Mortality Patterns Research Articles

Cancer incidence and mortality in the Far Eastern Federal District (2013–2022)

The aim of the study was to assess the territorial patterns in cancer incidence and mortality among the population of the Far Eastern Federal District in the period 2013–2022. Material and Methods. Data from official reports of cancer services (form No 35, No. 7) processed using standard cancer statistics programs were presented. Results. In the east of the country, 31,822 new cancer cases were registered in 2022, which was 1.3 % more than in 2021. The average cancer incidence rate in males was 294.06 ± 5.05 per 100,000 (2020: 296.94 ± 4.66), with a decrease rate of 3.0 %. In females, the equivalent rate increased to 240.96 ± 5.73 per 100,000 (2020: 237.92 ± 6.26 per 100,000) with a rise of 6.3 %. Skin cancer was the most common malignancy (11.6 %) followed by trachea, bronchi, lung (11.5 %), breast (11.3 %) and colon (6.3 %) cancers. The percent of actively detected patients increased to 23.2 % (2013: 14.0 %) as did the index of accumulation of contingents – 7.3 (2013: 5.3). The number of patients with stage I–II cancer increased to 57.0 % (2013: 47.5 %), while the number of stage III-IV cancers decreased to 20.8 % (2013: 24.7 %). The number of morphologic studies (94.1 %) was lower than the average for RF (95.8 %). The proportion of patients registered for five or more years decreased to 57.2 % (RF: 58.2 %). The average cancer mortality rate in men was 174.99 ± 3.10 per 100,000 (2020: 181.76 ± 2.51 per 100,000). The average cancer mortality rate in women was lower than in men, being 91.34 ± 1.20 per 100,000 (2020: 93.71 ± 0.80о per 100,000). Cancers of trachea, bronchi and lung (20.0 %), stomach (8.9 %), colon (7.0 %) and breast (6.6 %) were the leading causes of mortality. Conclusion. The low level of active cancer detection did not significantly change the incidence rates during the study period. A greater volume of preventive measures with improvement of their quality will enable the primary health care system to detect cancer at early stages, form groups being at high risk for cancer development and, consequently, to reduce mortality rates. A prerequisite for improving medical care for cancer patients is the continuous training of professional staff and the use of modern diagnostic and treatment technologies.

Directionality theory and mortality patterns across the primate lineage

Empirical studies of aging in primates show that local selective forces rather than phylogenetic history determine the exceptional nature of human longevity (Bronikowski et al., Science 331:1325–1328, 2011). This article proposes an evolutionary rationale for this pattern of primate mortality by invoking the parameter, Life-Table Entropy, a measure of the uncertainty in the life span of a randomly chosen newborn. Life-table entropy is positively correlated with maximal life span, that is, the mean life span of a species living under favourable conditions.The logic which underlies the exceptional nature of human longevity derives from the terrestrial life-history of humans – a singularity within the primate lineage; and the concomitant ecological constraints—the hunter-gatherer, agricultural, and industrial modes of subsistence, that have defined human evolutionary history. The effect of these ecological constraints on the evolution of life span is encoded in the Entropic Principle of Longevity: life-table entropy increases in equilibrium species, populations evolving in environments with stable, renewable resources; and decreases in opportunistic species, populations subject to fluctuating resource endowments.The Entropic Principle of Longevity is a derivative of Directionality Theory, an analytic study of the evolutionary process of variation and selection based on Evolutionary Entropy, a statistical measure of the uncertainty in the age of the mother of a randomly chosen newborn. Evolutionary entropy is the organizing concept of The Entropic Principle of Evolution: Evolutionary Entropy increases in equilibrium species and decreases in opportunistic species.

Prostate cancer incidence and mortality in Europe and implications for screening activities: population based study

ObjectiveTo provide a baseline comparative assessment of the main epidemiological features of prostate cancer in European populations as background for the proposed EU screening initiatives.DesignPopulation based study.Setting26 European countries, 19...

Pathogen Prevalence in Cetaceans Stranded along the Italian Coastline between 2015 and 2020.

The monitoring of stranded marine mammals represents a strategic method to assess their health, conservation status, and ecological role in the marine ecosystem. Networks worldwide track stranding events for the passive monitoring of mortality patterns, emerging and reemerging pathogens, climate change, and environmental degradation from a One Health perspective. This study summarizes pathogen prevalence data from the Italian Stranding Network (ISN) derived from post-mortem investigations on cetaceans found dead stranded along the Italian coastline between 2015 and 2020. The decomposition of the carcasses and logistics limited the post-mortem examination to 585 individuals, out of 1236 single-stranding reports. The most relevant pathogens identified were Cetacean Morbillivirus, Herpesvirus, Brucella spp., and Toxoplasma gondii, whose roles as environmental stressors are well known, despite their real impact still needing to be investigated in depth. Statistical analysis showed that age and sex seem to be positively related to the presence of pathogens. This study represents the first step in harmonizing post-mortem investigations, which is crucial for evidence-based conservation efforts. Implementing diagnostic and forensic frameworks could offer an indirect insight into the systematic monitoring of diseases to improve the identification of regional and temporal hotspots in which to target specific mitigation, management, and conservation strategies.

COVID-19 increased existing gender mortality gaps in high-income more than middle-income countries

ObjectiveTo analyze how patterns of excess mortality varied by sex and age groups across countries during the COVID-19 pandemic and their association with country income level. MethodsWe used World Health Organization excess mortality estimates by sex and age groups for 75 countries in 2020 and 62 countries in 2021, restricting the sample to estimates based on recorded all-cause mortality data. We examined patterns across countries using country-specific Poisson regressions with observations consisting of the number of excess deaths by groups defined by sex and age. FindingsMen die at higher rates in nearly all places and at all ages beyond age 45. In 2020, the pandemic amplified this gender mortality gap for the world, but with variation across countries and by country income level. In high-income countries, rates of excess mortality were much higher for men than women. In contrast, in middle-income countries, the sex ratio of excess mortality was similar to the sex ratio of expected all-cause mortality. The exacerbation of the sex ratio of excess mortality observed in 2020 in high-income countries, however, declined in 2021. ConclusionThe COVID-19 pandemic has killed men at much higher rates than women, as has been well documented, but these gender differences have varied by country income. These differences were the result of some combination of variation in gender patterns of infection rates and infection fatality rates across countries. The gender gap in mortality declined in high-income countries in 2021, likely as a result of the faster rollout of vaccination against COVID-19.

Glycemic status and effect on mortality: Multifactorial prevention programme for cardiovascular disease in Finnish primary care

AimsTo compare 13-year mortality rates in normoglycemic, prediabetic and diabetic subjects attending a community-based screening and intervention programme. MethodsPopulation survey identified 2569 cardiovascular disease (CVD) white risk subjects aged 45–70 years and without manifested CVD or diabetes. Oral glucose tolerance test was performed, and multifactorial intervention was provided. Effect of glycemic status on mortality was estimated in models adjusted for age, gender, education years, smoking, body mass index, mean arterial pressure, total cholesterol, and physical activity. ResultsOf the subjects, 2055 (77 %) were normoglycemic, 380 (14 %) had prediabetes and 224 (9 %) diabetes. Compared to the normoglycemic group, the fully adjusted hazard ratios (HR) for all-cause mortality were 1.34 (95 % CI: 0.98–1.83) in the prediabetes group and 2.31 (95 % CI: 1.62–3.31) in the diabetes group. Standardized mortality rates were 0.63 (95 % CI: 0.54–0.73), 0.91 (95 % CI: 0.69–1.18), and 1.55 (95 % CI: 1.19–2.02) in the normoglycemic, prediabetes, and diabetes groups, respectively. The most common cause of death was cancer (42 % of all deaths), followed by CVD (28 %). Conclusions/interpretationScreen-detected diabetes carries a substantial risk of death even after primary care intervention. The pattern of excess mortality has shifted towards cancer deaths.

Common molecular basis of aging and cancer dynamics: complex interactions among age, diseases, external stressors, and environmental factors

There are incremental efforts to understand the multifaceted aspects of aging, particularly focusing on its biological interplay with various environmental stressors and diseases such as cancer. The concept of biological age, which is distinct from chronological age, and its importance in predicting disease onset and mortality patterns are emphasized. Furthermore, exploration of the reversible nature of biological aging under different stress conditions, such as surgery, pregnancy, and diseases such as cancer and coronavirus disease 2019, is intriguing. This narrative review attempts to address the potential impact of viral infections such as severe acute respiratory syndrome coronavirus 2 and the altered landscape of diseases such as cancer on biological aging and their interconnected relationships. Additionally, it also touches upon the influence of emerging technologies, particularly artificial intelligence-driven machines, on aging dynamics, prompting further research in this area. This article may provide insight into a comprehensive framework for interdisciplinary research to better understand the complex interactions among age-related dynamics, diseases, external stressors, and environmental factors, with implications for future interventions and healthcare strategies.

Pattern Of Admission And Outcome Among Neonates Admitted Into The Special Care Baby Unit Of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Introduction: The neonatal disease pattern is a sensitive indicator of the availability, utilisation and effectiveness of mother and child health services in the community. Community based data are difficult to come by, so hospital based data most often is use to assess the burden of neonatal problems. Aim: To determine the pattern of morbidity, mortality and outcome of neonates admitted into the Special Care Baby Unit (SCBU) of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto from 1 st January 2022 to 31st December 2022. Methods: A hospital-based retrospective review of medical records of neonates admitted into the SCBU of UDUTH, Sokoto from 1 st January, 2022 to 31st December, 2022. Information retrieved included the biodata, place of birth, age at admission, diagnosis, duration of hospital stay and outcome. Data was analysed using SPSS version 22. Results: A total of 818 neonates were admitted during the study period, 393(48.0%) were males and 425(52.0%) were females giving a male to female ratio of 1:1.1. Most 606(74.1%) of the patients were out born. Birth Asphyxia 245(30.0%) was the main reason for admission, followed by prematurity 182(22.3%). Majority 653(79.2%) were discharged, 16(2.0%) left against medical advice, while 149(18.2%) of the admitted patients died. Prematurity related death 61(40.9%) and birth Asphyxia were the leading causes of death respectively. Majority 107(71.8%) of the deaths occur among the out-born. Conclusion: Birth asphyxia and prematurity related complications were the main reasons for neonatal admissions and the leading causes of death in this study. Most of the neonatal deaths were from preventable causes. Strengthening perinatal care, emergency obstetric services, facilities for improved preterm care should be provided in secondary and tertiary health facilities and improving the skills of health care providers on neonatal resuscitation are necessary to reduce neonatal mortality

Analysing space-time patterns of maternal mortality attributed to anaemia in Karnataka, India: a spatial epidemiological study

BackgroundMaternal health is a globally important health challenge and is the key indicator of healthcare services in any given region. One of the main objectives of Sustainable Development Goal 3.1...

A humanized ACE2 mouse model recapitulating age- and sex-dependent immunopathogenesis of COVID-19.

In the ongoing battle against coronavirus disease 2019 (COVID-19), understanding its pathogenesis and developing effective treatments remain critical challenges. The creation of animal models that closely replicate human infection stands as a critical step forward in this research. Here, we present a genetically engineered mouse model with specifically-humanized knock-in ACE2 (hiACE2) receptors. This model, featuring nine specific amino acid substitutions for enhanced interaction with the viral spike protein, enables efficient severe acute respiratory syndrome coronavirus 2 replication in respiratory organs without detectable infection in the central nervous system. Moreover, it mirrors the age- and sex-specific patterns of morbidity and mortality, as well as the immunopathological features observed in human COVID-19 cases. Our findings further demonstrate that the depletion of eosinophils significantly reduces morbidity and mortality, depending on the infecting viral dose and the sex of the host. This reduction is potentially achieved by decreasing the pathogenic contribution of eosinophil-mediated inflammation, which is strongly correlated with neutrophil activity in human patients. This underscores the model's utility in studying the immunopathological aspects of COVID-19 and represents a significant advancement in COVID-19 modeling. It offers a valuable tool for testing vaccines and therapeutics, enhancing our understanding of the disease mechanisms and potentially guiding more targeted and effective treatments.

Investigating sex, race, and geographic disparities in bronchus and lung cancer mortality in the United States: a comprehensive longitudinal study (1999-2020) utilizing CDC WONDER data.

Lung and bronchus cancer has become the leading cause of cancer-related mortality in the United States. Understanding the patterns of mortality is an absolute requirement. This study analyzed Lung and Bronchus cancer-associated mortality rates from 1999 to 2020 using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER). Age-adjusted mortality rates (AAMRs), per 100000 people, and annual percentage change (APCs) were also calculated. 3599577 lung and bronchus cancer-related deaths occurred in patients aged younger than 1-85+ years between 1999 and 2020. Overall AAMRs declined from 59.1 in 1999 to 58.9 in 2001 (APC: -0.1364) then to 55.9 in 2005 (APC: -1.4388*) 50.5 by 2010 (APC: -2.0574*) 44.7 by 2014 (APC: -2.9497*) and 35.1 by 2020 (APC: -4.1040*). Men had higher AAMRs than women (overall AAMR men: 61.7 vs. women: 38.3). AAMRs were highest among non-Hispanic (NH) Black or African American (52.7) patients followed by NH White (51.8), NH American Indian or Alaska Native (38.6), NH Asian or Pacific Islander (24.7) and Hispanic or Latino race (20.2). AAMRs varied in region (overall AAMR; South: 52.4; Midwest: 52.3; Northeast: 46.3; West: 39.1). Non-metropolitan areas had a higher AAMR (55.9) as compared to metropolitan areas (46.7). The top 90th percentile states of Lung and Bronchus cancer AAMR were Arkansas, Kentucky, Mississippi, Tennessee, and West Virginia. An overall decreasing trend in AAMRs for lung and bronchus cancer was seen. Public health measures to regulate risk factors and precipitating events are needed.

Demographical and Regional Trends of HIV-Related Mortality Among Young Adults in the United States From 1999 to 2020

BackgroundHIV remains a leading cause of death in the U.S. Previous research has examined mortality patterns among older adults with HIV, revealing regional and demographic disparities. This study aims to assess demographic and regional trends in HIV-related mortality among young adults from 1999 to 2020. MethodsCenters for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to identify young adults aged 15-44 where HIV was mentioned as either underlying or contributory cause of mortality between 1999 and 2020, using the B20-B24 codes from the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10). Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percentage change (APC) were determined. ResultsThe AAMRs for HIV in young adults consistently declined from 1999 to 2018, followed by a period of stability from 2018 to 2020 (annual percentage change: 0.5%; 95% confidence interval [95% CI], –7.4 to 9.0), with 64% deaths occurred in medical facilities. Overall, males had a twice AAMR than females (female: 2.22, 95% CI 2.19-2.24; male: 5.19, 95% CI 5.15-5.23). Non-Hispanic (NH) Blacks had sevenfold higher mortality rates than Whites (AAMR 14.88 vs. 2.036). The Southern region experienced threefold higher mortality compared to the Midwest. Metropolitan adults had a twofold higher AAMR than nonmetropolitan adults. States in the top 90th percentile for HIV-related mortality, including Mississippi, Maryland, Florida, Louisiana, and the District of Columbia, exhibited six times higher mortality compared to states in the bottom 10th percentile, such as North Dakota, Idaho, Wyoming, Montana, and Utah. ConclusionsTo address these disparities and ensure continued progress, urgent measures are required.

Fuzzy Bayesian inference for under-five mortality data

Under-five mortality remains a significant global health challenge, with millions of children dying before their fifth birthday each year. This study explores the application of fuzzy Bayesian inference for under-five mortality data using Tanzania as a case study. Fuzzy Bayesian inference has emerged as a promising technique that combines the flexibility of fuzzy set theory with the probabilistic framework of Bayesian inference. The study employs fuzzy sets and membership functions to represent the linguistic terms and their degrees of membership, along with the Poisson distribution to model the mortality rate. The results demonstrate the potential of fuzzy Bayesian inference for analyzing under-five mortality rates. This approach provides a more nuanced understanding of the complex mortality patterns.

COMPARATIVE LABORATORY ACTIVITY AND SEMI-FIELD EFFICACY OF OMNIPRENE® G AND ALTOSID® PELLETS AGAINST AEDES AEGYPTI.

Mosquito larval control by biorational larvicides plays a crucial role in mosquito and mosquito-borne disease management. However, the availability of larvicides that meet the criteria of efficacy, safety, and quality is limited and conventional pesticides are no longer preferred for larval control. Although efforts are made to research new active ingredients (AIs), it is equally important to innovate new formulations based on currently available AIs such as microbial agents and insect growth regulators. Studies were therefore conducted to compare the laboratory activity and semi-field efficacy of OmniPrene® G and Altosid® Pellets with DR-tech, both containing 4.25% S-methoprene, at 2.8 kg/ha and 11.2 kg/ha against the yellow fever mosquito Aedes aegypti (L.) in outdoor microcosms. Both products performed equally in bioassays against the test species with comparable inhibition of emergence activities. In the semi-field study, the lower dose of Altosid Pellets at 2.8 kg/ha, showed lower efficacy than OmniPrene G during the initial 6 weeks; this difference became negligible on week 7, followed by higher efficacy in Altosid Pellets on weeks 8 and 9. More uniform efficacy was observed at the higher dose of 11.2 kg/ha. Equal performance was revealed during weeks 2 to 6, with the OmniPrene G outperforming the Altosid Pellets in week 1, but the opposite during weeks 7 to 9. Mortality patterns were similar in both products, i.e., majority of mortality occurred before emergence, although more incomplete emergence was noted in lower doses, particularly in Altosid Pellets. Overall, newly available OmniPrene G provided comparable activity and efficacy with Altosid Pellets against the test species, with the advantages of fast initial AI release and even coverage, particularly when applied at low doses.

A study of neonatal morbidity and mortality patterns in very low birth weight neonates admitted in the neonatal intensive care unit at Al-Ameen Medical College and Hospital, Vijayapura

Background: Meticulous documentation of morbidity and mortality is essential for elucidating health patterns. The perinatal and neonatal periods, though brief, are pivotal in revealing the health and socio-biological conditions of vulnerable populations. This study seeks to analyze complex morbidity and mortality trends among neonates in a tertiary NICU. Methods: All VLBW neonates admitted to our NICU from April 2023 to March 2024 were analyzed. We gathered comprehensive maternal data, including age, socioeconomic status, and health risk factors. Excluding congenital anomalies, the study assessed demographic profiles, short-term morbidity, and outcomes. Results: In our NICU, 280 very low birth weight (VLBW) neonates were admitted, with 155 males (55.3%) and 125 females (44.7%). The mean birth weight was 1.240±0.110 kg for males and 1.270±0.105 kg for females. Among these, 170 (60.7%) were small for gestational age (SGA), 60 (21.4%) appropriate for gestational age (AGA), and 50 (17.9%) intrauterine growth restricted (IUGR). The gestational age distribution was: less than 28 weeks, 17 (6%); 28-32 weeks, 155 (55.3%); 32-34 weeks, 47 (16.9%); and 34-36 weeks, 61 (21.8%). Of the 280 neonates, 208 (74.2%) survived, while 72 (25.8%) did not. The leading causes of mortality were sepsis, with 39 deaths (54.2%), and respiratory distress syndrome, with 27 deaths (37.6%). Conclusions: Birth asphyxia, prematurity, jaundice, neonatal sepsis, and respiratory issues significantly contribute to neonatal mortality and morbidity. To mitigate these, it is vital to enhance prenatal care, ensure skilled birth attendance, expand NICU facilities, implement routine screenings, enforce stringent infection control and educate parents.

Assessing educational disparities in COVID-19 related excess mortality in Spain: a population register-linked mortality study.

Data on the increase in mortality during the COVID-19 pandemic based on individuals' socioeconomic positions are limited. This study examines this increase in mortality in Spain during the epidemic waves of 2020 and 2021. We calculated the overall and cause-specific mortality rates during the 2017-2019 pre-pandemic period and four epidemic periods in 2020 and 2021 (first, second, third-fourth, and fifth-sixth waves). Mortality rates were analyzed based on educational levels (low, medium, and high) and across various age groups (25-64, 65-74, and 75+). The increase in mortality during each epidemic period compared to the pre-pandemic period was estimated using mortality rate ratios (MRR) derived from Poisson regression models. An inverse educational gradient in overall mortality was observed across all periods; however, this pattern was not consistent for COVID-19 mortality in some age groups. Among those aged 75 years and older, highly educated individuals showed higher COVID-19 mortality during the first wave. In the 25-64 age group, individuals with low education experienced the highest overall mortality increase, while those with high education had the lowest increase. The MRRs were 1.21 and 1.06 during the first wave and 1.12 and 0.97 during the last epidemic period. In the 65-74 age group, highly educated individuals showed the highest overall mortality increase during the first wave, whereas medium-educated individuals had the highest increase during the subsequent epidemic periods. Among those aged 75 and older, highly educated individuals exhibited the highest overall mortality increase while the individuals with low education showed the lowest overall mortality increment, except during the last epidemic period. The varying educational patterns of COVID-19 mortality across different age groups contributed to the disparities of findings in increased overall mortality by education levels during the COVID-19 pandemic.

Epidemiological Pattern and Case Fatality Rate among COVID-19 Patients during First and Second Wave of Pandemic in Madhesh Province, Nepal

Background & Objectives: Evaluating multi-wave patterns of COVID-19 infection, hospitalization, and mortality across spatial scales can inform public health strategies for future pandemics. However, there is limited understanding of these patterns in developing countries, including Nepal. This study aimed to analyze epidemiological patterns, fatality rates, and factors associated with severe outcomes during the first and second waves of COVID-19 in Madhesh Province, Nepal. Materials and Methods: This retrospective cross-sectional study used provincial health records from Madhesh Province, covering April 9, 2020, to December 15, 2021, to analyze 37,551 positive COVID-19 cases and 1,037 deaths across two waves. The study examined changes in COVID-19-related deaths, with data on demographics, residence, isolation sites, treatment hospitals, care levels, and testing laboratories. The frequency and percentage of the variables were presented. The case fatality rate (CFR) for different categories were calculated. Additionally, the case fatality rate ratio (CFRR) for the first wave against second wave was obtained. Finally, case fatality risk ratios with 95% confidence intervals were presented. A p-value of <0.05 was set as statistically significant. Results: The case fatality rate (CFR) for COVID-19 was significantly higher in the second wave, especially among the elderly (≥47 years), and in institutional isolation (7.82%). Tertiary level care and private hospitals consistently showed higher CFRs. Furthermore, the multivariable analysis of risk ratios (RR) for COVID-19 case fatality in revealed that the 25–34 year age group had the highest RR (2.39). Similarly, males had a higher RR (1.42) than females, and institutional isolation had a substantially higher RR (93.33) compared to home isolation. Primary level care RR (28.11) and government hospitals RR (4.32) showed a higher risk. Place of residence also impacted the RR, with Sarlahi (7.68) having higher. Conclusion: A significant increase in COVID-19 case fatality rates during the second wave, particularly among the elderly and those in institutional isolation. Higher mortality was observed in tertiary hospitals and among those who were tested in private laboratories, with substantial variations in risk ratios based on age, isolation type, and place of residence.

A study of clinical profile and outcome of shock in pediatric intensive care unit of Al-Ameen Medical College and Hospital, Vijayapura

Background: The clinical syndrome of shock, a clinical state characterized by inadequate tissue perfusion, is one of the most dramatic, dynamic and life-threatening problems faced by the physician in the critical care setting. Methods: This retrospective observational study analysed all critically ill children aged 1 month to 12 years who were admitted to our hospital’s Pediatric Intensive Care Unit (PICU) between January 2023 and December 2023, requiring mechanical ventilation and presenting with clinical evidence of shock. The majority of deaths in this cohort were attributed to decompensated shock. The Paediatric Index of Mortality 3 (PIM3) score was calculated for each patient to evaluate the severity of illness and predict outcomes. The authors meticulously documented the patterns of morbidity and mortality across different types of shock and assessed the outcomes in the PICU. All collected data were systematically compiled and tabulated for comprehensive analysis. Results: The frequency of shock in our PICU was 2.1% (n=257). However, among mechanically ventilated patients it was present in 104.31 patients. Septic shock was the most commonly encountered shock (62.6%). Out of 186 cases, 125 survived (67.2%), 61 died (32.8%). Shock had no correlation with PIM3 score and mortality. Conclusions: Shock is a significant cause of morbidity and mortality in children, especially those under 5 years of age. In our study, septic shock was identified as the most prevalent form of shock, with severe pneumonia being the leading cause. We found that mortality rates were higher in patients who required prolonged mechanical ventilation. To improve outcomes and management strategies, larger prospective multicentric studies in developing countries are highly recommended.

A surveillance study of cancer incidence and mortality among young adults in Costa Rica

There has been an increase in certain cancers among young adults (YA) aged 20-39, particularly in LatinAmerica. This is the first study to examine cancer incidence and mortality in YA in Costa Rica, focusing on sex-specific patterns. Invasive cancer cases (excluding non-melanoma skin cancer) in YA from 2006 to 2015 were obtained from the Costa Rican National Registry of Tumors. Utilising SEER∗Stat software, age-standardized incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Trends and annual percent changes (APCs) in IRs were estimated using the Joinpoint regression analysis program. Cancer deaths from 2000 to 2021 were obtained from the Costa Rican National Institute of Statistics and Census. Age-standardised mortality rates were calculated using STATA®17. YA comprised 10.7% of all invasive cancer cases diagnosed from 2006 to 2015. The age-standardized incidence rate (ASIR) of invasive cancer in YA was 50.9/100,000 person-years. The ASIR was twofold higher for females compared to males (IRR=2.03, 95% CI:1.94, 2.13). This difference increased with age, peaking in the 35-39-year age group (IRR=2.84, 95% CI:2.62, 3.10). Thyroid, breast, and cervical cancer were the most common in females. Testicular cancer was the most common in males. Leading causes of cancer-related deaths included cervical and breast cancer in females and stomach and brain/nervous system cancer in males. The study highlights sex-specific patterns in cancer incidence and mortality among YA in Costa Rica to increase understanding and improve cancer outcomes in this age group. This study was funded by the Intramural Research Program of the National Cancer Institute.

Disentangling the relationship between cancer mortality and COVID-19 in the US

Cancer is considered a risk factor for COVID-19 mortality, yet several countries have reported that deaths with a primary code of cancer remained within historic levels during the COVID-19 pandemic. Here, we further elucidate the relationship between cancer mortality and COVID-19 on a population level in the US. We compared pandemic-related mortality patterns from underlying and multiple cause (MC) death data for six types of cancer, diabetes, and Alzheimer’s. Any pandemic-related changes in coding practices should be eliminated by study of MC data. Nationally in 2020, MC cancer mortality rose by only 3% over a pre-pandemic baseline, corresponding to ~13,600 excess deaths. Mortality elevation was measurably higher for less deadly cancers (breast, colorectal, and hematological, 2–7%) than cancers with a poor survival rate (lung and pancreatic, 0–1%). In comparison, there was substantial elevation in MC deaths from diabetes (37%) and Alzheimer’s (19%). To understand these differences, we simulated the expected excess mortality for each condition using COVID-19 attack rates, life expectancy, population size, and mean age of individuals living with each condition. We find that the observed mortality differences are primarily explained by differences in life expectancy, with the risk of death from deadly cancers outcompeting the risk of death from COVID-19.