Decline In Mortality Research Articles

Sustained high fatality during TB therapy amid rapid decline in TB mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini.

Despite declining TB notifications in Southern Africa, TB-related deaths remain high. We describe patient- and population-level trends in TB-related deaths in Eswatini over a period of 11 years. Patient-level (retrospective cohort, from 2009 to 2019) and population-level (ecological analysis, 2009-2017) predictors and rates of TB-related deaths were analysed in HIV-negative and HIV-coinfected first-line TB treatment cases and the population of the Shiselweni region. Patient-level TB treatment data, and population and HIV prevalence estimates were combined to obtain stratified annual mortality rates. Multivariable Poisson regressions models were fitted to identify patient-level and population-level predictors of deaths. Of 11,883 TB treatment cases, 1302 (11.0%) patients died during treatment: 210/2798 (7.5%) HIV-negative patients, 984/8443 (11.7%) people living with HIV (PLHIV), and 108/642 (16.8%) patients with unknown HIV-status. The treatment case fatality ratio remained above 10% in most years. At patient-level, fatality risk was higher in PLHIV (aRR 1.74, 1.51-2.02), and for older age and extra-pulmonary TB irrespective of HIV-status. For PLHIV, fatality risk was higher for TB retreatment cases (aRR 1.38, 1.18-1.61) and patients without antiretroviral therapy (aRR 1.70, 1.47-1.97). It decreases with increasing higher CD4 strata and the programmatic availability of TB-LAM testing (aRR 0.65, 0.35-0.90). At population-level, mortality rates decreased 6.4-fold (-147/100,000 population) between 2009 (174/100,000) and 2017 (27/100,000), coinciding with a decline in TB treatment cases (2785 in 2009 to 497 in 2017). Although the absolute decline in mortality rates was most pronounced in PLHIV (-826/100,000 vs. HIV-negative: -23/100,000), the relative population-level mortality risk remained higher in PLHIV (aRR 4.68, 3.25-6.72) compared to the HIV-negative population. TB-related mortality rapidly decreased at population-level and most pronounced in PLHIV. However, case fatality among TB treatment cases remained high. Further strategies to reduce active TB disease and introduce improved TB therapies are warranted.

The frail patient undergoing cardiac surgery: lessons learned and future perspectives.

Frailty is a geriatric condition characterized by the reduction of the individual's homeostatic reserves. It determines an increased vulnerability to endogenous and exogenous stressors and can lead to poor outcomes. It is an emerging concept in perioperative medicine, since an increasing number of patients undergoing surgical interventions are older and the traditional models of care seem to be inadequate to satisfy these patients' emerging clinical needs. Nowadays, the progressive technical and clinical improvements allow to offer cardiac operations to an older, sicker and frail population. For these reasons, a multidisciplinary team involving cardiac surgeons, clinical cardiologists, anesthesiologists, and geriatricians, is often needed to assess, select and provide tailored care to these high-risk frail patients to optimize clinical outcomes. There is unanimous agreement that frailty assessment may capture the individual's biological decline and the heterogeneity in risk profile for poor health-related outcomes among people of the same age. However, since commonly used preoperative scores for cardiac surgery fail to capture frailty, a specific preoperative assessment with dedicated tools is warranted to correctly recognize, measure and quantify frailty in these patients. On the contrary, pre-operative and post-operative interventions can reduce the risk of complications and support patient recovery promoting surgical resilience. Minimally invasive cardiac procedures aim to reduce surgical trauma and may be associated with better clinical outcome in this specific sub-group of high-risk patients. Among postoperative adverse events, the occurrence of delirium represents a risk factor for several unfavorable outcomes including mortality and subsequent cognitive decline. Its presence should be carefully recognized, triggering an adequate, evidence based, treatment. There is evidence, from several cross-section and longitudinal studies, that frailty and delirium may frequently overlap, with frailty serving both as a predisposing factor and as an outcome of delirium and delirium being a marker of a latent condition of frailty. In conclusion, frail patients are at increased risk to experience poor outcome after cardiac surgery. A multidisciplinary approach aimed to recognize more vulnerable individuals, optimize pre-operative conditions, reduce surgical invasivity and improve post-operative recovery is required to obtain optimal long-term outcome.

P192: The Unmet Needs of People with Mild to Moderate Dementia During COVID-19 Pandemic in East Jakarta

Background:The number of elderly populations continues to increase as the advancement in healthcare grows, which is shown by the increase of life expectancy, the declining mortality rates, and the surge of people with dementia (PwD). This mental health issue is barely identifiable by health workers and the elderly themselves especially during COVID-19 pandemic. Therefore, it is important to evaluate and identify the unmet needs of people with dementia, especially mild to moderate dementia.Objective:To describe the unmet needs of people with mild to moderate dementia during COVID- 19 pandemic in 2021 in East Jakarta, Indonesia.Methods:This study is using the CDR (Clinical Dementia Rating Scale) to assess severity level of Dementia, then using the CANE (Camberwell Assessment of Need for the Elderly) instrument to assess the unmet needs of people with mild to moderate dementia.Results:96 participants were assessed suffer from mild dementia (75%) and moderate dementia (25%). This study procured five substantial unmet needs proportion, which are friendship (26.0%), psychological distress (20.8%), close relationships (19.8%), memory dysfunction (16.7%), and daily activities (10.4%). During interviews in conducting unmet needs assessments, people with mild to moderate dementia and accompanying families expressed their desire for an activity that would be useful to overcome their unmet needs.Conclusion:The COVID-19 pandemic for the people with mild to moderate dementia has an impact on friendships, psychological distress, memory dysfunction and daily activities so they need meaningful activities to overcome them.

Abstract B028: Antiproliferative effect of a cathepsin L inhibitor on hepatocellular carcinoma

Abstract Liver cancer has emerged as one of the fastest-growing malignancies in the United States, despite an overall decline in cancer incidence and mortality rates. Hepatocellular carcinoma (HCC) exhibits significant gender and race/ethnicity differences in incidence and mortality. The need to address this escalating problem necessitates the development of novel and effective chemotherapeutic agents for HCC. The antiproliferative actions of two cathepsin L inhibitors (compounds 1 and 2) using in vitro and mice HCC xenograft models were investigated in this study. In addition, the ability of the compounds to inhibit CatB and generate ROS in HCC cell lines was investigated. The inhibitors have antiproliferative effects on Hep G2 and Hep 3B cell lines with low micromolar IC 50 values. Compound 1 preferentially inhibits both recombinant and endogenous CatL in a time-dependent manner compared to CatB. The levels of ROS produced when cells were treated with compound 1 were non-significant compared with vehicle-treated controls . Given the superior efficacy of compound 1 over its analog in antiproliferative studies, it was advanced to in vitro ADME studies. The inhibitor has bidirectional cellular permeability and is not a substrate for the P-glycoprotein efflux pump (P-gp). In mice, it produced a significant reduction in the sizes of subcutaneous tumors with no gross toxicity. Transcriptomics analysis using RNA-Seq revealed that the cell migration pathway was enriched in a time and dose-dependent manner. In addition, genes responsible for apoptosis and cell structural organization were overexpressed. Overall, the CatL inhibitors under investigation appear as promising starting points for investigation as potential chemotherapy against HCC. Citation Format: Olamide O. Crown, Ifedayo V. Ogungbe, Felicite K. Noubissi. Antiproliferative effect of a cathepsin L inhibitor on hepatocellular carcinoma [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B028.

Ovarian cancer disease burden decreased in the United States from 1975 to 2018: A joinpoint and age-period-cohort analysis.

Ovarian cancer (OC) is the leading cause of gynecological cancer-related deaths in the United States. The purpose of this study was to evaluate long-term trends in OC incidence and incidence-based mortality rates (IBM) in the U.S. from 1975 to 2018 and to assess the effects of age, period, and cohort factors on OC incidence and mortality using an age-period-cohort model. We obtained data from the U.S. OC incidence/mortality data from the Surveillance, Epidemiology, and End Results database from 1975 to 2018. Joinpoint regression analysis was used to determine long-term trends and transitions, and an age-period-cohort model was used to quantify the effects of age, period, and cohort parameters on incidence and mortality. In addition, 1990 to 2019 U.S. OC data obtained from the Global Burden of Disease study served as a potential validation set. Between 1975 and 2018, 80,622 new cases of OC and 60,218 deaths from OC were reported in the U.S. The average annual percent change for OC incidence was -1.33 (95% CI: -1.64 to -1.02, P < .001), with a significant decrease in incidence at a rate of 7.80% (95% CI: -11.52 to -3.92) per year from to 2015-2018. IBM reached its peak for the U.S. population in 1994, with an age-standardized mortality rate of 6.38 (per 100,000 people). IBM rose first, peaked in 1986, and then declined at a rate of 0.39% (95% CI: -0.66 to -0.12) and 2.48% (95% CI: -3.09 to -1.85) per year from to 1986-2007 and 2007-2018, respectively. In addition, age-period-cohort model analysis showed the highest risk of OC incidence in 1980 to 1984 and the highest risk of OC death in 1985-1989. This study reported a significant decline in OC morbidity and mortality in the U.S. since 1986. In addition, this study analyzed the changes in trends in OC incidence and mortality by race/ethnicity in the U.S. Monitoring trends in OC incidence and mortality by race/ethnicity can help in the development of targeted prevention and treatment measures.

ART in HIV/AIDS Adults and Adolescents

There has been a rapid decline in HIV-related mortality and morbidity due to the wider availability of affordable, more efficacious and less toxic ARVs over the last two decades. ART consists of the use of a combination of at least three ARV drugs from different classes to inhibit the replication of HIV and reduce viraemia to undetectable levels. Continued suppression of viral replication leads to the restoration of immune response, reflected by an increase in the CD4 count. Increase in CD4 count leads to slowing of the disease progression, reduced frequency of OIs, improvement in the quality of life and increased longevity. Successes achieved by ART have now transformed the perception about HIV infection from being a ‘virtual death sentence’ to a ‘chronic manageable illness’. ART was earlier known as Highly Active ART (HAART) and as combination ART (cART).

Mortality related to HCV and other chronic liver diseases in Veneto (Italy), 2008-2021: Changes in trends and age-period-cohort effects.

The objective of this study was to assess the impact of the COVID-19 pandemic and direct-acting antiviral (DAA) agents on mortality related to chronic liver diseases (CLD). Age-standardized mortality rates were computed based on CLD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple causes of death-MCOD). Time trends in age-standardized mortality rates were investigated using generalized estimation equation models. Additionally, we conducted age, period, and birth cohort (APC) analyses on CLD-related mortality associated with alcohol and hepatitis C virus (HCV). Between 2008 and 2021, among residents in the Veneto region (Northeastern Italy) aged ≥35 years, there were 20 409 deaths based on the UCOD and 30 069 deaths based on MCOD from all CLD. We observed a 4% annual decline in age-standardized MCOD-based mortality throughout 2008-2021, with minor peaks corresponding to COVID-19 epidemic waves. Starting in 2016, the decline in HCV-related mortality accelerated further (p < .001). A peak in HCV-related mortality in the 1963-1967 birth cohort was observed, which levelled off by the end of the study period. Mortality related to alcoholic liver disease declined at a slower pace, becoming the most common aetiology mentioned in death certificates. The study demonstrates a significant decrease in HCV-related mortality at the population level in Italy with the introduction of DAAs. Continuous monitoring of MCOD data is warranted to determine if this favourable trend will continue. Further studies utilizing additional health records are needed to clarify the role of other CLD etiologies.

Factors Associated with Male Partner Involvement in Maternity Care in Mbeya, Tanzania.

Male partner involvement in maternity care is critical to improving neonatal and maternal health by reducing maternal mortality, particularly in settings where males play a significant role in decision-making. This study aimed to assess factors associated with male partners involvement in maternity care in Mbeya, Tanzania. A community-based cross-sectional study was conducted among men in Mbeya City, Tanzania, from April to June 2021. A semi-structured questionnaire was used to collect information from participants. Male involvement level was measured as low, moderate or high. X2 test and multinomial logistic regression models were applied to determine association between male involvement levels and related factors. A total of 201 males participated in the study. The overall level of male involvement during antenatal care, labour and delivery and postnatal care indicated that 44 (21.7%) had a high level of involvement, 116 (58%) had a moderate level of involvement and 41 (20.3%) had a low level of involvement. Demographic and health facilities factors indicated a significant association with male partner level of participation (P<.001). The likelihood of a man accompanying the partner was significantly associated with staff attitude and the time spent at the health facility (AOR 1.726 at 95% CI 1,394-2.136 P<.001). Findings indicated a generally moderate level of male partner involvement as a critical concern that can accelerate the decline in maternal mortality and improve maternal health. Enhancing the male-friendliness of health facilities in terms of infrastructure, organisation of services and staff attitudes, as well as educating the community, particularly men, to sensitise them to the negative attitudes toward male participation in maternity care, can increase male participation.

Demographic change and natural interest rate of China

We study the impact of demographic change on the natural interest rate of China. We analyze the effect of aging population by constructing an overlapping generations model, which embeds demographics, technology and public debt to facilitate simulating China’s natural interest rate and its counterfactuals. We find that China’s natural interest rate has been declining slowly ever since 2000 and the main driver of this downward trend is the declining mortality rate. In the next two decades, due to increasing young labor, China’s natural interest rate will have a flat period of about ten years in the downward trend.

Application of a count regression model to identify the risk factors of under-five child morbidity in Bangladesh.

Bangladesh has seen a significant decline in child mortality in recent decades, but morbidity among children <5y of age remains high. The aim of this analysis was to examine trends and identify risk factors related to child morbidity in Bangladesh. This analysis is based on data from four successive cross-sectional Bangladesh Demographic and Health Surveys for the years 2007, 2011, 2014 and 2017-18. Several count regression models were fitted and the best model was used to identify risk factors associated with morbidity in children <5y of age. According to the results of the trend analysis, the prevalence of non-symptomatic children increased and the prevalence of fever, diarrhoea and acute respiratory infections (ARIs) decreased over the years. The Vuong's non-nested test indicated that Poisson regression could be used as the best model. From the results of the Poisson regression model, child age, sex, underweight, wasted, stunting, maternal education, wealth status, religion and region were the important determinants associated with the risk of child morbidity. The risk was considerably higher among women with a primary education compared with women with a secondary or greater education in Bangladesh. This analysis concluded that child morbidity is still a major public health problem for Bangladesh. Thus it is important to take the necessary measures to reduce child morbidity (particularly fever, diarrhoea and ARI) by improving significant influencing factors.

Cardiovascular hospitalizations and mortality among adults aged 25-64 years in the USA.

Declines in cardiovascular mortality have stagnated in the USA since 2011. There is growing concern that these patterns reflect worsening cardiovascular health in younger adults. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality has changed in this population. Changes in cardiovascular hospitalizations and mortality among adults aged 25-64 years were evaluated, overall and by community-level income. Using the National Inpatient Sample, age-standardized annual hospitalization and in-hospital mortality rates for acute myocardial infarction (AMI), heart failure, and ischaemic stroke were determined among adults aged 25-64 years. Quasi-Poisson and quasi-binominal regression models were fitted to compare outcomes between individuals residing in low- and higher-income communities. Between 2008 and 2019, age-standardized hospitalization rates for AMI increased among younger adults from 155.0 (95% confidence interval: 154.6, 155.4) per 100 000 to 160.7 (160.3, 161.1) per 100 000 (absolute change +5.7 [5.0, 6.3], P < .001). Heart failure hospitalizations also increased (165.3 [164.8, 165.7] to 225.3 [224.8, 225.8], absolute change +60.0 (59.3, 60.6), P < .001), as ischaemic stroke hospitalizations (76.3 [76.1, 76.7] to 108.1 [107.8, 108.5], absolute change +31.7 (31.2, 32.2), P < .001). Across all conditions, hospitalizations rates were significantly higher among younger adults residing in low-income compared with higher-income communities, and disparities did not narrow between groups. In-hospital mortality decreased for all conditions over the study period. There was an alarming increase in cardiovascular hospitalizations among younger adults in the USA from 2008 to 2019, and disparities between those residing in low- and higher-income communities did not narrow.

Trends in mortality from non-natural causes in children and adolescents (0–19 years) in Europe from 2000 to 2018

BackgroundNon-natural mortality in children and adolescents is a global public health problem that varies widely from country to country. Data on child and adolescent maltreatment are not readily available, and mortality due to violent causes is also underestimated.MethodsInjury-related mortality rates (overall and by specific causes) from 2000 to 2018 in selected European countries were analysed to observe mortality patterns in children and adolescents using data from the Eurostat database. Age-standardized mortality rates per 100,000 person-years were calculated for each country. Joinpoint regression analysis with a significance level of 0.05 and 95% confidence intervals was performed for mortality trends.ResultsChildren and adolescent mortality from non-natural causes decreased significantly in Europe from 10.48 around 2005 to 5.91 around 2015. The Eastern countries (Romania, Bulgaria, Poland, Slovakia, Czech Republic) had higher rates; while Spain, Denmark, Italy, and the United Kingdom had the lowest. Rates for European Country declined by 5.10% per year over the entire period. Larger downward trends were observed in Ireland, Spain and Portugal; smaller downward trends were observed for Eastern countries (Bulgaria, Czech Republic, Poland, Slovakia) and Finland. Among specific causes of death, the largest decreases were observed for accidental causes (-5.9%) and traffic accidents (-6.8%).ConclusionsMortality among children and adolescents due to non-natural causes has decreased significantly over the past two decades. Accidental events and transport accidents recorded the greatest decline in mortality rates, although there are still some European countries where the number of deaths among children and adolescents from non-natural causes is high. Social, cultural, and health-related reasons may explain the observed differences between countries.

Abstract 12331: Cardiovascular Hospitalizations and Mortality Among Young Adults Aged 25 to 64 Years in the United States

Introduction: Declines in cardiovascular mortality have stagnated in the United States since 2011. There is growing concern that these patterns may reflect worsening cardiovascular health in younger populations. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality have changed in young adults. Aim: To evaluate cardiovascular hospitalizations (AMI, heart failure, ischemic stroke) and in-hospital mortality among adults 25-64 years, overall and by income-level, as well as population-level cardiovascular mortality. Methods: We determined age-standardized cardiovascular hospitalization rates from 2012 to 2019, and fit quasi-Poisson and quasi-binominal regression models to compare hospitalizations and mortality between low- and higher-income young adults. Results: Between 2012 and 2019, age-standardized AMI hospitalization rates increased modestly among young adults from 162.0 (161.4, 162.6) to 163.7 (163.3, 164.2) per 100,000 (p&lt;0.001). In contrast, there were significant increases in heart failure (163.9 [163.3, 164.5] to 231.5 [231.0, 232.0], p&lt;0.001) and ischemic stroke hospitalizations (92.3 [91.8, 92.8] to 110.2 [109.9, 110.6], p&lt;0.001). Across all 3 conditions, low-income adults experienced a more pronounced rise in hospitalizations, and the gap between the low- and higher-income groups widened (p-interaction&lt;0.001), while in-hospital mortality decreased for heart failure and stroke. Population-level cardiovascular mortality rates increased in the subgroup of young adults aged 45-64 years (162.5 to 168.3 per 100,000, p&lt;0.001), particularly in the low-income population. Conclusions: There has been an alarming increase in cardiovascular hospitalizations and population-level cardiovascular mortality among young adults over the past decade in the US, with evidence of widening disparities between low- and higher-income populations.

Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: a nationwide inpatient sample analysis

BackgroundHip fractures frequently necessitate hospitalization, especially among patients aged 75 and above who might concurrently suffer from aortic stenosis (AS). This study focuses on postoperative outcomes, potential determinants of morbidity and mortality, as well as evolving trends in patients with AS undergoing surgical repair of hip fractures.MethodsA retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2019 was conducted. Hip fracture cases were identified, and a subgroup with AS was isolated using the ICD-9 and ICD-10 diagnostic codes. We compared baseline characteristics, postoperative in-hospital outcomes and trends in mortality and morbidity between patients with and without AS.ResultsFrom the dataset, 2,834,919 patients with hip fracture were identified on weighted analysis. Of these, 94,270 (3.3%) were found to have concurrent AS. The AS cohort was characterized by higher mean age and elevated burden of cardiovascular comorbidities, such as coronary artery disease, peripheral vascular disease, pulmonary hypertension, congestive heart failure and cardiac arrhythmias. Postoperative mortality following hip fracture surgery was greater in the AS groups compared to non-AS group (3.3% vs 1.57%, p < 0.001). Risk factors such as congestive heart failure (OR, 2.3[CI, 2.1–2.6]), age above 85 years (OR, 3.2[CI, 2.2–4.7]), cardiac arrhythmias (OR, 2.4[CI, 2.2–2.6]), end-stage renal disease (OR, 3.4[CI, 2.7–4.1]), malnutrition (OR, 2.3[CI, 2.1–2.7]) and AS (OR, 1.2[CI, 1.08–1.5] were associated with increased adjusted odds of postoperative mortality. AS was linked to higher adjusted odds of postoperative mortality (OR, 1.2 [CI, 1.1–1.5]) and complications such as acute myocardial infarction (OR, 1.2 [CI, 1.01–1.4]), cardiogenic shock (OR, 2.0[CI, 1.4–2.9]) and acute renal failure (OR, 1.1[CI, 1.02–1.2]). While hospital stay duration was comparable in both groups (average 5 days), the AS group incurred higher costs (mean $50,673 vs $44,607). The presence of acute heart failure in patients with AS and hip fracture significantly increased mortality, hospital stay, and cost. A notable decline in postoperative in-hospital mortality was observed in both groups from 2008–2019 though the rate of major in-hospital complications rose.ConclusionAS significantly influences postoperative in-hospital mortality and complication rates in hip fracture patients. While a reduction in postoperative mortality was observed in both AS and non-AS cohorts, the incidence of major in-hospital complications increased across both groups.

Mortality Trends and Causes of Death in Individuals with Thalassemia: A Population-Based Retrospective Study in the United States from 1999 to 2020

Background Thalassemia is a hereditary hemoglobinopathy that results in ineffective erythropoiesis. Patients with thalassemia have varying degrees of severity ranging from mild anemia to severe complications due to iron overload. Despite its clinical significance, the study on the mortality rate among patients with thalassemia in the United States (US) remains scarce. Objective This study aimed to analyze the trends in thalassemia-related mortality rate and the underlying causes of death among individuals with thalassemia. Methods We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database and performed serial cross-sectional analyses of national death certificate data for thalassemia-related mortality among patients of all ages. Thalassemia (International Classification of Diseases, Tenth Revision [ICD-10] D56) was listed as the contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and examined the trends over time by estimating the average annual percent change (AAPC) using the Joinpoint Regression Program. Subgroup analyses were performed by sex, age, race, census region, and urbanization level. Results From 1999 to 2020, there were 2,797 deaths related to thalassemia. Among these deaths, beta thalassemia accounted for 24.87%, alpha thalassemia accounted for 6.00%, thalassemia trait accounted for 2.52%, dominant thalassemia, hemoglobin C thalassemia, mixed thalassemia, or thalassemia with other hemoglobinopathies accounted for 1.92%, and unspecified thalassemia accounted for 64.37%. The baseline demographics of patients who met the inclusion criteria are shown in Table 1. Thalassemia-related mortality rate showed an overall decline in trend from 0.50 (95% CI, 0.41 - 0.58) per 1,000,000 individuals in 1999 to 0.34 (95% CI, 0.28 - 0.40) per 1,000,000 individuals in 2019, but increased to 0.48 (95% CI, 0.41 - 0.55) per 1,000,000 individuals in 2020 (Figure 1). The highest AAMR was observed among Asians (1.34 [95% CI, 1.20 - 1.47] per 1,000,000 individuals), followed by non-Hispanic Blacks (0.65 [95% CI, 0.59 - 0.71] per 1,000,000 individuals), non-Hispanic Whites (0.32 [95% CI, 0.30 - 0.33] per 1,000,000 individuals), and Hispanics (0.11 [95% CI, 0.08 - 0.14] per 1,000,000 individuals). The most common underlying causes of death among individuals with thalassemia were cardiovascular causes (26.0%), followed by hematological causes (20.7%), malignancy (17.8%), endocrine disorders (6.3%), respiratory causes (6.2%), disorders of the nervous system (5.0%), gastrointestinal diseases (4.9%), psychiatric disorders (3.3%), infection (3.0%), and other causes (6.7%). Among the cardiovascular causes, ischemic heart disease (11.0%) was the most common cause, followed by hypertensive disease (3.0%), cerebrovascular disease (1.7%), aortic valve disease (1.1%), cardiomyopathy (0.79%), and atrial fibrillation and flutter (0.79%). The urban population had a higher AAMR compared to the rural population (0.43 [95% CI, 0.41 - 0.45] per 1,000,000 individuals vs. 0.29 [95% CI, 0.26 - 0.32] per 1,000,000 individuals). Nevertheless, the rural areas exhibited an increasing trend in the AAMR (+6.90%) while the urban areas exhibited a decreasing trend in the AAMR (-11.36%) during the study period. Conclusion While there has been an overall decline in the thalassemia-related mortality rate, variations exist among different races, geographic regions, and urbanization levels. Our study emphasizes the need for targeted interventions to address these disparities.

Decoding the Historical TALE: COVID-19 Impact on Hematological Malignancy Patients - Insights from 2020 to 2022

Introduction From the onset of the COVID-19 pandemic, hematological malignancy patients have been at high risk of both contracting SARS-CoV-2 and experiencing its most severe effects, leading to hospitalization and high fatality rates. While the introduction of anti-SARS-CoV-2 vaccines, specific antivirals, and monoclonal antibodies significantly lessened the impact on otherwise healthy individuals, the same cannot always be said for patients with hematological malignancies due to their compromised immune systems. Methods The EPICOVIDEHA registry, part of the EHA-SWG Infections in Hematology, has been actively compiling data on COVID-19 cases in patients with hematological malignancies from the pandemic's onset, spanning diverse geographic locations worldwide. This registry has facilitated the acquisition of comprehensive epidemiological data, enabling a thorough analysis of the evolving patterns in COVID-19 incidence and characteristics during the initial three years of the pandemic. Results As of December 2022, the EPICOVIDEHA registry recorded 8,767 cases of COVID-19 in hematological malignancy patients from 152 centers in 41 countries. Of these cases, 42% were female. Non-Hodgkin's lymphoma accounted for 31% of the cases, followed by multiple myeloma at 17%, chronic lymphocytic leukemia at 13%, and acute myeloid leukemia at 12%, showing consistent proportions over time. Chronic cardiopathy emerged as the most prevalent non-malignant underlying condition, increasing from 32% during the first semester of 2020 to 44% in the second semester of 2022. Critical infections decreased significantly from 19% at the beginning of the pandemic to 4% in the second semester of 2022 (p=0.004). Overall mortality dropped from 29% at the pandemic's onset to 4% after three years (p&amp;lt;0.001). Survival rates for hematological malignancy patients consistently improved with each passing semester (p&amp;lt;0.001). Factors associated with mortality included increased age (HR 1.037, p&amp;lt;0.001), two or more comorbidities (HR 1.244, p&amp;lt;0.001), active malignancy at COVID-19 onset (HR 1.832, p&amp;lt;0.001), pulmonary symptoms (HR 1.299, p=0.003), and hospitalization (HR 12.767, p&amp;lt;0.001), particularly in the intensive care unit (HR 33.684, p&amp;lt;0.001). Conversely, factors linked to increased survival were anti-SARS-CoV-2 vaccination (1-2 doses: HR 0.681, p&amp;lt;0.001; 3+ doses: HR 0.451, p&amp;lt;0.001) and experiencing the COVID-19 episode in 2022 (HR 0.427, p&amp;lt;0.001) (Figure 1A). Initially, COVID-19 was the primary cause of mortality in 70% of the cases, decreasing to 42% by the second semester of 2022 (Figure 1B). Conclusion Our study revealed that patients with hematological malignancies face an elevated vulnerability to severe outcomes, resulting in higher hospitalization and mortality rates over time. However, there was a decline in critical infections and mortality rates during the study period. While factors associated with mortality remained consistent, vaccination and encountering COVID-19 more recently were linked to improved survival. Our findings emphasize the importance of continuous monitoring and targeted interventions to optimize outcomes for this vulnerable group during the pandemic and beyond.

Health Care Policy and Disparities in Health.

The United States has seen a 33% decline in age-adjusted cancer mortality since 1991. Despite this achievement, the United States has some of the greatest health disparities of any developed nation. US government policies are increasingly directed toward reducing health disparities and promoting health equity. These policies govern the conduct of research, cancer prevention, access, and payment for care. Although implementation of policies has played a significant role in the successes of cancer control, inconsistent implementation of policy has resulted in divergent outcomes; poorly designed or inadequately implemented policies have hindered progress in reducing cancer death rates and, in certain cases, exacerbated existing disparities. Examining policies affecting cancer control in the United States and realizing their unintended consequences are crucial in addressing cancer inequities.

Výsledky z evaluace screeningu kolorektálního karcinomu v České republice

Introduction: Colorectal cancer screening, which was introduced in the Czech Republic in 2000, plays an important role in reducing the population burden. It is necessary to continuously evaluate the organised population-based program and introduce necessary adjustments to ensure its high effectiveness, which in the long term leads to a reduction in the incidence and mortality of the disease. The aim of this article is to summarise and discuss the key results of the evaluation of the National Colorectal Cancer Screening Program based on available national data. Material and methods: The evaluation used the registries of the National Health Information System, the Registry of Preventive Colonoscopies, and data on population demographics managed by the Czech Statistical Office. The analysis was carried out on available data up to 2021. Basic indicators were calculated in accordance with international recommendations, which were adapted for the Czech environment. Results: A number of performance indicators for colorectal screening demonstrate the negative impact of the COVID-19 pandemic in 2020 and 2021. Coverage of the target population by screening has stabilised at around 30% before the pandemic. Considering a three-year interval, the full coverage of the target population by screening reaches around 50%. Participation rates for follow-up colonoscopy after a positive faecal occult blood test (FOBT) screening ranged between 60 and 70% over time. FOBT screening positivity increased in the recent years up to 10%, which is reflected in the increase in the average waiting time for follow-up FOBT+ colonoscopy. Despite the identified limitations of the screening program, there has been a clear long-term decline in colorectal cancer incidence and mortality. Conclusion: The comprehensive screening information system enables the evaluation of colorectal screening. The evaluated indicators show that despite the positive impact of the screening program on the population burden, it still has its opportunities for improvement, and therefore it is essential to continue its monitoring in order to improve the quality of the whole program. Keywords colonoscopy, colorectal neoplasms, mass screening, occult blood, program evaluation, performance indicators, registries

Trends in performance of hospital outpatient procedures and associated 30-day costs among Medicare beneficiaries from 2011 to 2018

BackgroundUnited States healthcare has increasingly transitioned to outpatient care delivery. The degree to which Academic Medical Centers (AMCs) have been able to shift surgical procedures from inpatient to outpatient settings despite higher patient complexity is unknown. MethodsThis observational study used a 20% sample of fee-for-service Medicare beneficiaries age 65 and older undergoing eight elective procedures from 2011 to 2018 to model trends in procedure site (hospital outpatient vs. inpatient) and 30-day standardized Medicare costs, overall and by hospital teaching status. ResultsOf the 1,222,845 procedures, 15.9% occurred at AMCs. There was a 2.42% per-year adjusted increase (95% CI 2.39%–2.45%; p < .001) in proportion of outpatient hospital procedures, from 68.9% in 2011 to 85.4% in 2018. Adjusted 30-day standardized costs declined from $18,122 to $14,353, (-$560/year, 95% CI -$573 to -$547; p < .001). Patients at AMCs had more chronic conditions and higher predicted annual mortality. AMCs had a lower proportion of outpatient procedures in all years compared to non-AMCs, a difference that was statistically significant but small in magnitude. AMCs had higher costs compared to non-AMCs and a lesser decline over time (p < .001 for the interaction). AMCs and non-AMCs saw a similar decline in 30-day mortality. ConclusionsThere has been a substantial shift toward outpatient procedures among Medicare beneficiaries with a decrease in total 30-day Medicare spending as well as 30-day mortality. Despite a higher complexity population, AMCs shifted procedures to the outpatient hospital setting at a similar rate as non-AMCs. ImplicationsThe trend toward outpatient procedural care and lower spending has been observed broadly across AMCs and non-AMCs, suggesting that Medicare beneficiaries have benefited from more efficient delivery of procedural care across academic and community hospitals.

Modern ways to reduced mortality of myocardial infarction. What should be done?

Myocardial infarction is a formidable manifestation of coronary artery disease and accounts for one third of deaths associated with coronary disease. In Russia, from 400 to 500 thousand patients with acute coronary syndrome are hospitalized annually, about half of them with myocardial infarction (MI). The dynamics of the number of hospitalized patients in recent years indicates its reduction. Short-term mortality (30-day, including hospital mortality) after acute MI has decreased significantly over the past 50 years: in absolute terms from 30 % in 1950 to 5–8 % at present. However, long-term mortality after MI did not improve. Moreover, in recent years, the rate of decline in 30-day mortality from MI has decreased significantly, almost reaching a “plateau” over the past 15 years. It has been established that in terms of the impact on survival, disability and quality of life of the working population, MI is an important not only medical but also social problem. This review of the literature discusses changes in approaches to reducing mortality in MI, as well as the main events in evidence-based cardiology over the past 50 years, which have made it possible to effectively manage the risk of death in this category of patients.