Circulatory Causes Research Articles

An approach estimating the short-term effect of NO2 on daily mortality in Spanish cities

BackgroundRoad traffic is the most significant source of urban air pollution. PM2.5 is the air pollutant whose health effects have been most closely studied, and is the variable most commonly used as a proxy indicator of exposure to air pollution, whereas evidence on NO2 concentrations per se is still under study. In the case of Spain, there are no specific updated studies which calculate short-term NO2-related mortality. ObjectiveTo quantify the relative risks (RRs) and attributable risks (ARs) of daily mortality associated with NO2 concentrations recorded in Spain across the study period, 2000–2009; and to calculate the number of NO2-related deaths. Material and methodsWe calculated daily mortality due to natural causes (ICD-10: A00 R99), circulatory causes (ICD-10: I00 I99) and respiratory causes (ICD-10: J00 J99) for each province across the period 2000–2009, using data supplied by the National Statistics Institute. Mean daily NO2 concentrations in μg/m3 for each provincial capital were furnished by the Ministry of Agriculture & Environment, along with the equivalent figures for the control pollutants (PM10). To estimate RRs and ARs, we used generalised linear models with a Poisson link, controlling for maximum and minimum daily temperature, trend of the series, seasonalities, and the autoregressive nature of the series. A meta-analysis with random effects was used to estimate RRs and ARs nationwide. ResultsThe overall RRs obtained for Spain, corresponding to increases of 10 μg/m3 in NO2 concentrations were 1.012 (95% CI: 1.010 1.014) for natural-cause mortality, 1.028 (95% CI: 1.019 1.037) for respiratory-cause mortality, and 1.016 (95% CI: 1.012 1.021) for circulatory-cause mortality. This amounted to an annual overall 6085 deaths (95% CI: 3288 9427) due to natural causes, 1031 (95% CI: 466 1585) due to respiratory causes, and 1978 (95% CI: 828 3197) due to circulatory causes. ConclusionBy virtue of the number of cities involved and the nature of the analysis performed, with quantification of the RRs and ARs of the short-term impact of NO2 on daily mortality in Spain, this study provides an updated estimate of the effect had by this type of pollutant on causes of mortality, and constitutes an important basis for reinforcing public health measures at a national level.

Comparing ARIMA and computational intelligence methods to forecast daily hospital admissions due to circulatory and respiratory causes in Madrid

Anticipating future workloads in a hospital may be of capital importance in order to distribute resources and improve patient attention. In this paper, we tackle the problem of predicting daily hospital admissions in Madrid due to circulatory and respiratory cases based on biometeorological indicators. A range of forecasting algorithms were proposed covering four model families: ensemble methods, boosting methods, artificial neural networks and ARIMA. Experiments show how the last two obtain better results in average, demonstrating that the problem can be properly solved with both approaches. Furthermore, a recently proposed technique known as stacked generalization was also used to dynamically combine the predictions from the four models, finally improving the performance with respect to the individual models.

Mortality risks from a spectrum of causes associated with wide-ranging exposure to fine particulate matter: A case-crossover study in Beijing, China

BackgroundExposure to fine particulate matter (≤2.5μm in aerodynamic diameter; PM2.5) has been shown to be associated with an increased risk of mortality due to cardiovascular, respiratory, and other pulmonary diseases. However, fewer studies have investigated the relationship between ambient PM2.5 and human mortality for a wider range of causes of death, or for more specific causes of death within these broader categories, especially at the high PM2.5 concentrations currently experienced in Chinese megacities. Beijing, China, has a very large population and a wide range of PM2.5 exposures, allowing a prime opportunity to estimate such risks across a broad spectrum of causes, including rarer causes of death. ObjectiveTo estimate the relative risk of cause-specific mortality associated with PM2.5 for a spectrum of causes of death, as well as characterize the time course of cause-specific mortality following PM2.5 exposure, in a location where PM2.5 concentrations are representative of common exposures in Chinese megacities. MethodsWe collected daily data on mortality counts of Beijing residents and Beijing weather and air pollution measurements for January 1, 2009 to December 31, 2012. We used a time-stratified case-crossover study design to estimate the association between ambient PM2.5 concentrations and risk of death from several broad causes of death and from more refined specific causes within these broader categories. Primary results were estimated for risks the day of and the day following exposure (lag 0–1), but the time pattern of associated risk was also explored up to seven days following exposure. ResultsIncreased concentrations of PM2.5 were associated with increased risks at lag days 0–1 of all-cause mortality (0.26% increase per 10μg/m3; 95% confidence interval [CI]: 0.12%–0.39%), non-accidental deaths (0.25%; 95% CI: 0.11%–0.38%), circulatory deaths (0.39%; 95% CI: 0.21%–0.59%), respiratory deaths (0.43%; 95% CI: 0.05%–0.81%), intentional self-harm deaths (1.94%; 95% CI: 0.19%–3.73%) and nervous system deaths (0.9%; 95% CI: −0.2%–2%), although the observed increase was not statistical significant for the final one rarer cause of death. In addition to these five broad death outcomes, risk also increased following PM2.5 exposure at lag days 0–1 for deaths from several specific causes, including most of the specific circulatory causes considered. The largest observed increased risk by far was for one of the rarest causes of death considered, extrapyramidal and movement disorders (2.35%; 95% CI: 0.03%–4.72%). ConclusionsThis study indicates that exposure to PM2.5 in a study location more representative of exposures in developing cities is associated with an increased risk of mortality from broad range of causes of death, including some causes rarely studied previously in association with PM2.5 exposure.

Variations in elderly peoples’ visits to the emergency departments in Iceland: A five-year population study

IntroductionElderly people visiting emergency departments (ED) are a non-homogenous group. Gender and other socio-demographic variations in emergency care might be present. However, gender-specific ED-data is scarce. MethodsWe retrieved retrospective data on all ED-visits, by 67years and older from 2008 to 2012, and calculated incidence of visits applying population registries. The relationship of age-categories, marital status, health and residence with outcomes were analyzed descriptively by Chi-square tests. Regression models were built to analyze gender-specific variations. ResultsOf the total ED-visits, 20% were from the elderly population (n=66,141), at a mean 3.1 visits per individual. Men (n=30.269) had higher incidence of visits in all age-categories. They were mostly married (69%) and women widowed (43%), although the incidence of partnered visitors underrepresented population-data while widowed and single living overrepresented. Women had more often co-morbidities, their most common causes of visits were musculoskeletal (20%) and men circulatory causes (14%). Men were more likely to be admitted (OR: 1.23; 95% CI 1.16–1.30) and had more unplanned ED-revisits (HR: 1.20; 95% CI 1.06–1.35) within 30 days. DiscussionElderly men visiting the ED were more often married than women. Gender differences were found in causes of visits and outcomes. In clinical practice, gender may be considered when identifying risk and planning adequate care related elderly ED-visits.

Causes of death after traumatic spinal cord injury-a 70-year British study.

Retrospective and prospective observational. Analyse causes of death after traumatic spinal cord injury (tSCI) in persons surviving the first year post injury, and establish any trend over time. Two spinal centres in Great Britain. The sample consisted of 5483 patients with tSCI admitted to Stoke Mandeville and Southport spinal centres who were injured between 1943 and 2010, survived first year post injury, had residual neurological deficit on discharge and were British residents. Mortality information, including causes of death, was collected up to 31 December 2014. Age-standardised cause-specific mortality rates were calculated for selected causes of death, and included trends over time and comparison with the general population. In total, 2322 persons (42.3% of the sample) died, with 2170 (93.5%) having a reliable cause of death established. The most frequent causes of death were respiratory (29.3% of all certified causes), circulatory, including cardiovascular and cerebrovascular diseases (26.7%), neoplasms (13.9%), urogenital (11.5%), digestive (5.3%) and external causes, including suicides (4.5%). Compared to the general population, age-standardised cause-specific mortality rates were higher for all causes, especially skin, urogenital and respiratory; rates showed improvement over time for suicides, circulatory and urogenital causes, no significant change for neoplasms, and increase for skin and respiratory causes. Leading causes of death after tSCI in persons surviving the first year post injury were respiratory, circulatory, neoplasms and urogenital. Cause-specific mortality rates showed improvement over time for most causes, but were still higher than the general population rates, especially for skin, urinary and respiratory causes.

The Main Cause of Death Following Primary Total Hip and Knee Replacement for Osteoarthritis: A Cohort Study of 26,766 Deaths Following 332,734 Hip Replacements and 29,802 Deaths Following 384,291 Knee Replacements.

Patients undergoing primary total joint replacement are selected for surgery and thus (other than having a transiently increased mortality rate postoperatively) have a lower mortality rate than age and sex-matched individuals do. Understanding the causes of death following joint replacement would allow targeted strategies to reduce the risk of death and optimize outcome. We aimed to determine the rates and causes of mortality for patients undergoing primary total hip or knee replacement compared with individuals in the general population who were matched for age and sex. We compared causes and rates of mortality between age and sex-matched individuals in the general population (National Joint Registry for England, Wales and Northern Ireland; Hospital Episode Statistics; and Office for National Statistics) and a linked cohort of 332,734 patients managed with total hip replacement (26,766 of whom died before the censoring date) and 384,291 patients managed with primary total knee replacement (29,802 of whom died before the censoring date) from 2003 through 2012. The main causes of death were malignant neoplasms (33.8% [9,037] of 26,766 deaths in patients with total hip replacement and 33.3% [9,917] of 29,802 deaths in patients with total knee replacement), circulatory system disorders (32.8% [8,784] of the deaths in patients with total hip replacement and 33.3% [9,932] of the deaths in patients with total knee replacement), respiratory system disorders (10.9% [2,928] of the deaths in patients with total hip replacement and 9.8% [2,932] of the deaths in patients with total knee replacement), and digestive system diseases (5.5% [1,465] of the deaths in patients with total hip replacement and 5.3% [1,572] of the deaths in patients with total knee replacement). There was a relative reduction in mortality (39%) compared with the individuals in the general population that equalized to the rate in the general population by 7 years for hips (overall standardized mortality ratio [SMR], 0.61; 95% confidence interval [CI], 0.60 to 0.62); for knees, the relative reduction (43%) partially attenuated by 7 years but still had not equalized to the rate in the general population (overall SMR, 0.57; 95% CI, 0.56 to 0.57). Ischemic heart disease was the most common cause of death within 90 days (29% [431] of the deaths in patients with primary hip replacement and 31% [436] of the deaths in patients with primary knee replacement). There was an elevated risk of death from circulatory, respiratory, and (most markedly) digestive system-related causes within 90 days postoperatively compared with 91 days to 1 year postoperatively. Ischemic heart disease is the leading cause of death in the 90 days following total joint replacement, and there is an increase in postoperative deaths associated with digestive system-related disease following joint replacement. Interventions targeted at reducing these diseases may have the largest effect on mortality in total joint replacement patients. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of short-term mortality attributable to particulate matter pollution in Spain

According to the WHO, 3 million deaths are attributable to air pollution due to particulate matter (PM) world-wide. However, there are no specific updated studies which calculate short-term PM-related cause specific mortality in Spain. The objective is to quantify the relative risks (RRs) and attributable risks (ARs) of daily mortality associated with PM10 concentrations, registered in Spanish provinces and to calculate the number of PM-related deaths. We calculated daily mortality due to natural (ICD-10: A00 R99), circulatory (ICD-10: I00 I99) and respiratory causes (ICD-10: J00 J99) for each province across the period 2000–2009. Mean daily concentrations of PM10, NO2 and O3 was used. For the estimate of RRs and ARs, we used generalised linear models with a Poisson link. A meta-analysis was used to estimate RRs and ARs in the provinces with statically significant results. The overall RRs obtained for these provinces, corresponding to increases of 10 μ g/m3 in PM10 concentrations were 1.009 (95% CI: 1.006 1011) for natural, 1.026 (95% CI: 1.019 1033) for respiratory, and 1.009 (95% CI: 1.006 1012) for circulatory-cause mortality. This amounted to an annual overall total of 2683 deaths (95% CI: 852 4354) due to natural, 651 (95% CI: 359 1026) due to respiratory, and 556 (95% CI: 116 1012) due to circulatory causes, with 90% of this mortality lying below the WHO guideline values. This study provides an updated estimate of the effect had by this type of pollutant on causes of mortality, and constitutes an important basis for reinforcing public health measures.

IMPACT OF ALCOHOL CONSUMPTION ON SUDDEN CARDIAC DEATH OCCURENCE BY THE REGISTRY GERMINA (REGISTRY OF SUDDEN CARDIAC DEATH OF ECONOMICALLY ACTIVE INHABITANTS IN BRYANSK REGION)

Aim . To investigate on the role of alcohol in sudden cardiac death onset (SCD) in economically active inhabitants. Material and methods. Totally, medical documentation was analyzed, of 1447 economically active inhabitants of Bryansk region in 2012, died due to circulatory causes: the outpatient chart, the inpatient chart, medical death certificate, forensic autopsy, common autopsy. The SCD criteria fulfilled 106 cases. With a unified questionnaire, 26 relatives were surveyed, and medical staff, of those who agreed to respond. In section of 61 corpse, alcohol concentration was measured, with the level of intoxication defined. Results. By the data from official documents, the part of alcohol cardiomyopathy (ICD I42.6) was 7% from all death cases of suddenly died economically active inhabitants. Outpatient charts and case histories documented the fact of alcohol abuse in 36% of those who requested medical help while alive. Relatives or medical staff, contacted with the died just before the death, confirmed alcohol overconsumption in 42%. Corpse blood investigation revealed 27% specimens with alcohol, and about a half of cases the concentration was at more than moderate intoxication. Conclusion . Alcohol plays significant role in SCD development in economically active inhabitants. Abuse with the alcohol beverages leads to development and progression of structural and functonal changes in the heart — the substrate for life-threatening ventricular arrhythmias. Also, in many cases alcohol might be the trigger for fatal rhythm disorders.

Effectiveness of Influenza Vaccine in Preventing Death among Ontario Residents Aged ≥65 Years during 20 Seasons

BackgroundEstimation of influenza vaccine effectiveness (VE) among older adults at high risk of serious complications of influenza infection is challenging. These challenges include identifying and adjusting for potential confounders. The rarity of documented influenza deaths, even among individuals at greatest risk, makes VE assessment for this outcome particularly difficult. Thus, population-level linkages of public health system records are helpful in estimating VE for preventing death.MethodsWe conducted a retrospective cohort study from 1993 through 2013 among community-dwelling residents of Ontario aged ≥65 years. Eligible subjects were registered with Ontario’s publicly funded health insurance program, which provided universal, free access to physician services, hospital care, and vaccines; we excluded those with no contact with the health system during the prior 3 years. We assessed influenza VE for preventing death from any cause and death for which the primary cause was a respiratory or circulatory condition. Influenza vaccination was determined using physician and pharmacist billing claims. Temperature and influenza virus detection data were collected from provincial sources. Ratio-of-ratios models were used to estimate VE, by comparing marginal changes in outcome rates among vaccinated and unvaccinated groups at various levels of influenza circulation. We evaluated several methods of characterizing temporal variation in influenza circulation and several geographic scales for using influenza and temperature data in VE estimation models.ResultsDuring the 20-year study period, we estimated VE among a mean of 1.39 million subjects each season, of whom a mean of 51.9% were vaccinated. During weeks of high influenza A circulation, we estimated that VE for the prevention of any death was 16% (95% CI -6% to 38%) and for the prevention of a respiratory or circulatory death was 21% (95% CI 2% to 40%). The precision of VE estimates improved when regional-level rather than Ontario-wide temperature data were used.ConclusionDuring weeks of influenza A circulation over 20 seasons, we found that modest but significant reductions in deaths with an underlying respiratory or circulatory cause occurred among Ontario residents aged ≥65 who received an influenza vaccine.Disclosures All authors: No reported disclosures.

Five-year outcome of consecutive unprotected left main percutaneous coronary interventions

Objectives We aimed to describe the procedural characteristics and 5-year outcome of consecutive patients undergoing unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) at our tertiary care centre between 1 January 2007 and 31 December 2008.Methods and results 76 patients underwent ULMCA PCI during the study period. Drug-eluting stents were used in 61. The mean EuroSCORE II, additive and logistic EuroSCOREs and SYNTAX score were 14.81, 10.2, 25.25 and 27.3, respectively. 30-day and 5-year mortality were 14.5% and 50%, respectively, with early mortality related exclusively to circulatory causes and late mortality being non-cardiac in 74%. Clinical presentation was a key determinant of 5-year mortality. During follow-up 1 patient suffered a non-fatal myocardial infarction (MI) related to ULMCA in-stent restenosis (ISR), 2 others suffered MI related to non-ULMCA lesions. Definite and probable stent thrombosis occurred in 1 (non-ULMCA stent) and 1, respectively. 3 patients had ULMCA ISR, 14 had non-ULMCA ISR necessitating redo revascularisation.Conclusions ULMCA PCI is a good treatment modality in patients who cannot undergo CABG. Clinical presentation and downstream disease have a major influence on the 5-year outcome.

The Pattern of Underlying Cause of Death in Patients with Inflammatory Bowel Disease in England: A Record Linkage Study.

Numerous studies have established that mortality risk in inflammatory bowel disease [IBD] patients is higher than in the general population, but the causes of death have seldom been examined. We aimed to describe causes of death in IBD. A matched cohort study using UK general practice data from Clinical Practice Research Datalink linked to death registration records. We described the distribution of causes of death among IBD patients by age at death and time since IBD diagnosis. We estimated age-specific mortality rates and hazard ratios of death in multivariable Cox proportional hazards models. 20293 IBD patients were matched to 83261 non IBD patients. The mortality rate was 40% higher in IBD patients [2005 deaths] than in non IBD patients [6024 deaths] (adjusted overall hazard ratio: = 1.4, 95% confidence interval [CI]: = 1.4-1.5], with greater risk of death in Crohn's disease [hazard ratio: = 1.6, 1.5-1.7] than in ulcerative colitis [1.3, 1.3-1.4]. Causes attributable to IBD constituted 3.7% of all deaths in ulcerative colitis and 8.3% in Crohn's disease. Among IBD patients, death was less likely to be due to circulatory, respiratory or neoplastic diseases than among non IBD patients. In both IBD and non IBD patients all these causes became more clinically important with advancing age, with the commonest neoplastic cause of death being lung cancer rather than gastrointestinal cancers. IBD patients have an additional risk of death. Most IBD patients die of circulatory or respiratory causes, and the contribution to mortality from long-term complications of IBD is clinically less important.

Effects of noise on telephone calls to the Madrid Regional Medical Emergency Service (SUMMA 112)

BackgroundAlthough the effects of noise on population morbidity and mortality have been observed both in the short and long term, the morbidity and mortality indicators used to date have not enabled information on such health effects to be accessed in real time. At an international level, there are relatively few studies, mostly recent, which have considered an alternative indicator, such as the demand for medical attention provided by emergency services, taking into account environmental factors other than noise. ObjectivesTo ascertain the short-term effect of road-traffic noise levels on medical care, broken down by organic, circulatory and respiratory causes, provided by the Madrid Regional Medical Emergency Service (Servicio de Urgencia Médica de Madrid/SUMMA 112). MethodsWe used an ecological time-series study and fitted Poisson regression models, to analyse the number of daily, cause-specific episodes of care provided in situ by SUMMA 112, via emergency ambulance dispatches, across the period 01/01/2008–31/12/2009. To this end, we considered diurnal (Leqd: 7–23h), nocturnal (Leqn: 23–7h) and daily (Leq24: 24h) noise (in db(A)) as the principal factor, and chemical air pollution (µg/m3) and temperature (°C) as the control variables. We also controlled for trend and seasonalities, the autoregressive nature of the series, and day of the week. ResultsNocturnal noise exceeded the WHO threshold (55 db(A)) on 100% of nights, despite displaying a downward trend across the study period. For all causes, with the exception of emergency calls due to ischaemic disease, it was nocturnal rather than diurnal noise levels that had a short-term effect (lags 0–1) on SUMMA 112 calls, with this impact being greater for respiratory than for circulatory causes. Hence, for every increase of 1db in Leqn, the relative risks (RRs) were as follows: 1.11 (95% CI 1.09–1.13) for organic causes; 1.14 (95% CI: 1.11–1.18) for respiratory causes; and 1.08 (95% CI: 1.05–1.10) for circulatory causes. ConclusionSUMMA 112 data give access to real-time information on the health effects associated with increases in noise levels, which cannot be obtained via mortality or hospital-admission data, since these are collected in the longer term. Accordingly, this is something that would be immediately applicable in any future implementation of a syndromic surveillance system focusing on the effects of environmental pollutants on health.

Saberes e práticas de pessoas com úlcera venosa em tratamento com bota de Unna

Objetivo: descrever os saberes e práticas de pessoas com úlcera venosa em tratamento com bota de Unna. Método: pesquisa qualitativa e descritiva. Realizada no ambulatório de angiologia de um hospital universitário no Rio Grande do Sul, Brasil. A coleta dos dados ocorreu em outubro e novembro de 2013, com oito pessoas, por meio de entrevista semiestruturada, fichas de avaliação de lesões e prontuários. Utilizou-se a análise de conteúdo temática no tratamento dos dados. Resultados: os saberes se relacionam à causa circulatória e as práticas, com o repouso e a cicatrização da úlcera venosa. A bota de Unna foi citada como tratamento benéfico e facilitador, embora possa proporcionar algum incômodo. Conclusão: os entrevistados referiram conhecimento sobre a origem da lesão, realizavam práticas de cuidado para melhora no retorno venoso e a bota de Unna foi considerada um tratamento benéfico.

Long term cause specific mortality among 34 489 five year survivors of childhood cancer in Great Britain: population based cohort study

Objective To determine whether modern treatments for cancer are associated with a net increased or decreased risk of death from neoplastic and non-neoplastic causes among survivors of childhood cancer.Design Population...

The influence of systemic circulation on hearing: The reliability of a different impact of microcirculatory defects and atherosclerosis

The extension of the dependence of hearing acuity from circulatory factors has been widely evaluated in the literature, without reaching an univocal conclusion. In our opinion, a precise distinction between acute/fluctuating disorders and progressive hearing loss must be made in order to identify the possible circulatory causes. Actually, it is conceivable to hypothesize that an acute lack of perfusion plays a major role in the inner ear microcirculation, and may be responsible for acute hearing damages; on the other hand, systemic atherosclerosis may coexist with good hearing provided that a sufficient local perfusion is maintained.This distinction, supported by our findings over the year, appears logical considering the autoregulatory properties of the cochlea and the differences between large/middle vessels and microvasculature; moreover, it can explain the finding of both people with no cardiovascular risk factors and (usually) unilateral inner ear affections and people with diffuse atherosclerosis and well preserved hearing, not exceptionally occurring in daily practice.

Estimated glomerular filtration rate, urine albumin excretion, and survival among patients consulting in public Chilean public primary care clinics

Chronic renal disease (CRD) in its pre-dialysis stage is an important risk factor for mortality among adults. The aim of this study was to assess the effects of CRD on mortality among consultants in Chilean public primary care clinics. We obtained information about serum creatinine, urinary albumin excretion (UAE), blood pressure, and body mass index of 5224 consultants [3379 females aged 67 (59–75) years and 1845 males aged 68 (59–75) years] in three clinics of Metropolitan Santiago. Kaplan–Meier curves and Cox proportional hazard regression models were used to determine risk factors for mortality, determined 41 months after obtaining the blood samples. During the follow-up period, 262 patients died (33% due to circulatory causes and 29% due to tumors). Kaplan–Meier curves showed that there was a significant association between survival, estimated glomerular filtration rate, and UAE. Cox models showed that serum creatinine, UAE, a lower body mass index, and a history of diabetes were significant mortality predictors. A sensitivity analysis performed eliminating extreme ages (less than 50 and more than 80 years), included high diastolic pressure as a predictor of survival. We conclude that among patients with CRD in its pre-dialysis stage, UAE is an important predictor of survival, along with serum creatinine. A low body mass index was associated with a higher mortality.

Mortality, cancer incidence, and survival in parents after bereavement

PurposeThe study objective was to investigate whether child loss is related to mortality, cancer incidence, and cancer survival in parents. MethodsWe used a population-based birth cohort (1964–1976) in Jerusalem and ascertained mortality (average follow-up of 39.1 years) and any cancer (average follow-up of 35.6 years) among parents who lost a child (2838 mothers and 2532 fathers) and among nonbereaved parents (38,212 mothers and 36,433 fathers). We also assessed mortality among parents with cancer. Time-dependent Cox models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). ResultsOverall mortality rates among bereaved parents were modestly increased when compared with nonbereaved parents (HR = 1.18, 95% CI: 1.05–1.32 in mothers; HR = 1.10, 95% CI: 1.01–1.20 in fathers). Hazard models indicated a significant relationship between bereavement and deaths from coronary heart disease in mothers (HR = 1.90, 95% CI: 1.23–2.95) and circulatory causes in both parents (HR = 1.69; 95% CI: 1.22–2.34 in mothers and HR = 1.25; 95% CI: 1.02–1.54 in fathers). Bereavement was not associated with parental risk of cancer disease and with survival from cancer. The association between bereavement and parental overall mortality was similar in the different parental sociodemographic characteristics. We observed a decrease in HRs for parental mortality associated with bereavement, with increasing time since the death of the child (HRs = 9–10, 0–3 years; HRs = 0.9–1.0, 9+ years; Pheterogeneity ≤3 × 10−32). A similar decrease in HRs was observed for parental survival from cancer (HRs = 6.7–8.7, 0–3 years; HRs = 0.9–1.0, 9+ years). ConclusionsOur study suggests that child loss was associated with slightly increased risk of all-cause and circulatory mortality in parents but not with incidence of cancer and cancer survival. The considerable increased parental mortality during a short period after child loss support the involvement of pathways related to psychological stress.

Geographical variation in relative risks associated with cold waves in Spain: The need for a cold wave prevention plan

In general, there are few studies that analyse the impact of low temperatures on mortality and fewer still that use cold-wave-definition thresholds based on epidemiological and non-climatological criteria. Such a threshold definition, which took into account population features such as socio-economic and demographic characteristics, made it possible for a specific threshold temperature to be obtained for each of Spain's 52 provincial capitals in this study. Using generalised linear models with the Poisson regression link, and controlling for trend, autocorrelations and seasonalities of the series, and influenza epidemics, we obtained the impact of low temperatures on mortality in each provincial capital by calculating the relative risks (RRs) and attributable risks (ARs) for natural as well as circulatory and respiratory causes. The study showed higher minimum temperature thresholds in coastal areas, and an overall impact of cold on mortality in Spain due to natural causes RR=1.13 (95% CI: 1.11–1.16), circulatory causes RR=1.18 (95% CI: 1.15–1.22) and respiratory causes RR=1.24 (95% CI: 1.20–1.29) slightly greater than that obtained to date for heat. From a public health standpoint, there is a need for specific cold wave prevention plans at a regional level which would enable mortality attributable to low temperatures to be reduced. These plans have shown themselves to be effective in decreasing heat-related mortality, and we feel that they are essential for reducing cold-related effects on morbidity and mortality.

Abstract 18068: Trends in Proportionate Cardiovascular Mortality Among Adults With Human Immunodeficiency Virus in the United States: 1999-2013

Introduction: Due to the success of antiretroviral therapy, Human Immunodeficiency Virus (HIV)-infected individuals live longer and are at risk for cardiovascular disease (CVD). Whether the proportion of deaths due to CVD in the HIV-infected population has increased over time is unknown. Hypothesis: Our hypothesis was that proportionate mortality from CVD in the HIV-infected population has increased significantly since 1999. Methods: Using the publicly available CDC Wonder database of U.S. national mortality data, we assessed proportionate CVD mortality among adults aged ≥25 years with HIV. We compared these data to proportionate CVD mortality in two control groups: the general population and people with underlying inflammatory disease (i.e., inflammatory polyarthropathies (IPA)). For each group, we calculated proportionate CVD mortality by dividing deaths attributed to circulatory causes (based on ICD10 coding) by all causes of death for each year from 1999 to 2013. Results: Proportionate CVD mortality increased among HIV+ individuals from 1.9% of deaths in 1999 to 4.6% in 2013 (Figure 1); this pattern of increasing proportionate mortality was highly significant for men and women (P<0.01) and consistent across race groups. Meanwhile, proportionate CVD mortality declined in the general population (41% in 1999 to 32% in 2013; P<0.01) and IPA population (40% in 1999 to 29% in 2013; P<0.01). A sensitivity analysis including only in-hospital deaths also revealed a highly significant increase in proportionate CVD mortality for HIV-infected individuals, from 2.1% in 1999 to 3.9% in 2013 (P<0.01). Hypertensive and pulmonary heart diseases were 2-3 times more likely to be the cause of death in the HIV population than in the general population. Conclusions: Proportionate CVD mortality appears to have increased substantially in the HIV-infected population since 1999. Further studies are needed to guide risk assessment and prevention in this unique population.

A Case-Crossover Study of Temperature and Infant Mortality in California.

While most research on temperature and mortality has focused on the elderly, little has concentrated on infants, who may also lack thermoregulatory responses to heat exposure. We examined mean daily apparent temperature, a combination of temperature and humidity, and infant deaths in California during the warm season of May through October 1999 to 2011. Deaths from all causes and specifically from congenital malformations, sudden infant death syndrome, abnormal gestation duration, respiratory causes, and circulatory causes were considered in a time-stratified case-crossover analysis of 12 356 infant deaths. For all-cause mortality, excess risk was 4.4% (95% confidence interval -0.3, 9.2) per 5.6°C increase for average of same day and previous 3 days apparent temperature (lag 03). The associations for apparent temperature and both all-cause mortality and deaths caused by gestation duration were highest for Black infants (13.3%, 95% CI 0.6, 27.6 and 23.7%, 95% CI -3.3, 58.2, respectively), while White infants had elevated risk for deaths from respiratory causes (44.6%; -0.7, 110.5). We further observed differential effects for neonates (infants aged 28 days and under) and post-neonates (infants above 28 days and under 1 year), and coastal and non-coastal regions. These associations remained even after considering criteria air pollutants. This study suggests that infants are a vulnerable subgroup to heat exposure. Further studies should be conducted with a sufficient number of cases of infant deaths in other locales.