Death Certificates Research Articles

Analysis of errors in medical certificates of cause of death (MCCD) at a tertiary care institute in 2022

AimMedical Certificates of Cause of Death (MCCD) play a pivotal role in shaping national health statistics and public health initiatives. This study investigates the quality of MCCD completion at a Tertiary Care Institute in India, focusing on certification errors made by physicians while issuing death certificates. MethodsUsing a retrospective, cross-sectional approach, 1603 MCCDs issued during the study period were analyzed for formal correctness and mistakes. The study employed predefined categories to assess the nature and impact of these errors. While this research did not verify the factual accuracy of the MCCDs against patients’ medical records, it categorized errors into major and minor, based on their potential to influence the accurate classification of the underlying cause of death.ResultsThe study showed the presence of errors in all 1603 death certificates examined, categorizing them as major, minor, or both. Notably, 99.2% of cases lacked the mention of the time interval between death and the morbid condition. Analysis of major errors indicated that in 64.6% of cases, competing causes of death were mentioned, while 77.4% featured multiple causes of death. Furthermore, improper sequencing of the cause of death was identified in 11.2%, whereas 7.9% had poorly defined conditions as the cause of death.ConclusionTo improve the quality of healthcare data and public health management, these findings highlight the necessity for precise MCCD reporting and the significance of comprehending mortality patterns. For informed decision-making and changes to the healthcare system, addressing the found errors and patterns is essential.

Effects of COVID-19 on motor neuron disease mortality in the United States: a population-based cross-sectional study

Background In March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) to be a pandemic, stating that those with underlying health conditions are most susceptible, including motor neuron disease (MND). Objective To examine the effect the COVID-19 pandemic had on deaths from MND in the United States. Methods Death certificate data for all MND deaths aged 20 years and older were analyzed from 2017 to 2019 (pre-COVID), then expanded to include 2020 and 2021 (COVID) deaths to evaluate if COVID-19 impacted MND deaths. Results The average number of MND deaths documented during the COVID-19 years was 8009, up from 7485 MND deaths pre-COVID. The age-adjusted mortality rate among the non-Hispanic population increased during COVID to 2.78 per 100,000 persons (95% CI = 2.73–2.82) from 1.81 (95% CI = 1.78–1.84). The Hispanic population also saw an increase in mortality rate during COVID (1.61, 95% CI = 1.51–1.71) compared with pre-COVID (1.10, 95% CI = 1.03–1.17). Decedent’s home as a place of death also saw a mortality rate increase during COVID (1.51, 95% CI = 1.48–1.54) compared with pre-COVID (1.30, 95% CI = 1.27–1.32). For the Hispanic population, the rate peaked at 80–84 years pre-COVID, but for the COVID years, the rate peaked earlier, at 75–79 years. Conclusion The total number of MND deaths was greater during COVID than in the preceding years. The analysis suggests there might have been a consequence of circumstances surrounding the global pandemic and the associated restrictions.

Investigating variation in reported location of death: A comparison of administrative data sources

BackgroundLocation of death is an important outcome in health research. Accordingly, the collection and assembly of these data is complex. In Canadian administrative healthcare data, the gold standard for mortality has been Vital Statistics (VS), which is based on death certificates. MethodsAll mortality records in the province of Alberta, Canada (population 4.6M) were extracted from VS between 2016 and 2021. These were deterministically linked on unique patient identifiers to databases including hospitalizations, emergency department (ED) visits, long-term care (LTC) and designated supportive living records. The primary outcome was location of death reported in administrative sources. ResultsThere were 162,835 mortality records identified in VS. Of deaths labeled as hospital, en route, or nursing in VS (113,554), 85.3% were linked to administrative data on inpatient, ED, LTC, and/or designated supporting living deaths. Of the 52.2% VS records reporting hospital deaths, 80.4% linked to a record of death to the inpatient database. Few records were linked and reported as occurring in the ED if not already classified through inpatient records (<0.5%). Of the 15.0% of VS deaths in nursing homes, 64.5% were linked to a record of death in LTC data, and a further 5.3% linked to a death record in designated supportive living records. ConclusionThere is considerable variation in the reported location of death across data sources in Alberta, with VS reporting lower than expected, confirmed numbers. These discrepancies require further validation in determining the ‘gold standard’ for location of death in subsequent research and quality improvement endeavors.

The incidence of sudden unexpected death in epilepsy (SUDEP) in the Republic of Ireland

BackgroundThe incidence of sudden unexpected death in epilepsy (SUDEP) in Ireland has previously been studied in only a small geographical area. Our aim was to calculate an incidence rate for the whole of the Republic of Ireland in 2019. MethodsAll deaths referred to the coroner in 2019 were examined. Those with a history of possible epilepsy were noted and subjected to a more detailed assessment. Cases fulfilling the definition of definite SUDEP were identified. The incidence of SUDEP was calculated using the population of the Republic of Ireland in 2019 and the known prevalence of epilepsy in Ireland. ResultsThirty-three cases of definite SUDEP were identified in the Republic of Ireland in 2019. The estimated incidence of SUDEP in the epilepsy population as a whole was 0.7/1000(0.46 – 0.94) person years. This may be a conservative estimate. More men than women were identified, and most individuals were found dead at home. SUDEP was mentioned on the death certificate in only 52 % of cases. ConclusionThis is the first nationwide study of SUDEP incidence in Ireland and provides an incidence rate in keeping with other populations. This work demonstrates that the interrogation of coronial records is a useful way to monitor epilepsy mortality albeit with certain limitations.

Building a Historic Population Platform

ObjectivesWith the increasing digital availability of large population databases of historical census or vital event records, the tasks of storing, cleaning, processing, linking and analysing such data become more challenging. Suitable computing platforms and software systems are required to handle such databases, and facilitate the application of complex record linkage algorithms, for example to reconstruct populations that cover a full country over many decades. We present our efforts to achieve these goals on a database of over 20 million vital event records spanning over 120 years to create a “Historic Population Platform” (HiPP). ApproachWe created a graph database using the Neo4J software, where each birth, death and marriage certificate is represented as a node. We then generated actor nodes from these certificates which represent individuals (such as birth babies and their parents, or marriage brides and grooms). Data cleaning steps included the correction and imputation of invalid, corrupted, and missing age and date values using information from related certificates. ResultsOur initial graph database contains over 100 million nodes and nearly 200 million edges, while our data cleaning methods help to substantially increase the number of valid age and date values. ConclusionThe availability of large historical population databases provides exciting opportunities for social science and health research. However, existing methods have limitations in handling data quality and the sizes of such databases. We presented novel methods to deal with these challenges which we hope will be of use for other projects that aim to build a HiPP.

Evolving Characteristics of Decedents With Hepatitis AListed as a Cause of Death, United States, 2011-2021.

Hepatitis A is a vaccine-preventable disease that typically causes mild illness. Hepatitis A outbreaks associated with person-to-person transmission have been widespread in the United States since 2016. We used public-use US Multiple Cause of Death data to compare characteristics and listed comorbidities among decedents with hepatitis A-listed deaths during non-outbreak (2011-2015) and outbreak (2017-2021) periods and assessed the median age at death among decedents with and without hepatitis A-listed deaths during the outbreak period. From the non-outbreak period to the outbreak period, hepatitis A-listed deaths more than doubled (from 369 to 801), while the hepatitis A-listed age-adjusted mortality rate increased 150% (p < 0.001). When compared with the non-outbreak period, hepatitis A-listed decedents during the outbreak period were more frequently male, aged 18-49 years, non-Hispanic White, died in an inpatient setting, and had hepatitis A listed as their underlying cause of death. The median age at death for hepatitis A-listed decedents was significantly younger during the outbreak period overall and among females (62 and 66 years, respectively) compared with the non-outbreak period (64 and 72 years, respectively, p < 0.001). During the outbreak period, median age at death for hepatitis A-listed decedents was 14 years younger than decedents without hepatitis A listed. Compared with the general US population, decedents with hepatitis A listed on the death certificate died at younger ages during 2017-2021. Efforts are needed to improve hepatitis A vaccination coverage among adults recommended for hepatitis A vaccination to prevent additional premature hepatitis A deaths.

The Weight of Numbers: Counting Border Crossing Deaths and Policy Intent

Executive Summary This article explores how undocumented border crosser (UBC) deaths are counted as well as mis- and under-counted across the US southwest, and proposes a suite of policy remediations to standardize this process. An accurate count of UBC recovered remains is vital to understanding the scope of fatalities associated with border crossing, providing evidence accounting for the reciprocal relationship between US border enforcement and the incidence of migration-related death. To meaningfully intervene, it is insufficient to advocate only for more robust individual death investigations, though this is pivotal to forensically identify UBC decedents and unite them with their loved ones. Though identification and reunification of UBCs are the elements of forensic care most commonly attributed as humanitarian, the relationship between forensic investigation and international humanitarian principles is equally about accumulating primary evidence for policy intervention and justice claims on behalf of those who wrongfully die. Even if existing counting mechanisms do not provide the means for establishing this attribution between border-crossing deaths and border enforcement policy, this article lays out an argument for why they must do so and it makes recommendations for how this can take place. Necessarily, this article begins with a critique of existing mechanisms for counting UBC deaths, from the federal observation of such deaths by Customs and Border Protection, to the bureaucratic mechanisms for the collection of vital statistics authored at the local level. It then suggests means for improving accurate counting using the US Standard Certificate of Death. It particularly explores two aspects of the certificate, Manner of Death reporting and a section that asks death filers to describe how the death occurred, sections 37 and 43 respectively. Finally, it explores historical precedent for altering the standard death form at local and then national levels, positing that select amendments to the existing death certificate would be useful for standardizing how medicolegal death filers across the border and beyond can more accurately enumerate and characterize UBC deaths. Policy recommendations include the following, in order of immediacy: ● Jurisdictions across the US southwest must adopt standardized criteria for counting fatalities believed to be associated with undocumented border crossing. ● Despite some local formalization of UBC counting, current means of representing UBC status in vital records remains ad hoc across the US southwest and existing mechanisms for counting elude wider scale national recognition in vital statistics. The most straightforward and reliable method of standardization to ensure systematic representation of UBC deaths across the borderlands would be a UBC checkbox on the death certificate. This would require cooperation with state-level public health departments and legislatures. Precedent exists for changing the death form at the state level, facilitating, in some cases, for eventual inclusion of new components of the death certificate to be adopted on the US Standard Certificate of Death. This is recommended as a longer-term goal. ● Finally, there must be a means to characterize the deadly relationship between UBC fatalities and US border enforcement policy and practice in vital records where UBC Manners of Death are most often characterized as “Natural” or “Accidental.” Both are inaccurate. Unilaterally ensuring an accurate count leaves room for a trend already well underway in which agencies associated with border enforcement have cast UBC deaths as simply due to unfortunate heat-related accidents, resulting in legislation aimed to mitigate deaths that fails to address the role of border policy in causing deaths. This paper recommends that a new Manner of Death category could be useful beyond the border to represent non-capital crimes enforced by leveraging bodily harm.

Understanding Causes of Death in Patients With Acute Respiratory Distress Syndrome: A Narrative Review.

To provide a comprehensive summary of the published data on cause of death in patients with acute respiratory distress syndrome (ARDS). PubMed (January 2015 to April 2024), bibliographies of relevant articles, and ARDS Network and Prevention & Early Treatment of Acute Lung Injury (PETAL) network websites. Observational studies and clinical trials that reported on cause of death in greater than or equal to 30 patients with ARDS, not obtained from death certificates. Animal studies, case reports, review articles, study protocols, and studies in pediatrics were excluded. Causes of death among ARDS patients who died were extracted and tabulated along with other pertinent study characteristics. We identified 15 observational studies (nine non-COVID ARDS, five COVID-related ARDS; one both) and five clinical trials (all non-COVID ARDS). Mutually exclusive prespecified categories were used for recording the cause of death in only eight studies although studies differed in the categories included and their definitions. When multiple organ failure was a predetermined category, it was the most common cause of death recorded (~50% of deaths), followed by respiratory causes with proportions varying from 16% to 42% depending on nomenclature (e.g., refractory hypoxemia, pulmonary causes) and definitions. However, the largest observational study in non-COVID ARDS (964 deaths), did not include multiple organ failure as a predetermined category, and found that pulmonary failure (42%) and cardiac failure (37%) were the most common causes of death. In COVID-related ARDS observational studies, pulmonary reasons were the most reported cause of death (up to 88%). Few studies have reported cause of death in patients with ARDS. In those that do, cause of death categories and definitions used are heterogeneous. Further research is needed to see whether a more rigorous and unified approach to assigning and reporting cause of death in ARDS would help identify more relevant endpoints for the assessment of targeted treatments in clinical trials.

Reproductive Factors and Thyroid Cancer Risk: The Multiethnic Cohort Study.

Background: Women are three times more likely to be diagnosed with thyroid cancer than men, with incidence rates per 100,000 in the United States of 20.2 for women and 7.4 for men. Several reproductive and hormonal factors have been proposed as possible contributors to thyroid cancer risk, including age at menarche, parity, age at menopause, oral contraceptive use, surgical menopause, and menopausal hormone therapy. Our study aimed to investigate potential reproductive/hormonal factors in a multiethnic population. Methods: Risk factors for thyroid cancer were evaluated among female participants (n = 118,344) of the Multiethnic Cohort Study. The cohort was linked to Surveillance, Epidemiology, and End Results cancer incidence and statewide death certificate files in Hawaii and California, with 373 incident papillary thyroid cancer cases identified. Exposures investigated include age at menarche, parity, first pregnancy outcome, birth control use, and menopausal status and type. Multivariable Cox proportional hazards models were used to obtain relative risk (RR) of papillary thyroid cancer and their 95% confidence intervals (CI). Covariates included age, race and ethnicity, reproductive history, body size, smoking, and alcohol consumption. Results: We observed a statistically significant increased risk of papillary thyroid cancer for oophorectomy (adjusted RR 1.58, 95% CI: 1.26, 1.99), hysterectomy (adjusted RR 1.65, 95% CI: 1.33, 2.04), and surgical menopause (adjusted RR 1.55, 95% CI: 1.22, 1.97), and decreased risk for first live birth at ≤20 years of age versus nulliparity (adjusted RR 0.66, 95% CI: 0.46, 0.93). These associations did not vary by race and ethnicity (p het > 0.44). Conclusion: The reproductive risk factors for papillary thyroid cancer reported in the literature were largely confirmed in all racial and ethnic groups in our multiethnic population, which validates uniform obstetric and gynecological practice.

Fatal journeys: causes of death in international travellers in South America.

Understanding mortality among travellers is essential for mitigating risks and enhancing travel safety. However, limited evidence exists on severe illnesses and injuries leading to death among travellers, particularly in low- and middle-income countries and remote regions. We conducted a retrospective census study using country-level observational data from death certificates of travellers of seven South American countries (Argentina, Brazil, Chile, Colombia, Ecuador, Peru, and Uruguay) from 2017 to 2021. Causes of death were evaluated using ICD-10 codes, categorised into non-communicable diseases (NCDs), communicable diseases, and injuries. We quantified causes of death by demographic characteristics (e.g. age, sex), and geographical variables. Chi-square tests were used to assess differences between categories. We calculated crude mortality rates and incidence rate ratios (IRRs) per country's subregions. A total of 17 245 deaths were reported. NCDs (55%) were the most common cause of death, followed by communicable diseases (23.4%) and injuries (18.1%). NCD-associated deaths increased after age 55years and were highest among ≥85years. Communicable diseases were more common at younger age (<20years). Injury-associated deaths were more common in men (79.9%) and 25-29-year-olds (17.1%). Most deaths (68.2%) could have been avoided by prevention or treatment. Mortality risk was higher among travellers in bordering regions between countries. In Roraima [Brazil] and Norte de Santander [Colombia], locations bordering Venezuela, the death incidence rate ratio was 863 and 60, respectively. These countries' reference mortality rates in those regions were much lower. More than 80% of the deaths in these border regions of Brazil and Colombia involved Venezuelan citizens. Conclusion: The study identified risk factors and high-risk locations for deaths among travellers in seven countries of South America. Our findings underscore the need for specific health interventions tailored to traveller demographics and destination to optimise prevention of avoidable deaths in South America.

Effectiveness of the Application of the Integrated Population Information System (Sintren) in the Issuance of Death Certificates at the Population and Civil Registration Office of Cirebon Regency

The Integrated Population Information System (SINTREN) is a collection of actions to organize and distribute death certificate documents and population data electronically or via the internet using existing technology, communication, and information facilities. The SINTREN system is used with the aim of providing convenience in population administration services related to death certificates in Cirebon Regency. This research aims to review whether the management of the application or website is able to cut the distance and time of users to be more efficient. The research employs a qualitative approach through observation, documentation, and observations, with a particular focus on informants who were directly involved in the application of the SINTEREN application for issuing death certificates. Data analysis was conducted using Budiani's theory of effectiveness, which includes evaluating the accuracy of program goals, the effectiveness of program socialization, the achievement of program objectives, and the monitoring mechanisms in place. The study contributes by analyzing and interpreting data collected from various sources, providing insights into its implementation, functionality, and impact on improving population and civil registration services. This study could help identify areas for improvement, enhance system efficiency, and inform future policy decisions regarding population information management in the region.

The effect of herpes zoster vaccination at different stages of the disease course of dementia: Two quasi-randomized studies.

The varicella zoster virus, a neurotropic herpesvirus, has been hypothesized to play a role in the pathophysiology of dementia, such as through neuroinflammatory processes or intracerebral vasculopathy. Using unique natural experiments, our group has previously found that live-attenuated herpes zoster (HZ) vaccination reduced the incidence of new diagnoses of dementia in both Wales and Australia. To inform further research and ultimately clinical care, it is crucial to understand at which stage of the disease course of dementia the HZ vaccine has its effect. Representing the two opposing ends of the dementia disease course as it can be ascertained from electronic health record data, the aims of this study were twofold: to determine the effect of HZ vaccination on i) new diagnoses of mild cognitive impairment (MCI) among individuals without any record of cognitive impairment, and ii) deaths due to dementia among individuals living with dementia. Our approach took advantage of the fact that at the time of the start date (September 1 2013) of the HZ vaccination program in Wales, individuals who had their eightieth birthday just after this date were eligible for HZ vaccination for one year whereas those who had their eightieth birthday just before were ineligible and remained ineligible for life. This eligibility rule created comparison groups just on either side of the September 2 1933 date-of-birth eligibility threshold who differed in their age by merely a week but had a large difference in their probability of receiving HZ vaccination. The key strength of our study is that these comparison groups should be similar in their health characteristics and behaviors except for a minute difference in age. We used regression discontinuity analysis to estimate the difference in our outcomes between individuals born just on either side of the date-of-birth eligibility threshold for HZ vaccination. Our dataset consisted of detailed country-wide electronic health record data from primary care in Wales, linked to hospital records and death certificates. We restricted our dataset to individuals born between September 1 1925 and September 1 1942. Among our study cohort of 282,557 without any record of cognitive impairment at baseline, HZ vaccination eligibility and receipt reduced the incidence of a new MCI diagnosis by 1.5 (95% CI: 0.5 - 2.9, p=0.006) and 3.1 (95% CI: 1.0 - 6.2, p=0.007) percentage points over nine years, respectively. Similarly, among our study cohort of 14,350 individuals who were living with dementia at baseline, being eligible for and receiving HZ vaccination reduced deaths due to dementia by 8.5 (95% CI: 0.6 - 18.5, p=0.036) and 29.5 (95% CI: 0.6 - 62.9, p=0.046) percentage points over nine years, respectively. Except for dementia, HZ vaccination did not have an effect on any of the ten most common causes of morbidity and mortality among adults aged 70 years and older in Wales in either of our two study cohorts. The protective effects of HZ vaccination for both MCI and deaths due to dementia were larger among women than men. Our findings suggest that the live-attenuated HZ vaccine has benefits for the dementia disease process at both ends of the disease course of dementia.

Hospital case fatality and mortality related to Chagas disease in Brazil over two decades

ObjectiveTo analyse hospital case fatality and mortality related to Chagas disease (CD) in Brazil, 2000–2019.MethodThis is a mixed ecological study with spatial and temporal trends, based on national population data from the Brazilian Ministry of Health - hospital admissions (HA) and death certificates (DC). Records with CD as a primary or secondary cause of death in HA and/or as an underlying or associated cause of death in DC were evaluated. Temporal trends were analysed by Joinpoint regression and the spatial distribution of age- and gender-adjusted rates, spatial moving averages, and standardized morbidity ratios.ResultsThere were a total of 4,376 HA due to CD resulting in death in Brazil, with a hospital case fatality rate of 0.11/100,000 inhabitants. The Southeast region had the highest rate (63.9%, n = 2,796; 0.17/100,000 inhabitants). The general trend for this indicator in Brazil is upwards (average annual percentage change [AAPC] 7.5; 95% confidence interval [CI] 5.3 to 9.9), with increases in the North, Northeast and Southeast regions. During the same period 122,275 deaths from CD were registered in DC, with a mortality rate of 3.14/100,000 inhabitants. The highest risk of CD-related death was found among men (relative risk [RR] 1.27) and Afro-Brazilians (RR 1.63). There was a downward trend in CD mortality in the country (AAPC − 0.7%, 95%CI -0.9 to -0.5), with an increase in the Northeast region (AAPC 1.1%, 95%CI 0.6 to 1.6). Municipalities with a very high Brazilian Deprivation Index tended to show an increase in mortality (AAPC 2.1%, 95%CI 1.6 to 2.7), while the others showed a decrease.ConclusionHospital case fatality and mortality due to CD are a relevant public health problem in Brazil. Differences related to gender, ethnicity, and social vulnerability reinforce the need for comprehensive care, and to ensure equity in access to health in the country. Municipalities, states, and regions with indicators that reveal higher morbidity and mortality need to be prioritized.

Predictors for cause-specific and timing of deaths in patients with COVID-19: a cohort study in Taiwan

BackgroundThis cohort study determines the predictors for cause-specific and timing of deaths in patients with COVID-19 in Taiwan.MethodsPatients with laboratory-confirmed COVID-19 admitted to Taipei City Hospital from January 1 to July 31, 2022, were recruited in this cohort. All patients were followed up until death, discharge from the hospital, or August 31, 2022. Early deaths within the first 2 weeks were recorded, and the cause of death was confirmed by the death certificate database of Taiwan. Predictors of cause-specific and timing of deaths of patients with COVID-19 were determined using multinomial Cox proportional hazards regression analysis.ResultsOf the 195 (8.0%) patients who died during hospitalization, 147 (84.0%) had COVID-19-specific deaths. Moreover, 54.9% of the deceased patients had early death. After controlling for other covariates, patients aged ≥ 65 years had a higher risk of COVID-19-specific, non-COVID-19-specific, early, and late deaths [adjusted hazards ratio (AHR): 3.85, 6.45, 3.33, and 6.57; 95% confidence interval (CI): 1.91–7.78, 1.17–35.68, 1.51–7.36, and 2.18–19.76, respectively]. Fully vaccinated patients had a lower risk of COVID-19-specific (AHR: 0.68; 95% CI: 0.47–0.98) and early deaths (AHR: 0.54; 95% CI: 0.35–0.84), whereas comorbid patients with chronic obstructive pulmonary disease had a higher risk of non-COVID-19-specific deaths (AHR: 5.43; 95% CI: 1.73–17.03).ConclusionsThis study suggests that prioritizing COVID-19 vaccination and carefully monitoring comorbid patients during hospitalization can reduce the risk of COVID-19-specific and early deaths and non-COVID-19-specific mortalities, respectively.

A Bayesian spatial–temporal varying coefficients model for estimating excess deaths associated with respiratory infections

Abstract Disease surveillance data are used for monitoring and understanding disease burden, which provides valuable information in allocating health programme resources. Statistical methods play an important role in estimating disease burden since disease surveillance systems are prone to undercounting. This paper is motivated by the challenge of estimating mortality associated with respiratory infections (e.g. influenza and COVID-19) that are not ascertained from death certificates. We propose a Bayesian spatial–temporal model incorporating measures of infection activity to estimate excess deaths. Particularly, the inclusion of time-varying coefficients allows us to better characterize associations between infection activity and mortality counts time series. Software to implement this method is available in the R package NBRegAD. Applying our modelling framework to weekly state-wide COVID-19 data in the US from 8 March 2020 to 3 July 2022, we identified temporal and spatial differences in excess deaths between different age groups. We estimated the total number of COVID-19 deaths in the US to be 1,168,481 (95% CI: 1,148,953 1,187,187) compared to the 1,022,147 from using only death certificate information. The analysis also suggests that the most severe undercounting was in the 18–49 years age group with an estimated underascertainment rate of 0.21 (95% CI: 0.16, 0.25).

Dietary antioxidant and inflammatory potential in asthmatic patients and its association with all-cause mortality

BackgroundThe occurrence and progression of asthma can be influenced by the components in food. Our study aims to determine whether dietary antioxidant and inflammatory potential are associated with the risk of mortality in asthma patients.MethodsParticipants from the 2001–2018 National Health and Nutrition Examination Survey (NHANES) aged 20 years and older with a diagnosis of asthma were included. Mortality status was obtained according to death certificate records from the National Death Index. The antioxidant and inflammatory potential of the diet was assessed using two widely used and dependable indices, Composite Dietary Antioxidant Index (CDAI) and Dietary Inflammatory Index (DII). Restricted cubic spline (RCS) regression was used to analyze the non-linear relationship between the two indexes and mortality. Multivariable Cox proportional risk models were used to estimate hazard ratio and 95% confidence intervals for mortality. Finally, the relationship between CDAI and DII was analyzed.ResultsA total of 4698 NHANES participants represented 23.2 million non-institutionalized residents of the US were enrolled in our study. Patients with higher CDAI or lower DII exhibited longer survival times. RCS regression showed a linear relationship of CDAI or DII with mortality. In the Cox regression, both crude and adjusted models demonstrated that higher CDAI or lower DII was linked to a reduced risk of all-cause mortality. Similar associations were found in subgroup analysis. Finally, a negative relationship was found between CDAI and DII.ConclusionReducing pro-inflammatory or increasing antioxidant diets could reduce all-cause mortality among adult asthma patients.

Strategy to Improve Electronic Medical Certification of Cause of Death at Rumah Sakit Persahabatan, Jakarta, Indonesia

Proper death certification has broad medical and public health benefits. Therefore, death certificates should be completed accurately according to the medical certification of cause of death (MCCD) scheme. To improve the data quality of MCCD, Rumah Sakit Persahabatan (RSP) has implemented an electronic form (e-SMPK) since 2023. Although equipped with a user manual and coordination support system, incomplete and inaccurate e-SMPKs are still found. This study aims to identify interventions that can improve the quality (completeness and accuracy) of e-SMPK in RSP using one action research cycle consisting of 4 stages, i.e., diagnosing, planning, taking, and evaluating action. Qualitative data was collected through focused group discussions and field observations. Quantitative data was collected by comparing the completeness and accuracy of e-SMPKs before and after the intervention agreed upon with the participants. Triangulation of the data was carried out to maintain the credibility of the research. This study found that obstacles to e-SMPK consist of system and regulatory factors, skills, practical tools, and processes. Interventions are implemented by adjusting regulations, providing guidance and training, revising electronic forms, improving coordination, and facilitating consultation and verification to overcome obstacles. An increase in the completeness and accuracy of filling in the e-SMPK elements was obtained, most of which were statistically significant.

Association between cardiovascular health and all-cause mortality risk in patients with osteoarthritis

BackgroundThis study was to explore the relationship between cardiovascular health (CVH) and the risk of all-cause mortality in patients with osteoarthritis (OA).MethodsThis cohort study retrieved the data of 3642 patients with OA aged ≥ 20 years from the 2007—2018 National Health and Nutrition Examination Survey (NHANES). CVH was evaluated based on Life’s Essential 8 (LE8) includes diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. The outcome of all-cause mortality was assessed using the death certificate records of participants from the National Death Index. Variables that might affect all-cause mortality were used as covariates. The weighted univariate COX proportional hazards model was used to explore the association between each covariate and all-cause mortality. The weighted univariate and multivariate COX proportional hazards models were used to explore the association between different CVH levels and all-cause mortality. A restricted cubic spline (RCS) curve was plotted to show the association between different CVH levels and all-cause mortality in OA patients. Hazard ratio (HR) and 95% confidence interval (CI) were calculated.ResultsFindings show that people with moderate CVH (HR = 0.67, 95% CI = 0.45—0.98) and high CVH (HR = 0.47, 95% CI = 0.26—0.87) were associated with reduced risk of all-cause mortality in patients with OA. The HR of all-cause mortality in patients with OA decreased by 0.12 as per 10 points increase of LE8 score (HR = 0.81, 95% CI = 0.73—0.90). The RCS curve revealed that the HR of all-cause mortality decreased with the increase in LE8 score. The survival probability of patients in the high CVH group was higher than the moderate CVH group and low CVH group (p = 0.002).ConclusionModerate-to-high CVH is associated with a decreased risk of all-cause mortality in patients with OA. These findings might provide a reference for the formulation of prognosis improvement strategies for the management of patients with OA.

Assessing the accuracy of reporting of hypertension on death certificates in Australia.

There is insufficient evidence of how accurately hypertension is reported on death certificates, which are the primary evidence of causes of death. This study assesses the accuracy of reporting of hypertension on death certificates of decedents in Australia who previously had their blood pressure measured. Blood pressure data from the 2014-15 and 2017-18 National Health Surveys were linked to death registration data from July 2015-December 2021 (average 3.3 years from survey to death). The percentage of decedents with hypertension reported on the death certificate was calculated according to blood pressure level and previous diagnosis of hypertension. Hypertension was reported on the death certificate of 20.2% (95% confidence interval 12.1-28.3%) of decedents who had very high to severe blood pressure (160/100 mmHg and above), 14.5% (10.3-18.8%) who had high blood pressure (140/90 mmHg to less than 160/100 mmHg), 14.1% (10.8%-17.4%) who had normal to high blood pressure (less than 140/90 mmHg) and who took hypertension medication, and 17.8% (13.6-22.0%) who had been diagnosed with hypertension. Where the decedent had very high to severe blood pressure, hypertension was reported for 27.9% (14.1-41.8%) of deaths if they had been diagnosed with hypertension and 21.7% (9.6-33.7%) where another cardiovascular disease was reported on the death certificate. Hypertension mortality in Australia is only reported for a minority of deaths of people with high or very high to severe blood pressure; this is also found for those with a prior diagnosis of hypertension.

Impact of the ARRIVE Trial on Stillbirth Rates in Nulliparous Individuals.

We aim to examine the population-level rates of induction, stillbirth, perinatal mortality, and neonatal death before and after the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial. This study was a cross-sectional analysis of publicly available U.S. Live Birth data linked with Infant Death and Fetal Death certificate data from National Vital Statistics Online. We limited analyses to nulliparous individuals with singleton pregnancy and cephalic presentation who delivered at 39 weeks or greater. The pre- and post-ARRIVE periods spanned from August 2016 to July 2018, and from January 2019 to December 2020, respectively. Our primary outcome was a stillbirth. Secondary outcomes included induction of labor, perinatal mortality, and neonatal death. Outcomes were compared between the pre- and post-ARRIVE periods. Modified Poisson regression was used to calculate adjusted relative risks (aRRs). Of 2,817,071 births, there were 1,454,346 births in the pre-ARRIVE period and 1,362,725 in the post-ARRIVE period; there were 1,196 and 1,062 stillbirths in the pre- and post-ARRIVE periods, respectively. Compared to the pre-ARRIVE period, the post-ARRIVE period was not associated with a significant decrease in the risk of stillbirth at 39 weeks or greater (aRR 0.92 [95% confidence interval {95% CI} 0.85-1.00]) and stillbirth at 40 weeks or greater (aRR 0.92 [95% CI 0.82-1.04]). Compared to the pre-ARRIVE trial period, the post-ARRIVE trial was associated with increased rates of induction of labor at 39 weeks (aRR 1.37 [95% CI 1.37-1.38]) and 40 weeks (aRR 1.24 [95% CI 1.24-1.25]. Similar to stillbirth, there was no significant decrease in the risk of perinatal mortality at 39 weeks or greater or 40 weeks or greater. There was also no statistically significant change in neonatal death rates at 39 weeks or greater or at 40 weeks or greater. The increase in induction of labor at 39 weeks was not large enough to impact the stillbirth rate at 39 weeks or greater. · Post-ARRIVE trial, rate of induction of labor increased at 39 and 40 weeks.. · Post-ARRIVE trial, stillbirth and perinatal mortality rates remained unchanged.. · Induction rate rise post-ARRIVE trial did not impact neonatal death rates..