Average Annual Mortality Research Articles

Epidemiological Profile of Marfan Syndrome in a General Population: A National Database Study

To explore the current epidemiological profile of Marfan syndrome in a general population. Patients who had received a diagnosis of Marfan syndrome were identified from the Taiwan National Health Insurance database records from January 1, 2000, through December 31, 2012 (average population size, 22,765,535). Cardiovascular events and interventions were identified by using the respective International Classification of Diseases codes. We identified 2329 patients (58% men) with Marfan syndrome. The overall prevalence was 10.2 (95% CI, 9.8-10.7) per 100,000 individuals, with peaks at the age of 15 to 19, 10 to 14, and 20 to 24 years. The minimal birth incidence of 23.3 (95% CI, 21.7-23.3) per 100,000 individuals was estimated in those aged 20 to 29 years. The average annual mortality was 0.23% (69 deaths), mostly owing to cardiac causes (including dissection and sudden death in 40 patients, 58%). Aortic dissection occurred in 226 patients (10%; 61% men) at a mean age of 36.6±10.7 years. The probability of freedom from dissection was 99%, 80%, and 66% at the age of 20, 40, and 50 years, respectively. Of the 69 deaths and 226 dissections during the follow-up period, more than half of the cases occurred before the age of 40 years. Cardiovascular intervention was performed in 360 patients, with early mortality being higher in the emergent operation group (8%) than in the elective group (0%). From this national cohort study, the minimal birth incidence was 23.3 per 100,000 individuals, that is, possibly 1 patient with Marfan syndrome per 4286 people. Despite medical advances, aortic dissection still occurs in about one-tenth of the patients and carries a high mortality risk. Early diagnosis and timely medical interventions are warranted.

Spatial and temporal variation in recovery of hatchery-released red drum (Sciaenops ocellatus) in stock-enhancement of Texas bays and estuaries

Spatial and temporal variation in recovery of hatchery-released red drum (Sciaenops ocellatus) was assessed in nine bays and estuaries along the Texas coast. Sixteen nuclear-encoded microsatellites were used to identify a total of 167 hatchery-released fish among 4325 red drum sampled between the fall of 2006 and the spring of 2009; these were added to 41 recovered hatchery-released fish identified in a prior study of 1332 red drum sampled from Galveston and Aransas bays in the fall of 2005 and spring of 2006. Recovery of hatchery releases across bays and years ranged from 0.28% to 17.65%. Of the 208 recovered hatchery-released fish, 158 were age 0–1, 46 were age 1–2, and four fish were age 2–3. The distribution of recovered hatchery-released fish and wild fish differed significantly across sampling periods within and among bays or estuaries. Allelic richness in recovered hatchery-released fish was significantly lower than in both hatchery brood fish and wild fish. In addition, recovered hatchery-released fish were produced by fewer dams, sires, and dam×sire combinations in 2005 and 2006 and by fewer dams and sires in 2007 than would be expected if reproductive success was distributed randomly among brood fish. The spatial distributions of recovered hatchery-released and wild fish deviated from random expectations for samples from the Upper Laguna Madre in the fall of 2006 and spring of 2007 and from West Matagorda Bay in the spring and fall of 2008. Correlation and principal components analysis identified a significant, positive relationship between annual average CPUE and relative annual mortality. No relationship was observed between the number of fish released per hectare and the percentage of recovered hatchery-released fish. Comparisons to other studies of red drum stock enhancement are discussed.

CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2006-2010

The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control (CDC) and National Cancer Institute (NCI), is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors (malignant and non-malignant) and supersedes all previous CBTRUS reports in terms of completeness and accuracy. All rates (incidence and mortality) are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 23.79 (Malignant AAAIR=7.08, non-Malignant AAAIR=16.71). This rate was higher in females compared to males (26.31 versus 21.09), Blacks compared to Whites (23.88 versus 23.83), and non-Hispanics compared to Hispanics (24.23 versus 21.48). The most commonly occurring malignant brain and other CNS tumor was glioblastoma (14.5% of all tumors), and the most common non-malignant tumor was meningioma (38.3% of all tumors). Glioblastoma was more common in males, and meningioma was more common in females. In children and adolescents (age 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.14. An estimated 83,830 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US in 2020 (24,970 malignant and 58,860 non-malignant). There were 81,246 deaths attributed to malignant brain and other CNS tumors between 2013 and 2017. This represents an average annual mortality rate of 4.42. The 5-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 23.5% and for a non-malignant brain and other CNS tumor was 82.4%.

Treadmill walking speed and survival prediction in men with cardiovascular disease: a 10-year follow-up study

ObjectiveTo determine whether the walking speed maintained during a 1 km treadmill test at moderate intensity predicts survival in patients with cardiovascular disease.DesignPopulation-based prospective study.SettingOutpatient secondary prevention programme in Ferrara,...

Ecology and population status of Trout-perch (Percopsis omiscomaycus) in western Lake Erie

Trout-perch Percopsis omiscomaycus is among the most abundant benthic species in Lake Erie, but comparatively little is known about its ecology. Although others have conducted extensive studies on trout-perch ecology, those efforts predated invasions of white perch Morone americana, Dreissena spp., Bythotrephes longimanus and round goby Neogobius melanostomus, suggesting the need to revisit past work. Trout-perch were sampled with bottom trawls at 56 sites during June and September 2010. We examined diets, fecundity, average annual mortality, sex ratio, and long-term population trends at sites sampled since 1961. Trout-perch abundance fluctuated periodically, with distinct shorter- (4-year) and longer-term (over period of 50years) fluctuations. Males had higher average annual mortality than females. Both sexes were equally abundant at age 0, but females outnumbered males 4:1 by age 2. Diets of trout-perch were dominated by macroinvertebrates, particularly chironomids and Hexagenia sp. Size distributions of trout-perch eggs varied widely and exhibited multiple modes indicative of protracted batch spawning. A review of the few other studies of trout-perch revealed periodic fluctuations in sex ratio of adults, which in light of our evidence of periodicity in abundance suggests the potential for sex-ratio-mediated intrinsic population regulation. Despite the introduction of numerous invasive species in Lake Erie, trout-perch remain one of the most abundant benthic invertivores and the population is relatively stable.

Heart Rate at Rest, Exercise Capacity, and Mortality Risk in Veterans

Heart rate (HR) at rest has been associated inversely with mortality risk. However, fitness is inversely associated with mortality risk and both increased fitness and β-blockade therapy affect HR at rest. Thus, both fitness and β-blockade therapy should be considered when HR at rest-mortality risk association is assessed. From 1986 to 2011, we assessed HR at rest, fitness, and mortality in 18,462 veterans (mean age = 58 ± 11 years) undergoing a stress test. During a median follow-up period of 10 years (211,398 person-years), 5,100 died, at an average annual mortality of 24.1 events/1,000 person-years. After adjusting for age, body mass index, cardiac risk factors, medication, and exercise capacity, we noted approximately 11% increase in risk for each 10 heart beats. To assess the risk in a wide and clinically relevant spectrum, we established 6 HR at rest categories per 10 heart beat intervals ranging from <60 to ≥100 beats. Mortality risk was significantly elevated at a HR at rest of ≥70 beats/min (hazard ratio 1.14, confidence interval 1.04 to 1.25; p <0.006) and increased progressively to 49% (hazard ratio 1.49, confidence interval 1.29 to 1.73; p <0.001) for those with a HR at rest of ≥100 beats/min. Similar trends were noted when for subjects aged <60 and ≥60 years and those treated with β blockers. In all assessments, mortality risk was consistently overestimated when fitness was not considered. In conclusion, HR at rest-mortality risk association was direct and independent. A progressive increase in risk was noted >70 beats/min for the entire cohort, those treated with β blockers, and those aged <60 and ≥60 years. Mortality risk was overestimated slightly when fitness status was not considered.

Temporal dynamics of a subtropical urban forest in San Juan, Puerto Rico, 2001–2010

Several studies report urban tree growth and mortality rates as well as species composition, structural dynamics, and other characteristics of urban forests in mostly temperate, inland urban areas. Temporal dynamics of urban forests in subtropical and tropical forest regions are, until now, little explored and represent a new and important direction for study and management of these ecosystems. This study used permanent plots and statistical models incorporating tree and plot-level covariates to analyze mortality, in-growth, diameter growth, and species composition, as well the socioeconomic and urban morphology factors driving change in San Juan, Puerto Rico's subtropical coastal island urban forests over a nine year period. A total of 87 plots contained 482 trees in 2001 and 749 trees in 2010. Between 2001 and 2010 average tree densities increased, and average annual mortality rates were nearly 30%. Mortality was lower for larger, open-grown, non-leguminous trees and in higher income neighborhoods, but higher for street trees and larger population areas. The most widespread tree was invasive Spathodea campanulata, but overall, average mortality was higher for invasive than non-invasive tree species. In-growth of invasive species increased with human population, while higher tree densities corresponded with increased in-growth of native species. Overall mean diameter growth rate was 0.98cm/yr, but remnant forest patch growth rates were 0.35cm/yr. Higher diameter growth rates were associated with larger human populations, amounts of duff/mulch cover, and open-grown conditions. This study adds new insights to broaden our understanding of these emergent ecosystems in the Caribbean region.

Long-term mortality rates and spatial patterns in an old-growth Pinus resinosa forest

Understanding natural mortality patterns and processes of forest tree species is increasingly important given projected changes in mortality owing to global change. With this need in mind, the rate and spatial pattern of mortality was assessed over an 89-year period in a natural-origin Pinus resinosa (Aiton)-dominated system to assess these processes through advanced stages of stand development (stand age 120–209 years). Average annual mortality rates fluctuated through time, yet were within the range reported in other studies (0.60%–3.88% depending on species and sampling interval). Tree mortality was attributed to multiple agents, including the senescence of the short-lived Pinus banksiana Lamb., windthrow, root-rot fungi (Armillaria ostoyae (Romagn.) Herink), and perhaps infrequent droughts. Despite the often contagious nature of many disturbance agents, the overall spatial pattern of mortality events (the arrangement of dead trees within the fixed initial population of live trees) was random at all scales tested. Similarly, the current spatial pattern of dead trees was predominantly random, despite clustering at small scales (2–4 m). These findings underscore the importance of studying mortality rates, agents, and spatial patterns over long time periods to avoid misinterpreting stochastic mortality events, and their influence on longer term stand structure and development.

Chronic disease mortality in rural and urban residents in Hubei Province, China, 2008–2010

BackgroundChronic non-communicable diseases have become the major cause of death in China. This study describes and compares chronic disease mortality between urban and rural residents in Hubei Province, central China.MethodsDeath records of all individuals aged 15 years and over who died from 2008 through 2010 in Hubei were obtained from the Disease Surveillance Points system maintained by the Hubei Province Centers for Disease Control and Prevention. Average annual mortality, standardized death rates, years of potential life lost (YLL), average years of potential life lost (AYLL) and rates of life lost were calculated for urban and rural residents. Standardized rate ratios (SRR) were calculated to compare the death rates between urban and rural areas.ResultsA total of 86.2% of deaths were attributed to chronic non-communicable diseases in Hubei. Cerebrovascular diseases, ischemic heart disease and neoplasms were the main leading causes in both urban and rural areas, and the mortality rates were higher among rural residents. Lung cancer was the principal cause of mortality from cancer among urban and rural residents, and stomach cancer and liver cancer were more common in rural than urban areas. Breast cancer mortality among women in rural areas was lower than in urban areas (SRR=0.73, 95% CI=0.63–0.85). The standardized mortality for chronic lower respiratory disease among men in rural areas was higher than in urban areas (SRR=4.05, 95% CI=3.82–4.29). Among men, total AYLL from liver cancer and other diseases of liver were remarkably higher than other causes in urban and rural areas. Among women the highest AYLL were due to breast cancer in both urban and rural areas.ConclusionsChronic diseases were the major cause of death in Hubei Province. While circulatory system diseases were the leading causes in both urban and rural areas, our study highlights that attention should also be paid to breast cancer among women and chronic lower respiratory disease among rural residents. It is important that governments focus on this public health issue and develop preventive strategies to reduce morbidity and premature mortality from chronic non-communicable diseases.

Statins Modulate the Mortality Risk Associated With Obesity and Cardiorespiratory Fitness in Diabetics

Statins are commonly prescribed to avert cardiovascular disease in diabetics. Little information, however, exists about the interrelationship of obesity, fitness, and statin treatment on mortality. Our objective was to evaluate the influence of statin therapy on body mass index (BMI), cardiorespiratory fitness, and all-cause mortality risk in diabetics. We gathered prospective observational data from Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, California, on type 2 diabetic male veterans (n = 3775; mean age = 58.9 ± 9.9 years) who underwent an exercise tolerance test during the period of 1986 to 2011. There were 930 deaths during a mean follow-up period of 10.5 years (37 826 person-years), with an average annual mortality of 24.6 events per 1000 person-years of observation. Adjusted Cox proportional hazard analysis revealed that mortality risk was 34% lower (hazard ratio [HR] = 0.66; confidence interval [CI] = 0.57-0.77) for individuals treated with statins compared with those not on statins. There was a paradoxical BMI-mortality association, with the highest mortality in those with a BMI of 18.5 to 24.9 kg/m(2) (HR = 1.54; CI = 1.26-1.87, P < .0001) compared with obese subjects (BMI of 30-34.9 kg/m(2)). However, this paradoxical association was evident only in those not treated with statins (HR = 1.79; CI = 1.39-2.29; P < .001) vs those on statins (HR = 1.06; CI = 0.75-1.54; P = .70). When statin therapy and fitness status were combined, mortality risk was 44% higher (HR = 1.44; CI = 1.16-1.78) in the least-fit not treated with statins compared with the least-fit treated with statins. Mortality risk declined progressively with increased fitness to 60% lower (HR = 0.40; CI = 0.24-0.66) and 49% lower (HR = 0.51; CI = 0.38-0.68) for the most highly fit individuals (>9 metabolic equivalents) treated and not treated with statins, respectively. Statin therapy was associated with increased survival in diabetic veterans, which was further enhanced when fitness and statin therapy were combined. In addition, statin therapy eliminated the increased mortality risk associated with BMI <25 kg/m(2). The presence of a paradoxical BMI-mortality risk association, which is modulated by statin therapy has novel clinically relevant implications.

SAT0063 Atherosclerosis and Coronary Artery Disease in Rheumatoid Arthritis Patients According to Autopsy Data

ObjectivesTo estimate the frequency of atherosclerotic damage of major arteries and coronary artery disease (CAD) in rheumatoid arthritis (RA) patients on the basis of analysis of postmortem examination reports of...

Abstract 36: Arm Exercise Stress Test Predictors of Outcome Over 12 Years

For patients with lower extremity disabilities precluding treadmill exercise, pharmacologic nuclear imaging stress tests necessitate administration of ionizing radiation, require much greater equipment and personnel resources, and are several times more expensive and time-consuming than exercise electrocardiography (ECG). In addition, they do not provide powerful prognostic and clinically relevant information on exercise capacity or on symptomatic, hemodynamic and ECG responses to exercise. In lower extremity disabled individuals, we have reported that arm exercise (AXT) capacity in METs and delta (peak exercise - rest) heart rate ([[Unable to Display Character: &amp;#8710;]]HR) prognosticate survival and an abnormal exercise ECG predicts all-cause mortality. However, these data included follow-up of only 5.3 years and did not provide information on heart rate recovery (HRR), an important prognosticator of survival for leg exercise. Furthermore, the predictive role of HRR has not been well-characterized in high-risk populations or for arm exercise. Thus, the purpose of the current investigation was to determine whether arm exercise HRR, AXT METs, [[Unable to Display Character: &amp;#8710;]]HR and an abnormal ECG response independently prognosticate all-cause mortality, subsequent myocardial infarction (MI) or coronary revascularization (CVASC) over a longer follow-up period in patients who cannot perform leg exercise. A total of 446 veterans, aged 64 +/- 11 yrs. underwent AXT between 1997 and 2002 and were followed to an endpoint of death or at least 10 years. Average annual mortality, MI, CVASC and combined event rates were 7.0%, 1.9%, 2.8% and 12.1%, respectively. Over an average follow-up of 12.0 +/- 1.3 years for survivors, HRR at both 1 and 2 minutes post-exercise was highly and inversely related to mortality (p &lt; 0.0001) by univariate analysis and remained highly significant after adjustment for demographic and clinical clinical variables (p&lt; 0.0001 for HRR 1 minute post-exercise; hazard ratio (HR)/bpm = 0.95 for death; confidence interval (CI ) = 0.94-0.97). AXT METs was independently related to survival by univariate and multivariate analyses (both p &lt; 0.0001; HR/MET = 0.55 for death; CI=0.46-0.66). Delta HR also predicted survival by both univariate and multivariate analyses (p &lt; 0.0001; HR/bpm = 0.98 for death; CI = 0.98-0.99). An abnormal AXT ECG was predictive of mortality by univariate (p = 0.03) but not multivariate analysis. None of these variables predicted MI but an exercise endpoint of typical chest pain and an abnormal AXT ECG prognosticated subsequent CVASC (multivariate p &lt; 0.0001; HR = 4.70; CI = 1.81-12.22 and p = 0.0002; HR = 2.64; CI = 1.61-4.33, respectively). We conclude that in high risk patients who cannot perform lower extremity exercise, HRR, AXT METs, and [[Unable to Display Character: &amp;#8710;]]HR are independently associated with survival, an abnormal AXT ECG predicts univariate mortality, and an AXT endpoint of typical chest pain and abnormal AXT ECG portend subsequent CVASC.

Amyotrophic lateral sclerosis/motor neuron disease deaths in the United States, 1999–2009

Our objective was to examine trends and epidemiology of amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND) associated deaths in the United States. ALS/MND associated death rates and trends in the United States for 1999–2009 were examined using the multiple cause-of-death mortality data. Age-specific and age-adjusted death rates were calculated. For 1999–2009, the average annual age-adjusted death rate was 2.17/100,000 persons. The age-specific rate increased with age until 75–79 years. Males experienced a higher death rate than females. There was no definitive trend in the annual ALS/MND associated death rate, although analyses suggested a possible decrease (p = 0.05); however, the rate increased for persons 20–49 years of age and declined for persons ≥ 65 years of age. The annual rate for males decreased whereas the rate for females showed no change. In conclusion, the suggested decreasing annual ALS/MND associated death rate for 1999–2009 contrasts with earlier reports indicating that the incidence and death rate of ALS were increasing. While the ALS/MND associated death rate slightly increased among adults 20–49 years of age, rates declined among two subpopulations at higher risk for ALS/MND – males and persons ≥ 65 years of age. Continued monitoring of ALS/MND mortality data and additional epidemiological studies will be important to further elucidate these epidemiological trends.

Usefulness of Preoperative Exercise Tolerance to Predict Late Survival and Symptom Persistence After Surgery for Chronic Nonischemic Mitral Regurgitation

Exercise duration during exercise treadmill testing (ETT) predicts long-term outcome among asymptomatic patients with mitral regurgitation. However, the prognostic value of preoperative exercise duration in patients who undergo mitral valve surgery is unknown. We examined findings among 45 prospectively followed (average 9.2 ± 4.3 years) patients (aged 54.8 ± 12.0 years, 45% men) with chronic isolated severe MR who underwent ETT before mitral valve surgery to test the hypotheses that exercise duration predicts long-term postoperative survival and persistent symptoms within 2 years after operation. During follow-up, 11 patients died; of these, 8 had persistent symptoms. Among patients who exercised >7 minutes, average annual postoperative all-cause and cardiovascular mortality risks were 0.75% (both endpoints) versus 5.4% and 4.8%, respectively, versus those who exercised ≤7 minutes (p= 0.003 all-cause, p= 0.007 cardiovascular). Exercise duration predicted postoperative deaths (p <.02 all cause, p <.04 cardiovascular) even when analysis was adjusted for preoperative variations in age, gender, medications, history of atrial fibrillation, and peak exercise heart rates. Other ETT, echocardiographic, and clinical variables were not independently associated with these outcomes when exercise duration was considered in the analysis. Preoperative exercise duration also predicted postoperative (New York Heart Association functional class ≥II) symptom persistence (p= 0.012), whereas other ETT, echocardiographic and clinical variables did not (NS, all). In conclusion, among patients who undergo surgery for chronic nonischemic mitral regurgitation, preoperative exercise duration, unlike many commonly used descriptors, is useful for predicting postoperative mortality and symptom persistence. Future research should determine whether interventions to improve exercise tolerance before mitral valve surgery can modify these postoperative outcomes.

Riluzole and Prognostic Factors in Amyotrophic Lateral Sclerosis Long-term and Short-term Survival: A Population-Based Study of 1149 Cases in Taiwan

BackgroundAmyotrophic lateral sclerosis (ALS) is a rare disease in Taiwan; thus, estimation of ALS mortality is difficult. We evaluated factors associated with ALS survival in Taiwan.MethodsThe study enrolled 1149 Taiwanese with a primary diagnosis of ALS during 1999–2008. Follow-up information was available for all patients; mean (SD) duration of follow-up was 2.91 (2.62) years. Medical interventions, including noninvasive positive pressure ventilation (NIPPV), tracheotomy, gastrostomy, and riluzole, were included in time-dependent survival analysis.ResultsOf the 1149 ALS patients, 438 (38.12%) died during follow-up. Mortality in the first year was 16%, which was 13 times (95% CI 11.1–15.2) the age- and sex-standardized rate of the general population in Taiwan. The average annual crude mortality rate was 13.1% (person-years). Factors significantly associated with increased mortality were male sex, advanced age, rural residence, lower economic status, no tracheotomy, and no riluzole treatment. Significant predictors of long-term versus average survival were younger age at diagnosis, being a dependent or receiving social welfare, and NIPPV support. Significant predictors of short-term versus average survival were older age, being employed, no tracheotomy, and no riluzole use.ConclusionsThe results support the use of riluzole to improve ALS survival. Patients who received riluzole and underwent tracheotomy had the best survival.

Factors Associated With Survival After Resection of Colorectal Adenocarcinoma in 314 Patients

specialized preoperative clinics may improve resource allocation and postoperative outcome. Background. An analysis of perioperative factors that were independently associated with survival up to 1000 days after scheduled colorectal adenocarcinoma resections in 314 patients. Methods. The association of 16 perioperative variables with postoperative survival and critical care unit (CCU) admission after scheduled resections for colorectal adenocarcinoma between September 2005 and March 2009 was analysed using multivariable Cox regression analyses and Fisher’s exact tests. Results. We followed survivors for a mean of 983 days (range 696–1000 days). Average annual postoperative mortality was 8.5%, 14% after surgery performed in 2005, and 3% after surgery in 2009. Risk of mortality was independently associated with five variables after stratifying for date of surgery: attending a preoperative high-risk clinic [hazard ratio (HR) 0.42, P¼0.006], worse World Health Organization performance status (HR 2.1, P¼0.001), BMI (HR 0.92, P¼0.009), higher nodal stage (HR 2.6, P,0.0001), and unplanned critical care admission (HR 7.2, P,0.0001). Patients who attended the preoperative clinic (207) were older, with worse renal function and ASA grade, than those who did not (107). Planned postoperative critical care admission was more common in patients who attended the high-risk clinic (24% vs 12%, P¼0.01) and may have partly accounted for the observed mortality difference.

Adult Steller sea lion mortality on rookeries in the Russian Far East, 2002–2010

We used visual observations during nine field seasons to determine the causes and death rate of Steller sea lions older than 1 year on eight rookeries in the Russian Far East. The average annual death rate was 0.48% of the total recorded Steller sea lions on shore and varied among rookeriesy. The mortality did not exceed 0.29% in six rookeries, but reached 0.80–1.19% in two rookeries. Individuals of all age and sex groups were recorded among dead animals. Bulls died as a result of territorial conflicts, and cows and young lions were crushed or suffocated by bulls during copulation. The death of nearly half of the females was attributed to 11 bulls.

Prediction of heat-related mortality impacts under climate change scenarios in Shanghai

To project the future impacts of climate change on heat-related mortality in shanghai. The statistical downscaling techniques were applied to simulate the daily mean temperatures of Shanghai in the middle and farther future under the changing climate. Based on the published exposure-reaction relationship of temperature and mortality in Shanghai, we projected the heat-related mortality in the middle and farther future under the circumstance of high speed increase of carbon e mission (A2) and low speed increase of carbon emission (B2). The data of 1961 to 1990 was used to establish the model, and the data of 1991 - 2001 was used to testify the model, and then the daily mean temperature from 2030 to 2059 and from 2070 to 2099 were simulated and the heat-related mortality was projected. The data resources were from U.S. National Climatic Data Center (NCDC), U.S. National Centers for Environmental Prediction Reanalysis Data in SDSM Website and UK Hadley Centre Coupled Model Data in SDSM Website. The explained variance and the standard error of the established model was separately 98.1% and 1.24°C. The R(2) value of the simulated trend line equaled to 0.978 in Shanghai, as testified by the model. Therefore, the temperature prediction model simulated daily mean temperatures well. Under A2 scenario, the daily mean temperature in 2030 - 2059 and 2070 - 2099 were projected to be 17.9°C and 20.4°C, respectively, increasing by 1.1°C and 3.6°C when compared to baseline period (16.8°C). Under B2 scenario, the daily mean temperature in 2030 - 2059 and 2070 - 2099 were projected to be 17.8°C and 19.1°C, respectively, increasing by 1.0°C and 2.3°C when compared to baseline period (16.8°C). Under A2 scenario, annual average heat-related mortality were projected to be 516 cases and 1191 cases in 2030 - 2059 and 2070 - 2099, respectively, increasing 53.6% and 254.5% when compared with baseline period (336 cases). Under B2 scenario, annual average heat-related mortality were projected to be 498 cases and 832 cases in 2030 - 2059 and 2070 - 2099, respectively, increasing 48.2% and 147.6% when compared with baseline period (336 cases). Under the changing climate, heat-related mortality is projected to increase in the future;and the increase will be more obvious in year 2070 - 2099 than in year 2030 - 2059.

Were Equatorial Regions Less Affected by the 2009 Influenza Pandemic? The Brazilian Experience

Although it is in the Tropics where nearly half of the world population lives and infectious disease burden is highest, little is known about the impact of influenza pandemics in this area. We investigated the mortality impact of the 2009 influenza pandemic relative to mortality rates from various outcomes in pre-pandemic years throughout a wide range of latitudes encompassing the entire tropical, and part of the subtropical, zone of the Southern Hemisphere (+5°N to −35°S) by focusing on a country with relatively uniform health care, disease surveillance, immunization and mitigation policies: Brazil. To this end, we analyzed laboratory-confirmed deaths and vital statistics mortality beyond pre-pandemic levels for each Brazilian state. Pneumonia, influenza and respiratory mortality were significantly higher during the pandemic, affecting predominantly adults aged 25 to 65 years. Overall, there were 2,273 and 2,787 additional P&I- and respiratory deaths during the pandemic, corresponding to a 5.2% and 2.7% increase, respectively, over average pre-pandemic annual mortality. However, there was a marked spatial structure in mortality that was independent of socio-demographic indicators and inversely related with income: mortality was progressively lower towards equatorial regions, where low or no difference from pre-pandemic mortality levels was identified. Additionally, the onset of pandemic-associated mortality was progressively delayed in equatorial states. Unexpectedly, there was no additional mortality from circulatory causes. Comparing disease burden reliably across regions is critical in those areas marked by competing health priorities and limited resources. Our results suggest, however, that tropical regions of the Southern Hemisphere may have been disproportionally less affected by the pandemic, and that climate may have played a key role in this regard. These findings have a direct bearing on global estimates of pandemic burden and the assessment of the role of immunological, socioeconomic and environmental drivers of the transmissibility and severity of this pandemic.

Carbon Monoxide–Related Deaths in Greece

Carbon monoxide (CO) is the cause of more than one half of the fatal poisonings throughout the world. The aim of this study was to assess the characteristics of nonfire CO-related deaths in Greece, as they were recorded at the Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens. This retrospective study concerned the toxicological records of all fatal cases of CO poisoning received by the Department of Forensic Medicine and Toxicology during the period 1987 to 2009. The records were reviewed and compiled according to the official coroner's verdict as to the manner of poisoning (accident or suicide), as well as according to the sex and the nationality of the victims. The registered victims were 176 (131 males, 45 females). Of CO deaths, 97.2% were accidental, and 2.8% were suicides, through automobile exhaust. Among the decedents, 32 victims were immigrants (30 males, 2 females). The average annual death rate for males was nearly 3½ times higher than that for females. This increase suggests a need for preventive strategies targeting not only high-risk population, such as homeless or immigrants, but also the general population. Preventive messages in many languages through the media about potential sources of CO exposure are recommended. Precautions should also be taken during periods of low temperatures.