Death In Austria Research Articles

Attributable deaths in Austria due to ozone under different climate scenarios.

Tropospheric ozone is an air pollutant that poses a public health problem in Europe. Climate change could increase the formation of ozone. Applying past and predicted annual total (all-cause) mortality data and modeled daily ozone concentrations, we performed a nationwide health impact assessment estimating annual ozone-related (attributable) deaths in Austria. Different approaches were compared. Estimates were based on maximal 1-h averages of ozone. Until the decade from 2045 till 2055, more people will die in Austria because of the demographic trends. Therefore, more deaths will also be attributable to ozone. Higher greenhouse gas emission scenarios (e.g. Representative Concentration Pathway RCP8.5 compared to RCP2.6) will lead to more ozone-related deaths, mostly due to the national emission of ozone precursors (a difference of 250-340 cases per year, depending on the model), but to a lesser extent because of global climate change. Increases in attributable deaths will be affected mostly by national, not global mitigation measures. National emission reduction will certainly have a strong and beneficial effect on local atmospheric chemistry, air quality, and public health.

Unrecognised COVID-19 deaths in central Europe: The importance of cause-of-death certification for the COVID-19 burden assessment.

In Central Europe, the increase in mortality during the COVID-19 pandemic exceeded the number of deaths registered due to coronavirus disease. Excess deaths reported to causes other than COVID-19 may have been due to unrecognised coronavirus disease, the interruptions in care in the overwhelmed health care facilities, or socioeconomic effects of the pandemic and lockdowns. Death certificates provide exhaustive medical information, allowing us to assess the extent of unrecognised COVID-19 deaths. Data from 187,300 death certificates with a COVID-19 mention from Austria, Bavaria (Germany), Czechia, Lithuania and Poland, 2020-2021, was used. The two step analysis uses Cause of Death Association Indicators (CDAIs) and Contributing CDAIs to identify and measure the statistical strength of associations between COVID-19 and all other medical mentions. 15,700 deaths were reported with COVID-19 only as a contributing condition (comorbidity). In three cases out of four, a typical, statistically significant coronavirus complication or pre-existing condition was registered as the underlying causes of death. In Austria, Bavaria, Czechia and Lithuania the scale of COVID-19 mortality would have been up to 18-27% higher had COVID-19 been coded as the underlying cause of death. Unrecognised coronavirus deaths were equivalent to the entire surplus of excess mortality beyond registered COVID-19 deaths in Austria and the Czech Republic, and its large proportion (25-31%) in Lithuania and Bavaria. Death certificates with typical coronavirus complications or comorbidities as the underlying causes of death and contributing COVID-19 mentions were plausibly unrecognized coronavirus deaths.

Towards an Electronic Health Prevention Record Based on HL7 FHIR and the OMOP Common Data Model.

Approximately 40% of all recorded deaths in Austria are due to behavioral risks. These risks could be avoided with appropriate measures. Extension of the concept of EHR and EMR to an electronic prevention record, focusing on primary and secondary prevention. The concept of a structured prevention pathway, based on the principles of P4 Medicine, was developed for a multidisciplinary prevention network. An IT infrastructure based on HL7 FHIR and the OHDSI OMOP common data model was designed. An IT solution supporting a structured and modular prevention pathway was conceptualized. It contained a personalized management of prevention, risk assessment, diagnostic and preventive measures supported by a modular, interoperable IT infrastructure including a health app, prevention record web-service, decision support modules and a smart prevention registry, separating primary and secondary use of data. A concept was created on how an electronic health prevention record based on HL7 FHIR and the OMOP common data model can be implemented.

SARS-CoV-2 whole-proteome sequences from environment as an indicator of community viral distribution, evolution and epidemiological dynamics: A cohort analysis of Austria.

Several investigations have been carried out to detect SARS‐CoV‐2 samples from the environment such as sewage waters and surface swabs. Whole‐proteome sequence analysis of 847 SARS‐CoV‐2 genome sequences collected from the environment in Austria during 2021 and deposited in GISAID indicates that alpha and delta are two dominant variants, coinciding with the human clinical samples with a Pearson correlation coefficient in the range of 0.58 (alpha variant) to 0.82 (delta variant). Both environmental and human samples show that Austrian SARS‐CoV‐2 alpha variant is found to possess N protein R203K and G204R/P mutations, whereas they are absent in the delta variant. SARS‐CoV‐2 delta variant is continuously seen in both the environmental and human clinical samples from the month of September 2021 and it spiked in November 2021, which is directly reflected in the increase of the number of SARS‐CoV‐2 infections and deaths in Austria during November 2021. Thus, the results presented here indicate that the environmental SARS‐CoV‐2 whole‐genome sequences collected from Austria reflect the community viral distribution, evolution and the concomitant epidemiological dynamics. Since SARS‐CoV‐2 keeps evolving, the results presented here further suggest the need to monitor the environment for the early detection of SARS‐CoV‐2 variants to take appropriate precautionary measures.

POSA172 How to Optimize COVID-19 Vaccination Considering Limited Vaccination Capacities: A Decision-Analytic Framework and Modeling Study

Systematic investigations of tradeoffs between varying COVID-19 vaccination strategies is essential, particularly in the initial phases when vaccine availability is limited. We aimed to develop a decision-analytic framework and a simulation model to evaluate targeted COVID-19 vaccination strategies, in order to minimize COVID-related hospitalizations and deaths in Austria.

Lipid lowering therapy in primary and secondary prevention in Austria: are LDL-C goals achieved? : Results from the DAVINCI study.

BackgroundCardiovascular disease (CVD) is the most frequent cause of death in Austria. The European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines recommend intensive lipid lowering therapy (LLT) in patients at high or very high CV risk. Lipid management and achievement of low-density lipoprotein cholesterol (LDL-C) goals in Austria have not recently been assessed.MethodsSubgroup analysis for Austria of a European 18 country, cross-sectional, observational study. Patients received LLT for primary (PP) or secondary prevention (SP). Data including LLT in the preceding 12 months and most recent LDL‑C were collected during a single visit between June 2017 and November 2018. Achievement of the risk-based 2016 and 2019 ESC/EAS LDL‑C goal while receiving stabilized LLT was assessed.ResultsA total of 293 patients were enrolled from 8 Austrian sites, of which 200 (PP = 104, SP = 96) received stabilized LLT at the LDL‑C measurement date. Overall, 58% (71% PP, 43% SP) and 38% (52% PP, 23% SP) achieved the risk-based 2016 and 2019 goals, respectively. Most patients received moderate-intensity statin monotherapy (46%), while 34% used high-intensity statin monotherapy. Combination therapy of moderate/high-intensity statin with ezetimibe (12%), or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors with statin ± ezetimibe (1%), was used infrequently.ConclusionThe current Austrian routine lipid management using mainly moderate-intensity or high-intensity statin monotherapy is insufficient to attain ESC/EAS guideline goals, in particular the more stringent 2019 recommendations, a situation comparable to other participating European countries. In addition to switching to and optimizing doses of high-intensity statins, a combination with ezetimibe or PCSK9 inhibitors will be needed in many cases.Supplementary InformationThe online version of this article (10.1007/s00508-021-01978-w) contains supplementary material, which is available to authorized users.

Targeted COVID-19 Vaccination (TAV-COVID) Considering Limited Vaccination Capacities-An Agent-Based Modeling Evaluation.

(1) Background: The Austrian supply of COVID-19 vaccine is limited for now. We aim to provide evidence-based guidance to the authorities in order to minimize COVID-19-related hospitalizations and deaths in Austria. (2) Methods: We used a dynamic agent-based population model to compare different vaccination strategies targeted to the elderly (65 ≥ years), middle aged (45–64 years), younger (15–44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW). First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed deriving a prioritization sequence for 2.45 million individuals, maximizing the reduction in total hospitalizations and deaths compared to no vaccination. We considered sterilizing and non-sterilizing immunity, assuming a 70% effectiveness. (3) Results: Maximum reduction of hospitalizations and deaths was achieved by starting vaccination with the elderly and vulnerable followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.45 million individuals yielded the same prioritization and avoided approximately one third of deaths and hospitalizations. Starting vaccination with HCW leads to slightly smaller reductions but maximizes occupational safety. (4) Conclusion: To minimize COVID-19-related hospitalizations and deaths, our study shows that elderly and vulnerable persons should be prioritized for vaccination until further vaccines are available.

Analysis of Austrian COVID-19 deaths by age and sex.

SummaryWe analyze the age and sex distribution of the reported COVID-19 deaths in Austria. In accordance with international studies, the Austrian data also suggests that the risk of death increases substantially with age. The observed age dependency of the proportions of registered COVID-19 deaths in relation to the population sizes in the age groups is approximately exponential, similar to the age dependency of the general age specific mortality rate. Furthermore, we compare the general age specific mortality rate in Austria with the estimates of the SARS-CoV‑2 infection fatality rate by Ferguson et al. (2020). The parallels to the general age specific mortality rates do not imply that COVID-19 does not pose an additional risk. On the contrary, it follows from the structure and magnitude of the infection fatality rate that it is substantial, especially for higher age groups. However, since in many cases persons with severe pre-existing conditions are affected, it is not yet possible to estimate what effects COVID-19 will have on life expectancy.

Austrian Consensus on High Blood Pressure 2019

Elevated blood pressure remains amajor cause of cardiovascular disease, disability, and premature death in Austria, with suboptimal rates of detection, treatment and control also in recent years. Management of hypertension is acommon challenge for physicians with different spezializations. In an attempt to standardize diagnostic and therapeutic strategies and, ultimately, to increase the rate of patients with controlled blood pressure and to decrease the burden of cardiovascular disease, 13Austrian medical societies reviewed the evidence regarding prevention, detection, workup, treatment and consequences of high blood pressure in general and in various clinical scenarios. The result is presented as the first national consensus on blood pressure. The authors and societies involved are convinced that ajoint national effort is needed to decrease hypertension-related morbidity and mortality in our country.

High prevalence of hypertension and early vascular aging: a screening program in pharmacies in Upper Austria.

Cardiovascular mortality is the leading cause of death in Austria, with uncontrolled blood pressure (BP) as a major risk factor. Increased arterial stiffness can indicate high cardiovascular risk. In a screening project, we acquired brachial waveforms with automated oscillometric devices in 45 public pharmacies and at 2 public health events in Upper Austria. Brachial BP was measured, and aortic pulse wave velocity (aoPWV) was estimated, using age, systolic BP, and waveform characteristics, with the validated ARCSolver algorithm. Using age-specific percentiles from a previous population study, we defined healthy (HVA) and early (EVA) vascular aging. In a subgroup, 24-h ambulatory BP monitoring was performed to verify hypertension status. Overall, 10,973 individuals (age 20-94 years) participated. Mean BP was 133/83 mm Hg. In all, 38.1% of participants had elevated BPs (≥140/90 mm Hg), 57.3% out of 3980 participants with known hypertension, and 29.5% out of 6066 participants without known hypertension. In all, 1.0% of participants had aoPWV below 10th reference percentile (HVA), with a negligible proportion above 60 years. In total, 37.3% were above the 90th reference percentile (EVA), with proportions rising from one-quarter in youngest partcipants to one-half in oldest participants. In participants with EVA, BP in the pharmacy was elevated in 79.5%. We were able to motivate a high number of customers at pharmacies to participate in a screening program by combining the measurements of BP and vascular aging. However, awareness and control of arterial hypertension in Austria remains suboptimal, and the high prevalence of EVA is alarming.

Impact of Austria's 2009 trans fatty acids regulation on all-cause, cardiovascular and coronary heart disease mortality.

BackgroundUnhealthy diet, especially consumption of trans fatty acids (TFAs), is a known risk factor for cardiovascular disease (CVD), a leading cause of death in Austria. In 2009, Austria introduced a law regulating the content of TFAs in foods. The aim of this study was to assess the impact of the TFA regulation on CVD-related outcomes.MethodsThe study evaluated the TFA regulation as an intervention in a natural experiment. Two study periods were assessed: pre-intervention (1995–2009) and post-intervention (2010–14). The study compared the age-standardized death rates per 100 000 population for CVD outcomes with those of a ‘synthetic’ international comparator population, created from data of OECD countries where TFA regulation has not been implemented, but where the population is otherwise comparable.ResultsThere was a continuous decrease in CVD-related mortality throughout the study period in both the synthetic international comparator population, as well as in the adult Austrian population, with no significant change in this trend observed as an effect of TFA regulation.ConclusionsWhilst the results are counterintuitive, given the established link between TFA consumption and an increased risk of CVD, there are many possible explanations: high prevalence of tobacco smoking, changes in TFA content in foods due to international guidance as opposed to formal regulation and a beneficial impact of TFA regulation on sub-groups of the population that might not be detected with nationally aggregated data. However, reduction in TFAs should still be considered an important part of risk factor reduction for CVD and other non-communicable diseases.

Clinical presentation and management of stable coronary artery disease in Austria.

BackgroundCardiovascular disease is the main cause of death in Austria. However, no systematic information exists regarding characteristics and treatments of contemporary patients with stable coronary artery disease (CAD) in Austria. We assembled two retrospective physicians’ databases to describe demographics, clinical profiles, and therapeutic strategies in patients with stable CAD. In addition, we compared patient profiles of secondary care internists and hospital-based cardiologists with those of general practitioners in a primary care setting outside of hospital.MethodsThe study population was identified from retrospective chart review of 1020 patients from 106 primary care physicians in Austria (ProCor II registry), and was merged with a previous similar database of 1280 patients under secondary care (ProCor I registry) to yield a total patient number of 2300.ResultsFemale patients with stable CAD were older, had more angina and/or heart failure symptoms, and more depression than males. Female gender, type 2 diabetes mellitus, higher CCS class and asthma/COPD were predictors of elevated heart rate, while previous coronary events/revascularization predicted a lower heart rate in multivariate analysis. There were no significant differences with regard to characteristics and management of patients of general practitioners in the primary care setting versus internists in secondary care.ConclusionsCharacteristics and treatments of unselected patients with stable ischemic heart disease in Austria resemble the pattern of large international registries of stable ischemic heart disease, with the exception that diabetes and systemic hypertension were more prevalent.

Potentially preventable premature deaths in women and men from the two leading causes of death in Austria, mortality statistics of the nine federal states 2010-2012.

BackgroundIn Austria, mortality from diseases of the circulatory system and malignant neoplasms is high and varies among the federal states. Lower mortality in some states indicates a preventive potential in those states with higher mortality.MethodsWe computed the number of premature deaths, for women and men separately, from the two leading causes of death, diseases of the circulatory system (ICD-10: I00-I09) and cancer (ICD-10: C00-C97), in the nine Austrian federal states between 2010-2012. The potentially preventable deaths per federal state and sex were calculated by subtracting expected deaths from observed deaths.ResultsThe western federal states had the lowest death rates, and thus the smallest preventive potential. In death from circulatory diseases and from cancer the differences between women and men varied remarkably between the federal states. For circulatory diseases among all federal states the highest difference in percent was given in Vorarlberg (6.2 %) with more potentially preventable deaths for men. For cancer, Burgenland had the highest difference (8.6 %) in comparison with the other federal states, again with the higher preventive potential for men.ConclusionsIntervention programs as lifestyle modification interventions as well as improvements in health care services provision, should focus on the characteristics of the specific federal state, which are setting-oriented and account for social determinants including sex/gender differences and economic factors. Relevant data gathering is therefore, urgently needed.

Epidemiology and Patterns of Transport-Related Fatalities in Austria 1980–2012

Objectives: Transport-related accidents remain the largest single cause of death among people aged 15 to 29 in the European Union, and despite the decrease in number of fatalities from 1990 onwards they remain a significant public health problem. The aim of this article was to analyze the long-term trends and patterns of transport-related fatalities, identify the anatomic distribution of most significant injuries in different road users, and identify the primary populations at risk of transport-related death in Austria between 1980 and 2013.Methods: Data on transport-related fatalities based on death certificates were obtained from Statistics Austria for the analyzed period. Crude and age-standardized mortality rates per 100,000 were calculated and broken down by age, gender, and month of death, and the anatomic distribution of most significant injuries were identified. Potential years of life lost before age 75 (PYLL-75) were used as a measure of public health impact.Results: A total of 39,709 transport-related fatalities were identified for the studied years; 74% were males and the mean age was 42.1 years (range 0–103). A decrease in the number of fatalities (from 2018 in 1980 to 554 in 2012), mortality rates (from 26 in 1980 to 7 in 2012), and PYLL-75 (from 68,960 in 1980 to 14,931 in 2012) was observed. Introduction of major prevention milestones (compulsory use of seat belts or child restraints) may have contributed to this decrease. Men 16–24 years old were at the highest risk of transport-related death. Pedestrian victims were more likely to be women and car drivers and motorcyclists were more often men. Most fatal transport accidents occurred between the months of May and October and prevailingly in towns of fewer than 20,000 inhabitants. Injuries to the head were the most significant injuries in all user groups (>50% of cases in all road user types). Reduced mortality rates could translate into higher prevalence of long-term disabilities in survivors of transport accidents.Conclusions: Despite the decreasing trend observed, transport-related fatalities remain a serious public health issue in Austria. An increase in the mortality of motor vehicle drivers warrants more preventive action in this group. Further research is needed on other outcomes of transport accidents such as long-term disabilities to elucidate the true public health burden of transport accidents.

Evaluation of Risk Factors for Parametrization of Cancer Models

Cancer is the second most cause of death in Austria and around 38000 people are diagnosed with cancer each year [1]. The goal of this paper is to analyze methods for evaluation of risk factors in order to parametrize a micro simulation model for cancer prevalence. The focus of this paper is on modeling the survival time. This is done by the methods of survival analysis and model selection. Firstly, the survival function is estimated by the Kaplan-Meier estimate. Afterwards, a Cox proportional hazards regression is performed with all possible sets of parameters. These models are tested by twos with the likelihood ratio test in order to compare them. Another approach is the so-called Lasso method. This method puts a constraint on the sum of the absolute values of the regression coefficients and in most cases forces some of the coefficients to go to zero. The Akaike Information Criterion is also applied. All three methods are compared and the parameters which are supported, at least to a certain extent, by all of them are included in the estimation of the survival time of the prevalence model.

Rapid spread and association of Schmallenberg virus with ruminant abortions and foetal death in Austria in 2012/2013

Schmallenberg virus (SBV) has emerged in summer–autumn 2011 in north-western Europe. Since then, SBV has been continuously spreading over Europe, including Austria, where antibodies to SBV, as well as SBV genome, were first detected in autumn 2012. This study was performed to demonstrate the dynamics of SBV spread within Austria, after its probable first introduction in summer 2012. True seroprevalence estimates for cattle and small ruminates were calculated to demonstrate temporal and regional differences of infection. Furthermore, the probability of SBV genome detection in foetal tissues of aborted or stillborn cattle and small ruminants as well as in allantoic fluid samples from cows with early foetal losses was retrospectively assessed.SBV first reached Austria most likely in July–August 2012, as indicated by retrospective detection of SBV antibodies and SBV genome in archived samples. From August to October 2012, a rapid increase in seroprevalence to over 98% in cattle and a contemporaneous peak in the detection of SBV genome in foetal tissues and allantoic fluid samples was noted, indicating widespread acute infections. Notably, foetal malformations were absent in RT-qPCR positive foetuses at this time of the epidemic. SBV spread within Austrian cattle reached a plateau phase as early as October 2012, without significant regional differences in SBV seroprevalence (98.4–100%). Estimated true seroprevalences among small ruminates were comparatively lower than in cattle and regionally different (58.3–95.6% in October 2012), potentially indicating an eastward spread of the infection, as well as different infection dynamics between cattle and small ruminants. Additionally, the probability of SBV genome detection over time differed significantly between small ruminant and cattle samples subjected to RT-qPCR testing.

PCN87 - Cost of Cancer in the Austrian Hospital Setting

CONTACT: Dr. Evelyn Walter IPF Institute for Pharmaeconomic Research Wolfengasse 4/7 1010 Vienna, Austria Tel +43-1-5132007-13 Fax +43-1-5132007-15 Email: e.walter@ipf-ac.at Web: www.ipf-ac.at Objectives In Austria, 38,000 people are yearly diagnosed with cancer, which is the world’s leading cause of death, followed by heart disease and stroke. Each year, cancer is causing 19,547 deaths in Austria. Advances in early detection, prevention and treatment have led to decreasing cancer deaths and more favorable outcomes. Moreover, significant increases in the cost of cancer care have come in parallel with these advances. The cost factor related to modern cancer treatment is increasingly a matter of debate. Hence, the aim of the analysis was to evaluate the cost of cancer expressed as reimbursed lump-sums of the DRG system, number of inpatients stays and Length-of-Stay (LOS) in the inpatient setting to bring more transparency in the discussion and to bridge the information-gap.

Influenza-related excess mortality, Austria 2001 till 2009

In Austria, a country with a total population of approximately 8.3 million, the published estimates of influenza-associated deaths within the past decade are surprisingly high (up to 6000 deaths per year) when compared to neighbouring countries. The objective of our analysis was to provide reliable estimates of the annual influenza-related deaths in Austria. We estimated the seasonal influenza-related excess mortality by calculating the difference between all-cause mortality observed during the influenza season and the baseline values to be expected during that time span if increased influenza activity was absent. Increased influenza activity was defined as moderate, usual or high, categorized by the influenza activity index using weekly data from the Austrian sentinel clinical surveillance system. For obtaining estimates of baseline all-cause mortality, a cyclic regression model was applied to the time series data on weekly all-cause mortality from 2001 to 2009. Austrian seasonal influenza-related excess mortality peaked in the seasons 2002/2003 (1060 excess deaths), 2004/2005 (1102 excess deaths) and 2008/2009 (1192 excess deaths). The rising trend observed is in parallel with the increasing proportion of the Austrian population older than 65 years for the same time span (2001:15.5%; 2009: 17.5%). Our findings on seasonal influenza-related excess mortality are in accordance with the estimates from Germany and Switzerland, which were derived from a similar approach. In order to gain and to preserve higher compliance with influenza vaccination initiatives, it is essential to have reliable data on influenza-related mortality. Thus, the numbers presented so far by Austrian public health institutions must be challenged.

Iatrogenic death: A review of cases from 1990–2000 investigated at the Department of Forensic Medicine, Vienna

Medical malpractice is a global problem which can have considerable financial and legal consequences for the community as well as personal consequences for those involved. Austria does not record any statistical and epidemiological data concerning medical malpractice cases. Data from 7,211 autopsy cases from the Department of Forensic Medicine in Vienna covering the period from 1990 to 2000 were analyzed. Fifty-five autopsy reports that were filed as suspected medical malpractice were recorded and analyzed. Thirty cases were classified as surgical incidents, 19 cases as negligence, and 6 cases as medication incidents. Out of a total of 40 cases from available court files, 36 cases were dropped, there were 2 acquittals and only two resulted in convictions. The number of instances of medical malpractice leading to iatrogenic deaths in Austria seems to be very low in comparison to other countries. The possibility that many cases go unnoticed needs to be taken into consideration.

Analysis of the spatial distribution of infant mortality by cause of death in Austria in 1984 to 2006

BackgroundIn Austria, over the last 20 years infant mortality declined from 11.2 per 1,000 life births (1985) to 4.7 per 1,000 in1997 but remained rather constant since then. In addition to this time trend we already reported a non-random spatial distribution of infant mortality rates in a recent study covering the time period 1984 to 2002.This present study includes four additional years and now covers about 1.9 million individual birth certificates. It aimes to elucidate the observed non-random spatial distribution in more detail. We split up infant mortality into six groups according to the underlying cause of death. The underlying spatial distribution of standardized mortality ratios (SMR) is estimated by univariate models as well as by two models incorporating all six groups simultaneously.ResultsWe observe strong correlations between the individual spatial patterns of SMR's except for "Sudden Infant Death Syndrome" and to some extent for "Peripartal Problems". The spatial distribution of SMR's is non-random with an area of decreased risk in the South-East of Austria. The group "Sudden Infant Death Syndrome" clearly and the group "Peripartal Problems" slightly show deviations from the common pattern. When comparing univariate and multivariate SMR estimates we observe that the resulting spatial distributions are very similar.ConclusionWe observe different non-random spatial distributions of infant mortality rates when grouped by cause of death. The models applied were based on individual data thereby avoiding ecological regression bias. The estimated spatial distributions do not substantially depend on the employed estimation method. The observed non-random spatial patterns of Austrian infant mortality remain to appear ambiguous.