Circulatory Deaths Research Articles

Causes of Excess Mortality in Diabetes Patients Without Coronary Artery Disease: A Cohort Study Revealing Endocrinologic Contributions.

Diabetes mellitus (DM) patients without coronary artery disease (CAD) have a higher all-cause mortality rate than patients with neither DM nor CAD. We examined cause-specific death of DM patients with and without CAD. We conducted a cohort study of all patients who underwent CAG in Western Denmark between 2003 and 2016. Using Danish health registries, patients were followed for a maximum of 10 years and stratified according to their DM and CAD status. Outcomes included all-cause-, cancer-, circulatory-, and endocrinologic death. Ten-year cumulative risks were computed as well as adjusted and unadjusted hazard ratios (aHR and HR). A total of 132,432 patients (28,524 deaths, median follow-up of 6.2 years) were included. Compared to patients with neither DM nor CAD, DM patients without CAD had a higher 10-year risk of all-cause death (27.9% versus 19.7%, aHR 1.43 [95% CI 1.35-1.52]), cancer death (7.2% versus 5.4%, aHR 1.29 [95% CI 1.15-1.46]), circulatory death (9.1% versus 6.9%, aHR 1.35 [95% CI 1.22-1.49]), and endocrinologic death (3.9% versus 0.3%, aHR 14.02 [95% CI 10.95-17.95]). Among endocrinologic deaths, 87% were due to classical complications of DM, such as diabetic nephropathy and ketoacidosis, in DM patients without CAD. Diabetes patients without CAD exhibit a higher risk of all-cause mortality, driven primarily by elevated rates of cancer, circulatory, and endocrinologic deaths, particularly related to diabetic microvascular complications.

Relationship between short-term ozone exposure, cause-specific mortality, and high-risk populations: A nationwide, time-stratified, case-crossover study

BackgroundPrevious studies reported that short-term exposure to ground-level ozone is associated with mortality risk. However, due to the limited monitored areas, existing studies were limited in assessing the nationwide risk and suggesting specific vulnerable populations to the ozone-mortality risk. MethodsWe performed a nationwide time-stratified case-crossover study to evaluate the association between short-term ozone and cause-specific mortality in South Korea (2015–2019). A machine learning-ensemble prediction model (a test R2 > 0.96) was used to assess the short-term ozone exposure. Stratification analysis was conducted to examine the high-risk populations, and the excess mortality due to non-compliance with the WHO guideline was also assessed. ResultsFor all-cause mortality (1,343,077 cases), the risk associated with ozone (lag0– 1) was weakly identified (odd ratio: 1.005 with 95% CI: 0.997–1.014), and the risk was prominent in mortality with circulatory system diseases. In addition, based on the point estimates, the ozone-mortality risk was higher in people aged less than 65y, and this pattern was also observed in circulatory system disease deaths and urban areas. ConclusionsThis study provides national estimates of mortality risks associated with short-term ozone. Results showed that the benefits of stricter air quality standards could be greater in vulnerable populations.

Impact of SARS-CoV-2 Pandemic on Ocular Tissue Donation in a Teaching Hospital

Objectives: To analyze the impact of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic on ocular tissue donations, assessing lost opportunities for potential donors due to the suspension of collections and changes in eligibility criteria, as well as hospital eligibility rates of donors and causes of non-donation. Methods: Data from patients who died in cardiopulmonary arrest in a Brazilian university hospital in 2020 were analyzed. The number of donations made, the number of deaths potentially eligible for donation, and the causes of non-donation were compared during the three periods of 2020: period 1, pre-pandemic ( January 1 to March 18, 2020), period 2, with suspension of donations in cardiorespiratory arrest (March 19 to September 19, 2020), and period 3, of collections with epidemiological screening for SARS-CoV-2 and reduction of the age range of donors less than 65 years old (September 20 to December 31 2020). Results: There were 710 circulatory deaths in 2020. The hospital eligibility rate was 5.7% among 140 deaths in the pre-pandemic period 1, 11.9% among 395 patients during the suspension of uptake in pandemic period 2, and 3.4% among 175 patients during age group restrictions and coronavirus disease 2019 (COVID-19) screening (p:0.004). Forty-seven patients who died in period 2 represented a loss of donation opportunities due to the suspension of collections, and 13 (7.6%) of the 175 patients in period 3 were ineligible due to the reduction in age group. Due to pandemic restrictions, eighty-one percent of the 75 eligible patients without clinical contraindications had limited tissue donation offers. Only one patient was considered ineligible for donation due to clinical-epidemiological screening for SARS-CoV-2. Serious infections were the leading cause of non-donation in 50.7, 48.1, and 47.4% of deaths in the three periods (p:0.615). Conclusion: The SARS-CoV-2 pandemic significantly affected the procurement of ocular tissues for transplants due to the restrictive measures implemented for safety reasons, leading to the loss of donation opportunities for 81% of families. Age restrictions significantly reduced potential donor eligibility rates. Serious infections were the leading cause of non-donation of ocular tissue, but it did not increase significantly in this study during the pandemic, in the period studied.

Impact of Back-to-Base Normothermic Machine Perfusion on Complications and Costs: A Multicenter, Real-World Risk-Matched Analysis.

Assess cost and complication outcomes after liver transplantation (LT) using normothermic machine perfusion (NMP). End-ischemic NMP is often used to aid logistics, yet its impact on outcomes after LT remains unclear, as does its true impact on costs associated with transplantation. Deceased donor liver recipients at 2 centers (January 1, 2019, to June 30, 2023) were included. Retransplants, splits, and combined grafts were excluded. End-ischemic NMP (OrganOx-Metra) was implemented in October 2022 for extended-criteria donation after brain death (DBDs), all donations after circulatory deaths (DCDs), and logistics. NMP cases were matched 1:2 with static cold storage controls (SCS) using the Balance-of-Risk [donation after brain death (DBD)-grafts] and UK-DCD Score (DCD-grafts). Overall, 803 transplantations were included, 174 (21.7%) receiving NMP. Matching was achieved between 118 NMP-DBDs with 236 SCS; and 37 NMP-DCD with 74 corresponding SCS. For both graft types, median inpatient comprehensive complications index values were comparable between groups. DCD-NMP grafts experienced reduced cumulative 90-day comprehensive complications index (27.6 vs 41.9, P =0.028). NMP also reduced the need for early relaparotomy and renal replacement therapy, with subsequently less frequent major complications (Clavien-Dindo ≥IVa). This effect was more pronounced in DCD transplants. NMP had no protective effect on early biliary complications. Organ acquisition/preservation costs were higher with NMP, yet NMP-treated grafts had lower 90-day pretransplant costs in the context of shorter waiting list times. Overall costs were comparable for both cohorts. This is the first risk-adjusted outcome and cost analysis comparing NMP and SCS. In addition to logistical benefits, NMP was associated with a reduction in relaparotomy and bleeding in DBD grafts, and overall complications and post-LT renal replacement for DCDs. While organ acquisition/preservation was more costly with NMP, overall 90-day health care costs-per-transplantation were comparable.

The threaten of typhoons to the health of residents in inland areas: a study on the vulnerability of residents to death risk during typhoon “Lekima”

BackgroundStudies had suggested increased risk of death of residents was associated with typhoons, particularly coastal regions. However, these findings ignored the impact of inland typhoons on the health of residents, especially the indirect death risk caused by typhoons. This study aimed to investigate the acute death risk of residents during inland typhoon Lekima in Jinan, further identify vulnerable populations and areas.MethodsWe selected the daily death from 11 to 27th August 2019 in Jinan as case period, and conducted a time-stratified case-crossover design to match the contemporaneous data from 2016 to 2018 as control period. We used the generalized linear Poisson models to estimate the related effects of death risk during typhoon Lekima and lag days.ResultsDuring the Lekima typhoon month, there were 3,366 deaths occurred in Jinan. Compared to unexposed periods, the acute death risk of non-accidental diseases (especially circulatory diseases), female and the older adults increased significantly in the second week after the typhoon. The maximum significant effect of circulatory disease deaths, female and older adult deaths were appeared on lag9, lag9, and lag13 respectively. And the typhoon-associated RR were 1.19 (95%CI:1.05,1.34), 1.28 (95%CI:1.08,1.52), and 1.22 (95%CI:1.06,1.42) respectively. The acute death risk of residents living in TQ and CQ increased significantly on Lag2 and Lag6 after the typhoon, respectively, while those living in LX, LC, HY, JY, and SH occurred from Lag 8 to Lag 13 after the typhoon. LC lasted the longest days.ConclusionsTyphoons would increase the vulnerability of residents living in Jinan which mainly occurred from the seventh day after the typhoon. Residents suffering from non-accidental diseases (circulatory diseases), female and the older adults were more vulnerable. The vulnerability of TQ and CQ occurred on Lag2 and Lag6 after typhoon Lekima, respectively, and the other areas except ZQ and PY occurred from Lag 8 to Lag 13. LC lasted the longest duration. Our findings emphasized the importance of the emergency response, which would help policymakers to identify vulnerable regions and populations accurately during typhoons and formulate the emergency response plan.

Unclosing Premature Mortality Gap Among Patients With Gout in the US General Population, Independent of Serum Urate and Atherosclerotic Cardiovascular Risk Factors.

Gout flares are followed by transient major cardiovascular (CV) risk, implicating the role of inflammation; the aim of this study was to determine whether premature mortality rates in patients with gout and CV risk are independent of serum urate (SU) and atherosclerotic CV disease (ASCVD) risk factors. Using serial US nationwide prospective cohorts, we evaluated the independent association of prevalent gout with all-cause and CV mortality, adjusting for SU, ASCVD risk factors, comorbidities, medications, and kidney function and compared mortality rates between the early (1988-1994 baseline) and late cohorts (2007-2016 baseline). We replicated late cohort findings among patients with gout in a nationwide UK cohort (2006-2010 baseline). Adjusted hazard ratios (HRs) for mortality rates in patients with prevalent gout were similar in early and late US cohorts (1.20 [1.03-1.40] and 1.19 [1.04-1.37], respectively); HRs with further adjustment for SU were 1.19 (1.02-1.38) and 1.19 (1.03-1.37), respectively. Adjusted HR among patients with gout from the UK late cohort was 1.61 (1.47-1.75); these associations were larger among women (P = 0.04) and prominent among Black individuals. Adjusted HR for CV mortality rates in the late US cohort was 1.39 (1.09-1.78); those for circulatory, CV, and coronary heart disease deaths among UK patients with incident gout were 1.48 (1.24-1.76), 1.49 (1.20-1.85), and 1.59 (1.26-1.99), respectively. Patients with gout experience a persistent mortality gap in all-cause and CV deaths, even adjusting for SU and ASCVD risk factors, supporting a role for gout-specific pathways (eg, flare inflammation). These findings suggest gaps in current care, particularly in women and possibly among Black patients.

Patterns and predictors of ten-year mortality after discharge from community-based post-acute care for acquired brain injury: A retrospective cohort study (ABI-RESTaRT), Western Australia, 1991–2017

BackgroundSurvivors of acquired brain injury (ABI) are left with long-term disability and an increased risk of mortality years post-injury. ObjectiveTo examine 10-year mortality in adults with ABI after discharge from post-acute care and identify modifiable risk factors to reduce long-term mortality risk. MethodsRetrospective cohort study of 586 adults with traumatic (TBI) or non-traumatic brain injury (NTBI), or neurologic condition, consecutively discharged from a post-acute rehabilitation service in Western Australia from 1-Mar-1991 to 31-Dec-2017. Data sources included rehabilitation records, and linked mortality, hospital, and emergency department data. Survival status at 10 years post-discharge was determined. All-cause and cause-specific age- and sex-adjusted standardised mortality ratios (SMR) by ABI diagnosis were calculated using Australian population reference data. Risk factors were examined using multilevel cox proportional hazards regression. ResultsCompared with the Australian population, 10-year all-cause mortality was significantly elevated for all diagnosis cohorts, with the first 12 months the highest risk period. Accidents or intentional self-harm deaths were elevated in TBI (13.2, 95%CI 5.4; 12.1). Neurodegenerative disease deaths were elevated in Neurologic (21.9, 95%CI 13.0; 30.9) and Stroke (19.8; 95%CI 2.4; 27.2) cohorts. Stroke (20.8; 95%CI 7.9; 33.8) and circulatory disease deaths (6.2; 95%CI 2.3; 9.9) were also elevated in Stroke. Psychiatric comorbidity was the strongest risk factor followed by older age, geographical remoteness, and cardiac, vascular, genitourinary and renal comorbidity. Clinically significant improvement in functional independence and psychosocial functioning significantly reduced mortality risk. ConclusionsIndividuals with ABI have an elevated risk of mortality years post-injury. Comorbidity management, continuity of care, and rehabilitation are important to reduce long-term mortality risk.

Does decarbonization policy decrease disease risks from black carbon in Beijing, China? A comparison study

Epidemiology studies evaluating the health effect of the decarbonization policy in Beijing, China are limited. This time series study sought to examine the health effectiveness of BC and PM2.5 in Beijing, a formerly heavily polluted city. Therefore, the objectives of this article were (1) to evaluate the modification effects of temperature on the health effects of black carbon (BC) and fine particles (PM2.5) in Beijing. (2) to compare the health effects of BC and PM2.5 pre- and post-implementation of decarbonization policy. Bivariate Response Surface Model and Generalised Additive Model were used to analyze the modification effects. Comparison analysis was conducted pre- and post-implementation of decarbonization policy. The results indicated that (i) Post-implementation, reductions were noted in non-accidental diseases (RR = 1.064 per 10 μg/m3), circulatory diseases (RR = 1.068 per 10 μg/m3) and respiratory diseases (RR = 1.148 per 10 μg/m3) related to BC; this was especially pronounced on cold days. (ii) Greater reductions in risk of non-accidental, circulatory and respiratory deaths (D-value: 0.134 versus 0.002, 0.180 versus 0.003, 0.176 versus 0.002) were noted for BC than for PM2.5. (iii) Higher risks of the impact of BC on respiratory diseases were observed in females than in males. In conclusion, a stronger correlation existed between BC and mortality on cold days than moderately cold days in Beijing. Furthermore, compared with PM2.5, BC posed a greater disease risk and the effectiveness of the decarbonization policy was more obvious.

Trends in Psychotropic Drug−Implicated Cardiovascular Mortality: Patterns in U.S. Mortality, 1999−2020

Psychotropic drug-implicated (PDI) mortality-deaths in which psychotropic drugs were a contributing but not underlying cause of death-increased over two decades, with circulatory mortality as the primary cause leading to such deaths. Trends in PDI circulatory mortality over a 22-year period and its patterning in U.S. deaths are described. Deaths extracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research Multiple Causes of Death database from 1999 to 2020 were analyzed to generate annual counts and rates for drug-implicated deaths due to diseases of the circulatory system, including by specific drug, sex, race/ethnicity, age, and state. During a period when overall age-adjusted circulatory mortality rates declined, PDI circulatory mortality more than doubled, from 0.22 per 100,000 in 1999 to 0.57 per 100,000 by 2020, now representing 1 in 444 circulatory deaths. Although PDI deaths from ischemic heart diseases are proportionally aligned with overall circulatory deaths (50.0% vs 48.5%), PDI deaths from hypertensive diseases represent a larger proportion (19.8% vs 8.0%). Psychostimulants generated the greatest escalation for PDI circulatory deaths (0.029-0.332 per 100,000). The sex gap in PDI mortality rates widened (0.291 females, 0.861 males). PDI circulatory mortality is particularly notable for Black Americans and midlife Americans, with considerable geographic variability. Circulatory mortality with psychotropic drugs as a contributing cause escalated over 2 decades. Trends in PDI mortality are not evenly distributed across the population. Greater engagement with patients about their substance use is needed to intervene in cardiovascular deaths. Prevention and clinical intervention could contribute to reinvigorating previous trends of declining cardiovascular mortality.

Days alive and out of hospital after liver transplant: comparing a patient-centered outcome between recipients of grafts from donation after circulatory and brain deaths

We retrospectively compared outcomes between recipients of donation after circulatory death (DCD) and donation after brain death (DBD) liver allografts using days alive and out of hospital (DAOH), a composite outcome of mortality, morbidity, and burden of care from patient perspective. The initial length of stay and duration of any subsequent readmission for the first year after liver transplantation were recorded. Donor category and perioperative and intraoperative characteristics pertinent to liver transplantation were included. The primary outcome was DAOH365. Secondary outcomes included early allograft dysfunction and hepatic arterial and biliary complications. Although the incidence of both early allograft dysfunction (P < .001) and ischemic cholangiopathy (P < .001) was significantly greater in the recipients of DCD, there were no significant differences in the length of stay and DAOH365. The median DAOH365 was 355 days for recipients of DBD allografts and 353 days for recipients of DCD allografts (P = .34). Increased transfusion burden, longer cold ischemic time, and non-White recipients were associated with decreased DAOH. There were no significant differences in graft failure (P = .67), retransplantation (P = .67), or 1-year mortality (P = .96) between the 2 groups. DAOH is a practical and attainable measure of outcome after liver transplantation. This metric should be considered for quality measurement and reporting in liver transplantation.

Perceptions and Early Outcomes of the Acuity Circles Allocation Policy Among Liver Transplant Centers in the United States.

A 28-item survey was sent to division chiefs and surgical directors of liver transplantation across the United States. Questions assessed the respondents' perceptions regarding center-level metrics and staff satisfaction. We used Organ Procurement and Transplantation Network data to study differences in allocation between the pre-AC implementation period (2019) and the post-AC implementation period (2020-2021). A total of 40 participants completed this ongoing survey study. Most responses were from region 8 (13%), region 10 (15%), and region 11 (13%). Sixty-three percent of respondents stated that the wait time for a suitable offer for recipients with model of end-stage liver disease score <30 has decreased, whereas 50% stated that wait time for a suitable offer for recipients with model of end-stage liver disease score >30 has increased. However, most respondents (75%) felt that the average cost per transplant had increased and that the rate of surgical complications and 1-y graft survival had remained the same. In most states, an observable decrease in in-state liver transplantations occurred each year between 2019 and 2021. In addition, most allocation regions reported an increase in donations after circulatory deaths between 2019 and 2021. Perceptions of the new AC policy among liver transplant surgeons in the United States remain mixed, highlighting the potential strengths and concerns regarding its future impact. Further studies should assess the effects of the AC policy on clinical outcomes and liver transplantation access.

Long-term Transplant Function After Thrombolytic Treatment Ex Vivo of Donated Kidneys Retrieved 4 to 5 H After Circulatory Death.

Using a novel thrombolytic technique, we present long-term transplant function, measured by creatinine and iohexol clearance, after utilizing kidneys from porcine donors with uncontrolled donation after circulatory deaths, with 4.5-5 h of warm ischemia. Pigs in the study group were subjected to simulated circulatory death. After 2 h, ice slush was inserted into the abdomen and 4.5 h after death, the kidneys were retrieved. Lys-plasminogen, antithrombin-III, and alteplase were injected through the renal arteries on the back table. Subsequent ex vivo perfusion was continued for 3 h at 15°C, followed by 3 h with red blood cells at 32°C, and then transplanted into pigs as an autologous graft as only renal support. Living-donor recipient pigs that did not receive ex vivo perfusion, and unilateral nephrectomized pigs served as the controls. Pigs in the study group (n = 13), surviving 10 d or more were included, of which 7 survived for 3 mo. Four animals in the living-donor group (n = 6) and all 5 nephrectomized animals survived for 3 mo. Creatinine levels in the plasma and urine, neutrophil gelatinase-associated lipocalin levels, Kidney Injury Marker-1 expression, and iohexol clearance at 3 mo did not differ significantly between the study and living-donor groups. Histology and transmission electron microscopy after 3 mo showed negligible fibrosis and no other damage. The present method salvages kidneys from extended unontrolled donation after circulatory death using thrombolytic treatment while preserving histology and enabling transplantation after ex vivo reconditioning, with clinically acceptable late function after 3 mo, as measured by creatinine and iohexol clearance.

Estimated mortality due to seasonal influenza in southeast of Iran, 2006/2007 to 2011/2012 influenza seasons.

Global estimates showed an estimate of up to 650,000 seasonal influenza-associated respiratory deaths annually. However, the mortality rate of seasonal influenza is unknown for most countries in the WHO Eastern Mediterranean Region, including Iran. We aimed to estimate the excess mortality attributable to seasonal influenza in Kerman province, southeast Iran for the influenza seasons 2006/2007-2011/2012. We applied a Serfling model to the weekly total pneumonia and influenza (PI) mortality rate during winter to define the epidemic periods and to the weekly age-specific PI, respiratory, circulatory, and all-cause deaths during non-epidemic periods to estimate baseline mortality. The excess mortality was calculated as the difference between observed and predicted mortality. Country estimates were obtained by multiplying the estimated annual excess death rates by the populations of Iran. We estimated an annual average excess of 40 PI, 100 respiratory, 94 circulatory, and 306 all-cause deaths attributable to seasonal influenza in Kerman; corresponding to annual rates of 1.4 (95% confidence interval [CI] 1.1-1.8) PI, 3.6 (95% CI 2.6-4.8) respiratory, 3.4 (95% CI 2.1-5.2) circulatory, and 11.0 (95% CI 7.3-15.6) all-cause deaths per 100,000 population. Adults ≥75 years accounted for 56% and 53% of all excess respiratory and circulatory deaths, respectively. At country level, we would expect an annual of 1119 PI to 8792 all-cause deaths attributable to seasonal influenza. Our findings help to define the mortality burden of seasonal influenza, most of which affects adults aged ≥75 years. This study supports influenza prevention and vaccination programs in older adults.

Mortality Associated with Extreme Heat in Washington State: The Historical and Projected Public Health Burden

Extreme heat is one of the most important pathways illustrating the connection between climate and human health, and climate change is expected to exacerbate this public health issue. This study first used a case-crossover analysis to characterize the historical (1980–2018) association between summertime heat and non-traumatic mortality in Washington State. A separate analysis was conducted for each of the state’s ten climate divisions to produce distinct exposure–response curves expressing odds of mortality as a function of humidex. Stratified analyses were used to assess the impact of age, sex, race/ethnicity, and select causes of death, and the reported results are pooled across all divisions using meta-analysis. The historical heat–mortality relationship was combined with climate projections to estimate the impact of climate change on heat-related deaths in 2030, 2050, and 2080 under two warming scenarios. The odds ratio (OR) and 95% confidence intervals of mortality at the 99th percentile of humidex compared to the 50th percentile did not include the null value in four climate divisions (E Olympic Cascade Foothills, NE Olympic San Juan, Northeastern, and Puget Sound Lowlands). The statewide odds of mortality are 8% higher (6%, 10%) on 99th percentile days compared to 50th percentile days, driven primarily by an OR of 1.09 (1.06, 1.11) in the Puget Sound Lowlands. Risk is higher for women than men and for Blacks than Whites. Risk increases with age and for diabetic, circulatory, cardiovascular, ischemic, cerebrovascular, and respiratory deaths. The 95% confidence intervals of projected heat-attributable mortality did not overlap with zero in three climate divisions (E Olympic Cascade Foothills, NE Olympic San Juan, and Puget Sound Lowlands). In these three divisions, the average percent increase in heat-attributable mortality across both warming scenarios is 35%, 35%, and 603% in 2030, 2050, and 2080, respectively. This research is the most extensive study of heat-related mortality in Washington to date and can help inform public health initiatives aiming to improve present and future health outcomes in the state.

Direct and indirect effects of the COVID-19 pandemic on mortality: an individual-level population-scale analysis.

ObjectivesThe COVID-19 pandemic has had a detrimental impact on healthcare utilisation, resulting in increased mortality both directly and indirectly associated with COVID-19. We aimed to assess the impact of the COVID-19 pandemic on all-cause and disease-specific mortality and further explore the impact of potential inequalities, deprivation status and ethnicity. ApproachPopulation-scale, individual-level, anonymised linked, routinely-collected electronic health records from demographic and administrative sources were used for two cohorts: i) C19-COHORT16 included individuals alive and resident in Wales on the 1st January 2016 with follow-up until death, break-in Welsh residency, or 31st December 2019; ii) C19-COHORT20 included individuals alive and resident in Wales on 1st January 2020 with follow-up until death, break-in Welsh residency, or study end. We used time-series analysis to investigate trends in mortality over time. We fitted negative binomial models to estimate expected all-cause and disease-specific mortality and compared these estimates to observed mortality in C19-COHORT20. ResultsExcess all-cause and COVID19-related deaths were higher during the period where the alpha variant was dominant. The trend in deaths decreased during the omicron dominant period. The Asian population had increased mortality during the period where the delta variant was dominant. Mortality was increased for most deprived groups compared to least deprived groups, however, the magnitude of this effect remained unchanged during the pandemic. COVID-19 indirectly affected cancer, circulatory, trauma, digestive and mental health related deaths, with a higher than expected mortality. The majority of trauma related deaths occurred early on in the pandemic, where a higher than expected number of deaths occurred outside of an NHS establishment. Mortality associated with respiratory disease (unrelated to COVID-19) was significantly lower than expected during the COVID-19 pandemic. ConclusionIncreased all-cause and disease-specific mortality was observed during the COVID-19 pandemic. Excess deaths may be a result of reduced healthcare utilisation, delayed investigation and/or treatment of chronic diseases. As healthcare systems recover from COVID-19, investigation of mortality trends will play a central role in healthcare planning, utilisation and resource use.

Extreme cold weather and circulatory diseases of older adults: A time-stratified case-crossover study in jinan, China

ObjectivesWe aimed to investigate the acute effect of extreme cold weather on circulatory disease mortality of older adults in Jinan, with individual and regional-scale characteristics as subgroup analyses to further identify vulnerable populations. MethodsThis study contained the death data of Jinan from 2011 to 2020 (Nov–Mar). A time-stratified case-crossover method was used to estimate the effects of extreme cold weather and lags 0–8 days, controlling for holiday and relative humidity. To evaluate the impact of different durations and thresholds of extreme cold weather, we considered 4 cold day and 12 cold wave definitions ResultsOur results showed an increase in circulatory disease deaths under several definitions. The number of older adults died of circulatory diseases totaled 92,119 during the study period. In the definitions of cold day, the maximum significant effect ranging from 1.08 (95% CI: 1.03,1.14) to 1.13 (95% CI: 1.04,1.24) and appeared on Lag5 or Lag6. In the definitions of cold wave, the maximum significant effect ranging from 1.07 (95% CI: 1.02, 1.12) to 1.14 (95% CI: 1.03, 1.25). The cold effect is mainly attributable to cold day rather than an added effect related to the duration. Our research confirmed that extreme cold weather had a stronger impact on women [maximum effects with an OR of 1.21 (95% CI: 1.08, 1.36) in P1, 1.19 (95% CI: 1.05, 1.36) in M12)], and the effect gradient increased with age. ConclusionsOur findings support the evidence on the impact of extreme cold weather on circulatory disease mortality and provide a basis for policymakers to select target groups to develop policies and reduce the public health burden.

Novel Ex-Vivo Thrombolytic Reconditioning of Kidneys Retrieved 4 to 5 Hours After Circulatory Death.

Background.Due to organ shortage, many patients do not receive donor organs. The present novel thrombolytic technique utilizes organs from donors with uncontrolled donation after circulatory deaths (uDCD), with up to 4–5 h warm ischemia, without advanced cardiopulmonary resuscitation (aCPR) or extracorporeal circulation (EC) after death.Methods.The study group of pigs (n = 21) underwent simulated circulatory death. After 2 h, an ice slush was inserted into the abdomen. Kidneys were retrieved 4.5 h after death. Lys-plasminogen, antithrombin-III (ATIII), and alteplase (tPA) were injected through the renal arteries on the back table. Subsequent ex vivo perfusion at 15 °C was continued for 3 h, followed by 3 h with red blood cells (RBCs) at 32 °C. Perfusion outcome and histology were compared between uDCD kidneys, receiving no thrombolytic treatment (n = 8), and live donor kidneys (n = 7). The study kidneys were then transplanted into pigs as autologous grafts with a single functioning autologous kidney as the only renal support. uDCD control pigs (n = 8), receiving no ex vivo perfusion, served as controls.Results.Vascular resistance decreased to <200 mmHg/mL/min (P < 0.0023) and arterial flow increased to >100 mL/100 g/min (P < 0.00019) compared to controls. In total 13/21 study pigs survived for >10 days, while all uDCD control pigs died. Histology was preserved after reconditioning, and the creatinine level after 10 days was next to normal.Conclusions.Kidneys from extended uDCD, not receiving aCPR/EC, can be salvaged using thrombolytic treatment to remove fibrin thrombi while preserving histology and enabling transplantation with a clinically acceptable early function.

A Time-Series Analysis on the Association Between Fine Particulate Matter and Daily Mortality - Shijiazhuang City, Hebei Province, China, 2015-2020.

IntroductionShijiazhuang is one of the most polluted cities in China, but few studies have investigated the acute impact of fine particulate matter (PM2.5) on mortality in this city. We assessed associations between PM2.5 and cause-specific mortality during 2015 to 2020. MethodsWe obtained air quality data from Shijiazhuang Ecology and Environment Bureau, meteorological data from Shijiazhuang Meteorological Bureau, and mortality data from Shijiazhuang CDC’s Cause of Death Reporting System for our analyses. We used a quasi-Poisson regression generalized additive model to assess excess risk of death for a single time-lag and for moving average time-lags of 0–7 days, stratifying by year, sex, age, and education.ResultsThere were 76,859 non-accidental deaths recorded in Shijiazhuang during the study period. The daily concentration of PM2.5 ranged from 6.3 μg/m3 to 625.3 μg/m3, and the annual mean concentration was 77.6 μg/m3. Regression analysis showed that an increment of PM2.5 of 10 μg/m3 in a two-day average concentration (lag01) was associated with 0.47% [95% Confidence Interval (CI): 0.24%, 0.70%], 0.49% (95% CI: 0.19%, 0.79%), and 0.72% (95% CI: 0.22%, 1.23%) increases in non-accidental deaths, cardiovascular disease deaths, and respiratory disease deaths, respectively. With reduction of PM2.5 concentration, impact of PM2.5 on respiratory disease deaths decreased, but the impact of PM2.5 on total non-accidental deaths and circulatory disease deaths did not change significantly. ConclusionAlthough PM2.5 has been greatly reduced in recent years, PM2.5 pollution is still serious in Shijiazhuang. PM2.5 was significantly associated with non-accidental death, cardiovascular disease death, and respiratory disease death. As PM2.5 concentrations decreased, risk of death from respiratory diseases also decreased.

Effects of ambient temperatures and extreme weather events on circulatory mortality in a high population density area: Exploring mortality data from Malta

BackgroundTemperature-related circulatory mortality has gained consistent public health importance worldwide due to changes in inter-annual average temperatures and the increased frequency of extreme events over time. This study investigates the association between temperature and circulatory deaths in one of the highest population densities in the world (Malta) with a Mediterranean climate. MethodsDaily deaths relating to circulatory mortality (32,847 deaths) were obtained from January 1992 to December 2017. A distributed lag non-linear model (DLNM) with a Poisson distribution was utilized to estimate effects of ambient temperatures and heatwaves or cold spells (2–4 consecutive days). Effects were also explored for the specific cause of death, different age groups, gender and time periods. ResultsThe study observed a U-shaped cumulative exposure–response curve with a greater mortality risk due to cooler temperatures (8–15°C) after adjusting for harvesting effects (0–27 days). Colder temperatures (<8.9°C) were strongly related to both ischemic heart disease (IHD) (RR, 1.85, 95% CI, 1.24–2.77) and cerebrovascular disease (RR, 3.80,95% CI, 1.57–9.17). While heat effects were short-term (0–5 lag days), the cold effects were long-term (0–27 days) and consistent across different lag days. Cooler temperatures (8.99–12.6°C) were also related to IHD mortality in males (RR, 1.94, 95% CI, 1.05–3.59) and females (RR, 1.95, 95% CI, 1.2–3.59) and cerebrovascular mortality in females (RR, 8.32, 95% CI, 2.58–26.80). Elderly females (over 65 years) had a higher risk of death relating to IHD (RR, 1.33, 95% CI, 1.19–3.18) and cerebrovascular diseases (RR, 8.84, 95% CI, 2.64–29.61). Interestingly, colder temperatures (<8.9°C) were highly related to cerebrovascular deaths in the earliest time period (1992–2000) and IHD deaths in the most recent time period (2000–2017). While the effect of heatwaves was unclear across the time periods, there was some visible cold-spell effects for cerebrovascular mortality (RR, 1.03, 95% CI, 1.01–1.06). ConclusionThis study used a long time series of mortality data from a high population density area to explore the impact of ambient temperature and extreme events on circulatory deaths. The results of the study will help to improve preventive and adaptive strategies to mitigate climatic health impacts.

The importance of the autopsy in ascertaining the cause of death and as an audit tool at the university college hospital, Ibadan.

Different reasons for autopsies include medico-legal causes, medical education and deducing the cause of death. An additional benefit is auditing with regards to patient care in the diagnosis and treatment of diseases. The main objective of this study was to determine the concordance between ante-mortem clinical diagnoses and post-mortem causes of death. From January 2009 to December 2015, Autopsy records at the Department of Pathology, University College Hospital, Ibadan were reviewed. Discrepancies between the clinical diagnoses and postmortem findings were categorised using Goldman criteria into major and minor classes. Goldman's criteria can be sub-categorised into five classes: Class I, Class II, Class III, Class IV and Class V. Classification of the cause of death categories was by the International Classification of Diseases, Version 10. The study was carried out with respect to the world medical association's Declaration of Helsinki (2013). Data analysis was carried out with the use of the Statistical Package for the Social Sciences (SPSS version 22). Five hundred and thirty-three cases were involved with a male-female ratio of 1.6. The most common postmortem causes of death were traumatic Injuries (20.6%), Circulatory system-related deaths (19.7%), infections (16.9%) and malignant neoplasms (9.4%). Only 298 (55.9%) of the cases showed a concordance between the post-mortem causes of death and the clinical diagnosis. The post-mortem autopsy is useful in the audit of current medical practice in our environment.