Regional Variations In Mortality Rates Research Articles

A Cross-Sectional Study of the Trends in Cardiovascular Mortality Among African Americans With Hypertension.

Background and Objective In the United States, hypertension remains a significant cause of cardiovascular disease mortality and morbidity, affecting various racial and ethnic groups. High blood pressure is a common health concern, given its high frequency among all populations and racial groups in the United States; nevertheless, the condition remains untreated in most individuals. It affects a significant number of individuals in the African American community and contributes to a notable proportion of deaths. Arguably more prevalent, severe, and tends to occur earlier in African Americans compared to some other races. This lack of blood pressure control may contribute to the increasing mortality rates associated with hypertension-related cardiovascular diseases in the United States, while notable race and sex disparities persist. This study aims to compare the number of deaths caused by each cardiovascular disease (hypertension) in African Americans to those of people of other races. Methodology To understand the impact of hypertension on mortality rates among different racial groups, this study utilized the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER)dataset, which includes death certificates filed in the United States. The research focused on individuals aged 25 years or older with a mention of hypertension and cardiovascular disease as the underlying cause of death between 1999 and 2019. The study analyzed hypertension-associated deaths by different cardiovascular disease subtypes, such as ischemic heart disease, heart failure (HF), and cerebrovascular diseases that include acute ischemic attacks, which are the most frequent in the United States, with specific assessments for African Americans, White, and other races' decedents. Results The study findings indicated that African American males had higher mortality rates from cardiovascular diseases compared to African American females. The prevalence of hypertension was also higher among African Americans (87.47%) compared to Whites (30.33%), Asian/Pacific Islanders (40.26%), and American Indians/Alaska Natives (61.18%). Additionally, the study identified regional variations in mortality rates, with states like Arizona, California, Texas, Florida, and Washington having higher rates, while Vermont, North Dakota, and Wyoming had lower rates. The northwest region had lower mortality compared to the western and southwestern regions. Conclusions Within the studied period, there was an increase in the prevalence of mortality due to hypertension amongst African Americans when compared to other races. These findings underscore the pressing need to address the increasing prevalence of hypertension and mortality rates among African American. More efforts should focus on prevention of CVD and hypertension and the associated risk factors based on the World Health Organization (WHO) recommendations, which include the promotion of healthy lifestyle behaviors, improvement of access to quality healthcare,and implementation ofculturally sensitive interventions tailored for African American communities.

First Peoples lost: Determining the state of status First Nations mortality in Canada using administrative data

AbstractWe present the most comprehensive set of estimates to date for status First Nations mortality in Canada. We use administrative data from Indigenous and Northern Affairs Canada to establish a set of stylized facts regarding status First Nations mortality rates. Between 2010 to 2013, the mortality rates of status First Nations men and boys are highest in nearly all age groups of status First Nations considered, with the exception of status girls between the ages of 10 to 14. On reserve, status boys between the ages of 15 to 19 have mortality rates nearly four times that in the general population, while status girls between the ages of 15 to 19 have mortality rates five times that in the general population. We demonstrate substantial regional variation in mortality rates. Finally, we document that there has been no improvement in mortality among status women and girls living on reserve in the last 30 years and relative mortality rates for all status people on reserve has not changed in 40 years.

Trends in regional cancer mortality in Taiwan 1992–2014

BackgroundAlthough the cancer mortality rate in Taiwan has been declining in recent years, no study has yet reported any regional differences in cancer mortality rates in Taiwan. We hypothesized that regional cancer mortality rates in Taiwan, an ethnically homogeneous society, exhibited no significant variations. MethodsWe investigated the trends in Taiwan regional cancer mortality between 1992 and 2014. We analyzed regional age-standardized cancer mortality rates for lung, liver, colon, stomach, oral, breast, and prostate cancers using the Taiwan Longitudinal Health Insurance Database and Demographic Database. Furthermore, we applied Joinpoint regression analysis to evaluate the trends across different regions. ResultsThere are clear regional variations in mortality rates for liver, stomach, and oral cancers, but not for lung, colon, breast, and prostate cancers. The regional death rates of oral cancer, especially for eastern Taiwan, not only elevate the fastest (APC = 14.78% per year, P < 0.001) but also show the largest disparities between men and women. Regional death rates for stomach cancer, which declined most rapidly, are converging in both general and gender groups. Liver cancer is the only one with regional variations whose trends do not all go in the same direction. We also demonstrated that northern Taiwan has significant regional advantages with respect to cancer mortality. ConclusionsSome but not all cancers in Taiwan show regional disparities. Liver, stomach, and oral cancers in Taiwan exhibit clear regional variations in mortality rates. In particular, the regional variations in oral cancer mortality rates are consistent with those in alcohol consumption.

Estimating regional variations in adult mortality in Zambia

Background: A dearth of regional level adult mortality estimates exists in Zambia. Regional adult mortality rates reflect inequalities in socioeconomic conditions and health service provision. Adult mortality rates are useful indicators for monitoring effectiveness and impact of health interventions (HIV/AIDS antiretroviral therapy (ART), tuberculosis (TB) and malaria) at regional level. Previous studies have not produced adult mortality rates at regional level. Data Source and Methods: Using data from the 2010 census, this study estimated adult mortality rates at regional level for age group 15-59 years. Age-specific mortality rates (ASMRs), cause-specific mortality rates (CSMRs), standardised mortality rates (SMRS) and probabilities of dying between age 15 and 60 years ( 45 q 15 ) were computed. Correlations with HIV prevalence and literacy rates, and mortality rates were also computed. Findings: Adult mortality rates varied across all provinces. The 45 q 15 was highest for males in Western province, 59 % and lowest in North-western province, 36.7 %. For females, 45 q 15 was highest in Copperbelt province, 47.9 % and lowest in North-western province, 34.8 %. Conclusion: HIV prevalence and literacy rates were positively correlated with regional adult mortality rates. Health policies and programmes aimed at reducing adult mortality should, therefore, be tailored to recognise the regional variations in mortality rates

Abstract 358: Annual Quality of Care Evaluations of Cardiac Surgery in British Columbia

Background: Cardiac Services BC (CSBC) is responsible for planning, coordinating, monitoring, and, in some cases, funding cardiac services across British Columbia (BC) in collaboration with senior administrators and physicians from five regional health authorities. CSBC maintains the BC Cardiac Registry (BCCR), a longitudinal clinical registry of all invasive cardiac procedures performed in BC. For over 10 years, CSBC has used BCCR data to evaluate annually quality of care indicators for isolated coronary artery bypass graft (CABG), isolated valve, and CABG+valve surgeries. Methods: In preparation for each annual review, CSBC meets with an established Planning Committee of representative surgeons. BCCR data is linked to provincial Vital Statistics data, to the national Discharge Abstract Database, and for the last 3 yearly analyses to the provincial Central Transfusion Registry which provides robust data on red blood cell (RBC) transfusion. At the annual review, CSBC meets with surgeons who are included in the analyses to present the indicator data. Results: In the 2012 evaluation, the following quality of care indicators were presented for the 2007-2011 period: 30-day mortality and 30-day stroke; 30-day RBC transfusion; and indicators for evidence-based medications at discharge. Risk-adjusted analyses were prepared for the 30-day mortality and 30-day stroke indicators to provide valid comparisons over time and according to hospital and surgeon. Patient characteristics and pre-procedural factors were included in the risk models. The risk-adjusted models performed well with C-statistics for the 30-day mortality models for isolated CABG, isolated valve, and CABG+valve surgeries of 0.86, 0.89, and 0.81, and for the 30-day stroke models 0.80, 0.83, and 0.74, respectively. Expected rates by hospital and by surgeon were determined from each risk model, and observed to expected (O/E) ratios were used for comparison of hospitals and surgeons. Rates of RBC transfusion varied by hospital, and a large reduction in transfusion rates from 69% (378 of 546) in 2007 to 43% (252 of 589) in 2011 was observed at one site with historically higher rates. Conclusion: Presenting quality of care indicators annually has raised awareness of outcome rates and variations which existed across the province. The annual process of engaging surgeons in the evaluation process and linkage with other administrative databases to obtain outcome data has been associated with a reduction in use of RBC transfusion and instigated further investigations into regional variation in mortality rates. The addition of new indicators and other risk-adjusted analyses in the future may further improve quality of care in cardiac surgery in BC.

Regional variations in mortality rates of pancreatic cancer in China: results from 1990-1992 national mortality survey.

To examine the regional variations in mortality rates of pancreatic cancer in China. Aggregated mortality data of pancreatic cancer were extracted from the 1990-1992 national death of all causes and its mortality survey in China. Age specific and standardized mortality rates were calculated at both national and provincial levels with selected characteristics including sex and residence status. Mortality of pancreatic cancer ranked the ninth and accounted for 1.38 percent of the total malignancy deaths. The crude and age standardized mortality rates of pancreatic cancer in China in the period of 1990-1992 were 1.48/100,000 and 1.30/100,000, respectively. Substantial regional variations in mortality rates across China were observed with adjusted mortality rates ranging from 0.43/100,000 to 3.70/100,000 with an extremal value of 8.7. Urban residents had significant higher pancreatic mortality than rural residents. The findings of this study show different mortality rates of this disease and highlight the importance of further investigation on factors, which might contribute to the observed epidemiological patterns.

Age period cohort analysis of time trends in regional mortality rates in England, Wales and Scotland.

Previous studies have demonstrated regional variation in mortality rates, this reducing for younger but not older individuals. However, it has not been clear from such studies whether or not the overall findings can or cannot be attributed to particular regions that may have abnormal patterns of change over time. We analyse mortality rates by region using data from the census years from 1931 until 1991 for adults. Age period cohort models, based on the local 'curvatures', are used to describe the changes in the rates. We also use estimable contrasts to compare the later periods with the earlier periods and to compare pre- and post-war cohorts. There is strong evidence that the changes in the mortality rates are associated with non-linear period and cohort effects. There is no evidence that these curvatures vary over regions. There is evidence that the curvatures are not the same among men and women. Among women there is evidence that there is a change in trend in the periods from 1961 to 1991 compared with the trend in the earlier periods from 1931 to 1951, such that the reduction in the mortality rates with time are slowing down for women. Among men who had higher mortality rates, there is not so much evidence of a slowing down of the reduction. Post-war cohorts of women from 1941 onwards are enjoying a reduction in mortality compared with the cohorts from 1901 to 31, while among men there is no evidence of a change in mortality trends among younger cohorts. Changes in the mortality rates over regions have come about from different long-term temporal trends in the regions rather than abrupt changes taking place at different times in different regions. The general convergence of mortality rates over regions over time with a consequent reduction in regional variance is masked by two regions, Scotland and East Anglia. These regions appear to differ from the regions as a whole in the relationship of mortality to age at a given period and in the reduction of mortality over time (drift), Scotland having a higher mortality, especially at younger ages, and lower downward trend, and East Anglia vice versa.

Simultaneous modelling of time trends and regional variation in mortality rates.

We seek to model the regional component of the variance in the mortality rates in the UK and to ascertain if there is evidence that this regional variance is increasing in recent periods. Age Period Cohort (APC) models, based on the local 'curvatures', are used in each region to describe the changes in the trends in the mortality rates. This is extended to a multilevel model to estimate the regional component of the variance in the rates and to estimate the effect of regional differences in the trends in the rates. We show how the use of a multilevel APC model can help to distinguish the cohort and period trends in the mortality rates from the cohort and period effects on the regional variance in these rates. For both sexes, but particularly for females, a reduction in the rate of decrease in mortality was found around 1960. In addition, particularly for females, cohorts born after 1930 appear to show reductions in mortality at an increased rate. It is demonstrated that there is evidence that the between-region variation in the rates has not remained constant and that it is much less now than it was at the beginning of the data series. Further, there is evidence that the trends in the rates are not the same in all regions and that while there is a convergence of the rates in many regions, Scotland, in particular, stands out as a region which contributes most to the regional variation in mortality rates. Evidence of regional variation in mortality rates has been found with a suggestion of a decrease over the period of the study though with some stability since 1951.

Has regional variation in mortality rates declined since 1931, and in all age groups, in Britain? A re-analysis using formal statistical modelling.

STUDY OBJECTIVE: To examine changes in regional variance in all cause mortality rates in Great Britain from 1931-91 using formal statistical modelling procedures, and to follow up the suggestion by...

Regional variations in mortality rates in England and Wales: An analysis using multi-level modelling

Mortality rates in England and Wales display a persistent regional pattern indicating generally poorer health in the North and West. Some of this is simply a reflection of regional differences in the extent of social deprivation which is known to exert a profound influence on health. Part of the pattern may also be the result of regional differences in urbanization which also affect mortality rates. However, there may be important regional differences over and above these compositional effects. This study attempts to establish the magnitude of such independent regional differences in mortality rates by using the techniques of multi-level modelling. Standardized mortality rates (SMRs) for males and females under 65 for 1989–1991 in local authority districts are grouped into categories using the ACORN classification scheme. The Townsend Index is included as a measure of social deprivation. Using a cross-classified multi-level model, it is shown that region accounts for approximately four times more variation in SMRs than is explained by the ACORN classification. Analysis of diagnostic residuals show a clear North-South divide in excess mortality when both regional and socio-economic classification of districts are modelled simultaneously, a possibility allowed for by the use of a multi-level model.