National Vital Registration System Research Articles

Effect of Age and Sex on Stroke Mortality of Young and Middle-aged Adults in China, 2002–2019, and Predictions to 2030

ObjectiveThis study aimed to examine the trends in stroke mortality among young and middle-aged adults in China. MethodsData were obtained from the China national vital registration system. Significant changes in mortality were assessed by Joinpoint regression. Age-period-cohort analysis was used to explain the reasons for the changes. Future mortality and counts were predicted by the Bayesian age-period-cohort model. ResultsBetween 2002 and 2019, a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded. The age-adjusted mortality rates (AAMRs) of women showed a downward trend. The annual percent changes (APC) were –3.5% (–5.2%, –1.7%) for urban women and –2.8% (–3.7%, –1.9%) for rural women. By contrast, the AAMRs per 100,000 for rural men aged 25–44 years continued to rise from 9.40 to 15.46. The AAMRS for urban men aged 25–44 years and urban and rural men aged 45–64 years did not change significantly. Between 2020 and 2030, the projected stroke deaths are 1,423,584 in men and 401,712 in women. ConclusionSignificant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China. Targeted health policy measures are needed to address the burden of stroke in the young generation, especially for rural men, with a focus on the prevention and management of high risk factors.

Timed up and go test predicts mortality in older adults in Peru: a population-based cohort study

BackgroundWhile there is evidence about stablished risk factors (e.g., raised blood pressure) and higher mortality risk in older population, less has been explored about other functional parameters like the Timed Up and Go test and the Gait Speed in older people at low- and middle-income countries. We aimed to study these mobility tests as predictors of mortality in a population of older people in Peru.MethodsPopulation-based prospective cohort study (2013–2020). Random sampling of people aged 60+ years in a community of Lima, Peru. Geriatricians conducted all clinical evaluations and laboratory tests were conducted in the local hospital. Participants were sought in the national vital registration system, and we collated cause (ICD-10) and date of death. We conducted a nested forward multivariate Cox proportional hazard model to identify all potential predictors of all-cause, communicable and non-communicable diseases mortality.ResultsAt baseline, there were 501 older people (mean age 70.6 and 62.8% were women), complete follow-up information was available from 427 people. Mean follow-up time was 46.5 months (SD = 25.3). In multivariate models, the Timed Up and Go test was associated with higher risk of all-cause mortality (HR = 1.05; 95% CI: 1.02–1.09). For cause-specific mortality, history of heart disease (HR = 2.25; 95% CI: 1.07–4.76) and age in years (HR = 1.05; 95% CI: 1.01–1.09) were predictors of non-communicable diseases mortality.ConclusionsIn addition to established risk factors for mortality in older population, the Timed Up and Go test, a functional parameter, raised as a relevant predictor of all-cause mortality.

Unattended Pregnancies and Perinatal Mortality in Georgia.

IntroductionThe majority of pregnant women in Georgia attend the free-of-charge, national antenatal care (ANC) programme, but over 5% of pregnancies in the country are unattended. Moreover, Georgia has one of the highest perinatal mortality (PM) rates in Europe (11.7/1000 births).PurposeTo assess the association between unattended pregnancies and the risk of PM.MethodsData were extracted from the Georgian Birth Registry (GBR) and the national vital registration system. All mothers who had singleton births and delivered in medical facilities in Georgia in 2017–2018 were included in the study and categorised into attended pregnancies (at least one ANC visit during pregnancy) and unattended pregnancies (no ANC visits during pregnancy). After exclusions, the study sample included 101,663 women and their newborns, of which 1186 were either stillborn or died within 7 days. Logistic regression analysis was used to assess the effect of unattended pregnancies on PM.ResultsDuring the study period, the PM rate was 12.9/1000 births. In total, 5.6% of women had unattended pregnancies. The odds of PM among women with unattended pregnancies were more than double those among women with attended pregnancies (odds ratio=2.21, [95% confidence interval: 1.81–2.70]). Multiparous women with higher education and who resided/delivered outside of Tbilisi were significantly less likely to experience PM.ConclusionThe risk of PM doubled among women with unattended pregnancies. Six percent of PM cases were attributable to unattended pregnancies. Targeting women with previous unattended pregnancies will likely reduce the PM rate in Georgia.

Twelve-year mortality in adults initiating antiretroviral therapy in South Africa.

Introduction: South Africa has the largest number of individuals living with HIV and the largest antiretroviral therapy (ART) programme worldwide. In September 2016, ART eligibility was extended to all 7.1 million HIV-positive South Africans. To ensure that further expansion of services does not compromise quality of care, long-term outcomes must be monitored. Few studies have reported long-term mortality in resource-constrained settings, where mortality ascertainment is challenging. Combining site records with data linked to the national vital registration system, sites in the International Epidemiology Databases to Evaluate AIDS Southern Africa collaboration can identify >95% of deaths in patients with civil identification numbers (IDs). This study used linked data to explore long-term mortality and viral suppression among adults starting ART in South Africa. Methods: The study was a cohort analysis of routine data on adults with IDs starting ART 2004–2015 in five large ART cohorts. Mortality was estimated overall and by gender using the Kaplan-Meier estimator and Cox’s proportional hazards regression. Standardized mortality ratios (SMRs) were calculated by dividing observed numbers of deaths by numbers expected if patients had been HIV-negative. Viral suppression in patients with viral loads (VLs) in their last year of follow-up was the secondary outcome. Results: Among 72,812 adults followed for 350,376 person years (pyrs), the crude mortality rate was 3.08 (95% CI 3.02–3.14)/100 pyrs. Patients were predominantly female (67%) and the percentage of men initiating ART did not increase. Cumulative mortality 12 years after ART initiation was 23.9% (33.4% male and 19.4% female). Mortality peaked in patients enrolling in 2007–2009 and was higher in men than women at all durations. Observed mortality rates were higher than HIV-negative mortality, decreasing with duration. By 48 months, observed mortality was close to that in the HIV-negative population, and SMRs were similar for all baseline CD4 strata. Three-quarters of patients had VLs in their last year, and 86% of these were virally suppressed. Conclusions: The South African ART programme has shown a remarkable ability to initiate and manage patients successfully over 12 years, despite rapid expansion. With further scale-up, testing and initiating men on ART must be a national priority.

Life expectancy trends in adults on antiretroviral treatment in South Africa.

Previous studies have reported improvements in life expectancies of patients on antiretroviral treatment (ART) over time, but it is not clear whether these improvements are explained by changes in baseline clinical characteristics, longer duration on ART or changes in clinical practices. Two parametric survival models were fitted to mortality data from South African ART cohorts that had linked patient records to the national vital registration system. The first model estimated mortality by age, sex, cohort, baseline CD4 cell count, time since ART initiation and period of ART initiation; the second model included only age, sex, cohort and period of follow-up. Life expectancies were calculated from the estimated mortality rates. The first model estimated little change in mortality over time: women starting ART at age 35 years, at CD4 cell counts of 200 cells/μl or higher, had life expectancies of 32.7 years [95% confidence interval (CI): 31.6-33.6], 32.4 years (95% CI: 31.3-33.4) and 33.0 years (95% CI: 32.0-34.1) in the 2001-2006, 2007-2009 and 2010-2014 periods, respectively. However, the second model estimated a significant improvement in life expectancy; for all women on ART at age 35 years, corresponding life expectancies were 13.0 years (95% CI: 12.1-14.2), 20.4 years (95% CI: 19.5-21.4) and 26.1 years (95% CI: 25.2-26.9), respectively. Although life expectancies in South African ART patients have improved over time, these improvements are not observed after controlling for changes in baseline CD4 cell count and ART duration. This suggests that changes in clinical practice and programme scale have had little impact on ART mortality in South Africa.

Post-Trauma Immunological Disruptions: A Review

Accidents and trauma are one of the world's most serious but neglected health problems. The fast moving transportation systems, unprecedented and unplanned urbanization and changing social patterns have contributed to the global increase in the incidence of trauma. Traffic accidents are an endemic disease which affects mainly the young adults in the economically productive age groups and are the leading cause of death in persons under 44 years of age. Globally, 26% of all deaths in the age group of 15-44 years are due to injuries. The national vital registration system registers around 18 million deaths annually due to injuries worldwide. In Developing countries, trauma is a major problem, due to a very high incidence of vehicular accidents, other accidental injuries, crime and violence. Rising population, urbanization, industrialization and a drastic rise in vehicular transport has contributed to an annual increase in road traffic accidents by 3% in India alone. An accident death is reported every 1.9 minutes in India; in 1997, 10.1% of all deaths in India were due to accidents and injuries. Despite of this, trauma care is still at a developmental stage in our country. Thus, there is a growing population of traumatized patients requiring highly sophisticated and specialized care. Because most of these patients are young adults, with no underlying illness, there is a great concern to save these patients

THE VALUE OF MULTI-SOURCE DATA HARVESTING FOR INJURY MORTALITY DATA: THE JAMAICAN EXPERIENCE

BackgroundUnder-reporting of fatal injuries, especially homicides is common to many Lower and Middle Income Countries and challenges the utility of injury mortality data. Since an evaluation of the vital registration...

Treatment outcomes after 7 years of public-sector HIV treatment

To assess outcomes over the first 7 years of antiretroviral therapy (ART) at Themba Lethu Clinic, Johannesburg, South Africa. Observational cohort study. Patients are managed according to South African National Treatment Guidelines. Mortality is ascertained through linkage with the national vital registration system. Loss to follow-up is defined as at least 3 months late for the last scheduled appointment. Between April 2004 and March 2010, 13 227 patients initiated ART, increasing from 1794 in the year 2004/2005 to 2481 in 2009/2010. Median CD4 cell count at ART initiation increased 39% between 2004 and 2009 (82 vs. 114 cells/ml). The proportion who died within 1 year on ART was below 11% at all time points, whereas the proportion lost by 1 year increased from 8.5% in 2004 to 12.1% in 2009 [risk ratio (RR) 1.42, 95% confidence interval (CI) 1.18–1.71]. We followed the 1794 patients initiated in April 2004 and March 2005 through August 2011 for 8172 person-years. We estimated 25% of patients were lost and 16% died. The overall mortality rate was 3.59 per 100 person-years (95% CI 3.20–4.02). Of the 1577 who completed at least 6 months of follow-up, 213 (13.5%) failed first-line treatment in a median (interquartile range) of 25.9 (15.8–41.4) months on treatment. Of those who failed, 141 (66.2%) switched to second-line for a rate of 48.5 per 100 person-years (95% CI 41.1–57.2). Despite some improvements over 7 years, more intervention is needed in the first year on treatment to reduce overall attrition.

Road Traffic Injuries in Kenya: The Health Burden and Risk Factors in Two Districts

Background: Road traffic injuries (RTIs) contribute to a significant proportion of the burden of disease in Kenya. They also have a significant impact on the social and economic well-being of individuals, their families, and society. However, though estimates quantifying the burden of RTIs in Kenya do exist, most of these studies date back to the early 2000s—more than one decade ago. Objective: This article aims to present the current status of road safety in Kenya. Using data from the police and vital registration systems in Kenya, we present the current epidemiology of RTIs in the nation. We also sought to assess the status of 3 well-known risk factors for RTIs—speeding and the use of helmets and reflective clothing. Methods: Data for this study were collected in 2 steps. The first step involved the collection of secondary data from the Kenya traffic police as well as the National Vital Registration System to assess the current trends of RTIs in Kenya. Following this, observational studies were conducted in the Thika and Naivasha districts in Kenya to assess the current status of speeding among all vehicles and the use of helmets and reflective clothing among motorcyclists. Results: The overall RTI rate in Kenya was 59.96 per 100,000 population in 2009, with vehicle passengers being the most affected. Notably, injuries to motorcyclists increased at an annual rate of approximately 29 percent (95% confidence interval [CI]: 27–32; P < .001). The mean age of death due to road traffic crashes was 35 years. Fatalities due to RTIs increased at an annual rate of 7 percent (95% CI: 6–8; P < .001) for the period 2004 to 2009. Observational studies revealed that 69.45 percent of vehicles in Thika and 34.32 percent of vehicles in Naivasha were speeding. Helmets were used by less than one third of motorcycle drivers in both study districts, with prevalence rates ranging between 3 and 4 percent among passengers. Conclusions: This study highlights the significant burden of RTIs in Kenya. A renewed focus on addressing this burden is necessary. Focusing on increasing helmet and reflective clothing use and enforcement of speed limits has the potential to prevent a large number of road traffic crashes, injuries, and fatalities. However, it is difficult to demonstrate the magnitude of the injury problem to policymakers with minimal or inaccurate data, and this study illustrates the need for national continuous, systematic, and sustainable data collection efforts, echoing similar calls for action throughout the injury literature.

Correcting for Mortality Among Patients Lost to Follow Up on Antiretroviral Therapy in South Africa: A Cohort Analysis

BackgroundLoss to follow-up (LTF) challenges the reporting of antiretroviral treatment (ART) programmes, since it encompasses patients alive but lost to programme and deaths misclassified as LTF. We describe LTF before and after correction for mortality in a primary care ART programme with linkages to the national vital registration system.Methods and FindingsWe included 6411 patients enrolled on ART between March 2001 and June 2007. Patients LTF with available civil identification numbers were matched with the national vital registration system to ascertain vital status. Corrected mortality and true LTF were determined by weighting these patients to represent all patients LTF. We used Kaplan-Meier estimates and Cox regression to describe LTF, mortality among those LTF, and true LTF. Of 627 patients LTF, 85 (28.8%) had died within 3 months after their last clinic visits. Respective estimates of LTF before and after correction for mortality were 6.9% (95% confidence interval [CI] 6.2–7.6) and 4.3% (95% CI 3.5–5.3) at one year on ART, and 23.9% (95% CI 21.0–27.2) and 19.7% (95% CI 16.1–23.7) at 5 years. After correction for mortality, the hazard of LTF was reversed from decreasing to increasing with time on ART. Younger age, higher baseline CD4 count, pregnancy and increasing calendar year were associated with higher true LTF. Mortality of patients LTF at 1, 12 and 24 months after their last visits was respectively 23.1%, 30.9% and 43.8%; 78.0% of deaths occurred during the first 3 months after last visit and 45.0% in patients on ART for 0 to 3 months.ConclusionsMortality of patients LTF was high and occurred early after last clinic visit, especially in patients recently started on ART. Correction for these misclassified deaths revealed that the risk of true LTF increased over time. Research targeting groups at higher risk of LTF (youth, pregnant women and patients with higher CD4 counts) is needed.

The global availability of data for estimating the burden of injuries

Reliable estimates of the burden of injuries are essential inputs for prioritising prevention strategies. While population-based injury surveillance is the best source for such information, it is recognised that these...

Using mortuary data for estimating urban injury mortality incidence in Africa

National vital registration systems that record causes of death do not exist in most African countries. This makes estimating incidence of mortality from injuries in African regions particularly challenging. We...

Validation of cause-of-death statistics in urban China

National vital registration systems are the principal source of cause specific mortality statistics, and require periodic validation to guide use of their outputs for health policy and programme purposes, and epidemiological research. We report results from a validation of cause of death statistics from health facilities in urban China. 2917 deaths from health facilities located in six cities in China constituted the study sample. A reference diagnosis of the underlying cause was derived for each death, based on expert review of available medical records, and compared with that filed at registration. Sensitivity, specificity and positive predictive value were computed for specific causes/cause categories according to the International Classification of Diseases (ICD), including analyses based on quality of evidence scores for each cause. Patterns of misclassification by the registration system were studied for individual causes of death. The registration system had good sensitivity in diagnosing cerebrovascular disease and several site specific cancers (lung, liver, stomach, colorectal, breast and pancreas). Sensitivity was average (50-75%) for some major causes of adult death in China, namely ischaemic heart disease (IHD), chronic obstructive lung disease (COPD), diabetes, and liver and kidney diseases, with compensatory misclassification patterns observed between several of them. Sensitivity was particularly low for hypertensive disease. Although diagnostic misclassification is not uncommon in urban death registration data, they appear to balance each other at the population level. Compensating misclassification errors suggest that caution is required when drawing conclusions about particular chronic causes of adult death in China. Investment is required to improve the quality of cause attribution for health facility deaths, and to assess the validity of cause attribution for home deaths. Periodic assessments of the quality of cause of death statistics will enhance their usability for health policy and epidemiological research.

Seasonality of birth: two findings from the decennial census.

The enigmatic seasonality of births in the US has been analyzed extensively, but gaps in the knowledge of this phenomenon exist along dimensions not accessed by the national vital registration system. Live births in the US have for some time followed a pattern of spring trough and summer peak--at least since the initiation of the national birth registration system in 1933. The pattern is known to be more pronounced for the South than for other regions and for blacks than for whites. In this study it has been shown that this pattern existed as far back as the 1890's, and currently is more pronounced for lower than for higher socioeconomic groups. These findings come from an analysis of census population data, rather than vital registration data. In this way census data have been used in an innovative way to address 2 aspects of the phenomenon which had heretofore not been adequately treated.

Nonmarital Childbearing: Divergent Legal and Social Concerns

American social scientists, policymakers, moral leaders, and members of the legal profession. Recent changes in both marriage and childbearing behavior have brought about an increase in the proportion of children born to mothers not married at the time of the birth. This trend in nonmarital fertility has been accompanied by an increase in the propensity of unwed mothers to keep and raise their infants rather than place them in adoptive or foster homes. Both trends have been subject to increased attention in the popular press and social scientific literature alike. This concern, however, has been accompanied by little discussion of either the conceptualization or operational definition of nonmarital fertility (see Davis, 1939, for an important but distant exception). In the absence of such discussion, nonmarital childbearing has been treated as virtually synonymous with illegitimate fertility as defined by the national vital registration system. I This paper presents the argument for a reconceptualization of nonmarital fertility and its measurement that is more consistent with the broad spectrum of concerns surrounding this mode of childbearing. We begin with a discussion of the current definition of illegitimacy in the United States and its historical foundation in a legalistic perspective. We show that a wide range of social, moral, medical, and policy considerations would imply a more encompassing definition of nonmarital childbearing. Informed by these considerations, we offer a more socially grounded conceptualization that we term out-of-wedlock childbearing. Then using data from the June 1980 Current Population Survey (CPS),2 we demonstrate the significant substantive differences that arise between the broader social measure and the traditional legal one. These differences are especially pronounced with respect to the numbers of nonmarital births involved. They also serve to weaken

Mortality data from the National Vital Registration System as they relate to exposure assessment.

Mortality data from the National Vital Registration System as they relate to exposure assessment.