Annual Percentage Change In Mortality Research Articles

Trendy v predčasných úmrtiach na zhubné nádory tráviacej sústavy na Slovensku v rokoch 2011–2020: 8 dia gnóz počas 10 rokov

Introduction and objectives: Slovakia ranks among the leaders in preventable deaths, but a systematic analysis of the share of digestive system cancers (DSCs) and their trends has been lacking. We analyzed data on mortality from DSCs in Slovakia in the years 2011–2020 with an emphasis on premature deaths, sex differences, and trends for individual locations. Material and methods: Data in the years 2011–2020 by ICD-10 codes C15–C26 aggregated by age subgroups (<50 years, <65 years, <75 years), sex, and individual locations were available. The crude death rate was calculated per 100,000 inhabitants and linear regression was used for the annual percentage change in mortality. Results: We recorded 46,508 deaths; 27,146 were men and 19,362 women with an average age of 70,5 ±11,6. Deaths under the age of 50, 65, and 75 made up 4.1%, 29.8%, and 60.4% of all deaths from DSCs. Among all deaths due to cancer under the age of 65, deaths from DSCs accounted for one-third in men and one-quarter in women. Under the age of 75, colorectal (41%), pancreatic (21%), stomach (12.8%), and liver (10%) cancers dominated the proportions of locations. The average age of death was significantly lower in men and increased over the decade for all locations. In women, the trend was identical, except for the liver, intrahepatic bile ducts (decrease by 1 year), bile ducts, and stomach (no change). Under the age of 65 in all cases, the average annual mortality rate decreased by 1.7%. In men, it decreased for locations in the esophagus, stomach, colorectum (–1.8%/year), liver, and gallbladder. In women, for colorectum (–1.8%/year) and gallbladder (–6%/year). In contrast, in the entire population mortality increased for locations in the pancreas (+2.3 to 2.8%/year) and bile ducts (+4.4 to 7.3%/year). Conclusion: DSCs are significant burden causing preventable deaths. Some favorable trends (stomach, gall bladder) are simultaneously followed by unfavorable ones (biliary tract, pancreas). In the global context of an aging population and increasingly longer exposure to risk factors, we need to introduce effective societal preventive measures as well as flexible adaptation of our healthcare systems.

Rural–urban disparities in the reduction of avoidable mortality and mortality from all other causes of death in Spain, 2003–2019

Abstract Aim This study aims to evaluate the trend of avoidable mortality and of mortality from all other causes of death in urban and rural areas in Spain, throughout the first 2 decades of the twenty-first century. Methods Data deaths and population by age and sex, according to the area of residence, were obtained from the National Institute of Statistics. Avoidable mortality refers to premature deaths (≤ 75 years old) for which there is reasonable scientific consensus that they should not occur in the presence of timely health care. In large urban, small urban, and rural areas, annual age-standardized mortality rates from avoidable causes and from all other causes of death were calculated from 2003 to 2019. The annual percentage change (APC) in the mortality rate in each area was estimated using linear regression models and taking age-standardized mortality rates as dependent variable. Results Mortality rates decreased between the beginning and the end of the period analysed. Large urban areas and rural areas showed the largest and smallest reduction in mortality rate respectively. The APC in avoidable mortality was −3.5% in men and −3.0% in women in large urban areas, and −2.7% in men and −2.6% in women in rural areas. The APC in the mortality rate from all other causes of death was −2.4% in men and −1.2% in women in large urban areas, and −1.4% in men and −1.0% in women in rural areas. Conclusion In Spain, avoidable mortality and mortality from other causes of death in rural and urban areas show similar trends, which suggests the presence of a common factor responsible for such findings.

Global, regional, and national time trends in mortality for stroke, 1990–2019: An age-period-cohort analysis for the global burden of disease 2019 study and implications for stroke prevention

Despite the fact that stroke is the second leading cause of death globally, a comprehensive and comparable assessment of mortality, and epidemiologic trends has not been conducted for most regions.We estimated the global and regional burden of stroke from 1990 to 2019 using data from the 2019 Global Study of Diseases, Injuries, and Risk Factors. For the period between 1990 and 2019, we used an age-period-cohort model to calculate the annual percentage changes in mortality (net drifts), local drifts, and period and cohort relative risks (period/cohort effects). Meanwhile, to quantify the temporal trends in stroke age-standardised mortality rate (ASMR), Average annual percentage changes (AAPCs) were determined by sex, area. With the potential to uncover disparities and treatment gaps in stroke care, this approach enables the examination and differentiation of age, period, and cohort effects in mortality trends. Global stroke deaths in 2019 were 6,552,725 (95% UI 5,995,200 to 7,015,139). Between 1990 and 2019, the ASMR declined globally by 36.43% (95% UI -41.65 to -31.2), with decreases in all SDI quintiles. The net drift in stroke mortality from 1990 to 2019 varied from -2.83% per year (95% confidence interval [CI]:-3.39 to -2.77) in countries with a high Socio-demographic Index (SDI) to -1.21% per year (95% CI: -1.26 to -1.16) in countries with a low SDI. During the past 30 years, favorable mortality reductions were generally found in high-SDI countries (net drift = -3.1% [95% CI: -3.4 to -2.8] per year) and high-middle SDI countries (-2.8% [-3.0 to -2.6]). However, 31 of 204 countries had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥ - 0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high and high-middle SDI countries, with the exceptions of Kuwait, Ukraine, Kazakhstan, Guam, RussianFederation, Lithuania, Turkey, Montenegro, Serbia, Bosnia and Herzegovin, and Bulgaria. Notwithstanding mortality from stroke has increased globally over the past 30 years, adverse period and cohort effects have been found in many countries, calling into question the adequacy of healthcare for stroke patients of all ages. These lapses have a significant impact on the likelihood of achieving the Sustainable Development Goal (SDG) targets on mortality from age 60+ and NCDs.

Trends in all-cause mortality among people with diagnosed diabetes in high-income settings: a multicountry analysis of aggregate data

Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes. In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdictions (in six data sources in Asia, eight in Europe, one from Australia, and four from North America) for the period from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in people with diagnosed total or type 2 diabetes. We collected data from administrative sources, health insurance records, registries, and a health survey. We estimated excess mortality using the standardised mortality ratio (SMR). In our dataset, there were approximately 21 million deaths during 0·5 billion person-years of follow-up among people with diagnosed diabetes. 17 of 19 data sources showed decreases in the age-standardised and sex-standardised mortality in people with diabetes, among which the annual percentage change in mortality ranged from -0·5% (95% CI -0·7 to -0·3) in Hungary to -4·2% (-4·3 to -4·1) in Hong Kong. The largest decreases in mortality were observed in east and southeast Asia, with a change of -4·2% (95% CI -4·3 to -4·1) in Hong Kong, -4·0% (-4·8 to -3·2) in South Korea, -3·5% (-4·0 to -3·0) in Taiwan, and -3·6% (-4·2 to -2·9) in Singapore. The annual estimated change in SMR between people with and without diabetes ranged from -3·0% (95% CI -3·0 to -2·9; US Medicare) to 1·6% (1·4 to 1·7; Lombardy, Italy). Among the 17 data sources with decreasing mortality among people with diabetes, we found a significant SMR increase in five data sources, no significant SMR change in four data sources, and a significant SMR decrease in eight data sources. All-cause mortality in diabetes has decreased in most of the high-income countries we assessed. In eight of 19 data sources analysed, mortality decreased more rapidly in people with diabetes than in those without diabetes. Further longevity gains will require continued improvement in prevention and management of diabetes. US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.

Global, regional, and national time trends in mortality for congenital heart disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study.

SummaryBackgroundCongenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort.MethodsCause-specific CHD mortality estimates were derived from the Global Burden of Disease 2019 study. We utilised an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0 to 4 to 65–69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period, and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care.FindingsCHD is the leading cause of deaths from non-communicable diseases (NCDs) in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval 177,000–262,000). There were 129 countries with at least 50 deaths. India, China, Pakistan, and Nigeria had the highest mortality, accounting for 39.7% of deaths globally. Between 1990 and 2019, the net drift of CHD mortality ranged from –2.41% per year (95% confidence interval [CI] –2.55, –2.67) in high Socio-demographic Index (SDI) countries to –0.62% per year (95% CI: –0.82, –0.42) in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from paediatric to adult populations, except for an increasing trend of mortality in those aged 10–34 years in Mexico and Pakistan. During the past 30 years, favourable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = –4.0% [95% CI –4.8 to –3.1] per year) and the United States (–2.3% [–2.5 to –2.0]), and also in many middle-SDI countries like Brazil (–2.7% [–3.1 to 2.4]) and South Africa (–2.5% [–3.2 to –1.8]). However, 52 of 129 countries had either increasing trends (net drifts ≥0.0%) or stagnated reductions (≥–0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts amongst high- and high-middle-SDI countries, with the exceptions of Saudi Arabia and Kazakhstan. 14 middle-SDI countries such as Ecuador and Mexico, and 16 low-middle-SDI countries including India and 20 low-SDI countries including Pakistan, had unfavourable or worsening risks for recent periods and birth cohorts.InterpretationCHD mortality is a useful and accessible indicator of trends in the provision of congenital cardiac care both in early childhood and across later life. Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally over the past three decades, unfavourable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age groups. These failings carry significant implications for the likelihood of achieving the Sustainable Development Goal targets for under-5 years and NCD mortality.FundingSupported by the 10.13039/501100001809National Natural Science Foundation of China (81525002, 31971048, 82073573 to ZZ and HZ), Shanghai Outstanding Medical Academic Leader program (2019LJ22 to HZ), and Collaborative Innovation Program of Shanghai Municipal Health Commission (2020CXJQ01 to HZ), the Bill & Melinda Gates Foundation for the Global Burden of Disease Project (to NJK) and NHMRC fellowship administered through the University of Melbourne (to GCP).

Abstract 11287: Trends in Pulmonary Embolism Mortality Rates by Age Group in the United States, 1999-2019

Introduction: Acute pulmonary embolism (PE) is a major cause of mortality in the United States. Recent reports indicate that PE-related mortality rates have increased among individuals 25-64 and 65-79 years old and plateaued among individuals ≥80 years old. A narrowly focused and clinically meaningful age group analysis is necessary. Methods: Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database were examined to determine all-cause PE mortality trends from 1999 to 2019 among adults 25-39, 40-54, 55-69, 70-84, and ≥85 years old. The crude death rates for individual years were calculated by dividing the number of PE-related deaths by the corresponding population. Annual percentage change (APC) was calculated to determine trends. Results: Among individuals 25-39 years old, the death rate increased from 1.76 to 2.01 (APC 0.7 [95% confidence interval (CI) 0.2 to 1.1]) between 1999 and 2014 and continued to increase from 2.01 to 2.42 (APC 4.1 [95% CI 1.8 to 6.5]) between 2014 and 2019. Among those 40-54 years old, the death rate increased from 5.7 to 7.46 (APC 2.0 [95% CI 1.6 to 2.5]) between 2007 and 2019. Among those 55-69 years old the death rate increased from 15.64 to 18.53 (APC 2.2 [95% CI 1.9 to 2.5]) between 2010 and 2019. Among those 70-84 years old the death rate decreased from 49.46 to 43.96 (APC -0.7 [95% CI -0.8 to -0.5]) between 1999 and 2019. While death rate among those older than 85 decreased from 112.31 to 100.53 (APC -1.3 [95% CI -1.9 to -0.7]) between 2007 and 2016, the death rate among this cohort increased non-significantly between 2016 and 2019. Conclusions: Despite significant improvements in PE risk stratification and clinical management, recent PE related mortality rates increased significantly among those younger than 69 years old. The APC in mortality was highest among those 25-39 years old. Among individuals older than 70 years old, recent death rates decreased or plateaued.

Abstract 11650: Global, Regional and National Time Trends in Mortality for Congenital Heart Disease, 1990-2019 an Age-Period-Cohort Analysis for the Global Burden of Disease Study 2019

Introduction: Congenital heart disease (CHD) is the leading birth defect worldwide. We report trends in CHD mortality in 204 countries and territories over the past 30 years, and associations with age, period, and birth cohort. Methods: Cause-specific CHD mortality estimates were derived from the Global Burden of Disease study 2019. We utilized an age-period-cohort model to estimate overall annual percentage change in mortality (net drifts), annual percentage change from 0-4 to 65-69 years (local drifts) and period (cohort) relative risks between 1990 and 2019. Results: Global CHD deaths in 2019 were 217,000 (95%UI: 177,000, 262,000). India, China, Pakistan and Nigeria were the top 4 countries accounting for 39.7% of deaths globally. The reduction in age-standardized mortality ranged from 66.3% in high-sociodemographic index (SDI) countries to 30.5% in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from pediatric to adult population, except for an increasing trend of mortality in 10~34 years in Mexico and Pakistan. During 1990-2019, favorable mortality reductions were found in most high-SDI countries like South Korea (net drift = -4.0% per year) and United States (-2.3%), and also in many middle-SDI countries like Brazil (-2.7%) and a few low-SDI countries like Ethiopia (-2.3%). However, 52 out of 129 countries with at least 50 deaths had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥-0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high- and high-middle SDI countries except Saudi Arabia and Kazakhstan. Fourteen middle-SDI countries such as Ecuador and Mexico, and sixteen low-middle-SDI countries like India and twenty low-SDI countries like Pakistan, had unfavorable or worsening risks for recent periods and birth cohorts. Conclusions: Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally, unfavorable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age-groups.

Global, Regional and National Time Trends in Mortality for Congenital Heart Disease, 1990-2019: An Age-Period-Cohort Analysis for the GBD 2019

Background: Congenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort. Methods: Cause-specific CHD mortality estimates were derived from the Global Burden of Disease study 2019. We utilized an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0-4 to 65-69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care. Findings: CHD is the leading cause of deaths from non-communicable diseases in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval: 177,000, 262,000).There were 129 countries with at least 50 deaths. India, China, Pakistan and Nigeria had the highest mortality accounting for 39.7% of deaths globally. Between 1990 and 2019, the reduction in CHD all-age mortality ranged from –71.3% [–74.7 to –64.6] in high-sociodemographic index (SDI) countries to –42.1% [–61.9 to 12.1] in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from pediatric to adult population, except for an increasing trend of mortality in 10~34 years in Mexico and Pakistan. During the past 30 years, favorable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = –4.0% [95% confidence interval: –4.8 to –3.1] per year) and United States (–2.3% [–2.5 to –2.0]), and also in many middle-SDI countries like Brazil (–2.7% [–3.1 to 2.4]) and South Africa (–2.5% [–3.2 to –1.8]) and a few low-SDI countries like Ethiopia (–2.3% [–3.0 to –1.6]). However, 52 out of 129 countries had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥–0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high- and high-middle SDI countries with the exceptions of Saudi Arabia and Kazakhstan. Fourteen middle-SDI countries such as Ecuador and Mexico, and sixteen low-middle-SDI countries including India and twenty low-SDI countries including Pakistan, had unfavorable or worsening risks for recent periods and birth cohorts. Interpretation: CHD mortality is an accessible metric that can be used to track trends and levels in the provision of congenital cardiac care for low- and middle-income countries. Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally over the past three decades, unfavorable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age-groups. These failings carry significant implications for the likelihood of achieving the Sustainable Development Goals in this domain. Funding Information: National Natural Science Foundation of China, Shanghai Outstanding Medical Academic Leader program, and Collaborative Innovation Program of Shanghai Municipal Health Commission. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The GBD study uses deidentified data and a waiver of informed consent was approved by the University of Washington Institutional Review Board.

Sex disparities in premature adult mortality in Estonia 1995–2016: a national register-based study

ObjectivesTo quantify sex disparities in cause-specific premature adult mortality in Estonia, to determine the causes of death with the largest differences, to provide insight into related behaviours and to offer...

Premature mortality from all causes and drug poisonings in the USA according to socioeconomic status and rurality: an analysis of death certificate data by county from 2000–15

SummaryBackgroundIncreasing premature mortality among some groups of Americans has been largely driven by increases in drug poisoning deaths. However, to our knowledge, a formal descriptive study by race and ethnicity, socioeconomic status, rurality, and geography has not been done. In this study, we examined US trends in premature all-cause and drug poisoning mortality between 2000 and 2015 at the county level among white, black, and Latino people.MethodsWe used US mortality data for the period Jan 1, 2000, to Dec 31, 2015, including underlying cause of death and demographic data, collected from death certificates by the Centers for Disease Control and Prevention National Center for Health Statistics, and ascertained county attributes from the 2011–15 Census American Community Survey. We categorised counties into quintiles on the basis of the percentage of people unemployed, the percentage of people with a bachelor’s degree, median income, and rurality. We estimated premature (ie, deaths in those aged 25–64 years) age-standardised mortality for all causes (by race and ethnicity) and drug poisoning, by county, for the periods of 2000–03 and 2012–15. We estimated annual percentage changes in mortality (2000–15) by county-level characteristics.FindingsPremature mortality declined from 2000–03 to 2012–15 among black and Latino people, but increased among white people in many US counties. Drug poisoning mortality increased in counties throughout the country. Significant increases between 2000 and 2015 occurred across low and high socioeconomic status and urban and rural counties among white people aged 25–64 years (annual percentage change range 4·56% per year [95% CI 3·56–5·57] to 11·51% per year [9·41–13·65]), black people aged 50–64 years (2·27% per year [0·42–4·16] to 9·46% per year [7·02–11·96]), Latino women aged 25–49 years (2·43% per year [1·18–3·71] to 5·01% per year [3·80–6·23]), and Latino men aged 50–64 years (2·42% per year [0·53–4·34] to 5·96% per year [3·86–8·11]). Although drug poisoning mortality increased rapidly in counties with the lowest socioeconomic status and in rural counties, most deaths during 2012–15 occurred in the largest metropolitan counties (121 395 [76%] in metropolitan counties with ≥250 000 people vs 2175 [1%] in the most rural counties), reflecting population size.InterpretationPremature mortality has declined among black and Latino people in the USA, and increased among white people, particularly in less affluent and rural counties. Increasing drug poisoning mortality was not limited to poor white people in rural areas. Rapid increases have occurred in communities throughout the USA regardless of race and ethnicity, socioeconomic status, or rurality. Widespread public health interventions are needed to addess this public health emergency.

Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: an analysis of death certificate data

Reduction of premature mortality is a UN Sustainable Development Goal. Unlike other high-income countries, age-adjusted mortality in the USA plateaued in 2010 and increased slightly in 2015, possibly because of rising premature mortality. We aimed to analyse trends in mortality in the USA between 1999 and 2014 in people aged 25-64 years by age group, sex, and race and ethnicity, and to identify specific causes of death underlying the temporal trends. For this analysis, we used cause-of-death and demographic data from death certificates from the US National Center for Health Statistics, and population estimates from the US Census Bureau. We estimated annual percentage changes in mortality using age-period-cohort models. Age-standardised excess deaths were estimated for 2000 to 2014 as observed deaths minus expected deaths (estimated from 1999 mortality rates). Between 1999 and 2014, premature mortality increased in white individuals and in American Indians and Alaska Natives. Increases were highest in women and those aged 25-30 years. Among 30-year-olds, annual mortality increases were 2·3% (95% CI 2·1-2·4) for white women, 0·6% (0·5-0·7) for white men, and 4·3% (3·5-5·0) and 1·9% (1·3-2·5), respectively, for American Indian and Alaska Native women and men. These increases were mainly attributable to accidental deaths (primarily drug poisonings), chronic liver disease and cirrhosis, and suicide. Among individuals aged 25-49 years, an estimated 111 000 excess premature deaths occurred in white individuals and 6600 in American Indians and Alaska Natives during 2000-14. By contrast, premature mortality decreased substantially across all age groups in Hispanic individuals (up to 3·2% per year), black individuals (up to 3·9% per year), and Asians and Pacific Islanders (up to 2·6% per year), mainly because of declines in HIV, cancer, and heart disease deaths, resulting in an estimated 112 000 fewer deaths in Hispanic individuals, 311 000 fewer deaths in black individuals, and 34 000 fewer deaths in Asians and Pacific Islanders aged 25-64 years. During 2011-14, American Indians and Alaska Natives had the highest premature mortality, followed by black individuals. Important public health successes, including HIV treatment and smoking cessation, have contributed to declining premature mortality in Hispanic individuals, black individuals, and Asians and Pacific Islanders. However, this progress has largely been negated in young and middle-aged (25-49 years) white individuals, and American Indians and Alaska Natives, primarily because of potentially avoidable causes such as drug poisonings, suicide, and chronic liver disease and cirrhosis. The magnitude of annual mortality increases in the USA is extremely unusual in high-income countries, and a rapid public health response is needed to avert further premature deaths. US National Cancer Institute Intramural Research Program.

Incidence and mortality of children and teenagers with AIDS: challenges in the southern region of Brazil

The objective of this study is to describe the time trend of coefficients of incidence and mortality associated with AIDS in children and adolescents. An ecological time trend study was conducted among individuals under 14 living in the regional context of high incidence of AIDS - Porto Alegre and the State of Rio Grande do Sul - from 1996 to 2012. For this purpose, a segmented regression model was adjusted for age categories and place of residence. AIDS morbidity and mortality indicators in Porto Alegre are still higher than those registered in the State, the southern region and other areas of the country. In Porto Alegre, 59.1% of cases (371/628) occurred in children under four years of age, the incidence showed peaks in the period and the mortality dropped from 9 to 2 per 100,000. A significant decreasing in annual percentage change in mortality was observed especially in children under 1 year of age in Porto Alegre. This drop may be related to prevention and treatment of pregnant women. The challenge is to identify possible fragilities of the STD/AIDS Program and its vulnerable points in order to make specific interventions and investments with a greater impact potential.

CE-08 Temporal trends in SLE mortality according to sex, race, ethnicity, and geographic region in the united states over the past five decades

Background Over the past half-century, diagnostic and therapeutic developments for SLE have led to dramatic improvements in the 5- and 10-year survival. Whether these achievements have improved the long-term trends in mortality in SLE is unclear. Materials and methods We measured temporal trends in age-standardised mortality rates (ASMR) for SLE and non-SLE causes by joinpoint trend analysis using county-level data abstracted from the Centres for Disease Control and Prevention database. We calculated the annual percentage change in mortality over 46 years. Logistic regression was applied to model the association of sex, race and geographic region on SLE deaths. We calculated SLE case-fatality by dividing the SLE-mortality by the estimated SLE prevalence within each demographic variable. Since no national SLE prevalence is available, we estimated these values with weighted visit data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Results SLE was listed as the primary cause of death in 50,249 individuals from 1968–2013 in the United States. While ASMR for non-SLE causes continuously declined throughout this period, the SLE ASMR showed periods of sustained increase from mid-1970s-1990s followed by a significant decline in 2000s. The higher SLE mortality in the general population was associated with female sex, Black race, and residence in the West or South. However, in the SLE subpopulation, males had a higher mortality. The national estimates for SLE prevalence per 100,000 were 221.17 in females, 20.08 (males), 170.5 (Blacks), 107.44 (Whites), 133.5 (Hispanics), 120.36 (non-Hispanics), and 106.36 (Midwest) to 138.35 (Northeast). Even after adjusting for the prevalence variability, the SLE mortality was higher in Blacks than Whites, and in people living in the South and the West than in the Midwest and the Northeast. Analysis of the trend in SLE case-fatality showed an overall decline in rates from 1999 through 2013. The average annual percent change in SLE case-fatality ranged from −2.5% per year to −3.1% per year in various subpopulations during 1999–2013. Blacks and Hispanics died from SLE at a younger age than Whites and non-Hispanics, respectively. Conclusions Increased SLE mortality in mid-1970s-1990s may reflect increased diagnoses with the establishment of diagnostic criteria as well as corticosteroid overuse, while the subsequent decrease in 2000s may reflect the effect of new immunosuppressive therapies resulting in an overall decreasing trend in SLE mortality in a half-century. Despite this, gender, racial and ethnic disparities persist in SLE mortality.

Corrections

An article[1][1] in the November 18 issue contained 2 errors. First, in Table 3, the average annual percentage change in mortality for liver cancer should have been listed as a 2.2% increase. Second, text was omitted from the first and second paragraphs under “Prevalence, incidence, mortality and

Trends in COPD mortality and hospitalizations in countries and regions of Asia‐Pacific

The growing burden of COPD in the Asia-Pacific region supports the need for more intensive research and analysis of the epidemiology of COPD to raise awareness of the disease and its causes, to ensure the development of effective national health policies and to facilitate equitable deployment of finite health-care resources in the prevention and management of COPD. This study estimated and compared COPD mortality and hospital morbidity rates and trends in these rates over time across countries and regions of Asia-Pacific. Data consistent with standard definitions of COPD (ICD-9/ICD-10) for the period 1991-2004 were obtained from national health statistics agencies. For countries/regions with complete national mortality and hospitalization data (Australia, Pacific Canada (British Columbia, Hong Kong, South Korea and Taiwan), annual age-standardized mortality and hospitalization rates were calculated for men and women aged >or= 40 years. Negative binomial regression modelling was used to estimate rate ratios for country/region, gender and age differences and general trends over time. Mortality rates per 10,000 population ranged 6.4-9.2 in men, 2.1-3.5 in women and 3.7-5.3 overall in 2003. Corresponding ranges for morbidity were 32.6-334.7, 21.2-129 and 28.1-207.3 per 10 000. Trend analysis of data since 1997 produced annual percentage changes in mortality versus hospitalization of -4.4% versus -0.7% in Australia, -3.6% versus 7.5% in Pacific Canada (British Columbia), -7.15% versus -5.6% in Hong Kong and -2.9% versus -4.2% in Taiwan. In Asia-Pacific, overall mortality and morbidity rates are high and trends in mortality and morbidity vary between countries/regions. Differences in rates and trends for men and women most likely reflect the different trends in historical and prevalent smoking profiles for COPD in the different countries and regions.

Effects of age, period and cohort on acute myocardial infarction mortality in Hong Kong

Background: Hong Kong has been experiencing a transition from a developing area to a developed area over the past few decades. The time trends of acute myocardial infarction (AMI) mortality would have implications for the future trends of AMI in Mainland China. Methods: Age-adjusted mortality rates during the period 1976–1999 were calculated by direct standardization with the world population using local mortality and population data. Log-linear regressions were used to estimate the annual percentage changes in mortality over different periods. Poisson regression models were used to explore the effects of age, calendar period and birth cohort. Results: A downward trend was observed for age-adjusted AMI mortality rate in both sexes in the 1990s, after the increasing trends in the 1970s and 1980s. The AMI mortality rate among men and women dropped by 36.4% and 37.4%, respectively. A negative annual percentage change was observed across all age groups in both sexes. Both the calendar period and the birth cohort showed significant effects on the changing AMI mortality rate, with the influence of period being stronger than the cohort, especially among males. Conclusion: Age-adjusted AMI mortality started to decrease during the last decade. Changing life styles and a reduction of coronary risk factors could have contributed, but the improvements in medical care and effective treatment for patients suffering from AMI should have an important role.