Mortality Rate Ratios Research Articles

Abstract 4113475: Association of Age at Diabetes Diagnosis and All-cause and Cardiovascular Mortality among 600,000 US Adults

Introduction: Diabetes is a leading cause of morbidity and mortality in the United States, causing an estimated 440,000 deaths among US adults in 2019. Establishing the relevance of diabetes diagnosis at various ages to mortality in the contemporary US population, both overall and among major demographic subgroups, may inform public health policy and strategy. Methods: We aimed to quantify the association between age at diabetes diagnosis and all-cause and cardiovascular mortality among US adults using publicly-available data from the National Health Interview Survey 1997-2018, linked to the National Death Index through 2019. We used Cox regression adjusted for age, sex, race and ethnicity, educational attainment, smoking status, body-mass index, physical activity, and insurance coverage to estimate all-cause and cardiovascular mortality rate ratios overall, by sex, and by race and ethnicity. Results: Among 601,467 included adults (56% female, 16% Hispanic and 14% non-Hispanic Black) there were 75,122 deaths during 6.6 million person-years of follow-up. Overall, the all-cause mortality rate ratio associated with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years were 3.87 (95% CI 3.47-4.32), 2.87 (2.68-3.07), 2.26 (2.16-2.36), 1.72 (1.65-1.79), 1.47 (1.41-1.53), and 1.26 (1.19-1.33), respectively. The corresponding cardiovascular mortality rate ratios were 5.02 (4.09-6.16), 3.37 (2.99-3.78), 2.88 (2.65-3.13), 1.94 (1.81-2.09), 1.53 (1.43-1.65), and 1.27 (1.15-1.40), respectively. Although these associations were similar by sex and by race and ethnicity, the age-specific prevalence of diabetes was greatest among non-White participants. Among individuals with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years, an estimated 74%, 65%, 56%, 42%, 32%, or 20% of deaths from any cause were attributable to diabetes. Conclusion: Age at diabetes diagnosis was associated with all-cause and cardiovascular mortality in a dose-dependent and approximately log-linear manner. Although associations were similar across diverse demographic groups, age-specific diabetes prevalence was greatest among non-White individuals, leading to greater mortality burden. If these associations were interpreted as largely causal, diabetes accounted for more than half of all deaths among those diagnosed before age 50 years. Preventing, delaying, and appropriately managing diabetes could prevent substantial excess mortality among US adults.

Abstract 4137880: Access to exercise opportunities, physical inactivity and cardiovascular mortality: A nationwide study in the U.S.

Aims: Despite efforts to promote physical activity, the prevalence of physical inactivity continues to rise. Exercise access influences population activity levels, but county-level variation in physical activity and its link to cardiovascular disease (CVD) mortality is unclear. We explored the associations between access to exercise opportunities, levels of physical inactivity, and CVD mortality across U.S. counties Methods: The County Health Rankings and Roadmaps data and CDC WONDER mortality data were integrated. We compared age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization. The rate ratio (RR) for CVD mortality was calculated using generalized linear models. Results: CVD mortality decreased from high to low values of the county-level of physical activity across all demographic subgroups (P<0.001) (Table 1&Figure 1). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR, 0.93 [0.91–0.95]), which was most pronounced in relation to acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76–0.85]). The county-level physical inactivity was associated with an increased risk of CVD mortality (RR, 1.16 [1.14–1.17]), especially for ischemic heart disease (IHD) mortality (RR, 1.35 [1.31–1.38]) and AMI mortality (RR, 1.32 [1.25–1.38]) (Figure 2). All demographic subgroups demonstrated similar benefits by improving the county-level indicators of physical activity. Conclusion: Counties have the potential to make significant strides in preventing CVD and improving the cardiovascular health of their populations by enhancing access to exercise opportunities and reducing physical inactivity.

Perinatal death in the Nordic countries in relation to gestational age: The impact of registration practice.

Although perinatal death rates in the Nordic countries are among the lowest in the world, the risk of perinatal death is unevenly distributed across the Nordic countries, despite similarity in health care systems and pregnancy care. Birth registration practices across countries may explain some of the differences. We investigated differences in national registration of perinatal mortality within the Nordic countries and its impact on perinatal mortality according to gestational age. Each country provided information by answering a questionnaire about registration of perinatal deaths. Furthermore, we collected aggregated count data based on Medical Birth Registries (MBR) from all Nordic countries in 2000 to 2021. Perinatal mortality was defined as stillbirth or neonatal death occurring within first 7 days of life. Data were grouped into six groups by gestational age (GA): extremely preterm (>28 + 0 weeks, subdivided into 22 + 0-23 + 6 and 24 + 0-27 + 6), very preterm (GA 28 + 0-31 + 6), moderate preterm (GA 32 + 0-33 + 6), late preterm (GA 34 + 0-36 + 6), term (GA 37 + 0-40 + 6) and late term or post-term birth (GA ≥ 41 + 0). Perinatal mortality rate and risk ratio with 95% confidence intervals were calculated per country for each gestational age group. For Denmark, separate analyses included and excluded induced abortions. The study included 6 343 805 live births, 22 727 stillbirths and 8932 liveborn infants who died within the first week of life after GA 22 + 0. Further 25 057 births were included with GA < 22 + 0, unknown GA and as a result of induced abortion. Overall, perinatal mortality rates decreased during year 2000-2021 in all Nordic countries. After exclusion of induced abortions, the perinatal mortality rate was similar in the five Nordic countries. The perinatal mortality rate for extremely preterm born infants was highest in Denmark, whereas the highest rate among infants born late term/post-term was in Sweden. The perinatal mortality rate in the Nordic countries is still decreasing, especially in the group of extremely preterm born infants. This study supports the need for further standardization of birth registration practices to ensure the validity of international comparisons.

New Clinical and Public Health Challenges: Increasing Trends in United States Alcohol Related Mortality

In the United States (US) and worldwide alcohol is a major contributor to premature mortality and morbidity. We explored US trends in alcohol related mortality from 1999 to 2020 overall and by age, gender, race, and region METHODS: Publicly available US Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) and the underlying cause of death file from CDC WONDER using ICD-10 codes. In 1999, there were 19,356 alcohol-related deaths, a mortality rate of 10.7 per 100,000. By 2020, deaths increased to 48,870 or 21.6 per 100,000. Overall, the mortality rate ratio (MRR) was significantly increased about 2.0-fold. There were significant increases in all 10-year age groups with the largest 3.8-fold in those 25 to 34. Women experienced a 2.5-fold increase;. Asians and Pacific Islanders had the largest increase of 2.4-fold:. the Midwest showed the largest regional increase of 2.5-fold. . During the last 20 years there have significant increases of about 2-fold in US alcohol-related mortality. Clinical challenges are increased by interrelationships of risk factors, especially overweight and obesity and diabetes. -Alcohol,overweight and obesity and diabetes all cause liver damage which may be additive and lead to earlier onset of alcohol related mortality. In addition health providers should also consider demographic shifts, and regional differences. . Targeted interventions by health care providers may reduce this increasing US epidemic of alcohol related mortality. These data also generate many hypotheses testable in analytic studies designed a priori to do so.

Trends in All-cause Mortality among U.S. Veterans with Sarcoidosis, 2004–2022

BACKGROUNDSarcoidosis is an idiopathic multiorgan disease with variable clinical outcomes. Comprehensive analysis of sarcoidosis mortality in U.S. Veterans is lacking. RESEARCH QUESTIONSWhat are the trends in all-cause mortality among U.S. Veterans with sarcoidosis, and how are these trends influenced by demographics, Black vs. White racial disparities, and geographic variability in relation to mortality? STUDY DESIGN AND METHODSUsing Veterans Health Administration (VHA) electronic health records (EHR), we conducted a population-based, retrospective cohort study of adjusted all-cause mortality 2004–2022 among Veterans diagnosed with sarcoidosis who received care through the VHA. Demographics, region of residence, service branch, tobacco use, and comorbidities were extracted from EHR. Annual trends in all-cause mortality and patient-level characteristics associated with mortality were examined with multivariable ungrouped Poisson regression. We visualized trends and analyzed state-by-state mortality using the marginal means procedure. In subgroup analysis (2015–2022), we considered the impact of neighborhood-level socioeconomic disparities using the area deprivation index (ADI). RESULTSIn all, 23,745 Veterans were diagnosed with sarcoidosis between 2004 and 2019 and followed through 2022. After adjustment, including age and sex, all-cause mortality increased annually by 4.7% (P<0.0001) and was 6.4% higher in Black than White Veterans (mortality rate ratio=1.064, P=0.02). A subgroup analysis comparing models with and without ADI adjustment showed no meaningful change in mortality trends. Risk factors for increased all-cause mortality included older age, male sex, Black race, and Northeast residence, and lower risk with “Other” service branches. Despite distinct geographical variations in mortality rates, no clear patterns emerged. INTERPRETATIONMortality among Veterans with sarcoidosis is rising. Differences identified by service branch and higher risk among male Veterans raise questions about differences in environmental exposures. The narrower racial disparities and smaller impact of ADI than in other studies may highlight the role of universal healthcare access in achieving equitable outcomes.

Transition towards cancer mortality predominance over cardiovascular disease mortality in Brazil, 2000–2019: a population-based study

Cardiovascular disease (CVD) and cancer are the first and second leading causes of death in Brazil and worldwide. However, an ongoing epidemiological transition in which cancer surpasses CVD has been observed in many high and middle-income countries. In this study, we provided a nationwide analysis of the transition towards cancer mortality predominance over CVD mortality in Brazil. We leveraged data from 5570 municipalities using the Mortality Information System and classified the causes of death using ICD-10 codes. Age-standardized CVD and cancer mortality rates were calculated annually between 2000 and 2019. Mortality rate ratios (MRRs=CVD rates divided by cancer rates) described the predominance of cancer or CVD mortality across municipalities and states. Choropleth maps displayed state-specific MRRs and the transition in the predominant cause of death over time. From 2000 to 2019, CVD mortality rates declined in 25 out of 27 states, whereas cancer mortality increased in 15 states, indicating a shift towards cancer predominance. While in 2000 cancer mortality was lower than CVD in all states and only exceeded the latter in 7% of the municipalities, by 2019 the gap narrowed considerably, with 13% of municipalities displaying higher cancer mortality rates vs CVD mortality rates. Additionally, higher household income correlated with higher mortality from cancer vs CVD. An ongoing epidemiological transition in which cancer mortality surpasses CVD mortality is occurring in Brazil, particularly in municipalities with higher household incomes. Our findings may provide important information for policymakers and public health practitioners in Brazil. National Council for Scientific and Technological Development (CNPq).

Socioeconomic inequalities in avoidable mortality: results from the Italian nationwide cohort

Abstract Background Inequalities in avoidable mortality have been well evaluated in many European countries. We aimed to assess the association between socioeconomic status and avoidable mortality in Italy. Methods The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012- 2019 mortality. Outcomes of preventable and of treatable mortality were evaluated among people aged 30-74. Exposures were education level and residence macro area (North-West, North-East, Center, South-Islands). Adjusted mortality rate ratios (MRRs) were estimated through multivariate quasi-Poisson regression models, by sex and group of causes, taking into account age at death and macro area of residence. Relative index of inequalities (RII) was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes. Results The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). Highest RII were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Higher risks of preventable and of treatable mortality were found for those living in the South-Islands. Conclusions We documented relevant socioeconomic inequalities in avoidable mortality in Italy, especially in the Southern regions. They represent a possible missed gain in health and suggest a reassessment of priorities and definition of health targets with the lens of equity. Key messages • An inverse socioeconomic gradient in avoidable mortality was observed in Italy, both for preventable and for treatable mortality, with geographical heterogeneity. • Greatest social disparities were found in mortality for causes strongly associated with risk behavior and for which it is possible to identify risk factors on which to intervene.

Unveiling social disparities in later life: Income’s Impact on mortality among the elderly in Italy

Abstract Background Income is an important predictor of adult mortality, as a proxy of living conditions, capability and access to health services. Previous studies show that mortality decreases by increasing income. In Italy, studies at a national level are missing. This study aims to investigate inequalities in mortality by income in Italy. Methods The analysis is based on the integration of the National Population Register (comprising the resident population as of Dec 31, 2018, and deaths in 2019) and the Income Statistical Register (representing perceived income during 2018). This integration enabled the availability of information on age, sex, residence, education, income, and vital status at the individual level for 13 million people aged 65 or above. Individuals were categorized according to their individual disposable income quintiles both before and after disability benefits. Inequalities by income are assessed by mortality rate ratios (MRR) estimated using negative binomial regression models controlling for demographic and socioeconomic features. The study is carried out within the Next Gen EU-funded project “Age-It Ageing well in an ageing society” (PE0000015), NRRF, M4.C2, Intervention 1.3. Results Considering income net of disability benefits, lower income levels are associated with higher mortality rates compared to the highest income level, for both sexes. Inequalities are more marked for men. The highest excess was observed for individuals with the lowest income (male MRR=1.65, 95%CI: 1.6-1.71; female MRR=1.43, 95%CI: 1.38-1.48). The excess decreases with increasing income. Conclusions The observed relationships between income and mortality are crucial for targeting policies to reduce health inequalities and promote the well-being of the elderly, the goal of which should be to improve access to social and health care and develop supportive policies for the most disadvantaged people. Further research will be devoted to the use of household income for individuals. Key messages • For the elderly, lower income levels are associated with higher mortality, with wider disparities in men. • The choice of definition of income is essential for an accurate assessment of the association between income and mortality.

Educational inequalities in cervical cancer mortality in the Baltic Sea region in 2008–2015

Abstract Background Reducing inequalities in cervical cancer mortality is a public health priority. This study aims to assess the absolute and relative educational inequalities in cervical cancer mortality in the Baltic countries and Finland in 2008-2015. Methods Data for Estonia, Latvia and Lithuania were obtained from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, and data for Finland from the longitudinal register-based population data file of Statistics Finland. Cervical cancer deaths (ICD-10 code C53) were linked from national mortality registries. Educational level was census- or registry-based. Absolute and relative educational inequalities in cervical cancer mortality were assessed in 2008-2015 for women aged 30-49 and 50-64, using age-standardized mortality rates (ASMRs) per 100 000 person-years and mortality rate ratios (RRs) with 95% confidence interval (CI). Results This study included 1724 cervical cancer deaths and about 22 million person-years. Absolute and relative educational inequalities in cervical cancer mortality were considerably larger in the Baltic countries compared to Finland. Among 30-49-year-olds, ASMRs for high educated ranged from 0.6 (95% CI: 0.4-1.0) in Finland to 3.6 (95% CI: 2.5-5.0) in Lithuania, and for low educated from 2.2 (95% CI: 1.2-3.7) in Finland to 24.6 (95% CI: 18.2-32.4) in Lithuania. RRs for low educated compared to high educated ranged from 3.51 (95% CI: 1.57-7.68) in Finland to 9.11 (95% CI: 4.28-19.32) in Estonia. Among 50-64-year-olds, ASMRs for high educated ranged from 1.3 (95% CI: 0.8-2.0) in Finland to 9.8 (95% CI: 7.2-13.1) in Estonia and for low educated from 2.9 (95% CI: 1.9-4.1) in Finland to 43.9 (95% CI: 34.4-55.1) in Lithuania. RRs for low educated compared to high educated ranged from 2.18 (95% CI: 1.20-4.05) in Finland to 6.32 (95% CI: 4.30-9.36) in Lithuania. Conclusions Equitable prevention is a key to reducing cervical cancer mortality in the Baltic countries. Key messages • Lower-educated women largely drive high cervical cancer mortality in the Baltic countries. • Equity-focused prevention is crucial for reducing cervical cancer mortality in the Baltic countries.

Deprivation and stroke incidence, treatment and mortality in Germany

Abstract Background Previous research suggests that regional deprivation significantly influences the risk of stroke. However, little is known about regional differences in stroke incidence and mortality within Germany. Methods We utilized data from the Diagnosis Related Groups statistics (2016-2019) and the German Federal Register of Physicians (2019). We used negative binomial regression analysis to investigate the relationship between the German Index of Multiple Deprivation 2015, covering 401 districts and district-free cities in Germany, and stroke incidence, treatment, and mortality. Results The adjusted rate ratios of stroke incidence and mortality with the highest deprivation level compared with the least deprived area were 1.16 (95% CI [1.14, 1.17]) and 1.19 (95% CI [1.14, 1.23]), respectively. Furthermore, this study showed that the density of physicians was higher in district-free cities than in districts. Conclusions The findings document a relationship between regional deprivation and stroke incidence and mortality, and call for a more targeted approach to stroke prevention in deprived regions. Key messages • Regional deprivation in Germany linked to increased stroke incidence and mortality rates. • Policy action needed for effective prevention measures.

High mortality rates among individuals misdiagnosed with tuberculosis: a matched retrospective cohort study of individuals diagnosed with tuberculosis in Brazil.

We conducted a matched retrospective cohort study comparing mortality among individuals receiving a false-positive tuberculosis diagnosis (n=3701) to individuals correctly diagnosed with TB (n=8595) in Brazil from 2007-2016. Over an average 5.4-year follow-up period, we estimated a mortality rate ratio of 1.95 (95% confidence interval: 1.80, 2.11) for individuals incorrectly diagnosed with TB compared to controls. The leading causes of death among the misdiagnosed were malignant neoplasms (40.9%) and respiratory system disorders (15.9%), conditions with symptoms similar to tuberculosis. Our findings highlight the need for improved follow-up care after identification of false-positive cases to increase survival for this high-risk population.

Cardiovascular Disease Mortality Among Native Hawaiian and Pacific Islander Adults Aged 35 Years or Older, 2018 to 2022.

Native Hawaiian and Pacific Islander (NHPI) adults have historically been grouped with Asian adults in U.S. mortality surveillance. Starting in 2018, the 1997 race and ethnicity standards from the U.S. Office of Management and Budget were adopted by all states on death certificates, enabling national-level estimates of cardiovascular disease (CVD) mortality for NHPI adults independent of Asian adults. To describe CVD mortality among NHPI adults. Race-stratified age-standardized mortality rates (ASMRs) and rate ratios were calculated using final mortality data from the National Vital Statistics System for 2018 to 2022. Fifty states and the District of Columbia. Adults aged 35 years or older at the time of death. CVD deaths were identified from International Classification of Diseases, 10th Revision codes indicating CVD (I00 to I99) as the underlying cause of death. From 2018 to 2022, 10 870 CVD deaths (72.6% from heart disease; 19.0% from cerebrovascular disease) occurred among NHPI adults. The CVD ASMR for NHPI adults (369.6 deaths per 100 000 persons [95% CI, 362.4 to 376.7]) was 1.5 times higher than for Asian adults (243.9 deaths per 100 000 persons [CI, 242.6 to 245.2]). The CVD ASMR for NHPI adults was the third highest in the country, after Black adults (558.8 deaths per 100 000 persons [CI, 557.4 to 560.3]) and White adults (423.6 deaths per 100 000 persons [CI, 423.2 to 424.1]). Potential misclassification of underlying cause of death or race group. NHPI adults have a high rate of CVD mortality, which was previously masked by aggregation of the NHPI population with the Asian population. The results of this study support the need for continued disaggregation of the NHPI population in public health research and surveillance to identify opportunities for intervention. National Institute of General Medical Sciences, National Institutes of Health.

Diabetes and all-cause mortality among middle-aged and older adults in China, England, Mexico, rural South Africa, and the United States: A population-based study of longitudinal aging cohorts.

There is a need for comparable worldwide data on the impact of diabetes on mortality. This study assessed diabetes and all-cause mortality among middle-aged and older adults in five countries. We analyzed adults aged 51 years or older followed between 2010 and 2020 from population-based cohorts in China, England, Mexico, rural South Africa, and the United States. Diabetes was defined by self-report or an elevated diabetes blood-based biomarker meeting the clinical criteria for diabetes. All-cause mortality was assessed through linkages or informant interviews. We used Poisson regression models to estimate mortality rate ratios and mortality rate differences, comparing people with diabetes to those without diabetes. Models were adjusted for age, gender, education, smoking status, body mass index, and economic status. We included 29,397 individuals, of whom 4,916 (16.7%) died during the study period. The median follow-up time ranged from 4.6 years in South Africa to 8.3 years in China. The adjusted all-cause mortality rate ratios for people with diabetes versus those without diabetes ranged from 1.53 (95% CI: 1.39-1.68) in the United States to 2.02 (95% CI: 1.34-3.06) in Mexico. The adjusted mortality rate differences (per 1,000 person-years) for people with diabetes versus those without diabetes ranged from 11.9 (95% CI: 4.8-18.9) in England to 24.6 (95% CI: 12.2-37.0) in South Africa. Diabetes was associated with increased all-cause mortality in population-based cohorts across five diverse countries. There is an urgent need to implement clinical and public health interventions to improve diabetes outcomes globally. Why did we undertake this study?: We aimed to address the need for comparable estimates of all-cause mortality among people with diabetes in diverse global settings.What is the specific question(s) we wanted to answer?: How does diabetes impact all-cause mortality among middle-aged and older adults (aged 51 years or greater) in China, England, Mexico, rural South Africa, and the United States?What did we find?: Middle-aged and older adults with diabetes had higher all-cause mortality than people without diabetes in all countries. Relative mortality differences ranged from mortality rate ratios of 1.53 in the United States to 2.02 in Mexico. Absolute mortality differences ranged from mortality rate differences (per 1,000 person-years) of 11.9 in England to 24.6 in South Africa.What are the implications of our findings?: There is an urgent need to implement clinical and public health interventions to improve diabetes outcomes globally.

The burden of COVID-19 mortality among solid organ transplant recipients in the United States

Solid organ transplant recipients (SOTRs) have heightened risk of adverse COVID-19 outcomes due to immunosuppression and medical comorbidity. We quantified the burden of COVID-19 mortality in US SOTRs. A sample of deaths documented in the US solid organ transplant registry from June 2020 through December 2022 were linked to the National Death Index to identify COVID-19 deaths and weighted to represent all SOTR deaths during the study period. Among 505,757 SOTRs, 57,575 deaths occurred and based on the linkage, 12,396 (21.5%) were due to COVID-19. COVID-19 mortality was higher in males (mortality rate ratio [MRR]: 1.13), SOTRs aged 65 and older (MRR: 1.50 in ages 65–74 vs. ages 55–64), and non-Hispanic Black and Hispanic SOTRs (MRRs: 1.55 and 1.79 vs. non-Hispanic White SOTRs). Kidney and lung recipients had the highest COVID-19 mortality, followed by heart, then liver recipients. COVID-19 mortality also varied over time and across US states. Overall, SOTRs had 7-fold increased risk of COVID-19 death compared to the US general population. SOTRs comprised 0.13% of the US population but accounted for 1.46% of all US COVID-19 deaths. SOTRs experience greatly elevated COVID-19 mortality. Clinicians should continue to prioritize COVID-19 prevention and treatment in this high-risk population.

A Global Meta-Analysis of the Effects of Greenspaces on COVID-19 Infection and Mortality Rates.

The COVID-19 outbreak in 2020 resulted in rapidly rising infection rates with high associated mortality rates. In response, several epidemiological studies aimed to define ways in which the spread and severity of COVID-19 can be curbed. As a result, there is a steady increase in the evidence linking greenspaces and COVID-19 impact. However, the evidence of the benefits of greenspaces or greenness to human wellbeing in the context of COVID-19 is fragmented and sometimes contradictory. This calls for a meta-analysis of existing studies to clarify the matter. Here, we identified 621 studies across the world on the matter, which were then filtered down to 13 relevant studies for meta-analysis, covering Africa, Asia, Europe, and the USA. These studies were meta-analyzed, with the impacts of greenness on COVID-19 infection rate quantified using regression estimates whereas impacts on mortality rates were measured using mortality rate ratios. We found evidence of significant negative correlations between greenness and both COVID-19 infection and mortality rates. We further found that the impacts on COVID-19 infection and related mortality are moderated by year of publication, greenness metrics, sample size, health and political covariates. This clarification has far-reaching implications for policy development toward the establishment and management of green infrastructure for the benefit of human wellbeing.

State Variations In Progress Toward Eliminating Disparities In Infant Mortality, 2007-19.

Progress toward eliminating the Black-White disparity in US infant mortality rates has been slow and highly variable by state. Among thirty-two eligible states, eight had an increase (worsening), and twenty-four had a reduction (improvement) in their Black-White infant mortality rate ratios from 2008 to 2018. These findings necessitate dynamic, multilevel initiatives aimed at preventing Black infant deaths.

Epidemiological Analysis of Foot and Mouth Disease (FMD) Outbreak in 2014 in Sri Lanka

Sri Lanka faced a massive Foot and Mouth Disease (FMD) outbreak in 2014, which was initiated in Jaffna district in December 2013, and lasted for a period of more than a year, until January 2015. The disease spread throughout the country, affecting 68895 domestic animals, and causing 2007 deaths. The aim of this study was to epidemiologically analyze the data of 2014 FMD outbreak in order to understand the pattern and determinants of the massive disease distribution. Data were collected regarding the number of cases and deaths in relation to the time and location. Data in Disease Outbreak Reports, Follow-up Reports, Disease Investigation Reports and Laboratory Investigation Reports were reviewed, and descriptive and simple statistical analyses were carried out concerning the 57 epidemiological week study period. Disease Incidence, Period Prevalence, Mortality Rate, and Case Fatality Ratio of the disease were determined to be 68895, 6.11%, 0.18% and 2.91%, respectively. Seasonal animal movements and unauthorized livestock transportation appeared to be the main causes for the extensive spreading of the disease, while inadequate vaccination and poor awareness seemingly facilitated the development of three epidemic curves during the outbreak period. Newly identified causative agent, the sub-lineage O/ME-SA/Ind-2001d has led to a more severe FMD outbreak in 2014 compared to the previous outbreaks occurred in Sri Lanka.

Abstract A069: Leading causes of death among Asian American individuals compared with Pacific Islander individuals in the United States, 2018-2020

Abstract Background: Asian American and Pacific Islander races are two distinct groups that continue to be aggregated in many large, national mortality statistics in the United States (US), which leads to structural biases encoded into databases and inaccurate health implications that may deprive Pacific Islander individuals from opportunities for interventions aimed at reducing health disparities. Examining mortality rates for disaggregated Asian American and Pacific Islander populations across all 50 states was not possible until 2018. We compared the leading causes of death between Asian American and Pacific Islander individuals in the US during 2018-2020, stratified by sex and age. Methods: Cause of death among non-Hispanic Asian American and Pacific Islander individuals aged ≥20 years who died during 2018-2020 were obtained from the US National Center for Health Statistics. Age-standardized all-cause mortality rates (MRs) and the 5 leading causes of death were reported per 100,000 person-years separately for Asian American and Pacific Islander individuals, by sex (female/male) and age (20-54/55-64/65-74/75- 84 years). MR ratios (MRRs) were calculated by comparing MRs among Pacific Islander with Asian American individuals (reference group), by sex and age. Results: During 2018-2020, 63,338 female and 85,601 male deaths occurred among Asian American adults, and 4,116 female and 5,512 male deaths occurred among Pacific Islander adults. Compared to Asian American individuals, all-cause mortality was higher for Pacific Islander females (MRR=2.50,95%CI=2.43-2.59) and males (MRR=2.10,95%CI=2.04-2.16). Cancer was the leading cause of death for Asian American (MR=93.8) and Pacific Islander females (MR=181.6) and second for Asian American (MR=100.4) and Pacific Islander males (MR=185.2) after heart disease. Death rates for leading causes were substantially higher for Pacific Islander compared to Asian American females: cancer (MRR=1.93,95%CI=1.82-2.06), heart disease (MRR=3.18,95%CI=2.95-3.42), stroke (MRR=2.41,95%CI=2.13-2.73), diabetes (MRR=4.03,95%CI=3.55-4.56), and COVID-19 (MRR=2.60,95%CI=2.25-3.01) and for Pacific Islander compared to Asian American males: heart disease (MRR=2.56,95%CI=2.42-2.71), cancer (MRR=1.52,95%CI=1.42-1.62, diabetes (MRR=3.14,95%CI=2.81-3.50), accidental death (MRR=2.60,95%CI=2.33-2.88), and COVID-19 (MRR=2.04,95%CI=1.82-2.27). The largest relative cancer mortality rate disparity occurred in those aged 20-54 years and declined with older age among women (MRR range=1.37-2.67) and men (MRR range=1.16-2.26). Conclusion: Cancer was among the leading cause of death for both Asian American and Pacific Islander individuals, but cancer mortality rates were twice as high among Pacific Islander women and men compared to Asian American women and men. These disparities persisted among Pacific Islander individuals for nearly all leading causes of death, regardless of sex and age, underscoring the need to disaggregate Pacific Islander from Asian American race data to improve tailored health equity-focused interventions. Citation Format: Jacqueline B. Vo, Jazmyn L Bess, Kekoa Taparra, Paloma R. Mitra, Amy Berrington de Gonzalez, Neal D. Freedman, Meredith S. Shiels, Jaimie Z. Shing. Leading causes of death among Asian American individuals compared with Pacific Islander individuals in the United States, 2018-2020 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A069.

Temporal trends in mortality and causes of death in patients with incident atrial fibrillation: a nationwide register study from 2010 to 2018

ObjectivesAtrial fibrillation (AF) is associated with increased mortality. Previous studies have reported conflicting results in temporal trends of mortality after AF diagnosis. We aim to address this disparity by investigating...

Analysis of the influence of living conditions, as a collection of social factors within the environment, on mortality rates among the rural and urban populations of the Nenets autonomous okrug from 2000 to 2019

BACKGROUND: Currently, in the Arctic zone of the Russian Federation (AZRF), there are evident indications of a deterioration in the medical and demographic situation amidst a lack of adequate social infrastructure development. For the first time, we attempted to analyze the impact of living conditions, which encompass various social factors within the habitat, shaped by the social infrastructure, on the mortality rates of the population of one of the regions within AZRF. AIM: To assess the impact of living conditions, as a set of social factors within the environment, on the mortality rates among the rural and urban populations of the Nenets autonomous okrug (NAO) in the period from 2000 to 2019. MATERIALS AND METHODS: The databases “Housing and communal services and social infrastructure in NAO in 2000-2019” and “Death cases in NAO in 2000–2019” including information on the population number and age and gender structure of the NAO population across individual settlements have been collected. Using the scoring system for assessing living conditions, a ranking with subsequent division into tertiles of all rural NAO settlements was carried out according to the value of the integral index of living conditions (IILC). A comparative analysis (tertiles with the city, and tertiles with each other) of average annual age-standardized rates of overall mortality, mortality from the main causes and structural components of external causes (EC) of mortality was performed. Relative risks were calculated as the ratio of mortality rates in each tertile to the corresponding indicator for the urban population. RESULTS: Average annual standardized rates and relative risks of mortality (total, EC, drowning, freezing, alcohol poisoning and transport accidents) of the NAO population demonstrated a “step by step” increase in the sequence “city — highest tertile — middle tertile — lowest tertile”, i.e. as living conditions worsen and as the IILC decreases. Statistically significant differences were identified between the city and tertiles, as well as between the highest (“favorable” living conditions) and lowest (“unfavorable” living conditions) tertiles in terms of total mortality, mortality from EC, drowning and freezing. Mortality rates from alcohol poisoning and transport accidents also increased as living conditions worsened, although the associations did reach the level of statistical significance. With the exception of suicides, the relative risks of mortality for individual EC reached maximum values in the lowest tertile of living conditions. CONCLUSION: Statistically significant inverse associations between total mortality, mortality from external causes and its main structural components, and the values of the integral index of living conditions have been identified among the rural population of NAO. A decrease in living conditions was significantly associated with an increase in mortality rates and relative risks.