Mortality Patterns Research Articles

Trend in the age mortality structure during the COVID-19 pandemic

Introduction. The COVID-19 pandemic, caused by a novel SARS-CoV-2 coronavirus infection, lasted just over three years. Its end was announced in early May 2023. According to official data, the pandemic claimed 6.9 million lives worldwide, but it is believed that at least 20 million people were victims. The first wave of the pandemic was caused by a virus that spread from China. The virus mainly kills representatives of older age groups of the population and is characterized by a high degree of mutagenicity, which contributes to the emergence of new strains of the virus. The most aggressive and established in the population new strains of the virus spread and gave rise to the second wave of the pandemic, which turned out to be the longest. The third wave was caused by the most aggressive strain, spreading from India, and caused the greatest number of deaths. Aim of the study was to identify the extent to which changes in the virus itself affected the gender and age mortality structure during the three waves of the COVID-19 pandemic observed between 2020 and 2021. Materials and methods. The method of single factor analysis of variance was applied. The study was based on the data of the Operational Headquarters under the Government of Samara region, which were published daily with the indication of gender, age, and cause of each death. Results. The analysis confirmed the influence of the virus variability factor on the age mortality structure at the significance level of p<0.05. Comparison of the diagrams of the shares of the selected age segments in the mortality of men and women in each of the pandemic waves clearly showed how the gender and age mortality structure changed. The result of the analysis of variance showed that the changes occurring in the virus itself, although not as significant, affected the mortality pattern, with male mortality being more affected than female mortality. Conclusion. The result of the analysis of variance showed changes occurring in the virus itself to have an impact on the mortality structure, and on male mortality to a greater extent than on female mortality.

Avian influenza viruses in wild birds in Canada following incursions of highly pathogenic H5N1 virus from Eurasia in 2021-2022.

We present the results of Canada's Interagency Surveillance Program for Avian Influenza in Wild Birds in the year following the first detection of highly pathogenic avian influenza virus (HPAIV) H5N1 on the continent. The surveillance program tested over 17,000 wild birds, both sick and apparently healthy, which revealed spatiotemporal and taxonomic patterns in HPAIV prevalence and mortality across Canada. The significant shift in the presence and distribution of HPAIV in Canada's wild birds underscores the need for sustained investment in wild bird surveillance and collaboration across One Health partners.

IGF-1 induces sex-specific oxidative damage and mortality in a songbird

The insulin-like growth factor 1 (IGF-1) is a pleiotropic hormone that regulates essential life-history traits and is known for its major contribution to determining individual ageing processes. High levels of IGF-1 have been linked to increased mortality and are hypothesised to cause oxidative stress. This effect has been observed in laboratory animals, but whether it pertains to wild vertebrates has not been tested. This is surprising because studying the mechanisms that shape individual differences in lifespan is important to understanding mortality patterns in populations of free-living animals. We tested this hypothesis under semi-natural conditions by simulating elevated IGF-1 levels in captive bearded reedlings, a songbird species with an exceptionally fast pace of life. We subcutaneously injected slow-release biodegradable microspheres loaded with IGF-1 and achieved a systemic 3.7-fold increase of the hormone within the natural range for at least 24 h. Oxidative damage to lipids showed marked sexual differences: it significantly increased the day after the manipulation in treated males and returned to baseline levels four days post-treatment, while no treatment effect was apparent in females. Although there was no overall difference in survival between the treatment groups, high initial (pre-treatment) IGF-1 and low post-treatment plasma malondialdehyde levels were associated with enhanced survival prospects in males. These results suggest that males may be more susceptible to IGF-1-induced oxidative stress than females and quickly restoring oxidative balance may be related to fitness. IGF-1 levels evolve under opposing selection forces, and natural variation in this hormone’s level may reflect the outcome of individual optimization.

Assessment of the Quality of Cause-of-Death Data in Serbia for 2005-2019 Vital Statistics Performance Index Estimation.

We aimed to evaluate the quality of the cause of death (COD) concerning mortality patterns and completeness of death registration to identify areas for improvement in Serbia. COD data collected from the mortality register in Serbia from 2005 to 2019 (1540615 deaths) were analyzed with the software Analysis of National Causes of Death for Action. The Vital Statistics Performance Index for Quality (VSPI(Q)) is estimated for the overall COD data quality. The completeness of death certification was higher than 98%. Usable underlying COD was registered in 57%, 24.1% with an unusable and 18.6% with insufficiently specified COD. The VSPI(Q) was 67.2%, denoting medium quality. The typical error was using intermediate COD (24.7% of all deaths), while 13.2% and 8.5% of all garbage codes (GC) belonged to the Very High and High Severity classes. The leading underlying COD is unspecified cardiomyopathy. The analysis revealed that 39.1% of GC has been redistributed to non-communicable diseases, 2.5% to external causes and 1.1% to communicable diseases. In the 15 years' worth of data analyzed, the true underlying COD, in many cases, was ill-defined, indicating that COD data at the national level could be distorted. The additional and continuous professional education of medical students as well as physicians is needed. It should focus on the most common GC among the leading COD and acquiring skills in certifying external causes of death.

Spatio-temporal patterns of excess mortality from non-COVID causes of death in the United States, march-December 2020.

Objectives To estimate the burden of excess mortality from 17 underlying causes of death between March-December 2020 in the United States, and to compare trends in excess deaths from non-COVID causes vs. from COVID-19. Methods Using time series models, we estimated monthly counts of all-cause and cause-specific excess deaths. We stratified by geographic region and compared temporal trends in excess deaths from non-COVID causes to trends in deaths attributed to COVID-19. Results Of approximately 500,000 excess deaths, 70% were attributed to COVID-19. We observed increases in several underlying causes of death, ranging from a 3% increase in kidney disease deaths to a 24% increase in homicides, as well as decreases in deaths from cancer (-0.3%), influenza and pneumonia (-2%), chronic lower respiratory disease (-3%), and suicide (-7%). Trends in excess deaths from cardiovascular disease, diabetes, and Alzheimer's disease closely mirrored trends in deaths from COVID-19. Trends in excess liver disease, homicide, suicide, and motor vehicle accident deaths were negatively correlated with trends in deaths from COVID-19. There was wide regional variation in excess death rates for some causes of death, including a disproportionate increase in homicide and motor vehicle accident deaths in the Great Lakes, and a sustained reduction in cancer deaths in the Mideast and New England. Conclusions Increases in cardiovascular disease, diabetes, and Alzheimer's disease deaths from March-December 2020 likely reflect healthcare system disruptions or acute complications of COVID-19. Excess deaths from homicide and liver disease are more likely to reflect social and economic effects of the emerging pandemic, or other separate causes.

Geographical patterns of under-five mortality in Nigeria: does internet use matter?

Geographical patterns of under-five mortality in Nigeria: does internet use matter?

What was Killing Babies in Rostock? An Investigation of Infant Mortality Using Individual-Level Cause-of-Death Data, 1800–1904

This paper examines the causes of infant mortality for the Hanseatic city of Rostock, Germany, between 1800 and 1904. Based on unique individual-level church records from Rostock's largest inner-city parish, St. Jakobi, we apply the novel ICD10h coding system for the first time to the German context. Using this coding system, we analyse cause-specific patterns of infant, neonatal and post-neonatal mortality in an internationally comparable way and bring new insights into the determinants of 19th-century infant mortality, which was shaped by increase and stagnation in wide parts of Germany. Our results show that Rostock experienced a stagnating infant mortality rate at a low level in international comparison during the first 40 years of the 19th century, followed by severe increases during the next 20 years and a stage of slight decline and stagnation towards the end of the study period. This suboptimal development from 1840 was strongly related to post-neonatal mortality and causes of death that are related to unfavourable sanitary conditions and/or poor nutrition, which possibly hints at worsening housing and living conditions following accelerated population growth. Our analyses also reveal that water-food borne diseases were underestimated in Rostock, even though symptomatic disease terms such as convulsions and teething, that were frequently recorded over much of the 19th century, had deviating seasonality patterns and thus cannot entirely refer to this disease group but rather to a wide field of different diseases. The applied coding scheme is a significant step forward to foster comparative international research on historical cause-specific mortality.

Time Trends and Geographic Patterns of Mortality Due to Tracheal, Bronchus, and Lung Cancer in Portugal

Tracheal, bronchus, and lung cancer (TBLC) remains a major public health concern. Knowledge about geographic patterns and time trends in TBLC could give insights to better address this problem. This study aimed to evaluate the geographic patterns and time trends in mortality due to TBLC observed in Portugal. TBLC-related deaths and population estimates (2011–2021) were derived from the Instituto Nacional de Estatística. Age-standardized mortality rates for people aged 50 or more (ASMR_50+) per 100,000 were obtained. Analyses were stratified by gender, geographic region, and level of urbanization. The time trends in ASMR_50+ were evaluated using joinpoint regression models, and the values for the annual percentage change (APC) and the respective 95% confidence interval (95% CI) were obtained. Differences in mortality due to TBLC between regions and levels of urbanization (2017–2021) were assessed through a standardized mortality ratio (SMR) and the respective 95% CI. In 2021, the ASMR_50+ per 100,000 inhabitants observed in mainland Portugal was 158.0 and 40.4 among men and women, respectively. According to the time-trend analysis, ASMR_50+ due to TBLC remained stable or described a downward trend among men, but there was an upward trend among women in suburban and urban regions. Observed deaths were significantly higher than the expected for men in urban areas (SMR = 125%; 95% CI: 121–128 and SMR = 118%; 95% CI: 115–122 in Norte and Lisboa, respectively), and women in Urban Norte (SMR = 125%; 95%CI: 119–131). Lower mortality than expected was observed among men living in Rural Norte and Rural Centro, as well as, among women living in all the rural areas. In suburban areas, the observed deaths were lower, higher, or as expected depending on the geographic region and gender. A notable upward trend in mortality due to TBLC among women was observed. The geographic patterns observed suggest the effects of deleterious environmental factors and smoking habits, deserving attention from policymakers.

Acute Lymphoblastic Leukemia Mortality trend in the Federal District, Brazil, 2000-2020

Objective: To identify the trend and spatial distribution of deaths from ALL from 2000 to 2020 in the Federal District, Brazil. Method: This is ecological time series study in which data were obtained from Brazil's Mortality Information System. The population was obtained through death certificates and investigation forms of the underlying cause of death classified by code C91.0 for Acute Lymphoblastic Leukemia in the International Classification of Diseases from 2000 to 2020 in the Federal District, Brazil. Statistical analysis was performed using Prais-Winsten linear regression. Results: The deaths from ALL predominantly occurred in male (51.70%), single (60.41%), and white (52.16%) subjects, as well as in those with four to seven years of schooling (27.37%). During the last 20 years, ALL mortality increased among subjects aged 0-4 and 50-59 years, with increment rates of 9.0% and 8.7% respectively. In children, ALL generally has a short latency time, progressing more quickly and invasively. Conclusions: Knowledge regarding mortality patterns for ALL in the Federal District will allow optimizing the allocation of federal and local resources, as well as understanding gaps in diagnosis and specific therapies that still need attention on the part of public policy makers.

Exploring the impacts of risk factors on mortality patterns of global Alzheimer’s disease and related dementias from 1990 to 2021

Alzheimer’s Disease and Related Dementias (ADRD) affect millions of people worldwide, with mortality rates influenced by several risk factors and exhibiting significant heterogeneity across geographical regions. This study aimed to investigate the impact of risk factors on global ADRD mortality patterns from 1990 to 2021, utilizing clustering and modeling techniques. Data on ADRD mortality rates, cardiovascular disease, and diabetes prevalence were obtained for 204 countries from the GBD platform. Additional variables such as HDI, life expectancy, alcohol consumption, and tobacco use prevalence were sourced from the UNDP and WHO. All the data were extracted for men, women, and the overall population. Longitudinal k-means clustering and generalized estimating equations were applied for data analysis. The findings revealed that cardiovascular disease had significant positive effects of 1.84, 3.94, and 4.70 on men, women, and the overall ADRD mortality rates, respectively. Tobacco showed positive effects of 0.92, 0.13, and 0.39, while alcohol consumption had negative effects of − 0.59, − 9.92, and − 2.32, on men, women, and the overall ADRD mortality rates, respectively. The countries were classified into five distinct subgroups. Overall, cardiovascular disease and tobacco use were associated with increased ADRD mortality rates, while moderate alcohol consumption exhibited a protective effect. Notably, tobacco use showed a protective effect in cluster A, as did alcohol consumption in cluster B. The effects of risk factors on ADRD mortality rates varied among the clusters, highlighting the need for further investigation into the underlying causal factors.

From single trees to country-wide maps: Modeling mortality rates in Germany based on the Crown Condition Survey

Most years in the period from 2018 to 2022 have been exceptionally dry in Central Europe. In Germany’s forests, this long-lasting drought has caused unprecedented tree mortality. Systematic ground-based surveys, such as the annual Crown Condition Survey, provide information on the vitality status of the different tree species and their mortality rates. However, models are needed to be able to map the spatial patterns of mortality for each tree species based on cause-effect relationships derived from field observations. In this study, logistic regression models were used to identify the most important drivers of mortality for the most important tree species in Germany. For this purpose, the dead and surviving trees from the Crown Condition Survey were combined with a large set of potential predictor variables from the domains of climate, topography, soil, land cover and deposition. After feature selection, the models were evaluated using the area under the curve (AUC) statistic. Norway spruce (Picea abies; AUC = 0.9) showed by far the greatest increase in mortality, with the country-wide average observed and predicted rates approaching almost 10% per year from 2020 to 2022, and much higher predicted rates at the regional level. Much of the spruce mortality was explained by the climatic water balance of the driest summer in previous years. The other main tree species also showed clear mortality responses to the drought conditions. However, in the case of European beech (Fagus sylvatica; AUC = 0.94) and Pedunculate and Sessile oak (Quercus robur and petraea; AUC = 0.88), the peaks in the time series of the country-wide mortality rates stayed below 1%. For these broadleaved species, mortality was more dependent on a range of site conditions, i.e., soil and topography. For Scots pine (Pinus sylvestris; AUC = 0.76), for which the observed mortality rate peaked at 1.2% in 2020, the given drivers could explain mortality only to a lesser degree than for the other species. The regression models were used for spatial prediction to produce country-wide maps of species-specific mortality rates at annual temporal and 100-m spatial resolution, covering all years from 1998 to 2022. The maps visualize the spatial patterns of mortality over time. The regions in western and central Germany, which were most seriously affected by spruce dieback can clearly be identified. The models and maps presented can be used for risk assessment, forest planning, and tree species selection, providing decision support for forest practitioners.

888 Incidence Rates of Penn Classes and Class-Specific Mortality in Acute Type an Aortic Dissection Patients: An Epidemiological Systematic Review and Meta-Analysis

Abstract Background Acute type A aortic dissection (ATAAD) is a life-threatening emergency which is associated with high morbidity and mortality. One of the complications is end-organ ischemia, a known predictor of mortality. The primary aim of this meta-analysis is to summarise the findings of observational studies investigating the utility of the Penn classification system as well as analyse the incidence rates and mortality patterns within each class. Method Electronic databases PubMed, MEDLINE, and Embase were searched through to April 2023. These were then filtered by multiple reviewers to meet the inclusion criteria. The extracted data included patient characteristics and primary outcomes included incidence rates of different Penn classes, along with the corresponding mortality for each class. Results Out of 1512 studies identified during the initial search, ten studies met the inclusion criteria. Pooled incidence of Penn A was the highest at 0.55 [0.52, 0.58] followed by Penn B at 0.21 [0.17, 0.25], and Penn C at 0.14 [0.11, 0.17]. Patients with both Penn B+C were found to be at the highest risk of death as their mortality rates were 0.36 [0.31, 0.41]. Within those populations, the subtype with the highest individual mortality was Penn C at 0.21 [0.15, 0.27] followed by Penn B at 0.19 [0.15, 0.23] and Penn A at 0.07 [0.05, 0.10]. Conclusions In conclusion, amongst patients presenting with ATAAD, Penn class A was the most frequently observed, followed by classes B, C, and BC. Our findings indicate an incremental increase in mortality rates with the progression of Penn classification.

Long-term dynamics of epidemiological characteristics of some chronic leukemia and lymphoma in Moscow before, during and after the pandemic of the new coronavirus infection COVID-19. Epidemiologic study

Background. The COVID-19 pandemic, which swept the world in 2020–2021, had a significant impact on the epidemiological picture of hematological malignancies. Aim. To study the dynamics of epidemiological indicators of five chronic hemoblastoses in Moscow over a 12-year period, and also to assess the impact of the COVID-19 pandemic on these indicators. Materials and methods. A population-based study was conducted for five types of oncohematological diseases: multiple myeloma, Hodgkin's lymphoma, follicular lymphoma, chronic lymphocytic leukemia, chronic myeloid leukemia. The annual rates of morbidity, mortality, prevalence of these nosologies, overall survival, and expected overall survival were calculated. Gender and age characteristics for each disease were determined. Results and discussion. The present study showed a uniform increase in the incidence and prevalence of five hematological malignancies between 2012 and 2019. Convincing evidence of an increase in mortality and a decrease in the number of diagnosed cases in comparison with the expected figures for these hematological malignancies in 2020–2021 was presented. A greater reduction was shown for cases diagnosed at early stages compared to later ones. During the pandemic, a significant increase in mortality was recorded among patients with chronic lymphocytic leukemia and multiple myeloma, while in cohorts of patients with chronic myeloid leukemia and Hodgkin lymphoma it increased slightly. The return of morbidity, mortality and prevalence rates to the original dynamics in 2022–2023 has been demonstrated. Conclusion. This study demonstrated the features of the regional pattern of incidence, mortality, prevalence and gender-age characteristics of five hematological malignancies and provided the changes in the indicators dynamics of different hematological malignancies during the COVID-19 pandemic.

Death on the permafrost: Revisiting the 1918-20 influenza pandemic in Alaska using death certificates.

The 1918-20 influenza pandemic devastated Alaska's Indigenous populations. We report on quantitative analyses of pandemic deaths due to pneumonia and influenza (P&I) using information from Alaska death certificates dating between 1915 and 1921 (n=7,147). Goals include a reassessment of pandemic death numbers, analysis of P&I deaths beyond 1919, estimates of excess mortality patterns overall and by age using intercensal population estimates based on Alaska's demographic history, and comparisons between Alaska Native (AN) and non-AN residents. Results indicate that ANs experienced 83% of all P&I deaths and 87% of all-cause excess deaths during the pandemic. AN mortality was 8.1 times higher than non-AN mortality. Analyses also uncovered previously unknown mortality peaks in 1920. Both subpopulations showed characteristically high mortality of young adults, possibly due to imprinting with the 1889-90 pandemic virus, but their age-specific mortality patterns were different: non-AN mortality declined after age 25-29 and stayed relatively low for the elderly, while AN mortality increased after age 25-29, peaked at age 40-44, and remained high up to age 64. This suggests a relative lack of exposure to H1-type viruses pre-1889 among AN persons. In contrast, non-AN persons, often temporary residents, may have gained immunity before moving to Alaska.

Impact of COVID Pandemic on Pattern and Outcome of Admissions in a Paediatric Emergency Unit in Sokoto, Nigeria

Background: The COVID pandemic had widespread impact on the world population, especially on health-care. This ranged from direct effects of the infection on populace, in addition to changing pattern of morbidity and mortality, children inclusive. Objectives: To compare the pattern and outcome of admissions during the COVID pandemic period (2020 – 2021) to the preceeding year (2019) in the emergency Paediatric unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: This was a retrospective study. The admission records of children aged > 1 month to 15 years were retrieved, relevant information extracted, entered into a study proforma and analysed with SPSS version 24. Results: Total admissions were 3741. The 1st pandemic year (2020) had the lowest (1116, 29.8%) while 1406 (37.6%) and 1219 (32.6%) patients were admitted in 2019 and 2021. The lowest admission was between March and June 2020 coinciding with the lockdown, highest was in August 2020 when restrictions had been lifted. The topmost admissions yearly were malaria, acute respiratory infections and acute gastroenteritis. The trend showed that all cases reduced in the pandemic years (2020-2021) but respiratory infections increased. Mortality was highest in 2020 (p=0.001). Malaria was the highest cause of mortality for the 3 years, however, mortality rate from sepsis, cardiac and respiratory diseases rose sharply in the pandemic years. Three confirmed cases of COVID were seen with 1 mortality. Conclusion: Admission rates reduced during the pandemic year in 2020 however, with increased rate of mortality. There was increase rate of sepsis, cardiac and respiratory mortality following the pandemic.

Trends and distribution patterns of infant mortality and maternal HIV positivity in South Africa: A decade review (2007 - 2016).

The infant mortality rate (IMR) (24 per 1 000 live births) remains high in South Africa (SA), well above the recommended sustainable development goal (SDG) 3 of 12 deaths per 1 000 live births. High infant mortality is a poor indicator of the health of a population and will hamper attainment of the SDGs. To investigate the trends and distribution patterns of IMR between 2007 and 2016 and its association with HIV-positive pregnant mothers in SA. This study used a cross-sectional study design by analysing secondary data on infant mortality from the 2007 and 2016 Statistics South Africa Community Surveys (CSs), as well as data from the 2007 National Antenatal Sentinel HIV and Syphilis Prevalence Survey. (Antenatal HIV Sentinel Survey - ANCHSS). Line charts with descriptive statistics were used to detail trends in IMRs, and multiple logistic regression models were used to identify risk factors for infant mortality in the 2007 and 2016 CS datasets. Spearman's rank-order correlation (rho) was used to correlate infant mortality with data from the 2007 ANCHSS. All analyses were performed with Stata version 16.0. A total sample of 87 805, comprising 43 922 males and 43 883 females, was included in the analysis. The results revealed a decline in IMR from 55 deaths per 1 000 live births in 2007 to 32 in 2016. Overall, there was a significant decrease in the mortality rate from 2007 to 2016. The infant mortality proportions by province showed KwaZulu-Natal Province having the highest IMR (17.5 deaths per 1 000 live births in 2007 and 6.3 in 2016). Males had a higher IMR (28 deaths per 1 000 live births in 2007 and 17.7 in 2016) compared with females at 26.7 deaths per 1 000 live births in 2007 and 13.8 in 2016. IMR data from the 2007 CS was correlated with the 2007 ANCHSS (28% HIV prevalence in 2007), using Spearman's rank-order correlation, which showed a moderate correlation of 0.58 (p<0.001). The study findings showed a reduction in the trends of infant mortality between 2007 and 2016 in SA; despite the reduction, health inequalities persist. There is a correlation evident between maternal HIV prevalence and IMR in SA. We recommend the use of disability-adjusted life expectancy in SA to measure population health and introduce robust data sets that can better inform policy.

“Racial mortality inversion”: Black-white disparities in mortality among people experiencing homelessness in the United States

Disparities in mortality between Black and White people have long been observed. These disparities persist at all income levels. However, similar patterns in racial mortality disparities are not observed among people experiencing homelessness. Instead, studies in a handful of cities show a reversal in the Black-White mortality disparity in the United States: Black people experiencing homelessness are less likely to die compared to White people experiencing homelessness. We propose a theory of “racial mortality inversion” and test whether inverted Black-White mortality patterns are observable in homeless populations throughout the United States. Using a novel dataset of 18,618 homeless decedents in 20 localities across 10 states and the District of Columbia, we find consistent evidence for “racial mortality inversion” across time and place. Between 2015 and 2020, the aggregate White homeless mortality rate was 67.8%–138.4% higher than the rate for the Black homeless population. Inverted racial mortality rates were observed in all 20 localities and in nearly every year. Across the entire sample, higher average ages of death were also observed for Black people compared to White people experiencing homelessness in 5 of 6 years, though racial inversion in age was not consistent across localities. These findings offer novel insight into racial health disparities among people experiencing homelessness and may inform policies and programs that seek to prevent homelessness and homeless mortality across racial groups.

Biological and Conservation Aspects of Otter Mortality: A Review

The post mortem exam is important in diagnosing and investigating wildlife diseases. It is even more important to monitor the population of species that are not easily observed in the wild, such as otters. Of the 13 otter species, 11 are endangered due to many factors, such as climate change, pollution, or urbanisation. The authors present a review of the patterns of mortality of free-ranging otters worldwide, aiming to improve the knowledge of otter mortality and the role of mortality studies in their conservation. The main cause of death in aquatic otters is vehicle collision; hence, sea otter deaths are associated with shark attacks and imprisonment in fishing gear. It is possible to conclude that humans and human activity play a significant role in the mortality of these animals. In the future, a more standardised analysis of otter carcasses is necessary to understand their threats and diseases and design significant measures to protect these species.

Common clinical findings identified in working equids in low- and middle-income countries from 2005 to 2021.

Despite several millions of working equids worldwide, there are few published studies regarding the epidemiology of their health and welfare. Data collected by non-governmental organisations (NGOs) operating in the working equid sphere therefore have important epidemiological value and could be used towards animal health surveillance. The aim of this study was to identify common clinical findings and mortality patterns of working equids in low- and middle-income countries and investigate their epidemiology using data collected from an international NGO. A retrospective analysis was conducted to determine the proportion of clinical findings and mortality risk by equid species, year and region. Negative binomial regression models were generated to investigate differences in mortality risk and proportion of key clinical findings between equid species, hemispheres and calendar month. A total of 4,313,606 presentations were reported from 14 countries between January 2005 and March 2021 (mean 22,121; SD ± 7,858 per month). Wounds and abscesses were the most reported clinical finding for all equid species (mean proportion 35%; SD ±0.19 of all findings). A higher proportion of wounds (mean proportion 41.7%; SD±0.2) was recorded in donkeys than mules or horses (P<0.001). Mules had higher reported mortality risk (1.2%; 95% CI 0.94-1.46%) than horses (0.4%; 95% CI 0.36-0.55%; p<0.001) or donkeys (0.2%; 95% CI 0.14-0.22%). Work-related wounds were the predominant finding in working equids, particularly so in donkeys. Prevention strategies should focus on improvements to work equipment and practices for all equids. Future investigations required include refinement of diagnostic approaches for donkeys and investigation of risk factors to understand the higher mortality in mules. Routine monitoring of clinical findings reported by national or international NGOs could be included in animal health surveillance strategies, although standardisation of data for this purpose is needed so that changes in prevalence following implementation of prevention strategies can be monitored.

Comprehensive analysis of morbidity and mortality patterns in familial partial lipodystrophy patients: insights from a population study.

There is a lack of information on the clinical and molecular presentation of familial partial lipodystrophy (FPLD), a rare genetic disorder characterized by partial subcutaneous fat loss. This study aimed to provide a comprehensive assessment of the clinical, metabolic, and genetic features of FPLD in the Brazilian population. In a multicenter cross-sectional investigation we evaluated patients with FPLD across five Brazilian reference centers for lipodystrophies. Diagnosis of FPLD was made by clinical evaluation and genetic confirmation. Data on genetic, clinical, and metabolic characteristics were captured. Statistical analysis involved the utilization of the Kruskal-Wallis test to identify differences. The study included 106 patients with genetic confirmation of FPLD. The mean age was 44 ± 15 years, and they were predominantly female (78.3%). LMNA pathogenic variants were identified in 85.8% of patients, PPARG in 10.4%, PLIN1 in 2.8%, and MFN2 in 0.9%. Diabetes mellitus (DM) was highly prevalent (57.5%), affecting 54 females (50.9%). Median triglycerides levels were 199 mg/dL (54-2724 mg/dL), severe hypertriglyceridemia (≥ 500 mg/dL) was found in 34.9% and pancreatitis in 8.5%. Metabolic-associated fatty liver disease (MAFLD) was observed in 56.6%, and cardiovascular disease in 10.4%. The overall mortality rate was 3.8%, due to cardiovascular events. This study presents an extensive cohort of Brazilian patients with FPLD, predominantly DM with several multisystem complications. A comprehensive characterization of lipodystrophy syndromes is crucial for effective patient management and care.