Cause-specific Mortality Patterns Research Articles

All-cause and cause-specific mortality by spirometric pattern and sex - a population-based cohort study.

Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated. To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF). Population-based prospective cohort study. Individuals with CAO [FEV1/vital capacity (VC) < 0.70], RSP [FEV1/VC ⩾ 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV1/VC ⩾ 0.70 and FVC ⩾ 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002-2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine-Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years. The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31-2.02 and 1.24, 1.06-1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05-6.82 and 1.40, 1.04-1.90). The hazard of respiratory death was significant in women (3.41, 1.05-11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01-2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05-6.82) but not for cardiovascular death (1.11, 0.74-1.66), with a similar pattern in both sexes. The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes.

Spectrum of second primary malignancies and cause-specific mortality in pediatric and adult langerhans cell histiocytosis

With the advent of targeted therapeutics in Langerhans cell histiocytosis (LCH), there is a growing survivor population that might be at risk for late mortality from non-LCH causes, including second primary malignancies (SPMs). We undertook a large study using the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the patterns of SPMs and cause-specific mortality among individuals with LCH (2000–2016) from the US. We found an increased risk of SPMs in the cohort (standardized incidence ratio [SIR] 2.07). The pediatric group was at a high risk of developing Hodgkin lymphoma (SIR 60.93) and non-Hodgkin lymphoma (SIR 60.88). People with adult-onset LCH were found to have a high risk of developing miscellaneous malignant cancers (SIR 11.43), which primarily included myelodysplastic syndrome. Adults were also at a high risk of developing carcinoma in-situ of vulva at 2–11 months [SIR 62.72] and B-ALL at 60–119 months [SIR 66.29] after LCH diagnosis. Additionally, 5% and 1% of the patients developed prior or concomitant malignancies with LCH, respectively. The 5 yr overall survival (OS) was 96.6% for pediatric and 88.5% for adult LCH cohorts. Most common cause of death was infections in pediatric and SPMs in adult LCH. Our study highlights that despite advances in treatments, people with LCH have an increased mortality risk from non-LCH causes when compared with the general population, including a high risk of SPMs.

Cause-Specific Mortality Patterns among Hospital Deaths in District Mardan, Khyber Pakhtunkhwa, Pakistan

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The impact of the SARS-CoV-2 pandemic on cause-specific- mortality: a systematic literature review

Abstract Background Although investigating the patterns of COVID-19 excess mortality (EM) is relevant, understanding the effects of the pandemic on cause-specific mortality is even crucial and should also be assessed, as this metric allows for a more detailed analysis of the true impact of the pandemic. The aim of this systematic literature review is to estimate the impact of the pandemic on different causes of death, providing a quantitative and qualitative analysis of the phenomenon. Methods We searched MEDLINE to identify studies that reported cause-specific mortality during the COVID-19 pandemic. We adopted several inclusion criteria: original article; assessed at least one cause-specific mortality during the pandemic; assessed causes of deaths using the ICD-10 classification; reporting of at least one of the following outcomes: cause-specific mortality estimates or cause-specific EM; full-length articles. Several relevant data were extracted (e.g. publication year, data stratification, territory, country income level, all-cause EM, and cause-specific mortality, etc.). Results The search identified 548 articles. After title, abstract and full-text screening, we extracted relevant data from the final set of 14 articles. Cause-specific mortality was reported using different units of measurement. Only 9 studies reported the statistical significance and/or confidence intervals. The most frequently analyzed causes of death were cardiovascular diseases (n = 11), cancer (n = 7), diabetes (n = 6), and suicide (n = 5). We found very heterogeneous patterns of cause-specific mortality, for all the specific causes of deaths, except for suicide and road accident. Conclusions The impact of the pandemic on cause-specific deaths has been very heterogeneous and the analyses conducted so far are not exhaustive. We advocate for the urgent need to find a consensus to define uniform methodological approaches to establish the true burden of the COVID-19 pandemic on non-COVID-19 mortality. Key messages • We reviewed the body of literature to estimate the impact of the COVID-19 pandemic on different causes of death, and to provide a quantitative and qualitative analysis of the phenomenon. • We did not identify unique patterns of cause-specific mortality due to too varied approaches in terms of disease classification and coding, and methodologies used for estimating mortality.

Interpreting global variations in the toll of COVID-19: The case for context and nuance in hypothesis generation and testing.

As of January 2022, the COVID-19 pandemic was on-going, affecting populations worldwide. The potential risks of the Omicron variant (and future variants) still remain an area of active investigation. Thus, the ultimate human toll of SARS-CoV-2, and, by extension, the variations in that toll among diverse populations, remain unresolved. Nonetheless, an extensive literature on causal factors in the observed patterns of COVID-19 morbidity and cause-specific mortality has emerged-particularly at the aggregate level of analysis. This article explores potential pitfalls in the attribution of COVID outcomes to specific factors in isolation by examining a diverse set of potential factors and their interactions. We sourced published data to establish a global database of COVID-19 outcomes for 68 countries and augmented these with an array of potential explanatory covariates from a diverse set of sources. We sought population-level aggregate factors from both health- and (traditionally) non-health domains, including: (a) Population biomarkers (b) Demographics and infrastructure (c) Socioeconomics (d) Policy responses at the country-level. We analyzed these data using (OLS) regression and more flexible non-parametric methods such as recursive partitioning, that are useful in examining both potential joint factor contributions to variations in pandemic outcomes, and the identification of possible interactions among covariates across these domains. Using the national obesity rates of 68 countries as an illustrative predictor covariate of COVID-19 outcomes, we observed marked inconsistencies in apparent outcomes by population. Importantly, we also documented important variations in outcomes, based on interactions of health factors with covariates in other domains that are traditionally not related to biomarkers. Finally, our results suggest that single-factor explanations of population-level COVID-19 outcomes (e.g., obesity vs. cause-specific mortality) appear to be confounded substantially by other factors. Our methods and findings suggest that a full understanding of the toll of the COVID-19 pandemic, as would be central to preparing for similar future events, requires analysis within and among diverse variable domains, and within and among diverse populations. While this may seem apparent, the bulk of the recent literature on the pandemic has focused on one or a few of these drivers in isolation. Hypothesis generation and testing related to pandemic outcomes will benefit from accommodating the nuance of covariate interactions, in an epidemiologic context. Finally, our results add to the literature on the ecological fallacy: the attempt to infer individual drivers and outcomes from the study of population-level aggregates.

Changing patterns of second primary malignancies and cause-specific mortality among patients with major salivary glands cancers in the United States: A population-based study.

e18081 Background: Salivary gland neoplasms are rare entities that comprise approximately 5% of all head and neck malignancies. The incidence of major salivary gland (MSG) cancers has increased about 54% from 1970 to 2000 in the United States (US). We undertook this study to investigate the risk of second primary malignancies (SPMs) and cause-specific mortality (CSM) in patients with MSG cancers using a national registry from the US. Methods: We estimated the incidence of SPMs among two-month survivors of MSG cancers using the Surveillance, Epidemiology, and End Results (SEER)-18 registries between 2008 to 2018. The risk of SPMs were calculated using standardized incidence ratios (SIRs) and the CSM by standardized mortality ratios (SMRs) and absolute excess risk (AER)/10,000 population. Results: We included 845 patients with MSG cancers in this study. The median age of diagnosis was 67 yrs (range 0 - 85 yrs). The median follow-up duration was 24 months (range 0 - 130 months). The median latency period for SPM development was 30 months (range 4 - 117 months). A total of 38 (4.5%) patients developed 41 SPMs at last follow-up. The SPM risk for cohort was significantly elevated (SIR = 1.81, 95% confidence interval [CI] = 1.30 - 2.46) compared with general population. The SPM risk was statistically higher among males (SIR = 2.42, 95% CI = 1.66 - 3.42) but not significant in females (SIR = 0.95, 95% CI = 0.44 - 1.81). Specific sites with highest SPMs risk included tonsil (SIR = 52.45, 95% CI = 1.33 - 292.22) followed by oral cavity (SIR = 15.55, 95% CI = 7.11 - 29.52). The risk for tonsil cancers were high from 5 to 10 years of initial diagnosis. While risk for oral cavity cancers, remained high throughout follow-up period. At the last follow-up, 214 (25%) patients had died. There was statistically significant risk of mortality due to MSG cancers (SMR = 5,453.61, 95% CI = 4,385.34 - 6,703.41, AER = 517.87) and oral cavity cancers (SMR = 663.40, 95% CI = 537.97 - 809.29, AER = 557.41) (Table). Conclusions: Our study concludes that men with MSG cancers are at an increased risk for SPMs compared to women. The risk of specific SPMs (tonsil and oral cavity cancers) was high even after a long period from the initial diagnosis of MSG cancers. This highlights the need for long-term surveillance in these patients for SPMs development.[Table: see text]

Adapting and validating the log quadratic model to derive under-five age- and cause-specific mortality (U5ACSM): a preliminary analysis

BackgroundThe mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without high functioning vital registration systems could benefit from estimates of age- and cause-specific mortality to inform health programming, however, to date the causes of under-five death have only been described for broad age categories such as for neonates (0–27 days), infants (0–11 months), and children age 12–59 months.MethodsWe adapt the log quadratic model to mortality patterns for children under five to all-cause child mortality and then to age- and cause-specific mortality (U5ACSM). We apply these methods to empirical sample registration system mortality data in China from 1996 to 2015. Based on these empirical data, we simulate probabilities of mortality in the case when the true relationships between age and mortality by cause are known.ResultsWe estimate U5ACSM within 0.1–0.7 deaths per 1000 livebirths in hold out strata for life tables constructed from the China sample registration system, representing considerable improvement compared to an error of 1.2 per 1000 livebirths using a standard approach. This improved prediction error for U5ACSM is consistently demonstrated for all-cause as well as pneumonia- and injury-specific mortality. We also consistently identified cause-specific mortality patterns in simulated mortality scenarios.ConclusionThe log quadratic model is a significant improvement over the standard approach for deriving U5ACSM based on both simulation and empirical results.

Cause-specific mortality among patients with different molecular subtypes of T1-2N0M0 breast cancer: A population-based study.

The objective of our study is to investigate mortality pattern and quantitatively assess prognostic risk for cause-specific death among T1-2N0M0 breast cancer survivors.The representative data of T1-2N0M0 breast cancer patients diagnosed between 2010 and 2016 was retrieved from the Surveillance, Epidemiology, and End Results program. Standardized mortality ratios (SMRs) were calculated taking US population as a reference. Cox regression analysis was conducted to analyze the potential prognostic factors for cause-specific mortality.A total of 161,966 patients were identified from the Surveillance, Epidemiology, and End Results database. After a median follow-up of 41 months, mortality occurred in 10,567 patients, of which 30.9% and 22.7% were attributed to breast cancer and cardiovascular diseases (CVDs). The standardized mortality ratios of CVD were 4.78, 4.27, 3.78, and 4.95 in patients with HR+/HER2+, HR−/HER2+, HR+/HER2−, and HR−/HER2− breast cancer compared to general US population, respectively. Cox proportional hazards regression analysis showed that the adjusted HRs of breast cancer-specific mortality were 0.999 (95% confidence interval [CI]: 0.879–1.135), 1.454 (95% CI: 1.246–1.697), 2.145 (95% CI: 1.962–2.345) for HR+/HER2+, HR−/HER2+, and HR−/HER2− breast cancer, respectively, as compared with HR+/HER2− subtype; HRs of CVD-specific death were 1.215 (95% CI: 1.041–1.418), 1.391 (95% CI: 1.209–1.601), and 1.515 (95% CI: 1.213–1.892), respectively. In addition, we found that older age at diagnosis, and black race were also independent predictors of CVD-specific death.In the present study, we revealed the mortality pattern of cause-specific mortality, and identified prognostic factors of overall mortality, breast cancer-specific mortality, and CVD-specific mortality in T1–2N0M0 breast cancer survivors, supporting early detection and more efficient CVD care for these patients.

The Association between Material Deprivation and Avoidable Mortality in Lisbon, Portugal.

There is considerable evidence pointing to the existence of a socioeconomic gradient in mortality, which tends to be steeper in urban areas. Similar to other European cities, Lisbon is far from homogeneous since considerable geographical inequalities exist between the more advantaged and the more deprived neighborhoods. The main goals of this study are to describe the geographical pattern of premature deaths (before 65 years old), avoidable deaths (preventable and amenable to healthcare) and cause-specific mortality (HIV/AIDS and suicide) in Lisbon, at the lower administrative level (civil parish, in Portuguese: Freguesia), and analyze the statistical association between mortality risk and deprivation, before (1999–2003) and during the economic crisis (2008–2012). Smoothed Standardized Mortality Ratios (sSMR) and Relative Risk (RR) with 95% credible intervals were calculated to identify the association between mortality and deprivation. The analysis of the geographical distribution of cause-specific mortality reveals that civil parishes with high sSMR in the first period continued to present higher mortality rates in the second. Moreover, a significant statistical association was found between all the causes of death and deprivation, except suicide. These findings contribute to understanding how social conditions influence health outcomes and can offer insights about potential policy directions for local government.

Corrigendum to: Is mode of transport to work associated with mortality in the working-age population? Repeated census-cohort studies in New Zealand, 1996, 2001 and 2006.

BACKGROUND Increasing active transport is proposed as a means to address both health and environmental issues. However, the associations between specific modes, such as cycling, walking and public transport, and health outcomes remain unclear. We examined the association between mode of travel to work and mortality. METHODS Cohort studies of the entire New Zealand working population were created using 1996, 2001 and 2006 censuses linked to mortality data. Mode of travel to work was that reported on census day, and causes of death examined were ischaemic heart disease and injury. Main analyses were Poisson regression models adjusted for socio-demographics. Sensitivity analyses included: additional adjustment for smoking in the 1996 and 2006 cohorts, and bias analysis about non-differential misclassification of cycling vs car use. RESULTS Walking (5%) and cycling (3%) to work were uncommon. Compared with people reporting using motor vehicles to travel to work, those cycling had a reduced all-cause mortality (ACM) in the socio-demographic adjusted models RR 0.87 (0.77-0.98). Those walking (0.97, 0.90-1.04) and taking public transport (0.96, 0.88-1.05) had no substantive difference in ACM. No mode of transport was associated with detectable statistically significant reductions in cause-specific mortality. Sensitivity analyses found weaker associations when adjusting for smoking and stronger associations correcting for likely non-differential misclassification of cycling. CONCLUSIONS This large cohort study supports an association between cycling to work and reduced ACM, but found no association for walking or public-transport use and imprecise cause-specific mortality patterns.

Long-term trends in seasonality of mortality in urban Madagascar: the role of the epidemiological transition

ABSTRACT Background: Seasonal patterns of mortality have been identified in Sub-Saharan Africa but their changes over time are not well documented. Objective: Based on death notification data from Antananarivo, the capital city of Madagascar, this study assesses seasonal patterns of all-cause and cause-specific mortality by age groups and evaluates how these patterns changed over the period 1976–2015. Methods: Monthly numbers of deaths by cause were obtained from death registers maintained by the Municipal Hygiene Office in charge of verifying deaths before the issuance of burial permits. Generalized Additive Mixed regression models (GAMM) were used to test for seasonality in mortality and its changes over the last four decades, controlling for long-term trends in mortality. Results: Among children, risks of dying were the highest during the hot and rainy season, but seasonality in child mortality has significantly declined since the mid-1970s, as a result of declines in the burden of infectious diseases and nutritional deficiencies. In adults aged 60 and above, all-cause mortality rates are the highest in the dry and cold season, due to peaks in cardiovascular diseases, with little change over time. Overall, changes in the seasonality of all-cause mortality have been driven by shifts in the hierarchy of causes of death, while changes in the seasonality within broad categories of causes of death have been modest. Conclusion: Shifts in disease patterns brought about by the epidemiological transition, rather than changes in seasonal variation in cause-specific mortality, are the main drivers of trends in the seasonality of all-cause mortality.

Spatial patterns of male alcohol-related mortality in Belarus, Lithuania, Poland and Russia.

Eastern Europe is known to suffer from a large burden of alcohol-related mortality. However, persisting unfavourable conditions at the national level mask variation at the sub-national level. We aim to explore spatial patterns of cause-specific mortality across four post-communist countries: Belarus, Lithuania, Poland and Russia (European part). We use official mortality data routinely collected over 1179 districts and cities. The analysis refers to males aged 20-64 years and covers the period 2006-2014. Mortality variation is mainly assessed by means of the standardised mortality ratio. Getis-Ord Gi* statistic is employed to detect hot and cold spots of alcohol-related mortality. Alcohol-related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southern Poland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within these countries, hot spots of alcohol-related mortality dominate the territories of northwestern and western Russia, eastern and northwestern Belarus, southeastern Lithuania, and eastern and central Poland. The observed mortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other countries, which appears to have started more than a century ago. Contemporary socioeconomic and demographic factors should be taken into account when developing anti-alcohol policies. The same is true for the peculiarities of culture, norms, traditions and behavioural patterns observed in specific geographical areas of the four countries. Reducing alcohol-related harm in the areas identified as hot spots should be prioritised.

Is mode of transport to work associated with mortality in the working-age population? Repeated census-cohort studies in New Zealand, 1996, 2001 and 2006.

Increasing active transport is proposed as a means to address both health and environmental issues. However, the associations between specific modes, such as cycling, walking and public transport, and health outcomes remain unclear. We examined the association between mode of travel to work and mortality. Cohort studies of the entire New Zealand working population were created using 1996, 2001 and 2006 censuses linked to mortality data. Mode of travel to work was that reported on census day, and causes of death examined were ischaemic heart disease and injury. Main analyses were Poisson regression models adjusted for socio-demographics. Sensitivity analyses included: additional adjustment for smoking in the 1996 and 2006 cohorts, and bias analysis about non-differential misclassification of cycling vs car use. Walking (5%) and cycling (3%) to work were uncommon. Compared with people reporting using motor vehicles to travel to work, those cycling had a reduced all-cause mortality (ACM) in the socio-demographic adjusted models RR 0.87 (0.77-0.98). Those walking (0.97, 0.90-1.04) and taking public transport (0.96, 0.88-1.05) had no substantive difference in ACM. No mode of transport was associated with detectable statistically significant reductions in cause-specific mortality. Sensitivity analyses found weaker associations when adjusting for smoking and stronger associations correcting for likely non-differential misclassification of cycling. This large cohort study supports an association between cycling to work and reduced ACM, but found no association for walking or public-transport use and imprecise cause-specific mortality patterns.

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017

Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Being under the age of 20 years between 1990 and 2017. Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.

Patterns of Cause-Specific Mortality Among 2053 Survivors of Retinoblastoma, 1914-2016.

Previous studies of hereditary retinoblastoma survivors have reported elevated mortality, particularly for sarcomas, compared with the general population. However, cause-specific mortality patterns for long-term hereditary and nonhereditary retinoblastoma survivors are poorly understood. Among 2053 retinoblastoma patients diagnosed during 1914-2006 at two major US treatment centers and followed to 2016, we estimated cumulative mortality, standardized mortality ratios (SMRs), and absolute excess risks (AERs) compared with the US general population. Most deaths occurred in 1129 hereditary retinoblastoma patients (n = 518 deaths, cumulative mortality 70 years after retinoblastoma = 75.8%, 95% CI = 69.0% to 82.6%; SMR = 8.5, 95% CI = 7.7 to 9.2). Of these, 267 were due to subsequent cancers (SMR = 27.4, 95% CI = 24.2 to 30.9; AER = 72.3 deaths/10 000 person-years), for which SMRs were highest 15-29 years after diagnosis (n = 69, SMR = 89.9, 95% CI = 70.0 to 113.8) but remained statistically significantly elevated at 60 and more years (n = 14, SMR = 6.7, 95% CI = 3.6 to 11.2), whereas AERs increased with time (AER<15years = 38.0; AER60+years = 327.5). Increased risk of death due to cancers of pancreas, large intestines, and kidney were noted for the first time. Overall risk of subsequent cancers was greater for those treated with radiotherapy and chemotherapy compared to radiotherapy alone, although patterns varied by organ site. For 924 patients with nonhereditary retinoblastoma, we noted a modestly increased risk of death for subsequent cancers (n = 27, SMR = 1.8, 95% CI = 1.2 to 2.6) possibly due to treatment or misclassification of hereditary status. Risks of noncancer causes of death were not elevated for hereditary or nonhereditary patients. Hereditary retinoblastoma survivors died mainly from an excess risk of subsequent cancers up to six decades later, highlighting the need to develop long-term clinical management guidelines for hereditary retinoblastoma survivors treated in the past.

Cause-specific mortality patterns among hospital deaths in Tanzania, 2006-2015.

BackgroundUnderstanding the causes of inpatient mortality in hospitals is important for monitoring the population health and evidence-based planning for curative and public health care. Dearth of information on causes and trends of hospital mortality in most countries of Sub-Saharan Africa has resulted to wide use of model-based estimation methods which are characterized by estimation errors. This retrospective analysis used primary data to determine the cause-specific mortality patterns among inpatient hospital deaths in Tanzania from 2006–2015.Materials and methodsThe analysis was carried out from July to December 2016 and involved 39 hospitals in Tanzania. A review of hospital in-patient death registers and report forms was done to cover a period of 10 years. Information collected included demographic characteristics of the deceased and immediate underlying cause of death. Causes of death were coded using international classification of diseases (ICD)-10. Data were analysed to provide information on cause-specific, trends and distribution of death by demographic and geographical characteristics.Principal findingsA total of 247,976 deaths were captured over a 10-year period. The median age at death was 30 years, interquartile range (IQR) 1, 50. The five leading causes of death were malaria (12.75%), respiratory diseases (10.08%), HIV/AIDS (8.04%), anaemia (7.78%) and cardio-circulatory diseases (6.31%). From 2006 to 2015, there was a noted decline in the number of deaths due to malaria (by 47%), HIV/AIDS (28%) and tuberculosis (26%). However, there was an increase in number of deaths due to neonatal disorders by 128%. Malaria and anaemia killed more infants and children under 5 years while HIV/AIDS and Tuberculosis accounted for most of the deaths among adults.ConclusionThe leading causes of inpatient hospital death were malaria, respiratory diseases, HIV/AIDS, anaemia and cardio-circulatory diseases. Death among children under 5 years has shown an increasing trend. The observed trends in mortality indicates that the country is lagging behind towards attaining the global and national goals for sustainable development. The increasing pattern of respiratory diseases, cancers and septicaemia requires immediate attention of the health system.

Abstract 4247: Racial/ethnic differences in all-cause and cause-specific mortality patterns among a cohort of invasive U.S. breast cancer patients

Abstract It is important to explore racial differences in mortality patterns due to breast cancer (BC), cardiovascular disease (CVD) and all-causes (AC) among women diagnosed with breast cancer in the U.S. Data from 891,635 non-Hispanic black (NHB) and white (NHW) women diagnosed with malignant breast cancer from 1990-2014 were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. Cumulative incidences for mortality due to BC and CVD were calculated at 2, 5, 10 and 20 years post-diagnosis by race and age (dichotomized at the study mean, 62.5 years). A Cox hazard model was used to obtain hazard ratios (HR) for all-cause mortality and the subdistribution hazards model was used for mortality due to BC and CVD, accounting for the presence of competing risks, along with their corresponding 95% confidence intervals (CI). A total of 300,445 deaths occurred over 6,319,054 person-years. Among women aged &amp;lt;62.5 years at diagnosis, the cumulative incidence of BC death and CVD death at 2, 5, 10, and 20 years was 5.2%, 10.6%, 15.3%, 19.5% and 0.2%, 0.6% 1.2%, 2.5%, respectively, for NHWs and 10.0%, 19.9%, 27.9%, 34.8% and 0.5%, 1.3%, 2.7%, 5.3% for NHBs. Results for BC were similar among women diagnosed &amp;gt;62.5 years, while there appeared to be no racial differences in CVD-death. Among women diagnosed at age &amp;lt;62.5 years, NHBs had an increased hazard of mortality due to BC (HR=2.03, 95% CI: 1.97, 2.08), CVD (HR=2.64, 95% CI: 2.38, 2.94), and AC (HR=2.84, 95% CI: 2.77, 2.91) during the first 2 years post-diagnosis. This association decreased over time for mortality due to BC (5-10 years: HR=1.76; 10-15 years: HR=1.58) and AC (5-10 years: HR=1.54; 10-15 years: HR=1.07, 15+ years: HR=0.93) but remained relatively stable for CVD (15+ years: HR=2.47). Among women diagnosed at age &amp;gt;62.5 years, NHBs had an increased hazard of mortality due to BC (HR=2.13, 95% CI: 2.06, 2.19), CVD (HR=1.33, 95% CI: 1.25, 1.40) and AC (HR=1.51, 1.48, 1.55) during the first 2 years post-diagnosis. The association decreased for BC (2-5 years: HR=1.55; 5-10 years: HR=1.15; 10-15 years: HR=0.88; 15+ years: HR=0.64) and CVD (2-5 years: HR=1.1.06; 5-10 years: HR=1.00; 10-15 years: HR=0.85; 15+ years: HR=0.65) while the association with AC mortality initially decreased, then remained relatively stable (5-10 years: HR=1.20). Results suggest NHB women diagnosed at younger ages have the highest cumulative incidence of mortality due to BC, CVD and AC over the 25-year follow-up period. In addition, among women diagnosed at younger ages, NHBs appeared to have a two-fold increase in hazards of AC, BC and CVD mortality during the years immediately following BC diagnosis compared to NHWs. The increased hazard for CVD mortality among younger NHBs remained relatively stable over time, whereas the hazards for AC and BC mortality attenuated over time. Results were less pronounced among women diagnosed at older ages. Citation Format: Alyssa N. Troeschel, Yuan Liu, Lindsay Collin, Kevin Ward, Keerthi Gogineni, Lauren McCullough. Racial/ethnic differences in all-cause and cause-specific mortality patterns among a cohort of invasive U.S. breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4247.

Pattern of all-causes and cause-specific mortality in an area with progressively declining malaria burden in Korogwe district, north-eastern Tanzania

BackgroundAlthough death records are useful for planning and monitoring health interventions, such information is limited in most developing countries. Verbal autopsy (VA) interviews are alternatively used to determine causes of death in places without or with incomplete hospital records. This study was conducted to determine all causes and cause-specific mortality in Korogwe health and demographic surveillance system (HDSS) undertaken in Korogwe district, northeastern Tanzania.MethodsThe study was conducted from January 2006 to December 2012 in 14 villages under Korogwe HDSS. Vital events such as births, deaths and migrations were routinely updated quarterly. A standard VA questionnaire was administered to parents/close relatives of the deceased to determine cause of death.ResultsOverall, 1325 deaths of individuals with median age of 46 years were recorded in a population with 170,471.4 person years observed (PY). Crude mortality rate was 7.8 per 1000 PY (95% CI 7.2–8.4) and the highest rate was observed in infants (77.9 per 1000 PY; 95% CI 67.4–90.0). The overall mortality increased between 2006 and 2007, followed by a slight decline up to 2011, with the highest decrease observed in 2012. Causes of deaths were established in 942 (71.1%) deaths and malaria (198 deaths, 21.0%) was the leading cause of death in all age groups except adults (15–59 years). HIV/AIDS (17.6%, n = 365) was the leading cause of death in individuals aged 15–59 years followed by malaria (13.9%) and tuberculosis. Non-communicable diseases (NCDs) including stroke, hypertension, cancer, and cardiac failure caused majority of deaths in elderly (60 years and above) accounting for 37.1% (n = 348) of all deaths, although malaria was the single leading cause of death in this group (16.6%).ConclusionThe study showed a significant decline of deaths in the Korogwe HDSS site and malaria was the main cause of death in all age groups (except adults, aged 15–59 years) while HIV/AIDS and NCDs were the main causes in adults and elderly, respectively. Further surveillance is required to monitor and document changes in cause-specific mortality as malaria transmission continues to decline in this and other parts of Tanzania.

The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0.

BackgroundVerbal autopsy (VA) is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS) systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed.Methods and findingsIn 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future.ConclusionsDespite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable.The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality.

Mortality in a combined cohort of uranium enrichment workers.

To examine the patterns of cause-specific mortality and relationship between internal exposure to uranium and specific causes in a pooled cohort of 29,303 workers employed at three former uranium enrichment facilities in the United States with follow-up through 2011. Cause-specific standardized mortality ratios (SMRs) for the full cohort were calculated with the U.S. population as referent. Internal comparison of the dose-response relation between selected outcomes and estimated organ doses was evaluated using regression models. External comparison with the U.S. population showed significantly lower SMRs in most diseases in the pooled cohort. Internal comparison showed positive associations of absorbed organ doses with multiple myeloma, and to a lesser degree with kidney cancer. In general, these gaseous diffusion plant workers had significantly lower SMRs than the U.S. The internal comparison however, showed associations between internal organ doses and diseases associated with uranium exposure in previous studies. Am. J. Ind. Med. 60:96-108, 2017. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.