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1.
Artigo em Russo | MEDLINE | ID: mdl-35439381

RESUMO

The diseases of digestive apparatus significantly contribute into premature mortality of population. In the Republic of Buryatia, the diseases of digestive apparatus occupy third place in the structure of primary morbidity of population (6.7%) and fourth place in the structure of total mortality (6.6%). The purpose of the study is to establish characteristics of structure and dynamics of morbidity and mortality of population because of diseases of digestive apparatus in the Republic of Buryatia in 2009-2018. The analysis was based on data from state statistical reporting forms and official reports of the Territorial Authority of the Federal State Statistics Service in Republic of Buryatia for 2009-2018, reporting and accounting forms of medical organizations. The study was carried out using statistical, analytical methods, as well as elements of comparative analysis. The analysis testifies increasing of indicator of primary morbidity of diseases of digestive apparatus from 4051.0 to 4226.1 per 100 thousand of population and of mortality of diseases of digestive apparatus in the Republic of Buryatia from 60.6 to 62.5 per 100 thousand of population. The main causes of increasing of morbidity and mortality from diseases of digestive apparatus in the Republic of Buryatia are liver diseases, in particular liver fibrosis and cirrhosis because of alcoholization of population, undue diagnostics and treatment of liver pathology in the group "older than able-bodied age".


Assuntos
Mortalidade Prematura , Morbidade , Federação Russa/epidemiologia
2.
Int J Mol Sci ; 23(8)2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35457018

RESUMO

Eukaryotic cells control nutritional homeostasis and determine cell metabolic fate through a series of nutrient transporters and metabolic regulation pathways. Lysosomal localized amino acid transporter member 9 of the solute carrier family 38 (SLC38A9) regulates essential amino acids' efflux from lysosomes in an arginine-regulated fashion. To better understand the physiological role of SLC38A9, we first described the spatiotemporal expression pattern of the slc38a9 gene in zebrafish. A quarter of slc38a9-/- mutant embryos developed pericardial edema and died prematurely, while the remaining mutants were viable and grew normally. By profiling the transcriptome of the abnormally developed embryos using RNA-seq, we identified increased apoptosis, dysregulated amino acid metabolism, and glycolysis/gluconeogenesis disorders that occurred in slc38a9-/- mutant fish. slc38a9 deficiency increased whole-body free amino acid and lactate levels but reduced glucose and pyruvate levels. The change of glycolysis-related metabolites in viable slc38a9-/- mutant fish was ameliorated. Moreover, loss of slc38a9 resulted in a significant reduction in hypoxia-inducible gene expression and hypoxia-inducible factor 1-alpha (Hif1α) protein levels. These results improved our understanding of the physiological functions of SLC38A9 and revealed its indispensable role in embryonic development, metabolic regulation, and stress adaption.


Assuntos
Mortalidade Prematura , Peixe-Zebra , Sistemas de Transporte de Aminoácidos/metabolismo , Aminoácidos/metabolismo , Animais , Apoptose/genética , Peixe-Zebra/genética , Peixe-Zebra/metabolismo
3.
JMIR Public Health Surveill ; 8(4): e33633, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35442209

RESUMO

BACKGROUND: Lung cancer is a leading cause of death worldwide, and its incidence shows an upward trend. A study of the long-term changes in the premature death rate in lung cancer in a developed region of China has great exploratory significance to further clarify the effectiveness of intervention measures. OBJECTIVE: This study examined long-term changes in premature lung cancer death rates in order to understand the changes in mortality and to design future prevention plans in Pudong New Area (PNA), Shanghai, China. METHODS: Cancer death data were collected from the Mortality Registration System of PNA. We analyzed the crude mortality rate (CMR), age-standardized mortality rate by Segi's world standard population (ASMRW), and years of life lost (YLL) of patients with lung cancer from 1973 to 2019. Temporal trends in the CMR, ASMRW, and YLL rate were calculated by joinpoint regression expressed as an average annual percentage change (AAPC) with the corresponding 95% CI. RESULTS: All registered permanent residents in PNA (80,543,137 person-years) from 1973 to 2019 were enrolled in this study. There were 42,229 deaths from lung cancer. The CMR and ASMRW were 52.43/105 and 27.79/105 person-years, respectively. The YLL due to premature death from lung cancer was 481779.14 years, and the YLL rate was 598.16/105 person-years. The CMR and YLL rate showed significantly increasing trends in men, women, and the total population (P<.001). The CMR of the total population increased by 2.86% (95% CI 2.66-3.07, P<.001) per year during the study period. The YLL rate increased with an AAPC of 2.21% (95% CI 1.92-2.51, P<.001) per year. The contribution rates of increased CMR values caused by demographic factors were more evident than those caused by nondemographic factors. CONCLUSIONS: Lung cancer deaths showed an increasing trend in PNA from 1973 to 2019. Demographic factors, such as the aging population, contributed more to an increased CMR. Our research can help us understand the changes in lung cancer mortality and can be used for similar cities in designing future prevention plans.


Assuntos
Neoplasias Pulmonares , Mortalidade Prematura , Idoso , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pesquisa
4.
BMJ Glob Health ; 7(4)2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35418410

RESUMO

The 'implementation gap' between national plans and successful implementation is a central theme in addressing non-communicable diseases (NCDs). It is a factor that has undermined Sustainable Development Goal 3.4, which aims to achieve a one-third reduction in premature mortality from four major NCDs by 2030. Responding to the potential of implementation research to support low-income and middle-income countries to effectively advance their strategies, we describe ways to make NCD plans more robust by including implementation steps. These steps are (1) choosing some (but not all) effective and cost-effective options; (2) tailoring interventions and their scale-up to national capacity; and (3) making the priorities implementable. We illustrate with examples from several countries.


Assuntos
Doenças não Transmissíveis , Países em Desenvolvimento , Humanos , Mortalidade Prematura , Doenças não Transmissíveis/prevenção & controle , Pobreza , Desenvolvimento Sustentável
5.
Front Public Health ; 10: 808917, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35242731

RESUMO

OBJECTIVE: Liver cancer is one of the most common causes of cancer-related death. Understanding how demographic factors influence mortality due to liver cancer is crucial for optimizing disease-control strategies. We aimed to characterize the long-term trends in the mortality and years of life lost (YLL) of liver cancer in Shanghai, China, 1973-2019, and quantitatively analyze the contributions of demographic and non-demographic factors on the mortality of liver cancer. METHODS: Using mortality data from the Mortality Registration System of Pudong New Area, the largest district of Shanghai with a population of permanent resident of 5.68 million, during 1973-2019, we analyzed the temporal trends for the mortality rates and YLL by Joinpoint Regression Program. The difference decomposition method was employed to estimate the increasing mortality rates related to demographic and non-demographic factors. RESULTS: A total of 21,530 deaths from liver cancer occurred from 1973 to 2019. The crude mortality rates (CMR) and age-standardized mortality rate by Segi's world standard population (ASMRW) of liver cancer were 26.73/105 person-years and 15.72/105 person-years, respectively. The CMR, ASMRW, and YLL rates of liver cancer showed significantly decreasing trends in males, females and the total population from 1973 to 2019, whereas the upward trends in the YLL were seen in males, females and the total population (all P < 0.05). A significant upward trend was observed in the increased CMR caused by demographic factors, but the changing rate caused by non-demographic factors decreased. CONCLUSIONS: The CMR and ASMRW of liver cancer continually decreased although YLL increased during 1973-2019 in Pudong New Area, Shanghai. The demographic factors, especially aging, might be responsible for the increase in the mortality of liver cancer. More effective prevention strategies tailored to liver cancer are needed to further reduce its disease burden in the elderly population.


Assuntos
Neoplasias Hepáticas , Mortalidade Prematura , Adulto , Idoso , Envelhecimento , China/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Humanos , Neoplasias Hepáticas/epidemiologia , Masculino
6.
JAMA Psychiatry ; 79(5): 444-453, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35353141

RESUMO

Importance: Premature mortality has been observed among people with mental disorders. Comorbid general medical conditions contribute substantially to this reduction in life expectancy. Objective: To provide an analysis of mortality associated with comorbidity between a broad range of mental disorders and general medical conditions. Design, Setting, and Participants: Population-based cohort study of 5 946 800 individuals born in Denmark from 1900 to 2015 and residing in the country at the start of follow-up (January 1, 2000, or their date of birth, whichever occurred later). Exposures: Danish health registers were used to identify people with mental disorders and general medical conditions. Main Outcomes and Measures: Considering pairs of mental disorders and general medical conditions, we calculated mortality rate ratios (MRRs) and differences in life expectancy (ie, life-years lost) to assess the association of mortality with both disorders of interest compared with the mental disorder of interest, the general medical condition of interest, and neither disorder of interest. Results: The study population comprised 2 961 397 males and 2 985 403 females, with a median (IQR) age of 32.0 years (7.3-52.9) at start of follow-up and 48.9 years (42.5-68.8) at the end. Based on all pairs of comorbid mental disorders and general medical conditions, the mean MRR compared with people without these conditions was 5.90 (median, 4.94; IQR, 3.80-7.30), and the mean reduction of life expectancy compared with the general population was 11.35 years (median, 11.08; range, 5.27-23.53; IQR, 8.22-13.72). The association with general medical condition comorbidity in those with mental disorders varied by general medical condition; for example, the addition of a neurological condition for each of the mental disorders was associated with a mean MRR of 1.22, whereas for cancer, the mean MRR for all mental disorders was 4.07. Conclusions and Relevance: In this study, shorter life expectancy was associated with comorbid mental disorders and general medical conditions compared with the entire population and also when compared with patients who had either mental disorders only or general medical conditions only. Prevention and early detection of comorbidities could reduce premature mortality in patients with mental disorders.


Assuntos
Transtornos Mentais , Adulto , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Feminino , Humanos , Expectativa de Vida , Masculino , Transtornos Mentais/epidemiologia , Mortalidade Prematura
7.
JCI Insight ; 7(8)2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35290244

RESUMO

Spinocerebellar ataxia type 1 (SCA1) is an adult-onset neurodegenerative disorder. As disease progresses, motor neurons are affected, and their dysfunction contributes toward the inability to maintain proper respiratory function, a major driving force for premature death in SCA1. To investigate the isolated role of motor neurons in SCA1, we created a conditional SCA1 (cSCA1) mouse model. This model suppresses expression of the pathogenic SCA1 allele with a floxed stop cassette. cSCA1 mice crossed to a ubiquitous Cre line recapitulate all the major features of the original SCA1 mouse model; however, they took twice as long to develop. We found that the cSCA1 mice produced less than half of the pathogenic protein compared with the unmodified SCA1 mice at 3 weeks of age. In contrast, restricted expression of the pathogenic SCA1 allele in motor neurons only led to a decreased distance traveled of mice in the open field assay and did not affect body weight or survival. We conclude that a 50% or greater reduction of the mutant protein has a dramatic effect on disease onset and progression; furthermore, we conclude that expression of polyglutamine-expanded ATXN1 at this level specifically in motor neurons is not sufficient to cause premature lethality.


Assuntos
Mortalidade Prematura , Ataxias Espinocerebelares , Animais , Ataxina-1/genética , Ataxina-1/metabolismo , Modelos Animais de Doenças , Camundongos , Neurônios Motores/patologia , Ataxias Espinocerebelares/genética , Ataxias Espinocerebelares/metabolismo
9.
Rocz Panstw Zakl Hig ; 73(1): 87-97, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35322961

RESUMO

Background: Many scientific reports have shown a decrease in total cerebrovascular disease (CeVD) mortality over the past few decades, but too little attention has been paid to premature mortality. CeVD accounted for 22.5% and 17.8% of premature cardiovascular disease deaths in Poland, in 2000 and 2016, respectively. Objective: The aim of the study was to analyse premature CeVD mortality in the Polish population in the recent years, the dynamics of its changes and the potential factors that may have contributed to the decline in mortality. The main goal of the study was to overview the levels and trends in premature CeVD mortality with an emphasis on haemorrhagic, ischaemic and unspecified (not specified as haemorrhagic or ischaemic) stroke. Material and methods: The analysis was based on a database of the Central Statistical Office of Poland and included data from 2000-2016 on premature cerebrovascular deaths occurring between 25 and 64 years of age (N=104,786). CeVD and haemorrhagic, ischaemic or unspecified stroke were coded with ICD-10 codes I60-I69, I61-I62, I63 and I64, respectively. The analysis included assessment of CeVD deaths distribution and evaluation of age-specific mortality rates in 10-year age groups and age-standardised mortality rates (SMR) in the age group 25-64 years, separately for men and women. Trends in SMRs have been studied in the period 2000-2016. Results: The number of CeVD deaths decreased by 32.8% in men and 48.8% in women. There was a two-fold decline in CeVD mortality: from 59 to 29 male and from 30 to 12 female per 100,000. In addition, a 2-year increase in the median age of CeVD death was observed (Men: 56.4 to 58.4 years, Women: 56.4 to 58.7 years, p<0.001). A statistically significant decline in mortality (per 100,000) was also noticed for haemorrhagic stroke (Men: 18.7 to 10.4; Women: 9.6 to 3.8), ischaemic stroke (Men: 11.8 to 8.4; Women: 4.7 to 3.0) and unspecified stroke (Men: 19.7 to 3.5; Women: 9.1 to 1.3). Conclusions: A substantial decline in premature CeVD mortality was observed in the period 2000-2016. Additionally, the number of deaths that could not be classified as haemorrhagic or ischaemic stroke death decreased significantly. The increasingly widespread use of new post-stroke therapies and their availability make it possible to expect a further decrease in CeVD mortality. However, the necessary actions should be taken to compensate for the disparities in CeVD mortality between men and women.


Assuntos
Isquemia Encefálica , Transtornos Cerebrovasculares , Acidente Vascular Cerebral , Adulto , Transtornos Cerebrovasculares/epidemiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade Prematura , Polônia/epidemiologia , Acidente Vascular Cerebral/epidemiologia
10.
Zhonghua Liu Xing Bing Xue Za Zhi ; 43(3): 354-358, 2022 Mar 10.
Artigo em Chinês | MEDLINE | ID: mdl-35345290

RESUMO

Objective: To understand the characteristics and trend of the premature death rate of 4 major chronic diseases in Ji'nan from 2015 to 2020. Methods: The death cause surveillance data and population data during 2015-2020 in Ji'nan were collected, and abbreviated life table, Joinpoint regression analysis and other methods were used to analyze the characteristics and change trends of the premature death rates of 4 major chronic diseases. Results: The crude mortality rate and age standardized mortality rate changes for the 4 major chronic diseases from 2015 to 2020 range from 568.65/100 000 to 604.06/100 000 and 366.77/100 000 to 432.48/100 000, respectively. The annual premature death rate of 4 major chronic diseases declined by 3.33% averagely from 2015 to 2020 (95%CI: -6.25%--0.32%), which might be explained by the declines of the premature death rates of cardiovascular and cerebrovascular diseases [average annual percentage change (AAPC)=-3.23%, 95%CI: -6.32%--0.05%] and cancer (AAPC=-3.58%,95%CI:-6.83%--0.21%). The average decline rate in women (AAPC=-4.19%,95%CI:-7.56%- -0.70%) was higher than that in men (AAPC=-2.92%,95%CI: -5.65%--0.11%). Conclusions: The premature death rate of 4 major chronic diseases showed a downward trend in Ji'nan from 2015 to 2020. Men should be considered as a key population in the prevention and control of 4 major chronic diseases, and attention should also be paid to the non-significant declines in the premature death rates of chronic respiratory diseases and diabetes.


Assuntos
Transtornos Cerebrovasculares , Diabetes Mellitus , Doença Crônica , Feminino , Humanos , Masculino , Mortalidade Prematura , Análise de Regressão
11.
J Clin Hypertens (Greenwich) ; 24(4): 475-482, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35257472

RESUMO

Low-income African Americans residing in impoverished neighborhoods confront myriad barriers to adhering to antihypertensive regimens. Substance use may thwart medication adherence and lifestyle modification efforts, which has implications for excess cardiovascular disease mortality. The Inner-City Hypertension and Body Organ Damage (ICHABOD) Study was a longitudinal cohort study that evaluated causes of mortality among African Americans who lived in urban areas, had severe, poorly controlled hypertension, and were admitted to a local hospital between 1999-2001 and 2002-2004. The authors employed Cox proportional hazards models to assess mortality associated with illicit substance use, including use of heroin and cocaine, as well as by use of tobacco and alcohol. Among192 participants with poorly controlled hypertension, 30% were active illicit substance users (specifically, 22.7% heroin users, 19.8% were cocaine users, and 30.7% were both cocaine and heroin users). The mean age among substance non-users was 52.3 years versus 48.7 years among those reporting current use. Mortality over 7.6 years of follow-up was 52.5% among substance users and 33.8% among nonusers (p-value, 0.01). After adjusting for potential confounders, the hazard ratio (HR) for cocaine use was 2.52 (95% confidence interval (CI) 1.38-4.59), while the HR for heroin use was 2.47 (95% CI 1.42-4.28) and the HR for both was 2.75 (95% CI 1.60-4.73). Substance use was associated with increased mortality among urban black Americans with poorly controlled hypertension. These data suggest the need for targeted interventions to support African Americans who have poorly controlled hypertension and use illicit substances, as a means of reducing excess mortality.


Assuntos
Cocaína , Dependência de Heroína , Hipertensão , Afro-Americanos , Cocaína/uso terapêutico , Heroína/uso terapêutico , Dependência de Heroína/complicações , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Estudos Longitudinais , Pessoa de Meia-Idade , Mortalidade Prematura , Estudos Prospectivos
12.
J Psychiatr Res ; 148: 340-347, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35202994

RESUMO

OBJECTIVES: Panic disorder (PD) is associated with high psychiatric and physical comorbidity, but the cause of mortality has not been well studied. This study investigated mortality rates and causes of death in an Asian cohort with PD. METHODS: We enrolled a nationwide retrospective cohort of 298,466 persons diagnosed with PD from January 1, 2001, to December 31, 2016. Each cohort member was matched with a comparison one randomly selected from the general population with the same sex, age at entry, and birth year. The data of both the PD cohort and the comparison group were linked with the national mortality database to obtain each individual's mortality status. We used mortality rate ratios (MRRs) to compare mortality risks between the patients with PD and the general population. Stratified analysis of mortality risks was performed based on sex and psychiatric comorbidities. RESULTS: PD was associated with a slightly increased mortality risk (MRR, 1.14 [99% CI, 1.11-1.17]). The risk of unnatural death (MRR, 2.83 [99% CI, 2.59-3.10]) was significantly higher among the individuals with PD than among the general population, whereas the risk of overall natural death across all categories was not (MRR, 1.01 [99% CI, 0.98-1.04]). The mortality risk was the highest for suicide (MRR, 4.94 [99% CI, 4.32-5.72]) and was higher in women (MRR, 6.37 [99% CI, 5.25-7.96]) than in men (MRR, 3.77 [99% CI, 3.14-4.64]). Comorbid substance use disorders increased the risk of mortality from natural (MRR, 3.23 [99% CI, 2.59-4.14]) and unnatural (MRR, 9.45 [99% CI, 6.29-17.85]) causes. CONCLUSION: PD was associated with increased all-cause mortality, especially suicide. Substance use further increased mortality risk in persons with PD. Targeted treatment for substance use and suicide prevention are essential among persons with PD.


Assuntos
Transtorno de Pânico , Transtornos Relacionados ao Uso de Substâncias , Suicídio , Causas de Morte , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Mortalidade Prematura , Transtorno de Pânico/epidemiologia , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
13.
BMJ Open ; 12(2): e054264, 2022 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-35190432

RESUMO

INTRODUCTION: Understanding the risk of premature death from suicide, accident and injury and other physical health conditions in people seeking healthcare for mental disorders is essential for delivering targeted clinical interventions and secondary prevention strategies. It is not clear whether morbidity and mortality outcomes in hospital-based adult cohorts are applicable to young people presenting to early-intervention services. METHODS AND ANALYSIS: The current data linkage project will establish the Brain and Mind Patient Research Register-Mortality and Morbidity (BPRR-M&M) database. The existing Brain and Mind Research Institute Patient Research Register (BPRR) is a cohort of 6743 young people who have accessed primary care-based early-intervention services; subsets of the BPRR contain rich longitudinal clinical, neurobiological, social and functional data. The BPRR will be linked with the routinely collected health data from emergency department (ED), hospital admission and mortality databases in New South Wales from January 2010 to November 2020. Mortality will be the primary outcome of interest, while hospital presentations will be a secondary outcome. The established BPRR-M&M database will be used to establish mortality rates and rates of ED presentations and hospital admissions. Survival analysis will determine how time to death or hospital presentation varies by identified social, demographic and clinical variables. Bayesian modelling will be used to identify predictors of these morbidity and mortality outcomes. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the human research ethics committee of the Sydney Local Health District (2019/ETH00469). All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals and scientific conference presentations.


Assuntos
Serviços de Saúde Mental , Mortalidade Prematura , Adolescente , Adulto , Teorema de Bayes , Humanos , Armazenamento e Recuperação da Informação , Morbidade
14.
Rev Soc Bras Med Trop ; 55(suppl 1): e0328, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35107541

RESUMO

INTRODUCTION: The goal of reducing the burden of non-communicable diseases (NCDs) requires close monitoring. Our objective is to characterize the decline of premature NCD mortality in Brazil based on Global Burden of Diseases (GBD) Study 2019 estimates. METHODS: We used GBD 2019 data to estimate death rates of the four main NCDs - cardiovascular diseases, neoplasms, diabetes, and chronic respiratory diseases. We estimated the unconditional probability of death between ages 30 to 69, as recommended by the World Health Organization, as well as premature crude- and age-standardized death rates and disability-adjusted life years (DALYs) lost for these conditions. We also estimated trends in suicide (self-harm) death rates. RESULTS: From 2010 to 2019, the age-standardized unconditional probability of premature death declined -1.4%/year (UI: -1.7%;-1.0%) . Age-standardized death rates declined -1.5%/year (UI: -1.9%; -1.2%), and crude death rates -0.6%/year (UI: (-1.0%; -0.2%). Level of development correlated strongly with the rate of decline, with greatest declines occurring in the Southeast, Center West and South regions. Age-standardized mortality from self-harm declined, most notably in the elderly. CONCLUSIONS: Premature mortality due to the main NCDs has declined from 1990 in Brazil, although at a diminishing rate over time. The unconditional probability of death and the age-standardized mortality rate produced similar estimates of decline for the four main NCDs, and mirror well decline in mortality from all NCDs. Declines, especially more recent ones, fall short of the international goals. Strategic public health actions are needed. The challenge to implement them will be great, considering the political and economic instability currently faced by Brazil.


Assuntos
Doenças não Transmissíveis , Suicídio , Adulto , Idoso , Brasil/epidemiologia , Carga Global da Doença , Humanos , Pessoa de Meia-Idade , Mortalidade Prematura
15.
Sci Total Environ ; 823: 153832, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35151734

RESUMO

The health impacts of global climate change mitigation will affect local populations differently. However, most co-benefits analyses have been done at a global level, with relatively few studies providing local level results. We aimed to quantify the local health impacts due to fine particles (PM2.5) under the governance arrangements embedded in the Shared Socioeconomic Pathways (SSPs1-5) under two greenhouse gas concentration scenarios (Representative Concentration Pathways (RCPs) 2.6 and 8.5) in local populations of Mozambique, India, and Spain. We simulated the SSP-RCP scenarios using the Global Change Analysis Model, which was linked to the TM5-FASST model to estimate PM2.5 levels. PM2.5 levels were calibrated with local measurements. We used comparative risk assessment methods to estimate attributable premature deaths due to PM2.5 linking local population and mortality data with PM2.5-mortality relationships from the literature, and incorporating population projections under the SSPs. PM2.5 attributable burdens in 2050 differed across SSP-RCP scenarios, and sensitivity of results across scenarios varied across populations. Future attributable mortality burden of PM2.5 was highly sensitive to assumptions about how populations will change according to SSP. SSPs reflecting high challenges for adaptation (SSPs 3 and 4) consistently resulted in the highest PM2.5 attributable burdens mid-century. Our analysis of local PM2.5 attributable premature deaths under SSP-RCP scenarios in three local populations highlights the importance of both socioeconomic development and climate policy in reducing the health burden from air pollution. Sensitivity of future PM2.5 mortality burden to SSPs was particularly evident in low- and middle- income country settings due either to high air pollution levels or dynamic populations.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Mudança Climática , Mortalidade Prematura , Material Particulado/análise
16.
PLoS One ; 17(2): e0264332, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35196345

RESUMO

BACKGROUND: Polypharmacy, defined as the concurrent use of ≥5 medications, increases the risk of drug-drug and drug-disease interactions as well as non-adherence to drug therapy. This may have negative health consequences particularly among older adults due to age-related pharmacokinetic and pharmacodynamic changes. This study aims to uncover the occurrence of polypharmacy among older adults in Denmark and investigate how polypharmacy relates to mortality. METHOD: This nationwide register-based study included 1,338,058 adults aged 65+ years between January 2013 and December 2017 in Denmark. Polypharmacy prevalence was measured at time of inclusion while incidence and the association between polypharmacy and mortality were measured over the five-year follow-up using Cox regression. In an attempt to adjust for confounding by indication, propensity scores with overlap weighting were introduced to the regression model. RESULTS: At time of inclusion, polypharmacy prevalence was 29% and over the five years follow-up, 47% of the remaining adults transitioned into polypharmacy. Identified risk factors included multimorbidity (2+ morbidities: HR = 3.51; 95% CI = 3.48-3.53), age (95+ years: HR = 2.85; 95% CI = 2.74-2.96), socioeconomic factors (Highest income quartile: HR = 0.81; 95% CI = 0.80-0.81), region of birth region (Non-western migrants: HR = 0.77; 95% CI = 0.75-0.79), marital status (Divorced: HR = 1.10; 95% CI = 1.10-1.12) and year of inclusion (2017: HR = 1.19; 95% CI = 1.19-1.22). Further analyses showed that polypharmacy involves many different drug cocktails with medication for the cardiovascular system (95%), blood and blood-forming organs (69%), alimentary tract and metabolism (61%) and nervous system (54%) contributing the most. After adjustment for propensity scores with OW, both polypharmacy (HR = 3.48, CI95% = 3.41-3.54) and excessive polypharmacy (HR = 3.48, CI95% = 3.43-3.53) increased the risk of death substantially. CONCLUSION: A considerable proportion of older adults in Denmark were exposed to polypharmacy dependent on health status, socio-economic status, and societal factors. The associated three- to four-fold mortality risk indicate a need for further exploration of the appropriateness of polypharmacy among older adults.


Assuntos
Mortalidade Prematura/tendências , Polimedicação/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Dinamarca , Feminino , Humanos , Masculino
17.
Glob Health Action ; 15(1): 2008627, 2022 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-35147492

RESUMO

The burden and impact of non-communicable diseases (NCDs) are well documented, accounting for 70% of premature deaths globally. In Sub-Saharan Africa, rising NCDs are estimated to account for 27% of mortality by 2020, a 4% increase from 2005. This increase will inevitably lead to a higher demand for NCD treatment services, exerting pressure on limited public financial resources. To get a sense of the resources required to treat NCDs, it is necessary to estimate the costs associated with the diagnosis, treatment and management thereof. Typically, in estimating costs for health services, countries use historical patient level data combined with demographic trend data and non-patient level data to arrive at estimated future costs. This methodology relies heavily on the availability of data from a wide variety of sources stretching beyond the health sector. Low-and-middle-income countries often lack the requisite data and are compelled to use less efficient ways to determine resource allocation. This study explores the use of probability-based cost estimation to estimate the cost of delivering NCD treatment services in South Africa, one such data-poor environment.Probability-based cost estimation, in combination with deterministic cost estimation, is used in arriving at a cost estimate for NCD treatment services at primary healthcare facility level. On its own, deterministic cost estimation can determine total costs, provided all the input variables are known. This is not always possible because of the lack of one or more input variables. In most instances, the lacking input variable is the quantities at which specific conditions will be treated. This problem is addressed by using probability-based cost estimation through which a mean cost is calculated and applied to the target population as a whole, eliminating the need for quantities per condition. Thus, this model contains both deterministic and probabilistic cost estimation elements.


Assuntos
Doenças não Transmissíveis , Custos de Cuidados de Saúde , Humanos , Mortalidade Prematura , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/terapia , Probabilidade , África do Sul/epidemiologia
18.
Environ Int ; 161: 107110, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35134714

RESUMO

Ambient PM2.5 was reported to be related to numerous negative health outcomes, leading to adverse public health impacts in many countries such as China. Despite the apparent reduction in PM2.5 levels over China due to its emission control policies in recent years, the health burdens were not reduced as much as expected. This calls for a comprehensive analysis to explain the reasons behind to provide a useful reference for formulating effective emission control strategies. Taking central China as an example due to its large population and high levels of PM2.5, this study quantified the spatiotemporal dynamics of premature mortality associated with PM2.5 pollution in central China for each year during 2003-2018 and applied a decomposition analysis to dissect the contribution of various driving factors including ambient PM2.5 level, demographic distribution and baseline incidence rate of four diseases related to air pollution. Results show significant spatiotemporal variations in PM2.5-attributed health impact in central China, including Henan, Hubei, and Hunan provinces. Five Henan cities had the largest PM2.5-attributable premature mortality (∼8-12 K premature mortalities), while three Hubei cities and one Hebei city had the least chronic PM2.5-related all-cause mortality numbers (<1 K mortalities). Throughout the study period, the PM2.5-caused premature mortality decreased by 54 K, in which changes in PM2.5 levels and baseline incidence rates of stroke and chronic obstructive pulmonary disease contributed to the positive effect, whereas demographic changes and baseline incidence rate change of ischemic heart disease and lung cancer brought a countervailing effect. Our findings suggest more dynamic and comprehensive policies and measures that take into account spatiotemporal variations of health burden for effective alleviation of the health impact of PM2.5 pollution in the country.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , China/epidemiologia , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Mortalidade Prematura , Material Particulado/efeitos adversos , Material Particulado/análise
19.
S Afr Med J ; 112(1): 13513, 2022 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-35139998

RESUMO

BACKGROUND: The impacts on mortality of both the SARS-CoV-2 epidemic and the interventions to manage it differ between countries. The Rapid Mortality Surveillance System set up by the South African Medical Research Council based on data from the National Population Register (NPR) provides a means of tracking this impact on mortality in South Africa. OBJECTIVES: To report on the change in key metrics of mortality (numbers of deaths, life expectancy at birth, life expectancy at age 60, and infant, under-5, older child and adolescent, young adult, and adult mortality) over the period 2015 - 2020. The key features of the impact are contrasted with those measured in other countries. METHODS: The numbers of registered deaths by age and sex recorded on the NPR were increased to account for both registered deaths that are not captured by the NPR and an estimate of deaths not reported. The estimated numbers of deaths together with estimates of the numbers in the population in the middle of each of the years were used to produce life tables and calculate various indicators. RESULTS: Between 2019 and 2020, the number of deaths increased by nearly 53 000 (65% female), and life expectancy at birth fell by 1 year for females and by only 2.5 months for males. Life expectancy at age 60 decreased by 1.6 years for females and 1.2 years for males. Infant mortality, under-5 mortality and mortality of children aged 5 - 14 decreased by 22%, 20% and 10%, respectively, while that for older children and adolescents decreased by 11% for males and 5% for females. Premature adult mortality, the probability of a 15-year-old dying before age 60, increased by 2% for males and 9% for females. CONCLUSIONS: COVID-19 and the interventions to manage it had differential impacts on mortality by age and sex. The impact of the epidemic on life expectancy in 2020 differs from that in most other, mainly developed, countries, both in the limited decline and also in the greater impact on females. These empirical estimates of life expectancy and mortality rates are not reflected by estimates from agencies, either because agency estimates have yet to be updated for the impact of the epidemic or because they have not allowed for the impact correctly. Trends in weekly excess deaths suggest that the drop in life expectancy in 2021 will be greater than that in 2020.


Assuntos
COVID-19/epidemiologia , Expectativa de Vida/tendências , Adolescente , Adulto , COVID-19/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Masculino , Mortalidade Prematura/tendências , África do Sul/epidemiologia , Adulto Jovem
20.
Zhonghua Liu Xing Bing Xue Za Zhi ; 43(1): 37-43, 2022 Jan 10.
Artigo em Chinês | MEDLINE | ID: mdl-35130650

RESUMO

Objective: To predict the number of deaths, standardized mortality and probability of premature mortality caused by malignant cancer in the context of risk factor control at different levels in China in 2030, and assess the possibility of achieving the target of reducing the probability of premature mortality of malignant cancer. Methods: According to the risk factor control standard for malignant cancer used both at home and abroad, the results of China from Global Burden of Disease Study 2015 were used to calculate the population attributable fraction of the risk factors. Based on the comparative risk assessment theory, the deaths of malignant cancer were classified as attributable deaths and un-attributable deaths. Proportional change model was used to predict risk factor exposure and un-attributable deaths of malignant cancer in the future, then the number of deaths, standardized mortality rate and probability of premature mortality of malignant cancer in 2030 was estimated. Data analyses were performed by using software R 3.6.1. Results: If the risk factor exposure level during 1990-2015 remains, the number of deaths, standardized mortality rate, and probability of premature mortality of malignant cancer would increase to 3.62 million, 153.96/100 000 and 8.92% by 2030, respectively. If the risk factor exposure control level meets the requirement, the probability of premature mortality from cancer in people aged 30-70 years would drop to 7.57% by 2030. Conclusions: The control of risk factor exposure will play an important role in reducing deaths, standardized mortality rate and probability of premature mortality of malignant cancer. But more efforts are needed to achieve the goals of Health China Action.


Assuntos
Mortalidade Prematura , Neoplasias , Adulto , Idoso , China/epidemiologia , Efeitos Psicossociais da Doença , Humanos , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Fatores de Risco
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