Changes in mortality associated with different hematologic malignancies during the pandemic in the United States.

Patients with hematologic malignancies are at increased risk of adverse COVID-19 outcomes; nonetheless, only sparse population-based data are available on mortality related to hematologic cancers during the pandemic. Number of deaths and age-standardized mortality rates for specific hematologic malignancies selected either as the underlying cause of death (UCOD), or mentioned in death certificates (multiple causes of death-MCOD) were extracted from the US National Center for Health Statistics, CDC WONDER Online Database. Joinpoint analysis was applied to identify changes in mortality trends from 1999 to 2021, and to estimate the annual percent change with 95% Confidence Intervals (CI) across time segments. Among the most common malignancies, chronic lymphocytic leukemia showed marked peaks in the monthly number of deaths attributed to COVID-19 during epidemic waves; acute myeloid leukemia showed the least variation, and non-Hodgkin lymphoma and multiple myeloma were characterized by an intermediate pattern. Age-standardized death rates relying solely on the UCOD did not show significant variations during pandemic years. By contrast, rates based on MCOD increased by 14.0% (CI, 10.2-17.9%) per year for chronic lymphocytic leukemia, by 5.1% (CI, 3.1-7.2%) for non-Hodgkin lymphoma and by 3.2% (CI, 0.3-6.1%) per year for multiple myeloma. Surveillance of mortality based on MCOD is warranted to accurately measure the impact of the COVID-19 pandemic and of other epidemics, including seasonal flu, on patients with hematologic malignancies, and to assess the effects of vaccination campaigns and other preventive measures.

Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries.

BACKGROUND: External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood. METHODS: Individual level data from national health registries in Denmark (1978-2001), Finland (1987-2003), Norway (1967-2002), and Sweden (1974-2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016-2018. Gestational age was categorized as "very/moderately preterm" (23-33 weeks), "late preterm" (34-36 weeks), "early term" (37-38 weeks), "full term" (39-41 weeks), and "post term" (42-44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country's estimates in meta-analyses. RESULTS: Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99-1.24) for males and 1.55 (95% CI 1.28-1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04-1.18) and 1.15 (95% CI 1.02-1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34-2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99-1.53] and 1.29 [95% CI 1.16-1.45], respectively) and females (HRs 1.53 [95% CI 0.97-2.41] and 1.35 [95% CI 1.07-1.71], respectively, with some heterogeneity across countries). CONCLUSIONS: Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males.

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.

Time to pregnancy and life expectancy: a cohort study of 18 796 pregnant couples.

STUDY QUESTION: Is fecundity, measured as time to pregnancy (TTP), associated with mortality in parents? SUMMARY ANSWER: Prolonged TTP is associated with increased mortality in both mothers and fathers in a dose-response manner. WHAT IS KNOWN ALREADY: Several studies have linked both male and female fecundity to mortality. In women, infertility has been linked to several diseases, but studies suggest that the underlying conditions, rather than infertility, increase mortality. STUDY DESIGN, SIZE, DURATION: A prospective cohort study was carried out on 18 796 pregnant couples, in which the pregnant women attended prophylactic antenatal care between 1973 and 1987 at a primary and tertiary care unit. The couples were followed in Danish mortality registers from their child's birth date until death or until 2018. The follow-up period was up to 47 years, and there was complete follow-up until death, emigration or end of study. PARTICIPANTS/MATERIALS, SETTING, METHODS: At the first antenatal visit, the pregnant women were asked to report the time to the current pregnancy. Inclusion was restricted to the first pregnancy, and TTP was categorised into <12 months, ≥12 months, not planned, and not available. In sub-analyses, TTP ≥12 was further categorized into 12-35, 36-60, and >60 months. Information for parents was linked to several Danish nationwide health registries. Survival analysis was used to estimate the hazard ratios (HRs) with a 95% CI for survival and adjusted for age at the first attempt to become pregnant, year of birth, socioeconomic status, mother's smoking during pregnancy, and mother's BMI. MAIN RESULTS AND THE ROLE OF CHANCE: Mothers and fathers with TTP >60 months survived, respectively, 3.5 (95% CI: 2.6-4.3) and 2.7 (95% CI: 1.8-3.7) years shorter than parents with a TTP <12 months. The mortality was higher for fathers (HR: 1.21, 95% CI: 1.09-1.34) and mothers (HR: 1.29, 95% CI: 1.12-1.49) with TTP ≥12 months compared to parents with TTP <12 months. The risk of all-cause mortality during the study period increased in a dose-response manner with the highest adjusted HR of 1.98 (95% CI: 1.62-2.41) for fathers and 2.03 (95% CI: 1.56-2.63) for mothers with TTP >60 months. Prolonged TTP was associated with several different causes of death in both fathers and mothers, indicating that the underlying causes of the relation between fecundity and survival may be multi-factorial. LIMITATIONS, REASONS FOR CAUTION: A limitation is that fecundity is measured using a pregnancy-based approach. Thus, the cohort is conditioned on fertility success and excludes sterile couples, unsuccessful attempts and spontaneous abortions. The question used to measure TTP when the pregnant woman was interviewed at her first attended prophylactic antenatal care: 'From the time you wanted a pregnancy until it occurred, how much time passed?' could potentially have led to serious misclassification if the woman did not answer on time starting unprotected intercourse but on the start of wishing to have a child. WIDER IMPLICATIONS OF THE FINDINGS: We found that TTP is a strong marker of survival, contributing to the still-emerging evidence that fecundity in men and women reflects their health and survival potential. STUDY FUNDING/COMPETING INTEREST(S): The authors acknowledge an unrestricted grant from Ferring. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication. M.L.E. is an advisor to Ro, VSeat, Doveras, and Next. TRIAL REGISTRATION NUMBER: N/A.

Mortality related to HCV and other chronic liver diseases in Veneto (Italy), 2008-2021: Changes in trends and age-period-cohort effects.

BACKGROUND AND AIMS: The objective of this study was to assess the impact of the COVID-19 pandemic and direct-acting antiviral (DAA) agents on mortality related to chronic liver diseases (CLD). METHODS: Age-standardized mortality rates were computed based on CLD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple causes of death-MCOD). Time trends in age-standardized mortality rates were investigated using generalized estimation equation models. Additionally, we conducted age, period, and birth cohort (APC) analyses on CLD-related mortality associated with alcohol and hepatitis C virus (HCV). RESULTS: Between 2008 and 2021, among residents in the Veneto region (Northeastern Italy) aged ≥35 years, there were 20 409 deaths based on the UCOD and 30 069 deaths based on MCOD from all CLD. We observed a 4% annual decline in age-standardized MCOD-based mortality throughout 2008-2021, with minor peaks corresponding to COVID-19 epidemic waves. Starting in 2016, the decline in HCV-related mortality accelerated further (p < .001). A peak in HCV-related mortality in the 1963-1967 birth cohort was observed, which levelled off by the end of the study period. Mortality related to alcoholic liver disease declined at a slower pace, becoming the most common aetiology mentioned in death certificates. CONCLUSIONS: The study demonstrates a significant decrease in HCV-related mortality at the population level in Italy with the introduction of DAAs. Continuous monitoring of MCOD data is warranted to determine if this favourable trend will continue. Further studies utilizing additional health records are needed to clarify the role of other CLD etiologies.

Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa: an analysis of verbal autopsy data from six countries.

OBJECTIVE: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum. DESIGN: Open population cohort (Health and Demographic Surveillance Systems). SETTING: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. POPULATION: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. METHODS: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43-365 days postpartum adjusting for HDSS and time period (2000-2009 and 2010-2019). MAIN OUTCOME MEASURES: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). RESULTS: Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42 days postpartum did not change significantly between 2000-2009 and 2010-2019. CONCLUSIONS: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration of non-obstetric care with ante-, intra- and postpartum care in high-burden settings.

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.

Evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after expert panel review: a mixed methods observational study.

INTRODUCTION: The present study was conducted with the aim of evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after an expert panel review. METHOD: The present study was a mixed methods observational study conducted at Umm al-Benin Hospital, the sole specialized obstetrics and gynecology center affiliated with Mashhad University of Medical Sciences. The study comprised three distinct stages: (1) Collecting primary ICD-PM codes assigned to perinatal death certificates, along with other relevant information, from October 2021 to March 2022; (2) Examining the circumstances of each perinatal death case and re-identifying the causes of death through a consensus process involving a panel of experts comprising pediatricians, obstetrics and gynecology specialists, and nursing and midwifery experts; presenting the new ICD-PM code; (3) Comparing the ICD-PM codes assigned to perinatal death certificates before and after the expert panel's evaluation. RESULT: During the study period, a total of seven specialized panels were conducted to examine perinatal deaths. Out of the 71 cases, 41 were carefully reviewed by experts. These cases included 32 stillbirths and nine neonatal deaths. The examination process followed specific inclusion and exclusion criteria. The findings revealed that there were no significant changes in the causes of neonatal deaths. However, it was notable that 80% of the previously unknown causes of stillbirths were successfully identified. Notably, the occurrence of stillbirths increased by 78% due to maternal causes and conditions. CONCLUSION: Convening panels of experts to discuss the causes of perinatal deaths can effectively reduce the percentage of unknown causes, as classified by ICD-PM. This approach also guarantees the availability of essential data for implementing effective interventions to decrease preventable perinatal deaths.

Cause-of-Death Determinants of Lifespan Inequality.

We propose a novel decomposition approach that breaks down the levels and trends of lifespan inequality as the sum of cause-of-death contributions. The suggested method shows whether the levels and changes in lifespan inequality are attributable to the levels and changes in (1) the extent of inequality in the cause-specific age-at-death distribution (the "Inequality" component), (2) the total share of deaths attributable to each cause (the "Proportion" component), or (3) the cause-specific mean age at death (the "Mean" component). This so-called Inequality-Proportion-Mean (or IPM) method is applied to 10 low-mortality countries in Europe. Our findings suggest that the most prevalent causes of death (in our setting, "circulatory system" and "neoplasms") do not necessarily contribute the most to overall levels of lifespan inequality. In fact, "perinatal and congenital" causes are the strongest drivers of lifespan inequality declines. The contribution of the IPM components to changes in lifespan inequality varies considerably across causes, genders, and countries. Among the three components, the Mean one explains the least lifespan inequality dynamics, suggesting that shifts in cause-specific mean ages at death alone contributed little to changes in lifespan inequality.

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.

The spectrum of idiopathic inflammatory myopathies in Western Australia: epidemiological characteristics and mortality over time.

To determine long term overall and subgroup specific incidence rates and associated mortality for idiopathic inflammatory myopathies (IIM) in a population wide study. We included patients hospitalised between 1980 and 2015 with incident IIM as defined by relevant diagnostic codes for dermatomyositis (DM) polymyositis (PM), inclusion body myositis (IBM), other IIM and overlap myositis (OM) in the Western Australia Health Hospital Morbidity Data Collection (n = 846). Trends over time for annual incidence rate per million population (AIR) were analysed by least square regression and Kaplan-Meier survival and mortality rates (MR)/100 person years compared with a matched control group (n = 3681). The averaged AIR for all IIM was 19 (CI 10.4-27.5) and stable over time with point prevalence reaching 205.3 (CI 185.6-226.6) per million in 2015. Over time, the AIR for DM 5.0 (CI 0.6-9.4) and IBM 3.3 (CI 0.7-9.6) was stable, while AIR decreased for PM (p < 0.01) and increased for other IIM (p < 0.01) and OM (p < 0.01). IBM patients were eldest at diagnosis (68 years, CI 59-77) with male preponderance in IBM (53.4%) and other IIM (55.8%) groups. Crude mortality (54.5 vs 41.3%), MR ratio (6.65 vs 5.91) and 5 (65.8% vs 71.6%) and 10-year (52.5% vs 58.7%) survival were all worse for IIM patients (all p < 0.05). IBM patients had highest MR (10.1; CI 8.38-12.14) and lowest 10-year survival (39.2%). While cardiovascular disease and cancer were predominant causes of death, they were proportionally lower in IIM patients, where respiratory and rheumatic disease were more frequent causes of death. While the overall incidence of IIM in WA was stable over 35 years, the spectrum of IIM has changed significantly with increases especially in other IIM and OM. The overall prognosis with IIM remains guarded with 10-year survival just over 50%.

Critical analyses of Latina mortality: disentangling the heterogeneity of ethnic origin, place, nativity, race, and socioeconomic status.

Despite the significant body of research on social determinants of health (SDH) and mortality, limited knowledge is available on the epidemiology of aggregated Latino health overall, and by women and subgroups. In population health studies, U.S. Latinos often are considered a monolithic population and presented as an aggregate, obscuring the diversity and variations within and across Latino subgroups, contributing to missed opportunities to identify SDH of health outcomes, and limiting the understanding of health differences. Given diverse environmental, racial, class, and geographic factors, a specific focus on women facilitates a more in-depth view of health disparities. This paper provides a scoping review of current gaps in research that assesses the relationships between SDH and mortality rates for the five leading causes of chronic-disease related deaths among Latinas by ethnic origin, place, race, and SES. We analyzed 2020 national mortality statistics from the CDC WONDER Online database jointly with reviews of empirical articles on Latina health, employing the EBSCOhost MEDLINE databases. These findings challenge the phenomenon of the Hispanic paradox that identified Latinos as a relatively healthy population compared to non-Hispanic White populations despite their lower economic status. The findings confirm that prior research on Latino women had methodological limitations due to the exclusion of SDH and an overemphasis on culturalist perspectives, while overlooking the critical role of socioeconomic impacts on health. Findings indicate major knowledge gaps in Latina mortality by SDH and subgroups that may undermine surveillance efforts and treatment efficacy. We offer forward-looking recommendations to assure the inclusion of key SDH associated with Latina mortality by subgroup as essential to inform future studies, intervention programs, and health policy.

Retrospective analysis of mortality among children under 5 years of age in Huangshi over the period 2002-2022, China.

BACKGROUND: The United Nations' Millennium Development Goals and Sustainable Development Goals both underscore the critical need to reduce the under-five mortality rate globally. China has made remarkable progress in decreasing the mortality rate of children under five. This study aims to examine the trends in child mortality rates from 2002 to 2022 and the causes of deaths among neonates, infants, and children under 5 years of age from 2013 to 2022 in Huangshi. METHODS: The data resource was supported and provided by the Huangshi Health Commission, Huangshi Maternal and Child Health Hospital, and the Huangshi Statistics Bureau. Figures were drawn using Origin 2021. RESULTS: The mortality rate among children under 5 years old significantly decreased, from 21.38 per 1,000 live births in 2002 to 3.53 per 1,000 live births in 2022. The infant mortality rate also saw a significant decline, to 15.06 per 1,000 live births. Among the 1,929 recorded child deaths from 2013 to 2022, the top three causes were: F2 (Disorders related to short gestation and low birth weight), accounting for 17.26% (333 deaths); I1 (Accidental drowning and submersion), for 14.83% (286 deaths); and I3 (Other accidental threats to breathing), for 12.29% (237 deaths). Of the 1,929 deaths, 1,117 were male children, representing 57.91%. The gender disparity in the Under-5 Mortality Rate (U5MR) was calculated to be 1.38 (boys to girls). The leading causes of death under the age of five shifted from F2 (Disorders related to short gestation and low birth weight) to I1 (Accidental drowning and submersion) as children aged, highlighting the need for policymakers and parents to intensify care and vigilance for children. CONCLUSIONS: Huangshi has achieved significant progress in lowering child mortality rates over the past two decades. The study calls for policymakers to enact more effective measures to further reduce the mortality rate among children under 5 years of age in Huangshi. Furthermore, it advises parents to dedicate more time and effort to supervising and nurturing their children, promoting a safer and healthier development.

Ischemic heart disease-related mortality in Brazil, 2006 to 2020. A study of multiple causes of death.

CONTEXT: Both the aging of the population and the increase in noncommunicable diseases may influence the progression and outcomes culminating in death, changing the evolution of ischemic heart diseases (IHDs) and their associated causes. Using the multiple causes of death method could help understand the magnitude of these relationships and enable better targeting of investments in health. OBJECTIVES: To evaluate the mortality from IHD in Brazil between 2006 and 2020 using the method of multiple causes and identify differences in the distribution pattern of IHD mortality by sex and geographic region. METHODS: Based on information extracted from death certificates (DCs) obtained from the database of the Department of Informatics of the Unified Health System (DATASUS), we used the multiple causes method to analyze the causes of death associated with IHD when IHD was defined as the underlying cause of death (UC) and the causes of death listed as the UC when IHD was recorded in any other lines of the DC, from 2006 to 2020, in Brazil. Subsequently, the proportion of these causes of death and differences between sexes and geographic regions were evaluated, with statistical relevance analyzed using the chi-square test, and the dependence between factors illustrated using stacked bar charts and small-world network graphs. RESULTS: When IHD was listed as the UC of death, the most frequent associated causes of death were, in descending order of frequency, acute myocardial infarction (AMI), arterial hypertension (AH), chronic ischemic heart disease (CHID), heart failure (HF), and diabetes mellitus (DM). When IHD was mentioned in any line of the DC, the most frequent UCs of death were AMI followed by DM, CIHD, chronic obstructive pulmonary disease (COPD), stroke, dyslipidemia, and, in the year 2020, COVID-19. The most frequent cause of death in women were DM as the UC and associated cause of death, AH as the UC, and CIHD and Alzheimer's disease as associated causes of death, while the most frequent causes of death in men were substance dependence as the UC and associated cause of death, and cancer as an associated cause of death. The most frequent causes of death were DM and stroke in the North and Northeast, dyslipidemia and obesity in the Midwest, Alzheimer's disease in the South and Southeast, and atherosclerotic heart disease (AHD) and COPD in the South. CONCLUSIONS: Several diseases - including AMI, AH, CIHD, HF, and DM - were the most frequent associated causes of death when IHD was recorded as the UC. In contrast, AMI, DM, CIHD, COPD, and stroke were the most frequent UCs when IHD was listed as an associated cause of death. The degree of these associations varied between sexes and geographic regions.

Occupational exposure to vapors, gasses, dusts, and fumes in relation to causes of death during 24 years in Helsinki, Finland.

PURPOSE: Environmental particulate matter (PM) exposure has been shown to cause excess all-cause and disease-specific mortality. Our aim was to compare disease-specific mortality by estimated occupational exposure to vapors, gasses, dusts, and fumes (VGDF). METHODS: The data source is the Helsinki part of the population-based FinEsS study on chronic obstructive pulmonary diseases including information on age, education level, main occupation, sex, and tobacco smoking combined with death registry information. We compared estimated VGDF exposure to mortality using adjusted competing-risks regression for disease-specific survival analysis for a 24-year follow-up. RESULTS: Compared to the no-exposure group, the high occupational VGDF exposure group had sub-hazard ratios (sHR) of 1.7 (95% CI 1.3-2.2) for all cardiovascular-related and sHR 2.1 (1.5-3.9) for just coronary artery-related mortality. It also had sHR 1.7 (1.0-2.8) for Alzheimer's or vascular dementia-related mortality and sHR 1.7(1.2-2.4) for all respiratory disease-related mortality. CONCLUSION: Long-term occupational exposure to VGDF increased the hazard of mortality- to cardiovascular-, respiratory-, and dementia-related causes. This emphasizes the need for minimizing occupational long-term respiratory exposure to dust, gasses, and fumes.

Age- and cause-specific contributions to increase in life expectancy at birth in Korea, 2000-2019: a descriptive study.

BACKGROUND: Korea's life expectancy at birth has consistently increased in the 21st century. This study compared the age and cause-specific contribution to the increase in life expectancy at birth in Korea before and after 2010. METHODS: The population and death numbers by year, sex, 5-year age group, and cause of death from 2000 to 2019 were acquired. Life expectancy at birth was calculated using an abridged life table by sex and year. The annual age-standardized and age-specific mortality by cause of death was also estimated. Lastly, the age and cause-specific contribution to the increase in life expectancy at birth in the two periods were compared using a stepwise replacement algorithm. RESULTS: Life expectancy at birth in Korea increased consistently from 2010 to 2019, though slightly slower than from 2000 to 2009. The cause-specific mortality and life expectancy decomposition analysis showed a significant decrease in mortality in chronic diseases, such as neoplasms and diseases of the circulatory system, in the middle and old-aged groups. External causes, such as transport injuries and suicide, mortality in younger age groups also increased life expectancy. However, mortality from diseases of the respiratory system increased in the very old age group during 2010-2019. CONCLUSIONS: Life expectancy at birth in Korea continued to increase mainly due to decreased mortality from chronic diseases and external causes during the study period. However, the aging of the population structure increased vulnerability to respiratory diseases. The factors behind the higher death rate from respiratory disease should be studied in the future.

Trends in socioeconomic inequalities in cause-specific premature mortality in Belgium, 1998-2019.

BACKGROUND: Higher levels of socioeconomic deprivation have been consistently associated with increased risk of premature mortality, but a detailed analysis by causes of death is lacking in Belgium. We aim to investigate the association between area deprivation and all-cause and cause-specific premature mortality in Belgium over the period 1998-2019. METHODS: We used the 2001 and 2011 Belgian Indices of Multiple Deprivation to assign statistical sectors, the smallest geographical units in the country, into deprivation deciles. All-cause and cause-specific premature mortality rates, population attributable fraction, and potential years of life lost due to inequality were estimated by period, sex, and deprivation deciles. RESULTS: Men and women living in the most deprived areas were 1.96 and 1.78 times more likely to die prematurely compared to those living in the least deprived areas over the period under study (1998-2019). About 28% of all premature deaths could be attributed to socioeconomic inequality and about 30% of potential years of life lost would be averted if the whole population of Belgium faced the premature mortality rates of the least deprived areas. CONCLUSION: Premature mortality rates have declined over time, but inequality has increased due to a faster pace of decrease in the least deprived areas compared to the most deprived areas. As the causes of death related to poor lifestyle choices contribute the most to the inequality gap, more effective, country-level interventions should be put in place to target segments of the population living in the most deprived areas as they are facing disproportionately high risks of dying.

Mortality rates, cause and risk factors in people with spina bifida, register-based study over five decades.

AIM: Care for people with spina bifida can be improved. This may be done by evaluating mortality rates and causes of death. METHODS: Between 1973 and 2021, 1735 people with spina bifida appeared in registers of the Swedish population. Survival rates and causes of death were calculated according to age and decade. RESULTS: Over almost 50 years, the prevalence of spina bifida decreased from 5.2 to 1.2 per 10 000 births. Mortality fell sharply during the first year of life, with survival rising from 75% to 94%. For children aged 2-18 years and adults, mortality rates were low and differences between decades were minimal. Causes of childhood deaths were congenital abnormalities, hydrocephalus and infections, the latter two also in adults. Adult causes also included self-inflicted injuries and substance abuse, with suicidal or unclear intent, both more common than in the general population. Bladder malignancies were also more frequent, although after reconstructive bladder surgery, mortality rates were similar. CONCLUSION: Survival in the first year of life increased in children with spina bifida, whereas there was no difference in survival rates between adults born between 1973 and 1999. For adults, proactive prevention methods regarding self-inflicted injury, substance abuse and bladder cancer are warranted.

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.

Method for redistributing ill-defined causes of death.

Analysis of causes of death is crucial for monitoring an epidemiological situation and for developing adequate policy responses. However, the comparability of cause-specific mortality data depends on the proportion of ill-defined deaths. To eliminate the bias resulting from the varying proportions of such causes over time and between populations, deaths from ill-defined causes need to be reassigned to other categories. We provide thorough documentation of and tools for the practical implementation of a regression-based method for redistributing ill-defined causes of death, as first proposed by Sully Ledermann in the 1950s. The method relies on subnational cause-specific mortality data to estimate unbiased death rates at both national and subnational levels. We refine Ledermann's method by elaborating on its mathematical properties, making additional adjustments, and evaluating the performance of the approach through simulations. To illustrate the practical application of the method, we rely on French subnational cause-of-death data and provide the R code for performing all calculations.