Higher Age-adjusted Mortality Research Articles

Adverse Trends in Premature Cardiometabolic Mortality in the United States, 1999 to 2018.

BackgroundLife expectancy in the United States has recently declined, in part attributable to premature cardiometabolic mortality. We characterized national trends in premature cardiometabolic mortality, overall, and by race‐sex groups.Methods and ResultsUsing death certificates from the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research, we quantified premature deaths (<65 years of age) from heart disease, cerebrovascular disease, and diabetes mellitus from 1999 to 2018. We calculated age‐adjusted mortality rates (AAMRs) and years of potential life lost (YPLL) from each cardiometabolic cause occurring at <65 years of age. We used Joinpoint regression to identify an inflection point in overall cardiometabolic AAMR trends. Average annual percent change in AAMRs and YPLL was quantified before and after the identified inflection point. From 1999 to 2018, annual premature deaths from heart disease (117 880 to 128 832), cerebrovascular disease (18 765 to 20 565), and diabetes mellitus (16 553 to 24 758) as an underlying cause of death increased. By 2018, 19.7% of all heart disease deaths, 13.9% of all cerebrovascular disease deaths, and 29.1% of all diabetes mellitus deaths were premature. AAMRs and YPLL from heart disease and cerebrovascular disease declined until the inflection point identified in 2011, then remained unchanged through 2018. Conversely, AAMRs and YPLL from diabetes mellitus did not change through 2011, then increased through 2018. Black men and women had higher AAMRs and greater YPLL for each cardiometabolic cause compared with White men and women, respectively.ConclusionsOver one‐fifth of cardiometabolic deaths occurred at <65 years of age. Recent stagnation in cardiometabolic AAMRs and YPLL are compounded by persistent racial disparities.

Trends in Heart Failure-related Cardiovascular Mortality in Rural Versus Urban Counties in the United States, 2011-2018

Introduction Mortality rates due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality are not known. Differences between rural and urban counties and the impact of county-level factors on HF-related mortality are needed to inform public health strategies. Hypotheses Substantial variation in HF-related mortality trends between 2011-2018 exists by rural-urban designation. In addition, county-level factors account for a large proportion rural-urban differences in HF-related mortality rates. Methods We queried CDC WONDER to identify HF deaths between 2011-2018 defined as any mention of HF (I50) on the death certificate and cardiovascular disease (I00-78) as the underlying cause of death. First, we calculated age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35-64 and 65-84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011-2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for sociodemographic factors, risk factor prevalence, and physician density. Results Between 2011-2018, AAMRs were consistently higher for rural compared with urban counties (e.g., 73.2 [95% CI: 72.2-74.2] vs. 57.2 [56.8-57.6] in 2018, respectively). The highest AAMR was observed in rural black men (131.1 [123.3-138.9] in 2018), and the greatest increases in HF-related mortality occurred in rural black men, age 35-64 years (+6.1%/year). Unadjusted models demonstrated significantly higher HF-related mortality in rural versus urban counties across the entire study period (IRR = 1.67 [95% CI: 1.57-1.78] and 1.16 [95% CI: 1.13-1.18] for younger and older adults, respectively). The rural-urban IRR was significantly attenuated after adjustment for county-level factors among both younger (1.10 [1.04-1.16]) and older adults (1.04 [1.02-1.07]). Conclusions Differences in county-level factors account for a significant amount of the observed variation in HF-related mortality between rural and urban counties.

Cervical cancer incidence and mortality rates in Kentucky

ObjectivesThe goal of this study was to assess how the incidence and mortality of cervical cancer in Kentucky has changed from 1995 through 2017. Additionally, trends in incidence and mortality across different geographic areas and between different races were evaluated. MethodsAge-adjusted annual incidence and mortality rates for cervical cancer were collected from the Kentucky Cancer Registry (KCR). A quadratic fit model was used to evaluate changes in the incidence and mortality over time and to compare differences in cervical cancer incidence and mortality by: 1) rural versus urban counties, 2) Appalachian versus non-Appalachian counties, and 3) black versus white women. ResultsOverall, the incidence of cervical cancer has significantly decreased throughout Kentucky since 1995. When comparing different geographic regions, the incidence was 14% and 23% higher in rural and Appalachian counties, respectively, compared to urban and non-Appalachian counties (p < 0.0001) throughout the study period. The incidence of cervical cancer was significantly higher in black women compared to white women from 1995 through 2007, but since 2008 there has been no significant difference in cervical cancer incidence based on race. Similar to incidence rates, mortality from cervical cancer was 29% higher in Appalachia (p = 0.0004) throughout the studied time period. Black women had higher age-adjusted mortality than white women until 2012, but since that time there has not been a significant difference in cervical cancer mortality based on race. ConclusionsWomen residing in rural and Appalachian Kentucky have higher cervical cancer incidence and mortality rates.

Are black and Hispanic persons disproportionately affected by COVID-19 because of higher obesity rates?

BackgroundOn March 13, 2020, the World Health Organization declared COVID-19 a pandemic. Shortly after that, it was reported that mortality rates in New York City (NYC), the epicenter of the pandemic in the United States, were found to be significantly higher in black and Hispanic populations.ObjectivesThe aim of this article is to evaluate the mortality rates in NYC among the different ethnic groups and the different boroughs as they relate to the obesity rates to see whether this issue merits further evaluation.SettingNYC.MethodsCOVID-19 data were obtained from the official New York authorities in relation to total number of cases in the different boroughs of NYC. Age-adjusted COVID-19–related mortality rates of the different ethnic groups were also obtained. These data were cross-compared with historic community health data on obesity rates previously published and also obesity rates among the different ethnic groups in NYC.ResultsThe 2 NYC boroughs that have the highest mortality rates are the Bronx (6%) and Brooklyn (5.4%). Both the Bronx and Brooklyn were also found to have the highest obesity rates at 32% and 27%, respectively. The 2 ethnic groups with the highest obesity rates (Hispanic and black) were also found to have the highest age-adjusted mortality rates per 100,000 compared with the other ethnic groups (22.8% and 19.8%, respectively).ConclusionsThe Hispanic and black populations in NYC seem to be disproportionately affected by the COVID-19 pandemic because of the higher incidence of mortality rates. Obesity may have played a role in the high incidence of mortality in those ethnic groups.

Analysis of the Breast Cancer Mortality Rate in Portugal Over a Decade: Spatiotemporal Clustering Analysis.

Breast cancer is the first cause of cancer-related death in Portuguese women. This study aimed to characterize femalebreast cancer mortality in Portugal in the period between 2002 and 2013, with a special focus on spatiotemporal patterns. The breast cancer mortality rate was studied using descriptive analysis (unadjusted and age-adjusted), andspatiotemporal clustering analyses. In 2002 - 2013 the breast cancer mortality rate was 28.47/100 000 inhabitants and the age-adjusted mortality rate was19.46/100 000 inhabitants. In this period the Lisbon region (urban), Alentejo and Algarve (rural) presented higher breast cancer mortalityrate, but Madeira (urban), Lisbon and Algarve had higher age-adjusted mortality rate. In the spatiotemporal analysis, the overallmortality rate showed an increasing trend of 1.218%/year, without spatial variations. Also, different patterns were detected in the < 50,50 - 64 and ≥ 65 age-groups (+ 0.725%, - 1.781% and + 0.896%, respectively). One temporal (2004 - 2006) and one spatiotemporalcluster (North coast) presented significantly lower mortality rate than expected for the period and/or area (26.2 and 16.1/100 000 inhabitants,respectively). Conversely, two spatiotemporal clusters, located in the city of Lisbon (2002 - 2007) and in the Centre region(2008 - 2013), presented significantly higher breast cancer mortality rate than expected (48.6 and 34.9/100 000 inhabitants, relativerisk: 1.74 and 1.26, respectively). The annual female crude and adjusted breast cancer mortality rate matched previous publications. However the annualincrease detected in the unadjusted rate clashes with the published literature. Overall, the presence of spatiotemporal clusters supportsthe uneven distribution of the breast cancer mortality reported previously in the different Portuguese regions. This study identified areas and trends of the female breast cancer mortality rate, showing high spatiotemporal variationsthat must support further detailed studies/interventions.

Abstract 15: Trends in Atrial Fibrillation-related Cardiovascular Mortality Rates in The United States: 1999-2017

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and the prevalence is increasing due to the aging of the population and the growing burden of vascular risk factors. Although deaths due to cardiovascular disease (CVD) death have dramatically decreased in recent years, trends in AF-related CVD death has not been previously investigated. Purpose: We sought to quantify trends in AF-related CVD death rates in the United States. Methods: AF-related CVD death was ascertained using the CDC WONDER online database. AF-related CVD deaths were identified by listing CVD (I00-I78) as underlying cause of death and AF (I48) as contributing cause of death among persons aged 35 to 84 years. We calculated age-adjusted mortality rates (AAMR) per 100,000 population, and examined trends over time estimating average annual percent change (AAPC) using Joinpoint Regression Program (National Cancer Institute). Subgroup analyses were performed to compare AAMRs by sex-race (black and white men and women) and across two age groups (younger: 35-64 years, older 65-84 years). Results: A total of 522,104 AF-related CVD deaths were identified between 1999 and 2017. AAMR increased from 16.0 to 22.2 per 100,000 from 1999 to 2017 with an acceleration following an inflection point in 2009. AAPC before 2009 was significantly lower than that after 2009 [0.4% (95% CI, 0.0 - 0.7) vs 3.5% (95% CI, 3.1 - 3.9), p &lt; 0.001). The increase of AAMR was observed across black and white men and women overall and in both age groups (FIGURE), with a more pronounced increase in black men and white men. Black men had the highest AAMR among the younger decedents, whereas white men had the highest AAMR among the older decedents. Conclusion: This study revealed that death rate for AF-related CVD has increased over the last two decades and that there are greater black-white disparities in younger decedents (&lt;65 years). Targeting equitable risk factor reduction that predisposes to AF and CVD mortality is needed to reduce observed health inequities.

Rural Health.

About one in five US residents-nearly 60million people-live in rural areas, which cover 97percent of the nation's land mass. People living in rural communities suffer disproportionately from adverse health outcomes, including poorer health, greater disability, and higher age-adjusted mortality. This month's DataGraphic illustrates some of the rural vs. urban differences in health outcomes.

Structural Urbanism Contributes To Poorer Health Outcomes For Rural America.

Rural populations disproportionately suffer from adverse health outcomes, including poorer health and higher age-adjusted mortality. We argue that these disparities are due in part to declining health care provider availability and accessibility in rural communities. Rural challenges are exacerbated by "structural urbanism"-elements of the current public health and health care systems that disadvantage rural communities. We suggest that biases in current models of health care funding, which treat health care as a service for an individual rather than as infrastructure for a population, are innately biased in favor of large populations. Until this bias is recognized, the development of viable models for care across the rural-urban continuum cannot move forward.

Mortality due to HIV/AIDS in Viet Nam: time trend and related socio-economic status in some populations and periods from 2005 to 2014

ABSTRACT The study examined mortality due to HIV/AIDS and its time trend and ecological variables of socio-economic status during 2005–2014. Mortality data were obtained from the database of population-based mortality registration. Five variables including name, age, sex, date of death, and cause of death were collected from 10,184 of 10,769 local state health centers. Mortality rates ratio and 95% confidence interval (MRR, 95%CI) were calculated to observe the risk of death from HIV/AIDS-related to socio-economic status and time trends. The age-adjusted HIV/AIDS mortality rate increased from 5.49 per 100,000 during 2005 to 6.03 during 2006 and 6.20 during 2007. An elevated risk of death was seen in high mountain districts in Nghe An province, adjusted MRR = 5.38, 95%, CI: 4.76–6.08 relative to the urban areas of Vinh and Cua Lo cities. The highest age-adjusted mortality rate (147.1 per 100,000) was observed in a commune located in Thai Nguyen province. There was a statically significant decrease in HIV/AIDS mortality in Nghe An province from 2005–2006 to 2013–2014 (p < 0.05). The findings suggest that people living with HIV/AIDS in disadvantaged regions have a higher risk of death but there was a significant decrease in HIV/AIDS mortality in Nghe An province by 2013–2014.

Geographic disparity in systemic sclerosis mortality in the United States: 1999-2017.

Previous studies reported a progressive decrease in the systemic sclerosis mortality rates in the United States from 1959 to 2002. Identification of areas with clusters of higher mortality rates is important to implement targeted interventions. In this study, we aimed to estimate the mortality rates of scleroderma and to analyze its geographic variability at the state level in the United States. Mortality rates of scleroderma from 1999 to 2017 were obtained from the CDC Wonder Underlying Cause of Death database and its query system, using International Classification of Diseases, Tenth Revision codes. Age-adjusted rates were calculated by state and demographics. A linear regression model was applied to evaluate trends over time. Over the period studied, a total of 24,525 deaths had scleroderma as the underlying cause of death. The age-adjusted mortality rate was 3.962 per million (95% CI: 3.912-4.012), decreasing progressively from 4.679 (95%CI: 4.423-4.934) in 1999 to 2.993 (95% CI: 2.817-3.170) per million in 2017. The age-adjusted mortality rate was 5.885 (95% CI: 5.802-5.967) and 1.651 (95% CI: 1.604-1.698) per million in females and males, respectively. Per races, the highest age-adjusted mortality rate was in Blacks or African Americans, at 5.703 per million (95% CI: 5.521-5.885), followed by American Indians or Alaska Native at 5.047 per million (95% CI: 4.428-5.667). Clusters of states with higher and lower mortality rates were identified. South Dakota had the highest whereas Hawaii had the lowest mortality rate. We found a trend to a progressive decrease in mortality rates of scleroderma during the years of our study. In addition, we found relevant state-by-state variation in mortality with several geographical clusters with higher mortality rates. Further analyses are warranted in order to better understand the factors associated with the observed geographic disparities.

Mortality From Heart Failure and Dementia in the United States: CDC WONDER 1999–2016

Heart failure and dementia are diseases of the elderly that result in billions of dollars in annual health care expenditure. With the aging of the United States population and increasing evidence of shared risk factors, there is a need to understand the conditions' shared contributions to nationwide mortality. The objectives of this study were to estimate the burden of mortality from heart failure and dementia and characterize the demographics of affected individuals. This retrospective study used National Vital Statistics Data from 1999 to 2016 provided by the Centers for Disease Control and International Classification of Diseases (10th edition) codes for heart failure and dementia as defined by the Medicare Chronic Conditions Data Warehouse. From 1999 to 2016, deaths contributed to by both heart failure and dementia totaled 214,706 and constituted 4.00% of all heart failure deaths and 9.04% of all dementia deaths. Women were more affected than men, with higher age-adjusted mortality rates (per 1,000,000 person-years): 38.67 (95% confidence interval [CI] 38.47-38.87) versus 32.90 (95% CI 32.65-33.15; P < .001). Whites were affected more than blacks, with age-adjusted mortality rates (per 1,000,000 person-years) of 38.00 (95% CI 37.83-38.16) versus 31.06 (95% CI 30.54-31.59; P < .001). However, under the age of 65 years, higher crude mortality rates (per 1,000,000 person-years) were reported in men (0.20, 95% CI 0.18-0.22) compared with women (0.15, 95% CI 0.13-0.16; P < .001). This study provides insight into temporal trends and nationwide mortality rates reported for heart failure and dementia. Our results suggest a disproportionate burden on populations over 85 years of age, whites, and women.

Access Delayed Is Access Denied: States with Higher Age-Adjusted Mortality Rate Have Poorer Access to Trauma Center Care

Access Delayed Is Access Denied: States with Higher Age-Adjusted Mortality Rate Have Poorer Access to Trauma Center Care

Prevalence of non-infectious comorbidities in the HIV-positive population in Belgium: a multicenter, retrospective study

Objectives: In Belgium, eleven AIDS Reference Centers (ARCs) and seven AIDS Reference Laboratories diagnose and treat HIV-positive individuals and track patients under care. As AIDS-related deaths are avoided and the HIV-positive population ages, non-infectious comorbidities (NICMs), such as cardiovascular disease, renal disease and certain cancers, play a larger role in the quality and length of patients’ lives. This study aims to characterize the HIV-positive population in Belgium in terms of the prevalence of key NICMs.Methods: We performed a retrospective study of 5787 HIV-positive patients under follow-up at four ARCs across Belgium between 1st of June 2014 and 1st of July 2016.Results: The mean age of patients under follow-up was 46.7 (SD = 11.6) years, and the mean nadir CD4 count was 268.8 cells/mm3 (SD = 189.5). The prevalence of diabetes mellitus, arterial hypertension and chronic kidney disease (CKD) were 5.9, 31 and 7.8%, respectively. Cardiovascular events, defined as the occurrence of myocardial infarction, stroke or an invasive coronary procedure, occurred in 2.9% of patients. The highest age-adjusted mortality rates were observed among patients 51–55 years of age. Mortality rates were also higher among patients with CKD and patients with viremic hepatitis C virus (p < 0.05).Conclusions: Helping the aging HIV-positive population avoids premature morbidity and mortality from NICMs represents a key challenge to further improve patient outcomes. Belgium has an advanced system of HIV care and patient management; however, standardized data collection across ARCs is needed to improve knowledge sharing and to support future countrywide analyses.

Concordance in the relative mortality rates for prostate cancer and gastric cancer in African Americans.

270 Background: The racial disparity in outcomes for prostate cancer, gastric cancer, and multiple myeloma is demonstrated by these malignancies having the highest age-adjusted mortality rate ratio for black Americans versus white Americans. A variety of factors have been identified as contributing to this disparity, leading to our hypothesis that there would not be concordance, in respect to the mean, when the county-level age-adjusted black: white mortality rate ratio for a malignancy was compared to the other two malignancies. Methods: Publically available information from cancerrates.gov was used to obtain county-level data in regards to race-specific age-adjusted mortality rates for prostate cancer, gastric cancer, and multiple myeloma. Counties with potentially unstable age-adjusted mortality rates were excluded. A malignancy’s age-adjusted mortality rate for blacks was divided by the complementary rate for whites to determine the black: white mortality rate ratio. Across a county, malignancies were compared for concordance in mortality rate ratios relative to the mean ratio for that malignancy. After a preliminary inspection noted that all New Jersey counties had a markedly lower black: white mortality ratio for gastric cancer than other counties in the data set, the New Jersey counties were excluded from analysis and odds ratios for concordance were calculated. Results: All counties (n = 68) had a black: white age-adjusted mortality ratio of &gt; 1 for each malignancy. In the analyzed counties (n = 52), there was a statistically significant concordance in black: white mortality rate ratios for prostate cancer and gastric cancer (OR = 3.26, p = 0.046). The black: white mortality rate ratios for neither prostate cancer (OR = 1.17, p = 0.78) nor gastric cancer (OR = 1.17, p = 0.78) demonstrated a statistically significant concordance with multiple myeloma. Conclusions: The concordance in the black: white mortality rate ratios for prostate cancer and gastric cancer in this dataset indicate that these two malignancies may share common clinical, environmental, or genetic factors in African-Americans. Future research is needed into what common factors may contribute to disparities in these two malignancies.

Alcohol Consumption Levels and All-Cause Mortality Among Women Veterans and Non-Veterans Enrolled in the Women's Health Initiative.

To address research gaps regarding women Veterans' alcohol consumption and mortality risk as compared to non-Veterans, the current study evaluated whether alcohol consumption amounts differed between women Veterans and non-Veterans, whether Veterans and non-Veterans within alcohol consumption groups differed on all-cause mortality, and whether Veteran status modified the association between alcohol consumption and all-cause mortality. Six alcohol consumption groups were created using baseline data from the Women's Health Initiative Program (N = 145,521): lifelong abstainers, former drinkers, less than 1 drink/week (infrequent drinkers), 1-7 drinks/week (moderate drinkers), 8-14 drinks/week (moderately heavy drinkers), and 15 or more drinks/week (heavy drinkers). The proportions of Veteran and non-Veteran women within each alcohol consumption category were compared. Mortality rates within each alcohol consumption category were compared by Veteran status. Cox proportional hazard models, including a multiplicative interaction term for Veteran status, were fit to estimate adjusted mortality hazard (rate) ratios for each alcohol consumption category relative to a reference group of either lifelong abstainers or moderate drinkers. Women Veterans were less likely to be lifelong abstainers than non-Veterans. Women Veterans who were former or moderate drinkers had higher age-adjusted mortality rates than did non-Veterans within these alcohol consumption categories. In the fully adjusted multivariate models, Veteran status did not modify the association between alcohol consumption category and mortality with either lifelong abstainers or moderate drinkers as referents. The results suggest that healthcare providers may counsel Veteran and non-Veteran women in similar ways regarding safe and less safe levels of alcohol consumption.

Behavioral and community correlates of adolescent pregnancy and Chlamydia rates in rural counties in Minnesota.

Identifying co-occurring community risk factors, specific to rural communities, may suggest new strategies and partnerships for addressing sexual health issues among rural youth. We conducted an ecological analysis to identify the county-level correlates of pregnancy and chlamydia rates among adolescents in rural (nonmetropolitan) counties in Minnesota. Pregnancy and chlamydia infection rates among 15-19 year-old females were compared across Minnesota's 87 counties, stratified by rural/urban designations. Regression models for rural counties (n = 66) in Minnesota were developed based on publicly available, county-level information on behaviors and risk exposures to identify associations with teen pregnancy and chlamydia rates in rural settings. Adolescent pregnancy rates were higher in rural counties than in urban counties. Among rural counties, factors independently associated with elevated county-level rates of teen pregnancy included inconsistent contraceptive use by 12th-grade males, fewer 12th graders reporting feeling safe in their neighborhoods, more 9th graders reporting feeling overweight, fewer 12th graders reporting 30 min of physical activity daily, high county rates of single parenthood, and higher age-adjusted mortality (P < .05 for all associations). Factors associated with higher county level rates of chlamydia among rural counties were inconsistent condom use reported by 12th-grade males, more 12th graders reporting feeling overweight, and more 12th graders skipping school in the past month because they felt unsafe. This ecologic analysis suggests that programmatic approaches focusing on behavior change among male adolescents, self-esteem, and community health and safety may be complementary to interventions addressing teen sexual health in rural areas; such approaches warrant further study.

Female patients undergoing primary PCI do not have higher age-adjusted mortality after 7 years follow-up

Female patients undergoing primary PCI do not have higher age-adjusted mortality after 7 years follow-up

Cardiovascular Disease Epidemiology in Asia

Cardiovascular disease (CVD) is the leading cause of death in the world and half of the cases of CVD are estimated to occur in Asia. Compared with Western countries, most Asian countries, except for Japan, South Korea, Singapore and Thailand, have higher age-adjusted mortality from CVD. In Japan, the mortality from CVD, especially stroke, has declined continuously from the 1960s to the 2000s, which has contributed to making Japan into the top-ranking country for longevity in the world. Hypertension and smoking are the most notable risk factors for stroke and coronary artery disease, whereas dyslipidemia and diabetes mellitus are risk factors for ischemic heart disease and ischemic stroke. The nationwide approach to hypertension prevention and control has contributed to a substantial decline in stroke mortality in Japan. Recent antismoking campaigns have contributed to a decline in the smoking rate among men. Conversely, the prevalence of dyslipidemia and diabetes mellitus increased from the 1980s to the 2000s and, therefore, the population-attributable risks of CVD for dyslipidemia and diabetes mellitus have increased moderately. To prevent future CVD in Asia, the intensive prevention programs for hypertension and smoking should be continued and that for emerging metabolic risk factors should be intensified in Japan. The successful intervention programs in Japan can be applied to other Asian countries.

Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: Results from the COMPERA registry

Originally reported to occur predominantly in younger women, idiopathic pulmonary arterial hypertension (IPAH) is increasingly diagnosed in elderly patients. We aimed to describe the characteristics of such patients and their survival under clinical practice conditions. Prospective registry in 28 centers in 6 European countries. Demographics, clinical characteristics, hemodynamics, treatment patterns and outcomes of younger (18-65 years) and elderly (>65 years) patients with newly diagnosed IPAH (incident cases only) were compared. A total of 587 patients were eligible for analysis. The median (interquartile, [IQR]) age at diagnosis was 71 (16) years. Younger patients (n=209; median age, 54 [16] years) showed a female-to-male ratio of 2.3:1 whereas the gender ratio in elderly patients (n=378; median age, 75 [8] years) was almost even (1.2:1). Combinations of PAH drugs were widely used in both populations, albeit less frequently in older patients. Elderly patients were less likely to reach current treatment targets (6 min walking distance>400 m, functional class I or II). The survival rates 1, 2, and 3 years after the diagnosis of IPAH were lower in elderly patients, even when adjusted for age- and gender-matched survival tables of the general population (p=0.006 by log-rank analysis). In countries with an aging population, IPAH is now frequently diagnosed in elderly patients. Compared to younger patients, elderly patients present with a balanced gender ratio and different clinical features, respond less well to medical therapy and have a higher age-adjusted mortality. Further characterization of these patients is required. NCT01347216.

P2-215 Mortality due exclusively to diseases fully attributable to alcohol consumption in 2006 in Brazil: effects of gender, education and ethnicity

IntroductionDiseases fully attributable to alcohol consumption, as mental and behavioural disorders and alcoholic liver disease, are important causes of morbidity and mortality around the world, especially among men. Some studies...