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2.
Nat Commun ; 12(1): 2671, 2021 05 11.
Artículo en Inglés | MEDLINE | ID: mdl-33976176

RESUMEN

The collection of fecal material and developments in sequencing technologies have enabled standardised and non-invasive gut microbiome profiling. Microbiome composition from several large cohorts have been cross-sectionally linked to various lifestyle factors and diseases. In spite of these advances, prospective associations between microbiome composition and health have remained uncharacterised due to the lack of sufficiently large and representative population cohorts with comprehensive follow-up data. Here, we analyse the long-term association between gut microbiome variation and mortality in a well-phenotyped and representative population cohort from Finland (n = 7211). We report robust taxonomic and functional microbiome signatures related to the Enterobacteriaceae family that are associated with mortality risk during a 15-year follow-up. Our results extend previous cross-sectional studies, and help to establish the basis for examining long-term associations between human gut microbiome composition, incident outcomes, and general health status.


Asunto(s)
Causas de Muerte/tendencias , Enterobacteriaceae/genética , Heces/microbiología , Microbioma Gastrointestinal/genética , ARN Ribosómico 16S/genética , Adolescente , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Enterobacteriaceae/clasificación , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población/métodos , Factores de Riesgo , Adulto Joven
3.
Natl Vital Stat Rep ; 70(4): 1-115, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34029179

RESUMEN

Objectives-This report presents final 2018 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2018," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2018. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Race and Hispanic-origin data are based on the Office of Management and Budget's 1997 standards for reporting race and Hispanic origin. Results-In 2018, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Accidents (unintentional injuries); Chronic lower respiratory diseases; Cerebrovascular diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 73.8% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2018 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Newborn affected by maternal complications of pregnancy; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Diseases of the circulatory system; Respiratory distress of newborn; and Neonatal hemorrhage. Variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.


Asunto(s)
Causas de Muerte/tendencias , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , Distribución por Sexo , Estados Unidos/epidemiología , Estadísticas Vitales , Adulto Joven
4.
Eur Rev Med Pharmacol Sci ; 25(9): 3610-3613, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34002836

RESUMEN

OBJECTIVE: The aim of the study is to assess the impact of the COVID-19 pandemic on causes of mortality through multiple methodological approaches. MATERIALS AND METHODS: The causes of mortality in the Veneto region (Italy) during the first epidemic wave, March-April 2020, were compared with the corresponding months of the previous two years. Both the underlying cause of death (UCOD), and all diseases reported in the death certificate (multiple causes of death) were investigated; a further analysis was carried out through a simulation where the UCOD was selected after substituting ICD-10 codes for COVID with unspecified pneumonia. RESULTS: Overall 10,222 deaths were registered in March-April 2020, corresponding to a 24% increase compared to the previous two years. COVID-19 was mentioned in 1,444 certificates, and selected as the UCOD in 1,207 deaths. Based on the UCOD, the increases in mortality were observed for COVID and related respiratory conditions, diabetes mellitus, hypertensive heart diseases, cerebrovascular diseases, and ill-defined causes. Multiple causes of death and the simulation analysis demonstrated further increases in mortality related to dementia/Alzheimer and chronic lower respiratory diseases. CONCLUSIONS: This first report demonstrates an increase of several causes of death during the pandemic, underlying the need of a continuous surveillance of mortality records through different analytic strategies.


Asunto(s)
/diagnóstico , Certificado de Defunción , /complicaciones , Causas de Muerte/tendencias , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Epidemias , Humanos , Italia/epidemiología , Neumonía/diagnóstico , Neumonía/etiología , Neumonía/mortalidad
5.
Rev Bras Epidemiol ; 24: e210015, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33825775

RESUMEN

OBJECTIVE: To evaluate all-cause mortality in approximately three years of follow-up and related sociodemographic, behavioral and health factors in community-dwelling older adults in Pelotas, RS. METHODS: This was a longitudinal observational study that included 1,451 older adults (≥ 60 years) who were interviewed in 2014. Information on mortality was collected from their households in 2016-2017 and confirmed with the Epidemiological Surveillance department of the city and by documents from family members. Associations between mortality and independent variables were assessed by crude and multiple Cox regression, with hazard ratio with respective 95% confidence intervals (95%CI). RESULTS: Almost 10% (n = 145) of the participants died during an average of 2.5 years of follow-up, with a higher frequency of deaths among males (12.9%), ?80 years (25.2%), widowhood (15.0%), no education (13.8%) and who did not work (10.5%). Factors associated with higher mortality were: being a male (HR = 2.8; 95%CI 1.9 - 4.2), age ?80 years (HR = 3.9; 95%CI 2.4 - 6.2), widowhood (HR = 2.2; 95%CI 1.4 - 3.7), physical inactivity (HR = 2.3; 95%CI 1.1 - 4..6), current smoking (HR = 2.1; 95%CI 1.2 - 3.6), hospitalizations in the previous year (HR = 2.0; 95%CI 1.2 - 3.2), depressive symptoms (HR = 2.0; 95%CI 1.2 - 3,4) and dependence for two or more daily life activities (HR = 3.1; 95%CI 1,7 - 5.7). CONCLUSION: The identification of factors that increased the risk of early death makes it possible to improve public policies aimed at controlling the modifiable risk factors that can lead to aging with a better quality of life.


Asunto(s)
Vida Independiente , Mortalidad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Causas de Muerte/tendencias , Femenino , Humanos , Vida Independiente/estadística & datos numéricos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Factores de Riesgo , Factores Socioeconómicos
6.
Yale J Biol Med ; 94(1): 23-40, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33795980

RESUMEN

Introduction: Lockdowns are designed to slow COVID-19 transmission, but they may have unanticipated relationships with other aspects of public health. Assessing the overall pattern in population health as a country implements and relaxes a lockdown is relevant, as these patterns may not necessarily be symmetric. We aimed to estimate the changing trends in cause-specific mortality in relation to the 2020 COVID-19 related lockdowns in Peru. Methods: Based on data from the Peruvian National Death Information System (SINADEF), we calculated death rates per 10 million population to assess the trends in mortality rates for non-external and external causes of death (suicides, traffic accidents, and homicides). We compared these trends to 2018-2019, before, during, and after the lockdown, stratified by sex, and adjusted by Peruvian macro-region (Lima & Callao (capital region), Coast, Highland, and Jungle). Results: Non-external deaths presented a distinctive pattern among macro-regions, with an early surge in the Jungle and a later increase in the Highland. External deaths dropped during the lockdown, however, suicides and homicides returned to previous levels in the post-lockdown period. Deaths due to traffic accidents dropped during the lockdown and returned to pre-pandemic levels by December 2020. Conclusions: We found a sudden drop in external causes of death, with suicides and homicides returning to previous levels after the lifting of the lockdown. Non-external deaths showed a differential pattern by macro-region. A close monitoring of these trends could help identify early spikes among these causes of death and take action to prevent a further increase in mortality indirectly affected by the pandemic.


Asunto(s)
/prevención & control , Causas de Muerte/tendencias , Política de Salud , Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/tendencias , Bases de Datos Factuales , Femenino , Homicidio/tendencias , Humanos , Masculino , Perú/epidemiología , Suicidio/tendencias
8.
MMWR Morb Mortal Wkly Rep ; 70(14): 519-522, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33830988

RESUMEN

CDC's National Vital Statistics System (NVSS) collects and reports annual mortality statistics using data from U.S. death certificates. Because of the time needed to investigate certain causes of death and to process and review data, final annual mortality data for a given year are typically released 11 months after the end of the calendar year. Daily totals reported by CDC COVID-19 case surveillance are timely but can underestimate numbers of deaths because of incomplete or delayed reporting. As a result of improvements in timeliness and the pressing need for updated, quality data during the global COVID-19 pandemic, NVSS expanded provisional data releases to produce near real-time U.S. mortality data.* This report presents an overview of provisional U.S. mortality data for 2020, including the first ranking of leading causes of death. In 2020, approximately 3,358,814 deaths† occurred in the United States. From 2019 to 2020, the estimated age-adjusted death rate increased by 15.9%, from 715.2 to 828.7 deaths per 100,000 population. COVID-19 was reported as the underlying cause of death or a contributing cause of death for an estimated 377,883 (11.3%) of those deaths (91.5 deaths per 100,000). The highest age-adjusted death rates by age, race/ethnicity, and sex occurred among adults aged ≥85 years, non-Hispanic Black or African American (Black) and non-Hispanic American Indian or Alaska Native (AI/AN) persons, and males. COVID-19 death rates were highest among adults aged ≥85 years, AI/AN and Hispanic persons, and males. COVID-19 was the third leading cause of death in 2020, after heart disease and cancer. Provisional death estimates provide an early indication of shifts in mortality trends and can guide public health policies and interventions aimed at reducing numbers of deaths that are directly or indirectly associated with the COVID-19 pandemic.


Asunto(s)
/mortalidad , Mortalidad/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Femenino , Disparidades en el Estado de Salud , Humanos , Lactante , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Estados Unidos/epidemiología , Estadísticas Vitales , Adulto Joven
9.
Proc Natl Acad Sci U S A ; 118(16)2021 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-33846260

RESUMEN

We use three indexes to identify how age-specific mortality rates in the United States compare to those in a composite of five large European countries since 2000. First, we examine the ratio of age-specific death rates in the United States to those in Europe. These show a sharp deterioration in the US position since 2000. Applying European age-specific death rates in 2017 to the US population, we then show that adverse mortality conditions in the United States resulted in 400,700 excess deaths that year. Finally, we show that these excess deaths entailed a loss of 13.0 My of life. In 2017, excess deaths and years of life lost in the United States represent a larger annual loss of life than that associated with the COVID-19 epidemic in 2020.


Asunto(s)
/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Niño , Preescolar , Europa (Continente)/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Estados Unidos/epidemiología , Adulto Joven
10.
Am J Epidemiol ; 190(6): 1075-1080, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-33712822

RESUMEN

Increasing hospitalizations for COVID-19 in the United States and elsewhere have ignited debate over whether to reinstate shelter-in-place policies adopted early in the pandemic to slow the spread of infection. The debate includes claims that sheltering in place influences deaths unrelated to infection or other natural causes. Testing this claim should improve the benefit/cost accounting that informs choice on reimposing sheltering in place. We used time-series methods to compare weekly nonnatural deaths in California with those in Florida. California was the first state to begin, and among the last to end, sheltering in place, while sheltering began later and ended earlier in Florida. During weeks when California had shelter-in-place orders in effect, but Florida did not, the odds that a nonnatural death occurred in California rather than Florida were 14.4% below expected levels. Sheltering-in-place policies likely reduce mortality from mechanisms unrelated to infection or other natural causes of death.


Asunto(s)
/prevención & control , Causas de Muerte/tendencias , Cuarentena/estadística & datos numéricos , /mortalidad , California/epidemiología , Florida/epidemiología , Humanos , Funciones de Verosimilitud , Estados Unidos
11.
JAMA ; 325(18): 1829-1830, 2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-33787821
12.
Medicine (Baltimore) ; 100(9): e25085, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655987

RESUMEN

ABSTRACT: Type 2 diabetes mellitus (T2DM) is a progressive disease. After metformin failure, the addition of insulin or sulfonylureas might increase the risk of hypoglycemia and cardiovascular (CV) morbidity. Here, the risk of all-cause mortality was compared between early insulin treatment and glimepiride use in T2DM patients with background metformin therapy.We conducted a 9-year retrospective cohort study from the population-based National Health Insurance Research Database in Taiwan. A total of 2054 patients with T2DM under insulin or glimepiride treatment were enrolled during 2004 to 2012. Overall event rates of all-cause mortality were compared between 1027 insulin users and 1027 matched glimepiride users.After the propensity score matching, the mortality rates were 72.5 and 4.42 per 1000 person-years for insulin users and glimepiride users. The adjusted hazard ratio of mortality was 14.47 (95% CI: 8.64-24.24; P value <.001) as insulin compared with glimepiride users. The insulin users had significantly higher risk of CV death (adjusted hazard ratio 7.95, 95% CI 1.65-38.3, P = .01) and noncardiovascular death (adjusted hazard ratio 14.9, 95% CI 8.4-26.3, P < .001).The nationwide study demonstrated that metformin plus insulin therapy was associated with higher risk of all-cause mortality.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insulina/uso terapéutico , Metformina/uso terapéutico , Vigilancia de la Población/métodos , Compuestos de Sulfonilurea/uso terapéutico , Adulto , Anciano , Causas de Muerte/tendencias , Diabetes Mellitus Tipo 2/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Taiwán/epidemiología , Factores de Tiempo , Resultado del Tratamiento
13.
Mayo Clin Proc ; 96(4): 952-963, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33714592

RESUMEN

OBJECTIVE: To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality. METHODS: This national death registry included all adult (aged ≥18 years) deaths in England and Wales between January 1, 2014, and June 30, 2020. Daily deaths during the COVID-19 pandemic were compared against the expected daily deaths, estimated with use of the Farrington surveillance algorithm for daily historical data between 2014 and 2020 by place and cause of death. RESULTS: Between March 2 and June 30, 2020, there was an excess mortality of 57,860 (a proportional increase of 35%) compared with the expected deaths, of which 50,603 (87%) were COVID-19 related. At home, only 14% (2267) of the 16,190 excess deaths were related to COVID-19, with 5963 deaths due to cancer and 2485 deaths due to cardiac disease, few of which involved COVID-19. In care homes or hospices, 61% (15,623) of the 25,611 excess deaths were related to COVID-19, 5539 of which were due to respiratory disease, and most of these (4315 deaths) involved COVID-19. In the hospital, there were 16,174 fewer deaths than expected that did not involve COVID-19, with 4088 fewer deaths due to cancer and 1398 fewer deaths due to cardiac disease than expected. CONCLUSION: The COVID-19 pandemic has resulted in a large excess of deaths in care homes that were poorly characterized and likely to be the result of undiagnosed COVID-19. There was a smaller but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, suggesting public avoidance of hospital care for non-COVID-19 conditions.


Asunto(s)
Causas de Muerte/tendencias , Cardiopatías/mortalidad , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Neoplasias/mortalidad , Casas de Salud/estadística & datos numéricos , Adulto , Anciano de 80 o más Años , /mortalidad , Errores Diagnósticos/mortalidad , Errores Diagnósticos/estadística & datos numéricos , Inglaterra/epidemiología , Femenino , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Gales/epidemiología
14.
J Public Health Manag Pract ; 27(3): 305-309, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33762546

RESUMEN

To understand county-level variation in case fatality rates of COVID-19, a statewide analysis of COVID-19 incidence and fatality data was performed, using publicly available incidence and case fatality rate data of COVID-19 for all 67 Alabama counties and mapped with health disparities at the county level. A specific adaptation of the Shewhart p-chart, called a funnel chart, was used to compare case fatality rates. Important differences in case fatality rates across the counties did not appear to be reflective of differences in testing or incidence rates. Instead, a higher prevalence of comorbidities and vulnerabilities was observed in high fatality rate counties, while showing no differences in access to acute care. Funnel charts reliably identify counties with unexpected high and low COVID-19 case fatality rates. Social determinants of health are strongly associated with such differences. These data may assist in public health decisions including vaccination strategies, especially in southern states with similar demographics.


Asunto(s)
/epidemiología , /prevención & control , Causas de Muerte/tendencias , Pandemias/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Vacunación/normas , Adulto , Anciano , Anciano de 80 o más Años , Alabama , Femenino , Predicción , Disparidades en el Estado de Salud , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia
15.
Public Health ; 193: 48-56, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33735693

RESUMEN

OBJECTIVES: The COVID-19 pandemic in Wales and the UK has highlighted significant and historic inequalities in health between social groups. To better understand the composition of these inequalities and inform planning after the pandemic, we undertook a decomposition of life expectancy inequalities between the most and least deprived quintiles for men and women by age and cause of death and explored trends between 2002 and 2018. STUDY DESIGN: Statistical decomposition of life expectancy inequalities by age and cause of death using routine population mortality datasets. METHODS: We used routine statistics from the Office for National Statistics for the period 2002-2018 on population and deaths in Wales stratified by age, gender, Welsh Index of Multiple Deprivation (WIMD) 2019 quintile and cause of death, categorised by International Classification of Disease, version 10, code into 15 categories of public health relevance. We aggregated data to 3-year rolling figures to account for low numbers of events in some groups annually. Next, we estimated life expectancy at birth by quintile, gender and period using life table methods. Lastly, we performed a decomposition analysis using the Arriaga method to identify the specific disease categories and ages at which excess deaths occur in more disadvantaged areas to highlight potential areas for action. RESULTS: Life expectancy inequalities between the most and least WIMD quintiles rose for both genders between 2002 and 2018: from 4.69 to 6.02 years for women (an increase of 1.33 years) and from 6.34 to 7.42 years for men (an increase of 1.08 years). Exploratory analysis of these trends suggested that the following were most influential for women: respiratory disease (1.50 years), cancers (1.36 years), circulatory disease (1.35 years) and digestive disease (0.51 years). For men, the gap was driven by circulatory disease (2.01 years), cancers (1.39 years), respiratory disease (1.25 years), digestive disease (0.79 years), drug- and alcohol-related conditions (0.54 years) and external causes (0.54 years). Contributions for women from respiratory disease, cancers, dementia and drug- and alcohol-related conditions appeared to be increasing, while among men, there were rising contributions from respiratory, digestive and circulatory disease. CONCLUSIONS: Life expectancy inequalities in Wales remain wide and have been increasing, particularly among women, with indications of worsening trends since 2010 following the introduction of fiscal austerity. As agencies recover from the pandemic, these findings should be considered alongside any resumption of services in Wales or future health and public policy.


Asunto(s)
Disparidades en el Estado de Salud , Esperanza de Vida/tendencias , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Gales/epidemiología , Adulto Joven
16.
Lancet Public Health ; 6(4): e240-e248, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33636104

RESUMEN

BACKGROUND: Mass incarceration has collateral consequences for community health, which are reflected in county-level health indicators, including county mortality rates. County jail incarceration rates are associated with all-cause mortality rates in the USA. We assessed the causes of death that drive the relationship between county-level jail incarceration and mortality. METHODS: In this retrospective, longitudinal study, we assessed the association between county-level jail incarceration rates and county-level cause-specific mortality using county jail incarceration data (1987-2017) for 1094 counties in the USA obtained from the Vera Institute of Justice and cause-specific mortality data for individuals younger than 75 years in the total county population (1988-2018) obtained from the US National Vital Statistics System. We fitted quasi-Poisson models for nine common causes of death (cerebrovascular disease, chronic lower respiratory disease, diabetes, heart disease, infectious disease, malignant neoplasm, substance use, suicide, and unintentional injury) with county fixed effects, controlling for all unmeasured stable county characteristics and measured time-varying confounders (county median age, county poverty rate, county percentage of Black residents, county crime rate, county unemployment rate, and state incarceration rate). We lagged county jail incarceration rates by 1 year to assess the short-term, by 5 years to assess the medium-term, and by 10 years to assess the long-term associations of jail incarceration with premature mortality. FINDINGS: A 1 per 1000 within-county increase in jail incarceration rate was associated with a 6·5% increase in mortality from infectious diseases (risk ratio 1·065, 95% CI 1·061-1·070), a 4·9% increase in mortality from chronic lower respiratory disease (1·049, 1·045-1·052), a 2·6% increase in mortality induced from substance use (1·026, 1·020-1·032), a 2·5% increase in suicide mortality (1·025, 1·020-1·029), and smaller increases in mortality from heart disease (1·021, 1·019-1·023), unintentional injury (1·015, 1·011-1·018), malignant neoplasm (1·014, 1·013-1·016), diabetes (1·013, 1·009-1·018), and cerebrovascular disease (1·010, 1·007-1·013) after 1 year. Associations between jail incarceration and cause-specific mortality rates weakened as time lags increased, but to a greater extent for causes of death with generally shorter latency periods (infectious disease and suicide) than for those with generally longer latency periods (heart disease, malignant neoplasm, and cerebrovascular disease). INTERPRETATION: Jail incarceration rates are potential drivers of many causes of death in US counties. Jail incarceration can be harmful not only to the health of individuals who are incarcerated, but also to public health more broadly. Our findings suggest important points of intervention, including disinvestment from carceral systems and investment in social and public health services, such as community-based treatment of substance-use disorders. FUNDING: US National Institute on Drug Abuse (National Institutes of Health).


Asunto(s)
Mortalidad/tendencias , Prisioneros/estadística & datos numéricos , Prisiones/estadística & datos numéricos , Causas de Muerte/tendencias , Humanos , Estudios Longitudinales , Estudios Retrospectivos , Estados Unidos/epidemiología
17.
Natl Vital Stat Rep ; 69(13): 1-83, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33541516

RESUMEN

Objectives-This report presents final 2018 data on U.S. deaths, death rates, life expectancy, infant and maternal mortality, and trends by selected characteristics such as age, sex, Hispanic origin and race, state of residence, and cause of death. The race categories are consistent with 1997 Office of Management and Budget (OMB) standards, which are different from previous reports (1977 OMB standards). Methods-Information reported on death certificates is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the National Center for Health Statistics. Causes of death are processed according to the International Classification of Diseases, 10th Revision. As of 2018, all states and the District of Columbia were using the 2003 revised certificate of death, which includes the 1997 OMB revised standards for race. The 2018 data based on the revised standards are not completely comparable to previous years. Selected estimates are presented in this report for both the revised and previous race standards to provide some reference for interpretation of trends. Results-In 2018, a total of 2,839,205 deaths were reported in the United States. The age-adjusted death rate was 723.6 deaths per 100,000 U.S. standard population, a decrease of 1.1% from the 2017 rate. Life expectancy at birth was 78.7 years, an increase of 0.1 year from 2017. Age-specific death rates decreased in 2018 from 2017 for age groups 15-24, 25-34, 45-54, 65-74, 75-84, and 85 and over. The 15 leading causes of death in 2018 remained the same as in 2017. The infant mortality rate decreased 2.2% to a historically low figure of 5.66 infant deaths per 1,000 live births in 2018. Conclusions-The age-adjusted death rate for the total, male, and female populations decreased from 2017 to 2018, and life expectancy at birth increased in 2018 for the total, male, and female populations.


Asunto(s)
Mortalidad/tendencias , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Niño , Preescolar , Grupos Étnicos/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Esperanza de Vida/tendencias , Masculino , Persona de Mediana Edad , Características de la Residencia/estadística & datos numéricos , Distribución por Sexo , Estados Unidos/epidemiología , Estadísticas Vitales , Adulto Joven
18.
Am J Public Health ; 111(4): 704-707, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33600247

RESUMEN

Objectives. To determine the number of excess deaths (i.e., those exceeding historical trends after accounting for COVID-19 deaths) occurring in Florida during the COVID-19 pandemic.Methods. Using seasonal autoregressive integrated moving average time-series modeling and historical mortality trends in Florida, we forecasted monthly deaths from January to September of 2020 in the absence of the pandemic. We compared estimated deaths with monthly recorded total deaths (i.e., all deaths regardless of cause) during the COVID-19 pandemic and deaths only from COVID-19 to measure excess deaths in Florida.Results. Our results suggest that Florida experienced 19 241 (15.5%) excess deaths above historical trends from March to September 2020, including 14 317 COVID-19 deaths and an additional 4924 all-cause, excluding COVID-19, deaths in that period.Conclusions. Total deaths are significantly higher than historical trends in Florida even when accounting for COVID-19-related deaths. The impact of COVID-19 on mortality is significantly greater than the official COVID-19 data suggest.


Asunto(s)
/mortalidad , Causas de Muerte/tendencias , Interpretación Estadística de Datos , Florida , Humanos , Modelos Estadísticos , Estudios Retrospectivos
19.
Am J Emerg Med ; 43: 103-108, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33550100

RESUMEN

IMPORTANCE: Initial guidelines recommended prompt endotracheal intubation rather than non-invasive ventilation (NIV) for COVID-19 patients requiring ventilator support. There is insufficient data comparing the impact of intubation versus NIV on patient-centered outcomes of these patients. OBJECTIVE: To compare all-cause 30-day mortality for hospitalized COVID-19 patients with respiratory failure who underwent intubation first, intubation after NIV, or NIV only. DESIGN: Retrospective study of patients admitted in March and April of 2020. SETTING: A teaching hospital in Brooklyn, New York City. PARTICIPANTS: Adult COVID-19 confirmed patients who required ventilator support (non-invasive ventilation and/or endotracheal intubation) at discretion of treating physician, were included. EXPOSURES: Patients were categorized into three exposure groups: intubation-first, intubation after NIV, or NIV-only. PRIMARY OUTCOME: 30-day all-cause mortality, a predetermined outcome measured by multivariable logistic regression. Data are presented with medians and interquartile ranges, or percentages with 95% confidence intervals, for continuous and categorical variables, respectively. Covariates for the model were age, sex, qSOFA score ≥ 2, presenting oxygen saturation, vasopressor use, and greater than three comorbidities. A secondary multivariable model compared mortality of all patients that received NIV (intubation after NIV and NIV-only) with the intubation-first group. RESULTS: A total of 222 were enrolled. Overall mortality was 77.5% (95%CI, 72-83%). Mortality for intubation-first group was 82% (95%CI, 73-89%; 75/91), for Intubation after NIV was 84% (95%CI, 70-92%; 37/44), and for NIV-only was 69% (95%CI, 59-78%; 60/87). In multivariable analysis, NIV-only was associated with decreased all-cause mortality (odds ratio [OR]: 0.30, 95%CI, 0.13-0.69). No difference in mortality was observed between intubation-first and intubation after NIV. Secondary analysis found all patients who received NIV to have lower mortality than patients who were intubated only (OR: 0.44, 95%CI, 0.21-0.95). CONCLUSIONS & RELEVANCE: Utilization of NIV as the initial intervention in COVID-19 patients requiring ventilatory support is associated with significant survival benefit. For patients intubated after NIV, the mortality rate is not worse than those who undergo intubation as their initial intervention.


Asunto(s)
/terapia , Unidades de Cuidados Intensivos , Intubación Intratraqueal/métodos , Respiración con Presión Positiva/métodos , Insuficiencia Respiratoria/terapia , Anciano , /epidemiología , Causas de Muerte/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias
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