Accurate maternal death tracking is a global priority to guide resource allocation for reduction of preventable maternal mortality. This retrospective observational study evaluated the accuracy of the Brazilian maternal death coding system and compared the official maternal mortality ratio (MMR) with a recalculated MMR including any reclassified maternal deaths. Mortality data from 2010 to 2021 were analyzed, including officially reported maternal deaths and deaths of women aged 10-49 years with pregnancy-puerperal status indicated on their death certificate but not coded as maternal. Brazil recorded 21,670 official and 3,480 uncoded maternal deaths during the study period. Inclusion of reclassified maternal deaths increased the median MMR from 58.2 to 67.5 per 100,000 live births. Uncoded maternal deaths compared with coded deaths were more likely among those with lower education, at younger and older maternal ages, with indirect causes of death, and with fewer death investigations. Improved maternal death coding is essential to reduce maternal mortality underreporting.

Maxillofacial surgery frequently faces the permanent and catastrophic impacts of firearm injuries, an alarming scenario due to rising mortality and morbidity rates, representing both global and individual losses. The main objective of this study was to outline and synthesize the epidemiological profile and trends in the global incidence of firearm-related maxillofacial injuries. A scoping systematic review was conducted, including observational studies, case series, and case reports published up to September 2025, retrieved from PubMed and Google Scholar, using the combination of the terms "maxillofacial injuries," "gunshot wounds," "firearms," "ballistic injuries," and "epidemiology." A total of 29 articles and mortality data from the World Health Organization (WHO) database were included. There were certain limitations in the global analysis of firearm-related mortality rates due to the scarcity of information. The average death rate from violence was higher in American countries compared to countries at war (p<0.01), and it was not possible to establish significant correlations between firearm mortality and most demographic variables. A moderate negative correlation was observed between GDP and mortality rates in war contexts (ρ=-0.55, p<0.05). Greater transparency in national reporting is necessary to establish a more robust global epidemiological profile. Conversely, the negative impact of wars on national economies and violence in American countries is evident, and strict firearm access, control, and distribution laws are one potential strategy to combat this growing epidemic.

First highly pathogenic avian influenza outbreak in a commercial poultry farm in Brazil: Outbreak timeline, control actions, risk analysis, and transmission modeling.

Heat and cold-related deaths are rising in the United States. Educational attainment provides a means for evaluating socioeconomic disparities. Using United States national mortality data (2010-2023), we identified all heat and cold-related deaths, among adults ≥25years old. Educational attainment was categorized as high school or less, at least some college, or more than college. Population information was obtained from the American Community Survey and age-adjusted mortality rates (AAMR) per 100,000 adults were calculated. Heat and cold-related mortality rates were greatest among the least educated group and increased the fastest throughout the study period. Among those with a high school education or less, heat AAMR increased from 0.5 (95% CI 0.5, 0.6) to 1.8 (95% CI 1.7, 1.9) and cold AAMR from 1.0 (95% CI 1.0, 1.1) to 1.8 (95% CI 1.7, 1.9). Among the highest educated group, heat AAMR increased from 0.1 (95% CI 0.1, 0.2) to 0.2 (95% CI 0.2, 0.3) while cold AAMR was 0.4 (95% CI 0.3, 0.5) in 2010 and 0.3 (0.3, 0.4) in 2023. Findings were consistent across sub-groups of sex, region, and race/ethnicity. Temperature-related deaths disproportionately impacted Americans with lower educational attainment and disparities widened over the study period.

Estimating palliative care demand at the end of life in Peru: A mortality-based analysis of 1,133,608 deaths (2017-2024).

Diabetes mellitus and sepsis are major contributors to mortality in the U.S., with increasing evidence of their clinical overlap. This study examines nationwide trends in diabetes and sepsis-related mortality from 1999 to 2024, stratified by sex, race/ethnicity, and geographic factors. Mortality data for individuals aged ≥ 25 years from 1999 to 2024 was extracted from the CDC-WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Trends over time were analyzed using Joinpoint regression to estimate annual percentage changes (APCs). We performed a time-series analysis using autoregressive integrated moving average (ARIMA) models to forecast AAMRs through 2030. From 1999 to 2024, 509,255 deaths were attributed to diabetes and sepsis. The overall AAMR was 8.88 in 1999, declined to 7.85 in 2018 (APC: -1.20; 95% CI: -1.90 to - 0.65), increased sharply to 12.08 in 2021 (APC: 17.32; 95% CI: 9.07 to 21.07), and then declined to 9.37 in 2024 (APC: -8.87; 95% CI: -14.91 to - 4.98). The forecasting analysis predicted an AAMR of 11.2 (95% CI: 6.9 to 15.5) in 2030. Males consistently had higher AAMRs than females (11.23 vs. 7.93 in 2024). The highest mortality burden was observed among NH Black individuals (15.66), followed by Hispanic or Latino (12.88), NH Other (9.10), and NH White (8.05) populations. Regionally, the South (10.95) experienced the highest mortality, followed by the West (10.4), Midwest (7.9), and Northeast (6.55). Rural areas showed consistently greater mortality than urban areas (8.81 vs. 8.18). Diabetes and sepsis-related mortality in the U.S. showed a declining trend until 2018, followed by a sharp rise during the pandemic and a subsequent decline. These findings highlight the need for targeted public health strategies to address persistent disparities and improve outcomes for vulnerable populations. The online version contains supplementary material available at 10.1007/s40200-026-01874-y.

The quality of institutions is widely recognized as a key determinant of public sector performance across various levels of governance. This paper investigates how institutional quality shaped the resilience of Italian Labour Market Areas during the COVID-19 pandemic. To this end, we introduce a localized, non-parametric Interrupted Time Series (ITS) approach, using long-run mortality data (2004-2023), to construct a data-driven, local-level resilience index. This index captures deviations from counterfactual mortality trajectories, reflecting the ability of local areas to withstand and recover from the pandemic. We then assess the determinants of this resilience index, with a particular focus on institutional quality. Our findings show that higher institutional quality - particularly the quality of local politicians - emerges as the most significant factor driving differences in performance at the local level. Multiple robustness checks, including alternative model specifications and pre-pandemic forecast accuracy benchmarks, confirm the reliability of our results.

Despite changes in legislation and public attitudes towards large predators, human-caused mortality continues to impact survival and conservation of carnivore species. Understanding the drivers and timing of mortality is critical for informing evidence-based management and policy decisions aimed at improving carnivore conservation outcomes, particularly in areas with varying management regimes. Using GPS collar and mortality data representing 1,002 wolf-years from 608 wolves in Minnesota, Wisconsin, and Michigan USA during 2010–2023, we assessed cause-specific mortality and survival in relation to federal protection status, whether wolf harvest was allowed, sex-age class, and wolf residency. Human-caused mortalities represented 65% of recorded mortalities. Illegal kill represented 38% of mortalities and peaked in mid-November, concurrent with white-tailed deer firearm seasons in the region. Whether legal harvest was allowed did not influence mortality risk for causes other than legal kill. Mean annual regional wolf survival (0.74) was similar across years and sex-age categories and did not vary with protection status, but survival probability for resident wolves was greater than for non-residents. Legal kill was the greatest source of mortality for gray wolves in the western Great Lakes region in years when harvest was allowed, emphasizing the importance of continued population monitoring and adaptive management. Illegal kill was the greatest source of recorded mortality overall and was not reduced by federal protection, highlighting the need to enhance enforcement and address socio-political factors influencing public tolerance of wolves.

Association of dietary index for gut microbiota with premature and all-cause mortality: A mediation analysis of biological age.

An artificial intelligence approach to support adolescent suicide prevention initiatives in the United States.

Cause-variations in neonatal mortality across Europe and Africa; evidence from a 20-year retrospective dataset and clinical practice guidelines.

Metabolic dysfunction-associated steatotic liver disease (MASLD) frequently coexists with type 2 diabetes (T2D) and increases cardiovascular disease (CVD) risk, with hepatic fibrosis being the main determinant of mortality. Existing non-invasive fibrosis scores often include age and may be less informative in early-stage disease or long-term follow-up. This study investigated the association between the Fibrotic NASH Index (FNI), an age-independent marker and long-term all-cause mortality in T2D. We conducted a retrospective longitudinal study in a cohort of 174 individuals with T2D (baseline age 67.6 ± 11.4 years; BMI 29.3 ± 5.2 kg/m2; HbA1c 7.1% ± 1.7%) enrolled in 2000-2001. Complete mortality data at 20 years were available for all the study participants. Hepatic steatosis was assessed by ultrasound, and fibrosis risk was estimated using FNI; FIB-4 and APRI were also calculated. Baseline metabolic, biochemical and clinical data were recorded. At baseline, steatosis was present in 78% and high fibrosis risk in 44% of participants. After 20 years, mortality reached 39.7%. The FNI-defined fibrosis risk was significantly associated with the vital status at 20 years in both univariate and multivariable models adjusted for age, sex, BMI, lipids, renal function, steatosis, diabetes' duration and CVD history (OR 11.75; 95% CI: 2.11-65.50; p = 0.005), whereas neither FIB4 nor APRI retained a significant association after multivariable adjustment (FIB-4: OR 1.50; 95% CI: 0.52-4.37; p = 0.45; APRI: OR 1.49; 95% CI: 0.29-7.53; p = 0.63). FNI-defined liver fibrosis risk is independently associated with long-term mortality in individuals with T2D. Incorporating non-invasive, age-independent fibrosis assessment may help improve early risk stratification and guide personalised management in dysmetabolic populations.

Objective: Assess the cancer burden in Inner Mongolia to provide evidence for cancer prevention and control decision-making. Methods: Using cancer incidence and mortality data from 38 cancer registration areas in 2020, combined with demographic statistics and all-cause death data, the lifetime cancer risk in Inner Mongolia was calculated by the adjusted multiple primary cancer method. Results: The lifetime cancer risk in Inner Mongolia was 25.02% (95% CI: 24.99%-25.05%). The top five cancers with the highest lifetime risk were lung cancer (6.60%), colorectal cancer (3.12%), liver cancer (2.86%), gastric cancer (2.22%), and esophageal cancer (1.70%). Cancer risk remained low before age 40 years, while the remaining lifetime cancer risk decreased with increasing age. Males having significantly higher risk (26.92%, 95% CI: 26.88%-26.96%) than females (22.80%, 95% CI: 22.76%-22.84%).Urban residents had higher lifetime risk (26.56%, 95% CI: 26.52%-26.59%) than rural residents (23.62%, 95% CI: 23.58%-23.65%). Specifically, lung cancer and colorectal cancer risks were higher in urban areas, while esophageal cancer and liver cancer risks were higher in rural areas. The highest lifetime cancer risk was found among urban males at 28.26% (95% CI: 28.21%-28.32%), while the lowest cancer risk was observed among rural females at 21.18% (95% CI: 21.13%-21.23%). Conclusions: The lifetime risk of developing cancer in Inner Mongolia is 25.02%, with higher risk in males and urban areas. Future efforts should focus on population-specific screening optimization, achieve rational allocation of medical resources, improve multi-cancer surveillance and regional precision prevention, and provide scientific basis for comprehensive cancer control in Inner Mongolia.

There is a knowledge gap regarding the geographic distribution of suicide risk and its associated socio-demographic factors in the years following the onset of the COVID-19 pandemic. This study aimed to describe the spatial patterns of suicide risk in Argentina from 2015 to 2022 and identify contributing factors. Suicide mortality data were obtained from the Ministry of Health of the Nation. Multivariate Bayesian hierarchical regression models were employed to assess associations between suicide risk and three key variables: population density, socioeconomic status, and an index of social fragmentation. In 2020, high-risk suicide areas in the center-east of the country, which had persisted in previous years, were no longer observed. However, these high-risk areas re-emerged during 2021 to 2022. Except for 2017 and 2019, suicide risk was consistently higher in rural areas. Elevated values of the social fragmentation index were associated with increased suicide risk during 2021 to 2022. The post-2020 period reflects a return to the pre-pandemic geographic pattern of suicide in Argentina, with rural areas remaining persistent high-risk zones. However, in the post-pandemic era, suicide appears to disproportionately affect areas with weaker social ties.

With the global increase in extreme weather events, understanding the effects of consecutive extreme PM2.5(EPM) and cold spells (CS) events on specific mortality is vital. Daily meteorological, air pollution, and mortality data were collected in Zigong. Using the Distributed Lag Nonlinear Model (DLNM), we defined the lag as 14 days and quantified the risk effect of EPM-CS events (P95 for EPM, P7.5 for CS) on resident mortality and explored the potential amplification of damage resulting from different patterns of sequential extreme events. Additionally, we calculated the attributable fraction (AF) of extreme events and conducted stratified analyses based on age, gender, marital status, etc. RESULTS: Exposure to cold spells, PM2.5, and compound events was statistically associated with an increased risk of mortality. The cumulative rate ratios (CRRs) of EPM-CS events for total non-accidental mortality was 1.56(1.44,1.69). The mortality risks of EPM-CS events in females, elderly people ≥ 65 years, low level of education, and widowed, divorced, and never married were higher, with AF were 6.64%(95%CI: 5.42%, 7.89%),6.51%(95%CI: 5.52%, 7.51%), 6.10%(95%CI: 5.17%, 7.06%) and 7.73%(95%CI: 6.07%, 8.51%), respectively. The attributable fraction of specific mortality due to the EPM-CS events was the highest for cerebrovascular disease. Exposure to combined events was associated with a substantial increase in mortality risk, and the damaging effect of combined events occurring in the short term was more significant. Our findings demonstrated synergistic mortality risks from compound cold and pollution exposure, highlighting a disproportionate impact on vulnerable populations. This evidence supports the rationale for developing integrated early warning systems as a targeted intervention.

Cardiovascular diseases (CVD) are a major global health challenge, with rising prevalence, high mortality and disability rates, and significant economic costs. Emerging research suggests that climate change worsens these risks. This study aims to assess the impact of climate change on CVD mortality. This study analyzed validated national CVD mortality data from 2017 to 2019, with annual recorded deaths of 18,146; 21,945; and 24,352, respectively. These figures were aggregated to form the basis for subsequent analysis. We utilized advanced spatial statistical techniques, including Anselin Local Moran's I and Hot Spot Analysis (Getis-Ord Gi*), to assess CVD mortality patterns. Additionally, GIS were employed to identify and analyze climate change impacts at the township level, enabling a comprehensive spatial understanding of environmental and health-related factors. Following temperature, climate, and topographic assessments, an initial national zoning of these parameters was conducted. Analysis of spatial patterns revealed significant heterogeneity in CVD mortality across Iran's diverse climate zones, which range from arid deserts to mountainous regions. Hotspot analysis (Getis-Ord Gi*) identified significant high-risk clusters, particularly in the central arid regions, and low-risk clusters in other areas. The findings demonstrate a clear association between extreme climatic conditions, geographic features, and elevated cardiovascular mortality rates. Climate change and environmental factors significantly influence CVD mortality in Iran. Rising extreme heat events threaten cardiovascular health, especially among vulnerable groups. To combat this, targeted public health strategies and adaptive measures are needed to reduce heat-related risks nationwide.

Prior research has shown suboptimal health and longevity among Native Americans in the Four Corners region of the United States, which encompasses Arizona, New Mexico, Colorado, and Utah. Our study (1) investigates how life expectancy trends and disparities changed among non-Hispanic Native Americans and Whites in the Four Corners States (FCS) during the COVID-19 pandemic and (2) examines the extent to which longevity changes are directly attributable to COVID-19, relative to other causes of death. Data sources include mortality data from the National Center for Health Statistics and population data from the U.S. Census Bureau. Life expectancy at birth for four race-sex groups in the FCS (Native American and White females and males) was calculated using abridged life table procedures, both pre-pandemic (2018−19) and peak pandemic (2020−22). Gaps in life expectancy between groups (and changes within groups) were decomposed into multiple causes of death to determine which causes contributed most to life expectancy gaps and changes across time periods. Life expectancy declined in the FCS over the study period; whereas Native American male and female longevity decreased by 7.33 years and 6.76 years, respectively, White male and female longevity decreased by 2.11 years and 1.72 years, respectively. Results indicate that the peak pandemic life expectancy gap between Native Americans and Whites widened by over 5 years, regardless of sex. Although COVID-19 was the single largest contributor to longevity changes within and between groups, causes of death related to drug and alcohol use also made notable contributions, especially among Native Americans. Restoring longevity to pre-pandemic levels in the FCS will require improved management of COVID-19 as well as heightened attention to the deleterious role of substance use in indigenous communities.

Cervical cancer is preventable and screen-detectable, yet it continues to cause significant mortality, with inequities across populations and regions. This study aims to identify modifiable causal exposures contributing to cervical cancer and explore how they vary across different populations. The objective is to inform targeted prevention strategies and optimize resource allocation to address these disparities. We used a two-part complementary design. First, cervical cancer mortality data (1999–2023) were extracted from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research and stratified by age, sex, race/ethnicity, census region, urbanization level, and state. Death counts and age-adjusted mortality rates were calculated. Joinpoint regression estimated average annual percent change (AAPC) and segment-specific annual percent change, and spatial patterns were visualized. Second, we conducted two-sample Mendelian randomization (MR) to evaluate genetically predicted trace element/nutrition-related exposures in relation to cervical cancer risk. Analyses included allele harmonization and instrument selection; inverse-variance weighted estimation was the primary approach (fixed vs random effects based on heterogeneity). Robustness was assessed using MR-Egger, weighted median, MR-Pleiotropy RESidual Sum and Outlier, and sensitivity analyses (leave-one-out, funnel, and scatter plots). Reverse MR was performed to examine the causal direction. Mortality declines differed markedly across strata. Age-adjusted mortality rate decreased significantly among those aged 65 to 74 and ≥85 years (AAPC = −1.81 and −2.81, respectively), whereas the decline in the 25 to 34-year group was smaller and not statistically significant (AAPC = −2.10, 95% confidence interval crossed 0). Heterogeneous declines were also observed by race/ethnicity, region, and urbanization level. In MR, genetically predicted vitamin C (7 single-nucleotide polymorphism instruments) showed a modest inverse association with cervical cancer risk in inverse-variance weighted fixed-effects analysis (odds ratio = 0.9962, 95% confidence interval = 0.9924–1.0000; P = .048). Weighted median and MR-Egger were directionally consistent but nonsignificant. No strong evidence of pleiotropy or heterogeneity was detected, and sensitivity analyses were generally robust. Reverse MR yielded no consistent evidence. Cervical cancer mortality has declined overall, but inequities persist, underscoring the need to pair vaccination and screening with more equitable access and continuity of care. MR provides suggestive genetic support for a small protective association of vitamin C, warranting validation with stronger instruments and larger datasets.

BackgroundUnderstanding age-specific mortality patterns across historic influenza pandemics is crucial for future pandemic preparedness. Prior research shows that, while the 1918 pandemic caused unprecedented mortality in younger adults, subsequent pandemics in 1957, 1968, and 2009 displayed varying mortality patterns, with elevated risks in some younger populations and elderly populations. However, cross-national comparative analyses of these patterns using harmonized all-cause mortality data remain lacking but are critical for informing public health strategies.MethodsWe analysed age-specific all-cause absolute and percentage excess mortality patterns across 48 populations during the 1918, 1957, 1968, and 2009 influenza pandemics by using data from the Human Mortality Database.ResultsWhile the 1918 pandemic consistently showed a peak in positive absolute excess mortality at younger ages (5–39 years), age-specific mortality patterns in 1918 also varied substantially across the populations, particularly at older and early-childhood ages; subsequent pandemics lacked this peak and revealed varied mortality patterns across the age groups, including inconsistent excess mortality rates among the elderly. The percentage of excess mortality also differed by country and pandemic, highlighting the complexity of age-based mortality risks.ConclusionThis work demonstrates that reports of increased severity among young people as a universal feature of all historical influenza pandemics may have been exaggerated, influenced by the exceptional mortality among the young during the 1918 pandemic.

This study aims to examine the national trends and disparities in mortality caused by liver failure among adult patients diagnosed with mental and behavioral disorders (MBDs) that are attributable to tobacco use in the United States using the Centers for Disease Control and Prevention (CDC) Wide-ranging online data for epidemiologic research mortality data. Understanding these trends is essential to identifying high-risk populations and informing targeted screening and early intervention strategies. The findings can guide integrated smoking cessation and liver disease management efforts to reduce preventable mortality in vulnerable groups. This descriptive study utilized CDC WONDER data for adults aged 25 years and older. Mortality cases were identified using the International Classification of Diseases, tenth revision codes K72 (Liver failure) and F17 (MBD due to tobacco use). Age-adjusted mortality rates (AAMRs) per 100,000 were computed and stratified by gender, race/ethnicity, census region, Urban-Rural status, and state. Joinpoint regression was applied to estimate annual percent changes with 95% confidence intervals, and statistical significance was defined as P < .05. A total of 46,227 deaths were analyzed, with most occurring in medical facilities (61.7%), followed by homes and nursing facilities. The overall AAMR rose from 0.074 in 1999 to 0.94 in 2020 and then slightly declined to 0.78 by 2023. Both females and males showed similar upward trends, with males having higher AAMRs. Non-Hispanic Whites experienced the largest long-term increase, while Hispanic and Black populations showed recent declines. Mortality increased more sharply in rural areas as compared to urban areas, and regionally, the Midwest and South had sharp rises. State-level rates were highest in North Dakota, Wyoming, and South Dakota and lowest in California, Virginia, and Massachusetts, highlighting significant geographic disparities in liver failure mortality among adults with MBDs due to tobacco use. Deaths due to liver failure in adults with MBDs due to tobacco use in the United States increased substantially in the last 20 years, with significant demographic and regional inequalities. These results indicate the necessity of targeted prevention, smoking cessation programs, and equitable healthcare policies in order to decrease the mortality rate.