Monthly Mortality Research Articles

It never rains but it pours: Austerity and mortality rate in peripheral areas

This study examines the impact of austerity measures on mortality rates across Italian regions from 2003 to 2018. Since 2007, regions experiencing substantial healthcare financial deficits have been required to implement recovery plans (RPs). We use a recent difference-in-differences staggered matching estimator to assess the effects of this austerity policy on municipal-level monthly mortality rates. This allows us to evaluate the policy’s spatial heterogeneity across treated municipalities, accounting for their distance from the nearest hospital. The analysis reveals a significant negative impact of austerity measures on health, particularly in peripheral areas and among vulnerable populations. Mortality rates are higher in regions under RPs, with this effect escalating with increasing distance from hospitals. The policy’s impact is also more pronounced among vulnerable populations, with differences observed between genders and across seasons.

Assessment of the impact of Uber system implementation on mortality from traffic injuries in Brazilian capital cities.

The rapid expansion of Uber Technologies, Inc.'s ride-sharing, courier service, and food delivery system and e-hailing applications has been transforming the logistics network and urban mobility around the world. We aimed to evaluate the impact of the Uber system on traffic injury (TI) mortality during its implementation in Brazilian capital cities. A quasiexperimental design of interrupted time series was used. The monthly mortality rates for TI standardized by age were analyzed. The date of availability of the Uber app, specific to each capital, was considered the start date. Data from the Brazilian Mortality Information System and the Brazilian Institute of Geography and Statistics were used. For the data analysis, from an interrupted time-series design, autoregressive integrated moving average (ARIMA) models with a transfer function were fitted. In 92.6% (n=25) of Brazilian capitals, there was no impact of Uber system implementation, 12 months after the start of its activities, on TI mortality. A reduction in mortality from this cause was observed after the system was implemented in Belo Horizonte and Rio de Janeiro. The impact on TI mortality was progressive and continuous in both. More studies are needed to establish the factors associated with the inequalities observed in the impact of Uber system implementation between different locations and the heterogeneity of effects.

Higher-Than-Expected Burden of Alcohol-Related Liver Diseases During COVID-19 Pandemic in the USA, with a Tapering Trend.

Coronavirus disease 2019 (COVID-19) pandemic has led to an increase in alcohol-related liver disease (ALD). The aim of this study was to evaluate the magnitude of ALD hospitalization surge during the pandemic in the USA. A retrospective trend analysis of adult hospitalizations for ALD at acute care hospitals across the USA in 2016-2020 was conducted. Hospitalizations were identified using the International Classification of Diseases 10 codes for ALD and non-alcoholic-related liver disease. Outcomes measured included the predicted monthly volume of hospitalizations for ALD and inpatient mortality rates. During the 2020 pandemic, monthly ALD hospitalizations reached 10,247 representing a 20.7% increase compared to pre-pandemic monthly average of 8490. Additional 4163 ALD hospitalizations occurred during the pandemic, in addition to a pre-pandemic uptrend. The peak of excess ALD hospitalizations was from May to October (monthly excess of 1138) decreasing to monthly excess of 280 in November and December. The excess increase in ALD hospitalizations was primarily observed in young adults, totaling 5256 cases affecting both male (2101 excess cases) and females (2041 excess cases). The age-standardized monthly mortality rate during the pandemic was notably higher than expected at 0.9% (95% CI 0.4 to 1.4%). The COVID-19 pandemic led to a significant increase in ALD hospitalizations, above and beyond the pre-existing upward trend, which tapered towards the end of 2020, suggesting a possible decline in the pandemic's impact. The excess increase in ALD hospitalizations was observed primarily in young adults and affected both males and females. These findings highlight the need for further attention to the long-term consequences of the pandemic.

Assessment of the annual trend of chemical aerogenic risk to health and mortality of the population at an industrial center

Introduction. Ambient air pollution determines high levels of risk to public health, causing excess mortality. 
 The purpose of the study is to analyze the dependence of the seasonal dynamics of pollutants and mortality from major non-infectious diseases in the population of the industrial center of Eastern Siberia.
 Materials and methods. Air pollution in Bratsk was assessed based on data from monitoring systems for 2017–2022, taking into account one-time, average monthly and annual concentrations. Hazard indices and mortality rates (MR) from major causes were calculated. The annual trend in indicators are assessed using seasonality indices (SI).
 Results. Features of the seasonal dynamics of pollutants were revealed: maximum fluctuations in SI are characteristic of benzo(a)pyrene (22% in the warm season, 214% in the cold season), formaldehyde (219 and 65%, respectively). The SI for mortality had significant fluctuations throughout the year and varied across age groups and disease classes. Changes in seasonality have been noted during the COVID-19 pandemic. Average monthly MR in the older group is associated with concentrations of PM2.5, formaldehyde, NO2.
 Limitations of the study are related to the limited data on monitoring pollutants, inevitable errors in conditional division into seasons, and the impossibility 
 of accurately determining the cause of death during a pandemic.
 Conclusion. The use of average monthly data on MR values and pollutant concentrations confirms the dependence of population mortality on air pollution when studying this phenomenon in medium-sized cities with high levels of hazard indices.

Influenza activity and regional mortality for non-small cell lung cancer

Lung cancer is the leading cause of cancer deaths in the United States and worldwide. While influenza illness is known to be particularly dangerous for frail and elderly patients, the relationship between influenza illness and outcomes in patients with cancer remains largely unknown. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with non-small cell lung cancer (NSCLC) diagnosed between 2009 and 2015. Influenza-like illness (ILI) activity, provided by the Outpatient Influenza-like Illness Surveillance Network of the Center of Disease for Control and Prevention, was merged with the SEER dataset on the state-month level. Regional monthly mortality rates were compared during low versus high flu months in this ecological cohort study. 202,485 patients with NSCLC from 13 SEER-reporting states were included in the analysis. 53 of 1049 state-months (5.1%) had high flu activity. Monthly mortality rates during low and high flu months were 0.041 (95% CI 0.041–0.042) and 0.051 (95% CI 0.050–0.053), respectively (RR 1.24 [95% CI 1.21–1.27]). The association between ILI activity and mortality was observed at the individual state level and in all clinical and regional subgroups. Increased regional influenza activity is associated with higher mortality rates for patients with NSCLC. Vaccine-directed initiatives and increased awareness amongst providers will be necessary to address the growing but potentially preventable burden of influenza-related lung cancer deaths in the U.S.

Epidemiologic features of neonatal sepsis and its COVID-19 associated temporal patterns in Jimma Medical Center, Ethiopia: A Joinpoint regression analysis.

Neonatal sepsis remains a leading cause of morbidity and mortality in neonates across all regions, including Africa. Compared to developed and some developing countries, there are relatively few epidemiological trends for neonatal sepsis and associated patterns with COVID-19 in Ethiopia. We modeled an epidemiological trend and pattern to aid in the monitoring of changes in neonatal sepsis. Retrospective data were collected from all admissions to the Neonatal Intensive Care Unit (NICU) in Ethiopia at Jimma Medical Center between May 2019 and April 2022. We analyzed the monthly neonatal sepsis incidence, mortality, and case-fatality rates using STATA software. Finally, we modeled a monthly time series of neonatal sepsis incidence trends and patterns associated with the COVID-19-impacted period using Joinpoint software. For all analyses, a P value of 0.05 was considered statistically significant at the 95% confidence interval (CI). In the 36 months, 6796 cases were admitted to the NICU, with a 9.5% (95% CI: 9.1, 10.0) incidence rate of neonatal sepsis. The overall admission mortality rate was 16.5% (95% CI: 13.6, 19.8), while sepsis-attributed mortality was 7.1% (95% CI: 5.8, 8.5). The data showed an unstable decreasing trend for three Joinpoints (August 2020, December 2020, and August 2021). Notably, a decrease in the incidence trend was observed from May 2019 to August 2020 (MPC, -4.1; 95% CI: -7.6, -0.5; P = 0.03), followed by a sharp increase (MPC, 23.7; 95% CI: -13.8, 77.7; P = 0.24) from August 2020 to December 2020. From December 2020 to August 2021, there was again a decreasing trend (MPC, -13.8; 95% CI: -23.3, -3.5; P = 0.01), followed by a slight increase from August 2021 to April 2022 (MPC, 4.2; 95% CI: -8.4, 18.6; P = 0.52). Finally, the study revealed an association between patterns of neonatal sepsis incidence trends and COVID-19, with a Joinpoint jump model comparability ratio (CR = 0.43) between pre- and COVID-19-impacted periods. Neonatal sepsis was prevalent at Jimma Medical Center, but it was on an unstably declining trend. The current results suggest a potential temporal association between the intensity of COVID-19 containment measures and a change in the incidence trend and patterns of neonatal sepsis. However, the quantified contribution of a particular containment measure requires further investigation.

Does Femoral Arterial Calcification Have an Effect on Mortality in Patients Who Underwent Hemiarthroplasty Due to Hip Fracture?

We aimed to investigate the effect of femoral arterial calcification on mortality in patients who underwent hemiarthroplasty due to hip fracture. In our study, 481 patients who were operated for hip fracture between 01.01.2015 and 01.01.2021 were evaluated retrospectively. Femoral arterial calcification on the fractured side was evaluated in the preoperative pelvic anteroposterior (AP) X-ray, and the patients were divided into two subgroups according to the presence or absence of femoral arterial calcification. The overall survival and first-month and first-year survival of the patients were evaluated. Patients' age, gender, side, fracture type, treatment method, time between fracture and operation date, presence of femoral arterial calcification and type of anesthesia (regional, general) were recorded. Of the 481 patients included in the study, 299 were female and 182 were male, and the mean age was calculated as 80.5. Of the patients, 187 were diagnosed with femoral neck fractures and the remaining 294 with pertrochanteric fractures. It was observed that the mortality rate in the first month after surgery was 58 (12%) for both groups, and the mortality rate in the first year was 173 (35.9%) for both groups. The overall postoperative mortality was calculated as 302 (62.7%) for both groups. Femoral arterial calcification was detected in 191 of 481 patients, and femoral arterial calcification was not observed in the remaining 290 patients. Similarly, when both groups were compared in terms of mortality in the first month after surgery, mortality in the first year and overall mortality rates, no significant difference was found between the groups (p>0.05). In our study we showed that femoral arterial calcification has no effect on mortality in acute hip fractures treated by hemiarthroplasty in people over 65 years of age.

No Excess of Mortality from Lung Cancer during the COVID-19 Pandemic in an Area at Environmental Risk: Results of an Explorative Analysis

The COVID-19 pandemic and the restrictive measures associated with it placed enormous pressure on health facilities and may have caused delays in the treatment of other diseases, leading to increases in mortality compared to the expected rates. Areas with high levels of air pollution already have a high risk of death from cancer, so we aimed to evaluate the possible indirect effects of the pandemic on mortality from lung cancer compared to the pre-pandemic period in the province of Taranto, a polluted site of national interest for environmental risk in the south of Italy. We carried out a retrospective observational study on lung cancer data (ICD-10: C34) from the Registry of Mortality (ReMo) for municipalities in Taranto Province over the period of 1 January 2011 to 31 December 2021. Seasonal exponential smoothing, Holt-Winters additive, Holt-Winters multiplicative, and auto-regressive integrated moving average (ARIMA) models were used to forecast the number of deaths during the pandemic period. Data were standardized by sex and age via an indirect method and shown as monthly mortality rates (MRs), standardized mortality ratios (SMRs), and adjusted mortality rates (AMRs). In Taranto Province, 3108 deaths from lung cancer were recorded between 2011 and 2021. In the province of Taranto, almost all of the adjusted monthly mortality rates during the pandemic were within the confidence interval of the predicted rates, with the exception of significant excesses in March (+1.82, 95% CI 0.11-3.08) and August 2020 (+2.09, 95% CI 0.20-3.44). In the municipality of Taranto, the only significant excess rate was in August 2020 (+3.51, 95% CI 0.33-6.69). However, in total, in 2020 and 2021, the excess deaths from lung cancer were not significant both for the province of Taranto (+30 (95% CI -77; +106) for 2020 and +28 (95% CI -130; +133) for 2021) and for the municipality of Taranto alone (+14 (95% CI -47; +74) for 2020 and -2 (95% CI -86; +76) for 2021). This study shows that there was no excess mortality from lung cancer as a result of the COVID-19 pandemic in the province of Taranto. The strategies applied by the local oncological services during the pandemic were probably effective in minimizing the possible interruption of cancer treatment. Strategies for accessing care in future health emergencies should take into account the results of continuous monitoring of disease trends.

COVID-19 Predictive Models Based on Grammatical Evolution

A feature construction method that incorporates a grammatical guided procedure is presented here to predict the monthly mortality rate of the COVID-19 pandemic. Three distinct use cases were obtained from publicly available data and three corresponding datasets were created for that purpose. The proposed method is based on constructing artificial features from the original ones. After the artificial features are generated, the original data set is modified based on these features and a machine learning model, such as an artificial neural network, is applied to the modified data. From the comparative experiments done, it was clear that feature construction has an advantage over other machine learning methods for predicting pandemic elements.

Extreme temperatures, mortality, and adaptation: Evidence from the county level in China.

Extreme temperatures are known to cause adverse health outcomes. Yet knowledge on the magnitude of this effect in developing countries is limited due to data availability and reliability issues. Collecting data for 2872 counties in China, we estimate the effects of daily temperatures on the monthly mortality rate. The results indicate that an additional day for which the maximum temperature is 38°C or above on average increases the monthly mortality rate by about 1.7% relative to if that day's maximum temperature had been in the range 16-21°C. This is after deducting deaths harvested from the subsequent month. Higher gross domestic product per capita at the county level is associated with lower mortality effects of hot and cold days. Improved dwelling conditions are found to be associated with a lower mortality effect of hot days and improved local healthcare infrastructure to be associated with a lower mortality effect of cold days. In the absence of strong adaptation efforts, the estimates suggest net upward pressure on annual mortality rates over coming decades in many populous counties, especially under more extreme climate change scenarios.

Perception of care givers regarding danger signs of illness and practices followed in young infants (0-2 months) as per IMNCI at selected areas of Amritsar, Punjab: A qualitative study.

In India, neonatal mortality contributes to over 64% of infant deaths, mostly occurring during the first week of life. Mortality rate in second month of life is also higher than at later ages. Delay in identification of warning signs of neonatal illness naturally postpones the initiation of treatment and referral to hospital. The study aimed to explore the perception of care givers regarding danger signs of illness and practices followed in young infants. Care givers who cared for the sick young infants during last six months were recruited using a convenient sampling technique and qualitative research approach. Five semi-structured interviews and one FGD were conducted using an interview and FGD guide. Data was analyzed manually by reading and rereading the transcribed verbatim leading to the emergence of themes, subthemes, and codes. Data explored that excessive crying was perceived as a danger sign by entire mothers, and many of them were unable to recognize important warning signs. The delay in decision making for medical care-seeking also shows dwindling awareness. Additionally, mothers were adapting few unhygienic practices as home remedies leading to worsening the symptoms and making a call for additional infections which needs to be addressed by the health authorities at community level. Pronounced efforts are expected to raise mindfulness of mothers toward the significance of early identification of neonatal danger signs to stave off the high magnitude of neonatal mortality. Inclusion of excessive crying as neonatal danger sign is recommended as well.

Uncovering the impact of COVID-19 on the place of death of cancer patients in South America.

The COVID-19 pandemic has significantly impacted healthcare systems worldwide, especially on the management of chronic diseases such as cancer. This study explores the effects of COVID-19 on cancer mortality trends in Brazil, Chile, and Peru. The monthly age-standardized mortality rates in different places of death (hospital/clinic or home) were estimated using vital statistics and death certificate databases. An interrupted time series analysis was performed for each country, using the date of lockdown implementation as the intervention point. Overall cancer mortality rates reduced after the implementation of pandemic restrictions, with a significant decrease in Brazil. In total, 75.3%, 55.4%, and 45.7% of deaths in Brazil, Peru, and Chile, respectively, occurred in hospitals. After lockdowns were implemented, at-home deaths increased in all countries, and in-hospital deaths correspondingly decreased only in Chile. Our results suggest that COVID-19 has significantly affected rates of cancer mortality and place of death in Latin America.

Mortality in Galla Goat Production System in Southern Rangelands of Kenya: Levels and Predictors

Herd health and adaptability are of concern in animal production in the tropics because of the persistent exposure to multiple stresses of low quality and quantity feeds, heat stress, high disease, and parasite incidences, poor husbandry, and breeding practices; the combined effects of these factors is high livestock mortality. High health-related mortality has been frequently reported as the major impediment to livestock production and thus the aim of this article is to investigate the vital infectious diseases and non-infectious factors that account for the majority of deaths which is crucial in determining mortality control strategies. The study applies a descriptive, Kaplan-Meier method, and truncated regression analysis using an eight-year retrospective data spanning from 2014 to 2021 was applied for this analysis. The results indicate infectious diseases as the most important cause of Galla goat mortality. The mean monthly and annual mortality rates are higher and the pre-weaning mortality of Galla goat appeared to be one of the major constraints hampering the development of replacement stock. The risk factors considered for high mortality were the age and sex of the kids. Among the infectious diseases analyzed, bacterial, parasitic, and non-specific infectious diseases were identified as the important causes of Galla goat mortality, while the non-infectious conditions included malnutrition and thermal/cold shock. The analysis provided an improved insight into animal-health-related factors which once addressed could reduce mortality and hence optimize animal husbandry performance in Galla goat production systems. Interventions in Galla goat health and husbandry are recommended to control kids' mortality.

Pulmoner Emboli ile D-dimer Düzeyinin Korelasyonu ve Yaşa Göre Eşik Değerlerinin Belirlenmesi

Aim: This study was conducted to determine the D-dimer threshold levels according to age in patients diagnosed with pulmonary embolism (PE) by pulmonary computed tomography (CT) angiography. Material and Methods: Patients who had pulmonary CT angiography performed and whose D-dimer test was obtained with the suspicion of pulmonary embolism (PE) in the emergency department of a tertiary university hospital between January 01, 2015, and December 30, 2019, were included in the study. The demographic characteristics of the patients, imaging reports, and 1-month mortality were evaluated retrospectively by examining the hospital information management system and patient files. Patients with missing records and patients who had diagnostic examinations other than the preliminary diagnosis of PE were excluded from the study. Results: Among the 6240 patients included in the study, 58.1% were female. The mean age of the patients was 43±17 years. Of the 1,507 patients who had a pulmonary CT angiogram, 9.8% were diagnosed with PE. When we looked at the 1-month mortality of 6240 patients, whose D-dimer assay was analyzed with the preliminary diagnosis of PE, we found that 0.3% of patients died. The monthly mortality rate was 0.7% in patients with high D-dimer levels while the mortality rate in patients with normal D-dimer levels was 0.1%. A positive and statistically significant correlation was found between the location of the pulmonary embolism in pulmonary CT angiography and the D-dimer level (spearman’s rho= 0.251, p<0.001). The cut-off D-dimer value in predicting the presence of PE in all age groups was calculated as 1.34 mg/L. The cut-off values of D-dimer to predict the presence of PE according to age ranges was calculated as 1.18 mg/L (<50 years), 1.19 mg/L (50-60 years), 1.58 mg/L (60-70 years) 1.79 mg/L (70-80 years), 2.83 mg/L (>80 years) respectively. Conclusion: As age increases, the D-dimer cut-off value for the diagnosis of PE also increases. There is a positive and significant relationship between D-dimer level and pulmonary embolism severity.

Estimating the infection burden of COVID-19 in Malaysia.

Malaysia has reported 2.75 million cases and 31,485 deaths as of 30 December 2021. Underestimation remains an issue due to the underdiagnosis of mild and asymptomatic cases. We aimed to estimate the burden of COVID-19 cases in Malaysia based on an adjusted case fatality rate (aCFR). Data on reported cases and mortalities were collated from the Ministry of Health official GitHub between 1 March 2020 and 30 December 2021. We estimated the total and age-stratified monthly incidence rates, mortality rates, and aCFR. Estimated new infections were inferred from the age-stratified aCFR. The total estimated infections between 1 March 2020 and 30 December 2021 was 9,955,000-cases (95% CI: 6,626,000-18,985,000). The proportion of COVID-19 infections in ages 0-11, 12-17, 18-50, 51-65, and above 65 years were 19.9% (n = 1,982,000), 2.4% (n = 236,000), 66.1% (n = 6,577,000), 9.1% (n = 901,000), 2.6% (n = 256,000), respectively. Approximately 32.8% of the total population in Malaysia was estimated to have been infected with COVID-19 by the end of December 2021. These estimations highlight a more accurate infection burden in Malaysia. It provides the first national-level prevalence estimates in Malaysia that adjusted for underdiagnosis. Naturally acquired community immunity has increased, but approximately 68.1% of the population remains susceptible. Population estimates of the infection burden are critical to determine the need for booster doses and calibration of public health measures.

The deadly effect of day-to-day temperature variation in the United States

Recent research has found anthropogenic forcing to also affect day-to-day variability of temperatures. For many people, the climate is not only becoming hotter but also more volatile. Based on the new climate-economy literature, I explore the historical impact of day-to-day temperature variation on mortality in the United States over a 35-year period. I find that an extra C of daily temperature variability caused an additional 0.206 deaths per 100 000, equal to a 0.28% increase in the average monthly mortality rate. There is, however, evidence of adaptation to daily temperature variability as income and access to air-conditioning have increased and as people have become accustomed to large seasonal variation in temperatures. Given the deadly effect of day-to-day temperature variation, falling average daily temperature variability in the US since 1970 could have resulted in as many as 1400 and 1600 premature deaths avoided every winter and summer, respectively. In comparison, the increase in the number of days with a mean temperature above 35 ∘C could have caused an additional 655 premature deaths every year. These back-of-the-envelope calculations show that current estimates of the social cost of carbon are omitting an important channel for the mortality impact of climate change by not considering this additional effect of temperature volatility.

Association of Extreme Heat and Cardiovascular Mortality in the United States: A County-Level Longitudinal Analysis From 2008 to 2017.

Extreme-heat events are increasing as a result of climate change. Prior studies, typically limited to urban settings, suggest an association between extreme heat and cardiovascular mortality. However, the extent of the burden of cardiovascular deaths associated with extreme heat across the United States and in different age, sex, or race and ethnicity subgroups is unclear. County-level daily maximum heat index levels for all counties in the contiguous United States in summer months (May-September) and monthly cardiovascular mortality rates for adults ≥20 years of age were obtained. For each county, an extreme-heat day was identified if the maximum heat index was ≥90 °F (32.2 °C) and in the 99th percentile of the maximum heat index in the baseline period (1979-2007) for that day. Spatial empirical Bayes smoothed monthly cardiovascular mortality rates from 2008 to 2017 were the primary outcome. A Poisson fixed-effects regression model was estimated with the monthly number of extreme-heat days as the independent variable of interest. The model included time-fixed effects and time-varying environmental, economic, demographic, and health care-related variables. Across 3108 counties, from 2008 to 2017, each additional extreme-heat day was associated with a 0.12% (95% CI, 0.04%-0.21%; P=0.004) higher monthly cardiovascular mortality rate. Extreme heat was associated with an estimated 5958 (95% CI, 1847-10 069) additional deaths resulting from cardiovascular disease over the study period. In subgroup analyses, extreme heat was associated with a greater relative increase in mortality rates among men compared with women (0.20% [95% CI, 0.07%-0.33%]) and non-Hispanic Black compared with non-Hispanic White adults (0.19% [95% CI, 0.01%-0.37%]). There was a greater absolute increase among elderly adults compared with nonelderly adults (16.6 [95% CI, 14.6-31.8] additional deaths per 10 million individuals per month). Extreme-heat days were associated with higher adult cardiovascular mortality rates in the contiguous United States between 2008 and 2017. This association was heterogeneous among age, sex, race, and ethnicity subgroups. As extreme-heat events increase, the burden of cardiovascular mortality may continue to increase, and the disparities between demographic subgroups may widen.

Mortality and Change in the Prevalence of Deep Vein Thrombosis Associated With SARS-CoV-2 P.1 Variant.

Background and objectiveThrombosis is one of the significant challenges associated with cardiovascular diseases and a prominent cause of death globally. This study aimed to determine the monthly and overall mortality rates by sex and age group in patients hospitalized with coronavirus disease 2019 (COVID-19) and the prevalence of deep vein thrombosis (DVT) in those patients. We also investigated whether the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) P.1 variant influenced DVT.MethodsWe determined the overall prevalence of COVID-19 per sex, age, and monthly mortality using hospital data at the São José do Rio Preto School of Medicine, state of São Paulo, Brazil. Data of COVID-19 patients with DVT as determined by echo-Doppler ultrasound (EDU) were analyzed by taking two time periods into account (prior to and after the onset of the predominance of the SARS-CoV-2 P.1 variant) to evaluate whether the viral variant exerted an influence on the prevalence of DVT. Patients with COVID-19 but without DVT comprised the control group. The first period was from March 2020 to February 2021, and the second was from March to June 2021.ResultsBetween March 2020 and June 2021, 6,199 patients were hospitalized with COVID-19 at our institution. Of these, 2,805 (45.25%) were women and 3,376 (54.47%) were men. Two hundred fifty-four were diagnosed with DVT based on lower limb EDU. The mean mortality rate was significantly associated with sex (38.36% for men and 27.16% for women; p=0.01). The incidence of DVT in patients with COVID-19 rose significantly from 1.6% during the first study period to 7.7% during the second study period (p=0.0001), when the P.1 variant became the predominant strain. The mortality rate was significantly higher in patients with COVID-19 and DVT (58.1%) compared to the control group (33.6%; p=0.0001).ConclusionBased on our findings, the incidence and prevalence of DVT increased with the predominance of P.1. viral variant. Early diagnosis and the reassessment of prophylaxis are the two most important factors to be addressed in this patient population.

Changes in cancer-related mortality during the COVID-19 pandemic in the United States.

6581 Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in delayed medical care that may have led to increased death rates in 2020 among people with medical conditions such as cancer. This study examined changes in cancer-related mortality between 2019 and 2020. Methods: We used the US 2019-2020 Multiple Cause of Death database from the CDC WONDER to identify cancer-related deaths, defined as decedents with invasive or noninvasive cancer as a contributing cause of death (ICD-10 codes: C00-C97 and D00-D09). We compared age-standardized cancer-related annual and monthly mortality rates (per 100,000 person-years and person-months, respectively) in January-December 2020 (pandemic) versus January-December 2019 (pre-pandemic) overall and stratified by rurality and place of death. We calculated the 2020 excess death by comparing the numbers of observed death with the projected death based on age-specific cancer-related death rate from 2015 to 2019. Results: The number of cancer-related deaths was 686 054 in 2020, up from 664 888 in 2019, with an annual increase of 3.2%. Compared to the number of projected deaths for 2020 (666 286), the number of cancer-related excess deaths was 19 768 in 2020. Annual age-standardized cancer-related mortality rate (per 100,000 person-years) continuously decreased from 173.7 in 2015 to 162.1 in 2019, while it increased to 164.1 in 2020 (2020 vs 2019 rate ratio (RR): 1.013, 95% confidence interval (CI): 1.009 - 1.016). The cancer-related monthly mortality rate was higher in April 2020 (RR: 1.032, 95% CI: 1.020 – 1.044) when healthcare capacity was most challenged by the pandemic, subsequently declined in May and June 2020, and higher mortality rates were again observed each month from July to December 2020 compared to 2019. In large metropolitan areas, the largest increase in cancer-related mortality was observed in April 2020, while in non-metropolitan areas, the largest increases occurred from July to December 2020, coinciding with the time-spatial pattern of COVID-19 incidence in the country. Compared to 2019, cancer-related mortality rates were lower from March to December 2020 in medical facilities, hospice facilities, and nursing homes or long-term care settings but higher in decedent's homes. Conclusions: The COVID-19 pandemic led to significant increases in cancer-related deaths in 2020 versus 2019. Ongoing evaluation of the spatial-temporal effects of the pandemic on cancer care and outcomes is warranted, especially in relation to patterns in vaccine uptake and COVID-19 hospitalization rates.[Table: see text]

End-of-Life Care During COVID-19: A Mixed Methods Analysis of Homebound Patients Cared for via Home-Based Primary and Palliative Care in New York City (RP510)

Outcomes1. Characterize patients in a home-based primary and palliative care (HBMC) practice who died during the spring 2020 COVID-19 surge in New York City2. Identify multiple levels of disruption that occurred during the COVID-19 surge3. Describe three ways that home-based medical and palliative care practices are positioned to support end-of-life care for homebound older adults during emergenciesImportanceCOVID-19 end-of-life research has focused primarily on patients who died in hospitals and nursing homes. Less is known about homebound patients receiving home-based primary and palliative care (HBMC) in the community.Objective(s)To describe characteristics and end-of-life care experiences of patients in an HBMC practice who died during New York City's initial 2020 COVID-19 surge.Method(s)Mixed-methods, retrospective quantitative and narrative analysis of demographic, clinical, and end-of-life data from unstructured electronic medical record notes for all patients who died between March 1 and June 30, 2020.Results112 (9%) of the practice's 1,300 patients died during this period, with the average monthly mortality rate doubling in April 2020, the peak of the NYC surge. Thirty-four (30.4%) had confirmed or probable COVID-19. 58 (52%) were referred to hospice, and 50 enrolled. Eighty-two patients (73%) died at home. Our qualitative analysis found that COVID-19 disrupted regular caregiving routines, often requiring new or inexperienced caregivers to step in; rapidly evolving COVID-19 knowledge and protocols complicated access to services (e.g., requiring patients to present a negative COVID-19 test to begin hospice despite testing shortages); avoiding hospitals and emergency departments became an urgent concern due to visitor restrictions and families’ fears of loved ones dying alone; and COVID-19 complicated ongoing care for complex conditions (e.g., continuing dialysis for COVID+ patients). Throughout the surge, the HBMC team drew on their collaborative practice and longstanding relationships with patients, families, and hospice and home care providers to navigate service disruptions and provide comfort and emotional support.Conclusion(s)Overall, COVID-19 created severe disruptions and barriers to necessary care, further complicating care for this very high-risk, high-needs population. HBMC played an integral role in supporting patients and their families through the pandemic surge.ImpactAs a model focused on interdisciplinary, whole-person care for medically complex patients, HBMC may be uniquely positioned to support homebound patients at the end of life, both during emergencies and beyond.