Avoidable Premature Mortality Research Articles

Mortality risk and mood stabilizers in bipolar disorder: a propensity-score-weighted population-based cohort study in 2002-2018.

Accumulating studies have assessed mortality risk associated with mood-stabilizers, the mainstay treatment for bipolar disorder (BD). However, existing data were mostly restricted to suicide risk, focused on lithium and valproate and rarely adequately adjusted for potential confounders. This study aimed to assess comparative mortality risk with all, natural and unnatural causes between lithium, valproate and three frequently prescribed second-generation antipsychotics (SGA), with adjustment for important confounders. This population-based cohort study identified 8137 patients with first-diagnosed BD, who had exposed to lithium (n = 1028), valproate (n = 3580), olanzapine (n = 797), quetiapine (n = 1975) or risperidone (n = 757) between 2002 and 2018. Data were retrieved from territory-wide medical-record database of public healthcare services in Hong Kong. Propensity-score (PS)-weighting method was applied to optimize control for potential confounders including pre-existing chronic physical diseases, substance/alcohol use disorders and other psychotropic medications. PS-weighted Cox proportional-hazards regression was conducted to assess risk of all-, natural- and unnatural-cause mortality related to each mood-stabilizer, compared to lithium. Three sets of sensitivity analyses were conducted by restricting to patients with (i) length of cumulative exposure to specified mood-stabilizer ≥90 days and its medication possession ratio (MPR) ≥90%, (ii) MPR of specified mood-stabilizer ≥80% and MPR of other studied mood-stabilizers <20% and (iii) monotherapy. Incidence rates of all-cause mortality per 1000 person-years were 5.9 (95% confidence interval [CI]: 4.5-7.6), 8.4 (7.4-9.5), 11.1 (8.3-14.9), 7.4 (6.0-9.2) and 12.0 (9.3-15.6) for lithium-, valproate-, olanzapine-, quetiapine- and risperidone-treated groups, respectively. BD patients treated with olanzapine (PS-weighted hazard ratio = 2.07 [95% CI: 1.33-3.22]) and risperidone (1.66 [1.08-2.55]) had significantly higher all-cause mortality rate than lithium-treated group. Olanzapine was associated with increased risk of natural-cause mortality (3.04 [1.54-6.00]) and risperidone was related to elevated risk of unnatural-cause mortality (3.33 [1.62-6.86]), relative to lithium. The association between olanzapine and increased natural-cause mortality rate was consistently affirmed in sensitivity analyses. Relationship between risperidone and elevated unnatural-cause mortality became non-significant in sensitivity analyses restricted to low MPR in other mood-stabilizers and monotherapy. Valproate- and lithium-treated groups did not show significant differences in all-, natural- or unnatural-cause mortality risk. Our data showed that olanzapine and risperidone were associated with higher mortality risk than lithium, and further supported the clinical guidelines recommending lithium as the first-line mood-stabilizer for BD. Future research is required to further clarify comparative mortality risk associated with individual SGA agents to facilitate risk-benefit evaluation of alternative mood-stabilizers to minimize avoidable premature mortality in BD.

Health benefits of reducing ambient levels of fine particulate matter: a mortality impact assessment in Taiwan

ABSTRACT While numerous studies have found a relationship between long-term exposure to airborne fine particulate matter (PM2.5) and higher risk of death, few investigations examined the contribution that a reduction of exposure to ambient PM2.5 levels might exert on mortality rates. This study aimed to collect data on changes in annual average ambient levels of PM2.5 from 2006 to 2020 and consequent health impact in public health in 65 municipalities in Taiwan. Avoidable premature mortality was used here as an indicator of adverse health impact or health benefits. Annual PM2.5 levels were averaged for the years 2006, 2010, and 2020. In accordance with World Health Organization (WHO) methodology, differences were estimated in the number of deaths attributed to ambient PM2.5 exposure which were derived from concentration-response data from prior epidemiological studies. PM2.5 concentrations were found to have been decreased markedly throughout Taiwan over the two-decade study. As the PM2.5 concentrations fell, so was the health burden as evidenced by number of deaths concomitantly reduced from 22.4% in 2006 to 8.47% in 2020. Data demonstrated that reducing annual mean levels of PM2.5 to PM10 ug/m3 was associated with decrease in the total burden of mortality, with a 2.22–13.18% fall in estimated number of PM2.5-related deaths between 2006 and 2020. Based upon these results, these declines in ambient PM2.5 levels were correlated with significant improvement in public health (health benefits) and diminished number of deaths in Taiwan.

Mortality statistics in a tertiary care teaching hospital in Bagalkot, Karnataka in the year 2022

Background: Mortality statistics is important for epidemiological purposes to find any unusual rise in deaths for investigation of the causes so as to take public health action at an early stage. Cause of death statistics from hospitals are routinely amalgamated along with mortality statistics from other sources to constitute essential statistics on the health of a population. This study was done to understand the mortality pattern in a tertiary care teaching hospital and to undertake preventive action as much as possible. Methods: A retrospective hospital based study was done with all the medical records of patients who died in Hangal Sri Kumareshwar hospital and medical research centre in the year 2022, attached to S. N. Medical College, Bagalkot, Karnataka. After IRB, the medical records were analyzed to study the pattern of disease causing deaths which were classified under ICD 10th revision. Age, sex, month of admission, place of residence and underlying cause of death was used for analysis using chi square test and percentages. Results: Out of 501 deaths, 316 (63.07%) were male and 185 (36.93%) were female. Majority of the deaths 152 (30.34%) occurred between the ages of 41 to 60 years. Non communicable diseases contributed to 71.05% of deaths and communicable diseases to 28.95% of deaths. Conclusions: Continuation of the maternal and child health program and effective implementation of the National health programs to overcome non communicable diseases can reduce avoidable premature mortality in the population.

Premature mortality in people affected by co-occurring homelessness, justice involvement, opioid dependence, and psychosis: a retrospective cohort study using linked administrative data

SummaryBackgroundHomelessness, opioid dependence, justice involvement, and psychosis are each associated with an increased risk of poor health and commonly co-occur in the same individuals. Most existing studies of mortality associated with this co-occurrence rely on active follow-up methods prone to selection and retention bias, and focus on a limited set of specific exposures rather than taking a population-based approach. To address these limitations, we did a retrospective cohort study using linked administrative data.MethodsIn this retrospective cohort study, we linked a population register of adults resident in Glasgow, UK, to administrative datasets from homelessness and criminal justice services; community pharmacies; and a clinical psychosis registry with data from April 1, 2010 to March 31, 2014. Linkage to death registrations from April 1, 2014 to March 31, 2019 provided follow-up data on premature mortality (age <75 years) from all causes, non-communicable diseases, and causes considered potentially avoidable through health-care or public health intervention. We estimated hazard ratios (HR) using Poisson regression, adjusting for age, gender, socioeconomic deprivation, and calendar time.FindingsOf 536 653 cohort members, 11 484 (2·1%) died during follow-up. All-cause premature mortality was significantly higher among people with multiple exposures than among people with single exposures, and among people with any exposure than among people with none (eg, homelessness plus other exposures vs no exposures: HR 8·4 [95% CI 7·3–9·5]; homelessness alone vs no exposures: HR 2·2 [1·9–2·5]). Avoidable premature mortality was highest among those with multiple exposures (eg, imprisonment plus other exposures vs no exposures: HR 10·5 [9·1–12·3]; imprisonment alone vs no exposures: HR 3·8 [3·0–4·8]). Premature mortality from non-communicable disease was higher among those with any exposures than among those with none, despite accounting for a lower proportion of deaths in the exposed group; although in some cases there was little difference between estimates for single versus multiple exposures.InterpretationThe co-occurrence of at least two of homelessness, opioid dependence, justice involvement, or psychosis is associated with very high rates of premature mortality, particularly from avoidable causes of death, including non-communicable disease. Responding to these findings demands wide-ranging efforts across health-care provision, public health, and social policy. Future work should examine the timing and sequencing of exposures to better understand the causal pathways underlying excess mortality.FundingChief Scientist Office, Medical Research Council, NHS Research Scotland.

An Economic Analysis of the Environmental Impact of PM2.5 Exposure on Health Status in Three Northwestern Mexican Cities

Introduction: This study provides an economic assessment of the health effects due to exposure to particulate matter PM2.5 in three medium-size cities of northwestern Mexico: Los Mochis, Culiacan and Mazatlán. People in these cities are exposed to high pollutant concentrations that exceed limits suggested in domestic and international guidelines. PM2.5 is an air contaminant negatively associated with people’s health when is highly concentrated in the atmosphere; its diameter is below 2.5 µm and causes the air to appear hazy when levels are elevated. To account for the economic impact of air pollution, a Health Impact Assessment (HIA) was used by the means of the European Aphekom Project. We figured the cost-savings of complying with current environmental standards and computed gains in life expectancy, total avoidable premature mortality, preventable cardiovascular disease, and the economic costs of air pollution related to PM2.5. A formal analysis of air pollution epidemiology is not pursued in this paper. Results: The cost of reducing PM2.5 pollution associated with negative health outcomes was based on two different scenarios: Official Mexican Standard (NOM, Spanish acronym) and World Health Organization (WHO) environmental standards. The mean PM2.5 concentrations in 2017 were 22.8, 22.4 and 14.1 µg/m3 for Los Mochis, Mazatlán and Culiacan, respectively. Conclusions: The mean avoidable mortality for all causes associated to PM2.5 exposure in these cities was 638 for the NOM scenario (i.e., with a reduction to 12 µg/m3) compared to 739 for the WHO scenario (reduction to 10 µg/m3). Complying with the WHO guideline of 10 µg/m3 in annual PM2.5 mean would add up to 15 months of life expectancy at age 30, depending on the city. The mean economic cost per year of the PM2.5 effects on human life in these three cities was USD 600 million (NOM scenario) and USD 695 million (WHO scenario). Thus, effective public health and industrial policy interventions to improve air quality are socially advantageous and cost-saving to promote better health.

Health benefits of achieving fine particulate matter standards in India – A nationwide assessment

BackgroundAmbient fine particulate matter (PM2.5) is one of the leading risk factors in India. The elevated levels of PM2.5 exposure concentration in India are related to higher premature mortality. However, health benefits or avoidable premature mortality by reducing PM2.5 concentration is uncertain. ObjectivesHere we simulated the health benefits by assuming the achievement of 1) National Ambient Air Quality Standards of India (PM2.5 annual average = 40 μg m−3), 2) National Clean Air Programme policy (30% reduction) and 3) World Health Organization standard (10 μg m−3). MethodologyUsing Environmental Benefits Mapping and Analysis Program – Community Edition (BenMAP-CE), the health benefits are estimated at national, state and district levels for various health endpoints viz., all-cause, ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), lung cancer and stroke. PM2.5 data, concentration-response coefficient, population, and baseline incidence rate are specified as input data in BenMAP–CE. ResultsAt the national level, all-cause health benefits in three simulations range from 0.79 to 2.1 million cases during 2019. Similarly, IHD, COPD, lung cancer, and stroke related health benefits are in the range of 0.28–0.68, 0.17–0.39, 0.01–0.03, and 0.14–0.34 million cases, respectively. State-level estimates showed that Uttar Pradesh, Bihar, and West Bengal are having maximum health benefits whereas north-eastern states are found with lowest estimates. Districts such as Allahabad, Lucknow, Muzaffarpur, Patna, and Sultanpur are estimated to have highest health benefits. States and districts with higher PM2.5 concentration and exposed population are found with maximum health benefits. Among the three simulations, achievement of the World Health Organization standard resulted in highest estimates. Further, the limitations and sensitivity of input parameters used in this study are discussed in detail. ConclusionStudy results highlighted the need for state and district-specific air quality management measures to increase PM2.5 related health benefits.

Patterns of mortality among adults with intellectual and developmental disabilities in the Canadian province of Manitoba

AbstractObjectivesThe goals of this study were to examine and compare (a) the annual adult mortality rates and (b) the most commonly reported underlying causes of death between a cohort of Manitobans with intellectual and developmental disabilities (IDD) and a matched comparison group without IDD.MethodsUsing linked health and nonhealth administrative data, a cohort of Manitoba adults with IDD, aged 25–99 years in 2012, was identified. Each person in the study cohort was matched with three persons without IDD based on age, sex, region of residence, and morbidity level. The two groups were followed for three years (2013–2015). Crude annual adult mortality rates and avoidable premature mortality rates were calculated. The leading causes of death over the 3‐year study period were tabulated by ICD‐10 chapter. Coding of the underlying causes of death was reviewed.ResultsThe crude annual mortality rates for Manitoba adults with IDD were 1.8–2.4 times higher than those for the matched comparison group and remained stable over time. Disparities in mortality rates for the IDD cohort relative to the matched comparison group decreased with increasing age. No significant sex differences were found. The leading causes of death among the IDD cohort were diseases of the circulatory system, cancer, and diseases of the respiratory system. Avoidable premature deaths were 2.3–3.3 times more prevalent among Manitoba adults with IDD compared to the matched comparison group. An IDD diagnostic code was reported as cause of death in 2.11% of cases.ConclusionsThe excess mortality among adults with IDD should be monitored in Manitoba and all other jurisdictions and attention paid to the causes of death and their coding.

Efficacy of smoking cessation with varenicline plus counselling for e-cigarettes users (VAREVAPE): A protocol for a randomized controlled trial

Tobacco smoking is a global pandemic that poses substantial health burdens and costs. With nearly six million deaths annually, smoking is the single most important cause of avoidable premature mortality in the world, mainly from lung cancer, coronary heart disease, chronic obstructive pulmonary disease and stroke. Smoking is a very difficult addiction to break, even for those with a strong desire to quit. Electronic cigarettes are an attractive long-term alternative source of nicotine to conventional cigarettes because of their many similarities with smoking. Electronic cigarette users report buying them to reduce cigarette consumption, to relieve tobacco withdrawal symptoms, to quit, and to continue having a ‘smoking’ experience, but with reduced health risks. Actually, there aren't antismoking treatments for people who smoke only electronic cigarette (single users) or electronic cigarette and classic cigarette (dual users). There isn't any specific information on the efficacy and safety of new pharmacological support for electronic cigarette users. We propose that smoking cessation with varenicline plus counselling delivered to electronic cigarette users could be associated with similar smoking abstinence rates compared to the results obtained in the general population. Herein, we describe the methodology of a double-blind, placebo-controlled, randomized clinical trial, of 24 weeks duration, that examines the efficacy of varenicline (1 mg BID - for 12 weeks) plus counselling compared to matched placebo (1 mg BID - for 12 weeks) plus counselling.

Nationwide Mortality Studies To Quantify Causes Of Death: Relevant Lessons From India's Million Death Study.

Progress toward the United Nations 2030 Sustainable Development Goals requires improved information on mortality and causes of death. However, causes of many of the fifty million annual deaths in low- and middle-income countries remain unknown, as most of the deaths occur at home without medical attention. In 2001 India began the Million Death Study in 1.3million nationally representative households. Nonmedical staff conduct verbal autopsies, which are structured interviews including a half-page narrative in local language of the family's story of the symptoms and events leading to death. Two physicians independently assess each death to arrive at an underlying cause of death. The study has thus far yielded information that substantially altered previous estimates of cause-specific mortality and risk factors in India. Similar robust studies are feasible at low cost in other low- and middle-income countries, particularly if they adopt electronic data management and ensure high quality of fieldwork and physician coding. Nationwide mortality studies enable the quantification of avoidable premature mortality and key risk factors for disease, and provide a practicable method to monitor progress toward the Sustainable Development Goals.

Are we with e-cigarette as a friend or against it as a foe?

Cigarette smoking is the most important cause of avoidable premature mortality in the world, and quitting is known to reduce the risk of fatal diseases. Electronic cigarettes (e-cigarettes) are becoming increasingly popular, especially among younger adults; they may be effective aids to smoking cessation. Despite the increasing prevalence of e-cigarette use, little is known about their realworld use. The major concerns include the nicotine content and the potential harm due to the high concentrations of propylene glycol, chemicals, and other compounds found in the e-cigarette vapor. To our knowledge, there are no data on the health effects of acute use of nicotine-free e-cigarettes. The aim of this study is to evaluate the immediate effect of ecigarette vapors on airway mechanics. Forty apparently healthy neversmokers or light smokers were divided into two groups. The first group was instructed to ‘vape’ e-cigarettes with a 12-mg nicotine-filled cartridge, and the second group was asked to ‘vape’ e-cigarettes with an empty cartridge. Pulmonary function tests were assessed before and after ‘vaping’. There was a significant increase in peripheral airway resistance of the first group, in which individuals vaped a nicotine-filled cartridge. There is potential for more permanent changes in lung function with long-term exposure to e-cigarettes, as with cigarette smoking.

Putting tobacco harm reduction in perspective: is it a viable alternative?

Tobacco use is a global pandemic. Worldwide, there are about 1.1 billion smokers1, and nearly six million deaths annually are attributed to tobacco use2 and it is recognized to be the single most important cause of avoidable premature mortality in the world mainly from cancer, coronary heart disease, chronic obstructive pulmonary disease and stroke. Tobacco control policies as outlined in the WHO Framework Convention on Tobacco Control3 (including price and tax increases, pictorial warnings, prevention of smoking in public and work places, monitoring of tobacco use, offering help to quit, tobacco advertisement and promotion ban) have achieved reductions in smoking prevalence of at best1 per cent per year4. Additionally, these policies are not very effective if not properly implemented or do not have adequate funding support5. Nicotine dependence is a chronic relapsing condition. At an individual level, though most tobacco users want to quit but they are unable to do so because they are addicted to nicotine6 and relapse rates are staggeringly high. Currently available first line medications for tobacco cessation are known to double or triple this quit rate under experimental conditions but in real world settings these have had low uptake and inferior efficacy7. Further, it is increasingly recognized that nicotine is such an addictive compound that millions of people smoking today will be unable to quit8. In this scenario, a different approach is required to reduce the harm from cigarette smoking for people who are not ready to or cannot quit. Further, the adverse health effects that accrue from taking tobacco come not from nicotine, but from hundreds of other toxins and carcinogens like nitrosamines in tobacco and in the tar and carbon monoxide and nitrogen oxides in the smoke. Thus, though our primary strategy for reducing harm must be to encourage cessation, at least reducing or minimizing harm for those who are unable to quit may seem like a reasonable strategy. Within this context, the approach of tobacco harm reduction has gained momentum in recent years.

EPA-1080 – Parity: from rhetoric to reality; future proofing society through mental health

The English health system has recently undergone significant change via the Health and Social Care Act 2012. The Royal College of Psychiatrists successfully lobbied for an amendment to this Act which explicitly recognised the importance of both physical and mental health. This became known as the ‘parity of esteem’ amendment.’ The College has since published an extensive report on how to achieve parity between mental and physical health in England. Many of the areas considered by this report (such as avoidable premature mortality, the stigma associated with mental illness and the low levels of treatment compared to incidence) are also significant problems in parts of Europe. To inform delegates about the English experience regarding parity of esteem, in order to inform their own engagement with nation-specific issues as necessary. The detailed aims of this session are to outline the English experience in (1) securing a legislative basis for parity of esteem, (2) defining parity of esteem as a concept and (3) identifying the England-specific issues which needed to be addressed in order to achieve parity. It is intended that delegates will be able to use the information provided as a template for action in their own country, as necessary. N/A N/A The longstanding lack of parity between mental and physical health remains inequitable and socially unjust. It is hoped that English experience will lead to improvements which can be exported to other European nations as necessary.

What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable?

Objective:To estimate the number of deaths among cancer patients diagnosed in Great Britain that would be avoidable within 5 years of diagnosis if the mean (or highest) survival in Europe for patients diagnosed during 1985–1989, 1990–1994 and 1995–1999 were achieved.Design:Five-year relative survival for cancers in Great Britain compared with that from other countries in the EUROCARE-2, -3 and -4 studies. Calculation of excess deaths (those more than expected from mortality in the general population) that would be avoidable among cancer patients in Britain if relative survival were the same as in Europe.Setting:Great Britain (England, Wales, Scotland) and 13 other European countries.Subjects:2.8 million adults diagnosed in Britain with 1 of 39 cancers during 1985–1989 (followed up to 1994), 1990–1994 (followed up to 1999) and 1995–1999 (followed up to 2003).Main outcome measure:Annual number of avoidable deaths within 5 years of diagnosis. Percentage of the excess (cancer-related) deaths among cancer patients that would be avoidable.Results:Compared with the mean European 5-year relative survival, the largest numbers of avoidable deaths for patients diagnosed during 1985–1989 were for cancers of the breast (about 18% of the excess mortality from this cancer, 7541 deaths), prostate (14%, 4285), colon (9%, 4090), stomach (8%, 3483) and lung (2%, 3548). For 1990–1994, the largest numbers of avoidable deaths were for cancers of the prostate (20%, 7335), breast (15%, 6165), colon (9%, 4376), stomach (9%, 3672), lung (2%, 3735) and kidney (22%, 2644). For 1995–1999, most of the avoidable deaths were for cancers of the prostate (17%, 5758), breast (15%, 5475), lung (3%, 4923), colon (10%, 4295), stomach (9%, 3137) and kidney (21%, 2686).Overall, some 6600–7500 premature deaths would have been avoided each year among cancer patients diagnosed in Britain during 1985–1999 if the mean survival in Europe had been achieved. This represents 6–7% of cancer-related mortality. Compared with the highest European survival, avoidable premature mortality among cancer patients fell from about 12 800 deaths a year (12.2% of cancer-related mortality) to about 11 400 deaths a year (10.6%) over the same period.A large component of the avoidable mortality is due to prostate cancer: excluding this cancer from comparison with the European mean survival reduces the annual number of avoidable deaths by 1000–1500, and the percentage of excess mortality by up to 1%. Compared with the highest survival, the annual number of avoidable deaths would be 1500–2000 fewer, and 1–2% lower as a percentage of excess mortality, but the overall trend in avoidable premature mortality among cancer patients would be similar, falling from 11.4% (1985–1989) to 10.3% (1990–1994) and 9.7% for those diagnosed during 1995–1999.For several cancers, survival in Britain was slightly higher than the mean survival in Europe; this represented some 110–180 premature deaths avoided each year during the period 1985–2003.Conclusions:Avoidable premature mortality among cancer patients diagnosed in Britain during 1985–1999 has represented 6–7% of cancer-related mortality compared with the mean survival in Europe. Compared with the highest levels of survival in Europe, the reduction from 12.2% to 10.6% of cancer-related mortality reflects small but steady progress over the period 1985–2003.