Risk Of Death In Individuals Research Articles

Material and social deprivation associated with public health actual causes of death among older people in Europe: longitudinal and multilevel results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

BackgroundAdverse socioeconomic conditions at the individual and regional levels are associated with an increased risk of mortality. However, few studies have examined this relationship using multilevel analysis and, if so, only within a single country. This study aimed to examine this relationship using data from several European countries.MethodsIndividual-level data were obtained from Waves 5 to 9 of the Survey of Health, Ageing and Retirement in Europe, while regional-level data were obtained from the Luxembourg Income Study Database. Cox regression analysis with gamma-shared frailty and a random intercept for country of residence was used to examine the association between individual mortality from all causes, cancer, heart attack, and stroke and measures of socioeconomic deprivation at the individual level, including material and social deprivation indices, and at the area level, including the Gini index.ResultsThe risk of mortality from all causes was increased for respondents with material deprivation (hazard ratio (HR) = 1.77, 95% CI = [1.60, 1.96]) and social deprivation (HR = 7.63, 95% CI = [6.42, 9.07]) compared with those without. A similar association was observed between individual deprivation and the risk of mortality from cancer, heart attack, or stroke. Regional deprivation had a modest contextual effect on the individual risk of death from all causes and cancer. However, when individual-level deprivation was included in the models, no contextual effects were found.ConclusionThe results indicate that individual socioeconomic conditions significantly predict causes of death in older European adults, with those with material deprivation and social deprivation having a higher risk of death from all causes, including cancer, heart attack, and stroke, while the Gini index has a minimal effect, although the Gini index reflects regional disparities across Europe.

Cardiovascular risk factors and all-cause mortality in older age (15-year cohort study)

Cardiovascular diseases (CVD) occupy a leading position in the structure of all-cause mortality. Prospective and interventional studies have identified the major risk factors for CVD and shown their associations with the risk of cardiovascular outcomes and all-cause death. The impact on the individual risk of death may vary by age, sex, study design, and may be population-specific. We aimed to study the contribution of major CVD risk factors to the 15-year risk of all-cause death in the Russian (Siberian) population cohort aged 45–69 years.Material and methods. A random population sample (men and women 45–69 years old, n = 9360) was examined at baseline in 2003–2005 (Novosibirsk, Russian branch of the HAPIEE project) and re-examined twice in 2006–2008 and 2015–2018. Current analysis included individuals without baseline CVD (n = 8087), the average follow-up period – 15.6 (SD 0.69) years. The fatal events were registered based on death certificates from the Population Registration Bureau (ZAGS), and using the data received at serial examinations and postal interview. We analyzed the association between CVD risk factors and all-cause death using multivariate Cox regression.Results. In a cohort aged 45–69, in the adjusted model, 15-year risk of all-cause death was positively associated with age (HR = 1.08; 95 % CI 1.07–1.09), male sex (HR = 1.46; 95 % CI 1.24–1.71), hypertension (HT) (HR = 1.39; 95 % CI 1.25–1.55), smoking (HR = 2.37; 95 % CI 2.08–2.70), high WHR (HR = 1.19; 95 % CI 1.06–1.33), and type 2 diabetes (T2DM) (HR = 1.52; 95 % CI 1.34–1.73), and it was negatively associated with elevated total cholesterol (TC) or LDL-C in blood. In age- and sex-adjusted model, the risk was additionally associated with high triglycerides (HTG), obesity and elevated fasting plasma glucose (FPG). In men, the risk of death was independently associated with age, HT, smoking, low HDL-C, high WHR, and T2DM. In women, the risk of death was independently associated with age, HT, T2DM smoking, and, in age-standardized models, obesity, high WHR, and hyperglycemia.Conclusions. In a population cohort of 45 years and older, among CVD risk factors male sex, HT, smoking, central obesity, and T2DM independently contributed to the risk of all-cause death. Among lipid parameters, low HDL-C and high TG levels increased the risk of death in men. Associations between cardiovascular risk factors and the risk of all-cause death in older people have the patterns specific for older age; these features are important to take into account in a strategy to reduce mortality in the population.

Individual-Level Exposure to Residential Redlining in 1940 and Mortality Risk

Historic redlining, the practice by the Home Owners' Loan Corporation (HOLC) of systematically denying credit to borrowers in neighborhoods that were inhabited by primarily African American individuals, has been associated with poor community outcomes, but the association with individual risk of death is not clear. To examine if exposure to residential redlining practices by HOLC in 1940 is associated with increased risk of death later in life. The study linked individuals who resided within HOLC-graded neighborhoods (defined as Census Enumeration Districts) in 1940 with administrative death records data. The study estimated hazard ratios as well as age-specific life expectancy gaps (at age 55, 65, and 75 years) for HOLC grading exposure. This was done using methods that adapted standard parametric survival analysis to data with limited mortality coverage windows and incomplete observations of survivors. The analysis sample consisted of 961 719 individual-level observations across 13 912 enumeration districts within 30 of the largest US cities (based on 1940 population counts) across 23 states. Data were analyzed between December 1, 2023, and September 4, 2024. The exposure was HOLC grade based on historic HOLC maps, with A representing "best" or creditworthy areas; B, "still desirable"; C, "definitely declining"; and D, "hazardous" areas not worthy of credit (ie, redlined), and the main outcome was age at death from the Social Security Numident file. The 961 719-person individual sample had a mean (SD) age of 19.26 (9.26) years in 1940 and a mean (SD) age at death of 76.83 (9.22) years. In a model adjusted for sex (52.48% female; 47.52% male), race and ethnicity (7.36% African American; 92.64% White), and latent place effects, a 1-unit lower HOLC grade was associated with an 8% (hazard ratio, 1.08 [95% CI, 1.07-1.09]) increased risk of death. At age 65 years, these hazard differentials translated into an estimated life expectancy gap of -0.49 (95% CI, -0.56 to -0.43) years for each 1-unit decrease of the HOLC grade. This study found that individuals who resided within redlined neighborhoods in 1940 had lower life expectancy later in life than individuals who resided within other HOLC-graded areas.

Can waterfowl buffer the mortality risk induced by GPS tags? A cautionary tale for applied inference across species

GPS tags have become a common tool in ecological studies of animal behaviour and demography despite previous research indicating negative impacts on vital rates across a variety of taxa. Many researchers face tradeoffs when deciding whether they are an appropriate tool because GPS tags may impact vital rates, but they provide detailed data on movements and behaviour that often cannot be obtained in other ways. Using band recovery data, we evaluated the strength of effects induced by GPS tags on annual mortality of adult females across 13 waterfowl taxa, and examined whether taxa with a slower life-history strategy and larger body size were more resilient to GPS tag effects than their fast-lived counterparts with small body size. All species were exposed to hunting, which may interact with underlying processes affecting the impact of GPS tags on mortality, but also allowed for robust analysis of overall annual mortality. Hazard ratios, indicating the risk of death for individuals wearing GPS tags compared to those wearing only metal bands, ranged from 1.13 to 3.25 and the mean proportional difference in survival between marker types across species was 0.33. The magnitude of tag effects was surprisingly consistent across life-history tempo and body size, indicating that slower-lived species did not buffer the effect of wearing GPS tags. Our results highlight that even large, long-lived species, which are generally better at buffering their mortality against environmental adversity, are not immune to the effects GPS tags can have on survival and mortality. The results of our study emphasize the importance of testing for such effects across taxa in future research as technology advances.

Selenium intake in relation to all-cause and cardiovascular mortality in individuals with nonalcoholic fatty liver disease: A nationwide study in nutrition.

Limited evidence exists regarding the association of selenium with risk of death in individuals with nonalcoholic fatty liver disease (NAFLD). This study was designed to investigate the relationship between dietary selenium intake with mortality in a nationally representative sample of United States adults with NAFLD. Dietary selenium intake was assessed in 2274 NAFLD adults younger than 60 years of age from the National Health and Nutrition Examination Survey (NHANES) III through a 24-hour dietary recall. NAFLD was diagnosed by liver ultrasound after excluding liver disease due to other causes. Cox proportional hazards models were utilized to assess the effect of dietary selenium intake on all-cause and cardiovascular mortality among individuals with NAFLD. At a median follow-up of 27.4 years, 577 deaths occurred in individuals with NAFLD, including 152 cardiovascular deaths. The U-shaped associations were discovered between selenium intake with all-cause (Pnolinear = 0.008) and cardiovascular mortality (Pnolinear < 0.001) in adults with NAFLD after multivariate adjustment, with the lowest risk around selenium intake of 121.7 or 125.9 μg/day, respectively. Selenium intake in the range of 104.1-142.4 μg/day was associated with a reduced risk of all-cause mortality and, otherwise, an increased risk. Selenium intake in the range of 104.1-150.6 μg/day was associated with a reduced risk of cardiovascular death and, otherwise, an increased risk. Both high and low selenium intake increased the risk of all-cause and cardiovascular death in adults younger than 60 years of age with NAFLD, which may help guide dietary adjustments and improve outcomes in adults with NAFLD.

PHYSICAL ACTIVITY IS ASSOCIATED WITH IMPROVED SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN THE UK BIOBANK

INTRODUCTION &amp; AIM Physical activity (PA) is known to be associated with a decreased risk of all-cause and cardiovascular mortality in apparently healthy adults. The association between PA and risk of death for individuals with prevalent cardiovascular disease (CVD) at baseline is less well understood. Therefore, the aim of this study was to determine the association between PA levels and survival in individuals with prevalent CVD at baseline. METHODS A survival analysis involving 38,291 UK Biobank participants with prevalent CVD at baseline was conducted. Physical activity was assessed using accelerometry-calibrated PA which measures total energy expended in PA. Prevalent CVD, all-cause mortality, and CVD mortality were determined through ICD-10 codes and data linkage through death and hospital records. Cox proportional hazard models were used to estimate the risk of all-cause, overall cardiovascular, and specific CVD category mortality for quartiles of PA after adjusting for known confounders. RESULTS There were 6,540 all-cause deaths and 3,559 cardiovascular deaths with median follow up time of 11.98 years. The risk of all-cause and overall cardiovascular mortality reduced with increasing dose of PA (highest vs lowest PA; HR = 0.70, 95% CI: 0.64 - 0.76 and 0.70, 95% CI: 0.62 - 0.79, respectively). Those in the highest quartile of PA had a 41% reduced risk of dying from cerebrovascular disease and a 38% reduced risk of dying from and hypertensive diseases (including hypertensive heart disease with heart failure). CONCLUSION Higher levels of PA are associated with lower risk of all-cause and overall cardiovascular mortality in individuals with prevalent CVD at baseline. These findings highlight the importance of PA in secondary prevention of cardiovascular disease.

Identification and validation of a gap junction protein related signature for predicting the prognosis of renal clear cell carcinoma.

Gap junction proteins (GJPs) are a class of channel proteins that are closely related to cell communication and tumor development. The objective of this study was to screen out GJPs related prognostic signatures (GRPS) associated with clear cell renal cell carcinoma (ccRCC). GJPs microarray data for ccRCC patients were obtained from The Gene Expression Omnibus (GEO) database, along with RNA sequencing data for tumor and paired normal tissues from The Cancer Genome Atlas (TCGA) database. In the TCGA database, least absolute shrinkage and selection Operator (LASSO) and Cox regression models were used to identify GJPs with independent prognostic effects as GRPS in ccRCC patients. According to the GRPS expression and regression coefficient from the multivariate Cox regression model, the risk score (RS) of each ccRCC patient was calculated, to construct the RS prognostic model to predict survival. Overall survival (OS) and progression-free survival (PFS) analyses; gene pan-cancer analysis; single gene survival analysis; gene joint effect analysis; functional enrichment analysis; tumor microenvironment (TME) analysis; tumor mutational burden (TMB) analysis; and drug sensitivity analysis were used to explore the biological function, mechanism of action and clinical significance of GRPS in ccRCC. Further verification of the genetic signature was performed with data from the GEO database. Finally, the cytofunctional experiments were used to verify the biological significance of GRPS associated GJPs in ccRCC cell lines. GJA5 and GJB1, which are GRPS markers of ccRCC patients, were identified through LASSO and Cox regression models. Low expression of GJA5 and GJB1 is associated with poor patient prognosis. Patients with high-RS had significantly shorter OS and PFS than patients with low-RS (p< 0.001). The risk of death for individuals with high-RS was 1.695 times greater than that for those with low-RS (HR = 1.695, 95%CI= 1.439-1.996, p< 0.001). Receiver Operating Characteristic (ROC) curve showed the great predictive power of the RS prognostic model for the survival rate of patients. The area under curve (AUC) values for predicting 1-year, 3-year and 5-year survival rates were 0.740, 0.781 and 0.771, respectively. The clinical column chart was also reliable for predicting the survival rate of patients, with AUC values of 0.859, 0.846 and 0.796 for predicting 1-year, 3-year and 5-year survival, respectively. The GRPS was associated with immune cell infiltration, the TME, the TMB, and sensitivity to chemotherapy drugs. Further in vitro experiments showed that knockdown of GJA5 or GJB1 could promote the proliferation, migration and epithelial-mesenchymal transition (EMT) and inhibit apoptosis of ccRCC cells. GJA5 and GJB1 could be potential biological markers for predicting survival in patients with ccRCC.

Risk of death following chikungunya virus disease in the 100 Million Brazilian Cohort, 2015–18: a matched cohort study and self-controlled case series

Chikungunya virus outbreaks have been associated with excess deaths at the ecological level. Previous studies have assessed the risk factors for severe versus mild chikungunya virus disease. However, the risk of death following chikungunya virus disease compared with the risk of death in individuals without the disease remains unexplored. We aimed to investigate the risk of death in the 2 years following chikungunya virus disease. We used a population-based cohort study and a self-controlled case series to estimate mortality risks associated with chikungunya virus disease between Jan 1, 2015, and Dec 31, 2018, in Brazil. The dataset was created by linking national databases for social programmes, notifiable diseases, and mortality. For the matched cohort design, individuals with chikungunya virus disease recorded between Jan 1, 2015, and Dec 31, 2018, were considered as exposed and those who were arbovirus disease-free and alive during the study period were considered as unexposed. For the self-controlled case series, we included all deaths from individuals with a chikungunya virus disease record, and each individual acted as their own control according to different study periods relative to the date of disease. The primary outcome was all-cause natural mortality up to 728 days after onset of chikungunya virus disease symptoms, and secondary outcomes were cause-specific deaths, including ischaemic heart diseases, diabetes, and cerebrovascular diseases. In the matched cohort study, we included 143 787 individuals with chikungunya virus disease who were matched, at the day of symptom onset, to unexposed individuals using sociodemographic factors. The incidence rate ratio (IRR) of death within 7 days of chikungunya symptom onset was 8·40 (95% CI 4·83-20·09) as compared with the unexposed group and decreased to 2·26 (1·50-3·77) at 57-84 days and 1·05 (0·82-1·35) at 85-168 days, with IRR close to 1 and wide CI in the subsequent periods. For the secondary outcomes, the IRR of deaths within 28 days after disease onset were: 1·80 (0·58-7·00) for cerebrovascular diseases, 3·75 (1·33-17·00) for diabetes, and 3·67 (1·25-14·00) for ischaemic heart disease, and there was no evidence of increased risk in the subsequent periods. For the self-controlled case series study, 1933 individuals died after having had chikungunya virus disease and were included in the analysis. The IRR of all-cause natural death within 7 days of symptom onset of chikungunya virus disease was 8·75 (7·18-10·66) and decreased to 1·59 (1·26-2·00) at 57-84 days and 1·09 (0·92-1·29) at 85-168 days. For the secondary outcomes, the IRRs of deaths within 28 days after disease onset were: 2·73 (1·50-4·96) for cerebrovascular diseases, 8·43 (5·00-14·21) for diabetes, and 2·38 (1·33-4·26) for ischaemic heart disease, and there was no evidence of increased risk at 85-168 days. Chikungunya virus disease is associated with an increased risk of death for up to 84 days after symptom onset, including deaths from cerebrovascular diseases, ischaemic heart diseases, and diabetes. This study highlights the need for equitable access to approved vaccines and effective anti-chikungunya virus therapeutics and reinforces the importance of robust vector-control efforts to reduce viral transmission. Brazilian National Research Council (CNPq), Fundação de Amparo à Pesquisa do Estado da Bahia, Wellcome Trust, and UK Medical Research Council. For the Portuguese translation of the abstract see Supplementary Materials section.

Association of Historical Housing Discrimination and Colon Cancer Treatment and Outcomes in the United States.

In the 1930s, the federally sponsored Home Owners' Loan Corporation (HOLC) used racial composition in its assessment of areas worthy of receiving loans. Neighborhoods with large proportions of Black residents were mapped in red (ie, redlining) and flagged as hazardous for mortgage financing. Redlining created a platform for systemic disinvestment in these neighborhoods, leading to barriers in access to resources that persist today. We investigated the association between residing in areas with different HOLC ratings and receipt of quality cancer care and outcomes among individuals diagnosed with colon cancer-a leading cause of cancer deaths amenable to early detection and treatment. Individuals who resided in zip code tabulation areas in 196 cities with HOLC rating and were diagnosed with colon cancer from 2007 to 2017 were identified from the National Cancer Database and assigned a HOLC grade (A, best; B, still desirable; C, definitely declining; and D, hazardous and mapped in red). Multivariable logistic regression models investigated association of area-level HOLC grade and late stage at diagnosis and receipt of guideline-concordant care. The product-limit method evaluated differences in time to adjuvant chemotherapy. Multivariable Cox proportional hazard models investigated differences in overall survival (OS). There were 149,917 patients newly diagnosed with colon cancer with a median age of 68 years. Compared with people living in HOLC A areas, people living in HOLC D areas were more likely to be diagnosed with late-stage disease (adjusted odds ratio, 1.06 [95% CI, 1.00 to 1.12]). In addition, people living in HOLC B, C, and D areas had 8%, 16%, and 24% higher odds of not receiving guideline-concordant care, including lower receipt of surgery, evaluation of ≥12 lymph nodes, and chemotherapy. People residing in HOLC B, C, or D areas also experienced delays in initiation of adjuvant chemotherapy after surgery. People residing in HOLC C (adjusted hazard ratio [aHR], 1.09 [95% CI, 1.05 to 1.13]) and D (aHR, 1.13 [95% CI, 1.09 to 1.18]) areas had worse OS, including 13% and 20% excess risk of death for individuals diagnosed with early- and 6% and 8% for late-stage disease for HOLC C and D, respectively. Historical housing discrimination is associated with worse contemporary access to colon cancer care and outcomes.

Оценка пожарных рисков в Российской Федерации в целом и её мегаполисах на примере Москвы и Санкт-Петербурга, 2009–2021 гг.

Summary. The purpose of the study is, in connection with the change in the procedure for statistical recording of fires, to assess their health consequences in the Russian Federation as a whole and its megacities using the example of Moscow and St. Petersburg for 13 years (2009–2021). Materials and methods of research. Data on the number of fires was taken from the Federal Database “Fires” [https://sites.google.com/site/statistikapozaro/]; population size – on the Rosstat website [https://rosstat.gov.ru/]. Retrospectively, fire statistics since 2009 have included fires. The results of the study were checked for normal distribution of characteristics. The dynamics of indicators was studied using the analysis of time series, for which a 2nd order polynomial trend was used, etc. Research results and their analysis. As a result of the study, the following risks were calculated for the population of the Russian Federation as a whole, Moscow and St. Petersburg: the risk of being caught in a fire; risk of dying in a fire; risk of injury in a fire; individual risk of dying in a fire per 100 thousand population; individual risk of injury in a fire per 100 thousand population. Conclusions: As a rule, the magnitude of individual fire risks in megacities, due to the coordinated work of fire crews during fire fighting, evacuation of people and a number of other circumstances, was less than in the Russian Federation as a whole; there is also a downward trend. The individual risk of death in a fire in Moscow and St. Petersburg was low for Russia; in Moscow the individual risk of injury was low, in St. Petersburg it was average. The calculated new fire risks can be used when carrying out more targeted work to reduce them in the regions of the Russian Federation.

Association of Metformin Treatment with Risk for Death in Diabetic Patients with Concomitant Gastric Cancer.

Despite the existing guideline's recommendation of metformin therapy as the initial approach for managing diabetes mellitus (DM), there remains a scarcity of comprehensive documentation regarding metformin's impact on outcomes that are important for patients. The objective of this study was to assess the potential impact of metformin treatment on the risk of death in individuals diagnosed with both gastric cancer and pre-existing diabetes mellitus (DM); Design, Setting, and Participants: The study made use of a dataset encompassing nationwide health insurance claims, allowing for a retrospective analysis of all patients with a history of gastric cancer diagnosis (classified under International Classification of Diseases 10th Revision code: C16.X) spanning from 1 January 2002 to 31 December 2012. The primary objective was to observe death within a 5-year follow-up period. The study population comprised 63,664 individuals who fell into two categories: those treated with metformin (n = 29,548) and those who did not receive metformin treatment (n = 34,116). This classification was based on the initial treatment allocation following the diagnosis of gastric cancer. Metformin treatment, comorbidities, concurrent medication, and procedural information. All-cause death, disease-specific death, cardiovascular death. During the 5-year follow-up period, the metformin treatment group exhibited a lower cumulative incidence of all-cause death (27.5%) in comparison to the group not receiving metformin treatment (32.8%). Furthermore, the relative hazards for all-cause death were significantly reduced in the metformin treatment group (HR: 0.80, 95% CI 0.78-0.82), indicating a lower risk of death when compared to the non-metformin group. In addition, metformin treatment was associated with lower occurrences of disease-specific death (related to gastric cancer) and cardiovascular death when compared to the group not undergoing metformin treatment. The findings demonstrated that the use of metformin was effective at improving prognosis among gastric cancer patients documented with prior DM. In this population-based cohort study, metformin treatment was associated with reduced risk of mortality.

Physical Activity And All-cause Mortality In Type 2 Diabetes: A Cross-country Comparison

The main physical activity recommendation (i.e. 150-300 minutes of moderate intensity activity (MVPA) per week) for individuals with type 2 diabetes (T2D) is identical to the general adult recommendation despite substantially less evidence for the recommendation aimed at those living with chronic conditions. PURPOSE: To examine the dose-response associations between leisure-time physical activity (LTPA) and risk of death in individuals with prevalent T2D; and to compare the magnitude of this association between the UK and China. METHODS: Individuals with prevalent T2D in the UK Biobank (UKB) and China Kadoorie Biobank (CKB) prospective cohort studies. Deaths were obtained from registries. Self-reported leisure-time physical activity was categorized as ‘no activity’ (reference), and activity ‘below’ (1-149 min of MVPA/week), ’meeting’ (150-300 min MVPA/w), or ‘above’ (>300 min of MVPA/w) the physical activity recommendations. Individuals with prevalent diseases were excluded. Associations with all-cause mortality were determined using multivariable-adjusted cox proportional hazard regression models. The continuous dose-response pattern was modelled using restricted cubic splines. RESULTS: We included 14,876 (mean (SD) age: 59.5 (7.2) years) and 17,459 (57.7 (9.7) years) men and women with T2D from UKB and CKB, respectively. During a median of 11.3 and 9.7 years of follow-up, 1227 (UKB) and 2351 (CKB) deaths were recorded. In UKB, Hazard ratios were 0.95 (95%CI 0.78, 1.15), 0.88 (0.70, 1.09) and 0.81 (0.66, 1.00) ‘below’, ’meeting’, and ‘above’ physical activity recommendations, respectively. The same contrasts yielded similar magnitude of associations in CKB; 0.87 (0.68, 1.09), 0.88 (0.75, 1.04) and 0.77 (0.70, 0.85). The continuous dose-response analysis did not support an optimal threshold or point of no added benefit in UKB (p-values for non-linearity 0.78), but no further risk reduction was observed above 600 min of MVPA/w in CKB (p-value for non-linearity 0.03). CONCLUSION: LTPA is inversely associated with mortality risk in individuals with T2D. Meeting current physical activity recommendations were associated with a 12% lower risk in both the UK and China cohorts. Stronger associations were observed at higher activity levels with conflicting support for an upper limit of benefit.

Natural and Man-Made Risks of the Southern Baikal Area

Objective. In the last decade, there has been a significant increase in natural phenomena, leading to catastrophic consequences. In this regard, there is a need to use science-based risk-oriented approaches to ensure the safety of people and protect the environment. Zoning of territories according to the levels of risk of emergency situations makes it possible to effectively process and respond to risk. This paper presents an analysis of the risks inherent in natural and man-made disasters in the Southern Baikal Area of the Irkutsk Region and a quantitative assessment of their level based on the modern risk analysis methodology.Methods. We used a retrospective statistical analysis and modeling of possible emergency situations. The processing and synthesis of statistical data was carried out as a whole for the Slyudyansky Municipality of the Irkutsk Region for the period 2015—2019 according to the data of the State Reports “On the State of the Protection of the Population and Territories of the Russian Federation from Natural and Man-made Emergencies” in the relevant years.Results. We assessed the complex risk indicator of the territory, which consists of the potential territorial risk, and the collective risk indicator, which characterizes the level of damage. We calculated the average individual risk of death of the population as a result of the cumulative impact of the damaging factors of emergency situations. It was shown that it exceeded the values of the acceptable risk adopted for the Irkutsk Region by 4.2 times. Based on the modeling of manmade emergencies with depressurization of containers with hazardous substances transported by rail and modeling of damage during catastrophic earthquakes that are possible in a given area, social risk curves were calculated and built. Based on all the results obtained, the zoning of the territory of the Southern Baikal Area was carried out according to the risks of emergencies.Conclusion. Based on the assessments of the complex risk, the territory of the Southern Baikal Area of the Irkutsk Region belongs to the zones with increased risk of natural and man-made emergency situations.

Effectiveness of rAd26-rAd5, ChAdOx1 nCoV-19, and BBIBP-CorV vaccines for risk of infection with SARS-CoV-2 and death due to COVID-19 in people older than 60 years in Argentina: a test-negative, case-control, and retrospective longitudinal study

BackgroundIn January, 2021, a vaccination campaign against COVID-19 was initiated with the rAd26-rAd5, ChAdOx1 nCoV-19, and BBIBP-CorV vaccines in Argentina. The objective of this study was to estimate vaccine effectiveness at reducing risk of SARS-CoV-2 infection and COVID-19 deaths in people older than 60 years.MethodsIn this test-negative, case-control, and retrospective longitudinal study done in Argentina, we evaluated the effectiveness of three vaccines (rAd26-rAd5, ChAdOx1 nCoV-19, and BBIBP-CorV) on SARS-CoV-2 infection and risk of death in people with RT-PCR confirmed COVID-19, using data from the National Surveillance System (SNVS 2.0). All individuals aged 60 years or older reported to SNVS 2.0 as being suspected to have COVID-19 who had disease status confirmed with RT-PCR were included in the study. Unvaccinated individuals could participate in any of the analyses. People with suspected COVID-19 who developed symptoms before the start of the implementation of the vaccination programme for their age group or district were excluded from the study. The odds ratio of SARS-CoV-2 infection was evaluated by logistic regression and the risk of death in individuals with RT-PCR confirmed COVID-19 was evaluated by proportional hazard regression models, adjusted for possible confounders: age at the time of the symptom onset date, sex, district of residence, epidemiological week corresponding to the symptom onset date, and history of COVID-19. The estimation of vaccine effectiveness to prevent death due to COVID-19 was done indirectly by combining infection and death estimates. In addition, we evaluated the effect of the first dose of viral vector vaccines across time.FindingsFrom Jan 31, to Sept 14, 2021, 1 282 928 individuals were included, of whom 687 167 (53·6%) were in the rAd26-rAd5 analysis, 358 431 (27·6%) in the ChAdOx1 nCoV-19 analysis, and 237 330 (18·5%) in the BBIBP-CorV analysis. Vaccine effectiveness after two doses was high for all three vaccines, adjusted odds ratio 0·36 (95% CI 0·35–0·37) for rAd26-rAd5, 0·32 (0·31–0·33) for ChAdOx1 nCoV-19, and 0·56 (0·55–0·58) for BBIBP-CorV. After two doses, the effect on deaths was higher than that on risk of infection: adjusted hazard ratio 0·19 (95% CI 0·18–0·21) for rAd26-rAd5, 0·20 (0·18–0·22) for ChAdOx1 nCoV-19, and 0·27 (0·25–0·29) for BBIBP-CorV. The indirectly estimated effectiveness on deaths was 93·1% (95% CI 92·6–93·5) for rAd26-rAd5, 93·7% (93·2–94·3) for ChAdOx1 nCoV-19, and 85·0% (84·0–86·0) for BBIBP-CorV following two doses. First dose effect of viral vector vaccines remained stable over time.InterpretationThe vaccines used in Argentina showed effectiveness in reducing infection and death by SARS-CoV-2 and COVID-19.FundingNone.

Tailoring care for frail and lonely older people with HIV in Canada: a cross-sectional study.

40-60% of people with HIV report experiencing loneliness, and 5-29% of PWH are frail (depending on the definition used). The risk of death in individuals who are frail and lonely, or frail and socially isolated has recently been estimated to be 1·8 times that in individuals who are not frail, lonely, or socially isolated. The aim of the present study was to determine the prevalence of loneliness, and other vulnerabilities related to ageing, in frail older adults with HIV. We assessed frailty with the Clinical Frailty Scale (CFS) in a cross-sectional, convenience sample of people with HIV aged 50 years or older in Southern Alberta, Canada. All Southern Alberta Clinic patients aged 50 years or older who attended a virtual or in-person clinic visit between March and October, 2020, and who underwent frailty screening were included in the present analyses. Individuals scoring 4 or higher on the CFS then completed a structured questionnaire to provide information on additional co-factors, including loneliness (Three-item Loneliness Scale), falls, impaired gait and balance, polypharmacy, unintentional weight loss, food insecurity, and subjective cognitive concerns. Age, sex, nadir CD4 cell count, duration of known HIV infection, ethnicity, and risk category were evaluated for associations with frailty. We used t tests to compare means and Pearson χ2 tests to compare proportions. Patients gave written informed consent for use of data. The use of data was approved by the University of Calgary Conjoint Heath Research Ethics Board. We assessed frailty in 292 older people with HIV. The mean age was 59 years (range 50-86 years) and 45 (16%) were women. On the basis of a score of 4 or greater on the CFS, 40 (14%) participants were identified as frail. Frail individuals tended to be older than those who were not frail (mean age 61·9 years, SD 8·5 versus 58·4 years, SD 6·3; t test difference 3·5, 95% CI 1·3-5·7; p=0·0011). However, there was no association between frailty status and sex, nadir CD4 cell count, duration of known HIV infection, or self-reported ethnicity. Frail individuals were more likely to report injection drug use as a component of their risk for acquisition than were non-frail individuals. Of the frail participants, 15 (42%) reported loneliness, 15 (42%) had fallen in the past year, and 18 (50%) reported impaired gait or balance. One-fifth (8) reported unintentional weight loss and 12 (33%) experienced food insecurity. Nearly 40% (14) reported subjective memory concerns. In this sample of ageing people with HIV, frailty and loneliness were prevalent. Given the increased risk of death when frailty and loneliness are both present, upstream and targeted interventions are urgently needed. These might include measures to address loneliness, risk of falls, weight loss, food insecurity, and memory concerns. Canadian Foundation for Healthcare Improvement, Advancing Frailty Care in the Community.

Risk of Death in Individuals Hospitalized for COVID-19 With and Without Psychiatric Disorders: An Observational Multicenter Study in France

BackgroundPrior research suggests that psychiatric disorders could be linked to increased mortality among patients with COVID-19. However, whether all or specific psychiatric disorders are intrinsic risk factors of death in COVID-19 or whether these associations reflect the greater prevalence of medical risk factors in people with psychiatric disorders has yet to be evaluated. MethodsWe performed an observational, multicenter, retrospective cohort study to examine the association between psychiatric disorders and mortality among patients hospitalized for laboratory-confirmed COVID-19 at 36 Greater Paris University hospitals. ResultsOf 15,168 adult patients, 857 (5.7%) had an ICD-10 diagnosis of psychiatric disorder. Over a mean follow-up period of 14.6 days (SD = 17.9), 326 of 857 (38.0%) patients with a diagnosis of psychiatric disorder died compared with 1276 of 14,311 (8.9%) patients without such a diagnosis (odds ratio 6.27, 95% CI 5.40–7.28, p < .01). When adjusting for age, sex, hospital, current smoking status, and medications according to compassionate use or as part of a clinical trial, this association remained significant (adjusted odds ratio 3.27, 95% CI 2.78–3.85, p < .01). However, additional adjustments for obesity and number of medical conditions resulted in a nonsignificant association (adjusted odds ratio 1.02, 95% CI 0.84–1.23, p = .86). Exploratory analyses after the same adjustments suggested that a diagnosis of mood disorders was significantly associated with reduced mortality, which might be explained by the use of antidepressants. ConclusionsThese findings suggest that the increased risk of COVID-19–related mortality in individuals with psychiatric disorders hospitalized for COVID-19 might be explained by the greater number of medical conditions and the higher prevalence of obesity in this population and not by the underlying psychiatric disease.

A Systematic Review and Meta-Analysis of Inpatient Mortality Associated With Nosocomial and Community COVID-19 Exposes the Vulnerability of Immunosuppressed Adults.

BackgroundLittle is known about the mortality of hospital-acquired (nosocomial) COVID-19 infection globally. We investigated the risk of mortality and critical care admission in hospitalised adults with nosocomial COVID-19, relative to adults requiring hospitalisation due to community-acquired infection.MethodsWe systematically reviewed the peer-reviewed and pre-print literature from 1/1/2020 to 9/2/2021 without language restriction for studies reporting outcomes of nosocomial and community-acquired COVID-19. We performed a random effects meta-analysis (MA) to estimate the 1) relative risk of death and 2) critical care admission, stratifying studies by patient cohort characteristics and nosocomial case definition.Results21 studies were included in the primary MA, describing 8,251 admissions across 8 countries during the first wave, comprising 1513 probable or definite nosocomial COVID-19, and 6738 community-acquired cases. Across all studies, the risk of mortality was 1.3 times greater in patients with nosocomial infection, compared to community-acquired (95% CI: 1.005 to 1.683). Rates of critical care admission were similar between groups (Relative Risk, RR=0.74, 95% CI: 0.50 to 1.08). Immunosuppressed patients diagnosed with nosocomial COVID-19 were twice as likely to die in hospital as those admitted with community-acquired infection (RR=2.14, 95% CI: 1.76 to 2.61).ConclusionsAdults who acquire SARS-CoV-2 whilst already hospitalised are at greater risk of mortality compared to patients admitted following community-acquired infection; this finding is largely driven by a substantially increased risk of death in individuals with malignancy or who had undergone transplantation. These findings inform public health and infection control policy and argue for individualised clinical interventions to combat the threat of nosocomial COVID-19, particularly for immunosuppressed groups.Systematic Review RegistrationPROSPERO CRD42021249023

Assessing relative COVID-19 mortality during the second wave: a prospective Swiss population-based study

ObjectiveDuring the first COVID-19 wave in Switzerland, relative mortality was at least eight times higher compared with the uninfected general population. We aimed to assess sex-specific and age-specific relative mortality...

VALIDATION OF RISK INDICATORS IN ASSESSING THE SAFETY OF ELECTRICAL EQUIPMENT BOILER HOUSE IN THUNDERSTORM

Introduction. Today requires the introduction and arrangement of modern enterprises automation of the technological process using various electronic and electrical equipment. The breakdown of one sensor leads to a stoppage of the technical process and thousands of losses. This equipment is sensitive to impulse overvoltages that occur for various reasons, as well as when hit by lightning. There is a misconception that the danger of lightning arises only when struck directly, forgetting about the socalled secondary phenomena, namely electromagnetic and electrostatic pulses. Pulse overvoltage is a short-term increase in voltage above the allowable value. Lightning protection systems are designed and designed to protect objects from dangerous lightning.Purpose. Given the automation of the process and the saturation of boilers with electronic and electrical equipment, there is a high risk of lightning and high potentials, which can lead to large-scale accidents. The purpose of this article is to validate the risk indicators for the boiler environment that occur during a thunderstorm.Methods. The use of various methods of calculation, assessment and ordering of risks during the design and layout of the system allows to implementation system lightning protection of buildings, equipment and people. General principles of risk assessment for the boiler environment must take into account: risk and determine the need for protection; the contribution of various risk components to the overall risk; the effect of various protection measures to reduce risk; selection of protection measures taking into account their economic efficiency.Results. Neglecting the high risk of a dangerous event leads to excessive damage and m irreparable losses, with which a person or community will not be able to achieve sustainable development. Therefore, it is a comprehensive, systematic approach to achieving safety, starting from the assessment stage, should take into account both the characteristics of the hazard, including a fire in the relevant facilities, and personal, the individual risk of death or injury. Lightning is an unpredictable natural event, no one in the world fully understands the mechanism of lightning and it is impossible to provide 100% protection under any circumstances under any standardization. For this purpose, the following calculations are given: loss of human life, including injuries; loss of the ability to provide public services; losses of cultural heritage and economic value of the building (structure) and economic losses required for the installation and operation of the system. Based on the obtained data, it is seen how the reduction of each risk is achieved depending on the proposed solution and the economic effect in general.Conclusion. Statistics on deaths and injuries from lightning hazards, losses from damage to property, buildings and struc-tures confirm that in risk assessment, which is standardized in DSTU EN 62305-2, it is necessary to introduce a methodology that would meet the conditions of Ukraine. The arrangement of the lightning protection system depends on the risk assessment, the reaction of the owner, the influence of control bodies. Therefore, it is important to decide on fire protection measures in lightning risk assessment procedures, but it can also be taken regardless of the results of the risk assessment where there is a desire to avoid unacceptable risk. Equipment that is often associated with two different services, e.g. power lines and data lines suffer a lot of surge damage. This case is not covered by the RX risk component. However, appropriate protection measures can be selected and established (see IEC 62305-4).

Features of patients that died for COVID-19 in a hospital in the south of Mexico: A observational cohort study.

Due to the wide spread of SARS-CoV2 around the world, the risk of death in individuals with metabolic comorbidities has dangerously increased. Mexico has a high number of infected individuals and deaths by COVID-19 as well as an important burden of metabolic diseases; nevertheless, reports about features of Mexican individuals with COVID-19 are scarce. The aim of this study was to evaluate demographic features, clinical characteristics and the pharmacological treatment of individuals who died by COVID-19 in the south of Mexico. We performed an observational study including the information of 185 deceased individuals with confirmed diagnoses of COVID-19. Data were retrieved from medical records. Categorical data were expressed as proportions (%) and numerical data were expressed as mean ± standard deviation. Comorbidities and overlapping symptoms were plotted as Venn diagrams. Drug clusters were plotted as dendrograms. The mean age was 59.53 years. There was a male predominance (60.1%). The mean hospital stay was 4.75 ± 4.43 days. The most frequent symptoms were dyspnea (88.77%), fever (71.42%) and dry cough (64.28%). Present comorbidities included diabetes (60.63%), hypertension (59.57%) and obesity (43.61%). The main drugs used for treating COVID-19 were azithromycin (60.6%), hydroxychloroquine (53.0%) and oseltamivir (27.3%). Mexican individuals who died of COVID-19 had shorter hospital stays, higher frequency of shortness of breath, and higher prevalence of diabetes than individuals from other countries. Also, there was a high frequency of off-label use of drugs for their treatment.