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1.
Environ Pollut ; 292(Pt B): 118392, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34678392

RESUMO

The short-term effects of ambient temperature on mortality have been widely investigated. However, the epidemiological evidence on the long-term effects of temperature on mortality is rare. In present study, we conducted a nationwide quasi-experimental design, which based on a variant of difference-in-differences (DID) approach, to examine the association between long-term exposure to ambient temperature and mortality risk in China, and to analyze the effect modification of population characteristics and socioeconomic status. Data on mortality were collected from 364 communities across China during 2006-2017, and environmental data were obtained for the same period. We estimated a 2.93 % (95 % CI: 2.68 %, 3.18 %) increase in mortality risk per 1 °C decreases in annual temperature, the greater effects were observed on respiratory diseases (5.16 %, 95 % CI: 4.53 %, 5.79 %) than cardiovascular diseases (3.43 %, 95 % CI: 3.06 %, 3.80 %), and on younger people (4.21 %, 95 % CI: 3.73 %, 4.68 %) than the elderly (2.36 %, 95 % CI: 2.06 %, 2.65 %). In seasonal analysis, per 1 °C decreases in average temperature was associated with 1.55 % (95 % CI: 1.23 %, 1.87 %), -0.53 % (95 % CI: -0.89 %, -0.16 %), 2.88 % (95 % CI: 2.45 %, 3.31 %) and 4.21 % (95 % CI: 3.98 %, 4.43 %) mortality change in spring, summer, autumn and winter, respectively. The effects of long-term temperature on total mortality were more pronounced among the communities with low urbanization, low education attainment, and low GDP per capita. In total, the decrease of average temperature in summer decreased mortality risk, while increased mortality risk in other seasons, and the associations were modified by demographic characteristics and socioeconomic status. Our findings suggest that populations with disadvantaged characteristics and socioeconomic status are vulnerable to long-term exposure of temperature, and targeted policies should be formulated to strengthen the response to the health threats of temperature exposure.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Idoso , Poluentes Atmosféricos/análise , Poluição do Ar/análise , China/epidemiologia , Exposição Ambiental/análise , Humanos , Mortalidade , Estações do Ano , Temperatura
2.
Appl Ergon ; 98: 103608, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34655965

RESUMO

BACKGROUND: Failure to rescue (FTR) denotes mortality from post-operative complications after surgery with curative intent. High-volume, low-mortality units have similar complication rates to others, but have lower FTR rates. Effective response to the deteriorating post-operative patient is therefore critical to reducing surgical mortality. Resilience Engineering might afford a useful perspective for studying how the management of deterioration usually succeeds and how resilience can be strengthened. METHODS: We studied the response to the deteriorating patient following emergency abdominal surgery in a large surgical emergency unit, using the Functional Resonance Analysis Method (FRAM). FRAM focuses on the conflicts and trade-offs inherent in the process of response, and how staff adapt to them, rather than on identifying and eliminating error. 31 semi-structured interviews and two workshops were used to construct a model of the response system from which conclusions could be drawn about possible ways to strengthen system resilience. RESULTS: The model identified 23 functions, grouped into five clusters, and their respective variability. The FRAM analysis highlighted trade-offs and conflicts which affected decisions over timing, as well as strategies used by staff to cope with these underlying tensions. Suggestions for improving system resilience centred on improving team communication, organisational learning and relationships, rather than identifying and fixing specific system faults. CONCLUSION: FRAM can be used for analysing surgical work systems in order to identify recommendations focused on strengthening organisational resilience. Its potential value should be explored by empirical evaluation of its use in systems improvement.


Assuntos
Mortalidade , Complicações Pós-Operatórias , Humanos
3.
Chemosphere ; 286(Pt 1): 131615, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34303049

RESUMO

BACKGROUND: Systematic evaluations of the cumulative effects and mortality displacement of ambient particulate matter (PM) pollution on deaths are lacking. We aimed to discern the cumulative effect profile of PM exposure, and investigate the presence of mortality displacement in a large-scale population. METHODS: We conducted a time-series analysis with different exposure-lag models on 13 cities in Jiangsu, China, to estimate the effects of PM pollution on non-accidental, cardiovascular, and respiratory mortality (2015-2019). Over-dispersed Poisson generalized additive models were integrated with distributed lag models to estimate cumulative exposure effects, and assess mortality displacement. RESULTS: Pooled cumulative effect estimates with lags of 0-7 and 0-14 days were substantially larger than those with single-day and 2-day moving average lags. For each 10 µg/m3 increment in PM2.5 concentration with a cumulative lag of 0-7 days, we estimated an increase of 0.50 % (95 % CI: 0.29, 0.72), 0.63 % (95 % CI: 0.38, 0.88), and 0.50 % (95 % CI: 0.01, 1.01) in pooled estimates of non-accidental, cardiovascular, and respiratory mortality, respectively. Both PM10 and PM2.5 were associated with significant increases in non-accidental and cardiovascular mortality with a cumulative lag of 0-14 days. We observed mortality displacement within 30 days for non-accidental, cardiovascular, and respiratory deaths. CONCLUSIONS: Our findings suggest that risk assessment based on single-day or 2-day moving average lag structures may underestimate the adverse effects of PM pollution. The cumulative effects of PM exposure on non-accidental and cardiovascular mortality can last up to 14 days. Evidence of mortality displacement for non-accidental, cardiovascular, and respiratory deaths was found.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Doenças Cardiovasculares , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Humanos , Mortalidade , Material Particulado/análise , Material Particulado/toxicidade
4.
J Environ Manage ; 301: 113751, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34628283

RESUMO

Heat-related mortality is one of the leading causes of weather-related deaths in the United States. With changing climates and an aging population, effective adaptive strategies to address public health and environmental justice issues associated with extreme heat will be increasingly important. One effective adaptive strategy for reducing heat-related mortality is increasing tree cover. Designing such a strategy requires decision-support tools that provide spatial and temporal information about impacts. We apply such a tool to estimate spatially and temporally explicit reductions in temperature and mortality associated with a 10% increase in tree cover in 10 U.S. cities with varying climatic, demographic, and land cover conditions. Two heat metrics were applied to represent tree impacts on moderately and extremely hot days (relative to historical conditions). Increasing tree cover by 10% reduced estimated heat-related mortality in cities significantly, with total impacts generally greatest in the most populated cities. Mortality reductions vary widely across cities, ranging from approximately 50 fewer deaths in Salt Lake City to about 3800 fewer deaths in New York City. This variation is due to differences in demographics, land cover, and local climatic conditions. In terms of per capita estimated impacts, hotter and drier cities experience higher percentage reductions in mortality due to increased tree cover across the season. Phoenix potentially benefits the most from increased tree cover, with an estimated 22% reduction in mortality from baseline levels. In cooler cities such as Minneapolis, trees can reduce mortality significantly on days that are extremely hot relative to historical conditions and therefore help mitigate impacts during heat wave conditions. Recent studies project highest increases in heat-related mortality in the cooler cities, so our findings have important implications for adaptation planning. Our estimated spatial and temporal distributions of mortality reductions for each city provide crucial information needed for promoting environmental justice and equity. More broadly, the methods and model can be applied by both urban planners and the public health community for designing targeted, effective policies to reduce heat-related mortality. Additionally, land use managers can use this information to optimize tree plantings. Public stakeholders can also use these impact estimates for advocacy.


Assuntos
Temperatura Alta , Árvores , Cidades , Mortalidade , Saúde Pública , Estações do Ano , Estados Unidos
5.
Environ Pollut ; 292(Pt B): 118396, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34688723

RESUMO

A growing number of studies report associations between air pollution and COVID-19 mortality. Most were ecological studies at the county or regional level which disregard important local variability and relied on data from only the first few months of the pandemic. Using COVID-19 deaths identified from death certificates in California, we evaluated whether long-term ambient air pollution was related to weekly COVID-19 mortality at the census tract-level during the first ∼12 months of the pandemic. Weekly COVID-19 mortality for each census tract was calculated based on geocoded death certificate data. Annual average concentrations of ambient particulate matter <2.5 µm (PM2.5) and <10 µm (PM10), nitrogen dioxide (NO2), and ozone (O3) over 2014-2019 were assessed for all census tracts using inverse distance-squared weighting based on data from the ambient air quality monitoring system. Negative binomial mixed models related weekly census tract COVID-19 mortality counts to a natural cubic spline for calendar week. We included adjustments for potential confounders (census tract demographic and socioeconomic factors), random effects for census tract and county, and an offset for census tract population. Data were analyzed as two study periods: Spring/Summer (March 16-October 18, 2020) and Winter (October 19, 2020-March 7, 2021). Mean (standard deviation) concentrations were 10.3 (2.1) µg/m3 for PM2.5, 25.5 (7.1) µg/m3 for PM10, 11.3 (4.0) ppb for NO2, and 42.8 (6.9) ppb for O3. For Spring/Summer, adjusted rate ratios per standard deviation increase were 1.13 (95% confidence interval: 1.09, 1.17) for PM2.5, 1.16 (1.11, 1.21) for PM10, 1.06 (1.02, 1.10) for NO2, and 1.09 (1.04, 1.14) for O3. Associations were replicated in Winter, although they were attenuated for PM2.5 and PM10. Study findings support a relation between long-term ambient air pollution exposure and COVID-19 mortality. Communities with historically high pollution levels might be at higher risk of COVID-19 mortality.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , COVID-19 , Poluentes Atmosféricos/análise , Poluição do Ar/análise , California/epidemiologia , Exposição Ambiental , Humanos , Mortalidade , Dióxido de Nitrogênio/análise , Material Particulado/análise , SARS-CoV-2
6.
Infectio ; 25(4): 262-269, oct.-dic. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1286720

RESUMO

Abstract Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection by COVID-19 in 5 Colombian institutions. Materials and methods: Is a retrospective observational study of consecutive hospitalized patients with a diagnosis of COVID-19 confirmed from March 01 to May 30, 2020 in Colombia. Results: A total of 44 patients were included. The median age was 62 years. 43.2% had a history of smoking, while 69.8% were overweight or obese. 88.6% had at least one comorbidity and 52.3% had three or more comorbidities. Hypertension and dyslipidaemia were the most frequent comorbidities (40.9% and 34.1%, respectively). The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome occurred in the 36.4%. The biomarkers associated with mor tality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Conclusions: The clinical course of SARS-CoV-2 infection in hospitalized Colombian was characterised by a more advanced stage of the infection.


Resumen Objetivo: Analizar las características, clínicas, factores de riesgo, y la evolución de pacientes hospitalizados con infección confirmada por COVID-19 en 5 Institu ciones de Colombia. Material y método: Es un estudio observacional retrospectivo de pacientes consecutivos hospitalizados con diagnóstico de COVID-19 confirmado entre 01 de Febrero de 2020 y 30 de Mayo de 2020 en Colombia. Resultados: Un total de 44 pacientes fueron incluidos. La mediana de edad fue de 62 años y la mayoría del sexo masculino. El 43.2% tenían historia de tabaquismo, mientras que el 69.8% tenían sobrepeso u obesidad. El 88.6% tenían al menos una comorbilidad y el 52.3% tenían tres o más comorbilidades. La hipertensión arterial fue la comorbilidad más frecuente (40.9%), seguido de la dislipidemia (34.1%). La tasa de letalidad a 30 días fue de 47.7% y ocurrió con una mediana de 11 días. El 36.4% presentó el desenlace compuesto. Los biomarcadores asociados con el riesgo de muerte fue troponina > 14 ng/mL (RR:5.25, IC95% 1.37-20.1, p=0.004) y dímero D mayor a 1000 mg/dL (RR: 3.0, IC95% 1.4-6.3, p=0.008). Conclusiones: El curso clínico de la infección por SARS-CoV-2 en colombianos hospitalizados fue un estadio más avanzado de la infección.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Biomarcadores , COVID-19 , Pacientes , Tabagismo , Comorbidade , Risco , Fatores de Risco , Mortalidade , Colômbia , Sobrepeso , Cursos , Infecções , Obesidade
7.
Infectio ; 25(4): 212-240, oct.-dic. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1286716

RESUMO

Abstract Intra-abdominal infections are frequent at all levels of health care, therefore, it is necessary to maintain a high level of clinical suspicion, performing the fastest and most cost-effective measures to confirm the diagnosis and offer a precise and targeted multidisciplinary therapy, this being the only way to have an impact on the morbidity of this infection, reducing mortality and minimizing the complications and costs of health care. Intra-abdominal infections are linked to the appearance and selection of resistant mutants in both bacteria and fungi, becoming currently a major public health problem. Increasing bacterial resistance when associated with a greater possibility of difficulties in antimicrobial treatment increases mortality. This evidence-based consensus brings together the recommendations for the diagnosis and treatment of intra-abdominal infections in the pediatric and adult population. With strict monitoring of bacterial resistance and stimulating the control of the risk factors that have the greatest impact on the appearance of this phenomenon, this consensus is intended to be a practical guide that is easy to implement, and with periodic updates it will favor and facilitate multidisciplinary and the adequacy of the therapeutic management of intra-abdominal infections.


Resumen Las infecciones intrabdominales son frecuentes en todos los niveles de atención en salud, por ende, es necesario mantener un alto nivel de sospecha clínica, realizando las medidas más rápidas y costoefectivas para confirmar el diagnóstico y así ofrecer de una forma precisa y dirigida la terapéutica multidisciplinaria, siendo esta la única manera de tener impacto en la morbilidad de esta infección, disminuyendo la mortalidad y minimizando las complicaciones y los costos de la atención en salud. Las infecciones intrabdominales se encuentran ligadas a la aparición y selección de las mutantes resistentes tanto en las bacterias como en los hongos, convirtiéndose en la actualidad en una gran problemática en la salud pública. La creciente resistencia bacteriana al asociarse a mayor posibilidad de dificultades en el tratamiento antimicrobiano incrementa la mortalidad. Este consenso basado en la evidencia, reúne las recomendaciones en el diagnóstico y en el tratamiento de las infecciones intrabdominales en la población pediátrica y de adultos. Con un estricto seguimiento de la resistencia bacteriana y estimulando el control de los factores de riesgo que tienen mas impacto en la aparición de este fenómeno, este consenso pretende ser una practica guía de fácil implementación, y con periódicas actualizaciones favorecerá y facilitará el manejo multidisciplinario y la adecuación del manejo terapéutico de las infecciones intrabdominales.


Assuntos
Humanos , Criança , Adulto , Infecções Intra-Abdominais , Peritonite , Bactérias , Fatores de Risco , Mortalidade , Colômbia , Sepse , Atenção à Saúde , Infecções , Antibacterianos
8.
Infectio ; 25(4): 207-211, oct.-dic. 2021. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1286715

RESUMO

Resumen Objetivo: Describir la proporción, características clínicas, demográficas y programáticas de casos fatales de coinfección TB/VIH de Cali-Colombia, en 2017. Material y Método: Estudio de corte transversal, con información de las bases de datos del programa de tuberculosis, las historias clínicas y unidades de análisis de mortalidad disponibles. Resultados: Se depuraron 257 casos fatales por TB, el 24,5% (63/257) falleció con coinfección TB/VIH. La mediana de edad fue 43 años (Rango Intercuartílico: 30-52), 73% (46/63) eran hombres, 76,2% (48/63) no pertenecían al régimen contributivo, 28,6% eran habitantes de calle. 81,2% (39/48) eran casos nuevos de TB, 76,6% (37/47), inició tratamiento; al 74,6% (47/63) se les realizó unidad de análisis de mortalidad. La presentación pulmonar fue frecuente (75,9%-44/58), en 60% de los registros se observó desnutrición (Índice de Masa Corporal <20), en 39,7% (25/63) dependencia al alcohol, tabaco o farmacodependencia. Conclusiones: La mortalidad asociada a TB/VIH es prevenible, pero en 2017 representó la cuarta parte de la mortalidad por TB en Cali. Hombres adultos con condiciones de vulnerabilidad social, diagnosticados en estados avanzados de enfermedad, fueron blanco de fatalidad. Mejorar los sistemas de información e integrar los programas de TB/VIH, deben ser estrategias prioritarias para la salud pública en Colombia.


Abstract Objective: To describe the proportion, clinical, demographic and programmatic characteristics of fatal cases of TB/HIV coinfection from Cali-Colombia, in 2017. Material and Method: Cross-sectional study, with information from the TB program databases, clinical records and mortality analysis units available. Results: 257 TB fatal cases were cleared in Cali in 2017, 24.5% (63/257) of these died with TB/HIV coinfection. The median age was 43 years (Interquartile Range: 30-52), 73% (46/63) were men, 76.2% (48/63) did not belong to the contributory health regimen, 28.6% were homeless. 81.2% (39/48) were new TB cases, 76.6% (37/47) started treatment; 74.6% (47/63) had mortality analysis register. Pulmonary presentation was frequent (75.9% -44 / 58), in 60% of the registries malnutrition was observed (Body Mass Index <20), in 39.7% (25/63), dependence on alcohol, tobacco or drug dependence was registered. Conclusions: Mortality associated with TB/HIV is preventable, but in 2017 it represented a quarter of the TB mortality in Cali. Adult men with conditions of social vulnerability, diagnosed in advanced stages of disease, were fatally targeted. Improving information systems and integrating TB/HIV programs should be priority strategies for public health in Colombia.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Tuberculose , HIV , Índice de Massa Corporal , Infecções por HIV , Saúde Pública , Estudos Transversais , Mortalidade , Estratégias de Saúde , Colômbia , Vulnerabilidade Social , Desnutrição
9.
BMC Health Serv Res ; 21(1): 1197, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34736434

RESUMO

BACKGROUND: Government responses to the pandemic varied in terms of timing, duration, and stringency, seeking to protect healthcare systems, whose pre-pandemic state varied significantly. Therefore, the severity of Covid-19 and, thus, excess mortality have been unequal across counties. This paper explores the geography of excess mortality and its underlying factors in 2020, highlighting the effects of health policies pre-pandemic and strategies devised by governments to cope with Covid-19. METHODS: Excess mortality is estimated for 79 high, medium and low-income countries. The factors of excess mortality are examined employing median quantile regression analysis. RESULTS: Health privatization, healthcare underfunding, and late implementation of containment and mitigation strategies were powerful drivers of excess mortality. By contrast, the results suggest a negative association of excess mortality with health expenditure, number of doctors and hospital beds, share of population covered by health insurance and test and trace capacity. CONCLUSIONS: The evidence highlights the importance of sufficiently funded healthcare systems with universal access and strong primary healthcare in the battle against the pandemic. An early response to Covid-19, including borders' controls and a strong test and trace capacity, could improve epidemiological surveillance and minimize excess mortality, with stringent and lengthy lockdowns not providing a significant benefit.


Assuntos
COVID-19 , Mortalidade , Pandemias , Controle de Doenças Transmissíveis , Atenção à Saúde , Acesso aos Serviços de Saúde , Humanos , Atenção Primária à Saúde
10.
Bull World Health Organ ; 99(11): 758-759, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34737467

RESUMO

A consensus is building around the value of systemic approaches to collision prevention. In Latin America, cities are beginning to take heed. Gary Humphreys reports.


Assuntos
Acidentes de Trânsito/prevenção & controle , Cidades , Humanos , América Latina/epidemiologia , Mortalidade
11.
Rev Saude Publica ; 55: 61, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34730747

RESUMO

OBJECTIVES: To analyze the behavior of mortality from diabetes mellitus (DM) for both sexes in Mexico from 1998 to 2018, and its impact on life expectancy (LE) from 60 to 85 years of age in the three-year periods 1998-2000 and 2016-2018, compared with other causes of death, as well as to determine the loss of years of life expectancy associated with DM in each three-year period. METHODS: The current study is observational and descriptive. Age-adjusted rates of mortality from DM were calculated for each sex from 1998 to 2018. Sex-specific life tables were constructed for 1998-2000 and 2016-2018, and both LE between 60 and 85 years, and years of life expectancy lost (YLELL) due to DM and selected causes between both ages were calculated. RESULTS: Between 1998 and 2018, the adjusted DM-resulting male mortality rate grew 55% in the population aged 60 and over, while the female mortality rate grew 20%. Between 1998-2000 and 2016-2018, male LE for 60-85 age group decreased 0.22 years, while female LE increased 0.24. In 2016-2018, DM was responsible for 1.30 YLEL among men of 60 to 85 years (19% of the total YLEL), and 1.24 YLEL for women (24% of the total), more than the other causes analyzed. CONCLUSIONS: The increase in mortality from DM has substantially contributed both to reduce LE of older adult men, and to slow the increase of LE among women aged 60 years and older so far this century. Thus, preventive policies should be implemented since early ages to reduce the high levels of overweight and obesity in the country and, therefore, the significant population ratio suffering from DM.


Assuntos
Diabetes Mellitus , Expectativa de Vida , Idoso , Brasil , Causas de Morte , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Lactente , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Sobrepeso
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(8): 1420-1428, 2021 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814563

RESUMO

Objective: To understand the geographical variations and temporal trends of all-cause mortality rate and life expectancy in China at national and subnational levels during 2005-2018. Methods: Using data from National Cause-of-death Reporting System, China National Maternal and Child Health Surveillance System, Under-reporting Surveys, and related social determinants covariates, we estimated all-cause mortality rate and life expectancy at national and subnational levels in China during 2005-2018. We depicted the geographical variations and temporal trends between provinces on mortality rate and life expectancy. We then decomposed changes in national and subnational deaths into three explanatory components: change due to age-specific mortality rate, change due to the population structure by age, and change due to growth of the total population. Results: In 2018, it was estimated that there were 10 482 297 total deaths (95%CI: 9 723 233-11 466 875 deaths) in China, with 6 113 926 men (95%CI: 5 773 158-6 572 407 men) and 4 368 241 women (95%CI: 3 950 075-4 894 468 women). The all-cause mortality rate was 755.54 per 100 000 (95%CI: 701.49 per 100 000-825.78 per 100 000), with 861.78 per 100 000 (95%CI: 813.75 per 100 000-926.40 per 100 000) in men and 642.73 per 100 000 (95%CI: 581.20 per 100 000-720.15 per 100 000) in women, while age-standardized all-cause mortality rate was 652.27 per 100 000 (95%CI: 599.22 per 100 000-721.71 per 100 000), with 806.38 per 100 000 (95%CI: 755.10 per 100 000-874.31 per 100 000) in men and 503.37 per 100 000 (95%CI: 450.50 per 100 000-572.01 per 100 000) in women. In 2018, it was estimated that the life expectancy in the whole country was 77.15 years old (95%CI: 75.92-78.11 years old), with 74.81 (95%CI: 73.57-75.76) in men and 79.87 (95%CI: 78.61-80.91) in women. Developed areas as Shanghai, Beijing, Jiangsu, and Zhejiang owned comparatively higher life expectancy, while undeveloped areas like Tibet, Guizhou, Xinjiang, and Qinghai showed lower levels. During 2005-2018, there was a 29.87% increase in total deaths at the national level, with 27.74% in men and 31.29% in women. Changes due to age-specific mortality rate, the population structure by age, and the growth of the total population constituted -35.74%, 7.34%, and 58.28% of the total increase, respectively. Conclusions: From 2005 to 2018, the all-cause mortality rate increased while the age-standardized mortality rate decreased substantially among Chinese residents. Change due to population structure by age was the dominant driver. An upward trend of life expectancy was observed in all provinces, with marked differences between the provinces.


Assuntos
Expectativa de Vida , Mortalidade , Idoso , Causas de Morte , Criança , China/epidemiologia , Feminino , Geografia , Humanos , Masculino , Tibet
13.
Int J Chron Obstruct Pulmon Dis ; 16: 2973-2981, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744434

RESUMO

Background: To examine trends in chronic obstructive pulmonary disease (COPD) mortality and years of life lost (YLL) due to COPD for all provinces in China during 2005-2020. Methods: Data for COPD mortality were derived from China National Mortality Surveillance System (NMSS). We analyzed the numbers and age-standardized rates of death and YLL due to COPD in China, during 2005-2020. We carried out decomposition analysis to analyze the drivers of change in COPD deaths during the study period. Results: The age-standardized mortality rate of COPD in China decreased significantly from 99.5/100,000 in 2005 to 50.5/100,000 in 2020. Similar trend was seen in the age-standardized YLL rate. The mortality rate increased with age. During 2005-2020, the age-standardized mortality rate decreased in all provinces (except for Tibet) with the largest decline in Jilin (-77.8%), Henan (-68.4%) and Fujian (-67.1%). The decreased number of deaths was decomposed as population growth (8.5%) and population ageing (69.7%) with offset by decline of age-specific mortality (-87.5%). Conclusion: COPD remains an important public health problem in China, though significant reductions of COPD mortality and YLL rate were observed. Vigorous prevention and control strategies should be enhanced to improve the quality of life of COPD patients and reduce the premature death caused by COPD in Chinese population.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Envelhecimento , China/epidemiologia , Humanos , Mortalidade , Mortalidade Prematura , Doença Pulmonar Obstrutiva Crônica/diagnóstico
14.
Crit Care ; 25(1): 382, 2021 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749756

RESUMO

BACKGROUND: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. METHODS: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. RESULTS: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. CONCLUSIONS: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.


Assuntos
COVID-19/epidemiologia , Estado Terminal/epidemiologia , Pessoas com Deficiência , Recuperação de Função Fisiológica/fisiologia , Retorno ao Trabalho/tendências , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , COVID-19/diagnóstico , COVID-19/terapia , Estudos de Coortes , Estado Terminal/terapia , Feminino , Seguimentos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Ann Palliat Med ; 10(10): 11035-11052, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763466

RESUMO

BACKGROUND: Fundamental transformations in overall population health have occurred in the past five decades and are continuing. Our aim in this study was to characterize the trends in population mortality rates in the United States (U.S.) from 1969 to 2017. METHODS: Data on the 109,836,044 deaths registered in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed by sex, race and ethnicity, and age. Temporal trends in population mortality rates were examined from 1969 to 2017. All data analyses were performed using the SEER*Stat software. RESULTS: The overall mortality rate for males and females in the U.S. per 100,000 population fell by 46.1% and 39.3%, from 1,610.0 and 1,019.3 in 1969 to 867.2 and 619.2 in 2017, respectively. This decline in overall mortality was mainly attributable to a decrease in mortality caused by heart and cerebrovascular diseases. From 1969 to 2017, the overall mortality rate was higher in males than females, and in blacks than whites for both sexes. From 1979 to 2017, the mortality rates of heart diseases, cerebrovascular diseases, and diabetes were all higher in blacks than in whites for both sexes. CONCLUSIONS: The results indicate that the U.S. has dramatically reduced its overall annual mortality rate between 1969 and 2017; however, the disparities among different races are still apparent.


Assuntos
Grupo com Ancestrais do Continente Europeu , Cardiopatias , Bases de Dados Factuais , Grupos Étnicos , Feminino , Humanos , Masculino , Mortalidade , Estados Unidos/epidemiologia
16.
Cien Saude Colet ; 26(10): 4483-4496, 2021 Oct.
Artigo em Português | MEDLINE | ID: mdl-34730637

RESUMO

In 2020, the 30th anniversary of the publication of the Organic Laws of the Unified Health System was celebrated. Since then, the change in the profile of morbidity and mortality has been a challenge to management to ensure that the health services can attend the significant heterogeneity of approximately 6,000 municipalities. To achieve this, it is necessary to monitor the leading indicators of the country. The scope of this study was to present an overview of trends in mortality and morbidity in Brazil between 1990 and 2019. Data from the Study on the Global Burden of Disease was used to describe morbidity and mortality by major groupings (infectious diseases, chronic diseases, and external causes), according to gender and age groups. There was a reduction in morbidity and mortality in the period, irrespective of the cause or age group, albeit with a varied difference between the sexes depending on the cause. The contribution of chronic diseases increases with age, with a marked difference according to gender. The curves for mortality and years lost due to disability have a typical profile, with a different pattern of curves for men due to external causes, with marked excess mortality at young ages. The trend confirms the decline of indicators in a linear manner over the period.


Assuntos
Aniversários e Eventos Especiais , Doenças Transmissíveis , Brasil/epidemiologia , Causas de Morte , Humanos , Masculino , Morbidade , Mortalidade
17.
Cien Saude Colet ; 26(10): 4795-4804, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34730664

RESUMO

The objective of this study was to analyze the temporal trend of suicide mortality in women in the states of Northeastern Brazil. This is an ecological study of a time series stratified by states in Northeast Brazil from 1996 to 2018, with data extracted from the Mortality Information System (SIM). The temporal trend was evaluated by negative binomial regression (p values≤0.05). There was a higher proportion of deaths in black and brown women (73.9%), single (57.3%), with the place of death occurring in the home (53.4%). Hanging and strangulation stood out as the perpetration means (47.6%). Most states showed an upward temporal trend, except for Pernambuco, Rio Grande do Norte, Sergipe and Maranhão, which showed a steady trend (p>0.05). An upward temporal trend was identified in the analysis of deaths by suicide in women in five states in northeastern Brazil between 1996 and 2018. The information presented can support planning and decision-making for the prevention of suicide among women in northeastern Brazil.


Assuntos
Suicídio , Asfixia , Brasil/epidemiologia , Feminino , Humanos , Sistemas de Informação , Mortalidade
18.
Rev Saude Publica ; 55: 67, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34730748

RESUMO

OBJECTIVES: To analyze the magnitude of changes in the incidence and mortality from cervical cancer (CC) and breast cancer (BC) in Campinas, São Paulo State, between the five-year periods of 1991-1995 and 2010-2014. METHODS: data on cancer were obtained from the Campinas Population-Based Cancer Registry and data on deaths from the Mortality Information System of the Computing Department of the Unified Health System. Age-standardized incidence and mortality rates were calculated by the direct method, with the respective 95% confidence intervals. The magnitude of the changes was measured by the rate ratio (rate ratio; 95%CI). RESULTS: among the periods studied, there was a threefold increase in the detection rate of in situ CC (3.03; 95%CI: 2.64-3.47) and fivefold increase for in situ BC (5.23; 95%CI: 4.98-5.50). The proportion of cases of in situ BC in relation to the total number of cases of BC increased from 3.31% to 11.05%. The incidence rate of invasive CC decreased by 57% (0.43; 95%CI: 0.40-0.47), and the incidence rate of invasive BC increased by 40% (1.40; 95%CI: 1.33-1.47). The mortality rate of the CC decreased by 58% (0.42; 95%CI: 0.32-0.56), and that of BC by 15% (0.85; 95%CI: 0.82-0.89). CONCLUSION: the incidence of in situ carcinomas of CC and BC increased in almost two decades. The rate of invasive carcinoma of CC decreased, and that of BC increased. Mortality from both cancers decreased. Observing these changes is useful for assessing the impact of the actions carried out in the period and for planning future actions.


Assuntos
Neoplasias da Mama , Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Brasil/epidemiologia , Neoplasias da Mama/epidemiologia , Feminino , Humanos , Incidência , Mortalidade , Sistema de Registros , Neoplasias do Colo do Útero/epidemiologia
19.
Rev Saude Publica ; 55: 71, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34730751

RESUMO

OBJECTIVE: To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil. METHODS: Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model. RESULTS: Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups. CONCLUSION: There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.


Assuntos
COVID-19 , Neoplasias , Brasil/epidemiologia , Causas de Morte , Pré-Escolar , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Mortalidade , SARS-CoV-2
20.
Rev Saude Publica ; 55: 72, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34755823

RESUMO

OBJECTIVE: Estimate the effect of age, period, and birth cohort on mortality from oral and oropharyngeal cancer in Brazil and its macro-regions. METHODS: Deaths from oral and oropharyngeal cancer from 1983 to 2017 were analyzed. The Poisson regression model was applied, using estimable functions proposed by Holford. RESULTS: From 1983 to 2017, 142,634 deaths from oral and oropharyngeal cancer were registered in Brazil, 81% among men, and the South and Southeast regions had the highest rates. The most significant period effects were observed in male mortality in the Southeast and Central-West regions for the 2003-2007 reference period. In the North, Northeast, and Central-West regions, an increased risk of mortality was observed in the most recent male cohorts. In the North region, the most significant risk identified was for men born during 1973-1977 (RR = 1.47; 95%CI 1.05-2.08); in the Northeast, for men born during 1988-1992 (RR = 2.77; 95%CI 1.66-4.63); and in the Central-West, for women born during 1973-1977 (RR = 2.01; 95%CI 1.19-3.39). In the Southeast and South regions, the most recent cohorts had lower mortality rates. The lowest risk in the Southeast region was observed in the male cohort born during 1978-1982 (RR = 0.53; 95%CI 0.45-0.62) and 1983-1987 in the South region (RR = 0.25; 95%CI 0.12-0.54). CONCLUSIONS: Age had a significant effect on mortality from oral and oropharyngeal cancer in all regions. In the North, Northeast, and Central-West regions, an increase in risk was observed in the most recent cohorts, while in the South and Southeast regions, these cohorts presented a lower risk when compared to the older cohorts.


Assuntos
Neoplasias Orofaríngeas , Fatores Etários , Brasil/epidemiologia , Efeito de Coortes , Estudos de Coortes , Feminino , Humanos , Masculino , Mortalidade
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