Mortality Rates In Rural Areas Research Articles

Evaluation of Mortality Rate Disparities for Cardiac Arrest Between Urban and Rural Cohorts in the United States Using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Database.

Introduction The United States includes diverse geographic areas with distinct urban and rural settings. Urban areas served with higher health services and the rural regions with restricted facilities. This disparity results in higher rural mortality rates. Thus, the study uses the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to assess the disparities in cardiac arrest mortality rates in urban versus rural areas. Methods This is a retrospective study to assess trends in overall mortality rates for urban versus rural areas in the United States between 1999 and 2020, using the CDC WONDER data for cardiac arrest (ICD-10 CODE I46), extracted on May 25, 2024. Urban/rural classification was based on the Metropolitan 2013 scheme. Statistical analysis was done via RStudio v.4.3.3 and included measures of central tendency, mortality rates per 100,000, and plotting of temporal trends. Results Between 1999 and 2020, the total number of deaths due to cardiac arrest in rural and urban areas was 103,115 and 262,505, respectively. Among the age groups, infants <1 year and elderly >85 years showed a high mortality rate in rural areas compared to urban areas.Gender analysis revealed both males (3.3 per 100,000) and females (3.52 per 100,000) had a high rural mortality rate, compared to urban rates of 1.51 and 1.54 per 100,000, respectively. Racial analysis showed that American Indian or Alaska Native and Asian or Pacific Islander populations had higher mortality in rural areas, with rates of 1.1 and 1.81 per 100,000, respectively, compared to the urban rates of 0.34 and 0.8 per 100,000. Conclusion Trends in mortality rate showed a general decline over time but the gap between urban and rural mortality persists, highlighting the need for continued efforts in rural areas.

Disparities in trends in bladder cancer mortality between urban and rural patients: A 2000-2020 analysis.

4583 Background: Patients in rural areas in the US often have worse healthcare outcomes due to socioeconomic deprivation, higher rates of smoking, and limited access to medical care. Despite a general decline in bladder cancer mortality over the past two decades, comprehensive studies comparing these trends between urban and rural mortality are scarce. Methods: Utilizing the CDC WONDER database, we extracted mortality data for bladder cancer from 2000 to 2020. Age-adjusted mortality rates per 100,000 persons were standardized to the Year 2000 US standard population. Data segmentation by urbanity utilized the 2013 National Center for Health Statistics Urban-Rural Classification Scheme. The National Cancer Institute's Joinpoint Regression Program was employed to calculate average annual percent changes (AAPCs) and annual percent changes (APCs). Results: In our analysis, we identified a total of 306,750 bladder cancer death cases from 2000 to 2020. Significant improvements in bladder cancer mortality were observed in urban areas, with large central metros experiencing the most pronounced decrease (AAPC -1.0%, p&lt;0.001). This decline was moderate between 2000 and 2016 (APC -0.3, p&lt; 0.001) but accelerated between 2016 and 2020 (APC -3.8%, p&lt;0.001). Large fringe and medium metros also saw comparatively smaller but significant declines (AAPC -0.6%, P&lt;0.05) and also accelerated between 2016-2020. In contrast, small metro and rural areas (micropolitan and noncore) showed no significant improvement, with mortality rates remaining stable between 2000 and 2020 (AAPC 0.2%, P=0.099). Conclusions: This analysis, the largest to date comparing urban and rural mortality trends in bladder cancer, highlights significant disparities in outcomes between large urban and rural areas. The marked improvement in urban areas, especially noted around the time novel agents such as immunotherapy were introduced, underscores the potential impact of advanced treatments. However, the stable mortality rates in rural areas suggest that access to advanced care, environmental influences, socioeconomic status, and slower adaptation of new guidelines in rural settings may play critical roles. These findings underline the urgent need for strategies to close the urban-rural gap. [Table: see text]

Exploring the County Level Mortality Pattern Variations in Rural Areas of Iran (2006-2016).

Mortality rate in rural areas is a useful measure of the health of the population and the function of the health system, which varies over space and time. The objective of this research is to explore the spatial and temporal variations in the rural mortality rate in Iran at the county level in 2006, 2011, and 2016. data were gathered from the rural population and mortality statistics published by the Statistical Centre of Iran (SCI) and the National Organization for Civil Registration (NOCR). Global spatial patterns were assessed using the global Moran's I and local clusters through the local Moran's I. Spatial distribution of rural mortality rate shows that during the years under study the number of counties with a lower rate has increased. The counties with rate of less form continuous areas in the southwest, central and east regions. The excess risk map reveals significant variations in both value and extent. Also, the values of Moran's index increased from 0.1848 in 2006 to 0.4041 in 2016, which indicates the strengthening of the cluster spatial pattern of the overall rural mortality rate. Local patterns have undergone substantial changes over space and time. The findings indicate significant spatial and temporal variations in rural mortality rates in Iran. Policy-makers can use this information to plan and enhance healthcare infrastructure in specific counties. The findings serve for evaluating the effectiveness of health policies, enabling policy-makers to make informed decisions, allocate resources efficiently and design targeted interventions for improved public health outcomes.

A system review of central nervous system tumors on children in China: epidemiology and clinical characteristics

BackgroundCentral nervous system (CNS) tumors are the most common solid tumors in children and the leading cause of cancer-related death in the latter. Currently, the incidence rate exceeds that of leukemia and ranks first in the incidence of malignant tumors in children.MethodsThe epidemiological data on childhood CNS tumors were collected from the Chinese Cancer Registry Annual Report. The annual percent change (APC) of incidence and mortality-rate changes were estimated via Joinpoint regression. Due to a lack of pertinent data, we performed a system review on the clinical-pathological characteristics in Chinese publications.ResultsThere was no significant increase in the incidence rate (APC: -0.1, 95% CI: -1.5 to 1.3), but there was a significant increase in the mortality rate (APC: 1.8, 95% CI: 0.3 to 3.4) for childhood CNS tumors. In the subgroup analysis, there were significant increases in both the incidence and mortality rates in rural areas (APC in the incidence: 6.2, 95% CI: 2.4 to 10.2; APC in mortality: 4.4, 95% CI: 0.4 to 8.4). The most common location and type of childhood CNS were, respectively, the cerebral hemisphere (25.5%, 95% CI: 21.7% to 29.4%) and astrocytomas (26.8%, 95% CI: 23.9% to 29.6%).ConclusionsThe epidemiological trends, and the relevant prediction, highlighted the need to pay continual attention to childhood CNS tumors, and the clinicopathology evinced its own distinctive characteristics. Timely detection and effective treatment must be further promoted regarding childhood CNS tumors with a view to decreasing the disease burden, especially in rural areas.

Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand

SummaryBackgroundPrevious research identified inequities in all-cause mortality between Māori and non-Māori populations. Unlike comparable jurisdictions, mortality rates in rural areas have not been shown to be higher than those in urban areas for either population. This paper uses contemporary mortality data to examine Māori and non-Māori mortality rates in rural and urban areas.MethodsA population-level observational study using deidentified routinely collected all-cause mortality, amenable mortality and census data. For each level of the Geographic Classification for Health (GCH), Māori and non-Māori age-sex standardised all-cause mortality and amenable mortality incident rates, Māori:Non-Māori standardised incident rate ratios and Māori rural:urban standardised incident rate ratios were calculated. Age and deprivation stratified rates and rate ratios were also calculated.FindingsCompared to non-Māori, Māori experience excess all-cause (SIRR 1.87 urban; 1.95 rural) and amenable mortality (SIRR 2.45 urban; 2.34 rural) and in all five levels of the GCH. Rural Māori experience greater all-cause (SIRR 1.07) and amenable (SIRR 1.13) mortality than their urban peers. Māori and non-Māori all-cause and amenable mortality rates increased as rurality increased.InterpretationThe excess Māori all-cause mortality across the rural: urban spectrum is consistent with existing literature documenting other Māori health inequities. A similar but more pronounced pattern of inequities is observed for amenable mortality that reflects ethnic differences in access to, and quality of, health care. The excess all-cause and amenable mortality experienced by rural Māori, compared to their urban counterparts, suggests that there are additional challenges associated with living rurally.FundingThis work was funded by the Health Research Council of New Zealand (HRC19/488).

Increased Mortality Trends in Patients With Chronic Non-communicable Diseases and Comorbid Hypertension in the United States, 2000-2019.

BackgroundAccording to the Sustainable Development Goals (SDGs), countries are required to reduce the mortality rates of four main non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic respiratory diseases (CRDs), and cancer (CA), by one-third in 2030 from the 2015 level. However, progress fell short of expectations, partly attributed to the high rates of hypertension-related NCD mortality. This study aimed to investigate the mortality trends of SDG-targeted NCDs with comorbid hypertension. In addition, the disparities in mortality rates among different demographic subgroups were further explored.MethodsMortality data from 2000 to 2019 were acquired from the Centers for Disease Control and Prevention in the United States. SDG-targeted NCDs were considered the underlying causes of death, and hypertension was considered a multiple cause of death. Permutation tests were performed to determine the time points of Joinpoints for mortality trends. The annual percent changes and average annual percent changes (AAPCs), as well as 95% confidence intervals (CIs), were calculated to demonstrate the temporary trend of mortality rates overall and by age, sex, ethnicity, and region.ResultsThe hypertension-related DM, CRD, and CA mortality rates increased over the 20 years, of which the AAPCs were 2.0% (95% CI: 1.4%, 2.6%), 3.2% (95% CI: 2.8%, 3.6%), and 2.1% (95% CI: 1.6%, 2.6%), respectively. Moreover, despite decreasing between 2005 and 2015, the hypertension-related CVD mortality rate increased from 2015 to 2019 [APC: 1.3% (95% CI: 0.7%, 1.9%)]. The increased trends were consistent across most age groups. Mortality rates among men were higher and increased faster than those among women. The hypertension-related CVD, DM, and CA mortality rates among African American people were higher than those among White people. The increased mortality rates in rural areas, especially in rural south, were higher than those in urban areas.ConclusionIn the United States, the hypertension-related DM, CRD, and CA mortality rates increased between 2000 and 2019, as well as hypertension-related CVD mortality between 2015 and 2019. Disparities existed among different sexes, ethnicities, and areas. Actions to prevent and manage hypertension among patients with NCDs are required to reduce the high mortality rates and minimize disparities.

Accidental death during pregnancy and puerperium from 2009 to 2019 in Hunan, China: a cross-sectional study

ObjectiveFew studies have analysed accidental maternal deaths. This study analysed the basic situation and classification of maternal accidental deaths and compared the differences between urban and rural areas.DesignA cross-sectional study...

The synchronicity of COVID-19 disparities: Statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America.

Early studies on COVID-19 identified unequal patterns in hospitalization and mortality in urban environments for racial and ethnic minorities. These studies were primarily single center observational studies conducted within the first few weeks or months of the pandemic. We sought to examine trends in COVID-19 morbidity, hospitalization, and mortality over time for minority and rural populations, especially during the U.S. fall surge. Data were extracted from a statewide cohort of all adult residents in Indiana tested for SARS-CoV-2 infection between March 1 and December 31, 2020, linked to electronic health records. Primary measures were per capita rates of infection, hospitalization, and death. Age adjusted rates were calculated for multiple time periods corresponding to public health mitigation efforts. Comparisons across time within groups were compared using ANOVA. Morbidity and mortality increased over time with notable differences among sub-populations. Initially, hospitalization rates among racial minorities were 3-4 times higher than whites, and mortality rates among urban residents were twice those of rural residents. By fall 2020, hospitalization and mortality rates in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Changes across time among demographic groups was significant for morbidity and hospitalization. Cumulative morbidity and mortality were highest among minority groups and in rural communities. The synchronicity of disparities in COVID-19 by race and geography suggests that health officials should explicitly measure disparities and adjust mitigation as well as vaccination strategies to protect those sub-populations with greater disease burden.

Human resources for health density and its associations with child and maternal mortality in the Islamic Republic of Iran.

The Family Physician and Social Protection Scheme for Iranian rural inhabitants was launched in June 2005 to improve physician density. To our knowledge, a comprehensive study of the impact of the Scheme on mortality-related health indicators has not been conducted. To investigate the effects of health workforce density on maternal, neonatal, infant and under-5 mortality rates in rural areas of the Islamic Republic of Iran between 2005 and 2011. We built mixed-effects Poisson regression models including mortality measures as response variables and physician and behvarz (community-based health worker) densities as independent variables, using data from the Iranian Vital Horoscope tool, annual Households Income and Expenditure Survey, and DTARH software. We also included population sizes, age of inhabitants, rate of urbanization, years of schooling, and wealth index in each district, as well as effect of time, as covariates. Physician density was significantly associated with child mortality rates (1.5%, 1.1% and 63.5% decrease in neonatal, under-5 and maternal mortality with a 1-unit increase in physician density per 1000 individuals). In the model built for infant mortality rate, physician density and behvarz densities were not significantly associated with this measure. Improving the distribution of family physicians was associated with lower child and maternal mortality. Improvements in behvarz densities were not associated with decrements in these rates, which probably calls for improvement in access to more professional health services and facilities.

Long-term effect of residential greenness on mortality in the French Gazel Cohort: examining urban -rural disparities

Background: There is growing interest in the relationship between exposure to greenness and health. However, very few studies have evaluated the potential modification of this relationship by the degree of urbanity. We aimed to examine the association between exposure to greenness and mortality in a French cohort, according to urban and rural areas. Methods: We used data from the population-based Gazel cohort with a follow up of 26 years, which enrolled 20,625 participants in 1989. We assigned the satellite-derived Normalised Difference Vegetation Index (NDVI) in different buffers (100, 300, 500 and 1000m) around participants’ residential addresses during follow up. We used the extended Cox proportional hazard model to estimate the association between long-term exposure to greenness and natural mortality with a 10-year lag, after adjusting for relevant covariates including sex, age, alcohol use, smoking status, BMI⋯ Stratified analyses were conducted by urban-rural areas and sex. Results: Among the 19,851 participants eligible in this study [mean age at enrollment 43.7 years (SD 3.5), 73% males], we registered 1847 deaths. Each 0.1 increase in NDVI at 100m was associated with 6% higher mortality rate regardless the type of area [Hazard Ratio (HR)=1.06, 95%CI: 1.03-1.10]. Within population subsets, we found 23% higher mortality rate in rural areas (HR=1.23, 95%CI: 1.15-1.31), but 2% lower mortality rate in urban areas (HR=0.98, 95%CI: 0.93-1.04), with a significant difference of the estimates (P&lt;0.001). These urban-rural differences were slightly amplified by sex, with higher HRs for males in rural areas and lower in urban areas. Results were similar for the other buffers.Conclusions: Greenness exposure was associated with higher mortality risk in rural areas with some indications of a potentially protective association in urban areas. Our study suggests a potential effect modification by urban-rural areas, which may provide relevant information for future research and policy developments.

Determining the lx and estimating the force of mortality for children under five in Bangladesh

Background: Under-five mortality is a health indicator in population health and the health sciences. Force of death is a more accurate measure of mortality than others, which indicates the situation of mortality when time tends to zero. The purpose of this research is to construct a simulation for lx (the number of people living at exact age x) for under-five mortality in Bangladesh as a whole, and separately for rural and urban areas, and then estimating the mortality rate in regard to these matched models. Methods: Secondary data were collected from Bangladesh Demographic and Health Survey 2007. A polynomial model was selected to match the lx values. To prove the accuracy of the model, the rule of cross-validity was applied. Results: It has been shown that fourth degree polynomial models can be adjusted to lx values ​​with explanation of more than 94% variation. It was noted that the mortality rate shows a rapidly decreasing pattern for people aged 0-20 months, a monotonically increasing pattern for those aged 20-53.5 months and then it begins to decrease. It is found that the mortality rate in rural areas is higher than in urban areas of all ages. Conclusions: It has been shown that the mortality rate in rural areas is higher than for urban areas of all ages, except for those aged 53.5 months. The health situation should therefore be improved to reduce mortality in rural Bangladesh.

Higher US Rural Mortality Rates Linked To Socioeconomic Status, Physician Shortages, And Lack Of Health Insurance.

All-cause mortality rates in rural areas have exceeded those in urban areas of the US since the 1980s, and the gap continues to widen. Yet no definitive causes of this difference are known, and within-state differences that might be amenable to state-level policy have not been explored. An analysis of 2016 state-level data indicated that rural mortality exceeded urban mortality in all but three states, with substantial variability in both rates across states. Overall, higher rural mortality at the state level can be mainly explained by three factors: socioeconomic deprivation, physician shortages, and lack of health insurance. To a certain degree, these factors reflect a state's health policies, such as expansion of eligibility for Medicaid, health infrastructure, and socioeconomic conditions. Our findings suggest that state and federal policy efforts to address rural-urban disparities in these areas could alleviate the higher rates of all-cause mortality faced by rural US residents.

Opioid mortality in rural communities

Opioid mortality has become a significant medical and economic burden in the UnitedStates, accounting for over 66.3% of drug-related overdoses and $78 billion dollars in healthcare costs. The current US “opioid crisis” has continued to grow with an estimated 2.5 millionpatients being diagnosed with opioid use disorders in 2016. In response, policy makers andgovernment agencies have initiated several programs to mitigate the adverse effects of opioidsthrough expanding access and delivery of evidenced-based treatment and rehabilitationprograms. Rural communities remain significant risk factors for opioid overdose and mortalityin areas lacking access to opioid therapy. Despite measures to provide access to rehabilitationand medical therapy, the opioid-related mortality rate in rural areas has increased significantlydue to greater opioid prescriptions in these areas, an out-migration of young adults, greaterrural social and kinship network connections, and economic stressors. However, limitedopioid-related mortality data in rural regions, such as West Texas, impede further analysisand investigation into effective programs for preventing and treating opioid overdoses in thesecommunities.

Association Between Rural Residence and Nonfatal Suicidal Behavior Among California Adults: A Population-Based Study.

Suicide mortality rates in rural areas of the United States are twice that of rates in urban areas, and identifying which factors-eg, higher rates of suicidal distress, lower rates of help-seeking behaviors, or greater access to firearms-contribute to this rural/urban disparity could help target interventions. Using 2015-2016 data on adult respondents to the California Health Interview Survey (n = 40,041), we examined associations between residence in a rural (vs nonrural) census tract and nonfatal suicidal ideation and attempt. We found that living in a rural area was not associated with nonfatal suicidal behavior (OR for past-year suicidal ideation = 0.87, 95% CI: 0.63-1.20; OR for past-year suicide attempt = 0.55, CI: 0.20-1.48). Women living in rural areas had higher odds of lifetime suicidal ideation compared to women living in nonrural areas, but this difference was not significant (OR = 1.17, CI: 0.94-1.44). We also found that, among individuals reporting suicidal behavior, there were few rural/nonrural differences in perceived need for treatment, such as seeing a physician or taking a prescription for mental health problems. Our results do not suggest higher suicidal distress or lower treatment-seeking behaviors as explanations for the rural/urban disparity in suicide mortality rates. Further attention is needed to the unique risk factors driving suicidality in rural areas, as well as exploring heterogeneity in these factors across different rural contexts.

An Empirical Assessment of Primary Health Care Quality Services and its Effect on Patient Satisfaction in Anuppur District, Madhya Pradesh

There is limited evidence on the quality of primary health care provision in India especially in the rural areas. It has been found that the death rate and the infant mortality rate in rural areas of Madhya Pradesh are quite high as compared to other states. Therefore, if government policy is to revitalize the primary care system, a basic understanding of the quality of services currently provided is a prerequisite. This study attempts to assess the quality of care and patient satisfaction in the primary health care services provided in the rural section of Anuppur District. This study also aimed at exploring the relationship and effect of quality of care on patient satisfaction. This study will also help the primary health care providers and policy maker to further enhance the quality of care and patient satisfaction in the Anuppur District (M.P). Data were analyzed from outpatients from various primary health care centres using descriptive statistics and SPSS 23. Findings indicated that the level of quality of care and patient satisfaction is medium or average and the results also showed that quality of care has a significant correlationship with a mild effect on patient satisfaction.

Divergent trends in ischaemic heart disease and stroke mortality in India from 2000 to 2015: a nationally representative mortality study.

SummaryIntroductionIndia accounts for about a fifth of cardiovascular deaths globally, but nationally representative data on mortality trends are not yet available. In this nationwide mortality study, we aimed to assess the trends in ischaemic heart disease and stroke mortality over 15 years using the Million Death Study.MethodsWe determined national and subnational cardiovascular mortality rates and trends by sex and birth cohort using cause of death ascertained by verbal autopsy from 2001 to 2013 among 2·4 million households. We derived mortality rates for ischaemic heart disease and stroke by applying mortality proportions to UN mortality estimates for India and projected the rates from 2000 to 2015.FindingsCardiovascular disease caused more than 2·1 million deaths in India in 2015 at all ages, or more than a quarter of all deaths. At ages 30–69 years, of 1·3 million cardiovascular deaths, 0·9 million (68·4%) were caused by ischaemic heart disease and 0·4 million (28·0%) by stroke. At these ages, the probability of dying from ischaemic heart disease increased during 2000–15, from 10·4% to 13·1% in men and 4·8% to 6·6% in women. Ischaemic heart disease mortality rates in rural areas increased rapidly and surpassed those in urban areas. By contrast, the probability of dying from stroke decreased from 5·7% to 5·0% in men and 5·0% to 3·9% in women. A third of premature stroke deaths occurred in the northeastern states, inhabited by a sixth of India’s population, where rates increased significantly and were three times higher than the national average. The increased mortality rates of ischaemic heart disease nationally and stroke in the northeastern states were higher in the cohorts of adults born in the 1970s onwards, than in earlier decades. A large and growing proportion of the ischaemic heart disease nationally and stroke deaths in high-burden states reported earlier diagnosis of cardiovascular disease, but low medication use.InterpretationThe unexpectedly diverse patterns of cardiovascular mortality require investigation to identify the role of established and new cardiovascular risk factors. Secondary prevention with effective and inexpensive long-term treatment and adult smoking cessation could prevent substantial numbers of premature deaths. Without progress against the control of cardiovascular disease in India, global goals to reduce non-communicable diseases by 2030 will be difficult to achieve.FundingFogarty International Center of the US National Institutes of Health, Dalla Lana School of Public Health, University of Toronto, Indian Council of Medical Research, and the Disease Control Priorities.

The trend of chronic lower respiratory disease mortality of the residents in Tianjin, China, 2000-2016

Objective: To explore the trends and distribution of chronic obstructive pulmonary disease (COPD) mortality of the residents with different characteristics from 2000 to 2016 in Tianjin. Methods: COPD mortality data in 2000-2016 were from Tianjin population based mortality surveillance system. The mortality rate of COPD, difference in the rate by gender, age, and geographic distribution, and the trend over years were analyzed. Age-sex-standardized mortality rates of COPD were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend analysis were used to examine the trend of mortality. Results: The crude COPD mortality rate in Tianjin decreased from 57.57/100 000 in 2000 to 28.23/100 000 in 2016 (annual percent change (APC)=-5.01%, Z=-64.76, P<0.001), and the standardized mortality rate decreased from 56.53/100 000 in 2000 to13.88/100 000 in 2016 (APC=-9.17%, Z=-100.83, P<0.001). The crude COPD mortality rate of males decreased from 54.57/100 000 to 27.77/100 000 (APC=-4.89%, Z=-43.63, P<0.001) and the standardized mortality rate decreased from 57.52/100 000 to 14.63/100 000 (APC=-9.07%, Z=-71.48, P<0.001). The crude COPD mortality rate of females decreased from 60.63/100 000 to 28.68/100 000 (APC=-5.12%, Z=-47.92, P<0.001) and the standardized mortality rate decreased from 55.53/100 000 to 13 13/100 000 (APC=-9.27%, Z=-71.13, P<0.001). The crude mortality rate of COPD in urban areas decreased from 45.07/100 000 to 19.54/100 000 (APC=-5.35%, Z=-42.38, P<0.001) and the standardized mortality rate decreased from 39.24/100 000 to 7.45/100 000 (Z=-63.97, P<0.001, APC=-10.22%). The crude mortality rate of COPD in rural areas decreased from 70.20/100 000 to 37.24/100 000 (APC=-4.77%, Z=-48.77, P<0.001) and the standardized mortality rate decreased from 78.88/100 000 to 25.70/100 000 (APC=-7.59%, Z=-72.43, P<0.001). The COPD mortality rate in rural areas was higher than that in urban areas (P<0.001). The COPD mortality rate in 35 years old and over decreased from 2000 to 2016 (P<0.001). Conclusion: The COPD mortality in Tianjin decreased from 2000 to 2016. More efforts are need to reduce COPD mortality in Tianjin, in particular people in rural areas.

The trend of intracerebral hemorrhage mortality of the residents with different characteristics in Tianjin, China, 1999-2015

Objective: To explore the trends and distribution of intracerebral hemorrhage (ICH) mortality of the residents with different characteristics from 1999 to 2015 in Tianjin. Methods: ICH mortality data in 1999-2015 were from Tianjin population based mortality surveillance system. The mortality rate of ICH, difference in the rate by gender, age, and geographic distribution, and trends over the years were analyzed. Standardized mortality rates of ICH were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to examine the trends in mortality. Results: A total of 102 279 ICH death cases were observed in Tianjin from year 1999 to 2015. The crude ICH mortality rate in Tianjin decreased from 76.35/100 000 in 1999 to 51.46/100 000 in 2015 (annual percent change (APC)=-1.96%, Z=-31.08, P<0.001) , and the standardized mortality rate decreased from 72.41/100 000 to 29.00/100 000 (APC=-5.20%, Z=-70.91, P<0.001). The crude mortality rate of ICH mortality in males decreased from 87.26/100 000 to 59.89/100 000 (APC=-1.79%, Z=-21.71, P<0.001) and the standardized mortality rate decreased from 85.65/100 000 to 35.75/100 000 (APC=-4.93%, Z=-52.32, P<0.001). The crude mortality rate of ICH mortality in females decreased from 65.21/100 000 to 42.98/100 000 (APC=-2.18%, Z=-22.28, P<0.001) and the standardized mortality rate decreased from 59.17/100 000 to 22.26/100 000 (APC=-5.63%, Z=-48.15, P<0.001). The ICH mortality rate under 35 years old increased from 0.78/100 000 to 0.92/100 000 (APC=4.41%, Z=5.07, P<0.001), especially in males increasing from 0.90/100 000 to 1.54/100 000 (APC=6.59%, Z=6.52, P<0.001). The crude mortality rate of ICH in urban areas decreased from 69.74/100 000 to 41.79/100 000 (APC=-3.18%, Z=-31.43, P<0.001) and the standardized mortality rate decreased from 57.56/100 000 to 20.42/100 000 (APC=-6.59%, Z=-53.43, P<0.001). The crude mortality rate of ICH in rural areas decreased from 82.99/100 000 to 61.49/100 000 (APC=-1.10%, Z=-14.06, P<0.001) and the standardized mortality rate decreased from 91.55/100 000 to 43.14/100 000 (APC=-3.78%, Z=-43.21, P<0.001). The ICH mortality rate in rural areas was higher than that in urban areas (P<0.05). Conclusion: ICH mortality rate in Tianjin decreased from 1999 to 2015. Further efforts to reduce ICH mortality in Tianjin is needed, in particular males, under 35 years old, and people in rural areas.

Skull Fracture and Haemorrhage Pattern among Fatal and Nonfatal Head Injury and Primary Reconstruction of Depressed Fracture

Head injuries is a worldwide problem. It is defined as insult to the head region and include fractures of the skull and facial bone. intracranial injuries and injuries to a special sense. The important factor that determines the outcome is terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intracranial haemorrhage. The study concluded a total of 206 cases with criminal head injury. All cases were from Minia Govern rate, Egypt. Age was ranged from 11 to 80 years old. In the current study the cases were with a definite head injury. Cases examined for age, sex, residence, type and site of fracture, treatment and complication. Cases were divided into 2 groups first group was patients with head injury and stay alive (non-fatal group) second group was patients with head injury and died at once after trauma or on their way to the hospital or after admission to the hospital (fatal group). Complete medical examination was done to the first group and complete autopsy was done to the second group, cross tabulations of the two groups for each variable were statistically analysed such variables include age, residence, sex, type of trauma, effect of trauma, treatment and complications. Chi square test was done to compare categorical variables with a P value < 0.05 is considered significant, ANOVA test was done to compare the age variable between the 2 examined groups. SPSS version 16 was used for statistical analysis, firearm injuries were the major cause of such criminal assault followed by injuries due to blunt trauma among fatal cases meanwhile blunt trauma was the common type of such criminal assault among non-fatal cases. Chance of survival following blunt trauma to the head is far greater as shown in the present study, light weapons are not sufficient to inflict fatal head injury, there was significant difference between both sex regarding fatality and outcome of head injuries, increasing age associated with poor outcome, the incidence of head injuries was very high in rural areas compared with urban areas and the mortality rate in rural areas was very high due to lack of facilities and all cases were referred to contral hospitals, the comminuted skull fracture was the commonest fatal type, the extradural and subdural haemorrhage were more common among the non-fatal cases and subarachnoid haemorrhage was more common among fatal cases.

Incidence and mortality of stomach cancer in China, 2014.

In this study, we aimed to estimate the updated incidence and mortality rate of stomach cancer based on the cancer registration data in 2014, collected by the National Central Cancer Registry of China (NCCRC). In 2017, 339 registries' data were qualified based on the criteria of data quality control of the NCCRC. Cases of stomach cancer were retrieved from the national database. We estimated numbers of stomach cancer cases and deaths in China using age-specific rates and corresponding national population stratified by area, sex, age-group (0, 1-4, 5-9, 10-14, …, 85+). Chinese standard population in 2000 and Segi's world population were applied for age-standardized incidence and mortality rates. In 2014, 410,400 new stomach cancer cases and 293,800 cancer-associated deaths were estimated to have occurred in China. The crude incidence rate of stomach cancer was 30.00/100,000, age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 19.62/100,000 and 19.51/100,000, respectively. The crude mortality rate of stomach cancer was 21.48/100,000, age-standardized mortality rates by Chinese (ASMRC) and by world standard population (ASMRW) were 13.44/100,000 and 13.30/100,000, respectively. Incidence and mortality rates in rural areas were both higher than that in urban areas. Stomach cancer has a strong relationship with gender and age. The disease has occurred more frequently among men than women with a male to female ratio of 2.4 for ASIRC. After age group of 40-44 years, incidence rates are substantially higher in men than in women, same pattern was seen for age-specific mortality rates. There is still a heavy burden of stomach cancer in China. The incidence and mortality patterns of stomach cancer show substantial gender and regional disparities. Great effort is needed to provide more accessible health services, sufficient financial resources, and adequate cancer-care infrastructure for the Chinese population, especially for people living in rural areas.