Sex Ratio Mortality Research Articles

COVID-19 increased existing gender mortality gaps in high-income more than middle-income countries

ObjectiveTo analyze how patterns of excess mortality varied by sex and age groups across countries during the COVID-19 pandemic and their association with country income level. MethodsWe used World Health Organization excess mortality estimates by sex and age groups for 75 countries in 2020 and 62 countries in 2021, restricting the sample to estimates based on recorded all-cause mortality data. We examined patterns across countries using country-specific Poisson regressions with observations consisting of the number of excess deaths by groups defined by sex and age. FindingsMen die at higher rates in nearly all places and at all ages beyond age 45. In 2020, the pandemic amplified this gender mortality gap for the world, but with variation across countries and by country income level. In high-income countries, rates of excess mortality were much higher for men than women. In contrast, in middle-income countries, the sex ratio of excess mortality was similar to the sex ratio of expected all-cause mortality. The exacerbation of the sex ratio of excess mortality observed in 2020 in high-income countries, however, declined in 2021. ConclusionThe COVID-19 pandemic has killed men at much higher rates than women, as has been well documented, but these gender differences have varied by country income. These differences were the result of some combination of variation in gender patterns of infection rates and infection fatality rates across countries. The gender gap in mortality declined in high-income countries in 2021, likely as a result of the faster rollout of vaccination against COVID-19.

Influence of temperature combined with photodynamic inactivation on the development of Aedes aegypti

To reduce the speed of selection of populations resistant to chemical insecticides, photodynamic inactivation (PDI) against Aedes aegypti is a hot-topic and promising alternative technique to vector control. Temperature is an important factor in the survival of Ae. aegypti larvae and mosquitoes as it influences physiology, behavior, and ecology. This work aimed to evaluate parameters of the biological cycle of Ae. aegypti such as: hatching rate, larval development, adult mosquito longevity, sex ratio, weight, and lethal concentration of larval mortality (LC) through the combination of PDI with different temperatures. The number of larvae found after 48 h suggests that temperature affects hatching rate. Additionally, results showed a delay in development of surviving larvae after PDI when compared to control groups, and there was a reduction in the longevity of mosquitoes that undertook photodynamic action. PDI also led to a predominance of male insects, and observed weight indicates that the inactivation method may have also interfered in mosquito size. The results point to a satisfactory performance of PDI at all tested temperatures. Experimental conditions that were not lethal to all larvae implied that PDI impacts the mosquitoes’ biological cycle. Though metabolism and development are improved at higher temperatures, so is PDI action, thus maintaining the net benefit. Therefore, it is assumed that the proposed photolarvicide can be useful in reducing arbovirus transmission, and results invite for future research in different abiotic conditions.

Sex differences in mortality among children, adolescents, and young people aged 0–24 years: a systematic assessment of national, regional, and global trends from 1990 to 2021

Differences in mortality exist between sexes because of biological, genetic, and social factors. Sex differentials are well documented in children younger than 5 years but have not been systematically examined for ages 5-24 years. We aimed to estimate the sex ratio of mortality from birth to age 24 years and reconstruct trends in sex-specific mortality between 1990 and 2021 for 200 countries, major regions, and the world. We compiled comprehensive databases on the mortality sex ratio (ratio of male to female mortality rates) for individuals aged 0-4 years, 5-14 years, and 15-24 years. The databases contain mortality rates from death registration systems, full birth and sibling histories from surveys, and reports on household deaths in censuses. We modelled the sex ratio of age-specific mortality as a function of the mortality in both sexes using Bayesian hierarchical time-series models. We report the levels and trends of sex ratios and estimate the expected female mortality and excess female mortality rates (the difference between the estimated female mortality and the expected female mortality) to identify countries with outlying sex ratios. Globally, the mortality sex ratio was 1·13 (ie, boys were more likely to die than girls of the same age) for ages 0-4 years (90% uncertainty interval 1·11 to 1·15) in 2021. This ratio increased with age to 1·16 (1·12 to 1·20) for 5-14 years, reaching 1·65 for 15-24 years (1·52 to 1·75). In all age groups, the global sex ratio of mortality increased between 1990 and 2021, driven by faster declines in female mortality. In 2021, the probability of a newborn male reaching age 25 years was 94·1% (93·7 to 94·4), compared with 95·1% for a newborn female (94·7 to 95·3). We found a disadvantage of females versus males (compared with countries with similar total mortality) in 2021 in five countries for ages 0-4 years (Algeria, Bangladesh, Egypt, India, and Iran), one country (Suriname) for ages 5-14 years, and 13 countries for ages 15-24 years (including Bangladesh and India). We found the reverse pattern (disadvantage of males vs females compared with countries of similar total mortality) in one country in ages 0-4 years (Vietnam) and eight countries in ages 15-24 years (including Brazil and Mexico). Globally, the number of excess female deaths from birth to age 24 years was 86 563 (-6059 to 164 000) in 2021, down from 544 636 (453 982 to 633 265) in 1990. The global sex ratio of mortality for all age groups in the first 25 years of life increased between 1990 and 2021. Targeted interventions should focus on countries with outlying sex ratios of mortality to reduce disparities due to discrimination in health care, nutrition, and violence. The Bill & Melinda Gates Foundation, US Agency for International Development, and King Abdullah University of Science and Technology.

Current Trends in Comorbidity Prevalence and Associated Mortality in a Population-Based Cohort of Hip Fracture Patients in Denmark.

Patients with hip fractures often have comorbidities, but detailed data on comorbidity and its impact on prognosis are lacking. We described the current trends in the prevalence of comorbidity and the magnitude of the associated mortality. From the Danish Multidisciplinary Hip Fracture Registry we included 31,443 hip fracture patients (diagnosed in 2014-2018). We calculated the prevalence of individual diseases and comorbidity measured with the Charlson Comorbidity Index (CCI), the Elixhauser Index, and the Rx-Risk Index. We calculated sex and age-adjusted odds ratios (aORs) for 30-day mortality and hazard ratios (aHRS) for one-year mortality with 95% confidence intervals (CI). The most common diseases identified with the CCI were cerebrovascular diseases (18%), malignancies (17%), chronic pulmonary disease (14%), and dementia (11%). Using the Elixhauser Index, hypertension (37%), cardiac arrhythmias (21%), and fluid and electrolyte disorders (15%) were most prevalent, while ischemic heart disease (42%), hypertension (39%), and use of antiplatelets (37%) were most prevalent when using the Rx-Risk Index. Using the Rx-Risk Index, only 28% of patients had no comorbidity compared to 38% for CCI and 44% for the Elixhauser Index, and the prevalence was stable through the years. Compared to patients with no comorbidity, patients with very severe comorbidity had an aORs for 30-day mortality of 2.6 (CI: 2.4-2.9) using CCI, 2.6 (CI: 2.4-3.1) using the Elixhauser Index, and 3.1 (CI: 2.7-3.4) using the Rx-Risk Index. More than 50% of the patients with hip fractures have moderate to very severe comorbidity, with considerable variation between indices. The prevalence of individual diseases varies considerably. All indices had comparable dose-response associations with mortality. These results are relevant for clinicians to amend prevention and target care, and for researchers to decide which comorbidity measure to use depending on the research question.

The Incidence and Age Distribution of Death: Mortality by Caste, Gender, and Sector of Origin in India in the Mid-2010s

ABSTRACT This paper considers the distribution of mortality across social groups classified by caste, gender and sector of origin in India in the mid-2010s: as such, the essay is intended to be both a methodological/measurement-oriented study and a substantive empirical assessment of an important dimension of human functioning in India. The analysis is carried out employing micro-data on the age-distributions of population and death-rates available in the National Family Health Survey of 2015–16 (NFHS-4). Mortality in the paper is measured in terms of the crude death rate, an indicator of “inefficiency” in the age-distribution of deaths, and an “age-adjusted” death rate which takes account of both the mean and the dispersion of a distribution. The last-mentioned indicator is taken to be the preferred measure of mortality. The analysis in the paper suggests that mortality outcomes across castes replicate the caste hierarchy and that there is a sharp rural-urban divide in the distribution of death. Mortality sex-ratios are found to be relatively more favourable for the lower than the higher castes. The results presented in the paper are not unexpected, but they provide quantitative confirmation of one's worst suspicions regarding the skewed distribution of mortality across social groups in India.

Reported mortality of Griffon VultureGyps fulvusin central Italy and indications for conservation and management

SummaryVultures are long-lived species sensitive to human-caused mortality that has already determined a widespread collapse in Asian and African populations. They provide significant ecosystem services (regulatory and cultural) consuming livestock carcasses and saving greenhouse gas emissions, favouring nutrient recycling, environmental sanitation, and providing financial revenue. Appraising the incidence and causes of mortality could help to improve management and conservation actions. We compiled records of reported mortalities for the reintroduced Griffon VultureGyps fulvuspopulation of the central Apennines in Italy (123 cases, July 1994–December 2020). The average mortality was 4.69 vultures per year (± 1.14 SE), with no significant temporal trend. The peak of mortality events, estimated by harmonic regression analysis, was in March, while the minimum occurred in October. No differences were found among age classes and sex ratio mortality was established at 1.43:1 (M:F,N= 68). Out of 103 (83.7%) vultures which underwent a post-mortem and toxicological screening, 53% were poisoned, mainly by carbamates, and 27% died of unknown causes. Overall, direct or indirect anthropogenic mortality caused 67% of deaths. Even considering an inherent bias associated with reported mortality as to the prevalence of causes of death and estimation of mortality rates, the overwhelming relevance of poisoning highlights that existing anti-poisoning efforts should be refined and incorporated into a coordinated multidisciplinary strategy. A standardised approach, from vulture carcass discovery to post-mortem procedures and toxicological analysis, should be applied to reduce uncertainty in the determination of causes of death, increasing effectiveness in the prosecution of wildlife crimes. As most of the poisoning cases affecting the Griffon Vulture population in the central Apennines likely represent a side (though illegal) effect of retaliatory efforts to defeat livestock predators, effective strategies in reducing human–wildlife conflicts should be applied.

Multiple Population Mortality Jointly Forecasting in China Using PCF Model

Based on the data of population mortality in China since 1994, this paper studies the changing trend of sex differences of mortality by proposing and implementing some novel approaches. First of all, this paper proposes a new method using the Poisson common factor (PCF) model to forecast the mortality jointly by both sexes. The study finds that the PCF model effectively captures the common trend of mortality between two sexes and uses additional factors to reflect differences of between two sexes, which can reduce the errors caused by low quality or large fluctuation of the mortality in China. Meanwhile, the forecasting values of mortality based on the PCF model can abide by the human biological law well, and the sex ratio of mortality converges to a fixed constant in the long run without increasing too much statistical error. Second, this paper improves the parameter estimation method of PCF model, and the innovative two-step method is used to estimate the model, which can make the maximum likelihood estimator converge more easily. Finally, as an application of the novel methods which are proposing in this study, we measure the longevity risk of pension by using the PCF model and find that the PCF model can make up the underestimation of longevity risk from traditional models and provide more scientific information to the sponsor of pension plan.

Stem xylem traits and wood formation affect sex-specific responses to drought and rewatering in Populus cathayana.

The increased frequency and intensity of drought pose great threats to the survival of trees, especially in dioecious tree species with sexual differences in mortality and biased sex ratios. The sex-specific mechanisms underlying stem xylem anatomy and function and carbon metabolism in drought resistance and recovery were investigated in dioecious Populus cathayana Rehder. The sex-specific drought resistance and subsequent recovery were linked to the xylem anatomy and carbon metabolism. Females had a greater xylem vessel area per vessel, biomass and theoretically hydraulic efficiency under well-watered conditions. Conversely, males had a lower xylem lumen area, but greater vessel numbers, and a higher cell wall thickness, suggesting a theoretically conservative water-use strategy and drought resistance. The recovery of photosynthetic ability after drought in males was largely dependent on the recovery of xylem function and the regulation of the xylem carbohydrate metabolism. Additionally, the number of upregulated genes related to xylem cell wall biogenesis was greater in males relative to females under drought stress and subsequent rewatering, which facilitated drought resistance and xylem function restoration in males. These results suggested that sex-specific drought resistance and restoration were related to xylem anatomy and function, carbohydrate metabolism and cell turgor maintenance.

Sex-Biased Mortality and Sex Reversal Shape Wild Frog Sex Ratios

Population sex ratio is a key demographic factor that influences population dynamics and persistence. Sex ratios can vary across ontogeny from embryogenesis to death and yet the conditions that shape changes in sex ratio across ontogeny are poorly understood. Here, we address this issue in amphibians, a clade for which sex ratios are generally understudied in wild populations. Ontogenetic sex ratio variation in amphibians is additionally complicated by the ability of individual tadpoles to develop a phenotypic (gonadal) sex opposite their genotypic sex. Because of sex reversal, the genotypic and phenotypic sex ratios of entire cohorts and populations may also contrast. Understanding proximate mechanisms underlying phenotypic sex ratio variation in amphibians is important given the role they play in population biology research and as model species in eco-toxicological research addressing toxicant impacts on sex ratios. While researchers have presumed that departures from a 50:50 sex ratio are due to sex reversal, sex-biased mortality is an alternative explanation that deserves consideration. Here, we use a molecular sexing approach to track genotypic sex ratio changes from egg mass to metamorphosis in two independent green frog (Rana clamitans) populations by assessing the genotypic sex ratios of multiple developmental stages at each breeding pond. Our findings imply that genotypic sex-biased mortality during tadpole development affects phenotypic sex ratio variation at metamorphosis. We also identified sex reversal in metamorphosing cohorts. However, sex reversal plays a relatively minor and inconsistent role in shaping phenotypic sex ratios across the populations we studied. Although we found that sex-biased mortality influences sex ratios within a population, our study cannot say at this time whether sex-biased mortality is responsible for sex ratio variation across populations. Our results illustrate how multiple processes shape sex ratio variation in wild populations and the value of testing assumptions underlying how we understand sex in wild animal populations.

Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan

(1) Background: The prevalence of opioid use in Taiwan increased by 41% between 2002 and 2014. However, little is known regarding the risk of mortality among long-term opioid analgesics users who do not have cancer. This study investigated this mortality risk with an emphasis on the calendar year and patients’ age and sex. (2) Methods: This retrospective cohort study included 12,990 adult individuals without cancer who were long-term users of opioid analgesics and were randomly selected from the data set of Taiwan’s National Health Insurance program from 2000 to 2012. They were then followed up through 2013. Information on the underlying causes of death was retrieved from the Taiwan Death Registry. Age, sex, and calendar year-standardized mortality ratios (SMRs) of all-cause and cause-specific mortality were calculated with reference to those of the general population. (3) Results: With up to 14 years of follow-up, 558 individuals had all-cause mortality in 48,020 person-years (cumulative mortality: 4.3%, mortality rate: 11.62 per 1000 person-years). Compared with the general population, the all-cause SMR of 4.30 (95% confidence interval (95% CI): 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural (5.04, 95% CI: 3.88–6.45) causes. (4) Conclusions: Long-term opioid analgesics use among individuals without cancer in Taiwan was associated with a significantly increased risk of mortality. The notably increased mortality in younger adults warrants attention. Strategies to reduce long-term opioid analgesics use, especially their overuse or misuse, are in an urgent need.

Seasonal variation in the ecology of tropical cavity-nesting Hymenoptera on Mt. Kilimanjaro

Insect communities vary seasonally with changing climatic conditions and related changes in resource availability, strength of competition, or pressure by natural antagonists. But seasonal dynamics, particularly in tropical mountain ecosystems, are not well understood. We monitored cavity-nesting Hymenoptera communities on Mt. Kilimanjaro, Tanzania, to analyse temporal patterns of nest-building activity, ecological rates, and life-history traits in relation to seasonal climatic variation and elevation. We installed trap nests on 25 study sites in natural and disturbed habitat types covering the colline (<1,300 m) and submontane zones (≥1,300 m a.s.l). We analysed patterns of seasonality in the cavity-nesting ecology of Hymenoptera at three different trophic levels –bees, caterpillar-hunting wasps and spider-hunting wasps– over a complete annual period, covering two rainy and two dry seasons. Nest-building activity showed strong seasonal trends in all three investigated trophic levels and peaked at the end of the short rainy season at low elevations. Nest-building activity was considerably higher and seasonal trends were better synchronised between the different trophic levels in the colline zone at low elevations. We also detected seasonal patterns for parasitism and natural mortality rates, sex ratio, and development time, which varied with trophic level and between elevation levels. Climate and flower abundance were important predictors for seasonal patterns in nest-building activity, ecological rates and life-history traits. These results reveal that seasonal trends in nest-building activity of lowland Hymenoptera seem to be linked to changes in climate and resource availability that reflect the seasonal patterns in plant growth and flowering documented in lowland savanna ecosystems. Higher resource availability also increased the sex ratio in bees towards the more costly females and enhanced their survival rates. These spatiotemporal links between climate, resources, ecological rates, and life-history traits indicate high sensitivity of plant-host-antagonist interactions to environmental changes.

743Determinants of childhood mortality sex ratios in low- and middle-income countries

Abstract Background Child mortality sex ratios may reflect community preferences and gender discrimination in health care. We assessed differences between observed and expected sex ratios of under-five mortality and their association with contextual factors. Methods Full birth histories from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010–2018) in 77 countries were used to estimate under-five mortality sex ratios (male-to-female). Expected sex ratios and their residuals (difference of observed from expected) were derived from a fractional polynomial model, adjusted for overall mortality. Higher male-to-female residuals indicate lower likelihood of discrimination against girls. The same approach was used for 720 subnational regions from 75 countries. Associations between residuals and national gender and development indices, and with survey-derived child health care indicators were tested using Spearman’s correlation. Results Greater positive residuals were found in countries with higher Gross National Product per capita (rho=0.26), women older age at first marriage (rho=0.36), Human Development Index (rho = 0.23), and the Women, Peace and Security Index (rho=0.25). The Gender Inequality Index, which indicates less discrimination among women, was inversely correlated with the residuals (rho=-0.30). None of the survey-based indicators of gender bias in health care were significantly associated with the residuals, either at national or subnational levels. Conclusion Contextual variables measured at country level are associated with the sex ratio of under-five mortality. Key messages In more developed societies there is less evidence of gender bias in child deaths.

Sex-specific growth of nestlings of the Whiskered Tern Chlidonias hybrida, a species with sexual size dimorphism and female brood desertion

The growth of a nestling during the first few weeks after hatching is crucial for its further life and is sensitive to the conditions experienced during this period. Among species exhibiting Sexual Size Dimorphism (SSD), one of the most important factors influencing growth parameters is the sex of the hatchlings. In this study, we tested whether sex and other factors (hatching date, egg volume, brood size and sex ratio in the brood) were related to sex on growth parameters in Whiskered Tern (Chlidonias hybrida) chicks. In this species, males are 3%–10% larger than females when adult. At hatching, only the total head length was greater in males than females, but values close to fledging were greater for most of the measured parameters (3%—tarsus, 4%—total head length, 13%—body mass). Moreover, the maximum body mass growth rate was higher in males but females entered the rapid growth phase somewhat earlier and achieved the final total head length sooner. Nestling growth was also significantly correlated with brood size and hatching date, though mostly negatively (e.g. lower tarsus and total head length asymptote, lower maximum growth rate and growth rate constant of total head length in bigger and later clutches). The occurrence of SSD during the nestling period and higher maximum growth rate of body mass in males indicates that the costs of raising sons may be higher than of raising daughters. However, we did not find evidence of either sex-biased nestling mortality or skewed sex ratio.

Levels and potential drivers of under-five mortality sex ratios in low- and middle-income countries.

BackgroundNon‐biological childhood mortality sex ratios may reflect community sex preferences and gender discrimination in health care.ObjectiveWe assessed the association between contextual factors and gender bias in under‐five mortality rates (U5MR) in low‐ and middle‐income countries.MethodsFull birth histories available from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010‐2018) in 80 countries were used to estimate U5MR male‐to‐female sex ratios. Expected sex ratios and their residuals (difference of observed and expected) were derived from a linear regression model, adjusted for overall mortality. Negative residuals indicate more likelihood of discrimination against girls, and we refer to this as a measure of potential gender bias. Associations between residuals and national development and gender inequality indices and with survey‐derived child health care indicators were tested using Spearman's correlation.ResultsMortality residuals for under‐five mortality were not associated with national development, education, religion, or gender inequality indices. Negative residuals were more common in countries where boys were more likely to be taken to health services than girls (rho −0.24, 95% confidence interval −0.45, −0.01).ConclusionsCountries where girls were more likely to die than boys, accounting for overall mortality levels, were also countries where boys were more likely to receive health care than girls. Further research is needed to understand which national characteristics explain the presence of gender bias, given that the analyses of development levels and gender equality did not discriminate between countries with or without excess mortality of girls. Reporting on child mortality separately by sex is required to enable such advances.

Sex-specific deaths in Norway and Sweden during the COVID-19 pandemic: Did mandates make a difference?

To determine whether differences between Norway's and Sweden's attempts to contain SARS-CoV-2 infection coincided with detectably different changes in their all-cause mortality sex ratios. Measuring temporal variation in the all-cause mortality sex ratio before and during the pandemic in populations exposed to different constraints on risky behavior would allow us to better anticipate changes in the ratio and to better understand its association with infection control strategies. I apply time Box-Jenkins modeling to 262 months of pre-pandemic mortality sex ratios to arrive at counterfactual values of 10 intra-pandemic ratios. I compare counterfactual to observed values to determine if intra-pandemic ratios differed detectably from those expected as well as whether the Norwegian and Swedish differences varied from each other. The male to female mortality sex ratio in both Norway and Sweden increased during the pandemic. I, however, find no evidence that the increase differed between the two countries despite their different COVID-19 containment strategies. Societal expectations of who will die during the COVID-19 pandemic will likely be wrong if they assume pre-pandemic mortality sex ratios because the intra-pandemic ratios appear, at least in Norway and Sweden, detectably higher. The contribution of differences in policies to reduce risky behavior to those higher ratios appears, however, small.

Development of The Fall Armyworm, Spodoptera frugiperda (J. E. Smith) on Three Host Plants نمو وتطور دودة الحشد الخريفية علي ثلاثة عوائل نباتية

The present laboratory study is first attempt in Egypt which focused on studying the development of recent invasive insect pest “fall armyworm” Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) on three host plants, Castor oil, Corn and Lettuce. Study was conducted at Department of Zoology, Faculty of Science, South Valley University, Qena Governorate, Egypt. The fall armyworm, S. frugiperda is an economically important polyphagous. The pest has recently invaded Egypt causing unexpected damage to maize and other crops. The life history of S. frugiperda on three different host food resources, castor leaves, corn and lettuce was studied under laboratory conditions. Larval mortality percentage, larval duration, pupation percentage, pupal weight, pupal duration, pupal mortality percentage, adult emergence, sex ratio, male and female longevity, fecundity (No. of egg laying/female) and fertility % (egg hatchability) were evaluated. Obtained results showed that, average larval duration was 23.36, 23.58 and 22.8 days for castor leaves, corn and lettuce, respectively. The pupal duration was 10.52, 10.75 and 10.89 days respectively at the same three hosts. There were non-significant different between all pupal duration values. Fecundity (eggs laid by the females) was 2299.0, 1839.5 and 2116.0 egg/female at the same three hosts, respectively. Also results indicated that, post ovipostion periods were 2.4, 1.0 and 2.19 days, for castor leaves, maize and lettuce respectively. There were no preferences for any of tested plants which may be related to antixenosis/antibiosis. The fall armyworm S. frugiperda can easily reared in laboratory using uneconomic plants castor oil leaves.

Increased Mortality Risk in People with Type 2 Diabetes Mellitus in Lithuania.

This retrospective cohort study aimed to analyze overall and cause-specific mortality risk in people with type 2 diabetes mellitus (T2DM) in Lithuania. Information on the diagnosis of T2DM and glucose-lowering medication was obtained from the National Health Insurance Fund database, causes of death–from death certificates. Sex, age, and calendar period-standardized mortality ratios (SMRs) were calculated. In addition, 89,512 patients were followed-up between 2010 and 2017, contributing to the observation period of 592,321 person-years. Overall mortality risk was increased for both sexes (overall SMR = 1.35, 95% confidence interval (CI) 1.34–1.37). Greatest mortality risk was in the age group of 40–49 years at diabetes diagnosis (SMR = 1.68, 95% CI 1.60–1.76) and among those who had died before the age of 50 (SMR = 22.04, 95% CI 18.82–25.81). Patients treated with insulin only had the highest SMR (2.43, 95% CI 2.32–2.55). Mortality risk increased with increasing diabetes duration and was higher in women in all these groups. The highest cause-specific SMRs were infection-related causes (SMR = 1.44), particularly septicemia (SMR = 1.78), diseases of the circulatory system (SMR = 1.42), especially ischemic heart (SMR = 1.46) and cerebrovascular diseases (SMR = 1.38), as well as diseases of the digestive system (SMR = 1.35). Cancer mortality risk was elevated for women (SMR = 1.13), but not for men (SMR = 0.93). In conclusion, people with T2DM had an excess mortality risk, which was higher in women compared to men, younger people, in those who were diagnosed with T2DM at a younger age, had longer diabetes duration, and who required treatment with insulin.

Cohort Analysis of Epithelial Cancer Mortality Male-to-Female Sex Ratios in the European Union, USA, and Japan.

Objective: To illustrate trends in sex ratios in epithelial cancer mortality in the EU, USA, and Japan, with a focus on age-specific and cohort patterns. Methods: We obtained certified deaths and resident populations from the World Health Organisation for the period of 1970–2014 for the USA, Japan, and the EU for 12 epithelial cancer sites. From these, we calculated both the age-specific and age-standardised male-to-female mortality sex ratios. We applied an age-period-cohort model to the sex ratios in order to disentangle the effects of age, period of death, and birth cohort. Results: Age-standardised mortality sex ratios were found to be unfavourable to males, apart from thyroid cancer. The highest standardised rates were in laryngeal cancer: 7·7 in the 1970s in the USA, 17·4 in the 1980s in the EU, and 16·8 in the 2000s in Japan. Cohort patterns likely to be due to excess smoking (1890 cohort) and drinking (1940 cohort) in men were identified in the USA, and were present but less defined in the EU and Japan for the oral cavity, oesophagus, liver, pancreas, larynx, lung, bladder, and kidney. Conclusion: Mortality sex ratio patterns are partly explained by the differences in exposure to known and avoidable risk factors. These are mostly tobacco, alcohol, and obesity/overweight, as well as other lifestyle-related factors.

Inequalities in cause-specific mortality in children and adolescents in the Moramanga health survey, Madagascar.

One child or young adolescent dies every 10min in Madagascar and large disparities in survival persist. We estimated cause-specific mortality in a cohort of children aged 0-14 in the Moramanga district and explored how causes of death shape these inequalities. Children were followed prospectively between 2012 and 2017. Causes of death were established based on verbal autopsies. Incidence rate ratios were estimated in Poisson regression models. The risk of dying before age 15 was 68.1 per thousand live births. Risks of dying were highest in the first year of life (31.2‰) and lowest in children aged 10-14 (6.4‰). The male-to-female sex ratios of mortality increased with age and reached 2.3 among adolescents aged 10-14. Communicable, nutritional and neonatal causes accounted for 79.5% of deaths below age 5 and 47.0% above age 5. Mortality was positively associated with household poverty, lack of education of the household head, and rural residence. Interventions should be designed with an equity lens to reduce large disparities in survival and be tailored to the needs of each age-group.

Mortality in children with severe acute malnutrition

Malnutrition is a major contributor to the global disease burden, accounting for more than one-third of child deaths worldwide. Severe Acute Malnutrition is a disease that is an underlying condition in many under five admissions in the study area of Hiwot Fana Specialized University Hospital, Harare and in Ethiopia as a whole. The main objective of the study is to identify the prevalent cause of mortality in Severe Acute Malnutrition, among children aged 6-59 months, admitted to Hiwot Fana Specialized University Hospital, Pediatric ward, Nutrition Rehabilitation Unit from 2013 to 2015. Which will be key to help improve the management protocol so as to see better outcomes in the patients in the study area, or at the very least to be a stepping stone to and point out the need for further analytical studies on the topic. The study was a retrospective, descriptive cross-sectional study which was conducted to identify the prevalent causes of mortality in patients aged 6-59 months admitted to Hiwot Fana Specialized University Hospital, Nutrition Rehabilitation Unit over the period of 2013-2015. The study reveals that the case recovery rate of the study area is 36% with the rate of patients who have disappeared or had left against physician's advice being a whapping 61.9%. The mortality rate weez was found to be 2.1% with the mortality sex ratio of Male: Female 1.6:1. The commonest complication that appears to related with mortality in Severe Acute Malnutrition was diarrheal disease (Acute Gastroenteritis) being present in 14 of the 15 deaths in the study period. The study concludes that the Case Fatality Rate of the study area, even though very low, the high rate of disappearance and yet a comparatively low rate of recovery brings to question the general quality of care in the facility. More to this the commonest complication associated with mortality being a preventable and manageable one i.e. AGE calls for Vigilance in the management of such patients.