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1.
BMJ ; 368: m131, 2020 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-32051121

RESUMO

OBJECTIVE: To compare established associations between risk factors and mortality in UK Biobank, a study with an exceptionally low rate of response to its baseline survey, against those from representative studies that have conventional response rates. DESIGN: Prospective cohort study alongside individual participant meta-analysis of other cohort studies. SETTING: United Kingdom. PARTICIPANTS: Analytical sample of 499 701 people (response rate 5.5%) in analyses in UK Biobank; pooled data from the Health Surveys for England (HSE) and the Scottish Health Surveys (SHS), including 18 studies and 89 895 people (mean response rate 68%). Both study populations were linked to the same nationwide mortality registries, and the baseline age range was aligned at 40-69 years. MAIN OUTCOME MEASURE: Death from cardiovascular disease, selected malignancies, and suicide. To quantify the difference between hazard ratios in the two studies, a ratio of the hazard ratios was used with HSE-SHS as the referent. RESULTS: Risk factor levels and mortality rates were typically more favourable in UK Biobank participants relative to the HSE-SHS consortium. For the associations between risk factors and mortality endpoints, however, close agreement was seen between studies. Based on 14 288 deaths during an average of 7.0 years of follow-up in UK Biobank and 7861 deaths over 10 years of mortality surveillance in HSE-SHS, for cardiovascular disease mortality, for instance, the age and sex adjusted hazard ratio for ever having smoked cigarettes (versus never) was 2.04 (95% confidence interval 1.87 to 2.24) in UK Biobank and 1.99 (1.78 to 2.23) in HSE-SHS, yielding a ratio of hazard ratios close to unity (1.02, 0.88 to 1.19). The overall pattern of agreement between studies was essentially unchanged when results were compared separately by sex and when baseline years and censoring dates were aligned. CONCLUSION: Despite a very low response rate, risk factor associations in the UK Biobank seem to be generalisable.


Assuntos
Bancos de Espécimes Biológicos , Causas de Morte/tendências , Inquéritos Epidemiológicos , Humanos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Reino Unido/epidemiologia
2.
West Afr J Med ; 37(1): 74-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030716

RESUMO

PURPOSE: Identification of health problems of women of reproductive age, using a reliable mortality data, is essential in evading preventable female deaths. This study aimed at investigating mortality profile of women of reproductive age group in Nigeria. MATERIALS AND METHODS: This is a descriptive, retrospective study involving women of reproductive age group of 15-49 years that died at DELSUTH from 1st January 2016 to 31st December 2018. The age, date of death and cause of death were retrieved from the hospital records and subsequently analyzed using SPSS version 21. RESULTS: One hundred and eighty-seven eligible deaths were encountered in this study, constituting 17.5% of all deaths in the hospital. Twenty four (12.8%) cases were of maternal etiology while 163 (87.2%) were of non-maternal causes. Non-communicable disease, communicable disease and external injuries accounted for 100 (53.5%), 44 (23.5%) and 19 (10.2%) deaths among the non-maternal causes. The mean age and the peak age group are 34.4 years and the 4th decade respectively. The leading specified non-maternal causes of death (in descending order) are AIDS/TB, cerebrovascular accidents (CVA), breast cancer, road traffic accident (RTA), diabetes, perioperative death and sepsis while the leading maternal causes of death are abortion, postpartum hemorrhage, eclampsia and puerperal sepsis. CONCLUSION: Most deaths affecting WRAG are preventable, with non-maternal causes in excess of maternal causes. There is need for holistic life-long interventional policies and strategies that will address the health need of these women, using evidence-based research findings.


Assuntos
Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Mortalidade Materna , Aborto Induzido/mortalidade , Adolescente , Adulto , Neoplasias da Mama/mortalidade , Causas de Morte/tendências , Eclampsia/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Nigéria/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Infecção Puerperal/mortalidade , Estudos Retrospectivos , Sepse/mortalidade , Acidente Vascular Cerebral , Tuberculose/mortalidade , Adulto Jovem
3.
Rev Esp Cardiol (Engl Ed) ; 73(1): 14-20, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31160265

RESUMO

INTRODUCTION AND OBJECTIVES: To compare the long-term results of direct oral anticoagulants (DOAC) vs vitamin K antagonists (VKA) in real-world-patients with nonvalvular atrial fibrillation (NVAF) in a nationwide, prospective study. METHODS: The FANTASIIA registry prospectively included outpatients with AF anticoagulated with DOAC or VKA (per protocol, proportion of VKA and DOAC 4:1), consecutively recruited from June 2013 to October 2014 in Spain. The incidence of major events was analyzed and compared according to the anticoagulant treatment received. RESULTS: A total of 2178 patients were included in the study (mean age 73.8±9.4 years), and 43.8% were women. Of these, 533 (24.5%) received DOAC and 1645 (75.5%) VKA. After a median follow up of 32.4 months, patients receiving DOAC vs those receiving VKA had lower rates of stroke-0.40 (95%CI, 0.17-0.97) vs 1.07 (95%CI,0.79-1.46) patients/y, P=.032-, severe bleedings-2.13 (95%CI, 1.45-3.13) vs 3.28 (95%CI, 2.75-3.93) patients/y; P = .044-, cardiovascular death-1.20 (95%CI, 0.72-1.99) vs 2.45 (95%CI, 2.00-3.00) patients/y; P = .009-, and all-cause death-3.77 (95%CI, 2.83-5.01) vs 5.54 (95%CI, 4.83-6.34) patients/y; P = .016-. In a modified Cox regression model by the Andersen-Gill method for multiple events, hazard ratios for patients receiving DOAC were: 0.42 (0.16-1.07) for stroke; 0.47 (0.20-1.16) for total embolisms; 0.76 (0.50-1.15) for severe bleedings; 0.67 (0.39-1.18) for cardiovascular death; 0.86 (0.62-1.19) for all-cause death, and 0.82 (0.64-1.05) for the combined event consisting of stroke, embolism, severe bleeding, and all-cause death. CONCLUSIONS: Compared with VKA, DOAC is associated with a trend to a lower incidence of all major events, including death, in patients with NVAF in Spain.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle , Vitamina K/antagonistas & inibidores , Administração Oral , Idoso , Fibrilação Atrial/complicações , Causas de Morte/tendências , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pacientes Ambulatoriais , Prognóstico , Estudos Prospectivos , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
4.
Rev Esp Cardiol (Engl Ed) ; 73(1): 35-42, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31122784

RESUMO

INTRODUCTION AND OBJECTIVES: This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals. METHODS: This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified. RESULTS: Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The darly strategy showed a nonsignificant inverse tendency in patients with GRACE score <140. CONCLUSIONS: In high-risk (GRACE score≥ 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea/métodos , Pontuação de Propensão , Sistema de Registros , Causas de Morte/tendências , Angiografia Coronária , Eletrocardiografia , Seguimentos , Humanos , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
5.
Rev Med Chil ; 147(6): 727-732, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859825

RESUMO

BACKGROUND: With the aim to inform end of life public policies, the place of death in Chile, its trends and associated factors were analysed. MATERIALS AND METHODS: A cross sectional using publically available death database from 1990 to 2014 was conducted. The proportion of hospital deaths was selected as the main outcome. A logistic regression was used to assess the association between place of death, age, and main diagnosis at death. Also, a Prais-Winsten regression and a Chi2 test were used to assess a time series and regional analysis, respectively. RESULTS: 2,063,615 deaths were analysed. Overall, deaths 898,871 (43.6%) occurred at hospital. Those who died over 85 years (OR 2,52 IC95% 2.49-2.55) and those who died from cancer (OR 2.43 IC95% 2.42-2.45) had higher risk for dying outside de hospital. For the general population and those who die form cancer, there is no evidence for an increase or decrease trend in the proportion of hospital deaths over time (p = 0,75 and p = 0.68, respectively). However, there is an increase of the proportion of hospital deaths in those who died over 85 years (p < 0.001,27% in 1990 to 32% in 2014). Also, there are geographic differences between country regions (p < 0.001) (Eg. Magallanes 52.9%). CONCLUSIONS: The proportion of hospital deaths has been stable over time in the general population and has increased in those over 85 years.


Assuntos
Mortalidade Hospitalar/tendências , Mortalidade/tendências , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Chile/epidemiologia , Estudos Transversais , Atestado de Óbito , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Probabilidade , Política Pública , Análise Espaço-Temporal , Assistência Terminal , Fatores de Tempo
6.
BMC Public Health ; 19(1): 1440, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675932

RESUMO

BACKGROUND: San Francisco has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. METHODS: Individuals diagnosed with HIV/AIDS and reported to the San Francisco Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in San Francisco at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. RESULTS: A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p < 0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p < 0.05). After adjustment, deaths due to mental disorders (aPR = 1.63, 95% CI 1.24, 2.14) were more likely and deaths due to non-AIDS cancers (aPR = 0.63, 95% CI 0.44, 0.89) were less likely among those experiencing homelessness. CONCLUSIONS: Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.


Assuntos
Causas de Morte/tendências , Infecções por HIV/diagnóstico , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por HIV/mortalidade , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , São Francisco/epidemiologia , Adulto Jovem
7.
Sleep Health ; 5(6): 630-638, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31678177

RESUMO

OBJECTIVES: To reveal sleep health phenotypes in older adults and examine their associations with time to 5-year all-cause and cardiovascular mortality. DESIGN: Prospective longitudinal cohorts. SETTING: The Study of Osteoporotic Fractures and Outcomes of Sleep Disorders in Older Men Study. PARTICIPANTS: N = 1722 men and women aged ≥65 years matched 1:1 on sociodemographic and clinical measures. MEASUREMENTS: Self-reported habitual sleep health characteristics (satisfaction, daytime sleepiness, timing, efficiency, and duration) measured at an initial visit and longitudinal follow-up for mortality. RESULTS: Latent class analysis revealed 3 sleep health phenotypes: (1) heightened sleep propensity (HSP; medium to long duration, high sleepiness, high efficiency/satisfaction; n = 322), (2) average sleep (AS; medium duration, average efficiency, high satisfaction, low sleepiness; n = 1,109), and (3) insomnia with short sleep (ISS; short to medium duration, low efficiency/satisfaction, moderate sleepiness; n = 291). Phenotype predicted time to all-cause mortality (χ2 = 9.4, P = .01), with HSP conferring greater risk than AS (hazard ratio [95% confidence interval] = 1.48 [1.15-1.92]) or ISS (1.52 [1.07-2.17]), despite ISS reporting the poorest mental and physical health. Although sex did not formally moderate the relationship between phenotype and mortality, subgroup analyses indicated that these findings were driven primarily by women. Phenotype did not predict cardiovascular mortality. CONCLUSIONS: These analyses support the utility of examining multidimensional sleep health profiles by suggesting that the combination of long sleep, high efficiency/satisfaction, and daytime sleepiness-previously identified as independent risk factors-may be components of a single high-risk sleep phenotype, HSP. Further investigation of sex differences and the mechanisms underlying mortality risk associated with HSP is warranted.


Assuntos
Sono , Idoso , Doenças Cardiovasculares/mortalidade , Causas de Morte/tendências , Feminino , Humanos , Estudos Longitudinais , Masculino , Fenótipo , Estudos Prospectivos , Fatores de Risco , Autorrelato
8.
Eur J Epidemiol ; 34(12): 1131-1142, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31729683

RESUMO

Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., 'relative' and 'absolute' inequalities, inequalities in 'attainment' and 'shortfall'). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.


Assuntos
Causas de Morte/tendências , Gastos em Saúde/tendências , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/tendências , Mortalidade/tendências , Classe Social , Escolaridade , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Sistema de Registros , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos
10.
J Prev Med Public Health ; 52(5): 308-315, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31588700

RESUMO

OBJECTIVES: Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes. METHODS: Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype. RESULTS: Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus-associated influenza or pneumonia deaths were more common in those under 65 years old. CONCLUSIONS: Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.


Assuntos
Causas de Morte/tendências , Influenza Humana/mortalidade , Influenza Humana/virologia , Estações do Ano , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1/fisiologia , Vírus da Influenza A Subtipo H3N2/fisiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos
11.
Lancet ; 394(10209): 1619-1628, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31570258

RESUMO

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is the preferred treatment option for older patients with symptomatic severe aortic stenosis. Differences in the properties of available TAVR systems can affect clinical outcomes. Among patients undergoing TAVR, we compared the self-expanding ACURATE neo TAVR system with the balloon-expandable SAPIEN 3 TAVR system with regard to early safety and efficacy. METHODS: In this randomised non-inferiority trial, patients (aged ≥75 years) undergoing transfemoral TAVR for treatment of symptomatic severe aortic stenosis, and who were deemed to be at increased surgical risk, were recruited at 20 tertiary heart valve centres in Germany, the Netherlands, Switzerland, and the UK. Participants were randomly assigned (1:1) to receive treatment with the ACURATE neo or the SAPIEN 3 with a computer-based randomly permuted block scheme, stratified by study centre and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) category. The primary composite safety and efficacy endpoint comprised all-cause death, any stroke, life-threatening or disabling bleeding, major vascular complications, coronary artery obstruction requiring intervention, acute kidney injury (stage 2 or 3), rehospitalisation for valve-related symptoms or congestive heart failure, valve-related dysfunction requiring repeat procedure, moderate or severe prosthetic valve regurgitation, or prosthetic valve stenosis within 30 days of the procedure. Endpoint assessors were masked to treatment allocation. Non-inferiority of ACURATE neo compared with SAPIEN 3 was assessed in the intention-to-treat population on the basis of a risk-difference margin of 7·7% for the primary composite endpoint, with a one-sided α of 0·05. This trial is registered with ClinicalTrials.gov (number NCT03011346) and is ongoing but not recruiting. FINDINGS: Between Feb 8, 2017, and Feb 2, 2019, up to 5132 patients were screened and 739 (mean age 82·8 years [SD 4·1]; median STS-PROM score 3·5% [IQR 2·6-5·0]) were enrolled. 30-day follow-up was available for 367 (99%) of 372 patients allocated to the ACURATE neo group, and 364 (99%) of 367 allocated to the SAPIEN 3 group. Within 30 days, the primary endpoint occurred in 87 (24%) patients in the ACURATE neo and in 60 (16%) in the SAPIEN 3 group; thus, non-inferiority of the ACURATE neo was not met (absolute risk difference 7·1% [upper 95% confidence limit 12·0%], p=0·42). Secondary analysis of the primary endpoint suggested superiority of the SAPIEN 3 device over the ACURATE neo device (95% CI for risk difference -1·3 to -12·9, p=0·0156). The ACURATE neo and SAPIEN 3 groups did not differ in incidence of all-cause death (nine patients [2%] vs three [1%]) and stroke (seven [2%] vs 11 [3%]); whereas acute kidney injury (11 [3%] vs three [1%]) and moderate or severe prosthetic aortic regurgitation (34 [9%] vs ten [3%]) were more common in the ACURATE neo group. INTERPRETATION: TAVR with the self-expanding ACURATE neo did not meet non-inferiority compared to the balloon-expandable SAPIEN 3 device in terms of early safety and clinical efficacy outcomes. An early composite safety and efficacy endpoint was useful in discriminating the performance of different TAVR systems. FUNDING: Boston Scientific (USA).


Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/mortalidade , Causas de Morte/tendências , Feminino , Alemanha/epidemiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Países Baixos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Índice de Gravidade de Doença , Suíça/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento , Reino Unido/epidemiologia
12.
BMC Public Health ; 19(1): 1322, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640631

RESUMO

BACKGROUND: Papua New Guinea (PNG) is a diverse country with high mortality and evidence of increased prevalence of non-communicable diseases (NCDs), but there is no reliable cause of death (COD) data because civil registration is insufficient and routine health data comprise only a small proportion of deaths. This study aims to estimate cause-specific mortality fractions (CSMFs) for five broad groups of causes (endemic infections, emerging infections, endemic NCDs, emerging NCDs and injuries), by sex for each of PNG's provinces. METHODS: CSMFs are calculated as the average of estimates obtained from: (1) Empirical cause method: Utilising available Verbal Autopsy (VA) data and Discharge Health Information System (DHIS) data, and applying statistical models of community versus facility CODs; and (2) Expected cause patterns method: Utilising existing estimates of mortality levels in each province and statistical models of the relationship between all-cause and cause-specific mortality using Global Burden of Disease (GBD) data. RESULTS: An estimated 41% of male and 49% of female deaths in PNG are due to infectious, maternal (female only), neonatal and nutritional causes. Furthermore, 45% of male and 42% of female deaths arise from NCDs. Infectious diseases, maternal, neonatal and nutritional conditions account for more than half the deaths in a number of provinces, including lower socioeconomic status provinces of Gulf and Sandaun, while provinces with higher CSMFs from emerging NCDs (e.g. ischemic heart disease, stroke) tend to be those where socioeconomic status is comparatively high (e.g. National Capital District, Western Highlands Province, Manus Province, New Ireland Province and East New Britain Province). Provinces with the highest estimated proportion of deaths from emerging infectious diseases are readily accessible by road and have the highest rates of sexually transmitted infections (STIs), while provinces with the highest CSMFs from endemic infectious, maternal, neonatal and nutritional causes are geographically isolated, have high malaria and high all-cause mortality. CONCLUSIONS: Infectious, maternal, neonatal and nutritional causes continue to be an important COD in PNG, and are likely to be higher than what is estimated by the GBD. Nonetheless, there is evidence of the emergence of NCDs in provinces with higher socioeconomic status. The introduction of routine VA for non-facility deaths should improve COD data quality to support health policy and planning to control both infectious and NCDs.


Assuntos
Causas de Morte/tendências , Carga Global da Doença/estatística & dados numéricos , Mortalidade/tendências , Doenças Transmissíveis/mortalidade , Doenças Transmissíveis Emergentes/mortalidade , Feminino , Humanos , Lactente , Masculino , Isquemia Miocárdica/mortalidade , Doenças não Transmissíveis/mortalidade , Papua Nova Guiné , Classe Social
13.
J Stroke Cerebrovasc Dis ; 28(12): 104431, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31624036

RESUMO

BACKGROUND AND AIM: Romanian national level stroke mortality data is relatively scarce. The current study investigated stroke mortality rates and trends in Romania. METHODS: All individual deaths registered in Romania during 1994-2017 were analyzed using an anonymized database, based on death certificates. Stroke crude mortality rates (CMR) and age-standardized mortality rates (ASMR) were calculated and expressed per 100,000 persons-year. RESULTS: Between 1994 and 2017, 6,281,873 persons died in Romania, stroke being registered as the underlying cause of death in 959,319 cases. The overall stroke CMR was 188.2 (199.3 for women and 176.5 for men). The CMR for hemorrhagic stroke (HEMS) was 32.4 and for ischemic stroke (ISCS) 10.9. There was a significant decrease in stroke ASMR from 344.4 (95% confidence interval [CI] 343.4-345.4) in 1994 to 192.1 (95% CI 191.5-192.7) in 2017, with an annual percent change (APC) of 2.53% per year (95% CI 2.50-2.55, P < .001). Although compared with men, women had higher CMRs, when those rates were age-standardized men had higher ASMR as compared with women. The decline in HEMS ASMR had an APC of 4.65% per year (95% CI 4.59-4.70, P < .001). ISCS ASMR showed an initial increase in ASMR during 1994-2005, with APC 6.39% per year (95% CI 6.09-6.70, P < .001), followed by a significant decrease until 2017, with APC 2.83% per year (95% CI 2.59-3.07, P < .001). CONCLUSION: There was a significant reduction in stroke ASMR during 1994-2017. The decline was slow until 2002 and became steeper after that, with significant differences in gender analysis.


Assuntos
Acidente Vascular Cerebral/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Feminino , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Medição de Risco , Fatores de Risco , Romênia/epidemiologia , Distribuição por Sexo , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
14.
Medicine (Baltimore) ; 98(42): e17627, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626145

RESUMO

Adjuvant radiation therapy (ART) is recommended without consideration of radical prostatectomy Gleason score (RP GS) for cases with adverse features. We compared the outcomes of pathologically localized high-grade (GS 8-10) prostate cancer (PC) with those of pT3 GS 7 PC.A total of 1585 men who underwent RP between 1995 and 2015 comprised the cohort, which was divided into group 1 (RP GS 7(3 + 4) and pT3; n = 760), group 2 (RP GS 7(4 + 3) and pT3; n = 565), and group 3 (RP GS 8-10 and pT2; n = 260). Biochemical recurrence (BCR), all-cause mortality (ACM), and PC-specific mortality (PCSM) risk were compared among groups using Cox regression and competing risk analysis.At a median follow-up of 58 months (interquartile range: 37-85), 721 men experienced BCR and 84 died (22 due to PC). BCR-free survival rates were lower in group 3 than in group 1 (P < .001); nevertheless, no difference was observed between groups 2 and 3 (P = .638). Furthermore, no difference in ACM was noted among groups. PCSM rates were higher in group 3 than in groups 1 and 2 (P = .001 and P = .005, respectively). This association persisted in multivariate models after adjustment for clinicopathological variables.Patients with RP GS 8-10 and pT2 PC had higher BCR and PCSM rates than those with RP GS 7 and pT3 PC. Localized high-grade PC should be considered in decision-making for ART.


Assuntos
Gradação de Tumores/métodos , Próstata/patologia , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico , Idoso , Causas de Morte/tendências , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Próstata/cirurgia , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/cirurgia , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências
15.
Public Health Rep ; 134(6): 634-642, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31600482

RESUMO

OBJECTIVES: Racial differences in mortality in the United States have narrowed and vary by time and place. The objectives of our study were to (1) examine the gap in life expectancy between white and black persons (hereinafter, racial gap in life expectancy) in 4 states (California, Georgia, Illinois, and New York) and (2) estimate trends in the contribution of major causes of death (CODs) to the racial gap in life expectancy by age group. METHODS: We extracted data on the number of deaths and population sizes for 1969-2013 by state, sex, race, age group, and 6 major CODs. We used a Bayesian time-series model to smooth and impute mortality rates and decomposition methods to estimate trends in sex- and age-specific contributions of CODs to the racial gap in life expectancy. RESULTS: The racial gap in life expectancy at birth decreased in all 4 states, especially among men in New York (from 8.8 to 1.1 years) and women in Georgia (from 8.0 to 1.7 years). Although few deaths occurred among persons aged 1-39, racial differences in mortality at these ages (mostly from injuries and infant mortality) contributed to the racial gap in life expectancy, especially among men in California (1.0 year of the 4.3-year difference in 2013) and Illinois (1.9 years of the 6.7-year difference in 2013). Cardiovascular deaths contributed most to the racial gap in life expectancy for adults aged 40-64, but contributions decreased among women aged 40-64, especially in Georgia (from 2.8 to 0.5 years). The contribution of cancer deaths to inequality increased in California and Illinois, whereas New York had the greatest reductions in inequality attributable to cancer deaths (from 0.6 to 0.2 years among men and from 0.2 to 0 years among women). CONCLUSIONS: Future research should identify policy innovations and economic changes at the state level to better understand New York's success, which may help other states emulate its performance.


Assuntos
Afro-Americanos/estatística & dados numéricos , Causas de Morte/tendências , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Expectativa de Vida , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Disparidades nos Níveis de Saúde , Humanos , Lactente , Mortalidade Infantil , Expectativa de Vida/etnologia , Expectativa de Vida/tendências , Masculino , Pessoa de Meia-Idade , Estados Unidos
16.
Cien Saude Colet ; 24(9): 3517-3528, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508769

RESUMO

The relevance of breast cancer for women has driven research about mortality of this disease. However, these studies are affected by problems generated by deaths due to ill-defined causes (IDC). To highlight distortions caused by IDC in studies that evaluate mortality, we calculated the age-standardized mortality rates of breast cancer, with and without adjustment for IDC for the years 1990, 2000, and 2010. Then, panel data regression models were estimated and enabled us to identify that the adjustment for IDC: has elevated breast cancer mortality rate of Brazilian municipalities by 9% in the period considered; has drawn mortality rates of the South, Southeast, Northeast and North regions closer; has reduced the increasing trend of mortality by almost 60%, mainly in the Southeast and South regions; has increased, more sharply, the mortality in cities with less than 5 thousand inhabitants; has curbed the significance of most factors associated with breast cancer; has revealed that the effect of longevity and the public health expenditure may be overestimated. These results highlight the importance of adjustment for IDC in producing reliable mortality indicators.


Assuntos
Neoplasias da Mama/mortalidade , Causas de Morte/tendências , Mortalidade/tendências , Brasil/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos
17.
Diving Hyperb Med ; 49(3): 192-203, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31523794

RESUMO

INTRODUCTION: The aim of this study was to identify characteristics of victims of fatal snorkelling and breath-hold diving accidents in Australia from 2001-2013, inclusive, to determine underlying factors and risks associated with such activities and inform appropriate countermeasures. METHODS: The National Coronial Information System (NCIS) was searched to identify snorkelling and breath-hold diving-related cases reported to Australian coroners for the years 2001-2013, inclusive. Coronial data in the form of findings, witness and police reports, medical histories and autopsies were collected and collated, and descriptive statistics were used to analyse these data. A chain of events analysis was used to determine the likely sequence of events. RESULTS: There were 175 identified snorkelling-related fatalities during the study period. Most victims were middle-aged males (mean age 49 years). Pre-existing health conditions were possible contributors to 41% of the deaths, the main being ischaemic heart disease. The majority of deaths occurred in Queensland in inexperienced snorkellers, often in commercial settings. The victim's plight often went unnoticed as they were alone, or poorly supervised, when the incident occurred. Apnoeic hypoxia appeared to have been associated with at least 12.5% of the deaths. The main disabling injuries were asphyxia (40%) and cardiac incidents (35%). CONCLUSION: Human factors, such as chronic health conditions, poor skills and inexperience and poor planning can play a substantial role throughout the chain of events leading to a snorkelling fatality. It is important to educate the community, doctors and dive industry professionals about potential problems associated with the interaction between certain health-related conditions, especially cardiovascular conditions, and snorkelling. Close supervision is strongly recommended for inexperienced snorkellers due to their likely poor skills, as well as for experienced breath-hold divers due to the potential for apnoeic hypoxia.


Assuntos
Suspensão da Respiração , Mergulho , Afogamento , Austrália , Causas de Morte/tendências , Mergulho/efeitos adversos , Afogamento/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Queensland
18.
Cardiovasc Pathol ; 43: 107147, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31494524

RESUMO

BACKGROUND: We evaluated the risk of cardiac death in patients with prior cancer diagnoses and compared risk by cancer type and ethnicity in a large US population. METHOD: Utilizing the Surveillance, Epidemiology, and End Results database, data on patients with a cancer diagnosis between 2000 and 2014 were obtained. We calculated the standardized mortality ratio (SMR) of cardiac death after a cancer diagnosis and the excess risk per 10,000 person-years. We stratified the analysis according to the time interval between cancer and cardiac events, cancer site, cancer stage, and race. RESULTS: A total of 4,671,989 patients with a cancer diagnosis were included, of which 163,255 died due to cardiac causes within 10 years of diagnosis. We found a significantly higher rate of cardiac death for cancer patients [SMR=1.16, 95% confidence interval (CI) 1.15-1.16] compared to the general population. When observed for each cancer site, the highest SMR was after a diagnosis of hepatocellular carcinoma (SMR=2.58, 95% CI 2.45-2.72), pancreatic cancer (SMR=2.36, 95% CI 2.25-2.47), and lung cancer (SMR=2.30, 95% CI 2.27-2.34). Patients with metastatic disease had a higher rate of cardiac death (SMR=2.16, 95% CI 2.13-2.19). When stratified by ethnicity, SMR for cardiac death was 1.76, 2.28, 3.68, 2.65, and 1.84 for whites, blacks, American Indians/Alaska Natives, Asians/Pacific Islanders, and Hispanics, respectively. CONCLUSIONS: Cancer patients are more vulnerable to cardiac death than the general population, especially those with nonwhite ethnicity; liver, lung, and pancreatic cancers; and history of metastasis. Healthcare providers should be aware of this risk and pay particular attention to the highest-risk groups.


Assuntos
Grupos de Populações Continentais , Grupos Étnicos , Cardiopatias/etnologia , Cardiopatias/mortalidade , Neoplasias/etnologia , Neoplasias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/patologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Programa de SEER , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
19.
BMC Public Health ; 19(1): 780, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31474224

RESUMO

BACKGROUND: With the changes in environmental, medical technique, population structure and national health projects, human mortality rates have undergone great changes all over the world. According to "World Health Statistics 2016: Monitoring Health for the SDGs (Sustainable Development Goals)", we can draw a globally vision about life expectancy and cause of death; also, significant inequality still persists within and among countries. This study was designed to research into the trend of mortality pattern in China, evaluate the disparities of age-specific and disease-specific mortality rates between male and female, and provides a scientific basis for further prevention strategies and policies design. METHODS: Data from the Chinese Disease Surveillance Points system were used to calculate crude and age-adjusted death rates, annual percent changes (APC) for men and women during 2004 to 2016. Age-standardized mortality rates (ASMR) were performed through the direct method with the World Health Organization's World Standard Population. APC, according to log linear model, was adopted to describe the mortality rate trend. The χ2 test was used to compare differences between age-specific and cause-specific mortality rates of men and women. Data analysis and figures were completed by R software. RESULTS: The mortality rates of men and women have decreased significantly (P < 0.05) during 2004-2016, and the APC were1.98 and 2.45%, respectively. In 2016, the crude mortality rate (CMR) and ASMR in all causes of death were 658.50 and 490.28 per 100,000 per year, respectively. The 5 leading causes of death were malignant neoplasm, cerebrovascular disease, heart disease, COPD, and accidental injury. The mortality rates of men were higher than that of women in all age groups. CONCLUSIONS: There are severe health gaps and disparities between male and female, and the chronic non-communicable diseases continue to be a serious health threat to Chinese residents.


Assuntos
Disparidades nos Níveis de Saúde , Mortalidade/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Causas de Morte/tendências , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Adulto Jovem
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