Years Of Potential Life Research Articles

Effect on mortality of inclusion of drugs in Thailand's National List of Essential Medicines, 2005–2016

ObjectiveTo assess the effect of long-run changes in the drugs included in the National List of Essential Medicines (NLEM) on mortality in Thailand. MethodsUsing longitudinal data on many diseases, I estimate difference-in-differences (2-way fixed effects) models to investigate whether diseases for which there were larger increases in the number of NLEM drugs had larger subsequent reductions (or smaller increases) in mortality. This design controls for the effects on mortality of general economic and societal factors (e.g. income, education, and behavioral risk factors), to the extent that those effects are similar across diseases. ResultsThe addition of drugs to the NLEM between 2003 and 2014 reduced the number of years of potential life lost before age 75 in 2016 by about 650 thousand. The addition of a new (post-2002) drug for a disease to the NLEM is estimated to have reduced the number of deaths from that disease two years later by 25%, while the addition of an old (pre-2003) drug is estimated to have reduced the number of deaths two years later by 5%. ConclusionThe expansion of the NLEM reduced the number of deaths and the number of years of potential life lost before ages 75 and 65 2–5 years later. A preliminary estimate of pharmaceutical expenditure per life-year before age 75 gained in 2016 from drugs added to the NLEM between 2003 and 2014 is 888 USD.

Racial and Ethnic Disparities in Years of Potential Life Loss Among Patients With Cirrhosis During the COVID-19 Pandemic in the United States.

Our aim was to evaluate the impact of race/ethnicity on cirrhosis-related premature death during the COVID-19 pandemic. We obtained cirrhosis-related death data (n = 872,965, January 1, 2012-December 31, 2021) from the US National Vital Statistic System to calculate age-standardized mortality rates and years of potential life lost (YPLL) for premature death aged 25-64 years. Significant racial/ethnic disparity in cirrhosis-related age-standardized mortality rates was noted prepandemic but widened during the pandemic, with the highest excess YPLL for the non-Hispanic American Indian/American Native (2020: 41.0%; 2021: 68.8%) followed by other minority groups (28.7%-45.1%), and the non-Hispanic White the lowest (2020: 20.7%; 2021: 31.6%). COVID-19 constituted >30% of the excess YPLLs for Hispanic and non-Hispanic American Indian/American Native in 2020, compared with 11.1% for non-Hispanic White. Ethnic minorities with cirrhosis experienced a disproportionate excess death and YPLLs in 2020-2021.

An Exploration of Productivity Costs and Years of Potential Life Lost: Understanding the Impact of Premature Mortality From Injury in Mongolia.

This study estimates the years of potential life lost (YPLL), years of potential productive life lost (YPPLL), and cost of productivity loss (CPL) owing to injury-related mortalities in Mongolia. By implementing a retrospective cohort study, the study used secondary mortality data for Mongolia from 2016 to 2020 from the Health Development Center. Our study incorporates information on 13 551 fatalities from injuries and external factors, with the aim of estimating YPLL, YPPLL, and CPL associated with the leading causes injury-induced deaths. These include exposure to toxic substances, road accidents, homicides, suicides, and falls. Our findings reveal majority of the losses occur because of exposure to poisonous chemicals, road accidents, suicides, falls, and homicides. Furthermore, 444 550 years of potential life are lost owing to injury-related mortalities, in which YPPLL accounts for 338 482 years. The CPL caused by these premature deaths during the study period accounts for $1.368 billion. Notably, YPLL, YPPLL, and CPL rates are significantly higher in males than in females. The YPLL from exposure to poisonous chemicals is higher than those caused by other factors. This study is the first to calculate the CPL owing to YPLL from injury in Mongolia.

Modeling the impact of child vaccination (5-11y) on overall COVID-19 related hospitalizations and mortality in a context of omicron variant predominance and different vaccination coverage paces in Brazil.

Developing countries have experienced significant COVID-19 disease burden. With the emergence of new variants, particularly omicron, the disease burden in children has increased. When the first COVID-19 vaccine was approved for use in children aged 5-11 years of age, very few countries recommended vaccination due to limited risk-benefit evidence for vaccination of this population. In Brazil, ranking second in the global COVID-19 death toll, the childhood COVID-19 disease burden increased significantly in early 2022. This prompted a risk-benefit assessment of the introduction and scaling-up of COVID-19 vaccination of children. To estimate the potential impact of vaccinating children aged 5-11 years with mRNA-based COVID-19 vaccine in the context of omicron dominance, we developed a discrete-time SEIR-like model stratified in age groups, considering a three-month time horizon. We considered three scenarios: No vaccination, slow, and maximum vaccination paces. In each scenario, we estimated the potential reduction in total COVID-19 cases, hospitalizations, deaths, hospitalization costs, and potential years of life lost, considering the absence of vaccination as the base-case scenario. We estimated that vaccinating at a maximum pace could prevent, between mid-January and April 2022, about 26,000 COVID-19 hospitalizations, and 4200 deaths in all age groups; of which 5400 hospitalizations and 410 deaths in children aged 5-11 years. Continuing vaccination at a slow/current pace would prevent 1450 deaths and 9700 COVID-19 hospitalizations in all age groups in this same time period; of which 180 deaths and 2390 hospitalizations in children only. Maximum vaccination of children results in a significant reduction of COVID-19 hospitalizations and deaths and should be enforced in developing countries with significant disease incidence in children. This manuscript was funded by the Brazilian Council for Scientific and Technology Development (CNPq - Process # 402834/2020-8).

ПОТЕРИ РОССИЙСКОГО НАСЕЛЕНИЯ ОТ ПРЕДОТВРАТИМЫХ ПРИЧИН СЕРДЕЧНО-СОСУДИСТОЙ СМЕРТНОСТИ В ПЕРИОДЫ ДО И ВО ВРЕМЯ ПАНДЕМИИ

Significance. The healthcare system can manage preventable causes of death if timely and effective interventions are in place including interventions aimed at improving living conditions and lifestyle of the population. Which diseases of the circulatory system are preventable? These are chronic rheumatic heart diseases and arterial hypertension at least in ages 5-64, and cerebrovascular diseases. The updated list of treatable diseases includes ischemic heart disease originally considered as a non-manageable cause. In the pre-COVID period the mortality structure underwent quality changes in terms of diseases and age distribution since the impact of preventive measures can manifest itself both in the decreased share of preventable causes and increased life expectancy of patients with cardio-vascular diseases. Did the gain in the age structure of preventable mortality from cardio-vascular diseases (CVD) sustain during the pandemic? The purpose of the study is to analyze contribution of preventable causes to cardio-vascular diseases mortality in the pre-COVID period and during the pandemic in Russia. Material and methods. The study used ROSSTAT data (Russian Federal State Statistics Service) to analyze data on cardio-vascular diseases mortality in the Russian Federation in 1999-2021. Male and female mortality was calculated for ages 5-64 years – the age interval of preventability. Since access to health care and risk factors of cardio-vascular diseases differ among urban and rural settings, rural and urban mortality was analyzed separately. Potential years of life lost (PYLL) were calculated as the sum products of the absolute number of deaths and potential years lost in each age group divided by 10 000 population of the corresponding age. Results. In most cases, the contribution of preventable causes to cardio-vascular diseases mortality in ages 5-64 has been steadily decreasing since 2003. The share of chronic rheumatic heart diseases equaling to less than one percent in males in the beginning of the century has decreased more than 3-fold during the pandemic. Similar trends are registered in female mortality, yet at higher rates. It should be emphasized here that mortality from chronic rheumatic heart diseases has been reducing since the end of the last century including throughout the period of social and economic collapse. The contribution of arterial hypertension to cardio-vascular diseases mortality is also low. The highest contribution to cardio-vascular diseases mortality is made by ischemic heart disease. Unlike other diseases under study, its contribution is higher among male urban population. Heart failure is associated with the lowest contribution to cardio-vascular diseases mortality. During the pandemic, its share has decreased in male mortality while hardly changed in females. The contribution of cerebrovascular diseases to cardio-vascular diseases mortality has significantly decreased sustaining this decline throughout the pandemic. In general, the contribution of preventable causes to cardio-vascular diseases mortality in ages 5-64 has been steadily reducing in males from 79.9% in 2003 to 72.7% in 2019 and to 71.6% in 2021 and in females from 80.5%% to 69.5% and 69.8%, respectively. The contribution of preventable causes in male mortality is higher among urban population compared to rural one (73.1% versus 71.3% in 2019, 71.9% versus 70.7% in 2021), while mortality in urban and rural females is almost the same. Conclusion. Analysis of preventable causes of cardio-vascular diseases mortality concludes as follows: First, it is those causes that have contributed the most to the decrease in mortality; Second, at the preventability age interval, the impact of preventive measures manifests itself in changes in mortality from ischemic heart disease and cerebrovascular diseases. Third, to ensure reduction in male mortality from cerebrovascular diseases it is necessary to intensify measures aimed at preventing alcohol use. Forth, it makes sense to analyze effectiveness of measures aimed at preventing avoidable mortality from diseases of the circulatory system using PYLL-70.

Procena prevremene smrtnosti u Srbiji - uvidi iz medijalne starosti godina izgubljenog života

Premature mortality, defined as death occurring before a predetermined chronological age, is a significant public health challenge in Serbia, compounded by an aging population, high rates of non-communicable diseases, and healthcare system challenges. This study introduces a novel indicator, the Median Age of Years of Life Lost (MeAYPLL), to assess the age distribution of premature mortality in Serbia and selected European Union (EU) countries during the pre-pandemic period (2000-2019). The findings reveal that Serbia is among the European countries with the highest rates of premature mortality, similar to other former socialist countries. However, the age distribution of premature deaths varies considerably across countries, influenced by factors such as the cause of death and population age structure. The results show that Serbia, in the period between 2017 and 2019, lost 539,591.3 years of potential life annually with Serbian MeAYPLL being 57.62 years in this period. The study underscores the importance of considering multiple dimensions of premature mortality, including its intensity, age structure, and geographical variations, for designing effective public health interventions. It also highlights the limitations of the MeAYPLL indicator, recommending its use in conjunction with other measures of premature mortality intensity for a comprehensive assessment.

The suicide burden: an estimate of potential years of life lost

<h3></h3> В России проблема социально-экономического ущерба от самоубийств контролируется государством на основании коэффициента смертности и посредством профилактических мероприятий, направленных преимущественно против случаев детской и подростковой смерти. Однако данная модель не может одновременно учитывать число умерших и возраст, в котором наступила смерть, что делает оценку потерь и направление превентивных мер недостаточно объективными. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Определить бремя суицидов в потерянных годах потенциальной жизни для разных половозрастных групп в период с 2016 по 2020 г. на примере города Санкт-Петербурга. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В ходе исследования проанализированы статистические данные о смертности по причине самоубийств в России и в Санкт-Петербурге за указанные 5 лет. С помощью алгоритма расчета показателя PYLL, представленного в методических рекомендациях ФГБУ «Центральный научно-исследовательский институт организации и информатизации здравоохранения» Минздрава России, проведена оценка бремени суицидов для Санкт-Петербурга. <h3>РЕЗУЛЬТАТЫ И ОБСУЖДЕНИЕ</h3> Несмотря на общее снижение коэффициента смертности от суицидов, доля женщин, умерших в трудоспособном возрасте, напротив, увеличилась за указанный период в 1,5 раза. Наибольшие потери лет обнаружены в группах мужчин 20—24 лет (<i>М</i>=602,0 года на 100 тыс. человек) и девушек 15—19 лет (<i>М</i>=221,5 года на 100 тыс. человек). Отмечен также общий прирост коэффициента потерянных лет потенциальной жизни среди женщин (темп прироста Rate PYLL — 20,1%). Кроме того, наблюдается восходящая линия тренда Rate PYLL, характерная для подростков, мужчин до 24 лет и женщин моложе 39 лет. <h3>ВЫВОДЫ</h3> На фоне выявленной ситуации сохраняется острая необходимость расширения программы профилактики суицидов.

ОЦЕНКА ЭКОНОМИЧЕСКОГО УЩЕРБА ОТ КЛЕЩЕВОГО ВИРУСНОГО ЭНЦЕФАЛИТА В АРХАНГЕЛЬСКОЙ ОБЛАСТИ С ИСПОЛЬЗОВАНИЕМ ПОКАЗАТЕЛЯ «ПОТЕРЯННЫЕ ГОДЫ ПОТЕНЦИАЛЬНОЙ ЖИЗНИ»

Significance. The assessment of economic damage from infectious diseases is important for substantiating the ongoing preventive and anti-epidemic measures. It makes it possible to identify the most significant diseases and make effective management decisions to reduce the incidence. The average incidence of tick-borne encephalitis (TBE) in the Arkhangelsk region in 2004-2021 exceeds the Russian one 3.2 times. The Arkhangelsk region reports lethal cases every year. It is necessary to calculate the TBE economic damage to determine priority control measures and update preventive measures at the regional level. The purpose of the study is to calculate the economic damage from lethal cases of tick-borne encephalitis in the Arkhangelsk region and provide interpretations. Material and methods. The assessment of economic damage from lethal TBE cases was based on calculation of potential years of life lost (PYLL) according to Methodological recommendations [1]. The study used data on lethal TBE cases from the forms of Federal statistical observation # 2 "Information on infectious and parasitic diseases" in the Arkhangelsk region for 2011-2021, maps of epidemiological examination of TBE foci. Results. For the period from 2011 to 2021, the average economic damage incurred by the Arkhangelsk region because of the lost regional gross product associated with TBE deaths adjusted for inflation calculated on the basis of YPLL adds up to 12,136,771.6 Russian rubles per year. Conclusions. The economic damage calculation makes it possible to visualize the burden associated with TBE incidence in the Arkhangelsk region and substantiates the need to further improve preventive and anti-epidemic measures with regard to tick-borne encephalitis. Scope of application. The study results can be used to make management decisions to reduce the TBE incidence, including the development of plans and programs of preventive and anti-epidemic measures.

Sequelas do neurodesenvolvimento encontradas em crianças em tratamento para doenças hemato-oncológicas

INTRODUCTION: Pediatric cancer is the second cause of hospitalization of children in Brazil and the primary reason for potential years of life lost. A wide range of therapies have been discussed in studies on the subject. Although they have improved patient outcomes, they are not free of side effects. OBJECTIVE: This study analyzes the neurodevelopmental impacts of cancer treatment on patients seen at a tertiary pediatric hospital in Curitiba/ PR. It also presents an epidemiological analysis of children undergoing treatment for blood cancers at a referral hospital in Curitiba/PR. METHOD: The records of 156 patients seen in the Hematologic Oncology Department of a referral hospital in the city of Curitiba/PR were selected. A descriptive analysis of the data was carried out, which were presented in absolute numbers and proportions, followed by correlations between the identified neurodevelopmental sequelae and the cancer types, together with the respective therapies prescribed. RESULTS: Acute lymphoblastic leukemia was the most prevalent type of cancer, with 52.6% of cases, followed by central nervous system tumors and acute myeloid leukemia. The main side effects were anxiety; depression; aggressiveness; attention deficit hyperactivity disorder (ADHD); cerebral palsy; auditory, visual, motor and speech impairment. Conclusion: Despite the significant reduction in morbidity and mortality, cancer therapies may cause early and late sequelae in patients undergoing treatment.

Modeling Costs and Life-Years Gained by Population-Wide Next-Generation Sequencing or Single-Gene Testing in Nonsquamous Non-Small-Cell Lung Cancer in the United States.

Many patients with actionable driver oncogenes (ADOs) are never identified and thus never receive targeted treatment. This study evaluated the economic impact and the potential life-years gained (LYG) that can be attributed to the extent of next-generation sequencing (NGS) testing in the United States compared with single-gene testing (SGT) in patients with metastatic nonsquamous non-small-cell lung cancer in the United States. A model was developed to evaluate incremental rates of SGT or NSG testing on the basis of LYG and cost per LYG. ADOs included for NGS included EGFR, ALK, ROS1, BRAF, RET, MET, and NTRK. SGT included EGFR and ALK. Assumptions were made for expected incidence of ADOs. Survival distributions were fit to published trial averages of median and 5-year overall survival. Treatment costs were estimated from drug cost averages. Reimbursement costs were based on data from the Center for Medicare and Medicaid Services. Each incremental 10% increase in NGS testing produces an average of 2,627.4 additional LYG, with an average cost savings per LYG of $75 US dollars (USD). Replacing SGT at the current rate of 80% with NGS testing would result in an average additional 21,09.6 LYG and reduce cost per LYG by an average of $599 USD. If 100% of eligible patients were tested with NGS and each identified patient had matched treatment, the total average cost per LYG would be $16,641.57 USD. On the basis of current evidence, population-level simulations demonstrate that clinically relevant gains in survival with non-negligible reduction in costs are obtainable from widespread adoption of NGS testing and appropriate treatment matching for patients with advanced nonsquamous non-small-cell lung cancer.

Potential years of life lost – criterion for socio-economic assessment of premature mortality

The article deals with the issues of assessing premature mortality using potential demographic methods, which allows taking into account not only the number of death events, but also the age of the deceased.&#x0D; This approach, applied by the authors to assessing the trends and structure of causes of death during the pandemic in Moscow and Russia, demonstrated an overestimation of the significance of causes specific to young ages. As part of the discussion, using the example of a comparative characteristic of potential life losses in the United States and other economically developed countries, it is shown how the factor of a younger mortality structure in the United States due to a pandemic caused significantly higher not only demographic, but also social losses.&#x0D; For citation: Ivanova AE, Semenova VG, Evdokushina GN, Kryukova IA, Potential years of life lost – criterion for socio-economic assessment of premature mortality. City Healthсare. 2022;3(4): 75–83 doi:10.47619/2713-2617.zm.2022.v.3i4; 75–83

Avoidable mortality due to long-term exposure to PM2.5 in Colombia 2014–2019

ObjectiveTo compare estimates of spatiotemporal variations of surface PM2.5 concentrations in Colombia from 2014 to 2019 derived from two global air quality models, as well as to quantify the avoidable deaths attributable to the long-term exposure to concentrations above the current and projected Colombian standard for PM2.5 annual mean at municipality level.MethodsWe retrieved PM2.5 concentrations at the surface level from the ACAG and CAMSRA global air quality models for all 1,122 municipalities, and compare 28 of them with available concentrations from monitor stations. Annual mortality data 2014–2019 by municipality of residence and pooled effect measures for total, natural and specific causes of mortality were used to calculate the number of annual avoidable deaths and years of potential life lost (YPLL) related to the excess of PM2.5 concentration over the current mean annual national standard of 25 µg/m3 and projected standard of 15 µg/m3.ResultsCompared to surface data from 28 municipalities with monitoring stations in 2019, ACAG and CAMSRA models under or overestimated annual mean PM2.5 concentrations. Estimations from ACAG model had a mean bias 1,7 µg/m3 compared to a mean bias of 4,7 µg/m3 from CAMSRA model. Using ACAG model, estimations of total nationally attributable deaths to PM2.5 exposure over 25 and 15 µg/m3 were 142 and 34,341, respectively. Cardiopulmonary diseases accounted for most of the attributable deaths due to PM2.5 excess of exposure (38%). Estimates of YPLL due to all-cause mortality for exceeding the national standard of 25 µg/m3 were 2,381 years.ConclusionComparison of two global air quality models for estimating surface PM2.5 concentrations during 2014–2019 at municipality scale in Colombia showed important differences. Avoidable deaths estimations represent the total number of deaths that could be avoided if the current and projected national standard for PM2.5 annual mean have been met, and show the health-benefit of the implementation of more restrictive air quality standards.

Causes of alcohol-attributable death and associated years of potential life lost among LGB and non-LGB veteran men and women in Veterans Health Administration

BackgroundAlcohol use is a significant concern nationally and research now highlights higher rates of alcohol attributable death (AAD) and years of potential life lost (YPLL) among lesbian, gay, and bisexual (LGB) veterans compared to non-LGB veterans. In this study, we examined specific causes of AAD and associated YPLL between LGB and non-LGB veteran men and women to highlight needed outreach, prevention, and treatment strategies. MethodsUsing data from the nationwide Veterans Health Administration electronic health record and National Death Index from 2014 to 2018, we examined the top ten ranked causes of AAD among LGB (n = 102,085) and non-LGB veteran (n = 5,300,521) men and women, as well as associated YPLL per AAD. ResultsWe observed higher rates of AAD among men than women, but higher rates among LGB veterans relative to their same-sex non-LGB counterparts. We noted greater YPLL per AAD among LGB men and all women compared to non-LGB men, even when of similar or same rank in cause of death. Acute-cause AAD death (e.g., alcohol-related suicide, poisonings) was ranked higher among LGB men and all women. YPLL was greater for both acute- and chronic-cause AAD (e.g., liver disease) among LGB men and all women compared to non-LGB men. ConclusionsCauses of AAD differ between LGB and non-LGB men and women. The differences observed highlight disparities in acute- and chronic-cause AAD between groups help explain the higher number of YPLL per AAD that disfavor LGB men and women veterans, and essential next steps in primary and secondary prevention of hazardous drinking and mortality risk.

Years of Potential Life Lost on Renal Replacement Therapy: Retrospective Study Cohort

Chronic kidney disease is the non-communicable disease with the highest growth in morbidity and mortality. Renal transplantation (RT) is the first option of renal replacement in end-stage kidney disease (ESKD) and dialysis is an alternative. However, there is no objective quantification of the impact of both options on a patient's overall survival. The purpose of our study is to assess the potential years of life lost by patients on renal replacement therapy. Retrospective study cohort conducted from 2008 to 2018 based on autonomic data registry. 11,551 patients included who received renal replacement therapy (RRT) in a range of age from 15 to 94 years. The mean age at the time of onset was 62.7 years, 95% confidence interval (95% CI) (62.4; 63.0). The mortality rate of RRT patients was 42.2%, 95% CI (41.5; 43.3) and the mean age at death was 72.7 years, 95% CI (72.4; 73.1). The number of patients with ESKD treated with RT was 3776, 32.7% of the total, 95% CI (31.8; 33.5). The total amount of years of potential life lost (YPLL) in the entire cohort was 77,831.3 years, 48,010.1 years in men, and 29,821.2 years in women. The mean number of YPLL per patient with RRT was 6.74 years in both sexes, 6.95 years in women, and 6.61 years in men. The mean number of potential years of life lost in dialysis patients was 9.0 years in both sexes, 8.8 years in men, and 9.2 years in women, while among kidney transplant recipients this figure decreased to 2.2 years in both men and women. End-stage chronic kidney disease in renal replacement therapy by dialysis causes an average of 9.0 years of life potentially lost for each patient on dialysis treatment, while having received a kidney transplant reduces this figure by 75.6%.

Inequalities in mortality associated with housing conditions in Belgium between 1991 and 2020

BackgroundPoor housing conditions have been associated with increased mortality. Our objective is to investigate the association between housing inequality and increased mortality in Belgium and to estimate the number of deaths that could be prevented if the population of the whole country faced the mortality rates experienced in areas that are least deprived in terms of housing.MethodsWe used individual-level mortality data extracted from the National Register in Belgium and relative to deaths that occurred between Jan. 1, 1991, and Dec. 31, 2020. Spatial and time-specific housing deprivation indices (1991, 2001, and 2011) were created at the level of the smallest geographical unit in Belgium, with these units assigned into deciles from the most to the least deprived. We calculated mortality associated with housing inequality as the difference between observed and expected deaths by applying mortality rates of the least deprived decile to other deciles. We also used standard life table calculations to estimate the potential years of life lost due housing inequality.ResultsUp to 18.5% (95% CI 17.7–19.3) of all deaths between 1991 and 2020 may be associated with housing inequality, corresponding to 584,875 deaths. Over time, life expectancy at birth increased for the most and least deprived deciles by about 3.5 years. The gap in life expectancy between the two deciles remained high, on average 4.6 years. Life expectancy in Belgium would increase by approximately 3 years if all deciles had the mortality rates of the least deprived decile.ConclusionsThousands of deaths in Belgium could be avoided if all Belgian neighborhoods had the mortality rates of the least deprived areas in terms of housing. Hotspots of housing inequalities need to be located and targeted with tailored public actions.

Firearm Mortality Among Pre-school Age Children, 2010-2020.

Firearms are a substantial cause of death for pre-school children (ages 0-5 years). The purpose of this study was to characterize fatal firearm violence in this age group. The Web-Based Injury Statistics Query and Reporting System (WISQARS) data from the Centers for Disease Control and Prevention (CDC) were analyzed for the years 2010-2020. There were 1,220 firearm deaths during the study period with a 75% increase in the rate of deaths per 100,000 population. Most deaths (two-thirds) were among males. Non-Hispanic Blacks comprised 56.4% of all deaths in 2020, a 172% increase from 2010 and the rate for non-Hispanic Whites increased by 15.4% from 2010 to 2020. The majority of the deaths occurred in the South. Almost two-thirds (65.9%) of all firearm deaths were homicides, 30% were unintentional, and 4.1% were undetermined. Homicides were also the majority of deaths for non-Hispanic Blacks (64.9%), non-Hispanic Whites (60.8%), and Hispanics (81.3%). The years of potential life lost before 80 years of age were 94,105, with a plurality (43.3%) of losses occurring among non-Hispanic Black children. Sustained awareness campaigns should be implemented to make parents and guardians aware of the profound dangers of unlocked and loaded or unsafely stored firearms in the home. Child healthcare providers should counsel parents and guardians on firearm safety in households. Public health professionals should advocate for laws that can help protect children from firearm violence (e.g., Domestic Violence Restraining Orders, Child Access Prevention laws, and Extreme Risk Protection Order laws).

Sex and Race Disparities in Mortality and Years of Potential Life Lost Among People With HIV: A 21-Year Observational Cohort Study.

Since the availability of antiretroviral therapy, mortality rates among people with HIV (PWH) have decreased; however, this does not quantify premature deaths among PWH, and disparities persist. We examined all-cause and premature mortality among PWH receiving care at the Vanderbilt Comprehensive Care Clinic from January 1998 to December 2018. Mortality rates were compared by demographic and clinical factors, and adjusted incidence rate ratios (aIRRs) were calculated using multivariable Poisson regression. For individuals who died, age-adjusted years of potential life lost (aYPLL) per total person-years living with HIV were calculated from US sex-specific life tables, and sex and race differences were examined using multivariable linear regression. Among 6531 individuals (51% non-Hispanic [NH] White race, 40% NH Black race, 21% cis-gender women, 78% cis-gender men) included, 956 (14.6%) died. In adjusted analysis, PWH alive in the most recent calendar era (2014-2018) had decreased risk of mortality compared with those in the earliest calendar era (1998-2003; aIRR, 0.22; 95% CI, 0.17-0.29), and women had increased risk of death compared with men (aIRR, 1.31; 95% CI, 1.12-1.54). Of those who died, Black women had the highest aYPLL (aIRR, 592.5; 95% CI, 588.4-596.6), followed by Black men (aIRR, 470.7; 95% CI, 468.4-472.9), White women (aIRR, 411.5; 95% CI, 405.6-417.4), then White men (aIRR, 308.6; 95% CI, 308.0-309.2). In adjusted models, higher YPLL remained associated with NH Black race and cis-gender women, regardless of HIV risk factor. Despite marked improvement over time, sex disparities in mortality as well as sex and race disparities in YPLL remained among PWH in this cohort.

739. The High Burden of Bloodstream Infection in Adults: A Nation-Wide Population- Based Study

Abstract Background Limited data exist on the long-term consequences of bloodstream infections (BSI). We examined incidence, 1-year mortality, and years of potential life lost (YPLL) following BSI by eight sentinel bacteria in adults. We also estimated the relative contribution of hospital-onset BSI (HO-BSI) and of antibiotic-resistant BSI to the burden of BSI. Methods We used data from Israel's national BSI surveillance system (covering E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, S. pneumoniae, S. aureus, E. faecalis and E. faecium, comprising 70% of all BSI) and the national death registry. Adults with BSI between 1/1/2018 and 31/12/2019 were included. The outcomes were all-cause 30-day and 1-year mortality. We constructed Kaplan-Meier curves and used the log-rank test to compare survival between age groups. We calculated the age-standardized mortality rate and YPLL using the Global Burden of Disease reference population and life expectancy tables. Results A total of 25,376 BSI occurred over 2 years in the adult Israeli population (mean adult population: 6,068,580). Drug-resistant BSI comprised 32% of all events (41.1% of HO-BSI). The annual BSI incidence was 209 per 100,000 population. The case fatality rate (CFR) was 25.6% at 30 days and 46.4% at 1 year. The 1-year CFR was higher among males than females (RR=1.17, 95% CI 1.14–1.20) and it increased with age (OR=1.37 per decade, 95% CI 1.36–1.39). In all age groups survival continued to decline up to 1 year (Figure). For the outcome of 1-year mortality, the annual age-standardized mortality rate and YPLL per 100,000 population following BSI were 48.6 and 1002.2, respectively. For comparison, the global mortality rate and YPLL from ischemic stroke are 36.6 and 521.8 per 100,000, respectively. HO-BSI represented 27.4% of BSI but contributed to 33.9% of deaths and 39.9% of YPLL. HO-BSI by drug-resistant bacteria represented 11.3% of BSI, 14.8% of deaths, and 17.4% of YPLL. Conclusion BSI have grave long-term consequences: nearly 50% of affected adult patients died within 1 year. The burden of BSI is higher than that of ischemic stroke. HO-BSI and drug-resistant BSI contribute disproportionately to BSI mortality and YPLL. Attention and resources should be directed to prevention of BSI, as well as to advances in early diagnosis and better treatment. Disclosures Yehuda Carmeli, MD, Allecra Therapeutics: Advisor/Consultant|MSD: Advisor/Consultant|Nabriva: Advisor/Consultant|Pfizer: Advisor/Consultant|Qpex Pharmaceuticals: Advisor/Consultant|Roche: Advisor/Consultant|Shinogi: Advisor/Consultant|Spero Therapeutics: Advisor/Consultant.

US racial and sex-based disparities in firearm-related death trends from 1981-2020.

Firearms cause the most suicides (60%) and homicides (36%) in the US. The high lethality and availability of firearms make them a particularly dangerous method of attempted violence. The aim of this study was to study US trends in firearm suicide and homicide mortality and years of potential life lost before age 75 (YPLL-75) between 1981 and 2020. Data in this cross-sectional study were collected between 1981 and 2020 from the Centers for Disease Control and Prevention (CDC)'s WISQARS database for fatal injury and violence. Data from the US population were considered for all age groups and were divided by racial groups and sex for analysis. Those most heavily impacted by firearm homicide were Black, with homicide age-adjusted death rates almost seven times higher than White people. A spike in firearm homicide deaths occurred between 2019 and 2020, with Black people having the largest increase (39%). White people had the highest rates of firearm suicide, and suicide death rates increased between 2019 and 2020. Increases in homicide and suicide YPLL-75 between 2011 and 2020 had most heavily impacted minority populations. Men had a firearm suicide rate that was seven times higher than women, and a firearm homicide rate that was five times higher than women. This study demonstrated that Black and White men were most impacted by firearm deaths, and that firearm homicide and suicide rates increased between 2019 and 2020 for all racial groups except Asian/Pacific Islander. Our results suggest that prevention efforts should focus on specific demographic factors and articulate the urgency to mitigate firearm-related deaths in the US.

Long-term outcome of convulsive status epilepticus: a 10-year follow-up

This study aimed to determine the mortality, causes of death and factors affecting the outcome of convulsive status epilepticus (CSE) at 10 years. This retrospective study consisted of 62 consecutive adult patients diagnosed with CSE at the Helsinki University Hospital (HUS) emergency department during 2002-2003. Patients were followed for up to 10 years or up to the time of death. Data on patient demographics, CSE characteristics, treatment, complications, and outcome from the time of CSE were collected. The Official Statistics of Finland provided the information on mortality and causes of death. Survival analysis was conducted using Cox proportional hazards regression analysis. In-hospital mortality was 8.1%, and mortality was 25.8% at one year, 51.6% at five years and 64.5% at 10 years. Estimated standardized mortality ratio (SMR) was 5.3 and the deceased patients lost 20.9 potential years of life, on average. The leading causes of death were disorders of the brain or the circulatory system, epilepsy-related conditions or intracranial tumours. The univariable survival analysis demonstrated that age ≥65 (HR=2.8, p=0.001), Charlson Comorbidity Index (CCI)>0 (CCI=1-3: HR=3.0, p=0.009; CCI>3: HR=8.4, p<0.001), Status Epilepticus Severity Score (STESS)>4 (HR=5.3, p<0.001) and Epidemiology-Based Mortality Score (EMSE-EAC)>15 (HR=2.2, p=0.036) were risk factors and a Glasgow outcome scale (GOS) of 5 at discharge (HR=0.14, p=0.025) was a protective factor for survival. The multivariable analysis established STESS>4 (HR=5.0, p=0.002) and CCI>0 (CCI=1-3: HR=2.9, p=0.015;CCI>3: HR=6.3, p=0.006) as independent risk factors and GOS>3 (time-dependent) (GOS=4: HR=0.33, p=0.048;GOS=5: HR=0.13, p=0.019) as a protective factor for survival. The rate of long-term mortality and number of potential years of life lost were high. Factors demonstrative of the overall situation of the patients, such as comorbidities, functional state after CSE and age, were significant predictors for long-term outcome.