Trends In Premature Mortality Research Articles

Trends in Premature Mortality from Acute Myocardial Infarction in American Indians/Alaska Natives in the United States from 1999 to 2020

Cardiovascular disease is the leading cause of mortality in American Indian and Alaska Native (AI/AN) groups. They are disproportionately found to have a higher rate of premature myocardial infarction (MI). The Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research were queried to identify premature MI deaths (female <65 years and male <55 years) occurring within the United States between 1999 and 2020. We investigated proportionate mortality trends related to premature MI in AI/ANs stratified by gender. Deaths attributed to acute MI (AMI) were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes I21 to I22. We compared the proportional mortality rate because of premature MI with that of a non-AI/AN racial group, which comprised all other races (Blacks, Whites, and Asian/Pacific Islander populations). In AI/ANs, we analyzed a total of 14,055 AMI deaths, of which 3,211 were premature MI deaths corresponding to a proportionate mortality rate of 22.8% (male 20.8%, female 26.2%). The non-AI/AN population had a lower proportionate mortality of 14.8% (male 13.7%, female 16%), p <0.01). On trend analysis, there was no significant improvement over time in the proportionate mortality of AI/ANs (19.8% in 1999 to 21.7% in 2020, p=0.09). Upon comparison of gender, proportionate mortality of premature MI in women showed a statistically nonsignificant increase from 21.6% in 1999 to 27.3% in 2020 [average annual percent change of 0.7, p=0.06)]. However, men had a statistically significant decrease in proportionate mortality of premature MI from 18.5% in 1999 to 18.2% in 2020 [average annual percent change of -0.8, p=0.01)]. AI/ANs have an alarmingly higher rate of proportionate mortality of premature MI than that of other races, with no improvement in the proportionate mortality rates over 20 years, despite an overall downtrend in AMI mortality. Further research to address the reasons for the lack of improvement in premature MI is needed to improve outcomes in this patient population.

Assessing progress of India in reduction of premature mortality due to four noncommunicable diseases towards achieving the WHO 25×25 goal and the sustainable development goals

AbstractThe World Health Organization (WHO) adopted a global noncommunicable disease monitoring framework in 2013 with a target of a 25% reduction in premature mortality from four noncommunicable diseases (NCDs) such as cancer, diabetes, cardiovascular disease (CVD) and chronic respiratory disease (CRD) by 2025 compared to 2010. The Sustainable Development Goals (SDGs) target to reduce premature deaths from the four major NCDs by one‐third from 2015 to 2030. The objective of this study was to estimate the trend and reduction in premature mortality in India due to 4 major NCDs combined and separately between 2001 and 2030 and compare its progress toward the WHO and SDG target achievement. The publicly available data from the census for population and the Sample Registration System (SRS) for cause of death by 5‐year‐age groups were extracted. Age standardized premature mortality rates, unconditional probability of dying and annual percent change (APC) were computed. The premature mortality for four major NCDs decreased by −13.9% from 2010 to 2025 and by −15.6% from 2015 to 2030. The percentage changes in premature mortality from 2010 to 2025 were −33.9%, −17.4%, −9.3%, and 6.9% for CRD, cancer, CVD and diabetes respectively. For 2015–2030, these changes were −21.7%, −11.5%, −15.4%, and −15.1%. A significant reduction trend was observed for CRD with an average APC of −5.2%. The current reduction trend in premature mortality indicates that either the 25% reduction by 2025 or a one‐third reduction by 2030 will require intensive implementation of policies and program for NCD reduction.

Carga das Doenças Crônicas Não Transmissíveis nos Países de Língua Portuguesa

Abstract The present study analyzed trends in premature mortality from Noncommunicable diseases (NCDs) between 1990 and 2019, the projections up to 2030, and the risk factors (RFs) attributable to these diseases in the Community of Portuguese Language Countries (CPLP). Estimates from the Global Burden of Disease (GBD) study and the analysis of the burden of premature mortality due to NCDs were used for nine CPLP countries, applying age-standardized rates, using RStudio. Portugal, Brazil, Equatorial Guinea, Angola, and Guinea Bissau showed declining premature mortality rates caused by NCDs, while East Timor, Cape Verde, São Tomé and Príncipe, and Mozambique showed an increase in rates. Projections indicate that none of the countries is expected to achieve the goals of reducing premature mortality due to NCDs by one third by 2030. The attributable burden of disease showed that the most important RFs in 2019 were: high systolic blood pressure (SBP), tobacco, dietary risks, high body mass index (BMI), and air pollution. It can therefore be concluded that there are profound differences in the burden of NCDs among the countries, with better results in Portugal and Brazil, and that no CPLP country is likely to reach the NCD reduction target by 2030.

Trends in premature mortality from diabetes mellitus in Costa Rica in the period 2000–2020

ABSTRACT Objectives To analyze the temporal trends of premature mortality from diabetes in Costa Rica in the period 2000–2020, at a national level and by province, and the effect of the COVID-19 pandemic on diabetes mortality during the year 2020 Methods We studied the temporal trends of mortality from diabetes in Costa Rica in the period between 2000 and 2020. Age-standardized mortality rates and corresponding 95% confidence intervals were calculated for each year, sex and province. Results We analyzed the data of 17,968 deceased persons. The mean age was 72.5 years (range 1 to 109 years), and 51.5% of the population (n = 9253) was younger than 75 years. In both men and women, we observed a significant decrease in mortality from 2000 to 2014, followed by the opposite trend from 2014 to 2020, with average yearly increases of 13.9% in men and 11.6% in women. Conclusions Premature mortality from diabetes has been growing from 2014. The COVID-19 pandemic changed the mortality pattern, increasing premature diabetes deaths in Costa Rica in 2020.

Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019.

BackgroundEvaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions.Methods and ResultsWe used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age‐adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age‐adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle‐aged adults, men, non‐Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age‐adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age‐adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and medium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age‐adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties.ConclusionsDuring the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to address cardiovascular health disparities and outcomes among nonelderly adults.

\u2018Trend in premature mortality from four major NCDs in Nanjing, China, 2007\u20132018\u2019

BackgroundThis study aims to analyze the trends of premature mortality caused from four major non-communicable diseases (NCDs), namely cardiovascular disease (CVD), cancer, chronic respiratory diseases, and diabetes in Nanjing between 2007 and 2018 and project the ability to achieve the “Healthy China 2030” reduction target.MethodsMortality data of four major NCDs for the period 2007–2018 were extracted from the Death Information Registration and Management System of Chinese Center for Disease Control and Prevention. Population data for Nanjing were provided by the Nanjing Bureau of Public Security. The premature mortality was calculated using the life table method. Joinpoint regression model was used to estimate the average annual percent changes (AAPC) in mortality trends.ResultsFrom 2007 to 2018, the premature mortality from four major NCDs combined in Nanjing decreased from 15.5 to 9.5%, with the AAPC value at − 4.3% (95% CI [− 5.2% to − 3.4%]). Overall, it can potentially achieve the target, with a relative reduction 28.6%. The premature mortality from cancer, CVD, chronic respiratory diseases and diabetes all decreased, with AAPC values at − 4.2, − 5.0%, − 5.9% and − 1.6% respectively. A relative reduction of 40.6 and 41.2% in females and in rural areas, but only 21.0 and 12.8% in males and in urban areas were projected.ConclusionAn integrated approach should be taken focusing on the modifiable risk factors across different sectors and disciplines in Nanjing. The prevention and treatment of cancers, diabetes, male and rural areas NCDs should be enhanced.

Recent trends in premature mortality and health disparities attributable to ambient PM2.5 exposure in China: 2005-2017.

In the past decade, particulate matter with aerodynamic diameter less than 2.5μm (PM2.5) has reached unprecedented levels in China and posed a significant threat to public health. Exploring the long-term trajectory of the PM2.5 attributable health burden and corresponding disparities across populations in China yields insights for policymakers regarding the effectiveness of efforts to reduce air pollution exposure. Therefore, we examine how the magnitude and equity of the PM2.5-related public health burden has changed nationally, and between provinces, as economic growth and pollution levels varied during 2005-2017. We derive long-term PM2.5 exposures in China from satellite-based observations and chemical transport models, and estimate attributable premature mortality using the Global Exposure Mortality Model (GEMM). We characterize national and interprovincial inequality in health outcomes using environmental Lorenz curves and Gini coefficients over the study period. PM2.5 exposure is linked to 1.8 (95% CI: 1.6, 2.0) million premature deaths over China in 2017, increasing by 31% from 2005. Approximately 70% of PM2.5 attributable deaths were caused by stroke and IHD (ischemic heart disease), though COPD (chronic obstructive pulmonary disease) and LRI (lower respiratory infection) disproportionately affected poorer provinces. While most economic gains and PM2.5-related deaths were concentrated in a few provinces, both gains and deaths became more equitably distributed across provinces over time. As a nation, however, trends toward equality were more recent and less clear cut across causes of death. The rise in premature mortality is due primarily to population growth and baseline risks of stroke and IHD. This rising health burden could be alleviated through policies to prevent pollution, exposure, and disease. More targeted programs may be warranted for poorer provinces with a disproportionate share of PM2.5-related premature deaths due to COPD and LRI.

Premature Mortality Due to Chronic Obstructive Pulmonary Disease (COPD) in Poland.

Background and objectives: Chronic obstructive pulmonary disease (COPD) is responsible for 5.3% of deaths worldwide and constitutes the third most common cause of death. The deaths from this cause occur over 10times more often in smokers than in non-smokers. Fortunately, for nearly 30 years, the proportion of people smoking tobacco in Poland has been decreasing. This study aims to analyse the change in premature mortality rates of men and women due to COPD in Poland during 2008–2017. Materials and Methods: The time trends of deaths occurring under 65 were analysed. Standardised premature mortality rates were used, as well as the mortality rates for the five-year age ranges, with a breakdown by gender. The Joinpoint model was used to determine time trends. Results: Over the period analysed, premature mortality in the female population decreased by 2.6% from year to year, albeit without statistical significance, and in the male population there was a decrease by statistically significant 5.2% per year. The biggest drop in mortality, almost 10% per year, was observed in the group of females aged between 50 and 54. Among males, the most significant reduction in mortality was observed in groups between the ages of 40 and 54, and it amounted to approximately 8% annually. With increasing age, the dynamics of mortality reduction decreased. Conclusions: The study showed a steady downward trend in premature mortality due to chronic obstructive pulmonary disease in Poland in both genders. The reduction in mortality was at a high level, despite the lower mortality due to this cause than in other European countries.

Trends in premature mortality due to ischemic heart disease in Spain from 1998 to 2018

Introduction and objectivesIschemic heart disease (IHD) is the leading cause of death and one of the leading causes of disability. The aim of this study was to analyze trends in premature mortality due to IHD in patients younger than 75 years in Spain from 1998 to 2018 by region. MethodsObservational study of temporal trends in premature mortality due to IHD in Spain by region and sex from 1998 to 2018. The study population included resident citizens aged between 0 and 74 years. The data sources were the continuous population register and the mortality registry of the National Institute of Statistics. We calculated age-adjusted mortality rates and their average annual percent change estimated by Poisson models. ResultsDuring the study period, mortality rates due to IHD decreased, both in the country as a whole and by provinces (53% in men and 61% in women), with an average annual percent change of –3.92% and –5.07%, respectively. In the first year (1998), mortality was unequally distributed among provinces, with higher mortality in the south of Spain. ConclusionsPremature mortality due to IHD significantly decreased in Spain during the study period in both sexes to roughly half of initial cases. This decrease was statistically significant in almost all regions. Interprovincial differences in mortality and their variation also decreased in recent years.

Average Lifespan Shortened due to Stroke in Canada: A Nationwide Descriptive Study From 1990 to 2015.

There are challenges in comparability when using existing life lost measures to examine long-term trends in premature mortality. To address this important issue, we have developed a novel measure termed average lifespan shortened (ALSS). In the present study, we used the ALSS measure to describe temporal changes in premature mortality due to stroke in the Canadian population from 1990 to 2015. Mortality data for stroke were obtained from the World Health Organization mortality database. Years of life lost was calculated using Canadian life tables. ALSS was calculated as the ratio of years of life lost in relation to the expected lifespan. Over a 25-year timeframe, the age-standardized rates adjusted to the World Standard Population for deaths from all strokes and stroke types substantially decreased in both sexes. The ALSS measure indicated that men who died of stroke lost 12.1% of their lifespan in 1990 and 11.4% in 2015, whereas these values among women were 11.1% and 10.0%, respectively. Patients with subarachnoid hemorrhagic stroke lost the largest portion whereby both sexes lost about one-third of their lifespan in 1990 and one-fourth in 2015. Men with intracerebral hemorrhagic stroke lost around 18% of their lifespan in 1990 and 14% in 2015 as compared to women who lost about 16% and 12% over the same timeframe. The loss of lifespan for patients with ischemic stroke and other stroke types combined was relatively stable at about 10% throughout the study period. Our study demonstrated a modest improvement in lifespan among patients with stroke in Canada between 1990 and 2015. Our novel ALSS measure provides intuitive interpretation of temporal changes in lifespan among patients with stroke and helps to enhance our understanding of the burden of strokes in the Canadian population.

Trends in premature mortality in the Islamic Republic of Iran: probability of dying between ages 30 and 70 years.

The burden of noncommunicable diseases (NCDs) is a major challenge facing the whole world. Around 15 million premature deaths due to NCDs occur in people aged 30-70 years annually. Mortality data based on death registration systems and population data were used to estimate proposed mortality statistics in the Islamic Republic of Iran. Various criteria and methods were used to assess the quality of mortality data. The probability of dying among those aged 30-70 years for all causes and for NCDs was calculated using the life table method. The mortality rate in the population aged 30-69 years was 343.12 (per 100 000 persons) in 2006 and decreased to 240.62 in 2016 in both sexes. The probability of dying due to NCDs was 21.36% in 2006 and declined to 14.95% in 2016 for both sexes. The number of premature deaths due to NCDs have decreased over the last decade. We predict that this reduction will continue and the country will meet the targets of the WHO NCD action plan by 2025 and also the targets of the Sustainable Development Goals for reducing premature deaths by 2030. However, the morbidity and burden of NCDs are still public health concerns in the country. Due to advancements in health care technologies and also the aging population, these concerns will impose greater costs on the health system. Hence, prevention programmes for NCDs should be an urgent priority for Iranian health policy.

Tendencias de mortalidad prematura por cardiopatía isquémica en España durante el periodo 1998-2018

Introduction and objectivesIschemic heart disease (IHD) is the leading cause of death and one of the leading causes of disability. The aim of this study was to analyze trends in premature mortality due to IHD in patients younger than 75 years in Spain from 1998 to 2018 by region. MethodsObservational study of temporal trends in premature mortality due to IHD in Spain by region and sex from 1998 to 2018. The study population included resident citizens aged between 0 and 74 years. The data sources were the continuous population register and the mortality registry of the National Institute of Statistics. We calculated age-adjusted mortality rates and their average annual percent change estimated by Poisson models. ResultsDuring the study period, mortality rates due to IHD decreased, both in the country as a whole and by provinces (53% in men and 61% in women), with an average annual percent change of –3.92% and –5.07%, respectively. In the first year (1998), mortality was unequally distributed among provinces, with higher mortality in the south of Spain. ConclusionsPremature mortality due to IHD significantly decreased in Spain during the study period in both sexes to roughly half of initial cases. This decrease was statistically significant in almost all regions. Interprovincial differences in mortality and their variation also decreased in recent years.Full English text available from:www.revespcardiol.org/en

Premature Mortality Due to Hodgkin Lymphoma, Non-Hodgkin Lymphoma, Multiple Myeloma, and Leukemia in Canada: A Nationwide Analysis From 1980 to 2015.

Recently, we introduced a novel measure of "average life span shortened" (ALSS) to improve comparability of premature mortality over time. In this study, we applied this novel measure to examine trends in premature mortality caused by hematological cancers in Canada from 1980 to 2015. Mortality data for Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma, and leukemia were obtained from the World Health Organization mortality database. Years of life lost was calculated according to Canadian life tables. ALSS was defined as the ratio between years of life lost and expected life span. Over the study period, age-standardized rates of mortality decreased for all types of hematological cancers. Our new ALSS measure showed favorable trends in premature mortality for all types of hematological cancers among both sexes. For instance, men with non-Hodgkin lymphoma lost an average of 23.7% of their life span in 1980 versus 16.1% in 2015, while women with non-Hodgkin lymphoma lost an average of 21.7% of their life span in 1980 versus 15.5% in 2015. Results from this study showed that patients with hematological cancers experienced prolonged survival over a 35-year period although the magnitude of these life span gains varied by types of hematological cancers.

Premature mortality due to stomach cancer in Japan: a nationwide analysis from 1980 to 2015

PurposePremature mortality offers an alternative approach for monitoring the burden of mortality; however, little is known about its measures for stomach cancer. In the present study, we investigated temporal changes in premature mortality because of stomach cancer in the Japanese population from 1980 to 2015. MethodsMortality data for stomach cancer were obtained from the World Health Organization mortality database. Years of life lost (YLL) was calculated using Japanese life tables. The average lifespan shortened was calculated and defined as the ratio of YLL in relation to the expected lifespan. ResultsOver a 35-year time frame, the age-standardized rates adjusted to the World Standard Population for deaths from stomach cancer substantially decreased in both sexes. The results from the average YLL (AYLL) measure showed that lifespan of stomach cancer patients was prolonged by about 3 and 5 years in men and women, respectively. The average lifespan shortened measure showed that stomach cancer led to a loss of 18.5% of lifespan among men and of 21.9% among women in 1980, but these numbers were reduced to 13.6% and 14.5%, respectively, in 2015. ConclusionsOur study demonstrated decreasing trends in premature mortality for stomach cancer in Japan over a 35-year period.

Suicide and Substance Use Disorder

Premature mortality trends in the United States are alarming, and years of life lost are mainly attributable to substance-related deaths and suicide. Suicide risk is significantly elevated among those with substance use and substance use disorder, even after adjusting for co-occurring mental health disorders and other social determinants of suicide risk. Potential mechanisms underlying these associations include the acute intoxication effects of substances on disinhibition, impulsivity, aggression, and psychosis; overlapping social and medical risk factors associated with both substance use disorder and suicide risk; and possibly overlapping genetic determinants in stress response circuitry and neurotransmitter functioning. Evidence-based treatments for substance use disorder (both medication interventions and psychosocial treatments) are effective in reducing substance use and suicide risk. Further development of universal suicide risk screening protocols and prevention training and education is especially important for the person at risk for using substances. [ Psychiatr Ann . 2020;50(4):158–162.]

Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990–2017: a population-based study

The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and only for people aged 30-70 years. This study focuses on premature avertable mortality from NCDs-premature deaths caused by NCDs that could be prevented through effective public policies and health interventions or amenable to high-quality health care-to assess trends at global, regional, and national levels using estimates from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017. We reviewed existing lists of NCD causes of death that are either preventable through public health policies and interventions or amenable to health care to create a list of avertable NCD causes of death, which was mapped to the GBD cause list. We estimated age-standardised years of life lost (YLL) per 100 000 population due to premature avertable mortality from NCDs, avertable NCD cause clusters, and non-avertable NCD causes by sex, location, and year and reported their 95% uncertainty intervals (UIs). We examined trends in age-standardised YLL due to avertable and non-avertable NCDs, assessed the progress of premature avertable mortality from NCDs in achieving SDG 3.4, and explored specific avertable NCD cause clusters that could make a substantial contribution to overall trends in premature mortality. Globally, premature avertable mortality from NCDs for both sexes combined declined -1·3% (95% UI -1·4 to -1·2) per year, from 12 855 years (11 809 to 14 051) in 1990 to 9008 years (8329 to 9756) in 2017. However, the absolute number of avertable NCD deaths increased 49·3% (95% UI 47·3 to 52·2) from 23·1 million (22·0-24·1) deaths in 1990 to 34·5 million (33·4 to 35·6) in 2017. Premature avertable mortality from NCDs reduced in every WHO region and in most countries and territories between 1990 and 2017. Despite these reductions, only the Western Pacific and European regions and 25 countries (most of which are high-income countries) are on track to achieve SDG target 3.4. Since 2017, there has been a global slowdown in the reduction of premature avertable mortality from NCDs. In 2017, high premature avertable mortality from NCDs was clustered in low-income and middle-income countries, mainly in the South-East Asia region, Eastern Mediterranean region, and African region. Most countries with large annual reductions in such mortality between 1990 and 2017 had achieved low levels of premature avertable mortality from NCDs by 2017. Some countries, the most populous examples being Afghanistan, the Central African Republic, Uzbekistan, Haiti, Mongolia, Turkmenistan, Pakistan, Ukraine, Laos, and Egypt, reported both an upward trend and high levels of premature avertable mortality from NCDs. Cardiovascular diseases, cancers, and chronic respiratory diseases have been the main drivers of the global and regional reduction in premature avertable mortality from NCDs, whereas premature mortality from substance use disorders, chronic kidney disease and acute glomerulonephritis, and diabetes have been increasing. Worldwide, there has been a substantial reduction in premature avertable mortality from NCDs, but progress has been uneven across populations. Countries vary substantially in current levels and trends and, hence, the extent to which they are on track to achieve SDG 3.4. By accounting for premature avertable mortality while avoiding arbitrary age cutoffs, premature avertable mortality from NCDs is a robust, comprehensive, and actionable indicator for quantifying and monitoring global and national progress towards NCD prevention and control. None.

Premature Mortality Due to Malignancies of the Kidney and Bladder in Japan, 1980-2010.

BackgroundIn the present study, we examined the trends of premature mortality due to kidney and bladder cancers among the Japanese population from 1980 through 2010.MethodsMortality data were obtained from the World Health Organization mortality database. Years of life lost (YLL) was estimated using Japanese life tables. Average lifespan shortened (ALSS) was calculated and defined as the ratio of years of life lost relative to the expected lifespan.ResultsOver the study period, the age-standardized rates to the World Standard Population for deaths from kidney and bladder cancers were stable. The average years of life lost (AYLL) measure shows decreases of about 4 and 6 years of life for kidney cancer in men and women, respectively, and decreases of about 2 years of life for bladder cancer in both sexes. The ALSS shows that patients with kidney cancer lost 21.0% and 24.7% of their lifespan among men and women in 1980, whereas respective losses were 15.3% and 15.8% in 2010. Also, patients with bladder cancer on average lost 13.5% in men and 14.2% in women in 1980 and 10.8% in men and 11.1% in women in 2010.ConclusionsOur study shows favorable trends in premature mortality for kidney and bladder cancers in Japan over a 30-year period; however, patients with bladder cancer on average lost a smaller proportion of their lifespan compared to those with kidney cancer. The development of a novel ALSS measure is convenient in examination of the burden of premature mortality over time.

Avoidable Cancer Mortality in Germany Since Reunification: Regional Variation and Sex Differences.

Background: Regional comparisons of cancer-related mortality in Germany are traditionally focused on disparities between East and West Germany. Recent improvements in all-cause and cancer-related mortality show a diverse regional pattern beyond the known East-West mortality divide. A generalized approach of the avoidable/amenable cancer mortality definition is applied for suitable regional comparisons of long-term trends.Methods: Standardized death rates of preventable and amenable cancer mortality for men and women were computed for the period 1990–2014 to observe sex-specific excess mortality due to specific cancers after the German reunification. For regional comparison, three German super regions were defined in Eastern, Northwestern, and Southwestern Germany to account for similarities in long-term regional premature and cancer-related mortality patterns, socioeconomic characteristics, and age structure.Results: Since preventable and amenable cancer mortality rates typically have driven the recent trends in premature mortality, our findings underline the current regional pattern of preventable cancer mortality for males with disadvantages for Eastern Germany, and advantages for Southwestern Germany. Among women, the preventable cancer mortality has increased in Northwestern and Southwestern Germany after the German reunification but has decreased in Eastern Germany and converged to the pattern of Southwestern Germany. Similar patterns can be observed for females in amenable cancer mortality.Conclusions: Although the “traditional” East-West gap in preventable cancer mortality was still evident in males, our study provides some hints for more regional diversity in avoidable cancer mortality in women. An establishing north-south divide in avoidable cancer mortality could alter the future trends in regional cancer-related mortality in Germany.

Reflection on modern methods: years of life lost due to premature mortality-a versatile and comprehensive measure for monitoring non-communicable disease mortality.

The analysis of causes impacting on premature mortality is an essential function of public health surveillance. Diverse methods have been used for accurately assessing and reporting the level and trends of premature mortality; however, many have important limitations, particularly in capturing actual early deaths. We argue that the framework of years of life lost (YLL), as conceptualized in disability-adjusted life-years (DALYs), is a robust and comprehensive measure of premature mortality. Global Burden of Disease study is systematically providing estimates of YLL; however, it is not widely adopted at country level, among other reasons because its conceptual and methodological bases seem to be not sufficiently known and understood. In this paper, we provide the concepts and the methodology of the YLL framework, including the selection of the loss of function that defines the time lost due to premature deaths, and detailed methods for calculating YLL metrics. We also illustrate how to use YLL to quantify the level and trends of premature non-communicable disease (NCD) mortality in the Americas. The tutorial style of the illustrative example is intended to educate the public health community and stimulate the use of YLL in disease prevention and control programmes at different levels.

Unconditional probability of dying and age-specific mortality rate because of major non-communicable diseases in India: Time trends from 2001 to 2013.

Background:Unconditional probability of dying because of four major non-communicable diseases (NCDs) between 30 and 70 years of age is the selected global indicator to measure the impact of NCD prevention and control programs.Objective:To calculate the unconditional probability of dying and age-specific mortality rate because of major NCDs in India from 2001 to 2013.Methods:This study used multiple data sources that are available in the public domain—Census 2001 and 2011, Sample Registration System, causes of death reports in 2001–03, 2004–06, and 2010–13. Unconditional probability of dying between ages 30 and 70 years during 2001, 2006, and 2013 was calculated by the formula suggested by the World Health Organization. Line graphs were used to depict time trends in age-specific mortality rates over the years in four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases).Results:The age-specific mortality rate because of four NCDs showed a decrease of 51 deaths per 100,000 population from 2001 to 2013. Of the four NCDs, age-specific mortality rate was highest in cardiovascular diseases (238.2/100,000 population) and least in diabetes mellitus (21.9/100,000 population); it was 76.3 and 58.2/100,000 population for cancer and chronic respiratory diseases, respectively. The probability of dying was very less and was almost the same from 30 to 44 years of life and increased steeply after that till 70 years of life; and it was more in males (24%) compared with females (17.4%).Conclusion:Although India has shown a decreasing trend in premature mortality because of NCDs in the past decade, the rate of decrease is not on par to achieve the global “25 × 25” target.