Changes In Standardized Mortality Ratios Research Articles

Relationship between changes in the public health nurses’ workforce and the empirical Bayes estimates of standardized mortality ratio: a longitudinal ecological study of municipalities in Japan

BackgroundThe role of public health nurses (PHNs) in the community is expected to become increasingly important, along with the promotion of a comprehensive community care system. However, a comprehensive study of all municipalities is yet to be undertaken, and the relationship between the workforce of PHNs and health indicators is yet to be clarified. This study examined the effect of workforce change among PHNs, one of the structural indicators of PHNs’ activities regarding changes in the empirical Bayes estimate of standardized mortality ratios (EBSMRs).MethodsAn ecological study was conducted using municipality-level aggregate data. The data used were publicly available Japanese government statistics. The first-difference model of panel data analysis was used to examine the relationship between changes in EBSMR and changes in the number of PHNs per 100,000 population from 2010 to 2015, adjusting for the effects of population and other healthcare resources, including the number of physicians, medical clinics, general hospitals, and welfare facilities. The variation by the 47 prefectures was added to the linear model as a random effect. We also performed a sensitivity analysis using the full Bayesian inference using the Besag-York-Mollie model.ResultsFor males, EBSMRs for all causes and malignant neoplasms significantly decreased with an increase in the number of PHNs per population (coefficients: -1.00 and -0.89, p values: 0.008 and 0.043, respectively). For females, although all EBSMRs except malignant neoplasms showed decreased tendencies due to the increase in the number of PHNs per population, none of them were significant. The full Bayesian inference confirmed these associations.ConclusionsAn increase in the number of PHNs per population was significantly associated with a greater reduction in deaths from all causes and malignant neoplasms in males. The results of the full Bayesian inference also suggest that the workforce of PHNs may be related to changes in standardized mortality ratios for deaths from all causes in females.

The early impact of COVID-19 on mental health and community physical health services and their patients’ mortality in Cambridgeshire and Peterborough, UK

BackgroundCOVID-19 has affected social interaction and healthcare worldwide. MethodsWe examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths. We conducted interrupted time series analyses with respect to the time of UK “lockdown”, which was shortly before the peak of COVID-19 infections in this area. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI). ResultsReferrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity. ConclusionsCOVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. “Supply” changes may have reduced access to mental health services for some. “Demand” changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.

The Early Impact of COVID-19 on Mental Health and Community Physical Health Services and Their Patients’ Mortality in Cambridgeshire and Peterborough, UK

BACKGROUND: COVID-19 has affected social interaction and healthcare worldwide.METHODS: We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK, plus service activity and deaths. We conducted interrupted time series analyses with respect to the UK “lockdown”. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI).OUTCOMES: Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for psychosis/mania and eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality, primarily in the over-70s, lagged slightly behind confirmed numbers of COVID-19 cases. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity.INTERPRETATION: COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. This may reflect a genuine reduction of need or a lack of help-seeking and pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.FUNDING: UK Medical Research Council and National Institute of Health Research.DECLARATION OF INTERESTS:  Several authors (PBJ, BRU, AM, ETB, ESO, JBD, CFH, FJT, RNC) are CPFT clinicians involved in delivering some of the services discussed here and two (BRU, FJT) are clinical directors and therefore involved in managing them.  PBJ is a scientific advisory board member for Johnson & Johnson and Recordati.  BRU is clinical director of the Windsor Unit at Fulbourn Hospital (CPFT), which delivers clinical trials in dementia/mild cognitive impairment for academic and commercial organisations without personal benefit, and is the clinical lead for dementia for the NIHR Clinical Research Network (CRN) in the East of England. His salary is part-funded by the NIHR CRN. He has been principal investigator on trials for Axovant, Lilly, and EIP Pharma; his institution has benefited from payment for research carried out but he has not personally received any money. His wife is the lead for mental health for Suffolk Clinical Commissioning Group.  AM’s salary is part-funded by the Anna Freud National Centre for Children and Families, a mental health charity.  ETB is a scientific advisory board member for Sosei Hepares, and was a half-time employee of GlaxoSmithKline until May 2019.  RNC consults for Campden Instruments Ltd and receives royalties from Cambridge University Press, Cambridge Enterprise, and Routledge.  SC, SB, EFO, JBD, CFH, FJT, JDA, MPS, and JRL have nothing else to disclose.ETHICS APPROVAL STATEMENT: De-identified data was extracted from CPFT clinical records by CPFT’s Information & Performance team and via the CPFT Research Database (NHS research ethics 17/EE/0442). The study was conducted under UK National Health Service Research Ethics approval (ref. 17/EE/0442).

Trends in geographic mortality inequalities and their association with population changes in France, 1975–2006

Although some studies have reported that population change is associated with spatial mortality inequalities, few of them have tried to take a dynamic approach to the association. The aim of this study was to explore and interpret the ecological association between the change in cause-specific mortality inequalities and population change over a 30-year period in areas exhibiting different deprivation and urbanization levels in France. The French communes were classified by category of demographic change during the period 1962-2006. The changes in standardized mortality ratios were analysed by category over 5 inter-censal periods, taking into account degree of urbanization and deprivation quintile. The magnitude and significance of the associations for various causes of death were estimated using a Generalised Estimating Equation Poisson model. Overall, the change in relative mortality was negatively associated with population growth. For a compound annual population growth rate of 1% in 1990-99, the standardized mortality ratios decreased, on average, by 2.1% (95% confidence interval: -1.45 to -2.72). The association was stronger in urban areas, and reversed in the least deprived areas. The association was stronger and more significant for men, subjects aged less than 65 years and alcohol-related and violent deaths. This study highlights the significance of dynamic approaches. Population growth was associated with a decrease in relative mortality level; the direction and strength of the association varied depending on the socio-territorial characteristics. As is the case for English-speaking countries, in France, population growth may be considered a component of current social dynamics that are not measured by usual indicators.