Mortality Patterns Research Articles

Time trends in the mortality of testicular cancer across the BRICS: an age-period-cohort analysis for the GBD 2019

Testicular cancer (TCa) is a rare but impactful malignancy that primarily affects young men. Understanding the mortality rate of TCa is crucial for improving prevention and treatment strategies to reduce the risk of death among patients. We obtained TCa mortality data by place (5 countries), age (20–79 years), and year (1990–2019) from the Global Burden of Disease Study 2019. Age-period-cohort model was used to estimate the net drift, local drift, age effects, period and cohort effects. In 2019, the global mortality of TCa increased to 10842 (95% UI 9961, 11902), with an increase of 50.08% compared to 1990.The all-age mortality rate for TCa in 2019 increased from 0.17/100,000 (95% UI 0.13, 0.20) in China to 0.48/100,000 (95% UI 0.38, 0.59) in Russian Federation, whereas the age-standardized mortality rate in 2019 was highest in the South Africa 0.47/100,000 (95% UI 0.42, 0.53) and lowest in the China 0.16/100,000 (95% UI 0.13, 0.19). China's aging population shifts mortality patterns towards the elderly, while in Russian Federation, young individuals are primarily affected by the distribution of deaths. To address divergent TCa mortality advancements in BRICS countries, we propose a contextually adaptive and resource-conscious approach to prioritize TCa prevention. Tailoring strategies to contextual diversity, including policy frameworks, human resources, and financial capacities, will enhance targeted interventions and effectiveness in reducing TCa mortality.

Patterns and inferred causes of liana mortality in a tropical forest.

Lianas are major contributors to tropical forest dynamics, yet we know little about their mortality. Using overlapping censuses of the lianas and trees across a 50 ha stand of moist tropical forest, we contrasted community-wide patterns of liana mortality with relatively well-studied patterns of tree mortality to quantify patterns of liana death and identify contributing factors. Liana mortality rates were 172% higher than tree mortality rates, but species-level mortality rates of lianas were similar to trees with 'fast' life-history strategies and both growth forms exhibited similar spatial and size-dependent patterns. The mortality rates of liana saplings (<2.1 cm in diameter), which represent about 50% of liana individuals, decreased with increasing disturbance severity and remained consistently low during post-disturbance stand thinning. In contrast, larger liana individuals and trees of all sizes had elevated mortality rates in response to disturbance and their mortality rates decreased over time since disturbance. Within undisturbed forest patches, liana mortality rates increased with increasing soil fertility in a manner similar to trees. The distinct responses of liana saplings to disturbance appeared to distinguish liana mortality from that of trees, whereas similarities in their patterns of death suggest that there are common drivers of woody plant mortality.

The Influence of Urbanization on the Patterns of Hepatocellular Carcinoma Mortality From 1999 to 2020.

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related fatalities despite early diagnosis and treatment progress, creating a significant public health issue in the United States. This investigation utilized death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to investigate HCC mortality patterns and death locations from 1999 to 2020. The objective was to analyze trends in HCC mortality across different population groups, considering the impact of urbanicity. In this study, death certificate data obtained from the CDC WONDER database were utilized to investigate the trends in HCC mortality and location of death between 1999 and 2020. The annual percent change (APC) method was applied to estimate the average annual rate of change during the specified timeframe for the relevant health outcome. Furthermore, including data on the location of death and geographic areas allowed us to gain deeper insights into the patterns and characteristics of HCC and its impact on different regions. Between 1999 and 2020, there were 184,073 reported deaths attributed to HCC, and data on the location of death were available for all cases. Most deaths occurred during inpatient admissions (34.93%) or at home (41.19%). The study also found that the highest age-adjusted mortality rate (AAMR) for HCC was observed among male patients, particularly among those identified as Asian or Pacific Islander. Variations in AAMR were determined based on the level of urbanization or rurality of the area, with higher rates observed in more densely populated and urbanized regions. In contrast, less urbanized and populated areas experienced a profound increase in AAMR over the past two decades. The HCC-related AAMRs have worsened over time for most ethnic groups, except for Asian or Pacific Islanders, which showed a reduction in APC despite having the worst AAMR. Although rural and less densely populated areas have substantially increased AAMR over the past two decades, more urbanized areas continued to have higher AAMR rates.

Patterns of Acute Ischemic Stroke Treatment from 2010 to 2020: An Evolving Landscape in Stroke Management Following Thrombectomy Trials.

Population-based studies on stroke can help guide the care of patients with acute ischemic stroke (AIS) by providing health care communities with information regarding the current usage of stroke treatments. It remains unclear how rapidly new techniques, particularly endovascular stroke treatment (EST), are being adopted and whether there is any disparity in their availability. Although studies using the National Inpatient Sample (NIS) have been conducted, updated studies over a longer period may provide further insights. This study aimed to understand patterns of AIS treatment, discharge disposition, in-hospital mortality, and mean length of stay (LOS) for each modality from 2010 to 2020 using the NIS database. This retrospective longitudinal study was conducted using NIS data from 2010 to 2020. Patients were categorized into groups based on whether they received intravenous recombinant tissue plasminogen activator (rt-PA), EST, both rt-PA and EST (combined therapy), or supportive care alone. Demographic, socioeconomic, regional, insurance, and hospital data were also obtained. The primary outcome was the proportion of patients receiving each modality, whereas the secondary outcomes were in-hospital mortality, mean LOS, and discharge disposition. The usage rates increased (p < 0.001) in all groups between 2010 and 2020 (rt-PA: 5.09% to 8.39%, EST: 0.31% to 4.40%, and rt-PA+EST: 0.46% to 1.09%). The highest increase in usage was observed for EST, with a thirteen-fold increase. Mortality decreased from 2010 to 2020 in all groups (rt-PA: 8.45% to 3.54%, EST: 25.22% to 12.50%, and rt-PA+EST: 21.12% in 2010 to 9.30%) (p < 0.001). Combination therapy demonstrated the greatest improvement, with an 11.2% reduction in absolute mortality. Mean LOS was reduced for patients who received rt-PA (6.8 to 4.8 days), EST (9.3 to 8.9 days), and combined therapy (10.0 to 8.3 days) (p < 0.001) over the study period. The proportion of patients discharged to home increased for rt-PA (29.01% to 41.85%), EST (14.13% to 17.70%), and combined therapy (12.89% to 24.29%) (p < 0.001). Overall, stroke treatment usage was higher among the higher income groups, regardless of race. Higher usage was also observed for Whites in the West and Hispanic ethnicities in the South and West. Regardless of income or treatment method, utilization rates were lower for Black patients. Utilization rates were lower for Black patients with Medicare, Medicaid, or self-pay than for White patients. Our study demonstrated that endovascular stroke treatment continues to expand, leading to better outcomes for mortality, LOS, and home discharge. Despite these positive patterns, there are visible inequities across regions, income status, and races.

Evaluation of trend and mortality pattern of communicable diseases in a teaching institution in Kerala.

Even in this era of epidemiologic transition communicable disease is still a major public health problem. Surveillance and timely prevention and control activities are the key to the reduction of morbidity and mortality of communicable diseases. Identifying the trend in communicable diseases and pattern of mortality for a period of ten years will be an insight into the ongoing surveillance. In this study we have analysed data from 2013 to 2022 to evaluate the trend and mortality pattern of communicable diseases in a teaching institution in Kerala. A retrospective record-based cross-sectional study conducted at the Department of Community Medicine, Government Medical College, Kottayam. All confirmed communicable disease cases reported from 2013 to 2022 were included in this study except COVID-19-positive cases. The communicable diseases were grouped as: airborne, waterborne, vector-borne, zoonosis, bloodborne diseases and others. SPSS version 20.0 software, Microsoft Word, and Excel were used in data handling and analysis. Total cases reported were 48124. The majority of the morbidity was due to airborne diseases (17585,37%) followed by waterborne diseases (6381, 13%). The total number of deaths reported was 1842. Airborne and zoonotic diseases together accounted for more than 50% of the mortality. Case fatality rate of zoonosis (20.2%) was the highest followed by bloodborne diseases (10.2%). Communicable diseases still continue as a public health problem contributing to morbidity and mortality. Airborne diseases and zoonotic diseases constitute the maximum mortality.

Estimating 1a0 and 4a1 in a Life Table: A Model Approach Based on Newly Collected Data

The average age of infant deaths, a10, and the average number of years lived—in the age interval—by those dying between ages 1 and 5, a41, are important quantities allowing the construction of any life table including these ages. In many applications, the direct calculation of these parameters is not possible, so they are estimated using the infant mortality rate—or the death rate from 0 to 1—as a predictor. Existing methods are general approximations that do not consider the full variability in the age patterns of mortality below the age of 5. However, at the same level of mortality, under-five deaths can be more or less concentrated during the first weeks and months of life, thus resulting in very different values of a10 and a41. This article proposes an indirect estimation of these parameters by using a recently developed model of under-five mortality and taking advantage of a new, comprehensive database by detailed age—which is used for validation. The model adapts to a variety of inputs (e.g., rates, probabilities, or the proportion of deaths by sex or for both sexes combined), providing more flexibility for the users and increasing the precision of the estimates. This fresh perspective consolidates a new method that outperforms all previous approaches.

Mortality trends (1999-2022) in patients with multiple myeloma with pneumonia, influenza, and COVID-19.

7553 Background: Patients (pts) with multiple myeloma (MM) are immunosuppressed either due to the hypogammaglobulinemia and impaired plasma cell function or due to pharmacological management and stem cell transplantations. Consequently, they are at a higher risk of infections. This study aims to evaluate the changes in mortality from COVID-19 (CVD), influenza virus (FLU), and pneumonia (PNA) in MM pts in the era of CVD pandemic. Methods: Using the Wide-ranging Online Data for Epidemiologic Research (WONDER) database from the CDC, we collected mortality data for pts with CVD (U07.1 code), FLU and PNA (J09-J18 codes), and MM (C90.0 code). Using sex and ethnicity-specific stratification, the gathered data made it easier to calculate age-adjusted mortality rates (AAMRs) per 100,000 people. Using the collected data we were able to analyze mortality patterns over the years 1999-2022. Results: Overall, 25,271 MM pts died from CVD, FLU and PNA between 1999 to 2022. The mortality rate remained stable from 1999 to 2019 ranging between 0.4 AAMR per 100,000 to 0.3 AAMR, representing an annual percentage change (APC) of -0.5%. However, the mortality rate increased in 2019, rising from 0.3 AAMR per 100,000 to 0.5 in 2022, with APC of 7%. When evaluating the trends by gender, there was an increase in mortality among male pts, rising from 0.4 AAMR per 100,000 to 0.7 between 2019 and 2020, while the increase among females was minimal, from 0.3 AAMR per 100,000 to 0.4. While Hispanic, White, and African American ethnicities mortality increased in 2020-2022, Asian pts maintained a rate of 0.2 AAMR in 2019, 2020, and 2022 (Table). Conclusions: We showed an increase in mortality among pts with MM combined with CVD, FLU, or PNA between 2020 and 2021. It might be attributable to the CVD pandemic, announced by WHO in March 2020. Despite the FDA's approval of the first CVD vaccine in December 2020, the emergence of new CVD variants and limited vaccine availability could have contributed to a continued increase in mortality in 2021.In 2022, we noticed a drop in mortality. It might be explained by the wider accessibility to CVD vaccination or to diminished virulence. Additionally, increased awareness of the importance of CVD vaccinations in immunocompromised pts could also lead to increased FLU vaccination rates. It might explain the downtrending mortality of pts with MM, FLU and PNA only in 2021. This is the first study presenting the mortality trend of MM pts with FLU, PNA and CVD, and comes to highlight the importance of vaccination in immunocompromised MM pts. [Table: see text]

In-hospital mortality patterns and risk factors in patients with cancer with COVID-19.

e23070 Background: The current body of knowledge regarding outcomes of patients with cancer and COVID-19 is conflicting, with some studies suggesting worsened mortality in those with both diseases This study seeks to shed light on the distinctive factors influencing in-hospital mortality in these two cohorts, providing crucial insights that can guide targeted interventions and enhance healthcare strategies for individuals facing the dual burden of cancer and COVID-19. Methods: We conducted a retrospective review of all patients hospitalized with COVID-19 at our institution between January 1, 2021 and April 1, 2023. Patients were stratified into a cohort of those with cancer and coexisting COVID-19 infection and those with solely COVID-19. The cancer and COVID-19 cohort included patients over the age of 18 who had received treatment for cancer within the last 6 months. Information regarding patient demographic characteristics and comorbidities, as well as in-hospital treatment characteristics and outcomes. We performed descriptive analysis and conducted Chi-squared and t-tests to assess for differences in baseline characteristics between cohorts, then developed Cox proportional hazards models to evaluate risk factors for in-hospital mortality. Results: 456 patients with cancer and COVID-19 were compared with 12,566 patients with only COVID-19. In-hospital mortality was 8.2% in the cancer cohort compared with 9.0% in the COVID-19 only cohort. Patients in the cancer cohort were more likely to be male (55.7% vs 48.2%, p = 0.004), older (71 vs 64 years, p &lt; 0.001) with histories of heart failure (27% vs 21%, p = 0.002), chronic kidney disease (50% vs 39%, p &lt; 0.001), COPD (35% vs 24%, p &lt; 0.001), and anemia (57% vs 24%, p &lt; 0.001). The cancer cohort experienced significantly longer length of stay (9 vs 7 days, p &lt; 0.001). Requirement of mechanical ventilation and ICU stay were similar between groups. Multivariate Cox proportional hazards ratios demonstrated similar mortality between cohorts (HR = 0.863, p = 0.361), with age (HR = 1.041, p &lt; 0.001) and history of acute myocardial infarction (HR = 1.275, p = 0.01) being significant predictors of death. Conclusions: Our study demonstrates the complex relationship between cancer, COVID-19, and in-hospital mortality. Despite differences in baseline characteristics between the cohorts, our findings reveal that, after adjusting for confounding factors, there is no significant disparity in mortality rates between patients concurrently battling cancer and COVID-19 and those solely afflicted by COVID-19. The identification of age and a history of acute myocardial infarction as significant predictors of mortality underscores the need for targeted interventions and vigilant management strategies for individuals facing the dual burden of cancer and COVID-19, ensuring equitable and effective healthcare outcomes in this complicated patient population.

Pattern of mortality in a tertiary care teaching hospital according to the 11th Revision International classification of disease

Pattern of mortality in a tertiary care teaching hospital according to the 11th Revision International classification of disease

Bayesian Spatio-Temporal Modeling of the Dynamics of COVID-19 Deaths in Peru.

Amid the COVID-19 pandemic, understanding the spatial and temporal dynamics of the disease is crucial for effective public health interventions. This study aims to analyze COVID-19 data in Peru using a Bayesian spatio-temporal generalized linear model to elucidate mortality patterns and assess the impact of vaccination efforts. Leveraging data from 194 provinces over 651 days, our analysis reveals heterogeneous spatial and temporal patterns in COVID-19 mortality rates. Higher vaccination coverage is associated with reduced mortality rates, emphasizing the importance of vaccination in mitigating the pandemic's impact. The findings underscore the value of spatio-temporal data analysis in understanding disease dynamics and guiding targeted public health interventions.

Mortality of working-age physicians compared to other high-skilled occupations in Austria from 1998 to 2020.

Physicians have been shown to have lower mortality compared to the general population, particularly regarding lifestyle-associated causes of death. Prior literature is divided on whether this is due to higher socioeconomic position (SEP), healthier lifestyle, or other specific occupational characteristics. This study analyzed the mortality of Austrian physicians compared to the general population and other (health) professionals with a similar SEP, and investigated patterns of lifestyle-associated mortality among physicians. Data from professional associations and cause-of-death statistics were collated to determine causes of death for all occupational groups. Gender-specific age-standardized mortality rates (ASMR) and standardized rate ratios (SRR) were calculated to compare main causes of death [cancer, cardiovascular disease (CVD), external causes] among physicians to other (health) professionals and the general population. Standardized mortality ratios (SMR) were calculated for more detailed causes of death in physicians compared to the general population. Physicians had lower all-cause mortality than the general population [SRR 0.45, 95% confidence interval (CI) 0.41-0.49 for males and SRR 0.60, 95% CI 0.54-0.66 for females] and health professionals (SRR 0.72, 95% CI 0.60-0.88 for males and SRR 0.77, 95% CI 0.63-0.93 for females), mostly due to low CVD and cancer mortality. SMR for detailed causes of death among physicians exhibited a pattern of particularly low mortality in lifestyle-associated causes of death and an increased SMR for suicide among female physicians (SMR 1.58, 95% CI 1.22-2.02). This study confirmed lower mortality among physicians compared to the general population and compared to other (health) professionals. Low physician mortality can be primarily explained by lifestyle-associated causes of death.

Evaluating drivers of recent large whale strandings on the East Coast of the United States.

Anthropogenic stressors threaten large whales globally. Effective management requires an understanding of where, when, and why threats are occurring. Strandings data provide key information on geographic hotspots of risk and the relative importance of various threats. There is currently considerable public interest in the increased frequency of large whale strandings occurring along the US East Coast of the United States since 2016. Interest is accentuated due to a purported link with offshore wind energy development. We reviewed spatiotemporal patterns of strandings, mortalities, and serious injuries of humpback whales (Megaptera novaeangliae), the species most frequently involved, for which the US government has declared an "unusual mortality event" (UME). Our analysis highlights the role of vessel strikes, exacerbated by recent changes in humpback whale distribution and vessel traffic. Humpback whales have expanded into new foraging grounds in recent years. Mortalities due to vessel strikes have increased significantly in these newly occupied regions, which show high vessel traffic that also increased markedly during the UME. Surface feeding and feeding in shallow waters may have been contributing factors. We found no evidence that offshore wind development contributed to strandings or mortalities. This work highlights the need to consider behavioral, ecological, and anthropogenic factors to determine the drivers of mortality and serious injury in large whales and to provide informed guidance to decision-makers.

Compensation effect of mortality is a challenge to substantial lifespan extension of humans.

Despite frequent claims regarding radical extensions of human lifespan in the near future, many pragmatic scientists caution against excessive and baseless optimism on this front. In this study, we examine the compensation effect of mortality (CEM) as a potential challenge to substantial lifespan extension. The CEM is an empirical mortality regularity, often depicted as relative mortality convergence at advanced ages. Analysis of mortality data from 44 human populations, available in the Human Mortality Database, demonstrated that CEM can be represented as a continuous decline in relative mortality variation (assessed through the coefficient of variation and the standard deviation of the logarithm of mortality) with age, reaching a minimum corresponding to the species-specific lifespan. Through this method, the species-specific lifespan is determined to be 96-97years, closely aligning with estimates derived from correlations between Gompertz parameters (95-98years). Importantly, this representation of CEM can be achieved non-parametrically, eliminating the need for estimating Gompertz parameters. CEM is a challenge to lifespan extension, because it suggests that the true aging rate in humans (based on loss of vital elements, e.g., functional cells) remains stable at approximately 1% per year in the majority of human populations and is not affected by environmental or familial longevity factors. Given this rate of functional cell loss, one might anticipate that the total pool of functional cells could be entirely depleted by the age of 115-120years creating physiological limit to human lifespan. Mortality pattern of supercentenarians (110 + years) aligns with this prediction.

Long‐term (29‐year) spatiotemporal patterns of sea turtle deaths in the southern Gulf of Mexico

Abstract Sea turtles are key imperilled species that interact with numerous threats in their critical in‐water and inland habitats, which they occupy along their complex life cycle. Therefore, analysing these interactions is essential for adapting ongoing conservation and management actions. The long‐term recording of stranded sea turtle individuals and the potential causes of death in their breeding habitats is crucial for defining and adapting conservation actions. Twenty‐nine years of sea turtle stranding and mortality data (1992–2019) at nesting beaches in Campeche, Mexico, were analysed to describe their spatiotemporal patterns per species and possible causes of death. The most impacted species was the hawksbill turtle, followed by green and Kemp's ridley individuals. The most frequent probable causes of death in this region were bycatch, seismic surveys, vehicle strikes and slaughter at nesting beaches. Both immature and breeding individuals were stranded, mostly the former, and the most frequent months were in the summer (June–August). This study establishes a historic reference baseline for the spatiotemporal mortality patterns of imperilled sea turtle species in the southeastern Gulf of Mexico. It shows their interactions with anthropogenic activities and the circumstances jeopardizing their population recovery. It also points out management and conservation actions to implement to improve their long‐term viability in the context of the operationalization of their key attributes and interactions with their seascapes.

Resistance of Indonesian tilapia strains, Oreochromis niloticus to Tilapia Lake Virus Disease (TiLVD)

This study aims to evaluate the resistance of six Indonesian tilapia strains to TiLV disease and assess the impact of mimicked daily water temperature fluctuations on the disease severity. Six widely cultured Indonesian tilapia (Oreochromis niloticus) strains were evaluated for resistance to tilapia lake virus disease (TiLVD). Resistance to TiLVD was assessed using two artificial infection methods, cohabitation and intraperitoneal (IP) injection. Fish infected with TiLVD exhibited behavioural, clinical and mortality patterns associated with TiLV disease. Virus presence was also confirmed molecularly. All six tilapia strains were susceptible to TiLV infection, causing disease and mortality. The range of mortality for cohabitation was 1.67% - 28.33% and for IP injection was 16.67% - 61.67%. The most resistant tilapia strain to TiLV disease was Gesit, followed by Best, Red/Albino, Nirwana, Non-specific and Srikandi. Daily temperature variation results in higher significant virus-induced mortality pattern among tilapia strains. These findings can be used to guide the selection of appropriate tilapia strain and temperature control to mitigate the adverse effects of TiLV associated disease.

Risk factor profile and outcomes in young patients presenting with acute ST-segment elevation myocardial Infarction

Abstract Introduction ST-elevation myocardial infarction (STEMI) is more prevalent in the elderly population1, but is now becoming more common in the younger population. It has been of particular concern due to its potential for premature death and long-term morbidity. Early identification and timely modification of risk factors in this population is critical2,3. Secondary prevention issues in populations are well studied, and such data for young adults are lacking in the literature. Purpose The purpose of this study was to compare pattern of traditional CVD risk factors, hospital mortality and major adverse cardiac events at discharge in young versus old patients (≤45years and above 45 years age respectively) admitted with STEMI and undergoing primary PCI. Methods This retrospective cohort study was conducted on consecutive patients presenting with STEMI between June 2013 and June 2018 in a single centre cardiac only tertiary care setup. Institute’s registry is fashioned along and is affiliated with US NCDR. Patients with cardiac arrest or cardiogenic shock at arrival were excluded. MACE was defined as post PCI cardiac arrest or cardiogenic shock, heart failure, major bleed or hospital death. Results Total of 5343 patients were admitted with STEMI during study period, after exclusion data of 1642 patients were analyzed. Table 1 demonstrates demographic and historical characteristics of the study population. Among young patients, the frequency of the male gender,any tobacco use and family history of premature coronary artery disease were significantly higher (all p values &amp;lt; 0.001). While in older STEMI patients frequency of heart failure, hypertension, prior myocardial infarction, diabetes mellitus ,abnormal creatinine clearance (&amp;lt;90 mL/min/1.73 m²) , multi-vessel coronary disease, advanced Killip class and higher body mass index was more prevalent (all P&amp;lt;0.001). Table 2 demonstrates predictors of in hospital death and MACE. Among young patients advanced Killip class and femoral access site(all P values &amp;lt;0.001), diabetes mellitus (p=0.03), abnormal creatinine clearance(p=0.04),and left ventricular ejection fraction less than 40%(p=0.01), were more significant in-hospital mortality predictor where as advanced Killip class,Left ventricular ejection fraction less than 40% male gender(p=0.04), diabetes mellitus(p=0.001),femoral access site(p=0.001), and Left ventricular ejection fraction less than 40% were more significant MACE predictors (all P&amp;lt;0.001). Conclusion There were no significant difference in hospital mortality and MACE among young versus old STEMI patients when adjusted for diabetes mellitus, abnormal creatinine clearance (&amp;lt;90 mL/min/1.73 m²), multi-vessel coronary disease, advanced Killip class. Tobacco use is the main modifiable risk factors for young patients with STEMI. Surprisingly, being a woman and having a positive family history with premature coronary artery disease were protective.

Sex differences at diagnosis and in one-year outcomes in patients with early atrial fibrillation

Abstract Background Little is known about differences in clinical phenotype between men and women with atrial fibrillation (AF). Our aim was to explore phenotypical sex differences at diagnosis and at one-year follow-up, in patients with early AF. Methods We used data from 5,469 participants of the DUTCH-AF registry; a nationwide prospective registry of patients with early AF or atrial flutter (diagnosis ≤ 6 months before inclusion) in the Netherlands, aged ≥ 18 years. We describe sex differences in clinical phenotype at diagnosis and at one-year follow-up, including the following outcomes: i) ischemic and bleeding events, ii) all-cause mortality, iii) AF-related hospital admissions, including ablation and cardioversion, and iv) AF progression patterns. Results At inclusion, women were older than men (median 73 vs. 69 years, p&amp;lt;0.001), had more often paroxysmal AF (66% vs. 55%, p&amp;lt;0.001), and less often persistent AF (27% vs. 37%, p&amp;lt;0.001). They also had hypertension more often (59% vs. 53%, p&amp;lt;0.001), and less often vascular disease (12% vs. 21%, p&amp;lt;0.001, and reported more often symptoms at inclusion and in the month before follow-up; 56% vs. 46%, p&amp;lt;0.001, and 31% vs. 23%, p&amp;lt;0.001, respectively. Women underwent cardioversion and ablation procedures less often than men (14% vs. 21% p&amp;lt;0.001 and 3% vs. 5%, p&amp;lt;0.001, respectively). Moreover, for the combined rhythm control intervention cardioversion and ablation, women also underwent this rhythm control outcome less often than men (unadjusted odds ratio was 0.63 95% CI (0.55-0.73)), regardless of age, and the type of AF (i.e., paroxysmal or persistent AF) at inclusion (adjusted odds ratio 0.77 95% CI (0.62-0.92)). No differences were observed for ischemic and bleeding events, all-cause mortality, or AF progression patterns, but the number of these events was small. Conclusion Men and women with early AF differ in age, comorbidities, symptoms, and management. These findings are building blocks for individualized sex-specific AF care and research.

Deciphering the genetic landscape of lumpy skin disease: Unraveling variable virulence through comprehensive genome sequence analysis in India

Lumpy Skin Disease (LSD), a poxvirus disease affecting cattle, emerged in India in 2019 and intensified in 2022, resulting in significant economic losses for dairy farmers. There was unusual shift in mortality and morbidity patterns during the second wave. A comprehensive genetic study conducted, analyzing samples from 2019 to 2022 revealed circulation of two distinct subclades (subclade 1.2a and 1.2b) in India, with the latter showing a different pattern in morbidity and mortality. Notably, the Ankyrin repeats gene-based analysis could differentiate animals with varying clinical scores. Genetic variations were significant, with unique deletions identified, including a 12-nucleotide deletion in the GPCR gene in virus isolates collected during 2022 outbreaks, not reported earlier in Indian LSDV strains. A crucial finding was a significant 95-nucleotide deletion in the Functional Resolution Sequence (FRS) repeats of LSDV genomes from 2022 outbreaks, absent in 2019 samples. These deletions may have influenced the virus's virulence in India.

Geospatial patterns of excess mortality in Belgium: Insights from the first year of the COVID-19 pandemic

Objectives:Belgium experienced multiple COVID-19 waves that hit various groups in the population, which changed the mortality pattern compared to periods before the pandemic. In this study, we investigated the geographical excess mortality trend in Belgium during the first year of the COVID-19 pandemic. Methods:We retrieved the number of deaths and population data in 2020 based on gender, age, and municipality of residence, and we made a comparison with the mortality data in 2017–2019 using a spatially discrete model. Results:Excess mortality was significantly associated with age, gender, and COVID-19 incidence, with larger effects in the second half of 2020. Most municipalities had higher risks of mortality with a number of exceptions in the northeastern part of Belgium. Some discrepancies in excess mortality were observed between the north and south regions. Conclusions:This study offers useful insight into excess mortality and will aid local and regional authorities in monitoring mortality trends.

Social Determinants of Health Among American Indians and Alaska Natives and Tribal Communities: Comparison with Other Major Racial and Ethnic Groups in the United States, 1990-2022.

Limited research exists on health inequities between American Indians and Alaska Natives (AIANs), tribal communities, and other population groups in the United States. To address this gap in research, we conducted time-trend analyses of social determinants of health and disease outcomes for AIANs as a whole and specific tribal communities and compared them with those from the other major racial/ethnic groups. We used data from the 1990-2022 National Vital Statistics System, 2015-2022 American Community Survey, and the 2018-2020 Behavioral Risk Factor Surveillance System to examine socioeconomic, health, disability, disease, and mortality patterns for AIANs. In 2021, life expectancy at birth was 70.6 years for AIANs, lower than that for Asian/Pacific Islanders (APIs) (84.1), Hispanics (78.8), and non-Hispanic Whites (76.3). All racial/ethnic groups experienced a decline in life expectancy between the pre-pandemic year of 2019 and the peak pandemic year of 2021. However, the impact of COVID-19 was the greatest for AIANs and Blacks whose life expectancy decreased by 6.3 and 5.8 years, respectively. The infant mortality rate for AIANs was 8.5 per 1,000 live births, 78% higher than the rate for non-Hispanic Whites. One in five AIANs assessed their physical and mental health as poor, at twice the rate of non-Hispanic Whites or the general population. COVID-19 was the leading cause of death among AIANs in 2021. Risks of mortality from alcohol-related problems, drug overdose, unintentional injuries, and homicide were higher among AIANs than the general population. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates, with differences in these indicators varying markedly across the AIAN tribes. AIANs remain a disadvantaged racial/ethnic group in the US in many health and socioeconomic indicators, with poverty rates in many Native American tribal groups and reservations exceeding 40%.