The Epidemiologic Transition in French Guiana: Secular Trends and Setbacks, and Comparisons with Continental France and South American Countries.

There are great variations between population subgroups, notably in poorer countries, leading to substantial inconsistencies with those predicted by the classical epidemiologic transition theory. In this context, using public data, we aimed to determine how the singular case of French Guiana fit and transitioned in the epidemiologic transition framework. The data show a gradual decline in infant mortality to values above 8 per 1000 live births. Premature mortality rates were greater but declined more rapidly in French Guiana than in mainland France until 2017 when they reascended in a context of political turmoil followed by the COVID-19 pandemic and strong reluctance to get vaccinated. Although infections were a more frequent cause of death in French Guiana, there is a marked decline and circulatory and metabolic causes are major causes of premature death. Fertility rates remain high (>3 live births per woman), and the age structure of the population is still pyramid-shaped. The singularities of French Guiana (rich country, universal health system, widespread poverty) explain why its transition does not fit neatly within the usual stages of transition. Beyond gradual improvements in secular trends, the data also suggest that political turmoil and fake news may have detrimentally affected mortality in French Guiana and reversed improving trends.

Changes in the Level of Premature Mortality in the Polish Population Due to Selected Groups of Cardiovascular Diseases before and during the Pandemic of COVID-19.

BACKGROUND: In the years 2020 and 2021, the COVID-19 pandemic disrupted Poland's health care system and caused a high number of excess deaths. After nearly 30 years of continuous dynamic increase in the life expectancy of the Polish population and a decrease in premature mortality that led to a reduction in the health gap between Poland and Western European countries, regrettably, a decline in life expectancy was recorded. For males, the decline amounted to 2.3 years and, for females, to 2.1 years. AIM: The aim of this study was to assess changes in the level of premature mortality due to selected cardiovascular diseases in Poland before and during the COVID-19 pandemic. METHOD: Time trends of deaths of patients under the age of 65 due to ischemic heart disease, cerebrovascular disease and aortic aneurysm were analyzed by gender and age groups. The joinpoint model was used in determining time trends. RESULTS: Premature mortality due to all of the cardiovascular diseases analyzed had been declining steadily by about 5% per year since 2008. However, at the end of the second decade of the 21st century, a significant change in the dynamics of the trend was observed, particularly with regard to deaths from ischemic heart disease, which since 2018 caused premature mortality increases of 10% per year in the female population. In the male population, an increase of nearly 20% per year has been observed since 2019. The changes also affected premature mortality due to cerebrovascular disease. CONCLUSIONS: After nearly three decades of significant decline in premature mortality from cardiovascular diseases in Poland, there was a reversal in the trend, in particular as regards ischemic heart disease. The unfavorable changes intensified in the subsequent two years. The simultaneous increase in the number of cardiovascular incidents ending in death and the decline in access to prompt diagnosis and effective treatment may explain the unfavorable changes in the deaths caused by cardiovascular disease and the increase in premature mortality due to cardiovascular disease.

Trends in premature mortality from diabetes mellitus in Costa Rica in the period 2000-2020.

OBJECTIVES: To analyze the temporal trends of premature mortality from diabetes in Costa Rica in the period 2000-2020, at a national level and by province, and the effect of the COVID-19 pandemic on diabetes mortality during the year 2020. METHODS: We studied the temporal trends of mortality from diabetes in Costa Rica in the period between 2000 and 2020. Age-standardized mortality rates and corresponding 95% confidence intervals were calculated for each year, sex and province. RESULTS: We analyzed the data of 17,968 deceased persons. The mean age was 72.5 years (range 1 to 109 years), and 51.5% of the population (n = 9253) was younger than 75 years. In both men and women, we observed a significant decrease in mortality from 2000 to 2014, followed by the opposite trend from 2014 to 2020, with average yearly increases of 13.9% in men and 11.6% in women. CONCLUSIONS: Premature mortality from diabetes has been growing from 2014. The COVID-19 pandemic changed the mortality pattern, increasing premature diabetes deaths in Costa Rica in 2020.

Tracking long-term population exposure risks to PM2.5 and ozone in urban agglomerations of China 2015-2021.

China has experienced severe air pollution in the past decade, especially PM2.5 and emerging ozone pollution recently. In this study, we comprehensively analyzed long-term population exposure risks to PM2.5 and ozone in urban agglomerations of China during 2015-2021 regarding two-stage clean-air actions based on the Ministry of Ecology and the Environment (MEE) air monitoring network. Overall, the ratio of the population living in the regions exceeding the Chinese National Ambient Air Quality Standard (35 µg/m3) decreases by 29.9 % for PM2.5 from 2015 to 2021, driven by high proportions in the Middle Plain (MP, 42.3 %) and Lan-Xi (35.0 %) regions. However, this ratio almost remains unchanged for ozone and even increases by 1.5 % in the MP region. As expected, the improved air quality leads to 234.7 × 103 avoided premature mortality (ΔMort), mainly ascribed to the reduction in PM2.5 concentration. COVID-19 pandemic may influence the annual variation of PM2.5-related ΔMort as it affects the shape of the population exposure curve to become much steeper. Although all eleven urban agglomerations share stroke (43.6 %) and ischaemic heart disease (IHD, 30.1 %) as the two largest contributors to total ΔMort, cause-specific ΔMort is highly regional heterogeneous, in which ozone-related ΔMort is significantly higher (21 %) in the Tibet region than other urban agglomeration. Despite ozone-related ΔMort being one order of magnitude lower than PM2.5-related ΔMort from 2015 to 2021, ozone-related ΔMort is predicted to increase in major urban agglomerations initially along with a continuous decline for PM2.5-related ΔMort from 2020 to 2060, highlighting the importance of ozone control. Coordinated controls of PM2.5 and O3 are warranted for reducing health burdens in China during achieving carbon neutrality.

Observed and predicted premature mortality in Australia due to non-communicable diseases: a population-based study examining progress towards the WHO 25X25 goal.

BACKGROUND: The World Health Organization's (WHO) 25X25 goal aims for a 25% relative reduction in premature death due to four non-communicable diseases (NCD4)-cancer, cardiovascular disease, chronic respiratory diseases and diabetes-by 2025 compared to 2010. This study aimed to quantify the premature mortality in the Australian population due to NCD4, quantify the variation in mortality rates by age and sex, predict the premature mortality due to NCD4 in 2025 and evaluate the progress towards the WHO 25X25 goal. METHODS: A population-based study using cause-specific mortality data of all deaths which occurred in Australia from 2010 to 2016 and registered up to 2017, for adults aged 30-69 years, was conducted. Age-specific and age-standardised mortality rates (ASMR) and probability of death for NCD4 were calculated for each year. ASMRs in 2016 were calculated for men and women. Deaths and the probability of death in 2025 were predicted using Poisson regression based on data from 2006 to 2016. To assess the progress against the WHO 25X25 goal, the relative reduction in the probability of death from NCD4 conditions in 2025 compared to 2010 was calculated. RESULTS: ASMRs for NCD4 decreased from 2010 to 2016, except for diabetes which increased on average by 2.5% per year. Across sociodemographic factors, ASMRs were highest in males and increased with age. The projected probability of premature death in 2025 was 7.36%, equivalent to a relative reduction of 25.16% compared to 2010 levels. CONCLUSIONS: Premature mortality due to cancer, cardiovascular disease, respiratory diseases and diabetes declined in Australia from 2010 to 2016. This trend is consistent across age groups and by sex, and higher mortality rates were observed in males and at older ages. Nationally, if the current trends continue, we estimate that Australia will achieve a 25.16% relative reduction in premature deaths due to NCD4 in 2025 compared to 2010, signifying substantial progress towards the WHO 25X25 goal. Concerted efforts will need to continue to meet the 25X25 goal, especially in the context of the COVID-19 pandemic.

Forecast of the socioeconomic burden of COPD in the Russian Federation in 2022

Chronic obstructive pulmonary disease (COPD) is characterized by a high level of morbidity and mortality and is associated with significant social and economic losses for the health care system and society. Aim. To predict the socio-economic burden of COPD in the Russian Federation in 2022, including the cost of drug treatment. Methods. The socio-economic burden of COPD in the Russian Federation in 2022 was predicted with and without taking into account the impact of COVID-19. The analysis of the cost of illness included the calculation of direct and indirect costs due to COPD. Data of Federal State Statistics Service, the State Guarantee Program of Free Medical Care for Citizens of Russian Federation, and data from the regional register of drug treatment of patients with COPD were used. Costs of medical care (ambulatory, hospital, and emergency care) were calculated based on compulsory health insurance tariffs. The disability benefits payments were calculated based on number of disabled persons and the amount of the disability benefit in each group. Indirect costs (or economic losses) included losses from products which were not produced due to disability and premature mortality of working-aged adults. Results. The predicted total economic losses due to COPD in 2022 will be 428.5 billion rubles when taking into account the impact of COVID-19, and 378.9 billion rubles when not accounting for COVID-19. Losses in the economy due to decreased labor productivity because of premature deaths (86%) are major part of the main burden. The cost of drug therapy for patients with COPD in outpatient settings will amount to over 17 billion rubles. Conclusion. Potential economic burden of COPD in 2022 depends on the incidence of COVID-19 and could be 0.34% of the GDP. Priority should be given to measures aimed at preventing the occurrence of COPD by correcting risk factors in the population, early diagnosis, slowing the progression of the disease and preventing exacerbations. Prevention of respiratory infections including COVID-19 in patients with COPD plays a special role.

Trajectories of UCR as a measure of biological mechanisms underlying ethnicity associated outcomes in COVID-19

Introduction: Patients with Black and Asian ethnic background have been disproportionately affected by COVID-19 with increased disease severity, organ failure, intensive care admission, and premature mortality. 1-3 The urea-to-creatinine ratio (UCR) has been described as a biochemical signature of persistent critical illness, its hallmark catabolic state and late mortality during prolonged ICU stay.4 Low serum creatinine reflecting reduced muscle mass, which declines rapidly in acute severe illness in combination with net muscle protein breakdown which contribute substrate for increased hepatic urea synthesis, results in markedly elevated UCR. Objectives: To assess UCR as a candidate biological feature driving ethnicity associated outcomes of COVID-19 disease. Methods: Prospective analysis using registry data from all patients aged ≥16 years with an emergency admission to hospitals within Barts Health NHS Trust with SARSCoV-2 infection during 1 January 2020 - 13 May 2020 (wave 1), and 1 September 2020 -17 February 2021 (wave 2). Trajectories of routine haematology and clinical biochemistry blood results during hospital admission were assessed, and distinct phenotypes defined using unsupervised longitudinal clustering techniques using day 0 to 15 results.We determined distribution of identified phenotypes within patients categorised by ethnic group. Multivariable logistic regression accounting for predefined baseline risk factors was used to assess association between ethnicity, phenotypes, and 30-day mortality. All analyses were performed using R software v4.02 and the kml package for clustering. 5 Results are presented as n (%) and adjusted odds ratios (OR) with 95% confidence intervals. Results: We assessed 459 (wave 1) and 1337 (wave 2) patients after excluding those with unknown ethnicity and those with <7 blood results. Three clusters were identified based on trajectories of UCR. In wave 1, 48.1% of patients had persistently low levels of UCR (A), 38.6% had higher but stable levels (B), and 13.3% had the highest levels peaking after day 7 (C). In wave 2, three clusters were identified in similar proportions: 42.8% (a), 45.1% (b), 12.1% (c). In wave 1, patients in cluster C compared to A had the highest risk of death at 30 days (OR 4.59 [2.27-9.26], p<0.001). In wave 2, both clusters b (OR 1.58 [1.18-2.12], p< 0.001) and c (OR 3.96 [2.62-5.99], p<0.001) had higher risk of death compared to a. Distribution of cluster membership varied by ethnic category. In both waves, greater proportions of patients within cluster A/a were observed in patients with Black ethnicity (65.5% wave 1, 61.1% wave 2) compared to Asian (50.0% wave 1, 37.3% wave 2) and White (39.7% wave 1, 39.6% wave 2) ethnicity. Black ethnicity patients also had lowest proportions in cluster C/c (6.9% wave 1, 6.3% wave 2) compared to Asian (17.4% wave 1, 14.2% wave 2) and White (13.2% wave 1, 12.9% wave 2) ethnicity. Inclusion of UCR trajectory attenuated the higher risk of death seen in Asian patients in wave 1. Conclusion: Phenotypes based on UCR trajectories during hospital admission are associated with adverse outcomes following COVID-19 infection. Further work is needed to understand phenotypes of prolonged COVID-19 disease muscle wasting and its association with longerterm outcomes.

The relationship Between Glycemic Control and Food Insecurity in People with Diabetes Mellitus and Comorbid Psychosis

Background/Significance: In the US, adults with psychosis have increased mortality mostly due to cardiovascular disease (CVD) (Olfson 2015). Diabetes mellitus (DM) is a potent CVD risk factor, which occurs in 28% of individuals with serious mental illnesses (Mangurian 2018). Little is understood of the contribution of social and environmental factors to diabetes health disparities experienced by people with psychosis. Food insecurity has been shown to be an independent risk factor for poor glycemic control (Seligman 2012). Methods: This IRB-approved cross-sectional survey aims to describe the prevalence and correlates of food insecurity among adults with DM and co-morbid psychosis who receive primary care through 12 clinics affiliated with a large academic healthcare system in Washington state. Administrative data was utilized to identify eligible patients: age 18-65;one inpatient or two outpatient diagnoses of schizophrenia (F20-29), bipolar disorder (F31), or major depressive disorder with psychotic features (F32.3;F33.3) and one inpatient or two outpatient diagnoses of DM (E08-E13.9). Patients with diagnoses of dementia or intellectual disability were excluded. All eligible patients were sent a letter with a unique link to a survey in Research Electronic Data Capture. The survey included questions related to diabetes clinical characteristics, self-care behaviors, and psychosis symptom severity in addition to demographics. Food insecurity was measured with the validated USDA’s Food Security Survey Module. Consistent with previous studies, participants will be considered food-insecure if two or more responses are affirmative. We compared food insecure and food secure particpants with level of social support and frequency of psychiatry symptoms. •Regression analysis was applied to examine the associations between food security status, social support, and mental health symptoms. Results: 624 patients with diabetes and psychosis were identified. 156 patients responded, giving a response rate of 26%. 25% of respondents were found to be food insecure. 16% of respondents demonstrated low social support while 43% showed moderate social support and 41% showed high social support. Mean CSI was 19.36, which suggests participants experienced symptoms several times per month (versus daily or weekly). Significantly lower social support was found in participants with food insecurity compared to those without (p=0.008). This relationship was driven by lower social support from family (p<0.001) compared to friends (p=0.61) or significant others (p=0.192). Additionally, greater psychiatric symptom severity was found in people with food insecurity (p <0.001). Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms. Discussion: This study showed that food insecurity was significantly associated with both low perceived social support and more frequent psychiatric symptoms. However, no evidence of a moderating effect of social support on the relationship between food insecurity and psychiatric symptom severity was found. Rate of food insecurity was found to be lower than previous studies, which showed approximately 50% of individuals who used public mental health services faced food insecurity (Adams et al., 2021). The study sample was not limited to public mental health service users, which is the likely cause of this lower rate. Conclusion/Implications: Food insecurity is associated with poorer mental health outcomes, which have been associated with poorer health outcomes. The presence of perceived social support does not mitigate the need for addressing food insecurity. There is a need for both medical and mental health providers who care for people with co-morbid diabetes and psychosis to specifically address food insecurity. References: 1. Adams WE, Rogers ES, Edwards JP, Lord EM, McKnight L, Barbone M. Impact of COVID-19 on Peer Support Specialists in the United States: Findings From a Cross-Sectional Online Survey. Psychiatr c Services. 2021 Jun 23:appi-ps. 2. Coleman-Jensen AJ. US food insecurity status: toward a refined definition. Social Indicators Research. 2010 Jan 1;95(2):215-30. 3. Hammami N, Leatherdale ST, Elgar FJ. Does social support moderate the association between hunger and mental health in youth? A gender-specific investigation from the Canadian Health Behaviour in School-aged Children study. Nutrition journal. 2020 Dec;19(1):1-1. 4. Mangurian CV et al. Diabetes and prediabetes prevalence by race and ethnicity. Diabetes care. 2018 Jul 1;41(7):e119-20. 5. Na M, Miller M, Ballard T, Mitchell DC, Hung YW, Melgar-Quiñonez H. Does social support modify the relationship between food insecurity and poor mental health? Evidence from thirty-nine sub-Saharan African countries. Public health nutrition. 2019 Apr;22(5):874-81. 6. Olfson M et al. Premature mortality among adults with schizophrenia in the United States. JAMA psychiatry. 2015 Dec 1;72(12):1172-81. Seligman HK et al. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes care. 2012 Feb 1;35(2):233-8. Stubbs B, Vancampfort D, De Hert M, Mitchell AJ.Acta Psychiatr Scand. 2015 Aug;132(2):144-57. Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms.

In hospital outcomes in older adults with COVID-19 and epilepsy

COVID-19 causes high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. Since epilepsy is associated with premature mortality, we aimed to evaluate in-hospital outcomes, including mortality, in older compared (>65) to younger adults (<65) with COVID-19 and epilepsy. We hypothesized that adults >65 years with epilepsy would have higher mortality despite adjustment for comorbidity. This retrospective study in a large multicenter New York health system included consecutive patients with epilepsy admitted with COVID-19 between 3/15/2020-5/17/2021. Epilepsy was identified using a validated ICD-CM based case definition. Outcomes were level of respiratory support, ICU admission, and mortality. Chi-square tests, Fisher's exact tests, Student's t-tests and Mann-Whitney U or Kolmogorov Smirnov tests were conducted as appropriate. Multivariable logistic regression models were generated to examine factors associated with mortality. We identified 173 older and 161 younger adults with epilepsy and COVID-19. Median age of older (>65) compared to younger (<65) adults was 74 vs. 52 (p<.001). A larger proportion of older adults died in hospital (35.8% vs. 23%, p=.01). Older adults were less likely to be discharged to home (21.4% vs. 38.5%, p<.001) and more likely to go to a chronic care facility (19.7% vs. 10.0%, p<.001). Ventilation status (35.8% vs. 39.8%, p=.45) or ICU admission rate (34.7% vs. 44.1%, p=.08) were not significantly different between the age groups. Older adults had higher odds of mortality after adjusting for sex, race, language and Charlson Comorbidity Index (CCI) (OR, 2.04;95% CI, 1.22-3.40, p=0.01). Within the over 65 group, increasing years of age (OR 1.07;95% CI 1.02-1.12, p=0.01), and increasing CCI score (OR 1.16, 95% CI 1.01-1.32, p=0.03) were associated with in-hospital mortality while sex, race, and language were not. Our study found higher in-hospital mortality in older compared to younger adults with epilepsy diagnosed with COVID-19. Consistent with prior work, increasing age and increasing number of comorbid diseases was associated with increased odds of mortality, reinforcing the need to communicate risks of multimorbidity and COVID-19 in older adults with epilepsy.

COVID-19 Lockdowns Afford the First Satellite-Based Confirmation That Vehicles Are an Under-recognized Source of Urban NH3 Pollution in Los Angeles

In situ measurements have suggested vehicle emissions may dominate agricultural sources of NH3 in many cities, which is alarming given the potential for urban NH3 to significantly increase human exposure to ambient particulate matter. However, confirmation of the prevalence of vehicle NH3 throughout a city has been challenging because of mixing with agricultural sources, and the latter are thus routinely assumed to dominate. Here we report vehicle NH3 emissions based on TROPOMI NO2 and CrIS NH3 (0.152 kg s(-1)) that are consistent with a model-based estimate (0.178 kg s(-1)) and show that COVID-19 lockdowns provide a unique opportunity for making the first satellite-based constraints on vehicle NH3 emissions for an entire urban region (western Los Angeles), which we find make up 60-95% of total NH3 emissions, substantially higher than the values of 13-22% in state and national inventories. This provides a new means of constraining a component of transportation emissions whose impacts may rival those of NOx yet which has been largely under-recognized and uncontrolled.

The Early Lessons of COVID-19: The Need for a Broader Health-Economic Perspective

Objectives: The current COVID-19 pandemic caused ∼20,000 deaths and ∼50,000 hospital admissions in the Netherlands. Efforts to manage this communicable disease and its impact on the health-care system without prior development of specific vaccines have put a strain on the fiscal budget. This study aims to indicatively quantify the impact of COVID-19 on the Dutch government’s fiscal position, simultaneously indicating the value of preventive vaccines from a payer perspective. Methods: Dutch COVID-19 specific population data on laboratory-confirmed infections, hospital admissions and mortality, was collected from the domestic start of the COVID-19 pandemic on 27 February 2020 until the first administered vaccine on 6 January 2021. A fiscal health modelling approach was used to estimate the loss in tax revenues. Occurred productivity losses were added as an indicator for the future burden on the social security system. Tax revenue losses were caused by premature mortality, whereas the productivity losses occurred through mortality as well as morbidity. Outcomes were expressed in total monetary impact (€, 2020). Results: The impact of the pandemic in the analysed time-period was estimated to amount to a total of €920.7 million. Tax loss due to premature mortality amounted to €58.8 million with 50% attributed to patients >60 years. Productivity loss due to morbidity summed up to €862 million with 46% due to patients 40-59 years. Conclusions: The fiscal impact of the current pandemic highlights the importance of a broader approach to health-economic analysis. A fiscal health framework, optimally linked to a disease simulation model, is a better instrument to inform decision-making in the context of communicable diseases. The reported fiscal estimates also highlight the benefit of investments in communicable disease prevention such as anticipative development of vaccines. In the decision-making process around pandemic preparedness measures, investment funding and real-options can consequently be informed by a fiscal health framework.

Causes and Circumstances of Death: Analysis in 266 Sickle Cell Adult Patients

Introduction Sickle cell disease is a genetic disease with acute and chronic complications. Pediatric mortality has decreased in recent decades with the introduction of systematic antibiotic therapy, preventive management of cerebral vasculopathy and therapeutic education of families. However, in the absence of cohort follow-up at birth, life expectancy, which is a different concept from age at death, cannot be assessed. In this retrospective, monocentric study, we describe causes and circumstances of death, acute chronic complications, long-term treatments and baseline biology of these patients. It seems important to analyze the risks of morbidity and mortality in order to decide on the necessary preventive measures. Material and method: Records of patients deceased between 2000 and 2020, from the national referral center (Henri Mondor Hospital), were retrospectively reviewed. The referral center follows 3500 patients. All deaths reported to the hospital, by families, other hospitals and health professionals were retrieved from computerized records. Deaths published by the INSEE (National Institute of Statistical and Economical study) from 2000 to December 2020 were accessible and compared with our databases to identify all our deceased patients. All patients with a medical record in our center were included for the study. Patients who had never visited our center were excluded. Results: During this period 226 patients including 128 women and 138 men are recorded. Genotypes for these patients were 204(76%) SS, 41 (15%) SC, 14(5%) Sβ°thalassemia and 7 (2%) Sβ+thalassemia. The median age at death was 41 years with an IQR [32-51]. 186 (70%) patients were hospitalized, 129 (70%) of whom were admitted to intensive care. 36 (13%) patients died at home, including 15 with opioid addiction and 5 patients with psychiatric pathology, and 4 patients on dialysis. This information was not available for 44 (16%) patients. The causes of death were vaso-occlusive complications with multivisceral failure in 44 cases, 42 sepsis, among which there were 11 renal failures, 9 of which were dialyzed. 5 patients died of COVID 19. Cerebral hemorrhage and neurological accident occurred in 22 cases, 4 of which were known to have macrovasculopathy. 25 patients died of a direct complication of renal failure, of which 17 were dialysed, 8 pre-dialysed and 3 transplanted. Acute liver failure in 16 cases, 10 precapillary pulmonary hypertension, 14 DHTR, 10 end-stage heart failure were noted. Two road accidents, 2 suicides, 1 dementia are repoted. For 51 cases, there was no information on the cause or circumstance of death. The causes of death according to genotype is on Table 1. Concerning the chronic complications, 94/266 (35%) patients had significant chronic organ damage. Sixteen patients had required renal or liver transplantation in their history. End-stage organ damage was frequent, 42 had end-stage renal failure, 21 had major liver failure, of which five were transplanted and 16 were awaiting transplantation. Twenty-one patients had known heart failure, 10 of which were associated with end-stage renal disease. Ten patients were followed for significant precapillary pulmonary hypertension. Transfusion difficulties due to a history of DHTR were found for 33 patients. Fourteen patients had an opioid addiction. Nine patients were pregnant and nine had received corticosteroids. Discussion: Causes of death have changed and chronic organ failure is the leading cause of death, especially in patients with kidney, liver and heart disease. This study does not calculate life expectancy, but there was an increase in age at death of about 1/4 of the patients who were between 51 and 81 years old.The management of sickle cell disease has progressed in recent years and new therapies are being proposed. Prevention of the development of these complications is one of the new challenges, especially for renal disease, which is associated with premature mortality. DHTR and cerebral hemorrhage, Covid-19 are new entities and DHTR was probably underdiagnosed in p evious publications. Pregnancy remains a period at risk, for which surveillance should be reinforced. The analysis is ongoing and correlations are currently being investigated between different parameters to find risk factors for mortality. [Formula presented] Disclosures: Habibi: Novartis: Consultancy, Honoraria;bluebird bio: Consultancy, Honoraria, Research Funding. Audard: Addmedica: Consultancy. Michel: Novartis: Consultancy;Amgen: Consultancy;Rigel: Honoraria;Alexion: Honoraria;UCB: Honoraria;Argenx: Honoraria. Galactéros: Addmedica: Membership on an entity's Board of Directors or advisory committees. Bartolucci: INNOVHEM: Other: Co-founder;Bluebird: Consultancy, Research Funding;F. Hoffmann-La Roche Ltd: Consultancy;GBT: Consultancy;Jazz Pharma: Other: Lecture fees;AGIOS: Consultancy;Hemanext: Consultancy;Emmaus: Consultancy;Fabre Foundation: Research Funding;Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Lecture fees, Steering committee, Research Funding;Addmedica: Consultancy, Other: Lecture fees, Research Funding.

'Trend in premature mortality from four major NCDs in Nanjing, China, 2007-2018'.

BACKGROUND: This study aims to analyze the trends of premature mortality caused from four major non-communicable diseases (NCDs), namely cardiovascular disease (CVD), cancer, chronic respiratory diseases, and diabetes in Nanjing between 2007 and 2018 and project the ability to achieve the "Healthy China 2030" reduction target. METHODS: Mortality data of four major NCDs for the period 2007-2018 were extracted from the Death Information Registration and Management System of Chinese Center for Disease Control and Prevention. Population data for Nanjing were provided by the Nanjing Bureau of Public Security. The premature mortality was calculated using the life table method. Joinpoint regression model was used to estimate the average annual percent changes (AAPC) in mortality trends. RESULTS: From 2007 to 2018, the premature mortality from four major NCDs combined in Nanjing decreased from 15.5 to 9.5%, with the AAPC value at - 4.3% (95% CI [- 5.2% to - 3.4%]). Overall, it can potentially achieve the target, with a relative reduction 28.6%. The premature mortality from cancer, CVD, chronic respiratory diseases and diabetes all decreased, with AAPC values at - 4.2, - 5.0%, - 5.9% and - 1.6% respectively. A relative reduction of 40.6 and 41.2% in females and in rural areas, but only 21.0 and 12.8% in males and in urban areas were projected. CONCLUSION: An integrated approach should be taken focusing on the modifiable risk factors across different sectors and disciplines in Nanjing. The prevention and treatment of cancers, diabetes, male and rural areas NCDs should be enhanced.

Comparing cancer and cardiovascular disease trends in 20 middle- or high-income countries 2000-19: A pointer to national trajectories towards achieving Sustainable Development goal target 3.4.

With the 2030 Sustainable Development Goals (SDG) target of a one-third reduction in noncommunicable diseases (NCDs) less than a decade away, it is timely to assess national progress in reducing premature deaths from the two leading causes of mortality worldwide. We examine trends in the probability of dying ages 30-70 from cardiovascular disease (CVD) and cancer 2000-19 in 10 middle-income (MICs) and 10 high-income (HICs) countries with high quality data. We then predict whether the SDG target will be met in each country for CVD, cancer and for the four main NCDs combined. Downward trends were more evident in HICs relative to the MICs, and for CVD relative to cancer. CVD and cancer declines ranged from 30-60% and 20-30% in HICs over the 20-year period, but progress was less uniform among the MICs. Premature deaths from cancer exceeded CVD in nine of the 10 HICs by 2000 and in all 10 by 2019; in contrast, CVD mortality exceeded cancer in all 10 MICs in 2000 and remained the leading cause in eight countries by 2019. Two of the 10 MICs (Colombia and Kazakhstan) and seven of the HICs (Australia, Chile, Italy, New Zealand, Norway, Slovakia, and the U.K.) are predicted to meet the SDG NCDs target. Whether countries are on course to meet the target by 2030 reflects changing risk factor profiles and the extent to which effective preventative and medical care interventions have been implemented. In addition, lessons can be learned given people living with NCDs are more susceptible to severe COVID-19 illness and death.

The cost of lost productivity due to premature mortality associated with COVID-19: a Pan-European study.

BACKGROUND: Economic cost estimates have the potential to provide a valuable alternative perspective on the COVID-19 burden. We estimate the premature mortality productivity costs associated with COVID-19 across Europe. METHODS: We calculated excess deaths between the date the cumulative total of COVID-19 deaths reached 10 in a country to 15th May 2020 for nine countries (Belgium, France, Germany, Italy, The Netherlands, Portugal, Spain, Sweden and Switzerland). Gender- and age-specific excess deaths and Years of Potential Productive Life Lost (YPPLL) between 30 and 74 years were calculated and converted into premature mortality productivity costs €2020 for paid and unpaid work using the Human Capital and the Proxy Good Approaches. Costs were discounted at 3.5%. RESULTS: Total estimated excess deaths across the nine countries were 18,614 (77% in men) and YPPLL were 134,190 (77% male). Total paid premature mortality costs were €1.07 billion (87% male) with Spain (€0.35 billion, 33.0% of total), Italy (€0.22 billion; 20.6%) and The Netherlands (€0.19 billion; 17.5%) ranking highest. Total paid and unpaid premature mortality costs were €2.89 billion (77% male). Premature mortality costs per death ranged between €40,382 (France) and €350,325 (Switzerland). Spain experienced the highest premature mortality cost as a proportion of Gross Domestic Product (0.11%). CONCLUSION: Even in the initial period of the pandemic in Europe, COVID-19-related premature mortality costs were significant across Europe. We provide policy makers and researchers with a valuable alternative perspective on the burden of the virus and highlight potential economic savings that may be accrued by applying timely public health measures.

Impact of COVID-19 infection on life expectancy, premature mortality, and DALY in Maharashtra, India.

BACKGROUND: The COVID-19 infections and deaths have largely been uneven within and between countries. With 17% of the world's population, India has so far had 13% of global COVID-19 infections and 8.5% of deaths. Maharashtra accounting for 9% of India's population, is the worst affected state, with 19% of infections and 33% of total deaths in the country until 23rd December 2020. Though a number of studies have examined the vulnerability to and spread of COVID-19 and its effect on mortality, no attempt has been made to understand its impact on mortality in the states of India. METHOD: Using data from multiple sources and under the assumption that COVID-19 deaths are additional deaths in the population, this paper examined the impact of the disease on premature mortality, loss of life expectancy, years of potential life lost (YPLL), and disability-adjusted life years (DALY) in Maharashtra. Descriptive statistics, a set of abridged life tables, YPLL, and DALY were used in the analysis. Estimates of mortality indices were compared pre- and during COVID-19. RESULT: COVID-19 attributable deaths account for 5.3% of total deaths in the state and have reduced the life expectancy at birth by 0.8 years, from 73.2 years in the pre-COVID-19 period to 72.4 years by the end of 2020. If COVID-19 attributable deaths increase to 10% of total deaths, life expectancy at birth will likely reduce by 1.4 years. The probability of death in 20-64 years of age (the prime working-age group) has increased from 0.15 to 0.16 due to COVID-19. There has been 1.06 million additional loss of years (YPLL) in the state, and DALY due to COVID-19 has been estimated to be 6 per thousand. CONCLUSION: COVID-19 has increased premature mortality, YPLL, and DALY and has reduced life expectancy at every age in Maharashtra.

[Air pollution and cardiovascular diseases]. / Luftverschmutzung und Herz-Kreislauf-Erkrankungen.

Air pollution in the environment and in households is responsible worldwide for almost 9 million preventable premature deaths per year and almost 800,000 such deaths within Europe. Air pollution therefore shortens life expectancy worldwide by almost 3 years. Smoking, a proven cardiovascular risk factor, shortens the mean life expectancy by 2.2 years. Epidemiological studies have shown that air pollution from fine and coarse particulate matter is associated with increased cardiovascular morbidity and mortality. Responsible for this are mainly cardiovascular diseases, such as coronary heart disease, heart attack, heart failure, stroke, hypertension and also diabetes, which are mainly caused or aggravated by fine particulate matter. After inhalation fine particulate matter can reach the brain directly and also reach the bloodstream via a transition process. There, the particles are absorbed by the blood vessels where they stimulate the formation of reactive oxygen species (ROS) in the vascular wall. They therefore promote the formation of atherosclerotic changes and in this way increase the cardiovascular risks, especially an increase in chronic ischemic heart disease and stroke. Recent studies also reported that in coronavirus disease 2019 (COVID-19) patients a high degree of air pollution is correlated with severe disease courses with cardiovascular complications and pulmonary diseases. This necessitates preventive measures, such as lowering of the upper limits for air pollutants. Individual measures to mitigate the health consequences of fine particulate matter are also discussed.

Projection of premature mortality from noncommunicable diseases for 2025: a model based study from Hunan Province, China, 1990-2016.

BACKGROUND: In 2011, the United Nations set a target to reduce premature mortality from non-communicable diseases (NCDs) by 25% by 2025. While studies have reported the target in some countries, no studies have been done in China. This study aims to project the ability to reach the target in Hunan Province, China, and establish the priority for future interventions. METHODS: We conducted the study during 2019-2020. From the Global Burden of Disease Study 2016, we extracted death data for Hunan during 1990-2016 for four main NCDs, namely cancer, cardiovascular disease (CVD), chronic respiratory diseases, and diabetes. We generated estimates for 2025 by fitting a linear regression to the premature mortality over the most recent trend identified by a joinpoint regression model. We also estimated excess premature mortality attributable to unfavorable changes over time. RESULTS: The rate of premature mortality from all NCDs in Hunan will be 19.5% (95% CI [19.0%-20.1%]) by 2025, with the main contributions being from CVD (8.2%, 95% CI [7.9%-8.5%]) and cancer (7.9%, 95% CI [7.8%-8.1%]). Overall, it will be impossible to achieve the target, with a relative reduction of 16.4%. Women may be able to meet the target except with respect to cancer, and men will not except with respect to chronic respiratory diseases. Most of the unfavorable changes have occurred since 2008-2009. DISCUSSION: More urgent efforts, especially for men, should be exerted in Hunan by integrating population-wide interventions into a stronger health-care system. In the post lock-down COVID-19 era in China, reducing the NCD risk factors can also lower the risk of death from COVID-19.

Changes of air quality and its associated health and economic burden in 31 provincial capital cities in China during COVID-19 pandemic.

With outbreak of the novel coronavirus disease (COVID-19), immediate prevention and control actions were imposed in China. Here, we conducted a timely investigation on the changes of air quality, associated health burden and economic loss during the COVID-19 pandemic (January 1 to May 2, 2020). We found an overall improvement of air quality by analyzing data from 31 provincial cities, due to varying degrees of NO2, PM2.5, PM10 and CO reductions outweighing the significant O3 increase. Such improvement corresponds to a total avoided premature mortality of 9410 (7273-11,144) in the 31 cities by comparing the health burdens between 2019 and 2020. NO2 reduction was the largest contributor (55%) to this health benefit, far exceeding PM2.5 (10.9%) and PM10 (23.9%). O3 instead was the only negative factor among six pollutants. The period with the largest daily avoided deaths was rather not the period with strict lockdown but that during February 25 to March 31, due to largest reduction of NO2 and smallest increase of O3. Southwest, Central and East China were regions with relatively high daily avoided deaths, while for some cities in Northeast China, the air pollution was even worse, therefore could cause more deaths than 2019. Correspondingly, the avoided health economic loss attributable to air quality improvement was 19.4 (15.0-23.0) billion. Its distribution was generally similar to results of health burden, except that due to regional differences in willingness to pay to reduce risks of premature deaths, East China became the region with largest daily avoided economic loss. Our results here quantitatively assess the effects of short-term control measures on changes of air quality as well as its associated health and economic burden, and such information is beneficial to future air pollution control.