Standardized Mortality Research Articles

Mortality from mental disorders and suicide in male professional American football and soccer players: A meta-analysis.

To determine the risk of mortality from mental disorders and suicide in professional sports associated with repeated head impacts. A systematic search was performed in PubMed, Web of Science, Scopus, and SPORTDiscus (since inception to June 8, 2021) to find studies comparing the incidence of mortality from mental disorders or suicide in former or active professional athletes of sports characterized by repeated head impacts vs athletes with no such exposure or the general non-athletic population. Seven retrospective studies of moderate-to-high quality that included data from boxers and from basketball, ice hockey, soccer, and National Football League (NFL) players, respectively (total=27477 athletes, 100% male) met all inclusion criteria. Former male NFL players (n=13217) had a lower risk of mortality from mental disorders (standard mortality rate [SMR]=0.30; 0.12-0.77; p=0.012) and suicide (SMR=0.54; 0.37-0.78; p<0.001) than the general population. This finding was also corroborated in male soccer players (n=13,065; SMR=0.55; 0.46-0.67; p<0.001). Male athletes participating in sports associated with repeated head impacts (n=18,606) had also a lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality (all p<0.01) than the general population. Participation of male athletes in American football or soccer at the professional level might confer a certain protective effect against mortality from mental disorders or suicide, besides its association with a lower risk of all-cause, CVD, or cancer-related mortality.

Exposure to air pollution, blue and green spaces and cause-specific mortality in Greece: An ecological study

BACKGROUND AND AIM: Previous studies have documented the effects of long-term exposure to ambient particulate pollution on mortality outcomes, while recently there is growing interest in the effects of green and blue spaces and their possible synergistic effects. We investigated the association of exposure to air pollution, green and blue spaces with cause-specific mortality in Greece using an ecological study design. METHODS: We collected socioeconomic and cause-specific mortality data for 1,035 Municipal Units (MU) from the 2011 Census. Annual fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) concentrations for 2010 were predicted at 100x100m grids by hybrid LUR models and a weighted average based on the built-up area percentage of each MU was estimated. The normalized difference vegetation index (NDVI) and the percentage of water bodies were used to assess exposure to green and blue spaces. We applied single and two-exposure Poisson regression models on standardized mortality rates accounting for spatial autocorrelation. RESULTS:PM2.5 was associated with increased mortality from cardiovascular and respiratory causes (Relative Risk (RR): 1.10 and 1.11, per 3.34 μg/m3 respectively), ischemic heart disease (RR: 1.05), cerebrovascular diseases (RR: 1.14) and also from diseases of the nervous system (RR: 1.14). Both BC and NO2 were associated with cardiovascular and cerebrovascular mortality. No associations with O3 were found. NDVI was associated with lower cause-specific mortality (RR: 0.90; 0.92; 0.91 per 0.16 for chronic obstructive pulmonary disease, respiratory mortality and mortality from diseases of the nervous system, respectively), while we did not find any association between exposure to blue spaces and mortality. Estimates were mostly robust to co-exposure adjustment. CONCLUSIONS:Our results support independent associations of air pollution and greenness with mortality. Further research is needed to investigate the role of blue spaces and the possible complex interactions between components of the physical environment. KEYWORDS: Air pollution, Blue space, Green space, Long-term exposure, Mortality

Medium and long-term mortality effects of an anthropogenic earthquake: a difference in difference analysis

BACKGROUND AND AIM: The moment magnitude (Mw) of 5.4 earthquake occurred in Pohang City on 15 November 2017. The earthquake and its aftershocks caused the most damage in Korea since the seismic observations began in 1905, and were estimated to be associated with a fluid injection activity at the Pohang geothermal plant. The aim of this study is to estimate the medium and long-term mortality effects of the 2017 Pohang City earthquake. METHODS: Mortality and population data were archived from Korean Statistical Office and cause-specific age standardized mortality rates were calculated. We selected Jeonju and Jeju cities as controls, which are similar in population size but located 200km and 370km away from Pohang City. We divided the study period into 45 weeks before (reference) and after (period 1:0-14 weeks; period 2: 15-29 weeks; period 3:30 to 45weeks) the earthquake and used difference-in-difference analysis to estimate how earthquake affect daily mortality rate of Pohang City. RESULTS:Non-accidental, respiratory, and pneumonia morality rates of Pohang City have increased around 10 weeks after the earthquake. Compared to Jeonju City, we found increased risks (RR, 95% CI) of non-accidental (Period 2: 1.12 (0.98, 1.27)) and pneumonia (Period 1: 1.61 (1.11, 2.35); Period 2: 1.71 (1.16, 2.54)) mortalities in Pohang City after the earthquake. Compared to Jeju City, we found increased risks of non-accidental (Period 2: 1.10 (0.96, 1.26)), respiratory (Period 2: 1.47 (1.04, 2.07)) and pneumonia (Period 1: 1.52 (1.01, 2.31); Period 1: 1.64 (1.06, 2.54)) mortalities in Pohang City after the earthquake. The effects were greater in elderly population (aged over 60). CONCLUSIONS:We found increase in non-accidental, respiratory, and pneumonia mortalities in Pohang City after the 2017 earthquake. Follow-up studies with health insurance data of Pohang City residents may confirm our study findings. KEYWORDS: earthquake, mortality, difference-in-difference, anthropogenic, health effect

Regionales Monitoring von Infektionen mittels standardisierter Fallfatalit\xe4tsraten am Beispiel von SARS-CoV-2 in Bayern

ZusammenfassungHintergrundKarten zur zeitlichen Entwicklung der regionalen Verteilung einer gesundheitsbezogenen Maßzahl ermöglichen public-health-relevante Bewertungen des Gesundheitsgeschehens.Ziel der ArbeitDie Arbeit führt das Konzept der standardisierten Fallfatalitätsrate (sFFR) ein. Sie beschreibt das Verhältnis der regionalen Abweichung in der Mortalität zur regionalen Abweichung im dokumentierten Infektionsprozess. Die regionalen sFFR-Werte werden in Karten dargestellt und die darin beobachtete zeitlich variierende regionale Heterogenität interpretiert.Materialien und MethodenDie regionale sFFR ist der Quotient der regionalen standardisierten Mortalitäts- und Fallrate. Sie wird mittels eines bivariaten Modells geschätzt. Die in Karten dargestellten sFFR-Werte basieren auf den SARS-CoV-2-Meldedaten aus Bayern seit Anfang April 2020 bis Ende März 2021. Es werden 4 Quartale (Q2/20, Q3/20, Q4/20, Q1/21) betrachtet.ErgebnisseIn den betrachteten Quartalen liegen die bayerischen naiven FFR-Werte bei 5,0 %, 0,5 %, 2,5 % und 2,8 %. In Q2/20 sind die regionalen sFFR-Werte unregelmäßig über das Bundesland verteilt. Diese Heterogenität schwächt sich in der zweiten Welle der Epidemie ab. In Q1/21 zeigen sich in Südbayern nur vereinzelt Regionen mit erhöhter sFFR (> 1,25). Im Norden Bayerns bilden sich Cluster von Regionen mit einer sFFR > 1,25. Das Oberallgäu ist die Region mit dem niedrigsten sFFR-Wert (0,39, 95 % Kredibilitätsintervall: 0,25–0,55).DiskussionIn Bayern zeigen sich heterogene regionale SARS-CoV-2-spezifische sFFR-Werte, die sich über die Zeit verändern. Sie schätzen das relative Risiko, als dokumentierter Infektionsfall an/mit COVID-19 zu versterben. Eine starke kleinräumige Variabilität der sFFR legt nahe, regionale gegenüber übergeordneten Maßnahmen zur Steuerung des Infektionsgeschehens vorzuziehen.

Risk of mortality due to COVID-19 and air pollution in Pakistan.

The present research aims to investigate the impact of air pollution on the number of mortalities caused by COVID-19 per Pakistani province. To do so, for each independent area of Pakistan, the observed mortality due to COVID-19 has been standardized over the entire population using standard age groups ranging from 0 to 4, 5 to 9, 10 to 14,…, 65, and above years, supported by the 2017 state people census. The impact of air pollution and COVID-19 transience among Pakistani areas, Islamabad Capital Territory (ICT), and the Federally Administered Tribal Region (FATA) was analyzed by a multiple-linear regression model, while the broad collection of attributes was observed by the resources of local spatial autocorrelation indicators, including the spatial portion of COVID-19 association. The result indicates that the observed mortality rate is much higher than predicted in certain provinces, namely, the Khyber Pakhtunkhwa and Punjab provinces, and the prevalence of PM10 was independently linked to mortality due to the corona virus. Additionally, the results of the local spatial autocorrelation indicators on the standardized mortality rate and PM10 define a collection of very higher ideologies in the broad range of KPK and the southern part of Punjab province, respectively, with a definite degree of connection between the two distributions in the Khyber Pakhtunkhwa region. In brief, this research seems to find a justification for confirming the existence of a correlation between the possibility of COVID-19 mortality and air pollution, more precisely considering air pollutants (i.e., particulate (PM10) and land take-over. To this end, the need to mediate in favor of measures aimed at eliminating emissions in the environment will be reiterated by speeding up current proposals and policies aimed at all causes of atmospheric pollution: urbanization, water and manufacturing, home heating, and transportation.

Dioxins Exposure and the Risk of Breast Cancer: A Systematic Review and Meta-Analysis

Context: Dioxins and dioxin-like chemicals composed of 419 compounds are a large group of compounds, including polychlorinated di-benzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), and biphenyls (PCBs). Dioxins are extremely persistent in the environment and disperse in a great distance from the emission source, and bioaccumulation in the food chain is one of their critical properties. The incidence of breast cancer among Iranian women is about 30 to 35 per 100,000 cases. The present study is a systematic review of published studies in English language to discover the relationship between exposure to dioxin compounds and breast cancer. Methods: We conducted a comprehensive literature review utilizing PubMed, Embase, Scopus, and ISI web of science databases. The MeSH-based keywords used included Organic Chemical (MeSH) OR Dioxins (MeSH) AND cancer (MeSH) OR Breast cancer (MeSH) AND Breast disease (MeSH). Results: The review of the literature indicated a significant positive association between dioxins exposure and the risk of breast cancer. Only in one study, breast cancer mortality rate was reported in terms of exposure to dioxins, and standardized mortality rates (SMRs) were determined. Conclusions: Although there were limitations in this study, statistical analyses in various epidemiological studies demonstrated that dioxins exposure is linked to an increased risk of breast cancer.

Inverse correlates of COVID-19 mortality across European countries during the first versus subsequent waves

The objectives of the study were to calculate the standardised mortality rates (SMRs) for COVID-19 in European Union/European Economic Area countries plus the UK and Switzerland and to evaluate the...

Tropical Australian Health-Data Linkage Shows Excess Mortality Following Severe Infectious Disease Is Present in the Short-Term and Long-Term after Hospital Discharge.

Background: In this study, we aimed to assess the risk factors associated with mortality due to an infectious disease over the short-, medium-, and long-term based on a data-linkage study for patients discharged from an infectious disease unit in North Queensland, Australia, between 2006 and 2011. Methods: Age-sex standardised mortality rates (SMR) for different subgroups were estimated, and the Kaplan-Meier method was used to estimate and compare the survival experience among different groups. Results: Overall, the mortality rate in the hospital cohort was higher than expected in comparison with the Queensland population (SMR: 15.3, 95%CI: 14.9–15.6). The long-term mortality risks were significantly higher for severe infectious diseases than non-infectious diseases for male sex, Indigenous, residential aged care and elderly individuals. Conclusion: In general, male sex, Indigenous status, age and comorbidity were associated with an increased hazard for all-cause deaths.

Evaluation of Methadone Consumption Rate Based on Post-mortem Toxicology Examinations in Cases of Drug-related Deaths in Iran: 2015-2017

Background: Given the increasing prevalence of methadone overdose and the growing number of deaths in Iran, the present study was conducted to determine the mortality rate of methadone detected in the cadavers brought to the Forensic Medicine Organization between 2015 and 2017. Methods: This cross-sectional study was performed on 7,486 cases of substance abuse deaths registered in the Forensic Medicine Organization during 2015-2017. In order to investigate the drug abuse, samples collected from the cadavers were initially examined for their drug contents, such as methadone, by standard screening methods and then confirmed by Thin Layer Chromatography (TLC). Using two checklists, the information collected about each cadaver consisted of the identity, autopsy and laboratory data. After data collection, they were entered into the Stata software version 14 MP. Results: The cadavers’ mean age was 36.6±12.6 years. Over the 3-year duration of the study, the standardized mortality rate increased from 35 to 39 cases per million per year. Of these cases, 6066 were randomly assigned to toxicology, 50.1% had used methadone one month before their death. Approximately 75% of the methadone abusers had taken another drug simultaneously, mostly morphine or methamphetamine. Conclusion: Considering the relatively high prevalence of methadone detected post-mortem, monitoring for methadone entry into public market and identifying the death-related factors in the drug abusers are considered as significant measures to improve upon the current alarming situation in the Iranian society.

Mortality rate in rheumatoid arthritis-related interstitial lung disease: the role of radiographic patterns

BackgroundTo assess mortality rate (MR) and standardized mortality rate (SMR) of rheumatoid arthritis-related interstitial lung disease (RA-ILD) patients and to evaluate the role of radiographic patterns in mortality.MethodsA longitudinal multicentric study was conducted in RA-ILD patients from 2005 to 2015 and followed-up until October 2018 in Madrid. Patients were included in the Neumologia-Reumatología y Enfermedades Autoinmunes Registry, from diagnosis of ILD. The main outcome was all-cause mortality. The radiographic pattern at baseline [usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), or others] was the independent variable. Covariables included sociodemographic and clinical data. Survival techniques were used to estimate MR, expressed per 1000 persons-year with their 95% confidence intervals [CI]. Cox multiple regression model was run to examine the influence of radiographic patterns on survival. SMR [CI] was calculated comparing MR obtained with MR expected in the general population of Madrid by indirect age-gender standardization.Results47 patients were included with a follow-up 242 patients-year. There were 16 (34%) deaths, and most frequent causes were acute ILD exacerbation and pneumonia. MR was 64.3 [39.4–104.9], and 50% of the patients died at 8.3 years from ILD diagnosis. After adjusting for confounders, (UIP compared to NSIP was associated with higher mortality risk. The overall SMR was 2.57 [1.4–4.17]. Women of 60–75 years of age were the group with the highest SMR.ConclusionsRA-ILD is associated with an excess of mortality compared to general population. Our results support that UIP increases the risk of mortality in RA-ILD, regardless other factors.

Mortality due to acute myocardial infarction in the Silesian Voivodship (Poland) in 2009-2014.

According to the Organization for Economic Cooperation and Development (OECD) data, 13% of deaths recorded in the European Union in 2010 were related to coronary heart disease. The Polish Central Statistical Office data show that cardiovascular mortality in 2014 was at the level of 100.1/100 000 general population. The aim of the study was to assess the current burden of deaths due to acute myocardial infarction (AMI) with the assessment of temporal and spatial variability in the Silesian Voivodeship, Poland. Depersonalized data obtained from the Silesian Voivodeship Branch of the National Health Fund of Poland, based in Katowice, were used as the study material. The death rate due to acute or subsequent myocardial infarction in each of the subregions of the Silesian Voivodeship was standardized to the European Standard Population 2013. The analyses of the annual AMI death rate for 2009-2014 were performed and assigned to all the subregions of the Silesian Voivodeship, according to the patients' domicile. In this study, 37.7% of the patients (N = 20 806) were females, and 30 142 healthcare services were granted to them, accounting for 36.64% of all services provided to all patients. The average patient's age during the service provision was 66±12 years, with women being about 6.5 years older than men (70±12 years vs. 64±11 years, respectively). The standardized death rate (SDR) values in each of the 8 subregions of the Silesian Voivodeship were analyzed. In 2009-2014, a substantial decrease in the SDR was noted in 7 of them, except for the Sosnowiec subregion in which an increase in the average annual SDR value was observed. Moreover, its values were the highest in the whole Silesian Voivodeship. The obtained results confirmed the spatial variability of mortality due to AMI in the study region. The worst situation was observed in the Sosnowiec subregion in which the number of specific deaths continuously increased, probably due to the limited availability of cardiological and invasive cardiology treatments or adverse health conditions. Int J Occup Med Environ Health. 2021;34(3):363-72.

Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

BackgroundEscherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each.MethodsDuring 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion.ResultsFrom 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female.ConclusionsIn our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

Expert Elicitation of Long-Term Survival for Pediatric Acute Lymphoblastic Leukemia Patients Receiving CTL019 in Eliana Phase II Study

Introduction: Decision-makers need to understand long-term outcomes to assess cost-effectiveness of new treatments. In the absence of long-term data from clinical trials, current practice to extrapolate overall survival (OS) is typically based on how well the model fits to the observed data without formally involving clinical experts to evaluate the plausibility of the results. At best, 1-2 clinicians may be asked to select the most ‘realistic’ model. Therefore, a more systematic and transparent process is needed to ensure clinical expertise is fully integrated in an unbiased manner. In the global multicenter ELIANA trial (NCT02435849) for CTL019 (chimeric antigen receptor T-cell (CAR-T therapy)), OS data has been reported, but only up to 1.5 years. In the absence of expert opinion regarding long-term OS, the predicted OS varies dramatically depending on the model used to extrapolate the observed data. The aim of this study was to estimate expected OS based on observed data from ELIANA and expert elicited OS rates at 2 years, 3 years, 4 years, and 5 years for patients with relapsed or refractory B-cell pediatric acute lymphoblastic leukemia (r/r/ pALL) treated with CTL019.Methods: A prospective qualitative research study was performed incorporating semi-structured interviews, adapted from the SHeffield ELicitation Framework. Pediatric oncologists and hematologists experienced with CAR-T therapies were recruited. Experts and the study sponsor were not identified to one another. Relevant evidence regarding the patient population from the CTL019 trials, historical first-line pALL data, and historical data on r/r/ pALL for FDA approved interventions was summarized to provide a common basis for expert judgments. Facilitators guided experts through a web-based application for the elicitation of OS rates at 2, 3, 4, and 5 years for patients treated with CTL019 in the ELIANA trial. Experts were first asked to estimate upper and lower plausible limits and then the most likely actual OS value at each time point. Results from each expert were combined with the observed data from ELIANA using time-to-event parametric models (i.e. fractional polynomials) in a Bayesian framework that accounted for each expert's uncertainty in their estimates, which produced an overall distribution of OS over time. In addition, the model was fully extrapolated assuming patients followed general population mortality, adjusted for having had pALL (standard mortality rate=15.2 based on Armstrong 2016).Results: Of the 19 clinical experts contacted, 7 participated in the final elicitation exercise. During a follow-up group meeting, experts agreed that the Gompertz model fit to the observed trial data reflected an appropriate consensus distribution for their estimates. When a Gompertz model was fit to the observed data (up to 1.5 years) and each expert's elicited data (24 to 60 months), the most likely values of OS for patients from the ELIANA trial treated with CTL019 at 2, 3, 4, and 5 years were estimated to be approximately 67.5% (Credible intervals (CrI): 49.5%, 83.1%), 61.1% (39.5%, 81.3%), 57.2% (31.5%, 80.7%), and 54.9% (24.5%, 80.5%) (Figure 1). In the fully extrapolated model, the 10-year OS is estimated to be 52.4% (CrI: 23.4%, 76.9%) with a median survival of approximately 13.4 years (CrI: 1.96, 35.5). Results were similar to OS rates from a phase I/II single-center study (NCT01626495) at 2 years (61%) and slightly higher at three years (52%).Conclusions: Predictions based on observed data and expert elicitations suggest that more than half of the patients in the ELIANA trial treated with CLT019 will survive up to five years. This study provides an example of how expert opinion can be elicited and synthesized with observed survival data using a transparent and unbiased process, which captures expert uncertainty and ensures that projected long-term survival is clinical plausible.Disclaimer: The study was sponsored by Novartis Pharmaceuticals Corporation [Display omitted] DisclosuresCope:Precision Health Economics: Employment; Novartis Pharmaceuticals Corporation: Consultancy. Ayers:Precision Health Economics: Employment; Novartis Pharmaceuticals Corporation: Consultancy. Shih:Precision Health Economics: Employment; Novartis Pharmaceuticals Corporation: Consultancy. Zhang:Novartis Pharmaceuticals Corporation: Employment. Jansen:Novartis Pharmaceuticals Corporation: Consultancy; Precision Health Economics: Employment. Batt:Precision Health Economics: Consultancy; Novartis Pharmaceuticals Corporation: Consultancy; Bayer: Consultancy.

A first analysis of excess mortality in Switzerland in 2020.

ObjectiveTo quantify excess all-cause mortality in Switzerland in 2020, a key indicator for assessing direct and indirect consequences of the COVID-19 pandemic.MethodsUsing official data on deaths in Switzerland, all-cause mortality in 2020 was compared with that of previous years using directly standardized mortality rates, age- and sex-specific mortality rates, and life expectancy.ResultsThe standardized mortality rate was 8.8% higher in 2020 than in 2019, returning to the level observed 5–6 years before, around the year 2015. This increase was greater for men (10.6%) than for women (7.2%) and was statistically significant only for men over 70 years of age, and for women over 75 years of age. The decrease in life expectancy in 2020 compared to 2019 was 0.7%, with a loss of 9.7 months for men and 5.3 months for women.ConclusionsThere was an excess mortality in Switzerland in 2020, linked to the COVID-19 pandemic. However, as this excess only concerned the elderly, the resulting loss of life expectancy was restricted to a few months, bringing the mortality level back to 2015.

Changes in mortality rates from acute types of coronary artery disease in Russia for the period from 2015 to 2019

Aim. To identify regional specifics of changes in mortality rates from acute types of coronary artery disease (CAD) in 82 Russian regions for the period from 2015 to 2019.Material and methods. The study used data from the Federal State Statistics Service of Russia on mortality from acute CAD types in 82 Russian regions. Standardized death rates (SDRs) for 2015 and 2019 were estimated based on the European standard. We analyzed the SDRs of the population from acute (primary) and recurrent myocardial infarction (MI), other acute CAD types (I21-I22, I24.8 in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)).Results. Over the period from 2015 to 2019, mortality from all acute CAD types decreased by 21%, from acute MI — by 9%, from recurrent MI — by 22%, from any MI (acute/recurrent) recurrent — by 14%, and from other CAD types — by 21%. A decrease in mortality from all acute CAD types was recorded in 69 regions, from acute MI — in 58 regions, and recurrent MI — in 62 regions. However, a simultaneous decrease in SDRs from each of the acute CAD types (acute MI, recurrent MI and other acute CAD types) for the period 2015-2019 occurred only in 29 Russian regions. An increase in mortality from all acute CAD types was noted in 14 regions and from any MI — in 21 regions. The coefficient of variation (Cv) for recurrent MI and other acute CAD types of 69% and 103%, respectively, in 2015 and its growth (up to 75% and 134%, respectively) by 2019 indicate growing problems with the coding of death causes.Conclusion. In 2019, compared to 2015, a decrease in mortality from acute CAD types was recorded in most Russian regions. The identified regional specifics require clarification of approaches to death cause coding and the introduction of additions to mortality reduction programs, taking into account the specifics of each Russian region.

Higher COVID-19 mortality in low-income communities in the City of Cape Town – a descriptive ecological study

Background Cape Town, a South African city with high levels of economic inequality, has gone through two COVID-19 waves. There is evidence globally that low-income communities experience higher levels of morbidity and mortality during the pandemic. Methods Age-standardized COVID-19 mortality in the eight sub-districts of Cape Town was compared by economic indicators taken from the most recent Census (unemployment rate, monthly income). Results The overall Standardized Death Rate (SDR) for COVID-19 in Cape Town was 1 640 per million, but there was wide variation across the different sub-districts. A linear relationship was seen between sub-districts with high poverty and high COVID-19 SDRs. Conclusions Low-income communities in Cape Town experienced higher levels of COVID-19 mortality. As we continue to contend with COVID-19, these communities need to be prioritized for access to quality health care.

The trend and burden of cardiovascular death in Anhui Province from 2013 to 2018

Objective To understand the characteristics and life loss of cardiovascular diseases (CVDs) among residents in Anhui Province. Methods The data of 24 surveillance points in Anhui Province from 2013 to 2018 in the national death information registration management system was collected. The mortality of CVDs was analyzed, and the change trend of CVDs mortality was tested by annual percent change (APC). Potential years of life lost (PYLL), potential years of life lost rate (PYLLR) and average years of life lost (AYLL) were used for disease burden assessment. Results From 2013 to 2018, the standardized mortality rate of CVDs in Anhui Province was 260.36/100 000, showing a decreasing trend year by year (APC%=-2.53%). The CVDs mortality rate was higher in men than in women, and higher in rural areas than in urban. And it is the highest in Northern Anhui, followed by central Anhui, and the lowest in southern Anhui. CVDs were the first cause of in the whole population (48.58%), with PYLLR of 12.86‰ and AYLL of 11.13 years. PYLLR was the highest in cerebral hemorrhage (4.69 ‰) and ischemic heart disease (4.28 ‰). AYLL ranked the top three in chronic rheumatic heart disease, cerebral hemorrhage and ischemic heart disease. Conclusion The prevention and control of CVDs in Anhui Province has received some achievement, but the burden of disease is still heavy, the prevention and control of high-risk groups should be strengthened.

Extremely high mortality rates among hemodialysis patients with COVID-19 before the era of SARS-CoV-2 vaccination: results from a large database from the North of Poland.

Preliminary reports suggested high incidence and mortality rates of SARS‑ CoV 2 infection in patients receiving kidney replacement therapy. We aimed to describe the incidence and outcomes of COVID‑ 19 in hemodialysis patients. We conducted a retrospective multicenter cohort study on the incidence and mortality of COVID‑ 19 in hemodialysis patients as compared with the general adult population in the period from the beginning of the pandemic until the commencement of the SARS‑ CoV 2 vaccination program. The study population included all patients who were receiving hemodialysis in any of the 14 dialysis units of Pomerania Province, Poland on December 31, 2019 and all individuals who were starting long‑ term hemodialysis between January 1, 2020 and January 31, 2021, amounting to a total of 1567 patients. Data on the general population were obtained from reports of the health authorities. The absolute cumulative incidence of SARS‑ CoV 2 infection in hemodialysis patients was 22.4%, and after standardization for age it was 3.98-fold higher compared with the general population (P <0.001). The epidemic trajectory of both groups ran in parallel, but the increase and decline in the number of new cases occurred earlier in hemodialysis patients. The fatality rate of COVID‑ 19 among hemodialysis patients was 30.4%. It was the highest among the oldest patients, reaching 43.81% in individuals aged 75 years or older (P = 0.003). Age‑ standardized fatality and mortality rates in hemodialysis patients were 5.5- and 10.9-fold higher than in controls, respectively (both P <0.001). The results of this study show the extremely high mortality rate of COVID‑ 19 in hemodialysis patients during the first and second waves of the epidemic in Pomerania Province, before the vaccination era.

Epidemiological Pattern of Esophageal Cancer based on the Database Analysis of National Cancer Registry of Ukraine

Background. Esophageal cancer remains a major medical challenge since it belongs to the most aggressive malignant neoplasms, usually diagnosed at a late stage of the disease.&#x0D; Purpose – Studying the general patterns of time course of esophageal cancer epidemiological status in terms of morbidity and mortality among the adult population of Ukraine within the period from 2014 to 2019.&#x0D; Materials and Methods. General and standardized morbidity and mortality rates resulting from esophageal cancer from 2014 to 2019 throughout Ukraine and in terms of administrative territories per 100 thousand adult population have been researched along with calculating the growth rate. The study was carried out based on the data of National Cancer Registry of Ukraine.&#x0D; Statistical processing of the obtained data was performed by means of generally accepted statistical methods.&#x0D; Results and discussion. The all-Ukrainian incidence of esophageal cancer averaged 4.5 per 100 thousand population. Zhytomyr, Sumy and Chernihiv regions can be considered as the regions with the highest incidence of esophageal cancer. The lowest number of esophageal cancer cases was found in Chernivtsi and Odesa regions of Ukraine.&#x0D; Esophageal cancer mortality rates ranged slightly from 3.3 to 3.6 per 100 thousand population, but it reduced by 8.3% within six years. Monitoring changes of esophageal cancer mortality rate over time, in 2014 and 2019 in Ivano-Frankivsk, Mykolaiv and Rivne regions and in Kyiv it increased by more than 20%. A 30% reduction in mortality was observed in Kirovohrad, Odesa, Kharkiv and Zhytomyr regions. In 2019, Odessa and Kirovograd could be considered the regions with a low mortality rate showing 2.1 per 100 thousand population. In 2018, 88% of esophageal cancer cases were diagnosed in men and only 12% in women. The vast majority of cancer patients were aged 50 to 80 years. Mortality from esophageal cancer was significantly higher in men (91.2%) compared to women.&#x0D; Conclusions. The consistency of morbidity and mortality levels of esophageal cancer among the population of Ukraine during 2014-2019 has been established with insignificant regional disparities.

Excess mortality by specific causes of deaths in the city of São Paulo, Brazil, during the COVID-19 pandemic.

To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic. Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method. COVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17-1.42) and women (SMR 1.2, 95% CI 1.06-1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67-2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years. There was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.