Mortality Rate Ratios Research Articles

Survival of Patients at a Neurology Clinic: No Improvement Over 12 Years.

We previously followed Emory patients with neurodegenerative disease from 1993 to 2006. Here, we follow survivor and new patients for 2007 to 2018. We studied mortality from 10 different diagnostic groups among 4322 research volunteers, and compared mortality rates to controls with normal cognition, using Cox regression. We assessed mortality through the National Death Index, controlling for sex, education, race, comorbidities, and age. Supplemental analyses considered APOE and cognitive test scores. Fifty-nine percent of patients died during follow-up. Mortality rate ratios, compared with controls (n=641) in descending order were 12.54, 6.61, 4.77, 4.92, 3.36, 2.25, 2.21 1.71, 1.39, and 1.17 for diagnostic groups ALS, (n=571), FTD (n=197), LBD (n=134), PD (n=584), AD (n=1118), MCI/dementia (n=82), dementia not specified (n=165), PD symptoms (n=256), vascular dementia (n=234), and MCI (n=340), respectively. Women, non-whites, those with higher education, with no comorbidities, and lower ages had lower mortality rates for most diagnostic groups. Mortality rates were higher in the presence of APOE4 variants for several diagnostic groups. Lower MMSEs predicted worse survival for most diseases. Overall, 41% of patients survived during 12 years of follow-up, compared with an expected 75% in the US population. Survival times for different diagnostic groups have changed little over several decades.

Understanding excess mortality during COVID in Belgium: the influence of pre-existing health status and social factors

BackgroundThis study aims to investigate how pre-existing health status and social background contribute to excess mortality during the COVID-19 crisis in Belgium.MethodsThe study population consists of almost 1.4 million adult members of Solidaris, the second largest health insurance fund in Belgium. Pre-existing health status was identified using health care reimbursement data, including medication use. Social characteristics included a proxy for low socio-economic status, nationality of origin, and living arrangement. Excess mortality during the COVID-19 crisis was measured by computing the relative difference between all-cause mortality in 2020 or 2021 and the average yearly mortality in 2015–2019. Directly Standardised Mortality Rates (DSMRs) were calculated to investigate absolute mortality inequalities. Mortality Rate Ratios (MRRs) were computed using Poisson regression analyses to investigate relative mortality inequalities.ResultsDSMRs show that persons with no previous disease experienced significant excess mortality in 2020, like men with one, two or three diseases and women with various numbers of pre-existing diseases. Results by specific disease show heterogenous results. After adjusting for age, sex and social characteristics, persons with cancer experienced a significant mortality deficit of 17% in 2020 and of 9% in 2021. For persons with cancer and asthma or COPD, significant mortality deficits of 10% and 3% were observed in 2020 and 2021, respectively.ConclusionThe study provides insights into the complex dynamics of mortality during the COVID-19 crisis, emphasising the need to consider individual-level information on pre-existing health and social background jointly.

Mortality risk among individuals who smoke opioids compared with those who inject: A propensity score-matched cohort analysis of United States national treatment data.

Opioid smoking is becoming more common in the United States. The aim of this analysis was to estimate relative mortality risk among those who primarily smoke opioids compared with those who inject. Retrospective propensity score-matched cohort analysis. 2006-2021 US treatment episode data from SAMHSA TEDS-D. We matched 287 481 individuals in a substance use treatment program reporting smoking opioids as their primary substance use to an equal weighted number of individuals in a substance use treatment program reporting injecting opioids as their primary substance use. The majority of individuals reporting smoking were male (62.6%), 21-29 years old (47.9%), white (65.7%), independently housed (54.3%) and in the West Census Region (70.3%). Cohort characteristics were closely balanced after matching. The outcome of interest was death during a treatment episode. Variables used for matching were year, opioid category, gender, race/ethnicity, age category, census region, housing status, employment status, number of prior treatment admissions, variables associated with opioid use severity (opioid use frequency, treatment setting intensity, age at first opioid use, use of medication-assisted treatment) and other reported substance use (methamphetamine, alcohol, benzodiazepines, cocaine). The mortality rate was 6.5 [95% confidence interval (CI) =5.9-7.1] per 1000 person-years in the smoking cohort and 9.7 (95% CI = 8.8-10.8) per 1000 person-years in the injection cohort, with a mortality rate ratio of 0.67 (95% CI = 0.58-0.77). Among individuals in substance use treatment in the United States, those who usually smoke opioids appear to have a lower all-cause mortality risk than those who usually inject.

Intelligent Bayesian Neural Networks for Stochastic SVIS Epidemic Dynamics: Vaccination Strategies and Prevalence Fractions with Wiener Process

Real-time forecasting of infectious diseases is crucial for effective public health management, particularly during outbreaks. When infectious disease predictions are based on mechanistic models, they can guide resource allocation and help evaluate the potential effects of different interventions. However, accurately parametrizing these models in real time presents a challenge, as timely information on behavioral shifts, interventions and transmission pathways is often lacking. This investigation leverages the artificial neural networks with the Bayesian regularization (BR-ANN) backpropagation approach to examine the dynamical pathogen spread with Wiener process incorporation. The stochastic differential model is structured into susceptible, vaccinated, infectious and susceptible (SVIS) compartments. The Kloeden–Platen–Schurz (KPS) computing paradigm for the stochastic differential system is utilized to generate synthetic datasets by applying transformations to key factors, including the population recruitment ratio, transmission ratio of vulnerable individuals, natural death rate of the population, vaccination rate of vulnerable individuals, total population size, immune loss ratio of susceptible individuals, recovery rate and mortality rate from the disease among infected individuals. Random selection from the generated datasets is exploited for the training and testing procedures for constructing the BR-ANN networks. The significance of the proposed scheme for various stochastic SVIS system scenarios is endorsed by the comprehensive assessments of the BR-ANN approach that are conducted by means of extensive experimentations and comparison with the reference KPS solutions of the SVIS system in terms of MSE optimal performance plots, absolute errors, autocorrelation analysis, regression indices and error histograms.

Spatial-Structural Mechanisms of Racialized Disparities in Overdose Mortality: A Spatiotemporal Analysis.

Efforts to understand and respond to the opioid crisis have focused on overdose fatalities. Overdose mortality rates (ratios of overdoses resulting in death) are rarely examined though they are important indicators of harm reduction effectiveness. Factors that vary across urban communities likely determine which community members are receiving the resources needed to reduce fatal overdose risk. Identifying communities with higher risk for overdose mortality and understanding influential factors is critical for guiding responses and saving lives. Using incident reports and mortality data from 2018 to 2021, we defined overdose mortality ratios across Milwaukee at the census tract level. To identify neighborhoods displaying higher mortality than predicted, we used Integrated nested Laplace approximation to define standardized mortality ratios (SMRs) for each tract. Geospatial and spatiotemporal analyses were used to identify emerging hotspots for high mortality risk. Overall, mortality was highest in Hispanic and lowest in White communities. Communities with unfavorable SMRs were predominantly Black or Hispanic, younger, less employed, poorer, less educated, and had higher incarceration rates and worse mental and physical health. Communities identified as hotspots for overdoses were predominantly non-White, poorer, and less employed and educated with worse mental and physical health, higher incarceration rates, and less housing stability. The findings demonstrate that overdose mortality rates vary across urban communities and are influenced by racial disparities. A framework that enables identification of challenged communities and guides community responses is needed.

Lung cancer and risk of cardiovascular mortality.

The aim of the present study was to investigate the cardiovascular mortality risk among lung cancer patients compared to the general population. Using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, we conducted a population-based cohort study including 278,418 lung cancer patients aged over 30 years between 1 January 1990 and 31 December 2020 as well as the general population. Poisson regression was employed to calculate incidence rate ratios (IRRs) for cardiovascular mortality. Patients exhibited a significantly higher IRR of cardiovascular mortality risk compared to the general population [IRR 1.74, 95% confidence interval (CI) 1.71-1.77]. The risk was most pronounced in patients aged 30-79 years (IRR 2.61, 95% CI 2.55-2.66), peaking at ages 30-34 years (IRR 48.93, 95% CI 21.98-108.92). Elevated cardiovascular mortality risks were observed across all subgroups, including diseases of the heart (IRR 1.79, 95% CI 1.75-1.82), cerebrovascular diseases (IRR 1.52, 95% CI 1.45-1.59), and other cardiovascular diseases (IRR 1.78, 95% CI 1.67-1.90). The first month after diagnosis presented the highest risk for patients aged 30-79 years (IRR 12.08, 95% CI 11.49-12.70) and ≥80 years (IRR 4.03, 95% CI 3.70-4.39). Clinical characteristics significantly modified cardiovascular mortality. Integrating cardiovascular disease monitoring and proactive management into lung cancer treatment protocols is essential to the improvement of overall survival and quality of life for lung cancer patients, particularly those who were young or with advanced tumor stage.

Association of Residential Segregation with Mortality in the U.S., 2018-2022.

This study aimed to examine the association of county-level racial and economic residential segregation with mortality rates in the U.S. between 2018 and 2022. Residential segregation was measured by the Index of Concentration at Extremes and categorized into quintiles. Outcomes included 2018-2022 county-level age-adjusted mortality rates from all causes and the top 10 causes. Multi-level linear mixed modeling was clustered at the state level and adjusted for county's poverty, metropolitan status, and racial composition. A total of 3,129 counties were included. County-level age-adjusted mortality rates decreased as the segregation level decreased for all causes (from 1078.8 deaths in the most segregated counties to 734.92 deaths in the least segregated counties per 100,000 persons per year) and for 10 leading causes. Adjusted rate ratios showed dose-response associations between segregation and mortality from all-causes and 9 out 10 leading causes. Using the least segregated counties as the reference group, the adjusted rate ratios (aRR) for all-cause mortality was 1.25 (95% confidence interval: 1.22, 1.28), 1.20 (1.17, 1.22), 1.13 (1.11, 1.15), and 1.09 (1.08, 1.10) for the first (most segregated) through the fourth quintile of segregation, respectively. Racial and economic residential segregation was positively associated with mortality rates at the county level in the contemporary U.S. Future study should elucidate the mechanisms underlying associations to inform evidence-based interventions and improve the health of the entire population.

Mortalidade proporcional e anos potenciais de vida perdidos devido a doenças do fígado entre trabalhadores rurais no Brasil de 2017 a 2022

Abstract: This study aimed to describe the profile and calculate the years of potential life lost (YPLL) due to liver diseases in Brazilian agricultural workers from 2017 to 2022. For this, we analyzed microdata available in the Brazilian Mortality Information System considering the underlying cause of death with codes K70-K77 (International Classsification of Disease, 10th revision − ICD-10) as the outcome of interest. Workers’ profile was characterized according to sociodemographic variables and Brazilian regions, forming a comparison group with all other Brazilian workers aged from 18-69 years who died in the same period and from the same underlying cause. Calculations of proportional mortality, YPLL rates, and YPLL rate ratios were applied. In the studied period, 15,362 deaths due to liver diseases occurred in Brazilian agricultural workers, with an average age at death of 51.3 years (±10.7), concentrated in K70 − alcoholic liver disease (53.8%). A higher proportional mortality occurred in men (86.2%), Mixed individuals (61.1%), up to age 49 years (40.9%), with ≤ 7 years of education level (52.4%), and residence in the Northeast (56.9%). The sum of YPLL totaled 382,869 years among agricultural workers, with YPLL rate of 4,527 years per 100,000 workers and a YPLL rate ratio 1.45 times higher than the national average. The concentration of deaths due to K70 raises concern due to the potential chronic exposure to alcoholic beverages. These results highlight the early causes of deaths from liver diseases among agricultural workers, especially those in Northeast Brazil and mixed.

Mortality rate and standardized mortality ratio of childhood-onset type 1 diabetes according to incidentally detected non-acute-onset or acute-onset subtype, sex, and onset age: A cohort study

Mortality rate and standardized mortality ratio of childhood-onset type 1 diabetes according to incidentally detected non-acute-onset or acute-onset subtype, sex, and onset age: A cohort study

MAFLD but not MASLD increases risk of all-cause mortality in regional Australia, with components of metabolic syndrome exacerbating factors: 20year longitudinal, cohort study.

Controversy remains whether the mortality risk in people with fatty liver disease (FLD) including metabolic-(dysfunction) associated steatotic liver disease (MASLD) and metabolic-(dysfunction) associated fatty liver disease (MAFLD) is higher than observed in those without FLD. We aimed to determine the mortality rate and mortality rate ratio (MRR) for these FLDs. The study population was a randomly selected cohort of community-dwelling adults in regional Victoria, Australia between 2001 and 2003 with sufficient data evaluable for Fatty Liver Index and determination on alcohol consumption. MASLD and MAFLD were diagnosed by established criteria. The primary outcome was overall mortality and main secondary outcome was major adverse liver outcomes (MALO) (i.e., decompensated liver disease, primary liver cancer and liver-related death). Non-fatal and fatal outcomes were captured via data linkage to hospital admission, cancer registry, and death registries. MRR was calculated with non-FLD participants as the comparator. 1444 (99.3%) and 1324 (91.1%) individuals from a total of 1454 were included in the final MAFLD and MASLD analyses. The median follow-up was 19.7years (IQR 19.1-20.1) and there were 298 deaths. The MRR for MAFLD and MASLD was 1.39 (95% CI 1.10-1.76) and 1.25 (95% CI 0.96-1.61), respectively. MAFLD persisted as a risk factor for all-cause death on multivariable models correcting for lifestyle and socioeconomic variables, but not when adjusted for metabolic risk factors. MALOs were increased in MAFLD [incidence rate ratio (IRR) 3.03, 95% CI 1.22-8.18] and MASLD (IRR 2.80, 95% CI 1.05-7.90). Metabolic risk factors increased the risk of overall mortality and MALO, and cancer (34.3-34.6%) and cardiovascular disease (30.1-33.7%) were the most common cause of death in FLD. In this population-based longitudinal study, MAFLD but not MASLD increases the risk of overall mortality, with metabolic syndrome components key risk factors increasing risk of death.

Liver-related mortality in homeless-experienced adults over a 16-year period.

Homeless-experienced adults have higher liver-related mortality than the general population. The objective of our study was to examine temporal liver-related mortality trends and assess cause-specific liver-related mortality disparities in a large cohort of homeless-experienced adults. We linked a cohort of 60,092 adults who received care at Boston Health Care for the Homeless Program (BHCHP) from 2003-2017 to Massachusetts death occurrence files spanning 2003-2018. We evaluated temporal trends in age-standardized liver-related mortality rates in comparison to the MA population. We identified the leading causes of liver-related death aggregated across the study period and compared these cause-specific mortality rates to the general population, reporting standardized mortality rate ratios (SRRs). Of the 7,130 deaths in the cohort, 652 (9.1%) were liver-related. Among liver-related decedents, the mean age at death was 55.7 years (SD 8.3); 517 (79.2%) were male and 399 (61.2%) were White. Liver-related mortality decreased on average 3.5% annually (95% CI: -6.6%, -0.3%), though remained significantly higher than the MA population throughout the study period. Leading causes of liver-related death were cirrhosis (n=157, SRR 3.2 [95% CI: 3.2, 3.3]), liver cancer (n=148, SRR 2.4 [95% CI: 2.4, 2.5]), alcohol-related liver disease (n=140, SRR 4.4 [95% CI: 4.3, 4.6]), and viral hepatitis (n=99, SRR 7.2 [95% CI: 6.9, 7.6]).Liver-related deaths are an important contributor to excess mortality among homeless-experienced adults. Efforts to reduce this disparity should address alcohol use disorder and viral hepatitis given their substantial contribution to the disparity of mortality in this population.

National and Subnational Trends of Mortality and Years of Life Lost Due to Stroke and Its Subtypes in Young Adults in China, 2005-2020.

The incidence of stroke among young adults was rising globally, but the death burden of stroke in young adults in China is lacking. We aimed to examine the temporal trends in mortality and years of life lost (YLLs) caused by stroke among young adults from 2005 to 2020 across China. Based on the data from the National Mortality Surveillance System in China, we estimated the number and age-standardized rate of mortality and YLLs due to stroke and its subtypes among young adults aged 15-49 years during 2005-2020, for both China and its 31 mainland provinces. During 2005-2020, the age-standardized mortality rate of stroke among young adults aged 15-49 years in China decreased by 21.0%, from 5.9/100,000 to 4.7/100,000, and the YLL rate decreased from 286.9/100,000 to 229.5/100,000. The age-standardized mortality rate among young adults due to intracerebral hemorrhage (ICH) showed a significant downward trend with a decrease of 26.3% while that of ischemic stroke (IS) and subarachnoid hemorrhage (SAH) decreased by 4.5% and 0.6%, respectively. In 2020, the mortality rate of ICH was 3.5 times higher than that of IS (3.3/100,000 vs 0.9/100,000) among young adults in China. The male/female ratio of age-standardized mortality rate of stroke in young adults increased from 2.0 in 2005 to 3.1 in 2020. The age-standardized mortality rate of IS and SAH in young men increased by 11.0% and 2.5%, respectively. In 2020, Tibet (18.4/100,000), Jilin (10.4/100,000), and Qinghai (8.3/100,000) were the top 3 provinces holding the highest age-standardized mortality rate due to stroke among young adults. Tibet was found to have the highest mortality rate due to ICH and SAH while that of IS was higher in northeast China. In China, the death burden caused by ICH among young adults was substantially higher than that of IS. The increasing death burden of IS and SAH among young men requires special attention. Evidence-based intervention strategies are needed to improve the outcomes of stroke and alleviate the death burden due to stroke among young adults in Chinese population.

Tele-Critical Care, Severity of Illness, and 30-Day Mortality Risk: A Retrospective, Cohort Analysis.

Introduction: Studies have shown that tele-critical care (TCC) improves outcomes in intensive care unit (ICU) settings with low baseline performance. Evidence also suggests that TCC outcomes may be modified by heterogenous baseline severity of illness. We examined the association of admission Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score quartiles (APQ1-APQ4) and TCC exposure with 30-day mortality. Methods: Retrospective, cohort study of 151,780 consecutive ICU patients admitted to nine hospitals within Cleveland Clinic Health System from 2010 to 2019. Data were abstracted from an institutional ICU Datamart and APACHE IV registry. Analyses included summary statistics for demographics, unadjusted survival functions, and incidence rates across ascending APACHE quartiles (APQ1-APQ4). Multivariate Poisson regression modeled covariates associated with incidence rate ratio (IRR) for mortality, across quartiles including statistical interaction between TCC exposure and APACHE quartiles. Results: Unadjusted mortality risk ratios of TCC/no TCC were statistically different across APQ1 (0.83; 95% confidence interval [CI] 0.71-0.97), APQ3 (0.63; 95% CI 0.57-0.69), and APQ4 (0.77; 95% CI 0.74-0.82) (all p < 0.05) but not in APQ2 (0.98; 95% CI 0.88-1.10; p = 0.77). Multivariate Poisson modeling found reduced IRR with TCC (IRR 0.82; 95% CI 0.70-0.97). Relative to APQ1, risk was increased across quartiles, APQ2 (IRR 2.15; 95% CI 1.83-2.52), APQ3 (IRR 3.93; 95% CI 3.39-4.56), and APQ4 (IRR 9.30; 95% CI 8.10-10.67). Interaction with TCC significantly reduced risk in APQ3 (IRR 0.80; 95% CI 0.67-0.96). Conclusion: TCC exposure is associated with reduced 30-day mortality, affected by various clinical factors, to provide heterogenous impact. Mortality benefit appears to particularly accrue among patients with higher, but not the highest quartile for severity of illness, based on their APACHE IV scores.

Impact of access to coronary angiography and percutaneous coronary intervention on in-hospital and five-year mortality in patients with acute coronary syndrome: a propensity-matched cohort study in Thailand.

Coronary artery angiography (CAG) and percutaneous coronary intervention (PCI) are superior to non-invasive approaches in reducing mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, their efficacy remains uncertain in non-ST-elevation acute coronary syndromes (NSTE-ACS) and limited in low-resource settings. This study aimed to compare in-hospital and 5-year mortality rates between patients with a first event of STEMI and NSTE-ACS who underwent CAG and PCI and those with similar severity who did not undergo CAG and PCI. A propensity-matched retrospective cohort study was conducted using population-based claims data of national universal coverage of Thailand for identification of patients with acute coronary syndromes. The mortality of recruited patients was additionally linked to the national database of vital registration. Patients aged ≥ 40years who were hospitalized for STEMI and NSTE-ACS in 2017, with a focus on access to CAG and PCI were included. For each condition either STEMI or NSTE-ACS, patients who underwent CAG and PCI were matched to those who did not undergo usingpropensity score matching (PSM) to balance measured confounders, such as age, sex, and underlying conditions. In-hospital mortality rate ratio and 5-year mortality were analyzedas measures. Through PSM, 2,702 non-intervention STEMIpatients were paired with an equal number of intervention patients, and similarly, 5,072 non-intervention NSTE-ACSpatients were matched with an equivalent group who received interventions. For patients with STEMI, the in-hospital mortality rate ratio (95% confidence interval (CI)) for those who underwent CAG and PCI compared to those who did not was 30.1% (30.0%, 30.2%). Similar trends were observed in patients with NSTE-ACS with a mortality rate of 34.7% (34.6%, 34.8%). For the five-year mortality comparison, the hazard ratios (95% CI) of mortality after discharge were 0.55 (0.50, 0.62) for STEMI and 0.57 (0.54, 0.61) for NSTE-ACS cases. Access to CAG and PCI was significantly associated with lower in-hospital and 5-year mortality rates in patients who experienced their first event of ACS, despite the limited availability of some unmeasured or residual confounders. Healthcare systems should expand their resources for CAG and PCI in Thailand and other countries to equitably enhance longevity.

Abstract 4113475: Association of Age at Diabetes Diagnosis and All-cause and Cardiovascular Mortality among 600,000 US Adults

Introduction: Diabetes is a leading cause of morbidity and mortality in the United States, causing an estimated 440,000 deaths among US adults in 2019. Establishing the relevance of diabetes diagnosis at various ages to mortality in the contemporary US population, both overall and among major demographic subgroups, may inform public health policy and strategy. Methods: We aimed to quantify the association between age at diabetes diagnosis and all-cause and cardiovascular mortality among US adults using publicly-available data from the National Health Interview Survey 1997-2018, linked to the National Death Index through 2019. We used Cox regression adjusted for age, sex, race and ethnicity, educational attainment, smoking status, body-mass index, physical activity, and insurance coverage to estimate all-cause and cardiovascular mortality rate ratios overall, by sex, and by race and ethnicity. Results: Among 601,467 included adults (56% female, 16% Hispanic and 14% non-Hispanic Black) there were 75,122 deaths during 6.6 million person-years of follow-up. Overall, the all-cause mortality rate ratio associated with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years were 3.87 (95% CI 3.47-4.32), 2.87 (2.68-3.07), 2.26 (2.16-2.36), 1.72 (1.65-1.79), 1.47 (1.41-1.53), and 1.26 (1.19-1.33), respectively. The corresponding cardiovascular mortality rate ratios were 5.02 (4.09-6.16), 3.37 (2.99-3.78), 2.88 (2.65-3.13), 1.94 (1.81-2.09), 1.53 (1.43-1.65), and 1.27 (1.15-1.40), respectively. Although these associations were similar by sex and by race and ethnicity, the age-specific prevalence of diabetes was greatest among non-White participants. Among individuals with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years, an estimated 74%, 65%, 56%, 42%, 32%, or 20% of deaths from any cause were attributable to diabetes. Conclusion: Age at diabetes diagnosis was associated with all-cause and cardiovascular mortality in a dose-dependent and approximately log-linear manner. Although associations were similar across diverse demographic groups, age-specific diabetes prevalence was greatest among non-White individuals, leading to greater mortality burden. If these associations were interpreted as largely causal, diabetes accounted for more than half of all deaths among those diagnosed before age 50 years. Preventing, delaying, and appropriately managing diabetes could prevent substantial excess mortality among US adults.

Abstract 4137880: Access to exercise opportunities, physical inactivity and cardiovascular mortality: A nationwide study in the U.S.

Aims: Despite efforts to promote physical activity, the prevalence of physical inactivity continues to rise. Exercise access influences population activity levels, but county-level variation in physical activity and its link to cardiovascular disease (CVD) mortality is unclear. We explored the associations between access to exercise opportunities, levels of physical inactivity, and CVD mortality across U.S. counties Methods: The County Health Rankings and Roadmaps data and CDC WONDER mortality data were integrated. We compared age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization. The rate ratio (RR) for CVD mortality was calculated using generalized linear models. Results: CVD mortality decreased from high to low values of the county-level of physical activity across all demographic subgroups (P&lt;0.001) (Table 1&amp;Figure 1). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR, 0.93 [0.91–0.95]), which was most pronounced in relation to acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76–0.85]). The county-level physical inactivity was associated with an increased risk of CVD mortality (RR, 1.16 [1.14–1.17]), especially for ischemic heart disease (IHD) mortality (RR, 1.35 [1.31–1.38]) and AMI mortality (RR, 1.32 [1.25–1.38]) (Figure 2). All demographic subgroups demonstrated similar benefits by improving the county-level indicators of physical activity. Conclusion: Counties have the potential to make significant strides in preventing CVD and improving the cardiovascular health of their populations by enhancing access to exercise opportunities and reducing physical inactivity.

Perinatal death in the Nordic countries in relation to gestational age: The impact of registration practice.

Although perinatal death rates in the Nordic countries are among the lowest in the world, the risk of perinatal death is unevenly distributed across the Nordic countries, despite similarity in health care systems and pregnancy care. Birth registration practices across countries may explain some of the differences. We investigated differences in national registration of perinatal mortality within the Nordic countries and its impact on perinatal mortality according to gestational age. Each country provided information by answering a questionnaire about registration of perinatal deaths. Furthermore, we collected aggregated count data based on Medical Birth Registries (MBR) from all Nordic countries in 2000 to 2021. Perinatal mortality was defined as stillbirth or neonatal death occurring within first 7 days of life. Data were grouped into six groups by gestational age (GA): extremely preterm (>28 + 0 weeks, subdivided into 22 + 0-23 + 6 and 24 + 0-27 + 6), very preterm (GA 28 + 0-31 + 6), moderate preterm (GA 32 + 0-33 + 6), late preterm (GA 34 + 0-36 + 6), term (GA 37 + 0-40 + 6) and late term or post-term birth (GA ≥ 41 + 0). Perinatal mortality rate and risk ratio with 95% confidence intervals were calculated per country for each gestational age group. For Denmark, separate analyses included and excluded induced abortions. The study included 6 343 805 live births, 22 727 stillbirths and 8932 liveborn infants who died within the first week of life after GA 22 + 0. Further 25 057 births were included with GA < 22 + 0, unknown GA and as a result of induced abortion. Overall, perinatal mortality rates decreased during year 2000-2021 in all Nordic countries. After exclusion of induced abortions, the perinatal mortality rate was similar in the five Nordic countries. The perinatal mortality rate for extremely preterm born infants was highest in Denmark, whereas the highest rate among infants born late term/post-term was in Sweden. The perinatal mortality rate in the Nordic countries is still decreasing, especially in the group of extremely preterm born infants. This study supports the need for further standardization of birth registration practices to ensure the validity of international comparisons.

New Clinical and Public Health Challenges: Increasing Trends in United States Alcohol Related Mortality

In the United States (US) and worldwide alcohol is a major contributor to premature mortality and morbidity. We explored US trends in alcohol related mortality from 1999 to 2020 overall and by age, gender, race, and region METHODS: Publicly available US Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) and the underlying cause of death file from CDC WONDER using ICD-10 codes. In 1999, there were 19,356 alcohol-related deaths, a mortality rate of 10.7 per 100,000. By 2020, deaths increased to 48,870 or 21.6 per 100,000. Overall, the mortality rate ratio (MRR) was significantly increased by about 2.0-fold. There were significant increases in all 10-year age groups with the largest 3.8-fold in those 25 to 34. Women experienced a 2.5-fold increase; Asians and Pacific Islanders had the largest increase of 2.4-fold; and the Midwest showed the largest regional increase of 2.5-fold. During the last 20 years there have been significant increases of about 2-fold in US alcohol-related mortality. Clinical challenges are increased by interrelationships of risk factors, especially overweight and obesity, and diabetes, alcohol, overweight and obesity all cause liver damage which may be additive and lead to earlier onset of alcohol related mortality. In addition, health providers should also consider demographic shifts and regional differences. Targeted interventions by health care providers may reduce this increasing US epidemic of alcohol related mortality. These data also generate many hypotheses testable in analytic studies designed a priori to do so.

Trends in All-cause Mortality among U.S. Veterans with Sarcoidosis, 2004–2022

BACKGROUNDSarcoidosis is an idiopathic multiorgan disease with variable clinical outcomes. Comprehensive analysis of sarcoidosis mortality in U.S. Veterans is lacking. RESEARCH QUESTIONSWhat are the trends in all-cause mortality among U.S. Veterans with sarcoidosis, and how are these trends influenced by demographics, Black vs. White racial disparities, and geographic variability in relation to mortality? STUDY DESIGN AND METHODSUsing Veterans Health Administration (VHA) electronic health records (EHR), we conducted a population-based, retrospective cohort study of adjusted all-cause mortality 2004–2022 among Veterans diagnosed with sarcoidosis who received care through the VHA. Demographics, region of residence, service branch, tobacco use, and comorbidities were extracted from EHR. Annual trends in all-cause mortality and patient-level characteristics associated with mortality were examined with multivariable ungrouped Poisson regression. We visualized trends and analyzed state-by-state mortality using the marginal means procedure. In subgroup analysis (2015–2022), we considered the impact of neighborhood-level socioeconomic disparities using the area deprivation index (ADI). RESULTSIn all, 23,745 Veterans were diagnosed with sarcoidosis between 2004 and 2019 and followed through 2022. After adjustment, including age and sex, all-cause mortality increased annually by 4.7% (P<0.0001) and was 6.4% higher in Black than White Veterans (mortality rate ratio=1.064, P=0.02). A subgroup analysis comparing models with and without ADI adjustment showed no meaningful change in mortality trends. Risk factors for increased all-cause mortality included older age, male sex, Black race, and Northeast residence, and lower risk with “Other” service branches. Despite distinct geographical variations in mortality rates, no clear patterns emerged. INTERPRETATIONMortality among Veterans with sarcoidosis is rising. Differences identified by service branch and higher risk among male Veterans raise questions about differences in environmental exposures. The narrower racial disparities and smaller impact of ADI than in other studies may highlight the role of universal healthcare access in achieving equitable outcomes.

Socioeconomic inequalities in avoidable mortality: results from the Italian nationwide cohort

Abstract Background Inequalities in avoidable mortality have been well evaluated in many European countries. We aimed to assess the association between socioeconomic status and avoidable mortality in Italy. Methods The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012- 2019 mortality. Outcomes of preventable and of treatable mortality were evaluated among people aged 30-74. Exposures were education level and residence macro area (North-West, North-East, Center, South-Islands). Adjusted mortality rate ratios (MRRs) were estimated through multivariate quasi-Poisson regression models, by sex and group of causes, taking into account age at death and macro area of residence. Relative index of inequalities (RII) was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes. Results The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). Highest RII were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Higher risks of preventable and of treatable mortality were found for those living in the South-Islands. Conclusions We documented relevant socioeconomic inequalities in avoidable mortality in Italy, especially in the Southern regions. They represent a possible missed gain in health and suggest a reassessment of priorities and definition of health targets with the lens of equity. Key messages • An inverse socioeconomic gradient in avoidable mortality was observed in Italy, both for preventable and for treatable mortality, with geographical heterogeneity. • Greatest social disparities were found in mortality for causes strongly associated with risk behavior and for which it is possible to identify risk factors on which to intervene.