Average Annual Mortality Research Articles

Grey relation between main meteorological factors and mortality

PurposeThe purpose of this paper is to explore the effects of main meteorological factors on the mortality of urban residents and provide empirical evidence for the prevention of effects of climate changes.Design/methodology/approachGrey relational analysis (GRA) was used to analyse the interrelationships between meteorological factors and mortality among residents in Chaoyang District, Beijing, during the period between 1998 and 2008.FindingsThe changes of annual average mortality had a strong grey relation with temperature and relative humidity. The monthly average mortality (MAM) showed a strong grey relation with air pressure and the MAM in Summer season had a strong grey relation with air pressure, relative humidity and wind speed.Originality/valueMeteorological factors including temperature, relative humidity, air pressure and wind speed are all related with mortality changes. GRA can well reveal the trend of the curve approximation between meteorological factors and mortality and can quantify the different approximation.

One Century of Forest Monitoring Data in Switzerland Reveals Species- and Site-Specific Trends of Climate-Induced Tree Mortality.

Climate-induced tree mortality became a global phenomenon during the last century and it is expected to increase in many regions in the future along with a further increase in the frequency of drought and heat events. However, tree mortality at the ecosystem level remains challenging to quantify since long-term, tree-individual, reliable observations are scarce. Here, we present a unique data set of monitoring records from 276 permanent plots located in 95 forest stands across Switzerland, which include five major European tree species (Norway spruce, Scots pine, silver fir, European beech, and sessile and common oak) and cover a time span of over one century (1898–2013), with inventory periods of 5–10 years. The long-term average annual mortality rate of the investigated forest stands was 1.5%. In general, species-specific annual mortality rates did not consistently increase over the last decades, except for Scots pine forests at lower altitudes, which exhibited a clear increase of mortality since the 1960s. Temporal trends of tree mortality varied also depending on diameter at breast height (DBH), with large trees generally experiencing an increase in mortality, while mortality of small trees tended to decrease. Normalized mortality rates were remarkably similar between species and a modest, but a consistent and steady increasing trend was apparent throughout the study period. Mixed effects models revealed that gradually changing stand parameters (stand basal area and stand age) had the strongest impact on mortality rates, modulated by climate, which had increasing importance during the last decades. Hereby, recent climatic changes had highly variable effects on tree mortality rates, depending on the species in combination with abiotic and biotic stand and site conditions. This suggests that forest species composition and species ranges may change under future climate conditions. Our data set highlights the complexity of forest dynamical processes such as long-term, gradual changes of forest structure, demography and species composition, which together with climate determine mortality rates.

Clinical and Epidemiological Evolution of Sheep Pox in Morocco

Sheep pox is an infectious viral disease that affects specifically sheep and it is caused by the Capripoxvirus genus. The clinical signs include fever, diarrhea, difficulty breathing, nodules, lung lesions and death. In Morocco, the 2010 epidemic of sheep pox was characterized by the emergence of a nodular form of the disease. The local strain was isolated and the analysis of affected animals was positively confirmed by virus isolation and real-time polymerase chain reaction (RT-PCR). The epidemiological analysis of 911 data records showed that the virus is endemic in the country; an average of 350 cases per year with an epizootic evolution was observed in 2010. The incidence varies depending on provinces and the disease appears confined to the central and the eastern regions of the country where a very intensive sheep breeding activity is taking place. The statistical analysis showed that there is a positive correlation between the endemicity and the significant factor of the rural market (p = 0.006). The annual average morbidity and mortality rates were 2.96% (1.26% to 4.32%) and 0.71% (0.41% to 0.94%), respectively. The clinical findings associated to the epidemiological data analysis confirmed the presence of sheep pox in its nodular form and suggest that new pathogenic strains may have been introduced from Mauritania. The purpose of this work was to provide a better description of the spatiotemporal evolution of sheep pox disease based on some epidemiological indicators and to put forward plausible hypotheses regarding the emergence of the virus in order to implement an adequate control strategy.

Analysis of Epidemiological Characteristics of Notifiable Diseases Reported in Children Aged 0⁻14 Years from 2008 to 2017 in Zhejiang Province, China.

This study aims to learn the characteristics of morbidity and mortality of notifiable diseases reported in children aged 0–14 years in Zhejiang Province in 2008–2017. We collated data from the China Information System for Disease Control and Prevention in Zhejiang province between 1 January 2008 and 31 December 2017 of children aged 0–14 years. From 2008 to 2017, a total of 32 types and 1,994,740 cases of notifiable diseases were reported in children aged 0–14 years, including 266 deaths in Zhejiang Province. The annual average morbidity was 2502.87/100,000, and the annual average mortality was 0.33/100,000. Male morbidity was 2886.98/100,000, and female morbidity was 2072.16/100,000, with the male morbidity rate higher than the female morbidity rate (χ2 = 54,033.12, p < 0.01). No Class A infectious diseases were reported. The morbidity of Class B infectious diseases showed a downward trend, but that of Class C infectious diseases showed an upward trend. There were 72,041 cases in 22 kinds of Class B infectious disease and 138 death cases, with a morbidity rate of 90.39/100,000, and a mortality rate of 0.17/100,000. There were 1,922,699 cases in 10 kinds of Class C infectious disease and 128 death cases, with a morbidity rate of 2412.47/100,000, and a mortality rate of 0.16/100,000. The main high-prevalence diseases included hand-foot-and-mouth disease (1430.38/100,000), other infectious diarrheal diseases (721.40/100,000), mumps (168.83/100,000), and influenza (47.40/100,000). We should focus on the prevention and control of hand-foot and mouth disease, other infectious diarrheal diseases, mumps and influenza in children aged 0–14 years in Zhejiang Province. It is recommended to strengthen epidemic surveillance and undertake early prevention and control measures in order to reduce the younger children incidence rate of infectious diseases. Immunization planning vaccines can help achieve a significant preventive decline of infectious diseases.

Mortality risk stratification in patients with asymptomatic carotid stenosis

AIMS: The aim of this analysis was to (a) determine the long-term 5-year all-cause and cardiovascular (CV) mortality in patients with asymptomatic internal carotid artery stenosis (ACS), (b) identify risk factors that could be used in mortality risk stratification, and (c) develop a model for predicting a patient's risk of CV death within 5 years. METHODS: This was a multicenter natural history study involving 1121 patients with ACS undergoing medical intervention alone. Proportional-hazards models were used to calculate all-cause and CV mortality using clinical and plaque texture features. RESULTS: Totally 1121 patients with 50%–99% ICA stenosis (European Carotid Surgery Trial criteria) from the Asymptomatic Carotid Stenosis and Risk of Stroke study were included in this analysis for mortality. Mean follow-up was 48 months (range, 6–96 months). There were 213 (19%) deaths during follow-up. Average annual all-cause mortality was 4.6%. About 68.1% of all deaths were due to CV causes. Independent predictors of all-cause mortality were age, male gender, carotid stenosis >80% (NASCET criteria), diabetes, cardiac failure, left ventricular hypertrophy (LVH) on electrocardiogram (ECG), smoking, absence of antiplatelet therapy, and history of vertebrobasilar symptoms. It was also shown that age, male gender, diabetes, fibrinogen >3.6 g/L, carotid stenosis >80% (NASCET criteria), cardiac failure, absence of antiplatelet therapy, and LVH on ECG were independent risk factors for CV mortality. Receiver operating characteristic curves for the above models were 0.709 (95% confidence interval [CI], 0.659–0.754) and 0.701 (95% CI, 0.656–0.746), respectively. The CV mortality prediction model could identify several subgroups of asymptomatic patients with different risk. The highest 90%–100% predicted 5-year CV mortality carried 25 times the risk of the low-risk subgroup in which the 5-year predicted CV mortality was 4%. CONCLUSION: Mortality risk can be taken into consideration in clinical practice, in order to identify patients with ACS who are unlikely to benefit from carotid endarterectomy. The majority of patients with ACS have a very high risk of myocardial infarction and should not be denied aggressive risk factor modification or a full cardiac investigation according to the current guidelines.

Top‐down pressure on a coastal ecosystem by harbor seals

AbstractHistoric hunting has led to severe reductions of many marine mammal species across the globe. After hunting ceased, some populations have recovered to pre‐exploitation levels and may have regained their prominent position as top predator in marine ecosystems. Also, the harbor seal population in the international Wadden Sea grew at an exponential rate following a ban on seal hunting in 1960s, and the current number ~38,000 is close to the historic population size. Here we estimate the impact of the harbor seal predation on the fish community in the Wadden Sea and nearby coastal waters. Fish remains in fecal samples and published estimates on the seal's daily energy requirement were used to estimate prey selection and the magnitude of seal consumption. Estimates on prey abundance were derived from demersal fish surveys, and fish growth was estimated using a Dynamic Energy Budget model. GPS tracking provided information on where seals most likely caught their prey. Harbor seals hauling‐out in the Dutch Wadden Sea fed predominantly on demersal fish, for example, flatfish species (flounder, sole, plaice, dab), but also on sandeel, cod, and whiting. Although harbor seals acquire the majority of prey further offshore in the adjacent North Sea, and only spend 14% of their diving time in the Wadden Sea, seal predation was still estimated to cause an average annual mortality of 43% of the remaining fish in the Wadden Sea and 60% in the nearby shallow coastal waters (&lt;20 m). There were however large sources of uncertainty in the estimated impact of seals on fish, including the migration of fish between the North Sea and Wadden Sea, and catchability estimates of the fish survey sampling gear, particularly for sandeel and other pelagic fish species. Our estimate suggested a considerable top‐down pressure by harbor seals on demersal fish. However, predation by seals may also alleviate density‐dependent competition between the remaining fish, allowing for increased fish growth, and partly compensating for the reduction in fish numbers. This study shows that recovering coastal marine mammal populations could become an important component in the functioning of shallow coastal ecosystems.

Establishing Digital Biomarkers for Occupational Health Assessment in Commercial Salmon Fishermen: Protocol for a Mixed-Methods Study.

BackgroundCommercial salmon fishing in Alaska is one of the most dangerous occupations in the United States. Between 1992 and 2008, the average annual industry mortality rate was 128 deaths per 100,000 workers, and despite an increase in industry regulations, there has not been a significant decrease in mortality rate since 2000. Unpredictable fishing openings and fierce competition for limited resources result in periods of intense sleep deprivation and physical strain during the short commercial salmon season in Alaska.ObjectiveWe hypothesize that the combined effect of sleep deprivation, intense physical workload, and significant short-term chronic stress may be deleterious to health in both the short- and long-term among commercial salmon drift gillnet fishermen in Alaska. The objective of this protocol is to determine the feasibility of the study design to test this hypothesis.MethodsThe study design uses mixed methods and includes biometric monitoring consisting of heart rate variability, respiration, and movement data collected via a personal, wearable biometric device. Additional methods include observational data on activity, including duration and quality of sleep, weather, catch, and financial gain, as well as the collection of salivary cortisol. As such, the study will provide a holistic assessment of individual stress on multiple simultaneous timescales: immediately and continuously through the personal wearable biometric device, on the minute-hour level through the multiple daily collections of salivary cortisol, and by the hour-day through the use of participant and environment observational data.ResultsData collection was initiated in July 2017 and will extend through August 2019. Initial data collection has indicated that the methods outlined in this protocol are feasible and allow for effective collection of qualitative and quantitative data related to the psychological and physiological impact of Alaska commercial salmon fishing.ConclusionsWe anticipate that the use of a biometric device will be crucial in establishing measures of stress and physical activity within a population and environment uniquely challenged by physical isolation, strong weather patterns, and the potential for significant financial gain by fishermen. The potential exists for individuals engaged long-term in the fishing industry, through repeated and extended exposure to periods of intense sleep deprivation and chronic stress, to be at increased risk of cardiovascular disease.International Registered Report Identifier (IRRID)DERR1-10.2196/10215

A 10-Year retrospective review of renal cases seen in a Tertiary Hospital in West Africa.

IntroductionRenal diseases commonly present to the Komfo Anokye Teaching Hospital (KATH). There has not been a comprehensive analysis of the number of renal cases managed. We set out to analyze comprehensively the renal cases seen at KATH to describe the trends a decade.MethodsA retrospective study was conducted from January 2006 to December 2016. We collected secondary data from the records on the wards, outpatient clinics and hemodialysis unit from the KATH annual reports. Trends in renal cases were then plotted. ResultsRenal outpatient clinics started in 2007. There were an average of 65,273 medical out patients seen yearly with renal conditions accounting for 5,397 (8.3%). Renal clinic patients increased by 271% from 710 in 2007 to 1927 in 2016.The average yearly medical admission was 6,880 patients of which renal admissions accounted for 276 (4.0%). The average position of renal admissions was 6th (range 2nd-10th) of total medical admissions. The average annual mortality rate of renal admissions was 32.7%. The average mortality of general medical cases was 23.8% annually.Hemodialysis services commenced in 2006. Patients on haemodialysis have increased by 50 times from 8 in 2006 to 407 in 2016. Hemodialysis session also increased by 38.8 times from 59 in 2006 to 2350 in 2016. The average number of patients on hemodialysis per year was 211.5.ConclusionRenal disease is a common condition in KATH associated with significant morbidity and mortality. A concerted effort is needed to enhance the diagnosis and management of renal diseases in Ghana.

Changes in mortality and economic vulnerability to climatic hazards under economic development at the provincial level in China

Studies have reported that economic development can contribute to reducing vulnerability to natural hazards. However, there exist considerable variations in the association between economic growth and vulnerability, especially at the sub-country scale. Based on climatic hazard impact (indicated by mortality and direct economic losses (DEL)) and economic development data for 31 provinces in the mainland of China from 1990 to 2015, trends of disaster impact, and trends of vulnerability (indicated by mortality rate and DEL rate), were detected using the Mann–Kendall trend test at the provincial level. Next, the relationship between income and vulnerability was characterized. At the provincial level during 1990–2015, there was a clear transformation of the climatic hazard impact landscape from high average annual mortality to high average annual DEL. Both the mortality and the DEL rates presented downward trends for most provinces. The magnitude of vulnerability decrease was higher in the economically developed provinces compared to the underdeveloped provinces, and vulnerability declined nonlinearly with income increase. A vulnerability trap appears to exist approximately below 1600 US$ for income—above this threshold, a province’s vulnerability significantly decreased. Mortality and economic vulnerability to climatic hazards are correlated with economic development, but causal links between economic development and vulnerability reduction need further investigation. Our findings suggest that shortening the transitional period from the low-income trap and reducing inter-provincial disparity of economic development may be powerful tools for reducing vulnerability to climatic hazards, especially for economically underdeveloped regions. These should also be important considerations in developing efficient adaption strategies for climate change.

Impact of primary care provider density on detection and diagnosis of cutaneous melanoma.

IntroductionEarly diagnosis of cutaneous melanoma is critical in preventing melanoma-associated deaths, but the role of primary care providers (PCPs) in diagnosing melanoma is underexplored. We aimed to explore the association of PCP density with melanoma incidence and mortality.MethodsAll cases of cutaneous melanoma diagnosed in the United States from 2008–2012 and reported in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed in 2016. County-level primary care physician density was obtained from the Area Health Resources File (AHRF). We conducted multivariate linear regression using 1) average annual melanoma incidence or 2) average annual melanoma mortality by county as primary outcomes, adjusting for demographic confounders and dermatologist density. Cox proportional hazard regression was conducted using individual outcome data from SEER with the same covariates.ResultsAcross 611 counties, 167,305 cases of melanoma were analyzed. Per 100,000 people, an additional 10 PCPs per county was associated with 1.62 additional cases of melanoma per year (95% CI 1.06–2.18, p<0.001). This increased incidence occurred disproportionally in early-stage melanoma (Stage 0: 0.69 cases (0.38–1.00), p<0.001; Stage I: 0.63 cases (0.37–0.89), p<0.001; Stage II: 0.11 cases (0.03–0.19), p = 0.005). There was no statistically significant association between PCP density and incidence of stage III or IV melanoma, or with melanoma-specific mortality. Survival analysis demonstrated elimination of 5-year post-diagnosis mortality risk in medically underserved counties after adjusting for stage.ConclusionsHigher densities of PCPs may be linked to increased diagnosis of early-stage melanoma without corresponding decreases in late-stage diagnoses or melanoma-associated mortality.

Cold-related mortality vs heat-related mortality in a changing climate: A case study in Vilnius (Lithuania)

IntroductionDirect health effects of extreme temperatures are a significant environmental health problem in Lithuania, and could worsen further under climate change. This paper attempts to describe the change in environmental temperature conditions that the urban population of Vilnius could experience under climate change, and the effects such change could have on excess heat-related and cold-related mortality in two future periods within the 21st century. MethodsWe modelled the urban climate of Vilnius for the summer and winter seasons during a sample period (2009–2015) and projected summertime and wintertime daily temperatures for two prospective periods, one in the near (2030–2045) and one in the far future (2085–2100), under the Representative Concentration Pathway (RCP) 8.5. We then analysed the historical relationship between temperature and mortality for the period 2009–2015, and estimated the projected mortality in the near future and far future periods under a changing climate and population, assuming alternatively no acclimatisation and acclimatisation to heat and cold based on a constant-percentile threshold temperature. ResultsDuring the sample period 2009–2015 in summertime we observed an increase in daily mortality from a maximum daily temperature of 30 °C (the 96th percentile of the series), with an average of around 7 deaths per year. Under a no acclimatisation scenario, annual average heat-related mortality would rise to 24 deaths/year (95% CI: 8.4–38.4) in the near future and to 46 deaths/year (95% CI: 16.4–74.4) in the far future. Under a heat acclimatisation scenario, mortality would not increase significantly in the near or in the far future. Regarding wintertime cold-related mortality in the sample period 2009–2015, we observed increased mortality on days on which the minimum daily temperature fell below − 12 °C (the 7th percentile of the series), with an average of around 10 deaths a year. Keeping the threshold temperature constant, annual average cold-related mortality would decrease markedly in the near future, to 5 deaths/year (95% CI: 0.8–7.9) and even more in the far future, down to 0.44 deaths/year (95% C: 0.1–0.8). Assuming a “middle ground” between the acclimatisation and non-acclimatisation scenarios, the decrease in cold-related mortality will not compensate the increase in heat-related mortality. ConclusionThermal extremes, both heat and cold, constitute a serious public health threat in Vilnius, and in a changing climate the decrease in mortality attributable to cold will not compensate for the increase in mortality attributable to heat. Study results reinforce the notion that public health prevention against thermal extremes should be designed as a dynamic, adaptive process from the inception.

Epidemiological characteristics of echinococcosis death cases in China from 2008 to 2016

To understand the epidemiological characteristics of death cases of echinococcosis in China from 2008 to 2016, so as to provide an important reference for the prevention and control of echinococcosis. The death information registration and management system data were selected to analyze the epidemiological characteristics of the death cases of echinococcosis. The data were analyzed by SPSS 21.0 and the map was drawn by ArcGIS 10.1 software. From 2008 to 2016, a total of 367 death cases of echinococcosis were reported in China, and the number of deaths in turn was 33, 30, 21, 32, 35, 54, 55, and 81 in each year, with an annual average crude mortality of 129.29 /105. The average age of death was (56 ± 18) years; the sex ratio of male to female was 100∶94. There was no statistical difference between the male and female death cases (χ2 = 0.33, P > 0.05).The death cases of echinococcosis were mainly distributed in endemic areas of Qinghai, Sichuan, Ningxia, Xinjiang, Gansu, Inner Mongolia, Yunnan and non-endemic areas of Heilongjiang, Jiangsu, Henan and Shandong. The death cases in the first eleven provinces accounted for 87.5% (321/367) of the total death cases, among which the highest proportions of the nationality, occupation, educational level, highest diagnostic units, and the place of death were Han (52.0%, 191/367), farmer (46.6%, 171/367), junior high school or below (57.2%, 210/367), provincial or three-level hospitals (46.6%, 171/367), and at home (59.9%, 220/367). Since 2014, the death cases of echinococcosis in China have been increasing year by year, indicating that the prevention and treatment of echinococcosis is still very serious. The causes for the rise of the fatality rate remain to be further studied.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016

The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories. Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

PDB66 - Survival of Patients with Diabetes Mellitus By Residential Area in Colombia, 2008-2017

To estimate the survival in a dynamic cohort of patients with diabetes mellitus (DM) affiliated to a public health insurer in Colombia. Retrospective cohort study (2008 - 2017) of 29,286 patients diagnosed with DM affiliated to a public health insurer, grouped by residence area (urban and rural). Sociodemographic variables and mortality incidence were analyzed. Survival curves were estimated using Kaplan-Meier (KM), Log-Rank significance test and Cox regression models to identify risk factors mortality. The average annual mortality rate was 2.2 / 100persons-year [CI95% = 2.1-2.3]. In the fourth year of the study, the probability of survival in the urban area was 88.7% [CI95% = 87.8-89.6%] and in the rural area it was 83.9% [CI95% = 81.1% -86.3 %]. For the last year the gap tends to increase; in the urban area the probability of survival was 43.4% [CI95% = 37.8% -48.8%], while in the rural area it was 19.83% [CI95% = 9.9% -32.2%]. The Logan-Rank test shows a higher diabetic death risk in patients living in rural areas (Chi2 = 27.23, p-value = 0.00 and NS = 5%). The Cox regression indicate that a diabetic patient from the rural area, presents a death risk of 26.3% [CI95% = 17.2% -34.5%] greater than the urban patients. In both areas, death probability increases with age (1048) [CI95% = 1.04-1.05]. The survival probability remained high during the first two years and then decreases at a higher rate in the rural area. There is a significant gap in services access and / or medicines for the control of DM at the urban-rural level. A medium-term policy would be the implementation of DM risk management programs and the timely supply of medicines to patients in rural areas.

The Association Between Acute Respiratory Distress Syndrome Hospital Case Volume and Mortality in a U.S. Cohort, 2002-2011.

This study examines the relationships between hospitals' annual acute respiratory distress syndrome case volume with hospitals' acute respiratory distress syndrome case fatality rates and individuals' odds of acute respiratory distress syndrome hospital mortality. Retrospective cohort study. The U.S. Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, 2002-2011. Acute respiratory distress syndrome discharges defined by the presence of an acute respiratory distress syndrome International Classification of Diseases, 9th revision, Clinical Modification diagnosis code (518.82 or 518.5) and a mechanical ventilation procedure code (96.70, 96.71 or 96.72) on the discharge diagnosis and procedure lists. If the procedure code 96.71 was on the discharge record (mechanical ventilation < 96 hr duration), the patient also needed to be classified as deceased. None. We analyzed 2,686 hospitals and 117,204 cases of acute respiratory distress syndrome. Average annual hospital acute respiratory distress syndrome in-hospital mortality was 47%. Acute respiratory distress syndrome case volume was categorized as low (1-9), medium (10-49), and high (50-423 cases per year). In a hospital-level Poisson regression adjusting for hospital characteristics, when compared with low-volume acute respiratory distress syndrome hospitals, high- and medium-volume acute respiratory distress syndrome hospitals had lower annual acute respiratory distress syndrome case fatality (rate ratio, 0.75; 99% CI, 0.71-0.79 and rate ratio, 0.86; 99% CI, 0.82-0.90, respectively; p ≤ 0.001 for both). In an individual-level, multivariable model adjusting for hospital and individual characteristics, high and medium acute respiratory distress syndrome volume hospitals were associated with lower odds of acute respiratory distress syndrome mortality compared with low-volume hospitals (odds ratio, 0.85 [99% CI, 0.74-0.99]; p = 0.006 and odds ratio, 0.89 [99% CI 0.79-1.00]; p = 0.01, respectively). In this cohort, at both an individual- and hospital-level, higher acute respiratory distress syndrome hospital case volume is associated with lower acute respiratory distress syndrome hospital mortality.

Differences in Race and Ethnicity in Muscular Dystrophy Mortality Rates for Males under 40 Years of Age, 2006–2015

Background/Aims: Duchenne Muscular Dystrophy (DMD) has childhood onset, primarily affects males, and is usually fatal before the age of 40 years. Previous studies have indicated that this X-linked condition is more prevalent in whites than in blacks, but those were based on active surveillance, and limited to smaller populations and younger ages. Methods: US death data were used to calculate mortality rates by race and ethnicity, with MD as either the underlying or multiple cause of death (MCD). Poisson approximation was used for confidence intervals; chi-square was used to compare rates. Results: From 2006 to 2015, there were 3,256 deaths in males <40 years with MD as MCD, and 71% of these were aged 15–29 years. For whites, the average annual death rate was 0.43/100,000, which was significantly higher (p < 0.0001) that that of blacks (0.28), American Indian/Alaska Natives (0.20), and Asian/Pacific Islanders (0.21). The rate for non-Hispanic whites (0.46) was significantly higher (p < 0.0001) than the rates for Hispanic whites (0.31), Hispanic blacks (0.07), and non-Hispanic blacks (0.29). Conclusion: Since DMD is the primary cause of deaths in young males with MD, mortality rates are a reasonable proxy for the relative difference in racial prevalence. It appears that DMD is significantly more common in white males than in males of other races.

Alcohol Consumption and Chronic Liver Disease Mortality in New Mexico and the United States, 1999-2013.

Current chronic liver disease (CLD) mortality surveillance methods may not adequately capture data on all causes of CLD mortality. The objective of this study was to calculate and compare CLD death rates in New Mexico and the United States by using both an expanded definition of CLD and estimates of the fractional impact of alcohol on CLD deaths. We defined CLD mortality as deaths due to alcoholic liver disease, cirrhosis, viral hepatitis, and other liver conditions. We estimated alcohol-attributable CLD deaths by using national and state alcohol-attributable fractions from the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. We classified causes of CLD death as being alcohol-attributable, non-alcohol-attributable, or hepatitis C. We calculated average annual age-adjusted CLD death rates during five 3-year periods from 1999 through 2013, and we stratified those rates by sex, age, and race/ethnicity. By cause of death, CLD death rates were highest for alcohol-attributable CLD. By sex and race/ethnicity, CLD death rates per 100 000 population increased from 1999-2001 to 2011-2013 among American Indian men in New Mexico (67.4-90.6) and the United States (38.9-49.4), American Indian women in New Mexico (48.4-63.0) and the United States (27.5-39.5), Hispanic men in New Mexico (48.6-52.0), Hispanic women in New Mexico (16.9-24.0) and the United States (12.8-13.1), non-Hispanic white men in New Mexico (17.4-21.3) and the United States (15.9-18.4), and non-Hispanic white women in New Mexico (9.7-11.6) and the United States (7.6-9.7). CLD death rates decreased among Hispanic men in the United States (30.5-27.4). An expanded CLD definition and alcohol-attributable fractions can be used to create comprehensive data on CLD mortality. When stratified by CLD cause and demographic characteristics, these data may help states and jurisdictions improve CLD prevention programs.

Job loss, firm-level heterogeneity and mortality: Evidence from administrative data

This paper estimates the effect of job loss on mortality for older male workers with a strong labor force attachment. Using Dutch administrative data, we find that job loss due to firm closure increased the probability of death within five years by a sizable 0.60 percentage points. Importantly, this effect is estimated using a model that controls for firm-level worker characteristics, such as lagged firm-level annual average mortality rates. On the mechanism driving the effect of job loss on mortality, we provide evidence for an effect running through stress and changes in life style.

An exploratory survey of long horn beetle damage on the dryland flagship tree species Boswellia papyrifera (Del.) Hochst

Boswellia papyrifera (Del.) Hochst, a flagship tree species in the drylands of Ethiopia, is of high ecological, economic and social value. Recent work has shown that a wood-boring beetle is threatening its survival. In situ and ex situ studies were carried out to study the biology and damage associated with the insect in the dry lowlands of Northern Ethiopia. The beetle's life cycle, biology, and population were studied for 10 months. The mortality of B. papyrifera trees due to the wood-boring beetle was assessed in two land management systems (managed and unmanaged) in 64 (400 m2) randomly allocated plots in Boswellia woodlands of Central and Western Tigray. The beetle was identified as Idactus spinipennis Gahan. Average annual tree mortality attributed to I. spinipennis was up to 7% and 8% ha−1 for Central and Western Tigray, respectively. I. spinipennis has a detrimental effect on the succession of Boswellia woodlands, causing resource loss and fragmentation. Estimated average losses in Central Tigray were 45.7 kg frankincense ha−1 (US $137.1 ha-1) and 26.9 kg frankincense ha−1 (US $80.6 ha-1) from unmanaged and managed Boswellia woodlands, respectively. Hence immediate management interventions are required to reduce ecological and economic loss of the Boswellia woodland.

Multiple Sclerosis Mortality by Race/Ethnicity, Age, Sex, and Time Period in the United States, 1999–2015

Background: Multiple sclerosis (MS) carries high morbidity and shortens life span. While there is recent recognition of other US minority populations such as blacks and Hispanics being affected with MS, examination of MS-specific mortality trends by race/ethnicity has been lacking. Objective: To investigate MS mortality rates and trends in the United States by sex, age, and race/ethnicity. Methods: We used the Compressed Mortality data file for 1999–2015 in the Wide-ranging online Data for Epidemiological Research system developed by the Center for Disease Control and Prevention to calculate the age-adjusted (US 2000 standard population) and age-specific MS mortality rate (per 100,000) by race/ethnicity and sex over time. Five mutually exclusive racial/ethnic groups were included in the analysis: non-Hispanic (NH) white, NH black, NH Asian or Pacific Islander (API), NH American Indian or Alaska Native, and Hispanic. Results: The average annual age-adjusted MS mortality rate was highest among NH whites (0.90 for males and 1.50 for females) immediately followed by NH blacks (0.75 for males and 1.42 for females), and lowest among APIs (0.05 for males and 0.12 for females). Statistically significant, increasing trend in age-adjusted MS mortality was observed during 1999–2015 among NH whites and NH blacks regardless of sex, more substantially in the latter. Age-specific MS mortality patterns showed NH blacks had the highest rate under age 55 and NH whites had the highest rate after that age point. For these 2 groups, MS mortality increased with age in both sexes and peaked at ages 55–64 for NH blacks and 65–74 for NH whites before declining substantially, while for Hispanic and API groups the risk plateaued after age 55. Conclusion: MS-specific mortality trends demonstrate distinctive differences by race/ethnicity and age. The observations that whites and females are more likely to die from MS is in line with the overall understanding that these groups are affected more by MS. However, the findings of blacks dying at an earlier age and having more substantially increasing mortality trends than whites suggest that MS burden weighs unequally by race. Further investigation into these trends may provide additional evidence into risk or protective factors within each group.