Avoidable Deaths Research Articles

Mixed messages, broken trust, avoidable deaths: A critical appraisal of the UK government’s response to the COVID-19 pandemic

Abstract This short commentary draws on academic and grey literature to critically evaluate the UK response to the COVID-19 pandemic, highlighting aspects in which the response fell short and their ramifications on public trust and compliance with preventive measures. Such aspects include the initial delay in response to the outbreak, the controversial “herd immunity approach,” the mismanagement of care home patients, the inadequacy of the contact tracing system, the scandals around the procurement of personal protective equipment, and the breach of lockdown/social distancing regulations by government officials. Based on the lessons learned from these shortcomings, this commentary seeks to provide suggestions for effective public governance in the face of future health emergencies.

Ethical and Practical Considerations for an Agreement to Ensure Equitable Vaccine Access Comment on "More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry's Role in Widening the Access Gap".

This paper discusses the potential of an international agreement to ensure equitable vaccine distribution, addressing the failures witnessed during the COVID-19 pandemic. COVAX was unable to prevent vaccine monopolization and unequal distribution, which led to significant disparities in vaccination rates and avoidable deaths. Any future agreement on equitable vaccine distribution must address ethical and practical issues to ensure global health equity and access. The proposed agreement should recognize healthcare as a human right and consider vaccines beyond mere commodities, emphasizing the social responsibility of pharmaceutical companies to prioritize affordability, availability, and accessibility, particularly for low-income countries (LICs). Voluntary licensing agreements are suggested as a means to enhance access to essential medicines. The paper also outlines the necessity of international cooperation, with robust compliance mechanisms, to effectively enforce such an agreement and mitigate future health crises.

Unraveling determinants of severe anaphylaxis — A cluster analysis from a large national hospitalization database

BackgroundUnderstanding potential risk factors and phenotypes at-risk of anaphylaxis can tailor public health actions to prevent avoidable deaths. Therefore, our aim was to explore patterns of hospital admissions diagnosed with anaphylaxis in France from 2012 to 2021, across different age groups, using the national French hospital database and to evaluate potential determinants to propose phenotypes at-risk, with a particular view to severe cases. MethodsThis is a descriptive study, using data from the French Program for the Medicalization of Information Systems, from 2012 to 2021. We included all patients hospitalized for anaphylaxis using International Classification of Diseases (ICD)-10 codes listed as a primary diagnosis. Potential risk factors were selected according to corresponding ICD codes, available as secondary data of hospitalization. Severe anaphylaxis (SA) was defined based on the need of admissions in intensive care units. To explore the patterns and characteristics, we employed cluster analysis using the clustering large applications algorithm. Charlson comorbidity index (CCI) was used to evaluate comorbidities. ResultsDuring the 9-year study period, 78,453 patients had 86,654 admissions due to anaphylaxis for all-causes. Most of the cases were non-severe anaphylaxis (93.7%), 5.9% were SA, and 0.4% evolved to fatal anaphylaxis (FA). Rate of admissions for SA was 0.08/100,000/year. Seasonal trend of cases of anaphylaxis due to Hymenoptera venoms were shown. Increased severity and risk of death were significantly higher in the elderly. Food-induced anaphylaxis is more frequent in childhood, but SA occurred at adolescence and early adulthood. The CCI was higher in SA and FA. By applying the clustering algorithm CLARA, we identified 3 clusters distributed according to the severity. ConclusionMore than providing a snap shot of potential risk factors for anaphylaxis in France, we were able to suggest phenotypes of anaphylaxis of different severities and to propose actions based on our findings. Although further research is needed in the field, we strongly believe that the data presented may contribute to public health advancements to ensure quality of care of patients suffering from anaphylaxis.

Contributing causes of mortality and potentially avoidable deaths of people with intellectual or learning disability: A data‐linkage study

AbstractBackgroundPeople with intellectual disabilities are at much higher risk of preventable deaths compared to the general community. However, studies identifying the cause of death in people with intellectual disability are generally based on one primary cause which is frequently attributed to the person's disability. Therefore, the aim of this study was to identify the most common associated causes that may have contributed to the deaths of Australians with intellectual or learning disabilities, particularly those that may be avoidable.MethodsLinked data that had previously been used to identify underlying causes of deaths were re‐analysed to determine other contributing causes of death in Australians with intellectual disabilities aged under 65 years who accessed disability services between July 2013 and June 2018.FindingsTwo thousand three hundred and thirty‐three deaths occurred among 180,790 people with intellectual disability. Contributing causes of death with the greatest disparities compared to the general community were lung diseases due to external agents (adjusted rate ratio (RR) 70.6 (95% confidence interval [95% CI] 63.7–78.2), influenza and pneumonia (RR 18.3; 95% CI 16.4–20.4), and coronary heart disease (RR 3.3; 95% CI 2.8–3.8).ConclusionsAnalysing all contributing causes of death in people with intellectual disabilities can ensure that the higher rates of preventable deaths in people with intellectual disability are identified and addressed earlier in the disability and health sectors.

Air pollution deaths attributable to fossil fuels: observational and modelling study

ObjectivesTo estimate all cause and cause specific deaths that are attributable to fossil fuel related air pollution and to assess potential health benefits from policies that replace fossil fuels with...

Utilising routine clinical laboratory data to support quality improvement in health care: Application of a national acute kidney injury alert system as a proof of concept.

Acute kidney injury (AKI) is a global health issue known to cause avoidable harm and death. Improvement in its prevention and management is therefore considered an important goal for the health-care sector. The work here aimed to develop a tool which could be used to robustly and reliably measure, monitor, and compare the effectiveness of health-care interventions related to AKI across the Welsh NHS, a mechanism which did not exist previously. Using serum creatinine (SCr) as a biomarker for AKI and a validated national data-set collected from the all Wales Laboratory Information Management System, work involved applying Donabedian's framework to develop indicators with which to measure outcomes related to AKI, and exploring the potential of statistical process control (SPC) techniques for analysing data on these indicators. Rate of AKI incidence and 30-day AKI-associated mortality are proposed as valid, feasible indicators with which to measure the effectiveness of health-care interventions related to AKI. The control chart, funnel plot, and Pareto chart are proposed as appropriate, robust SPC techniques to analyse and visualise variation in AKI-related outcomes. This work demonstrates that routinely collected large SCr data offer a significant opportunity to monitor and therefore inform improvement in patient outcomes related to AKI. Moreover, while this work concerns utilisation of SCr data for improvement in AKI strategies, it is a proof of concept which could be replicated for other routinely collected clinical laboratory data, to improve the prevention and/or management of the conditions to which they relate.

Systemic primary carnitine deficiency induces severe arrhythmia due to shortening of QT interval

BackgroundSystemic primary carnitine deficiency (PCD) is characterized by cardiomyopathy and arrhythmia. Without carnitine supplementation, progression is usually towards fatal cardiac decompensation. While the cardiomyopathy is most likely secondary to energy deficiency, the mechanism of arrhythmia is unclear, and may be related to a short QT interval. ObjectiveWe aim to describe rhythmic manifestations at diagnosis and with carnitine supplementation. MethodsFrench patients diagnosed for PCD were retrospectively included. Clinical and para clinical data at diagnosis and during follow-up were collected. Electrocardiograms with QT interval measurements were blinded reviewed by two paediatric cardiologists. ResultsNineteen patients (median age at diagnosis 2.3 years (extremes 0.3–28.9)) followed in 8 French centres were included. At diagnosis, 21% of patients (4/19) had arrhythmia (2 ventricular fibrillations, 1 ventricular tachycardia and 1 sudden death), and 84% (16/19) had cardiomyopathy. Six electrocardiograms before treatment out of 11 available displayed a short QT (QTc < 340 ms). Median corrected QTc after carnitine supplementation was 404 ms (extremes 341–447) versus 350 ms (extremes 282–421) before treatment (p < 0.001). The whole QTc was prolonged, and no patient reached the criterion of short QT syndrome with carnitine supplementation. Three patients died, probably from rhythmic cause without carnitine supplementation (two extra-hospital sudden deaths and one non-recoverable rhythmic storm before carnitine supplementation), whereas no rhythmic complication occurred in patients with carnitine supplementation. ConclusionPCD is associated with shortening of the QT interval inducing severe arrhythmia. A potential explanation would be a toxic effect of accumulated fatty acid and metabolites on ionic channels embedded in the cell membrane. Carnitine supplementation normalizes the QTc and prevents arrhythmia. Newborn screening of primary carnitine deficiency would prevent avoidable deaths.

Adherence to heart failure therapy influences LV recovery in women with PPCM

Abstract Introduction Peripartum cardiomyopathy (PPCM) is characterised by left ventricular (LV) dilatation and dysfunction developing towards the end of pregnancy or in the first months postpartum. Although about 60% of women with PPCM, the majority on evidence based (EBM) heart failure medications, show LV recovery within six to twelve months, others remain with persistently impaired LV function. Poor adherence to EBM represents a major cause of avoidable hospitalizations, disability and death in other cardiovascular conditions. Purpose We aimed to study drug adherence to heart failure (HF) therapy of women with PPCM and to identify possible associations between drug adherence and LV recovery, functional status and psychosocial factors. Methods In this prospective, observational study, we included 36 consecutive women with PPCM, who returned for their regular follow-up visit. Adherence to HF treatment was assessed by self-reported adherence, pharmacy refills of HF drugs [ACE-i/ARB, BB, MRA] and drug levels by means of liquid chromatography high-resolution mass spectrometry (LC-HRMS) of plasma. Participants were classified as following: "adherent" (all prescribed HF drugs were detectable by LC-HRMS), "partially adherent" (at least one prescribed drug detectable) and "non-adherent" (none of the prescribed drugs were detectable). Health state index scores were assessed by EQ5D including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Results Patients’ median age was 32.4 years (IQR 27.6-36.1) with a median time of 16 months (IQR 5-45) between the first presentation and the adherence visit. Prescription at the adherence visit included 77.8% BB, 75% ACE-i/ARB, 47.2% MRA and 95.2% loop diuretics. The median LVEF at follow-up was 46% (IQR 34-55). Self-reported adherence was 50% and 66.7% of patients collected all pharmacy refills in 6 months prior to follow-up. According to LC-HRMS, 23.5% participants were classified as adherent, 53% as partially adherent, and 23.5% as non-adherent. Adherent patients showed significantly lower LVEDD at follow-up (47 mm [IQR 46-52), vs 56 mm [IQR 49-64] in partially adherent, and 62 mm [IQR 55-64] in non-adherent, p=0.022) and had a higher LVEF at follow up (60% [IQR 41-65]), vs partially adherent (46% [IQR 34-50]) and non-adherent patients (41% [IQR 29-47], p=014). Adherent patients had a lower overall EQ5D score (5.5 [IQR 5-7.5], vs 6 [IQR 5-7] in partially adherent, and 10 [IQR 8-15] non-adherent patients, p=0.032) suggestive of a better self-rated health status (Figure 1). Conclusion For the first time, we show that drug adherence in PPCM is sub-optimal. High adherence to HF therapy was associated with favourable LV remodeling. A better self-rated health status was associated with adherence. Our study highlights the importance of drug adherence for functional recovery in PPCM. Drug adherence should be an important component of patient communication and specific interventions in PPCM.Figure 1

Raman Spectroscopy Spectral Fingerprints of Biomarkers of Traumatic Brain Injury.

Traumatic brain injury (TBI) affects millions of people of all ages around the globe. TBI is notoriously hard to diagnose at the point of care, resulting in incorrect patient management, avoidable death and disability, long-term neurodegenerative complications, and increased costs. It is vital to develop timely, alternative diagnostics for TBI to assist triage and clinical decision-making, complementary to current techniques such as neuroimaging and cognitive assessment. These could deliver rapid, quantitative TBI detection, by obtaining information on biochemical changes from patient's biofluids. If available, this would reduce mis-triage, save healthcare providers costs (both over- and under-triage are expensive) and improve outcomes by guiding early management. Herein, we utilize Raman spectroscopy-based detection to profile a panel of 18 raw (human, animal, and synthetically derived) TBI-indicative biomarkers (N-acetyl-aspartic acid (NAA), Ganglioside, Glutathione (GSH), Neuron Specific Enolase (NSE), Glial Fibrillary Acidic Protein (GFAP), Ubiquitin C-terminal Hydrolase L1 (UCHL1), Cholesterol, D-Serine, Sphingomyelin, Sulfatides, Cardiolipin, Interleukin-6 (IL-6), S100B, Galactocerebroside, Beta-D-(+)-Glucose, Myo-Inositol, Interleukin-18 (IL-18), Neurofilament Light Chain (NFL)) and their aqueous solution. The subsequently derived unique spectral reference library, exploiting four excitation lasers of 514, 633, 785, and 830 nm, will aid the development of rapid, non-destructive, and label-free spectroscopy-based neuro-diagnostic technologies. These biomolecules, released during cellular damage, provide additional means of diagnosing TBI and assessing the severity of injury. The spectroscopic temporal profiles of the studied biofluid neuro-markers are classed according to their acute, sub-acute, and chronic temporal injury phases and we have further generated detailed peak assignment tables for each brain-specific biomolecule within each injury phase. The intensity ratios of significant peaks, yielding the combined unique spectroscopic barcode for each brain-injury marker, are compared to assess variance between lasers, with the smallest variance found for UCHL1 (σ2 = 0.000164) and the highest for sulfatide (σ2 = 0.158). Overall, this work paves the way for defining and setting the most appropriate diagnostic time window for detection following brain injury. Further rapid and specific detection of these biomarkers, from easily accessible biofluids, would not only enable the triage of TBI, predict outcomes, indicate the progress of recovery, and save healthcare providers costs, but also cement the potential of Raman-based spectroscopy as a powerful tool for neurodiagnostics.

Adverse Health Impacts of Outdoor Air Pollution, Including from Wildland Fires, in the United States: "Health of the Air," 2018-2020.

Rationale: Adverse health impacts from outdoor air pollution occur across the United States, but the magnitude of these impacts varies widely by geographic region. Ambient pollutant concentrations, emission sources, baseline health conditions, and population sizes and distributions are all important factors that need to be taken into account to quantify local health burdens. Objectives: To determine health impacts from ambient air pollution concentrations in the United States that exceed the levels recommended by the American Thoracic Society. Methods: Using a methodology that has been well established in previous "Health of the Air" reports, this study provides policy-relevant estimates for every monitored county and city in the United States for the adverse health impacts of outdoor pollution concentrations using U.S. Environmental Protection Agency design values for years 2018-2020. Additionally, for the first time, the report includes adverse birth outcomes as well as estimates of health impacts specifically attributable to wildland fires using an exposure dataset generated through Community Multiscale Air Quality simulations. Results: The adverse health burdens attributable to air pollution occur across the entire age spectrum, including adverse birth outcomes (10,660 preterm and/or low-weight births; 95% confidence interval [CI], 3,180-18,330), in addition to mortality impacts (21,300 avoidable deaths; 95% CI, 16,180-26,200), lung cancer incidence (3,000 new cases; 95% CI, 1,550-4,390), multiple types of cardiovascular and respiratory morbidity (748,660 events; 95% CI, 326,050-1,057,080), and adversely impacted days (52.4 million days; 95% CI, 7.9-92.4 million days). Two different estimates of mortality impacts from wildland fires were created based on assumptions regarding the underlying toxicity of particles from wildland fires (low estimate of 4,080 deaths, 95% CI, 240-7,890; middle estimate of 28,000 deaths, 95% CI, 27,300-28,700). Conclusions: This year's report identified sizable health benefits that would be expected to occur across the United States with compliance with more health-protective air quality standards such as those recommended by the American Thoracic Society. This study also indicates that a large number of excess deaths are attributable to emissions from wildland fires; air quality management strategies outside what is required by the Clean Air Act will be needed to best address this important source of air pollution and its associated health risks.

Causes of sudden neonatal mortality disclosed by autopsy and histopathological examination.

The neonatal period, or the first 28 days of life, is the most vulnerable time in a child's life. Neonatal mortality has decreased in recent years. However, this progress varies at the national level, which necessitates actual regional data from different countries to identify local handicaps for life-saving precautions. This study aimed to investigate the causes for neonatal deaths as revealed by autopsy and histopathological examinations. A retrospective cross-sectional study was designed to identify the main causes of neonatal deaths in children who were autopsied at our institution between January 1, 2014, and December 31, 2021. Children who died within the first 28 days after birth (1-28 days of age) were referred to as neonatal cases. The main causes of neonatal death in children were determined via autopsy and histopathological and toxicological examinations. Furthermore, the causes of death were classified according to their manner of death. During this period, 122 neonatal children were autopsied at our institution. This group comprised 57 girls and 65 boys. For the manner of the death, natural causes were the most common cause (n = 91, 74.5%). Among natural causes, pneumonia (n = 66) was the leading one, representing 54% of all neonatal deaths, followed by perinatal conditions (n = 16, 13.1%). One of the pioneering reasons for death was sudden, unexpected postnatal collapse (n = 24, 19.6%), which was categorized under the undetermined group considering the manner of death. Unintentional (accidental) deaths accounted for 0.8% (n = 1) of total deaths, and intentional deaths were responsible for 6 neonates (4.9%) losses. This study shows that newborn children still die from simple and treatable infectious causes, probably arising from various familial and/or public inadequacies. In addition, sudden and unexpected postnatal collapse remains an important cause of neonatal mortality that has yet to be fully resolved. This study points out valuable inferences for caregivers and competent authorities to take preventive measures to prevent avoidable neonatal deaths.

Regional and temporal patterns of Italian COVID-19 mortality

Abstract Background Italy responded to COVID-19 with stringent lockdowns and a mass vaccination campaign. We describe the temporal and regional impact of these measures on mortality, along with social-behavioral correlates. Methods The analysis uses National Ministry of Health data on COVID-19 mortality (CM), excess mortality (EM), and vaccine uptake, along with survey data. We calculate avoidable mortality (AM) as observed mortality minus the lowest regional EM rate in each period. Results In 2020-21 EM was 180,169, of which 76% were counted as COVID-19. This fraction varied from 13% in the South in Jun-Oct 2020 to 140% in the Northeast in Mar-Jul 2021. Impact varied across Italy, with EM and AM highest in the North during the first and second waves (Feb-Jun 2020 &amp; Nov 2020-Feb 2021) and in the South afterwards (Mar-Dec 2021). After the first wave, there were 33,587 avoidable deaths, 41% of which were in the South. Higher rates in the North in Nov 2020-Feb 2021 were possibly due to less social distancing (e.g. avoiding social events and staying home from work/school), perhaps because residents of the North are more likely to be employed in private industry, which were more likely than public agencies to remain open. Higher rates in the South after Mar 2021 were possibly due to lower trust in hospitals and reduced vaccine uptake, particularly among those aged 80+. Conclusions Official CM was differentially under-reported, so EM estimates provide a more robust picture of regional and temporal patterns of COVID-19 deaths. Mortality was high in the North in the second as well as first wave. It was high in the South afterwards (Mar-Dec 2021), accounting for 41% of avoidable mortality. Key messages • Excess mortality estimates provide a more robust understanding of regional and temporal patterns of COVID-19 deaths than reported COVID-19 deaths. • Heterogeneous impact of COVID-19 was associated with differences in preventive habits, trust levels, and vaccine uptake.

Avoidable mortality contributes to the European Union’s life expectancy and lifespan dispersion gaps

Abstract Background Mortality differences between established (EMS) and post-2004 European Union member states (NMS) remain large. Contributing to this gap are deaths avoidable through prevention (preventable mortality) or adequate medical treatment (treatable mortality). This study examined the potential of reduced avoidable, preventable, and treatable mortality to close life expectancy and lifespan dispersion gaps between EMS and NMS. Methods Death and population counts were extracted from the WHO Mortality Database to calculate age and cause-specific mortality rates for each EU member state for 2005-2014. Causes of death were categorised as avoidable, amenable, and preventable based on the OECD/Eurostat lists of preventable and treatable causes of death. The gaps in life expectancy at birth and life span dispersion between EMS and NMS were estimated where: 1) all amenable, preventable, and avoidable deaths were averted across the EU, and 2) NMS achieved the same level of avoidable mortality as EMS. Results Averting all avoidable deaths throughout the EU would reduce the life expectancy gap between EMS and NMS from 4.4 to 2.4 years for women and 7.4 to 3.3 years for men. The difference in lifespan dispersion would be reduced from 0.9 (favouring EMS) to 0.1 years (favouring NMS) in women and from 1.5 years to 0.3 years (favouring EMS) in men. Were NMS to achieve the avoidable mortality observed in EMS, the life expectancy gap between EMS and NMS would fall from 4.4 to 2.5 years for women and from 7.4 to 3 years for men, while the difference in lifespan dispersion would be reduced from 0.9 to 0.3 years in women and from 1.5 years to 0.3 years in men. Conclusions NMS achieving the avoidable mortality observed in EMS would have halved the life expectancy gap and almost eliminated the life span dispersion gap between EMS and NMS during 2005-2014. Effective exchange of best practices in prevention and treatment could transform mortality differences across the EU. Key messages • This is the first study to examine the potential of reduced avoidable, preventable, and treatable mortality to close the life expectancy and lifespan dispersion gaps between EMS and NMS. • Achieving the avoidable mortality observed in established EU member states in post-2004 EU member states would greatly reduce mortality differences across the EU.

Supporting drug and alcohol service users to cut down or stop smoking: review and evidence.gaps

Abstract Background Globally, drug and alcohol service users are underserved by smoking cessation and tobacco control services despite their high rates of smoking, smoking-related disease and interest in quitting or cutting down. DASHES (drug and alcohol users help to exit smoking) is developing and evaluating a tobacco harm reduction intervention with service users and staff of specialist third sector and NHS services, public health, and policymakers. It combines NHS Scotland behavioural change, pharmacotherapy, NRT delivered as vapes and tailored support. We sought evidence of approaches on which to build and assess our model. Methods Rapid review of smoking cessation interventions for drugs and/or alcohol service users. Papers screened by title and abstract, extracted using Covidence and appraised by 4 researchers using CASP guidance. Included papers were quality reviewed. We used PROGRESS-PLUS to assess consideration of equity. Narrative synthesis explored components of smoking cessation/reduction interventions. Results We quality reviewed 29 eligible studies. Heterogeneity and lack of power precluded meta-analysis and limited estimation of effect sizes. Some interventions fell short of existing, evidence-based practice. Despite funders and authorities requiring commitment to increasing equity and diversity of research participation, few studies monitored or addressed equity of participation, barriers to smoking cessation or provision of trauma-informed care explicitly. Promising interventions included designs and supportive features that mitigate healthcare inequities for other conditions. Conclusions Our review identified promising components for inclusion in DASHES but effective and equitable delivery of smoking cessation/reduction services for people using drug and alcohol services remains understudied. Lack of attention contributes to the ongoing burden of avoidable disease and death associated with tobacco-related harm in this population. Key messages • Smoking-related inequities will continue and drug and alcohol service users remain underserved by smoking cessation/tobacco control services until gaps in the evidence base are addressed. • Action to assure equity in research participation, quality and design of interventions remains limited and must be addressed by policymakers funders, researchers and services.

Exploring avoidable, preventable, treatable mortality trends and effect factors by income level

Abstract Background Avoidable mortality (AM) mean death caused by insufficient health policy and health care intervention, and is a rising public health issue. Income polarization in healthcare utilization is a significant concern. The aim of this study was to derive the trend and effect factors of AM, treatable mortality (TM), preventable mortality (PM) according to income levels in South Korea over the period 2008-2017. Methods This serial cross-sectional analysis was conducted using national health information data from 2008 to 2017. AM was classified based on criteria presented by the Office for National Statistics in 2011. Age-standardized AM was analyzed annually according to income levels. The odds ratio of AM was examined using multivariable logistic regression after adjusting health behaviors and clinical variables collected in 2016-2017. Results There were persistent income inequalities in AM, and the degree of inequality was larger in PM than in TM throughout the period. Medical benefit recipients had an AM of about 8.5 times higher than the highest income quartiles, and men were three times higher than women. In 2016-2017, compared to the highest income quartile, the risk of TM and PM of medical benefit recipients was about 10 times higher and 1.5 times higher in the first quintile. The risk of AM remained significantly higher in low-income levels even after adjusting for health behaviors and clinical variables. Conclusions While AM in South Korea has decreased over time, it remains high in low-income levels. There was a statistically significant difference in AM based on income level. Therefore, inclusion in health policy and services development and in health promotion programs is urgently required to address avoidable deaths and health inequalities for low-income levels. Key messages • AM in South Korea have declined over time, but, compared to the highest income quartile, the risk of TM and PM of medical benefit recipients was about 10 times higher. • Among health insurance eligible people, the first quintile, the more the proportion of TM and PM, and the highest income quartile, the lower the proportion of non-avoidable deaths.

Individual characteristics associated with perceptions of control over mortality risk and determinants of health effort.

People who believe they have greater control over health and longevity are typically more likely to invest in their long-term health. Investigating individual differences in perceived control over risk and exploring different determinants of health effort may help to tailor health promotion programs to more effectively encourage healthy behaviors. From a sample of 1500 adults, we measured perceived control over 20 causes of death, overall perceived uncontrollable mortality risk (PUMR), state-level optimism, self-reported health effort, and the accuracy of estimations of avoidable deaths. We found individual differences in perceptions of control over specific causes of death based on age, gender, and income. PUMR was predicted by socioeconomic variables expected to influence exposure to risk and resource availability. Higher levels of PUMR, not perceptions of control over specific causes of death, predicted self-reported health effort. The strength of relationship between PUMR and lower health effort was not moderated by state-level optimism. Age and education both positively predicted greater accuracy in assessing the prevalence of avoidable deaths. We suggest that PUMR may capture people's "general sense" of mortality risk, influenced by both exposure to hazards and the availability of resources to avoid threats. Conversely, perceived control over specific risks may involve more deliberate, considered appraisals of risk. This general sense of risk is thought to play a more notable role in determining health behaviors than specific assessments of control over risk. Further study is needed to investigate the degree to which PUMR accurately reflects objective measures of individual risk.

The sensitivity of health impact assessments of PM2.5 from South African coal-fired power stations

Unabated emissions of precursor gases from coal-fired power stations in South Africa greatly contribute to ambient PM2.5 concentration in the region, but estimates of the number of associated premature mortalities vary vastly. The application of the exposure-response function is one of the reasons for the differences in estimates of premature mortalities; since the relationship between mortality and PM2.5 exposure flattens out at higher PM2.5 concentrations, a smaller number of premature mortalities is calculated if a reduction in PM2.5 concentration occurs at the actual ambient concentration (“avoidable deaths”), while a greater number of mortalities is calculated if other sources are not considered (at low ambient concentrations) (“single-source deaths”). It is more appropriate to attribute deaths to a source in proportion to the contribution made by the source to ambient PM2.5 levels (“attributable deaths”). Total ambient PM2.5 concentrations are extrapolated from 38 ambient monitoring stations in the north-eastern region of South Africa using a regression model based on household socio-economic factors, and PM2.5 concentrations derived from power station emissions are estimated using a reduced-form intake fraction model. It is estimated that there are around 800 attributable premature mortalities per year due to PM2.5 from coal-fired power station emissions in South Africa. The number of premature mortalities is 44% higher when calculating single-source deaths and 53% lower when calculating avoidable deaths. Using the attributable death approach is particularly important in highly polluted areas such as low-income residential areas where households use solid and liquid fuels.

Use of Microsoft Power BI to display pregnancy related performance statistics within NHS trusts

ObjectiveWe wanted to create a dashboard that allowed midwives and doctors to monitor the performance of their NHS Trust by viewing the statistics relating to their performance in identifying babies at risk due to not growing well in the womb (small for gestational age, SGA), the single largest cause of stillbirths and subject to national guidelines and reporting requirements. Antenatal detection of SGA allows clinicians to undertake further investigations and plan for a timely delivery.&#x0D; MethodThe use of Power BI instead of a solution requiring software development allowed the data analysis team to be in control of creating the application and facilitate a streamlined updating process. We used the dashboard feature, dropdowns and radio buttons to display statistics relating to the rate of identification of SGA at antenatal ultrasound scan as a proportion of all babies that are SGA at birth (sensitivity) as well as false positivity. The dashboard is contained within the web-based application to monitor growth during antenatal care. Applying the row level security feature with DAX formula, we were able to personalise the report for each Trust depending on who logged into the web-app.&#x0D; ResultsThe application facilitates monitoring performance of the service in real time, longitudinally by month, quarter and year as well benchmark cross-sectionally against network/regional and national averages. The dashboard lets clinicians access their information in a clear and secure manner without the need for a separate link. The ready availability of data allows Trusts to enact policies to improve their performance and ultimately prevent avoidable deaths, and has contributed to the year on year decline in stillbirth rates in units that have been running this application.&#x0D; ConclusionDevelopment of this dashboard has resulted trusts being more aware of their own data to promote improvements in antenatal care.

Regularised B-splines Projected Gaussian Process Priors to Estimate Time-trends in Age-specific COVID-19 Deaths

The COVID-19 pandemic has caused severe public health consequences in the United States. In this study, we use a hierarchical Bayesian model to estimate the age-specific COVID-19 attributable deaths over time in the United States. The model is specified by a novel non-parametric spatial approach over time and age, a low-rank Gaussian Process (GP) projected by regularised B-splines. We show that this projection defines a GP with attractive smoothness and computational efficiency properties, derive its kernel function, and discuss the penalty terms induced by the projected GP. Simulation analyses and benchmark results show that the B-splines projected GP may perform better than standard B-splines and Bayesian P-splines, and equivalently well as a standard GP at considerably lower runtimes. We apply the model to weekly, age-stratified COVID-19 attributable deaths reported by the US Centers for Disease Control, which are subject to censoring and reporting biases. Using the B-splines projected GP, we can estimate longitudinal trends in COVID-19 associated deaths across the US by 1-year age bands. These estimates are instrumental to calculate age-specific mortality rates, describe variation in age-specific deaths across the US, and for fitting epidemic models. Here, we couple the model with age-specific vaccination rates to show that vaccination rates were significantly associated with the magnitude of resurgences in COVID-19 deaths during the summer 2021. With counterfactual analyses, we quantify the avoided COVID-19 deaths under lower vaccination rates and avoidable COVID-19 deaths under higher vaccination rates. The B-splines projected GP priors that we develop are likely an appealing addition to the arsenal of Bayesian regularising priors.

Pregnancy-related mortality in the United States from 2018 to 2020

BackgroundMaternal reproductive health is facing significant challenges in the United States. Currently, the nation has the highest maternal death rate among high-income countries, and the rate continues to increase. Recent United States data indicate that 80% of maternal deaths are preventable, highlighting the urgent need for action on this critical issue. MethodsWe analyzed United States national death certificate data and birth data from the CDC's wide-ranging online data for epidemiologic research databases. We estimated pregnancy-related mortality rates by state, age group and race, and ethnicity. We assessed cause-specific pregnancy-related mortality and late maternal death (i.e., deaths occurring >42 days and up to 1-year post-pregnancy). ResultsDuring 2018–2020, we observed 3364 pregnancy-related deaths, including 1006 late maternal deaths. The age-standardized mortality rate (ASR) increased by 37.2% from 25.4 (95% CI: 23.8–26.9) per 100,000 live births in 2018–34.7 (95% CI: 32.8–36.5) in 2020. Rates ranged from 16.8 per 100,000 to 57.5 per 100,000. If the national rate was reduced to the lowest state rate, 1448 pregnancy-related deaths could have been avoided. The rate among non-Hispanic Black people (ASR2018–2020 = 70.7 per 100,000) was two to three times higher than other groups estimated. Cardiovascular conditions are the leading cause of pregnancy-related deaths overall, yet cancer was associated with 20% of late maternal death. Mental and behavioral disorders and drug and alcohol-induced death were also important contributors to late maternal death. ConclusionsWe observed alarming trends of increasing pregnancy-related death rates in the United States. Our study provides important insights for identifying opportunities to reduce avoidable maternal deaths.