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1.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 59(1): [101411], ene.-feb. 2024. ilus, tab
Article in Spanish | IBECS | ID: ibc-229861

ABSTRACT

Introducción El creciente envejecimiento poblacional trae consigo un aumento de la incidencia del trastorno neurocognitivo (TNC) así como diversas situaciones generadoras de dependencia. Objetivo Analizar mediante una revisión sistemática la relación que existe entre TNC y dependencia con el riesgo de mortalidad en personas mayores. Métodos Se realizó una búsqueda bibliográfica de los estudios longitudinales publicados en Pubmed y Scopus abordando la relación entre TNC, dependencia para las actividades básicas de la vida diaria (ABVD) y mortalidad publicados entre los años 1995 y 2021 De los 1040 artículos encontrados, se seleccionaron 10 estudios. Resultados Se observó que las cohortes de personas mayores con TNC presentaron riesgo de mortalidad asociado a la afectación de las ABVD (test de Barthel) y a las puntuaciones de Mini-Mental State Examination siguiendo una tendencia lineal significativa. Otros factores asociados al riesgo de mortalidad fueron: niveles bajos de educación, vivir solo y presentar fragilidad. Es clara la vinculación entre los tres términos utilizados en la búsqueda de este trabajo y, sin embargo, destaca que haya pocos estudios longitudinales que los analicen conjuntamente. Conclusiones Los resultados hallados subrayan la importancia de realizar evaluaciones del estado cognitivo y funcional mediante escalas validadas, ya que ambas áreas se asocian con la mortalidad. La evaluación de la dependencia y de la función cognitiva en adultos mayores debe considerarse tanto en la investigación como en la práctica clínica, ya que aportarían información sobre su posible relación con la mortalidad. (AU)


Introduction The increasing aging of the population brings with it an increase in the incidence of neurocognitive disorder (NCD) as well as various situations that generate dependence. Objective To analyze by means of a systematic review the relationship between NCD and dependence with the risk of mortality in the elderly. Methods A bibliographic search of longitudinal studies published in Pubmed and Scopus addressing the relationship between NCI, dependence for basic activities of daily living (ADL) and mortality published between 1995 and 2021 was performed. Of the 1040 articles found, 10 studies were selected. Results It was observed that cohorts of elderly people with NCI presented mortality risk associated with ABVD impairment (Barthel test) and Mini-Mental State Examination scores following a significant linear trend. Other factors associated with mortality risk were low levels of education, living alone, and frailty. Conclusions The results underline the importance of performing assessments of cognitive and functional status using validated scales, since both areas are associated with mortality. The link between the three terms used in the search for this work is clear, but it is noteworthy that there are few longitudinal studies that analyze them together. The assessment of dependence and cognitive function in older adults should be considered in both research and clinical practice as it would provide information on their possible relationship with mortality. (AU)


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Neurocognitive Disorders/complications , Mortality
2.
Med. intensiva (Madr., Ed. impr.) ; 48(2): 85-91, Feb. 2024. tab, graf
Article in English | IBECS | ID: ibc-229320

ABSTRACT

Objective As calculated by the severity scores, an unknown number of patients are admitted to the Intensive Care Unit (ICU) with a very high risk of death. Clinical studies have poorly addressed this population, and their prognosis is largely unknown. Design Post hoc analysis of a multicenter, cohort, longitudinal, observational, retrospective study (CIMbA). Setting Sixteen Portuguese multipurpose ICUs. Patients Patients with a Simplified Acute Physiology Score II (SAPS II) predicted hospital mortality above 80% on admission to the ICU (high-risk group); A comparison with the remaining patients was obtained. Interventions None. Main Variables of Interest Hospital, 30 days, 1 year mortality. Results We identified 4546 patients (59.9% male), 12.2% of the whole population. Their SAPS II predicted hospital mortality was 89.0±5.8%, whilst the observed mortality was lower, 61.0%. This group had higher mortality, both during the first 30 days (aHR 3.52 [95% CI 3.34–3.71]) and from day 31 to day 365 after ICU admission (aHR 1.14 [95%CI 1.04–1.26]), respectively. However, their hospital standardized mortality ratio was similar to the other patients (0.69 vs. 0.69, P=.92). At one year of follow-up, 30% of patients in the high-risk group were alive. Conclusions Roughly 12% of patients admitted to the ICU for more than 24h had a SAPS II score predicted mortality above 80%. Their hospital standardized mortality was similar to the less severe population and 30% were alive after one year of follow-up. (AU)


Objetivo Según las escalas de gravedad, un número indeterminado de pacientes ingresan en la Unidad de Cuidados Intensivos (UCI) con riesgo de muerte muy elevado. Este grupo ha sido poco abordado en los estudios clínicos y se desconoce en gran medida su pronóstico. Diseño Análisis post-hoc de estudio multicéntrico, de cohortes, longitudinal, observacional y retrospectivo (CIMbA). Âmbito Dieciséis UCI polivalentes portuguesas. Pacientes Pacientes con mortalidad hospitalaria prevista en el Simplified Acute Physiology Score II (SAPS II) superior al 80% nel ingreso en la UCI (grupo de alto riesgo); se compararon con los restantes. Intervenciones Ninguna. Variables de interés principals Mortalidad hospitalaria, a 30 días y 1 año. Resultados Se identificaron 4546 pacientes (59.9% hombres), 12.2% da población. La mortalidad hospitalaria estimada por lo SAPS II fue de 89.0±5.8%, aunque la observada fue inferior, 61.0%. Este grupo presentó mayor mortalidad, tanto durante los primeros 30 días (aHR 3.52 [IC 95%: 3.34–3.71]) y desde el día 31 hasta el día 365 después del ingreso en UCI (aHR 1.14 [IC 95%: 1.04–1.26]). Sin embargo, su índice de mortalidad hospitalaria estandarizada fue similar a los otros pacientes (0.69 vs. 0.69; P=.92). Al primer año de seguimiento, 30% de los pacientes de alto riesgo estaban vivos. ConclusionesAproximadamente 12% de los pacientes ingresados en la UCI durante más de 24 horas tenían una mortalidad prevista por SAPS II superior al 80%. Su mortalidad hospitalaria estandarizada fue similar a la de la población menos grave y el 30% estaban vivos después de un año de seguimiento. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Intensive Care Units/statistics & numerical data , Mortality , Risk Assessment , Aftercare/statistics & numerical data , Epidemiology , Cohort Studies , Longitudinal Studies , Retrospective Studies , Multicenter Studies as Topic , Portugal/epidemiology
3.
Int J Epidemiol ; 53(2)2024 Feb 14.
Article in English | MEDLINE | ID: mdl-38365965

ABSTRACT

BACKGROUND: Attempts at assessing heterogeneity in countries' mortality profiles often rely on measures of cause of death (CoD) diversity. Unfortunately, such indicators fail to take into consideration the degree of (dis)similarity among pairs of causes (e.g. 'transport injuries' and 'unintentional injuries' are implicitly assumed to be as dissimilar as 'transport injuries' and 'Alzheimer's disease')-an unrealistic and unduly restrictive assumption. DEVELOPMENT: We extend diversity indicators proposing a broader class of heterogeneity measures that are sensitive to the similarity between the causes of death one works with. The so-called 'CoD inequality' measures are defined as the average expected 'dissimilarity between any two causes of death'. A strength of the approach is that such measures are decomposable, so that users can assess the contribution of each cause to overall CoD heterogeneity levels-a useful property for the evaluation of public health policies. APPLICATION: We have applied the method to 15 low-mortality countries between 1990 and 2019, using data from the Global Burden of Disease project. CoD inequality and CoD diversity generally increase over time across countries and sex, but with some exceptions. In several cases (notably, Finland), both indicators run in opposite directions. CONCLUSIONS: CoD inequality and diversity indicators capture complementary information about the heterogeneity of mortality profiles, so they should be analysed alongside other population health metrics, such as life expectancy and lifespan inequality.


Subject(s)
Alzheimer Disease , Life Expectancy , Humans , Cause of Death , Longevity , Finland , Mortality
4.
BMC Public Health ; 24(1): 350, 2024 02 02.
Article in English | MEDLINE | ID: mdl-38308279

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in significant excess mortality globally. However, the differences in excess mortality between the Omicron and non-Omicron waves, as well as the contribution of local epidemiological characteristics, population immunity, and social factors to excess mortality, remain poorly understood. This study aims to solve the above problems. METHODS: Weekly all-cause death data and covariates from 29 countries for the period 2015-2022 were collected and used. The Bayesian Structured Time Series Model predicted expected weekly deaths, stratified by gender and age groups for the period 2020-2022. The quantile-based g-computation approach accounted for the effects of factors on the excess all-cause mortality rate. Sensitivity analyses were conducted using alternative Omicron proportion thresholds. RESULTS: From the first week of 2021 to the 30th week of 2022, the estimated cumulative number of excess deaths due to COVID-19 globally was nearly 1.39 million. The estimated weekly excess all-cause mortality rate in the 29 countries was approximately 2.17 per 100,000 (95% CI: 1.47 to 2.86). Weekly all-cause excess mortality rates were significantly higher in both male and female groups and all age groups during the non-Omicron wave, except for those younger than 15 years (P < 0.001). Sensitivity analysis confirmed the stability of the results. Positive associations with all-cause excess mortality were found for the constituent ratio of non-Omicron in all variants, new cases per million, positive rate, cardiovascular death rate, people fully vaccinated per hundred, extreme poverty, hospital patients per million humans, people vaccinated per hundred, and stringency index. Conversely, other factors demonstrated negative associations with all-cause excess mortality from the first week of 2021 to the 30th week of 2022. CONCLUSION: Our findings indicate that the COVID-19 Omicron wave was associated with lower excess mortality compared to the non-Omicron wave. This study's analysis of the factors influencing excess deaths suggests that effective strategies to mitigate all-cause mortality include improving economic conditions, promoting widespread vaccination, and enhancing overall population health. Implementing these measures could significantly reduce the burden of COVID-19, facilitate coexistence with the virus, and potentially contribute to its elimination.


Subject(s)
COVID-19 , Humans , Female , Male , Adolescent , Bayes Theorem , Pandemics , Time Factors , Research Design , Mortality
5.
BMJ Open ; 14(2): e079471, 2024 02 02.
Article in English | MEDLINE | ID: mdl-38309756

ABSTRACT

OBJECTIVES: Excess winter mortality is a well-established phenomenon across the developed world. However, whether individual-level factors increase vulnerability to the effects of winter remains inadequately examined. Our aim was to assess long-term trends in excess winter mortality in Finland and estimate the modifying effect of sociodemographic and health characteristics on the risk of winter death. DESIGN: Nationwide register study. SETTING: Finland. PARTICIPANTS: Population aged 60 years and over, resident in Finland, 1971-2019. OUTCOME MEASURES: Age-adjusted winter and non-winter death rates, and winter-to-non-winter rate ratios and relative risks (multiplicative interaction effects between winter and modifying characteristics). RESULTS: We found a decreasing trend in the relative winter excess mortality over five decades and a drop in the series around 2000. During 2000-2019, winter mortality rates for men and women were 11% and 14% higher than expected based on non-winter rates. The relative risk of winter death increased with age but did not vary by income. Compared with those living with at least one other person, individuals in institutions had a higher relative risk (1.07, 95% CI 1.05 to 1.08). Most pre-existing health conditions did not predict winter death, but persons with dementia emerged at greater relative risk (1.06, 95% CI 1.04 to 1.07). CONCLUSIONS: Although winter mortality seems to affect frail people more strongly-those of advanced age, living in institutions and with dementia-there is an increased risk even beyond the more vulnerable groups. Protection of high-risk groups should be complemented with population-level preventive measures.


Subject(s)
Dementia , Male , Humans , Female , Middle Aged , Aged , Finland/epidemiology , Mortality
6.
Sci Rep ; 14(1): 3835, 2024 Feb 15.
Article in English | MEDLINE | ID: mdl-38360870

ABSTRACT

Using data for 201 regions (NUTS 2) in Europe, we examine the mortality burden of the COVID-19 pandemic and how the mortality inequalities between regions changed between 2020 and 2022. We show that over the three years of the pandemic, not only did the level of excess mortality rate change considerably, but also its geographical distribution. Focusing on life expectancy as a summary measure of mortality conditions, we find that the variance of regional life expectancy increased sharply in 2021 but returned to the pre-pandemic level in 2022. The 2021 increase was due to a much higher-than-average excess mortality in regions with lower pre-pandemic life expectancy. While the life expectancy inequality has returned to its pre-pandemic level in 2022, the observed life expectancy in almost all regions is far below that expected without the pandemic.


Subject(s)
COVID-19 , Pandemics , Humans , COVID-19/epidemiology , Life Expectancy , Europe/epidemiology , Mortality
7.
Int J Public Health ; 69: 1606585, 2024.
Article in English | MEDLINE | ID: mdl-38362307

ABSTRACT

Objectives: The aim was to determine the association between self-reported health (SRH), allostatic load (AL) and mortality. Methods: Data derived from the Lolland-Falster Health Study undertaken in Denmark from 2016-2020 (n = 14,104). Median follow-up time for death was 4.6 years where 456 participants died. SRH was assessed with a single question and AL by an index of ten biomarkers. Multinomial regression analysis were used to examine the association between SRH and AL, and Cox regression to explore the association between SRH, AL and mortality. Results: The risk of high AL increased by decreasing level of SRH. The ratio of relative risk (RRR) of having medium vs. low AL was 1.58 (1.11-2.23) in women reporting poor/very poor SRH as compared with very good SRH. For men it was 1.84 (1.20-2.81). For high vs. low AL, the RRR was 2.43 (1.66-3.56) in women and 2.96 (1.87-4.70) in men. The hazard ratio (HR) for all-cause mortality increased by decreasing SRH. For poor/very poor vs. very good SRH, the HR was 6.31 (2.84-13.99) in women and 3.92 (2.12-7.25) in men. Conclusion: Single-item SRH was able to predict risk of high AL and all-cause mortality.


Subject(s)
Allostasis , Health Status , Male , Humans , Female , Self Report , Proportional Hazards Models , Risk , Mortality
8.
BMC Public Health ; 24(1): 470, 2024 Feb 14.
Article in English | MEDLINE | ID: mdl-38355531

ABSTRACT

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.


Subject(s)
Health Status Disparities , Mortality, Premature , Male , Humans , Female , Belgium/epidemiology , Socioeconomic Factors , Cause of Death , Mortality
9.
BMJ Open ; 14(2): e077476, 2024 02 07.
Article in English | MEDLINE | ID: mdl-38326265

ABSTRACT

OBJECTIVES: The fragmentation of the response to the COVID-19 pandemic at national, regional and local levels is a possible source of variability in the impact of the pandemic on society. This study aims to assess how much of this variability affected the burden of COVID-19, measured in terms of all-cause 2020 excess mortality. DESIGN: Ecological retrospective study. SETTING: Lombardy region of Italy, 2015-2020. OUTCOME MEASURES: We evaluated the relationship between the intensity of the epidemics and excess mortality, assessing the heterogeneity of this relationship across the 91 districts after adjusting for relevant confounders. RESULTS: The epidemic intensity was quantified as the COVID-19 hospitalisations per 1000 inhabitants. Five confounders were identified through a directed acyclic graph: age distribution, population density, pro-capita gross domestic product, restriction policy and population mobility.Analyses were based on a negative binomial regression model with district-specific random effects. We found a strong, positive association between COVID-19 hospitalisations and 2020 excess mortality (p<0.001), estimating that an increase of one hospitalised COVID-19 patient per 1000 inhabitants resulted in a 15.5% increase in excess mortality. After adjusting for confounders, no district differed in terms of COVID-19-unrelated excess mortality from the average district. Minimal heterogeneity emerged in the district-specific relationships between COVID-19 hospitalisations and excess mortality (6 confidence intervals out of 91 did not cover the null value). CONCLUSIONS: The homogeneous effect of the COVID-19 spread on the excess mortality in the Lombardy districts suggests that, despite the unprecedented conditions, the pandemic reactions did not result in health disparities in the region.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Retrospective Studies , Incidence , Italy/epidemiology , Mortality
10.
Sci Rep ; 14(1): 3181, 2024 02 07.
Article in English | MEDLINE | ID: mdl-38326605

ABSTRACT

While low winter temperatures are associated with increased mortality, this phenomenon has been suggested to be most severe in regions with seemingly mild winters. The study aimed to establish a temperature-based formula that could elucidate the previously ambiguous regional differences in vulnerability to low temperature. European weekly mortality data (2000-2019) were matched with meteorological data to determine for each region vulnerability to temperature decrease and the optimal temperature with lowest mortality. Regression models were developed to generalize and explain these findings considering regional temperature characteristics. Optimal temperature could be predicted based on local average summer temperature (R2 = 85.6%). Regional vulnerability to temperature decrease could be explained by combination of winter and summer temperatures (R2 = 86.1%). Regions with warm winters and cold summers showed the highest vulnerability to decrease of temperature during winter. Contrary to theories about economic disparities Eastern Europe exhibited resistance comparable to Scandinavia. The southern edges of Europe demonstrated serious low temperature vulnerability to decreased temperatures, even if temperature was relatively high around 20 °C. This suggests that the observed connection primarily reflects the modulation of the length of respiratory virus infection seasons by climate conditions, counterbalanced by varying levels of acquired immunity and the presence of heatwaves eliminating the most frail individuals. Thus, relatively low vulnerability and a flat mortality cycle in countries with harsh climates paradoxically imply the presence of threats throughout the whole year.


Subject(s)
Climate , Cold Temperature , Humans , Seasons , Temperature , Europe/epidemiology , Mortality , Hot Temperature
11.
Environ Health Perspect ; 132(2): 27004, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38334741

ABSTRACT

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a heterogeneous pulmonary disease affecting 16 million Americans. Individuals with COPD are susceptible to environmental disturbances including heat and cold waves that can exacerbate disease symptoms. OBJECTIVE: Our objective was to estimate heat and cold wave-associated mortality risks within a population diagnosed with a chronic respiratory disease. METHODS: We collected individual level data with geocoded residential addresses from the Veterans Health Administration on 377,545 deceased patients with COPD (2016 to 2021). A time stratified case-crossover study was designed to estimate the incidence rate ratios (IRR) of heat and cold wave mortality risks using conditional logistic regression models examining lagged effects up to 7 d. Attributable risks (AR) were calculated for the lag day with the strongest association for heat and cold waves, respectively. Effect modification by age, gender, race, and ethnicity was also explored. RESULTS: Heat waves had the strongest effect on all-cause mortality at lag day 0 [IRR: 1.04; 95% confidence interval (CI): 1.02, 1.06] with attenuated effects by lag day 1. The AR at lag day 0 was 651 (95% CI: 326, 975) per 100,000 veterans. The effect of cold waves steadily increased from lag day 2 and plateaued at lag day 4 (IRR: 1.04; 95% CI: 1.02, 1.07) with declining but still elevated effects over the remaining 7-d lag period. The AR at lag day 4 was 687 (95% CI: 344, 1,200) per 100,000 veterans. Differences in risk were also detected upon stratification by gender and race. DISCUSSION: Our study demonstrated harmful associations between heat and cold waves among a high-risk population of veterans with COPD using individual level health data. Future research should emphasize using individual level data to better estimate the associations between extreme weather events and health outcomes for high-risk populations with chronic medical conditions. https://doi.org/10.1289/EHP13176.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Veterans , Humans , United States/epidemiology , Hot Temperature , Cross-Over Studies , Cold Temperature , Pulmonary Disease, Chronic Obstructive/epidemiology , Mortality
12.
BMC Public Health ; 24(1): 431, 2024 Feb 10.
Article in English | MEDLINE | ID: mdl-38341549

ABSTRACT

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.


Subject(s)
Life Expectancy , Mortality , Infant, Newborn , Humans , Middle Aged , Aged , Cause of Death , Life Tables , Chronic Disease , Republic of Korea/epidemiology
13.
Proc Natl Acad Sci U S A ; 121(6): e2313661121, 2024 Feb 06.
Article in English | MEDLINE | ID: mdl-38300867

ABSTRACT

In the United States, estimates of excess deaths attributable to the COVID-19 pandemic have consistently surpassed reported COVID-19 death counts. Excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by pandemic health care interruptions, and/or deaths from the pandemic's socioeconomic impacts. The geographic and temporal distribution of these deaths may help to evaluate which explanation is most plausible. We developed a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 mo of the pandemic. From March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally [90% PI (Posterior Interval): 1,046,000 to 1,340,204]. A total of 162,886 of these excess natural-cause deaths (90% PI: 14,276 to 308,480) were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was greater in nonmetropolitan counties (36.0 deaths), the West (Rocky Mountain states: 31.6 deaths; Pacific states: 25.5 deaths), and the South (East South Central states: 26.0 deaths; South Atlantic states: 25.0 deaths; West South Central states: 24.2 deaths). In contrast, reported COVID-19 death counts surpassed estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths correlated temporally with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or prior month. This suggests that many excess deaths reported to non-COVID-19 natural causes during the first 30 mo of the pandemic in the United States were unrecognized COVID-19 deaths.


Subject(s)
COVID-19 , Humans , United States/epidemiology , Pandemics , Bayes Theorem , Cause of Death , New England , Mortality
14.
PLoS One ; 19(2): e0294870, 2024.
Article in English | MEDLINE | ID: mdl-38315717

ABSTRACT

BACKGROUND: Covid-19 epidemics raged around the world in years 2020-2022. The dynamics of the epidemics and their mortality varied by country depending on prevention, treatments, vaccination and health status of the population. OBJECTIVE: The study compares Covid-19 morbidity and mortality in South-Africa and in France, two countries with similar population size and with reliable reporting systems, in order to better understand the dynamics and impacts of the epidemics and the effects of health policies and programs. DATA AND METHODS: Data on cases, deaths, hospitalizations, vaccinations were drawn from national statistics. Published data on cases and deaths were corrected for undercount. RESULTS: Results show a different epidemiology in the two countries in the first three years of the epidemic (2020-2022). Incidence was higher in South Africa, and some 44% more people were infected by December 2022 than in France. Mortality and case-fatality were also higher in South Africa despite a favourable age structure. The age pattern of mortality showed higher values in South Africa among the young adults. Young women appeared somewhat disadvantaged in South Africa. Lastly, vaccination appeared to have had no effect on incidence, but a large effect on case-fatality in France. CONCLUSIONS: Despite about the same population size and the same crude death rate at baseline, South Africa exhibited more cases and more deaths from Covid-19 over the 2020-2022 period. Prevention strategies (lockdown and vaccination) appear to have had large impacts on morbidity and mortality.


Subject(s)
COVID-19 , Young Adult , Humans , Female , COVID-19/epidemiology , South Africa/epidemiology , Communicable Disease Control , Morbidity , France/epidemiology , Mortality
15.
Arch. bronconeumol. (Ed. impr.) ; 60(1): 10-15, enero 2024. tab, graf
Article in English | IBECS | ID: ibc-229516

ABSTRACT

Introduction: The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts.MethodsCOPD patients from the BODE (n=360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n=722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated.ResultsIn total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE≥3: 9% and 20%; mMRC≥2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD<350m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality – 33% and 22% respectively.ConclusionsAn important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice. (AU)


Subject(s)
Humans , Mortality , Pulmonary Disease, Chronic Obstructive , Spirometry , Comorbidity , Dyspnea
17.
Cir. Esp. (Ed. impr.) ; 102(1): 11-18, Ene. 2024. ilus, graf, tab
Article in Spanish | IBECS | ID: ibc-229697

ABSTRACT

Introducción: El trasplante cardiopulmonar (TCP) ha presentado una disminución progresiva en el número de procedimientos. En nuestro país existe poca información al respecto, siendo el objetivo de este estudio analizar la experiencia de un hospital de referencia. Métodos: Estudio observacional unicéntrico de una cohorte histórica en el periodo entre 1990 y 2021. Las asociaciones entre categorías se evaluaron mediante la prueba de X2 o la f de Fisher. La supervivencia se analizó a través del método de Kaplan-Meier. Las diferencias se evaluaron con el estudio de log-rank y el análisis multivariante con el método de Cox. Resultados: Se observó una reducción del número de procedimientos realizados en el último decenio (2000-2009: 19 [44,2%]; 2010-2021: 15 [34,8%]). La mortalidad posoperatoria precoz fue de 23,3%, reduciéndose a 13,3% a partir del 2010. La intrahospitalaria fue de 41%, disminuyendo a 33% en 2010. Los factores asociados a la mortalidad fueron cirugía torácica previa, corticoterapia, circulación extracorpórea (CEC) mayor a 200 min, tiempo de isquemia mayor a 300 min y dehiscencia traqueal (p < 0,005). La supervivencia global a uno, cinco y 10 años fue de 58, 44,7 y 36,1%, respectivamente. Los factores asociados a menores tasas de supervivencia fueron cirugía torácica previa, donante masculino, CEC mayor 200 min, tiempo de isquemia mayor a 300 min, dehiscencia traqueal y diferencia de pesos (p < 0,005). Conclusiones: Existe una disminución en el número de procedimientos, siendo más evidente en la última década, pero evidenciando una mejora tanto de la mortalidad posoperatoria y supervivencia.(AU)


Introduction: Heart–lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital. Methods: We performed a retrospective study of a historical cohort of heart–lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ2 test or Fisher's exact test. Survival was analyzed using the Kaplan–Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method. Results: A decrease in the number of procedures performed in the last decade was observed [2000–2009: 19 procedures (44.2%); 2010–2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010. Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005). Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005). Conclusions: There has been a progressive decrease in the number of heart–lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.(AU)


Subject(s)
Humans , Male , Female , Prognosis , Heart-Lung Transplantation , Survivorship , Mortality , Eisenmenger Complex , Heart Defects, Congenital , Cohort Studies , General Surgery , Hypertension, Pulmonary
18.
Rev. clín. esp. (Ed. impr.) ; 224(1): 35-42, ene. 2024. tab, graf
Article in Spanish | IBECS | ID: ibc-229910

ABSTRACT

Introducción Durante la pandemia de COVID se especuló que los pacientes con el virus que tenían relación con el tabaco podrían tener una menor probabilidad de agravamiento de la enfermedad o muerte. Para evaluar si existe una asociación entre el tabaquismo y el riesgo de mortalidad intrahospitalaria se utiliza la tecnología de Big Data y Procesamiento del Lenguaje Natural (PLN) de SAVANA. Método Se llevó a cabo un estudio de cohortes retrospectivo, observacional y sin intervención basado en datos de vida real extraídos de registros médicos de toda Castilla-La Mancha utilizando las técnicas de PLN e inteligencia artificial desarrolladas por SAVANA. El estudio abarcó toda la población de esta Comunidad con historia clínica electrónica en SESCAM que presentara diagnóstico de COVID desde el 1 de marzo de 2020 al 28 de febrero de 2021. Resultados Los fumadores tienen mayor porcentaje de factores de riesgo cardiovascular (hipertensión arterial, dislipemia y diabetes), EPOC, asma, EPID, CI, ECV, TEP, cáncer en general y cáncer de pulmón en particular, bronquiectasias, insuficiencia cardíaca y antecedentes de neumonía, de forma significativa (p<0,0001). Los pacientes exfumadores, fumadores y no fumadores tienen una diferencia de edad significativa. En cuanto a las muertes hospitalarias, fueron más frecuentes en el caso de los exfumadores, siguiendo los fumadores y luego los no fumadores (p<0,0001). Conclusión Existe un mayor riesgo de mortalidad intrahospitalaria en los pacientes infectados por SARS-CoV-2 que sean fumadores activos o hayan fumado en el pasado. (AU)


Introduction During the COVID pandemic, it was speculated that patients with the virus who were smoking-related might have a lower likelihood of disease exacerbation or death. To assess whether there is an association between smoking and risk of in-hospital mortality, SAVANA's big data and natural language processing (NLP) technology is used. Method A retrospective, observational, non-interventional cohort study was conducted based on real-life data extracted from medical records throughout Castilla-La Mancha using natural language processing and artificial intelligence techniques developed by SAVANA. The study covered the entire population of this region with Electronic Medical Records in SESCAM presenting with a diagnosis of COVID from March 1, 2020 to February 28, 2021. Results Smokers had a significantly higher percentage of cardiovascular risk factors (hypertension, dyslipidemia and diabetes), COPD, asthma, IDP, IC, CVD, PTE, cancer in general and lung cancer in particular, bronchiectasis, heart failure and a history of pneumonia (P<.0001). Former smokers, current smokers and non-smokers have a significant age difference. As for in-hospital deaths, they were more frequent in the case of ex-smokers, followed by smokers and then non-smokers (P<.0001). Conclusion There is an increased risk of dying in hospital in SARS-CoV-2-infected patients who are active smokers or have smoked in the past. (AU)


Subject(s)
Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Coronavirus Infections/epidemiology , Tobacco , Mortality , Big Data , Retrospective Studies , Cohort Studies
19.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 42(1): 24-29, Ene. 2024. ilus, tab
Article in Spanish | IBECS | ID: ibc-229215

ABSTRACT

Introducción: La infección por Listeria monocytogenes es una enfermedad grave que afecta mayoritariamente a personas de edad avanzada e inmunodeprimidos y cuya incidencia está aumentando. En este estudio se analizan los casos de listeriosis en dos hospitales con el fin de estudiar cambios en su incidencia, formas de presentación clínica y posibles factores asociados a mortalidad. Material y métodos: Estudio retrospectivo multicéntrico de pacientes con listeriosis diagnosticada por aislamiento microbiológico entre 1977 y 2021 en dos hospitales universitarios de Madrid. Se recogen variables epidemiológicas, clínicas, estado de inmunodepresión, pruebas complementarias y tratamiento. Se analizan factores asociados a mortalidad. Resultados: Se analizaron 194 casos de listeriosis. La incidencia de listeriosis por ingresos aumentó a lo largo del estudio, con una importante caída del número de casos en 2020. La bacteriemia aislada (37,1%) y la afectación del sistema nervioso central (SNC) (36,6%) fueron las presentaciones más frecuentes. El 21% de los casos tuvo síntomas de gastroenteritis. El 16,5% presentó otras infecciones focales, siendo las más frecuentes peritonitis bacteriana espontánea (8,2%), colecistitis (2,1%), infección respiratoria (1,5%) e infección de prótesis vascular (1,5%). La mortalidad intrahospitalaria fue del 24,7%. Fueron factores independientes asociados a mortalidad al ingreso la edad (odds ratio [OR] 1.027, intervalo de confianza [IC] 95% 1.003-1.056) y la presencia de tumor sólido (OR 3.525, IC 95% 1.652-7.524). Conclusiones: En este estudio se constata un aumento de la incidencia de listeriosis en nuestro medio. Las presentaciones más frecuentes fueron la bacteriemia aislada y la afectación del SNC. La mortalidad intrahospitalaria se asoció a la edad y al diagnóstico de tumor sólido.(AU)


Introduction: Listeria monocytogenes infection is a severe disease affecting mainly aged people and patients with immune depression. The incidence of listeriosis seems to be increasing. In the present study cases of listeriosis from two hospitals are analyzed with the aims of studying changes in its incidence, clinical forms of presentation and possible factors associated with mortality. Methods: Retrospective multicentric study of patients with culture-proven listeriosis in two university hospitals in Madrid between 1977 and 2021. Epidemiological and clinical variables, as well as factors for immune depression, complementary studies and treatments were registered. Factors associated with mortality were analyzed. Results: A total of 194 cases of listeriosis were analyzed. The incidence of listeriosis among in-patients increased through the study period, with a significant drop in the number of cases in 2020. The most common clinical presentations were isolated bacteriemia (37.1%) and central nervous system involvement (CNS) (36.6%). Symptoms of gastroenteritis occurred in 21% of cases. Other focal infections were present in 16.5% of patients, the most frequent were spontaneous bacterial peritonitis (8.2%), cholecystitis (2.1%), respiratory infection (1.5%) and vascular prothesis infection (1.5%). In-hospital mortality was 24.7%. Independent factors associated with mortality at admission were age (odds ratio [OR] 1.027, 95% confidence interval [95% CI]1.003–1.056) and a diagnosis of a solid tumor (OR 3.525, 95% CI1.652–7.524). Conclusions: This study confirms an increasing incidence of listeriosis in our millieu. The most common clinical presentations were isolated bacteriemia and central nervous system involvement. In-hospital mortality was associated with age and the diagnosis of a solid tumor.(AU)


Subject(s)
Humans , Male , Female , Listeriosis , Prognosis , Listeria monocytogenes , Mortality , Central Nervous System Infections , Bacteremia , Retrospective Studies , Incidence , Microbiology , Microbiological Techniques
20.
Med. clín (Ed. impr.) ; 162(1): 9-14, ene. 2024. ilus, mapas
Article in English | IBECS | ID: ibc-229040

ABSTRACT

Introduction Mortality from COPD has decreased in Spain in recent years, but it is unknown whether this decline has been homogeneous among the different regions. Methods From the Statistical Portal of the Ministry of Health of Spain we obtained the age-adjusted mortality rates/100,000 inhabitants for men and women in Spain and the Autonomous Communities for the years 1999–2019, using the coding of the International Classification of Diseases (ICD 10, sections J40–J44). With the adjusted rates we performed a jointpoint regression analysis to estimate an annual percentage change (APC), as well as identify possible points of trend change. Statistical significance was considered for a value of p<0.05. Results During the study period, COPD mortality rates adjusted in Spain decreased from 28.77 deaths/100,000 inhabitants in 1999 to 12.14 deaths/100,000 inhabitants in 2019. We observed a linear decline in COPD mortality in men at national level of −3.67% per year (95% CI −4.1 to −3.4; p<0.001), with differences between the Autonomous Communities. Mortality in women also experienced a decrease in mortality in two phases, with a first period from 1999 to 2006 with a fall of −6.8% per year (95% CI −8.6 to −5.0; p<0.001) and a second period from 2006 to 2019 with a decrease in mortality of −2.1% (95% CI −2.8 to −1.3; p<0.001), with again differences between the Autonomous Communities. Conclusion Mortality rates from COPD have decreased heterogeneously among the different Autonomous Communities in both men and women (AU)


Introducción La mortalidad por EPOC ha disminuido en España en los últimos años, pero se desconoce si esta caída ha sido homogénea entre las diferentes comunidades autónomas. Metodología consultando el Portal Estadístico del Ministerio de Sanidad de España obtuvimos las tasas ajustadas por edad/100.000 habitantes para hombres y mujeres de España y las CCAA para los años 1999 a 2019, utilizando la codificación de la Clasificación Internacional de Enfermedades (CIE 10, secciones J40 a J44). Con las tasas ajustadas realizamos un análisis de regresión de jointpoint con el objetivo de estimar un porcentaje anual de cambio (APC), así como identificar posibles puntos de cambio de tendencia. Se consideró la significación estadística para un valor de p<0.05. Resultados Durante el periodo de estudio, las tasas de mortalidad global ajustada por EPOC en España pasaron de 28.77 muertes/100.000 habitantes en 1999 a 12.14 muertes/100.000 habitantes en 2019. Observamos una caída de la mortalidad por EPOC en varones a nivel de España lineal del -3.67% anual (IC 95% -4.1 a -3.4; p<0.001), con diferencias entre las CCAA. La mortalidad en mujeres también experimentó una disminución de mortalidad en dos fases, con un primer periodo de 1999 a 2006 con caída del -6.8% anual (IC 95% -8.6 a -5.0; p<0.001) y un segundo periodo de 2006 a 2019 con un descenso de la mortalidad del -2.1% (IC 95% -2.8 a -1.3; p<0.001), encontrando diferencias entre las CCAA. Conclusiones Las tasas de mortalidad por EPOC han disminuido de forma heterogénea entre las diferentes CCAA (AU)


Subject(s)
Humans , Male , Female , Pulmonary Disease, Chronic Obstructive/mortality , Mortality/trends , Spain/epidemiology
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