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1.
Medicine (Baltimore) ; 100(9): e25085, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655987

RESUMO

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.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Insulina/uso terapêutico , Metformina/uso terapêutico , Vigilância da População/métodos , Compostos de Sulfonilureia/uso terapêutico , Adulto , Idoso , Causas de Morte/tendências , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Seguimentos , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia , Fatores de Tempo , Resultado do Tratamento
2.
Natl Vital Stat Rep ; 69(13): 1-83, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33541516

RESUMO

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.


Assuntos
Mortalidade/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Criança , Pré-Escolar , Grupos Étnicos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Expectativa de Vida/tendências , Masculino , Pessoa de Meia-Idade , Características de Residência/estatística & dados numéricos , Distribuição por Sexo , Estados Unidos/epidemiologia , Estatísticas Vitais , Adulto Jovem
3.
Lancet Diabetes Endocrinol ; 9(3): 165-173, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33549162

RESUMO

BACKGROUND: The prevalence of diabetes has increased in the UK and other high-income countries alongside a substantial decline in cardiovascular mortality. Yet data are scarce on how these trends have changed the causes of death in people with diabetes who have traditionally died primarily of vascular causes. We estimated how all-cause mortality and cause-specific mortality in people with diabetes have changed over time, how the composition of the mortality burden has changed, and how this composition compared with that of the non-diabetes population. METHODS: In this epidemiological analysis of primary care records, we identified 313 907 individuals with diabetes in the Clinical Practice Research Datalink, a well described primary care database, between 2001 to 2018, and linked these data to UK Office for National Statistics mortality data. We assembled serial cross sections with longitudinal follow-up to generate a mixed prevalence and incidence study population of patients with diabetes. We used discretised Poisson regression models to estimate annual death rates for deaths from all causes and 12 specific causes for men and women with diabetes. We also identified age-matched and sex matched (1:1) individuals without diabetes from the same dataset and estimated mortality rates in this group. FINDINGS: Between Jan 1, 2001, and Oct 31, 2018, total mortality declined by 32% in men and 31% in women with diagnosed diabetes. Death rates declined from 40·7 deaths per 1000 person-years to 27·8 deaths per 1000 person-years in men and from 42·7 deaths per 1000 person-years to 29·5 deaths per 1000 person-years in women with diagnosed diabetes. We found similar declines in individuals without diabetes, hence the gap in mortality between those with and without diabetes was maintained over the study period. Cause-specific death rates declined in ten of the 12 cause groups, with exceptions in dementia and liver disease, which increased in both populations. The large decline in vascular disease death rates led to a transition from vascular causes to cancers as the leading contributor to death rates in individuals with diagnosed diabetes and to the gap in death rates between those with and without diabetes. INTERPRETATION: The decline in vascular death rates has been accompanied by a diversification of causes in individuals with diagnosed diabetes and a transition from vascular diseases to cancers as the leading contributor to diabetes-related death. Clinical and preventative approaches must reflect this trend to reduce the excess mortality risk in individuals with diabetes. FUNDING: Wellcome Trust.


Assuntos
Causas de Morte/tendências , Complicações do Diabetes/mortalidade , Diabetes Mellitus/mortalidade , Mortalidade/tendências , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Causalidade , Diabetes Mellitus/epidemiologia , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Registro Médico Coordenado , Pessoa de Meia-Idade
4.
Am J Public Health ; 111(4): 704-707, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33600247

RESUMO

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.


Assuntos
/mortalidade , Causas de Morte/tendências , Interpretação Estatística de Dados , Florida , Humanos , Modelos Estatísticos , Estudos Retrospectivos
5.
Lancet Diabetes Endocrinol ; 9(3): 144-152, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33482107

RESUMO

BACKGROUND: There has been a considerable increase in thyroid cancer incidence among adults in several countries in the past three decades, attributed primarily to overdiagnosis. We aimed to assess global patterns and trends in incidence and mortality of thyroid cancer in children and adolescents, in view of the increased incidence among adults. METHODS: We did a population-based study of the observed incidence (in 49 countries and territories) and mortality (in 27 countries) of thyroid cancer in children and adolescents aged 0-19 years using data from the International Incidence of Childhood Cancer Volume 3 study database, the WHO mortality database, and the cancer incidence in five continents database (CI5plus; for adult data [age 20-74 years]). We analysed temporal trends in incidence rates, including absolute changes in rates, and the strength of the correlation between incidence rates in children and adolescents and in adults. We calculated the average annual number of thyroid cancer deaths and the age-standardised mortality rates for children and adolescents. FINDINGS: Age-standardised incidence rates of thyroid cancer among children and adolescents aged 0-19 years ranged from 0·4 (in Uganda and Kenya) to 13·4 (in Belarus) cancers per 1 million person-years in 2008-12. The variability in the incidence rates was mostly accounted for by the papillary tumour subtype. Incidence rates were almost always higher in girls than in boys and increased with age in both sexes. Rapid increases in incidence between 1998-2002 and 2008-12 were observed in almost all countries. Country-specific incidence rates in children and adolescents were strongly correlated (r>0·8) with rates in adults, as were the temporal changes in the respective incidence rates (r>0·6). Thyroid cancer deaths in those aged younger than 20 years were less than 0·1 per 10 million person-years in each country. INTERPRETATION: The pattern of thyroid cancer incidence in children and adolescents mirrors the pattern seen in adults, suggesting a major role for overdiagnosis, which, in turn, can lead to overtreatment, lifelong medical care, and side effects that can negatively affect quality of life. We suggest that the existing recommendation against screening for thyroid cancer in the asymptomatic adult population who are free from specific risk factors should be extended to explicitly recommend against screening for thyroid cancer in similar populations of children and adolescents. FUNDING: International Agency for Research on Cancer and the Union for International Cancer Control; French Institut National du Cancer; Italian Association of Cancer Research; and Italian Ministry of Health.


Assuntos
Saúde Global/tendências , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/mortalidade , Adolescente , Idade de Início , Causas de Morte/tendências , Criança , Mortalidade da Criança , Pré-Escolar , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Expectativa de Vida/tendências , Masculino , Sobremedicalização/estatística & dados numéricos , Fatores de Risco , Neoplasias da Glândula Tireoide/diagnóstico , Adulto Jovem
6.
Scand J Public Health ; 49(1): 69-78, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33413051

RESUMO

Aims: To compare the early impact of COVID-19 infections and mortality from February to July 2020 across the Nordic nations of Sweden, Norway, Denmark, and Finland through available public data sources and conduct a descriptive analysis of the potential factors that drove different epidemiological outcomes, with a focus on Sweden's response. Methods: COVID-19 cases, deaths, tests, case age distribution, and the difference between 2020 all-cause mortality and the average mortality of the previous 5 years were compared across nations. Patterns in cell phone mobility data, testing strategies, and seniors' care home deaths were also compared. Data for each nation were based on publicly available sources as of July 31, 2020. Results: Compared with its Nordic peers, Sweden had a higher incidence rate across all ages, a higher COVID-19-related death rate only partially explained by population demographics, a higher death rate in seniors' care, and higher all-cause mortality. Sweden had approximately half as much mobility change as its Nordic neighbours until April and followed similar rates as its neighbours from April to July. Denmark led its Nordic peers in testing rates, while Sweden had the highest cumulative test-positivity rate continuously from mid-March. Conclusions: COVID-19 pushed Sweden's health system to its capacity, exposed systemic weaknesses in the seniors' care system, and revealed challenges with implementing effective contact tracing and testing strategies while experiencing a high case burden. Looser government restrictions at the beginning of the outbreak are likely to have played a role in the impact of COVID-19 in Sweden. In an effort to improve epidemic control, Sweden has increased testing rates, implemented more restrictive prevention measures, and increased their intensive care unit bed capacity.


Assuntos
/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Causas de Morte/tendências , Criança , Pré-Escolar , Dinamarca/epidemiologia , Finlândia/epidemiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Mortalidade/tendências , Noruega/epidemiologia , Suécia/epidemiologia , Adulto Jovem
7.
Int J Cardiol ; 329: 266-269, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33309764

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) global pandemic has strikingly high mortality rate with hypercoagulability state being part of the imputed mechanisms. We aimed to compare the rates of in hospital mortality in propensity score matched cohorts of COVID-19 patients in chronic anticoagulation versus those that were not. METHODS: In this population-based study in the Veneto Region, we retrospectively reviewed all patients aged 65 years or older, with a laboratory-confirmed COVID-19 diagnosis. We compared, after propensity score matching, those who received chronic anticoagulation for atrial fibrillation with those who did not. RESULTS: Overall, 4697 COVID-19 patients fulfilled inclusion criteria, and the propensity score matching yielded 559 patients per arm. All-cause mortality rate ratio was significantly higher among non-anticoagulated patients (32.2% vs 26.5%, p = 0.036). On time to event analysis, all-cause mortality was found lower among anticoagulated patients, although the estimate was not statistically significant. (HR 0.81, 95%CI 0.65-1.01, p = 0.054). CONCLUSION: Among elderly patients with COVID-19, those on chronic oral anticoagulant treatment for atrial fibrillation seem to be at lower risk of all-cause mortality compared to their propensity score matched non-anticoagulated counterpart. This finding needs to be confirmed in further studies.


Assuntos
Anticoagulantes/administração & dosagem , Vigilância da População , Pontuação de Propensão , Tromboembolia/prevenção & controle , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Feminino , Humanos , Itália/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Tromboembolia/epidemiologia , Tromboembolia/etiologia
8.
Public Health ; 190: 23-29, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33338899

RESUMO

OBJECTIVES: We aimed to determine whether there are any differences in all-cause and cause-specific mortality with cardiovascular disease (CVD) risk between health screening attenders and non-attenders among young adults. STUDY DESIGN: We performed a retrospective cohort study using claim data from the Korean National Health Insurance Service database. METHODS: Individuals aged 20-39 years who had received health screening at least once between 2002 and 2005 were classified as attenders, and the others were classified as non-attenders. After propensity score matching according to attendance of health screening, 2,060,409 attenders and 2,060,409 non-attenders were included. We estimated adjusted hazard ratios (HRs) and 95% confidence interval (CI) for all-cause mortality, cause-specific mortality, and hospitalization of CVD from 2006 to 2015. RESULTS: Survival from all-cause mortality was greater among attenders than among non-attenders (log rank P < 0.001). Similarly, death from CVD (log rank P = 0.007) and CVD events (log rank P < 0.001) were less likely among attenders. The risk for all-cause mortality in attenders was significantly lower than that in non-attenders (HR = 0.83, 95% CI = 0.81 to 0.84). The risk for CVD mortality (HR = 0.80, 95% CI = 0.73 to 0.87) and hospitalization of CVD (HR = 0.92, 95% CI = 0.91 to 0.94) were lower in attenders. In stratified analyses, the risk for all-cause and cause-specific mortalities was lower among attenders regardless of insurance type. CONCLUSIONS: Among young adults, the risk for all-cause mortality, CVD mortality, and hospitalization of CVD were lower for those who underwent health screenings. Future studies that evaluate the cost-effectiveness of health screening with additional consideration of psychosocial aspects are needed.


Assuntos
Doenças Cardiovasculares/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , Causas de Morte/tendências , Estudos de Coortes , Feminino , Hospitalização , Humanos , Incidência , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos
9.
J Invasive Cardiol ; 33(3): E206-E219, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33348315

RESUMO

BACKGROUND: Public reporting of percutaneous coronary intervention (PCI) outcomes is a performance metric and a requirement in many healthcare systems. There are inconsistent data on the causes of death after PCI, and the proportion of these deaths that are attributable to cardiac causes. METHODS: All patients undergoing PCI in England between January 1, 2017 and May 10, 2020 (n = 273,141) were retrospectively analyzed according to their outcome from the date of PCI: no death, in-hospital death, postdischarge death, and total 30-day death. The present study examined short-term primary causes of death after PCI in a national cohort before and during COVID-19. RESULTS: The overall rates of in-hospital and 30-day death were 1.9% and 2.8%, respectively. The rate of 30-day death declined between 2017 (2.9%) and February 2020 (2.5%), mainly due to lower in-hospital death (2.1% vs 1.5%), before rising again from March 1, 2020 (3.2%) due to higher rates of postdischarge mortality. Only 59.6% of 30-day deaths were due to cardiac causes, with the most common causes being acute coronary syndrome, cardiogenic shock, and heart failure, and this persisted throughout the study period. In the 30-day death group, 10.4% after March 1, 2020 were due to confirmed COVID-19. CONCLUSIONS: In this nationwide study, we show that 40% of 30-day deaths are due to non-cardiac causes. Non-cardiac deaths have increased even more from the start of the COVID-19 pandemic, with 1 in 10 deaths from March 2020 being COVID-19 related. These findings raise a question of whether public reporting of PCI outcomes should be cause specific.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Pandemias , Intervenção Coronária Percutânea/mortalidade , Síndrome Coronariana Aguda/epidemiologia , Idoso , Causas de Morte/tendências , Comorbidade , Inglaterra/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências
10.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(6): 317-325, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192480

RESUMO

ANTECEDENTES Y OBJETIVO: La pandemia por SARS-CoV-2 condiciona elevadas tasas de mortalidad en pacientes mayores hospitalizados. Actualmente, pocos estudios incluyen pacientes octogenarios y ninguno analiza el impacto del estado funcional sobre este resultado de salud. Nuestro objetivo es describir las características de los pacientes mayores de 80 años hospitalizados por coronavirus disease 2019 (COVID-19), determinar la tasa de mortalidad e identificar factores asociados. MATERIALES Y MÉTODOS: Estudio observacional prospectivo realizado en mayores de 80 años ingresados por COVID-19 en un Servicio de Geriatría. Se recogieron variables sociodemográficas, clínicas, funcionales, mentales, analíticas, radiológicas, terapéuticas y asistenciales. Se analizaron mediante análisis bivariante los factores asociados a mortalidad intrahospitalaria. RESULTADOS: Fueron incluidos 58 casos con COVID-19 confirmado por laboratorio, edad media 88,3 ± 5,4 años, 69% mujeres, 65,5% deterioro cognitivo moderado-severo e índice de Barthel previo 40,6 ± 36. Los principales síntomas fueron fiebre (60,3%), disnea (53,4%) y deterioro del estado funcional (50%). Las comorbilidades más frecuentes fueron enfermedad cardiovascular (75,9%), hipertensión arterial (HTA) (74,1%) y enfermedad renal crónica (ERC) (50%). Se detectó una tasa de mortalidad del 41,4%, siendo los factores asociados: dependencia funcional severa (OR = 3,8 [1,2-12,2]), ERC (OR = 3,2 [1,1-9,7]), deterioro cognitivo moderado-severo (OR = 4,9 [1 a 25,4]). CONCLUSIONES: Se objetivan altas tasas de mortalidad en pacientes mayores hospitalizados por COVID-19, con mayor riesgo de fallecer en aquellos con dependencia funcional severa o deterioro cognitivo. Estos hallazgos refuerzan la importancia de la Valoración Geriátrica para elaborar estrategias que permitan adecuar la toma de decisiones diagnósticas y terapéuticas y optimizar la atención al paciente anciano ante un nuevo brote epidémico


OBJECTIVE: The SARS-CoV-2 pandemic conditions high mortality rates in hospitalized elderly. Currently, a few studies include octogenarian patients and none of them analyze the impact of functional status on this health outcome. Our objective is to describe the characteristics of patients older than 80 years hospitalized for coronavirus disease 2019 (COVID-19), to determine the mortality rate and to identify associated factors. MATERIAL AND METHODS: Prospective observational study carried out on patients over 80 years admitted for COVID-19 in a Geriatrics Service. Sociodemographic, clinical, functional, mental, analytical, radiological, therapeutic and healthcare variables were collected. The factors associated with in-hospital lethality were analyzed by bivariate analysis. RESULTS: 58 cases with laboratory-confirmed COVID-19 were included, mean age 88.3 ± 5.4 years, 69% women, 65.5% moderate-severe cognitive impairment and previous Barthel index 40.66 ± 36. The main symptoms were fever (60,3%), dyspnea (53.4%) and deterioration of functional condition (50%). The most frequent comorbidities were cardiovascular disease (75.9%), hypertension (HT) (74.1%) and chronic kidney disease (CKD) (50%). A mortality rate of 41,4% was detected and the associated factors were: severe functional dependence (OR = 3.8 [1.2-12.2]), moderate-severe cognitive impairment (OR = 4.9 [1-25.4]) and CKD (OR = 3.2 [1.1-9.7]). CONCLUSION: High mortality rates are observed in older patients hospitalized for COVID-19, with a higher risk of dying in those with severe functional dependence or cognitive impairment. These findings reinforce the value of Geriatric Assessment to develop strategies to adapt diagnostic and therapeutic decision-making and to optimize care for elderly patients in the event of a new epidemic outbreak


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar/tendências , Vírus da SARS/isolamento & purificação , Estudos Prospectivos , Indicadores de Morbimortalidade , Causas de Morte/tendências , Idoso Fragilizado/estatística & dados numéricos
11.
PLoS One ; 15(12): e0244380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347505

RESUMO

According to the most recent annual report released by Korea Statistics, the life expectancy at birth (for both sexes) in 2018 was 82.7 years, an increase of 0.0 years over 2017, reflecting the first stagnation in life expectancy since 1960. In this study, a time-series analysis was conducted of trends in life expectancy from 2003 to 2018, and causes of death were analyzed using the Kannisto-Thatcher method and the Arriaga decomposition method. The time trend analysis of yearly life expectancy changes indicated that, in Korea, there was a tendency for the yearly increase in life expectancy between 2003 and 2018 to decrease by 0.0211 years per calendar year. The contribution of cardiovascular diseases, the most important contributor to the life expectancy increase in Korea, gradually decreased over this period. The contribution of cardiovascular diseases to the life expectancy increase was 0.506 years in 2003-2006, but this contribution decreased to 0.218 years in 2015-2018. The positive contributions of ill-defined causes and external causes to life expectancy increase detected in previous periods were not evident in 2015-2018. Diseases of the respiratory system made the largest negative contribution both between 2015 and 2018 and between 2017-2018. The life expectancy stagnation in 2018 could be understood as the combined effect of (a) decreasing momentum in the increase of life expectancy and (b) a chance event in 2018 involving life expectancy. Currently, it is difficult to judge whether the stagnation of life expectancy in 2018 is temporary, and further analyses of life expectancy and contributing causes of death in the future are needed.


Assuntos
Doenças Cardiovasculares/epidemiologia , Causas de Morte/tendências , Expectativa de Vida/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , República da Coreia/epidemiologia , Adulto Jovem
12.
Colomb Med (Cali) ; 51(2): e4270, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-33012885

RESUMO

Introduction: The COVID-19 disease pandemic is a health emergency. Older people and those with chronic noncommunicable diseases are more likely to develop serious illnesses, require ventilatory support, and die from complications. Objective: To establish deaths from respiratory infections and some chronic non-communicable diseases that occurred in Cali, before the SARS-CoV-2 disease pandemic. Methods: During the 2003-2019 period, 207,261 deaths were registered according to the general mortality database of the Municipal Secretary of Health of Cali. Deaths were coded with the International Classification of Diseases and causes of death were grouped according to WHO guidelines. Rates were standardized by age and are expressed per 100,000 people-year. Results: A direct relationship was observed between aging and mortality from respiratory infections and chronic non-communicable diseases. Age-specific mortality rates were highest in those older than 80 years for all diseases evaluated. Seasonal variation was evident in respiratory diseases in the elderly. Comments: Estimates of mortality rates from respiratory infections and chronic non-communicable diseases in Cali provide the baseline that will serve as a comparison to estimate the excess mortality caused by the COVID-19 pandemic. Health authorities and decision makers should be guided by reliable estimates of mortality and of the proportion of infected people who die from SARS-CoV-2 virus infection.


Assuntos
Causas de Morte/tendências , Doenças não Transmissíveis/epidemiologia , Infecções Respiratórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Colômbia/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Humanos , Doenças não Transmissíveis/mortalidade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Infecções Respiratórias/mortalidade , Fatores de Risco , Estações do Ano
13.
PLoS One ; 15(10): e0240286, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33035253

RESUMO

In this study we present the first comprehensive analysis of the spatio-temporal differences in excess mortality during the COVID-19 pandemic in Italy. We used a population-based design on all-cause mortality data, for the 7,904 Italian municipalities. We estimated sex-specific weekly mortality rates for each municipality, based on the first four months of 2016-2019, while adjusting for age, localised temporal trends and the effect of temperature. Then, we predicted all-cause weekly deaths and mortality rates at municipality level for the same period in 2020, based on the modelled spatio-temporal trends. Lombardia showed higher mortality rates than expected from the end of February, with 23,946 (23,013 to 24,786) total excess deaths. North-West and North-East regions showed one week lag, with higher mortality from the beginning of March and 6,942 (6,142 to 7,667) and 8,033 (7,061 to 9,044) total excess deaths respectively. We observed marked geographical differences also at municipality level. For males, the city of Bergamo (Lombardia) showed the largest percent excess, 88.9% (81.9% to 95.2%), at the peak of the pandemic. An excess of 84.2% (73.8% to 93.4%) was also estimated at the same time for males in the city of Pesaro (Central Italy), in stark contrast with the rest of the region, which does not show evidence of excess deaths. We provided a fully probabilistic analysis of excess mortality during the COVID-19 pandemic at sub-national level, suggesting a differential direct and indirect effect in space and time. Our model can be used to help policy-makers target measures locally to contain the burden on the health-care system as well as reducing social and economic consequences. Additionally, this framework can be used for real-time mortality surveillance, continuous monitoring of local temporal trends and to flag where and when mortality rates deviate from the expected range, which might suggest a second wave of the pandemic.


Assuntos
Causas de Morte/tendências , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais , Pneumonia Viral/epidemiologia , Teorema de Bayes , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Modelos Teóricos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia
14.
Acta Biomed ; 91(3): e2020021, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921718

RESUMO

The COVID-19 epidemic initially started in Wuhan, China in December 2019 due to SARS-CoV-2. SARS-CoV-2 is genetically similar to the bat beta-coronavirus genus, but the novel specie of this genus can infect humans. The most common clinical features of COVID-19 are fever, cough, myalgia, fatigue, expectoration, and dyspnea. The primary reported mortality rate was about 2-3% in China; however, it reached up to 10% among patients with underlying cardiovascular diseases. The primary epidemiological investigations showed a high prevalence of underlying cardiovascular diseases in more than 40% of infected patients. A high prevalence of hypertension, ischemic heart disease, and diabetes were reported among deceased patients in Italy. Previous experiments in different pandemic situations showed that the cardiovascular system has been affected in many ways. Previous studies on SARS-CoV and MERS-CoV reported that cardiovascular co-morbidities had a direct correlation with the risk of infection, the severity of disease, and the mortality rate. Therefore, brief and available protocols for controlling the negative effects of this novel respiratory infection on the cardiovascular system, especially in a high-risk populations with underlying cardiovascular conditions, is one of the most serious concerns among healthcare providers. Herein, we aimed to review the available data on the cardiac manifestation of COVID-19. Besides, we described useful maps for the better treatment of COVID-19 infection in patients with underlying cardiovascular conditions, as a high-risk group of patients.


Assuntos
Betacoronavirus , Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Medição de Risco/métodos , Causas de Morte/tendências , Comorbidade , Saúde Global , Humanos , Taxa de Sobrevida/tendências
16.
Intern Emerg Med ; 15(8): 1533-1544, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32910363

RESUMO

Infection with SARS-CoV-2 is becoming the leading cause of death in most countries during the 2020 pandemic. The objective of this study is to assess the association between COVID-19 and cause-specific death. The design is retrospective cohort study. We included data from inpatients diagnosed with COVID-19 between March 18 and April 21, 2020, who died during their hospital stay. Demographic, clinical and management data were collected. Causes of death were ascertained by review of medical records. The sample included 128 individuals. The median age was 84 (IQR 75-89), 57% were men. In 109 patients, the death was caused by SARS-CoV-2 infection, whereas in 19 (14.8%, 95 CI 10-22%), the infection acted only as a precipitating factor to decompensate other pathologies. This second group of patients was older (88y vs 82, p < 0.001). In age-adjusted analysis, they had a greater likelihood of heart failure (OR 3.61 95% CI 1.15-11.32), dependency in activities of daily living (OR 12.07 95% CI 1.40-103.86), frailty (OR 8.73 95% CI 1.37-55.46). The presence of X-ray infiltrates was uncommon (OR 0.07, 95% CI 0.02-0.25). A higher percentage of patient deaths from causes unrelated to COVID-19 complications occurred during the two first weeks of the pandemic. Fifteen percent of patients with COVID-19 infection died from decompensation of other pathologies and the cause of death was unrelated to COVID-19 severe complications. Most of these patients had more comorbidities and were frail and elderly. These findings can partially explain the excess mortality in older people.


Assuntos
Causas de Morte/tendências , Infecções por Coronavirus/mortalidade , Pandemias/estatística & dados numéricos , Pneumonia Viral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Insuficiência Respiratória/complicações , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia , Estatísticas não Paramétricas , Tromboembolia/complicações , Tromboembolia/epidemiologia
17.
MMWR Morb Mortal Wkly Rep ; 69(37): 1324-1329, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32941417

RESUMO

Since February 12, 2020, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2-associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged <21 years constitute 26% of the U.S. population (4), and this report describes characteristics of U.S. persons in that population who died in association with SARS-CoV-2 infection, as reported by public health jurisdictions. Among 121 SARS-CoV-2-associated deaths reported to CDC among persons aged <21 years in the United States during February 12-July 31, 2020, 63% occurred in males, 10% of decedents were aged <1 year, 20% were aged 1-9 years, 70% were aged 10-20 years, 45% were Hispanic persons, 29% were non-Hispanic Black (Black) persons, and 4% were non-Hispanic American Indian or Alaska Native (AI/AN) persons. Among these 121 decedents, 91 (75%) had an underlying medical condition,* 79 (65%) died after admission to a hospital, and 39 (32%) died at home or in the emergency department (ED).† These data show that nearly three quarters of SARS-CoV-2-associated deaths among infants, children, adolescents, and young adults have occurred in persons aged 10-20 years, with a disproportionate percentage among young adults aged 18-20 years and among Hispanics, Blacks, AI/ANs, and persons with underlying medical conditions. Careful monitoring of SARS-CoV-2 infections, deaths, and other severe outcomes among persons aged <21 years remains particularly important as schools reopen in the United States. Ongoing evaluation of effectiveness of prevention and control strategies will also be important to inform public health guidance for schools and parents and other caregivers.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Adolescente , Causas de Morte/tendências , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pandemias , Estados Unidos/epidemiologia , Adulto Jovem
18.
Lancet ; 396(10254): 819-829, 2020 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-32877652

RESUMO

BACKGROUND: Both DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin) trials showed that sodium-glucose co-transporter-2 (SGLT2) inhibition reduced the combined risk of cardiovascular death or hospitalisation for heart failure in patients with heart failure with reduced ejection fraction (HFrEF) with or without diabetes. However, neither trial was powered to assess effects on cardiovascular death or all-cause death or to characterise effects in clinically important subgroups. Using study-level published data from DAPA-HF and patient-level data from EMPEROR-Reduced, we aimed to estimate the effect of SGLT2 inhibition on fatal and non-fatal heart failure events and renal outcomes in all randomly assigned patients with HFrEF and in relevant subgroups from DAPA-HF and EMPEROR-Reduced trials. METHODS: We did a prespecified meta-analysis of the two single large-scale trials assessing the effects of SGLT2 inhibitors on cardiovascular outcomes in patients with HFrEF with or without diabetes: DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin). The primary endpoint was time to all-cause death. Additionally, we assessed the effects of treatment in prespecified subgroups on the combined risk of cardiovascular death or hospitalisation for heart failure. These subgroups were based on type 2 diabetes status, age, sex, angiotensin receptor neprilysin inhibitor (ARNI) treatment, New York Heart Association (NYHA) functional class, race, history of hospitalisation for heart failure, estimated glomerular filtration rate (eGFR), body-mass index, and region (post-hoc). We used hazard ratios (HRs) derived from Cox proportional hazard models for time-to-first event endpoints and Cochran's Q test for treatment interactions; the analysis of recurrent events was based on rate ratios derived from the Lin-Wei-Yang-Ying model. FINDINGS: Among 8474 patients combined from both trials, the estimated treatment effect was a 13% reduction in all-cause death (pooled HR 0·87, 95% CI 0·77-0·98; p=0·018) and 14% reduction in cardiovascular death (0·86, 0·76-0·98; p=0·027). SGLT2 inhibition was accompanied by a 26% relative reduction in the combined risk of cardiovascular death or first hospitalisation for heart failure (0·74, 0·68-0·82; p<0·0001), and by a 25% decrease in the composite of recurrent hospitalisations for heart failure or cardiovascular death (0·75, 0·68-0·84; p<0·0001). The risk of the composite renal endpoint was also reduced (0·62, 0·43-0·90; p=0·013). All tests for heterogeneity of effect size between trials were not significant. The pooled treatment effects showed consistent benefits for subgroups based on age, sex, diabetes, treatment with an ARNI and baseline eGFR, but suggested treatment-by-subgroup interactions for subgroups based on NYHA functional class and race. INTERPRETATION: The effects of empagliflozin and dapagliflozin on hospitalisations for heart failure were consistent in the two independent trials and suggest that these agents also improve renal outcomes and reduce all-cause and cardiovascular death in patients with HFrEF. FUNDING: Boehringer Ingelheim.


Assuntos
Compostos Benzidrílicos/efeitos adversos , Glucosídeos/efeitos adversos , Insuficiência Cardíaca/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Volume Sistólico/efeitos dos fármacos , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Compostos Benzidrílicos/uso terapêutico , Índice de Massa Corporal , Estudos de Casos e Controles , Causas de Morte/tendências , Ensaios Clínicos como Assunto , Morte , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Taxa de Filtração Glomerular/fisiologia , Glucosídeos/uso terapêutico , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neprilisina/antagonistas & inibidores , Avaliação de Resultados da Assistência ao Paciente , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
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