To elucidate the role of housing status in observed racial disparities in opioid overdose mortality, we conducted a cross-sectional study using vital statistics, medical, and housing records in San Francisco, California from 2021 to 2023. We reported standardized mortality ratio (SMR); indirectly age- and sex-standardized mortality rate; and observed, expected, and excess deaths for each race or ethnicity group among people experiencing homelessness, using adult Californians as the standard population. Forty-seven percent (812/1727) of overdose decedents were recently homeless, and people experiencing homelessness had 33 times the rate of opioid overdose mortality (SMR 33.2, CI 29.1-37.3) compared to the general population, standardized by age, race, and sex. There were a minimum of 244 excess deaths per year in San Francisco due to the increased risk of overdose among people experiencing homelessness, which disproportionally affected Black people. Reducing opioid overdose mortality and related disparities requires addressing the housing crisis.

ABSTRACT This research note explores excess mortality among institutionalised children and adolescents in the Netherlands from the 1860s to the 1960s, linking a recent case study of the Catholic Good Shepherd institution to broader, comparative questions in historical family demography. Public debates have increasingly framed mortality as definitive evidence of institutional violence, exemplified by the 2024 documentary De meisjes van de Goede Herder. Yet the underlying demographic analysis, while confirming excess mortality among both boarders and nuns, highlighted the limits of available sources and cautioned against drawing overly deterministic conclusions. This research note situates that case within a wider institutional landscape that included Protestant, Catholic and ‘neutral’ homes, and argues that mortality in these settings was shaped by shifting populations, evolving institutional regimes and historically contingent notions of death. Surveying institutional histories of neutral and Protestant reformatory homes, orphanages and post-war girls’ homes, the article shows that although sickness and death frequently appear in narrative sources, systematic mortality analysis is largely absent. This absence hinders our ability to determine whether Catholic institutions were exceptional or whether elevated mortality reflected broader structural risks inherent to institutional care: social selection of highly vulnerable children, exposure to infectious disease, overcrowding, limited medical resources and confessional interpretations that sometimes sacralised early death. The article outlines a research agenda for comparative institutional mortality studies, emphasising the need to integrate demographic reconstruction, life-course analysis, and qualitative contextual evidence. It argues that understanding excess mortality requires disentangling background vulnerability, institutional conditions and wider public health trends. Rather than reinforcing speculative interpretations, a comparative and methodologically rigorous approach can illuminate structural risks and institutional responsibilities, contributing to contemporary debates on care, accountability and the historical conditions under which children (and those who worked with them) faced heightened risks of death.

Many thanks to the editors of the International Journal of Risk & Safety in Medicine for inviting me to provide commentary and context on the academic discourses around 4 articles published herein that provide a more balanced view of COVID-19 vaccines, including research on the potential harms of the vaccines and their possibly contributing to excess mortality. I conclude that the criticisms highlighted here are unsuccessful in allaying the concerns raised in these studies, and that ongoing scrutiny on COVID-19 vaccines is warranted and necessary.

The period from 1965 to 2020 in Russia was marked by unprecedentedly high alcohol-related and overall mortality, making it unique in the country’s demographic history. Despite the significance of this issue, alcohol-related causes of death and overall mortality trends have often been studied in isolation, without simultaneously considering their long-term dynamics. This study aims to comprehensively analyze alcohol-related and overall mortality trends over this period and identify key stages marked by changes in mortality patterns. Using Rosstat data, standardized mortality rates for men and women due to alcohol poisoning and all causes were calculated for 1965–2020. Correlation and regression analyses were performed to examine the relationship between overall and alcohol-related mortality. The dynamics of these indicators were compared over the entire period and across individual stages. The results revealed three complete cycles of synchronous fluctuations in alcohol and overall mortality in Russia: 1965–1988, 1988–1998, and 1998–2019, with peaks in 1980, 1994, and 2003, respectively. The historical maximum mortality rate occurred in 1994. Between 1965 and 1994, overall mortality increased by 47%, while alcohol poisoning mortality increased by 361%. By the early 2010s, both indicators had returned close to their 1965 levels. Analysis indicated that each shift in mortality trends was associated with the emergence of new, often multiple, factors affecting alcohol consumption and mortality, specific to periods of growth or decline. A strong synchronicity between overall and alcohol-related mortality was observed (R = 0.84; 95% CI: 0.73–0.91), despite alcohol poisoning accounting for only 1.4% of all deaths. Two exceptions were noted: 1965–1980 among women, and 2005–2019 among individuals with severe alcohol dependence, reflecting specific drinking behaviors. Four post-World War II anti-alcohol campaigns (1958, 1972, 1985, and 2000) were also analyzed. Only the 2000 campaign achieved a significant and sustained reduction in alcohol consumption and mortality. The synchronicity between alcohol-related and overall mortality in Russia indicates a substantial contribution of alcohol to excess mortality and population decline. Despite notable declines in alcohol consumption and overall mortality between 2005 and 2019, both indicators remain high. Russia continues to rank among the highest globally in alcohol-related mortality, showing disproportionately high mortality relative to alcohol consumption levels.

Maternal antibodies protect mink kits early in life, but their duration and impact on subsequent SARS-CoV-2 exposure remain unclear. We longitudinally characterized passive immunity in kits born to mothers previously infected with lineage B.1.1.305 on a commercial farm in Greece and related antibody kinetics to a later heterologous virus incursion. Breeder animals showed a 93.3% seropositivity rate after the initial outbreak. On day 20 postpartum, 81.4% of mothers and 69.8% of kits were positive for SARS-CoV-2 nucleocapsid (N)-specific antibodies by enzyme-linked immunosorbent assay (ELISA); a maternal S/P% >160.1% was associated with kit seropositivity at the same time-point (area under the curve 0.985; sensitivity 90%; specificity 100%). Kit seropositivity declined to 2.4% by D*56, consistent with the rapid waning of maternally derived antibodies. On D*87, 97.6% of kits had seroconverted, and 90.0% of mothers were seropositive; Analysis of oropharyngeal swabs by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and next generation sequencing (NGS) confirmed introduction of lineage B.1.177. No clinical signs or excess mortality were observed during this reinfection event. These data demonstrate efficient passive transfer, rapid loss of detectable antibodies by ∼8 weeks, and farm-wide seroconversion after re-exposure to a new lineage. The absence of disease despite widespread seroconversion suggests maternally acquired immunity may have mitigated illness but did not prevent infection. Silent SARS-CoV-2 circulation can therefore occur in partially immune mink farms, with important implications for biosecurity and targeted SARS-CoV-2 surveillance. To our knowledge, this is the first longitudinal study to track the dynamics of maternally derived SARS-CoV-2 antibodies in mink kits and link them to subsequent exposure outcomes.

Objectives. To examine the association of abortion bans with changes in maternal, pregnancy-related, and pregnancy-associated mortality. Methods. Using national vital statistics data (2016-2023), we used a Bayesian panel model to examine maternal, pregnancy-related, and pregnancy-associated mortality in 14 US states that implemented abortion bans by the end of 2022. Models accounted for temporal trends and state-specific factors. Results. Among the 14 states with abortion bans, there was some evidence of a potential 9.2% (95% credible interval [CI] = -1.6, 20.7) increase in the number of pregnancy-associated deaths above expectation, equivalent to 68 (95% CI = -13, 147) excess deaths; the rate was also higher than expected, with 3.3 (95% CI = -2.6, 9.0) additional deaths per 100 000 live births. Relative changes in pregnancy-related mortality were similar in magnitude but had greater uncertainty. There was no detectable increase in maternal mortality. Conclusions. Abortion bans may be associated with an increase in pregnancy-associated and pregnancy-related mortality, although data limitations and chance variation in these rare outcomes constrain the certainty of these and other findings. (Am J Public Health. Published online ahead of print April 23, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308465).

Visual Impairment as a Marker of Systemic Vulnerability and Cause-Specific Mortality in U.S. Adults.

Frailty predicts poor outcomes after pancreatectomy, but whether excess mortality and readmission reflect more postoperative complications, worse rescue after complications, or broader recovery vulnerability remains unclear. We performed a retrospective study of the ACS-NSQIP Pancreatectomy database (2014-2023) including 71,104 patients undergoing pancreatic resection. Frailty was defined as modified 5-item frailty index score ≥2. Multivariable logistic regression evaluated associations between frailty and 30-day mortality and readmission. Causal mediation analysis quantified total, direct, and complication-mediated indirect effects. Interaction modeling compared failure-to-rescue and non-precedented deaths by frailty status. Of 71,104 patients, 15,779 (22.2%) were frail. Frailty was independently associated with 30-day mortality (aOR 1.29, 95% CI 1.13-1.46; p<0.001) and readmission (aOR 1.11, 95% CI 1.06-1.16; p<0.001). For mortality, the total effect of frailty was significant (RR 1.32, 95% CI 1.23-1.40; p<0.001), the indirect effect through complications was significant (RR 1.25, 95% CI 1.22-1.27; p<0.001), and the direct effect was not (RR 1.07, 95% CI 0.99-1.14; p=0.400); complications mediated 80.72% of the frailty-mortality association. The largest contributors were unplanned reintubation, bleeding requiring transfusion, septic shock, acute kidney injury requiring dialysis, myocardial infarction, and organ/space surgical site infection. Major complications increased mortality similarly in frail and non-frail patients, without meaningful frailty-related differences in failure-to-rescue. For readmission, complications explained only 17% of the frailty association. After pancreatectomy, frailty-associated mortality is largely explained by postoperative complications, whereas frailty-associated readmission is driven predominantly by vulnerability beyond complications. These findings support complication prevention, prehabilitation, and intensified post-discharge follow-up for frail patients.

Quantifying Vascular Access-Associated Excess Mortality In Maintenance Hemodialysis Patients.

The residual Gensini score (rGS) was developed to quantify the severity of coronary atheroma burden after coronary revascularisation. The predictive value of the rGS for clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) remains unexplored. Our retrospective study included 1034 consecutive patients who presented with STEMI between 2016 and 2020. Patients were stratified based on the third tertile of rGS values: rGS ≤ 16 (Group 1) and rGS > 16 (Group 2). Compared with patients in group 1, epicardial and microvascular perfusion were significantly impaired in group 2 as evidenced by poorer final flow grade TIMI 3 (89% vs. 74%, p < 0.0001) and lower complete ST resolution (STR) rates > 70% (56% vs. 49%, p = 0.007). In the unadjusted analysis, excess mortality in group 2 was observed early (45-day mortality rate: 6% vs. 12%, p = 0.0005) and persisted during the 2-year follow-up (9% vs. 18%, p < 0.0001). After stabilized Inverse Exposure Probability Weighting (sIEPW) adjustment, the early mortality of the patients was similar in both groups: 45-day mortality: 10% vs. 9%, p = 0.45, Harrell's c-index 40%. However, the rGS remained associated with worse prognosis thereafter: 1 year mortality: 11% versuss 21%, Harrell's c-index: 61%, p < 0.0001. In a real-world cohort of patients with STEMI, rGS is associated with a worse long-term prognosis as from 1 year follow-up, but without significantly stratifying early follow-up. These findings provide important insight with regard to the optimal use of angiography scoring system as prognostic factor. (ClinicalTrials.gov Identifier: NCT05679843).

Abstract Orthostatic hypotension (OH), defined as a sustained reduction of ≥ 20 mmHg in systolic or ≥ 10 mmHg in diastolic blood pressure within 3 minutes of standing, represents one of the most clinically significant manifestations of autonomic failure. Beyond its hemodynamic definition, OH is associated with disabling symptoms, falls, syncope, reduced quality of life, increased healthcare utilization, and excess mortality. In clinical practice, management often requires balancing objective blood pressure measurements with the patient’s lived experience of orthostatic intolerance. This viewpoint argues that symptoms represent an appropriate and clinically meaningful target for screening and management of OH. Three central assumptions support this perspective. First, patients are reliable reporters of orthostatic symptoms and clinicians are capable interpreters of these reports. Validated patient-reported outcome measures, such as the Orthostatic Hypotension Questionnaire (OHQ), demonstrate that symptom burden and functional impairment can be reproducibly quantified and that clinically meaningful changes can be detected. Second, although the relationship between orthostatic blood pressure changes and symptoms is not absolute, evidence supports a clinically relevant association, with symptomatic individuals often experiencing greater cerebral hypoperfusion when upright. Third, symptoms serve as a practical proxy for meaningful OH-related outcomes, including functional independence, fall risk, and quality of life, and have been accepted as primary endpoints in pivotal clinical trials. A symptom-centered framework complements objective hemodynamic assessment by contextualizing physiological findings within patients’ functional experience. Integrating symptom reporting with orthostatic measurements provides a pragmatic, patient-centered approach to screening, treatment decisions, and evaluation of therapeutic response in OH.

Governments frequently adopt austerity policies when facing economic crises, yet their long-term consequences for population health remain incompletely understood. This paper examines the impact of large-scale fiscal austerity on infant mortality by exploiting the Troika-led economic adjustment program implemented in Greece beginning in 2010 as a quasi-experimental shock. Using the synthetic control method, we construct a counterfactual for Greece based on OECD and Union for the Mediterranean countries that did not experience austerity of comparable depth or duration. Relative to this counterfactual, Greece experienced a sharp and persistent increase in infant mortality following the onset of austerity. The divergence emerges immediately after 2010, remains statistically significant throughout the post-intervention period, and shows little evidence of full reversion prior to the COVID-19 pandemic. The estimated effect corresponds to an average 43 percent increase in the infant mortality rate. Mortality effects are larger for boys than for girls and are concentrated in the neonatal period. Accounting explicitly for the fertility decline, we estimate approximately 854 excess infant deaths cumulatively from 2010 to 2020. Extensive robustness checks support the findings. The results identify the total effect of austerity and highlight the importance of protecting early-life health during fiscal consolidation.

Study DesignNationwide register study.ObjectiveThe incidence of cervical spine fractures and related surgeries are increasing in the ageing population, yet population-based outcome data remain limited. This study aimed to identify factors associated with mortality and to analyze causes of death following surgical treatment for cervical spine fractures in a nationwide cohort.MethodsA cohort of 979 patients undergoing surgery for cervical spine fractures (2017-2024) was identified from the nationwide FinSpine register. Independent risk factors for mortality were identified with Cox proportional hazards models. Patient data were linked with national records on mortality and causes-of-death. Standardized mortality ratios (SMRs) were calculated for comparison with the age- and sex-matched general population.ResultsThe 1-year mortality rate was 11.8%, increasing with age from 3.9% in patients younger than 65years to 24.9% in those aged 85years or older. Increasing age (HR 1.06 per year) and spinal cord injury (HR 1.71) predicted mortality. Compared with the general population, mortality was significantly elevated across all age groups, with highest standardized mortality ratio in patients younger than 65years (SMR 8.3) and lowest for patients aged ≥85years (SMR 2.0). External causes (accidents and violence) were the leading causes of death and highly over-represented (SMR 22.7) in the patients.ConclusionsIncreasing age and spinal cord injury predict mortality after surgery for cervical spine fractures. The low relative excess mortality in elderly patients, compared to the general population, supports the potential role of operative management with careful patient selection even in advanced age.

Chronic subdural hematoma (cSDH) is among the most common neurosurgical disorders in older adults. Although short-term outcomes after surgery are favorable, long-term survival and health-related quality of life (HRQoL) remain poorly characterized. To evaluate long-term survival, excess mortality, and HRQoL 10 years after surgical treatment of cSDH. This population-matched cohort study was conducted at a single tertiary referral center in Switzerland, with mortality follow-up through December 31, 2023 (mean [SD] follow-up, 9.55 [1.24] years), and cross-sectional HRQoL assessment through December 31, 2024 (mean [SD] follow-up, 10.05 [1.16] years). Analyses were conducted from October to December 2025. Adults surgically treated for cSDH between June 2012 and August 2016 were included, matched with the Swiss general population by age, sex, and birth month for mortality analysis. Among survivors, those completing HRQoL assessment were compared with age- and sex-weighted European reference values. Surgically treated cSDH. The primary outcome was all-cause mortality, estimated using Kaplan-Meier analysis, with excess mortality expressed as absolute survival differences and standardized mortality ratios (SMRs). Secondary outcomes were the following HRQoL domains: cognitive functioning (CF), physical functioning (PF), role functioning (RF), emotional functioning (EF), social functioning (SF), and global QoL, compared using 2-sided z tests. A total of 359 adults surgically treated for cSDH were included; among survivors, 147 completed HRQoL assessment and were compared with age- and sex-weighted European reference values. Among 359 patients (mean [SD] age, 73.4 [11.0] years; 117 female patients [32.6%]), overall survival was significantly lower than matched controls (hazard ratio [cohort vs control], 2.02; 95% CI, 1.73-2.37; log-rank P < .001). One-year survival in the cSDH cohort was 92.8% (95% CI, 90.1%-95.5%) vs 98.8% (95% CI, 98.7%-98.8%) in controls, representing an excess mortality of 6.0 percentage points (SMR, 3.22; 95% CI, 2.10-4.72); 5-year survival was 76.6% (95% CI, 72.3%-81.1%) vs 88.2% (95% CI, 88.2%-88.3%), representing an excess of 11.6 percentage points (SMR, 1.19; 95% CI, 0.95-1.47); and 10-year survival was 55.5% (95% CI, 50.3%-61.3%) vs 73.5% (95% CI, 73.4%-73.6%), representing an excess of 18.0 percentage points (SMR, 1.12; 95% CI, 0.94-1.31). Men reported significantly lower mean (SD) PF scores (75.9 [26.8] vs control mean score, 83.22; P < .001), RF scores (74.9 [32.0] vs 84.87; P < .001), CF scores (77.6 [22.6] vs 87.38; P < .001), and SF scores (84.3 [24.0] vs 90.00; P = .02) than controls, and women reported lower mean (SD) RF (69.0 [30.9] vs 80.91; P = .02) and CF scores (70.2 [24.8] vs 86.50; P < .001). EF and global QoL did not differ significantly from European reference values. In this population-matched cohort study, patients surgically treated for cSDH experienced sustained excess mortality and clinically relevant HRQoL deficits 10 years after surgery. These findings call for structured postoperative and rehabilitative care beyond the acute phase.

Despite effective chemotherapy, tuberculosis (TB) survivors experience excess morbidity and mortality associated with long-term sequelae. Ventilatory defects, such as airflow obstruction, restriction, and mixed patterns, have been reported in over half of treated pulmonary TB cases. Spirometry alone underestimates burden, with impaired diffusing capacity, gas trapping, heterogeneous airway, and parenchymal damage on lung imaging, functional impairment, and persistent respiratory symptoms commonly reported. Bronchiectasis and chronic pulmonary aspergillosis are also common and occur in approximately one-third of TB survivors. Beyond the lungs, observational data consistently link TB to elevated cardiovascular disease risk, including myocardial infarction, stroke, and peripheral arterial disease, during and after TB treatment. Tuberculosis is also associated with increased lung cancer risk independent of smoking exposure, with adenocarcinoma, squamous cell, and small cell carcinomas commonly reported. While ongoing research suggests a key role of a dysfunctional host inflammatory response in the pathogenesis of TB sequelae, several knowledge gaps persist. Key among them include identifying individuals at highest risk of TB sequelae, defining clinically relevant phenotypes, endotypes, and natural history trajectories, and identifying prognostic biomarkers and potentially modifiable targets for immunomodulatory therapies. In this narrative review, we discuss key long-term sequelae of pulmonary TB, highlight research priorities, and propose a way forward through new research initiatives such as the "Long TB Study."

Municipal solid waste management (MSWM) in Jordan faces significant challenges. Jordan's primary waste management strategy relies heavily on final disposal, with up to 80% of all generated solid waste ultimately being landfilled. These unsustainable practices lead to environmental degradation and public health risks. Increased methane emissions have harmed air quality: methane can lead to the formation of ground-level ozone, which in turn causes respiratory problems including asthma and pneumonia. The main objective of this study is to evaluate the impact of improved solid waste management strategies on methane emissions in the period from 2020 to 2050. The Low Emissions Analysis Platform (LEAP) is used for the analysis, and current methane emissions from municipal solid waste are estimated using data obtained from the Ministry of Local Administration, the Greater Amman Municipality, the Department of Statistics, and the World Health Organization. These datasets, which include information on waste quantities and landfill boundaries, are integrated into the LEAP software to facilitate estimation of methane emissions. Our analysis finds that, without intervention, methane emissions will rise from 4.3 million metric tons of carbon dioxide equivalent in 2020 to 7.8 million tons by 2050 due to increasing population and economic expansion. In addition to the serious environmental consequences, we estimate public health damages of $41 billion per year by 2050, linked to excess mortality. In the short-term, methane emissions can be mitigated by following a "circular economy" strategy of reuse and recycling. This could reduce methane emissions by 12% by 2030. Medium-term strategies, including the establishment of sanitary landfills and recycling facilities, combined with the short-term projects can reduce methane emissions 34% below baseline by 2040. Adding long-term strategies, including composting and additional reuse, leads to reductions of 55% by 2050. More dramatic individual changes to the system also have large effects: shifting to incineration instead of landfills reduces methane emissions by 52%. Advanced recycling facilities can reduce emissions by 35%. These results highlight the impact of improved integrated waste management approaches on reducing emissions and thus enhancing public health and global climate goals. The paper underscores the importance of technical advancement in solid waste management in Jordan. We show that large environmental and economic gains are possible with aggressive governmental actions and collaboration among stakeholders.

Diabetes confers increased risk for fracture independently from FRAX-estimated fracture probability. To compare the relative performance of the rheumatoid arthritis (RA) input and trabecular bone score (TBS) adjustment, alone or in combination, to capture FRAX-independent risk associated with diabetes. We analyzed data on 54,609 individuals from the Manitoba Bone Density Program aged ≥ 40years with FRAX-based probability and TBS measurements (mean age 63.8years, 89.9% female) including 5274 (9.7%) with diabetes. Incident major osteoporotic fracture (MOF, 5723, 10.5%) and hip fractures (1715, 3.1%) were ascertained during mean 9.6years observation from population-based healthcare data. The effect of diabetes on fracture outcomes was modeled without (Cox regression) and with competing mortality (Fine-Gray regression), adjusted for FRAX-based probability before and after RA input and TBS adjustment. For MOF prediction in those with diabetes duration less than 5years, no FRAX adjustment was required. For those with duration 5-10years, FRAX adjusted with TBS was slightly better than the unadjusted FRAX output. For those with diabetes duration greater than 10years, the larger effect from RA was beneficial, with or without TBS. In contrast, hip fracture risk was consistently greater regardless of diabetes duration and required the use of TBS, with or without RA. Diabetes was associated with incident MOF and hip fracture independent of baseline fracture probability, but this risk was partially offset by excess mortality. TBS adjustment and RA input showed complementary benefits for improving fracture prediction that differed according to diabetes duration and fracture outcome.

People with substance-use disorders (SUDs) have increased mortality risk, yet Chilean estimates of SUD-based mortality are scarce. This study aimed to quantify all-cause and cause-specific mortality following SUD treatment in Chile compared with the general population and assess variation across key clinical and demographic subgroups. National-level registry-based retrospective data linkage cohort study. Publicly funded SUD psychosocial treatments offered by the Chilean National Drug Agency, linked with official national mortality records from 2010 to 2020. 70064 adults aged 18-64 years (24% women, median age 35 at treatment entry) were followed after their first treatment episode until death or 31 December 2020. Primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality by the International Classification of Diseases, 10th revision, underlying and external causes. We estimated age-sex-calendar year directly standardized rates (DSR), and standardized mortality ratios (SMR) compared with the expected rate for the (sub)population. We also stratified rates and ratios by sex (men/women), attained age (18-29, 30-44, 45-59, 60+), setting (ambulatory/residential), primary substance (alcohol; illicit: predominantly cocaine paste base, marijuana and cocaine hydrochloride) and treatment compliance (not completed/completed). Additionally, we estimated rates and SMRs for underlying and external causes of mortality. Over a median 4.9-year follow-up (353 826 person-years), 2996 deaths occurred [DSR = 10.6, 95% confidence interval (CI) = 8.6-13.1]. Overall SMR was 3.65 (95% CI = 3.52-3.79). Excess risk was particularly pronounced for women (SMR = 5.57, 95% CI = 5.14-6.03), patients admitted due to alcohol use disorder (SMR = 4.59, 95% CI = 4.33-4.86), in residential care (SMR = 4.91, 95% CI = 4.45-5.42) and treatment noncompletion (SMR = 4.04, 95% CI = 3.85-4.24). Cause-specific mortality revealed elevated external-cause excess risk for SUD patients, including intentional self-harm (SMR = 6.67, 95% CI = 6.05-7.36), unintentional injuries (SMR = 5.37, 95% CI = 4.79-6.02) and assaults (SMR = 4.98, 95% CI = 4.16-5.96). Notable excess risk was also observed for non-external mortality causes: digestive system (SMR = 8.20, 95% CI = 7.62-8.83), symptoms and signs (SMR = 5.18, 95% CI = 4.29-6.26) and respiratory diseases (SMR = 5.18, 95% CI = 4.47-5.99) were greater than expected. In Chile, patients with a history of publicly funded substance-use disorder treatment appear to have an all-cause mortality up to 3.7 times higher than the general population, driven predominantly by digestive and respiratory causes, as well as self-harm, unintentional injuries and assaults.

The health impacts of rising temperatures in care home settings are of growing concern. We seek to characterise the risk of heat-related mortality in nursing and residential care home settings in England and to assess potential modification of heat effects by Care Quality Commission (CQC) ratings. Heat episode analysis was used to assess excess mortality during the heatwave of 16-20 July 2022. Daily time-series regression analysis employing Distributed Lag Non-linear Models was used to assess short-term associations between daily mean temperature and daily number of deaths in care home residents during 2022-24, adjusting for season and day-of-week effects. Nursing home deaths increased by 34.1% (95% CI 21.1, 48.2) and residential care home deaths by 13.0% (0.1, 27.0) during the July 2022 heatwave. During 2022-24, the relative risk of death on a day of 25°C compared to a day of 16°C was 2.09 (95% CI 1.68, 2.60) among nursing home residents and 1.56 (1.24, 1.96) in residential care homes. There was a gradient of increasing heat-related mortality risk associated with poorer CQC rating, although almost all CQC categories were associated with raised risks. Heat-related mortality risk in care homes was greatest in the West Midlands and London regions. Our findings indicate a growing need for heat stress to be recognised as an important risk factor for care home residents. Urgent and wide-scale improvements in heat adaptation strategies are needed in care homes across England to help improve the resilience of the social care system to climate change.

This study aims to estimate the impact of type-II diabetes (DM-II) on kidney transplant outcomes and graft utility. A nation-wide, registry-based study that compares outcomes for all primary kidney transplantations performed between 2000 and 2022 in the Netherlands in DM-II patients (761 deceased and 364 living donor procedures) with non-diabetic controls. Short-term (≤90 days) transplant outcomes for living donor procedures were similar for DM-II and non-diabetic controls. Deceased donor transplantions in DM-II patients were associated with an increased incidence of delayed graft function (p<0.0002), and a doubling of 90-days mortality (HR: 2.19 (95% CI: 1.49-3.23), p< 0.0001). Evaluation of long-term graft survival, with death as competing risk indicated an equal (sub-distribution Hazard Rate (sHR) 0.95 [0.74-1.23]); respectively compromised (sHR 1.91 [1.37-2.65]; p<0.001) survival for grafts from deceased or living donors. DM-II profoundly impacted recipient survival (HR for death 1.63 [1.45-1.82] and 1.81 [1.51-2.17]; p<0.001 for recipients of a deceased or living donor graft respectively (non-diabetic recipients reference):, with cardiovascular and infection as dominant causes of death. The compromised recipient survival profoundly impacted the utility of kidney transplantations (p<0.001). Despite excellent graft survival, the efficacy of kidney transplantations in DM-II patients is compromised by reduced recipient survival. Cause of death distribution suggests a role for immunosuppressive regimens in the excess mortality observed. A shift in focus from optimized transplant- to optimized patient survival is warranted for DM-II patients. Moreover, the conflict between increasing incidences of DM-II, a lower transplant utility, but persistent donor organ shortages calls for development of novel organ allocation strategies.