High Proportion Of Deaths Research Articles

Gambaran Epidemiologi Kasus Leukemia Anak di Rumah Sakit Kanker “Dharmais”, 2004-2008

This current study describes epidemiology of leukemia among children seeking care to Dharmais cancer hospital in the year 2004-2008. This is a case series study using primary and secondary data. Result showed the highest proportion of death was found among cases with AML leukemia, followed by patients with high risk ALL cases, and those who were refered. The older the age at first diagnosis, the smaller the probability to survive among children with leukemia, in general.

Development of a heart rate variability and complexity model in predicting the need for life-saving interventions amongst trauma patients

BackgroundTriage trauma scores are utilised to determine patient disposition, interventions and prognostication in the care of trauma patients. Heart rate variability (HRV) and heart rate complexity (HRC) reflect the autonomic nervous system and are derived from electrocardiogram (ECG) analysis. In this study, we aimed to develop a model incorporating HRV and HRC, to predict the need for life-saving interventions (LSI) in trauma patients, within 24 h of emergency department presentation.MethodsWe included adult trauma patients (≥ 18 years of age) presenting at the emergency department of Singapore General Hospital between October 2014 and October 2015. We excluded patients who had non-sinus rhythms and larger proportions of artefacts and/or ectopics in ECG analysis. We obtained patient demographics, laboratory results, vital signs and outcomes from electronic health records. We conducted univariate and multivariate analyses for predictive model building.ResultsTwo hundred and twenty-five patients met inclusion criteria, in which 49 patients required LSIs. The LSI group had a higher proportion of deaths (10, 20.41% vs 1, 0.57%, p < 0.001). In the LSI group, the mean of detrended fluctuation analysis (DFA)-α1 (1.24 vs 1.12, p = 0.045) and the median of DFA-α2 (1.09 vs 1.00, p = 0.027) were significantly higher. Multivariate stepwise logistic regression analysis determined that a lower Glasgow Coma Scale, a higher DFA-α1 and higher DFA-α2 were independent predictors of requiring LSIs. The area under the curve (AUC) for our model (0.75, 95% confidence interval, 0.66–0.83) was higher than other scoring systems and selected vital signs.ConclusionsAn HRV/HRC model outperforms other triage trauma scores and selected vital signs in predicting the need for LSIs but needs to be validated in larger patient populations.

Trends in mortality at Federal Medical Centre, Owo, Ondo State, Nigeria 2006-2014.

Introductionvital events registration is not accurately done in Nigeria. Hence, mortality data is often not available. Health facility-based data can provide useful information on the trends in mortality of a population. This study describes the trend of deaths in a tertiary health facility.Methodsa retrospective review of the medical records of all patients that died in the Federal Medical Centre, Owo, Ondo State, Nigeria from 2006 to 2014 was conducted. Data extracted from the records included age, sex, primary cause of death and date of admission and death. Frequencies were done and the median age of male and female deaths were compared using Mann-Whitney U test.Resultsa total of 1,326 deaths occurred in the hospital. The median age at death was 46 years (range: 0-110), median age was 49 years in males and 43 years in females (p = 0.025). One fifth (20.9%) of deaths was in infants. The median length of hospital stay was 4 days (range: 0-277). The highest proportion of death (16.4%) was in 2009 and on Wednesdays (15.9%). More deaths occurred in January (11.5%) and (10.3%) in February than in other months. The leading cause of communicable disease death in age 1 and above were HIV (15.2%) and TB (2.5%). Birth asphyxia (39.3%) and low birth weight (46%) were the commonest cause of death in infants.Conclusionover the years the leading causes of mortality were preventable. Infant mortality remains a public health problem. Hospital mortality data could guide health decision making and interventions in Nigeria. Interventions to reduce death from communicable diseases and in infants are urgently recommended.

Quality of cause-of-death data in Brazil: Garbage codes among registered deaths in 2000 and 2015.

reliability of mortality data is essential for health assessment and planning. In Brazil, a high proportion of deaths is attributed to causes that should not be considered as underlying causes of deaths, named garbage codes (GC). To tackle this issue, in 2005, the Brazilian Ministry of Health (MoH) implements the investigation of GC-R codes (codes from chapter 18 "Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, ICD-10") to improve the quality of cause-of-death data. This study analyzes the GC cause of death, considered as the indicator of data quality, in Brazil, regions, states and municipalities in 2000 and 2015. death records from the Brazilian Mortality Information System (SIM) were used. Analysis was performed for two GC groups: R codes and non-R codes, such as J18.0-J18.9 (Pneumonia unspecified). Crude and age-standardized rates, number of deaths and proportions were considered. an overall improvement in the quality of mortality data in 2015 was detected, with variations among regions, age groups and size of municipalities. The improvement in the quality of mortality data in the Northeastern and Northern regions for GC-R codes is emphasized. Higher GC rates were observed among the older adults (60+ years old). The differences among the areas observed in 2015 were smaller. the efforts of the MoH in implementing the investigation of GC-R codes have contributed to the progress of data quality. Investment is still necessary to improve the quality of cause-of-death statistics.

Tuberculose entre crianças e adolescentes indígenas no Brasil: fatores associados ao óbito e ao abandono do tratamento

The study aimed to describe clinical and sociodemographic characteristics, estimate incidence, and analyze factors associated with dropout and death during treatment of TB cases reported in indigenous children and adolescents in Brazil from 2006 to 2016. A historical case series was performed on incidence according to age bracket and major geographic region, and multinomial logistic regression was used to explain factors associated with treatment dropout and death. Of the 2,096 reported cases, 88.2% evolved to cure, 7.2% dropped out of treatment, and 4.6% evolved to death. There was a predominance of cases in boys 15-19 years of age and a higher proportion of deaths (55.7%) in children < 4 years. Considering indigenous children and adolescents with TB in Brazil as a whole, mean incidence was 49.1/100,000, ranging from 21.5/100,000 to 97.6/100,000 in the Northeast and Central, respectively. Cases with insufficient and irregular follow-up showed higher odds of dropout (OR = 11.1; 95%CI: 5.2-24.8/OR = 4.4; 95%CI: 1.9-10.3) and death (OR = 20.3; 95%CI: 4.9-84.9/OR = 5.1; 95%CI: 1.2-22.7). Cases in retreatment (OR = 2.4; 95%CI: 2.08-8.55) and with HIV coinfection (OR = 8.2; 95%CI: 2.2-30.9) were also associated with dropout. Extrapulmonary (OR = 1.8; 95%CI: 1.1-3.3) and mixed clinical forms (OR = 5.6; 95%CI: 2.8-11.4), age < 4 years (OR = 3.1; 95%CI: 1.5-6.4), and cases from the North (OR = 2.8; 95%CI: 1.1-7.1) and Central (OR = 2.8; 95%CI: 1.1-7.0) were associated with death. TB control in indigenous children and adolescents cannot be achieved without investments in research and development and without reducing social inequalities.

The end game: Mortality outcomes in North American professional athletes.

Comprehensive investigations into the mortality outcomes of elite athletes can assist in decoding risk factors for premature mortality and provide avenues for exploring human health through engagement in sport. As such, the purpose of this study was to comprehensively examine lifespan trends of athletes from the 4 major sports in North America: Major League Baseball (MLB), National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL). We hypothesized that proportional death rates would be similar across the 4 sports, when standardizing the data by debut years. Overall, 17523 of 50515 (34.7%) athletes were deceased as of the respective data collection cutoff date for their sport, with MLB players having the highest risk of imminent mortality. Professional basketball players generally had the highest relative proportion of death when standardizing data by debut year, although NHL and NFL players who debuted after 2005 had the highest proportion of death. In addition, a 1-year increase in career length significantly decreased the risk of death (HR: 0.982, 95% CI: 0.978-0.985), even after adjusting for sport type (HR: 0.977, 95% CI: 0.974-0.980). Meaningful significance should be considered given the historical and unique nature of the sample. Nevertheless, investigating risk of death differences through different occupational and biological variables can help highlight aversive trends to lifespan that permeate throughout high-performance athlete populations.

Trends in mortality rates where alcohol was a necessary cause of death in Brazil, 2000-2013.

ABSTRACTObjectiveTo analyze trends in mortality due to diseases and conditions fully attributable to alcohol in Brazil.MethodsThis was an ecological time-series study. Proportional, specific, and age-standardized mortality rates between 2000 and 2013 that were due to underlying or contributing causes fully attributable to alcohol use were analyzed by sex, ethnicity/skin color, age group, and region of residence in the country. Data on deaths were obtained from the Brazilian Mortality Information System (SIM). Prais-Winsten regression was used to analyze trends.ResultsDeaths with underlying causes and/or conditions contributing to death fully attributable to alcohol accounted for 2.5% of total deaths in the period. There were more deaths among men (3.8%) than among women (0.7%). In both sexes, there was a higher proportion of deaths in those 40–49 years old (27.9%) and those of black or pardo (mixed race) skin color (48.8%). Between 2000 and 2013, there was an upward trend in specific mortality rates attributable to alcohol in the country as a whole (average annual growth rate (AAGR) = 5.59%; 95% confidence interval (CI) = 3.55%-7.68%), especially in people aged less than 20 years old, in pardos (AAGR = 13.42%; 95% CI = 9.70%-17.25%), and in residents of the North region (AAGR = 17.01%; 95% CI = 14.94%-19.13%), the Northeast region (AAGR = 15.49%; 95% CI = 10.61%-20.58%), and the Midwest region (AAGR = 8.40%; 95% CI = 5.57%-11.32%).ConclusionAlcohol is an important and growing cause of premature death in Brazil, especially among men, black/pardo people, and the population living in the most disadvantaged regions. This overall increase in the harmful use of alcohol reflects ethnic and socioeconomic inequalities in Brazil, and it also points to the need for population-based policies to reduce the impact of morbidity and to prevent early mortality.

Trends in colorectal cancer mortality in hispanics: a SEER analysis.

BackgroundColorectal cancer (CRC) mortality among Hispanics is lower than Non-Hispanic Whites (NHW). If Hispanics receive equitable care and achieve the same degree of health benefit, their trend of better survival should be maintained. This study assesses mortality trends among Hispanics overtime to compare their survival improvement with NHW.MethodsWe used the Incidence-Based Mortality database of the Surveillance, Epidemiology, and End Results Program (SEER) to assess the mortality gap, which is defined as the difference in stage-specific mortality between NHWs and Hispanics, and currently has an advantage for Hispanics.ResultsThere is a statistically significant disparity in stage-specific mortality of CRC by race, with a higher proportion of deaths from metastatic disease among Hispanics than NHW (48% vs. 44% respectively). Comparing the time intervals of 2000-2005 and 2006-2011, mortality was reduced by 15.1% for NHWs and 5.9% for Hispanics, resulting in a narrowing of the mortality gap. The mortality gap between Hispanics and NHW is tapering overtime for every stage of the disease, reflecting that Hispanics have a disparity in CRC mortality.ConclusionThe mortality gap between Hispanics and NHWs is narrowing, supporting a significantly lower rate of mortality improvement in Hispanics. If the current trend continues, mortality rates in Hispanics will outpace that of NHWs.

Cardiovascular complications in nonreperfused acute ST segment elevation myocardial infarction

BACKGROUND: Cardiovascular diseases are currently the leading cause of death in industrialized countries. Among them, coronary artery disease is the most prevalent manifestation and is associated with high morbidity and mortality worldwide. In Mexico, ischemic heart disease is the leading cause of death in older than 60s and the second cause in the general population. OBJECTIVE: To evaluate cardiovascular complications in patients with acute ST segment elevation myocardial infarction who did not receive acute reperfusion therapy. MATERIAL AND METHOD: Descriptive, cross-sectional, retrospective study in which 35 medical files of patients with acute ST segment elevation myocardial infarction without reperfusion treatment who were admitted to the Hospital Central Militar from january 1st to december 31st in 2013. Cardiovascular complications and their association with clinical variables were quantified, as well as the quantification of time in the care system. RESULTS: The complications were: heart failure 68.2%, arrhythmias 17.1% and death 17.1%. Variables associated with a higher proportion of total cardiovascular complications and heart failure were age ? 65 years, location of extensive anterior infarction, and TIMI risk score ? 7. Variables such as type 2 diabetes, location of extensive anterior infarct, TIMI risk score ? 7, Killip &gt; 2 and arrhythmias were associated with a higher proportion of deaths. Patients who underwent late angioplasty with adequate indication had a lower proportion of deaths. The patient-first medical contact time had a median of 8 hours, the first medical-diagnostic contact time had a median of 11.5 hours and the diagnostic-admission time to the hospital had a median of 3 hours. CONCLUSIONS: All patients admitted for acute myocardial infarction with ST segment elevation without reperfusion therapy had at least one cardiovascular risk factor and a characteristic symptom of acute coronary syndrome at the time of first medical contact.

Burden of traffic accidents among pedestrians of Fars province, southern Iran; estimate of years of life lost in a sample of Iranian population from 2009 to 2013

PurposeTraffic injuries are among the leading causes of mortality and morbidity worldwide. Pedestrians have been considered as a high-risk group among road users, especially in middle- or low-income communities. This study attempted to determine the burden of pedestrians' fatalities in Fars, the southern province of Iran using years of life lost (YLL) approach. MethodsThe data used in this study were retrieved from Fars Forensic Medicine Organization database on pedestrian traffic accidents. The YLL from 2009 to 2013 was estimated using the method presented by World Health organization. Some epidemiological characteristics of pedestrians' fatalities were analyzed by SPSS. ResultsAlthough YLL among 1000 male pedestrians decreased from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period. Higher proportion of death was found in female, illiterate, and married pedestrians (p < 0.001). In addition, mortality was higher in pedestrians living the cities, during daytime, at home, and in hospitals (p < 0.001). ConclusionConsistent with the global trends, burden of pedestrian accidents in Fars was also exceptionally high. Considering the national and cultural aspects of different countries, improving the safety of pedestrians demands a multi-dimensional approach with interventional factors concerning policies, rules, pedestrians, motor vehicles and environmental conditions taken into consideration.

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.

Care for young victims of assault in public emergency services in 2011: Sex differences.

This article aims to describe the characteristics of assaults among youth victims of violence treated in Public Emergency Departments, according to sex. This is a descriptive study using data from the Brazilian Violence and Accidents Surveillance System based on a multicenter survey conducted by the Ministry of Health in 71 public emergency departments, located in 24 state capitals and the Federal District in 2011. Male subjects predominated among the victims (75.1%) and also among aggressors (83.1% and 69.7% of cases of violence against male and female victims, respectively). Among female victims, episodes of violence were more frequent at home (43.6%). The perpetrator was a stranger in 49.7% and 26.8% of cases among male and female victims, respectively, while the perpetrator was a partner or ex-partner in 3.9% and 31.5% cases, respectively (p < 0.001). Greater severity of injuries among men was consistent with the higher proportion of deaths in the first 24 hours (2.1%) compared to women (0.2%) (p < 0.001). The violence profile among youth victims treated in Public Emergency Departments was substantially different according to the sex of the victims. The results highlight the need to implement intersectoral policies, in line with the Brazilian Youth Statute.

Abstract P059: Multiple Cause-of-Death Analysis Reveals Under Reporting of Disease Burden for Diabetes

Introduction: Despite being considerably under reported as the underlying cause of death on death certificates, and consequently on mortality figures, diabetes is among the ten leading causes of death in the U.S. A multiple cause-of-death analysis shows the extent to which diabetes is associated with other leading causes of death. Hypothesis: Analysis of multiple-cause-of-death will confirm prevalence rates of diabetes among racial/ethnic minority populations, demonstrate the impact of diabetes in association with other causes of death, and highlight variations of burden of disease among different racial/ethnic groups. Methods: Causes of death were identified using the Multiple Cause Mortality Files of the National Center for Health Statistics from 2003 to 2012. Age-adjusted mortality rates were calculated for diabetes both as the underlying cause of death (UCD) and as multiple causes of death (MCD) by racial/ethnic groups (NHWs, Blacks, Asians, and Hispanic/Latinos). Frequencies and proportions were calculated by race/ethnicity groups. Linear regression model was used for number of causes per death. Results: A total of 2,335,198 decedents had diabetes listed as MCD in the U.S. national death records from 2003-2012. Mortality rates of diabetes as MCD were 3.4 times than UCD for Asians, 2.9 times for Blacks, 2.9 times for Hispanics and 3.7 times for NHWs (Figure). Minority populations had higher proportion of deaths with diabetes reported as MCD than NHWs (1.7 times higher for Hispanics, 1.5 times higher for Blacks and Asians). Adjusting for age, gender, and race/ethnicity, there were 1.7 more causes per death co-occurred for diabetes decedents compared to decedents who died due to all other causes (95% CI: 1.714, 1.718). Conclusions: Our findings underscore the importance of a multiple-cause-of-death approach in the analyses for a more comprehensive understanding of the impact of diabetes.

A lower baseline glomerular filtration rate predicts high mortality and newly cerebrovascular accidents in acute ischemic stroke patients.

Chronic kidney disease (CKD) is gradually recognized as an independent risk factor for cardiovascular and cardio-/cerebrovascular disease. This study aimed to examine the association of the estimated glomerular filtration rate (eGFR) and clinical outcomes at 3 months after the onset of ischemic stroke in a hospitalized Chinese population.Totally, 972 patients with acute ischemic stroke were enrolled into this study. Modified of Diet in Renal Disease (MDRD) equations were used to calculate eGFR and define CKD. The site and degree of the stenosis were examined. Patients were followed-up for 3 months. Endpoint events included all-cause death and newly ischemic events. The multivariate logistic model was used to determine the association between renal dysfunction and patients’ outcomes.Of all patients, 130 patients (13.4%) had reduced eGFR (<60 mL/min/1.73 m2), and 556 patients had a normal eGFR (≥90 mL/min/1.73 m2). A total of 694 patients suffered from cerebral artery stenosis, in which 293 patients only had intracranial artery stenosis (ICAS), 110 only with extracranial carotid atherosclerotic stenosis (ECAS), and 301 with both ICAS and ECAS. The patients with eGFR <60 mL/min/1.73m2 had a higher proportion of death and newly ischemic events compared with those with a relatively normal eGFR. Multivariate analysis revealed that a baseline eGFR <60 mL/min/1.73 m2 increased the risk of mortality by 3.089-fold and newly ischemic events by 4.067-fold. In further analysis, a reduced eGFR was associated with increased rates of mortality and newly events both in ICAS patients and ECAS patients. However, only an increased risk of newly events was found as the degree of renal function deteriorated in ICAS patients (odds ratio = 8.169, 95% confidence interval = 2.445–14.127).A low baseline eGFR predicted a high mortality and newly ischemic events at 3 months in ischemic stroke patients. A low baseline eGFR was also a strong independent predictor for newly ischemic events in ICAS patients.

Mortality in traffic accidents with older adults in Colombia.

ABSTRACTOBJECTIVE To analyze the traffic accident mortality in the Colombian older adults during the 1998-2012 period and show the loss of productive years and mortality from this cause.METHODS Quantitative study of the trend analysis of deaths in Colombia in traffic accidents, from 1998 to 2012, according to death records and population projected by the Colombian National Administrative Department of Statistics. Frequency distribution profile of the deceased, death rates per hundred thousand inhabitants, potential years of life lost and calculation of excess mortality by age in the over 60 were made.RESULTS In the study period 100,758 deaths occurred in traffic accidents, 6,717 annual average, of which 18.5% occurred in people aged 60 years and over. The predominated deaths were men; the risk of dying was 32.15 per hundred thousand people in this age range, with double risk of dying those under 60 years.CONCLUSIONS The young population has a higher proportion of deaths, but those over 60 years are at increased risk of death, leading to the need to turn our gaze to the improvement of road infrastructure and standards, to educate the population in self-care and compliance with safety measures and prepare society for an ever more adult population, more numerous and more prone to take risks.

MTE01.01 Strategies to Improve Tobacco Control in Central European Countries

Tobacco use is the single most preventable cause of death and disease, especially of lung cancer. Approximately 1.6 million people in the WHO European Region die of tobacco-related diseases every year and the Region has the highest proportion of deaths (16%) attributable to tobacco use. Globally, Europe also has the highest prevalence of tobacco smoking among adults (28%), including one of the highest smoking prevalence rates among women (19%). In the meantime it is well-known that a wide range of political decisions can stop the tobacco epidemic and reduce substantially smoking. According to the first health treaty in history, the WHO Framework Convention on Tobacco Control, following strategies are the most effective: raising cigarette prices through higher cigarette tax and combating illicit trade of cigarettes, protecting from secondhand smoke through comprehensive smoke-free air laws, enforcing bans on advertising, promotion and sponsorship, placing warnings (pictures and text as big as possible) on tobacco packages and communicate the warnings through media/educational programs and finally offering greater access to smoking cessation services. WHO Europe has established a database on countries of the WHO European region showing the effects of the reduction in smoking prevalence as a result of implementing tobacco control policies. This presentation will analyze the current situation in this Region and showing the lessons learnt from past years with regards to future prevention of smoking. Strategies for effective tobacco control, WHO European region, especially Central Europe, Tobacco prevention

Long-term Mortality and End-Stage Renal Disease in a Type 1 Diabetes Population Diagnosed at Age 15-29 Years in Norway.

To study long-term mortality, causes of death, and end-stage renal disease (ESRD) in people diagnosed with type 1 diabetes at age 15-29 years. This nationwide, population-based cohort with type 1 diabetes diagnosed during 1978-1982 (n = 719) was followed from diagnosis until death, emigration, or September 2013. Linkages to the Norwegian Cause of Death Registry and the Norwegian Renal Registry provided information on causes of death and whether ESRD was present. A clinical committee reviewed the causes of death. We calculated standardized mortality ratios (SMRs) for comparison with the background population. During 30 years' follow-up, 4.6% of participants developed ESRD and 20.6% (n = 148; 106 men and 42 women) died. Cumulative mortality by years since diagnosis was 6.0% (95% CI 4.5-8.0) at 10 years, 12.2% (10.0-14.8) at 20 years, and 18.4% (15.8-21.5) at 30 years. The SMR was 4.4 (95% CI 3.7-5.1). Mean time from diagnosis of diabetes to ESRD was 23.6 years (range 14.2-33.5). Death was caused by chronic complications (32.2%), acute complications (20.5%), violent death (19.9%), or any other cause (27.4%). Death was related to alcohol in 15% of cases. SMR for alcohol-related death was 6.8 (95% CI 4.5-10.3), for cardiovascular death was 7.3 (5.4-10.0), and for violent death was 3.6 (2.3-5.3). The cumulative incidence of ESRD was low in this cohort with type 1 diabetes followed for 30 years. Mortality was 4.4 times that of the general population, and more than 50% of all deaths were caused by acute or chronic complications. A relatively high proportion of deaths were related to alcohol.

Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey.

This study demonstrates that most cholera deaths in this region of Cameroon occur out of hospital. This is a region which is prone to cholera, and interventions are needed to improve access to emergency medical care, especially during cholera outbreaks. Cameroon has experienced 14 cholera epidemics during the last 20 years, and these have had high case fatality rates. This study attempted to assess the effect of delays in seeking care and the locations of care as possible risk factors for cholera mortality. The study used data from a community-based survey regarding the circumstances of 97 fatal cases and 197 control (nonfatal) cases following a cholera-like syndrome in villages with cholera-like diseases during cholera outbreaks in Cameroon during 2009-2011. Deaths occurred in one of four environments: the community, in a temporary community treatment center (TCTC), in transit to a treatment center, or in a hospital (39%, 32%, 5%, and 24%, respectively). Using a case-control analysis, factors associated with deaths included the nonuse of a cholera treatment center, receiving health care in a TCTC instead of a hospital, and greater than 4 hours delay between the onset of symptoms and the decision to go to a treatment center (odds ratios of 17.1 [confidence interval (CI): 7.0-41.8], 2.5 [CI: 1.2-5.0], and 2.2 [CI: 1.0-4.6], respectively). During cholera epidemics, a higher proportion of deaths are still occurring in communities. The nonuse and delays in deciding to go a treatment center, and treatment at TCTC rather than a hospital were risk factors for death among patients with cholera-like syndrome in Cameroon. Informing people on community management of cholera-like syndrome and improving care in all health facilities are needed to reduce deaths during cholera epidemics.

Suicide Among Military Personnel and Veterans Aged 18-35 Years by County-16 States.

IntroductionSuicide among military personnel and young Veterans remains a health concern. This study examined stateside distribution of suicides by U.S. county to help focus prevention efforts.MethodsUsing 2005–2012 National Violent Death Reporting System data from 16 states (963 counties, or county-equivalent entities), this study mapped the county-level distribution of suicides among current military and Veteran decedents aged 18–35 years. This study also compared incident circumstances of death between decedents in high-density counties (i.e., counties with the highest proportion of deaths) versus those in medium/low-density counties to better understand the precipitators of suicide in counties most affected. Last, this study identified potential military and Veteran Health Administration intervention sites. All analyses were conducted in 2015.ResultsWithin the National Violent Death Reporting System participating states, an estimated 262 (33%) current military suicides occurred in just ten (1.0%) counties, and 391 (33%) Veteran suicides occurred in 33 (3.4%) counties. Mental health and intimate partner problems were common precipitating circumstances, and some circumstances differed between cases in high-versus those in medium/low-density counties. Multiple potential intervention sites were identified in high-density counties.ConclusionsThese findings suggest that military and Veteran suicides are concentrated in a small number of counties. Increased efforts at these locales might be beneficial.

Sudden cardiac death in non-dialysis chronic kidney disease patients

BackgroundA relatively high proportion of deaths in dialysis patients occur suddenly and unexpectedly. The incidence of sudden cardiac death (SCD) in non-dialysis advanced chronic kidney disease (CKD) stages has been less well investigated. ObjectiveThis study aims to determine the incidence and predictors of SCD in a cohort of 1078 patients with CKD not yet on dialysis. MethodsProspective observational cohort study, which included patients with advanced CKD not yet on dialysis (stage 4–5). The association between baseline variables and SCD was assessed using Cox and competing-risk (Fine and Gray) regression models. Demographic, clinical information, medication use, and baseline biochemical parameters of potential interest were included as covariates. ResultsDuring the study period (median follow-up time 12 months), 210 patients died (19%), and SCD occurred in 34 cases (16% of total deaths). All-cause mortality and SCD incidence rates were 113 (95% CI: 99–128), and 18 (95% CI: 13–26) events per 1000patient-years respectively. By Cox regression analysis, covariates significantly associated with SCD were: Age, comorbidity index, and treatment with antiplatelet drugs. This latter covariate showed a beneficial effect over the development of SCD. By competing-risk regression, in which the competing event was non-sudden death from any cause, only age and comorbidity index remained significantly associated with SCD. ConclusionsSCD is relatively common in non-dialysis advanced CKD patients. SCD was closely related to age and comorbidity, and some indirect data from this study suggest that unrecognized or undertreated cardiovascular disease may predispose to a higher risk of SCD.