Burden Of Death Research Articles

Paediatric digital clinical decision support for global health

Effective, scalable and sustainable strategies to improve quality of care are needed to address the substantial burden of preventable deaths of children under-five in resource-constrained settings. Clinical decision support systems (CDSS), digital tools which generate recommendations for healthcare providers based on patient-specific information, show promise. By strengthening adherence to evidence-based assessment, diagnosis and management and generating high-quality data, CDSS can improve quality care - care that is effective, safe, people-centered, timely, equitable, integrated and efficient. Designing and implementing CDSS that deliver this impact is a complex and iterative process. We advocate for collaboration on developing and evaluating these tools to guide their implementation for maximal impact.

ISH-PP-6: ADDRESSING GLOBAL DISPARITIES IN BLOOD PRESSURE CONTROL: PERSPECTIVES OF THE INTERNATIONAL SOCIETY OF HYPERTENSION

Raised blood pressure is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high and low resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in blood pressure control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanisation, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial and environmental determinants, and strengthening health systems implement a well-designed customised quality of care improvement framework.

RAG-SACA-2: EPIDEMIOLOGY OF HYPERTENSION IN SOUTH ASIA

Hypertension is the one of major risk factor contributes to the burden of heart disease, stroke, kidney failure, disability and premature death. According to 2019 WHO fact sheet, an estimated 1.13 billion people worldwide have hypertension while only 21% of people have it under control. Further, more than one million deaths are related to hypertension. It is projected that 1.56 billion adults (29.2%) have hypertension globally by 2025 and 75% of them will be Asians and Africans.Hypertension is the most prevalent risk factor of stroke among Asians and cardiovascular complications associated with hypertension is steeper in Asians compared to west. Asia is a diverse region with differences in prevalence, awareness, treatment and control of hypertension. The trend of prevalence of hypertension has been vividly increased over the past two decades in South East Asian countries and numerous factors contribute to the current hypertension burden including modernization, urbanization, lifestyle changes and socioeconomic status. Hypertension prevalence in south East Asia is 25% and is slightly higher than the global prevalence (22%). According to the data from May-Measurement-Month 2018, the prevalence of hypertension in South Asia was 29.3% and only 46% of them aware about their hypertension while 43% was on medication. However, only 23.9% of them had controlled blood pressure either with medication, life style modification or both. East Asia had the lowest blood pressure average (117.0/75.4 mm Hg). In contrast, South Asia had the highest average (124.6/78.1 mm Hg). According to a recent meta-analysis, the prevalence of hypertension was 17.9% in Bangladesh, 20.9% in Sri Lanka,23.9% in Bhutan,25% in Pakistan,31.4% in India,31.5% in Maldives and 33.8% in Nepal. As per WHO data in 2020 among South Asians, Pakistan had highest hypertensive related death whereas Sri Lanka had the lowest (nearly 20 vs 4 per 100,000). Overweight and obesity in women and higher waist circumference in men are significantly associated with uncontrolled hypertension. Excess salt intake (average daily intake is higher than 12 g) associated with elevated blood pressure is also considered as a specific characteristic of hypertension in Asia. A vital issue in Asia is not just the high prevalence of hypertension, especially in some countries, but also the low level of awareness and treatment rates in many regions. Future research are necessary to implement strategies for prevention and control of hypertension, especially in low-income populations and to precisely assess the prevalence and financial burden of hypertension in the region.

Comparative genome analysis of Streptococcus strains to identify virulent genes causing neonatal meningitis

To determine Streptococcus agalactiae genes responsible for causing neonatal meningitis. Streptococcus agalactiae strain 2603V/R is causative agent of neonatal meningitis, maternal infection and sepsis in young children. World health organisation reported high burden of new born death caused by this bacterium. Streptococcus agalactiae colonizing epithelial cells of vagina and endothelial cells have high resistance to available antibiotic drugs which makes it essential to determine new drug targets. To compare the genome of selected strain with the non-pathogenic strains of streptococcus and identify the virulent and antibiotic resistant genes for adaptation in host environment. The whole genome of human pathogen Streptococcus agalactiae strain 2603V/R was analysed and compared with Streptococcus dysgalactiae strains using visualization and annotation tools. Genomic islands, mobile genetic elements, virulent and resistant genes were studied. Genetically pathogenic strain is most similar to Streptococcus dysgalactiae subsp. equisimilis strain NCTC 7136. Comparative analysis revealed the importance of capsular polysaccharides and surface proteins responsible for avoiding immune system attachment to host epithelial cells and virulent behaviour. High number of genes coding for antibiotics resistance may provide a competitive advantage for survival of pathogenic Streptococcus agalactiae strain 2603V/R in its niche. The comparative analysis of pathogenic strain Streptococcus agalactiae with non-pathogenic strains of Streptococcus dysgalactiae provided new insights in pathogenicity that could aid in recognization for new regions and genes for development of new drug development strategies considering presence of high number of resistance genes.

The emerging role of FAM46C as a biomarker and therapeutic target in gastric adenocarcinoma.

On a global scale, gastric adenocarcinoma (GCa) accounts for a large burden of death from cancer. Despite advances in systemic therapy and surgical technique, the fatality rate for GCa remains unacceptably high in Europe and North America, where diagnosis is typically made at an advanced stage. Biomarkers that can accurately predict response to new therapies and provide novel therapeutic strategies are urgently sought. FAM46C, a putative noncanonical nucleotidyltransferase, has garnered interest for its tumor suppressor function in multiple myeloma. A frequent and profound depletion of FAM46C has been described in GCa patients from China, Japan and now Canada. Furthermore, the degree of FAM46C depletion meaningfully portends cancer recurrence following resection, and death from GCa. In this review, we provide an updated summary of the literature regarding FAM46C as a biomarker in GCa and explore the potential mechanism(s) through which FAM46C depletion promotes GCa progression, including dis-inhibition of oncogenic Plk4 kinase activity. We highlight the potential for restoration of FAM46C levels as a therapeutic strategy. Norcantharidin, a synthetic analogue of the traditional Chinese medicine cantharidin derived from the blister beetle, is the only bio-available compound presently known to upregulate FAM46C expression and is under investigation in phase one trials in cancer patients.

Outcome of tuberculous meningitis in children aged 9 months to 12 years at the end of intensive phase of treatment

BackgroundTuberculous meningitis (TBM) is associated with high morbidity and mortality. Most of the literature focuses on outcomes at the end of therapy when it may be too late for intervention to improve the outcomes. So, the present study addresses outcomes by the end of intensive course of therapy. MethodsIt was a prospective cohort observational study that enrolled 80 patients with TBM between 9 months and 12 years of age. Participants were classified into Definite, Probable and Possible TBM using Marais criteria. Survival/Mortality was evaluated at the end of hospital stay. Demographic, clinical, cerebrospinal fluid and radiological parameters were evaluated for predictors of morbidity and mortality. Standardized tools were used to assess possible impairments in different domains at the end of intensive phase of treatment, namely Gross Motor Functional Classification System for motor functional ability, Pediatric-Mini Mental score examination (MMSE), Blantyre Coma Scale (BCS) score and Vineland Social Maturity Scale (VSMS) for cognitive outcome, Auditory Brainstem Evoked Responses for hearing outcome and using Teller's/Snellen's visual acuity charts to assess visual impairment. ResultsA high Mortality rate of 42.5% was seen in the enrolled patients. Out of the total 80 patients, 20% recovered completely while 36.25% survived with disability (morbidity). Motor, Hearing, Cognitive and Vision impairment was present in 33.3%, 4%, 33.3% and 48.9% of the survivors respectively. On multivariate regression, raised intracranial tension and stage III disease were significantly associated with mortality. Morbidity was significantly associated with Stage III disease on multivariate analysis. ConclusionsDespite advances in treatment, Tuberculous meningitis is associated with high burden of deaths and devastating neurological sequelae. Timely diagnosis and intervention of neurological impairments is needed to improve the outcome of TBM in survivors.

Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland

BackgroundChildhood neurosurgical conditions such as hydrocephalus and spina bifida represent a significant burden of death and disability worldwide, particularly in low and middle-income countries. However, there are limited data on...

Trends of Mortality in End-Stage Liver Disease - China, 2008-2020.

Liver cancer and cirrhosis represent the most prevalent forms of end-stage liver diseases (ESLDs). Notably, in China, deaths attributed to ESLDs contribute significantly to the global mortality rate of these disorders. Enhanced comprehension of the mortality profile associated with ESLDs in China could provide crucial insights into intervention prioritization, which could in turn help reduce the overall global burden of these diseases. Data were obtained from China's Disease Surveillance Points system. The presentation includes both crude and age-standardized mortality rates, stratified by sex, residential location, and region. Using Joinpoint Regression, trends in annual mortality rates were estimated from the period of 2008 to 2020 and expressed as the average annual percentage change (AAPC). In 2020, the gross mortality rate of ESLD stood at 30.08 cases per 100,000 individuals. A higher age-standardized ESLD mortality rate was observed in males and rural populations in comparison to their female and urban counterparts, respectively. Noticeably, the highest mortality rates associated with liver cancer and cirrhosis were reported in South and Southwest China, respectively. A positive correlation was noticed between age-specific ESLD mortality rates and advancing age. Interestingly, an annual decrease in the ESLD mortality rate was observed from 2008 to 2020. In urban contexts, the AAPC of cirrhosis was noted to be higher than that of liver cancer. The mortality rate associated with ESLDs in China decreased between 2008 and 2020. Nevertheless, the death burden attributable to ESLD continues to be alarmingly high. Future initiatives should prioritize the reduction of ESLD mortality in particular populations: males, elderly individuals, and those residing in rural regions of South and Southwest China. The emphasis of future interventions should be placed on antiviral therapy for adults diagnosed with viral hepatitis, and on the prevention of hepatitis B virus (HBV) infection across all demographics.

Adherence and retention studies of HIV-positive adolescents in Southeastern Nigeria and factors responsible for their outcomes: a quantitative and qualitative study

Adolescents living with HIV have an increasing burden of AIDS-related illnesses and death. Studies in other countries showed poor adherence to antiretroviral therapy (ART) and retention-in-care among this group. Limited studies exist in Nigeria on this subject. This cross-sectional study therefore assessed the level of adherence to ART and retention-in-care by HIV-positive adolescents in South-East Nigeria and the factors responsible for their outcomes, using a mixed methods approach. The study states and the interview participants were selected using convenient and purposive techniques, respectively. A multistage sampling technique was used for the selection of the study hospitals. The data for the quantitative study were from eligible patients' folders. For the qualitative studies, face-to-face in-depth interviews and key informant interviews were conducted on purposively selected HIV-positive adolescents and healthcare staff, respectively. Quantitative and qualitative data were analysed descriptively and thematically, respectively. The result showed that only 34.7% of the 147 HIV-positive adolescents assessed achieved ≥ 95% adherence to ART, and 72.2% were retained-in-care in 2016. The adherence level was not affected by the demographic variables and was not statistically different in the study states. Poverty was the major constraint, and improved working conditions were a major facilitator to the study outcome measures identified. HIV-positive adolescents in South-East Nigeria had poor adherence to ART (34.7) %, and a somewhat poor retention-in-care (72.2) %. The findings are worse than the reported poor global level of 62% adherence to ART and 85% retention-in-care. Service delivery interventions using the identified factors will improve these outcomes.

The Forms, Challenges and Strength of the Monkeypox Surveillance System in Nigeria

Monkeypox is now a disease of global public health concern, making it cut across boundaries into different countries, continents and spread worldwide. However, it originated in the Democratic Republic of Congo as a human pathogen in 1970, with the first case reported in Nigeria in 1971. The World Health Organization recently declared Nigeria the country with the highest burden of monkeypox-confirmed cases and deaths in Africa for the current outbreak. This study aimed to identify forms, challenges, strengths, and ways to further strengthen the surveillance system of monkeypox in Nigeria. We conducted a rapid narrative review of articles published in English on monkeypox between January 2018 and October 2022. Google Scholar and PubMed were searched with the following terms: "Monkeypox", "Surveillance system", "Strengthening", "Challenges" "Nigeria" and relevant publications were reviewed. The forms of surveillance systems in Nigeria include Indicator-based and Event-based surveillance, contact tracing, laboratory-based surveillance, sero-surveillance, and mortality surveillance. Shortage of highly skilled staff in public health interventions, insufficient testing capacities, power instability, poor healthcare systems and stigmatization from communities with misinformation, and co-epidemic surveillance burden in Nigeria are some of the challenges contributing to weak surveillance in the country. The Nigerian governments must focus on investing in surveillance systems and bolster preparedness to stem the rapid spread of infectious diseases. Strengthening the surveillance system in the country as a response intervention for monkeypox is no longer a matter of option in Nigeria but of necessity to prevent the forecasted effect the incidence portends.

Drug Overdose Deaths Among Non-Hispanic Black Men in the U.S.: Age-Specific Projections Through 2025

Fatal drug overdoses have risen sharply in the U.S. since 2015, reaching their highest levels during the pandemic. Non-Hispanic Black men have been disproportionately harmed by this latest surge; overdose mortality per 100,000 has increased fourfold since 2015. Whether the mortality rate will continue to climb is unknown. In this study, we addressed the narrower question of which age groups are likely to experience a significant increase or decrease in the burden of drug overdose deaths through 2025, based on foreseeable changes in the age structure of the Black male population. We used the 2020 and provisional 2021 age-specific mortality rates from the Centers for Disease Control WONDER (Wide-Ranging Online Data for Epidemiologic Research) database and the standard population balancing equation to project overdose deaths in 2025. Overdose deaths were identified by ICD-10 codes. We bracketed the projections between 2 plausible alternatives: a pessimistic forecast based on time series extrapolations and an optimistic forecast that assumes success nationally in lowering overdose deaths through prevention, treatment, and harm reduction initiatives. Among Black men aged 31-47 years, overdose deaths in 2025 are expected to increase by 440 or 11% (95% CI=8%, 14%) relative to 2020. By contrast, overdose deaths among younger Black men aged 19-30 years are expected to decline by 160 or -9% (95% CI= -15%, -5%). Among older Black men aged 48-64 years, overdose deaths are also expected to decline by 330 or -7% (95% CI= -10%, -4%). Similar results were found using 2021 provisional mortality rates. Overdose deaths are predicted to increase significantly over current levels among Black men in their 30s and 40s. Local policy makers should direct harm reduction resources, such as naloxone kits, syringes, and fentanyl test strips, to places frequented by Black men in this age group. Outreach messaging should be tailored to resonate with men of middle age. Equally urgent is the scaling up of nonstigmatizing, evidence-based drug treatment and recovery support services in Black neighborhoods.

1866. Burden of Death Associated with SARS-CoV-2 Infection during the Pandemic in Flint, Michigan (MI): Mortality Trends over the 2-year time period

Abstract Background Approximately 2.4 million cases of SARS-CoV-2 infection have been reported in MI, leading to 35,935 deaths. We aimed to study the mortality trends in patients with SARS-CoV-2 infection during the pandemic in Flint, MI. Methods Hurley Medical Center, is a 443-bed inner city teaching hospital in Flint, MI. We retrospectively collected basic demographics, treatment data, and outcomes on adults (≥ 18 years (yrs) of age) with confirmed SARS-CoV-2 infection, admitted and discharged from our facility from 03/2020 through 02/2022. The 2-year span was further divided into 6-time periods (Table 1). Results During the 2-year study period, the overall crude 90-day mortality rate was 16% (269/1668) and the In-hospital case fatality rate was 15% (244/1668). 90-day mortality was lowest in the time period 5 (Table 1). Men comprised 50% of the cohort and were 1.5 times more likely to die than women (p-value 0.001). African Americans comprised 51% and whites 44% of the cohort. A specific race was not associated with mortality (Table 2). Non-survivors tended to be older, mean age of 68 vs 57 yrs (p-value < .0001). See Table 3 for mean Body Mass Index (BMI). Hypertension (HTN) was the most common co-morbidity (61%), and was strongly associated with mortality (p-value < 0.005) (Table 4). During the study period, 12% of the cohort (207/1668) had received at least one dose of available COVID-19 vaccines (including single dose of Johnson and Johnson’s Jansen vaccine). 89% of non-survivors were unvaccinated (adjusted Odds ratio for mortality 1.61, 95% CI 1.03 - 2.53, p-value 0.038). Conclusion Despite substantial changes in supportive care and management, SARS-CoV-2 infection regardless of the circulating variants carried a significant mortality risk. Trend towards improving mortality can partly be attributed to better supportive care-treatments, and some background immunity from prior infection or vaccination. Immunization against COVID-19 is highly protective against severe disease. Vaccination coverage in this high-risk cohort was low, at only 12%. Vaccination coverage in Flint and surrounding areas remains low at less than 50% as reported by Genesee County health department. Public health efforts should be focused at overcoming the barriers to vaccine acceptance in this high-risk unique population. Disclosures All Authors: No reported disclosures.

988 UNCLEAR SUDDEN DEATH IN THE YOUNG: DIFFERENT DISTRIBUTION AMONG THE ITALIAN REGIONS

Abstract Introduction Sudden death (SD) in the young due to cardiovascular diseases remains a focus of the public health system. It occurs unexpectedly in apparently healthy people. In addition, several of the diseases that cause sudden death in the young can be diagnosed and treated prior to the first lethal event; on the other hands, a post mortem approach, by the means of clinical autopsy and molecular autopsy, may clarify the underling disease to better develop futher prevention by a familial approach. The attention on this issue has greatly sensitized doctors and public opinion. Aim The aim of the manuscript was to evaluate the frequency of sudden deaths in Italy in the decade 2008-2017. Methods and Data sources The searches were carried out by consulting the database of the National Institute of Statistics (ISTAT). We counted in the ISTAT database all the deceased under the age of 40 due to unclear causes in the decade 2008-2017. Results We counted 7159 young patients with DS, unevenly distributed throughout the Italian territory. In detail, 10% (1373) were in the North-West, 14% (988) in the North-East, 13% (934) in the Center, 44% (3178) in the South and 10% (686) in the islands. The analysis showed how the unclear SD in Italy have decreased over time. Southern Italy had the highest number (357) of SD at the start of the observation which slightly dropped to 272 in 2017. Despite this significant reduction, the South remains the place where the largest number of unclear SD are counted. Most likely, the initial studies conducted in the Veneto region sensitized doctors to SD in young people and athletes, leading a wider screening through cardiological examination and electrocardiogram for prevention; furthermore a widespread recurrence to clinical autopsy, to reach a clear diagnosis, allows the awareness that other cases could occur in the same family. Grief coping approach and cultural competency may explain the regional difference. The new methods available to genetics, such as next generation sequency (NGS), have allowed an increase in diagnoses even in the deceased and have identified possible pathogenic genes in family members. Conclusions Sudden death in young people represents an important challenge, considering the number of events that occur in our country and the different distribution in the Italian regions. Medical community need to better address this issue, by implementing both prevention and post-mortem analysis, to reduce the sudden death burden, especially in southern region. Thiene G. Sudden cardiac death in the young: a genetic destiny? Clin Med (Lond). 2018 Apr 1;18(Suppl 2):s17-s23. Markwerth P, Bajanowski T, Tzimas I, Dettmeyer R. Sudden cardiac death-update. Int J Legal Med. 2021 Mar;135(2):483-495.Webster G, Carberry T, Berger S. Screening for prevention of sudden death in the young: what is new? Curr Opin Cardiol. 2020 Jan;35(1):80-86.

The Global, Regional, and National Burden and Trends of NAFLD in 204 Countries and Territories: An Analysis From Global Burden of Disease 2019

Nonalcoholic fatty liver disease (NAFLD) poses a substantial socioeconomic burden and is becoming the fastest growing driver of chronic liver disease, potentially accompanied by a poor prognosis. We aim to elucidate the global and regional epidemiologic changes in NAFLD during the past 30 years and explore the interconnected diseases. Data on NAFLD incidence, prevalence, death, and disability-adjusted life-years (DALYs) were extracted from the Global Burden of Disease Study 2019. The age-standardized incident rate (ASIR), age-standardized prevalent rate (ASPR), age-standardized death rate (ASDR), and age-standardized DALYs were calculated to eliminate the confounding effects of age when comparing the epidemiologic changes between different geographical regions. In addition, we also investigated the correlation between the NAFLD burden and the sociodemographic index (SDI). Finally, the associations of the 3 common comorbidities with NAFLD were determined. Globally, the incidence and prevalence of NAFLD both increased drastically during the past 3 decades (incidence: from 88,180 in 1990 to 172,330 in 2019, prevalence: from 561,370,000 in 1990 to 1,235,700,000 in 2019), mainly affecting young adults who were aged from 15 to 49 years. The ASIR increased slightly from 1.94 per 100,000 population in 1990 to 2.08 per 100,000 population in 2019, while ASPR increased from 12,070 per 100,000 population in 1990 to 15,020 per 100,000 population in 2019. In addition, the number of deaths and DALYs attributable to NAFLD increased significantly as well from 93,760 in 1990 to 168,970 in 2019 and from 2,711,270 in 1990 to 4,417,280 in 2019, respectively. However, the ASDR and age-standardized DALYs presented decreasing trends with values of estimated annual percentage change equaling to -0.67 and -0.82, respectively (ASDR: from 2.39 per 100,000 population in 1990 to 2.09 per 100,000 population in 2019; age-standardized DALYs: from 63.28 per 100,000 population in 1990 to 53.33 per 100,000 population in 2019). Thereinto, the burden of death and DALYs dominated the patients with NAFLD who are older than 50 years. Moreover, SDI appeared to have obvious negative associations with ASPR, ASDR, and age-standardized DALYs among 21 regions and 204 countries, although there is no marked association with ASIR. Finally, we found that the incidence and prevalence of NAFLD were positively related to those of diabetes mellitus type 2, stroke, and ischemic heart disease. NAFLD is leading to increasingly serious health challenges worldwide. The morbidity presented a clear shift toward the young populations, while the heavier burden of death and DALYs in NAFLD was observed in the aged populations and in regions with relatively low SDI. Comprehensive acquisition of the epidemiologic pattern for NAFLD and the identification of high-risk comorbidities may help policy makers and clinical physicians develop cost-effective prevention and control strategies, especially in countries with a high NAFLD burden.

Diagnoses and mortality among prehospital emergency patients calling 112 with unclear problems: a population-based cohort study from Denmark

BackgroundPatients calling for an emergency ambulance and assessed as presenting with ‘unclear problem’ account for a considerable part of all emergency calls. Previous studies have demonstrated that these patients are at increased risk for unfavourable outcomes. A deeper insight into the underlying diagnoses and outcomes is essential to improve prehospital treatment. We aimed to investigate which of these diagnoses contributed most to the total burden of diseases in terms of numbers of deaths together with 1- and 30-day mortality.MethodsA historic regional population-based observational cohort study from the years 2016 to 2018. Diagnoses were classified according to the World Health Organisation ICD-10 System (International Statistical Classification of Diseases and Related Health Problems, 10th edition). The ICD-10 chapters, R (‘symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified)’ and Z (‘factors influencing health status and contact with health services”) were combined and designated “non-specific diagnoses”.Poisson regression with robust variance estimation was used to estimate proportions of mortality in percentages with 95% confidence intervals, crude and adjusted for age, sex and comorbidities.ResultsDiagnoses were widespread among the ICD-10 chapters, and the most were ‘non-specific diagnoses’ (40.4%), ‘circulatory diseases’ (9.6%), ‘injuries and poisonings’ (9.4%) and ‘respiratory diseases’ (6.9%). The diagnoses contributing most to the total burden of deaths (n = 554) within 30 days were ‘circulatory diseases’ (n = 148, 26%) followed by ‘non-specific diagnoses’ (n = 88, 16%) ‘respiratory diseases’ (n = 85, 15%), ‘infections’ (n = 54, 10%) and ‘digestive disease’ (n = 39, 7%). Overall mortality was 2.3% (1-day) and 7.1% (30-days). The risk of mortality was highly associated with age.ConclusionThis study found that almost half of the patients brought to the hospital after calling 112 with an ‘unclear problem’ were discharged with a ‘non-specific diagnosis’ which might seem trivial but should be explored more as these contributed the second-highest to the total number of deaths after 30 days only exceeded by ‘circulatory diseases’.

Ecological study of ambient air pollution exposure and mortality of cardiovascular diseases in elderly.

As an independent risk factor, ambient air pollution can assume a considerable part in mortality and worsening of cardiovascular disease. We sought to investigate the association between long-term exposure to ambient air pollution and cardiovascular disease mortality and their risk factors in Iranian's elderly population. This inquiry was conducted ecologically utilizing recorded data on cardiovascular disease mortality from 1990 to 2019 for males and females aged 50years or more from the Global Burden of Disease dataset. Data was interned into Joinpoint software 4.9.0.0 to present Annual Percent Change (APC), Average Annual Percent Change (AAPC), and its confidence intervals. The relationship between recorded data on ambient air pollution and cardiovascular disease' mortality, the prevalence of high systolic blood pressure, high LDL cholesterol levels, high body mass index, and diabetes mellitus type2 was investigated using the Spearman correlation test in R 3.5.0 software. Our finding demonstrated that cardiovascular diseases in elderly males and females in Iran had a general decreasing trend (AAPC = -0.77% and -0.65%, respectively). The results showed a positive correlation between exposure to ambient ozone pollution (p ≤ 0.001, r = 0.94) ambient particulate and air pollution (p < 0.001, r = 0.99) and mortality of cardiovascular disease. Also, ambient air pollution was positively correlated with high systolic blood pressure (p < 0.001, r = 0.98), high LDL cholesterol levels (p < 0.001, r = 0.97), high body mass index (p < 0.001, r = 0.91), diabetes mellitus type2 (p < 0.001, r = 0.77). Evidence from this study indicated that ambient air pollution, directly and indirectly, affects cardiovascular disease mortality in two ways by increasing the prevalence of some traditional cardiovascular disease risk factors. Evidence-based clinical and public health methodologies are necessary to decrease the burden of death and disability associated with cardiovascular disease.

Worsening premature death burden gap from systemic sclerosis in men and black persons: A US nationwide population-based study.

Male sex and black race incur poor prognosis in systemic sclerosis (SSc). There is no nationwide population-based assessment of premature SSc death burden by sex and race. This is a population-based study comprising all recorded SSc deaths across the United States. We constructed histograms depicting the number of SSc deaths for each age by sex and race, and calculated the cumulative percent death at each age and the median age of death. We determined the odds ratios for the risk of premature death from SSc by sex and race. We then calculated the percent of total SSc deaths for different age groups by sex and race from 1970 to 2015. We performed chi-square test with Yates's correction and quantified the odds ratio (OR) with 95% confidence interval (CI). The median age of SSc death was 63 years in males versus 68 years in females, and 57 years in blacks versus 70 years in whites. The odds for SSc death before 65 years age was 1.8 (95% CI, 1.6-2.0) for males compared with females and 5.1 (95% CI, 4.4-6.0) for blacks compared with whites. The higher odds for premature death in males than in females was similar for both races. Differences in the proportions of premature deaths from 1970 to 2015 increased between males and females (-5% to 17%) and between blacks and whites (14% to 36%). Males and black persons die of SSc at younger ages. The worsening premature death burden gap between the two sexes and races over the last five decades is troublesome.

Profile: Maternal and Child Health Surveillance System in peri-urban areas of Karachi, Pakistan

A Maternal and Child Health Surveillance System (MCHSS) was set up by the department of pediatrics and child health, Aga Khan University, Pakistan in peri-urban areas of Karachi to provide a platform for various research projects. It was established in five low-socioeconomic communities in a stepwise manner between 2003 and 2014. The total area currently under surveillance is 18.6 km2 covering a population of 302,944. We maintain a record of all births, deaths, pregnancies, and migration events by two monthly household visits. Verbal autopsies for stillbirths, deaths of children under the age of five years and adult female deaths are also conducted. For over a decade, the MCHSS has been a platform for a variety of studies describing the burden of various infectious diseases like typhoid, pneumonia and diarrhea, evaluation of effectiveness of various treatment regimens for neonatal sepsis, assessment of the acceptance of hospitalized care, determination of the etiology of moderate to severe diarrhea, assessment of burden and etiology of neonatal sepsis and a multi-center cohort study measuring the burden of stillbirths, neonatal and maternal deaths. More recently we have also established a bio-repository of the well-characterized maternal and newborn cohort. Through a well-established MCHSS, we aim to provide concrete evidence base to guide policy makers to make informed decisions at local, national, and international levels.

Mechanism of Impaired Cognitive Function in Patients with Chronic Kidney Disease

Each stage of chronic kidney disease has a high risk of cognitive dysfunction.The decline of cognitive function will affect the daily life and treatment compliance of the patients with chronic kidney disease and increase the patients' risk of death and public health burden,which has aroused widespread concern.However,the specific mechanism of cognitive impairment in the patients with chronic kidney disease remains unclear.This paper summarizes the possible association mechanisms,related indicators,and impaired cognitive domains,aiming to provide a theoretical basis for the early diagnosis and slow down the progression of the cognitive impairment associated with chronic kidney disease.

Opportunities and challenges to non-communicable disease (NCD) research and training in Pakistan: a qualitative study from Pakistan

IntroductionMost of the global non-communicable disease (NCD)-related death burden is borne by low and middle-income countries (LMICs). In LMICs like Pakistan, however, a major gap in responding to NCDs is...