Specific Causes Of Mortality Research Articles

Increasing inequalities in mortality among individuals with a foreign background in Sweden

Abstract Background Previous research indicates that migrants in high-income destination countries not only experience a mortality advantage but also demonstrate lower or absent socioeconomic inequalities in mortality compared to the general native population. Yet the extent to which an income mortality gradient may also be evident among the descendants of migrants has been largely unexamined. Existing evidence has revealed that descendants of migrants face mortality risks higher than both migrants and their native-born peers. Methods This study utilizes longitudinal population registries covering the entire registered population of Sweden from 2004 to 2016. The study population comprises individuals aged 25 to 64, employing an open cohort design. Using Poisson regression, we examine the relationship between income rank position and cause-specific mortality among native-origin Swedes and eight nativity groups based on individuals’ country/region of birth, age of migration or parental origin. Results While foreign-born individuals who migrated as adults exhibited lower inequalities in all-cause mortality compared to native-origin Swedes, descendants of immigrants, particularly those with non-European backgrounds, show larger inequalities. Examination of specific causes of mortality revealed that external causes, notably accidents and assaults, account for increased disparities among non-European foreign-born men who migrated during childhood and male descendants of immigrants with non-European backgrounds. Conclusions Income-related inequalities in mortality are less pronounced among migrants compared to the native-born majority population in Sweden and tend to be higher among descendants of migrants, depending on gender and parental origin. The analysis highlights the role of external causes of mortality in shaping these inequalities, indicating that income disadvantages, augmented by a migrant background during upbringing, amplify specific health risks within these groups. Key messages • The study reveals lower mortality inequalities among migrant adults but a higher magnitude of inequalities among male descendants of immigrants, especially with non-European backgrounds. • Income disparities, combined with migrant backgrounds, amplify health risks among descendants of migrants in Sweden, underscoring the need for tackling social inequalities.

The impact of macro- and micro-steatosis on the outcomes of patients who undergo liver transplant: Analysis of the UNOS-STAR database.

The presence of steatosis in a donor liver and its relation to post-transplantation outcomes are not well defined. This study evaluates the effect of the presence and severity of micro- and macro-steatosis of a donor graft on post-transplantation outcomes. The UNOS-STAR registry (2005-2019) was used to select patients who received a liver transplant graft with hepatic steatosis. The study cohort was stratified by the presence of macro- or micro-vesicular steatosis, and further stratified by histologic grade of steatosis. The primary endpoints of all-cause mortality and graft failure were compared using sequential Cox regression analysis. Analysis of specific causes of mortality was further performed. There were 9184 with no macro-steatosis (control), 150 with grade 3 macro-steatosis, 822 with grade 2 macro-steatosis and 12 585 with grade 1 macro-steatosis. There were 10 320 without micro-steatosis (control), 478 with grade 3 micro-steatosis, 1539 with grade 2 micro-steatosis and 10 404 with grade 1 micro-steatosis. There was no significant difference in all-cause mortality or graft failure among recipients who received a donor organ with any evidence of macro- or micro-steatosis, compared to those receiving non-steatotic grafts. There was increased mortality due to cardiac arrest among recipients of a grade 2 macro-steatosis donor organ. This study shows no significant difference in all-cause mortality or graft failure among recipients who received a donor liver with any degree of micro- or macro-steatosis. Further analysis identified increased mortality due to specific aetiologies among recipients receiving donor organs with varying grades of macro- and micro-steatosis.

The role of donor sex on the post-liver transplant outcomes in patients with primary sclerosing cholangitis.

Primary sclerosing cholangitis (PSC) can result in hepatic decompensation and require liver transplantation (LT). This study investigates the effect of the sex of the donor and recipient as a prognostic risk factor for adverse outcomes after LT in patients with PSC. UNOS registry was used to select LT patients with PSC from 1987 to 2019. The study cohort was stratified based on the sex of the recipient and further subdivided based on the sex of the donor. The primary endpoints of this study were all-cause mortality and graft failure, which were evaluated using a sequential Cox regression analysis. This study included 2829 patients; 906 female recipients were transplanted from 441 male donors and 465 female donors. 1923 male recipients were transplanted from 1194 male donors and 729 female donors. Within the mismatch analyses, the male-to-male recipients also had a significantly reduced hazard ratio of graft failure compared to female-to-male transplants [aHR 0.51, 95% confidence interval (CI) 0.33-0.79, P = 0.003]. No difference in graft failure was observed in the mismatched female recipient subgroup. The mismatched male recipient group also showed a decreased hazard ratio of mortality from graft rejection and respiratory causes. No differences in specific mortality causes were identified in the mismatched female recipient group. This study demonstrated an increase in the risk of graft failure and mortality secondary to graft failure in male recipients of female donor livers. No differences in mortality or graft failure were identified in female recipients of male livers.

The prevalent causes of death in patients with peripheral artery disease undergoing revascularisation or amputation.

Preventing untimely death in patients with peripheral artery disease (PAD) requires a detailed understanding of the predominant causes of death (COD). This literature review aims to describe how short- and long-term COD are reported in patients who had surgery for PAD. A literature review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for articles reporting specific causes of mortality in patients who had surgery for all stages of PAD. Articles were included if they reported COD after open surgical or endovascular revascularisation, or major or minor amputation for PAD. Critical appraisals were conducted according to included study types, using the Joanna Briggs Institute tools. Cause of death was reported in 21 publications. Twenty were observational and one was a randomised control trial. Study size ranged from 25 to 10,505 patients. Cardiovascular disease was the most prevalent COD in perioperative periods (42.5% from 13 studies). Long-term follow-up ranged from 1month and 7years with 15 studies reporting cardiac related mortality as the most frequent cause of death. However, mortality from neoplasia, respiratory disease (including pneumonia and pulmonary emboli), stroke and sepsis were prevalent. Many studies were low-average quality, with few population-based observational studies. Whilst cardiovascular COD are the most prevalent reasons for mortality in patients with PAD, the proportion of patients dying from neoplasia and respiratory disease is high. Improved reporting standards for COD in studies examining PAD are needed.

Do expenditures on public health reduce preventable mortality in the long run? Evidence from the Canadian provinces

BackgroundInvestments in public health – prevention of illnesses, and promotion, surveillance, and protection of population health – may improve population health, however, effects may only be observed over a long period of time. ObjectiveTo investigate the potential long-run relationship between expenditures on public health and avoidable mortality from preventable causes. MethodsWe focused on the country spending the most on public health in the OECD, Canada. We constructed a longitudinal dataset on mortality, health care expenditures and socio-demographic information covering years 1979–2017 for the ten Canadian provinces. We estimated error correction models for panel data to disentangle short-from long-run relationships between expenditures on public health and avoidable mortality from preventable causes. We further explored some specific causes of mortality to understand potential drivers. For comparison, we also estimated the short-run relationship between curative expenditures and avoidable mortality from treatable causes. ResultsWe find evidence of a long-run relationship between expenditures on public health and preventable mortality, and no consistent short-run associations between these two variables. Findings suggest that a 1% increase in expenditures on public health could lead to 0.22% decrease in preventable mortality. Reductions in preventable mortality are greater for males (−0.29%) compared to females (−0.09%). These results are robust to different specifications. Reductions in some cancer and cardiovascular deaths are among the probable drivers of this overall decrease. By contrast, we do not find evidence of a consistent short-run relationship between curative expenditures and treatable mortality, except for males. ConclusionThis study supports the argument that expenditures on public health reap health benefits primarily in the long run, which, in this case, represents a reduction in avoidable mortality from preventable causes. Reducing public health expenditures on the premise that they have no immediate measurable benefits might thus harm population health outcomes in the long run.

Causes of Death Among Health Care Professionals in the United States.

Specific causes of mortality among various types of health care professionals (HCPs), including those characterized by age, gender, and race, have not been well described. The National Occupational Mortality Surveillance data for deaths in 26 US states in 1999, 2003-2004, and 2007-2014 were queried to address this question. Proportionate mortality ratios (PMRs) were calculated to compare specific causes of mortality among HCPs compared with those among the general population. HCPs were less likely to die from heart disease (PMR 93, 95% confidence intervals [CI] 92-94), alcoholism (PMR 62, 95% CI 57-68), drugs (PMR 80, 95% CI 70-90), and more likely to die from cerebrovascular disease (PMR 105, 95% CI 104-107) and diabetes (PMR 107, 95% CI 105-109). HCPs aged 18-64 years were more likely to die by suicide (PMR 104, 95% CI 101-107), whereas those aged 65-90 years were less likely to die by suicide (PMR 84, 95% CI 77-91), with physicians (PMR 251, 95% CI 229-275) and other HCPs having high PMR for suicide. Among all HCPs, suicide PMR was similarly increased, whereas heart disease PMRs are similarly decreased among Black compared with those among White HCPs and those among male compared with those among female HCPs. HCPs as a group and specific types of HCPs demonstrate causes of mortality that differ in important ways from the general population. Race and gender-based trends in PMRs for key causes of mortality among HCPs suggest that employment in a health care field may not alter race and gender disparities noted among the general population.

Polygenic propensity for longevity, APOE-ε4 status, dementia diagnosis and risk for cause-specific mortality: a large population-based longitudinal study of older adults.

To deepen the understanding of genetic mechanisms influencing mortality risk, we investigated the impact of genetic predisposition to longevity and APOE-ε4, on all-cause mortality and specific causes of mortality. We further investigated the mediating effects of dementia on these relationships. Utilising data on 7131 adults aged ≥50 years (mean=64.7 years, SD=9.5) from the English Longitudinal Study of Ageing, genetic predisposition to longevity was calculated using polygenic score approach (PGSlongevity). APOE-ε4 status was defined according to absence or presence of ε4 alleles. The causes of death were ascertained from the National Health Service central register, which were classified into cardiovascular diseases, cancers, respiratory illness, and all other causes of mortality. Of the entire sample, 1234 (17.3%) died during an average of the 10-year follow-up. One standard deviation (1-SD) increase in PGSlongevity was associated with a reduced risk for all-cause mortality (Hazard ratio [HR]=0.93, 95%CI=0.88-0.98, P=0.010) and mortalities due to other causes (HR=0.81, 95%CI=0.71-0.93, P=0.002) in the following 10 years. In gender stratified analyses, APOE-ε4 status was associated with a reduced risk for all-cause mortality and mortalities related to cancers in women. Mediation analyses estimated that the percent excess risk of APOE-ε4 on other causes of mortality risk explained by the dementia diagnosis was 24%, which increased to 34% when the sample was restricted to adults who were aged ≤75 years old. To reduce mortality rate in adults who are aged ≥50 years old, it is essential to prevent dementia onset in the general population.

Associations with Blood Lead and Urinary Cadmium Concentrations in Relation to Mortality in the US Population: A Causal Survival Analysis with G-Computation

Using the parametric g-formula, we estimated the 27-year risk of all-cause and specific causes of mortality under different potential interventions for blood lead (BLLs) and urinary cadmium (UCd) levels. We used data on 14,311 adults aged ≥20 years enrolled in the NHANES-III between 1988 and 1994 and followed up through 31 Dec 31 2015. Time and cause of death were determined from the National Death Index records. We used the parametric g-formula with pooled logistic regression models to estimate the relative and absolute risk of all-cause, cardiovascular, and cancer mortality under different potential threshold interventions for BLLs and UCd concentrations. Median follow-up was 22.5 years. A total of 5167 (36%) participants died by the end of the study, including 1550 from cardiovascular diseases and 1135 from cancer. Increases in BLLs and creatinine-corrected UCd levels from the 5th to the 95th percentiles were associated with risk differences of 4.17% (1.54 to 8.77) and 6.22% (4.51 to 12.00) for all-cause mortality, 1.52% (0.09 to 3.74) and 1.06% (-0.57 to 3.50) for cardiovascular disease mortality, and 1.32% (-0.09 to 3.67) and 0.64% (-0.98 to 2.80) for cancer mortality, respectively. Interventions to reduce historical exposures to lead and cadmium may have prevented premature deaths, especially from cardiovascular disease.

The mortality burden of frailty in hip fracture patients: a nationwide retrospective study of cause-specific mortality

PurposeFrailty is a condition characterized by a reduced ability to adapt to external stressors because of a reduced physiologic reserve, which contributes to the high risk of postoperative mortality in hip fracture patients. This study aims to investigate how frailty is associated with the specific causes of mortality in hip fracture patients.MethodsAll adult patients in Sweden who suffered a traumatic hip fracture and underwent surgery between 2008 and 2017 were eligible for inclusion. The Orthopedic Hip Frailty Score (OFS) was used to classify patients as non-frail (OFS 0), pre-frail (OFS 1), and frail (OFS ≥ 2). The association between the degree of frailty and both all-cause and cause-specific mortality was determined using Poisson regression models with robust standard errors and presented using incidence rate ratios (IRRs) with corresponding 95% confidence intervals (CIs), adjusted for potential sources of confounding.ResultsAfter applying the inclusion and exclusion criteria, 127,305 patients remained for further analysis. 23.9% of patients were non-frail, 27.7% were pre-frail, and 48.3% were frail. Frail patients exhibited a 4 times as high risk of all-cause mortality 30 days [adj. IRR (95% CI): 3.80 (3.36–4.30), p < 0.001] and 90 days postoperatively [adj. IRR (95% CI): 3.88 (3.56–4.23), p < 0.001] as non-frail patients. Of the primary causes of 30-day mortality, frailty was associated with a tripling in the risk of cardiovascular [adj. IRR (95% CI): 3.24 (2.64–3.99), p < 0.001] and respiratory mortality [adj. IRR (95% CI): 2.60 (1.96–3.45), p < 0.001] as well as a five-fold increase in the risk of multiorgan failure [adj. IRR (95% CI): 4.99 (3.95–6.32), p < 0.001].ConclusionFrailty is associated with a significantly increased risk of all-cause and cause-specific mortality at 30 and 90 days postoperatively. Across both timepoints, cardiovascular and respiratory events along with multiorgan failure were the most prevalent causes of mortality.

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

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

Assessment of Calf Management and Hygiene Practices Adopted in Large and Small-Scale Dairy Farms in Wondo Genet Area, Southern Ethiopia.

Although calf management is the cornerstone of dairy cattle productivity and profitability, little attention is given by researchers particularly in developing nations including Ethiopia. Therefore, this research was conducted to characterize calf management and hygiene practices adopted by dairy farmers at Wondo Genet, a potential milk shed for southern Ethiopia. Calf management and hygiene practice-related data were collected from 57 dairy farms through a semi-structured pre-tested questionnaire and personal observation. All sampled farms were visited once by technical staff and administered the questionnaire by face-to-face interview during the period February 2017 to December 2019. The obtained data were analyzed using descriptive statistics. The majority (96.5%) of the farms had a slatted calf pen floor that was made of concrete. Although more than half of the farms (57.9%) had a good calf pen drainage system, only some (n = 8, 14%) are cleaned on a daily basis. All the calves (100%) had a history of calf scour, 96% survived from cowdriosis (heartwater). The majority of the calves born in the dairy farms (68.5%) received colostrum within 30 minutes of birth, but most of them (82.5%) were fed with waste milk till weaning age. Although the majority of the farms separately house recently born calves, 24.6% of the farms raise their calves together with other domestic animals. Dairy farm owners in the study area adopted some established risky calf management and hygiene practices that might lead to high calf morbidity/mortality in the farm. Awareness creation and further study to identify the specific causes of mortality and morbidity should be in place to improve the management and hygiene of calves and implement specific control and preventive measures.

Long-term exposure to PM2.5 and avoidable mortality in Colombia 2014-2019

Objective: To compare estimates of surface PM2.5 concentrations in Colombia from 2014-2019 at municipality level derived from two global air quality models, as well as to quantify the avoidable deaths attributable to the long-term exposure to concentrations above the current PM2.5 annual mean national standard of 25 µg/m3 and projected standard of 15 µg/m3. Methods: We retrieved PM2.5 concentrations at the surface level from the ACAG and CAMSRA global air quality models for all 1,122 municipalities, and compare 28 of them with available concentrations from monitor stations. Annual mortality data 2014-2019 by municipality of residence and pooled effect measures for total, natural and specific causes of mortality were used to calculate the number of annual avoidable deaths and years of potential life lost. Results: Compared to surface data from 28 municipalities with monitoring stations in 2019, ACAG and CAMSRA models under or overestimated annual mean PM2.5 concentrations. Estimations from ACAG model had a mean bias 1,7 &amp;#x3bc;g/m3 compared to a mean bias of 4,7 &amp;#x3bc;g/m3 from CAMSRA model. Using ACAG model, estimations of total nationally attributable deaths to PM2.5 exposure over 25 and 15 &amp;#x3bc;g/m3 were 142 and 34,341, respectively. Cardiopulmonary diseases accounted for most of the attributable deaths due to PM2.5 excess of exposure (38%). Estimates of YPLL due to all-cause mortality for exceeding the national standard of 25 &amp;#x3bc;g/m3 were 2,381 years. Conclusions: Comparison of two global air quality models for estimating surface PM2.5 concentrations during 2014-2019 at municipality scale in Colombia showed important differences. Avoidable deaths estimations represent the total number of deaths that could be avoided if the current and projected national standard for PM2.5 annual mean have been met, and show the health-benefit of the implementation of more restrictive air quality standards. Key words: Air quality standards, Particulate Matter, Satellite data, Mortality

Compensatory human and predator risk trade-offs in neonatal white-tailed deer

Neonatal mortality is a primary determinant of ungulate population dynamics and occurs from multiple proximal causes, but few studies have compared relationships between risk factors and cause-specific mortality. We evaluated how landscape and physiological characteristics influenced white-tailed deer ( Odocoileus virginianus ) fawn risk from predators (American black bears [ Ursus americanus ], bobcats [ Lynx rufus ], coyotes [ Canis latrans ], and wolves [ Canis lupus ]), anthropogenic causes, and non-predation natural causes (i.e ., disease, injury, or starvation). We monitored 363 fawns and identified 166 mortalities in the Upper Peninsula of Michigan, USA during 2009–2019. Human development reduced fawn predation, particularly from coyotes, but predation was compensated by vehicle collisions. Coyote predation also was reduced in more forested areas, which was offset by increased predation from black bears, bobcats, and wolves. Smaller birth mass increased risk of non-predation natural mortality but did not influence predation or anthropogenic mortality. Our results suggest that for prey living alongside human development, the survival advantage of a “human shield” from predation can be offset by anthropogenic mortality. Birth mass relationships with mortality contradicted the hypothesis that predators select weaker individuals. We conclude that landscape attributes and fawn characteristics may interact with top-down, bottom-up, and anthropogenic processes to shape neonatal white-tailed deer mortality. Because some causes of mortality have opposing relationships with risk factors, combined mortality risk assessment may mask the processes driving specific mortality causes.

Is the Number of Missing Teeth Associated With Mortality? A Longitudinal Study Using a National Health Screening Cohort.

This study aimed to estimate the risk of mortality related to the number of missing teeth in a South Korean population. The ≥ 40-year-old population of the Korean National Health Insurance Service-Health Screening Cohort 2002–2003 was analyzed. Participants were selected from a total of 220,189 participants and included in groups of 0 teeth lost, 1–2 teeth lost, and ≥ 3 teeth lost. Among the total population, 17,211 participants were included in no missing teeth, 1–2 missing teeth, and ≥ 3 missing teeth and were randomly matched 1:1:1 for age and sex. Mortality from specific causes and all-cause mortality were compared among the groups. The hazard ratio (HR) of the number of missing teeth for all-cause mortality or each cause of mortality was analyzed using Cox proportional hazard models. According to the cause of death, the HRs for metabolic disease, digestive disease, and trauma were greater in the group with ≥ 3 missing teeth than in the no missing teeth group. The group with ≥ 3 missing teeth indicated a 1.19-fold higher HR for all-cause mortality than the no missing teeth group [95% confidence intervals (95% CIs) = 1.12–1.27, P < 0.001]. The group with 1- 2 missing teeth did not show a higher HR for all-cause mortality. In the group with 1–2 missing teeth, the HRs for mortality from mental disease and digestive disease were higher than those in the no missing teeth group. The group with 1–2 missing teeth did not show a higher HR for all-cause mortality. The number of missing teeth was linked with a higher risk of mortality. For specific causes of mortality, mortality from metabolic disease, digestive disease, and trauma was higher in the participants with the number of missing teeth.

Causes of deaths in neonates and children aged 1–59 months in Nigeria: verbal autopsy findings of 2019 Verbal and Social Autopsy study

BackgroundNigeria has one of the highest under-five mortality rates in the world. Identifying the causes of these deaths is crucial to inform changes in policy documents, design and implementation of appropriate interventions to reduce these deaths. This study aimed to provide national and zonal-level estimates of the causes of under-five death in Nigeria in the 2013–2018 periods.MethodsWe conducted retrospective inquiries into the cause of deaths of 948 neonates and 2,127 children aged 1–59 months as identified in the 2018 Nigeria Demographic and Health Survey (NDHS). The verbal autopsy asked about signs and symptoms during the final illness. The Physician Coded Verbal Autopsy (PCVA) and Expert Algorithm Verbal Autopsy (EAVA) methods were employed to assign the immediate and underlying cause of deaths to all cases.ResultFor the analysis, sampling weights were applied to accommodate non-proportional allocation. Boys accounted for 56 percent of neonatal deaths and 51.5 percent of the 1–59-months old deaths. About one-quarter of under-5 mortality was attributed to neonatal deaths, and 50 percent of these neonatal deaths were recorded within 48 h of delivery. Overall, 84 percent of the under-5 deaths were in the northern geopolitical zones. Based on the two methods for case analysis, neonatal infections (sepsis, pneumonia, and meningitis) were responsible for 44 percent of the neonatal deaths, followed by intrapartum injury (PCVA: 21 percent vs. EAVA: 29 percent). The three main causes of death in children aged 1–59 months were malaria (PCVA: 23 percent vs. EAVA: 35 percent), diarrhoea (PCVA: 17 percent vs. EAVA: 23 percent), and pneumonia (PCVA: 10 percent vs. EAVA: 12 percent). In the North West, where the majority of under-5 (1–59 months) deaths were recorded, diarrhoea was the main cause of death (PCVA: 24.3 percent vs. EAVA: 30 percent).ConclusionThe causes of neonatal and children aged 1–59 months deaths vary across the northern and southern regions. By homing on the specific causes of mortality by region, the study provides crucial information that may be useful in planning appropriately tailored interventions to significantly reduce under-five deaths in Nigeria.

The association between osteoporosis medications and lowered all-cause mortality after hip or vertebral fracture in older and oldest-old adults: a nationwide population-based study.

Background: Osteoporotic fracture is a common public-health problem in ageing societies. Although post-fracture usage of osteoporosis medications may reduce mortality, recent results have been inconsistent. We aimed to examine associations between osteoporosis medication and mortality in older adults, particularly oldest-old adults (>=85 years old).Methods: Participants aged 65 years old and older newly diagnosed with both osteoporosis and hip or vertebral fractures within 2009-2017 were recruited from the records of 23,455,164 people in Taiwan National Health Insurance Research Database (NHIRD). Osteoporosis medication exposure was calculated after the first-time ambulatory visit with newly diagnosed osteoporosis. Mortality and its specific causes were ascertained from Cause of Death Data. Patients were followed until death or censored at the end of 2018.Results: A total of 87,935 participants aged 65 years old and over (73.4% female), with a mean 4.13 follow-up years, were included. Taking medication was associated with significantly lower risk of mortality (hip fracture HR 0.75, vertebral fracture HR 0.74), even in the oldest-old adults (hip fracture HR 0.76, vertebral fracture HR 0.72), where a longer duration of taking osteoporosis medication was associated with lower all-cause mortality. Specific causes of mortality were also significantly lower for participants taking osteoporosis medication (cancer HR 0.84 in hip fracture, 0.75 in vertebral fracture; cardiovascular disease HR 0.85 in hip fracture, 0.91 in vertebral fracture).Conclusions: Osteoporosis medication after hip or vertebral fracture may reduce mortality risk in older adults, notably in oldest-old adults. Encouraging the use of post-fracture osteoporosis medication in healthcare policies is warranted.

Long-term prognosis of patients with alcohol-related liver disease or non-alcoholic fatty liver disease according to metabolic syndrome or alcohol use.

The boundary betweennon-alcoholic (NAFLD) and alcohol-related liver disease (ALD) is based on alcohol consumption. However, metabolic syndrome and alcohol use frequently co-exist. The aim of this study was to determine prognostic factors of long-term morbidity and mortality in patients with NAFLD or ALD. From 2003 to 2016, all consecutive NAFLD or ALD patients were prospectively included in this cohort study. We evaluated overall survival, specific cause of mortality and occurrence of any complication.The primary endpoint was analysed by the Kaplan Meier method, secondary endpoints were estimated by Gray test method or logistic regressions.Factors independently associated with overall mortality and morbidity were identified byamultivariate Cox model. A total of 3365 patients (1667 with ALD and 1698 with NAFLD) were included. Median follow-up was 54months (range: 30-86)and 563 subjects died. Inthe overall population, overall mortality was higher in patients with ALD (HR: 10.1 [7.57-13.3]), and with weekly alcohol consumption >7 units (HR:1.66 [1.41-1.96]). Liver-related mortality was higher in patients with ALD (HR: 11 [7.27-16.5]). IntheNAFLD group, weekly alcohol consumption >1 unit was associated with higher overall mortality (HR: 1.9 [1.1-3.4]), and weekly alcohol consumption >7 units was associated with higher overall morbidity (OR: 1.89 [1.61-2.21]). In the ALD group,the presence of metabolic syndrome was associated with higher overall (HR:1.27 [1.02-1.57]), and liver (HR: 1.47 [1.1-1.96]) mortalities, and overall (OR: 1.46 [1.14-1.88]), liver (OR: 1.46 [1.14-1.88]) morbidities. In fatty liver diseases, light alcohol consumption and metabolic syndrome are prognosis cofactors.

Self-reported cataract surgery and 10-year all-cause and cause-specific mortality: findings from the National Health and Nutrition Examination Survey

PurposeTo investigate the association of self-reported cataract surgery with all-cause and cause-specific mortality using a large-scale population-based sample.MethodsData from the 1999–2008 cycles of the National Health and Nutrition Examination Survey...

Associations between blood lead and urinary cadmium levels and mortality, and effect modification by dietary inflammatory index

BACKGROUND AND AIM: Previous studies in the US reported a high mortality risk associated with higher blood lead (BPb) and urinary cadmium (UCd) concentrations. Although the mechanisms of these metals toxicity are not completely understood, increasing oxidative stress and inflammation are suspected major pathways. In parallel, diet with a high anti-inflammatory potential may prevent from chronic inflammation. We extended the follow-up of the previous analyses and evaluated the potential modifying effect of the dietary inflammatory index (DII) in the association between BPb and UCd concentrations and all-cause and specific causes of mortality. METHODS: We used data on 15,598 adults aged ≥20 years enrolled in the NHANES-III between 1988 and 1994 and followed up through Dec 31, 2015. The DII was computed from baseline dietary intake assessed using 24-hour dietary recalls. Mortality was determined from the National Death Index records. Associations between metals concentrations and mortality were assessed using Cox regression models while controlling for confounding. Interaction terms between metals concentrations and DII were included in the models and stratified analyses across the DII groups were presented. RESULTS:Over the follow-up, 1398 participants died (1398 from heart diseases, 399 from cerebrovascular diseases, 1247 from malignant neoplasms). Each increase in blood Pb level was associated with increased mortality from all-cause (HR: 1.50, 95%CI: 1.46-1.55), heart diseases (HR: 1.64, 95%CI: 1.55-1.74), cerebrovascular diseases (HR: 1.44, 95%CI: 1.30-1.60), and from malignant (1.46, 95%CI: 1.38-1.56). There was an interaction between BPb concentration and DII for all-cause and specific causes of mortality (p 0.033 for all). Participants with lower DII scores, corresponding to a higher anti-inflammatory potential of the diet, have lower risk of mortality compared to those with higher DII. The same patterns of associations were observed for UCd. CONCLUSIONS:Our findings suggest that a higher anti-inflammatory diet may help prevent BPb and UCd adverse effects in adult. KEYWORDS: Diet, Inflammation, Mortality, CVD, Cancer, Nhanes

Physical activity and all-cause and cause-specific mortality: assessing the impact of reverse causation and measurement error in two large prospective cohorts.

Most cohort studies have only a single physical activity (PA) measure and are thus susceptible to reverse causation and measurement error. Few studies have examined the impact of these potential biases on the association between PA and mortality. A total of 133,819 participants from Nurses' Health Study and Health Professionals Follow-up Study (1986-2014) reported PA through biennial questionnaires. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for PA and mortality using different analytic approaches comparing single (baseline, simple update = most recent) versus repeated (cumulative average) measures of PA and applying various lag times separating PA measurement and time at risk. Over 3.2 million person-years, we documented 47,273 deaths. The pooled multivariable-adjusted HR (95% CI) of all-cause mortality per 10 MET-hour/week was 0.95 (0.94-0.96) for baseline PA, 0.78 (0.77-0.79) for simple updated PA and 0.87 (0.86-0.88) for cumulative average PAin the range of 0-50 MET-hour/week. Simple updated PA showed the strongest inverse association, suggesting larger impact of reverse causation. Application of 2-year lag substantially reduced the apparentreverse causation(0.85 (0.84-0.86) for simple updated PA and 0.90 (0.89-0.91) for cumulative average PA), and 4-12-year lags had minimal additional effects. In the dose-response analysis, baseline or simple updated PA showed a J or U-shaped association with all-cause mortality while cumulative average PA showed an inverse association across a wide range of PA (0-150 MET-hour/week). Similar findings were observed for different specific mortality causes. In conclusion,PA measured at baseline or with short lag time was prone to bias. Cumulative average PA showed robust evidence that PA is inversely associated with mortality in a dose-response manner.