Spatial disparities in cause-specific mortality in Ukraine: A district-level analysis, 2006-19.

Turbulent socio-economic development, recent political challenges, and remarkable regional diversity with deep historical roots make Ukraine an important case study for understanding mortality trends in Eastern Europe. In this paper, we provide the first comprehensive, spatially detailed analysis of cause-specific mortality trends and patterns in Ukraine, focusing on the period 2006-19. We rely on official mortality data and use various demographic and spatial analysis techniques. Our results suggest a notable attenuation of the long-standing West-East and West-South-East mortality gradients. Cardiovascular mortality at older ages largely explains the gap between the vanguard (lowest mortality) and laggard (highest mortality) areas, especially for females and in the most recent period. By contrast, the impact of mortality from external causes has greatly diminished over time. Hotspot analyses reveal strong and persistent clustering of mortality from suicide, HIV, and lung cancer. Further research should focus on in-depth assessment of the mechanisms causing the observed patterns.

Long-term survival analysis of patients with primary Sjögren's syndrome in China: A multicenter retrospective cohort study.

AIM: This study aimed to evaluate the long-term survival, causes of death, and prognostic factors in Chinese patients with primary Sjögren syndrome (pSS). METHODS: We included patients with pSS registered in the Chinese Rheumatism Data Centre between May 2016 and December 2021, and collected baseline clinical, laboratory, and treatment data. Survival and standard mortality rates were calculated using general population mortality data. Factors related to mortality were identified using Cox proportional hazards regression. RESULTS: Among the 8588 patients included, 274 died during a median follow-up of 4.0 years. The overall standardized mortality ratio was 1.61 (95% CI: 1.43-1.81). Overall survival rates were 98.2% at 5 years and 93.8% at 10 years. The predominant causes of death were comorbidities, including cardiovascular diseases, tumors, and infections, while the most frequent pSS-related causes of death were interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). Male sex, older age, ILD, PAH, and high EULAR Sjögren's syndrome disease activity index (ESSDAI), thrombocytopenia, anemia, high immunoglobulin A (IgA) level, and glucocorticoid treatment independently increased the mortality risk, while using hydroxychloroquine was a protective factor. CONCLUSION: Mortality rates have significantly increased in Chinese patients with pSS. Comorbidities, rather than pSS-related organ damage, were the main causes of death. All-cause mortality was associated with male sex, older age, ILD, PAH, high ESSDAI, thrombocytopenia, anemia, high IgA level, and glucocorticoid treatment, whereas hydroxychloroquine use might improve the long-term survival.

[Examination of cases in which senility was determined to be the cause of death in community medicine].

AIM: In community medicine, there are many opportunities in which senility is noted as the cause of death. However, there are no clear criteria for diagnosing senility, and this decision is often left to the judgment of individual doctors. This study investigated the clinical characteristics of patients diagnosed with senility at our hospital. METHODS: The subjects included 43 patients whose cause of death was listed as senility from among the death certificates of 282 patients prepared at our hospital. The survey items included age, sex, medical history, place of death, period from the day of explanation of the condition of senility to the date of death, BMI at the time of explanation, and blood sampling test. RESULTS: The mean age of patients who died due to senility was 92.2±6.5 years old. The male to female ratio was 15: 28. The most common medical history was dementia (76.7%), followed by hypertension and orthopedic disease (74.4%), respiratory disease (66.7%), and heart disease and gastrointestinal disease (60.5%). The places of death were nursing homes and private homes, and hospitals. The overall average time from presentation until death occurred was 110.2 days. There were also considerable differences depending on the case. The average BMI was 19.7±3.0, and the blood sampling results showed that total protein and serum albumin levels were lower than the reference values. CONCLUSIONS: Although the diagnosis of senility is vague and unclear, it is important to explain such a diagnosis to the family at an appropriate time and to cooperate with multiple professionals in the treatment process.

Life Expectancy and Causes of Death in Patients with Myotonic Dystrophy Type 2.

Background: Myotonic Dystrophy type 2 (DM2) is a dominantly inherited multisystem disease caused by a CCTG repeat expansion in intron 1 of the CNBP gene. Although in the last two decades over 1500 patients with DM2 have been diagnosed worldwide, our clinical impression of a reduced life expectancy in DM2 has not been investigated previously. Objective: The aim of this observational study was to determine the life expectancy and the causes of death in patients with genetically confirmed DM2. Methods: We identified the data of all deceased patients with DM2 in the Dutch neuromuscular database between 2000 and 2023. Ages and causes of death and the patients' clinical features during lifetime were determined. Age of death in DM2 was compared to the general population by using life tables with prognostic cohort life expectancy (CLE) and period life expectancy (PLE) data of the Dutch electronic database of statistics (CBS StatLine). Results: Twenty-six deceased patients were identified in the Dutch DM2 cohort (n = 125). Median age of death in DM2 (70.9 years) was significantly lower compared to sex- and age-matched CLE (78.1 years) and PLE (82.1 years) in the Netherlands. Main causes of death were cardiac diseases (31%) and pneumonia (27%). Seven patients (27%) had a malignancy at the time of death. Conclusion: These results provide new insights into the phenotype of DM2. Life expectancy in patients with DM2 is reduced, possibly attributable to multiple causes including increased risk of cardiac disease, pneumonia, and malignancies. The occurrence of a significantly reduced life expectancy has implications for clinical practice and may form a basis for advanced care planning, including end-of-life care, to optimize quality of life for patients with DM2 and their family. Research in larger cohorts should be done to confirm these findings and to ascertain more about the natural course in DM2.

A Finnish nationwide register-based study shows a further 50% decline in already low child mortality.

AIM: Child mortality declined significantly in Finland in 1969-2004. We investigated whether the already low mortality rate could still decline from 2005 to 2020. METHODS: This was a nationwide register-based study. The subjects were children under 16 years of age who had resided in Finland between 2005 and 2020. The study population was identified from Finland's Population Information System of the Digital and Population Data Services Agency. Causes of death were obtained from Statistics Finland. Changes in annual overall and cause-specific mortality rates were evaluated. RESULTS: 3685 children (55% boys) under 16 years of age died in Finland in 2005-2020 from 325 causes. Overall annual child mortality declined by 50% (95% confidence interval 37 to 64%) during the study period, from 0.31/1000 in 2005 to 0.16/1000 in 2020. The mortality rate in children under one year of age declined from 3.1/1000 in 2005 to 1.8/1000 in 2020. The deaths from sudden infant death syndrome fell by 84%, congenital malformations by 62%, infectious diseases by 60%, external causes by 52%, and perinatal disorders by 41%. CONCLUSION: Finland's low child mortality further declined over the past two decades. Contributing factors likely include achievements in paediatric research, public health, and clinical practice.

Cause-specific and all-cause mortalities in vegetarian compared with those in nonvegetarian participants from the Adventist Health Study-2 cohort.

BACKGROUND: There have been mixed results reported internationally when associating vegetarian dietary patterns with all-cause and cause-specific mortalities. OBJECTIVES: This study aimed to extend our previous results by evaluating, with a larger number of deaths (N = 12,515), cause-specific mortalities comparing different vegetarian types with nonvegetarians. METHODS: This prospective study used data from the Adventist Health Study-2 cohort. Mortality was ascertained between study baseline, 2002-2007, and follow-up through 2015. Dietary data were collected at baseline using a validated quantitative food frequency questionnaire and then categorized into 5 dietary patterns: nonvegetarian, semivegetarian, pescovegetarian, lacto-ovovegetarian, and vegan. Main outcomes and measures include all-cause and cause-specific mortalities using Cox proportional hazards regression models and competing risk methods. RESULTS: The analytic sample included 88,400 participants who provided 971,424 person-years of follow-up. We report results pairwise as estimated at ages 65 and 85 y owing to age dependence of many hazard ratios (HRs). Compared with nonvegetarians, vegetarians had lower risks of mortality, overall (HR: 0.89; 95% confidence interval [CI]: 0.83, 0.95; HR: 0.98; 95% CI: 0.91, 1.04), from renal failure (HR: 0.52; 95% CI: 0.38, 0.70; HR: 0.65; 95% CI: 0.55, 0.76), infectious disease (HR: 0.57; 95% CI: 0.40, 0.82; HR: 0.90; 95% CI: 0.70, 1.17), diabetes (HR: 0.51; 95% CI: 0.33, 0.78; HR: 0.69; 95% CI: 0.53, 0.88), select cardiac (HR: 0.75; 95% CI: 0.65, 0.87; HR: 0.89; 95% CI: 0.83, 0.95), and ischemic heart disease causes (HR: 0.73; 95% CI: 0.59, 0.90; HR: 0.84; 95% CI: 0.75,0.94). Vegans, lacto-ovovegetarians, and pescovegetarians were also observed to have lower risks of total mortality and several similar cause-specific mortalities. However, higher cause-specified neurologic mortalities were observed among older vegetarians (estimated at age 85 y), specifically stroke (HR: 1.17; 95% CI: 1.02, 1.33), dementia (HR: 1.13; 95% CI: 1.00, 1.27), and Parkinson's disease (HR: 1.37; 95% CI: 0.98, 1.91). Results in Black subjects for vegetarian/nonvegetarian comparisons largely followed the same trends, but HRs were less precise owing to smaller numbers. CONCLUSIONS: Vegetarian diets are associated with lower risk for all-cause and many cause-specific mortalities, especially among males and in younger subjects. However, higher risks are observed among older vegetarians for stroke and dementia. These results need further support and investigation.

[The analysis of age dynamics of causes of mortality of population of elderly age groups as reserve of maintaining population of older able-bodied age].

The article analyzes age dynamics of initial causes of death according to records in medical death certificates of population of older age groups. Materials and methods. The records of causes of death of 34.914 persons aged 60 years and older were used as primary source of information. The initial cause of death was determined according to the ICD-10 rules. The rate of registration by reason of death was calculated as intensive value per 100 deaths in concrete age and sex group. Each cause was coded according to the ICD-10 rules (revision 2014-2016). The belonging to group was determined by first character (letter) in four-digit code that corresponded to the Class. On the basis of analysis of structure of causes of death, the group A of causes that included five Classes of ICD-10, determined 81.4% of all deaths in population aged 60 years and older. Two Classes: "Diseases of the circulatory system" (Class IX) and "Neoplasms" (Class II) determine in all studied age groups more than a half of all deaths (from 55% to 71% of males and from 59% to 67% in females) and namely they determine mortality rate in older age groups. There are no gender differences in age characteristics of registration rate in these groups (p > 0.05), however age dynamics differ. In case of diseases of circulatory system initial cause of death is increase rate of registration at increasing of age. In case of neoplasms at increasing of age decrease of registration rate as initial cause of death is established. At that, rate of decline is higher than rate of increase that determines certain decrease of structural significance of combined contribution of these two groups of causes at increasing of age. The Group B of causes, including three Classes of ICD-10 "Respiratory diseases" (Class X), "Diseases of the digestive system" (Class XI) and "Diseases of the nervous system" (Class VI), determined in overall 11.9% of all deaths in population aged 60 years and older. The age dynamics of causes of death of population of older age groups exists for certain groups of causes and it should be considered in organizing medical care of population of older age groups.

Causes and investigation of stillbirths in Brazil: A multicentre cross-sectional study in 10 referral maternity hospitals.

OBJECTIVE: Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death. METHODS: A cross-sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility. RESULTS: Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. "Intrauterine hypoxia and asphyxia" (ICD-10 P20) and "unspecific causes of death" (ICD-10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases. CONCLUSION: The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed.

Causes of death analysis and the prognostic model construction in neuroendocrine carcinoma of the cervix: A SEER-based study.

PURPOSE: Neuroendocrine carcinoma of the cervix (NECC) is rare but results in poor prognosis. The causes of death (CODs) in NECC patients are rarely reported. Our study aimed to explore the distributions of death causes of NECC patients compared with squamous cell carcinoma (SCC) and adenocarcinoma (ADC) and to develop a validated survival prediction model. METHODS: Patients diagnosed with NECC, SCC, or ADC were identified from the Surveillance, Epidemiology, and End Results Program database from 1975 to 2019. We analyzed the standardized mortality ratio (SMR) to determine each cause of death for each survival time category. The Kaplan-Meier method was used for survival analysis. Univariate and multivariate Cox regression analyses were used to establish a nomogram model. RESULTS: A total of 358 NECC patients were included in this study, and 270 (75.4%) died during the follow-up period. Patients with NECC had 5.55 times (95% CI, 4.53-6.79, p < 0.0001) higher risk of death compared with patients with SCC and 10.38 times (95% CI, 8.28-13.01, p < 0.0001) higher compared with ADC. Cervical cancer is the main cause of death in NECC. As the diagnosis time increased, the risk of death from all causes and cervix cancer gradually decreased. While after at least 10 years of follow-up time, the highest and most dramatical SMR values were observed for metastasis (SMR, 138.81; 95% CI, 37.82-355.40; p < 0.05) and other cancers as the reason for death has an over 7-fold higher SMR (SMR: 7.07; 95% CI: 2.60-15.40, p < 0.05) more than 5 years after the cancer diagnosis. Race, FIGO stage, and surgery were independent risk factors for the overall survival (OS) of NECC patients. For the predictive nomogram, the C-index was 0.711 (95% CI: 0.697-0.725) and was corrected to 0.709 (95% CI: 0.680, 0.737) by bootstrap 1000 resampling validation. CONCLUSION: Compared with SCC and ADC, NECC patients have an elevated risk of mortality due to cervical cancer and metastasis. We successfully constructed a prognostic nomogram for patients with NECC. Based on refractoriness and high mortality of NECC, targeted treatment strategies and follow-up plans should be further developed according to the risk of death and distribution characteristics of CODs.

Stagnation in old age mortality among Finnish women: cause-of-death decomposition of life expectancy trends by income.

AIMS: The decline in old age mortality and subsequent increase in life expectancy among older women has stalled in some high-income countries. The contribution of causes of death to and sub-group variations in these trends are generally not well understood. We assess trends in mortality and cause-of-death decomposition of life expectancy by income over the past 30 years in Finland. METHODS: We obtained total population, annual register-based data on individuals (aged 30-89 years) residing in Finland in 1991-2020. We examined the trends in age-specific mortality rates and decomposed the contribution of various causes of death to changes in partial life expectancy among women aged 65-79 years over time and within each income quintile. In addition, we estimated life expectancy trends for the total population and by income quintile with and without causes related to alcohol consumption and smoking. RESULTS: Our results indicate stagnation in mortality development among women in Finland aged 65-79 years. The slowdown of improvements in circulatory and heart disease mortality contributed substantially to the observed stagnation, although similar trends were observed in virtually all the causes of death we studied. The lowest income groups experienced the most adverse developments during the study period. CONCLUSIONS: The stagnating life expectancy observed among Finnish women cannot be attributed solely to one cause of death. In contrast to findings on the topic from many other developed countries, smoking-related causes of death were of little significance. The stagnation is linked to growing inequality in mortality development among older women in Finland, which affects the overall trend.

Comparison of fatalities due to COVID-19 and other nonexternal causes during the first five pandemic waves : Results from multiple cause of death statistics in Bavaria.

BACKGROUND: Older age is a risk factor for a fatal course of SARS-CoV­2 infection, possibly due to comorbidities whose exact role in this context, however, is not yet well understood. In this paper, the characteristics and comorbidities of persons who had died of COVID-19 in Bavaria by July 2022 are shown and compared with the characteristics of other fatalities during the pandemic. METHODS: Based on data from multiple cause of death statistics, odds ratios for dying from COVID-19 (compared to dying from other nonexternal causes of death) were calculated by using logistic regression models, stratified by age, sex, and pandemic waves. RESULTS: In Bavaria, a total of 24,479 persons (6.5% of all deaths) officially died from COVID-19 between March 2020 and July 2022. In addition to increasing age and male sex, preexisting diseases and comorbidities such as obesity, degenerative diseases of the nervous system, dementia, renal insufficiency, chronic lower respiratory diseases, and diabetes mellitus were significantly associated with COVID-19-related deaths. Dementia was mainly associated with increased COVID-19 mortality during the first and second waves, while obesity was strongly associated during the fourth wave. DISCUSSION: The frequency of specific comorbidities in COVID-19 deaths varied over the course of the pandemic. This suggests that wave-specific results also need to be interpreted against the background of circulating virus variants, changing immunisation levels, and nonpharmaceutical interventions in place at the time.

Contributions of causes of death to differentials in life expectancy by internal migrant status in the Netherlands. A population register based study, 2015-2019.

Important health differences exist in the context of international migration and residential mobility. Less is known about health differences regarding the medium-distance level of internal migration. This study examines life expectancy gaps between internal movers and stayers in the Netherlands and their underlying processes by assessing the contribution of different causes of death by age and sex. It uses individually-linked death counts and population exposures extracted from population registers, covering the native Dutch population aged 10+ from 2015 to 2019. The pooled data were disaggregated by causes-of-death group (neurodegenerative diseases, cardiovascular diseases, lifestyle-related mortality, external causes, and other causes), internal migrant status (movers and stayers, based on past 10-year residence in the 40 NUTS-3 [Nomenclature of Territorial Units for Statistics, level 3] regions), age, and sex. Comparing movers and stayers, we computed life expectancy at age 10 (e10), age- and cause-specific mortality risks, and applied decomposition methods to assess contributions of causes of death to e10 gaps. In the Netherlands in 2015-2019, e10 was lower for movers between NUTS-3 regions than stayers (males: 2.49 years; females: 3.51 years), due to excess mortality for movers at most ages. Movers only had a lower mortality than stayers at younger working ages (males: ages 20-44; females: ages 20-34). Mortality from neurodegenerative diseases and cardiovascular diseases were the largest contributors to the e10 gap, especially at ages 75+ and for females. Mortality from lifestyle-related and external causes of death contributed less, with the largest contributions for females aged 75-89 and males aged 45-69. The lower e10 of movers in the Netherlands is likely explained by health selection effects-in particular care-related moves as coping behaviour-rather than by causal effects through risk accumulation. Research focusing on regional or spatial heterogeneity of the mover-stayer health gap would be insightful to further understand these processes.

[Potentially preventable causes of mortality in acute calculous cholecystitis: a population-based study]. / Potentsial'no predotvratimye prichiny letal'nosti pri ostrom kal'kuleznom kholetsistite: populyatsionnoe issledovanie.

OBJECTIVE: To analyze potentially preventable causes of mortality from acute calculous cholecystitis (ACC) at the population level. MATERIAL AND METHODS: A retrospective study of causes of ACC-related mortality was conducted. We used online survey of state hospitals and estimated fatal outcomes following ACC considering appropriate annual e-database. RESULTS: There were 1.500 deaths among 142.975 patients aged ≥18 years with acute cholecystitis. We received responses to the proposed questionnaire about 1154 deaths (76.9%). Analysis included 648 cases of ACC (K80.0). Mean age of patients was 76.0 years (31-100). There were 256 (39.5%) men and 392 (60.5%) women. ACC severity was assessed according to the Tokyo guidelines (2018). Mild (I) degree was noted in 24 (3.7%) cases, moderate (II) - 270 (41.7%), severe (III) - 354 (54.6%) patients. Cardiovascular diseases and complications caused death in mild ACC regardless of treatment method in 16 (66.7%) cases, in moderate ACC - 106 (39.3%), in severe ACC - 97 (27.4%) cases. ACC caused death in 3 (12.5%) patients with mild disease, 111 (41.1%) with moderate disease and 200 (56.5%) ones with severe disease. Postoperative complications caused death in 4 (16.7%) patients with mild disease, 29 (10.7%) ones with moderate disease and 30 (8.5%) patients with severe disease. Other causes comprised 4.1% (n=1), 8.9% (n=24) and 7.6% (n=27), respectively. Potentially preventable causes of death were identified in 33.0% of cases. CONCLUSION: ACC-related mortality is mainly associated with comorbidity in elderly and senile patients, late presentation and complicated course of disease. Delayed surgical treatment due to diagnostic and tactical problems, as well as technical intraoperative errors is potentially preventable causes of death.

Pregnancy-related maternal mortality in the state of Georgia: Timing and causes of death.

BACKGROUND: The maternal mortality rate in the United States is high and disparities among non-Hispanic White and non-Hispanic Black women remain. In the State of Georgia, the pregnancy-related death rate is among the worst in the nation. OBJECTIVE: To examine current pregnancy-related deaths in the State of Georgia using measures of timing and cause-specific mortality across maternal sociodemographic characteristics. DESIGN: This cross-sectional study of pregnancy-related deaths in Georgia was based on 2016-2019 maternal mortality data obtained from the Georgia Department of Public Health. METHODS: Our study analysis involved complete-case data of maternal deaths identified as pregnancy-related deaths (n = 129). Statistical analyses included two distinct population-level measures: (a) timing (i.e. during pregnancy, 0 to 60 days, 61 to 180 days, and 181 to 365 days postpartum) and (b) cause-specific deaths patterned by sociodemographic groups of women and by rural and urban county of residence. Categorical variables were compared using the Chi square or Fisher's exact test and presented as numbers and percentages. A post hoc power analysis was conducted to inform whether there was sufficient power to detect statistically significant effects given available sample sizes. RESULTS: Among a total of 129 pregnancy-related deaths, 30 (23.3%) deaths occurred during pregnancy and 63 (48.8%) deaths occurred within the first 60 days postpartum. Pregnancy-related deaths were disproportionally common among non-Hispanic Black, 25 to 34 years old, and poorly educated women. Three leading underlying causes, cardiomyopathy (22.7%), hemorrhage (21.6%), and cardiovascular or coronary disease (20.4%), accounted for about 65% of all pregnancy-related deaths. Mental health conditions were common causes of death among non-Hispanic White women during pregnancy and in late postpartum. CONCLUSION: Continued monitoring, collecting and analyzing reliable data will help identify root causes and find ways to eliminate the disproportionate burden of pregnancy-related deaths in the State of Georgia.

Life expectancy in relation to societal development level: significant discordant factors.

OBJECTIVES: The aim of this study is to determine the interdependence between life expectancy and numerous social indicators, i.e., to determine the factors that encourage an increase or decrease in life expectancy. METHODS: Pearson coefficients as well as linear and logarithmic trends and correlations between the dependent variable of life expectancy and numerous independent variables were calculated and analysed. The calculations were carried out for all countries in the world for which data is available. Based on the strength of the correlations between life expectancy and numerous indicators, we have tried to determine the reasons for the different values of life expectancy in the various countries. RESULTS: Important factors for achieving high life expectancy values are economic development and healthcare spending but the spread of "diseases of the modern era", such as obesity or diabetes, have a significant negative impact on life expectancy. Other important limiting factors for life expectancy are large income inequalities, a higher share of private healthcare expenditure in total healthcare expenditure and lower total healthcare expenditure. Less developed societies can significantly increase their life expectancy by providing clean water and safe sanitation and by combating various infectious diseases (especially HIV). CONCLUSIONS: Life expectancy is a meaningful indicator of the state of social development and accurately reflects the general state of a particular society. It has been shown that GDP per capita (PPP) is a key determinant of life expectancy, while other important factors play the role of a further modifier.

The Trend of Death Rate and Causes of Death Based on the ICD-10 among Young People in Iran within the Last Three Decades.

Background: Youth is undeniably the most important resource of any country. This study aimed to determine the trend of mortality rate and the cause of death, based on the ICD-10, among young people in Iran and examines significance of the changes in any cause during the last three decades. Methods: The present study is a secondary analysis of data, which examines the trend of death rate and its causes among young adult, aged 15-24 yr, longitudinally during 1990-2019. The data source was the GBD web-site. Linear Regression analysis was used to measure the slope of changes in mortality rates and causes of death during the period, where "time" was the independent variable and "mortality rate" and "causes of mortality" were dependent variables. Results: The death rate of young people declined by 56% during the period, equal to an average of 2.17 units per year. The most common cause of death has been injuries (69%), then NCDs (25%), and finally communicable diseases (6%). However, death due to injuries (except SUD), communicable diseases (except HIV), and NCDs (except musculoskeletal disorders) declined significantly by 1.43, 0.3, and 0.09 units per year, over 30 yr respectively. Conclusion: Examining past trends in death rates and causes strengthens insights into the state and future trends in health and death-related indicators, which are crucial for policy-making, especially in developing countries with limited resources.

Overall and cause-specific mortality in anorexia nervosa; impact of psychiatric comorbidity and sex in a 40-year follow-up study.

OBJECTIVE: This study investigates the overall and cause-specific mortality in males and females with anorexia nervosa (AN) from 1977 to 2018, focusing on the impact of psychiatric comorbidity on mortality risk, a less explored aspect despite a high prevalence in patients with AN. METHOD: We conducted a nationwide population-based cohort study in Denmark including all patients with AN (n = 14,774) with a median follow-up time of 9.1 years and a 1:10 age- and sex-matched general population comparison cohort. Using Cox proportional hazard model, we calculated adjusted hazard ratios (aHR) for death stratified by psychiatric comorbidity, sex, and age at AN onset and evaluated the causes of death using Fine and Gray sub-distribution hazard ratios (SHR). RESULTS: In patients with AN, the weighted average aHR for all-cause mortality was 4.5 [95% CI 4.1-4.9] with up to 40 years follow-up. Psychiatric comorbidity was present in 47% of patients with AN at index date, which was associated with a 1.9-fold increase in 10-year mortality compared with patients without comorbidity and a notably four-fold increase, when diagnosed at age 6-25 years. The mortality risk was similar according to sex. 13.9% of all deaths in patients with AN were due to suicide (SHR 10.7 [8.1-14.2]). The risk of dying of natural causes was increased with a SHR of 3.8 [95% CI 3.4-4.2]. DISCUSSION: The increased mortality risk in both males and females with AN and psychiatric comorbidity, particularly when diagnosed at young age, underscores the need for comprehensive treatment addressing both AN and coexisting psychiatric conditions. PUBLIC SIGNIFICANCE: The mortality in patients with anorexia nervosa (AN) is high and we show in our study that the mortality is doubled in the presence of psychiatric comorbidity particularly the first 10 years after diagnosis seen in both sexes and with suicide as a major cause of death. These findings stress the importance of detection and treatment of psychiatric comorbidities alongside the eating disorder to prevent fatal outcome.

Postoperative sarcopenia increases both gastric cancer and other-cause mortality in older adults undergoing radical gastrectomy for cancer.

BACKGROUND & AIMS: Preoperative sarcopenia in gastric cancer is associated with increased postoperative complications and reduced long-term survival. However, the association between postoperative sarcopenia and long-term outcomes remains unclear. Therefore, this study aims to clarify the association between sarcopenia after gastrectomy for gastric cancer and survival outcomes. METHODS: This retrospective study included 1512 patients aged ≥65 who underwent curative gastric resection for clinical stage I-III primary gastric cancer during 2008-2018. Sarcopenia was assessed preoperatively by measuring arm muscle area and grip strength, which was repeated 1 month after surgery. We compared the clinical characteristics, surgical treatments, and long-term outcomes between the postoperative normal and sarcopenia groups. RESULTS: Sarcopenia was observed in 173 and 305 patients pre- and postoperatively, respectively. Factors increasing the risk of postoperative sarcopenia included age of ≥75, lower preoperative body mass index, diabetes, and clinical stage II/III gastric cancer. Patients with postoperative sarcopenia after surgery had a significantly lower overall survival rate (hazard ratio [HR] 2.596, p < 0.001). Furthermore, postoperative sarcopenia was linked to decreased overall survival in patients with (HR 2.813, p = 0.002) and without (HR 1.925, p < 0.001) preoperative sarcopenia. Cumulative incidence showed significantly higher rates of deaths due to gastric cancer (HR 1.928, p < 0.001) and other causes (HR 2.736, p < 0.001) in the postoperative sarcopenia group. CONCLUSIONS: Postoperative sarcopenia in gastric cancer is linked to an increased risk of death due to cancer and other causes, underscoring the importance of perioperative sarcopenia management strategies.

Causes of death in mucopolysaccharidoses.

Mucopolysaccharidoses are inherited metabolic diseases caused by mutations in genes encoding enzymes required for degradation of glycosaminoglycans. A lack or severe impairment of activity of these enzymes cause accumulation of GAGs which is the primary biochemical defect. Depending on the kind of the deficient enzyme, there are 12 types and subtypes of MPS distinguished. Despite the common primary metabolic deficit (inefficient GAG degradation), the course and symptoms of various MPS types can be different, though majority of the diseases from the group are characterized by severe symptoms and significantly shortened live span. Here, we analysed the frequency of specific, direct causes of death of patients with different MPS types, the subject which was not investigated comprehensively to date. We examined a total of 1317 cases of death among MPS patients, including 393 cases of MPS I, 418 cases of MPS II, 232 cases of MPS III, 45 cases of MPS IV, 208 cases of MPS VI, and 22 cases of MPS VII. Our analyses indicated that the most frequent causes of death differ significantly between MPS types, with cardiovascular and respiratory failures being predominant in MPS I, MPS II, and MPS VI, neurological deficits in MPS III, respiratory issues in MPS IV, and hydrops fetalis in MPS VII. Results of such studies suggest what specific clinical problems should be considered with the highest priority in specific MPS types, apart from attempts to correct the primary causes of the diseases, to improve the quality of life of patients and to prolong their lives.