Cause Of Death Statistics Research Articles

Editor's Choice – Assessment of Correlation Between Mean Size of Infrarenal Abdominal Aortic Aneurysm at Time of Intact Repair Against Repair and Rupture Rate in Nine Countries

This study aimed to analyse the mean abdominal aortic aneurysm (AAA) diameter for repair in nine countries, and to determine variation in mean AAA diameter for elective AAA repair and its relationship to rupture AAA repair rates and aneurysm related mortality in corresponding populations. Data on intact (iAAA) and ruptured infrarenal AAA (rAAA) repair for the years 2010-2012 were collected from Denmark, England, Finland, Germany, Hungary, New Zealand, Norway, Sweden, and the USA. The rate of iAAA repair and rAAA per 100000 inhabitants above 59 years old, mean AAA diameter for iAAA repair and rAAA repair, and the national rates of rAAA were assessed. National cause of death statistics were used to estimate aneurysm related mortality. Direct standardisation methods were applied to the national mortality data. Logistic regression and analysis of variance model adjustments were made for age groups, sex, and year. There was a variation in the mean diameter of iAAA repair (n=34566; range Germany=57mm, Denmark=68mm). The standardised iAAA repair rate per 100000 inhabitants varied from 10.4 (Hungary) to 66.5 (Norway), p<.01, and the standardised rAAA repair rate per 100000 from 5.8 (USA) to 16.9 (England), p<.01. Overall, there was no significant correlation between mean diameter of iAAA repair and standardised iAAA rate (r2 = 0.04, p = .3). There was no significant correlation between rAAA repair rate (n=12628) with mean diameter of iAAA repair (r2 = 0.2, p = .1). Despite recommendations from learned society guidelines, data indicate variations in mean diameter for AAA repair. There was no significant correlation between mean diameter of AAA repair and rates of iAAA repair and rAAA repair. These analyses are subject to differences in disease prevalence, uncertainties in rupture rates, validations of vascular registries, causes of death and registrations.

ANACONDA: a new tool to improve mortality and cause of death data

BackgroundThe need to monitor the Sustainable Development Goals (SDGs) and to have access to reliable and timely mortality data has created a strong demand in countries for tools that can assist them in this. ANACONDA (Analysis of National Causes of Death for Action) is a new tool developed for this purpose which allows countries to assess how accurate their mortality and cause of death are. Applying ANACONDA will increase confidence and capacity among data custodians in countries about their mortality data and will give them insight into quality problems that will assist the improvement process.MethodsANACONDA builds on established epidemiological and demographic concepts to operationalise a series of 10 steps and numerous sub-steps to perform data checks. Extensive use is made of comparators to assess the plausibility of national mortality and cause of death statistics. The tool calculates a composite Vital Statistics Performance Index for Quality (VSPI(Q)) to measure how fit for purpose the data are. Extracts from analyses of country data are presented to show the types of outputs.ResultsEach of the 10 steps provides insight into how well the current data is describing different aspects of the mortality situation in the country, e.g. who dies of what, the completeness of the reporting, and the amount and types of unusable cause of death codes. It further identifies the exact codes that should not be used by the certifying physicians and their frequency, which makes it possible to institute a focused correction procedure. Finally, the VSPI(Q) allows periodic monitoring of data quality improvements and identifies priorities for action to strengthen the Civil Registration and Vital Statistics (CRVS) system.ConclusionsANACONDA has demonstrated the potential to dramatically improve knowledge about disease patterns as well as the functioning of CRVS systems and has served as a platform for galvanising wider CRVS reforms in countries.

Studying Geographic Inequalities in Mortality in Contexts with Deficient Data Sources: Lessons from Ecuador.

In Ecuador, there are inequalities in the completeness and quality of the mortality registry between men and women and among geographical areas. Consequently, using cause of death statistics leads to several difficulties. Our aim was to analyze geographical inequalities in mortality due to some of the main specific causes of death in the provinces of Ecuador (2001-2016) after correction for the deficiencies found in the mortality registry. This ecologic study used mortality data from 2001 to 2016 for the 22 provinces of Ecuador at the beginning of the study period. We assessed completeness using death distribution methods for the intercensal period 2001-2010. We assessed quality by estimating the percentage of garbage codes for the entire study period. We corrected mortality using completeness as a correction factor and applying a garbage code redistribution protocol. We estimated age-standardized mortality ratios in the provinces of Ecuador for men and women, before and after applying the correction methods. We found substantial changes in the number of deaths due to the selected causes after garbage code redistribution and correction for completeness. These changes corresponded to the deficiencies in completeness and quality found in the study areas and the manner in which garbage codes were redistributed to each of the studied causes. We observed changes in the geographical patterns of mortality due to specific causes. Correcting deficiencies in the mortality registry resulted not only in changes in the number of deaths but also in the geographical patterns of mortality in Ecuador.

Mortality and Causes of Death in Late 19th-Century Trondheim, Norway (with Reference to Parish Registers Analysis)

This article provides detailed analysis of mortality in Trondheim, the third largest city in Norway in the second half of the nineteenth century. Referring to individual-level causes of death available in burial registers from Trondheim, this study provides an in-depth analysis of reporting practices and trends in cause of death registration and changes in a city that witnessed increasing urbanisation and industrialisation. Having studied the history of causes of death registration in Norway, the authors analyse the accuracy of recording practices performed by priests and age-specific profiles of individual death causes. The coding and classification system employed by the authors includes 141 categories following the etiology or mode of infection and transmission. To facilitate the analysis, all the entries found in records, both the ones that indicate the causes of death of the inhabitants of Trondheim and fail to do so, are divided into six major groups, i.e. infectious diseases; non-infectious diseases; external causes; older rationals; ill-defined, and not reported (blank). Treated critically, the data generates interesting insights into the epidemiological history of a period where cause of death statistics from doctors was still scarce in most of the country. The analysis demonstrates that in the second half of the nineteenth century, airborne infectious diseases dominated the disease environment in Trondheim. Airborne diseases were particularly common in children aged one to four, accounting for 60 percent of the total of deaths among children of the age group. As for foodborne infectious diseases, such as diarrhoea and dysentery, the study indicates that the water pipes which started being used as early as the 1850s and from 1880 also appeared inside houses, had a certain effect, in addition to the top priority of personal hygiene addressed by the city’s Health Commission. Moreover, the cause of death classification related to ‘older rationales’ had a clear clustering both among the elderly and children.

P5489Old ladies paradox: trends in the inpatient care of coronary heart disease 2005–2016 in Germany

Abstract Objectives Coronary heart disease (CHD) and subsequent illnesses are the most common cause of death in industrialized countries and they continue to lead the cause of death statistics. In Germany, 2015 from all registered deaths 7.1% (n=65,686) are due to chronic CHD and 5.3% (n=49,210) due to acute myocardial infarction (AMI), but the proportion has fallen: Compared to 2003, when 10.9% (n=92,637) of the deceased of CHD and 7.5% of AMI (n=64,229). It is established that there are sex-differences in prevalence and in the age of the persons concerned. E.g. 2015 AMI infarction is cause of death in 57% (n=27,835) men and 43% (n=21,375) women from 49% men (n=36,049) and 51% women (n=37,127) in 2003. Aim of the study was, whether these differences in prevalence and diagnostic and interventional measurements in the hospital sector have shifted in recent years with the various entities of the acute coronary disease. Methods G-DRG Report-Browser 2005–2016 of the German DRG-Institute (InEK) and Federal Statistical Office data were used. Analysis was carried out with Microsoft Excel and Access (version 2016). Results Inpatient cases of main diagnosis AMI increased from 2005 from 206,104 cases to 219,156 cases in 2016 (+6.3%). Share of male increased from 62.5% to 66.6%. The NSTEMI share increased from 39.7% in 2005 to 66.2% in 2016; a total 145.202 cases (+77.2% to 2005). The increase was smaller in older women: 60–70y: +33.7%; 70–80y: +44.5%; 80–90y: +61.9%The NSTEMI increase in men was slightly higher than in women; proportion of men 2005: 64.2%, 2016; 65.1%. The STEMIs number shrank from 104,082 in 2005 to 70,521 (−34.0%) in 2016. The relative reduction was very high in older women: 60–70y: −45.2%; 70–80y: −55.3%; 80–90y: −54.1%. Share of men 2005: 60.1%, 2015; 70.0%. In 2008: 220,595 diagnostic-only coronarographies were conducted from a total of 690,745 coronarography measurements. These numbers increased to 485.496 (+120.1%) and 869.002 (+25.8%) in 2016. Share of the male decreased from 73.0% in 2008 to 65.6% in 2015. The increase for all coronarographies was highest in older women: 50–60y: +60.7% 60–70y: +39.4%; 70–80y: +72.5%; 80–90y: +168,4% The total number of percutaneous transluminal vascular interventions (PCI) increased from 2008 with 488,542 to 661,693 in 2016 (+35.4%). The relative increase in PCI was high in older women: 60–70y: +18.6%; 70–80y: +42.7%; 80–90y: +126.1%; &gt;90y: +314.1% Conclusions The number of cases of ACS is declining since 2005. There is a significant shift from STEMI to NSTEMI events over the observation period. In all forms of the ACS, the proportion of men in is increasing. The rate of coronary diagnostic and coronary intervention in men is disproportionately high in relation to disease rate. Paradoxically the share of examinations older women without further action increases strongly, despite their share in the disease was small and is still decreasing.

Overwork-related disorders and recent improvement of national policy in South Korea

ObjectivesRecently, overwork‐related disorders have become a major public health concern in Korea. This study investigated the current trends of working hours, causes of death in the working population, and compensation rates.MethodsWe reviewed the current trends of working hours, cause of death statistics in the working population, industrial accident compensation insurance (IACI) statistics, issues of compensation and prevention of work‐related cerebro‐cardio vascular diseases (CCVDs), mental disorders, and suicide.ResultsAlthough weekly working hours and the proportion of long working days have decreased, workers in small companies with fewer than five employees and those in the service sector continue to work long hours. The age standardized mortality due to CCVD and suicide was highest among those with managerial roles. In total, 589 CCVD cases and 104 mental disorder or suicide cases were compensated as occupational diseases in 2017. Between 2016 and 2017, 61% of 59 compensated suicides were related to overwork, specifically: long working hours, increased responsibility, or increased workload. The Korean government has introduced various policies to reduce working hours and to increase compensation approval rate for overwork‐related CCVDs. Stakeholders have called for the introduction of independent laws to prevent overwork‐related disorders, change organizational culture, and address the blind spots of the IACI Act and Labor Standard Act.ConclusionsPrevention and compensation policies have improved working conditions in Korea, but there remains much to be done. This review significantly contributes to the understanding of the overall policies and research to prevent overwork‐related disorders in Korea.

Cause of death coding in Switzerland: evaluation based on a nationwide individual linkage of mortality and hospital in-patient records

BackgroundCause of death statistics are an important tool for quality control of the health care system. Their reliability, however, is controversial. Comparing death certificates with their corresponding medical records is implemented only occasionally but may point to quality problems. We aimed at exploring the agreement between information in the cause of death statistics and hospital discharge diagnoses at death.MethodsSelection of disease categories was based on ICD-10 Tabulation List for Morbidity and ICD-10 Mortality Tabulation List 2. Index cases were defined as deaths having occurred among Swiss residents 2010–2012 in a hospital and successfully linked to the Swiss National Cohort. Rare, external and ill-defined causes were excluded from comparison, leaving 53,605 deaths from vital statistics and 47,311 deaths from hospital discharge statistics. For 95% of individuals, respective information from the 2000 census could be retrieved and used for multiple logistic regression.ResultsFor 83% of individuals the underlying cause of death could be traced among hospital diagnoses and for 77% the principal hospital diagnosis among the cause of death information. Mirroring different evaluation of complex situations by individual physicians, rates of agreement varied widely depending on disease/cause of death, but were generally in line with similar studies. Multiple logistic regression revealed however significant variation in reporting that could not entirely be explained by age or cause of death of the deceased suggesting differential exploitation of available diagnosis information.ConclusionSubstantial regional variation and lower agreement rates among socially disadvantaged groups like single, less educated, or culturally less integrated persons suggest potential for improving reporting of diagnoses and causes of death by physicians in Switzerland. Studies of this kind should be regularly conducted as a quality monitoring.

Analysis of Coding Quality of Death Certificates and Autopsy Rates in Chemnitz: 2010-2013

Postmortem examination as the last service of physicians has been increasingly criticized recently. The aim of this project was to study the influence of place of death, type of postmortem physician, age and sex of the deceased person on the completeness and quality of ICD-10 coding of death certificates issued by physicians in Chemnitz, Germany. We reviewed 15 612 death certificates and 353 autopsy reports of the health office of Chemnitz for the years 2010-2013. We extracted age and sex of the deceased, causes of death as based on the primary postmortem examination and after autopsy if applicable, type of death (natural or unnatural cause of death), and complications as discovered at the second postmortem examination before cremation. In addition, we documented the place of death and type of physician carrying out the postmortem examination. Furthermore, we corrected the inappropriate or missing ICD-10 codes followed by agreement analysis. The analysis was in agreement with the rules of the German Institute of Medical Documentation and Information. The autopsy rate was 2.3%. The underlying condition was not documented in 34.1% of the cases. The agreement between quality-controlled ICD-10 coding of the cause of death and the original ICD-10 coding (three-digit codes) was high (96.5%). High age at death, death not occurring in hospitals, and postmortem examination not carried out in hospitals were associated with a higher probability of ICD-10 miscoding. The observed agreement of 3-digit ICD-10 coded underlying condition after primary postmortem examination and after autopsy was 26.3%. The underlying cause of death contained garbage codes in 24.2%, that is, codes that are inappropriate for cause of death statistics. Physicians have to be sensitized to the need for appropriate documentation of causes of death. Autopsy very frequently resulted in a change of the assessment of the underlying cause of death and therefore remains an important quality control measure for certification on the cause of death. ICD-10 coding of causes of death is not a primary task of physicians and physicians should not be required by law to carry out this task.

Incidence of Fall Accident in Suseong District of Daegu Metropolitan City, Republic of Korea

Background: Among the various types of injuries in the world, falls are one of the most important health problem related issues, especially for modern societies with aged populations. Korea, a country where industrialization and urbanization have made building structures and living spaces complex, has also been facing the emerging danger of falls. So, among the causes of death due to unintended injury accidents, falls are second reason of injury worldwide following traffic accidents. Falls are important causes in increase of morbidity rates, hospitalization rates, death rates and medical fees. Falls are not unfortunate accidents rather, they are preventable and predictable. Therefore, we needs to identify the incidence and causes of falls. Objectives The purposes of this study are to identify the incidence of fall accident in Suseong district of Daegu metropolitan city and to develop the evidence based fall accident program for Suseong district. Methods: In order to identify the incidence of falls of the citizens of Suseong district, authors analyzed the annual report on the causes of death statistics from the National Statistical Office and the injury data from Fire Station 119 Rescue Activity Daily Record. As well, in order to understand the current state of falls in households, an epidemiological survey was conducted to people from 1,977 households in Suseong district by home visited. The collected data were analyzed using SPSS WIN 17.0 based on the research objectives, and the frequency and percentages were investigated. Results: According to the data from the National Statistical Office, the death rate due to falls was 4.1 people (per 100,000 persons). In terms of age, elders aged 65 and over was the highest death rate with 17.0 out of 100,000 persons. In the injury transfer rate analyzed from rescue records of 119, accidents due to falls were highest with 2.3 cases out of 1,000 persons. In terms of age, elders aged 65 and over was the highest injury rate with 9.2 out of 1000 persons. After analyzing the injury causes of the citizens of Suseong district through household visits, the highest rate of falls was 43.7%, followed by traffic accidents (24.9%) and bump injuries (21.1%). Therefore, we were able to confirm once again that the fall prevention program is a very important program for improving the safety of citizens. Housework (29.4%) was the most common cause of falls. The most common places for falls were living rooms (22.6%), followed by restrooms and entrance. Conclusion: Mortality due to falls can be reduced through education, environmental improvements, and safety policies. It is necessary to conduct preventive education for elderly people who are vulnerable to falls, and to apply gymnastic exercises that can enhance balance and lower extremity muscle strength. In addition to, it is necessary to strengthen regulations on safety facilities at the senior community center. Therefore the government and related organizations should put fall prevention as the primary task and spread an effective evidence-based fall prevention program based on result of research.

Incidence-Based versus Prevalence-Based Approaches on Measuring Disability-Adjusted Life Years for Injury.

BackgroundInjury represents an important aspect of disease that affects everyone at some point in their lives. To better understand and prevent these injuries, various analytical methods have been developed to assess both the magnitude and features of injury burden. In this study, we attempted to estimate the injury burden of Korea in 2014 by comparing the prevalence-based approach used by the Global Burden of Diseases (GBD) team and the World Health Organization against an alternative incidence-based approach, and to assess the different implications of these measurements.MethodsThe 10th Korean National Hospital Discharge survey data and causes of death statistics in 2014 were used as data sources. Years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) were calculated using both the incidence- and prevalence-based approaches. The Korean Classification of Diseases (KCD) version 5 diagnostic codes were used to classify the mechanism of injury.ResultsThe prevalence-based injury burden tended to be higher (1,670,229 DALYs) than the incidence-based injury burden (1,544,467 DALYs). The elderly population exhibited a higher prevalence-based YLD and DALY relative to incidence-based outcomes. In order of significance, the three most common causes of injury as calculated using an incidence-based approach were road injury, fall, and self-harm, compared with a prevalence-based method, which identified self-harm, road injury, and falls as the most common injuries.ConclusionAn appropriate prevention program is needed for injuries with potential to cause long-lasting morbidity. Accordingly, a tailored injury-prevention strategy should be developed for each high-risk group.

Injury death certificates without specification of the circumstances leading to the fatal injury \u2013 the Norwegian Cause of Death Registry 2005\u20132014

BackgroundFor injury deaths, the underlying cause of death is defined as the circumstances leading to the injury. When this information is missing, the ICD-10 code X59 (Exposure to unspecified factor) is used. Lack of knowledge of factors causing injuries reduces the value of the cause of death statistics. The aim of this study was to identify predictors of X59-coded deaths in Norway, and to assess methods to identify the true underlying cause of injury deaths.MethodsWe used data from the Norwegian Cause of Death Registry from 2005 to 2014. We used logistic regression to identify determinants of X59-coded deaths. For redistribution of the X59 deaths, we used a multinomial logistic regression model based on the cases where injury circumstances were known. The data were divided into training and test sets. The model was developed on the training set and assessed on the test set before it was applied to the X59 deaths. The models used death certificate information on the nature of injury and demographic characteristics as predictor variables. Furthermore, we mailed a query to the certifying physicians of X59 deaths reported in the year 2015, where we asked for additional information on the circumstances leading to the fatal injury.ResultsThere were 24,963 injury deaths reported to the Cause of Death Registry of Norway 2005–2014. Of these, 6440 (25.8%) lacked information on the circumstances leading to the death. The strongest predictor for a X59 death was the nature of injury (hip fracture), followed by lack of information on the scene of injury. Applying our redistribution algorithm, we estimated that 97% of the X59-coded deaths were accidental falls. The strongest covariate was the nature of injury, followed by place of death and age at death. In 2015, there were 591 X59-coded deaths. Queries were sent to the certifying doctors in 559 cases. Among the informative replies to the query, 88% of the deaths were reclassified to accidental falls.ConclusionsA large proportion of injury deaths in Norway lack information on the circumstances leading to the fatal injury. Typically, these deaths represent accidental falls causing hip fracture in elderly individuals.

The Pyramid of Injury: Estimation of the Scale of Adolescent Injuries According to Severity.

ObjectivesDue to their developmental characteristics, adolescents have a higher probability than other age groups of experiencing injuries caused by accidents, violence, and intentional self-harm. The severity and characteristics of injuries vary by the intentionality and mechanism of injury; therefore, there is a need for a national-level estimate of the scale and the severity of injuries in adolescents that takes these factors into account.MethodsBy using data from the Emergency Department-based Injury In-depth Surveillance Data, National Emergency Department Information System, the Korean National Hospital Discharge In-depth Injury Survey, and cause of death statistics, we calculated the emergency department (ED) visit rate, hospitalization rate, and death rate of injuries per 100 000 adolescents for each injury mechanism. The calculated rates were used to generate the injury pyramid ratio (ratio of death rate to hospitalization rate to ED visit rate) to visualize the scale and the severity of the injury.ResultsThe mortality rate in adolescents due to injury was 10/100 000; the corresponding rates for hospitalization and ED visits were 1623 and 4923, respectively, resulting in an injury pyramid ratio with the general pyramid form, with a 1:162:492 ratio of deaths to hospitalizations to ED visits. The mortality rate due to suicide/intentional self-harm was 5/100 000, while 35 were hospitalized for this reason and 74 made ED visits. The pyramid ratio of 1:7:15 for intentional self-harm/suicide showed a steep pyramidal form, indicating considerable lethality. The mortality rate due to motor vehicle collisions (MVCs) was 3/100 000; 586 were hospitalized for this reason, while 1023 made ED visits. The pyramid ratio of 1:195:341 for MVCs showed a gradual pyramid form, indicating that the lethality was low and the scale of injury was high.ConclusionsThe main categories of injuries in adolescents were visualized in pyramid form, contributing to an understanding of the scale of each injury by mechanism in terms of levels of death, hospitalization, and ED visits. These findings will be helpful for understanding how to prioritize injuries in adolescents.

Pediatric Deaths Attributed to Complex Chronic Conditions over 10 Years in Korea: Evidence for the Need to Provide Pediatric Palliative Care.

BackgroundPediatric palliative care (PPC) is the active total care of children suffering from life-threatening illnesses. Palliative care includes symptom management, psychosocial support, and end-of-life care. Despite significant advances in disease diagnosis and treatment, resources for PPC of children with serious illnesses are limited in Korea. This study aimed to investigate the scale, time trends, disease composition, regional distribution, and unmet needs of children dying from complex chronic conditions (CCCs).MethodsWe examined available information on children who died of CCCs from 2005 to 2014 using the cause of death statistics in Korea.ResultsThere were 36,808 cases of pediatric deaths in Korea during that 10-year period, one-third (12,515 cases, 34.0%) of which were due to CCCs. In 2014, there were 1,044 cases of pediatric deaths due to CCCs (9.8 deaths per 100,000 children) in Korea. The rate of pediatric deaths due to CCCs has declined over this 10-year period. Among CCCs, malignancy was the most common cause of death overall, as well as in children and adolescents, whereas neonatal disorders were the most common cause of death in infants. Although over 1,000 children die from chronic illnesses each year, there are no hospitals or institutes in Korea that meet the minimum standards for specialized PPC.ConclusionTo improve the quality of life of children suffering from CCCs and to support their families who face enormous distress, children with CCCs should be able to access adequate palliative care services. Health authorities should consider supporting the establishment of PPC centers and increasing PPC accessibility in Korea.

How much information is there in annual cause of death statistics? The Netherlands example

How much information is there in annual cause of death statistics? The Netherlands example

The incomparability of cause of death statistics under \u201cone country, two systems\u201d: Shanghai versus Hong Kong

BackgroundValid and comparable cause of death (COD) statistics are crucial for health policy analyses. Variations in COD assignment across geographical areas are well-documented while socio-institutional factors may affect the process of COD and underlying cause of death (UCD) determination. This study examines the comparability of UCD statistics in Hong Kong and Shanghai, having two political systems within one country, and assesses how socio-institutional factors influence UCD comparability.MethodsA mixed method was used. Quantitative analyses involved anonymized official mortality records. Mortality rates were analyzed by location of death. To analyze the odds ratio of being assigned to a particular UCD, logistic regressions were performed. Qualitative analyses involved literature reviews and semi-structural interviews with key stakeholders in death registration practices. Thematic analysis was used.ResultsAge-standardized death rates from certain immediate conditions (e.g., septicemia, pneumonia, and renal failure) were higher in Hong Kong. Variations in UCD determination may be attributed to preference of location of death, procedures of registering deaths outside hospital, perceptions on the causal chain of COD, implications of the selected UCD for doctors’ professional performance, and governance and processes of data quality review.ConclusionsVariations in socio-institutional factors were related to the process of certifying and registering COD in Hong Kong and Shanghai. To improve regional data comparability, health authorities should develop standard procedures for registering deaths outside hospital, provide guidelines and regular training for doctors, develop a unified automated coding system, consolidate a standard procedure for data review and validity checks, and disseminate information concerning both UCD and multiple causes of death.

Predictors of all-cause mortality among 514,866 participants from the Korean National Health Screening Cohort.

BackgroundThere is not enough evidence regarding how information obtained from general health check-ups can predict individual mortality based on long-term follow-ups and large sample sizes. This study evaluated the applicability of various health information and measurements, consisting of self-reported data, anthropometric measurements and laboratory test results, in predicting individual mortality.MethodsThe National Health Screening Cohort included 514,866 participants (aged 40–79 years) who were randomly selected from the overall database of the national health screening program in 2002–2003. Death was determined from causes of death statistics provided by Statistics Korea. We assessed variables that were collected at baseline and repeatedly measured for two consecutive years using traditional and time-variant Cox proportional hazards models in addition to random forest and boosting algorithms to identify predictors of 10-year all-cause mortality. Participants’ age at enrollment, lifestyle factors, anthropometric measurements and laboratory test results were included in the prediction models. We used c-statistics to assess the discriminatory ability of the models, their external validity and the ratio of expected to observed numbers to evaluate model calibration. Eligibility of Medicaid and household income levels were used as inequality indexes.ResultsAfter the follow-up by 2013, 38,031 deaths were identified. The risk score based on the selected health information and measurements achieved a higher discriminatory ability for mortality prediction (c-statistics = 0.832, 0.841, 0.893, and 0.712 for Cox model, time-variant Cox model, random forest and boosting, respectively) than that of the previous studies. The results were externally validated using the community-based cohort data (c-statistics = 0.814).ConclusionsIndividuals’ health information and measurements based on health screening can provide early indicators of their 10-year death risk, which can be useful for health monitoring and related policy decisions.

Examination of Cause-of-Death Data Quality Among New York City Deaths Due to Cancer, Pneumonia, or Diabetes From 2010 to 2014.

The cause-of-death (COD) statement on the standard US death certificate is a valuable tool for public health practice, but its utility is impaired by reporting inaccuracies. To assess the quality of CODs reported in New York City, we developed and applied a quality measure to 3 leading CODs: cancer, pneumonia, and diabetes. The COD quality measure characterized 5 common issues with COD completion: nonspecific conditions as the underlying COD (UCOD); UCOD discrepancies; the presence of only 1 informative cause on the entire certificate; competing causes listed together on 1 line; and clinically improbable sequences. COD statements with more than 1 quality issue were defined as statements of "limited" quality. Of 82,116 deaths with cancer, diabetes, or pneumonia assigned as the UCOD in New York City from 2010 to 2014, 66.8% of pneumonia certificates were classified as "limited" quality as compared with 45.6% of cancer certificates and 32.3% of diabetes certificates. Forty percent of cancer certificates listed only 1 informative condition on the death certificate. Almost half of pneumonia certificates (45.9%) contained only enough information to assign International Classification of Diseases, Tenth Revision, code J18.9 ("unspecified pneumonia") as the UCOD, whereas most diabetes certificates contained UCOD discrepancies (25.2%). These limitations affect the quality of mortality data but may be reduced through quality improvement efforts.

Trends of Classification, Incidence, Mortality, and Survival of MDS Patients in Switzerland Between 2001 and 2012

Background and Aims: Myelodysplastic syndromes (MDS) are mainly diagnosed in the elderly with an increasing burden on healthcare systems. As a consequence, population-based studies are important in order to estimate the evolution of this emerging disease in different countries.Objectives: The objective of this study was to provide trends ofannual case frequency, morphological subtypes, incidence, mortality and survival of patients diagnosed with MDS in Switzerland between 2001 and 2012.Methods: A retrospective, population-based, epidemiological study was carried out on MDS cases reported to the Swiss Cantonal Cancer Registries and aggregated by the National Institute for Epidemiology and Cancer Registration. The Swiss Federal Statistical Office provided mid-year population estimates and cause of death statistics. Due to changes in the WHO classification of MDS, data was stratified for two time periods 2001-2007 and 2008-2012, respectively. 56 million person-years (py) were observed, covering 60%-65% of the Swiss population, during a time period of 12 years.Results: 2138 MDS cases were reported with a median age of 77 years (range of means: 75-78 years). The estimated annual case frequency increased from 263 to 316 (+20%) but the overall age-standardized (adjusted) incidence-rate did not change between the time periods (Table 1). A substantial increase in incidence was only visible for men aged 80-84 (+57.7%), men aged 85+ (+29.3%) and women aged 85+ (+13.4%). With respect to mortality rates, a 10% decline was observed for men aged 85+. Incidence and mortality were very low below the age of 60 years but the rates steeply increased thereafter (Figure 1a). Irrespective of time period, incidence- and mortality-rates were almost twice as high among men compared to women (Figure 1b). Classification in MDS subtypes was poor and improved only modestly from 20% to 39% with a higher awareness for diagnosis of higher-risk diseases. Relative survival at 5 years (RS at 5y) for all patients was 37% in 2008-2012 with better survival for younger patients < 65 years (61%) compared to older patients > 65 years (24-37%). No differences in survival could be observed between the two time periods (Figure 2).Conclusions: In this study we provide the first population-based, epidemiologic data from MDS patients in Switzerland. The analysis showed a 20% increase of annual incidence mainly due to population aging and not explained by increase in age-specific risk. This observation will impact on the future prevalence of the disease and its burden on healthcare systems.The age-specific incidence-ratesin patients > 75 years increased markedlyconsistent with the general increase of cancer-incidence in the elderly population. An increased diagnostic awareness of higher-risk disease seems to shift the population-based data for MDS sub-classification. We observed that younger patients without classified MDS subtypes have a similar survival like lower-risk disease, indicating that lower-risk MDS is underreported. Unsurprisingly, our data showed that younger patients have a better survival than elderly patients. This is most likelyrelated to higher frequency of lower-risk diseases in younger patients and their eligibility for allogeneic HSCT. However,the lack of a survival benefit observed in elderly patients on population-based level, after introduction of hypomethylating agents as standard treatment for transplant ineligible patients, is intriguing. The underlying reasons require further health-service research investigations.Relevance: The currently available data from CCRs in Switzerland is insufficient for detailed health service research on MDS patients, since important data is lacking on treatment, side effects and outcomes. A new cancer registration law with mandatory notification of cancer cases will be implemented in Switzerland by 2018. Moreover, the Swiss MDS Study Group has launched a Swiss MDS Registry that has started recruitment in 2016. Both initiatives will be of great value to improve data collection in order to foster future health service research of MDS patients in Switzerland with international collaborators. [Display omitted] [Display omitted] [Display omitted] DisclosuresBonadies:Bristol-Myers Squibb: Consultancy; Celgene: Consultancy, Research Funding; Novartis: Consultancy, Research Funding. Ruefer:Novartis: Consultancy; Celgene: Consultancy, Research Funding. Gerber:Celgene: Consultancy. Benz:Celgene: Consultancy. Lehmann:Novartis: Consultancy.

Bicycle fatalities: Trends in crashes with and without motor vehicles in The Netherlands

Boufous and Olivier (2015) recently found an increasing trend of police-reported cyclist deaths in single-vehicle crashes while a decreasing trend was found for fatal bicycle-motor vehicle crashes. This study sets out to conduct the same trend analyses for the Netherlands using causes of death statistics. The results show that for 1996–2014, the number of cyclist deaths in motor vehicle collisions per km cycled (i.e. the risk) has declined by 3.8% per annum (95% CI: −4.6%, −3.0%) while the risk of cyclist deaths in crashes without motor vehicles increased by 7.0% per annum (95% CI: 5.5%, 8.7%). The large majority of cyclist deaths at the beginning of the study period were due to bicycle-motor vehicle crashes. By 2014, however, the share with motor vehicles was only slightly higher than the share without motor vehicles. We also conducted trend analyses controlling for age by stratifying into nine age groups. After controlling for age, the average annual decrease of cyclist deaths in crashes with motor vehicles was 5.4% (95% CI: −6.0% to−4.7%). The average annual increase of deaths in crashes without motor vehicles was 4.4% (95% CI: 3.1–5.7%). These trends are more favourable than those without controlling for age which can be explained by more cycling among the elderly who have an elevated risk. We conclude that, similar to Australia, cyclist deaths following motor vehicle crashes in the Netherlands have decreased while deaths without motor vehicles have increased.

Spatial analysis of the regional variation of hypertensive disease mortality and its socio-economic correlates in South Korea.

This paper presents a cross-sectional study based on the cause of death statistics in 2011 extracted from all 229 local governments in South Korea. The standardised hypertensive disease mortality rate (SHDMR) was defined by age- and sex-adjusted mortality by hypertensive diseases distinguished by International Classification of Disease- 10 (ICD-10). Variables taken into account were the number of doctors per 100,000 persons, the proportion with higher education (including university students and high school graduates), the number of recipients of basic livelihood support per 100,000 persons, the annual national health insurance premium per capita and the proportion of persons classified as high-risk drinkers. Ordinary least square (OLS) regression and geographically weighted regression (GWR) were applied to identify the potential associations. The statistical analysis was conducted with SAS ver. 9.3, while ArcGIS ver. 10.0 was utilised for the spatial analysis. The OLS results showed that the number of basic livelihood recipients per 100,000 persons had a significant positive association with the SHDMR, and the proportion with higher education had a significant negative one. GWR coefficients varied depending on region investigated and some regional variables had various directions. GWR showed higher adjusted R2 than that of OLS. It was found that the SHDMR was affected by socio-economic status, but as the effects observed were not consistent in all regions of the country, the development of health policies will need to consider the potential for regional variation.