Death Rate Ratio Research Articles

Effect of Dapagliflozin on Total Heart Failure Events in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction

In the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial, dapagliflozin reduced the risk of time to first worsening heart failure (HF) event or cardiovascular death in patients with HF with mildly reduced or preserved ejection fraction (EF). To evaluate the effect of dapagliflozin on total (ie, first and recurrent) HF events and cardiovascular death in this population. In this prespecified analysis of the DELIVER trial, the proportional rates approach of Lin, Wei, Yang, and Ying (LWYY) and a joint frailty model were used to examine the effect of dapagliflozin on total HF events and cardiovascular death. Several subgroups were examined to test for heterogeneity in the effect of dapagliflozin, including left ventricular EF. Participants were enrolled from August 2018 to December 2020, and data were analyzed from August to October 2022. Dapagliflozin, 10 mg, once daily or matching placebo. The outcome was total episodes of worsening HF (hospitalization for HF or urgent HF visit requiring intravenous HF therapies) and cardiovascular death. Of 6263 included patients, 2747 (43.9%) were women, and the mean (SD) age was 71.7 (9.6) years. There were 1057 HF events and cardiovascular deaths in the placebo group compared with 815 in the dapagliflozin group. Patients with more HF events had features of more severe HF, such as higher N-terminal pro-B-type natriuretic peptide level, worse kidney function, more prior HF hospitalizations, and longer duration of HF, although EF was similar to those with no HF events. In the LWYY model, the rate ratio for total HF events and cardiovascular death for dapagliflozin compared with placebo was 0.77 (95% CI, 0.67-0.89; P < .001) compared with a hazard ratio of 0.82 (95% CI, 0.73-0.92; P < .001) in a traditional time to first event analysis. In the joint frailty model, the rate ratio was 0.72 (95% CI, 0.65-0.81; P < .001) for total HF events and 0.87 (95% CI, 0.72-1.05; P = .14) for cardiovascular death. The results were similar for total HF hospitalizations (without urgent HF visits) and cardiovascular death and in all subgroups, including those defined by EF. In the DELIVER trial, dapagliflozin reduced the rate of total HF events (first and subsequent HF hospitalizations and urgent HF visits) and cardiovascular death regardless of patient characteristics, including EF. ClinicalTrials.gov Identifier: NCT03619213.

A Deep-Learning Neural Network Approach for Secure Wireless Communication in the Surveillance of Electronic Health Records

The electronic health record (EHR) surveillance process relies on wireless security administered in application technology, such as the Internet of Things (IoT). Automated supervision with cutting-edge data analysis methods may be a viable strategy to enhance treatment in light of the increasing accessibility of medical narratives in the electronic health record. EHR analysis structured data structure code was used to obtain data on initial fatality risk, infection rate, and hazard ratio of death from EHRs for prediction of unexpected deaths. Patients utilizing EHRs in general must keep in mind the significance of security. With the rise of the IoT and sensor-based Healthcare 4.0, cyber-resilience has emerged as a need for the safekeeping of patient information across all connected devices. Security for access, amendment, and storage is cumulatively managed using the common paradigm. For improving the security of surveillance in the aforementioned services, this article introduces an endorsed joint security scheme (EJSS). This scheme recognizes the EHR utilization based on the aforementioned processes. For each process, different security measures are administered for sustainable security. Access control and storage modification require relative security administered using mutual key sharing between the accessing user and the EHR database. In this process, the learning identifies the variations in different processes for reducing adversarial interruption. The federated learning paradigm employed in this scheme identifies concurrent adversaries in the different processes initiated at the same time. Differentiating the adversaries under each process strengthens mutual authentication using individual attributes. Therefore, individual surveillance efficiency through log inspection and adversary detection is improved for heterogeneous and large-scale EHR databases.

COVID-19 infection, admission and death and the impact of corticosteroids among people with rare autoimmune rheumatic disease during the second wave of COVID-19 in England: results from the RECORDER Project.

To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the second wave of the COVID-19 pandemic in England, and describe the impact of corticosteroids on outcomes. Hospital Episode Statistics data were used to identify people alive on 1 August 2020 with ICD-10 codes for RAIRD from the whole population of England. Linked national health records were used to calculate rates and rate ratios of COVID-19 infection and death up to 30 April 2021. Primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. NHS Digital and Office for National Statistics general population data were used for comparison. The association between 30-day corticosteroid usage and COVID-19-related death, COVID-19-related hospital admissions and all-cause deaths was also described. Of 168 330 people with RAIRD, 9961 (5.92%) had a positive COVID-19 PCR test. The age-standardized infection rate ratio between RAIRD and the general population was 0.99 (95% CI: 0.97, 1.00). 1342 (0.80%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardized mortality rate for COVID-19-related death was 2.76 (95% CI: 2.63, 2.89) times higher than in the general population. There was a dose-dependent relationship between 30-day corticosteroid usage and COVID-19-related death. There was no increase in deaths due to other causes. During the second wave of COVID-19 in England, people with RAIRD had the same risk of COVID-19 infection but a 2.76-fold increased risk of COVID-19-related death compared with the general population, with corticosteroids associated with increased risk.

The Association of Blood Banks per City with Mortality Due to Traumatic Hemorrhagic Shock in Colombia: A Population-Based Analysis.

Hemorrhagic shock is the second leading cause of death for injured people and disproportionately affects low resource economies. The potential role of spatial allocation of blood banks and the unmet transfusion needs of patients are yet to be characterized. We aimed to estimate the effect of the number of blood banks in mortality due to traumatic hemorrhagic shock (THS) in Colombia. We performed a population-based cross-sectional study using secondary data from the Colombian Government: including annual reports from the Blood Bank Network, mortality, and population estimates for 2015-2016. International Classification of Disease 10th code T79.4 identified THS as the primary cause of death. A city-clustered multivariate negative binomial regression, weighted by violent deaths rate, was used to obtain incidence rate ratios (IRR) of death due to THS with 95% confidence intervals (95%CI). Of the 59,030 violent deaths in Colombia in 2015-2016, 36.76% were due to THS. Only 3.13% of Colombian municipalities had a blood bank. THS incidence decreased as the number of blood banks in a city increased, and the lowest incidence was observed at ten banks (IRR:0.18, 95%CI:0.15-0.22). Receiving medical care in a city with blood banks had a more substantial impact on THS (IRR:0.85; 95%CI:0.76-0.96). The number of blood banks per city was associated with lower incidence of THS deaths. These findings may highlight the inequitable distribution of blood systems and their association with preventable deaths. Further studies with more focused clinical and geographical data might clarify the geographic determinants of blood products' availability.

Diabetes and infectious disease mortality in Mexico City

IntroductionAlthough higher risks of infectious diseases among individuals with diabetes have long been recognized, the magnitude of these risks is poorly described, particularly in lower income settings. This study sought...

Body Composition and Risk of Vascular-Metabolic Mortality Risk in 113 000 Mexican Men and Women Without Prior Chronic Disease.

Background Body-mass index is the sum of fat mass index (FMI) and lean mass index (LMI), which vary by age, sex, and impact on disease outcomes. We investigated the separate and joint relevance of FMI and LMI with vascular-metabolic causes of death in Mexican adults. Methods and Results A total of 113 025 adults aged 35 to 74 years and free from diabetes or other chronic diseases when recruited into the Mexico City Prospective Study were followed for 19 years. Cox models estimated sex-specific death rate ratios from vascular-metabolic causes after adjustment for confounders and exclusion of the first 5 years of follow-up. To account for the strong correlation between FMI and LMI, additional models estimated rate ratios associated with "residual FMI" and "residual LMI" (ie, the residuals from linear regression analyses of FMI on LMI, or vice versa). In both sexes, higher FMI and LMI were associated with higher risks of vascular-metabolic mortality. For a given (ie, fixed) level of LMI, the rate ratio (95% CI) for vascular-metabolic mortality per 1 kg/m2 higher residual FMI strengthened and was higher in women (1.52 [1.38-1.68]) than in men (1.19 [1.13-1.25]). By contrast, for a given level of FMI, higher residual LMI was inversely associated with vascular-metabolic mortality (rate ratio per 1 kg/m2 0.67 [0.56-0.80] in women and 0.94 [0.90-0.98] in men). Conclusions In this study, higher residual FMI was more strongly associated with vascular-metabolic mortality in women than in men. Conversely, higher residual LMI was inversely associated with vascular-metabolic mortality, particularly in women.

Vaccine Effectiveness Against the SARS-CoV-2 B.1.1.529 Omicron Variant in Solid Organ and Islet Transplant Recipients in England: A National Retrospective Cohort Study.

The effectiveness of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.529 Omicron variant in immunosuppressed solid organ and islet transplant (SOT) recipients is unclear. National registries in England were linked to identify SARS-CoV-2 positive tests, noninjury hospitalization within 14 d, and deaths within 28 d between December 7, 2020, and March 31, 2022 in adult SOT recipients. Incidence rate ratios (IRRs) for infection, and hospitalization or death, were adjusted for recipient demographics and calendar month for the Omicron-dominant period (December 20, 2021, to March 31, 2022). Mortality risk following SARS-CoV-2 infection was adjusted for recipient demographics and dominant variant using a Cox proportional-hazards model for the entire time period. During the Omicron-dominant period, infection IRRs (95% confidence intervals) were higher in those receiving 2, 3, and 4 vaccine doses than in unvaccinated patients (1.25 [1.08-1.45], 1.46 [1.28-1.67], and 1.79 [1.54-2.06], respectively). However, hospitalization or death IRRs during this period were lower in those receiving 3 or 4 vaccine doses than in unvaccinated patients (0.62 [0.45-0.86] and 0.39 [0.26-0.58], respectively). Risk-adjusted analyses for deaths after SARS-CoV-2 infection between December 7, 2020, and March 31, 2022, found hazard ratios (95% confidence intervals) of 0.67 (0.46-0.98), 0.46 (0.30-0.69), and 0.18 (0.09-0.35) for those with 2, 3, and 4 vaccine doses, respectively, when compared with the unvaccinated group. In immunosuppressed SOT recipients, vaccination is associated with incremental, dose-dependent protection against hospitalization or death after SARS-CoV-2 infection, including against the Omicron variant.

Empirical evidence on structural racism as a driver of racial inequities in COVID-19 mortality.

This study contributes to the literature by empirically testing the extent to which place-based structural racism is a driver of state-level racial inequalities in COVID-19 mortality using theoretically-informed, innovative approaches. CDC data are used to measure cumulative COVID-19 death rates between January 2020 and August 2022. The outcome measure is a state-level Black-White (B/W) ratio of age-adjusted death rates. We use state-level 2019 administrative data on previously validated indicators of structural racism spanning educational, economic, political, criminal-legal and housing to identify a novel, multi-sectoral latent measure of structural racism (CFI = 0.982, TLI = 0.968, and RMSEA = 0.044). We map B/W inequalities in COVID-19 mortality as well as the latent measure of structural racism in order to understand their geographic distribution across U.S. states. Finally, we use regression analyses to estimate the extent to which structural racism contributes to Black-White inequalities in COVID-19 mortality, net of potential confounders. Results reveal substantial state-level variation in the B/W ratio of COVID-19 death rates and structural racism. Notably, regression estimates indicate that the relationship between the structural racism and B/W inequality in COVID-19 mortality is positive and statistically significant (p < 0.001), both in the bivariate model (adjusted R2 = 0.37) and net of the covariates (adjusted R2 = 0.54). For example, whereas states with a structural racism value 2 standard deviation below the mean have a B/W ratio of approximately 1.12, states with a structural racism value 2 standard deviation above the mean have a ratio of just above 2.0. Findings suggest that efficacious health equity solutions will require bold policies that dismantle structural racism across numerous societal domains.

Clinical Impact of the Intensity of Induction Regimens Prior to Consolidation in Treatment-Naïve Patients with Peripheral T-Cell Lymphoma (PTCL)

Introduction: Frontline treatment of peripheral T-cell lymphoma (PTCL) remains a challenge because, despite good overall response rate (ORR 60-70%) to chemotherapy, more than 50% of patients (pts) relapse quickly and die of their disease. (Mehta-Shah, ASH 2019). Two prospective clinical trials (D'Amore, JCO 2012 - non-randomized study- and Horwitz, Lancet 2019 - randomized) demonstrated improved outcomes by adding Brentuximab Vedotin (BV-CHP) or etoposide (CHOEP) to the cyclophosphamide-vincristine-adriamycine-prednisone (CHOP) backbone in selected PTCL populations. Intensive induction chemotherapy (IIC) regimens commonly used in high grade B-cell malignancies (i.e. HyperCVAD) have also been used in PTCL based on phase I-II trial data (Abramson, Ann Oncol 2014). However, IIC regimens have not been compared to CHOP or CHOP+ (CHOEP/BV-CHP) in prospective studies. Methods: Naïve PTCL treated at Roswell Park Comprehensive Cancer Center between 1997 to 2020 were identified. Pts were divided in three groups based on front-line therapy: CHOP vs. CHOP+ (CHOEP/BV-CHP) vs. IIC (HyperCVAD, ICE). We retrospectively analyzed pre-treatment characteristics, clinical outcomes (overall and complete response rate (ORR, CR), incidence rate ratio of relapse or death within 2 years of treatment (IRR), progression free (PFS), and overall survival (OS) at 5 years) and gross toxicity indices (treatment interruptions unrelated to progression of disease (POD), and causes of death). We used the chi square test and logistic regression to compare categorical variables, the Poisson distribution to compare IRR, log rank to compare time to event curves (PFS/OS). Analysis and graphs were done with SAS and STATA software programs. Results: We identified 151 newly diagnosed PTCL treated at RPCCC. Twenty pts who received palliative therapy or comfort care were excluded from the study. We excluded 6 NK/T-cell lymphoma nasal type (NKTL), 5 hepatosplenic gamma delta TCL (HSTCL) and 1 Adult T-cell leukemia/lymphoma (ATLL) for which CHOP-like regimens are not standard of care. In addition, we also excluded 18 ALK+ Anaplastic large cell lymphoma (ALCL) from the analysis as this good prognosis group exclusively received CHOP or CHOP+, potentially confounding the analysis. A total of 101 pts were included in the analysis representing the following subtypes: angioimmunoblastic T cell lymphoma (AITL) (N=22, 21.8%), PTCL-not otherwise specified (NOS) (N=36, 35.6%), PTCL-with T follicular helper phenotype (TFH) (N=2, 2.0%) or ALK- ALCL (N=41, 35.6%). CHOP was used in 54 pts, 27 received CHOP+ (18 CHOEP, 8 BV-CHP, 1 EPOCH), and 20 received IIC chemo (17 HyperCVAD, 3 ICE). Consolidation with HDC-ASCT was performed in 7 pts after CHOP (14%), 5 pts after CHOP+ (18%) and 8 pts after IIC treatment (40%). Baseline characteristics including sex, age, comorbidities, performance status (ECOG), international prognostic index (IPI) and histology were balanced in the CHOP, CHOP+ and IIC chemo treatment groups, after we excluded ALK+ ALCL as described above (all p values > 0.4). ORR was 69% (61% CR), 86% (81% CR) and 80% (80% CR) in the CHOP, CHOP+ and IIC groups (p=0.3). A multivariate analysis including treatment type, ECOG performance status, Charlson comorbidity score and age did not show any significant correlation with ORR (lowest p value was 0.07 for the Charlson comorbidity score). Incidence rate ratio of progression or death was 3.1, 3.4 and 4.6 per 100-person months respectively for CHOP, CHOP+ and IIC chemo (proportions: 46%, 44%, 60% respectively). PFS and OS did not show significant differences among treatment groups (Log Rank test p = 0.90 for PFS and p = 0.79 for OS). The proportion of treatment interruptions without evidence of POD was 23% in the CHOP, 28% in the CHOP+ and 40% in the IIC group (p=0.31). Of all death events per group, POD was the cause of 43%, 41% and 36% deaths respectively in the CHOP, CHOP+ and IIC groups (p=0.92), death for treatment related toxicity occurred in 21% (CHOP), 41% (CHOP+) and 45% (ICC chemo) of all deaths per group, p=0.19. Conclusions: In our population, the intensity of front-line chemotherapy does not seem to impact on IRR PFS or OS. CHOP+ and IIC might have a tendency towards better ORR and CR rates vs CHOP. However, IIC have a tendency (non-statistically significant) of an increase in adverse events leading to treatment interruptions unrelated to POD and deaths for toxicity. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Perinatal mortality in Ireland: inequalities by socio-economic group and country of birth.

While perinatal mortality rates have decreased in Ireland in recent years, it is not known if this reduction was shared equally among all groups. The aim of this study is to examine inequalities in perinatal mortality by country of birth and socio-economic group in Ireland between 2004 and 2019. Data for the analysis was obtained from the National Perinatal Reporting System dataset, which includes all births (including stillbirths) in Ireland. The rate and risk ratios for perinatal death were calculated for mothers' socio-economic group and country of birth for two time periods (2004-11 and 2012-19). Adjustment was made for mothers' age, marital status, parity and country of birth/socio-economic group. A total of 995154 births and 5710 perinatal deaths were included in the analysis. With the exception of African born mothers, the perinatal mortality rate decreased for all groups over time; however, inequalities persisted. Relative to Irish born mothers, the risk for African born mothers increased from 1.63 to 2.00 over time. Adjusting for other variables including socio-economic status reduced but did not eliminate this elevated relative risk. Mothers who were classified as unemployed or engaged in home duties had a higher risk of a perinatal death relative to higher professional mothers, with the relative risk remaining relatively constant over time. Reducing inequalities in health is a key objective of the Irish government. Further research is required to identify why perinatal mortality continues to be higher in some groups so that targeted action can be implemented.

Risk of Myocarditis After Sequential Doses of COVID-19 Vaccine and SARS-CoV-2 Infection by Age and Sex.

Background:Myocarditis is more common after severe acute respiratory syndrome coronavirus 2 infection than after COVID-19 vaccination, but the risks in younger people and after sequential vaccine doses are less certain.Methods:A self-controlled case series study of people ages 13 years or older vaccinated for COVID-19 in England between December 1, 2020, and December 15, 2021, evaluated the association between vaccination and myocarditis, stratified by age and sex. The incidence rate ratio and excess number of hospital admissions or deaths from myocarditis per million people were estimated for the 1 to 28 days after sequential doses of adenovirus (ChAdOx1) or mRNA-based (BNT162b2, mRNA-1273) vaccines, or after a positive SARS-CoV-2 test.Results:In 42 842 345 people receiving at least 1 dose of vaccine, 21 242 629 received 3 doses, and 5 934 153 had SARS-CoV-2 infection before or after vaccination. Myocarditis occurred in 2861 (0.007%) people, with 617 events 1 to 28 days after vaccination. Risk of myocarditis was increased in the 1 to 28 days after a first dose of ChAdOx1 (incidence rate ratio, 1.33 [95% CI, 1.09–1.62]) and a first, second, and booster dose of BNT162b2 (1.52 [95% CI, 1.24–1.85]; 1.57 [95% CI, 1.28–1.92], and 1.72 [95% CI, 1.33–2.22], respectively) but was lower than the risks after a positive SARS-CoV-2 test before or after vaccination (11.14 [95% CI, 8.64–14.36] and 5.97 [95% CI, 4.54–7.87], respectively). The risk of myocarditis was higher 1 to 28 days after a second dose of mRNA-1273 (11.76 [95% CI, 7.25–19.08]) and persisted after a booster dose (2.64 [95% CI, 1.25–5.58]). Associations were stronger in men younger than 40 years for all vaccines. In men younger than 40 years old, the number of excess myocarditis events per million people was higher after a second dose of mRNA-1273 than after a positive SARS-CoV-2 test (97 [95% CI, 91–99] versus 16 [95% CI, 12–18]). In women younger than 40 years, the number of excess events per million was similar after a second dose of mRNA-1273 and a positive test (7 [95% CI, 1–9] versus 8 [95% CI, 6–8]).Conclusions:Overall, the risk of myocarditis is greater after SARS-CoV-2 infection than after COVID-19 vaccination and remains modest after sequential doses including a booster dose of BNT162b2 mRNA vaccine. However, the risk of myocarditis after vaccination is higher in younger men, particularly after a second dose of the mRNA-1273 vaccine.

POPULATION DYNAMICS AND ECONOMIC GROWTH IN MAHARASHTRA STATE

Demographic trends have a substantial impact on any country’s economic performance. The present study demonstrates and analyzes the probable relationship between population indicators and economic growth of Maharashtra. For population dynamics and economic growth assessment, we have selected these indicators such as – per capita income, total population, urban population, literacy rate, birth rate, death rate and sex ratio of 1961, 1971, 1981, 1991, 2001 and 2011. To understand the Bivariate association between population indicators and economic growth and which variable will more affect economic growth, various statistical techniques has been used like- Karl Pearson Product Movement Correlation method and Stepwise Multivariate Regression has been used. The result shows that there is a positive high correlation between per capita income and total population (R = 0.858) that means when population increase that translate into increase of participation in the workforce. And there is also high positive correlation between per capita income and urban population (R = 0.883). Considering all the causal factors in the stepwise regression, it indicates that the highest correlation coefficient (R2 =0.779) which collectively explains the 77.90 per cent change through urban population in economic growth.

Contributions of event rates, pre-hospital deaths, and deaths following hospitalisation to variations in myocardial infarction mortality in 326 districts in England: a spatial analysis of linked hospitalisation and mortality data

Myocardial infarction mortality varies substantially within high-income countries. There is limited guidance on what interventions-including primary and secondary prevention, or improvement of care pathways and quality-can reduce myocardial infarction mortality. Our aim was to understand the contributions of incidence (event rate), pre-hospital deaths, and hospital case fatality to the variations in myocardial infarction mortality within England. We used linked data from national databases on hospitalisations and deaths with acute myocardial infarction (ICD-10 codes I21 and I22) as a primary hospital diagnosis or underlying cause of death, from Jan 1, 2015, to Dec 31, 2018. We used geographical identifiers to estimate myocardial infarction event rate (number of events per 100 000 population), death rate (number of deaths per 100 000 population), total case fatality (proportion of events that resulted in death), pre-hospital fatality (proportion of events that resulted in pre-hospital death), and hospital case fatality (proportion of admissions due to myocardial infarction that resulted in death within 28 days of admission) for men and women aged 45 years and older across 326 districts in England. Data were analysed in a Bayesian spatial model that accounted for similarities and differences in spatial patterns of fatal and non-fatal myocardial infarction. Age-standardised rates were calculated by weighting age-specific rates by the corresponding national share of the appropriate denominator for each measure. From 2015 to 2018, national age-standardised death rates were 63 per 100 000 population in women and 126 per 100 000 in men, and event rates were 233 per 100 000 in women and 512 per 100 000 in men. After age-standardisation, 15·0% of events in women and 16·9% in men resulted in death before hospitalisation, and hospital case fatality was 10·8% in women and 10·6% in men. Across districts, the 99th-to-1st percentile ratio of age-standardised myocardial infarction death rates was 2·63 (95% credible interval 2·45-2·83) in women and 2·56 (2·37-2·76) in men, with death rates highest in parts of northern England. The main contributor to this variation was myocardial infarction event rate, with a 99th-to-1st percentile ratio of 2·55 (2·39-2·72) in women and 2·17 (2·08-2·27) in men across districts. Pre-hospital fatality was greater than hospital case fatality in every district. Pre-hospital fatality had a 99th-to-1st percentile ratio of 1·60 (1·50-1·70) in women and 1·75 (1·66-1·86) in men across districts, and made a greater contribution to variation in total case fatality than did hospital case fatality (99th-to-1st percentile ratio 1·39 [1·29-1·49] and 1·49 [1·39-1·60]). The contribution of case fatality to variation in deaths across districts was largest in women aged 55-64 and 65-74 years and in men aged 55-64, 65-74, and 75-84 years. Pre-hospital fatality was slightly higher in men than in women in most districts and age groups, whereas hospital case fatality was higher in women in virtually all districts at ages up to and including 65-74 years. Most of the variation in myocardial infarction mortality in England is due to variation in myocardial infarction event rate, with a smaller role for case fatality. Most variation in case fatality occurs before rather than after hospital admission. Reducing subnational variations in myocardial infarction mortality requires interventions that reduce event rate and pre-hospital deaths. Wellcome Trust, British Heart Foundation, Medical Research Council (UK Research and Innovation), and National Institute for Health Research (UK).

Trends in the disease burden of congenital heart disease in China over the past three decades.

To investigate the disease burden of congenital heart disease (CHD) in China from 1990 to 2019. Using the data from Global Burden of Disease (GBD) study 2019, the incidence, age-standardized incidence rates, the mortality, age-standardized mortality rates, disability-adjusted life year (DALY) and age-standardized DALY rates of CHD were calculated. Time trend analysis of disease burden-related indicators was analyzed by Joinpoint regression model. Age-period-cohort model was used to describe age, period, and birth cohort effects in CHD mortality population. The relationship between age-standardized incidence, mortality, DALY rates of congenital heart disease and human development index (HDI) were analyzed by Pearson correlation. From 1990 to 2019, the mean annual percentage change (AAPC) in age-standardized incidence rate, mortality rate and DALY rate of CHD in China were -0.1%(95% CI: -0.7%-0.4%)、-3.5%(95% CI: -3.7%--3.2%) and -3.5%(95% CI: -3.7%--3.2%), respectively. CHD usually occurred in the first year of life. The mean incidence rate at birth was 2497.9/100 000, and the mean incidence rate under 1 year of age was 2626.6/100 000. During the period of 1995-2000, the incidence rate in newborn and <1 year children showed an exponential upward trend, then it remained a steady downward trend. However, there was an exponential increase in <1 year children during 2010-2013 and 2014-2015, followed by an exponential decrease to the lowest value in the last three decades. The mortality of CHD tended to decrease with age, with mortality of 101.67/100 000 for children under 5 years of age and a decrease after 5 years of age. However, there was a transient increase in mortality in age group 55-<60. From 1995 to 2019, the relative risk of death of patients with CHD showed a downward trend. Compared with 1995-1999, the rate ratio of death decreased by 24% in 2015-2019. Such downward trend was also observed in the birth cohort after 1945. Compared with the 1945-1949 birth cohort, the rate ratio of death for patients with CHD decreased by 75% in the 2015-2019 birth cohort. When HDI<0.58 (before 1999), the age-standardized incidence of CHD was positively correlated with HDI ( r=0.74, P<0.05). When HDI≥0.58 (after 1999), the age-standardized incidence of CHD was negatively correlated with HDI ( r=-0.76, P<0.01). The age-standardized mortality and DALY rates were negatively correlated with HDI ( r=-0.95 and -0.93, both P<0.01). During 1990 to 1999, the incidence of CHD increases and is positively correlated with the social development. During 1999 to 2019, the incidence of CHD decreases and is negatively correlated with the social development. The disease burden of CHD decreases and is negatively correlated with the social development. Some progress has been made in the field of prevention and control of CHD, but the disease burden remains high among younger population in China.

Systemic Inflammation Is Associated With Future Risk of Fatal Infection: An Observational Cohort Study.

BackgroundMany diseases are associated with chronic inflammation, resulting in widening application of anti-inflammatory therapies. Although they are effective as disease-modifying agents, these anti-inflammatory therapies increase the risk of serious infection; however, it remains unknown whether chronic systemic inflammation per se is also associated with fatal infection.MethodsUsing serum C-reactive protein (CRP) data from 461 052 UK Biobank participants, we defined incidence rate ratios (IRRs) for death from infection, cardiovascular disease, or other causes and adjusted for comorbidities and the use of anti-inflammatory therapies.ResultsSystemic inflammation, defined as CRP ≥2 mg/L, was common in all comorbidities considered. After adjusting for confounding factors, systemic inflammation was associated with a higher IRR point estimate for infection death (1.70; 95% confidence interval [CI], 1.51–1.92) than cardiovascular (1.48; CI, 1.40–1.57) or other death (1.41; CI, 1.37–1.45), although CIs overlapped. C-reactive protein thresholds of ≥5 and ≥10 mg/L yielded similar findings, as did analyses in people with ≥2, but not <2, comorbidities.ConclusionsSystemic inflammation per se identifies people at increased risk of infection death, potentially contributing to the observed risks of anti-inflammatory therapies in clinical trials. In future clinical trials of anti-inflammatory therapies, researchers should carefully consider risks and benefits in target populations, guided by research into mechanisms of infection risk.

Neighborhood disparities in COVID-19 outcomes in New York city over the first two waves of the outbreak

PurposeTo assess the association of neighborhood demographic and socioeconomic characteristics with COVID-19 incidence and mortality in New York City (NYC) over the first two waves of outbreak.MethodsThis retrospective study used neighborhood-level data from 177 modified ZIP code tabulation areas in NYC between March 01, 2020 and April 30, 2021.ResultsNeighborhoods that were most severely impacted in wave 1 were also more affected in wave 2. Neighborhoods with a higher percentage of seniors (≥75 years), males, Black and Hispanic population, and large-size households had higher incidence rates of COVID-19 in wave 1 but not in wave 2. Neighborhoods with higher percentage of Black and Hispanic population and lower insurance coverage had higher death rate per capita and case fatality ratio in wave 1, and neighborhoods with higher percentage of Black and Asian population had elevated case fatality ratio in wave 2. Median household income was negatively associated with incidence rate and death rate per capita but not associated with case fatality ratio in both waves. Neighborhoods with more seniors had higher death rate and case fatality ratio in both waves.ConclusionsNeighborhood disparities in COVID-19 incidence and mortality across NYC neighborhoods were dynamic during the first two waves of outbreak.

Application of layers of protection analysis to prevent coronavirus infection

Layers of protection analysis (LOPA) methodology is applied to an encounter with the SARS‐COV‐2 infection as an initiating event, and subsequently, independent protection layers (IPLs) (namely health safeguarding protocols), such as social distancing, ventilation, hand hygiene, face masks, and vaccinations. LOPA is applied considering numerical quantification of the COVID fatality index in order to manage the transmission risk to a tolerable level, namely the fatality risk due to seasonal flu. This measurement tool quantifies the ratio of the annual death rate due to the SARS‐COV‐2 infection to the annual death rate of the common flu, and it is applied to a chemical plant. The lower this quantified value is, the more the COVID‐19 infection death rate approaches that of the common flu. Thus, any improvement in safeguarding protocols should reduce this index. The input data is based on public domain COVID‐19 infection statistical data and websites accessible in the United Kingdom. The COVID‐19 transmission rate is statistically analyzed with random number sampling to simulate the random pattern of the virus' person‐to‐person infection in the community. The success of the COVID‐19 protection protocols is probabilistic and depends on the public's compliance, which is modeled by observational surveys.

58 Burn Injuries in Asia: A Global Burden of Disease Study

IntroductionBurn injuries disproportionately affect low- and middle-income countries. Work conditions, rapid industrialization, social conditions, cultural activities, political conflict, and lack of access to safe and affordable surgery are key barriers to effective burn care in Asia. This study aimed to better define the burn burden in Asia, its sub-regions, and related sex and age disparities to elucidate populations where targeted burn care interventions are most needed.MethodsThe 2019 Global Burden of Disease (GBD19) of the Global Health Data Exchange was used to acquire 151,741 sources of epidemiological data on fire, heat, and hot substance-related injuries for 53 countries in Asia from 1990 to 2019. Measures used to derive summative statistics included incidence, deaths, disability-adjusted life years (DALYs), and mortality ratio (deaths: incidence) by year, sex, age, and location. Spatial mapping was performed to geographically delineate burn indicators.ResultsFrom 1990 to 2019, an estimated 117 million burns occurred in Asia. The relative proportion of global burns, deaths, and DALYs from Asia increased during that time. By 2019, 46% of global burn cases, 47% of deaths, and 46% of DALYs were from Asia. The two most burdened regions were South and Southeast Asia, accounting for 30-40% of all global cases, deaths, and DALYs. Compared to global averages, the incidence, death, and DALY rates for Asia were 32%, 22%, and 23% higher. Central Asia had the worst rates, averaging 2.9, 2.3, and 2.6 times the global averages. Throughout Asia, men were 32%, 63%, and 47% more likely to be burned, die, and suffer DALYs than women versus the global disparities of 7%, 26%, and 10%. Only South Asia’s trend was reversed with women suffering 15%, 20%, and 27% more burns, deaths, and DALYs than men. In Asia, those under 5 years were most impacted by DALYs (314 years/100,000 people), 5-14 year olds had the highest burn rate (219 cases/100,000), and 70+ year olds had the highest death rate (8.4 deaths/100,000) and mortality ratio (54%).ConclusionsIn 2019, Asia had an estimated 3.8 million burns comprising nearly half of all the world’s burn cases, deaths, and DALYs. While Asia’s burn indicators have declined since 1990, global improvements have surpassed Asia’s. South and Southeast Asia accounted for the greatest burden of burn morbidity and mortality, but Central Asia consistently had the highest rates relative to overall population. Men were more affected than women, except in South Asia, and the extremes of age (< 5 and 70+ years) suffered the greatest rates of disability and death.

Rates of Severe Influenza-Associated Outcomes Among Older Adults Living With Diabetes-Influenza Hospitalization Surveillance Network (FluSurv-NET), 2012-2017.

Diabetes mellitus (DM) is common among older adults hospitalized with influenza, yet data are limited on the impact of DM on risk of severe influenza-associated outcomes. We included adults aged ≥65 years hospitalized with influenza during 2012-2013 through 2016-2017 from the Influenza Hospitalization Surveillance Network (FluSurv-NET), a population-based surveillance system for laboratory-confirmed influenza-associated hospitalizations conducted in defined counties within 13 states. We calculated population denominators using the Centers for Medicare and Medicaid Services county-specific DM prevalence estimates and National Center for Health Statistics population data. We present pooled rates and rate ratios (RRs) of intensive care unit (ICU) admission, pneumonia diagnosis, mechanical ventilation, and in-hospital death for persons with and without DM. We estimated RRs and 95% confidence intervals (CIs) using meta-analysis with site as a random effect in order to control for site differences in the estimates. Of 31 934 hospitalized adults included in the analysis, 34% had DM. Compared to those without DM, adults with DM had higher rates of influenza-associated hospitalization (RR, 1.57 [95% CI, 1.43-1.72]), ICU admission (RR, 1.84 [95% CI, 1.67-2.04]), pneumonia (RR, 1.57 [95% CI, 1.42-1.73]), mechanical ventilation (RR, 1.95 [95% CI, 1.74-2.20]), and in-hospital death (RR, 1.48 [95% CI, 1.23-1.80]). Older adults with DM have higher rates of severe influenza-associated outcomes compared to those without DM. These findings reinforce the importance of preventing influenza virus infections through annual vaccination, and early treatment of influenza illness with antivirals in older adults with DM.

Incident Gout: Risk of Death and Cause-Specific Mortality in Western Sweden: A Prospective, Controlled Inception Cohort Study.

BackgroundExcess mortality in gout has been attributed to cardiovascular diseases (CVD). Considering the decline in CVD mortality in the general population, we wanted to evaluate overall mortality in gout and cause-specific contributions to mortality beyond CVD and temporal trends.MethodsAll incident cases of gout between 2006 and 2015 in western Sweden and 5 population controls per case matched for age, sex, and county were identified. Comorbidities were identified for 5 years preceding the index date. Follow-up ended at death, migration, or end of study on December 2017. Effect of gout on death risk was calculated using COX regression on the whole population and stratified by sex, adjusted for demographics, and comorbidities. Death incidence rates were compared between the two time periods, 2006–2010 and 2011–2015.ResultsWe identified 22,055 cases of incident gout and 98,946 controls, median age (Q1, Q3) 69–68 (57, 79/56, 78) years and 67.6–66.5% males. Except for dementia, all comorbidities were significantly more common at baseline among gout cases. Overall, the risk for death in incident gout was neither increased overall nor in men, but women had a 10% elevated risk. In adjusted models for cause-specific mortality, death from CVD, renal disease, and digestive system diseases were significantly increased in the total gout population while death from dementia, cancer, and lung diseases were significantly decreased. There were no significant differences in overall incident death rate ratios between cases and controls in the two time periods examined.ConclusionsAn increased risk for CVD, renal disease, and diseases of the digestive system in patients with gout highlights the importance of addressing CVD risk factors in gout management. Gout was associated with reduced mortality from dementia, which may have implications on urate lowering therapy and possible effects on dementia risk.