Variation In Mortality Research Articles

Sensitivity of major chronic diseases and patients of different ages to the collapse of the healthcare system during the COVID-19 pandemic in China.

This study evaluates the sensitivity of major chronic diseases to the collapse of the healthcare system for developing prevention and control strategies under normal and emergency conditions. Data for the years 2018, 2019, and 2020 (coronavirus disease 2019 [COVID-19] pandemic) were curated from the National Disease Mortality Surveillance System, Chinese Center for Disease Control and Prevention for diseases such as cancer, heart disease (HD), cerebrovascular disease (CVD), and chronic obstructive pulmonary disease (COPD). The yearly death rate change for 2018, 2019, and 2020 were calculated. Similarly, expected and observed death cases, 95% confidence intervals, and Z-score were calculated for the year 2020 (COVID-19 pandemic). Furthermore, linear regression analysis was performed to analyze a correlation between the median age of various groups and the mortality rate. The observed death cases for cerebrovascular, heart, and other chronic diseases, were more than the expected death cases (430,007 vs 421,317, 369,684 vs 368,957, and 302,974 vs 300,366) as well as an upper limit of 95% confidence interval. The observed death cases for COPD and cancer are less than the expected death cases (127,786 vs 140,524, 450,346 vs 463,961) and lower limit of the 95% confidence interval. The highest Z-score was noted for cerebrovascular disease (105.14). The disease impact of severity was CVD, other chronic diseases, and HD in descending order. The unexpected decline in deaths was found for COPD and cancers with Z-scores (-166.45 and -116.32). The severity of impact was CVD, other chronic diseases, HD, cancer, and COPD in descending order. The COVID-19 pandemic has also resulted in an increase in deaths of the relatively young population as shown by the difference in rate of slop. The healthcare system collapsed due to prevention, control measures and increased burden of COVID-19 patients, affected chronic disease treatment/management and as a consequence variation in death rates occurs in different chronic diseases. A marked increase in mortality was observed in cerebrovascular disease. The unexpected decline in deaths from COPD and cancers, and increase in deaths of the relatively young population suggests that there may be opportunities for improvement in chronic disease management.

Morphological and molecular characterization of Purpureocillium lilacinum along with its biopesticidal effect against fall armyworm (Spodoptera frugiperda) in Southern Taiwan

BackgroundFall armyworm (FAW), Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae), a key agricultural pest, impacts a broad spectrum of crop species, such as cotton, maize, rice, sorghum, and a range of vegetables. Chemical pesticides and transgenic maize are commonly used to protect crops against this major pest. However, biological control offers a safer and more sustainable solution for long-term FAW management. Entomopathogenic fungi (EPF), a substitute for synthetic insecticides, have been proven to be an effective biocontrol agent for managing pest populations. The present study objective is to isolate and identify the EPF, Purpureocillium lilacinum from soil using morphological and molecular techniques and evaluate its pathogenicity against FAW eggs and various larval stages under different spore concentrations.ResultsThe micro-morphological characteristics fluctuated in growth behavior, appearance, and color under diverse growth media and temperatures. Molecular analysis, which involved constructing a phylogenetic tree from ITS and TEF gene regions, confirmed that PT-02 was P. lilacinum. The pathogenicity of the fungus was tested on FAW eggs, neonates, and larvae at multiple concentrations (1 × 108, 1 × 107, and 1 × 106 spores/ml), resulting in variation mortality. The egg mortality rate at 1 × 108, 1 × 107, and 1 × 106 spores/ml was 98, 98 and 96%, respectively. The neonate mortality rate was 100%, while first and second instars larvae mortality ranged from 10–36% across three concentrations, seven days after treatment (DAT). The median lethal concentration (LC50) values of P. lilacinum PT-02 against FAW eggs, first and second instars, were 3.02 × 107, 1.38 × 108, and 2.56 × 108 spore/ml, respectively.ConclusionsThe findings revealed that the native strain of P. lilacinum exhibited strong virulence against FAW, suggesting its potential use as an effective biocontrol agent for managing field pest populations.

Association of Ramadan and Death Rates in a Metropolitan City in Turkey: A Review of Literature and a Seasonally Adjusted Study.

In this study, death rates for a metropolitan city were analyzed over a period of 33years to investigate any potential relationship between the month of Ramadan and death rates. The study also aimed to obtain seasonally adjusted results using time series analysis. Ultimately, the total evaluation of the 33-year period revealed no significant variation in death rates between Ramadan and non-Ramadan periods. Separate analyses for each season with time series also yielded no significant findings for most parameters, with the exception that the number of female deaths during Ramadan in winter was significantly higher than expected. According to these results, the increase in the number of deaths observed among women during the winter Ramadan period requires further investigation to determine whether a causal relationship exists. The use of seasonally adjusted approaches and time series analyses in future Ramadan and health studies is crucial for the accuracy of the results.

Infant Mortality in Mother and Baby Homes in 20th Century Ireland

During the first half of the 20th century, infant mortality in the general population fell by more than 50% in higher income countries. Despite accounting for a disproportionately high share of deaths in these countries during this period, few quantitative studies have examined the experiences of infants who were born or raised in an institutional context. In this paper, we quantify mortality rates in Mother and Baby Homes in Ireland, institutions that were aimed primarily at unmarried mothers and their infants. Using information on over 40,000 infants born in the 6 largest of these insitutions in Ireland, we assess how this risk of mortality changed over the course of the 20th century relative to the general population, and assess variation in death rates by observed characteristics. The mortality penalty for these institutions was greatly elevated, reaching four times the national mortality rate in the 1930s and 1940s. By comparing the outcomes of infants from the Mother and Baby Homes with the rest of the population using large-scale quantitative data, this study documents the scale of the disadvantage faced by marginalised communities born outside public hospital systems, and highlights the potential role of nutrition-related causes in these disparities.

Assessing the toxicity of six insecticides on larvae of red palm weevil under laboratory condition

ObjectiveThe red palm weevil (RPW), is one of the most threatening pests of date palm trees worldwide, causing significant economic losses annually for date palm growers, both globally and in the Middle East, including Saudi Arabia. The primary objective of this research was to assess the insecticide market in Saudi Arabia, test various insecticides claimed to be effective against RPW, and evaluate their efficacy in laboratory settings. This evaluation aims to inform further trials under field conditions. MethodsSix insecticides, including imidacloprid, thiamethoxam, fipronil, emamectin benzoate, deltamethrin, and fenitrothion, were tested to assess their toxicity against red palm weevil 8th instar larvae by diet incorporation under laboratory conditions. The insecticides were applied according to the manufacturer’s recommendations with dosages of 1000 µl, 0.20 µl, 7.5 µl, 0.25 µl, 0.25 µl, and 0.5 µl for imidacloprid, thiamethoxam, fipronil, emamectin benzoate, deltamethrin, and fenitrothion, respectively. ResultsThe results revealed that all tested insecticides exhibited 100 % mortality against 8th instar RPW larvae, with the exception of deltamethrin. However, the time required to achieve this mortality varied. Fenitrothion caused 100 % mortality after 72 h, while thiamethoxam, imidacloprid, and fipronil caused 100 % mortality after 96 h. Emamectin benzoate and deltamethrin resulted in 100 % and 93 % mortality, respectively, after 10 days. The variability in mortality rates may be attributed to differences in their active ingredients, which show varying levels of lethality. In conclusion, all tested insecticides showed effectiveness against RPW larvae and represent viable options for controlling this pest in date palm orchards in Saudi Arabia.

Kejadian Mortalitas Wanita dengan Kanker Payudara Berdasarkan Indeks Massa Tubuh (BMI): Tinjauan Naratif

Breast cancer is the most common cancer found in women of all types of cancer in the world. The relationship between body mass index and the death rate from breast cancer in women has drawn attention recently. This study sought to ascertain the relevance of the variation in death rates between women with breast cancer who had a normal body mass index (BMI) and those who had a BMI of ≥25. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) references were used to guide the systematic review process in this investigation. The Newcastle-Ottawa Scale for cohort design studies and the Robins-I test for single-arm experimental design studies were used to assess the quality of the articles. The data source consisted of 142 Pubmed publications published between 2016 and 2023. The analysis's findings revealed differences between the five publications that discussed the connection between obesity and breast cancer. The development of breast cancer is linked to an increase in leptin and estrogen, which is consistent with an increase in fat. It is concluded that individuals with a body mass index (BMI) of ≥ 25 had a poorer chance of surviving breast cancer than patients with a normal BMI.

A population-based analysis of hematological malignancies from a French-West-Indies cancer registry’s data (2009–2018)

BackgroundA worldwide increased incidence of HM has been marked in recent decades. Therefore, to update epidemiological characteristics of HM in a French West Indies territory, we have performed analysis through Martinique's population-based cancer registry database.MethodsWe included cancer case data, from 2009–2018, coded in strict compliance with international standards set by International Agency for Research on Cancer. We calculated standardized incidence rates, cumulative rate (ages 0–74), and temporal trends for cases and deaths using the global population standard, by sex and five age group. Mortality rates were obtained from the French Epidemiology Center on Medical Causes of Death (CépiDc).ResultsOne thousand forty seven new cases and 674 deaths from HM were recorded, of which 501 MM (47.8%), 377 LMNH (36%), 123 LAM (11.8%), and 46 LH (4.4%) were reported in both sexes. MM is one of the hematological malignancies with the highest incidence in Martinique among men. Temporal trends of incidence rates for all HM decreased overall in both sexes, except for MM in men. There is significant variability in mortality rates for both sexes. In addition, over the period, the temporal trends of mortality rates for all HMs has decreased overall. Gender-specific rates, between 2009 and 2018, showed that all lymphoid HM have a multimodal distribution curve that increased with age.ConclusionsCharacteristics of HM in Martinique over the reporting periods differ from mainland France. Higher incidences have been observed, particularly for MM, and non-significant sub-mortality is observed compared to mainland France. Moreover, temporal distribution of mortality and incidence trends had decreased over the reporting periods except for MM. Our results showed similarities with African-Americans groups in United States and in particular an equivalence in the frequency distribution of diagnosed HM. However, SMR remains lower compared to US black ethnic groups. Our results contributed to expanding knowledge on the epidemiology of HM with Caribbean data.

Interactive effects of multiple stressors with significant wave height exposure on farmed Atlantic salmon (Salmo salar) welfare along an inshore-offshore gradient

Fish farming is the fastest growing food production sector worldwide and now accounts for most human fish consumption. Expansion of finfish aquaculture to exposed offshore marine environments is appealing where additional sheltered areas are unavailable. While more energetic environments may reduce waste accumulation and parasite exposure, effects on fish health and wellbeing are largely speculative. The multiple stressors faced by fish on offshore farms may interact synergistically and increase their cumulative impact. We used 20 months of health and welfare data from eight Atlantic salmon (Salmo salar) sea pen farms in Scotland along a wave exposure gradient to assess the effects of, and interactions between, environmental variables and management treatments on fish mortality and parasite loads. While farms showed high variability in mortality rate and sea lice infections, multi-level Bayesian modelling indicated that wave exposure primarily modulated effects of other variables. Higher exposure farms showed steeper increases in mortality with time and with extreme temperatures. Similarly, sea lice infections tended to increase with time, with higher exposure farms seeing steeper increases at higher Amoebic Gill Disease (AGD) scores and at high temperatures. The effect of AGD was greater at slow water speeds. Treatments against parasites were more frequent at low exposure farms, leading to uncertainty in their impact on welfare across farms. The support for interactive effects of wave exposure with other variables rather than strong direct effects suggests an accumulation of chronic and acute stressors. Expansion of aquaculture to more energetic offshore environments may have negative impacts on fish health in some circumstances, requiring adaptation of practices. In particular, the stronger increase in mortality over time may have implications for cycle length in different environments, and the more dramatic impacts of the warmest temperatures at high exposure farms call for consideration of the change in water temperature both inshore and offshore.

Epidemiologic transition of lung cancer mortality in Italy by sex, province of residence and birth cohort (1920-1929 to 1960-1969).

Space-time analysis of mortality risk is useful to evaluate the epidemiologic transitions at the subnational level. In our study, we analysed the death certificate records for lung cancer in Italy in 1995-2016, obtained from the Italian National Institute of Statistics. Our objective was to investigate the spatial-temporal evolution of lung cancer mortality by sex and province of residence (n = 107) using the birth cohort as relevant time axis. We built Bayesian space-time models with space-time interactions. Among males (n = 554 829), mortality peaked in the 1920-1929 cohort, followed by a generalised decline. Among females (n = 158 619), we found novel original evidence for a peak in the 1955-1964 cohort, equivalent to a 35-year delay, with a downward trend being observed thereafter. Over time, the documented north-south decreasing mortality gradient has been replaced by a west-east decreasing gradient. Naples has become the province at highest risk in Italy, both among males and females. This pattern is consistent with an epidemiologic transition of risk factors for lung cancer to the south-west of the country and raises concern, because 5-year age-standardised net survival from the disease in this geographic area is lower than in northern and central Italy. The variability of mortality rates among provinces has changed over time, with an increasing homogeneity for males and an opposite trend for females in the more recent birth cohorts. These unprecedented observations provide evidence for a profound spatio-temporal transition of lung cancer mortality in Italy.

Breast Cancer Screening in Latin America: The Challenge to Move from Opportunistic to Organized-Systematic Screening

Background: Breast cancer is the leading cause of death from cancer among women in Latin America. Most Latin American countries started national mammogram screening programs a decade ago. The implementation level and effects of screening programs in Latin America have not been evaluated. Aim: To evaluate the association between screening programs implementation and breast cancer mortality in selected North American and European countries compared to a group of Latin American countries with national screening programs. Methods: The study applied an ecological design with secondary data from official national and international sources. Join point regression analysis was conducted to describe the trends in mortality rates in a group of five Latin American countries (Brazil, Chile, Colombia, Costa Rica and Mexico) with five Non-Latin American countries (Canada, Spain, Sweden, United Kingdom and the United States of America). The association between screening and mortality rates was explored using correlation and linear regression. National cancer plans were assessed to describe screening strategies among selected countries. Results: A significant reduction in standardized breast cancer mortality rates was observed in all Non-Latin American countries with an Average Annual Percent Change (AAPC) of -2.00 (p<.05, 95%CI [-3.33, -0.70]) for the period 2010-2020. In contrast, Latin American countries reported a significant increase in the AAPC of +1.38 (p<.05, 95%CI [0.86,1.76]) in breast cancer mortality rates for the period 2010-2020. For Latin American countries, with screening rates below 50%, there was no correlation between screening and mortality rates for the period 1985-2020 (r = -0.17, p = .78). For non-Latin American countries, with screening rates over 70%, the linear regression model explained significantly 55% of the variance in mortality rates (R2aj =.55, F (5,14) = 5.69, p = .005), with a negative and significant effect of mammogram screening on mortality rates (β = -0.14, p = .01). The National Plans analysis revealed an opportunistic screening model for Latin American countries and an organized-systematic model in Non-Latin American countries. Conclusion: There is an association between the level of implementation of screening programs and mortality rates from breast cancer. Latin American countries should transform their opportunistic strategy into an organized-systematic model.

Detailed analysis of mortality rates in the female progeny of 1,001 Holstein bulls allows the discovery of new dominant genetic defects.

Reducing juvenile mortality in cattle is important for both economic and animal welfare reasons. Previous studies have revealed a large variability in mortality rates between breeds and sire progeny groups, with some extreme cases due to dominant mutations causing various syndromes among the descendants of mosaic bulls. The purpose of this study was to monitor sire-family calf mortality within the French and Walloon Holstein populations, and to use this information to detect genetic defects that might have been overlooked by lack of specific symptoms. In a population of heifers born from 1,001 bulls between 2017 and 2020, the average sire-family mortality rates were of 11.8% from birth to 1 year of age and of 4.2, 2.9, 3.1, and 3.2% for the perinatal, postnatal, preweaning, and postweaning subperiods, respectively. After outlining the 5 worst bulls per category, we paid particular attention to the bulls Mo and Pa, because they were half-brothers. Using a battery of approaches, including necropsies, karyotyping, genetic mapping, and whole-genome sequencing, we described 2 new independent genetic defects in their progeny and their molecular etiology. Mo was found to carry a de novo reciprocal translocation between chromosomes BTA26 and BTA29, leading to increased embryonic and juvenile mortality because of aneuploidy. Clinical examination of 2 calves that were monosomic for a large proportion of BTA29, including an orthologous segment deleted in human Jacobsen syndrome, revealed symptoms shared between species. In contrast, Pa was found to be mosaic for a dominant de novo nonsense mutation of GATA 6 binding protein (GATA6), causing severe cardiac malformations. In conclusion, our results highlight the power of monitoring juvenile mortality to identify dominant genetic defects due to de novo mutation events.

The potentials of Pangi leaf extract for Aedes spp. mosquito control

Aedes spp. are the primary vectors of arboviruses such as dengue, Zika, and chikungunya. To date neither an approved vaccine nor a drug that can definitively prevent or treat these diseases, vector control continues to be an essential method of disease prevention. Plant-based insecticides are an alternative to chemical insecticides because they are less toxic to non-target insects and degrade more quickly. The Papuan people have used Pangi leaves for generations as a potent natural chemical against head lice and mosquito larvae. This study aimed to evaluate the potential of pangi (Pangium edule) leaf extract as a biolarvicide and mosquito repellent. Fresh pangi leaves were extracted with water by using a blender to pulverize the leaves. One-way ANOVA was used to examine the variance in mortality rates, and the LC50 value was calculated for probit analysis. Dead larvae were identified and counted. In addition to testing the effectiveness of the extracts as biolarvicide, the extract was also tested as potential insect repellents. The findings demonstrated that pangi leaf extract can kill mosquito larvae. The concentration of the extract affected larval mortality. Furthermore, the extract demonstrated its effectiveness as an insect repellent. Pangi leaf extract contains alkaloids, flavonoids, tannins, saponins, phenolic compounds, and cyanide compounds, with alkaloids being the most abundant. The study found that there was a direct correlation between the concentration of the insecticide and the number of dead Aedes spp. larvae. The LC50 probit test revealed that pangi leaf extract belongs to the category of toxic substances. Several compounds, including alkaloids, flavonoids, tannins, saponins, and cyanide, may be responsible for the toxicity of pangi leaf extract. Thus, pangi leaf extract might be established as a means of overcoming numerous health issues caused by mosquito vectors.

30-Days to 10-Years Mortality Rates following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of the Last Decade (2011-2021).

Mortality data following primary total knee arthroplasty (TKA) beyond 1-year postoperative time period is sparse. This systematic review and meta-analysis aimed to: (1) estimate contemporary mortality rates at 30 days, 90 days, 1 year, 5 years, and 10 years following primary TKA; and (2) identify risk factors and causes of mortality following TKA. PubMed, MEDLINE, Cochrane, EBSCO host, and Google Scholar databases were queried from January 1, 2011 to October 30, 2021 for all studies reporting mortality rates following primary TKA. A meta-analysis of proportions was conducted using a random-effects model to ascertain pooled mortality rates (95% confidence interval [CI]). Meta-regression was utilized to account for confounding effects on mortality rates due to the study's country of origin, median date of study data, average patient age, and patient gender ratios, with a level of significance maintained at p-value <0.05. A total of 44 articles were included in quantitative synthesis. The pooled 30-day mortality rate was 0.14% (95% CI:0.05-0.22%; n = 1,817,647). The pooled 90-day mortality rate was 0.35% (95% CI:0.0.28-0.43%; n = 1,641,974). The pooled 1-year mortality rate was 1.1% (95% CI:0.71-1.49%; n = 1,178,698). The pooled 5-year mortality rate was 5.38% (95% CI:4.35-6.42%; n = 597,041). The pooled 10-year mortality rate was 10.18% (95% CI:7.78-12.64%; n = 815,901). Our 30-day mortality rate was lower than previously reported. The most common causes of death at all time points were due to cardiac disease, cerebrovascular disease, and malignancy. Obesity demonstrated mixed effects on long-term mortality rates. Overall mortality rates of TKA remain low worldwide at all time points and immediate postoperative mortality rates continue to fall. Compared to symptomatic knee osteoarthritic patients reported in the literature, TKA patients qualitatively exhibited lower mortality rates, which may support the value of TKA in improving quality of life without associated excess mortality. Future long-term mortality studies should be conducted to account for geographical variability in mortality rates and further elucidate modifiable risk factors associated with mortality among TKA patients.

Records of Human Deaths from Echinococcosis in Brazil, 1995-2016.

Simple SummaryEchinococcosis is a zoonotic disease relevant to public health in many countries. The disease is present in Brazil; however, it is often underreported due to the lack of mandatory notification of cases across all Brazilian states. The records of two national databases were accessed during the period of 1995–2016 to describe the registered cases and deaths from echinococcosis in the country. Demographic, epidemiological, and health care data related to the occurrence of disease, and deaths attributed to echinococcosis are described. During the study period, 7955 hospitalizations were recorded due to echinococcosis, with 185 deaths. In a second database recording just mortality, a further 113 deaths were documented. Deaths were observed in every state of Brazil. When comparing between states, there was great variability in mortality rates, possibly indicating differences in the quality of health care received by patients and reinforcing the need to expand the compulsory notification of the disease across the country.Echinococcosis is a zoonotic disease relevant to public health in many countries, on all continents except Antarctica. The objective of the study is to describe the registered cases and mortality from echinococcosis in Brazil, from 1995 to 2016. The records of two national databases, the Hospital Information System (HIS) and the Mortality Information System (MIS), were accessed during the period of 1995–2016. Demographic, epidemiological, and health care data related to the occurrence of disease and deaths attributed to echinococcosis in Brazil are described. The results showed that 7955 records of hospitalizations were documented in the HIS, during the study period, with 185 deaths from echinococcosis, and 113 records of deaths were documented in the MIS Deaths in every state of Brazil in the period. When comparing between states, the HIS showed great variability in mortality rates, possibly indicating heterogeneity in diagnosis and in the quality of health care received by patients. Less severe cases that do not require specialized care are not recorded by the information systems, thus the true burden of the disease could be underrepresented in the country. A change in the coding of disease records in the HIS in the late 1990s, (the integration of echinococcosis cases with other pathologies), led to the loss of specificity of the records. The records showed a wide geographic distribution of deaths from echinococcosis, reinforcing the need to expand the notification of the disease in Brazil. Currently, notification of cases is compulsory in the state of Rio Grande do Sul.

Ефекти віку, періоду та когорти у довгостроковій динаміці смертності в Україні

This study analyzes the effects of age, period, and birth cohorts on long-term mortality in Ukraine. For the first time, the APC model was used to analyze mortality in Ukraine for the 1850-2011 period and the cohorts born from 1850 to 1923. These estimations allow us to discriminate the impact of the historical and contemporary factors (at specific times) that could change the mortality rates. The following statistical methods are used: calculation of period and cohort death rates; age-period-birth cohort (APC) model that provides a method to assess the significance of the three interrelated factors (age, calendar period of death, and birth cohort) on mortality. As indicated by the results of APC analysis, the contribution of the period effect to the long-term mortality in Ukraine is likely to be larger than that of the cohort effect, and both effects are found to be more influential for men than for women. The analysis revealed intergenerational variations in death rates and inversion in cohort mortality when survival rates for the younger generations are worse than for the older generations. In particular, almost all generations born during the first half of the XX century had higher mortality rates than the reference cohort born in 1900, while lower mortality rates are found only for those born after 1945. At the same time, the overall decline in mortality among cohorts born after 1945 varied across different age groups: while death rates at the age 0 to 15 declined with each new generation, mortality in the 45 to 60 age group for younger generations tended to be higher than for older generations. The cohorts born in 1915—1925 and especially in 1917—1921 appeared to be the most disadvantaged and the hardest affected in terms of survival. A comparative analysis of the probability of dying in large age intervals for different generations showed that, first, among the cohorts of adult men who participated in World War II, those born in 1915—1925 were the most affected; second, during the First World War, the Ukrainian Revolution of 1917—1921 and the famine of 1921—1923 young and middle-aged men born in 1880—1890 suffered the greatest losses whereas the highest mortality due to Holodomor of 1932—1933 was observed among children and adolescents, as well as older persons born in the 1870s.

Factors associated with, and variations in, COVID-19 hospital death rates in England’s first two waves: observational study

ObjectivesTo assess patient-level and hospital-level predictors of death and variation in death rates following admission for COVID-19 in England’s first two waves after accounting for random variation. To quantify the...

Factors Associated With Geographic Disparities in Gastrointestinal Cancer Mortality in the United States

Significant geographic variability in gastrointestinal (GI) cancer-related death has been reported in the United States. We aimed to evaluate both modifiable and nonmodifiable factors associated with intercounty differences in mortality due to GI cancer. Data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research platform were used to calculate county-level mortality from esophageal, gastric, pancreatic, and colorectal cancers. Multivariable linear regression models were fit to adjust for county-level covariables, considering both patient (eg, sex, race, obesity, diabetes, alcohol, and smoking) and structural factors (eg, specialist density, poverty, insurance prevalence, and colon cancer screening prevalence). Intercounty variability in GI cancer-related mortality explained by these covariables was expressed as the multivariable model R2. There were significant geographic disparities in GI cancer-related county-level mortality across the US from 2010-2019 with the ratio of mortality between 90th and 10th percentile counties ranging from 1.5 (pancreatic) to 2.1 (gastric cancer). Counties with the highest 5% mortality rates for gastric, pancreatic, and colorectal cancer were primarily in the Southeastern United States. Multivariable models explained 43%, 61%, 14%, and 39% of the intercounty variability in mortality rates for esophageal, gastric, pancreatic, and colorectal cancer, respectively. Cigarette smoking and rural residence (independent of specialist density) were most strongly associated with GI cancer-related mortality. Both patient and structural factors contribute to significant geographic differences in mortality from GI cancers. Our findings support continued public health efforts to reduce smoking use and improve care for rural patients, which may contribute to a reduction in disparities in GI cancer-related death.

Identification of severe fever with thrombocytopenia syndrome virus genotypes in patients and ticks in Liaoning Province, China

BackgroundSevere fever with thrombocytopenia syndrome (SFTS), caused by the SFTS virus (SFTSV), is an acute infectious disease transmitted by ticks that has recently been identified. There are no reports of epidemic serotypes in Liaoning Province, PR China. The aim of this study was, therefore, to identify genotypes of SFTSV in this province.MethodsIn 2019, quantitative PCR testing was performed on 17 patients suspected of being infected with SFTS in Liaoning Province and on 492 ticks from the counties and cities surrounding the patients’ residences. Four samples were subjected to virus isolation and whole-genome amplification.ResultsMolecular diagnostic results confirmed SFTSV infection in five of the 17 suspected cases of SFTS and in 12 of the 492 ticks, with a prevalence of 2.4%. Four strains of SFTSV were successfully isolated from patients’ blood and ticks. Phylogenetic analysis after whole-genome amplification and sequencing showed that they all belonged to genotype A of SFTSV.ConclusionsThis study is the first to determine the genotype of SFTSV in patients and ticks in Liaoning Province, PR China. The results deepen our understanding of the SFTS epidemic and provide information on the variability in mortality rate among genotypes.Graphical

Modeling COVID-19 Outbreaks in Long-Term Care Facilities Using an Agent-Based Modeling and Simulation Approach.

The elderly, especially those individuals with pre-existing health problems, have been disproportionally at a higher risk during the COVID-19 pandemic. Residents of long-term care facilities have been gravely affected by the pandemic and resident death numbers have been far above those of the general population. To better understand how infectious diseases such as COVID-19 can spread through long-term care facilities, we developed an agent-based simulation tool that uses a contact matrix adapted from previous infection control research in these types of facilities. This matrix accounts for the average distinct daily contacts between seven different agent types that represent the roles of individuals in long-term care facilities. The simulation results were compared to actual COVID-19 outbreaks in some of the long-term care facilities in Ontario, Canada. Our analysis shows that this simulation tool is capable of predicting the number of resident deaths after 50 days with a less than 0.1 variation in death rate. We modeled and predicted the effectiveness of infection control measures by utilizing this simulation tool. We found that to reduce the number of resident deaths, the effectiveness of personal protective equipment must be above 50%. We also found that daily random COVID-19 tests for as low as less than 10% of a long-term care facility’s population will reduce the number of resident deaths by over 75%. The results further show that combining several infection control measures will lead to more effective outcomes.

Income-Related Mortality Inequalities and Its Social Factors among Middle-Aged and Older Adults at the District Level in Aging Seoul: An Ecological Study Using Administrative Big Data.

This study investigated income-related health inequality at sub-national level, focusing on mortality inequality among middle-aged and older adults (MOAs). Specifically, we examined income-related mortality inequality and its social factors among MOAs across 25 districts in Seoul using administrative big data from the National Health Insurance Service (NHIS). We obtained access to the NHIS’s full-population micro-data on both incomes and demographic variables for the entire residents of Seoul. Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated. The effects of social attributes of districts on SIIs and RIIs were examined through ordinary least squares and spatial regressions. There were clear income-related mortality gradients. Cross-district variance of mortality rates was greater among the lowest income group. SIIs were smaller in wealthier districts. Weak spatial correlation was found in SIIs among men. Lower RIIs were linked to lower Gini coefficients of income for both genders. SIIs (men) were associated with higher proportions of special occupational pensioners and working population. Lower SIIs and RIIs (women) were associated with higher proportions of female household heads. The results suggest that increasing economic activities, targeting households with female heads, reforming public pensions, and reducing income inequality among MOAs can be good policy directions.