Health Statistics Research Articles

Trends and Patterns in Emergency Department Visits: A Comprehensive Analysis of Adult Data From the National Center for Health Statistics (NCHS) Database.

Background Emergency department (ED) visits among adults have increased in recent years, with the United States reporting 140 million ED visits in 2021, equating to an overall rate of 43 visits per 100 people. This trend underscores challenges in accessing primary care and addressing underlying health conditions. Understanding the trends and patterns in ED utilization is essential for informing healthcare policy and practice. Objective This study aims to comprehensively analyze trends and patterns in ED visits among adults using data from the National Center for Health Statistics (NCHS) database. Methods We conducted a retrospective analysis of ED visit data from 1999 to 2019, focusing on adults aged 18 and over. The prevalence rates of ED visits were examined across demographic, socioeconomic, and geographic groups using datasets retrieved from the NCHS database. Statistical analysis included one-way ANOVA and chi-square tests to assess variations in ED visit rates. Results This study's findings revealed a consistent increase in overall ED visits among adults, from 17.2 ± 0.3% in 1999 to 21.7 ± 0.3% in 2019. Disparities in ED utilization were evident across demographic and socioeconomic groups. Females had slightly higher visit rates, and significant racial disparities were noted, with American Indian or Alaska Native and Black or African American individuals showing the highest visit rates. Age-specific variations were observed, with young adults (18-24 years) and older adults (65 years and above) exhibiting higher visit rates. Socioeconomic status and health insurance coverage emerged as significant determinants, highlighting disparities in healthcare access. Conclusion This study provides valuable insights into the trends and patterns of ED visits among adults, emphasizing the need for targeted interventions to address healthcare disparities and improve access to primary care services.

Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period. Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20-64 years (younger adults) and 65 years and older (older adults). Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13·4 deaths per 100 000 population (95% uncertainty interval 13·3-13·6), an increase of 65·3% (61·9-68·8) from 8·1 deaths per 100 000 (8·0-8·3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15·9 deaths per 100 000 population [95% uncertainty interval 14·0-18·2]) and White population (14·8 deaths per 100 000 [14·6-15·0]), and was about half as high among the Latino (8·7 deaths per 100 000 [8·3-9·0]), Black (8·1 deaths per 100 000 [7·9-8·4]), and Asian (7·5 deaths per 100 000 [7·1-7·9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all counties with unmasked estimates, there was higher mortality in the AIAN population than in all other racial and ethnic populations, while there were pockets of high mortality in the Latino population, particularly in the Mountain West region. For older adults, mortality was particularly high in the White population within clusters of counties across states including Florida, Minnesota, and Wisconsin. Age-standardised mortality due to falls increased over the study period for each racial and ethnic population and almost every county. Wide variation in mortality across geography, age, and race and ethnicity highlights areas and populations that might benefit most from efficacious fall prevention interventions as well as additional prevention research. US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

Differences in cancer rates among adults born between 1920 and 1990 in the USA: an analysis of population-based cancer registry data

Trends in cancer incidence in recent birth cohorts largely reflect changes in exposures during early life and foreshadow the future disease burden. Herein, we examined cancer incidence and mortality trends, by birth cohort, for 34 types of cancer in the USA. In this analysis, we obtained incidence data for 34 types of cancer and mortality data for 25 types of cancer for individuals aged 25-84 years for the period Jan 1, 2000, to Dec 31, 2019 from the North American Association of Central Cancer Registries and the US National Center for Health Statistics, respectively. We calculated birth cohort-specific incidence rate ratios (IRRs) and mortality rate ratios (MRRs), adjusted for age and period effects, by nominal birth cohort, separated by 5 year intervals, from 1920 to 1990. We extracted data for 23 654 000 patients diagnosed with 34 types of cancer and 7 348 137 deaths from 25 cancers for the period Jan 1, 2000, to Dec 31, 2019. We found that IRRs increased with each successive birth cohort born since approximately 1920 for eight of 34 cancers (pcohort<0·050). Notably, the incidence rate was approximately two-to-three times higher in the 1990 birth cohort than in the 1955 birth cohort for small intestine (IRR 3·56 [95% CI 2·96-4·27]), kidney and renal pelvis (2·92 [2·50-3·42]), and pancreatic (2·61 [2·22-3·07]) cancers in both male and female individuals; and for liver and intrahepatic bile duct cancer in female individuals (2·05 [1·23-3·44]). Additionally, the IRRs increased in younger cohorts, after a decline in older birth cohorts, for nine of the remaining cancers (pcohort<0·050): oestrogen-receptor-positive breast cancer, uterine corpus cancer, colorectal cancer, non-cardia gastric cancer, gallbladder and other biliary cancer, ovarian cancer, testicular cancer, anal cancer in male individuals, and Kaposi sarcoma in male individuals. Across cancer types, the incidence rate in the 1990 birth cohort ranged from 12% (IRR1990 vs 1975 1·12 [95% CI 1·03-1·21] for ovarian cancer) to 169% (IRR1990 vs 1930 2·69 [2·34-3·08] for uterine corpus cancer) higher than the rate in the birth cohort with the lowest incidence rate. The MRRs increased in successively younger birth cohorts alongside IRRs for liver and intrahepatic bile duct cancer in female individuals, uterine corpus, gallbladder and other biliary, testicular, and colorectal cancers, while MRRs declined or stabilised in younger birth cohorts for most cancers types. 17 of 34 cancers had an increasing incidence in younger birth cohorts, including nine that previously had declining incidence in older birth cohorts. These findings add to growing evidence of increased cancer risk in younger generations, highlighting the need to identify and tackle underlying risk factors. American Cancer Society.

Special Supplemental Nutrition Program for Women, Infants, and Children Enrollment and Adverse Pregnancy Outcomes Among Nulliparous Individuals.

To evaluate the relationship between changes in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment during pregnancy from 2016 to 2019 and rates of adverse pregnancy outcomes in U.S. counties in 2019. We conducted a serial, cross-sectional ecologic study at the county level using National Center for Health Statistics natality data from 2016 to 2019 of nulliparous individuals eligible for WIC. The exposure was the change in county-level WIC enrollment from 2016 to 2019 (increase [more than 0%] vs no change or decrease [0% or less]). Outcomes were adverse pregnancy outcomes assessed in 2019 and included maternal outcomes (ie, gestational diabetes mellitus [GDM], hypertensive disorders of pregnancy, cesarean delivery, intensive care unit [ICU] admission, and transfusion) and neonatal outcomes (ie, large for gestational age [LGA], small for gestational age [SGA], preterm birth, and neonatal intensive care unit [NICU] admission). Among 1,945,914 deliveries from 3,120 U.S. counties, the age-standardized rate of WIC enrollment decreased from 73.1 (95% CI, 73.0-73.2) per 100 live births in 2016 to 66.1 (95% CI, 66.0-66.2) per 100 live births in 2019, for a mean annual percent change decrease of 3.2% (95% CI, -3.7% to -2.9%) per year. Compared with individuals in counties in which WIC enrollment decreased or did not change, individuals living in counties in which WIC enrollment increased had lower rates of maternal adverse pregnancy outcomes, including GDM (adjusted odds ratio [aOR] 0.71, 95% CI, 0.57-0.89), ICU admission (aOR 0.47, 95% CI, 0.34-0.65), and transfusion (aOR 0.68, 95% CI, 0.53-0.88), and neonatal adverse pregnancy outcomes, including preterm birth (aOR 0.71, 95% CI, 0.56-0.90) and NICU admission (aOR 0.77, 95% CI, 0.60-0.97), but not cesarean delivery, hypertensive disorders of pregnancy, or LGA or SGA birth. Increasing WIC enrollment during pregnancy at the county level was associated with a lower risk of adverse pregnancy outcomes. In an era when WIC enrollment has decreased and food and nutrition insecurity has increased, efforts are needed to increase WIC enrollment among eligible individuals in pregnancy.

Space Alpha Particle Fluxes Towards the Earth Increase Human Mortality. Is It Possible an Intervention of Non-Human Intelligence?

In the present work, a dangerous phenomenon for mankind is described, increasing mortality, mainly from the most deadly diseases on the planet – circulatory diseases, in particular ischemic heart diseases. In the joint analysis of data from satellites in orbit around the Earth and from the health statistics sources EUROSTAT and US medical statistics, it became clear that, by some mechanism, flows of positively charged particles with high energy entering the Earth's orbit increase human mortality, mainly from diseases of the circulatory system, but also from diseases of many other organs and systems of the human body. The circulatory disease mortality increase as a result of said alpha radiation is by an average of 5% to 15% in a zone of maximum risk in the Northern Hemisphere, parallel to the equator and bounded by the parallels of 30° and 50° north latitude. A hypothetical mechanism based on observational evidence has been proposed, according to which this dangerous phenomenon is due to solar alpha particles of high energy sufficient to overcome the resistance of the atmosphere and reach the Earth's surface in a limited area of maximum death impact. The impact is most often short-lasting – for minutes, hours, or sometimes a few days. In the area with maximum risk, alpha particles have a detrimental effect on the human body. The area with maximum risk is limited in area and in time by two conditions 1. the path of the particles through the atmosphere to the Earth's surface is as short as possible (during the local culmination of the Sun, local noon) and 2. the direction of the incoming alpha particles coincides with the direction of the vector of geomagnetic induction at the point of maximum risk, where alpha particles are not affected by the deflecting force of the geomagnetic field. Such a coincidence between the culmination of the Sun, which changes during the year, and the direction of the geomagnetic induction vector, which is unchanged for a given point of observation, occurs twice a year for points with a geographical latitude of 30° – 50° N. Examples are given confirming the proposed mechanism of action. In the second part of the study, attention is paid to the nature of alpha particle streams reaching the Earth's orbit. In addition to those emitted by the Sun as a result of natural processes, there are also series of pulses lasting less than 5 minutes, with strict periodicity in the series day or week, with the same moment of registration of the pulses and coincidence of the pulses in the series by magnitude over extended time intervals, sometimes over the lifetime of the series from months to years. The alpha particles from each pulse in the series bombard the Earth's surface always in the same place. There are many such series, differing in time of recording and period, each of which is focused on a certain region of the Earth's surface. Such are, in particular, the series of pulses affecting the territory of the USA, Europe, and Central Asia. There is statistical confirmation in the US health statistics that the series of pulses affecting the country cause an increase in the mortality of ischemic heart disease by up to 5%. The lack of free access to detailed statistics on the cases of death in the other countries affected by the phenomenon does not allow a conclusion of the impact of the series of pulses of alpha particles on the health of their inhabitants. The strange characteristics of the mentioned series of pulses of alpha particles do not exclude the hypothesis that they are artificially generated from a non-human mind. The level of technological development of human civilization does not imply the possibility for it to generate such large-scale processes as the series of pulses of alpha particles, i.e. the highly developed non-human mind that generates them has nothing to do with human civilization. The series of pulses may be navigational signals causing unwitting casualties to humanity, but they may also be a form of murderous contact with a higher civilization that we have long sought, expecting only benefits after its realization, not suspecting that we live in this nightmarish contact indefinitely.

Health-care Systems around the World: Diversity, Challenges, and Innovations

Abstract This study aims to explore the diversity of health-care systems globally, identify the challenges they face, and highlight innovative solutions being implemented to overcome these obstacles. By examining health-care models from various countries, the research seeks to understand how different systems can learn from each other to improve patient outcomes, efficiency, and sustainability. A comparative analysis was conducted across health-care systems in multiple countries, including high-income, middle-income, and low-income nations. Data were collected through a review of existing literature, health statistics, and case studies. Key metrics such as accessibility, quality of care, cost-effectiveness, and patient satisfaction were analyzed. In addition, interviews with health-care professionals and policymakers provided insights into the operational dynamics and innovation strategies within these systems. The findings reveal a wide spectrum of health-care models, from publicly funded systems to private insurance-based and mixed models. Common challenges identified include rising health-care costs, unequal access to services, and the burden of noncommunicable diseases. However, innovative practices such as digital health technologies, community-based health care, and integrated care models have shown promise in addressing these issues. The effectiveness of these innovations varied depending on the context of the health-care system in which they were implemented. In conclusion, the diversity of health-care systems worldwide presents both challenges and opportunities for innovation and improvement. While there is no one-size-fits-all solution, the successful strategies identified in this study emphasize the importance of adaptable, patient-centered care models that leverage technology and community resources. Policymakers and health-care providers should foster collaboration and learning across borders to enhance the resilience and efficiency of their health-care systems.

A general procedure for evaluating models and ensemble Support Vector Regression

In practice, we may want to discover if there is a relationship between a response variable as a function of the predictor variables. Multiple linear regression (MLR) is a popular tool for such purpose. When the relationship is nonlinear, nonparametric regression methods such as local linear regression, smoothing splines, and support vector regression (SVR) provide flexible alternatives to MLR. How do we compare the performance of these methods and choose an appropriate one for use? In this research, we propose a general procedure to evaluate the performance of different regression methods for use in large data. We also propose an ensemble SVR for regression analysis. The proposed methods are applied to address research questions using the Research and Development Survey, conducted by the National Center for Health Statistics.

Maternal Obesity and Risk of Sudden Unexpected Infant Death

Rates of maternal obesity are increasing in the US. Although obesity is a well-documented risk factor for numerous poor pregnancy outcomes, it is not currently a recognized risk factor for sudden unexpected infant death (SUID). To determine whether maternal obesity is a risk factor for SUID and the proportion of SUID cases attributable to maternal obesity. This was a US nationwide cohort study using Centers for Disease Control and Prevention National Center for Health Statistics linked birth-infant death records for birth cohorts in 2015 through 2019. All US live births for the study years occurring at 28 weeks' gestation or later from complete reporting areas were eligible; SUID cases were deaths occurring at 7 to 364 days after birth with International Statistical Classification of Diseases, Tenth Revision cause of death code R95 (sudden infant death syndrome), R99 (ill-defined and unknown causes), or W75 (accidental suffocation and strangulation in bed). Data were analyzed from October 1 through November 15, 2023. Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). SUID. Of 18 857 694 live births eligible for analysis (median [IQR] age: maternal, 29 [9] years; paternal, 31 [9] years; gestational, 39 [2] weeks), 16 545 died of SUID (SUID rate, 0.88/1000 live births). After confounder adjustment, compared with mothers with normal BMI (BMI 18.5-24.9), infants born to mothers with obesity had a higher SUID risk that increased with increasing obesity severity. Infants of mothers with class I obesity (BMI 30.0-34.9) were at increased SUID risk (adjusted odds ratio [aOR], 1.10; 95% CI, 1.05-1.16); with class II obesity (BMI 35.0-39.9), a higher risk (aOR, 1.20; 95% CI, 1.13-1.27); and class III obesity (BMI ≥40.0), an even higher risk (aOR, 1.39; 95% CI, 1.31-1.47). A generalized additive model showed that increased BMI was monotonically associated with increased SUID risk, with an acceleration of risk for BMIs greater than approximately 25 to 30. Approximately 5.4% of SUID cases were attributable to maternal obesity. The findings suggest that infants born to mothers with obesity are at increased risk of SUID, with a dose-dependent association between increasing maternal BMI and SUID risk. Maternal obesity should be added to the list of known risk factors for SUID. With maternal obesity rates increasing, research should identify potential causal mechanisms for this association.

Association between interpregnancy interval and adverse perinatal outcomes among subsequent twin pregnancies: a nationwide population-based study

BackgroundThe existing evidence on the association between interpregnancy interval (IPI) and pregnancy outcomes primarily focuses on singleton pregnancies, with limited research on twin pregnancies. ObjectiveThis study aimed to investigate the association between IPI and adverse perinatal outcomes in twin pregnancies. Study DesignThis population-based, retrospective cohort study analyzed data from the National Center for Health Statistics in the United States between 2016 and 2020. We included multiparous women aged 18 to 45 years with live-born twins without congenital anomalies, born between 26 and 42 weeks of gestation. Poisson regression models, adjusted for potential confounders, were used to evaluate the associations between IPI and adverse outcomes, including preterm birth (PTB) <36 weeks, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, neonatal composite morbidity, and infant death. Missing data on covariates were managed using multiple imputations. Dose-response analyses were performed using the restricted cubic splines (RCS) approach. Subgroup analyses were stratified by maternal age, parity, and combination of neonatal sex. Sensitivity analyses were conducted using complete data and excluding pregnancies with intervening events during the IPI. ResultsA total of 143,014 twin pregnancies were included in the analysis. Compared to the referent group (IPI of 18–23 months), an IPI of less than 6 months was associated with an increased risk of PTB<36 weeks (RR, 1.21; 95% confidence interval [95% CI]: 1.17–1.25), SGA (RR, 1.11; 95% CI: 1.03–1.18), neonatal composite morbidity (RR, 1.19; 95% CI: 1.12–1.27), NICU admission (RR, 1.18; 95% CI: 1.14–1.22), and infant death (RR, 1.29; 95% CI: 1.05–1.60). An IPI of 5 years or more was associated with an increased risk of PTB<36 weeks (RR, 1.18; 95% CI: 1.15–1.21), SGA (RR, 1.24; 95% CI: 1.18–1.30), neonatal composite morbidity (RR, 1.10; 95% CI: 1.05–1.15), and NICU admission (RR, 1.14; 95% CI: 1.11–1.17). The dose-response analyses showed that these outcomes had U-shaped or J-shaped associations with IPI. The associations between IPI and the outcomes slightly differed by advanced maternal age, parity, and combination of neonatal sex. The sensitivity analyses yielded similar results to the main findings. ConclusionExtreme IPI, less than 6 months or more than 5 years, was associated with adverse outcomes in twin pregnancies. IPI could be used as a predictor for risk stratification in high-risk twin pregnancies.

Moving Beyond Medical Statistics: A Systematic Review on Missing Data Handling in Electronic Health Records

Moving Beyond Medical Statistics: A Systematic Review on Missing Data Handling in Electronic Health Records

Clinical-statistical study on oral rehabilitation methods using dental implants.

The development of dental implantology is based on a thorough examination of the interaction of implants with the surrounding tissues, as well as methods of stimulating osteogenesis around implants. The most common approach to restore lost dentition in terms of function and aesthetics is now represented by implants. The objective of our study was to comparatively assess the efficiency of prosthetic treatments performed on implants alone versus on implants in conjunction with abutment teeth. The study was carried out over seven years (2016-2023), with evaluations at one, two, three, and five years. For this analysis, MedCalc® version 12.5.0.0 (MedCalc® Software, Mariakerke, Belgium) was utilised as the medical statistical software. When using dental implants and natural teeth abutments for prosthodontic reconstruction, the failure rates rise approximately 43 times when compared to dental implant rehabilitation; similarly, osteoporosis and diabetes mellitus increase failure rates by 32 and 20 times, respectively. Gingival inflammation is a frequent event (almost 50% frequency) observed during follow-up of patients who had prosthetic restoration using dental implants alone as well as implants and abutment teeth. For both groups, difficulties usually arise two years later.

Predictive Modeling of Future Trends in US Healthcare Data and Outcomes

Predictive modeling has great potential to help guide healthcare policymaking and planning through forecasting future trends in domains such as disease prevalence, resource utilization, and costs. However, past research in this area has been limited by mostly examining small, narrow datasets that only captured specific illnesses or geographic regions. This study aimed to leverage more sophisticated predictive analytics to generate informed estimations of the most consequential healthcare trends anticipated in the United States throughout the next decade. The analysis drew upon an extensive collection of over 50 million longitudinal electronic health records spanning a 5-year timeframe, comprehensive national public health statistics from the same period, and Medicare claims encompassing 72 million beneficiaries. Advanced machine learning techniques, including neural networks and Bayesian additive regression trees, were applied to identify nonlinear relationships and temporal patterns across 500 variables related to patient demographics, medical diagnoses, therapeutic procedures, reimbursement amounts, and clinical outcomes. Models were trained using data from 2010 to 2015 then utilized to project trends and forecasts for the years 2020 to 2025. Five-fold cross-validation testing was conducted to evaluate the accuracy and generalizability of the predictive models. The model projections indicate that chronic disease prevalence nationwide will rise by approximately 40% by the conclusion of 2025, primarily fueled by growing epidemics of obesity and an increasingly aging American population. Additionally, heart disease and stroke are estimated to maintain their positioning as leading causes of death, but cases of dementia and Alzheimer's disease specifically are projected to climb even more sharply at over a 50% increase. Healthcare costs on the whole are anticipated to rise on average between 4-6% annually, and costs may potentially double for elderly patients presenting with multiple morbidities. As outpatient and home-based care options expand further, inpatient hospital facility utilization may drop marginally between 10-15%. Improved management of chronic medical conditions within local community settings could reduce preventable hospital readmissions from 25-30%. Primary care, nursing, and mental healthcare roles are likely to face looming staffing shortages as well. Telehealth adoption is forecasted to surge by approximately 45% as virtual visit formats help address access obstacles. By 2025, biologics and gene therapies could account for over 25% of total drug spending pertaining to oncology and rare disease treatment. Larger Medicaid, Medicare, and ACA commercial coverage markets may motivate higher rates of health insurance enrollment over the next few years.

Expose to volatile organic compounds is associated with increased risk of depression: A cross-sectional study

With increasing prevalence rate of depression by years, more attention has been paid to the influence of environmental pollutants on depression, but relationship between exposure to volatile organic compounds (VOCs) and depression is rarely studied. Therefore, this cross-sectional study use the National Center for Health Statistics (NHANES) database (2013–2016 years) to explore association between exposure to multiple VOCs and depression in general population. Multiple linear and logistic regression models were used to analyze the association between urinary VOC metabolism (mVOCs) and depression. To further analyze effect of multiple mVOCs mixed exposure, Bayesian kernel machine regression (BKMR) models were performed. A total of 3240 participants and 16 mVOCs were included in the analysis. Results showed that 10 mVOCs exposure were positively correlated with depression by multiple linear and logistic regression models, especially CYMA and MHBMA3, which also showed significant positive association with depression in BKMR model. Mixed exposure of multiple mVOCs was significantly positively correlated with depression. Gender differences were existed in effects of some VOCs concentrations on depression. AAMA, CYMA and MA had significant positive correlations with depression by women, and DHBMA had significant positive correlations with depression by men. Hence, this study showed that exposing to VOCs might have negative impacts on depression, and impact of CYMA and MHBMA3 on depression may be more evident, which provide new ideas for prevention and control of depression. But further research and exploration are needed to clarify the mechanism and influence factors of this relationship, to demonstrate the reliability of these relationship.

Türkiye's Global Burden of Disease and Health Policy Priorities

ABSTRACT Purpose: This study was conducted to reveal Türkiye's current situation and make policy recommendations within the scope of the global disease burden 2019 report. Materials and Methods: The data of the study were obtained from the Ministry of Health 2022 health statistics yearbook and IHME 2019 global disease burden report. Within the scope of YLL, YLD, DALY and HALE data, international comparisons were made with age, gender, time, causes and risk factors within the scope of 2002-2019 in Türkiye and policy recommendations were made. Results: Ischemic heart disease, stroke, respiratory tract cancer and diseases are in an upward trend in the disease burden of Türkiye. There have been positive developments regarding maternal and child health. The most important risk factors are; It has been observed that there is tobacco use, high fasting blood sugar and blood pressure, and obesity. Conclusion: Türkiye has indicators at the level of middle-upper income country group in terms of disease burden. Although there are positive developments regarding maternal and child health, Türkiye has an increasing tendency to face a heavy burden of chronic diseases after middle age. This situation indicates that the management of health services becomes more difficult, health expenditures increase and an unhealthy aging society. It is recommended that protective, preventive and health-promoting policies be implemented widely and effectively by balancing the capacity of treatment services.

Predictors of Life Expectancy at Birth In Turkiye: A Longitudinal Study

ABSTRACT Objective: The aim of this study is to examine the impact of social, behavioral, economic and healthcare system related factors on life expectancy at birth in Turkiye. Methods: Enrollment rate in tertiary education, tobacco consumption gram per capita, out-of-pocket payments and GDP per capita were included as predictors. The data was obtained from the database of OECD, World Bank and Health Statistics Yearbooks published by Ministry of the Health for 2000-2019. Johansen Cointegration test was used to define the existence of the long-run statistical relationship between life expectancy at birth and the predictors. Results: Enrollment rate in tertiary education, GDP per capita and out-of-pocket payments are positively associated with life expectancy, while tobacco consumption gram per capita has a negative association. It has been concluded that short-term deviations from the equilibrium, using an error correction model, will reach long-term equilibrium approximately one year later. Granger causality test and the estimation result revealed that enrollment rate in tertiary education, tobacco consumption, out-of-pocket health expenditure, GDP per capita are the short-term and long-term causes of life expectancy at birth. Conclusion: This study provides important evidence for policymakers to allocate resources to the social, behavioral, healthcare-related and economic determinants of health status to increase life expectancy. In addition, the determination of out-of-pocket payments to have a positive relationship with life expectancy gives a clue about the need to make more efforts regarding the economic accessibility of healthcare services in the Turkish health system.

Cost-effectiveness of implementing performance-based financing for improving maternal and child health in Ethiopia.

Performance Based Financing (PBF) supports realization of universal health coverage by promoting bargaining between purchasers and health service providers through identifying priority services and monitoring indicators. In PBF, purchasers use health statistics and information to make decisions rather than merely reimbursing invoices. In this respect, PBF shares certain elements of strategic health purchasing. PBF implementation began in Ethiopia in 2015 as a pilot at one hospital and eight health centers. Prior to this the system predominantly followed input-based financing where providers were provided with a predetermined budget for inputs for service provision. The purpose of the study is to determine whether the implementation of PBF is cost-effective in improving maternal and child health in Ethiopia compared to the standard care. The current study used cost-effectiveness analysis to assess the effects of PBF on maternal and child health. Two districts implementing PBF and two following standard care were selected for the study. Both groups of selected districts share common grounds before initiating PBF in the selected group. The provider perspective costing approach was used in the study. Data at the district level were gathered retrospectively for the period of July 2018 to June 2021. Data from health service statistics were transformed to population level coverages and the Lives Saved Tool method used to compute the number of lives saved. Additionally for purpose of comparison, lives saved were translated into discounted quality-adjusted life years. The number of lives saved under PBF was 261, whereas number of lives saved under standard care was 194. The identified incremental cost per capita due to PBF was $1.8 while total costs of delivering service at PBF district was 8,816,370 USD per million population per year while the standard care costs 9,780,920 USD per million population per year. QALYs obtained under PBF and standard care were 6,118 and 4,526 per million population per year, respectively. The conclusion made from this analysis is that, implementing PBF is cost-saving in Ethiopia compared to the standard care. Due to lack of district-level survey-based data, such as prevalence and effects on maternal and child health, national-level estimates were used into the LiST tool.There may be some central-level PBF start-up costs that were not captured, which may have spillover effects on the existing health system performance that this study has not considered.There may be health statistics data accuracy differences between the PBF and non-PBF districts. The researchers considered using data from records as reported by both groups of districts.

The burden of cirrhosis mortality by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

Cirrhosis is responsible for substantial health and economic burden in the USA. Reducing this burden requires better understanding of how rates of cirrhosis mortality vary by race and ethnicity and by geographical location. This study describes rates and trends in cirrhosis mortality for five racial and ethnic populations in 3110 US counties from 2000 to 2019. We estimated cirrhosis mortality rates by county, race and ethnicity, and year (2000-19) using previously validated small-area estimation methods, death registration data from the US National Vital Statistics System, and population data from the US National Center for Health Statistics. Five racial and ethnic populations were considered: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Cirrhosis mortality rate estimates were age-standardised using the age distribution from the 2010 US census as the standard. For each racial and ethnic population, estimates are presented for all counties with a mean annual population greater than 1000. From 2000 to 2019, national-level age-standardised cirrhosis mortality rates decreased in the Asian (23·8% [95% uncertainty interval 19·6-27·8], from 9·4 deaths per 100 000 population [8·9-9·9] to 7·1 per 100 000 [6·8-7·5]), Black (22·8% [20·6-24·8], from 19·8 per 100 000 [19·4-20·3] to 15·3 per 100 000 [15·0-15·6]), and Latino (15·3% [13·3-17·3], from 26·3 per 100 000 [25·6-27·0] to 22·3 per 100 000 [21·8-22·8]) populations and increased in the AIAN (39·3% [32·3-46·4], from 45·6 per 100 000 [40·6-50·6] to 63·5 per 100 000 [57·2-70·2] in 2000 and 2019, respectively) and White (25·8% [24·2-27·3], from 14·7 deaths per 100 000 [14·6-14·9] to 18·5 per 100 000 [18·4-18·7]) populations. In all years, cirrhosis mortality rates were lowest among the Asian population, highest among the AIAN population, and higher in males than females for each racial and ethnic population. The degree of heterogeneity in county-level cirrhosis mortality rates varied by racial and ethnic population, with the narrowest IQR in the Asian population (median 8·0 deaths per 100 000, IQR 6·4-10·4) and the widest in the AIAN population (55·1, 30·3-78·8). Cirrhosis mortality increased over the study period in almost all counties for the White (2957 [96·9%] of 3051 counties) and AIAN (421 [88·8%] of 474) populations, but in a smaller proportion of counties for the Asian, Black, and Latino populations. For all racial and ethnic populations, cirrhosis mortality rates increased in more counties between 2000 and 2015 than between 2015 and 2019. Cirrhosis mortality increased nationally and in many counties from 2000 to 2019. Although the magnitude of racial and ethnic disparities decreased in some places, disparities nonetheless persisted, and mortality remained high in many locations and communities. Our findings underscore the need to implement targeted and locally tailored programmes and policies to reduce the burden of cirrhosis at both the national and local level. US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

Optimal gestational weight change associated with improved perinatal outcomes in women with gestational diabetes mellitus: a population-based study in the United States

BackgroundOptimal gestational weight change (GWC) is little known among pregnant women with gestational diabetes mellitus (GDM). ObjectivesThis study aimed to explore the optimal GWC ranges for women with GDM and validate these ranges compared with the Institute of Medicine (IOM) guidelines. MethodsA population-based cohort study using natality data from the National Center for Health Statistics in the United States included 1,338,460 mother–infant pairs with GDM from 2014 to 2020. Poisson regression models were performed to identify GWC ranges (GDM targets) associated with acceptable risks (<10% increase) for a severity-weighted composite outcome including preterm birth (PTB) <37 wk, large for gestational age (LGA, birthweight >90th percentile) and small for gestational age (SGA, birthweight <10th percentile). These targets were validated in individual outcomes including PTB, LGA, SGA, hypertensive disorders of pregnancy, neonatal intensive care unit admission, and neonatal respiratory morbidity, and compared with the IOM guidelines using logistic regression models with population-attributable fractions (PAFs) calculated. ResultsThe severity-weighted composite outcome had a U-shaped or a J-shaped relationship with GWC across body mass index categories. The GDM targets were 14.1 to 20.3 kg, 9.0 to 17.0 kg, 4.8 to 13.8 kg, –0.8 to 10.8 kg, –2.4 to 8.2 kg, and –8.3 to 6.0 kg for underweight, normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. GWC outside the GDM or the IOM targets was associated with increased adverse perinatal outcomes in validation analyses. PAFs indicated that the IOM guidelines reduced a similar or higher proportion of adverse perinatal outcomes compared with the GDM targets for women with GDM, except for those with class 2 and 3 obesity. ConclusionsThe IOM guidelines are generally applicable for women with GDM, except for women with moderate and severe obesity. The optimal GWC ranges for women with GDM and moderate to severe obesity may be lower than the IOM guidelines.

Public Health Surveillance in Electronic Health Records: Lessons From PCORnet.

PCORnet, the National Patient-Centered Clinical Research Network, is a large research network of health systems that map clinical data to a standardized data model. In 2018, we expanded existing infrastructure to facilitate use for public health surveillance. We describe benefits and challenges of using PCORnet for surveillance and describe case studies. In 2018, infrastructure enhancements included addition of a table to store patients' residential zip codes and expansion of a modular program to generate population health statistics across conditions. Chronic disease surveillance case studies conducted in 2019 assessed atrial fibrillation (AF) and cirrhosis. In April 2020, PCORnet established an infrastructure to support COVID-19 surveillance with institutions frequently updating their electronic health record data. By August 2023, 53 PCORnet sites (84%) had a 5-digit zip code available on at least 95% of their patient populations. Among 148,223 newly diagnosed AF patients eligible for oral anticoagulant (OAC) therapy, 43.3% were on any OAC (17.8% warfarin, 28.5% any novel oral anticoagulant) within a year of the AF diagnosis. Among 60,268 patients with cirrhosis (2015-2019), common documented etiologies included unknown (48%), hepatitis C infection (23%), and alcohol use (22%). During October 2022 through December 2023, across 34 institutions, the proportion of COVID-19 patients who were cared for in the inpatient setting was 9.1% among 887,051 adults aged 20 years or older and 6.0% among 139,148 children younger than 20 years. PCORnet provides important data that may augment traditional public health surveillance programs across diverse conditions. PCORnet affords longitudinal population health assessments among large catchments of the population with clinical, treatment, and geographic information, with capabilities to deliver rapid information needed during public health emergencies.

Suicides among construction workers in the United States, 2021.

Construction workers have the second highest suicide death rate; despite this, there is limited literature examining suicides in the industry, which is necessary to identify those at higher risk of death by suicide. The objective of this study was to examine the characteristics of those who died by suicide in construction to address this knowledge gap. Data from the National Center for Health Statistics National Vital Statistics System 2021 public use Mortality Multiple Cause-of-Death file were used to identify deaths by suicide, while denominator data for rates come from the 2021 Current Population Survey. In 2021, construction workers were disproportionately affected by suicide deaths. Almost a fifth (17.9%) of deaths by suicide with a reported industry code were in construction, despite construction workers accounting for only 7.4% of the workforce. Male construction workers accounted for a majority (97.8%) of suicide deaths. The highest percent of deaths by suicide were among individuals who were white, non-Hispanic, completed high school or equivalent, and single, across construction and all industries for males and females. Male and female construction workers had the highest rates of suicide across all characteristics when compared to all industries. Our findings support the need for ongoing prevention efforts within the industry. Future research is needed to understand suicide risk among certain characteristics and occupations. In addition, the work environment or other work-related factors should be studied to understand how the unique nature of the construction industry may be associated with higher suicide rates.