Mortality In Europe Research Articles

Increased Central European forest mortality explained by higher harvest rates driven by enhanced productivity

Increasing tree growth and mortality rates in Europe are still poorly understood and have been attributed to a variety of drivers. This study explored the role of climate drivers, management and age structure in driving changes in tree mortality rates in six Central European countries from 1985 to 2010, using the process-based vegetation model LPJ-GUESS. Simulations show a strong positive trend in canopy mortality rates in Central Europe, consistent with satellite observations. This trend was explained by an assumed increase in managed thinning in response to a modelled increase in forest productivity caused by climate change and rising atmospheric CO2 concentration. Simulated rates of canopy mortality were highly sensitive to the minimum tree size threshold applied for inclusion in the rate calculation, agreeing with satellite observations that are likely to only capture the loss of relatively large trees. The calculated trends in mortality rate also differed substantially depending on the metric used (i.e. carbon, stem or canopy mortality), highlighting the challenge of comparing tree mortality trends from different observation types. We conclude that changes in forest productivity and management in combination can profoundly affect regional-scale patterns of tree mortality. Our findings underscore the fact that increasing forest mortality can occur without reductions in forest growth when mediated by management responses to increasing productivity.

The role of HIV/hepatitis B virus/hepatitis C virus RNA+ triple infection in end-stage liver disease and all-cause mortality in Europe.

There are limited data on end-stage liver disease (ESLD) and mortality in people with HIV (PWH) coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV). All PWH aged greater than 18 under follow-up in EuroSIDA positive for HBsAg (HBV), and/or HCVRNA+, were followed from baseline (latest of 1 January 2001, EuroSIDA recruitment, known HBV/HCV status) to ESLD, death, last visit, or 31 December 2020. Follow-up while HCVRNA- was excluded. In two separate models, Poisson regression compared three groups updated over time; HIV/HBV, HIV/HCV, and HIV/HBV/HCV. Among 5733 included individuals, 4476 (78.1%) had HIV/HCV, 953 (16.6%) had HIV/HBV and 304 (5.3%) had HIV/HBV/HCV. In total, 289 (5%) developed ESLD during 34 178 person-years of follow-up (PYFU), incidence 8.5/1000 PYFU [95% confidence interval (CI) 7.5-9.4] and 707 deaths occurred during 34671 PYFU (incidence 20.4/1000 PYFU; 95% CI 18.9-21.9). After adjustment, compared with those with HIV/HCV, persons with HIV/HBV had significantly lower rates of ESLD [adjusted incidence rate ratio (aIRR) 0.53; 95% CI 0.34-0.81]. Those with HIV/HBV/HCV had marginally significantly higher rates of ESLD (aIRR 1.49; 95% CI 0.98-2.26). Those under follow-up in 2014 or later had significantly lower rates of ESLD compared with 2007-2013 (aIRR 0.65; 95% CI 0.47-0.89). Differences in ESLD between the three groups were most pronounced in those aged at least 40. After adjustment, there were no significant differences in all-cause mortality across the three groups. HIV/HBV-coinfected individuals had lower rates of ESLD and HIV/HBV/HCV had higher rates of ESLD compared with those with HIV/HCV, especially in those aged more than 40. ESLD decreased over time across all groups. NCT02699736.

Ethnic‐specific infant care practices and infant mortality in late Imperial Russia

AbstractThe Russian Empire had the highest infant mortality rate in Europe at the beginning of the twentieth century. Using a variety of official statistical sources and qualitative evidence, this paper documents uniquely high infant mortality among ethnic Russians. In contrast, among other ethnic groups of the empire, infant mortality rates did not exceed those of the European countries by much. The evidence suggests that the explanation for the Russian infant mortality pattern was ethnic‐specific infant care practices, such as the early introduction of solid food, which increased the incidence of lethal gastrointestinal diseases. Our findings highlight the importance of traditional infant feeding practices in mortality in pre‐industrial societies.

Nursing homes and mortality in Europe: Uncertain causality.

The current health crisis has particularly affected the elderly population. Nursing homes have unfortunately experienced a relatively large number of deaths. On the basis of this observation and working with European data (from SHARE), we want to check whether nursing homes were lending themselves to excess mortality even before the pandemic. Controlling for a number of important characteristics of the elderly population in and outside nursing homes, we conjecture that the difference in mortality between those two samples is to be attributed to the way nursing homes are designed and organized. Using matching methods, we observe excess mortality in Sweden, Belgium, Germany, Switzerland, Czech Republic and Estonia but not in the Netherlands, Denmark, Austria, France, Luxembourg, Italy and Spain. This raises the question of the organization and management of these nursing homes, but also of their design and financing.

Influences of area-level sociodemographic factors on heat-related mortality in Europe: insights to guide adaptation strategies

BackgroundEurope is the world region most affected by heat-attributable mortality, but impact patterns are heterogenous. We aimed to assess the contributions to this heterogeneity of four area-level predictors (education, life expectancy, the ratio of older to younger people [ageing index], and relative income) to identify general adaptation strategies. MethodsWe extracted four outcomes from a heat-mortality study covering 147 areas in 16 European countries: the rate of increase in risk at (1) moderate and (2) extreme temperatures, (3) the minimum mortality percentile, and (4) the underlying mortality rate. We used structural equation modelling to quantify the direct and indirect associations between the predictors and outcomes, accounting for country-level random effects. FindingsHigher levels of education (compared with lower levels) were directly associated with lower heat-related mortality burdens via reduced risk at moderate and extreme temperatures, and lower underlying mortality rates. However, it had ambiguous indirect associations with heat-related mortality burden through positive associations with life expectancy, ageing index, and relative income. Higher life expectancy (compared with lower life expectancy) had contradictory relations with the mortality burden, being associated with higher risk at moderate temperatures but lower underlying mortality rates. A higher ageing index (compared with a lower index) was associated with higher burdens through higher risk at extreme temperatures and higher underlying mortality rates. Relative income made a small and ambiguous contribution. The relative magnitudes of the county-level random effects suggested innate human physiology had a major role in risk at extreme temperatures but that addressing modifiable sociomaterial conditions might reduce the burden via influence on risk at moderate temperatures and the underlying mortality burden. InterpretationOur findings support three general adaptation strategies, showing the need for both general social transformation and focused climate-specific interventions: (1) general social strategies to improve health and reduce underlying mortality, (2) targeted social interventions to address factors instilling patterns of vulnerability at moderate temperatures, and (3) specific actions during extreme temperatures. FundingThe EU's Horizon 2020 research and innovation programme (grant agreement 865564 European Research Council Consolidator Grant EARLY-ADAPT).

Benefits of future clean air policies in Europe: Proposed analyses of the mortality impacts of PM2.5 and NO2.

Benefits of future clean air policies in Europe: Proposed analyses of the mortality impacts of PM2.5 and NO2.

The burden of mental health-related mortality in the Baltic States in 2007-2018

BackgroundThe problem of underestimating the burden of mental health-related mortality is widely discussed in the public health literature. Relevant scientific evidence from societies experiencing the largest burden of mental health mortality is important for better understanding global and national mental health challenges and improving policies. Three Baltic States - Estonia, Lithuania, and Latvia - are countries in the Central and Eastern European region that experienced post-soviet transition trauma and showed among the highest suicide and alcohol-related mortality rates in Europe. This study aimed to examine the change in the burden of mental health-related mortality in three Baltic States in the context of consistent growth in life expectancy in 2007-2018.MethodsWe calculated age-standardized years of life lost due to specific mental health-related causes of death in three Baltic countries from 2007 to 2018. Four mental health-related causes of death groups were analyzed: (i) all mental and behavioural disorders; (ii) intentional self-harm; (iii) main substance use-related causes of death; and (iv) external causes of death. The number of deaths came from the WHO Mortality Database; population exposures were extracted from the Human Mortality Database.ResultsWe found that the proportion of age-standardized years of life lost due to mental disorders was relatively low in all three countries. It varied from 0.2% for females in Lithuania in 2009 to 2.4% for males in Estonia in 2007. However, the proportion of age-standardized years of life lost from self-harm and substance use remained high. In 2018, the proportion of age-standardized years of life lost due to self-harm was highest among males in Lithuania (4.1%) while the highest proportion due to substance use-related causes of death was among males in Estonia (7.3%).ConclusionsOur findings indicate that the burden of mental health-related mortality remained high and showed divergent temporal changes across the three countries. In the context of the Baltic States and other post-soviet countries, fractions of various external causes of death and alcohol-related causes of death should be considered in assessing the total burden of mental health-related mortality.

Interactive effects of heat and air pollution on mortality in Europe using small area data – Results of the exhaustion project

Background and Aim: Studies on the interactive short-term health effects of heat and air pollution are limited and mostly carried out in cities thus providing limited evidence at national level and on the effects in suburban and rural areas. Methods: We used daily data on natural, cardiovascular and respiratory mortality, air temperature, particulate matter (PM2.5, PM10) and ozone (O3) for administrative small areas (municipalities) in five regions of Europe (Norway, England and Wales, Germany, Italy, and the Attica Region, Greece) during the warm season. We applied a two-stage design, where area-specific data were analyzed in the first stage with over-dispersed Poisson regression models, and a random-effects meta-analysis was conducted in the second. The interaction between temperature and air pollutants was analysed by a response-surface model with a tensor smoother. The study reports the effects of air temperature for an increase from 75th to 99th percentile by levels of air pollutants (95th percentile=high, 50th=medium, 5th=low). Results: Overall results showed an effect modification by PM2.5 in the relationship between heat and mortality. For an increase in mean temperature, the overall risk of natural mortality increased by 6.6% (95% CI: -1.9%, 15.8%), 10.9% (95% CI: 2.7%, 19.7%), and 14.2% (95% CI: 4.5%, 24.9%) at the low, medium, and high levels of PM2.5, respectively. Stronger heat effects were observed for respiratory mortality with high PM2.5 levels (25.0%; 95%CI: 6.4%, 46.9%). For O3 we found a suggestion of effect modification in the relationship between heat and mortality, with a trend in effect estimates for increasing levels of O3. Among the five regions some heterogeneity in effect estimates and in the impact of effect modification by air pollution was observed. Conclusions: Evidence of effect modification between heat and air pollutants on mortality during the warm period was found, with slightly heterogeneous patterns within regions.

The role of values in road safety culture: Examining the relationship between valuation of freedom to take risk and accident risk among motorcycle riders and car drivers

Focus on paternalistic values versus individual freedom is a fundamental theme, which defines the status of road safety in different settings. The present study examines the role of values related to freedom to take risk in traffic in road safety culture based on survey data from car drivers (n = 882) and motorcycle riders (n = 330) from two countries with distinctly different road safety records: Norway, which had the lowest road mortality rate in Europe with 20 road deaths per million inhabitants in 2017, and Greece, which had 69 road deaths per million inhabitants, which was well above the EU average of 50. Contrary to our first hypothesis, we do not find a statistically significant higher valuation of freedom to take risk in traffic among Greek drivers and riders than among drivers and riders from Norway. In line with our second hypothesis, we find that motorcycle riders in both countries value freedom to take risk in traffic significantly higher than car drivers in their country. Regression analyses indicate a relationship between higher valuation of freedom to take risk in traffic and risky rider behaviours, which are related to accident involvement. Our results indicate that values focusing on freedom to take risk have an important role in road safety culture, presumably legitimizing and motivating risky driving/riding. This is in line with previous research, where riders cite freedom as the main enjoyment factor for riding. Previous studies find six times higher accident risk among riders than drivers, which is explained partly by pointing to risky rider behaviours.

Differences in severe exacerbations rates and healthcare utilisation in COPD populations in the UK and France

IntroductionChronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might...

Raman Spectroscopic Differentiation of Streptococcus pneumoniae From Other Streptococci Using Laboratory Strains and Clinical Isolates.

Streptococcus pneumoniae, commonly referred to as pneumococci, can cause severe and invasive infections, which are major causes of communicable disease morbidity and mortality in Europe and globally. The differentiation of S. pneumoniae from other Streptococcus species, especially from other oral streptococci, has proved to be particularly difficult and tedious. In this work, we evaluate if Raman spectroscopy holds potential for a reliable differentiation of S. pneumoniae from other streptococci. Raman spectra of eight different S. pneumoniae strains and four other Streptococcus species (S. sanguinis, S. thermophilus, S. dysgalactiae, S. pyogenes) were recorded and their spectral features analyzed. Together with Raman spectra of 59 Streptococcus patient isolates, they were used to train and optimize binary classification models (PLS-DA). The effect of normalization on the model accuracy was compared, as one example for optimization potential for future modelling. Optimized models were used to identify S. pneumoniae from other streptococci in an independent, previously unknown data set of 28 patient isolates. For this small data set balanced accuracy of around 70% could be achieved. Improvement of the classification rate is expected with optimized model parameters and algorithms as well as with a larger spectral data base for training.

Quality of acute stroke care in Romania: Achievements and gaps between 2017 and 2022.

Romania has one of the highest incidences of stroke and one of the highest mortality rates in Europe. The mortality rate due to treatable causes is also very high and is associated with the lowest public spending on healthcare in the European Union. Nonetheless, significant achievements in acute stroke care have been made in Romania in the last 5 years, most notably the increase of the national thrombolysis rate from 0.8% to 5.4%. Numerous educational workshops and constant communication with the stroke centers led to a solid and active stroke network. Due to the joint efforts of this stroke network and the ESO-EAST project, the quality of stroke care has significantly improved. However, Romania still faces many problems: a major lack of specialists in interventional neuroradiology and consequently a low number of stroke patients treated by thrombectomy and carotid revascularization procedures, a low number of neuro-rehabilitation centers and a country-wide lack of neurologists.

Does aspirin have an effect on risk of death in patients with COVID-19? A meta-analysis.

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has shown unprecedented impact world-wide since the eruption in late 2019. Importantly, emerging reports suggest an increased risk of thromboembolism development in patients with COVID-19. Meanwhile, it is found that aspirin reduced mortality in critically ill patients with non-COVID-19 acute respiratory distress syndrome. Therefore, a meta-analysis was performed to investigate the effects of aspirin on COVID-19 mortality.MethodsA systematic literature search was conducted in 10 electronic databases and 4 registries. Random effects models were used to calculate pooled relative risks (RRs) with 95% confidence intervals (Cis) to estimate the effect of aspirin on COVID-19 mortality. Relevant subgroup analyses and sensitivity analyses were also performed.ResultsThe results showed that aspirin use was associated with a reduction in COVID-19 mortality (adjusted RR 0.69; 95% CI 0.50–0.95; P < 0.001). Subgroup analysis found that the low-dose group was associated with a reduced COVID-19 mortality (adjusted RR 0.64; 95% CI 0.48–0.85; P < 0.01). Aspirin use was associated with reduced COVID-19 mortality in Europe and America (crude RR 0.71; 95% CI 0.52–0.98; P = 0.04), and results from cohort studies suggested that aspirin use was a protective factor for COVID-19 mortality (adjusted RR 0.73; 95% CI 0.52–0.99; P = 0.04). Meanwhile, aspirin use was not associated with bleeding risk (crude RR 1.22; 95% CI 0.80–1.87; P = 0.96).ConclusionsThis meta-analysis found that aspirin use was associated with a reduction in mortality in patients with COVID-19 and not with an increased risk of bleeding.Supplementary informationThe online version contains supplementary material available at 10.1007/s00228-022-03356-5.

Trends in age- and sex-specific lung cancer mortality in Europe and Northern America: Analysis of vital registration data from the WHO Mortality Database between 2000 and 2017

BackgroundIn the context of new targeted therapies and immunotherapy as well as screening modalities for lung cancer patients, detailed mortality trends in Europe and Northern America are unknown. MethodsTime-trend analysis using vital registration data of Northern America and Europe from the WHO Mortality Database (years 2000/2017). To assess improvements in lung cancer mortality, we performed a population-averaged Poisson autoregressive analysis. The average annual percent change (AAPC) was used as a summary measure of overall and country-specific trends in mortality. Second, we studied time trends of lung cancer incidence and smoking prevalence rates. FindingsIn the total population of 872·5 million people between 2015 and 2017, the average annual age-standardised mortality from lung cancer was 54·6 deaths per 100 000, with substantial differences across countries. Lung cancer was reported as the primary cause of death in 5·4 cases per 100 deaths. The age-standardised mortality rate decreased constantly (AAPC –1·5%) between 2000 and 2017. While mortality in men dropped annually by an average of −2·3%, mortality in women decreased by an average of −0·3%. This slight decline was driven exclusively by the USA. In contrast, 21 out of 31 countries registered a significant increase in female lung cancer mortality between 2000 and 2017, with Spain (AAPC 4·1%) and France (AAPC 3·6%) leading the list. InterpretationDespite overall decreases in lung cancer mortality trends, female mortality remained unchanged or increased significantly in all countries except the USA. National mortality outcomes reflect variabilities in tobacco control, screening, therapeutic advances, and access to health care.

Why do we find dead bumblebees under linden trees?

Linden trees (Tilia spp.) have for a long time been associated with bumblebee (Bombus spp.) mortality in Europe and North America. Several explanations have been suggested for this phenomenon. This study aimed to explore to which extent the factors of predation, ageing, starvation, and poisonous nectar serve as explanations for bumblebee mortality in association with linden trees. Starvation, ageing, and predation all contributed to mortality of bumblebees found under flowering linden trees. The mean weight of a dead wild bumblebee found under linden trees was found to be close to the weight of a starved bumblebee of the same size. This indicated that starvation was the main driver for many of the deaths. A significant proportion of the dead bumblebees collected under linden trees had injuries indicating predation. The authors suggest that predation may serve as a secondary explanation for the bumblebee mortality, after weakening by starvation or other factors. A small proportion of the bumblebees may have died from physical degradation or age. The present study did not support the poisonous nectar hypothesis. It is necessary to explore the covariation between the suggested hypotheses more closely, to better understand the interplay between the different factors. In addition, there is a need to investigate alternative hypotheses for the association between bumblebees and linden trees.

Impact of Hypogonadism on Quality of Life in Men with Coronary Artery Disease

Today, the issue of improving care for patients with cardiovascular diseases is particularly acute, because despite all the achievements of modern medicine, they remain one of the leading causes of disability and mortality in Europe and the world. Despite the fact that many factors have been established that affect the prognosis and course of cardiovascular diseases, such as arterial hypertension, smoking, gender, obesity, age, diabetes mellitus, obesity, metabolic disorders, etc.,[1] their search continues. So, the factor influencing the course of cardiovascular diseases is the presence of androgen deficiency in men. According to studies [2],[3],[4],[5],[6] conducted in world practice, there is evidence that androgen deficiency has a negative impact on the course of cardiovascular diseases, in particular coronary artery disease. However, this issue requires further study. The aim of the study was to study the possible impact of androgen deficiency on the quality of life in men with coronary heart disease.

A Protective HLA Extended Haplotype Outweighs the Major COVID-19 Risk Factor Inherited From Neanderthals in the Sardinian Population.

Sardinia has one of the lowest incidences of hospitalization and related mortality in Europe and yet a very high frequency of the Neanderthal risk locus variant on chromosome 3 (rs35044562), considered to be a major risk factor for a severe SARS-CoV-2 disease course. We evaluated 358 SARS-CoV-2 patients and 314 healthy Sardinian controls. One hundred and twenty patients were asymptomatic, 90 were pauci-symptomatic, 108 presented a moderate disease course and 40 were severely ill. All patients were analyzed for the Neanderthal-derived genetic variants reported as being protective (rs1156361) or causative (rs35044562) for severe illness. The β°39 C>T Thalassemia variant (rs11549407), HLA haplotypes, KIR genes, KIRs and their HLA class I ligand combinations were also investigated. Our findings revealed an increased risk for severe disease in Sardinian patients carrying the rs35044562 high risk variant [OR 5.32 (95% CI 2.53 - 12.01), p = 0.000]. Conversely, the protective effect of the HLA-A*02:01, B*18:01, DRB*03:01 three-loci extended haplotype in the Sardinian population was shown to efficiently contrast the high risk of a severe and devastating outcome of the infection predicted for carriers of the Neanderthal locus [OR 15.47 (95% CI 5.8 – 41.0), p < 0.0001]. This result suggests that the balance between risk and protective immunogenetic factors plays an important role in the evolution of COVID-19. A better understanding of these mechanisms may well turn out to be the biggest advantage in the race for the development of more efficient drugs and vaccines.

131MO Trends in age and sex specific lung cancer mortality in Europe and Northern America: Analysis of vital registration data from the WHO mortality database between 2000 and 2017

131MO Trends in age and sex specific lung cancer mortality in Europe and Northern America: Analysis of vital registration data from the WHO mortality database between 2000 and 2017

Tumor Microenvironment of Hepatocellular Carcinoma: Challenges and Opportunities for New Treatment Options

The prevalence of liver cancer is constantly rising, with increasing incidence and mortality in Europe and the USA in recent decades. Among the different subtypes of liver cancers, hepatocellular carcinoma (HCC) is the most commonly diagnosed liver cancer. Besides advances in diagnosis and promising results of pre-clinical studies, HCC remains a highly lethal disease. In many cases, HCC is an effect of chronic liver inflammation, which leads to the formation of a complex tumor microenvironment (TME) composed of immune and stromal cells. The TME of HCC patients is a challenge for therapies, as it is involved in metastasis and the development of resistance. However, given that the TME is an intricate system of immune and stromal cells interacting with cancer cells, new immune-based therapies are being developed to target the TME of HCC. Therefore, understanding the complexity of the TME in HCC will provide new possibilities to design novel and more effective immunotherapeutics and combinatorial therapies to overcome resistance to treatment. In this review, we describe the role of inflammation during the development and progression of HCC by focusing on TME. We also describe the most recent therapeutic advances for HCC and possible combinatorial treatment options.

The association of intensity and duration of non-pharmacological interventions and implementation of vaccination with COVID-19 infection, death, and excess mortality: Natural experiment in 22 European countries

BackgroundCritical questions remain regarding the need for intensity to continue NPIs as the public was vaccinated. We evaluated the association of intensity and duration of non-pharmaceutical interventions (NPIs) and vaccines with COVID-19 infection, death, and excess mortality in Europe. MethodsData comes from Our Word in Data. We included 22 European countries from January 20, 2020, to May 30, 2021. The time-varying constrained distribution lag model was used in each country to estimate the impact of different intensities and duration of NPIs on COVID-19 control, considering vaccination coverage. Country-specific effects were pooled through meta-analysis. ResultsThis study found that high-intensity and long-duration of NPIs showed a positive main effect on reducing infection in the absence of vaccines, especially in the intensity above the 80th percentile and lasted for 7 days (RR = 0.93, 95% CI: 0.89–0.98). However, the adverse effect on excess mortality also increased with the duration and intensity. Specifically, it was associated with an increase of 44.16% (RR = 1.44, 95% CI: 1.27–1.64) in the excess mortality under the strict intervention (the intensity above the 80th percentile and lasted for 21 days). As the vaccine rollouts, the inhibition of the strict intervention on cases growth rate was increased (RR dropped from 0.95 to 0.87). Simultaneously, vaccination also alleviated the negative impact of the strict intervention on excess mortality (RR decreased from 1.44 to 1.25).Besides, maintaining the strict intervention appeared to more reduce the cases, as well as avoids more overall burden of death compared with weak intervention. ConclusionsOur study highlights the importance of continued high-intensity NPIs in low vaccine coverage. Lifting of NPIs in insufficient vaccination coverage may cause increased infections and death burden. Policymakers should coordinate the intensity and duration of NPIs and allocate medical resources reasonably with widespread vaccination.