Voting is a stronger determinant of mortality than education: a full-electorate survival analysis with 21-year follow-up.

BackgroundLife expectancy at birth in the United States will likely surpass 80 years in the coming decade. Yet recent studies suggest that longevity gains are unevenly shared across age and socioeconomic groups. First, mortality in midlife has risen among non-Hispanic whites. Second, low-educated whites have suffered stalls (men) or declines (women) in adult life expectancy, which is significantly lower than among their college-educated counterparts. Estimating the number of life years lost or gained by age and cause of death, broken down by educational attainment, is crucial in identifying vulnerable populations.Methods and FindingsUsing U.S. vital statistics data from 1990 to 2010, this study decomposes the change in life expectancy at age 25 by age and cause of death across educational attainment groups, broken down by race and gender. The findings reveal that mortality in midlife increased for white women (and to a lesser extent men) with 12 or fewer years of schooling, accounting for most of the stalls or declines in adult life expectancy observed in those groups. Among blacks, mortality declined in nearly all age and educational attainment groups. Although an educational gradient was found across multiple causes of death, between 60 and 80 percent of the gap in adult life expectancy was explained by cardiovascular diseases, smoking-related diseases, and external causes of death. Furthermore, the number of life years lost to smoking-related, external, and other causes of death increased among low- and high school-educated whites, explaining recent stalls or declines in longevity.ConclusionsLarge segments of the American population—particularly low- and high school-educated whites under age 55—are diverging from their college-educated counterparts and losing additional years of life to smoking-related diseases and external causes of death. If this trend continues, old-age mortality may also increase for these birth cohorts in the coming decades.

Exactitud de las estadísticas de mortalidad por causas externas y naturales con intervención médico-legal en Cataluña, 1996

BackgroundMany injury deaths are related to the environment. This study examined the impact of ambient temperature on external causes of death in Yunnan Province.MethodsData on external causes of death and...

Background:Although substantial evidence suggests that high and low temperatures are adversely associated with nonaccidental mortality, few studies have focused on exploring the risks of temperature on external causes of death.Objectives:We investigated the short-term associations between temperature and external causes of death and four specific categories (suicide, transport, falls, and drowning) in 47 prefectures of Japan from 1979 to 2015.Methods:We conducted a two-stage meta-regression analysis. First, we performed time-stratified case-crossover analyses with a distributed lag nonlinear model to examine the association between temperature and mortality due to external causes for each prefecture. We then used a multivariate meta-regression model to combine the association estimates across all prefectures in Japan. In addition, we performed stratified analyses for the associations by sex and age.Results:A total of 2,416,707 external causes of death were included in the study. We found a J-shaped exposure–response curve for all external causes of death, in which the risks increased for mild cold temperatures [20th percentile; relative risk (95% confidence interval [CI]: 1.05,1.12)] and extreme heat [99th percentile; (95% CI: 1.20, 1.29)] compared with those for minimum mortality temperature (MMT). However, the shapes of the exposure–response curves varied according to four subcategories. The risks of suicide and transport monotonically increased as temperature increased, with RRs of 1.35 (95% CI: 1.26, 1.45) and 1.60 (95% CI: 1.35, 1.90), respectively, for heat, whereas J- and U-shaped curves were observed for falls and drowning, with RRs of 1.14 (95% CI: 1.03, 1.26) and 1.95 (95% CI: 1.70, 2.23) for heat and 1.13 (95% CI: 1.02, 1.26) and 2.33 (95% CI: 1.89, 2.88) for cold, respectively, compared with those for cause-specific MMTs. The sex- and age-specific associations varied considerably depending on the specific causes.Discussion:Both low and high temperatures may be important drivers of increased risk of external causes of death. We suggest that preventive measures against external causes of death should be considered in adaptation policies. https://doi.org/10.1289/EHP9943

Impact of prison security level on mortality

Trends in external causes of deaths in the Baltic States--Estonia, Latvia and Lithuania--were analysed against the background of turbulent political, social and economic changes. The reliability of mortality statistics concerning external causes of death in these countries is considered to be good. This study is based on data published by the statistical offices of the three Baltic States and on data obtained through interviews with personnel employed at the national statistical offices. The study period was divided, by socio-political and economic factors, into a period of stagnation (1970-1984) and a period of reforms (1985-1997). During 1970-1984 a stable slightly upward trend of external causes of death rates was observed. The curve became S-shaped in the reform period: between 1984 and 1988 a marked decrease occurred followed by a rapid increase of rates until 1994, and then by 1997 a fall to the approximate level of 1984. The male to female ratio of external causes of death was between 3.4:1 and 4.2:1. External deaths accounted for 10% to 14% of all deaths before 1984. During the period 1984-1988 the proportion of external deaths was under 10% and peaked in 1994 at 16%. Fluctuations in the trends of external death were more pronounced among males than females in all Baltic countries. Trends in external causes of death were similar in Baltic States. High proportions of violent death decreased life-expectancy for both sexes, but markedly for males. Social stresses and alcohol consumption could be considered as factors influencing the mortality rates and specific fluctuations in trends of external death, especially among males.

Although empirical data suggest a possible link between female reproductive events and risk of nonfatal accidents and suicidal behaviors, evidence to determine these effects on mortality is scarce. This study investigated the association between female reproductive factors and the risk of external causes of death among middle-aged Japanese women. We used a population-based cohort study consisting of 71 698 women residing in 11 public health center areas across Japan between 1990 and 1994. Multivariable-adjusted Cox proportional hazard regression models were used to estimate hazard ratios (HRs) of the risk of all external causes, suicide, and accidents according to female reproductive factors at the baseline survey. During 1 028 583 person-years of follow-up for 49 279 eligible subjects (average 20.9 years), we identified 328 deaths by all injuries. Among parous women, ever versus never breastfeeding [0.67 (95% CI: 0.49–0.92)] was associated with a decreased risk of all injuries. Risk of suicide was inversely associated with ever versus never parity [0.53 (95% CI: 0.32–0.88)]. A lower risk of death by accidents was seen in ever breastfeeding [0.63 (95% CI: 0.40–0.97)] compared to never breastfeeding. This study suggests that parity and breastfeeding are associated with reduced risk of death by all external causes, suicide and/or accidents among Japanese women.

BackgroundWe present a method for reclassifying external causes of death categorized as “event of undetermined intent” (EUIs) into non-transport accidents, suicides, or homicides. In nations like Russia and the UK the absolute number of EUIs is large, the EUI death rate is high, or EUIs comprise a non-trivial proportion of all deaths due to external causes. Overuse of this category may result in (1) substantially underestimating the mortality rate of deaths due to specific external causes and (2) threats to the validity of studies of the patterns and causes of external deaths and of evaluations of the impact of interventions meant to reduce them.MethodsWe employ available characteristics about the deceased and the event to estimate the most likely cause of death using multinomial logistic regression. We use the set of known non-transport accidents, suicides, and homicides to calculate an mlogit-based linear score and an estimated classification probability (ECP). This ECP is applied to EUIs, with varying levels of minimal classification probability. We also present an optional second step that employs a population-level adjustment to reclassify deaths that remain undetermined (the proportion of which varies based on the minimal classification probability). We illustrate our method by applying it to Russia. Between 2000 and 2011, 521,000 Russian deaths (15 % percent of all deaths from external causes) were categorized as EUIs. We used data from anonymized micro-data on the ~3 million deaths from external causes. Our reclassification model used 10 decedent and event characteristics from the computerized death records.ResultsResults show that during this period about 14 % of non-transport accidents, 13 % of suicides, and 33 % of homicides were officially categorized as EUIs. Our findings also suggest that 2011 levels of non-transport accidents and suicides would have been about 24 % higher and of homicide about 82 % higher than that reported by official vital statistics data.ConclusionsOveruse of the external cause of death classification “event of undetermined intent” may indicate questionable quality of mortality data on external causes of death. This can have wide-ranging implications for families, medical professionals, the justice system, researchers, and policymakers. With our classification probability set as equal to or higher than 0.75, we were able to reclassify about two-thirds of EUI deaths in our sample. Our optional additional step allowed us to redistribute the remaining unclassified EUIs. Our method can be applied to data from any nation or sub-national population in which the EUI category is employed.

The article analyzes the structure of forensic medical examinations of persons older than working age and its change during the period of improving social and economic conditions in the country. Persons whose causes of death are determined by forensic medical examination are considered as a deviant group of people who did not adapt to changing socio-cultural conditions and to age changes. This is manifested in the causes and circumstances of death (external causes, death at home without witnesses, death on street or in hospital without examination). The information on 72 324 forensic examinations of elderly residents in the Nizhny Novgorod oblast for 2003–2017 is analyzed. It is done in terms of sex, residency in the oblast center or in rural areas, and age group (advanced age: 60–74 years for men and 55–74 years for women; senile age: 75–84 years; age of longevity: 85 years and older). It is shown that the size of the deviant group of retirees is increasing, and this increase is not a consequence only of the population aging. The contribution of loneliness to the formation of the deviant group exceeds the contribution of socioeconomic disadvantages: no correlation is found between the frequency of forensic examinations and the mortality from causes related to alcohol; from 2003 to 2017, the share of external causes of death and the proportion of corpses taken for examination from the street decreased. The structure of external and somatic causes of death of persons older than working age that are established during forensic medical research is determined by age, place of residence, as well as social and economic situations in the oblast, which changed over the period studied in direction of reducing differences.

Background Observing drug-related deaths in Slovenia in the last years we have seen more and more combined suicides; with combination of illicit drugs or medicinal drugs taken in toxic or lethal concentrations and an external cause of death that is not poisoning. Methods In the case study we studied 4 cases of combined suicides in 2018, with combination of illicit drugs taken and an external cause of death that is not poisoning. Those deaths occurred among drug users shortly after the consumption of the substances, when drug(s) had reached toxic or lethal concentrations in their body in combination with external cause of death that is not poisoning. We examined forensic reports and toxicology analyses, involvement in treatment of drug addiction and hospital treatments. Results We will present 3 case reports of combined suicides, according to basic demographic characteristics, illicit drugs profile, external cause of death, history of treatment of drug addiction and hospital treatments. Conclusions Drug-related deaths are becoming increasingly complex and require consideration about the extension of the methodology to determine the cause of death. Cases of combined suicides pose a dilemma of the primary cause of death. Key messages Drug-related deaths are becoming increasingly complex. Trend of combined suicides; with combination of illicit drugs or medicinal drugs taken in toxic or lethal concentrations and an external cause of death that is not poisoning.

Mortality in Russia

Mortality in treatment-resistant unipolar depression: A register-based cohort study in Sweden

External causes of death are the third most common causes of death, after cardiovascular diseases and malignant neoplasms, in inhabitants of Poland. External causes of death pose the greatest threat to people aged 5-44, which results in a great number of years of life lost. The aim of the study is the analysis of years of life lost due to external causes of death among rural inhabitants in Poland, particularly due to traffic accidents and suicides. The study material included a database created on the basis of 2,100,785 certificates of rural inhabitants in Poland in the period 1999-2012. The SEYLLp (Standard Expected Years of Life Lost per living person) and the SEYLLd (per death) indices were used to determine years of life lost due to external causes of death. Joinpoint models were used to analyze time trends. In the period 1999-2012, 151,037 rural inhabitants died due to external causes, including 27.2% due to traffic accidents and 25.2% due to suicides. In 2012, the SEYLLp was 1,817 per 100,000 males and 298 per 100,000 females. Among males, suicides (SEYLLp = 633 years per 100,000) and traffic accidents (SEYLLp = 473 years per 100,000) contributed to the largest number of years of life lost. Among females, SEYLLp values were: 109 years due to traffic accidents and 69 years due to suicides (per 100,000). Among males, SEYLLp values started to decrease in 2008 at the average annual rate of 3.2%. In the group of females in the period 1999-2012, SEYLLp values were decreasing by 2.4% per year. The decreasing trend of the number of lost years of life due to external causes among rural inhabitants does not apply to suicides among men. The SEYLLp due to this group of causes has been steadily increasing since 1999. Analysis of the years of life lost focuses on the social and economic aspects of premature mortality due to external causes.

Living Arrangements and External Causes of Deaths in Early Adulthood

The intensity of premature deaths in the Łódź region in 2014 amounted to 40 per 10 000, and was the highest in the country (the average rate for Poland was 32). Excess mortality of men aged <65 continues to be a major medical and social problem. The aim of the study is to analyze time trends of excess male mortality in the working age population in the Łódź region, both in general and due to the most important causes of deaths. The research material consists of information on 144 589 deaths of the Łódź region inhabitants aged 20-64 in 1999-2014. Crude and standardized mortality rates were calculated, as well as excess male mortality rates both in general and by cause of death. Standardization was carried out using the direct method according to the standard European population. A study of time trends was performed with the use of the joinpoint regression analysis. Average annual percentage rates of changes were estimated. The excess mortality rate of men at the productive age decreased from 2.9 to 2.8 in the Łódź region in 1999-2014. The most important causes of death among men aged 20-64 in 2014 were (rates per 10 000): cardiovascular diseases (19.1), malignant neoplasms (16.6) and external causes of death (12.3). Among women, the most significant were malignant neoplasms (11.1), cardiovascular diseases (5.1) and diseases of the digestive system (2.1). The excess mortality rate of men aged 20-64 in the analyzed period reached the highest values due to external causes of death (5.1-7.3) and cardiovascular diseases (3.0-3.7). The highest rate of the decline in excess male mortality in 1999-2014 was recorded due to malignant neoplasms, on average 1.4% per year (p < 0.05). Meanwhile, the fastest growth concerned external causes of death, on average 1.0% per year (p < 0.05). Despite the decline in the mortality rates among both sexes, excess male mortality due to external causes of death and cardiovascular diseases increased. Med Pr. 2020;71(3):325-35.