Trends In Cause-specific Mortality Research Articles

Trends in cause-specific mortality among people with type 2 and type 1 diabetes from 2002 to 2019: a Danish population-based study

BackgroundDespite advances in primary and secondary prevention of cardiovascular disease, excess mortality persists within the diabetes population. This study explores the components of this excess mortality and their interaction with sex. MethodsUsing Danish registries (2002-2019), we identified residents aged 18-99 years, their diabetes status, and recorded causes of death. Applying Lexis-based methods, we computed age-standardized mortality rates (asMRs), mortality relative risks (asMRRs), and log-linear trends for cause-specific mortality. FindingsFrom 2002-2019, 958,278 individuals died in Denmark (T2D: 148,620; T1D: 7,830) during 84.4M person-years. During the study period, overall asMRs declined, driven by reducing cardiovascular mortality, notably in men with T2D. Conversely, cancer mortality remained high, making cancer the leading cause of death in individuals with T2D. Individuals with T2D faced an elevated mortality risk from nearly all cancer types, ranging from 9% to 257% compared to their non-diabetic counterparts. Notably, obesity-related cancers exhibited the highest relative risks: liver cancer (Men: asMRR 3·58(3·28;3·91); Women: asMRR 2·49(2·14;2·89)), pancreatic cancer (Men: asMRR 3·50(3·25;3·77); Women: asMRR 3·57(3·31;3·85)), and kidney cancer (Men: asMRR 2·10(1·84;2·40); Women: asMRR 2·31(1·92;2·79)). In men with type 2 diabetes, excess mortality remained stable, except for dementia. In women, diabetes-related excess mortality increased by 6-17% per decade across all causes of death, except cardiovascular disease. InterpretationIn the last decade, cancer has emerged as the leading cause of death among individuals with T2D in Denmark, emphasizing the need for diabetes management strategies incorporating cancer prevention. A sex-specific approach is crucial to address persistently higher relative mortality in women with diabetes. FundingSupported by Steno Diabetes Center Aarhus, which is partially funded by an unrestricted donation from the Novo Nordisk Foundation, and by The Danish Diabetes Academy.

Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019

ABSTRACT Background There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status. Objectives To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda. Methodology Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood. Results Between 1999 and 2019, 63082 adults (15–60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33–5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61–12.28) to 3.27 (95% CI: 2.89–3.68) per 1000 pyo between 1999–2004 and 2015–2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively. Conclusion There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.

Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth

Mortality rates in US youth have increased in recent years. An understanding of the role of racial and ethnic disparities in these increases is lacking. To compare all-cause and cause-specific mortality trends and rates among youth with Hispanic ethnicity and non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, Black, and White race. This cross-sectional study conducted temporal analysis (1999-2020) and comparison of aggregate mortality rates (2016-2020) for youth aged 1 to 19 years using US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Data were analyzed from June 30, 2023, to January 17, 2024. Pooled, all-cause, and cause-specific mortality rates per 100 000 youth (hereinafter, per 100 000) for leading underlying causes of death were compared. Injuries were classified by mechanism and intent. Between 1999 and 2020, there were 491 680 deaths among US youth, including 8894 (1.8%) American Indian or Alaska Native, 14 507 (3.0%) Asian or Pacific Islander, 110 154 (22.4%) Black, 89 251 (18.2%) Hispanic, and 267 452 (54.4%) White youth. Between 2016 and 2020, pooled all-cause mortality rates were 48.79 per 100 000 (95% CI, 46.58-51.00) in American Indian or Alaska Native youth, 15.25 per 100 000 (95% CI, 14.75-15.76) in Asian or Pacific Islander youth, 42.33 per 100 000 (95% CI, 41.81-42.86) in Black youth, 21.48 per 100 000 (95% CI, 21.19-21.77) in Hispanic youth, and 24.07 per 100 000 (95% CI, 23.86-24.28) in White youth. All-cause mortality ratios compared with White youth were 2.03 (95% CI, 1.93-2.12) among American Indian or Alaska Native youth, 0.63 (95% CI, 0.61-0.66) among Asian or Pacific Islander youth, 1.76 (95% CI, 1.73-1.79) among Black youth, and 0.89 (95% CI, 0.88-0.91) among Hispanic youth. From 2016 to 2020, the homicide rate in Black youth was 12.81 (95% CI, 12.52-13.10) per 100 000, which was 10.20 (95% CI, 9.75-10.66) times that of White youth. The suicide rate for American Indian or Alaska Native youth was 11.37 (95% CI, 10.30-12.43) per 100 000, which was 2.60 (95% CI, 2.35-2.86) times that of White youth. The firearm mortality rate for Black youth was 12.88 (95% CI, 12.59-13.17) per 100 000, which was 4.14 (95% CI, 4.00-4.28) times that of White youth. American Indian or Alaska Native youth had a firearm mortality rate of 6.67 (95% CI, 5.85-7.49) per 100 000, which was 2.14 (95% CI, 1.88- 2.43) times that of White youth. Black youth had an asthma mortality rate of 1.10 (95% CI, 1.01-1.18) per 100 000, which was 7.80 (95% CI, 6.78-8.99) times that of White youth. In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease that were associated with recent increases in youth mortality rates. Addressing the increasing disparities affecting American Indian or Alaska Native and Black youth will require efforts to prevent homicide and suicide, especially those events involving firearms.

Time trends in liver-related mortality in people with and without diabetes: Results from a population based study.

Patients with diabetes are at increased risk of dying from liver-related events, but little is known on whether this increased risk changed in recent years. The aim of the present study is to describe time trends in cause-specific liver-related mortality in people with and without diabetes from the general Italian population. Data were retrieved from the healthcare utilization databases of Lombardy, a region of Italy that accounts for about 16% (almost ten million) of its population. Annual cause-specific mortality rates and proportionate mortality were computed among individuals with and without diabetes from 2010 to 2019. Liver-related deaths were categorized as viral, alcohol related and non-viral non-alcohol related (NVNA). Liver diseases were responsible for 2% and 1% of deaths in people with and without diabetes (2019). Among patients with diabetes, the crude mortality rate for liver diseases decreased from 1.13 to 0.64 deaths per 1,000 person-years from 2010 to 2019. The largest proportion of liver-related deaths was attributable to NVNA diseases and it increased from 63% in 2010 to 68% in 2019, with a corresponding relative reduction of viral causes (from 27% to 23%). The Standardized Mortality Ratio for patients with diabetes was 3.35 (95% CI 2.96-3.76) for NVNA, 1.66 (95% CI 1.33-2.01) for viral hepatitis and 1.61 (95% CI 1.13-2.17) for alcoholic liver disease and it remained relatively stable over time. Excess mortality risk in patients with diabetes for liver-related mortality was higher than for cardiovascular mortality and cancer. While liver-related mortality rates decreased significantly among patients with diabetes, NVNA causes comprised the majority of cases. Excess mortality for liver-related causes in patients with diabetes compared with controls remained constant in the studied period.

Trends in all-cause and cause-specific mortality in older adults with and without diabetes: A territory-wide analysis in one million older adults in Hong Kong

AimsDirect comparisons of population-level trends in all-cause and cause-specific mortalities among older adults with and without diabetes are lacking. MethodsWe performed a territory-wide analysis of 1,142,000 unique older adults aged ≥ 65 years (31.7 % with diabetes) with at least one attendance in the Hong Kong Hospital Authority in 2014–2018. We used Joinpoint regression to describe trends of age- and sex-standardised all-cause and cause-specific mortalities (cardiovascular disease [CVD], cancer, and non-CVD and non-cancer) in older adults with and without diabetes. ResultsAll-cause mortality decreased in older adults with (average annual percent change [AAPC] = -1.6, 95 % confidence interval [-2.7, -0.4]) and without (AAPC = -3.1 [-4.2, -2.1]) diabetes. Largest declines were seen for CVD-cause mortalities for people with and without diabetes (AAPC = -5.5 [-6.8, -4.1] vs AAPC = -5.8 [-8.6, -2.9], respectively). Cancer-cause mortalities were similar in both groups with no change. Men with diabetes showed less favourable improvements. An increasing mortality trend was seen only in the 65-69 age-group regardless of diabetes status. ConclusionsMortality continued to decline in older adults with and without diabetes, mainly driven by a decline in CVD deaths, with no narrowing of the mortality gap. Our findings call for continued actions to address excess mortalities especially in older men with diabetes and younger older adults.

US exceptionalism? International trends in midlife mortality.

Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64years) age-standardized death rates across 15 major cause-of-death categories. US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54year and in Canada, Poland and Sweden among for those aged 25-44 years. The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.

Systematic review with meta-analysis: Cause-specific and all-cause mortality trends across different coeliac disease phenotypes.

Data on mortality in coeliac disease are contrasting. To systematically review the literature on all-cause and cause-specific mortality in coeliac disease compared to the general population, and evaluate differences across clinical phenotypes, geographical regions, and over time. We searched PubMed and Embase from 1 January 1970 to 31 December 2022 for eligible studies reporting on all-cause and cause-specific mortality in coeliac disease compared to the general population or controls. The protocol was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/852DN). We included 25 studies. All-cause mortality (HR 1.16, 95% CI 1.05-1.27, I2 = 89%), mortality due to malignancies (HR 1.21, 95% CI 1.08-1.36, I2 = 65%) and respiratory disease (HR 1.39, 95% CI 1.04-1.86, I2 = 76%) were increased. Mortality due to non-Hodgkin lymphoma (HR 10.14, 95% CI 2.19-46.88, I2 = 96%) was markedly increased. Mortality significantly decreased in recent decades: 1989-2004 (HR 1.61, 95% CI 1.27-2.03, I2 = 91%), 2005-2014 (HR 1.16, 95% CI 0.99-1.36, I2 = 89%), 2015-2022 (HR 1.19, 95% CI 1.05-1.35, I2 = 93%). All-cause mortality was not increased in dermatitis herpetiformis (HR 0.85, 95% CI 0.73-0.99, I2 = 40%) and undiagnosed coeliac disease (HR 1.09, 95% CI 0.95-1.25, I2 = 0%). Mortality was increased in the UK (HR 1.23, 95% CI 1.03-1.47, I2 = 91%) but not Scandinavia (HR 1.01, 95% CI 0.91-1.13, I2 = 81%). Limitations include high heterogeneity and lack of data for many countries. Mortality in coeliac disease is increased, predominantly due to malignancies-particularly non-Hodgkin lymphoma-although differing significantly across disease phenotypes. Mortality of patients with coeliac disease has significantly decreased in recent decades. These results may influence diagnosis and management.

Trends in cause-specific mortality among persons with Alzheimer's disease in South Carolina: 2014 to 2019.

Inconsistencies of reports contributes to the underreporting of Alzheimer's disease (AD) on death certificates. Whether underreporting exists within South Carolina has not been studied. We conducted a prospective, population-based study on a cohort of persons (N = 78,534) previously diagnosed with AD and died between 2014-2019. We linked vital records with the South Carolina Alzheimer's Disease and Related Dementias Registry to investigate their cause of death and survival rates. Descriptive analyses calculated frequencies of demographic and health-related characteristics. Turnbull's method estimated the survival probabilities for different subgroups of patients. Hazard ratios were computed from the Cox proportional hazards model, adjusting for the following confounding variables of age at diagnosis, education level, gender, and race. The top immediate cause of death was Alzheimer's disease among all racial groups, except for Native American/American Indian. More females (60.3%) were affected by AD compared to males (39.7%). There is a 25% probability of survival, beyond 5 years, after AD diagnosis. Black/African American AD patients have the smallest risk of all-cause mortality across all racial/ethnic groups (HR 0.87; 95% CI, 0.85-0.89). Individuals with lower education had a lower likelihood of mortality. Although AD was not underreported in the state of South Carolina further research is needed to develop protocols around classification of deaths among those diagnosed with dementia and comorbidities, including cardiovascular disease, to ensure dementia is properly reported as we move to prevent and treat Alzheimer's disease by 2025 and beyond.

Temporal trends and patterns in cause-specific mortality and hospitalisations after incident atrial fibrillation in England from 2001 to 2017

Abstract Background Atrial fibrillation (AF) incidence is increasing, and in high income countries outstrips that of many cancers.(1) Following AF diagnosis reports of temporal trends of mortality are conflicting,(2-7) whilst reports of hospitalisation provide an incomplete picture of drivers of admission.(4,8) Purpose To investigate trends in cause-specific mortality and hospitalisation for patients with incident AF, including by age, sex, socioeconomic status and diagnostic care setting. Methods We used linked primary and secondary care records of 72 412 patients in England aged ≥16 years with incident AF between Jan 1, 2001 and Dec 31, 2017. The primary outcomes were all-cause and cause-specific mortality and hospitalisation at 1 year following diagnosis. Poisson regression estimated rate ratios (RRs) with 95% confidence intervals (CIs) comparing 2001/02 and 2016/17, adjusted for age, sex, region, socioeconomic status and 18 major comorbidities. Results Mean age at diagnosis was 75·6 years (SD 12·4), and 44 762 (61·8%) had ≥3 comorbidities. One-year mortality following incident AF was 20·0% and declined over the study period (RR 2016/17 vs. 2001/02, 0·72; 95% CI, 0·65–0·80) with larger declines for cardiovascular (RR 0·46; 95% CI, 0·37-0·58) and cerebrovascular mortality (RR 0·41; 95% CI, 0·29–0·60) than other causes of death (Figure 1). By 2016/17 dementia (67, 8·0%) accounted for more deaths than myocardial infarction, heart failure and acute stroke combined (56, 6·7%), and for patients aged ≥80 years death from non-cardio/cerebrovascular causes did not decline (RR 1·05; 95% CI 0·88–1·25). Mortality was higher for patients in the most deprived socioeconomic quintile compared with those in the least deprived quintile (RR 1·22; 95% CI 1·15–1·29), and for those diagnosed in hospital compared with primary care (RR 2·58; 95% CI 2·48-2·68), but similar between men and women. Hospitalisation within the first year after AF diagnosis was high (1·72 hospitalisations per patient-year at risk), with infection the most common cause and cardio/cerebrovascular diseases representing less than a fifth of all admissions (Figure 2). Hospitalisations increased (RR 1·17; 95% CI 1·13-1·22), driven by admissions for non-cardio/cerebrovascular causes (RR 1·42; 95% CI 1·39-1·45). Individuals aged ≥80 years experienced a greater increase in hospitalisation compared with younger individuals (RR 1·39, 95% CI 1·30-1·48) particularly for non-cardio/cerebrovascular causes (RR 1·54, 95% CI 1·44-1·65). Patterns for hospital admissions by sex and diagnostic setting were similar to those observed for mortality, but frequency of hospitalisation was similar between most and least deprived individuals. Conclusion For patients newly diagnosed with AF, cardiovascular and cerebrovascular mortality has declined, and hospitalisations for non-cardio/cerebrovascular diseases increased. The changing outcomes of AF require new strategies to reduce its health burden.Figure 1:Temporal trends in mortalityFigure 2:Temporal trends in admission

Preventable premature mortality in Northern Dimension partnership countries 2003-2021

Abstract Background Potential Years Life Lost (PYLL) is an established method to measure, follow trends and compare disease burden within and between countries. Northern Dimension Partnership in Health and Social wellbeing (NDPHS) network was established in 2003 and includes the following countries in same geographic area but considerable differences in social and economic development: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden. Due to the Russian invasion to Ukraine, Russia is now excluded from the collaboration. Aims To study total and cause-specific premature mortality and mortality trends in NDPHS countries from 2003 to 2021. Methods Premature mortality is defined as a death before the age of 70 years. PYLL-rates per 100,000 population are presented in six cause of deaths categories: total mortality, external causes, vascular diseases, cancers, alcohol-related deaths and suicides. Data are obtained from Eurostat and analyses are standardized to EU standard population. Results PYLL-rates declined from 2003 to 2017 in all countries and in most causes of death sub-groups. In 2017 PYLL rates, in men and women respectively, were lowest in Norway, 3001 and 1921, and highest in Russia, 14267 and 5363. Most premature losses were due to malignant neoplasms (1122), followed by vascular diseases (947) and external causes (902). Difference between countries was largest in vascular diseases (316 vs. 2845), external causes (478 vs. 2845) and alcohol related causes (62 vs. 842). The new data until 2021 are available in May and updated results will be presented in the EPH Conference. Conclusions The number of years lost due to premature preventable mortality have declined markedly in all NDPHS countries in last decades. However, in 2017 there were remarkable differences in PYLL-rates between countries. The updated analysis will show whether the positive trend continues and whether differences between countries are diminishing. Key messages • The number of years lost due to premature preventable mortality have declined markedly in all NDPHS countries in last decades. • In 2017 there were remarkable differences in PYLL-rates between NDPHS countries.

TCT-631 Temporal Trends in 1-Year Cause-Specific Mortality After Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry

TCT-631 Temporal Trends in 1-Year Cause-Specific Mortality After Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry

Cause-of-Death Contributions to Declining Mortality Improvements and Life Expectancies Using Cause-Specific Scenarios

In recent years, improvements in all-cause mortality rates and life expectancies for males and females in England and Wales have slowed down. In this article, cause-specific mortality data for England and Wales from 2001 to 2018 are used to investigate the cause-specific contributions to the slowdown in improvements. Cause-specific death counts in England and Wales are modeled using negative binomial regression, and a breakpoint in the linear temporal trend in log mortality rates is investigated. Cause-specific scenarios are generated, where the post-breakpoint temporal trends for certain causes are reverted to pre-breakpoint rates and the effects of these changes on age-standardized mortality rates and period life expectancies are explored. These scenarios are used to quantify cause-specific contributions to the mortality improvement slowdown. Reductions in improvements at older ages in circulatory system diseases, as well as the worsening of mortality rates due to mental and behavioral illnesses and nervous system diseases, provide the greatest contributions to the reduction of improvements in age-standardized mortality rates and period life expectancies. Future period life expectancies scenarios are also generated, where cause-specific mortality rate trends are assumed to either persist or be reverted. In the majority of scenarios, the reversion of cause-specific mortality trends in a single cause of death results in the worsening of period life expectancies at birth and age 65 for both males and females. This work enhances the understanding of cause-specific contributions to the slowdown in all-cause mortality rate improvements from 2001 to 2018, while also providing insights into causes of death that are drivers of life expectancy improvements. The findings are of benefit to researchers, policymakers, and insurance professionals.

Trends in cause-specific mortality: deaths of despair in Spain, 1980-2019.

Research from various countries has shown increases in alcohol- and drug-related deaths and suicide, known as 'deaths of despair' over recent decades, particularly among low-educated middle-aged individuals. However, little is known about trends in death-of-despair causes in Spain. Therefore, we aim to descriptively examine this among 25-64-year-olds from 1980 to 2019 and by educational attainment for the years 2017-19. We obtained mortality and population data from the National Institute of Statistics to estimate age-standardized mortality rates and assess educational inequalities using the relative index of inequality (RII). Deaths of despair as a share of total mortality slightly increased from 2000 onwards, particularly among 25-64-year-old men (from 9 to 10%). Only alcohol-related mortality declined relatively more since 1980 compared with all-cause mortality. Regarding educational differences, low-educated men presented higher mortality rates in all death-of-despair causes (alcohol-related: RII 3.54 (95% CI: 2.21-5.66); drug-related: RII 3.49 (95% CI: 1.80-6.77); suicide: RII 1.97 (95% CI: 1.49-2.61)). Women noteworthy differences were only observed for alcohol-related (RII 3.50 (95% CI: 2.13-5.75)). Findings suggest an increasing proportion of deaths of despair among 25-64-year-olds since 2000, particularly among men. Public health policies are needed to reduce and prevent these premature and preventable causes of mortality.

1406-P: Trends in All-Cause and Cause-Specific Mortality in Older Adults With and Without Diabetes—A Territory-Wide Analysis in One Million Older Adults in Hong Kong

Objective: Nationwide data on trends in mortality in older adults with and without diabetes in Asia are lacking. We described the recent trends of all-cause and cause-specific (pneumonia, cardiovascular [CV], and cancer) mortality in adults aged ≥65 years in Hong Kong in 2014-2018. Methods: We performed a territory-wide analysis in 1,152,418 elderlies who had at least one in- or out-patient attendance in the Hospital Authority. We used the Joinpoint regression to assess patterns of mortality rate. Results: In 2014-2018, 354,357 (31.7%) and 763,488 (68.3%) old adults with and without diabetes were included respectively. All-cause death rate has declined in older adults with (458.7 vs. 431.2 events/10,000 person-years, average annual percent change [AAPC]: -3.1% [95% CI -4.2%, -2.1%]) and without (337.0 vs. 294.6 events/10,000 person-years, AAPC: -1.6% [-2.7, -0.4%]) diabetes. In 2018, compared with adults without diabetes, those with diabetes had higher all-cause mortality (1.4-fold), CV- (1.9-fold), and pneumonia-cause (1.3-fold) mortality. Pneumonia was the leading cause of death. CV death has declined significantly in old adults with with (AAPC: -5.5% [-6.8, -4.1%]) and without (AAPC: -5.8% [-8.6, -2.9%]) diabetes. There were no declines in cancer death in older adults with (AAPC: -1.6% [-2.7, 0.4%]) and without (AAPC: -1.6% [-2.7, 3.9%]) diabetes, while cancer death has surpassed CV death in old adults with diabetes. Cancer death has increased markedly in men with diabetes versus those without diabetes (AAPC: 2.9% [1.1, 4.6%] vs. 1.8% [-5.0, 1.4%]), particularly in the youngest-older adults (65-74 years) with diabetes. Conclusions: One in 3 elderlies had diabetes. Overall, cardiovascular-death had declined in these elderlies. Although elderly people with diabetes had a greater decline in all-cause death, they had substantially higher risk of cancer-death than those without diabetes, especially in younger men. Disclosure A.Yang: None. M.Shi: None. E.S.H.Lau: None. E.Chow: Research Support; Medtronic, Merck KGaA, Speaker's Bureau; Novartis, Bayer Inc., Sanofi. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer Inc., Celltrion, Boehringer Ingelheim and Eli Lilly Alliance, Sanofi, Research Support; AstraZeneca, Servier Laboratories, Viatris Inc., Hua Medicine, Merck KGaA, Applied Therapeutics Inc., Lee Powder, Pfizer Inc., Speaker's Bureau; Novartis, Stock/Shareholder; GemVCare Ltd.

Joint models for cause-of-death mortality in multiple populations

AbstractWe investigate jointly modelling age–year-specific rates of various causes of death in a multinational setting. We apply multi-output Gaussian processes (MOGPs), a spatial machine learning method, to smooth and extrapolate multiple cause-of-death mortality rates across several countries and both genders. To maintain flexibility and scalability, we investigate MOGPs with Kronecker-structured kernels and latent factors. In particular, we develop a custom multi-level MOGP that leverages the gridded structure of mortality tables to efficiently capture heterogeneity and dependence across different factor inputs. Results are illustrated with datasets from the Human Cause-of-Death Database (HCD). We discuss a case study involving cancer variations in three European nations and a US-based study that considers eight top-level causes and includes comparison to all-cause analysis. Our models provide insights into the commonality of cause-specific mortality trends and demonstrate the opportunities for respective data fusion.

A Narrowing Mortality Gap: Temporal Trends of Cause-Specific Mortality in a National Matched Cohort Study in US Veterans With Rheumatoid Arthritis.

To examine temporal trends in all-cause and cause-specific mortality in patients with rheumatoid arthritis (RA) in the Veterans Health Administration (VHA). We conducted a matched cohort study in the VHA from January 1, 2000 to December 31, 2017. Incident RA patients were matched up to 1:10 on age, sex, and VHA enrollment year to non-RA patients, then followed until death or end of study period. Cause of death was obtained from the National Death Index. Multivariable Cox regression models stratified by RA diagnosis years were used to examine trends in RA-related risk of all-cause and cause-specific mortality. Among 29,779 incident RA patients (matched to 245,226 non-RA patients), 9,565 deaths occurred. RA patients were at increased risk of all-cause (adjusted hazard ratio [HRadj ] 1.23 [95% confidence interval (95% CI) 1.20-1.26]), cardiovascular (HRadj 1.19 [95% CI 1.14-1.23]), cancer (HRadj 1.19 [95% CI 1.14-1.24]), respiratory (HRadj 1.46 [95% CI 1.38-1.55]), and infection-related mortality (HRadj 1.59 [95% CI 1.41-1.80]). Interstitial lung disease was the cause of death most strongly associated with RA (HRadj 3.39 [95% CI 2.88-3.99]). Nearly 70% of excess deaths in RA were attributable to cardiopulmonary disease. All-cause mortality risk related to RA was lower among those diagnosed during 2012-2017 (HRadj 1.10 [95% CI 1.05-1.15]) compared to 2000-2005 (HRadj 1.31 [95% CI 1.26-1.36]), but still higher than for non-RA controls (P < 0.001). Cause-specific mortality trends were similar. Excess RA-related mortality was driven by cardiovascular, cancer, respiratory, and infectious causes, particularly cardiopulmonary diseases. Although our findings support that RA-related mortality risk is decreasing over time, a mortality gap remains for all-cause and cause-specific mortality in RA.

Trends in Cause-Specific Mortality Among Veterans With HIV: A 35-Year (1982-2016) Analysis of the HIV Atlanta VA Cohort Study.

Causes of death and their trends among veterans with HIV (VWH) are different than those in the general population with HIV, but this has not been fully described. The objective was to understand the trends in, and risk factors for, all-cause and cause-specific mortality across eras of combination antiretroviral therapy (cART) among VWH. The HIV Atlanta VA Cohort Study includes all VWH who ever sought care at the Atlanta VA Medical Center. Age-adjusted all-cause and cause-specific mortality rates were calculated annually and compared between pre-cART (1982-1996), early-cART (1997-2006), and late-cART (2007-2016) eras. Trends were assessed using Kaplan-Meier curves, cumulative incidence functions, and joinpoint regression models. Risk factors were identified by Cox proportional hazards models. Of the 4674 VWH in the HIV Atlanta VA Cohort Study, 1752 died; of whom, 1399 (79.9%), 301 (17.2%), and 52 (3.0%) were diagnosed with HIV in the pre-cART, early-cART, and late-cART eras, respectively. Significant increases were observed in rates of all-cause, AIDS-related, and non-AIDS-related mortality in the pre-cART era, followed by declines in the early-cART and late-cART eras. All-cause, AIDS-related, and non-AIDS-related mortality rates plummeted by 65%, 81%, and 45%, respectively, from the pre-cART to late-cART eras. However, VWH continue to die at higher rates due to AIDS-related infections, non-AIDS-related malignancies, respiratory disease, cardiovascular disease, and renal failure than those in the general population with HIV. In older populations with HIV, it is important that providers not only monitor for and treat diseases associated with aging but also intervene and address lifestyle risk factors.

Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019

SummaryBackgroundBetter evaluation of existing health programmes, appropriate policy making against emerging health threats, and reducing inequalities in Iran rely on a comprehensive national and subnational breakdown of the burden of diseases, injuries, and risk factors.MethodsIn this systematic analysis, we present the national and subnational estimates of the burden of disease in Iran using the Global Burden of Disease Study 2019. We report trends in demographics, all-cause and cause-specific mortality, as well as years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by major diseases and risk factors. A multi-intervention segmented-regression model was used to explore the overall impact of health sector changes and sanctions. For this analysis, we used a variety of sources and reports, including vital registration, census, and survey data to provide estimates of mortality and morbidity at the national and subnational level in Iran.FindingsIran, which had 84·3 million inhabitants in 2019, had a life expectancy of 79·6 years (95% uncertainty interval 79·2–79·9) in female individuals and 76·1 (75·6–76·5) in male individuals, an increase compared with 1990. The number of DALYs remained stable and reached 19·8 million (17·3–22·6) in 2019, of which 78·1% were caused by non-communicable diseases (NCDs) compared with 43·0% in 1990. During the study period, age-standardised DALY rates and YLL rates decreased considerably; however, YLDs remained nearly constant. The share of age-standardised YLDs contributing to the DALY rate steadily increased to 44·5% by 2019. With regard to the DALY rates of different provinces, inequalities were decreasing. From 1990 to 2019, although the number of DALYs attributed to all risk factors decreased by 16·8%, deaths attributable to all risk factors substantially grew by 43·8%. The regression results revealed a significant negative association between sanctions and health status.InterpretationThe Iranian health-care system is encountering NCDs as its new challenge, which necessitates a coordinated multisectoral approach. Although the Iranian health-care system has been successful to some extent in controlling mortality, it has overlooked the burden of morbidity and need for rehabilitation. We did not capture alleviation of the burden of diseases in Iran following the 2004 and 2014 health sector reforms; however, the sanctions were associated with deaths of Iranians caused by NCDs.FundingBill & Melinda Gates Foundation.

Trends in Late Mortality and Life Expectancy After Autologous Blood or Marrow Transplantation Over Three Decades: A BMTSS Report.

We determined trends in life expectancy and cause-specific late mortality after autologous blood or marrow transplantation (BMT) performed over a 30-year period, using the BMT Survivor Study. We constructed a cohort of 4,702 individuals with hematologic neoplasms who lived ≥ 2 years after autologous BMT performed between 1981 and 2014 at three transplant centers. The end of follow-up was April 19, 2021. The primary exposure variable was autologous BMT performed in four eras: 1981-1999; 2000-2005; 2006-2010; and 2011-2014. Vital status and cause of death were obtained from National Death Index Plus program and Accurinct databases. The median age at BMT was 53 years (range, 0-78 years), 58.7% were male, 67.8% were non-Hispanic White, and 28.3% had undergone transplantation between 2011 and 2014. Autologous BMT recipients experienced a 7-year reduction in life expectancy. The adjusted hazard of 5-year all-cause mortality declined over the four eras (reference: 1981-1999; hazard ratio [HR]2000-2005 = 0.77; 95% CI, 0.62 to 0.94; HR2006-2010 = 0.64; 95% CI, 0.51 to 0.79; HR2011-2014 = 0.56; 95% CI, 0.45 to 0.71; Ptrend < .001), as did years of life lost (5.0 years to 1.6 years). The reduction in all-cause mortality was most pronounced among those transplanted for Hodgkin lymphoma or plasma cell dyscrasias, but was not observed among those transplanted for non-Hodgkin lymphoma or those conditioned with total-body irradiation. We also observed a decline in late deaths because of infection (Ptrend < .0001; primarily for BMTs before 2006) and subsequent neoplasms (Ptrend = .03; confined to decline in therapy-related myeloid neoplasm-related mortality) but not because of cardiovascular or renal disease. Late mortality among autologous BMT recipients has declined over a 30-year period. However, ongoing efforts are needed to mitigate development of infections, subsequent neoplasms, and cardiovascular and renal disease to further reduce late mortality.

Changes in cause-specific mortality trends across occupations in working-age Japanese women from 1980 to 2015: a cross-sectional analysis

BackgroundReducing health inequalities is an important public health challenge. Many studies have examined the widening health gap by occupational class among men, but few among women. We therefore estimated variation in absolute and relative mortality by occupational category across four leading causes of mortality—cancer, ischaemic heart disease, cerebrovascular disease, and suicide—to explore how occupational class is associated with health among working women aged 25–64 in Japan.MethodsWe conducted a repeated cross-sectional study using Poisson regression analysis on each five-yearly mortality data from 1980 to 2015, obtained from the National Vital Statistics and the Japanese Population Census.ResultsThere was a decreasing trend in mortality from all cancers, ischaemic heart disease, cerebrovascular disease, and suicide among women in all occupational groups from 1980 to 2015. Agriculture workers had higher risk of mortality than professional workers for all four causes of death. The absolute difference in mortality rates for all cancers and cerebrovascular disease was higher in 2000–2015 than 1980–1995. The mortality trend among clerks and sales workers decreased after 2000, except for suicide.ConclusionsMortality rates from all four causes are higher among agriculture workers compared to professional workers, and attention is needed to reduce this mortality gap. Continuous monitoring of ongoing mortality trends is essential to ensure better health and wellbeing in Japan.