Características clínicas y evolución del paciente anciano mayor de 80 años en una Unidad de Cuidados Intensivos / Clinical features and disease progression of elderlypatients at the ICU setting

Objetivo Describir y caracterizar una cohorte de pacientes octogenarios ingresados en la UCI del Hospital Universitario Central de Asturias (HUCA). Diseño Estudio retrospectivo, observacional y descriptivo de 14 meses de duración. Ámbito Unidad de Cuidados Intensivos (UCI) Cardiaca y UCI Polivalente del Servicio de Medicina Intensiva del HUCA (Oviedo). Participantes Pacientes mayores de 80 años que ingresaron en la UCI durante más de 24 horas.Intervenciones Ninguna. Variables de interés principales Edad, sexo, comorbilidad, capacidad funcional, tratamiento, complicaciones, evolución, mortalidad. Resultados Los motivos de ingreso más frecuentes fueron la cirugía cardiaca y la neumonía. La estancia media de ingreso fue significativamente mayor en pacientes menores de 85 años (p=0,037). El 84,3% de estos últimos se benefició de ventilación mecánica invasiva (VMI) vs. 46,2% de los pacientes más mayores (p=<0,001). Los pacientes mayores de 85 años presentaron mayor fragilidad. El ingreso por intervención quirúrgica cardiaca se asoció con menor riesgo de mortalidad (hazard ratio [HR]=0,18; intervalo de confianza [IC] 95%, 0,062-0,527; p=0,002). Conclusiones Los resultados muestran una asociación entre el motivo de ingreso en UCI y el riesgo de mortalidad en pacientes octogenarios. La cirugía cardiaca se asoció con mejor pronóstico frente a la patología médica, donde la neumonía se asoció con mayor riesgo de mortalidad. Además, se observó una relación positiva significativa entre edad y fragilidad. (AU)

ObjectiveTo describe and characterize a cohort of octogenarian patients admitted to the ICU of the University Central Hospital of Asturias (HUCA). Design Retrospective, observational and descriptive study of 14 months’ duration. Setting Cardiac and Medical Intensive Care Units (ICU) of the HUCA (Oviedo). Participants Patients over 80 years old who were admitted to the ICU for more than 24hours. Interventions None. Main variables of interest Age, sex, comorbidity, functional dependence, treatment, complications, evolution, mortality. Results The most frequent reasons for admission were cardiac surgery and pneumonia. The average admission stay was significantly longer in patients under 85 years of age (p=0,037). 84,3% of the latter benefited from invasive mechanical ventilation compared to 46,2% of older patients (p=<0,001). Patients over 85 years of age presented greater fragility. Admission for cardiac surgery was associated with a lower risk of mortality (HR=0,18; 95% CI (0,062-0,527; p=0,002). Conclusions The results have shown an association between the reason for admission to the ICU and the risk of mortality in octogenarian patients. Cardiac surgery was associated with a better prognosis compared to medical pathology, where pneumonia was associated with a higher risk of mortality. Furthermore, a significant positive association was observed between age and frailty. (AU)

Association of low muscle mass with cognitive function and mortality in USA seniors: results from NHANES 1999-2002.

BACKGROUND: Sarcopenia and cognitive impairment have been linked in prior research, and both are linked to an increased risk of mortality in the general population. Muscle mass is a key factor in the diagnosis of sarcopenia. The relationship between low muscle mass and cognitive function in the aged population, and their combined impact on the risk of death in older adults, is currently unknown. This study aimed to explore the correlation between low muscle mass and cognitive function in the older population, and the relationship between the two and mortality in older people. METHODS: Data were from the National Health and Nutrition Examination Survey 1999-2002. A total of 2540 older adults aged 60 and older with body composition measures were included. Specifically, 17-21 years of follow-up were conducted on every participant. Low muscle mass was defined using the Foundation for the National Institute of Health and the Asian Working Group for Sarcopenia definitions: appendicular lean mass (ALM) (< 19.75 kg for males; <15.02 kg for females); or ALM divided by body mass index (BMI) (ALM: BMI, < 0.789 for males; <0.512 for females); or appendicular skeletal muscle mass index (ASMI) (< 7.0 kg/m2 for males; <5.4 kg/m2 for females). Cognitive functioning was assessed by the Digit Symbol Substitution Test (DSST). The follow-up period was calculated from the NHANES interview date to the date of death or censoring (December 31, 2019). RESULTS: We identified 2540 subjects. The mean age was 70.43 years (43.3% male). Age-related declines in DSST scores were observed. People with low muscle mass showed lower DSST scores than people with normal muscle mass across all age groups, especially in the group with low muscle mass characterized by ALM: BMI (60-69 years: p < 0.001; 70-79 years: p < 0.001; 80 + years: p = 0.009). Low muscle mass was significantly associated with lower DSST scores after adjusting for covariates (ALM: 43.56 ± 18.36 vs. 47.56 ± 17.44, p < 0.001; ALM: BMI: 39.88 ± 17.51 vs. 47.70 ± 17.51, p < 0.001; ASMI: 41.07 ± 17.89 vs. 47.42 ± 17.55, p < 0.001). At a mean long-term follow-up of 157.8 months, those with low muscle mass were associated with higher all-cause mortality (ALM: OR 1.460, 95% CI 1.456-1.463; ALM: BMI: OR 1.452, 95% CI 1.448-1.457); ASMI: OR 3.075, 95% CI 3.063-3.088). In the ALM: BMI and ASMI-defined low muscle mass groups, participants with low muscle mass and lower DSST scores were more likely to incur all-cause mortality ( ALM: BMI: OR 0.972, 95% CI 0.972-0.972; ASMI: OR 0.957, 95% CI 0.956-0.957). CONCLUSIONS: Low muscle mass and cognitive function impairment are significantly correlated in the older population. Additionally, low muscle mass and low DSST score, alone or in combination, could be risk factors for mortality in older adults.

Long-term exposure to PM2.5 and mortality in a national cohort in South Korea: effect modification by community deprivation, medical infrastructure, and greenness.

BACKGROUND: Long-term exposure to PM2.5 has been linked to increased mortality risk. However, limited studies have examined the potential modifying effect of community-level characteristics on this association, particularly in Asian contexts. This study aimed to estimate the effects of long-term exposure to PM2.5 on mortality in South Korea and to examine whether community-level deprivation, medical infrastructure, and greenness modify these associations. METHODS: We conducted a nationwide cohort study using the National Health Insurance Service-National Sample Cohort. A total of 394,701 participants aged 30 years or older in 2006 were followed until 2019. Based on modelled PM2.5 concentrations, 1 to 3-year and 5-year moving averages of PM2.5 concentrations were assigned to each participant at the district level. Time-varying Cox proportional-hazards models were used to estimate the association between PM2.5 and non-accidental, circulatory, and respiratory mortality. We further conducted stratified analysis by community-level deprivation index, medical index, and normalized difference vegetation index to represent greenness. RESULTS: PM2.5 exposure, based on 5-year moving averages, was positively associated with non-accidental (Hazard ratio, HR: 1.10, 95% Confidence Interval, CI: 1.01, 1.20, per 10 µg/m3 increase) and circulatory mortality (HR: 1.22, 95% CI: 1.01, 1.47). The 1-year moving average of PM2.5 was associated with respiratory mortality (HR: 1.33, 95% CI: 1.05, 1.67). We observed higher associations between PM2.5 and mortality in communities with higher deprivation and limited medical infrastructure. Communities with higher greenness showed lower risk for circulatory mortality but higher risk for respiratory mortality in association with PM2.5. CONCLUSIONS: Our study found mortality effects of long-term PM2.5 exposure and underlined the role of community-level factors in modifying these association. These findings highlight the importance of considering socio-environmental contexts in the design of air quality policies to reduce health disparities and enhance overall public health outcomes.

Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality.

BACKGROUND: Choline, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality, is limited and inconclusive. This study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S. METHODS: This study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. The study utilized survey-weighted logistic and Cox regression analyses to explore the associations between choline consumption and health outcomes. Restricted cubic spline (RCS) analysis was used for dose‒response estimation and for testing for nonlinear associations. RESULTS: In our study of 14,289 participants (mean age 48.08 years, 47.71% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively (p for trend = 0.017). Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. RCS analysis revealed a linear correlation between choline intake and CVD risk. Moderate choline intake (Q3) was associated with a reduced risk of mortality, with an HR of 0.75 (95% CI 0.60-0.94) compared with Q1. RCS analysis demonstrated a significant nonlinear association between choline intake and all-cause mortality (P for nonlinearity = 0.025). The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk. CONCLUSION: Elevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. Additional comprehensive investigations are warranted to elucidate the broader health implications of choline.

Mortality Associated with Priority Diseases in Flood-Affected Areas Using District Health Information System (DHIS2) During September-December 2022: Pakistan Experience.

OBJECTIVES: To quantify the burden of communicable diseases and characterize the most reported infections during public health emergency of floods in Pakistan. METHODS: The study's design is a descriptive trend analysis. The study utilized the disease data reported to District Health Information System (DHIS2) for the 12 most frequently reported priority diseases under the Integrated Disease Surveillance and Response (IDSR) system in Pakistan. RESULTS: In total, there were 1,532,963 suspected cases during August to December 2022 in flood-affected districts (n = 75) across Pakistan; Sindh Province reported the highest number of cases (n = 692,673) from 23 districts, followed by Khyber Pakhtunkhwa (KP) (n = 568,682) from 17 districts, Balochistan (n = 167,215) from 32 districts, and Punjab (n = 104,393) from 3 districts. High positivity was reported for malaria (79,622/201,901; 39.4%), followed by acute diarrhea (non-cholera) (23/62; 37.1%), hepatitis A and E (47/252; 18.7%), and dengue (603/3245; 18.6%). The crude mortality rate was 11.9 per 10 000 population (1824/1,532,963 [deaths/cases]). CONCLUSION: The study identified acute respiratory infection, acute diarrhea, malaria, and skin diseases as the most prevalent diseases. This suggests that preparedness efforts and interventions targeting these diseases should be prioritized in future flood response plans. The study highlights the importance of strengthening the IDSR as a Disease Early Warning System through the implementation of the DHIS2.

Cognitive Function, Healthy Lifestyle, and All-Cause Mortality among Chinese Older Adults: A Longitudinal Prospective Study.

BACKGROUND: Both cognitive decline and unhealthy lifestyles have been linked to an elevated risk of mortality in older people. We aimed to investigate whether a healthy lifestyle might modify the association between cognitive function and all-cause mortality in Chinese older populations. METHODS: The final analysis included 5124 individuals free of dementia, selected from the Chinese Longitudinal Healthy Longevity Survey from 2011 to 2018. Cognitive function was assessed in 2011 using the Mini-Mental State Examination (MMSE). A lifestyle score was calculated based on five lifestyle factors, including smoking, alcohol consumption, physical activity, diet, and body mass index. Cox proportional hazards models were performed to evaluate the association between baseline cognitive function and the risk of all-cause mortality, with an interaction term of cognitive function and lifestyle score being added to the models. RESULTS: The average age of participants was 81.87 years old at baseline. During a median follow-up of 6.4 years, 1461 deaths were documented. Both higher cognitive function (HR: 0.96; 95% CI: 0.96-0.97) and a healthier lifestyle (HR: 0.92; 95% CI: 0.87-0.97) were significantly associated with a reduced risk of mortality. We found that lifestyle significantly modified the association of cognitive function with mortality (p for interaction = 0.004). The inverse relation between cognitive function and mortality was found to be more pronounced among participants with a healthier lifestyle. Of note, among the lifestyle scores component, diet showed a significant interaction with mortality (p for interaction = 0.003), and the protective HR of the all-cause mortality associated with higher MMSE scores was more prominent among participants with healthy diets compared with unhealthy diets. CONCLUSIONS: Our study indicates that cognitive decline is associated with a higher risk of mortality, and such associations are attenuated by maintaining a healthy lifestyle, with a particular emphasis on healthy diet.

Research on social and economic factors influencing regional mortality patterns in China.

Regional population mortality correlates with regional socioeconomic development. This study aimed to identify the key socioeconomic factors influencing mortality patterns in Chinese provinces. Using data from the Seventh Population Census, we analyzed mortality patterns by gender and urban‒rural division in 31 provinces. Using a functional regression model, we assessed the influence of fourteen indicators on mortality patterns. Main findings: (1) China shows notable gender and urban‒rural mortality variations across age groups. Males generally have higher mortality than females, and rural areas experience elevated mortality rates compared to urban areas. Mortality in individuals younger than 40 years is influenced mainly by urban‒rural factors, with gender becoming more noticeable in the 40-84 age group. (2) The substantial marginal impact of socioeconomic factors on mortality patterns generally becomes evident after the age of 45, with less pronounced differences in their impact on early-life mortality patterns. (3) Various factors have age-specific impacts on mortality. Education has a negative effect on mortality in individuals aged 0-29, extending to those aged 30-59 and diminishing in older age groups. Urbanization positively influences the probability of death in individuals aged 45-54 years, while the impact of traffic accidents increases with age. Among elderly people, the effect of socioeconomic variables is smaller, highlighting the intricate and heterogeneous nature of these influences and acknowledging certain limitations.

[Is mortality an objective indicator for measuring the impact of an epidemic?: The example of Covid-19 in Switzerland]. / La mortalité est-elle un indicateur objectif pour mesurer l'impact d'une épidémie ?. L'exemple du Covid-19 en Suisse.

Measuring the health impact of an epidemic using appropriate indicators is necessarily complex. Mortality does not sum up all the issues, but at least it seems to be an objective indicator. There are, however, a number of different mortality indicators, which do not all convey the same message. During the Covid-19 epidemic in Switzerland, the mortality rate rose by 10.2% in 2020, while life expectancy fell by "only" 0.8%, or 8.3 months, a decline described as "modest" or "complete freefall" depending on when it was published. In reality, the population living in Switzerland in 2020 lost an average of "only" 2.4 days, as the epidemic did not last their entire lives. The use of such an indicator, in comparison with losses due to other factors, would enable us to better estimate the real impact of an epidemic.

Mesurer l'impact sanitaire d'une épidémie à l'aide d'indicateurs appropriés est forcément complexe. La mortalité ne résume pas tous les enjeux mais semble au moins être un indicateur objectif. Il existe cependant différents indicateurs de mortalité ne donnant pas tous le même message. Lors de l'épidémie de Covid-19 en Suisse, le taux de mortalité a augmenté de 10,2 % en 2020, alors que l'espérance de vie n'a diminué « que ¼ de 0,8 %, ou 8,3 mois, recul par ailleurs qualifié de « modeste ¼ ou de « chute libre ¼ selon quand il a été publié. En réalité, la population vivant en Suisse en 2020 n'a perdu en moyenne « que ¼ 2,4 jours car l'épidémie n'a pas duré toute sa vie. L'utilisation d'un tel indicateur, en comparaison avec les pertes dues à d'autres facteurs, permettrait une meilleure estimation de l'impact réel d'une épidémie.

Terminal trajectory of HbA1c for 10 years supports the HbA1c paradox: a longitudinal study using Health and Retirement Study data.

Objectives: We aimed to assess the potential time-varying associations between HbA1c and mortality, as well as the terminal trajectory of HbA1c in the elderly to reveal the underlying mechanisms. Design: The design is a longitudinal study using data from the Health and Retirement Study. Setting and participants: Data were from the Health and Retirement Study. A total of 10,408 participants aged ≥50 years with available HbA1c measurements at baseline (2006/2008) were included. Methods: Longitudinal HbA1c measured at 2010/2012 and 2014/2016 were collected. HbA1c values measured three times for their associations with all-cause mortality were assessed using Cox regression and restricted cubic splines. HbA1c terminal trajectories over 10 years before death were analyzed using linear mixed-effect models with a backward time scale. Results: Women constitute 59.6% of the participants with a mean age of 69 years, with 3,070 decedents during the follow-up (8.9 years). The mortality rate during follow-up was 29.5%. Increased mortality risk became insignificant for the highest quartile of HbA1c compared to the third quartile (aHR 1.148, 1.302, and 1.069 for a follow-up of 8.9, 6.5, and 3.2 years, respectively) with a shorter follow-up, while it became higher for the lowest quartile of HbA1c (aHR 0.986, 1.068, and 1.439 for a follow-up of 8.9, 6.5, and 3.2 years, respectively). Accordingly, for both decedents with and without diabetes, an initial increase in HbA1c was followed by an accelerating terminal decline starting 5-6 years before death. Conclusions and implications: The time-varying association between HbA1c and mortality mapped to the terminal trajectory in HbA1c. High and low HbA1c may have different clinical relationships with mortality. The HbA1c paradox may be partially explained by reverse causation, namely, early manifestation of death.

Life tables of annual life expectancy and risk factors for mortality in cats in the UK.

OBJECTIVES: The aims of the present study were to generate the first life tables for the UK companion cat population overall as well as broken down by sex and breed status, and to quantify associations between mortality and traits such as sex, neuter status, breed status and body weight in relation to mortality. METHODS: Life table construction and modelling included data on 7936 confirmed deaths in cats under primary veterinary care at clinics participating in the VetCompass Programme in 2019. The life tables were built for cats overall, female and male cats, and crossbred and purebred cats. Multivariable generalised linear regression models were generated to explore the risk factors for a shortened lifespan. RESULTS: Life expectancy at age 0 for UK companion cats overall was 11.74 years (95% confidence interval [CI] 11.61-11.87). The probability of death at each year interval increased with age from year interval 3-4, with the probability value not exceeding 0.05 before year 9. Female cats (12.51 years; 95% CI 12.32-12.69) had a 1.33-year longer life expectancy than male cats (11.18 years; 95% CI 11.01-11.38) at age 0. Among the 12 breeds (including crossbred) analysed, Burmese and Birman had the longest life expectancy at year 0, showing 14.42 years (95% CI 12.91-15.93) and 14.39 years (95% CI 12.87-15.91), respectively. Sphynx had the shortest life expectancy at year 0 among the analysed breeds at 6.68 years (95% CI 4.53-8.83). Being entire, purebred and with a non-ideal body weight were significantly linked to a decreased lifespan. CONCLUSIONS AND RELEVANCE: The life tables presented here for companion cats in the UK overall, by sex, and by crossbred and purebred cats can contribute to a better understanding of the life trajectory of cats, helping with evidence-based decision-making for cat owners and the veterinary profession. We have also provided an updated life expectancy at age 0 for various cat breeds for 2019 and showed evidence of the association between non-ideal weight and a decreased lifespan.

The association between disability and mortality: a mixed-methods study.

BACKGROUND: Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities. METHODS: We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374. FINDINGS: Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ2=0·28, I2=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types. INTERPRETATION: Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health. FUNDING: National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.

Association of ultra-processed food consumption with all cause and cause specific mortality: population based cohort study.

OBJECTIVE: To examine the association of ultra-processed food consumption with all cause mortality and cause specific mortality. DESIGN: Population based cohort study. SETTING: Female registered nurses from 11 US states in the Nurses' Health Study (1984-2018) and male health professionals from all 50 US states in the Health Professionals Follow-up Study (1986-2018). PARTICIPANTS: 74 563 women and 39 501 men with no history of cancer, cardiovascular diseases, or diabetes at baseline. MAIN OUTCOME MEASURES: Multivariable Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for the association of ultra-processed food intake measured by semiquantitative food frequency questionnaire every four years with all cause mortality and cause specific mortality due to cancer, cardiovascular, and other causes (including respiratory and neurodegenerative causes). RESULTS: 30 188 deaths of women and 18 005 deaths of men were documented during a median of 34 and 31 years of follow-up, respectively. Compared with those in the lowest quarter of ultra-processed food consumption, participants in the highest quarter had a 4% higher all cause mortality (hazard ratio 1.04, 95% confidence interval 1.01 to 1.07) and 9% higher mortality from causes other than cancer or cardiovascular diseases (1.09, 1.05 to 1.13). The all cause mortality rate among participants in the lowest and highest quarter was 1472 and 1536 per 100 000 person years, respectively. No associations were found for cancer or cardiovascular mortality. Meat/poultry/seafood based ready-to-eat products (for example, processed meat) consistently showed strong associations with mortality outcomes (hazard ratios ranged from 1.06 to 1.43). Sugar sweetened and artificially sweetened beverages (1.09, 1.07 to 1.12), dairy based desserts (1.07, 1.04 to 1.10), and ultra-processed breakfast food (1.04, 1.02 to 1.07) were also associated with higher all cause mortality. No consistent associations between ultra-processed foods and mortality were observed within each quarter of dietary quality assessed by the Alternative Healthy Eating Index-2010 score, whereas better dietary quality showed an inverse association with mortality within each quarter of ultra-processed foods. CONCLUSIONS: This study found that a higher intake of ultra-processed foods was associated with slightly higher all cause mortality, driven by causes other than cancer and cardiovascular diseases. The associations varied across subgroups of ultra-processed foods, with meat/poultry/seafood based ready-to-eat products showing particularly strong associations with mortality.

The long-term changing patterns of suicide mortality in China from 1987 to 2020: continuing urban-rural disparity.

BACKGROUND: Over the past three decades, China has experienced significant changes in urban-rural, gender, and age-specific suicide mortality patterns. This study aimed to investigate the long-term trends in suicide mortality in China from 1987 to 2020. METHODS: Suicide mortality data were obtained from China's National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modeling to estimate age, period, and cohort effects on suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated. RESULTS: Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987 to 2020, with a more pronounced decrease in rural areas (net drift = -7.07%, p<0.01) compared to urban areas (net drift = -3.41%, p<0.01). The decline curve of urban areas could be divided into three substages. Period and cohort effects were more prominent in rural areas. Suicide risk was highest among individuals aged 20-24 and gradually increased after age 60. Females, particularly those of childbearing age, had higher suicide risk than males, with a reversal observed after age 50. This gender reversal showed distinct patterns in urban and rural areas, with a widening gap in urban areas and a relatively stable gap in rural areas. CONCLUSIONS: Suicide mortality in China has consistently declined over the past three decades. However, disparities in age, gender, and urban-rural settings persist, with new patterns emerging. Targeted suicide prevention programs are urgently needed for high-risk groups, including females of childbearing age and the elderly, and to address the slower decrease and reversing urban-rural gender trends.

Ambient fine particulate matter and daily mortality: a comparative analysis of observed and estimated exposure in 347 cities.

BACKGROUND: Model-estimated air pollution exposure products have been widely used in epidemiological studies to assess the health risks of particulate matter with diameters of ≤2.5 µm (PM2.5). However, few studies have assessed the disparities in health effects between model-estimated and station-observed PM2.5 exposures. METHODS: We collected daily all-cause, respiratory and cardiovascular mortality data in 347 cities across 15 countries and regions worldwide based on the Multi-City Multi-Country collaborative research network. The station-observed PM2.5 data were obtained from official monitoring stations. The model-estimated global PM2.5 product was developed using a machine-learning approach. The associations between daily exposure to PM2.5 and mortality were evaluated using a two-stage analytical approach. RESULTS: We included 15.8 million all-cause, 1.5 million respiratory and 4.5 million cardiovascular deaths from 2000 to 2018. Short-term exposure to PM2.5 was associated with a relative risk increase (RRI) of mortality from both station-observed and model-estimated exposures. Every 10-µg/m3 increase in the 2-day moving average PM2.5 was associated with overall RRIs of 0.67% (95% CI: 0.49 to 0.85), 0.68% (95% CI: -0.03 to 1.39) and 0.45% (95% CI: 0.08 to 0.82) for all-cause, respiratory, and cardiovascular mortality based on station-observed PM2.5 and RRIs of 0.87% (95% CI: 0.68 to 1.06), 0.81% (95% CI: 0.08 to 1.55) and 0.71% (95% CI: 0.32 to 1.09) based on model-estimated exposure, respectively. CONCLUSIONS: Mortality risks associated with daily PM2.5 exposure were consistent for both station-observed and model-estimated exposures, suggesting the reliability and potential applicability of the global PM2.5 product in epidemiological studies.

Measuring population health using health expectancy estimates from morbidity and mortality databases.

The progressive incorporation of quality of life indicators in health planning meets a critical need: The evaluation of the performance of health services, which are under stress by multiple causes, but in particular by an ageing population. In general, national health plans rely on health expectancies obtained using the Sullivan method. The Sullivan health expectancy index combines age-specific mortality rates and age-specific prevalence of healthy life, obtained from health surveys. The objective of this work is to investigate an equivalent estimation, using available information from morbidity and mortality datasets. Mortality and morbidity information, corresponding to years 2016 and 2017, was obtained for the population of the county of Baix Empordà (Catalonia), N = 91,130. Anonymized individual information on diagnoses, procedures and pharmacy consumption contained in the individual clinical record (ICD and ATC codes), were classified into health states. Based on the observed health transitions and mortality, life expectancies by health state were obtained from a multistate microsimulation model. Healthy life expectancies at birth and 65 years for females and males were respectively HLE0female = 39.94, HLE0male = 42.87, HLE65female = 2.43, HLE65male = 2.17. These results differed considerably from the Sullivan equivalents, e.g., 8.25 years less for HLE65female, 9.26 less for HLE65male. Point estimates for global life expectancies at birth and 65 years of age: LE0female = 85.82, LE0male = 80.58, LE65female = 22.31, LE65male = 18.86. Health indicators can be efficiently obtained from multistate models based on mortality and morbidity information, without the use of health surveys. This alternative method could be used for monitoring populations in the context of health planning. Life Expectancy results were consistent with the standard government reports. Due to the different approximation to the concept of health (data-based versus self-perception), healthy life expectancies obtained from multistate micro simulation are consistently lower than those calculated with the standard Sullivan method.

Estimation of standardized real-time fatality rate for ongoing epidemics.

BACKGROUND: The fatality rate is a crucial metric for guiding public health policies during an ongoing epidemic. For COVID-19, the age structure of the confirmed cases changes over time, bringing a substantial impact on the real-time estimation of fatality. A 'spurious decrease' in fatality rate can be caused by a shift in confirmed cases towards younger ages even if the fatalities remain unchanged across different ages. METHODS: To address this issue, we propose a standardized real-time fatality rate estimator. A simulation study is conducted to evaluate the performance of the estimator. The proposed method is applied for real-time fatality rate estimation of COVID-19 in Germany from March 2020 to May 2022. FINDINGS: The simulation results suggest that the proposed estimator can provide an accurate trend of disease fatality in all cases, while the existing estimator may convey a misleading signal of the actual situation when the changes in temporal age distribution take place. The application to Germany data shows that there was an increment in the fatality rate at the implementation of the 'live with COVID' strategy. CONCLUSIONS: As many countries have chosen to coexist with the coronavirus, frequent examination of the fatality rate is of paramount importance.

Daily exposure to stressors, daily perceived severity of stress, and mortality risk among US adults.

Prior studies of perceived stress and mortality have yielded mixed results, but most are based on one-time measurements of perceived stress. We use daily diary data from the Midlife in the United States study to measure exposure to stressors and perceived severity of stress and investigate their associations with mortality. We also explore whether the associations vary by age and assess whether the associations are stronger for extrinsic than intrinsic mortality, which is more likely to be aging-related. The analysis included 4,756 observations for 2,915 respondents aged 21-95 who participated in at least one of three waves (1996-97, 2004-09, 2017-19) of the National Study of Daily Experiences. Participants reported daily stressors and perceived severity on 8 consecutive evenings at each wave. Mortality was followed through December 31, 2021. In fully-adjusted models, daily exposure to stressors was associated with mortality, but only at younger ages (HR = 1.20 per SD at age 50, 95% CI: 1.01‒1.42). The association was slightly stronger for extrinsic (HR = 1.31 per SD at age 50, 95% CI: 1.01‒1.69) than for intrinsic mortality, which was not significant (HR = 1.24 per SD at age 50, 95% CI: 0.98‒1.56). When we used an alternative measure of daily perceived severity of stress, the demographic-adjusted association appeared to be similar in magnitude, but after careful adjustment for potential confounding with health status, the association weakened and was no longer statistically significant (HR = 1.17 per SD at age 50, 95% CI: 0.99-1.37). Perceived severity was not significantly associated with either extrinsic or intrinsic mortality even at age 50. Most Americans die at older ages, where stress exposure does not appear to be significantly associated with mortality. Nonetheless, our results suggest that stress exposure is more strongly associated with midlife mortality, which has an undue influence on overall life expectancy.