Higher Cause-specific Mortality Research Articles

Mortality, cancer incidence, and disability among professional drivers in Slovenia.

Literature data about all-cause and cause-specific mortality among professional drivers are inconsistent. Most studies report lower all-cause and higher cause-specific mortality. Higher cause-specific mortality is most often the result of malignant and circulatory diseases. The aim of our retrospective cohort study was to get a better insight into the mortality, cancer incidence, and occupational disability of the entire professional driver population in Slovenia (N=8,231) from 1997 to 2016 through standardised mortality ratio (SMR), standardised proportional mortality ratio (SPMR), standardised cancer incidence ratio (SIR), and standardised disability ratio (SDR). Total mortality was significantly lower than that of the general working population (SMR=0.49; 95 % CI=0.44-0.55). When SPMR was calculated, however, the risk of all-cause mortality increased to 1 (SPMR=1.00; 95 % CI=0.89-1.12), of cancer-related mortality to 1.13 (95 % CI=0.94-1.35), and of injury-related mortality to 1.25 (95 % CI=0.97-1.59). Cancer incidence was lower than in the general male working population for all types of cancer (SIR=0.66; 95 % CI=0.59-0.72), lung cancer included (SIR=0.56; 95 % CI=0.41-0.73). Occupational all-cause and cause-specific disability were also lower than in the rest of the working population. Even though all types of cancer and injuries were established among professional drivers in Slovenia, no major risk stand out. However, our findings may have been skewed by the healthy worker effect.

Residual Kidney Function and Cause-Specific Mortality Among Incident Hemodialysis Patients

The survival benefit of residual kidney function (RKF) in patients on hemodialysis is presumably due to enhanced fluid management and solute clearance. However, data are lacking on the association of renal urea clearance (CLurea) with specific causes of death. We conducted a longitudinal cohort study of 39,623 adults initiating thrice-weekly in-center hemodialysis from 2007 to 2011 and had data on renal CLurea and urine volume. Multivariable cause-specific proportional hazards model was used to examine the associations between baseline RKF and cause-specific mortality, including sudden cardiac death (SCD), non-SCD cardiovascular death (CVD), and non-CVD. Restricted cubic splines were fitted for change in RKF over 6 months after initiating hemodialysis. Among 39,623 patients with data on baseline renal CLurea and urine volume, there was a significant trend toward a higher mortality risk across lower RKF levels, irrespective of cause of death in a case-mix adjustment model (Ptrend< 0.05). Adjustment for ultrafiltration rate (UFR) slightly attenuated the association between low renal CLurea and high cause-specific mortality, whereas adjustment for highest potassium did not have substantial effect. Among 12,169 patients with data on change in RKF, a 6-month decline in renal CLurea showed graded associations with SCD, non-SCD CVD, and non-CVD risk, whereas the graded associations between faster 6-month decline in urine output and higher death risk were clear only for SCD and non-CVD. Lower RKF and loss of RKF were associated with higher cause-specific mortality among patients initiating thrice-weekly in-center hemodialysis.

Association of HSD3B1 Genotype and Clinical Outcomes in Postmenopausal Estrogen-Receptor-Positive Breast Cancer.

Homozygous inheritance of a single-nucleotide polymorphism (1245A > C) in HSD3B1 results in an adrenal permissive phenotype of increased adrenal steroid precursor conversion to potent androgens. This is associated with poor outcomes in prostate cancer. We hypothesized that inheritance of the HSD3B1 adrenal permissive genotype would similarly negatively impact breast cancer outcomes. Germline HSD3B1 was sequenced in 644 postmenopausal women diagnosed between 2004 and 2015 with stage I-III estrogen receptor-positive (ER+), HER2/neu-negative (HER2-) breast cancer enrolled in a population-based study in western Washington. Primary endpoint was distant metastatic recurrence according to genotype. Secondary endpoint was breast cancer-specific survival. Hazard ratios (HR) were calculated using cause-specific Cox regression accounting for competing risks. Adrenal restrictive genotype (homozygous wild type) was most prevalent (47%), followed by heterozygous (44%) and adrenal permissive (9%). There were no significant differences comparing demographic, tumor, or treatment characteristics apart from higher frequency of adrenal permissive genotype among non-Hispanic white participants (p = 0.04). After accounting for competing risks, the cumulative incidence of distant metastatic recurrence (15 events) was significantly higher among participants with adrenal permissive compared with the adrenal restrictive genotype (HR 4.9, 95% CI 1.32-18.4, p = 0.02). The adrenal permissive genotype was also predictive of breast cancer-specific mortality (HR 3.5, 95% CI 1.27-9.59, p = 0.02). Inheritance of the HSD3B1 adrenal permissive genotype is associated with increased incidence of distant metastasis and higher cause-specific mortality in postmenopausal ER+/HER2- breast cancer. Further research is necessary to understand the effect of excess adrenal androgen metabolism in promoting breast cancer growth and progression.

Leading causes of death and high mortality rates in an HIV endemic setting (Kisumu county, Kenya, 2019).

In resource-limited settings, underlying causes of death (UCOD) often are not ascertained systematically, leading to unreliable mortality statistics. We reviewed medical charts to establish UCOD for decedents at two high volume mortuaries in Kisumu County, Kenya, and compared ascertained UCOD to those notified to the civil registry. Medical experts trained in COD certification examined medical charts and ascertained causes of death for 456 decedents admitted to the mortuaries from April 16 through July 12, 2019. Decedents with unknown HIV status or who had tested HIV-negative >90 days before the date of death were tested for HIV. We calculated annualized all-cause and cause-specific mortality rates grouped according to global burden of disease (GBD) categories and separately for deaths due to HIV/AIDS and expressed estimated deaths per 100,000 population. We compared notified to ascertained UCOD using Cohen's Kappa (κ) and assessed for the independence of proportions using Pearson's chi-squared test. The four leading UCOD were HIV/AIDS (102/442 [23.1%]), hypertensive disease (41/442 [9.3%]), other cardiovascular diseases (23/442 [5.2%]), and cancer (20/442 [4.5%]). The all-cause mortality rate was 1,086/100,000 population. The highest cause-specific mortality was in GBD category II (noncommunicable diseases; 516/100,000), followed by GBD I (communicable, perinatal, maternal, and nutritional; 513/100,000), and III (injuries; 56/100,000). The HIV/AIDS mortality rate was 251/100,000 population. The proportion of deaths due to GBD II causes was higher among females (51.9%) than male decedents (42.1%; p = 0.039). Conversely, more men/boys (8.6%) than women/girls (2.1%) died of GBD III causes (p = 0.002). Most of the records with available recorded and ascertained UCOD (n = 236), 167 (70.8%) had incorrectly recorded UCOD, and agreement between notified and ascertained UCOD was poor (29.2%; κ = 0.26). Mortality from infectious diseases, especially HIV/AIDS, is high in Kisumu County, but there is a shift toward higher mortality from noncommunicable diseases, possibly reflecting an epidemiologic transition and improving HIV outcomes. The epidemiologic transition suggests the need for increased focus on controlling noncommunicable conditions despite the high communicable disease burden. The weak agreement between notified and ascertained UCOD could lead to substantial inaccuracies in mortality statistics, which wholly depend on death notifications.

Comparison of the Epidemiological Features of COVID-19 in Iraq and Selected Countries

Background: The COVID-19 pandemic is a puzzling phenomenon and complete knowledge regarding its various aspects is yet to be available. Objective: This research aims to present a comparative profile of the epidemiological features of the COVID-19 pandemic in Iraq and several other countries. Methods: This paper used data on the daily cases of COVID-19 pandemic in Iraq and eight other countries— three from the Eastern Mediterranean region (Bahrain, Iran and Lebanon), four from Europe (Greece, Switzerland, Austria and Norway), along with Brazil. These countries were chosen based on the similarity in the date of onset of the pandemic. Relevant data were obtained from several websites, including Corona World meters, www.sehhty and the Iraqi Ministry of Health for daily reports on new cases. Results: Substantial variations were found in the time trend of COVID-19 cases (epidemic curves) and three epidemiological outcome measurements (incidence rate, case fatality ratio and cause-specific mortality rate) during the first five months of the pandemic in the nine countries studied in this paper. The four European countries—Greece, Switzerland, Austria and Norway—achieved a leveled curve and still maintain such leveling despite their differences in the three outcome measurements. The rest of the countries could not achieve any sustainable leveling in their epidemic curves and also had varying outcome measurements. Among these countries, Bahrain showed the highest incidence rate (15531.3/million) but the lowest case fatality ratio (0.4%). Brazil had the highest cause-specific mortality rate (274.7/million), and Greece had the highest case fatality ratio (12.2%). The other countries had values that were within these ranges. Conclusions: The outcome of COVID-19 within the last five months of experience with the pandemic is very difficult to predict. Different countries have exhibited diverse infection-related behaviors and epidemiological parameters. A study of the multiple factors that might be behind such variations would be helpful in facilitating a successful exit from the pandemic. Keywords: COVID-19, epidemiology, epidemic curve, incidence rate

Mortality rates in people with intellectual disabilities

ABSTRACTObjectivesA growing body of evidence highlights a disparity in mortality rates for people with intellectual disability (ID) compared with the general population. However, national data for England is lacking. The objective of this study was to provide evidence on mortality rates in people with ID.&#x0D; ApproachPatients registered for at least a day during 01/04/10-31/03/14 at a GP practice contributing to the Clinical Practice Research Datalink (CPRD) and consenting to linkage were included. Patients with ID were identified via Read codes. Date and cause of death were identified using linked Office of National Statistics mortality data. Crude mortality rates, life expectancy and indirectly age/sex standardised mortality ratios (SMR) were calculated with 95% confidence intervals (CI), overall, by ICD10 chapter, for frequently occurring causes, and those classified as avoidable.&#x0D; Results11 million person-years were included (0.5% for patients with ID) and 98,035 deaths occurred (0.7% in patients with ID). The mortality rate for patients with ID was 11.2 per 1,000 population, 1.3 times the rate for those without ID, with an associated SMR of 3.2 (95% CI 2.93.4). Life expectancy was 65.5 years (95% CI 61.969.2)for patients with ID and 85.3 years for those without (95% CI 85.285.4). Mortality rates were higher in patients with ID in all age/sex groups, with larger differences for younger ages. Patients with ID had higher cause-specific mortality rates across all ICD10 chapters, with highest SMRs for congenital malformations (72.9, 95% CI 55.194.7), nervous system diseases (9.8, 95% CI 7.812.1) and mental disorders (5.4, 95% CI 3.97.3). Circulatory deaths were the most frequent, with ischaemic heart disease (SMR 2.2, 95% CI 1.62.8) and cerebrovascular disease (SMR 3.3, 95% CI 2.34.5) most prominent. A higher proportion of deaths were classified as avoidable for patients with ID (44.7%, 95% CI 41.048.5%) compared to those without (21.0%, 95% CI 20.721.3).&#x0D; ConclusionNational English data confirm that patients with ID have higher mortality rates than those without. Mortality rates for patients with ID were higher across all age/sex groups and causes, with almost half of deaths classified as avoidable.

Prostate cancer in young men: an important clinical entity.

Prostate cancer is considered a disease of older men (aged >65 years), but today over 10% of new diagnoses in the USA occur in young men aged ≤55 years. Early-onset prostate cancer, that is prostate cancer diagnosed at age ≤55 years, differs from prostate cancer diagnosed at an older age in several ways. Firstly, among men with high-grade and advanced-stage prostate cancer, those diagnosed at a young age have a higher cause-specific mortality than men diagnosed at an older age, except those over age 80 years. This finding suggests that important biological differences exist between early-onset prostate cancer and late-onset disease. Secondly, early-onset prostate cancer has a strong genetic component, which indicates that young men with prostate cancer could benefit from evaluation of genetic risk. Furthermore, although the majority of men with early-onset prostate cancer are diagnosed with low-risk disease, the extended life expectancy of these patients exposes them to long-term effects of treatment-related morbidities and to long-term risk of disease progression leading to death from prostate cancer. For these reasons, patients with early-onset prostate cancer pose unique challenges, as well as opportunities, for both research and clinical communities. Current data suggest that early-onset prostate cancer is a distinct phenotype-from both an aetiological and clinical perspective-that deserves further attention.

Abstract 4510: BRAF V600E mutation status and survival after colorectal cancer diagnosis according to patient and tumor characteristics

Abstract BACKGROUND. BRAF mutations in colorectal cancer (CRC) are disproportionately observed in tumors that exhibit microsatellite instability (MSI), and are also associated with other tumor and patient characteristics that may be associated with CRC survival. The association between BRAF mutation status and CRC survival, however, remains unclear. OBJECTIVE. We evaluated the association between the BRAF V600E mutation, which accounts for 90% of BRAF mutations in colorectal tumors, and mortality in CRC patients. METHODS. Men and women diagnosed with incident invasive CRC between 1997-2007 in western Washington State were identified using the Surveillance, Epidemiology, and End Results cancer registry. Formalin-fixed paraffin-embedded tumor tissue specimens were collected for BRAF mutation and MSI assays. A total of 1,826 cases were tested for BRAF mutations using 2 assays specific to the V600E mutation; MSI status was determined based on instability at 10 microsatellite repeats and/or staining for 4 DNA mismatch repair proteins. Follow-up for mortality was completed through linkage to the National Death Index. We used Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between BRAF mutation status and both cause-specific and all-cause mortality after CRC diagnosis. Stratified analyses were conducted by MSI status (MSS, MSI-high), tumor site (proximal, distal, rectal), sex, and age at diagnosis (&amp;lt;50, Δ50). RESULTS. BRAF V600E mutations were detected in 13% of cases (N=231). Cases with BRAF-mutated CRC were more likely to have MSI-high disease (54% vs. 10%, respectively), to have a proximal tumor site (79% vs. 35%), to be female (72% vs. 52%), and to be aged β50 years at diagnosis (88% vs. 72%). Overall, BRAF mutation status was not associated with mortality after adjusting for age and stage at diagnosis, sex, and tumor site (HR = 1.11, 95% CI: 0.76-1.61 and HR = 1.11, 95% CI: 0.85-1.43 for cause-specific and all-cause mortality, respectively). Results were similar by tumor site and by sex. However, the BRAF mutation was associated with higher cause-specific mortality in CRC cases diagnosed at ages &amp;lt;50 (HR=3.10, 95% CI: 1.43-6.71) and in cases with MSS CRC (HR=1.62, 95% CI: 1.04-2.53); similar associations were not observed in cases diagnosed at ages β50 (HR=1.15, 95% CI: 0.75-1.76) or with MSI-high disease (HR=0.88, 95% CI: 0.35-2.18). Comparable patterns of association were observed for all-cause mortality, although there was no significant interaction by age or MSI. DISCUSSION. Our results are consistent with prior reports that the BRAF V600E mutation in CRC is associated with a distinct phenotype. Overall, this distinct phenotype does not translate to differences in survival; however, among CRC cases diagnosed at an early age and among those with MSS CRC, presence of a BRAF V600E mutation is associated with poorer survival. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4510. doi:1538-7445.AM2012-4510

Cause‐specific mortality and death certificate reporting in adults with moderate to profound intellectual disability

The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population-based study to explore cause-specific mortality in adults with ID compared with the general population. Cause-specific standardised mortality ratios (SMRs) and exact 95% confidence intervals were calculated by age and sex for adults with moderate to profound ID living in the unitary authorities of Leicester, Leicestershire and Rutland, UK, between 1993 and 2006. Causes of death were also studied to determine how often ID and associated conditions, such as Down syndrome, were mentioned. A total of 503 (17% of population) adults with ID died during the 14-year study period (30 144 person-years). Relatively high cause-specific mortality was seen for deaths caused by congenital abnormalities (SMR = 8560), diseases of the nervous system and sense organs (SMR = 1630), mental disorders (other than dementia) (SMR = 1141) and bronchopneumonia (SMR = 647). Excess deaths were also seen for diseases of the genitourinary system or digestive system, cerebrovascular disease, other respiratory infections, dementia (in men only), other circulatory system diseases (in women only) and accidental deaths (in women only). Two-fifths (n = 204; 41%) of deaths recorded in adults with ID mentioned ID or an associated condition as a contributing cause of death. Strategies to reduce inequalities in people with ID need to focus on decreasing mortality from potentially preventable causes, such as respiratory infections, circulatory system diseases and accidental deaths. The lack of mention of ID on death certificates highlights the importance of effective record linkage and ID reporting in health and social care settings to facilitate the government's confidential inquiry into causes of death in this population.

Mesothelioma mortality in Greece from 1983 to 2003

To present summary statistics of the Greek mesothelioma epidemic including summaries by occupation and geographical area. The National Statistics Service provides our data, which contain all deaths from 1983 to 2003 where mesothelioma was mentioned on the death certificate. The annual number of mesothelioma deaths has increased from 9 in the 3-year period of time 1983-1985 to 53 in 2001-2003. Current deaths in males account for about 72% of the cases. The area of Epirus in Greece has the highest cause-specific mortality rate over the period 1983-2003. The occupational group which is related to the higher number of mesothelioma deaths was clerks and those occupied in business; following farmers, workers-technicians and drivers. Our data suggest a change in the balance of risk away from traditional asbestos exposure industries to industries where one could describe the exposure as secondary such as plumbers, technicians, drivers, farmers. Also, we found out that the higher cause-specific mortality rate was 0.38/100,000 population in Epirus, the lower was 0.025/100,000 in Thessalia and the national average rate was 0.10/100,000 population.

Colorectal cancer survival trends in Norway 1958–1997

The purpose of this study was to examine the pattern of survival for colorectal adenocarcinoma (CRC), and to investigate the prognostic factors for the disease. In the analysis, 50 993 cases of CRC aged 40–84 years, diagnosed between 1958 and 1997 in Norway, were included. Esteve's relative survival method was used, together with a time trend analysis, conducted by least-squares linear regression. Cox proportional hazards regression analysis was used to examine cause-specific mortality. Five-year relative CRC survival has increased by an estimated 3% per 5-year diagnostic period. In 1958–1962, relative survival was about 40% for both males and females, and increased to 56 and 60%, respectively, in 1993–1997. Rectal cancer had a higher cause-specific mortality (RR 1.26, 95% CI 1.22–1.30) than proximal colon (reference) and distal colon (RR 0.97, 95% CI 0.93–1.00 cancers), while females had a lower cause-specific mortality than males (RR 0.88, 95% CI 0.86–0.90). The increase in the relative survival rate in Norway is probably due to improved treatments and advanced diagnostics. Norway has a higher CRC survival rate than the EUROCARE average.