Changes In Case Fatality Rates Research Articles

Country-based modelling of COVID-19 case fatality rate: A multiple regression analysis.

The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection. The determinants of mortality on a global scale cannot be fully understood due to lack of information. To identify key factors that may explain the variability in case lethality across countries. We identified 21 Potential risk factors for coronavirus disease 2019 (COVID-19) case fatality rate for all the countries with available data. We examined univariate relationships of each variable with case fatality rate (CFR), and all independent variables to identify candidate variables for our final multiple model. Multiple regression analysis technique was used to assess the strength of relationship. The mean of COVID-19 mortality was 1.52 ± 1.72%. There was a statistically significant inverse correlation between health expenditure, and number of computed tomography scanners per 1 million with CFR, and significant direct correlation was found between literacy, and air pollution with CFR. This final model can predict approximately 97% of the changes in CFR. The current study recommends some new predictors explaining affect mortality rate. Thus, it could help decision-makers develop health policies to fight COVID-19.

Differences in case-fatality-rate of emerging SARS-CoV-2 variants

ObjectsVariants of Severe-Acute-Respiratory-Syndrome Coronavirus-2 (SARS-CoV-2) has caused tremendous impact globally. It has been widely reported that the Omicron (B.1.1.529) variant is less deadly than the Delta (B.1.617.2) variant, presumably due to immunity from vaccination and previous infection. When measuring the severity of a variant, Case-Fatality-Rate (CFR) is often estimated. The purpose of this work is to calculate the change in CFR of different variants over time from a large number of countries/regions since the start of the pandemic in 2020. Study designA Cross-sectional study. MethodsWe extend the comparison to all previous VOCs in 58 counties/regions. We use reported death divided by reported cases in 30-day sliding window with a two-week shift between reported death and reported cases. ResultsThe drop from Delta variant to Omicron variant is substantial and the difference between subvariants of Omicron is not evident. ConclusionWe showed that the CFR dropped over time, presumably due to vaccine-induced immune and infection induced immune. Population age structure and prevalence of comorbidity influence CFR.

A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania.

To address high levels of maternal mortality in Kigoma, Tanzania, stakeholders increased women's access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. To ensure that women used services, implementers worked to continuously improve and sustain quality of care while creating demand. Program evaluation included periodic health facility assessments, pregnancy outcome monitoring, and enhanced maternal mortality detection region-wide in program- and nonprogram-supported health facilities. Between 2013 and 2018, the average number of lifesaving interventions performed per facility increased from 2.8 to 4.7. The increase was higher in program-supported than nonprogram-supported health centers and dispensaries. The institutional delivery rate increased from 49% to 85%; the greatest increase occurred through using health centers (15% to 25%) and dispensaries (21% to 46%). The number of cesarean deliveries almost doubled, and the population cesarean delivery rate increased from 2.6% to 4.5%. Met need for emergency obstetric care increased from 44% to 61% while the direct obstetric case fatality rate declined from 1.8% to 1.4%. The institutional maternal mortality ratio across all health facilities declined from 303 to 174 deaths per 100,000 live births. The total stillbirth rate declined from 26.7 to 12.8 per 1,000 births. The predischarge neonatal mortality rate declined from 10.7 to 7.6 per 1,000 live births. Changes in case fatality rate and maternal mortality were driven by project-supported facilities. Changes in neonatal mortality varied depending on facility type and program support status. Decentralizing high-quality comprehensive EmONC delivered mostly by associate clinicians and nurses led to significant improvements in the availability and utilization of lifesaving care at birth in Kigoma. Dedicated efforts to sustain high-quality EmONC along with supplemental programmatic components contributed to the reduction of maternal and perinatal mortality.

Epidemiology of invasive meningococcal disease and sequelae in the United Kingdom during the period 2008 to 2017 \u2013 a secondary database analysis

BackgroundInvasive meningococcal disease (IMD) causes high fatality in untreated patients alongside long-term sequelae in 20% survivors. For a comprehensive assessment of epidemiology, an analysis of these sequelae is required. This study aims to investigate the epidemiology of disease between 2008 and 2017 including a description of the sequelae, through the analysis of data collected from the UK Clinical Practice Research Datalink (CPRD) linked with data from the Hospital Episode Statistics (HES), and Office for National Statistics (ONS) mortality registry data.MethodsThis was a 10-year retrospective observational cohort study designed to describe the incidence, case-fatality rate (CFR) and occurrence of sequelae due to meningococcal disease, in the UK between 2007 and 2017 using data from the UK CPRD-HES-ONS. Cases were identified and matched on age, gender, date of diagnosis of IMD and followed-up-time with a control group without IMD. Demographics, clinical characteristics, mortality, and IMD-related sequelae were examined for IMD cases and compared with matched controls for a more comprehensive assessment.ResultsThe study analysed 640 IMD patients with majority of the cases diagnosed (76.9%) in a hospital setting. Age-group analysis showed a decrease in the incidence rate of IMD in patients aged <1 year (30.4 – 7.5%) and an increase in those >50 years (10.4 – 27.8%). CFR was slightly higher among females, toddlers, and adults >50 years. No significant change in CFR was observed over study period. Case-control study showed a higher number of IMD sequelae among cases compared to age- and gender-matched controls, especially in those ≥ 50 years.ConclusionThe study showed that, despite a relatively low incidence rate, IMD is responsible for a high CFR, namely in older age groups and by a high number of IMD sequelae. The study showed that leveraging data from existing databases can be used to complement surveillance data in truly assessing the epidemiology of IMD. Despite the availability of routine vaccination programs, IMD still poses a significant burden in the healthcare system of the UK. Optimization of vaccination programs may be required to reduce the disease burden.

Impact of a multifaceted intervention to improve emergency care on newborn and child health outcomes in Rwanda.

Implementing context-appropriate neonatal and paediatric advanced life support management interventions has increasingly been recommended as one of the approaches to reduce under-five mortality in resource-constrained settings like Rwanda. One such intervention is ETAT+, which stands for Emergency Triage, Assessment and Treatment plus Admission care for severely ill newborns and children. In 2013, ETAT+ was implemented in Rwandan district hospitals. We evaluated the impact of the ETAT+ intervention on newborn and child health outcomes. We used monthly time-series data from the DHIS2-enabled Rwanda Health Management Information System from 2012 to 2016 to examine neonatal and paediatric hospital mortality rates. Each hospital contributed data for 12 and 36 months before and after ETAT+ implementation, respectively. Using controlled interrupted time-series analysis and segmented regression model, we estimated longitudinal changes in neonatal and paediatric hospital mortality rates in intervention hospitals relative to matched concurrent control hospitals. We also studied changes in case fatality rate specifically for ETAT+-targeted conditions. Our study cohort consisted of 7 intervention hospitals and 14 matched control hospitals contributing 142 424 neonatal and paediatric hospital admissions. After controlling for secular trends and autocorrelations, we found that the ETAT+ implementation had no statistically significant impact on the rate of all-cause neonatal and paediatric hospital mortality in intervention hospitals relative to control hospitals. However, the case fatality rate for ETAT+-targeted neonatal conditions decreased immediately following implementation by 5% (95% confidence interval: -9.25, -0.77) and over time by 0.8% monthly (95% confidence interval: -1.36, -0.25) in intervention hospitals compared with control hospitals. Case fatality rate for ETAT+-targeted paediatric conditions did not decrease following the ETAT+ implementation. While ETAT+ focuses on improving the quality of hospital care for both newborns and children, we only found an impact on neonatal hospital mortality for ETAT+-targeted conditions that should be interpreted with caution given the relatively short pre-intervention period and potential regression to the mean.

Explaining among-country variation in COVID-19 case fatality rate

While the epidemic of SARS-CoV-2 has spread worldwide, there is much concern over the mortality rate that the infection induces. Available data suggest that COVID-19 case fatality rate had varied temporally (as the epidemic has progressed) and spatially (among countries). Here, we attempted to identify key factors possibly explaining the variability in case fatality rate across countries. We used data on the temporal trajectory of case fatality rate provided by the European Center for Disease Prevention and Control, and country-specific data on different metrics describing the incidence of known comorbidity factors associated with an increased risk of COVID-19 mortality at the individual level. We also compiled data on demography, economy and political regimes for each country. We found that temporal trajectories of case fatality rate greatly vary among countries. We found several factors associated with temporal changes in case fatality rate both among variables describing comorbidity risk and demographic, economic and political variables. In particular, countries with the highest values of DALYs lost to cardiovascular, cancer and chronic respiratory diseases had the highest values of COVID-19 CFR. CFR was also positively associated with the death rate due to smoking in people over 70 years. Interestingly, CFR was negatively associated with share of death due to lower respiratory infections. Among the demographic, economic and political variables, CFR was positively associated with share of the population over 70, GDP per capita, and level of democracy, while it was negatively associated with number of hospital beds ×1000. Overall, these results emphasize the role of comorbidity and socio-economic factors as possible drivers of COVID-19 case fatality rate at the population level.

Forty-two years of responding to Ebola virus outbreaks in Sub-Saharan Africa: a review

IntroductionEbola virus disease (EVD) is one of the deadliest haemorrhagic fevers affecting humans and non-human primates. Thirty-four outbreaks have been reported in Africa since it was first recognised in 1976....

Use of Combat Casualty Care Data to Assess the US Military Trauma System During the Afghanistan and Iraq Conflicts, 2001-2017

Although the Afghanistan and Iraq conflicts have the lowest US case-fatality rates in history, no comprehensive assessment of combat casualty care statistics, major interventions, or risk factors has been reported to date after 16 years of conflict. To analyze trends in overall combat casualty statistics, to assess aggregate measures of injury and interventions, and to simulate how mortality rates would have changed had the interventions not occurred. Retrospective analysis of all available aggregate and weighted individual administrative data compiled from Department of Defense databases on all 56 763 US military casualties injured in battle in Afghanistan and Iraq from October 1, 2001, through December 31, 2017. Casualty outcomes were compared with period-specific ratios of the use of tourniquets, blood transfusions, and transport to a surgical facility within 60 minutes. Main outcomes were casualty status (alive, killed in action [KIA], or died of wounds [DOW]) and the case-fatality rate (CFR). Regression, simulation, and decomposition analyses were used to assess associations between covariates, interventions, and individual casualty status; estimate casualty transitions (KIA to DOW, KIA to alive, and DOW to alive); and estimate the contribution of interventions to changes in CFR. In aggregate data for 56 763 casualties, CFR decreased in Afghanistan (20.0% to 8.6%) and Iraq (20.4% to 10.1%) from early stages to later stages of the conflicts. Survival for critically injured casualties (Injury Severity Score, 25-75 [critical]) increased from 2.2% to 39.9% in Afghanistan and from 8.9% to 32.9% in Iraq. Simulations using data from 23 699 individual casualties showed that without interventions assessed, CFR would likely have been higher in Afghanistan (15.6% estimated vs 8.6% observed) and Iraq (16.3% estimated vs 10.1% observed), equating to 3672 additional deaths (95% CI, 3209-4244 deaths), of which 1623 (44.2%) were associated with the interventions studied: 474 deaths (12.9%) (95% CI, 439-510) associated with the use of tourniquets, 873 (23.8%) (95% CI, 840-910) with blood transfusion, and 275 (7.5%) (95% CI, 259-292) with prehospital transport times. Our analysis suggests that increased use of tourniquets, blood transfusions, and more rapid prehospital transport were associated with 44.2% of total mortality reduction. More critically injured casualties reached surgical care, with increased survival, implying improvements in prehospital and hospital care.

Changes in obstetric case fatality and early newborn mortality rates in hospitals after the implementation of the Expanding Maternal and Neonatal Survival program in Indonesia: Results from a health information system.

Case fatality rates (CFRs) are often used as the key indicator for the measurement of quality of care at hospitals. We examine the trends of obstetric CFRs and very early neonatal mortality rates at hospitals in selected districts of Indonesia after implementation of a facility-based maternal and neonatal health intervention-the Expanding Maternal and Neonatal Survival (EMAS) program. Random-effects Poisson regression models were fitted to routine facility data collected from 101 hospitals over approximately 4years. Predicted incidence rates from the models were used for ascertaining the changes in CFRs and very early neonatal mortality rates during the EMAS intervention period. The obstetric CFR from any maternal complications decreased significantly by 50% (adjusted incidence rate ratio [IRR] 0.50; 95% confidence interval [CI] 0.42-0.61) at hospitals after the implementation of the EMAS program. On average, the CFR decreased from 5.4 to 2.6 deaths per 1000 cases of obstetric complications admitted during the program period. The very early neonatal mortality rate (deaths within 24hours of birth) decreased by 21% (IRR 0.79; 95% CI, 0.65-0.96). Our study suggests that overall obstetric case fatality and very early neonatal mortality rates-two indicators for tracking the quality of emergency obstetric care-decreased significantly at hospitals after the implementation of the EMAS intervention program in Indonesia.

Drivers of measles mortality: the historic fatality burden of famine in Bangladesh.

Measles is a major cause of childhood morbidity and mortality in many parts of the world. Estimates of the case-fatality rate (CFR) of measles have varied widely from place to place, as well as in the same location over time. Amongst populations that have experienced famine or armed conflict, measles CFR can be especially high, although past work has mostly focused on refugee populations. Here, we estimate measles CFR between 1970 and 1991 in a rural region of Bangladesh, which experienced civil war and famine in the 1970s. We use historical measles mortality data and a mechanistic model of measles transmission to estimate the CFR of measles. We first demonstrate the ability of this model to recover the CFR in the absence of incidence data, using simulated mortality data. Our method produces CFR estimates that correspond closely to independent estimates from surveillance data and we can capture both the magnitude and the change in CFR suggested by these previous estimates. We use this method to quantify the sharp increase in CFR that resulted in a large number of deaths during a measles outbreak in the region in 1976. Most of the children who died during this outbreak were born during a famine in 1974, or in the 2 years preceding the famine. Our results suggest that the period of turmoil during and after the 1971 war and the sustained effects of the famine, is likely to have contributed to the high fatality burden of the 1976 measles outbreak in Matlab.

Epidemiology and outcome of sepsis in adult patients with Streptococcus pneumoniae infection in a Norwegian county 1993-2011: an observational study.

BackgroundInvasive pneumococcal disease (IPD) is responsible for significant mortality and morbidity worldwide. There are however few longitudinal studies on the changes in case fatality rate of IPD in recent years. We carried out a prospective observational study of patients with IPD in Nord Trøndelag county in Norway from 1993 to 2011 to study the clinical variables and disease outcome. The main outcome was all-cause mortality after 30 and 90 days.MethodsPatients with positive blood cultures were registered prospectively by the microbiology laboratory and clinical variables were registered retrospectively from patients’ hospital records. The severity of sepsis was assigned according to the 2001 International Sepsis Definition Conference criteria. The association between mortality and predictive factors was studied using a logistic regression model.ResultsThe total number of patients was 414 with mean age of 67 years and 53 % were male. Comorbidity was assessed by the Charlson Comorbidity Index (CCI). A CCI-score of 0 was registered in 144 patients (34.8 %), whereas 190 had a score of 1–2 (45.9 %) and 80 (19.3 %) had a score ≥3. 68.8 % of the patients received appropriate antibiotics within the first 6 h. The 30-day mortality risk increased by age and was 3-fold higher for patients aged ≥80 years (24.9, 95 % CI 16.4–33.4 %) compared to patients aged <70 (8.0, 95 % CI 3.5–12.4 %). 110 patients, (26.6 %) had severe sepsis and 37 (8.9 %) had septic shock. The 30 day all-cause mortality risk for those with sepsis without organ failure was 5.4 % (95 % CI 2.7–8.0 %), 20.2 % (95 % CI 13.5–27.4 %) for those with severe sepsis and 35.0 % (95 % CI 21.6–49.0 %) for those with septic shock. The mortality risk did not differ between the first and the second halves of the study period with a 30-day mortality risk of 13.5 % (95 % CI 7.9–19.2 %) for 1993–2002 versus 11.8 % (95 % CI 8.2–15.3 %) for 2003–2011.ConclusionIPD carries a high mortality despite early and appropriate antibiotics in most cases. We found no substantial decrease in case fatality rate during the study period of 18 years. Older age and higher severity of disease were important risk factors for death in IPD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1553-8) contains supplementary material, which is available to authorized users.

Evaluation of the impact on non-communicable chronic diseases of a major integrated primary health care program in Mexico.

Primary health care is the best framework for implementing actions for the prevention and control of non-communicable diseases at an appropriate scale. In 2002, the Mexican Institute for Social Security (IMSS), which provides health care to half of the Mexican population, implemented a primary care-based integrated program that included the improvement of the family health care practice and a preventive strategy called PREVENIMSS, to reduce the burden of disease. To asess the impact of this program on selected non-communicable chronic diseases. Morbidity and mortality were compared before and after implementation of the program and time trends in IMSS affiliates and non-affiliates using the difference-in-differences (DD) method. Incidence rates of diabetes and hypertension increased whereas those of cervical cancer, breast cancer and other cerebrovascular diseases decreased from 2000 to 2013. The DD in mortality rates, expressed per 100000 persons, showed a decrease of 49.4 for diabetes mellitus, 9.1 for hypertensive disease, 42.9 for ischemic heart disease, 17.4 for cerebrovascular disease, 7.5 for cervical cancer and 5.8 for breast cancer. The reductions in mortality rates could be explained by both changes in incidence rates and changes in case fatality rates associated with early detection and treatment. These initial findings can be interpreted as the potential impact of integrated programs based on primary health care in a developing country.

Disparities in myocardial infarction case fatality rates among the elderly: The 20-year Medicare experience

Case fatality rates after acute myocardial infarction (MI) have decreased markedly over the last 3 decades. Some subgroups may have benefited more than others, but this hypothesis has not been evaluated in a large nationally representative cohort. Accordingly, we sought to assess long-term temporal trends in mortality after hospitalization for MI and to assess whether these trends differ by sex, race, or age in a cohort of elderly patients. We studied a cohort of 4.9 million Medicare beneficiaries >or=65 years hospitalized for MI between 1984 and 2003 and calculated the proportion that died inhospital, within 30 days, and within 1 year of hospitalization. We used multivariable risk models to estimate relative and absolute changes in case fatality rate according to race, sex, and age groups. After adjustment for age, sex, and race, between 1984 and 2003, there was a 54.3% (95% CI 53.7%-54.8%), 39.7% (95% CI 39.1%-40.3%), and 23.0% (95% CI 22.5%-23.5%) reduction in the risk of inhospital, 30-day, and 1-year mortality, respectively. Relative and absolute reductions were greater in whites than in blacks, with the biggest differences observed for 1-year mortality. Small and inconsistent differences were seen by sex after stratifying by race. Patients aged >or=90 years experienced the smallest relative reductions in case fatality rates, with the biggest differences observed for 1-year mortality. Among US Medicare beneficiaries, short-term MI case fatality rates have decreased significantly in all groups, but more so among whites than blacks. Additional studies are needed to clarify the basis for these observations.

Changes in subarachnoid hemorrhage mortality, incidence, and case fatality in New Zealand between 1981-1983 and 1991-1993.

As with total stroke, mortality rates from subarachnoid hemorrhage (SAH) have declined in New Zealand since the mid-1970s. Data from the Auckland Region Stroke studies allow an understanding of reasons for the change, as SAH incidence and 28-day case fatality rates were measured as part of population-based stroke registers. National death registrations were used to describe the trends in mortality rates from SAH (International Classification of Diseases [ICD] code 430) among men and women in New Zealand. Changes in incidence and case fatality rates were determined from 2 large-scale population-based stroke registries carried out in 1981-1983 and 10 years later in Auckland. Similar methodology and case ascertainment techniques were used in both studies. The mortality rates from SAH declined in both men and women after the mid-1970s. The mortality rate remained higher among women than men. The incidence of SAH was lower in 1991-1993 (11.3 per 100,000) compared with 1981-1983 (14.6 per 100,000). In the younger age groups, the decrease was mostly due to a lower incidence among men, whereas in the older age groups women older than 65 years had a lower incidence. There was no consistent change in case fatality rates between the 2 periods in either men or women. Mortality rates from SAH have decreased in both men and women. This decrease may be explained by a decrease in the incidence of SAH, because case fatality rates showed no change.

Case-Fatality Rates and Functional Outcome After Subarachnoid Hemorrhage

During the last three decades, new management strategies have been developed for patients with aneurysmal subarachnoid hemorrhage. To assess whether the case-fatality rate has improved after the introduction of new management strategies, we studied outcome in all population-based studies from 1960 onward. To identify population-based studies that reported on case-fatality rate in subarachnoid hemorrhage, we performed a MEDLINE search and checked all reference lists of the studies found. Two authors (J.W.H. and G.J.E.R.) independently assessed all studies for eligibility, using predefined criteria for case finding and diagnosis, and extracted data on case-fatality rates. We used weighted linear regression analysis to quantify change in case-fatality rate over time. We found 21 studies, describing 25 study periods between 1960 and 1992. Case-fatality rates varied between 32% and 67%, with the exception of one recent study. The case-fatality rate decreased by 0.5% per year (95% confidence interval, -0.1 to 1.2); the decline was steeper after adjustment for age and sex (0.9% per year; 95% confidence interval, -0.7 to 2.6; data from 12 studies). The case-fatality rate after subarachnoid hemorrhage has decreased during the last three decades. A plausible explanation for this decrease is the improved management of patients with subarachnoid hemorrhage.

Changes in drug treatment and case fatality of patients with acute myocardial infarction. Observations from the Newcastle MONICA Project, 1984/1985 to 1988/1990.

To describe changes in medications administered to patients with acute myocardial infarction between 1984/1985 and 1988/1990 and changes in case fatality. Descriptive study from the Newcastle MONICA Project, which monitors all heart attacks in men and women aged 25 to 69 years in the Lower Hunter Region of New South Wales. All patients admitted to hospital with a "definite" acute myocardial infarction who survived at least 28 days during periods in 1984/1985 (513 events) and 1988/1990 (790 events). Changes in drugs being taken immediately before the onset of the myocardial infarction, prescribed during hospitalisation and on discharge from hospital, and changes in case fatality rates. From the first time period to the second there were significant increases in the use of aspirin, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and hypolipidaemic agents, and significant reductions in the use of diuretics. In 1988/1990, 34% of patients with a definite myocardial infarction received thrombolytic therapy compared with fewer than 1% in 1984/1985. Among those patients who survived at least one hour from onset of symptoms, the case fatality rate declined from 13.5% to 7.9% (change -5.6%; 95% confidence limits, -8.9%, -2.2%). Large changes in drug treatment of patients with acute myocardial infarction have occurred in the second half of the 1980s. These may be responsible for the reduction in case fatality. Nevertheless, use of drugs of proven effectiveness in acute care and for secondary prevention is surprisingly low in this population.

The world health organization monica project (monitoring trends and determinants in cardiovascular disease): A major international collaboration

A World Health Organization Working Group has developed a major international collaborative study with the objective of measuring over 10 years, and in many different populations, the trends in, and determinants of, cardiovascular disease. Specifically the programme focuses on trends in event rates for validated fatal and non-fatal coronary heart attacks and strokes, and on trends in cardiovascular risk factors (blood pressure, cigarette smoking and serum cholesterol) in men and women aged 25–64 in the same defined communities. By this means it is hoped both to measure changes in cardiovascular mortality and to see how far they are explained; on the one hand by changes in incidence mediated by risk factor levels; and on the other by changes in case-fatality rates, related to medical care. Population centres need to be large and numerous; to reliably establish 10-year trends in event rates within a centre 200 or more fatal events in men per year are needed, while for the collaborative study a multiplicity of internally homogeneous centres showing differing trends will provide the best test of the hypotheses. Forty-one MONICA Collaborating Centres, using a standardized protocol, are studying 118 Reporting Units (sub-populations) with a total population aged 25–64 (both sexes) of about 15 million