Death Rate Ratio Research Articles

A stochastic comparison result for the multitype contact process with unequal death rates

A stochastic comparison result that makes progress towards understanding the classical multitype contact process with unequal death rates is given. It has long been conjectured that the particle type with the largest birth to death rate ratio survives and the other dies out. A point process coupling result of Broman (2007) is used to give a sufficient condition for when the dominant particle type survives.

A modified common factor model for modelling mortality jointly for both sexes

There is an increasing attention on the joint modelling of multiple populations. Populations are related in several ways, such as neighbouring countries, females and males, and socioeconomic subgroups within a population. They are associated due to certain common driving forces, and mortality projection models should be constructed to allow for such underlying relationships. One such example is the Poisson common factor model. In this paper, we consider some extensions of the original Poisson common factor model. The first is to use a different number of additional factors for each sex. With this, the potential trend differences between the two sexes can be captured. The second is to incorporate a common age sensitivity effect into the additional factors. It may help improve parameter parsimony. A hybrid version between these two extensions is also considered. Overall, the modified versions deliver better fitting and projection results than the original model, using mortality data from eight developed countries. Qualitatively speaking, the new models provide much more flexibility in modelling populations with different mortality patterns. Empirically, they are shown to be able to produce improved performance in fitting and projection. The models are selected as the optimal choices based on information criteria statistics, and they tend to produce more accurate forecasts of the male-to-female ratios of death rates.

Atrial fibrillation in the elderly general population: a 30-year follow-up from 70 to 100 years of age

Objectives. There is limited knowledge of atrial fibrillation (AF) incidence among the very old. Data from longitudinal cohort studies may give us a better insight. The aim of the study was to investigate the incidence rate and prevalence of AF, as well as the impact of AF on mortality, in the general population, from 70 to 100 years of age. Design. This was a population-based prospective cohort study where three representative samples of 70-year-old men and women (n = 2,629) from the Gerontological and Geriatric Populations Studies in Gothenburg (H-70) were included between 1971 and 1982. The participants were examined at age 70 years and were re-examined repeatedly until 100 years of age. AF was diagnosed according to a 12-lead electrocardiogram (ECG) recording at baseline and follow-up examinations, from the Swedish National Patient Register (NPR), or from the Cause of Death Register. Results. The cumulative incidence of AF from 70 to 100 years of age was 65.6% for men and 52.8% for women. Mortality was significantly higher in participants with AF compared with those without, rate ratio (RR) 1.92 (95% CI 1.73–2.14). In a subgroup analysis comprising only participants with AF diagnosed by ECG at screening, the RR for death was 1.29 (95% C.I: 1.03–1.63). Conclusions. Among persons surviving to age 70, the cumulative incidence of AF was over 50% during follow-up. Mortality rate was twice as high in participants with AF compared to participants without AF. Among participants with AF first recorded at a screening examination, the increased risk was only 29%.

Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial

BackgroundThere are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.MethodsA total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants.ResultsAmong men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P=0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9.ConclusionsIn this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.)

Constraints and risk factors contributing to young stock mortalities in small ruminants in Jordan

• Diseases and malnutrition are the major reasons of mortalities for young stocks. • The overall annual mortality rates were higher in kids than lambs. • The overall annual mortality rates of male kids and lambs were higher than females. • Deaths were found to peak during cold season and drop in warm months. • Ecology, production system, flock size affected death rates of newborns. A single-visit survey was conducted from June to October 2017 to estimate the kid and lamb mortalities, and identify major causes and risk factors in Karak governorate of Jordan. Semi-structured questionnaires were administered to 120 small ruminant farmers in addition to focus group discussions. Results showed that diseases, feed shortage, poor mothering, predators and insufficient milk provision were perceived to be the most important causes of mortality in kids and lambs. Among diseases, diarrhea and pneumonia, were the top causes of young stock death losses. The overall mean annual mortality rates were 27.4 kids and 8.2 lambs per 100 live births a year. Mortality rates were higher in kids than lambs and found to decrease with age categories. The overall mean annual mortality rates of male kids and lambs within and between production systems were significantly higher than their female counterparts (P < 0.05). Deaths were found to peak (57.3%) during cold season (December to February), and drop (3.5%) in warm months (June to August). Death rates were significantly higher in mountain region, with incidence rate ratio of 2.5 times greater in lambs and 2.1 times more in kids compared to those in semi-desert ecology. Lamb mortality was also higher in transhumant production system (1.6 times more) than sedentary system but no difference for kids. For a unit increase in flock size, the incidence rate ratio of lamb death rate was found to decrease by factor of 0.99. In general, young stock mortality is a challenge for small ruminant production in the study area and calls for improvements of health care and proper feeding during the last stage of pregnancy of females and increased care for newborns.

Association between type-specific influenza circulation and incidence of severe laboratory-confirmed cases; which subtype is the most virulent?

ObjectivesExcess population mortality during winter is most often associated with influenza A(H3N2), though susceptibility differs by age. We examined differences between influenza types/subtypes in their association with severe laboratory-confirmed cases, overall and by age group, to determine which type is the most virulent. MethodsWe used nine seasons of comprehensive nationwide surveillance data from Greece (2010–2011 to 2018–2019) to examine the association, separately for influenza A(H1N1)pdm09, A(H3N2) and B, between the number of laboratory-confirmed severe cases (intensive care hospitalizations or deaths) per type/subtype and the overall type-specific circulation during the season (expressed as a cumulative incidence proxy). Quasi-Poisson models with identity link were used, and multiple imputation to handle missing influenza A subtype. ResultsFor the same level of viral circulation and across all ages, influenza A(H1N1)pdm09 was associated with twice as many intensive care hospitalizations as A(H3N2) (rate ratio (RR) 1.89, 95% CI 1.38–2.74) and three times more than influenza B (RR 3.27, 95%CI 2.54–4.20). Similar associations were observed for laboratory-confirmed deaths. A(H1N1)pdm09 affected adults over 40 years at similar rates, whereas A(H3N2) affected elderly people at a much higher rate than younger persons (≥65 vs. 40–64 years, RR for intensive care 5.42, 95% CI 3.45–8.65, and RR for death 6.19, 95%CI 4.05–9.38). Within the 40–64 years age group, A(H1N1)pdm09 was associated with an approximately five times higher rate of severe disease than both A(H3N2) and B. DiscussionInfluenza A(H1N1)pdm09 is associated with many more severe laboratory-confirmed cases, likely due to a more typical clinical presentation and younger patient age, leading to more testing. A(H3N2) affects older people more, with cases less often recognized and confirmed.

Rheumatoid Arthritis-Associated Interstitial Lung Disease: Clinical Characteristics and Predictors of Mortality

Introduction: Interstitial lung disease (ILD) is a serious extraarticular manifestation of rheumatoid arthritis (RA), but no evidence-based therapy exists. Ongoing studies investigate the role of antifibrotic therapies for progressive fibrosing ILD (PF-ILD), including RA-ILD. The aim of the present study was to investigate the frequency of PF-ILD and the clinical characteristics of RA-ILD in a well-characterised, population-based cohort. Methods: We identified patients with RA-ILD diagnosed and followed at the ILD referral centre in Aarhus, Denmark, from 2004 to 2016. Adjusted hazard rate ratios for death were estimated using Cox regression models. The presence of PF-ILD was assessed using recently proposed definitions of relative forced vital capacity (FVC) decline ≥10%, relative diffusion capacity of the lung for carbon monoxide (DLco) decline ≥15% or worsening symptoms or a worsening radiological appearance accompanied by a ≥5 to <10% FVC decline. Results: We identified 102 patients with RA-ILD, and 52% had PF-ILD. Mean follow-up was 3.8 years and median survival was 7.1 years. Thirty-eight patients died during follow-up, and most deaths were from respiratory causes. Predictors of mortality in a multivariate model were DLco and high titres of IgM rheumatoid factor. Conclusion: PF RA-ILD was common and the associated mortality was high.

Determinants of vaccination uptake, and influenza vaccine effectiveness in preventing deaths and hospital admissions in the elderly population; Treviso, Italy, 2014/2015-2016/2017 seasons

ABSTRACTSeasonal influenza is an important cause of morbidity and mortality, particularly among the elderly population. Determinants of vaccination uptake and its impact on health outcomes in the seasons 2014/2015–2016/2017 in elderly living in Treviso area (Veneto Region, North-Eastern Italy) were evaluated. A retrospective cohort study was conducted combining information from several health administrative databases, and multiple Poisson regression models were applied to evaluate the influenza vaccine effectiveness, also adjusting for confounding factors. MF59-adjuvanted trivalent-inactivated vaccine was mainly administered. Data from more than 83,000 elderly people were analyzed by year. Vaccine coverage was about 50%; influenza vaccination uptake was independently associated with older age, male sex, increasing number of underlying chronic conditions, previous pneumococcal vaccination, annual expenses for specialist medical cares, and general practitioner to whom the elderly was in charge. After adjusting for previously described characteristics, vaccination was associated with lower mortality and influenza-related hospitalization rates. Specifically, during influenza season the adjusted incidence rate ratio of death and of influenza-related hospitalizations for vaccinated compared to unvaccinated persons was 0.63 [95% confidence interval (CI) 0.58–0.69, p < .001] and 0.86 (95% CI 0.81–0.91, p < .001), respectively. A similar effectiveness was estimated for death in all age groups (≤74, 75–84, ≥85 years old), whereas a higher effect was found for hospitalizations in subjects aged ≥75 years old. Vaccination was also effective both in males and females. Findings suggest a health benefit of the influenza vaccination in the elderly population. Efforts should be focused on strategies to increase the vaccination uptake as important instrument of prevention.

Deaths Associated With Hepatitis C Virus Infection Among Residents in 50 States and the District of Columbia, 2016-2017.

Mortality associated with hepatitis C virus (HCV) has been well-documented nationally, but an examination across regions and jurisdictions may inform health-care planning. To document HCV-associated deaths sub-nationally, we calculated age-adjusted, HCV-associated death rates and compared death rate ratios (DRRs) for 10 US regions, 50 states, and Washington, D.C., using the national rate and described rate changes between 2016 and 2017 to determine variability. We examined the mean age at HCV-associated death, and rates and proportions by sex, race/ethnicity, and birth year. In 2017, there were 17 253 HCV-associated deaths, representing 4.13 (95% confidence interval [CI], 4.07-4.20) deaths/100 000 standard population, in a significant, 6.56% rate decline from 4.42 in 2016. Age-adjusted death rates significantly surpassed the US rate for the following jurisdictions: Oklahoma; Washington, D.C.; Oregon; New Mexico; Louisiana; Texas; Colorado; California; Kentucky; Tennessee; Arizona; and Washington (DRRs, 2.87, 2.77, 2.24, 1.62, 1.57, 1.46, 1.36, 1.35, 1.35, 1.35, 1.32, and 1.32, respectively; P < .05). Death rates ranged from a low of 1.60 (95% CI, 1.07-2.29) in Maine to a high of 11.84 (95% CI, 10.82-12.85) in Oklahoma. Death rates were highest among non-Hispanic (non-H) American Indians/Alaska Natives and non-H Blacks, both nationally and regionally. The mean age at death was 61.4 years (range, 56.6 years in West Virginia to 64.1 years in Washington, D.C.), and 78.6% of those who died were born during 1945-1965. In 2016-2017, the national HCV-associated mortality declined but rates remained high in the Western and Southern regions and Washington, D.C., and among non-H American Indians/Alaska Natives, non-H Blacks, and Baby Boomers. These data can inform local prevention and control programs to reduce the HCV mortality burden.

Determination of Mesothelin Levels in Pleural Effusion Does Not Help Predict Survival of Patients With Malignant Pleural Mesothelioma.

This study evaluated the prognostic value of soluble mesothelin-related protein (SMRP) levels in pleural effusions (PE) from patients with pleural mesothelioma (MPM). SMRP level in PE was tested using an enzyme-linked immunosorbent assay (ELISA) in 109 patients with MPM at diagnosis before any treatment. The Kaplan-Meier method and the Cox regression were applied to compare overall survival probabilities across tertile categories of SMRP level. No significant differences in Kaplan-Meier overall survival probabilities among the SMRP categories were found. A statistically non-significant trend for increased death rate ratio (RR) was computed (p=0.327) when the higher (>46.5 nM, RR=1.38) and intermediate (8.5-46.5 nM, RR=1.18) SMRP categories were compared to the lower category (<8.5 nM, RR=1.00). Cox regression modelling including a restricted cubic spline showed a moderately rising non-linear trend in death rate. The SMRP level in PE does not appear to have prognostic significance and its detection is not recommended in routine clinical management of patients with MPM.

Mechanistic modelling of prostate-specific antigen dynamics shows potential for personalized prediction of radiation therapy outcome.

External beam radiation therapy is a widespread treatment for prostate cancer. The ensuing patient follow-up is based on the evolution of the prostate-specific antigen (PSA). Serum levels of PSA decay due to the radiation-induced death of tumour cells and cancer recurrence usually manifest as a rising PSA. The current definition of biochemical relapse requires that PSA reaches nadir and starts increasing, which delays the use of further treatments. Also, these methods do not account for the post-radiation tumour dynamics that may contain early information on cancer recurrence. Here, we develop three mechanistic models of post-radiation PSA evolution. Our models render superior fits of PSA data in a patient cohort and provide a biological justification for the most common empirical formulation of PSA dynamics. We also found three model-based prognostic variables: the proliferation rate of the survival fraction, the ratio of radiation-induced cell death rate to the survival proliferation rate, and the time to PSA nadir since treatment termination. We argue that these markers may enable the early identification of biochemical relapse, which would permit physicians to subsequently adapt patient monitoring to optimize the detection and treatment of cancer recurrence.

Ethnic and socioeconomic variation in cause-specific preterm infant mortality by gestational age at birth: national cohort study

ObjectiveTo describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth.DesignNational birth cohort study.SettingEngland and Wales 2006–2012.SubjectsSingleton live births at 24–36 completed weeks’...

To What Extent Does Age at Death Account for Sex Differences in Rates of Mortality From Alzheimer Disease?

Our objective was to compare sex-specific rates of death with Alzheimer disease (AD) or dementia as the underlying or associated cause of death using death records. Deidentified individual records on causes of death for all people aged 60 years or more who died in Australia during 2006-2014 (n = 1,104,684) were analyzed. There were 184,562 records with International Classification of Diseases, Tenth Revision, codes for dementia (AD, vascular dementia, or unspecified dementia). Death rate ratios for women versus men were estimated using Poisson regression. Women had a greater crude rate of death from all types of dementia than men (5.9 deaths per 1,000 person-years as compared with 3.8 deaths per 1,000 person-years), which disappeared after adjustment for age. For AD, the age-adjusted rate was higher among women (rate ratio = 1.14, 95% confidence interval: 1.12, 1.16), while for vascular dementia age-adjusted rates were higher for men (rate ratio = 0.80, 95% confidence interval: 0.78, 0.82). There was no evidence of a differential bias in coding of dementia type between men and women. Women's older age at death explained much of the sex-related difference in rates of death from AD or dementia. However, excess numbers of AD deaths among women and vascular dementia deaths among men remained, providing support for the hypothesis of greater biological risk of AD in women.

Impaired Sensitivity to Thyroid Hormones Is Associated With Diabetes and Metabolic Syndrome.

Diabetes prevalence and incidence increase among individuals with hypothyroidism but also among those with hyperthyroxinemia, which seems contradictory. Both high free thyroxine (fT4) and high thyroid-stimulating hormone (TSH) are present in the resistance to thyroid hormone syndrome. A mild acquired resistance to thyroid hormone might occur in the general population and be associated with diabetes. We aimed to analyze the association of resistance to thyroid hormone indices (the Thyroid Feedback Quantile-based Index [TFQI], proposed in this work, and the previously used Thyrotroph T4 Resistance Index and TSH Index) with diabetes. We calculated the aforementioned resistance to thyroid hormone indices based on a U.S. representative sample of 5,129 individuals ≥20 years of age participating in the 2007-2008 National Health and Nutrition Examination Survey (NHANES). Also, to approximate TFQI, a U.S.-referenced Parametric TFQI (PTFQI) can be calculated with the spreadsheet formula =NORM.DIST(fT4_cell_in_pmol_per_L,10.075,2.155,TRUE)+NORM.DIST(LN(TSH_cell_in_mIU_per_L),0.4654,0.7744,TRUE)-1. Outcomes of interest were glycohemoglobin ≥6.5%, diabetes medication, diabetes-related deaths (diabetes as contributing cause of death), and additionally, in a fasting subsample, diabetes and metabolic syndrome. Logistic and Poisson regressions were adjusted for sex, age, and race/ethnicity. Odd ratios for the fourth versus the first quartile of TFQI were 1.73 (95% CI 1.32, 2.27) (P trend = 0.002) for positive glycohemoglobin and 1.66 (95% CI 1.31, 2.10) (P trend = 0.001) for medication. Diabetes-related death rate ratio for TFQI being above versus below the median was 4.81 (95% CI 1.01, 22.94) (P trend = 0.015). Further adjustment for BMI and restriction to normothyroid individuals yielded similar results. Per 1 SD in TFQI, odds increased 1.13 (95% CI 1.02, 1.25) for diabetes and 1.16 (95% CI 1.02, 1.31) for metabolic syndrome. The other resistance to thyroid hormone indices showed similar associations for diabetes-related deaths and metabolic syndrome. Higher values in resistance to thyroid hormone indices are associated with obesity, metabolic syndrome, diabetes, and diabetes-related mortality. Resistance to thyroid hormone may reflect energy balance problems driving type 2 diabetes. These indices may facilitate monitoring treatments focused on energy balance.

Geographic Inequalities in Progress against Lung Cancer among Women in the United States, 1990-2015.

Background: Lung cancer-related death rates in the United States have declined steadily since 1990 in men but not until the mid-2000s in women, with the gap in mortality narrowing during the most recent time period. We examined variation in the declining trend among women by county, where many tobacco control policies are implemented.Methods: We obtained county-level lung cancer death rates among women from the National Center for Health Statistics mortality file and calculated relative changes from 1990-1999 to 2006-2015. Optimized hotspot analysis identified contiguous counties with small declines or increases in death rates.Results: We identified two distinct clusters of counties: 669 in Appalachia and the Midwest (Hotspot 1) and 81 in the northern Midwest (Hotspot 2). From 1990-1999 to 2006-2015, death rates among women increased by 13% in Hotspot 1 and by 7% in Hotspot 2 counties, while rates decreased by 6% in the non-hotspot United States. From 1990-2015, death rate ratios (RRs) in hotspot versus non-hotspot counties changed from 4% lower (RR, 0.96; 95% CI, 0.94-0.99) to 28% higher [RR, 1.28; 95% confidence interval (CI), 1.25-1.31] for Hotspot 1 counties and from 18% lower (RR, 0.82; 95% CI, 0.76-0.89) to unity (RR, 0.99; 95% CI, 0.93-1.05) for Hotspot 2 counties.Conclusions: We identified areas in the Midwest and Appalachia where progress against lung cancer mortality among women has lagged compared with a steady national decline.Impact: Targeted tobacco control programs could reduce the excess burden of lung cancer among women living in hotspot counties and prevent widening geographic inequity. Cancer Epidemiol Biomarkers Prev; 27(11); 1261-4. ©2018 AACR.

Febrile Neutropenia and Long-term Risk of Infection Among Patients Treated With Chemotherapy for Malignant Diseases.

BackgroundFebrile neutropenia (FN) is a common complication to chemotherapy, associated with increased short-term morbidity and mortality. However, the long-term outcomes after FN are poorly elucidated. We examined the long-term risk of infection and mortality rates in cancer patients with and without FN.MethodsPatients aged >16 years treated with firstline chemotherapy were followed from 180 days after initiating chemotherapy until first infection, a new treatment with chemotherapy, death, or end of follow-up. Risk factors for infections were analyzed by competing risks regression, with death or another treatment with chemotherapy as competing events. Adjusted incidence rate ratios (aIRRs) of infection and death were analyzed using Poisson regression. In analyses of mortality, infection was included as a time-updated variable.ResultsWe included 7190 patients with a median follow-up (interquartile range) of 0.58 (0.20–1.71) year. A total of 1370 patients had an infection during follow-up. The aIRRs of infection were 1.86 (95% confidence interval [CI], 1.56–2.22) and 2.19 (95% CI, 1.54–3.11) for patients with 1 or >1 episode of FN compared with those without FN. Mortality rate ratios were 7.52 (95% CI, 6.67–8.48) <1 month after, 4.24 (95% CI, 3.80–4.75) 1–3 months after, 2.33 (95% CI, 1.63–3.35) 3–6 months after, and 1.09 (95% CI, 0.93–1.29) >6 months after an infection, compared with the time before infection.ConclusionsFN during chemotherapy is associated with a long-term increased risk of infection. Mortality rates are substantially increased for 6 months following an infection.

Is intelligence associated with mortality from lethal force by law enforcement?

Intelligence (IQ) has emerged as an important determinant of many social and health outcomes, and is associated with criminal behavior. This ecological study tested whether IQ was associated with the use of lethal force by law enforcement by examining estimates of state IQ and mortality from lethal force in 50 U.S. states. These data were obtained from a variety of sources freely available on the Internet, including information about mortality from lethal force from a database compiled by a news website, The Guardian. State IQ was negatively correlated with the rate of people killed by law enforcement (r = −0.50, p < .01). This association persisted even after adjusting for numerous demographic and social characteristics; each point increase in state IQ was associated with a 6% reduction in the rate ratio of deaths from lethal force (IRR = 0.94 [95% CI = 0.90, 0.98]). States with higher IQs may have safer communities, and law enforcement officers may act less confrontationally or hostilely during police-suspect encounters in these areas. However, this hypothesis needs to be investigated in future studies using smaller aggregate units for IQ and include more information about neighborhood, law enforcement, and suspect characteristics.

The Charcot Foot and Mortality from 2000 to 2016

Introduction: The Charcot foot is a relatively rare but serious foot complication in patients with diabetes and neuropathy. The aim was to study the mortality and compare baseline characteristics at diagnosis between Charcot patients who died or survived during follow-up. Materials and Methods: A retrospective cohort study including all patients with a Charcot diagnosis at our centre from 2000 to 2016. Poisson regression analyses were done. Results: A total of 164 patients had the diagnosis Charcot (DM146) and 52 (31.1%) died during follow-up. They lived for 1973 days (range: 219-4895) i.e., 5.4 years. Patients were followed for 1122 years in total, median 6.0 years/patient (Q1-Q3=3.2-10.0). The mortality rate was 4.6/100 person-years-at-risk. Patients who died were significantly older (61±10 vs. 54±11 years), had less often type 1 diabetes (40 (27-55) vs. 60% (50-70)), were less often non-smokers (35 (22-49) vs. 52% (42-61)), had a lower hemoglobin (7.9±1.2 vs. 8.3±0.9), a higher creatinine (114 [88-161] vs. 85 [69-109]) and were more often treated with antitrombotic agents (71 (57-83) vs. 53% (43-62)) compared to survivors. Rate ratios for death were insignificantly different among smokers and non-smokers, among patients with type 1 and 2 diabetes, among patients with a diabetes duration below or above 10 years and among patients with HbA1c above or below 60 mmol/mol-both in univariate analyses and after adjustment for age and gender. Conclusion: The mortality rate among patients with Charcot feet was 4.6%/person-years-at-risk and was not affected by diabetes type, smoking, diabetes duration or HbA1c-level. Disclosure S. Engberg: None. K. Kirketerp-Møller: None. A. Rasmussen: None.

Increased mortality among patients with rheumatoid arthritis and COPD: A population-based study.

Only few studies have addressed the prognostic impact of chronic obstructive pulmonary disease (COPD) among patients with rheumatoid arthritis (RA), although both diseases are frequent and smoking is a shared risk factor. The objectives of the present study were to investigate the burden of COPD among RA patients and the subsequent mortality. We included patients who had a first-time diagnosis of RA in the Danish National Patient Registry between 2004 and 2016. RA patients with COPD were identified and matched with RA patients without COPD for year of birth, gender, and age at RA diagnosis. Mortality risks were assessed using Kaplan-Meier mortality curves. Adjusted hazard rate ratios (aHRRs) for death were estimated using Cox regression models. The study population included 31,333 individuals with RA. 3254 of those (10.4%) had a diagnosis of COPD and were matched to 9706 RA patients without COPD. The mortality risks in RA patients with COPD and RA patients without COPD were 4.5% and 1.5% within 2-6 months (aHRR = 3.0, CI 2.3-3.9), and 59.3% and 39.8% within 0.5-10 years (aHRR = 2.1, CI 1.9-2.1). Mortality was significantly increased among RA patients with COPD. The relative mortality risk remained significantly increased throughout the course of follow up.

2006 Formative evaluation and adaptation of a safe sleep intervention for infants in rural underserved communities

OBJECTIVES/SPECIFIC AIMS: This abstract describes a recently-funded 2 year study that aims to: (1) explore the community advisors’ perspectives of the safe sleep intervention’s acceptability, feasibility, and adaptability using focus groups and key informant interviews. (2) Adapt the selected safe sleep interventions (SSI) and identify promising implementation strategies to support it through an evidence-based quality improvement process with a multistakeholder group. METHODS/STUDY POPULATION: Background sudden unexpected infant death (SUID) is the leading cause of post-neonatal infant death in the United States. Sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed account for over 50% of SUID, leading to recommendations for supine sleep position and safer sleep environments for infants. However, despite significant reductions in SIDS after “back to sleep” and “safe to sleep” campaigns, significant racial and urban-rural disparities persist. In 2015, the rural-urban crude death rate ratio was 4:1 and Black infants are twice as likely to die from SUID as White infants. Adherence to safe sleep recommendations is highly variable and a number of hospital and community-based interventions have been suggested to improve knowledge and change parent behavior. Hospital programs to promote safe sleep education and policies may serve to educate families about safe sleep, but may not be uniformly available in rural and underserved areas. The AAP evidence-based safe sleep guidelines have demonstrated reductions in SIDS and SUID when child caregivers adhere to them. Community-based SSI, including safety baby showers, promote safe sleep practices, but barriers may exist for participation, especially in rural areas. Partnering with community groups serving a high risk area, we will explore the barriers and facilitators to more widespread safety baby shower (SBS) delivery/adoption in rural underserved communities (RUC). Observation of the evidence-based SBS as it is currently delivered, focus groups and key informant interviews will be conducted with program leaders and participants. Based on this knowledge and using an evidence-based development process, we will adapt the SBS and identify implementation strategies to support its uptake in RUC. RESULTS/ANTICIPATED RESULTS: We expect to develop a modified safe sleep intervention that reaches more expectant and new mothers is more efficient at delivering safe sleep guidelines to rural community members and can be more readily adopted and implemented by RUC. Supporting implementation strategies will be identified during the formative evaluation. DISCUSSION/SIGNIFICANCE OF IMPACT: Developing a safe sleep intervention adapted for the local context through a collective decision-making process between intervention experts and local community advisors will potentially improve safe sleep guideline delivery and adherence in RUC. The next study will pilot test the effectiveness of the adapted safe sleep intervention with identified supporting implementation strategies.