Percent Change In Mortality Research Articles

The global burden of cardiovascular disease attributable to diet low in fiber among people aged 60 years and older, 1990–2019: an age–period–cohort analysis of the global burden of disease study

ObjectivesThis study aimed to quantify the global cardiovascular disease (CVD) burden attributable to diet low in fiber among adults aged 60 years and older using data from the Global Burden of Disease (GBD) Study 2019.MethodsWe extracted data on CVD mortality, disability-adjusted life-years (DALYs), and risk-factor exposures from the GBD 2019 study for people aged 60 and older. Age-period-cohort models were used to estimate the overall annual percentage change in mortality and DALY rate (net drift, % per year), mortality and DALY rate for each age group from 1990 to 2019 (local drift, % per year), longitudinal age-specific rate corrected for period bias (age effect), and mortality and Daly rate for each age group from 1990 to 2019 (local drift, % per year). And period/cohort relative risk (period/cohort effect).ResultsFrom 1990 to 2019, global age-standardized cardiovascular disease (CVD) mortality rates attributable to low dietary fiber intake decreased by 2.37% per year, while disability-adjusted life years (DALYs) fell by 2.48% annually. Decreases were observed across all sociodemographic index regions, with fastest declines in high and high-middle SDI areas. CVD mortality and DALY rates attributable to low fiber increased exponentially with age, peaking at 85–89 years, and were higher in men than women. Regarding period effects, mortality and DALY rates declined since 2000, reaching nadirs in 2015–2019. For birth cohort patterns, risks attributable to low fiber intake peaked among early 1900s births and subsequently fell, with more pronounced reductions over time in women.ConclusionsLow dietary fiber intake is a leading contributor to the global cardiovascular disease burden, accounting for substantial mortality and disability specifically among older adults over recent decades.

Global, regional, and national trends in metabolic risk factor-associated mortality among the working-age population from 1990-2019: An age-period-cohort analysis of the Global Burden of Disease 2019 study

BackgroundMetabolic diseases contribute significantly to premature mortality worldwide, with increasing burdens observed among the working-age population (WAP). This study assessed global, regional, and national trends in metabolic disorders and associated mortality over three decades in WAP. MethodsData from the Global Burden of Disease 2019 study were leveraged to assess global metabolism-associated mortality and six key metabolic risk factors in WAP from 1990-2019. An age-period-cohort model was employed to determine the overall percentage change in mortality. ResultsThe 2019 global metabolic risk-related mortality rate in WAP rose significantly by 50.73%, while the age-standardized mortality rate declined by 21.5%. India, China, Indonesia, the USA, and the Russian Federation were the top contributing countries to mortality in WAP, accounting for 51.01% of the total. High systolic blood pressure (HSBP), high body mass index (HBMI), and high fasting plasma glucose (HFPG) were the top metabolic risk factors for the highest mortality rates. Adverse trends in HBMI-associated mortality were observed, particularly in lower sociodemographic index (SDI) regions. HFPG-related mortality declined globally but increased in older age groups in lower SDI countries. ConclusionsDespite a general decline in metabolic risk-related deaths in WAP, increasing HBMI- and HFPG-related mortality in lower SDI areas poses ongoing public health challenges. Developing nations should prioritize interventions addressing HBMI and HFPG to mitigate mortality risks in WAP.

The global burden of cardiovascular disease attributable to diet high in sugar-sweetened beverages among people aged 60 years and older: an analysis for the global burden of disease study 2019.

This study aimed to quantify the global cardiovascular disease (CVD) burden attributable to diet high in sugar-sweetened beverages (SSB) among adults aged 60 years and older using data from the Global Burden of Disease (GBD) Study 2019. We extracted data on CVD mortality, disability-adjusted life-years (DALYs), and risk-factor exposures from the GBD 2019 study for people aged 60 and older. Age-period-cohort models were used to estimate the overall annual percentage change in mortality and DALY rate (net drift, % per year), mortality and DALY rate for each age group from 1990 to 2019 (local drift, % per year), longitudinal age-specific rate corrected for period bias (age effect), and mortality and Daly rate for each age group from 1990 to 2019 (local drift, % per year). And period/cohort relative risk (period/cohort effect). Between 1990 and 2019, global age-standardized CVD mortality (ASMR) and disability-adjusted life years (DALY) rates attributable to high SSB intake decreased, with larger reductions in high-SDI regions. ASMR declined from 19.5 to 13 per 100,000 (estimated annual percentage change (EAPC): -1.46%) and ASDR declined from 345.8 to 220.6 per 100,000 (EAPC: -1.66%). Age-period-cohort analysis showed CVD deaths and DALYs increased exponentially with age, peaking at 85-89 years. Period effects indicated declining CVD mortality and DALY rates since 1999, especially in higher-SDI regions. Cohort effects demonstrated consistent risk declines across successive generations born between 1900 and 1959. Predictions suggest continuing decreases through 2045 globally, but slower declines in lower-SDI regions. In conclusion, this comprehensive assessment of global CVD burden among older adults attributable to high SSB intake highlights major achievements but also persistent areas needing attention. Favorable declining mortality and DALY rate trends reflect substantial progress in CVD control amid population growth and aging.

Global, regional, and national temporal trends in mortality and disability-adjusted life years for cardiovascular disease attributable to low temperature during 1990-2019: an age-period-cohort analysis of the global burden of disease 2019 study.

Few studies have focused on the region-specific relationship between cardiovascular disease (CVD) and low temperature worldwide. We aimed to provide an overview of trends in mortality and disability-adjusted life years (DALYs) for CVD and its subtypes attributable to low temperature over the past 30 years in 204 countries and regions, along with the associations of these trends with age, period, and birth cohorts. Data on the estimated burden of CVDs (including ischemic heart disease, hypertensive heart disease, and stroke) attributable to low temperature were obtained from the Global Burden of Disease Study 2019. We utilized an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 15 ~ 19 to 81 ~ 85 years (local drifts), and period and cohort relative risk (period/cohort effects) between 1990 and 2019. Among noncommunicable diseases, CVDs had the highest mortality rate and DALY loss attributable to low temperature worldwide and has increased from 65.7 to 67.3%, which is mainly attributed to the increase in East Asia and Pacific region. In terms of the level of economic and social development, an inverted U-shape was found in the age-standardized mortality rates (ASMR) due to low-temperature across different sociodemographic indices (SDI) regions. Both high CVD mortality (19.45, 95% CI [14.54, 24.17%]) and a decreasing mortality rate related to low temperature (from 1990 to 2019, net drift, -3.25% [-3.76, 2.73%] per year) was found in high SDI countries or territories, with opposite outcome found in low SDIs regions. The older adults (70+) and men share the highest rate of CVD ASMR and DALY attributed to low temperature across all regions, especially in North America and Europe and Central Asia. Mortality and DALY loss from CVD attributable to low temperature showed an overall decreasing trend globally except for East Asia and Pacific region. SDI, sex, age and geographic location contributed to the diversity of the CVD disease burden associated with low temperature worldwide. More attention should be given to the older adults, men, and low SDI regions.

Trendy v predčasných úmrtiach na zhubné nádory tráviacej sústavy na Slovensku v rokoch 2011–2020: 8 dia gnóz počas 10 rokov

Introduction and objectives: Slovakia ranks among the leaders in preventable deaths, but a systematic analysis of the share of digestive system cancers (DSCs) and their trends has been lacking. We analyzed data on mortality from DSCs in Slovakia in the years 2011–2020 with an emphasis on premature deaths, sex differences, and trends for individual locations. Material and methods: Data in the years 2011–2020 by ICD-10 codes C15–C26 aggregated by age subgroups (<50 years, <65 years, <75 years), sex, and individual locations were available. The crude death rate was calculated per 100,000 inhabitants and linear regression was used for the annual percentage change in mortality. Results: We recorded 46,508 deaths; 27,146 were men and 19,362 women with an average age of 70,5 ±11,6. Deaths under the age of 50, 65, and 75 made up 4.1%, 29.8%, and 60.4% of all deaths from DSCs. Among all deaths due to cancer under the age of 65, deaths from DSCs accounted for one-third in men and one-quarter in women. Under the age of 75, colorectal (41%), pancreatic (21%), stomach (12.8%), and liver (10%) cancers dominated the proportions of locations. The average age of death was significantly lower in men and increased over the decade for all locations. In women, the trend was identical, except for the liver, intrahepatic bile ducts (decrease by 1 year), bile ducts, and stomach (no change). Under the age of 65 in all cases, the average annual mortality rate decreased by 1.7%. In men, it decreased for locations in the esophagus, stomach, colorectum (–1.8%/year), liver, and gallbladder. In women, for colorectum (–1.8%/year) and gallbladder (–6%/year). In contrast, in the entire population mortality increased for locations in the pancreas (+2.3 to 2.8%/year) and bile ducts (+4.4 to 7.3%/year). Conclusion: DSCs are significant burden causing preventable deaths. Some favorable trends (stomach, gall bladder) are simultaneously followed by unfavorable ones (biliary tract, pancreas). In the global context of an aging population and increasingly longer exposure to risk factors, we need to introduce effective societal preventive measures as well as flexible adaptation of our healthcare systems.

Global, regional, and national time trends in mortality for stroke, 1990–2019: An age-period-cohort analysis for the global burden of disease 2019 study and implications for stroke prevention

Despite the fact that stroke is the second leading cause of death globally, a comprehensive and comparable assessment of mortality, and epidemiologic trends has not been conducted for most regions.We estimated the global and regional burden of stroke from 1990 to 2019 using data from the 2019 Global Study of Diseases, Injuries, and Risk Factors. For the period between 1990 and 2019, we used an age-period-cohort model to calculate the annual percentage changes in mortality (net drifts), local drifts, and period and cohort relative risks (period/cohort effects). Meanwhile, to quantify the temporal trends in stroke age-standardised mortality rate (ASMR), Average annual percentage changes (AAPCs) were determined by sex, area. With the potential to uncover disparities and treatment gaps in stroke care, this approach enables the examination and differentiation of age, period, and cohort effects in mortality trends. Global stroke deaths in 2019 were 6,552,725 (95% UI 5,995,200 to 7,015,139). Between 1990 and 2019, the ASMR declined globally by 36.43% (95% UI -41.65 to -31.2), with decreases in all SDI quintiles. The net drift in stroke mortality from 1990 to 2019 varied from -2.83% per year (95% confidence interval [CI]:-3.39 to -2.77) in countries with a high Socio-demographic Index (SDI) to -1.21% per year (95% CI: -1.26 to -1.16) in countries with a low SDI. During the past 30 years, favorable mortality reductions were generally found in high-SDI countries (net drift = -3.1% [95% CI: -3.4 to -2.8] per year) and high-middle SDI countries (-2.8% [-3.0 to -2.6]). However, 31 of 204 countries had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥ - 0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high and high-middle SDI countries, with the exceptions of Kuwait, Ukraine, Kazakhstan, Guam, RussianFederation, Lithuania, Turkey, Montenegro, Serbia, Bosnia and Herzegovin, and Bulgaria. Notwithstanding mortality from stroke has increased globally over the past 30 years, adverse period and cohort effects have been found in many countries, calling into question the adequacy of healthcare for stroke patients of all ages. These lapses have a significant impact on the likelihood of achieving the Sustainable Development Goal (SDG) targets on mortality from age 60+ and NCDs.

Association between Sociodemographic Factors, Coverage and Offer of Health Services with Mortality Due to Oral and Oropharyngeal Cancer in Brazil: A 20-Year Analysis.

To investigate the association between sociodemographic factors and variables related to oral health services in oral and oropharyngeal cancer mortality in Brazil, between 2000 and 2019. This study had an ecological design. Standardized mortality rates were compared between age group, sex, and regions. Age–Period–Cohort analysis was applied. Oral health services variables were analyzed in correlation tests. Survival analysis included Kaplan–Meier estimators, log-rank tests, and Cox regression. The mortality rate increased with age and was higher in men. Southeast and south regions had the highest rates for men, and the northeast and southeast had it for women. Age–Period–Cohort analysis showed a slight increase in female deaths and an increasing trend in the annual percent change in mortality for men over age 55. In survival analysis, males, Black individuals and southern residents were more strongly associated with death. The correlation between oral health teams’ coverage was high and negative, while the number of dental specialty centers and soft tissue biopsies had a high and positive correlation. Mortality and survival patterns were dependent on sex, age, geographic region and race/ethnicity. It was observed that preventive and diagnostic procedures were not being performed, which may be related to the increase in mortality.

Burden of Cardiovascular Diseases Attributable to Risk Factors in Portuguese-Speaking Countries: Data from the "Global Burden of Disease 2019" Study.

ResumoFundamento:O impacto dos fatores de risco (FR) sobre a morbimortalidade por doença cardiovascular (DCV) na maioria dos países de língua portuguesa (PLP) é pouco conhecido.Objetivo:Analisar a morbimortalidade por DCV atribuível aos FR e sua variação nos PLP de 1990 a 2019, a partir de estimativas do estudo Global Burden of Disease (GBD) 2019.Métodos:Avaliamos as mudanças nos FR ocorridas no período, as taxas de mortalidade e os anos de vida perdidos por incapacidade (DALYs), padronizados por idade, entre 1990 e 2019. Realizou-se a correlação entre a variação percentual das taxas de mortalidade e o índice sociodemográfico (SDI) de cada PLP pelo método de Spearman. O valor p<0,05 foi considerado estatisticamente significativo.Resultados:A pressão arterial sistólica (PAS) elevada foi o principal fator de risco para mortalidade e DALY por DCV para todos os PLP. A mortalidade por DCV mostrou uma tendência de redução em 2019, maior em Portugal (-66,6%, IC95% -71,0 - -61,2) e no Brasil (-49,8%, IC95% -52,5 - -47,1). Observou-se tendência à correlação inversa entre SDI e a variação percentual da mortalidade, que foi significativa para os riscos dietéticos (r=-0,70, p=0,036), colesterol LDL elevado (r=-0,77, p=0,015) e PAS elevada (r=-0,74, p=0,023).Conclusões:Além da PAS, os FR dietéticos e metabólicos justificaram uma maior variação da carga de DCV, correlacionada com o SDI nos PLP, sugerindo a necessidade de adoção de políticas de saúde adaptadas à realidade de cada país, visando a redução de seu impacto sobre a população.

Breast Cancer Mortality Trends and Predictions to 2030 and Its Attributable Risk Factors in East and South Asian Countries.

BackgroundAmidst the rising breast cancer burden in Asia, we aim to predict the future mortality risk due to breast cancer and identify the risk-attributable deaths for breast cancer among East and South Asian countries.MethodsWe used country-level data to predict the trends in the next decade relating to female breast cancer mortality by employing data from 1990 to 2019 from the Global Burden of Disease 2019 study. We used the stochastic mortality modeling and prediction techniques to forecast the age-specific and risk-attributable breast cancer mortality trends at the regional and national levels of East and South Asia.ResultsThe number of deaths caused by the breast cancer is predicted to increase in East and South Asian countries in the next decade (2020–2030). Age-standardized death rate (ASDR) of breast cancer is predicted to increase by 7.0% from 9.20/100,000 (95% CI: 6.04–12.12) in 1990 to 9.88/100,000 (95% CI: 7.12–11.4) in 2030 in East Asia, and about 35% increase from 13.4/100,000 (95% CI: 9.21–16.02) in 1990 to 18.1/100,000 (95% CI: 13.23–21.10) in 2030 in South Asia. At the national level, the highest percent change in ASDR between 1990 and 2030 was reported in Pakistan (a 62% increase) and Nepal (a 47% increase). The highest percent change in breast cancer mortality between 2020 and 2030 for females of age group 80–84 years was observed in Pakistan [21.6, (95% CI, 20.6–94.7)], followed by Afghanistan [13.3 (4.0–80.8)], and Nepal [36.6 (11.1–125.7)] as compared to the other countries. In the females of aged 50–80 years, the predicted death rates were associated with high body mass index, high-fasting plasma glucose, and diet high in red meat, across the majority of countries under study. Furthermore, reductions in percent change in mortality rates occurred in several countries with increases in sociodemographic index (SDI), notably across high SDI countries.ConclusionBreast cancer mortality risk varies substantially across East and South Asian countries with higher mortality risk in low/middle SDI countries. Early detection using screening, awareness among females and health workers, and cost-effective and timely treatment of patients with breast cancer is vital in stemming the tide of breast cancer in the next decade.

Trends in all-cause mortality among people with diagnosed diabetes in high-income settings: a multicountry analysis of aggregate data

Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes. In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdictions (in six data sources in Asia, eight in Europe, one from Australia, and four from North America) for the period from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in people with diagnosed total or type 2 diabetes. We collected data from administrative sources, health insurance records, registries, and a health survey. We estimated excess mortality using the standardised mortality ratio (SMR). In our dataset, there were approximately 21 million deaths during 0·5 billion person-years of follow-up among people with diagnosed diabetes. 17 of 19 data sources showed decreases in the age-standardised and sex-standardised mortality in people with diabetes, among which the annual percentage change in mortality ranged from -0·5% (95% CI -0·7 to -0·3) in Hungary to -4·2% (-4·3 to -4·1) in Hong Kong. The largest decreases in mortality were observed in east and southeast Asia, with a change of -4·2% (95% CI -4·3 to -4·1) in Hong Kong, -4·0% (-4·8 to -3·2) in South Korea, -3·5% (-4·0 to -3·0) in Taiwan, and -3·6% (-4·2 to -2·9) in Singapore. The annual estimated change in SMR between people with and without diabetes ranged from -3·0% (95% CI -3·0 to -2·9; US Medicare) to 1·6% (1·4 to 1·7; Lombardy, Italy). Among the 17 data sources with decreasing mortality among people with diabetes, we found a significant SMR increase in five data sources, no significant SMR change in four data sources, and a significant SMR decrease in eight data sources. All-cause mortality in diabetes has decreased in most of the high-income countries we assessed. In eight of 19 data sources analysed, mortality decreased more rapidly in people with diabetes than in those without diabetes. Further longevity gains will require continued improvement in prevention and management of diabetes. US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.

Global, regional, and national time trends in mortality for congenital heart disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study.

SummaryBackgroundCongenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort.MethodsCause-specific CHD mortality estimates were derived from the Global Burden of Disease 2019 study. We utilised an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0 to 4 to 65–69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period, and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care.FindingsCHD is the leading cause of deaths from non-communicable diseases (NCDs) in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval 177,000–262,000). There were 129 countries with at least 50 deaths. India, China, Pakistan, and Nigeria had the highest mortality, accounting for 39.7% of deaths globally. Between 1990 and 2019, the net drift of CHD mortality ranged from –2.41% per year (95% confidence interval [CI] –2.55, –2.67) in high Socio-demographic Index (SDI) countries to –0.62% per year (95% CI: –0.82, –0.42) in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from paediatric to adult populations, except for an increasing trend of mortality in those aged 10–34 years in Mexico and Pakistan. During the past 30 years, favourable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = –4.0% [95% CI –4.8 to –3.1] per year) and the United States (–2.3% [–2.5 to –2.0]), and also in many middle-SDI countries like Brazil (–2.7% [–3.1 to 2.4]) and South Africa (–2.5% [–3.2 to –1.8]). However, 52 of 129 countries had either increasing trends (net drifts ≥0.0%) or stagnated reductions (≥–0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts amongst high- and high-middle-SDI countries, with the exceptions of Saudi Arabia and Kazakhstan. 14 middle-SDI countries such as Ecuador and Mexico, and 16 low-middle-SDI countries including India and 20 low-SDI countries including Pakistan, had unfavourable or worsening risks for recent periods and birth cohorts.InterpretationCHD mortality is a useful and accessible indicator of trends in the provision of congenital cardiac care both in early childhood and across later life. Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally over the past three decades, unfavourable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age groups. These failings carry significant implications for the likelihood of achieving the Sustainable Development Goal targets for under-5 years and NCD mortality.FundingSupported by the 10.13039/501100001809National Natural Science Foundation of China (81525002, 31971048, 82073573 to ZZ and HZ), Shanghai Outstanding Medical Academic Leader program (2019LJ22 to HZ), and Collaborative Innovation Program of Shanghai Municipal Health Commission (2020CXJQ01 to HZ), the Bill & Melinda Gates Foundation for the Global Burden of Disease Project (to NJK) and NHMRC fellowship administered through the University of Melbourne (to GCP).

Impact of the early COVID-19 pandemic on outcomes in a rural Ugandan neonatal unit: A retrospective cohort study.

During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April-September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.

Abstract 11650: Global, Regional and National Time Trends in Mortality for Congenital Heart Disease, 1990-2019 an Age-Period-Cohort Analysis for the Global Burden of Disease Study 2019

Introduction: Congenital heart disease (CHD) is the leading birth defect worldwide. We report trends in CHD mortality in 204 countries and territories over the past 30 years, and associations with age, period, and birth cohort. Methods: Cause-specific CHD mortality estimates were derived from the Global Burden of Disease study 2019. We utilized an age-period-cohort model to estimate overall annual percentage change in mortality (net drifts), annual percentage change from 0-4 to 65-69 years (local drifts) and period (cohort) relative risks between 1990 and 2019. Results: Global CHD deaths in 2019 were 217,000 (95%UI: 177,000, 262,000). India, China, Pakistan and Nigeria were the top 4 countries accounting for 39.7% of deaths globally. The reduction in age-standardized mortality ranged from 66.3% in high-sociodemographic index (SDI) countries to 30.5% in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from pediatric to adult population, except for an increasing trend of mortality in 10~34 years in Mexico and Pakistan. During 1990-2019, favorable mortality reductions were found in most high-SDI countries like South Korea (net drift = -4.0% per year) and United States (-2.3%), and also in many middle-SDI countries like Brazil (-2.7%) and a few low-SDI countries like Ethiopia (-2.3%). However, 52 out of 129 countries with at least 50 deaths had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥-0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high- and high-middle SDI countries except Saudi Arabia and Kazakhstan. Fourteen middle-SDI countries such as Ecuador and Mexico, and sixteen low-middle-SDI countries like India and twenty low-SDI countries like Pakistan, had unfavorable or worsening risks for recent periods and birth cohorts. Conclusions: Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally, unfavorable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age-groups.

Trends in Mortality Due to Stimulants Use in Adolescents and Young Adults

Objectives: Stimulant medications including illegal use of Methamphetamine (MA) continues to rise in adolescents and young adults. This study aims to examine mortality trends because of the stimulant overdose in this age group (15 to 34 years). Methods: Age-adjusted mortality data, including 95% confidence intervals and standard errors, were extracted using publicly available multiple causes of death files from the United States Centers for Disease Control Wide-ranging ONline Data for Epidemiologic Research (WONDER). The data was filtered using International Classification of Disease (ICD-10) codes: F15.0 (Mental and behavioral disorders because of use of other stimulants, acute intoxication), F15.1 (Mental and behavioral disorders because of use of other stimulants, harmful use), T43.6 (Psychostimulants with abuse potential). The trends analysis for 1999 to 2019 was conducted using Joinpoint regression statistical software. Results: The mortality rate has been consistently increasing in the last decade across all races and ethnicities in adolescents and young adults. Non-Hispanic White population had the highest mortality rates (7.6 per 100,000 in 2019) compared with non-Hispanic Black (3.08 per 100,000 in 2019) and Hispanic population (3.33 per 100,000 in 2019). But the annual percent change in mortality was shown to be highest in non-Hispanic Black population (34.3% between 2009 and 2019). Conclusion: The increase in overall mortality rate because of stimulants use reflects the increase of MA use in this age group. The difference in the rate of change shows worsening racial inequality. Public health policies should be implemented to include evidence-based strategies to prevent MA misuse or overdose.

Institutional mortality rate and cause of death at health facilities in Ghana between 2014 and 2018.

BackgroundThe epidemiological transition, touted as occurring in Ghana, requires research that tracks the changing patterns of diseases in order to capture the trend and improve healthcare delivery. This study examines national trends in mortality rate and cause of death at health facilities in Ghana between 2014 and 2018.MethodsInstitutional mortality data and cause of death from 2014–2018 were sourced from the Ghana Health Service’s District Health Information Management System. The latter collates healthcare service data routinely from government and non-governmental health institutions in Ghana yearly. The institutional mortality rate was estimated using guidelines from the Ghana Health Service. Percent change in mortality was examined for 2014 and 2018. In addition, cause of death data were available for 2017 and 2018. The World Health Organisation’s 11th International Classification for Diseases (ICD-11) was used to group the cause of death.ResultsInstitutional mortality decreased by 7% nationally over the study period. However, four out of ten regions (Greater Accra, Volta, Upper East, and Upper West) recorded increases in institutional mortality. The Upper East (17%) and Volta regions (13%) recorded the highest increase. Chronic non-communicable diseases (NCDs) were the leading cause of death in 2017 (25%) and 2018 (20%). This was followed by certain infectious and parasitic diseases (15% for both years) and respiratory infections (10% in 2017 and 13% in 2018). Among the NCDs, hypertension was the leading cause of death with 2,243 and 2,472 cases in 2017 and 2018. Other (non-ischemic) heart diseases and diabetes were the second and third leading NCDs. Septicaemia, tuberculosis and pneumonia were the predominant infectious diseases. Regional variations existed in the cause of death. NCDs showed more urban-region bias while infectious diseases presented more rural-region bias.ConclusionsThis study examined national trends in mortality rate and cause of death at health facilities in Ghana. Ghana recorded a decrease in institutional mortality throughout the study. NCDs and infections were the leading causes of death, giving a double-burden of diseases. There is a need to enhance efforts towards healthcare and health promotion programmes for NCDs and infectious diseases at facility and community levels as outlined in the 2020 National Health Policy of Ghana.

Exploration of PM mass, source, and component-related factors that might explain heterogeneity in daily PM2.5-mortality associations across the United States

Multi-city epidemiologic studies examining short-term (daily) differences in fine particulate matter (PM2.5) provide evidence of substantial spatial heterogeneity in city-specific mortality risk estimates across the United States. Because PM2.5 is a mixture of particles, both directly emitted from sources or formed through atmospheric reactions, some of this heterogeneity may be due to regional variations in PM2.5 toxicity. Using inverse variance weighted linear regression, we examined change in percent change in mortality in association with 24 “exposure” determinants representing three basic groupings based on potential explanations for differences in PM toxicity – size, source, and composition. Percent changes in mortality for the PM2.5-mortality association for 313 core-based statistical areas and their metropolitan divisions over 1999–2005 were used as the outcome. Several determinants were identified as potential contributors to heterogeneity: all mass fraction determinants, vehicle miles traveled (VMT) for diesel total, VMT gas per capita, PM2.5 ammonium, PM2.5 nitrate, and PM2.5 sulfate. In multivariable models, only daily correlation of PM2.5 with PM10 and long-term average PM2.5 mass concentration were retained, explaining approximately 10% of total variability. The results of this analysis contribute to the growing body of literature specifically focusing on assessing the underlying basis of the observed spatial heterogeneity in PM2.5-mortality effect estimates, continuing to demonstrate that this heterogeneity is multifactorial and not attributable to a single aspect of PM.

Global, Regional and National Time Trends in Mortality for Congenital Heart Disease, 1990-2019: An Age-Period-Cohort Analysis for the GBD 2019

Background: Congenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort. Methods: Cause-specific CHD mortality estimates were derived from the Global Burden of Disease study 2019. We utilized an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0-4 to 65-69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care. Findings: CHD is the leading cause of deaths from non-communicable diseases in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval: 177,000, 262,000).There were 129 countries with at least 50 deaths. India, China, Pakistan and Nigeria had the highest mortality accounting for 39.7% of deaths globally. Between 1990 and 2019, the reduction in CHD all-age mortality ranged from –71.3% [–74.7 to –64.6] in high-sociodemographic index (SDI) countries to –42.1% [–61.9 to 12.1] in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from pediatric to adult population, except for an increasing trend of mortality in 10~34 years in Mexico and Pakistan. During the past 30 years, favorable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = –4.0% [95% confidence interval: –4.8 to –3.1] per year) and United States (–2.3% [–2.5 to –2.0]), and also in many middle-SDI countries like Brazil (–2.7% [–3.1 to 2.4]) and South Africa (–2.5% [–3.2 to –1.8]) and a few low-SDI countries like Ethiopia (–2.3% [–3.0 to –1.6]). However, 52 out of 129 countries had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥–0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high- and high-middle SDI countries with the exceptions of Saudi Arabia and Kazakhstan. Fourteen middle-SDI countries such as Ecuador and Mexico, and sixteen low-middle-SDI countries including India and twenty low-SDI countries including Pakistan, had unfavorable or worsening risks for recent periods and birth cohorts. Interpretation: CHD mortality is an accessible metric that can be used to track trends and levels in the provision of congenital cardiac care for low- and middle-income countries. Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally over the past three decades, unfavorable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age-groups. These failings carry significant implications for the likelihood of achieving the Sustainable Development Goals in this domain. Funding Information: National Natural Science Foundation of China, Shanghai Outstanding Medical Academic Leader program, and Collaborative Innovation Program of Shanghai Municipal Health Commission. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The GBD study uses deidentified data and a waiver of informed consent was approved by the University of Washington Institutional Review Board.

Outcomes in a Rural Ugandan Neonatal Unit Before and During the Early COVID-19 Pandemic: A Retrospective Cohort Study

Background: Little has been published on neonatal outcomes from low resource facilities during the COVID-19 pandemic. In the past 20 years Uganda has improved newborn mortality but the pandemic and resulting restrictions threaten to affect this vulnerable segment of the population. During the first two months of the pandemic in Uganda travel was tightly restricted for pregnant women and sick newborns and public transport was difficult to access for two months thereafter. Methods: We report outcomes from admissions captured in an existing electronic dataset of a well-established newborn unit in central Uganda before (September 2019 to March 2020) and during the early COVID-19 period (April – September 2020). We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. Findings: There was an 8% decrease in admissions from outside the facility and an increase in overall admissions with birth asphyxia (22% vs. 15%) during the early pandemic. Patients born outside the facility were older on admission than previously (median 1 day of age vs. on the day of birth). Mortality significantly differed between the COVID-19 period and pre-COVID-19 periods [15·7% (89/567) vs. 11·1% (69/619), p=0·017]. Mortality was increased in all categories of birthweight and diagnosis. Most prominent was the increased mortality among patients born outside the facility (21·2% vs. 14·3%, p= 0·028), a relative increase of 55% above seasonal expected mortality in this group. Interpretation: This increased mortality is likely attributed to disruptions due to the pandemic affecting maternal and newborn demand for, access to and quality of peripartum healthcare. Impacts on these vulnerable newborns requires deliberate focus by health officials to prioritize their care despite pandemic conditions. Funding Information: Adara Development. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: Human Subjects Approval was obtained from Makerere University School of Public Health Institutional Review Board (protocol number 917) and approved by the Uganda National Council for Science and Technology (registration number SS813ES). The University of Washington institutional review board designated this as an exempt study.

Does air pollution modify the effect of heat on mortality during the warm season? Results from a multi-country study.

Background: The health effects of heat on mortality are well known worldwide, less is known on the synergistic effect of heat and air pollutants. The aim of the study is to estimate the role of air pollution as effect modifier of the association between temperature and mortality effects during the warm season (6 months) in 24 countries across the globe.Methods: Time-series analysis was run for each city. Heat effects were estimated as the percent change in mortality for increases in mean temperature between the 75th and 99th percentile. To evaluate the interaction, a bivariate tensor product between mean air temperature (lag 0-1) and either PM10 or ozone (both lag 0-1) was defined and temperature estimates were extrapolated at three pollutant percentile levels: low (10th), medium (50th), and high (90th).Results: Daily mortality, mean temperature (°C) and air pollution data (PM10 and ozone) for 482 cities were considered. Meta-analytical results showed statistically significant effects of heat on mortality for increasing levels of ozone and PM10. Considering the interaction with PM10, temperature estimates rose from 7.1% (CI 95%:3.1%-11.2%) to 14.5% (CI 95%:10.2%-9.0%) in the low and high levels respectively. A similar trend was observed when considering effect modification by ozone, with estimates ranging from 3.4% (CI 95%:1.0%-5.8%) to 12.8 % (CI 95%: 8.7%-17.1%) in the low and high levels respectively. Considering country specific estimates some heterogeneity was observed with a positive trend in the effect of heat by levels of PM10 in Australia, Brazil, Canada, S. Korea, and most European countries and similarly in Australia, Canada, Japan, Thailand, USA and European countries for ozone.Conclusion: This study shows the synergistic effect of heat and pollution on mortality during summer, which is important when considering the future health impacts of climate change.On behalf of the MCC collaborative group.

Mortality trend for multiple sclerosis in Italy during the period 1980–2015

BackgroundThe epidemiology of Multiple Sclerosis (MS) is relevant for health-services planning. Most of MS prevalence and incidence studies in Italy referred to specific geographical areas and periods, whereas mortality data are routinely collected at the national level. The aim was to assess MS mortality trend and geographical differences in Italy from 1980 to 2015. MethodsMortality data were provided by the Italian Institute of Statistics. Due to a low number of annual deaths, mortality data were analysed for both the entire period under study and for sub-periods. Temporal trends were first evaluated using age-adjusted mortality rates (AMRs) comparing each sub-period with the initial one. Then, the annual percent change in mortality was estimated through the joinpoint regression model. Spatial differences between 5 main geographical areas were evaluated using standardized mortality ratios (SMRs). ResultsDuring the study period, 4,959 deaths for males and 7,434 for females were observed. The higher overall AMR was observed for females (F:0.71 vs. M: 0.56 per 100,000 persons per year). Analysing mortality by gender and geographical area, SMRs 〈 100 were observed in South Italy for both sexes, and in Central Italy for males only, whereas SMRs 〉 100 for Islands for both sexes, and in North-East and North-West for females only. The analysis of the mortality trend through AMRs calculated for sub-periods revealed no difference between the first and the last period for males, whereas a significant increase in mortality was observed for females. The joinpoint regression analysis showed a significant decrease in mortality up to 1995 for males (APC -3.23%) and up to 1999 for females, (APC -1.01%), followed by a significant increase for both sexes, but more marked for females (APC +1.9% M, +2.34% F). ConclusionThe increasing trend of mortality for MS, especially for females, may reflect the increase in the prevalence of MS and the improvement in the quality of diagnosis or coding of the cause of death.