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1.
BMC Infect Dis ; 21(1): 343, 2021 Apr 12.
Artículo en Inglés | MEDLINE | ID: mdl-33845774

RESUMEN

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.


Asunto(s)
/epidemiología , Esperanza de Vida , Mortalidad Prematura , Años de Vida Ajustados por Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , India/epidemiología , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Adulto Joven
2.
BMJ ; 372: n530, 2021 03 24.
Artículo en Inglés | MEDLINE | ID: mdl-33762255

RESUMEN

OBJECTIVE: To investigate the association of spontaneous abortion with the risk of all cause and cause specific premature mortality (death before the age of 70). DESIGN: Prospective cohort study. SETTING: The Nurses' Health Study II (1993-2017), United States. PARTICIPANTS: 101 681 ever gravid female nurses participating in the Nurses' Health Study II. MAIN OUTCOMES MEASURES: Lifetime occurrence of spontaneous abortion in pregnancies lasting less than 6 months, determined by biennial questionnaires. Hazard ratios and 95% confidence intervals for all cause and cause specific premature death according to the occurrence of spontaneous abortion, estimated with time dependent Cox proportional hazards models. RESULTS: During 24 years of follow-up, 2936 premature deaths were recorded, including 1346 deaths from cancer and 269 from cardiovascular disease. Crude all cause mortality rates were comparable for women with and without a history of spontaneous abortion (1.24 per 1000 person years in both groups) but were higher for women experiencing three or more spontaneous abortions (1.47 per 1000 person years) and for women reporting their first spontaneous abortion before the age of 24 (1.69 per 1000 person years). The corresponding age adjusted hazard ratios for all cause premature death during follow-up were 1.02 (95% confidence interval 0.94 to 1.11), 1.39 (1.03 to 1.86), and 1.27 (1.11 to 1.46), respectively. After adjusting for confounding factors and updated dietary and lifestyle factors, the occurrence of spontaneous abortion was associated with a hazard ratio of 1.19 (95% confidence interval 1.08 to 1.30) for premature mortality during follow-up. The association was stronger for recurrent spontaneous abortions (hazard ratio 1.59, 95% confidence interval 1.17 to 2.15 for three or more spontaneous abortions; 1.23, 1.00 to 1.50 for two; and 1.16, 1.05 to 1.28 for one compared with none), and for spontaneous abortions occurring early in a woman's reproductive life (1.32, 1.14 to 1.53 for age ≤23; 1.16, 1.01 to 1.33 for ages 24-29; and 1.12, 0.98 to 1.28 for age ≥30 compared with none). When cause specific mortality was evaluated, the association of spontaneous abortion with premature death was strongest for deaths from cardiovascular disease (1.48, 1.09 to 1.99). Spontaneous abortion was not related to premature death from cancer (1.08, 0.94 to 1.24). CONCLUSIONS: Spontaneous abortion was associated with an increased risk of premature mortality, particularly death from cardiovascular disease.


Asunto(s)
Aborto Espontáneo , Causas de Muerte , Mortalidad Prematura , Adulto , Anciano , Femenino , Estudios de Seguimiento , Encuestas Epidemiológicas , Humanos , Persona de Mediana Edad , Embarazo , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Estados Unidos/epidemiología
3.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(2): 291-296, 2021 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-33626618

RESUMEN

Objective: To analyze the trend of premature death of non-communicable diseases (NCDs) in Wuxi from 2008 to 2018 and evaluate the influence of premature mortality probability caused by four main NCDs on life expectancy. Methods: Based on the mortality data collected by Wuxi Mortality Registration System and the population data collected by Wuxi Public Security Bureau during 2008-2018, this study analyzes the trend of the probability of premature death on malignant tumors, cardiovascular and cerebrovascular diseases, chronic respiratory diseases, and diabetes. The impact on life expectancy was analyzed by using the methods of abridged life table, Joinpoint regression, and life expectancy contribution decomposition. Results: From 2008 to 2018, the total probability of premature death of four main NCDs in Wuxi were declined consistently from 11.25% to 9.25% (AAPC = -2.0%, 95%CI: -2.6--1.5), higher in female (from 7.74% to 5.91%) than that in male (from 14.49% to 12.51%). The Wuxi resident's life expectancy increased by 1.86 years (from 78.66 to 80.52 years), in males and 1.26 years (from 83.85 to 85.11 years) in females, respectively. The decline of premature death of malignant tumors, cardiovascular and cerebrovascular diseases and chronic respiratory system diseases had a positive contribution to life expectancy, which contributed 0.34 years (23.90%), 0.15 years (10.50%), and 0.03 years (2.36%) to the life expectancy growth, respectively. Among which, premature death of cardiovascular and cerebrovascular diseases in men aged 40-55y had a negative contribution to life expectancy (-0.04 years). The probability of premature death of males with diabetes was on the rise (AAPC = 7.1%, 95%CI: 2.8-11.6), which negatively contributed to life expectancy for both males and females, reducing life expectancy by 0.03 years (-2.14%) in Wuxi. Conclusion: The premature death probability of four main NCDs in Wuxi declined consistently from 2008 to 2018, which played a positive role in the growth of life expectancy. Compared with females, males had a higher premature death probability and a slower rate of decline. More intervention and health management of premature male death on cardiovascular and cerebrovascular diseases and diabetes should be conducted to improve life expectancy further.


Asunto(s)
Mortalidad Prematura , Enfermedades no Transmisibles , Adulto , China/epidemiología , Femenino , Humanos , Esperanza de Vida , Tablas de Vida , Masculino , Persona de Mediana Edad , Enfermedades no Transmisibles/mortalidad , Probabilidad
4.
Orv Hetil ; 162(4): 144-152, 2021 01 24.
Artículo en Húngaro | MEDLINE | ID: mdl-33486466

RESUMEN

Összefoglaló. Bevezetés: A cerebrovascularis betegségek népegészségügyi szempontból jelentosek, világszerte a vezeto halálokok között szerepelnek, és a rokkantság egyik fo okát képezik. Célkituzés: Vizsgálatunk célja a cerebrovascularis betegségekbol eredo, ido elotti halálozás hazai és nemzetközi adatainak elemzése régiónkénti bontásban a 45-59 éves korcsoportban. Módszerek: Retrospektív, kvantitatív elemzés keretében vizsgáltuk a cerebrovascularis betegségekbol eredo, korspecifikus, 1990 és 2014 közötti halálozást az Egészségügyi Világszervezet (WHO) Európai Régióján belül kiválasztott nyugat-európai (n = 17), kelet-európai országokban (n = 10) és a volt Szovjetunió utódállamaiban (n = 15), 100 000 fore vetítve, a WHO Európai Halálozási Adatbázisának adatai alapján. Leíró statisztikai módszereket, idosoros kimutatást, Kruskal-Wallis-próbát alkalmaztunk. Eredmények: A cerebrovascularis betegségekbol eredo, 100 000 fore vetített korspecifikus halálozás a nyugat-európai országokban volt a legalacsonyabb (férfiak: 1990: 35,14, 2014: 14,31; nok: 1990: 21,11, 2014: 8,76) és a Szovjetunió utódállamaiban a legmagasabb (férfiak: 1990: 134,19; 2014: 91,13; nok: 1990: 83,62, 2014: 41,83) (p<0,05). A kelet-európai és a nyugat-európai országok, valamint a nyugat-európai országok és a Szovjetunió utódállamainak korspecifikus, cerebrovascularis halálozása között szignifikáns különbséget találtunk mindkét nemben (1990, 2004, 2014: p<0,05). A cerebrovascularis betegségek korspecifikus standardizált halálozása 1990 és 2014 között a nyugat-európai országokban (férfiak: -59,28%, nok: -58,29%) csökkent a legnagyobb mértékben, melyet a vizsgált kelet-európai országok (férfiak: -54,14%, nok: -57,53%), majd a Szovjetunió utódállamai (férfiak: -32,09%, nok: -49,97%) követtek. Következtetések: A korspecifikus, cerebrovascularis halálozás a férfiak és a nok körében egyaránt csökkent az egyes régiókban. Magyarországon a nyugat-európai átlagnál jobban, 62,2%-kal csökkent a férfiak és 59,1%-kal a nok korai cerebrovascularis halálozása 1990 és 2014 között. Orv Hetil. 2021; 162(4): 144-152. INTRODUCTION: Cerebrovascular diseases are a significant public health concern, they are among the leading causes of death worldwide and one of the major causes of disability. OBJECTIVE: Our aim was to analyse national and international data regarding premature, cerebrovascular disease mortality per region in the 45-59 age group. METHODS: We performed a retrospective, quantitative analysis on age-specific, premature cerebrovascular disease mortality between 1990 and 2014 per 100 000 population on data derived from the World Health Organisation, European Mortality Database on Western European (n = 17), Eastern European (n = 10) countries, and countries of the former Soviet Union (n = 15). Descriptive statistics, time series analysis and Kruskal-Wallis test were performed. RESULTS: Age-related, cerebrovascular disease mortality per 100 000 population was the lowest in Western European countries (males: 1990: 35.14, 2014: 14.31; females: 1990: 21.11, 2014: 8.76), and the highest in former Soviet Union countries (males: 1990: 134.19; 2014: 91.13; females: 1990: 83.62, 2014: 41.83) (p<0,05). Significant differences were found in age-specific, cerebrovascular disease mortality in both sexes between Eastern and Western European countries and former Soviet Union countries (1990, 2004, 2014: p<0.05). Between 1990 and 2014, age-specific, standardized cerebrovascular disease mortality showed the biggest decrease in Western European countries (males: -59.28%, females: -58.29%) followed by Eastern European (males: -54.14%, females: -57.53%) and former Soviet Union countries (males: -32.09%, females: -49.97%). CONCLUSIONS: Age-specific, cerebrovascular disease mortality decreased in both sexes in all regions analysed. Hungary was found to have seen a decrease above the Western European average, premature cerebrovascular mortality decreased by 62.2% in males and 59.1% in females between 1990 and 2014. Orv Hetil. 2021; 162(4): 144-152.


Asunto(s)
Trastornos Cerebrovasculares/mortalidad , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad Prematura , Estudios Retrospectivos
5.
JAMA Netw Open ; 4(1): e2032779, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33416885

RESUMEN

Importance: Adverse long-term outcomes in individuals born before full gestation are not confined to individuals born at extreme gestational ages. Little is known regarding mortality patterns among individuals born in the weeks close to ideal gestation, and the exact causes are not well understood; both of these are crucial for public health, with the potential for modification of risk. Objective: To examine the risk of all-cause and noncommunicable diseases (NCD) deaths among young adults born preterm and early term. Design, Setting, and Participants: This multinational population-based cohort study used nationwide birth cohorts from Norway, Sweden, Denmark, and Finland for individuals born between 1967 and 2002. Individuals identified at birth who had not died or emigrated were followed up for mortality from age 15 years to 2017. Analyses were performed from June 2019 to May 2020. Exposures: Categories of gestational age (ie, moderate preterm birth and earlier [23-33 weeks], late preterm [34-36 weeks], early term [37-38 weeks], full term [39-41 weeks] and post term [42-44 weeks]). Main Outcomes and Measures: All-cause mortality and cause-specific mortality from NCD, defined as cancer, diabetes, chronic lung disease, and cardiovascular disease (CVD). Results: A total of 6 263 286 individuals were followed up for mortality from age 15 years. Overall, 339 403 (5.4%) were born preterm, and 3 049 100 (48.7%) were women. Compared with full-term birth, the adjusted hazard ratios (aHRs) for all-cause mortality were 1.44 (95% CI, 1.34-1.55) for moderate preterm birth and earlier; 1.23 (95% CI, 1.18-1.29) for late preterm birth; and 1.12 (95% CI, 1.09-1.15) for early-term birth. The association between gestational age and all-cause mortality were stronger in women than in men (P for interaction = .03). Preterm birth was associated with 2-fold increased risks of death from CVD (aHR, 1.89; 95% CI, 1.45-2.47), diabetes (aHR, 1.98; 95% CI, 1.44-2.73), and chronic lung disease (aHR, 2.28; 95% CI, 1.36-3.82). The main associations were replicated across countries and could not be explained by familial or individual confounding factors. Conclusions and Relevance: The findings of this study strengthen the evidence of increased risk of death from NCDs in young adults born preterm. Importantly, the increased death risk was found across gestational ages up to the ideal term date and includes the much larger group with early-term birth. Excess mortality associated with shorter gestational age was most pronounced for CVDs, chronic lung disease, and diabetes.


Asunto(s)
Causas de Muerte , Nacimiento Prematuro/mortalidad , Adolescente , Adulto , Dinamarca/epidemiología , Femenino , Finlandia/epidemiología , Edad Gestacional , Humanos , Masculino , Mortalidad Prematura , Noruega/epidemiología , Factores de Riesgo , Suecia/epidemiología
6.
Am J Cardiol ; 145: 58-63, 2021 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-33454344

RESUMEN

Patients with homozygous familial hypercholesterolemia (HoFH) have a high risk for premature death. Supravalvular aortic stenosis (SVAS) is a common and the feature lesion of the aortic root in HoFH. The relation between SVAS and the risk of premature death in patients with HoFH has not been fully investigated. The present study analysis included 97 HoFH patients with mean age of 14.7 (years) from the Genetic and Imaging of Familial Hypercholesterolemia in Han Nationality Study. During the median (±SD) follow-up 4.0 (±4.0) years, 40 (41.2%) participants had SVAS and 17 (17.5%) participants experienced death. The proportion of premature death in the non-SVAS and SVAS group was 7.0% and 32.5%, respectively. Compared with the non-SVAS group, SVAS group cumulative survival was lower in the HoFH (log-rank test, p <0.001). This result was further confirmed in the multivariable Cox regression models. After adjusting for age, sex, low density lipoprotein cholesterol (LDL_C)-year-score, lipid-lowering drugs, cardiovascular disease, and carotid artery plaque, SVAS was an independent risk factor of premature death in HoFH on the multivariate analysis (hazard ratio 4.45; 95% confidence interval, 1.10 to 18.12; p = 0.037). In conclusion, a significantly increased risk of premature death was observed in HoFH patients with SVAS. Our study emphasized the importance of careful and aggressive management in these patients when appropriate.


Asunto(s)
Estenosis Aórtica Supravalvular/epidemiología , Hiperlipoproteinemia Tipo II/epidemiología , Mortalidad Prematura , Adolescente , Adulto , Estenosis Aórtica Supravalvular/diagnóstico por imagen , Estenosis Aórtica Supravalvular/fisiopatología , Apolipoproteína B-100/genética , Arco Senil/epidemiología , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/epidemiología , Estudios de Casos y Controles , Causas de Muerte , Niño , Preescolar , Ecocardiografía , Femenino , Estudios de Seguimiento , Homocigoto , Humanos , Hiperlipoproteinemia Tipo II/tratamiento farmacológico , Hiperlipoproteinemia Tipo II/genética , Hiperlipoproteinemia Tipo II/fisiopatología , Hipolipemiantes/uso terapéutico , Lactante , Masculino , Análisis Multivariante , Modelos de Riesgos Proporcionales , Proproteína Convertasa 9/genética , Receptores de LDL/genética , Riesgo , Factores de Riesgo , Xantomatosis/epidemiología , Adulto Joven
7.
JAMA Netw Open ; 4(1): e2032086, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33471116

RESUMEN

Importance: To address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of government. However, few or no all-cause mortality data are available at the local level to motivate and guide city-level actions for health equity within the country's biggest cities. Objectives: To provide city-level data on all-cause mortality rates and racial inequities within cities and to determine whether these measures changed during the past decade. Design, Setting, and Participants: This cross-sectional study used mortality data from the National Vital Statistics System and American Community Survey population estimates to calculate city-level mortality rates for the non-Hispanic Black (Black) population, non-Hispanic White (White) population, and total population from January 2016 to December 2018. Changes from January 2009 to December 2018 were examined with joinpoint regression. Data were analyzed for the United States and the 30 most populous US cities. Data analysis was conducted from February to November 2020. Exposure: City of residence. Main Outcomes and Measures: Total population and race-specific age-standardized mortality rates using 3-year averages, mortality rate ratios between Black and White populations, excess Black deaths, and annual average percentage change in mortality rates and rate ratios. Results: The study included 26 295 827 death records. In 2016 to 2018, all-cause mortality rates ranged from 537 per 100 000 population in San Francisco to 1342 per 100 000 in Las Vegas compared with the overall US rate of 759 per 100 000. The all-cause mortality rate among Black populations was 24% higher than among White populations nationally (rate ratio, 1.236; 95% CI, 1.233 to 1.238), resulting in 74 402 excess Black deaths annually. At the city level, this ranged from 6 excess Black deaths in El Paso to 3804 excess Black deaths every year in Chicago. The US rate remained constant during the study period (average annual percentage change, -0.10%; 95% CI, -0.34% to 0.14%; P = .42). The racial inequities in rates for the US decreased between 2008 and 2019 (annual average percentage change, -0.51%; 95% CI, -0.92% to -0.09%; P =0.02). Only 14 of 30 cities (46.7%) experienced improvements in overall mortality rates during the past decade. Racial inequities increased in more cities (6 [20.0%]) than in which it decreased (2 [6.7%]). Conclusions and Relevance: In this study, mortality rates and inequities between Black and White populations varied substantially among the largest US cities. City leaders and other health advocates can use these types of local data on the burden of death and health inequities in their jurisdictions to increase awareness and advocacy related to racial health inequities, to guide the allocation of local resources, to monitor trends over time, and to highlight effective population health strategies.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Mortalidad/tendencias , Causas de Muerte , Estudios Transversales , Femenino , Humanos , Masculino , Mortalidad Prematura/tendencias , Estados Unidos/epidemiología
8.
Am J Public Health ; 111(2): 265-268, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33351654

RESUMEN

Objectives. To investigate how census tract (CT) estimates of mortality rates and inequities are affected by (1) differential privacy (DP), whereby the public decennial census (DC) data are injected with statistical "noise" to protect individual privacy, and (2) uncertainty arising from the small number of different persons surveyed each year in a given CT for the American Community Survey (ACS).Methods. We compared estimates of the 2008-2012 average annual premature mortality rate (death before age 65 years) in Massachusetts using CT data from the 2010 DC, 2010 DC with DP, and 2008-2012 ACS 5-year estimate data.Results. For these 3 denominator sources, the age-standardized premature mortality rates (per 100 000) for the total population respectively equaled 166.4 (95% confidence interval [CI] = 162.2, 170.6), 166.4 (95% CI = 162.2, 170.6), and 166.3 (95% CI = 162.1, 170.5), and inequities in the range from best to worst quintile for CT racialized economic segregation were from 103.4 to 260.1, 102.9 to 258.7, and 102.8 to 262.4. Similarity of results across CT denominator sources held for analyses stratified by gender and race/ethnicity.Conclusions. Estimates of health inequities at the CT level may not be affected by use of 2020 DP data and uncertainty in the ACS data.


Asunto(s)
Censos , Disparidades en Atención de Salud/estadística & datos numéricos , Mortalidad Prematura , Grupos de Población/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Massachusetts , Persona de Mediana Edad , Privacidad , Factores Socioeconómicos , Estados Unidos
9.
Chemosphere ; 263: 127925, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32818847

RESUMEN

Long-term exposure to fine particulate matter (PM2.5) poses a great threat to public health in China. To this end, the Chinese government promulgated the Air Pollution Prevention and Control Action Plan (the Action Plan) in 2013. However, the health benefits of the Action Plan have not been well explained. In this paper, the underlying causes of changes in premature mortality attributable to PM2.5 pollution and the response of this mitigation policy in China were explored using sensitivity analysis. The simulated annual average PM2.5 concentration reduced by 24.9% over mainland China from 2008 to 2016. Subsequently, national premature mortality would decrease by 14.4% from 1.14 million (95% CI: 0.54, 1.55) in 2008 to 0.98 million (95% CI: 0.44, 1.38) in 2016. Specifically, premature mortality reduced by 209,600 cases (-18.3%) owing to PM2.5 reduction during 2008-2016, of which 188,500 cases were from 2014 to 2016 due to the Action Plan in 2013. Note that the health benefits were limited when compared with air quality improvements, mainly due to that the IER functions have a stable curve at higher concentration intervals. Meanwhile, premature mortality would have increased by 14.2% from 2008 to 2016 owing to demographic changes, substantially weakening the impact of the decrease in PM2.5 and baseline mortality. The effectiveness of China's new air pollution mitigation policy was proved through the research. However, considering the non-linear response of mortality to PM2.5 changes and the aggravation of demography trends, stronger emission control steps should be further taken to protect public health in China.


Asunto(s)
Contaminación del Aire/estadística & datos numéricos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Material Particulado/análisis , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , China/epidemiología , Exposición a Riesgos Ambientales/análisis , Humanos , Mortalidad/tendencias , Mortalidad Prematura , Salud Pública
10.
Rev. enferm. UFSM ; 11: e24, 2021. tab, ilus
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1177757

RESUMEN

Objetivo: avaliar a taxa de mortalidade prematura por doenças crônicas não transmissíveis (DCNT) e sua associação com a cobertura populacional pelas equipes de Atenção Básica nos municípios de Santa Catarina. Método: estudo transversal que utilizou dados secundários do banco de dados oficiais do Estado. Os indicadores mortalidade prematura por DCNT e cobertura populacional pelas equipes de Atenção Básica nos anos 2017 e 2018, foram coletados em 2019. Os dados foram analisados no Statistical Package for the Social Sciences versão 25.0, para estatística descritiva e apresentados por média e desvio padrão. Utilizou-se teste de correlação de Spearman para as variáveis em estudo. Resultados: houve aumento nas taxas de mortalidade prematura por DCNT e redução na cobertura populacional pelas equipes de Atenção Básica, sem associação significativa entre esses indicadores. Conclusão: o aumento da mortalidade prematura por DCNT e o não cumprimento das metas pactuadas requerem avaliação das ações realizadas na Atenção Básica.


Objective: to evaluate the rate of premature mortality due to chronic noncommunicable diseases (CNCD) and its association with population Coverage of Primary Care teams in Santa Catarina municipalities. Method: cross-sectional study that used secondary data from the official state database. The indicators premature Mortality due to CNCD and population Coverage of Primary Care teams in the years 2017 and 2018 were collected in 2019. The data were analyzed in the Statistical Package for the Social Sciences version 25.0, for descriptive statistics and presented by mean and standard deviation. Spearman correlation test was used for the variables under study. Results: there was an increase in the rates of premature Mortality due to CNCD and a reduction in population Coverage of Primary Care teams, with no significant association between these indicators. Conclusion: the increase in premature mortality due to CNCD and the non-compliance with the agreed goals require evaluation of the actions performed in Primary Care.


Objetivo: evaluar la tasa de mortalidad prematura por enfermedades crónicas no transmisibles (ECNT) y su asociación con la cobertura poblacional por parte de los equipos de atención primaria en los municipios de Santa Catarina. Método: estudio transversal que utilizó datos secundarios de la base de datos oficial del estado. Los indicadores Mortalidad prematura por ECNT y cobertura poblacional por parte de los equipos de atención primaria en los años 2017 y 2018 se recogieron en 2019. Los datos fueron analizados en el Statistical Package for the Social Sciences versión 25.0, para estadística descriptiva y presentados por media y desviación estándar. La prueba de correlación de Spearman se utilizó para las variables en estudio. Resultados: hubo aumento en las tasas de mortalidad prematura debido a la ECNT y reducción en la cobertura poblacional por parte de los equipos de atención primaria, sin una asociación significativa entre estos indicadores. Conclusión: el aumento de la Mortalidad prematura por ECNT y el incumplimiento de las metas acordadas requiere evaluación de las acciones realizadas en Atención Primaria.


Asunto(s)
Humanos , Atención Primaria de Salud , Salud de la Familia , Mortalidad Prematura , Enfermedades no Transmisibles , Promoción de la Salud
12.
Epilepsia ; 62(1): 51-60, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33316095

RESUMEN

OBJECTIVE: To use clinically informed machine learning to derive prediction models for early and late premature death in epilepsy. METHODS: This was a population-based primary care observational cohort study. All patients meeting a case definition for incident epilepsy in the Health Improvement Network database for inclusive years 2000-2012 were included. A modified Delphi process identified 30 potential risk factors. Outcome was early (within 4 years of epilepsy diagnosis) and late (4 years or more from diagnosis) mortality. We used regularized logistic regression, support vector machines, Gaussian naive Bayes, and random forest classifiers to predict outcomes. We assessed model calibration, discrimination, and generalizability using the Brier score, mean area under the receiver operating characteristic curve (AUC) derived from stratified fivefold cross-validation, plotted calibration curves, and extracted measures of association where possible. RESULTS: We identified 10 499 presumed incident cases from 11 194 182 patients. All models performed comparably well following stratified fivefold cross-validation, with AUCs ranging from 0.73 to 0.81 and from 0.71 to 0.79 for early and late death, respectively. In addition to comorbid disease, social habits (alcoholism odds ratio [OR] for early death = 1.54, 95% confidence interval [CI] = 1.12-2.11 and OR for late death = 2.62, 95% CI = 1.66-4.16) and treatment patterns (OR for early death when no antiseizure medication [ASM] was prescribed at baseline = 1.33, 95% CI = 1.07-1.64 and OR for late death after receipt of enzyme-inducing ASM at baseline = 1.32, 95% CI = 1.04-1.66) were significantly associated with increased risk of premature death. Baseline ASM polytherapy (OR = 0.55, 95% CI = 0.36-0.85) was associated with reduced risk of early death. SIGNIFICANCE: Clinically informed models using routine electronic medical records can be used to predict early and late mortality in epilepsy, with moderate to high accuracy and evidence of generalizability. Medical, social, and treatment-related risk factors, such as delayed ASM prescription and baseline prescription of enzyme-inducing ASMs, were important predictors.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Registros Electrónicos de Salud , Epilepsia/tratamiento farmacológico , Mortalidad Prematura , Atención Primaria de Salud , Adulto , Edad de Inicio , Anciano , Anciano de 80 o más Años , Alcoholismo/epidemiología , Anemia/epidemiología , Área Bajo la Curva , Teorema de Bayes , Neoplasias Encefálicas/epidemiología , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Inductores de las Enzimas del Citocromo P-450/uso terapéutico , Demencia/epidemiología , Quimioterapia Combinada , Epilepsia/epidemiología , Femenino , Humanos , Cirrosis Hepática/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mortalidad , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Curva ROC , Insuficiencia Renal Crónica/epidemiología , Medición de Riesgo , Fumar/epidemiología , Máquina de Vectores de Soporte , Factores de Tiempo
13.
Rev Saude Publica ; 54: 139, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33331531

RESUMEN

OBJECTIVE: To verify the effect of the Pact for Health on premature mortality (30-69 years) attributed to cervical cancer in Brazil and its macroregions, using interrupted time series analysis. METHODS: Segmented regression was used to assess "change in level" and "change in trend" in premature mortality rates attributed to cervical cancer considering the post-Pact period (2010-2018), controlling by the pre-Pact period (1998-2006). Understanding the triennium 2007-2009 as essential for the adoption and implementation of the policy, it was excluded from the main modeling, but assessed in the sensitivity analysis. RESULTS: From 1998 to 2018, there were more than 119,000 deaths due to cervical cancer in women aged 30 to 69 years in Brazil. The Northern region experienced the highest rates (> 20 per 100,000). Comparing with baseline (1998-2006), segmented regression showed a progressive increase in changing trend from cervical cancer deaths in Brazil as a whole (coefficient = 0.513; 95%CI 0.430 to 0.596) and in the Southeast region (coefficient = 0.515; 95%CI 0.358 to 0.674), South region (coefficient = 0.925; 95%CI 0.642 to 1.208), and Midwest region (coefficient = 0.590; 95%CI 0.103 to 1.077). The Northeast region presented the most promising effects with immediate reduction in change level (-0.635; 95%CI -1.177 to -0.092) and progressive reduction in the changing trend of premature deaths (coefficient= -0.151; 95%CI -0.231 to -0.007). CONCLUSIONS: Premature mortality rates due to cervical cancer are high in Brazil and its macroregions. This interrupted time series was not able to reveal the effectiveness of initiatives related to the Pact for Health on premature deaths from cervical cancer nationally and in all macroregions equally. The best results are restricted to the Northeast region.


Asunto(s)
Mortalidad Prematura , Neoplasias del Cuello Uterino/mortalidad , Adulto , Anciano , Brasil/epidemiología , Femenino , Humanos , Análisis de Series de Tiempo Interrumpido , Persona de Mediana Edad , Neoplasias del Cuello Uterino/patología
14.
PLoS One ; 15(12): e0243948, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33373366

RESUMEN

BACKGROUND: Studies from high-income countries reported reduced life expectancy in children with cerebral palsy (CP), while no population-based study has evaluated mortality of children with CP in sub-Saharan Africa. This study aimed to estimate the mortality rate (MR) of children with CP in a rural region of Uganda and identify risk factors and causes of death (CODs). METHODS AND FINDINGS: This population-based, longitudinal cohort study was based on data from Iganga-Mayuge Health and Demographic Surveillance System in eastern Uganda. We identified 97 children (aged 2-17 years) with CP in 2015, whom we followed to 2019. They were compared with an age-matched cohort from the general population (n = 41 319). MRs, MR ratios (MRRs), hazard ratios (HRs), and immediate CODs were determined. MR was 3952 per 100 000 person years (95% CI 2212-6519) in children with CP and 137 per 100 000 person years (95% CI 117-159) in the general population. Standardized MRR was 25·3 in the CP cohort, compared with the general population. In children with CP, risk of death was higher in those with severe gross motor impairments than in those with milder impairments (HR 6·8; p = 0·007) and in those with severe malnutrition than in those less malnourished (HR = 3·7; p = 0·052). MR was higher in females in the CP cohort, with a higher MRR in females (53·0; 95% CI 26·4-106·3) than in males (16·3; 95% CI 7·2-37·2). Age had no significant effect on MR in the CP cohort, but MRR was higher at 10-18 years (39·6; 95% CI 14·2-110·0) than at 2-6 years (21·0; 95% CI 10·2-43·2). Anaemia, malaria, and other infections were the most common CODs in the CP cohort. CONCLUSIONS: Risk of premature death was excessively high in children with CP in rural sub-Saharan Africa, especially in those with severe motor impairments or malnutrition. While global childhood mortality has significantly decreased during recent decades, this observed excessive mortality is a hidden humanitarian crisis that needs to be addressed.


Asunto(s)
Parálisis Cerebral/mortalidad , Mortalidad Prematura , Adolescente , Parálisis Cerebral/patología , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Factores de Riesgo , Población Rural , Uganda/epidemiología
15.
PLoS One ; 15(12): e0244375, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33362274

RESUMEN

Cancer is responsible annually for around 27% of all deaths in Spain, 15% of which are caused by colorectal cancer. This malignancy has increased its incidence considerably over the past years, which surely impacts global productivity losses. The evaluation of lost productivity due to premature mortality provides valuable information that guides healthcare policies into the establishment of prevention and screening programs. The purpose of this study was to assess the productivity losses from premature deaths due to colorectal cancer over a ten year period (2008-2017). The costs derived from premature mortality due to this highly prevalent cancer were estimated using data on mortality, age- and sex-specific reference salaries and unemployment rates in Spain via the human capital approach. Between 2008 and 2017, 15,103 persons died per year from colorectal cancer, representing almost 15% of all cancer-related deaths. Annually, 25,333 years of potential productive life were estimated to be lost on average, 14,992 in males and 10,341 in females. Productivity losses summed €510.8 million in in 2017, and the cancers of the colon and rectum accounted for 9.6% of cancer-related productivity losses in 2017 in Spain. Colorectal cancer has an important weight in terms of productivity losses within the Spanish population, consequently, prevention and early detection programmes should be promoted and implemented to achieve significant reductions in mortality and productivity losses.


Asunto(s)
Neoplasias Colorrectales/economía , Neoplasias Colorrectales/mortalidad , Desempleo/estadística & datos numéricos , Adolescente , Adulto , Eficiencia , Femenino , Humanos , Incidencia , Esperanza de Vida , Masculino , Persona de Mediana Edad , Mortalidad Prematura , Caracteres Sexuales , España/epidemiología , Adulto Joven
16.
Rev. enferm. UERJ ; 28: e39729, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1116093

RESUMEN

Objetivo: identificar as principais causas de óbito entre adolescentes de 10 a 19 anos em um município no interior do estado do Rio de Janeiro. Método: estudo descritivo, exploratório de abordagem quantitativa, a partir do levantamento de dados em registros de óbitos do município de Rio das Ostras. O desfecho foi causa básica do óbito. Os dados foram processados no Programa R. Resultados: foram observados 84 (100%) óbitos, com maior prevalência entre adolescentes de 17 a 19 anos, 49 (58,3%), do sexo masculino, 71 (84,5%) e de cor parda, 38 (45,2%). As principais causas de óbitos foram homicídio/perfuração por arma de fogo, 35 (41,7%), e acidentes, 32 (38,1%). Conclusão: o reconhecimento dessa vulnerabilidade configura importante caminho para o enfrentamento e resolução desse grave problema, sobretudo municípios localizados longe de centros urbanos, parece muitas vezes esquecido, no que tange o cumprimento de estatutos e políticas públicas a favor desse grupo etário.


Objective: to identify the main causes of death among adolescents aged 10 to 19 years in a municipality in the state of Rio de Janeiro. Method: in this exploratory, descriptive, quantitative study, based on data collected from death records in the municipality of Rio das Ostras, the basic cause of death was the outcome. The data were processed in the statistics software, R. Results: of the 84 (100%) deaths observed, prevalence was higher among adolescents aged 17 to 19 years (49; 58.3%), males (71; 84.5%), and pardos (38; 45.2%). The main causes of deaths were firearm Injury / homicide (35; 41.7%) and accidents (32; 38.1%). Conclusion: one important step towards confronting and solving this serious problem is to acknowledge this vulnerability, especially in municipalities distant from urban centers, which often seem neglected as regards compliance with statutes and public policies in favor of this age group.


Objetivo: identificar las principales causas de muerte entre adolescentes de 10 a 19 años en un municipio del estado de Río de Janeiro. Método: en este estudio exploratorio, descriptivo, cuantitativo, basado en los datos recopilados de los registros de defunciones en el municipio de Rio das Ostras, la causa básica de la muerte fue el resultado. Los datos se procesaron en el programa estadístico R. Resultados: de las 84 (100%) muertes observadas, la prevalencia fue mayor entre los adolescentes de 17 a 19 años (49; 58.3%), varones (71; 84.5%) y pardos (38; 45,2%). Las principales causas de muerte fueron lesiones por arma de fuego / homicidio (35; 41.7%) y accidentes (32; 38.1%). Conclusión: un paso importante para enfrentar y resolver este grave problema es reconocer esta vulnerabilidad, especialmente en municipios alejados de los centros urbanos, que a menudo parecen descuidados en cuanto al cumplimiento de los estatutos y las políticas públicas a favor de este grupo de edad.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Accidentes/estadística & datos numéricos , Causas de Muerte , Poblaciones Vulnerables/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Brasil , Epidemiología Descriptiva , Factores de Edad , Vulnerabilidad Social , Mortalidad Prematura
17.
BMJ ; 371: m3464, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32998909

RESUMEN

OBJECTIVE: To evaluate whether irregular or long menstrual cycles throughout the life course are associated with all cause and cause specific premature mortality (age <70 years). DESIGN: Prospective cohort study. SETTING: Nurses' Health Study II (1993-2017). PARTICIPANTS: 79 505 premenopausal women without a history of cardiovascular disease, cancer, or diabetes and who reported the usual length and regularity of their menstrual cycles at ages 14-17 years, 18-22 years, and 29-46 years. MAIN OUTCOME MEASURES: Hazard ratios and 95% confidence intervals for all cause and cause specific premature mortality (death before age 70 years) were estimated from multivariable Cox proportional hazards models. RESULTS: During 24 years of follow-up, 1975 premature deaths were documented, including 894 from cancer and 172 from cardiovascular disease. Women who reported always having irregular menstrual cycles experienced higher mortality rates during follow-up than women who reported very regular cycles in the same age ranges. The crude mortality rate per 1000 person years of follow-up for women reporting very regular cycles and women reporting always irregular cycles were 1.05 and 1.23 for cycle characteristics at ages 14-17 years, 1.00 and 1.37 for cycle characteristics at ages 18-22 years, and 1.00 and 1.68 for cycle characteristics at ages 29-46 years. The corresponding multivariable adjusted hazard ratios for premature death during follow-up were 1.18 (95% confidence interval 1.02 to 1.37), 1.37 (1.09 to 1.73), and 1.39 (1.14 to 1.70), respectively. Similarly, women who reported that their usual cycle length was 40 days or more at ages 18-22 years and 29-46 years were more likely to die prematurely than women who reported a usual cycle length of 26-31 days in the same age ranges (1.34, 1.06 to 1.69; and 1.40, 1.17 to 1.68, respectively). These relations were strongest for deaths related to cardiovascular disease. The higher mortality associated with long and irregular menstrual cycles was slightly stronger among current smokers. CONCLUSIONS: Irregular and long menstrual cycles in adolescence and adulthood are associated with a greater risk of premature mortality (age <70 years). This relation is slightly stronger among women who smoke.


Asunto(s)
Ciclo Menstrual , Trastornos de la Menstruación/epidemiología , Mortalidad Prematura , Salud Reproductiva/estadística & datos numéricos , Adolescente , Adulto , Enfermedades Cardiovasculares/epidemiología , Causas de Muerte , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Neoplasias/epidemiología , Medición de Riesgo , Factores de Riesgo , Autoinforme , Fumar/epidemiología , Estados Unidos/epidemiología
18.
Cien Saude Colet ; 25(suppl 2): 4169-4176, 2020 Oct.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33027353

RESUMEN

The objective of this study is to show the impact of the early death of the elderly, especially those who are financially responsible for families, on the income of other family members. It is considered to be premature, because death occurs at an age where life expectancy is positive and different from zero. The concern arises from the finding that 74.7% of the deaths recorded by Covid-19 until 8/13/2020 occurred in individuals aged 60 years or older, of which 56.4% were men. For example, at age 60 a male individual could still expect to live another 18.1 years, given the health conditions prevailing in 2018.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Composición Familiar , Renta , Mortalidad Prematura , Neumonía Viral/mortalidad , Adulto , Betacoronavirus , Brasil/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Desempleo/estadística & datos numéricos , Adulto Joven
19.
PLoS Med ; 17(10): e1003402, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33079941

RESUMEN

BACKGROUND: In the United States, non-Hispanic Black (NHB), Hispanic, and non-Hispanic American Indian/Alaska Native (NHAIAN) populations experience excess COVID-19 mortality, compared to the non-Hispanic White (NHW) population, but racial/ethnic differences in age at death are not known. The release of national COVID-19 death data by racial/ethnic group now permits analysis of age-specific mortality rates for these groups and the non-Hispanic Asian or Pacific Islander (NHAPI) population. Our objectives were to examine variation in age-specific COVID-19 mortality rates by racial/ethnicity and to calculate the impact of this mortality using years of potential life lost (YPLL). METHODS AND FINDINGS: This cross-sectional study used the recently publicly available data on US COVID-19 deaths with reported race/ethnicity, for the time period February 1, 2020, to July 22, 2020. Population data were drawn from the US Census. As of July 22, 2020, the number of COVID-19 deaths equaled 68,377 for NHW, 29,476 for NHB, 23,256 for Hispanic, 1,143 for NHAIAN, and 6,468 for NHAPI populations; the corresponding population sizes were 186.4 million, 40.6 million, 2.6 million, 19.5 million, and 57.7 million. Age-standardized rate ratios relative to NHW were 3.6 (95% CI 3.5, 3.8; p < 0.001) for NHB, 2.8 (95% CI 2.7, 3.0; p < 0.001) for Hispanic, 2.2 (95% CI 1.8, 2.6; p < 0.001) for NHAIAN, and 1.6 (95% CI 1.4, 1.7; p < 0.001) for NHAP populations. By contrast, NHB rate ratios relative to NHW were 7.1 (95% CI 5.8, 8.7; p < 0.001) for persons aged 25-34 years, 9.0 (95% CI 7.9, 10.2; p < 0.001) for persons aged 35-44 years, and 7.4 (95% CI 6.9, 7.9; p < 0.001) for persons aged 45-54 years. Even at older ages, NHB rate ratios were between 2.0 and 5.7. Similarly, rate ratios for the Hispanic versus NHW population were 7.0 (95% CI 5.8, 8.7; p < 0.001), 8.8 (95% CI 7.8, 9.9; p < 0.001), and 7.0 (95% CI 6.6, 7.5; p < 0.001) for the corresponding age strata above, with remaining rate ratios ranging from 1.4 to 5.0. Rate ratios for NHAIAN were similarly high through age 74 years. Among NHAPI persons, rate ratios ranged from 2.0 to 2.8 for persons aged 25-74 years and were 1.6 and 1.2 for persons aged 75-84 and 85+ years, respectively. As a consequence, more YPLL before age 65 were experienced by the NHB and Hispanic populations than the NHW population-despite the fact that the NHW population is larger-with a ratio of 4.6:1 and 3.2:1, respectively, for NHB and Hispanic persons. Study limitations include likely lag time in receipt of completed death certificates received by the Centers for Disease Control and Prevention for transmission to NCHS, with consequent lag in capturing the total number of deaths compared to data reported on state dashboards. CONCLUSIONS: In this study, we observed racial variation in age-specific mortality rates not fully captured with examination of age-standardized rates alone. These findings suggest the importance of examining age-specific mortality rates and underscores how age standardization can obscure extreme variations within age strata. To avoid overlooking such variation, data that permit age-specific analyses should be routinely publicly available.


Asunto(s)
Afroamericanos , Grupo de Ascendencia Continental Asiática , Infecciones por Coronavirus/etnología , Disparidades en el Estado de Salud , Hispanoamericanos , Indios Norteamericanos , Grupo de Ascendencia Oceánica , Neumonía Viral/etnología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Grupos de Población Continentales , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/virología , Estudios Transversales , Grupos Étnicos , Grupo de Ascendencia Continental Europea , Humanos , Persona de Mediana Edad , Mortalidad Prematura , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/virología , Estados Unidos/epidemiología
20.
Lancet Planet Health ; 4(10): e474-e482, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32976757

RESUMEN

BACKGROUND: Exposure to poor air quality leads to increased premature mortality from cardiovascular and respiratory diseases. Among the far-reaching implications of the ongoing COVID-19 pandemic, a substantial improvement in air quality was observed worldwide after the lockdowns imposed by many countries. We aimed to assess the implications of different lockdown measures on air pollution levels in Europe and China, as well as the short-term and long-term health impact. METHODS: For this modelling study, observations of fine particulate matter (PM2·5) concentrations from more than 2500 stations in Europe and China during 2016-20 were integrated with chemical transport model simulations to reconstruct PM2·5 fields at high spatiotemporal resolution. The health benefits, expressed as short-term and long-term avoided mortality from PM2·5 exposure associated with the interventions imposed to control the COVID-19 pandemic, were quantified on the basis of the latest epidemiological studies. To explore the long-term variability in air quality and associated premature mortality, we built different scenarios of economic recovery (immediate or gradual resumption of activities, a second outbreak in autumn, and permanent lockdown for the whole of 2020). FINDINGS: The lockdown interventions led to a reduction in population-weighted PM2·5 of 14·5 µg m-3 across China (-29·7%) and 2·2 µg m-3 across Europe (-17·1%), with unprecedented reductions of 40 µg m-3 in bimonthly mean PM2·5 in the areas most affected by COVID-19 in China. In the short term, an estimated 24 200 (95% CI 22 380-26 010) premature deaths were averted throughout China between Feb 1 and March 31, and an estimated 2190 (1960-2420) deaths were averted in Europe between Feb 21 and May 17. We also estimated a positive number of long-term avoided premature fatalities due to reduced PM2·5 concentrations, ranging from 76 400 (95% CI 62 600-86 900) to 287 000 (233 700-328 300) for China, and from 13 600 (11 900-15 300) to 29 500 (25 800-33 300) for Europe, depending on the future scenarios of economic recovery adopted. INTERPRETATION: These results indicate that lockdown interventions led to substantial reductions in PM2·5 concentrations in China and Europe. We estimated that tens of thousands of premature deaths from air pollution were avoided, although with significant differences observed in Europe and China. Our findings suggest that considerable improvements in air quality are achievable in both China and Europe when stringent emission control policies are adopted. FUNDING: None.


Asunto(s)
Contaminación del Aire/prevención & control , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Infecciones por Coronavirus/prevención & control , Modelos Teóricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Betacoronavirus , China/epidemiología , Control de Enfermedades Transmisibles/economía , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Exposición a Riesgos Ambientales/análisis , Exposición a Riesgos Ambientales/prevención & control , Europa (Continente)/epidemiología , Humanos , Mortalidad Prematura/tendencias , Pandemias/economía , Material Particulado/análisis , Neumonía Viral/economía , Neumonía Viral/epidemiología
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