Standardized Mortality Research Articles

Analysis on the trend of liver cancer morbidity and mortality in certain district, Suzhou City, Jiangsu Province, 2017 to 2019

Objective: To analyze the trend of liver cancer morbidity and mortality among residents with household registration in certain District, 2017 to 2019. Methods: The crude morbidity and mortality rate of males and females in the whole population were calculated by using the relevant data from the certain District Cancer Registry and Report System and the Cause of Death Surveillance System. The standardized morbidity and mortality rate were calculated according to the age structure of 2000 National Demographic Census and Segi's world population, respectively. Trend in liver cancer morbidity and mortality were evaluated using percent change (PC), annual percentage change, and case-number-weighted annual percent change. Age-specific rates were used to analyze the epidemic trend of liver cancer with age. Results: The crude morbidity rate of liver cancer in the whole population (male and female) of the certain district from 2017 to 2019 were 18.86/100 000, 26.05/100 000 and 11.90/100 000 respectively, and the crude mortality rates were 21.20/100 000, 29.29/100 000 and 13.38/100 000 respectively. The crude morbidity and mortality rate of liver cancer among male showed a downward trend (PC=-16.77% and -20.15% respectively). The crude morbidity and mortality rate of liver cancer among female showed inconsistent changes; however, the crude morbidity rate showed a downward trend, and the crude mortality rate first increased and then decreased (PC=-19.42% and -0.30% respectively). Liver cancer morbidity and mortality rate in male after the age of 30 were increased with age. The two key points of accelerated growth were around the age of 65 and 75, and the peak of morbidity (130.78/100 000) and mortality (201.96/100 000) were after the age of 80. The morbidity and mortality rate were significantly lower in female than those of male aged 60; however, after the age of 65, the morbidity rate was increased rapidly and gradually approached as that of male. After the age of 80 (the peak morbidity and mortality were 104.40/100,000 and 132.87/100,000, respectively), male were about twice as high as those female aged between 75 and 79. Conclusion: Morbidity and mortality rate of liver cancer in the certain District showed an overall downward trend from 2017 to 2019, but it increased with age, and the disease burden was relatively high among the elderly population. Liver cancer mostly occurred in male, so the prevention and control of liver cancer epidemics in middle-aged and elderly should be actively monitored.

Trends in Thoracic Aortic Aneurysm Hospital Admissions, Interventions, and Mortality in England between 1998 and 2020: An Observational Study

To assess trends in thoracic aortic aneurysm (TAA) hospital admissions, interventions, and aneurysm related mortality (ARM) in England, and examine the impact of endovascular repair on mortality for the years 1998 to 2020. Hospital admission and operative approach (thoracic endovascular aortic repair, [TEVAR] or open surgical repair) using Hospital Episodes Statistics, and ARM data from the Office for National Statistics for England standardised to the 2013 European Standard Population were analysed using linear regression and Joinpoint regression analyses. ARM was compared between the pre-endovascular era (1998 - 2008) and the endovascular era (2009 - 2019). A rising trend in hospital admission incidence has been observed, mainly due non-ruptured admissions (4.11 per 100 000 in 1998; 95% confidence interval (CI) 3.71 - 4.50 to 12.61 per 100 000 in 2020; 95% CI 12.00 - 13.21 in 2020; r2= .98; p < .001). Operative interventions increased mainly due to an increase in TEVAR (2.15 per 100 000; 95% CI 1.91 - 2.41 in 2020 vs. 0.26 per 100 000; 95% CI 0.16 - 0.36 in 2006; r2= .90; p < .001). Reductions in ARM from TAA were observed for males and females, irrespective of age and rupture status. The greatest reduction in ARM in the endovascular era was observed in females aged > 80 years with ruptured disease (15.26 deaths per 100 000 vs. 9.50 deaths per 100 000; p < .001). A significant increase in hospital admissions for non-ruptured TAA has been observed in the last 23 years in England, paralleled by a shift towards endovascular repair, and significant declining trends in ARM, irrespective of sex and age. The significant reductions in age standardised death rates from ruptured and non-ruptured TAA in the endovascular era, particularly for females aged > 80 years with ruptured disease, affirm the positive impact of an endovascular approach to TAA.

Analysis on liver cancer mortality and cause eliminated life expectancy in key areas of 4 provinces, China, 2008-2018

Objective: To explore the changes of liver cancer mortality and the effect of liver cancer on life expectancy in key areas of four provinces in China from 2008 to 2018 and provide the basis for the evaluation of comprehensive prevention and control of cancer and promotion of the rational allocation of health resources. Methods: Based on the national cause-of-death surveillance in key areas of the 4 provinces from 2008 to 2018, we analyzed the mortality of liver cancer, cause eliminated life expectancy (CELE) and potential gains in life expectancy (PGLEs). Software Joinpoint 4.9.0.0 was used to calculate the average annual percentage change (AAPC). Arriaga's decomposition method was used to estimate the contribution of the changes of liver cancer mortality in each age group to life expectancy. Results: The standardized mortality of liver cancer in key areas of the 4 provinces showed a downward trend from 2008 to 2018 (AAPC=-4.37%, P<0.001). The changes of liver cancer mortality had a positive effect on the increase of life expectancy, with a contribution value of 0.240 years and a contribution degree of 5.62%. The positive effect was greatest in age group 45-49 years (0.041 years, 0.96%), and the negative effect was greatest in age group 50-54 years (-0.015 years, -0.35%). Compared with 2008, the life expectancy increased by 4.27 years (AAPC=0.59%, P<0.001), the liver cancer CELE increased by 4.20 years (AAPC=0.58%, P<0.001), the PGLEs decreased by 0.07 years (AAPC=-0.62%,P<0.001), and life loss rate decreased by 0.13% (AAPC=-1.18%, P=0.001). The liver cancer PGLEs increased in Yongqiao district, Anhui province (0.09 years), and decreased in other districts (counties), with the largest decline was in Fugou county, Henan province (-0.21 years). Conclusions: From 2008 to 2018, the standardized mortality rate of liver cancer in key areas of the 4 provinces decreased gradually, contributing to the growth of life expectancy. The life loss caused by liver cancer decreased gradually, but the PGLEs varied with districts (counties).

Mortality from acute types of coronary artery disease in men and women in Russia in 2015 and 2019

Aim. To comparison standardized mortality rates (SMRs) among men and women from acute types of coronary artery disease (CAD) and their regional variability in Russia in 2015 and 2019.Material and methods. The Federal State Statistics Service (Rosstat) data on the population and the number of deaths from CAD based on the brief nomenclature of death causes using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in 2015 and 2019 in 82 Russian subjects are presented. For each sex, SMR was calculated for acute (primary) and recurrent myocardial infarction (MI) (I21-I22), for other types of acute CAD (I20, I24.1-9), as well as average regional SMRs, coefficient of variation (CV).Results. The average regional SMR for each of the acute CAD types among men was significantly higher than among women both in 2015 (p&lt;0,0001) and in 2019 (p&lt;0,0001). For the period of 2015-2019 in men, SMR from all acute CAD types decreased by 22,5%, from acute MI — by 7,4%, from recurrent MI — by 22,2% and from other acute CAD types — by 25,8%, while in women, these figures were 11,8, 8,8, 19,0 and 29,7%, respectively. The men-to-women SMR ratio in 2015 and 2019 were 2,79/2,72 for all acute CAD types, 2,58/2,55 for all MI cases, and 3,36/4,18 for other acute CAD types. The minimum CV values (41,9% among men in 2019 and 44,7% among women in 2015) were recorded for acute MI, while the maximum CV values (129,3% among men and 158,6% among women in 2019) for other acute CAD types.Conclusion. Over the period of 2015-2019, the average regional SMR from acute CAD types in men and women decreased in Russia, with a more noticeable decrease for men. Greater regional variability in mortality, especially for other acute CAD types, poses the problem of finding organizational, methodological and strategic solutions to clarify the criteria for coding and refine the logistics schemes for providing healthcare for doubtful or uncertain diagnostic signs of acute CAD.

Performance of Pediatric Risk of Mortality III and Pediatric Index of Mortality III Scores in Tertiary Pediatric Intensive Unit in Saudi Arabia.

ObjectiveTo assess the performance of the Pediatric Risk of Mortality III (PRISM III) and Pediatric Index of Mortality III (PIM III) indices in a tertiary pediatric intensive care unit (PICU) in Saudi Arabia and to identify the factors affecting the observed performance.DesignRetrospective, single-center study using data collected from the Virtual Pediatric Systems web-based database.SettingKing Fahad Medical City PICU, Saudi Arabia.PatientsAll pediatric patients <14 years of age admitted between 1 January 2015, and 31 December 2019.InterventionsComparison of PRISM III and PIM III performances in predicting mortality across different age groups, disease categories, and resuscitation decision statuses.MeasurementsNormality of distribution was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests. Patient characteristics were compared between survivors and non-survivors. The medians and ranges were calculated for continuous data, whereas frequencies and percentages were used for nominal data. The Mann–Whitney U test, Kruskal–Wallis test, and Chi-square test were used to compare the characteristics of survivors and non-survivors.Main ResultsThere was a significant difference between the predicted mortality and observed mortality in both the PRISM III and PIM III. Better discrimination was found after excluding do-not-resuscitate (DNR) patients. The worst calibration and discrimination were recorded for infants <12 months of age. The PRISM III performed significantly better in patients with metabolic/genetic and central nervous system illnesses. Non-DNR patients had a lower standardized mortality rate using the PRISM III and PIM III. The PRISM III and PIM III indices performed better in patients who died within the first week of admission.ConclusionThese models had sufficient discrimination ability and poor calibration. Since they were designed for particular patient characteristics and PICUs, further testing in different environments is necessary before utilization for planning and assessing performance. Alternatively, new models could be developed which are suitable for local PICUs.

Causes of death following small cell lung cancer diagnosis: a population-based analysis

PurposeTo examine the distribution of causes of death (CODs) in patients with small cell lung cancer (SCLC).MethodsPatients diagnosed with SCLC were identified from the Surveillance, Epidemiology, and End Results Program database during 2004–2015. Standardized mortality rates (SMRs) were performed for each COD to present changes in risk for a particular COD following SCLC diagnosis.ResultsA total of 44,506 patients diagnosed with SCLC were identified in this study, and 42,476 patients died during the follow-up. Of total deaths, 69.5% occurred within the first years after diagnosis, 26% occurred from 1 to 3 years, and 4.5% individuals survived longer than 3 years. In addition, 88.7% of deaths were caused by SCLC, followed by non-cancer causes (7.1%) and other cancers (4.2%). Moreover, non-cancer CODs increased from 6.3 to 30% over time after 3 years of diagnosis. As for non-cancer CODs, cardiovascular diseases, COPD, and septicemia were the most common in SCLC.ConclusionNon-cancer CODs, such as cardiovascular events, COPD and septicemia, contribute to a considerable proportion of deaths among long-term SCLC survivors, supporting the involvement of multidisciplinary care for the follow-up strategy in SCLC.

Trends in cervical cancer mortality rate in women aged 20 years and older in Brazil from 2005 to 2019

ABSTRACT The objective of this study was to analyze the trend of the age standardized mortality rate (ASMR) for cervical cancer in Brazil between 2005 and 2019 and investigate its association with the Socio-demographic Index (SDI), an indicator of development status strongly correlated with health outcomes. We conducted an ecological time-series study using data from the Mortality Information System of the Ministry of Health. Trend analyses were performed using Prais–Winsten regression. The association between the SDI and ASMR was evaluated using simple linear regression. Between 2005 and 2019, 105,472 deaths from cervical cancer were recorded. The ASMR was 10.18 deaths/100,000 women. The North region presented the highest magnitude (20.23 deaths/100,000 women) and the Southeast region the lowest (7.83 deaths/100,000 women). We observed a decreasing trend of the ASMR for cervical cancer in the country. The Northeast, Central-West and Southeast regions showed a decreasing trend; South stationary trend and the North region showed an increasing trend. Most of the states showed a stationary or decreasing trend. It was found that the SDI was inversely associated with the ASMR and Annual Percent Change (APC). In conclusion, we observed a decreasing trend of ASMR for cervical cancer and inverse association with SDI in Brazil.

Burden of disease for stroke attributable to ambient PM_(2.5) exposure in China 1990-2019

To analyze the trend of disease burden of stroke attributable to ambient PM_(2.5) exposure among Chinese residents from 1990 to 2019. On the basis of the data of global burden of disease study 2019(GBD 2019) in China, the burden of stroke attributable to the ambient PM_(2.5) exposure in China from 1990 to 2019 were analyzed using the number and rate of deaths, disability adjusted life year(DALY), DALY rate and its standardized rate and estimated annual percentage change(EAPC). In 2019, 24.7% of stroke deaths among people aged 15 years and above in China were due to ambient PM_(2.5) exposure. Compared with 1990, in China the number of stroke deaths and mortality attributable to ambient PM_(2.5) exposure increased to 541 800 and 39.08/100 000, respectively in 2019, and the attributable DALY and DALY rates increased by 2.07% and 1.56%, respectively, in 2019. And the attributable DALY and DALY in males were higher than those in females, and they were all increasing with aging. The attributed standardized mortality and DALY rates in China were higher than those of the global and different socio-demographic index(SDI) regions, and showed an increasing trend, with EAPCs of 1.11(95% CI 0.47-1.75) and 1.11(95% CI 0.53-1.69), respectively. The burden of stroke disease due to ambient PM_(2.5) exposure is heavy in China, with differences in gender and age, and is higher than those of the global and different SDI regions.

Cardiovascular mortality in Central and Eastern Europe: differences and similarities

Objective. To identify differences and similarities in trends and patterns of cardiovascular mortality in Central (Romania and Poland) and Eastern (Moldova and Ukraine) European countries before and after the political transition. Material and methods. The mortality series reconstructed according to ICD-10 since 1970 for Moldova, Ukraine and Poland and since 1980 for Romania were used. Directly standardized death rates by sex, age and detailed cardiovascular disease were computed. Results. After a long period of stagnation or rise, cardiovascular mortality started declining after 1991 in Poland, 1995 in Moldova, 1997 in Romania and 2005 in Ukraine. The progress in Romania and Poland was associated with both heart diseases and cerebrovascular diseases. In Moldova and Ukraine, the recent improvements were primarily related to cerebrovascular diseases. Compared to Central Europe, the quality of codification of heart diseases was found poor in Eastern Europe. Conclusions. The lack of effective control of mortality from heart diseases is the major public health problem in Moldova and in pre-war Ukraine. Romania and Poland follow very similar mortality patterns and trends, though with a certain time lag.

Aplastic Anemia-Related Mortality in Brazil, 2000-2018

In Brazil, 2000 to 2018, 35,523 deaths related to AA occurred, 13.629 (38.4%) as underlying cause, and 21,894 (61.6%) as associated (non-underlying) cause of death. Average standardized mortality rates were for underlying, associated and all mentions cause deaths, respectively, 4.02, 6.40 and 10.42 deaths per million population. The overall mean and median ages at death for all mentions were, respectively, 51.5 (± 24.7) and 55.5 (range 32.5-71.5) years.

Impact of adherence to CKD-MBD guidelines on mortality among Japanese dialysis patients: an ecological study.

This study evaluated the association between prefecture-level achievement of chronic kidney disease-mineral and bone disorder (CKD-MBD) parameter targets and mortality in Japanese dialysis patients. We conducted an ecological study of all prefectures in Japan using data from the Japanese Society of Dialysis Therapy and National Vital Statistics between 2016 and 2017. We calculated adherence rates to recommend target ranges for CKD-MBD parameters, including phosphate, corrected calcium, and parathyroid hormone (PTH), and explored associations of these rates with prefecture-specific standardized mortality rates (SMRs) among the general population and among prevalent dialysis patients using bivariate association analysis and structural equation modeling. Prefecture-level adherence to the target phosphate range was significantly and negatively associated with prefecture-specific SMRs in men (standardized estimate (β) = -0.61, p < 0.001) and women (β = -0.41, p < 0.001). However, prefecture-level adherence to the target corrected calcium range was significantly and negatively associated with prefecture-specific SMRs only in men (β = -0.28, p = 0.01). Meanwhile, prefecture-level adherence to the target PTH range was significantly and positively associated with prefecture-specific SMRs in men (β = 0.23, p = 0.04). Prefecture-level SMRs of females in the general population had a significant impact on prefecture-level SMRs of female dialysis patients (β = 0.27, p = 0.03). The models explained 52% of variance in SMR for men and 33% for women. A higher prefecture-level achievement rate of the target phosphate range recommended by the Japanese CKD-MBD guidelines was associated with a lower prefecture-specific SMR in the Japanese dialysis population.

Age and COVID-19 mortality in the United States: a comparison of the prison and general population

PurposeThe USA has a rapidly aging prison population that, combined with their poorer health and living conditions, is at extreme risk for COVID-19. The purpose of this paper is to compare COVID-19 mortality trends in the US prison population and the general population to see how mortality risk changed over the course of the pandemic. The authors first provide a national overview of trends in COVID-19 mortality; then, the authors assess COVID-19 deaths among older populations using more detailed data from one US state.Design/methodology/approachThe authors used multiple publicly available data sets (e.g. Centers for Disease Control and prevention, COVID Prison Project) and indirect and direct standardization to estimate standardized mortality rates covering the period from April 2020 to June 2021 for the US and for the State of Texas.FindingsWhile 921 COVID-19-related deaths among people in US prisons were expected as of June 5, 2021, 2,664 were observed, corresponding to a standardized mortality ratio of 2.89 (95%CI 2.78, 3.00). The observed number of COVID-19-related deaths exceeded the expected number of COVID-19-related deaths among people in prison for most of the pandemic, with a substantially widening gap leading to a plateau about four weeks after the COVID-19 vaccine was introduced in the USA. In the state population, the older population in prison is dying at younger ages compared with the general population, with the highest percentage of deaths among people aged 50–64 years.Research limitations/implicationsPeople who are incarcerated are dying of COVID-19 at a rate that far outpaces the general population and are dying at younger ages.Originality/valueThis descriptive analysis serves as a first step in understanding the dynamic trends in COVID-19 mortality and the association between age and COVID-19 death in US prisons.

Impact of the COVID-19 crisis on the mortality profiles of the foreign-born in France during the first pandemic wave

BackgroundImmigrants in Western countries have been particularly affected by the COVID-19 crisis. ObjectiveWe analysed excess mortality rates among the foreign-born population and changes in their distinctive mortality profiles (“migrant mortality advantage”) during the first pandemic wave in France. Data and methodsDeaths from all causes in metropolitan France from March 18 to May 19, 2020 were used, with information on sex, age, region of residence and country of birth. Similar data from 2016 through 2019 were used for comparisons. ResultsDuring the pre-pandemic period (2016–2019), immigrant populations (except those from Central and Eastern Europe) had lower standardized mortality rates than the native-born population, with a particularly large advantage for immigrants from sub-Saharan Africa. In the regions most affected by COVID-19 (Grand-Est and Île-de-France), the differences in excess mortality by country of birth were large, especially in the working-age groups (40–69 years), with rates 8 to 9 times higher for immigrants from sub-Saharan Africa, and about 3 to 4 times higher for immigrants from North Africa, from the Americas and from Asia and Oceania relative to the native-born population. The relative overall mortality risk for men born in sub-Saharan Africa compared to native-born men, which was 0.8 before the pandemic, shifted to 1.8 during the first wave (0.9 to 1.5 for women). It also shifted from 0.8 to 1.1 for men from North Africa (0.9 to 1.1 for women), 0.7 to 1.0 for men from the Americas (0.9 to 1.3 for women), and 0.7 to 1.2 for men from Asia and Oceania (0.9 to 1.3 for women). ConclusionOur findings shed light on the disproportionate impact of the first wave of the pandemic on the mortality of populations born outside Europe, with a specific burden of excess mortality within the working-age range, and a complete reversal of their mortality advantage.

Levels and trends of significant injury-caused deaths in the Chinese population, 2010-2019

Objective: To analyze the level and changing trend of significant injury-caused deaths in the Chinese population from 2010 to 2019 and provide evidence for related intervention. Methods: Data on notable injury-caused deaths in areas under National Disease Surveillance Programs were collected from 2010 to 2019. Crude and standardized mortality rates of four significant injuries were calculated to describe the status of injury-caused deaths. The trend of changes in standardized mortality rates was analyzed using the Joinpoint regression model. Results: The overall trend of standardized mortality rate on an injury during 2010-2019 was consistently decreasing (AAPC=-3.5%, P<0.001) while the general direction of accidental fall standardized mortality rate was increasing (AAPC=1.0%, P=0.104). The standardized mortality rate for significant injuries fluctuated with age, increasing for those aged 50-79 years (AAPC=3.9% for the 50- group, AAPC=5.6% for the 60- group, and AAPC=4.6% for the 70- group, all P<0.001). The standardized mortality rates for all major injuries were higher in males than those in females, with road traffic accidents and drowning declining faster in males than that in females (AAPC=-5.3% in the male road traffic accident group, AAPC=-3.8% in the female road traffic accident group, AAPC=-4.0% in the male drowning group, AAPC=-3.5% in the female drowning group, all P<0.001), and suicide and sequelae declining faster in females than that in males (AAPC=-6.4% in female, AAPC=-4.7% in male, all P<0.001). The standardized mortality rate for significant injuries was higher in rural than that in urban areas and decreased faster than that in urban areas. The central region had the highest standardized mortality rate for suicide and sequelae. The western part had the highest standardized mortality rates for road traffic accidents, accidental falls, and drowning, with the fastest decline in road traffic accidents and drowning (AAPC=-5.3% in the road traffic accident group and AAPC=-5.3% in the drowning group, both P<0.001). Conclusions: The mortality rate from significant injuries in the Chinese population showed a continuous downward trend from 2010 to 2019, with a rebound in the standardized mortality rate from accidental falls in recent years among the elderly, males, rural residents, and central and western regions being the focus of future prevention and control.

Long term Follow up Study of Phone Contacts in Catalonia

We’ll present the Catalan experience of follow up by phone contats of suicide attempters, and the results up to 10 years. We develop a Suicide Prevention Program that started with the EAAD project in 2008 in a 0,5 M people catchment area, later generalized to 7,5 M people through the Catalonia Suicide Risk Code (SRC-Cat). The SRC-cat is a real-time registry of suicide attempts (65% women) that allows immediate attention and telephone follow-up and ensures continuity of care for 12 months. To evaluate the effectiveness of our telephone management plan, we conducted two types of analysis; a) 12-month short-term analysis: non-randomised controlled analysis of suicide reattempts comparing two cities (2007-2008); b) 8-year long-term analysis with the evolution of suicide rates (men and women) between our area, and two other cities (territorial differences and over time from 2010 to 2017). Results: a) the SRC-Cat in our catchment area reduced significantly the proportion of people who re-attempt suicide by 57% over 12 months (from 14% to 6 %); b) we found lower standardized suicide death rate among women in our catchment area (both territorially and over time). Conclusions: a) Short-term telephone management (12-month), ensuring chain of care after hospital discharge, reduces more than 50% the proportion of patients who re-attempt; b) Long-term telephone management (8-year) of suicide attempt survivors over 12 months, significantly reduces suicide deaths in women only (64% of patients in telephone follow-up are women).DisclosureNo significant relationships.

Trends in incidence and mortality in kidney cancer patients over the last 25 years in Reggio Emilia Province of the North Italy.

e22511 Background: In the last years, the incidence of renal cell carcinoma (RCC) has rapidly increased in Western countries. From the first decade of this century the new drugs (tyrosine kinase inhibitors, immune checkpoint inhibitors) have markedly improved the clinical outcomes of these patients (pts). The increase in survival has allowed to observe the emergence of other illness including cardiovascular disease (CVD). The aim of our study is to examine the trend in incidence and mortality for tumors and for CVD in RCC pts of Reggio Emilia Province. Methods: All cases of RCC recorded from 1996 to 2020 in Reggio Emilia Cancer Registry (RE-CR) were included. The RE-CR covers a population of 529,609 inhabitants. It is considered a high-quality CR thanks high histological confirmation and data updated to 2020. Kidney cancer cases were defined based on the ICD-O-3 as topography C64.9. The causes of death were classified as kidney cancer, other cancers, CVD (ICD-10 I00-I99). Mortality data were selected based on classification C64 used in the ICD-O-10. Descriptive analyses of patient characteristics with kidney cancer were performed by number of deaths for all causes, for CVD, for kidney cancer and for other cancer. For difference within these groups, we performed one-way Anova test. Analyses were performed using STATA 16.1 software. Trends over time were analyzed by calculating the annual percent change (APC) in age-standardized rates using Joinpoint regression. Results: 2,331 pts with RCC were identified, mainly males (1,504 cases) and aged 60-79 years (1,240 cases). There were 1,257 deaths, with no differences by sex but with a significant gradient according to age (12.1% among young people and 80.4% among over 80 years). The standardized incidence rate showed an increase in males between 1996 and 2011 (APC = 2.3) and then decreased. In females the trend appeared stable. Mortality dropped significantly among those who received diagnosis in the recent years (79.4% in 1996-2000 vs 25.2% in 2016-2020). The standardized mortality rate decreased both in males (APC = -3.3%) and in females (APC = -4.5%). Comparing the same periods, kidney cancer specific mortality decreased from 81.8% to 43.7% (p &lt; 0.01). The opposite occurred for CVD mortality with an increasing not-statistically significant trend. The risk of CVD mortality increased as we move away from the diagnosis (from 6.2% to 27.5%, p &lt; 0.01). The same trend was observed for other causes of death (from 12.6% to 32.1%, p &lt; 0.01). Conclusions: The percentage of mortality from RCC has decreased over the years, while that from CVD has slightly increased starting from 2009. These data may be related to the introduction of new active therapies with a significantly reduction in mortality in the first two years from diagnosis and a longer survival. Dedicated studies are required to define the impact of cancer treatment on CVD risk in long-term cancer survivors.

1089-P: Importance of Cardiorenal Complications for Prognosis in Persons with Type 1 Diabetes and Controls

Background: Historically, life expectancy in persons with type 1 diabetes (T1D) has been shorter than the general population, but earlier studies did not stratify patients according to cardiorenal complications. Methods: T1D persons were identified in the Swedish National Diabetes Registry (n=45,575) and compared with matched controls from the general population (n=220,141) . Mortality rates from 2002 to 20were estimated in persons with T1D overall and after stratification for prevalent cardiovascular and renal disease. Results: In persons with T1D, mean age was 32.4 years and 44.9% were women. Age- and sex- adjusted mortality rates decreased over time in both groups but remained significantly higher in those with T1D during 2017 to 2019. In T1D persons ≥45 years without previous renal or cardiovascular complications (approximately 50% of persons in this age group) similar standardized mortality rates were observed, over time compared with controls, with slightly lower mortality in T1D persons during the last period, 5.55 (95% CI 4.51-6.60) vs. 7. (95% CI 6.75-7.40) deaths per 1,000 person years (Figure) . Conclusion: Excess mortality persisted over time in persons with T1D, largely in patients with cardiorenal complications. Improved secondary prevention with a focus on differentiated treatment is needed to close the gap in mortality for persons with T1D. Disclosure S. Hallström: None. M.O. Wijkman: None. J. Ludvigsson: Advisory Panel; Dompé. Research Support; Diamyd Medical. M.A. Pfeffer: Consultant; AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance, Corvidia Therapeutics, GlaxoSmithKline plc., Lexicon Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Peerbridge, Sanofi. Research Support; Novartis Pharmaceuticals Corporation. Other Relationship; DalCor Pharmaceuticals, National Heart, Lung, and Blood Institute. A. Rosengren: None. M. Lind: Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk. Research Support; Eli Lilly and Company, Novo Nordisk. Funding ALF [ALFGBG-717211] and [ALFGBG-966173], grants from the Novo Nordisk foundation, Swedish Heart and Lung Foundation [20180589], [20210679], Swedish Research Council [2018-02527] [VRREG 2019-00193], and the Gothenburg Society of Medicine.

Trends in mortality from aortic dissection analyzed from the World Health Organization Mortality Database from 2000 to 2017

BackgroundWe assessed trends in aortic dissection (AD) death rates in 23 countries from 2000 to 2017. MethodsWe extracted AD mortality data for countries with high usability data from the World Health Organization (WHO) Mortality Database and from the Center for Disease Control (CDC) WONDER Database for the United States of America (USA). Age Standardized Death Rates (ASDRs) per 100,000 population were computed. Trends were assessed by locally weighted scatter plot smoother (LOWESS) regression. ResultsBetween 2000 and 2017, ASDRs from AD decreased in Australia, Belgium, Croatia, Denmark, France, Italy, New Zealand, Norway, Sweden, the United Kingdom, and the USA for both sexes. Increasing AD mortality was observed in Austria, Czech Republic, Germany, Hungary, Israel, and Japan for both sexes. The largest absolute increases in ASDR were in Japan for men (+1.59) and women (+1.11). The largest percentage decreases were in Norway for men (−0.91) and in New Zealand (−0.6) for women. In 2017, the highest mortality rates were in Japan for both sexes (3.22 and 2.09, respectively). The lowest ASDR was in Kyrgyzstan for both sexes (0.16 and 0.10, respectively). ASDRs for AD in 2017 were higher for men than women in all countries included. Spain had the greatest difference between the gender's mortality rates with a 2.71-fold higher mortality average rate in men. ConclusionWe identified an overall decrease in AD mortality in most included countries, while an increase was noted in other countries including Israel and Japan.

DPQL: a lossless distributed algorithm for generalized linear mixed model with application to privacy-preserving hospital profiling.

ObjectiveTo develop a lossless distributed algorithm for generalized linear mixed model (GLMM) with application to privacy-preserving hospital profiling.Materials and MethodsThe GLMM is often fitted to implement hospital profiling, using clinical or administrative claims data. Due to individual patient data (IPD) privacy regulations and the computational complexity of GLMM, a distributed algorithm for hospital profiling is needed. We develop a novel distributed penalized quasi-likelihood (dPQL) algorithm to fit GLMM when only aggregated data, rather than IPD, can be shared across hospitals. We also show that the standardized mortality rates, which are often reported as the results of hospital profiling, can also be calculated distributively without sharing IPD. We demonstrate the applicability of the proposed dPQL algorithm by ranking 929 hospitals for coronavirus disease 2019 (COVID-19) mortality or referral to hospice that have been previously studied.ResultsThe proposed dPQL algorithm is mathematically proven to be lossless, that is, it obtains identical results as if IPD were pooled from all hospitals. In the example of hospital profiling regarding COVID-19 mortality, the dPQL algorithm reached convergence with only 5 iterations, and the estimation of fixed effects, random effects, and mortality rates were identical to that of the PQL from pooled data.ConclusionThe dPQL algorithm is lossless, privacy-preserving and fast-converging for fitting GLMM. It provides an extremely suitable and convenient distributed approach for hospital profiling.

Trends in obesity-related cancer burden in Czechia.

Obesity is amajor lifestyle risk factor that contributes greatly to the burden of disease, including cancer. Overweight and obesity have shown association with several types of cancer. As Czechia is one of the most overweight countries in Europe, and has high cancer mortality, this study aims to investigate the country's long-term burden of obesity-related cancer. Using the Czech National Cancer Register and the NCD Risk Factor Collaboration (NCD-RisC), standardized incidence and mortality rates were calculated for 12types of cancer related to obesity for the years 1985-2018. Population attributable fractions (PAF) were calculated. Finally, the standardized attributable rates were calculated from the standardized incidence and mortality rates and the PAFs. Approximately 11.0% of selected cancer cases in the male population and 12.3% in the female population were attributable to overweight and obesity in 2018. Since the beginning of the millennium, obesity attributable cancer mortality has dropped, while incidence has remained constant. The incidence throughout the whole period was almost twice as high (18.7cases per 100,000 population in 2018) in women than in men (10.9cases per 100,000 population in 2018). Obesity-related cancer mortality in Czechia has declined in the last two decades, but the incidence has remained constant. Given the increasing prevalence of overweight and obesity in western countries, this issue needs to be prioritized in future healthcare and policy making.