Mortality Crisis Research Articles

Small-scale spatial distribution of COVID-19-related excess mortality

Mortality due to massive events like the COVID-19 pandemic is underestimated because of several reasons, among which the impossibility to track all positive cases and the inadequacy of coding systems are presumably the most relevant. Therefore, the most affordable method to estimate COVID-19-related mortality is excess mortality (EM). Very often, though, EM is calculated on large spatial units that may entail different EM patterns and without stratifying deaths by age or sex, while, especially in the case of epidemics, it is important to identify the areas that suffered a higher death toll or that were spared. We developed the Stata COVID19_EM.ado procedure that estimates EM within municipalities in six subgroups defined by sex and age class using official data provided by ISTAT (Italian National Statistics Bureau) on deaths occurred from 2015 to 2020. Using simple linear regression models, we estimated the mortality trend in each age-and-sex subgroup and obtained the expected deaths of 2020 by extrapolating the linear trend. The results are then displayed using choropleth maps. Subsequently, local autocorrelation maps, which allow to appreciate the presence of local clusters of high or low EM, may be obtained using an R procedure that we developed.•We focused on estimating excess mortality in small-scale spatial units (municipalities) and in population strata defined by age and sex.•This method gives a deeper insight on excess mortality than summary figures at regional or national level, enabling to identify the local areas that suffered the most and the high-risk population subgroups within them.•This type of analysis could be replicated on different time frames, which might correspond to successive epidemic waves, as well as to periods in which containment measures were enforced and for different age classes; moreover, it could be applied in every instance of mortality crisis within a region or a country.

The Female Mortality Advantage in the Seventeenth‐Century Rural Low Countries

ABSTRACTData from famines from the nineteenth century onward suggest that women hold a mortality advantage during times of acute malnutrition, while modern laboratory research suggests that women are more resilient to most pathogens causing epidemic diseases. There is, however, a paucity of sex‐disaggregated mortality data for the period prior to the Industrial Revolution to test this view across a broader span of history. We offer a newly compiled database of adult burial information for 293 rural localities and small towns in the seventeenth‐century Low Countries, explicitly comparing mortality crises against ‘normal’ years. In contrast to expected results, we find no clear female mortality advantage during mortality spikes and, more to the point, women tended to die more frequently than men when only taking into account those years with very severe raised mortality. Gender‐related differences in levels of protection, but also exposure to vectors and points of contagion, meant that some of these female advantages were ‘lost’ during food crises or epidemic disease outbreaks. Responses to mortality crises such as epidemics may shine new light on gender‐based inequalities perhaps hidden from view in ‘normal times’ – with relevance for recent work asserting ‘female agency’ in the early modern Low Countries context.

Revising our attitudes towards agonist medications and their diversion in a time of pandemic

The COVID-19 pandemic led government regulators to relax prescribing rules for buprenorphine and methadone, the agonist medications that effectively treat opioid use disorder, allowing for take home supplies of up to 28 days. These changes prioritized the availability of these medications over concerns about their misuse and diversion, and they provided a means for overdose prophylaxis during the highly uncertain conditions of the pandemic. In considering how to capitalize on this shift, research should determine the extent to which increased diversion has occurred as a result, and what the consequences may have been. The shifts also set the stage to consider if methadone can be safely prescribed in primary care settings, and if the monthly injectable formulation of buprenorphine is a suitable alternative to increased supplies of sublingual strips if concerns about diversion persist. The disruptions of the pandemic have caused a surge in overdose deaths, so carefully considering the prophylactic potential of agonist medications, in addition to their role as a treatment, may help us address this mortality crisis.

Let COVID-19 Serve as a Catalyst to Fix National Crisis of Poor Maternal Mortality Data.

Let COVID-19 Serve as a Catalyst to Fix National Crisis of Poor Maternal Mortality Data.

AnneCase and AngusDeaton, Deaths of Despair and the Future of Capitalism, Princeton, NJ: Princeton University Press, 2020. 312 p. $27.95

AnneCase and AngusDeaton, Deaths of Despair and the Future of Capitalism, Princeton, NJ: Princeton University Press, 2020. 312 p. $27.95

‘Safer opioid distribution’ as an essential public health intervention for the opioid mortality crisis – Considerations, options and examples towards broad-based implementation

•Canada experiences excessive opioid mortality, mainly from toxic opioid exposure.•Many interventions have been implemented, but are limited in reach and impact.•'Safer opioid distribution' (SOD) is a crucial preventive measure for overdose.•SOD needs to be implemented for a large, 'at-risk' opioid user population.•Other community-based public health interventions may guide SOD organization.

The Continued Crisis of Maternal Mortality: Is Consolidation of Care the Answer?

(Anesth Analg. 2020;130:49–51) There is a concerning trend of maternal mortality among nonwhite, impoverished, publicly insured women compared with white populations, and a patient’s care center could be a contributing factor to that mortality. Researchers have noted that high-risk medical centers who serve socially vulnerable populations tend to have poorer maternal outcomes, while white women frequently deliver in hospitals that have lower rates of severe maternal morbidity. Because of this imbalance, in-depth analysis is necessary to determine if higher morbidity rates can be attributed solely to the high-risk case rate in a certain area, or if some facilities provide a lower quality of care.

Slow release oral morphine versus methadone for opioid use disorder in the fentanyl era (pRESTO): Protocol for a non-inferiority randomized clinical trial

BackgroundNorth America is facing an unprecedented public health crisis of opioid-related morbidity and mortality, increasingly as a result of the introduction of illicitly manufactured fentanyl into the street drug market. Although the treatment of opioid use disorder (OUD) is a key element in the response to the opioid overdose epidemic, currently available pharmacotherapies (e.g., methadone, buprenorphine) may not be acceptable to or effective in all patients. Available evidence suggests that slow-release oral morphine (SROM) has similar efficacy rates as methadone with respect to promoting abstinence, and with improvements in a number of patient-reported outcomes among persons using heroin. However, little is known about the relative effectiveness and acceptability of SROM compared to methadone in the context of fentanyl use. This study aims to address this research gap. MethodspRESTO is a 24-week, open-label, two arm, non-inferiority, randomized controlled trial comparing SROM versus methadone for the treatment of OUD. Participants will be 298 clinically stable, non-pregnant adults with OUD, recruited from outpatient clinics in Vancouver, Canada, where the majority of the illicit opioids are contaminated with fentanyl. The primary outcome is suppression of illicit opioid use, measured by bi-weekly urine drug screens. Secondary outcomes include: treatment retention, medication safety, overdose events, treatment satisfaction, psychological functioning, changes in drug-related problems, changes in quality of life, opioid cravings, other substance use, and cost-effectiveness. DiscussionpRESTO will be among the first studies to evaluate treatment options for individuals primarily using synthetic street opioids, providing important evidence to guide treatment strategies for this population.

Characterization of the woody biomass feedstock potential resulting from California\u2019s drought

Regional tree die-off events generate large quantities of standing dead wood, raising concern over catastrophic wildfire and other hazards. Governmental responses to tree die-off have often focused on incentivizing biomass energy production that utilizes standing dead trees removed for safety concerns. However, the full distribution of potential woody bioenergy feedstock after tree die-off has not been evaluated due to the complexities of surveying and precisely measuring large forested areas. In this paper, we present a novel method for estimating standing dead biomass at a fine spatial resolution that combines aerial survey data with forest structure maps. Using this method, we quantify biomass generated by the unprecedented tree die-off that occurred in California following a 4-year drought and widespread pest outbreaks. The results are used to estimate feasibly recoverable feedstock for energy production. We find that approximately 95.1 million bone-dry tons (BDT) of dead biomass resulted from 2012–2017 mortality, with a lower bound of 26.2 million BDT. In other words, of the aboveground live tree biomass in 2012, ~1.3–4.8% died by 2017. Of the standing dead biomass, 29% meets minimum constraints for potential cost-effective bioenergy feedstock. This proportion drops to as low as 15% in the most affected areas due to terrain slope, wilderness status, and other factors, highlighting the need to complement disposal via biomass energy with other strategies to mitigate the risks of the tree mortality crisis, which is likely to only become more severe over time due to climate change.

Parish Records and the History of Philippine Epidemics

The Philippine epidemic experience suggests a research perspective that is attentive to local spatial variation and also recognizes connections across long periods of time, particularly across the Spanish and American colonial eras and the epidemic experience then and since. Among historical materials that need to be incorporated into the discourse and connected with evidence from modern, spatially disaggregated data systems are parish archival records of births, deaths, and marriages; households; and population changes. This research note outlines the Philippine parish records and presents illustrative results from twenty-eight parishes. Those records include local time series of deaths from which mortality crises, generally reflecting epidemics, are presented. KEYWORDS: PARISH ARCHIVES • EPIDEMIC • CRISIS MORTALITY • HISTORICAL DEMOGRAPHY • PHILIPPINES

The effect of evictions on accidental drug and alcohol mortality.

To assess the relationship between county-level eviction rates and drug and alcohol mortality rates. Eviction rates from 2003 to 2016 provided by the Princeton University Eviction Lab were merged with Multiple Cause-of-Death Mortality Files and aggregated to the county-year level. All opioid (prescription and heroin), cocaine, psychostimulant, benzodiazepine, antidepressant, and alcohol poisoning-related deaths per 100000 people, eviction rates, and socioeconomic indicators were merged at the county-year level from 2003 to 2016. We estimated a series of mortality rate models with county and year fixed effects and used a control function (2SRI) method to adjust for the endogeneity of eviction rates. We matched retrospectively collected datasets. Higher levels of eviction rates were consistently associated with higher rates of mortality across six of nine substance categories studied when all counties were combined. Subanalysis by USDA population density measures indicated this positive association was almost entirely driven by urban counties; few systematic associations between the eviction rate levels and mortality were observed for suburban or rural counties. Risk of eviction appears to exacerbate the current "deaths of despair" crisis associated with substance use. Proposed changes to Housing and Urban Development policy that are expected to substantially increase the risk of eviction may worsen an already-acute mortality crisis.

Do Probiotics Improve the Health Status of Individuals with Diabetes Mellitus? A Review on Outcomes of Clinical Trials.

Probiotics are now considered as an adjuvant and complementary therapeutic agent for several health complications, especially for metabolic and gastrointestinal disorders because of the influential impact of probiotic consumption on gut microbiota and immunity. Diabetes mellitus (DM) is fourth, in noncommunicable disease category, leading cause of mortality, morbidity, and economic crises in the world. Though several progressions are added in the medical field in recent decades, the treatment and management of diabetic-related health issues are still challenging. The present study summarizes the effects of probiotic supplementation on the health status of diabetic patients. The relevant information was collected from Scopus, PubMed, and Google Scholar. The detailed literature survey revealed that the consumption of probiotic supplementation significantly improved the overall health condition of diabetic patients. Especially, the probiotic intervention improved the fasting blood glucose, insulin sensitivity, and systemic inflammatory and antioxidant status in type 2 diabetic (T2D) patients. Moreover, improvement of gut microbial composition and prevention of bacterial translocation has also been observed in probiotic-supplemented T2D people. Some of the studies evidenced that the supplementation of probiotics can prevent and improve the gestational DM. Nevertheless, some of the studies reported negative results and limitations in the results of clinical trials. However, further studies are mandatory to develop a concrete probiotic-based adjuvant treatment procedure to treat DM.

Deindustrialisation, Foreign Investment and Social Development: Mortality in the Hungarian Rustbelt

Abstract Background Many nations are experiencing deindustrialisation. A common strategy to cope with this is encouraging foreign investment. We still know little about the health impact of such industrial transformations, especially their role in the postsocialist mortality crisis. Methods Utilising a novel dataset constructed over two years covering 52 towns, 550 companies and 42,800 subjects, using multilevel survival modelling I test how deindustrialisation and foreign investment affect mortality in medium-sized towns in Hungary. I group towns into severely, and moderately deindustrialised (1989-1995), and into state ownership, domestic private and foreign ownership dominated categories (1995-2004). A retrospective cohort study in these towns collected data on vital status of respondents. I use multiple robustness checks and sensitivity analyses to reduce selection bias and endogeneity. Findings Deindustrialisation is associated with significantly higher odds of mortality for men between 1989 and 1995 (OR = 1. 16; p < 0.01). Foreign investment was not associated with mortality in any of the models for the 1989-1995 period. Between 1995 and 2004, women living in towns dominated by state ownership had a significantly lower risk of mortality compared to those living in towns dominated by foreign investment (OR = 0.79; p < 0.05) or domestic private ownership (OR = 0.74; p < 0.01). Foreign investment was associated with higher income growth in both periods; however, this was not associated with better health results. Conclusions Severe deindustrialisation was a crucial factor behind the post-socialist mortality crisis for men. The indirect economic benefits of foreign investment do not translate automatically into better health; in fact, women living in towns dominated by foreign investors appear to have a higher risk of dying. Foreign investment might promote economic growth but in itself cannot mitigate the health impact of severe deindustrialisation. Key messages Deindustrialisation is a significant contextual health risk factor. Spontaneous market processes, such as foreign investment, do not automatically reduce the detrimental health effect of plant closures.

Abstract P102: A Vegan Approach for Gestational Hypertension in African Americans

The mortality rates in the African American infant population are higher than average. Non-Hispanic black infants died 11.4 to 1000 live births in 2016. The majority of complications stem from uncontrolled gestational hypertension. The purpose of this paper is to introduce the vegan diet with supplemental prenatal vitamins as a solution to a national crisis of infant mortality in the African American communities that would decrease gestational hypertension and its complications thereby improving maternal and fetal outcomes.The purpose of this paper is to introduce a research review that would strengthen the Vegan concept to prevent gestational hypertension and its complications in African Americans thus improving maternal and fetal outcomes. Perhaps the ancestors of African Americans, who originally lived in hot, arid climates wherein sodium conservation was important for survival, evolved the physiologic machinery which protected them in their original habitat but makes it difficult for them to handle the excessive sodium they ingest when they migrate. African Americans tend to have higher blood volume, lower plasma renin activity as compared to white population (Langford, 1981). If gestational hypertension is genetic to all Africa, we would expect to see poor outcomes for black women everywhere, but studies have found that foreign-born black women living in the United States have birth outcomes almost identical to white American women’s. Only descendants of the slave trade carry the hypertension gene and it has been shown to also exist in Western African countries, where Americans collected slaves. In the United States the Western diet consisting of a high content of sugars, fats and oils have pulled many triggers in our body’s responses, one of them being hypertension. Dietary fat reduction is critical in reducing insulin resistance which leads to hypertension. By educating the African American population on how a vegan diet can decrease both the maternal and neonatal mortalities, a significant improvement in mortality can be achieved.

Death by the Lake: Mortality Crisis in Early Fourteenth-Century Central Asia

Our information about the fourteenth-century plague in Central Asia, or indeed anywhere east of the Crimea/Caspian, derives from a close analysis of the epigraphical evidence from three East Syriac (Nestorian) cemeteries not far from Issyk-Kul’ lake in northern Kyrgyzstan. The absence of palaeogenetic data to confirm it could be partially rectified by both textual and palaeoclimatological data. The ratio of mortality rates between “normal” and plague years in the Issyk-Kul’ communities is not unlike that in Europe during the plague years 1348 to 1350. A proper appreciation of the pandemic outbreak requires setting its timing in a climatic context. After two pluvial episodes in the 1310s and 1320s, precipitation levels in Issyk-Kul’ during the 1330s underwent a sharp decline, thereby depriving sylvatic rodents of sufficient grass to sustain their high population density. Hence, the plague pathogen and its vectors needed an alternative host to maintain their activity. Anthropogenic factors, including international trade and military campaigns along Central Asian trade routes, may also have contributed to the outbreak and spread of the plague. The Issyk-Kul’ mortality crisis ties into wider questions about the origins and initial spread of plague after the “big bang” of the thirteenth century, whereby four new plague branches emerged (possibly in Central Asia).

The US Mortality Crisis: An Examination of Non-Hispanic White Mortality and Morbidity in Yavapai County, Arizona.

Midlife non-Hispanic white mortality in the United States is rising, particularly in small metro and rural counties. This article responds to calls for county-level studies. We examine social determinants of morbidity and mortality among adult non-Hispanic whites in Yavapai County, Arizona, as part of an integrative study. We report overall mortality trends in Yavapai County using CDC Wonder data and then examine social determinants of reported physical health and mental distress in Yavapai County data using 6years (2011-2016) of the Arizona Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS includes 1,024 non-Hispanic white respondents aged 25-64. We also present data from the recently established Yavapai County Overdose Fatality Review Board (YCOFRB). Mortality trends indicate that suicide and drug and alcohol-related mortality have all increased since 1999. These increases affect all 5-year age groups from 25 to 64 and both men and women. BRFSS data show that low education and unemployment, but not number of children or home ownership, are significantly associated with worse reported health and frequent mental distress in multivariate analyses. The YCOFRB point to the importance of homelessness and mental health. The mortality crisis in Yavapai County is not restricted to midlife or to drug-related deaths. The unemployed and those with low levels of education are particularly at risk. There is a need for integrative approaches that use local data to elucidate social determinants of morbidity and mortality and to reveal structural determinants.

Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consensus Panel Report.

A national crisis of opioid-related morbidity, mortality, and misuse has led to initiatives to address the appropriate role of opioids to treat pain. Deployment of a guideline from the Centers for Disease Control and Prevention to reduce the risks of opioid therapy has raised substantial clinical and public policy challenges. The agency anticipated implementation challenges and committed to reevaluating the guideline for intended and unintended effects on clinician and patient outcomes. A multidisciplinary expert panel met to review the influence of the core recommendations of the guideline on pain management practices, principally regarding the estimated 5 to 8 million Americans with chronic pain currently on opioids. The panel identified implementation challenges, including application of dosage ceilings and prescription duration guidance, failure to appreciate the importance of patient involvement in decisions to taper or discontinue opioids, barriers to diagnosis and treatment of opioid use disorder, and impeded access to recommended comprehensive, multimodal pain care. Furthermore, policy-making and regulatory bodies may misapply guideline recommendations without flexibility and, sometimes, without full awareness of what the guideline contains. The panel largely supported the guideline, endorsing its focal points of safety and comprehensive assessment and monitoring. To mitigate clinical and policy challenges identified with implementing the guideline, the panel discussed areas where viewpoints diverged and arrived at consensus proposals. The target audience includes the leaders and institutions that create policy and influence guideline implementation to include regulatory agencies, legislators, public and private payers, and health care systems.

Criminal Justice Barriers to Treatment of Opioid Use Disorders in the United States: The Need for Public Health Advocacy.

Expanding access to treatment of opioid use disorder (OUD) is central to addressing the US overdose mortality crisis. Numerous barriers to OUD treatment are encountered in criminal justice institutions and processes, with which people with OUD are disproportionately involved. OUD treatment access is severely limited in US corrections facilities, with few exceptions. Drug treatment courts, which in principle provide court-supervised treatment as an alternative to prison, have also unduly limited treatment options, particularly medication-assisted treatment. The voice and expertise of health professionals are urgently needed to remove these barriers and ensure that criminally accused persons are systematically linked to the care they need.

Cross-country evidence on the social determinants of the post-socialist mortality crisis in Europe: a review and performance-based hierarchy of variables.

An unprecedented mortality crisis befell the former socialist countries between 1989 and 1995, representing one of the greatest demographic shocks of the period after the Second World War. While it is likely that country-level variation in the post-socialist mortality crisis in Eastern Europe can be explained by a constellation of political and socio-economic factors, no comprehensive review of the existing scholarly attempts at explaining these factors exists. We review 39 cross-national multi-variable peer reviewed studies of social determinants of mortality in post-socialist Europe in order to assess the social factors behind the post-socialist mortality crisis, determine the gaps in the existing literature and to make suggestions for future research. We propose a novel methodology to determine the relative importance of variables based on the ratio of significant to insignificant findings for each variable. The literature identifies inequality, welfare payments, religious composition, democracy, economic performance and unemployment as the leading factors that have a significant influence on mortality outcomes. Existing cross-country studies fail to establish a definitive connection between mortality and diets, drinking patterns, liberalisation, trust, health expenditure and war. We also point out that the level of analysis is not a neutral methodological choice but might influence the results themselves.

A survival analysis of the last great European plagues: The case of Nonantola (Northern Italy) in 1630

This paper develops the first survival analysis of a large-scale mortality crisis caused by plague. For the time-to-event analyses we used the Cox proportional hazards regression model. Our case study is the town of Nonantola during the 1630 plague, which was probably the worst to affect Italy since the Black Death. Individual risk of death did not depend on sex, grew with age (peaking at ages 40–60 and then declining), was not affected by socio-economic status, and was positively associated with household size. We discuss these findings in light of the historical–demographic and palaeo-demographic literature on medieval and early modern plagues. Our results are compatible with the debated idea that ancient plague was able to spread directly from human to human. Our methods could be replicated in other studies of European plagues to nuance and integrate the findings of recent palaeo-biological and palaeo-demographic research on plague.