-based poverty measures. We are also able to estimate the effects of the various indicators of disadvantage on homicide rates in regression models, thereby assessing construct validity. The results reveal that the infant mortality rate is more strongly correlated with “relative poverty” than with “absolute poverty,” although much unexplained variance remains. In the regression models, the measure of infant mortality and the relative poverty measure yield significant positive effects on homicide rates, while the absolute poverty measure does not exhibit any significant effects. Our analyses suggest that it would be premature to dismiss relative deprivation in cross-national research on homicide, and that disadvantage is best conceptualized and measured as a multidimensional construct. PMID:21643432

Understanding Racial and Ethnic Disparities in U.S. Infant Mortality Rates

MedlinePlus

... 37–38 weeks of gestation. Data source and methods This report is based on data from the ... infant mortality rates is computed using the Kitagawa method, which is described in detail elsewhere ( 10 ). Preterm- ...

Infant mortality in Bangladesh: trends and differentials.

PubMed

Begum, S

1983-12-01

Overall mortality decline in contemporary developing countries including Bangladesh has remained a remarkable success story. In Bangladesh, the mortality rate has dropped from about 45/1000 in the early 1920s to about 20/1000 by the mid 1970s. This study investigates recent behavior of infant mortality in Bangladesh. Using 1974 Bangladesh Retrospective Survey of Fertility and Mortality data, infant mortality rates for Bangladesh are obtained by Feeney's method. In understanding trends and differentials of Bangladesh infant mortality it is desirable that one remains confined to the 1960s only instead of the total period covered in the study (1957-1978). During the 1960s urban areas achieved a very steady and distinct improvement in their mortality rates while rural areas at that time could barely maintain a status quo. In the 1960s, parents' education was inversely related to infant mortality; mother's education is far more important than father's education in augmenting the prospect of survival of their children. Findings reveal: 1) despite the fact that Bangladesh has accomplished some decline in overall mortality in recent decades, no corresponding decline has taken place in infant mortality; 2) the absence of mortality improvement is not true for all sub-groups of population while such stagnation holds true for a large marjority; 3) Bangladesh has strong differentials in infant mortality; and 4) these differentials have widened further in recent years. The Bangladesh government has to make a definite attack on death in infancy; about 33% of the total Bangladesh deaths took place at this age, and overall mortality is reducible to that extent by proper policy devices.

Identification of genomic loci associated with resting heart rate and shared genetic predictors with all-cause mortality.

PubMed

Eppinga, Ruben N; Hagemeijer, Yanick; Burgess, Stephen; Hinds, David A; Stefansson, Kari; Gudbjartsson, Daniel F; van Veldhuisen, Dirk J; Munroe, Patricia B; Verweij, Niek; van der Harst, Pim

2016-12-01

Resting heart rate is a heritable trait correlated with life span. Little is known about the genetic contribution to resting heart rate and its relationship with mortality. We performed a genome-wide association discovery and replication analysis starting with 19.9 million genetic variants and studying up to 265,046 individuals to identify 64 loci associated with resting heart rate (P < 5 × 10 -8 ); 46 of these were novel. We then used the genetic variants identified to study the association between resting heart rate and all-cause mortality. We observed that a genetically predicted resting heart rate increase of 5 beats per minute was associated with a 20% increase in mortality risk (hazard ratio 1.20, 95% confidence interval 1.11-1.28, P = 8.20 × 10 -7 ) translating to a reduction in life expectancy of 2.9 years for males and 2.6 years for females. Our findings provide evidence for shared genetic predictors of resting heart rate and all-cause mortality.

[Mortality by avoidable causes in preschool children].

PubMed

Lurán, Albenia; López, Elizabeth; Pinilla, Consuelo; Sierra, Pedro

2009-03-01

The infant-mortality rate in children aged less than five is an indicator of the general state of health of a population and directly reflects the quality of life and the level of socio-economic development of a country. Avoidable mortality was assessed in preschool children as a reflection of Colombia quality of life and socio-economic development. Mortality trends were analyzed in preschool children aged less than five throughout Colombia during a 20-year period from 1985-2004, and focused on mortality causes that were considered avoidable. This was a descriptive, retrospective study; the sources of information were Departamento Administrativo Nacional de Estadística records of deaths and population projections 1985-2004. Mortality rate due to avoidable causes was the statistical indicator. In children aged less than one, the reducible mortality due to "early diagnosis and medical treatment" occupied the first place amongst causes for every year of the study period and accounted for more than 50% of recorded deaths. In children aged 1 to 4, the category "other important reducible causes" was associated with 40% of recorded deaths-deaths due mainly to respiratory diseases. Over the 20-year period, the avoidable mortality rate decreased by 34% in children aged less than one, in children 1-4, it decreased by 23%. Although the infant-mortality rate in preschool children was reduced, the decrease was small, from 80% to 77%. The situation requires more analysis with respect to strategies in public health, particularly concerning preventable diseases of the infancy.

Effectiveness of traffic-related elements in tree bark and pollen abortion rates for assessing air pollution exposure on respiratory mortality rates.

PubMed

Carvalho-Oliveira, Regiani; Amato-Lourenço, Luís F; Moreira, Tiana C L; Silva, Douglas R Rocha; Vieira, Bruna D; Mauad, Thais; Saiki, Mitiko; Saldiva, Paulo H Nascimento

2017-02-01

The majority of epidemiological studies correlate the cardiorespiratory effects of air pollution exposure by considering the concentrations of pollutants measured from conventional monitoring networks. The conventional air quality monitoring methods are expensive, and their data are insufficient for providing good spatial resolution. We hypothesized that bioassays using plants could effectively determine pollutant gradients, thus helping to assess the risks associated with air pollution exposure. The study regions were determined from different prevalent respiratory death distributions in the Sao Paulo municipality. Samples of tree flower buds were collected from twelve sites in four regional districts. The genotoxic effects caused by air pollution were tested through a pollen abortion bioassay. Elements derived from vehicular traffic that accumulated in tree barks were determined using energy-dispersive X-ray fluorescence spectrometry (EDXRF). Mortality data were collected from the mortality information program of Sao Paulo City. Principal component analysis (PCA) was applied to the concentrations of elements accumulated in tree barks. Pearson correlation and exponential regression were performed considering the elements, pollen abortion rates and mortality data. PCA identified five factors, of which four represented elements related to vehicular traffic. The elements Al, S, Fe, Mn, Cu, and Zn showed a strong correlation with mortality rates (R 2 >0.87) and pollen abortion rates (R 2 >0.82). These results demonstrate that tree barks and pollen abortion rates allow for correlations between vehicular traffic emissions and associated outcomes such as genotoxic effects and mortality data. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

Female Literacy Rate is a Better Predictor of Birth Rate and Infant Mortality Rate in India

PubMed Central

Saurabh, Suman; Sarkar, Sonali; Pandey, Dhruv K.

2013-01-01

Background: Educated women are known to take informed reproductive and healthcare decisions. These result in population stabilization and better infant care reflected by lower birth rates and infant mortality rates (IMRs), respectively. Materials and Methods: Our objective was to study the relationship of male and female literacy rates with crude birth rates (CBRs) and IMRs of the states and union territories (UTs) of India. The data were analyzed using linear regression. CBR and IMR were taken as the dependent variables; while the overall literacy rates, male, and female literacy rates were the independent variables. Results: CBRs were inversely related to literacy rates (slope parameter = −0.402, P < 0.001). On multiple linear regression with male and female literacy rates, a significant inverse relationship emerged between female literacy rate and CBR (slope = −0.363, P < 0.001), while male literacy rate was not significantly related to CBR (P = 0.674). IMR of the states were also inversely related to their literacy rates (slope = −1.254, P < 0.001). Multiple linear regression revealed a significant inverse relationship between IMR and female literacy (slope = −0.816, P = 0.031), whereas male literacy rate was not significantly related (P = 0.630). Conclusion: Female literacy is relatively highly important for both population stabilization and better infant health. PMID:26664840

Exceptionally high mortality rate of the 1918 influenza pandemic in the Brazilian naval fleet.

PubMed

Schuck-Paim, Cynthia; Shanks, G Dennis; Almeida, Francisco E A; Alonso, Wladimir J

2013-01-01

The naval experience with the 1918 pandemic during World War I remains underexplored despite its key role on the pandemic's global diffusion and the epidemiological interest of isolated and relatively homogeneous populations. The pandemic outbreak in the Brazilian naval fleet is of particular interest both because of its severity and the fact that it was the only Latin American military force deployed to war. To study the mortality patterns of the pandemic in the Brazilian fleet sent to patrol the West African coast in 1918. We investigated mortality across vessels, ranks, and occupations based on official population and mortality records from the Brazilian Navy Archives. The outbreak that swept this fleet included the highest influenza mortality rate on any naval ship reported to date. Nearly 10% of the crews died, with death rates reaching 13-14% on two destroyers. While overall mortality was lower for officers, stokers and engineer officers were significantly more likely to die from the pandemic, possibly due to the pulmonary damage from constant exposure to the smoke and coal dust from the boilers. The fatality patterns observed provide valuable data on the conditions that can exacerbate the impact of a pandemic. While the putative lack of exposure to a first pandemic wave may have played a role in the excessive mortality observed in this fleet, our results indicate that strenuous labor conditions, dehydration, and exposure to coal dust were major risk factors. The unequal death rates among vessels remain an open question. © 2012 Blackwell Publishing Ltd.

Epidemiology, clinical characteristics, and risk factors for mortality of early- and late-onset invasive candidiasis in intensive care units in China

PubMed Central

Yang, Yi; Guo, Fengmei; Kang, Yan; Zang, Bin; Cui, Wei; Qin, Bingyu; Qin, Yingzhi; Fang, Qiang; Qin, Tiehe; Jiang, Dongpo; Cai, Bojing; Li, Ruoyu; Qiu, Haibo

2017-01-01

Abstract To identify the epidemiology, treatments, outcomes, and risk factors for patients with early- or late-onset invasive candidiasis (EOIC or LOIC) in intensive care units in China. Patients were classified as EOIC (≤10 days) or LOIC (>10 days) according to the time from hospital admission to IC onset to identify distinct clinical characteristics. There were 105 EOIC cases and 201 LOIC cases in this study. EOIC was related to more severe clinical conditions at ICU admission or prior to IC. Significantly, more cases of Candida parapsilosis infection were found in patients with LOIC than in those with EOIC. The mortality of EOIC was significantly lower than that for LOIC. Sequential Organ Failure Assessment (SOFA) score at ICI diagnosis in the EOIC group and the interval from ICU admission to ICI occurrence in the LOIC group were identified as risk factors for mortality. Susceptibility to the first-line agent was associated with a lower risk of mortality in the LOIC group. The mortality rate was significantly lower in the EOIC group, and there were more cases of non-albicans infection in the LOIC group. Susceptibility to the first-line agent was an important predictor of mortality in the LOIC group. SOFA score at ICI diagnosis in the EOIC group and interval from ICU admission to ICI occurrence in the LOIC group were identified as risk factors for mortality. PMID:29049184

The Decline in Maternal Mortality in Sweden

PubMed Central

Högberg, Ulf

2004-01-01

The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy. The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy. PMID:15284032

Early mortality in SCN8A-related epilepsies.

PubMed

Johannesen, Katrine M; Gardella, Elena; Scheffer, Ingrid; Howell, Katherine; Smith, Douglas M; Helbig, Ingo; Møller, Rikke S; Rubboli, Guido

2018-07-01

SCN8A-related epilepsies are often severe developmental and epileptic encephalopathies. Seizures can be treatment resistant, and patients suffer from severe intellectual disability. Reports have suggested that SCN8A-related epilepsies have a high mortality with SUDEP as the major underlying cause. SUDEP is a catastrophic event, and the risk of occurrence should be correctly and carefully discussed with patients and families. We tested the hypothesis of SUDEP as the main cause of death in SCN8A-related epilepsies by reviewing all the currently reported patients with SCN8A. In addition, we collected unpublished patients through an international network. In total, we reviewed the data of 190 patients. In our cohort, 10 patients were deceased, and the overall mortality was 5.3%. Within the ten deceased patients, age at death ranged from 16 months to 17 years; the majority (7/10) of them died in early childhood. Three patients died of probable or definite SUDEP. Thus, our data do not indicate an increased risk when compared to other DEEs. Indeed, death in SCN8A-related epilepsies seems to occur most often in children experiencing a relentless worsening of their epilepsy and neurological condition, rendering them susceptible to pulmonary infections and respiratory distress that ultimately can be fatal. Copyright © 2018 Elsevier B.V. All rights reserved.

Initial fractal exponent of heart-rate variability is associated with success of early resuscitation in patients with severe sepsis or septic shock: a prospective cohort study

PubMed Central

Brown, Samuel M.; Tate, Quinn; Jones, Jason P.; Knox, Daniel; Kuttler, Kathryn G.; Lanspa, Michael; Rondina, Matthew T.; Grissom, Colin K.; Behera, Subhasis; Mathews, V.J.; Morris, Alan

2013-01-01

Introduction Heart-rate variability reflects autonomic nervous system tone as well as the overall health of the baroreflex system. We hypothesized that loss of complexity in heart-rate variability upon ICU admission would be associated with unsuccessful early resuscitation of sepsis. Methods We prospectively enrolled patients admitted to ICUs with severe sepsis or septic shock from 2009 to 2011. We studied 30 minutes of EKG, sampled at 500 Hz, at ICU admission and calculated heart-rate complexity via detrended fluctuation analysis. Primary outcome was vasopressor independence at 24 hours after ICU admission. Secondary outcome was 28-day mortality. Results We studied 48 patients, of whom 60% were vasopressor independent at 24 hours. Five (10%) died within 28 days. The ratio of fractal alpha parameters was associated with both vasopressor independence and 28-day mortality (p=0.04) after controlling for mean heart rate. In the optimal model, SOFA score and the long-term fractal alpha parameter were associated with vasopressor independence. Conclusions Loss of complexity in heart rate variability is associated with worse outcome early in severe sepsis and septic shock. Further work should evaluate whether complexity of heart rate variability (HRV) could guide treatment in sepsis. PMID:23958243

An evaluation of vital registers as sources of data for infant mortality rates in Cameroon.

PubMed

Ndong, I; Gloyd, S; Gale, J

1994-06-01

Infant mortality rates have been widely used as indicators of health status and the availability, utilization and effectiveness of health services. Two principal sources of data for infant mortality rates are vital registers and censuses. This study was designed to evaluate the accuracy of vital registers as sources of data for infant mortality rates in Cameroon. A household census of births and infant deaths that occurred in Buea Subdivision between 1 November 1991 and 31 October 1992 was conducted to determine the proportion that were registered and the reasons why the remainder were not registered. The registration coverage was found to be 62% for births and 4% for infant deaths. The most frequently reported reasons for not registering births were lack of money, lack of time and a complicated registration procedure. For infant deaths the reasons were lack of knowledge and no perceived benefits. Vital registers of birth and death are not an accurate source of data for infant mortality rates in Cameroon. Motivation for birth and death registration appear to be dependent on the perceived benefits. A mechanism of registration that uses medical institutions may substantially increase registration coverage for births and infant deaths.

Mortality rates for stroke in England from 1979 to 2004: trends, diagnostic precision, and artifacts.

PubMed

Goldacre, Michael J; Duncan, Marie; Griffith, Myfanwy; Rothwell, Peter M

2008-08-01

Stroke mortality appears to be declining more rapidly in the UK than in many other Western countries. To understand this apparent decline better, we studied trends in mortality in the UK using more detailed data than are routinely available. Analysis of datasets that include both the underlying cause and all other mentioned causes of death (together, termed "all mentions"): the Oxford Record Linkage Study from 1979 to 2004 and English national data from 1996 to 2004. Mortality rates based on underlying cause and based on all mentions showed similar downward trends. Mortality based on underlying cause alone misses about one quarter of all stroke-related deaths. Changes during the period in the national rules for selecting the underlying cause of death had a significant but fairly small effect on the trend. Overall, mortality fell by an average annual rate of 2.3% (95% confidence interval 2.1% to 2.5%) for stroke excluding subarachnoid hemorrhage; and by 2.1% (1.7% to 2.6%) per annum for subarachnoid hemorrhage. Coding of stroke as hemorrhagic, occlusive, or unspecified varied substantially across the study period. As a result, rates for hemorrhagic and occlusive stroke, affected by artifact, seemed to fall substantially in the first part of the study period and then leveled off. Studies of stroke mortality should include all mentions as well as the certified underlying cause, otherwise the burden of stroke will be underestimated. Studies of stroke mortality that include strokes specified as hemorrhagic or occlusive, without also considering stroke overall, are likely to be misleading. Stroke mortality in the Oxford region halved between 1979 and 2004.

Design and validation of a model to predict early mortality in haemodialysis patients.

PubMed

Mauri, Joan M; Clèries, Montse; Vela, Emili

2008-05-01

Mortality and morbidity rates are higher in patients receiving haemodialysis therapy than in the general population. Detection of risk factors related to early death in these patients could be of aid for clinical and administrative decision making. Objectives. The aims of this study were (1) to identify risk factors (comorbidity and variables specific to haemodialysis) associated with death in the first year following the start of haemodialysis and (2) to design and validate a prognostic model to quantify the probability of death for each patient. An analysis was carried out on all patients starting haemodialysis treatment in Catalonia during the period 1997-2003 (n = 5738). The data source was the Renal Registry of Catalonia, a mandatory population registry. Patients were randomly divided into two samples: 60% (n = 3455) of the total were used to develop the prognostic model and the remaining 40% (n = 2283) to validate the model. Logistic regression analysis was used to construct the model. One-year mortality in the total study population was 16.5%. The predictive model included the following variables: age, sex, primary renal disease, grade of functional autonomy, chronic obstructive pulmonary disease, malignant processes, chronic liver disease, cardiovascular disease, initial vascular access and malnutrition. The analyses showed adequate calibration for both the sample to develop the model and the validation sample (Hosmer-Lemeshow statistic 0.97 and P = 0.49, respectively) as well as adequate discrimination (ROC curve 0.78 in both cases). Risk factors implicated in mortality at one year following the start of haemodialysis have been determined and a prognostic model designed. The validated, easy-to-apply model quantifies individual patient risk attributable to various factors, some of them amenable to correction by directed interventions.

[Perinatal mortality at Hospital de Ginecoobstetricia No. 23 of Monterrey, Nuevo León, 2002-2006 period].

PubMed

Gutiérrez Saucedo, María Elena; Hernández Herrera, Ricardo Jorge; Luna García, Sergio Arturo; Flores Santos, Roberto; Alcalá Galván, Luis Gerardo; Martínez Gaytán, Victoria

2008-05-01

Perinatal period begins at 22 gestational weeks and ends seven days after birth. Perinatal mortality is an important quality indicator of the obstetric and pediatric care available, and representative of the population's health service. To know fetal, early neonatal, and perinatal dead rates, and them main mortality causes. Descriptive and retrospective study at IMSS's no. 32 UMAE (Monterrey, Nuevo León, México), from January 2002 to December 2006. Mortality rates during fetal and perinatal, or neonatal periods, were estimated per 1,000 births or 1,000 live born, respectively. There were 1,681 deaths: 747 stillbirths and 934 neonatal. Two hundred and nineteen (29.3%) stillbirths had 22 to 27 gestational weeks, and 528 (70.6%) had 28. Three hundred and sixty neonatal deaths (38.5%) occurred before 27th gestational week, 320 (34.2%) between weeks 28th and 35th, and 254 (27.1%) after 36 weeks of pregnancy. Seven hundred and sixty four neonates died within 0 to 6 days of life, and 170 (18%) between seventh to 28th days of life. Fetal, neonatal, early neonatal, and late neonatal mortality rates were 7.2 in 1,000 births, 9.08 in 1,000 live born, 7.42 in 1,000 live born, and 1.65 in 1,000 births, respectively, and overall perinatal mortality rate was 14.58 in 1,000 births. Stillbirth, early neonatal, and perinatal mortality rates of this study were under national mean. Main mortality causes (70%) were congenital defects and prematurity.

Social capital and collective efficacy in Hungary: cross sectional associations with middle aged female and male mortality rates.

PubMed

Skrabski, A; Kopp, M; Kawachi, I

2004-04-01

Social capital, collective efficacy, and religious involvement have each been linked to population health. This study examined the relations between these measures and male/female mortality rates in Hungary. Cross sectional, ecological study. 150 sub-regions of Hungary. 12643 people were interviewed in 2002 (the "Hungarostudy 2002" survey). Social capital was measured by lack of social trust, reciprocity between citizens, and membership in civil organisations. Collective efficacy was measured by survey items from the Project on Human Development in Chicago Neighborhoods. Religious involvement was measured by church attendance. Gender specific all cause mortality rates for the middle aged population (45-64 years) in the 150 sub-regions of Hungary, provided by the Central Statistical Office (CSO). Social capital, collective efficacy, as well as religious involvement were each significantly associated with middle age mortality. After education, collective efficacy showed the strongest association with mortality in both men and women. Among men, socioeconomic status, collective efficacy, social distrust, competitive attitude, reciprocity, and membership of civic organisations explained 68.0% of the sub-regional variations in mortality rates. Among women the same variables explained only 29.3% of the variance in mortality rates. Religious involvement was protective among women. Collective efficacy and social capital are significant predictors of mortality rates in both men and women across sub-regions of Hungary. Gender differences in the relative importance of social factors may help to explain the differential impact of economic transformation on mortality rates for men and women in Central-Eastern European countries.

Estimating mortality rates of adult fish from entrainment through the propellers of river towboats

USGS Publications Warehouse

Gutreuter, S.; Dettmers, J.M.; Wahl, David H.

2003-01-01

We developed a method to estimate mortality rates of adult fish caused by entrainment through the propellers of commercial towboats operating in river channels. The method combines trawling while following towboats (to recover a fraction of the kills) and application of a hydrodynamic model of diffusion (to estimate the fraction of the total kills collected in the trawls). The sampling problem is unusual and required quantifying relatively rare events. We first examined key statistical properties of the entrainment mortality rate estimators using Monte Carlo simulation, which demonstrated that a design-based estimator and a new ad hoc estimator are both unbiased and converge to the true value as the sample size becomes large. Next, we estimated the entrainment mortality rates of adult fishes in Pool 26 of the Mississippi River and the Alton Pool of the Illinois River, where we observed kills that we attributed to entrainment. Our estimates of entrainment mortality rates were 2.52 fish/km of towboat travel (80% confidence interval, 1.00-6.09 fish/km) for gizzard shad Dorosoma cepedianum, 0.13 fish/km (0.00-0.41) for skipjack herring Alosa chrysochloris, and 0.53 fish/km (0.00-1.33) for both shovelnose sturgeon Scaphirhynchus platorynchus and smallmouth buffalo Ictiobus bubalus. Our approach applies more broadly to commercial vessels operating in confined channels, including other large rivers and intracoastal waterways.

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.

Low infant mortality among Palestine refugees despite the odds.

PubMed

Riccardo, Flavia; Khader, Ali; Sabatinelli, Guido

2011-04-01

To present data from a 2008 infant mortality survey conducted in Jordan, Lebanon, the Syrian Arab Republic, the Gaza Strip and the West Bank and analyse infant mortality trends among Palestine refugees in 1995-2005. Following the preceding birth technique, mothers who were registering a new birth were asked if the preceding child was alive or dead, the day the child was born and the date of birth of the neonate whose birth was being registered. From this information, neonatal, infant and early child mortality rates were estimated. The age at death for early child mortality was determined by the mean interval between successive births and the mean age of neonates at registration. In 2005-2006, infant mortality among Palestine refugees ranged from 28 deaths per 100 000 live births in the Syrian Arab Republic to 19 in Lebanon. Thus, infant mortality in Palestine refugees is among the lowest in the Near East. However, infant mortality has stopped decreasing in recent years, although it remains at a level compatible with the attainment of Millennium Development Goal 4. Largely owing to the primary health care provided by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East and other entities, infant mortality among Palestine refugees had consistently decreased. However, it is no longer dropping. Measures to address the most likely reasons - early marriage and childbearing, poor socioeconomic conditions and limited access to good perinatal care - are needed.

Improved hospital mortality with a low MET dose: the importance of a modified early warning score and communication tool.

PubMed

Mullany, D V; Ziegenfuss, M; Goleby, M A; Ward, H E

2016-11-01

Rapid response systems have been mandated for the recognition and management of the deteriorating patient. Increasing medical emergency team (MET) dose may be associated with improved outcomes. Large numbers of MET calls may divert resources from the program providing the service unless additional personnel are provided. To describe the implementation and outcomes of a multifaceted rapid response system (RRS) in a teaching hospital, we conducted an observational study. The RRS consisted of the introduction of a MET together with 1) redesign of the ward observation chart with the vital sign variables colour-coded to identify variation from normal; 2) mandated minimum frequency of vital sign measurement; 3) three formal levels of escalation based on the degree of physiological instability as measured by a modified early warning score (MEWS); 4) COMPASS© education and e-learning package with a two-hour face-to-face small group tutorial; 5) practise in escalation and communication using the ISBAR (Identify, Situation, Background, Assessment, Response/Recommendation) communication tool. The primary outcome measures were all-cause hospital mortality rate and hospital standardised mortality ratio (HSMR) compared to peer hospitals calculated by the Health Round Table. There were 161,153 separations and 1,994 hospital deaths from July 2008 to December 2012. The MET call rate was 11.3 per 1000 separations in 2012. There was a decline in all-cause hospital mortality from 13.8 to 11 deaths/1000 separations. The HSMR decreased from 95.7 in 2008 to 66 in the second half of 2012 (below the three standard deviation control limit). A low MET dose may be associated with improved hospital mortality when combined with a MEWS and an intervention to improve communication.

Mortality rates of pathogen indicator microorganisms discharged from point and non-point sources in an urban area.

PubMed

Kim, Geonha; Hur, Jin

2010-01-01

This research measured the mortality rates of pathogen indicator microorganisms discharged from various point and non-point sources in an urban area. Water samples were collected from a domestic sewer, a combined sewer overflow, the effluent of a wastewater treatment plant, and an urban river. Mortality rates of indicator microorganisms in sediment of an urban river were also measured. Mortality rates of indicator microorganisms in domestic sewage, estimated by assuming first order kinetics at 20 degrees C were 0.197 day(-1), 0.234 day(-1), 0.258 day(-1) and 0.276 day(-1) for total coliform, fecal coliform, Escherichia coli, and fecal streptococci, respectively. Effects of temperature, sunlight irradiation and settlement on the mortality rate were measured. Results of this research can be used as input data for water quality modeling or can be used as design factors for treatment facilities.

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.

Associated influence of hypertension and heart rate greater than 80 beats per minute on mortality rate in patients with anterior wall STEMI

PubMed Central

Davidovic, Goran; Iric-Cupic, Violeta; Milanov, Srdjan

2013-01-01

Acute myocardial infarction as a form of coronary heart disease is characterized by permanent damage/loss of anatomical and functional cardiac tissue. Diagnosis of STEMI includes data on anginal pain and persistent ST-segment elavation. According to the numerous epidemiological studies, arterial blood pressure and heart rate are offten increased especially during the first hours of pain due to domination of sympathetic response. We wanted to investigate the associated influence of heart rate greater than 80 beats per minute and hypertension on the mortality in patients with anterior wall STEMI. Research included 140 patients treated in Coronary Unit, Clinical Center Kragujevac form January 2001 to June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission, recorded on monitor and electrocardiogram. Data for history of hypertension were collected and blood pressure levels were measured in a lying position after 5 minutes of rest, and classified according to the VII JNC recommendations as confirmation of hypertension. Collected data were analyzed in SPSS 13.0 for Windows. Heart rate greater than 80 bpm influences the hospital mortality. Systolic blood pressure levels were higher in the survivors, while for the diastolic there was no difference. History of hypertension was singled out as a significant predictor of mortality without difference between the respondents with heart rate greater and lower than 80 bpm in the survivors and fatal. Increased heart rate and hypertension at admission are significant predictors of mortality in patients with anterior wall STEMI. PMID:23724155

The correlation between burn mortality rates from fire and flame and economic status of countries.

PubMed

Peck, Michael; Pressman, Melissa A

2013-09-01

Over 95% of burn deaths occur in low- and middle-income countries globally. However, the association between burn mortality rates and economic health has not been evaluated for individual countries. This study seeks to answer the question, how strong is the correlation between burn mortality and national indices of economic strength? A retrospective review was performed for 189 countries during 2008-2010 using economic data from the World Bank as well as mortality data from the World Health Organization (WHO). Countries were categorized into four groups based on income level according to stratification by the World Bank: low income, lower middle income, upper middle income, and high income. The Pearson correlation coefficient was used to estimate presence and strength of association among death rates, Gini coefficient (measure of inequality of distribution of wealth), gross domestic product (GDP) per capita, and gross national index (GNI) per capita. Statistically significant associations (p<0.05) were found between burn mortality and GDP per capita (r=-0.26), GNI per capita (r=-0.36), and Gini (r=+0.17). A nation's income level is negatively correlated with burn mortality; the lower the income level, the higher the burn mortality rates. The degree to which income within a country is equitably or inequitably distributed also correlates with burn mortality. Both governmental and non-governmental organizations need to focus on preventing burns in low-income countries, as well as in other countries in which there is marked disparity of income. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Hospital closures had no measurable impact on local hospitalization rates or mortality rates, 2003-11.

PubMed

Joynt, Karen E; Chatterjee, Paula; Orav, E John; Jha, Ashish K

2015-05-01

The Affordable Care Act (ACA) set in motion payment changes that could put pressure on hospital finances and lead some hospitals to close. Understanding the impact of closures on patient care and outcomes is critically important. We identified 195 hospital closures in the United States between 2003 and 2011. We found no significant difference between the change in annual mortality rates for patients living in hospital service areas (HSAs) that experienced one or more closures and the change in rates in matched HSAs without a closure (5.5 percent to 5.2 percent versus 5.4 percent to 5.4 percent, respectively). Nor was there a significant difference in the change in all-cause mortality rates following hospitalization (9.1 percent to 8.2 percent in HSAs with a closure versus 9.0 percent to 8.4 percent in those without a closure). HSAs with a closure had a drop in readmission rates compared to controls (19.4 percent to 18.2 percent versus 18.8 percent to 18.3 percent). Overall, we found no evidence that hospital closures were associated with worse outcomes for patients living in those communities. These findings may offer reassurance to policy makers and clinical leaders concerned about the potential acceleration of hospital closures as a result of health care reform. Project HOPE—The People-to-People Health Foundation, 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

Effect of marital status on death rates. Part 2: Transient mortality spikes

NASA Astrophysics Data System (ADS)

Richmond, Peter; Roehner, Bertrand M.

2016-05-01

We examine what happens in a population when it experiences an abrupt change in surrounding conditions. Several cases of such ;abrupt transitions; for both physical and living social systems are analyzed from which it can be seen that all share a common pattern. First, a steep rising death rate followed by a much slower relaxation process during which the death rate decreases as a power law. This leads us to propose a general principle which can be summarized as follows: ;Any abrupt change in living conditions generates a mortality spike which acts as a kind of selection process;. This we term the Transient Shock conjecture. It provides a qualitative model which leads to testable predictions. For example, marriage certainly brings about a major change in personal and social conditions and according to our conjecture one would expect a mortality spike in the months following marriage. At first sight this may seem an unlikely proposition but we demonstrate (by three different methods) that even here the existence of mortality spikes is supported by solid empirical evidence.

[Determination of the 120-day post prostatic biopsy mortality rate].

PubMed

Canat, G A; Duclos, A; Couray-Targe, S; Schott, A-M; Polazzi, S; Scoazec, J-Y; Berger, F; Perrin, P

2014-06-01

Concerning death-rates were reported following prostate biopsy but the lack of contexts in which event occurred makes it difficult to take any position. Therefore, we aimed to determine the 120-day post-biopsy mortality rate. Between 2000 and 2011, 8804 men underwent prostate biopsy in the hospice civils de Lyon. We studied retrospectively, the mortality rate after each of the 11,816 procedures. Biopsies imputability was assessed by examining all medical records. Dates of death were extracted from our local patient management database, which is updated trimestrially with death notifications from the French National Institute for Statistics and Economic Studies. In our study 42 deaths occurred within 120days after 11,816 prostate biopsies (0.36%). Of the 42 records: 9 were lost to follow-up, 3 had no identifiable cause of death, 28 had an intercurrent event ruling out prostate biopsy as a cause of death. Only 2 deaths could be linked to biopsy. We reported at most 2 deaths possibly related to prostate biopsy over 11,816 procedures (0.02%). We confirmed the fact that prostate biopsies can be lethal but this rare outcome should not be considered as an argument against prostate screening given the circumstances in which it occurs. 5. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

What doesn't kill you makes you poorer: Adult wages and early-life mortality in India.

PubMed

Lawson, Nicholas; Spears, Dean

2016-05-01

A growing literature indicates that effects of early-life health on adult economic outcomes could be substantial in developing countries, but the magnitude of this effect is debated. We document a robust gradient between the early-life mortality environment to which men in India were locally exposed in their district and year of birth and the wages that they earn as adults. A 1 percentage point reduction in infant mortality (or 10 point reduction in IMR) in an infant's district and year of birth is associated with an approximately 2 percent increase in his subsequent adult wages. Consistent with theories and evidence in the literature, we find that the level of schooling chosen for a child does not mediate this association. Because of its consequences for subsequent wages, early-life health could also have considerable fiscal externalities; if so, public health investments could come at very low net present cost. Copyright © 2015 Elsevier B.V. All rights reserved.

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.

Background mortality rates for recovering populations of Acropora cytherea in the Chagos Archipelago, central Indian Ocean.

PubMed

Pratchett, M S; Pisapia, C; Sheppard, C R C

2013-05-01

This study quantified background rates of mortality for Acropora cytherea in the Chagos Archipelago. Despite low levels of anthropogenic disturbance, 27.5% (149/541) of A. cytherea colonies exhibited some level of partial mortality, and 9.0% (49/541) of colonies had recent injuries. A total of 15.3% of the overall surface area of physically intact A. cytherea colonies was dead. Observed mortality was partly attributable to overtopping and/or self-shading among colonies. There were also low-densities of Acanthaster planci apparent at some study sites. However, most of the recent mortality recorded was associated with isolated infestations of the coral crab, Cymo melanodactylus. A. cytherea is a relatively fast growing coral and these levels of mortality may be biologically unimportant. However, few studies have measured background rates of coral mortality, especially in the absence of direct human disturbances. These data are important for assessing the impacts of increasing disturbances, especially in projecting likely recovery. Copyright © 2013. Published by Elsevier Ltd.

Mortality Rates and Cause of Death Among Former Prison Inmates in North Carolina.

PubMed

Jones, Mark; Kearney, Gregory D; Xu, Xiaohui; Norwood, Tammy; Proescholdbell, Scott K

2017-01-01

BACKGROUND Inmates face challenges upon release from prison, including increased risk of death. We examine mortality among former inmates in North Carolina, including both violent and nonviolent deaths. METHODS A retrospective cohort study among former North Carolina inmates released between 2008 and 2010 were linked with North Carolina mortality data to determine cause of death. Inmates were followed through December 31, 2012. Mortality rates among former inmates were compared with deaths among North Carolina residents using standardized mortality ratios (SMRs). RESULTS Among former inmates (N = 41,495), there were 926 deaths during the study period. Compared to the North Carolina general population, SMRs were higher for all-cause mortality for total deaths (SMR = 2.10, 95% CI: 1.97-2.24), heart disease (SMR = 4.45, 95% CI: 3.64-5.34), cancer (SMR = 3.92, 95% CI: 3.34-4.62), suicide (SMR = 14.46, 95% CI: 10.28-19.76), and homicide (SMR = 7.98, 95% CI: 6.34-10.03). DISCUSSION The death rate among former North Carolina inmates is significantly higher than that of other North Carolina residents. Although more research is needed, identifying areas for interventions is essential for reducing the risk of death among this population. ©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

A midpoint assessment of the American Cancer Society challenge goal to halve the U.S. cancer mortality rates between the years 1990 and 2015.

PubMed

Byers, Tim; Barrera, Ermilo; Fontham, Elizabeth T H; Newman, Lisa A; Runowicz, Carolyn D; Sener, Stephen F; Thun, Michael J; Winborn, Sara; Wender, Richard C

2006-07-15

The American Cancer Society has challenged the U.S. to reduce cancer mortality rates 50% over the 25 years from 1990 to 2015. The current report is an analysis and commentary on progress toward that goal through 2002, the midpoint of the challenge period. Cancer mortality rates were examined from 1990 through 2002, and projections to the Year 2015 were made. Cancer deaths that were prevented or deferred by the declining death rates were expressed as the difference between the observed and projected numbers of deaths and the numbers that would have been observed over that period had the 1990 death rates persisted. Since 1990, cancer mortality rates have been declining in the U.S. by approximately 1% per year. Trends especially have been favorable for cancers of the breast, prostate, and colorectum and for lung cancer among men. Should this rate of decline continue over the coming decade, death rates from cancer will be approximately 23% lower in the Year 2015 than they were in 1990, and approximately 1.8 million deaths from cancer will have been prevented or deferred. At this midpoint of the 25-year challenge period, it appears that fully reaching the goal will require substantial breakthroughs in cancer early detection and/or in cancer therapy. Between now and 2015, however, many more cancer deaths can be averted by concerted action to control tobacco and obesity, by redoubling efforts in mammography and colorectal screening, and by enacting policies to close gaps in access to cancer detection and treatment services.

Declining Mortality Inequality within Cities during the Health Transition.

PubMed

Costa, Dora L; Kahn, Matthew E

2015-05-01

In the United States in the late 19th and early 20th century, large cities had extremely high death rates from infectious disease. Within major cities such as New York City and Philadelphia, there was significant variation at any point in time in the mortality rate across neighborhoods. Between 1900 and 1930 neighborhood mortality convergence took place in New York City and Philadelphia. We document these trends and discuss their consequences for neighborhood quality of life dynamics and the economic incidence of who gains from effective public health interventions.

High Exercise Capacity Attenuates the Risk of Early Mortality After a First Myocardial Infarction: The Henry Ford Exercise Testing (FIT) Project.

PubMed

Shaya, Gabriel E; Al-Mallah, Mouaz H; Hung, Rupert K; Nasir, Khurram; Blumenthal, Roger S; Ehrman, Jonathan K; Keteyian, Steven J; Brawner, Clinton A; Qureshi, Waqas T; Blaha, Michael J

2016-02-01

To examine the effect of objectively measured exercise capacity (EC) on early mortality (EM) after a first myocardial infarction (MI). This retrospective cohort study included 2061 patients without a history of MI (mean age, 62±12 years; 38% [n=790] women; 56% [n=1153] white) who underwent clinical treadmill stress testing in the Henry Ford Health System from January 1, 1991, through May 31, 2009, and suffered MI during follow-up (MI event proportion, 3.4%; mean time from the exercise test to MI, 6.1±4.3 years). Exercise capacity was categorized on the basis of peak metabolic equivalents (METs) achieved: less than 6, 6 to 9, 10 to 11, and 12 or more METs. Early mortality was defined as all-cause mortality within 28, 90, or 365 days of MI. Multivariable logistic regression models were used to assess the effect of EC on the risk of mortality at each time point post-MI adjusting for baseline demographic characteristics, cardiovascular risk factors, medication use, indication for stress testing, and year of MI. The 28-day EM rate was 10.6% overall, and 13.9%, 10.7%, 6.9%, and 6.0% in the less than 6, 6 to 9, 10 to 11, and 12 or more METs categories, respectively (P<.001). Patients who died were more likely to be older, be less fit, be nonobese, have treated hypertension, and have a longer duration from baseline to incident MI (P<.05). Adjusted regression analyses revealed a decreased risk of EM with increasing EC categories. A 1-MET higher EC was associated with an 8% to 10% lower risk of mortality across all time points (28 days: odds ratio [OR], 0.92; 95% CI, 0.87-0.98; P=.006; 90 days: OR, 0.90; 95% CI, 0.86-0.95; P<.001; 365 days: OR, 0.91; 95% CI, 0.87-0.94; P<.001). Higher baseline EC was independently associated with a lower risk of early death after a first MI. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Sodium Butyrate Improves Locomotor Impairment and Early Mortality in a Rotenone-Induced Drosophila Model of Parkinson’s Disease

PubMed Central

St. Laurent, Robyn; O’Brien, Liam M.; Ahmad, S. Tariq

2013-01-01

Parkinson’s disease (PD) is a neurodegenerative disorder primarily affecting the dopaminergic neurons in the nigrastriatal pathway resulting in debilitating motor impairment in both familial and sporadic cases. Histone deacetylase (HDAC) inhibitors have been recently implicated as a therapeutic candidate because of their ability to correct the disrupted HDAC activity in PD and other neurodegenerative diseases. Sodium butyrate (SB), an HDAC inhibitor, reduces degeneration of dopaminergic neurons in a mutant alpha-synuclein Drosophila transgenic model of familial PD. Chronic exposure to the pesticide rotenone also causes selective degeneration of dopaminergic neurons and causes locomotor impairment and early mortality in a Drosophila model of chemically-induced PD. This study investigated the effects of sodium butyrate on locomotor impairment and early mortality in a rotenone-induced PD model. We show that treatment with 10 mM SB-supplemented food rescued the rotenone-induced locomotor impairment and early mortality in flies. Additionally, flies with the genetic knockdown of HDAC activity through Sin3A loss-of-function mutation (Sin3Alof) were resistant to rotenone-induced locomotor impairment and early mortality. Furthermore, SB-supplemented Sin3Alof flies had a modest additive effect for improving locomotor impairment. We also show SB-mediated improvement of rotenone-induced locomotor impairment was associated with elevated dopamine levels in the brain. However, the possibility of SB-mediated protective role through mechanisms independent from dopamine system is also discussed. These findings demonstrate that HDAC inhibitors like SB can ameliorate locomotor impairment in a rotenone-induced PD model. PMID:23623990

Early-life reproduction is associated with increased mortality risk but enhanced lifetime fitness in pre-industrial humans

PubMed Central

Hayward, Adam D.; Nenko, Ilona; Lummaa, Virpi

2015-01-01

The physiology of reproductive senescence in women is well understood, but the drivers of variation in senescence rates are less so. Evolutionary theory predicts that early-life investment in reproduction should be favoured by selection at the cost of reduced survival and faster reproductive senescence. We tested this hypothesis using data collected from preindustrial Finnish church records. Reproductive success increased up to age 25 and was relatively stable until a decline from age 41. Women with higher early-life fecundity (ELF; producing more children before age 25) subsequently had higher mortality risk, but high ELF was not associated with accelerated senescence in annual breeding success. However, women with higher ELF experienced faster senescence in offspring survival. Despite these apparent costs, ELF was under positive selection: individuals with higher ELF had higher lifetime reproductive success. These results are consistent with previous observations in both humans and wild vertebrates that more births and earlier onset of reproduction are associated with reduced survival, and with evolutionary theory predicting trade-offs between early reproduction and later-life survival. The results are particularly significant given recent increases in maternal ages in many societies and the potential consequences for offspring health and fitness. PMID:25740893

Excess mortality rate associated with hepatitis C virus infection: A community-based cohort study in rural Egypt.

PubMed

Mostafa, Aya; Shimakawa, Yusuke; Medhat, Ahmed; Mikhail, Nabiel N; Chesnais, Cédric B; Arafa, Naglaa; Bakr, Iman; El Hoseiny, Mostafa; El-Daly, Mai; Esmat, Gamal; Abdel-Hamid, Mohamed; Mohamed, Mostafa K; Fontanet, Arnaud

2016-06-01

>80% of people chronically infected with hepatitis C virus (HCV) live in resource-limited countries, yet the excess mortality associated with HCV infection in these settings is poorly documented. Individuals were recruited from three villages in rural Egypt in 1997-2003 and their vital status was determined in 2008-2009. Mortality rates across the cohorts were compared according to HCV status: chronic HCV infection (anti-HCV antibody positive and HCV RNA positive), cleared HCV infection (anti-HCV antibody positive and HCV RNA negative) and never infected (anti-HCV antibody negative). Data related to cause of death was collected from a death registry in one village. Among 18,111 survey participants enrolled in 1997-2003, 9.1% had chronic HCV infection, 5.5% had cleared HCV infection, and 85.4% had never been infected. After a mean time to follow-up of 8.6years, vital status was obtained for 16,282 (89.9%) participants. When compared to those who had never been infected with HCV in the same age groups, mortality rate ratios (MRR) of males with chronic HCV infection aged <35, 35-44, and 45-54years were 2.35 (95% CI 1.00-5.49), 2.87 (1.46-5.63), and 2.22 (1.29-3.81), respectively. No difference in mortality rate was seen in older males or in females. The all-cause mortality rate attributable to chronic HCV infection was 5.7% (95% CI: 1.0-10.1%), while liver-related mortality was 45.5% (11.3-66.4%). Use of a highly potent new antiviral agent to treat all villagers with positive HCV RNA may reduce all-cause mortality rate by up to 5% and hepatic mortality by up to 40% in rural Egypt. Copyright © 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Cancer mortality rates and spillover effects among different areas: A case study in Campania (southern Italy).

PubMed

Agovino, Massimiliano; Aprile, Maria Carmela; Garofalo, Antonio; Mariani, Angela

2018-05-01

The present study analyses the spatial distribution of cancer mortality rates in Campania (an Italian region with the highest population density), in which residents in several areas are exposed to major environmental health hazards. The paper has the methodological aims of verifying the existence, or otherwise, of a spatial correlation between mortality from different types of cancer and the occurrence of some specific area characteristics, using both Bayesian statistics and spatial econometrics. We show that the use of the Spatial Empirical Bayes Smoothed Rate, instead of the more commonly used Raw Rate, allows a more comprehensive analysis of the mortality rate, highlighting the existence of different cluster sizes throughout the region, according to the type of cancer mortality rate analysed. By using a Spatial Durbin model we verify that cancer mortality rates are related to the environmental characteristics of specific areas with spatial spillover effects. Our results validate the hypothesis that living along the coast by Mt Vesuvius and, to a lesser extent, along the Domitio-Flegreo coast NW of Naples and in more urbanised municipalities, increases the risk of dying of cancer. By contrast, living in less urbanised municipalities, with the presence of natural and historical attractions, has a positive effect on the residents' health, reducing their risk of disease. In both cases significant spillover effects (negative and positive) are found in municipalities close to the areas in question. Despite a number of reasonable limitations, our findings may provide useful information support for policy makers to foster knowledge, awareness and informed participation of citizens. Copyright © 2018 Elsevier Ltd. All rights reserved.

Modelling infant mortality rate in Central Java, Indonesia use generalized poisson regression method

NASA Astrophysics Data System (ADS)

Prahutama, Alan; Sudarno

2018-05-01

The infant mortality rate is the number of deaths under one year of age occurring among the live births in a given geographical area during a given year, per 1,000 live births occurring among the population of the given geographical area during the same year. This problem needs to be addressed because it is an important element of a country’s economic development. High infant mortality rate will disrupt the stability of a country as it relates to the sustainability of the population in the country. One of regression model that can be used to analyze the relationship between dependent variable Y in the form of discrete data and independent variable X is Poisson regression model. Recently The regression modeling used for data with dependent variable is discrete, among others, poisson regression, negative binomial regression and generalized poisson regression. In this research, generalized poisson regression modeling gives better AIC value than poisson regression. The most significant variable is the Number of health facilities (X1), while the variable that gives the most influence to infant mortality rate is the average breastfeeding (X9).

[The analysis of the trend of mortality rate of falls in China from 1990 to 2015].

PubMed

Ye, P P; Er, Y L; Jin, Y; Duan, L L

2018-05-06

Objective: To understand the status and trend of the mortality rate of falls in different gender, age groups and provinces in China from 1990 to 2015, to explore the number of subgroups of different trends in all provinces, and to determine the different trajectory of subgroups. Methods: Using the mortality rate of falls in China from 1990 to 2015 from the Global Disease Burden 2015 (data covers 31 provinces, autonomous regions, municipalities, as well as Hong Kong and Macau Special Administrative Regions, excluding Taiwan Province) to describe the status of the mortality rate of falls in different gender, age group and provinces in China 2015 and to calculate the corresponding relative change. Using log linear model to calculate the annual percent changes from 1990 to 2015. The number of subgroups and corresponding characteristics of different trajectories were analyzed by trajectory model to analyze with four indicators, P value of the coefficient of independent variables with different orders in all subgroups, Bayesian information criterion, log Bayes factor and average posterior probability. Results: In 2015, the age standardized mortality rate of falls in China was 8.38/100 000 (95 %UI : 5.54/100 000-9.30/100 000), which was higher in men (10.81/100 000, 95 %UI : 6.58/100 000-12.14/100 000) than that in women (5.84/100 000,95 %UI : 3.41/100 000-6.62/100 000), and in the elderly aged 70-year-old and above (60.50/100 000, 95 %UI : 38.36/100 000-67.75/100 000) than that in other age groups. From 1990 to 2015, there was no obvious change in the age standardized mortality rate of falls in total population, men and women with average percent change about 0.37 (95 %UI : -0.08-0.83), 0.45 (95 %UI : 0.05-0.84) and 0.31 (95 %UI : -0.26-0.87) respectively, but a significant decrease and increase could be seen in children under 15-year-old, especially under 5-year-old with average percent change about -4.07 (95 %UI : -5.62--2.51), and the elderly aged 70-year-old and

Extreme all-cause mortality in JUPITER requires reexamination of vital records.

PubMed

Serebruany, Victor L

2011-01-01

To compare all-cause mortality in JUPITER with other statin trials at 21 months of follow-up. Outcome advantages including all-cause mortality reduction yielded from the JUPITER trial support aggressive use of rosuvastatin and, perhaps by extension, other statins for primary prevention. Despite enrolling apparently healthy subjects and early trial termination at 21 months of mean follow-up, JUPITER revealed very high all-cause mortality in both the placebo (2.8%) and rosuvastatin (2.2%) arms. Comparison of all-cause mortality prorated for 21 months in 10 primary prevention studies and 1 acute coronary syndromes statin trial. The all-cause mortality in JUPITER was more than twice that of the average of primary prevention studies, matching well only with specific trials designed in diabetics (ASPEN or CARDS), early hypertension studies (ALLHAT-LLT) or a trial in patients with acute coronary syndromes (PROVE IT). Since the 'play of chance' is unlikely to explain these discrepancies due to excellent baseline match, excess death rates and all-cause mortality rates in both JUPITER arms must be questioned. It may be important that the study sponsor self-monitored sites. Excess all-cause mortality rates in the apparently relatively healthy JUPITER population are alarming and require independent verification. If, indeed, the surprising outcomes in JUPITER are successfully challenged, and considering established harm of statins with regard to rhabdomyolysis as well as, potentially, diabetes, millions of patients may find better and safer options for primary prevention of vascular events. Copyright © 2011 S. Karger AG, Basel.

Modelling small-area inequality in premature mortality using years of life lost rates

NASA Astrophysics Data System (ADS)

Congdon, Peter

2013-04-01

Analysis of premature mortality variations via standardized expected years of life lost (SEYLL) measures raises questions about suitable modelling for mortality data, especially when developing SEYLL profiles for areas with small populations. Existing fixed effects estimation methods take no account of correlations in mortality levels over ages, causes, socio-ethnic groups or areas. They also do not specify an underlying data generating process, or a likelihood model that can include trends or correlations, and are likely to produce unstable estimates for small-areas. An alternative strategy involves a fully specified data generation process, and a random effects model which "borrows strength" to produce stable SEYLL estimates, allowing for correlations between ages, areas and socio-ethnic groups. The resulting modelling strategy is applied to gender-specific differences in SEYLL rates in small-areas in NE London, and to cause-specific mortality for leading causes of premature mortality in these areas.

The mortality and hospitalization rates associated with the long interdialytic gap in thrice-weekly hemodialysis patients.

PubMed

Fotheringham, James; Fogarty, Damian G; El Nahas, Meguid; Campbell, Michael J; Farrington, Ken

2015-09-01

Excess mortality and hospitalization have been identified after the 2-day gap in thrice-weekly hemodialysis patients compared with 1-day intervals, although findings vary internationally. Here we aimed to identify factors associated with mortality and hospitalization events in England using an incident cohort of 5864 hemodialysis patients from years 2002 to 2006 inclusive in the UK Renal Registry linked to hospitalization data. Higher admission rates were seen after the 2-day gap irrespective of whether thrice-weekly dialysis sequence commenced on a Monday or Tuesday (2.4 per year after the 2-day gap vs. 1.4 for the rest of the week, rate ratio 1.7). The greatest differences in admission rates were seen in patients admitted with fluid overload or with conditions associated with a high risk of fluid overload. Increased mortality following the 2-day gap was similarly independent of session pattern (20.5 vs. 16.7 per 100 patient years, rate ratio 1.22), with these increases being driven by out-of-hospital death (rate ratio 1.59 vs. 1.06 for in-hospital death). Non-white patients had an overall survival advantage, with the increased mortality after the 2-day gap being found only in whites. Thus, fluid overload may increase the risk of hospital admission after the 2-day gap and that the increased out-of-hospital mortality may relate to a higher incidence of sudden death. Future work should focus on exploring interventions in these subgroups.

Can better infrastructure and quality reduce hospital infant mortality rates in Mexico?

PubMed

Aguilera, Nelly; Marrufo, Grecia M

2007-02-01

Preliminary evidence from hospital discharges hints enormous disparities in infant hospital mortality rates. At the same time, public health agencies acknowledge severe deficiencies and variations in the quality of medical services across public hospitals. Despite these concerns, there is limited evidence of the contribution of hospital infrastructure and quality in explaining variations in outcomes among those who have access to medical services provided at public hospitals. This paper provides evidence to address this question. We use probabilistic econometric methods to estimate the impact of material and human resources and hospital quality on the probability that an infant dies controlling for socioeconomic, maternal and reproductive risk factors. As a measure of quality, we calculate for the first time for Mexico patient safety indicators developed by the AHRQ. We find that the probability to die is affected by hospital infrastructure and by quality. In this last regard, having been treated in a hospital with the worse quality incidence doubles the probability to die. This paper also presents evidence on the contribution of other risk factors on perinatal mortality rates. The conclusions of this paper suggest that lower infant mortality rates can be reached by implementing a set of coherent public policy actions including an increase and reorganization of hospital infrastructure, quality improvement, and increasing demand for health by poor families.

Despite Access to Antiretrovirals for Prevention and Treatment, High Rates of Mortality Persist Among HIV-infected Infants and Young Children.

PubMed

Abrams, Elaine J; Woldesenbet, Selamawit; Soares Silva, Juliana; Coovadia, Ashraf; Black, Viviane; Technau, Karl-Günter; Kuhn, Louise

2017-06-01

Outcomes of HIV-infected children before widespread use of antiretroviral therapy (ART) for treatment and prevention of mother-to-child transmission (PMTCT) have been well characterized but less is known about children who acquire HIV infection in the context of good ART access. We enrolled newly diagnosed HIV-infected children ≤24 months of age at 3 hospitals and 2 clinics in Johannesburg, South Africa. We report ART initiation and mortality rates during 6 months from enrollment and factors associated with mortality. Of 272 children enrolled, median age 6.1 months, 69.5% were diagnosed during hospitalization. By 6 months postenrollment, 53 (19.5%) died and 73 (26.8%) were lost-to-follow-up. Using Kaplan-Meier analysis, the probability of death by 6 months after enrollment was 23.5%. The median age of death was 9.1 months [95% confidence interval (CI): 8.6-12.0]. Overall, 226 (83%) children initiated ART which was associated with a 71% reduction in risk of death [hazard ratio (HR) = 0.29 (95% CI: 0.15-0.58)]. In multivariable analysis of infant factors, weight-for-age Z score < -2 standard deviation (SD) [HR = 2.43 (95% CI: 1.03-5.73)], CD4 <20% [HR = 3.29 (95% CI: 1.60-6.76)] and identification during hospitalization [HR = 2.89 (95% CI: 1.16-7.25)] were independently associated with mortality. In multivariable analysis of maternal factors, CD4 ≤350/no maternal ART was associated with increased mortality risk [HR = 2.57 (95% CI: 1.19-5.59)] versus CD4 >350/no maternal ART; exposure to maternal/infant antiretrovirals for PMTCT was associated with reduced mortality risk [HR = 0.53 (95% CI: 0.28-0.99)] versus no PMTCT. ART initiation is highly protective against death in young children. However, despite improved access to ART, young children remain at risk for early death; innovative approaches to rapidly diagnose and initiate treatment as early in life as possible are needed.

Rate of Contrast Extravasation on CT Angiography Predicts Hematoma Expansion and Mortality in Primary Intracerebral Hemorrhage

PubMed Central

Brouwers, H. Bart; Battey, Thomas W.K.; Musial, Hayley H.; Ciura, Viesha A.; Falcone, Guido J.; Ayres, Alison M.; Vashkevich, Anastasia; Schwab, Kristin; Viswanathan, Anand; Anderson, Christopher D.; Greenberg, Steven M.; Pomerantz, Stuart R.; Ortiz, Claudia J.; Goldstein, Joshua N.; Gonzalez, R. Gilberto; Rosand, Jonathan; Romero, Javier M.

2015-01-01

Background and Purpose In primary intracerebral hemorrhage (ICH), the presence of contrast extravasation following CT angiography (CTA), termed the ‘spot sign’, predicts hematoma expansion and mortality. Since the biological underpinnings of the spot sign are not fully understood, we investigated whether the rate of contrast extravasation - which may reflect the rate of bleeding - predicts expansion and mortality beyond the simple presence of the spot sign. Methods Consecutive ICH patients with first-pass CTA followed by a 90-second delayed post-contrast CT (delayed CTA) were included. CTAs were reviewed for spot sign presence by two blinded readers. Spot sign volumes on first-pass and delayed CTA and ICH volumes were measured using semi-automated software. Extravasation rates were calculated and tested for association with hematoma expansion and mortality using uni- and multivariable logistic regression. Results 162 patients were included, 48 (30%) of whom had ≥1 spot sign. Median spot sign volume was 0.04mL on first-pass CTA and 0.4mL on delayed CTA. Median extravasation rate was 0.23mL/min overall, and 0.30mL/min among expanders versus 0.07mL/min in non-expanders. Extravasation rates were also significantly higher in patients who died in hospital: 0.27mL/min versus 0.04mL/min. In multivariable analysis, the extravasation rate was independently associated with in-hospital mortality (OR1.09 [95%CI 1.04–1.18], p=0.004), 90-day mortality (OR1.15 [95%CI 1.08–1.27], p=0.0004), and hematoma expansion (OR1.03 [95%CI 1.01–1.08], p=0.047). Conclusions Contrast extravasation rate, or spot sign growth, further refines the ability to predict hematoma expansion and mortality. Our results support the hypothesis that the spot sign directly measures active bleeding in acute ICH. PMID:26243220

Pre-epidemic mortality rates for common Phytophthora ramorum host tree species in California

Treesearch

T.M. Barrett

2006-01-01

Understanding the impacts of Phytophthora ramorum on forests will require knowledge of pre-disease distribution, abundance, and rates of change for affected species. This study estimated pre-epidemic mortality rates for nine common host tree species: bigleaf maple (Acer macrophyllum), California bay laurel (Umbellularia...

The trend in mental health-related mortality rates in Australia 1916-2004: implications for policy

PubMed Central

2010-01-01

Background This study determines the trend in mental health-related mortality (defined here as the aggregation of suicide and deaths coded as "mental/behavioural disorders"), and its relative numerical importance, and to argue that this has importance to policy-makers. Its results will have policy relevance because policy-makers have been predominantly concerned with cost-containment, but a re-appraisal of this issue is occurring, and the trade-off between health expenditures and valuable gains in longevity is being emphasised now. This study examines longevity gains from mental health-related interventions, or their absence, at the population level. The study sums mortality data for suicide and mental/behavioural disorders across the relevant ICD codes through time in Australia for the period 1916-2004. There are two measures applied to the mortality rates: the conventional age-standardised headcount; and the age-standardised Potential Years of Life Lost (PYLL), a measure of premature mortality. Mortality rates formed from these data are analysed via comparisons with mortality rates for All Causes, and with circulatory diseases, cancer and motor vehicle accidents, measured by both methods. Results This study finds the temporal trend in mental health-related mortality rates (which reflects the longevity of people with mental illness) has worsened through time. There are no gains. This trend contrasts with the (known) gains in longevity from All Causes, and the gains from decreases achieved in previously rising mortality rates from circulatory diseases and motor vehicle accidents. Also, PYLL calculation shows mental health-related mortality is a proportionately greater cause of death compared with applying headcount metrics. Conclusions There are several factors that could reverse this trend. First, improved access to interventions or therapies for mental disorders could decrease the mortality analysed here. Second, it is important also that new efficacious

Change in Self-Rated Health and Mortality among Community-Dwelling Disabled Older Women

ERIC Educational Resources Information Center

Han, Beth; Phillips, Caroline; Ferrucci, Luigi; Bandeen-Roche, Karen; Jylha, Marja; Kasper, Judith; Guralnik, Jack M.

2005-01-01

Purpose: Our study assessed whether change in self-rated health is a stronger predictor of mortality than baseline self-rated health and the most recent self-rated health (prior to death or loss to follow-up) among disabled older women. Design and Methods: The Women's Health and Aging Study examined disabled older women at baseline and every 6…

Misery Loves Company? A Meta-Regression Examining Aggregate Unemployment Rates and the Unemployment-Mortality Association

PubMed Central

Roelfs, David J.; Shor, Eran; Blank, Aharon; Schwartz, Joseph E.

2015-01-01

PURPOSE Individual-level unemployment has been consistently linked to poor health and higher mortality, but some scholars have suggested that the negative effect of job loss may be lower during times and in places where aggregate unemployment rates are high. We review three logics associated with this moderation hypothesis: health selection, social isolation, and unemployment stigma. We then test whether aggregate unemployment rates moderate the individual-level association between unemployment and all-cause mortality. METHODS We use 6 meta-regression models (each utilizing a different measure of the aggregate unemployment rate) based on 62 relative all-cause mortality risk estimates from 36 studies (from 15 nations). RESULTS We find that the magnitude of the individual-level unemployment-mortality association is approximately the same during periods of high and low aggregate-level unemployment. Model coefficients (exponentiated) were 1.01 for the crude unemployment rate (p = 0.27), 0.94 for the change in unemployment rate from the previous year (p = 0.46), 1.01 for the deviation of the unemployment rate from the 5-year running average (p = 0.87), 1.01 for the deviation of the unemployment rate from the 10-year running average (p = 0.73), 1.01 for the deviation of the unemployment rate from the overall average (measured as a continuous variable; p = 0.61), and showed no variation across unemployment levels when the deviation of the unemployment rate from the overall average was measured categorically. Heterogeneity between studies was significant (p < .001), supporting the use of the random effects model. CONCLUSIONS We found no strong evidence to suggest that unemployment experiences change when macro-economic conditions change. Efforts to ameliorate the negative social and economic consequences of unemployment should continue to focus on the individual and should be maintained regardless of periodic changes in macro-economic conditions. PMID:25795225

Misery loves company? A meta-regression examining aggregate unemployment rates and the unemployment-mortality association.

PubMed

Roelfs, David J; Shor, Eran; Blank, Aharon; Schwartz, Joseph E

2015-05-01

Individual-level unemployment has been consistently linked to poor health and higher mortality, but some scholars have suggested that the negative effect of job loss may be lower during times and in places where aggregate unemployment rates are high. We review three logics associated with this moderation hypothesis: health selection, social isolation, and unemployment stigma. We then test whether aggregate unemployment rates moderate the individual-level association between unemployment and all-cause mortality. We use six meta-regression models (each using a different measure of the aggregate unemployment rate) based on 62 relative all-cause mortality risk estimates from 36 studies (from 15 nations). We find that the magnitude of the individual-level unemployment-mortality association is approximately the same during periods of high and low aggregate-level unemployment. Model coefficients (exponentiated) were 1.01 for the crude unemployment rate (P = .27), 0.94 for the change in unemployment rate from the previous year (P = .46), 1.01 for the deviation of the unemployment rate from the 5-year running average (P = .87), 1.01 for the deviation of the unemployment rate from the 10-year running average (P = .73), 1.01 for the deviation of the unemployment rate from the overall average (measured as a continuous variable; P = .61), and showed no variation across unemployment levels when the deviation of the unemployment rate from the overall average was measured categorically. Heterogeneity between studies was significant (P < .001), supporting the use of the random effects model. We found no strong evidence to suggest that unemployment experiences change when macroeconomic conditions change. Efforts to ameliorate the negative social and economic consequences of unemployment should continue to focus on the individual and should be maintained regardless of periodic changes in macroeconomic conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

Mortality of spruce and fir in Maine in 1976-78 due to the spruce budworm outbreak

Treesearch

Donald W. Seegrist; Stanford L. Arner

1982-01-01

The spruce budworm population in Maine's spruce-fir forests has been at epidemic levels since the early 1970's. Spruce-fir mortality in 1976-78 is compared with predictions of what mortality would have been had the natural mortality rates remained at the levels experienced before the budworm outbreak. It appears that mortality of spruce and fir has increased...

Cardiac and peripheral adjustments induced by early exercise training intervention were associated with autonomic improvement in infarcted rats: role in functional capacity and mortality.

PubMed

Jorge, Luciana; Rodrigues, Bruno; Rosa, Kaleizu Teodoro; Malfitano, Christiane; Loureiro, Tatiana Carolina Alba; Medeiros, Alessandra; Curi, Rui; Brum, Patricia Chakur; Lacchini, Silvia; Montano, Nicola; De Angelis, Kátia; Irigoyen, Maria-Cláudia

2011-04-01

To test the effects of early exercise training (ET) on left ventricular (LV) and autonomic functions, haemodynamics, tissues blood flows (BFs), maximal oxygen consumption (VO(2) max), and mortality after myocardial infarction (MI) in rats. Male Wistar rats were divided into: control (C), sedentary-infarcted (SI), and trained-infarcted (TI). One week after MI, TI group underwent an ET protocol (90 days, 50-70% VO(2) max). Left ventricular function was evaluated non-invasively and invasively. Baroreflex sensitivity, heart rate variability, and pulse interval were measured. Cardiac output (CO) and regional BFs were determined using coloured microspheres. Infarcted area was reduced in TI (19 ± 6%) compared with SI (34 ± 5%) after ET. Exercise training improved the LV and autonomic functions, the CO and regional BF changes induced by MI, as well as increased SERCA2 expression and mRNA vascular endothelial growth factor levels. These changes brought about by ET resulted in mortality rate reduction in the TI (13%) group compared with the SI (54%) group. Early aerobic ET reduced cardiac and peripheral dysfunctions and preserved cardiovascular autonomic control after MI in trained rats. Consequently, these ET-induced changes resulted in improved functional capacity and survival after MI.

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

Low infant mortality among Palestine refugees despite the odds

PubMed Central

Khader, Ali; Sabatinelli, Guido

2011-01-01

Abstract Objective To present data from a 2008 infant mortality survey conducted in Jordan, Lebanon, the Syrian Arab Republic, the Gaza Strip and the West Bank and analyse infant mortality trends among Palestine refugees in 1995–2005. Methods Following the preceding birth technique, mothers who were registering a new birth were asked if the preceding child was alive or dead, the day the child was born and the date of birth of the neonate whose birth was being registered. From this information, neonatal, infant and early child mortality rates were estimated. The age at death for early child mortality was determined by the mean interval between successive births and the mean age of neonates at registration. Findings In 2005–2006, infant mortality among Palestine refugees ranged from 28 deaths per 100 000 live births in the Syrian Arab Republic to 19 in Lebanon. Thus, infant mortality in Palestine refugees is among the lowest in the Near East. However, infant mortality has stopped decreasing in recent years, although it remains at a level compatible with the attainment of Millennium Development Goal 4. Conclusion Largely owing to the primary health care provided by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East and other entities, infant mortality among Palestine refugees had consistently decreased. However, it is no longer dropping. Measures to address the most likely reasons – early marriage and childbearing, poor socioeconomic conditions and limited access to good perinatal care – are needed. PMID:21479095

Early risk of mortality after coronary artery revascularization in patients with left ventricular dysfunction and potential role of the wearable cardioverter defibrillator.

PubMed

Zishiri, Edwin T; Williams, Sarah; Cronin, Edmond M; Blackstone, Eugene H; Ellis, Stephen G; Roselli, Eric E; Smedira, Nicholas G; Gillinov, A Marc; Glad, Jo Ann; Tchou, Patrick J; Szymkiewicz, Steven J; Chung, Mina K

2013-02-01

Implantation of implantable cardioverter defibrillator for prevention of sudden cardiac death is deferred for 90 days after coronary revascularization, but mortality may be highest early after cardiac procedures in patients with ventricular dysfunction. We determined mortality risk in postrevascularization patients with left ventricular ejection fraction ≤35% and compared survival with those discharged with a wearable cardioverter defibrillator (WCD). Hospital survivors after surgical (coronary artery bypass graft surgery) or percutaneous (percutaneous coronary intervention [PCI]) revascularization with left ventricular ejection fraction ≤35% were included from Cleveland Clinic and national WCD registries. Kaplan-Meier, Cox proportional hazards, propensity score-matched survival, and hazard function analyses were performed. Early mortality hazard was higher among 4149 patients discharged without a defibrillator compared with 809 with WCDs (90-day mortality post-coronary artery bypass graft surgery 7% versus 3%, P=0.03; post-PCI 10% versus 2%, P<0.0001). WCD use was associated with adjusted lower risks of long-term mortality in the total cohort (39%, P<0.0001) and both post-coronary artery bypass graft surgery (38%, P=0.048) and post-PCI (57%, P<0.0001) cohorts (mean follow-up, 3.2 years). In propensity-matched analyses, WCD use remained associated with lower mortality (58% post-coronary artery bypass graft surgery, P=0.002; 67% post-PCI, P<0.0001). Mortality differences were not attributable solely to therapies for ventricular arrhythmia. Only 1.3% of the WCD group had a documented appropriate therapy. Patients with left ventricular ejection fraction ≤35% have higher early compared to late mortality after coronary revascularization, particularly after PCI. As early hazard seemed less marked in WCD users, prospective studies in this high-risk population are indicated to confirm whether WCD use as a bridge to left ventricular ejection fraction improvement or

Changes in U.S. Hospitalization and Mortality Rates following Smoking Bans

ERIC Educational Resources Information Center

Shetty, Kanaka D.; DeLeire, Thomas; White, Chapin; Bhattacharya, Jayanta

2011-01-01

U.S. state and local governments have increasingly adopted restrictions on smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short-term changes in mortality and hospitalization rates in smoking-restricted regions with control regions. In contrast with smaller…

Evaluating mortality rates with a novel integrated framework for nonmonogamous species.

PubMed

Tenan, Simone; Iemma, Aaron; Bragalanti, Natalia; Pedrini, Paolo; De Barba, Marta; Randi, Ettore; Groff, Claudio; Genovart, Meritxell

2016-12-01

The conservation of wildlife requires management based on quantitative evidence, and especially for large carnivores, unraveling cause-specific mortalities and understanding their impact on population dynamics is crucial. Acquiring this knowledge is challenging because it is difficult to obtain robust long-term data sets on endangered populations and, usually, data are collected through diverse sampling strategies. Integrated population models (IPMs) offer a way to integrate data generated through different processes. However, IPMs are female-based models that cannot account for mate availability, and this feature limits their applicability to monogamous species only. We extended classical IPMs to a two-sex framework that allows investigation of population dynamics and quantification of cause-specific mortality rates in nonmonogamous species. We illustrated our approach by simultaneously modeling different types of data from a reintroduced, unhunted brown bear (Ursus arctos) population living in an area with a dense human population. In a population mainly driven by adult survival, we estimated that on average 11% of cubs and 61% of adults died from human-related causes. Although the population is currently not at risk, adult survival and thus population dynamics are driven by anthropogenic mortality. Given the recent increase of human-bear conflicts in the area, removal of individuals for management purposes and through poaching may increase, reversing the positive population growth rate. Our approach can be generalized to other species affected by cause-specific mortality and will be useful to inform conservation decisions for other nonmonogamous species, such as most large carnivores, for which data are scarce and diverse and thus data integration is highly desirable. © 2016 Society for Conservation Biology.

Factors Influencing The Six-Month Mortality Rate In Patients With A Hip Fracture

PubMed Central

Ristic, Branko; Rancic, Nemanja; Bukumiric, Zoran; Zeljko, Stepanovic; Ignjatovic-Ristic, Dragana

2016-01-01

Abstract Background There are several potential risk factors in patients with a hip fracture for a higher rate of mortality that include: comorbid disorders, poor general health, age, male gender, poor mobility prior to injury, type of fracture, poor cognitive status, place of residence. The aim of this study was to assess the influence of potential risk factors for six-month mortality in hip fracture patients. Methods The study included all patients with a hip fracture older than 65 who had been admitted to the Clinic for orthopaedic surgery during one year. One hundred and ninety-two patients were included in the study. Results Six months after admission due to a hip fracture, 48 patients had died (6-month mortality rate was 25%). The deceased were statistically older than the patients who had survived. Univariate regression analysis indicated that six variables had a significant effect on hip fracture patients’ survival: age, mobility prior to the fracture, poor cognitive status, activity of daily living, comorbidities and the place where they had fallen. Multivariate regression modelling showed that the following factors were independently associated with mortality at 6 months post fracture: poor cognitive status, poor mobility prior to the fracture, comorbid disease. Conclusion Poor cognitive status appeared to be the strongest mortality predictor. The employment of brief tests for cognitive status evaluation would enable orthopaedists to have good criteria for the choice of treatment for each patient screened. PMID:27284379

Risk factors for and perinatal mortality of abruptio placentae in patients hospitalised for early onset severe pre-eclampsia - a case controlled study.

PubMed

Odendaal, H J; Hall, D R; Grové, D

2000-07-01

We set out to determine which patients admitted for expectant management of early onset severe pre-eclampsia develop abruptio placentae and to compare the perinatal mortality rate of patients who developed abruptio placentae with those who did not have this complication. This was a case controlled study, using gestational age at delivery to select a control group for 69 patients who developed abruptio placentae. The only significant difference on admission was the higher uric acid levels in patients who developed abruptio placentae. Mean admission to delivery intervals were 11.9 and 8.8 days for the control and abruption groups respectively (P = 0.0083). Fifty-eight per cent of the babies in the abruptio placentae group developed late decelerations, as determined by fetal heart rate monitoring compared with 32% in the control group. Lactate dehydrogenase levels before delivery were significantly higher in the abruption group, but it only became elevated shortly before delivery and in the minority of cases. There were two intrauterine and four neonatal deaths in the abruption group and two neonatal deaths in the control group. Late decelerations detected by frequent fetal heart rate monitoring in patients with early onset severe pre-eclampsia is the only early warning of abruptio placentae.

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data.

PubMed

de Jonge, Ank; Baron, Ruth; Westerneng, Myrte; Twisk, Jos; Hutton, Eileen K

2013-08-01

the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking. secondary analyses using published data from the Euro-PERISTAT study. women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term). odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data. combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births. compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3). the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Needs Assessment of Health Issues Related to Maternal Mortality Rates in Afghanistan: A Pilot Study.

PubMed

Naim, Ali; Feldman, Robert; Sawyer, Robin

2015-01-01

Maternal death rates in Afghanistan were among the highest in the world during the reign of the Taliban. Although these figures have improved, current rates are still alarming. The aim of this pilot study was to develop a needs assessment of the major health issues related to the high maternal mortality rates in Afghanistan. In-depth interviews were conducted with managerial midwives, clinical midwives, and mothers. Results of the interviews indicate that the improvement in the maternal mortality rate may be attributed to the increase in the involvement of midwives in the birthing process. However, barriers to decreasing maternal mortality still exist. These include transportation, access to care, and sociocultural factors such as the influence of the husband and mother-in-law in preventing access to midwives. Therefore, any programs to decrease maternal mortality need to address infrastructure issues (making health care more accessible) and sociocultural factors (including husbands and mother-in-laws in maternal health education). However, it should be noted that these findings are based on a small pilot study to help develop a larger scale need assessment. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Early growth rates and their relationships to mortalities of five breeds of chickens following exposure to acute gamma radiation stress

DOE Office of Scientific and Technical Information (OSTI.GOV)

Latimer, B.E.; Brisbin, I.L. Jr.

Growth and mortality responses were recorded for 541 chicks, representing five different breeds of chickens, following acute exposures to gamma radiation stress at two days of age. Although there were no statistically significant differences in the LD50/30 of the five breeds studied, Cobb broilers showed the highest (1580R) and White Leghorn bantams the lowest (980R) levels, respectively. Other breeds studied included the standard White Leghorn, Athens Randombreds and a strain of feral bantam. Growth rates of body weights were proportionately more depressed by radiation stress than were body sizes, as measured by the lengths of the culmen, tarsus, middle toemore » and longest primary wing feather of all 32 day-old survivors. Among these structures, the length of the culmen seemed to be the least affected by radiation stress in all of the breeds studied. Feral bantams were able to tolerate the greatest depression in weight gain before exhibiting mortality at exposures below their LD50/30' while Cobb broilers tolerated the greatest depression of weight gain at higher exposure levels. There was a suggestion that those characteristics which were strongly selected for in the course of a particular breed's development were those which experienced the greatest proportional depressions following exposure to gamma radiation stress.« less

The "Sapienza University Mortality and Morbidity Event Rate (SUMMER) study in diabetes": Study protocol.

PubMed

Barchetta, I; Capoccia, D; Baroni, M G; Buzzetti, R; Cavallo, M G; De Cosmo, S; Leonetti, F; Leotta, S; Morano, S; Morviducci, L; Prudente, S; Pugliese, G; Trischitta, V

2016-02-01

The rate of mortality in diabetic patients, especially of cardiovascular origin, is about twice as much that of nondiabetic individuals. Thus, the pathogenic factors shaping the risk of mortality in such patients must be unraveled in order to target intensive prevention and treatment strategies. The "Sapienza University Mortality and Morbidity Event Rate (SUMMER) study in diabetes" is aimed at identifying new molecular promoters of mortality and major vascular events in patients with type 2 diabetes mellitus (T2DM). The "SUMMER study in diabetes" is an observational, prospective, and collaborative study conducted on at least 5000 consecutive patients with T2DM, recruited from several diabetes clinics of Central-Southern Italy and followed up for a minimum of 5 years. The primary outcome is all-cause mortality; the secondary outcomes are cardiovascular mortality, acute myocardial infarction, stroke, and dialysis. A biobank will be created for genomic, transcriptomic, and metabolomic analysis, in order to unravel new molecular predictors of mortality and vascular morbidity. The "SUMMER study in diabetes" is aimed at identifying new molecular promoters of mortality and major vascular events in patients with T2DM. These novel pathogenic factors will most likely be instrumental in unraveling new pathways underlying such dramatic events. In addition, they will also be used as additional markers to increase the performance of the already existing risk-scoring models for predicting the above-mentioned outcomes in T2DM, as well as for setting up new preventive and treatment strategies, possibly tailored to specific pathogenic backgrounds. ClinicalTrials.gov, NCT02311244; URL https://clinicaltrials.gov/ct2/show/NCT02311244?term=SUMMER&rank=5. Copyright © 2015 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published

Tagging methods for estimating population size and mortality rates of inland striped bass populations

USGS Publications Warehouse

Hightower, Joseph E.; Pollock, Kenneth H.

2013-01-01

Striped bass Morone saxatilis in inland reservoirs play an important role ecologically and in supporting recreational fishing. To manage these populations, biologists need information about abundance and mortality. Abundance estimates can be used to assess the effectiveness of stocking programs that maintain most reservoir striped bass populations. Mortality estimates can indicate the relative impact of fishing versus natural mortality and the need for harvest regulation. The purpose of this chapter is to evaluate tagging studies as a way of obtaining information about abundance and mortality. These approaches can be grouped into three broad categories: tag recapture, tag return, and telemetry. Tag-recapture methods are typically used to estimate population size and other demographic parameters but are often difficult to apply in large systems. A fishing tournament can be an effective way of generating tagging or recapture effort in large systems, compared to using research sampling only. Tag-return methods that rely on angler harvest and catch and release can be used to estimate fishing (F) and natural (M) mortality rates and are a practical approach in large reservoirs. The key to success in tag-return studies is to build in auxiliary studies to estimate short-term tagging mortality, short- and longterm tag loss, reporting rate, and mortality associated with catch and release. F and M can also be estimated using telemetry tags. Advantages of this approach are that angler nonreporting does not bias estimates and fish with transmitters provide useful ecological data. Cost can be a disadvantage of telemetry studies; thus, combining telemetry tags with conventional tag returns in an integrated analysis is often the optimal approach. In summary, tagging methods can be a powerful tool for assessing the effectiveness of inland striped bass stocking programs and the relative impact of fishing versus natural mortality

Public health regulation and mortality: Evidence from early 20th century milk laws.

PubMed

Komisarow, Sarah

2017-12-01

In this paper, I estimate the impact of city-level public health regulations in the market for cow's milk on the mortality of infants and young children between 1900 and 1920. I find that the introduction of city-level dairy farm inspections reduced mortality from Diarrhea & Enteritis for one-year-old children by 1.3 annual deaths per thousand, a 14 percent effect relative to the baseline rate for this cause and a 3 percent effect relative to the baseline rate for all causes for this age group. Back-of-the-envelope calculations reveal that the benefits from these regulations exceeded costs by at least a factor of two. Copyright © 2017 Elsevier B.V. All rights reserved.

Timing and location of mortality of fledgling, subadult, and adult California Gulls

USGS Publications Warehouse

Pugesek, B.H.; Diem, K.L.

2008-01-01

We investigated patterns of mortality during post-breeding migrations of California Gulls (Larus californicus) nesting near Laramie, Wyoming, USA. We used 151 recoveries and 647 sightings of banded and patagially-marked gulls to compare ratios of mortalities to observations of live birds (1) during four time periods (early and late fall migration, winter, and spring migration), (2) at two locations (Pacific coast and inland), and (3) among three age-classes of gulls (fledglings, 1- and 2-year-olds, and breeding-age adults). Mortality rates were higher in inland areas (35%) than in coastal areas (15%) and were dependent on season within inland areas, but not in coastal areas. Mortality in inland areas during early fall (21%) was comparable with that in coastal areas (13%) but was higher during late fall (68 vs. 13%) and spring migration (46 vs. 17%). Both fledgling (71%) and adult (64%) gulls experienced high mortality rates during late fall migration, possibly because some gulls were too weak to make their way to the Pacific coast and became trapped by poor weather conditions. Adult gulls also experienced high mortality inland during spring migration; few subadults made the costly migration to and from the breeding area. Some adults also skipped breeding and remained in coastal areas during the breeding season.

Trends in corrected lung cancer mortality rates in Brazil and regions.

PubMed

Malta, Deborah Carvalho; Abreu, Daisy Maria Xavier de; Moura, Lenildo de; Lana, Gustavo C; Azevedo, Gulnar; França, Elisabeth

2016-06-27

To describe the trend in cancer mortality rates in Brazil and regions before and after correction for underreporting of deaths and redistribution of ill-defined and nonspecific causes. The study used data of deaths from lung cancer among the population aged from 30 to 69 years, notified to the Mortality Information System between 1996 and 2011, corrected for underreporting of deaths, non-registered sex and age , and causes with ill-defined or garbage codes according to sex, age, and region. Standardized rates were calculated by age for raw and corrected data. An analysis of time trend in lung cancer mortality was carried out using the regression model with autoregressive errors. Lung cancer in Brazil presented higher rates among men compared to women, and the South region showed the highest death risk in 1996 and 2011. Mortality showed a trend of reduction for males and increase for women. Lung cancer in Brazil presented different distribution patterns according to sex, with higher rates among men and a reduction in the mortality trend for men and increase for women. Descrever a tendência da mortalidade por câncer de pulmão no Brasil e regiões, antes e após as correções por sub-registro de óbitos, redistribuição de causas mal definidas e causas inespecíficas. Foram utilizados dados de óbitos por câncer de pulmão da população de 30 a 69 anos, notificados ao Sistema de Informação sobre Mortalidade, entre 1996 e 2011, corrigidos para sub-registro de óbitos, declaração de sexo e idade ignorados e causas com códigos mal definidos e inespecíficos segundo sexo, idade e região. Foram calculadas taxas padronizadas por idade para dados brutos e corrigidos. Realizou-se análise da tendência temporal da mortalidade por câncer de pulmão por meio do modelo de regressão com erros autorregressivos. O câncer de pulmão no Brasil apresentou taxas mais elevadas em homens que em mulheres e a região Sul foi a que apresentou maior risco de morte em 1996 e

Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program

PubMed Central

Jones, Stephen L.; Ashton, Carol M.; Kiehne, Lisa; Gigliotti, Elizabeth; Bell-Gordon, Charyl; Disbot, Maureen; Masud, Faisal; Shirkey, Beverly A.; Wray, Nelda P.

2016-01-01

Background Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it. Methods The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008–2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program. Results By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006–2008) to 21.1% after implementation (2009–2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care. Conclusion This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way. PMID:26484679

Age-specific excess mortality patterns and transmissibility during the 1889-1890 influenza pandemic in Madrid, Spain.

PubMed

Ramiro, Diego; Garcia, Sara; Casado, Yolanda; Cilek, Laura; Chowell, Gerardo

2018-05-01

Although the 1889-1890 influenza pandemic was one of the most important epidemic events of the 19th century, little is known about the mortality impact of this pandemic based on detailed respiratory mortality data sets. We estimated excess mortality rates for the 1889-1890 pandemic in Madrid from high-resolution respiratory and all-cause individual-level mortality data retrieved from the Gazeta de Madrid, the Official Bulletin of the Spanish government. We also generated estimates of the reproduction number from the early growth phase of the pandemic. The main pandemic wave in Madrid was evident from respiratory and all-cause mortality rates during the winter of 1889-1890. Our estimates of excess mortality for this pandemic were 58.3 per 10,000 for all-cause mortality and 44.5 per 10,000 for respiratory mortality. Age-specific excess mortality rates displayed a J-shape pattern, with school children aged 5-14 years experiencing the lowest respiratory excess death rates (8.8 excess respiratory deaths per 10,000), whereas older populations aged greater than or equal to 70 years had the highest rates (367.9 per 10,000). Although seniors experienced the highest absolute excess death rates, the standardized mortality ratio was highest among young adults aged 15-24 years. The early growth phase of the pandemic displayed dynamics consistent with an exponentially growing transmission process. Using the generalized-growth method, we estimated the reproduction number in the range of 1.2-1.3 assuming a 3-day mean generation interval and of 1.3-1.5 assuming a 4-day mean generation interval. Our study adds to our understanding of the mortality impact and transmissibility of the 1889-1890 influenza pandemic using detailed individual-level mortality data sets. More quantitative studies are needed to quantify the variability of the mortality impact of this understudied pandemic at regional and global scales. Copyright © 2017 Elsevier Inc. All rights reserved.

Adjusting the HIV prevalence for non-respondents using mortality rates in an open cohort in northwest Tanzania.

PubMed

Tenu, Filemon; Isingo, Raphael; Zaba, Basia; Urassa, Mark; Todd, Jim

2014-06-01

To estimate HIV prevalence in adults who have not tested for HIV using age-specific mortality rates and to adjust the overall population HIV prevalence to include both tested and untested adults. An open cohort study was established since 1994 with demographic surveillance system (DSS) and five serological surveys conducted. Deaths from Kisesa DSS were used to estimate mortality rates and 95% confidence intervals by HIV status for 3- 5-year periods (1995-1999, 2000-2004, and 2005-2009). Assuming that mortality rates in individuals who did not test for HIV are similar to those in tested individuals, and dependent on age, sex and HIV status and HIV, prevalence was estimated. In 1995-1999, mortality rates (per 1000 person years) were 43.7 (95% CI 35.7-53.4) for HIV positive, 2.6 (95% CI 2.1-3.2) in HIV negative and 16.4 (95% CI 14.4-18.7) in untested. In 2000-2004, mortality rates were 43.3 (95% CI 36.2-51.9) in HIV positive, 3.3 (95% CI 2.8-4.0) in HIV negative and 11.9 (95% CI 10.5-13.6) in untested. In 2005-2009, mortality rates were 30.7 (95% CI 24.8-38.0) in HIV positive, 4.1 (95% CI 3.5-4.9) in HIV negative and 5.7 (95% CI 5.0-6.6) in untested residents. In the three survey periods (1995-1999, 2000-2004, 2005-2009), the adjusted period prevalences of HIV, including the untested, were 13.5%, 11.6% and 7.1%, compared with the observed prevalence in the tested of 6.0%, 6.8 and 8.0%. The estimated prevalence in the untested was 33.4%, 21.6% and 6.1% in the three survey periods. The simple model was able to estimate HIV prevalence where a DSS provided mortality data for untested residents. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

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.

National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment.

PubMed

Chao, Fengqing; You, Danzhen; Pedersen, Jon; Hug, Lucia; Alkema, Leontine

2018-05-01

The progress to achieve the fourth Millennium Development Goal in reducing mortality rate in children younger than 5 years since 1990 has been remarkable. However, work remains to be done in the Sustainable Development Goal era. Estimates of under-5 mortality rates at the national level can hide disparities within countries. We assessed disparities in under-5 mortality rates by household economic status in low-income and middle-income countries (LMICs). We estimated country-year-specific under-5 mortality rates by wealth quintile on the basis of household wealth indices for 137 LMICs from 1990 to 2016, using a Bayesian statistical model. We estimated the association between quintile-specific and national-level under-5 mortality rates. We assessed the levels and trends of absolute and relative disparity in under-5 mortality rate between the poorest and richest quintiles, and among all quintiles. In 2016, for all LMICs (excluding China), the aggregated under-5 mortality rate was 64·6 (90% uncertainty interval [UI] 61·1-70·1) deaths per 1000 livebirths in the poorest households (first quintile), 31·3 (29·5-34·2) deaths per 1000 livebirths in the richest households (fifth quintile), and in between those outcomes for the middle quintiles. Between 1990 and 2016, the largest absolute decline in under-5 mortality rate occurred in the two poorest quintiles: 77·6 (90% UI 71·2-82·6) deaths per 1000 livebirths in the poorest quintile and 77·9 (72·0-82·2) deaths per 1000 livebirths in the second poorest quintile. The difference in under-5 mortality rate between the poorest and richest quintiles decreased significantly by 38·8 (90% UI 32·9-43·8) deaths per 1000 livebirths between 1990 and 2016. The poorest to richest under-5 mortality rate ratio, however, remained similar (2·03 [90% UI 1·94-2·11] in 1990, 1·99 [1·91-2·08] in 2000, and 2·06 [1·92-2·20] in 2016). During 1990-2016, around half of the total under-5 deaths occurred in the poorest two quintiles