Various Causes Of Death Research Articles

Quantification of cyanide metabolite 2-aminothiazoline-4-carboxylic acid in postmortem dried blood spot samples by liquid chromatography–tandem mass spectrometry

2-Aminothiazoline-4-carboxylic acid (ATCA), which is produced by the reaction of cyanide with endogenous cystine, is a promising biomarker of cyanide exposure because of its physicochemical stability. Analysis of more stable metabolite than the toxic gas itself is sometimes useful for postmortem diagnosis of gas poisoning. Here, we developed and validated an approach that uses liquid chromatography coupled with electrospray ionization−tandem mass spectrometry for quantifying ATCA in dried blood spot (DBS) samples. The linearity of the calibration curve was good in the concentration range of 20–1500 ng/mL. Our method allows for repeatable and the accurate quantification of ATCA, with intra- and inter assay coefficients of variation of below 7.8 % and below 9.3 %, respectively. In addition, the concentration of ATCA in DBSs remained stable for at least one month when stored at −20°C. Our results indicated that our analytical approach can be used to determine past exposure to higher doses of cyanide. In a comparison of ATCA concentrations in DBSs obtained from cadavers with various causes of death, significantly higher ATCA concentrations were observed in fire victims than in non-fire victims, confirming that fire victims inhale large amounts of cyanide gas. Thus, here we extended the possible uses of DBS for quantification of ATCA to forensic toxicological testing for cyanide poisoning.

Current state of the problem of forensic medical determination of the time since death (literature review)

Determining the time since death is a key issue for forensic authorities when working with a corpse at the scene of death. After all, it is precisely the accurate data provided by the forensic medical expert that makes it possible to answer important questions during the investigation of a crime. Despite the enormous amount of fundamental research conducted over many decades and devoted to the exact establishment of the time since death, this problem has not been solved yet. Despite the obtained promising results, most of the proposed methods were characterized as unreliable due to sensitivity to the influence of many external and internal modifying factors. In our opinion, it is promising to combine different methods of postmortem interval diagnostics for the simultaneous analysis of several components, which will allow taking into account various causes of death, pathological conditions and other factors that can influence the obtained result.

Можливості впливу засобів фізичної терапії на перебіг цукрового діабету та розвиток діабетичних ускладнень

According to the latest data from the World Health Organization experts, the incidence of diabetes mellitus in economically developed countries of the world is up to 6% of the population. Throughout the world and in Ukraine in particular, diabetes mellitus is one of the most common chronic non-infectious diseases. Complications of diabetes mellitus occupy the third place among various causes of death. The use of modern pharmacological agents in the treatment of diabetes mellitus does not solve all the problems of this difficult and multifaceted pathology, therefore the search for non-pharmacological methods of physical therapy and rehabilitation of such patients remains relevant and has been studied insufficiently. In addition, an effective combination of drug and physical treatment methods can accelerate the achievement of diabetes compensation, prevent or cause regression of the development of neurovascular complications. The purpose of the study was to discuss the possibilities of the influence of physical therapy on the course of diabetes mellitus and the development of diabetic complications at the current stage. Results. In accordance with modern requirements, rehabilitation of patients with diabetes mellitus and diabetic complications is carried out in acute, subacute and long-term rehabilitation periods at the inpatient and outpatient stages of treatment. Properly dosed physical activity has a positive effect on all types of metabolism; this may allow to reduce the level of glycemia, increase the number of insulin receptors and their sensitivity, as well as reduce the doses of hypoglycemic drugs. Physical therapy has a positive effect on the condition of the central and peripheral nervous system, the disorders of which are important in the development of diabetic complications. The level of physical exertions should correspond to the patient's state of health, his/her physical capabilities, taking into account the stage and state of compensation of the disease, the presence of diabetic complications. The probability of success in physical therapy for such patients depends on the complex of physical therapy tools in combination with physiotherapeutic methods and massage. The effectiveness and safety of the physical therapy should be monitored by the dynamics of glycemia, glycosuria, and body weight. Conclusion. Therefore, the modern strategy of complex management of diabetic patients from the standpoint of physical and rehabilitation medicine involves a multidisciplinary approach with the inclusion of effective means of physical therapy, rehabilitation technologies, physiotherapeutic methods, as well as ergotherapeutic measures aimed at increasing functional reserves, compensation of impaired vascular and innervation mechanisms, regeneration capabilities, secondary prevention of diabetic complications, social adaptation and restoration of working capacity of patients

The 1964 US Surgeon General's report on smoking and health.

The 1964 report of the US Surgeon General on smoking and health made an authoritative case that tobacco smoking was a cause of premature deaths from lung cancer and chronic bronchitis. It justified the practice of drawing causal inferences from epidemiological studies, specified influential criteria for doing so, and made use of an early form of meta-analysis.

근감소증 예방을 위한 운동

This study comprehensively analyzed the physical and cognitive functions and exercise methods of the elderly through a previous study that proved the effect of exercise on geriatric sarcopenia, studied for 10 years from January 2007 to July 2017. 'elderly', 'sarcopenia', 'physical activity', and 'exercise' were searched mainly on academic research information service, domestic academic information portal, and PubMed to select papers. In terms of the effects of exercise, the data collected have a significant impact on the metabolic, cellular, and inflammatory mechanisms of sarcopenia, and the effects of these effects include improvements in body function, cardiovascular risk factors, various causes of death, and quality of life. Unlike drugs and invasive methods, this study observed the effect of exercise without side effects on sarcopenia in men and women over 65 years of age. As a result, it is expected that it can be used as basic data to prevent sarcopenia due to aging by suggesting an effective exercise program.

93P Noncancer-specific mortality in patients with stage IA1 NSCLC after surgical resection: The role of comorbidities in prognosis

Relapse and metastasis were commonly responsible for the poor prognosis for early-stage non-small cell lung cancer(NSCLC). With the increasing cases of elderly patients, the prevalence and clinical implications of noncancer-specific mortality have not been seen revealed previously due to the comorbidities. We identified the patients with stage IA1 NSCLC between 2004 and 2015 in the Surveillance, Epidemiology, and End Results(SEER) database and reviewed patients between 2014 and 2018 from West China Hospital, Sichuan University. We compared the incidence and survival between lung cancer-specific mortality(LCSM) and noncancer-specific mortality(NCSM), and intended to reveal the impact of age and various causes of death on prognosis. Kaplan-Meier analysis and propensity score matching analysis were employed to determine the survival difference between LCSM and NCSM. A total of 4955 patients were included with a median follow-up of 50 months(interquartile range, 26-85 months) from the SEER database, in which 431(8.7%) died of lung cancer and 1317(26.6%) of other causes. Those who died of other causes were older than those who died of cancer(70.01 years versus 67.69 years, P<0.001), while no significant difference was observed between LCSM and NCSM in overall survival(LCSM versus NCSM, OR=0.93; 95%CI, 0.83-1.03; P=0.171). Among the causes of NCSM, the survival time was significantly impaired in the deaths of hepatobiliary and pancreatic diseases, diseases of the oral cavity, tonsil and pharynx, and other carcinomas compared to the diseases of other systems(P<0.001). NCSM was crucial to the prognosis of early-stage NSCLC after surgical resection, and thus, better management of the comorbidities was supposed to be considered in routine follow-up among these patients. The clinical implications and practice of these comorbidities remain to be studied in further prospective studies.

An epidemiological retrospective profile of medico-legal autopsy cases reported at a tertiary care center in Dhulikhel, Nepal

Autopsy is a systematic scientific examination of dead body that helps in manifesting the information about the cause of death in case of an unnatural death. Medico legal autopsy profiling helps to understand the nature of casualties, it helps to assess the social and economic profile for understanding the nature of crime in particular area, helps to address the demographic needs according to the mortality statistics specific to that region and helpful to identify the need necessary to take preventive measures to stop the crime or unnatural deaths by means of spreading awareness and psychological course. This study aims to analyses the pattern of autopsy cases with manner and various causes of death which was conducted in a tertiary level hospital. This is a retrospective study conducted over a period of one year (Oct 2020 to Oct 2021) at Dhulikhel hospital, Nepal. During the study period on one year, a total of 258 cases of medicolegal autopsies were performed at Department of Forensic Medicine and Toxicology. Out of the 258 cases analyzed maximum incidence of the postmortems were reported in the age group of 43.80% was reported from 20 to 39 years aged group which are the most productive years in one’s life. The maximum incidence of the postmortems was reported in the male population of 70.54% compared to the female population (29.46%). Our strongest conclusion is that male/female differences in medicolegal autopsies are highly dependent on historical time and geographic location. The maximum incidence 32.56% was reported within 6 – 12 hours’ time group and minimum incidence 12.02% was reported within 0 – 6 hours’ time group. The maximum incidence 48.06% was reported from Suicide group and minimum incidence 6.20% was reported from Homicide group. The maximum incidence 33.72% was reported by Hanging group and minimum incidence 0.39% were reported from Choking and Traumatic Asphyxia groups during the medicolegal autopsies, , , , ,

Assisting Role of Pulmonary Hypostasis Phenomenon in Diagnosis of Drowning.

To study the phenomenon of pulmonary hypostasis in corpses of various causes of death, and to explore the potential value of this phenomenon in assisting forensic pathological diagnosis of drowning. A total of 235 cases with clear cause of death through systematic autopsy were collected from January 2011 to June 2021 in Guangzhou. According to the location of body discovery, the cases were divided into the water body group (97 cases) and the non-water body group (138 cases), and the water body group was further divided into the water drowning group (90 cases) and the water non-drowning group (7 cases). Non-water body group was further divided into the non-water drowning group (1 case) and the non-water non-drowning group (137 cases). Three senior forensic pathologists independently reviewed autopsy photos to determine whether there was hypostasis in the lungs. The detection rate of pulmonary hypostasis was calculated. The detection rate of pulmonary hypostasis in the water drowning group (90 cases) was 0, and the negative rate was 100%. The detection rate of pulmonary hypostasis in the water non-drowning group (7 cases) was 100% and the negative rate was 0. The detection rate of pulmonary hypostasis in the water body group and in the non-water body group (after excluding 2 cases, 136 cases were calculated) was 7.22% and 87.50%, respectively. There were statistically significant differences in the detection rate of pulmonary hypostasis between water body group and non-water body group, and between water drowning group and water non-drowning group (P<0.05). The disappearance of pulmonary hypostasis can be used as a specific cadaveric sign to assist in the forensic pathological diagnosis of drowning.

S1225 Multivariate Analysis of Causes of Death Among Hepatocellular Carcinoma Patients: A SEER-Based Study

Introduction: Hepatocellular Carcinoma (HCC), has a very poor prognosis and meek survival rates. Despite decades of research, a clear understanding of various causes of death among HCC patients is not well established. Identifying the causative factors helps develop targeted therapeutic regimens and formulate prophylactic measures. This study was therefore undertaken to identify various cancer and non-cancer causes of death in hepatocellular carcinoma (HCC) patients over different time periods after diagnosis, and to compare the mortality risk of each cause in HCC patients with the general population. Methods: In this retrospective cohort study, data of 67,637 HCC patients from 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We investigated the association between different causes of death and the following variables: age, race, tumor stage at diagnosis, and treatment (surgery, chemotherapy, and radiotherapy); each according to the periods of < 1 year, 1-5 years, 5-10 years, and >10 years following the diagnosis. Standardized mortality ratios (SMRs) and their 95% confidence intervals (CIs) were calculated for cancer and non-cancer deaths in each of the mentioned periods following diagnosis. Results: Data of 67,637 patients, of whom 50,571 patients died during the follow-up period, were analyzed. Most deaths were due to HCC itself (35,535, 70.3%), followed by other cancers (3,983, 7.9%). The most common non-cancer causes of death, with higher mortality risk in HCC patients than in the general population, included infectious and parasitic diseases including HIV (2,823 patients, SMR = 105.68, 95% CI: 101.82-109.65), chronic liver disease and cirrhosis (2,719 patients, SMR = 76.56, 95% CI: 73.71,79.5), and heart diseases (1,265 patients, SMR = 2.26, 95% CI: 2.14-2.39). Conclusion: The mortality rates showed a declining trend from the high of within the first year after diagnosis to a low of 10 years after diagnosis. The leading cause of death in HCC patients remains HCC itself over all time intervals after diagnosis. The commonest non-cancer causes of death were chronic liver disease and cirrhosis, infectious and parasitic diseases including HIV, and they had varying incidences across different time intervals. HCC patients had a higher risk of chronic liver disease, cirrhosis, infectious and parasitic diseases including HIV as compared to the general population whereas mortality risk due to heart diseases among HCC patients was similar to the general population.

Urban-rural disparity of the short-term association of PM2.5 with mortality and its attributable burden

Although studies have investigated the associations between PM2.5 and mortality risk, evidence from rural areas is scarce. We aimed to compare the PM2.5-mortality associations between urban cities and rural areas in China. Daily mortality and air pollution data were collected from 215 locations during 2014–2017 in China. A two-stage approach was employed to estimate the location-specific and combined cumulative associations between short-term exposure to PM2.5 (lag 0–3 days) and mortality risks. The excess risks (ER) of all-cause, respiratory disease (RESP), cardiovascular disease (CVD), and cerebrovascular disease (CED) mortality for each 10 μg/m3 increment in PM2.5 across all locations were 0.54% (95% confidence interval [CI]: 0.38%, 0.70%), 0.51% (0.10%, 0.93%), 0.74% (0.50%, 0.97%), and 0.52% (0.20%, 0.83%), respectively. Slightly stronger associations for CVD (0.80% versus 0.60%) and CED (0.61% versus 0.26%) mortality were observed in urban cities than in rural areas, and slightly greater associations for RESP mortality (0.51% versus 0.43%) were found in rural areas than in urban cities. A mean of 2.11% (attributable fraction [AF], 95% CI: 1.48%, 2.76%) of all-cause mortality was attributable to PM2.5 exposure in China, with a larger AF in urban cities (2.89% [2.12%, 3.67%]) than in rural areas (0.61% [−0.60%, 1.84%]). Disparities in PM2.5-mortality associations between urban cities and rural areas were also found in some subgroups classified by sex and age. This study provided robust evidence on the associations of PM2.5 with mortality risks in China and demonstrated urban-rural disparities of PM2.5-mortality associations for various causes of death.

Czyje góry: Boga czy Śmierci? O dwóch romantycznych modelach interpretacji krajobrazu

In the article the author seeks to answer the question — suggested by Romantic accounts — about whether the most colourful feature of mountain landscape is its religious nature or whether its most evident characteristics are those that turn it into a land of death. Drawing on biblical arguments, Romantic culture assigned to the mountains attributes of sacred a space inspiring strong religious experiences verging on mystical experiences (Ludwik Zejszner). Thus in the Romantic way of thinking the mountains became witnesses to the creation of the world (Antoni Czajkowski), while the natural landscape began to be viewed as hypostasis of divinity. That is why a homage paid to nature became a religious experience and a tribute to the greatness of God. Hierophanies turning the mountains into a sacred space generated strong religious responses in Romantic subjects; they encouraged prayer and prayerful ritualisation of behaviour. A Romantic wanderer felt a sense of unity with God both on top of a mountain and by the Morskie Oko lake. However, the mountains were also presented many times as a space of death, a fact stemming from the terror of their landscape. Romantic tourists were made aware of this omnipresence of death in the mountains by crosses placed in the mountains as well as graves scattered across them. Victims of the mountains included highlanders, tourists, treasure hunters and poachers. That is why in some literary visions various places in the mountains appeared as a big graveyard (“Czarny Staw as the capital of death”, Łucja Rautenstrauchowa). In the article the author points to various causes of death and characteristic ways of dying in the mountains.

OP0219 THE ASSOCIATION OF PSORIATIC ARTHRITIS WITH ALL-CAUSE MORTALITY AND LEADING CAUSES OF DEATH IN PSORIATIC ARTHRITIS

Background:Data on the association between PsA and mortality remains conflicting as it has been hampered by small sample size with few events and the potential for confounders of selection and severity biases from clinic-based studies.Objectives:To examine the association between PsA and all-cause mortality in a cohort of PsA patients and matched controls, using data from a population-based large medical record database.Methods:Patients with newly diagnosis of PsA between January 1st, 2003 and December 31st, 2018 from the Clalit Health database were identified. 4 controls without PsA were selected and matched to cases of PsA by age (within 1 year), sex, ethnicity (Jewish vs. non-Jewish), and index date. The two groups were followed from the index date until the first occurrence of death from any cause or end of follow-up (June 30, 2019). Data on mortality and on the immediate cause of death was based on the Notification of Death form legally required by the Israeli Ministry of the Interior for every deceased person in the country. Demographic data including age, sex, ethnicity (Jewish or Arab), and socioeconomic status (SES) at inception were retrieved from the CHS database. Data regarding tobacco use (ever), obesity, body mass index, diabetes mellitus, hyperlipidemia, hypertension, ischemic heart disease, prior cerebrovascular accident, congestive heart failure, chronic renal failure, chronic obstructive pulmonary disease, cirrhosis, prior malignancy, psoriasis, and the concomitant use of glucocorticosteroids, conventional and biologic disease-modifying anti-rheumatic drugs (cDMARDs and bDMARDs, respectively) were extracted from the database.We estimated the attributable fraction of the various causes of death in PsA patients and compared it to the proportionate mortality rate (PMR) of the leading causes of death in Israel during 2014-2016 based on a recently published report by the Central Bureau of Statistics. Cox proportional hazard regression models were used to estimate the crude and the multivariate adjusted hazard ratio (HR) for the association between PsA and all-cause mortality, as well as for factors associated with mortality within the PsA group.Results:A total of 5275 PsA patients were identified between 2003 and 2018 and where matched to 21,011 controls based on age, sex, and ethnicity. The mean age was 51.7 ± 15.4 years of whom 53% were females. More individuals in the PsA group were smokers, obese, with diabetes, hypertension, and dyslipidemia, as well as with a history of ischemic heart disease, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, chronic renal failure and cirrhosis than patients in the control group, and 38.2% of PsA patients were on b-DMARDS. Overall 471 (8.9%) patients died in the PsA group compared to 1,668 (7.9%) in the control group during a mean follow-up of 7.2 ± 4.4 years. The crude HR for the association of PsA and all-cause mortality was 1.16 (95% CI, 1.042-1.29). However, the association was not significant on multivariate analysis with HR of 1.096 (95% CI, 0.977-1.229).In PsA patients, malignancy was the leading cause of death, constituting 26% of all deaths, followed by ischemic heart disease 15.8%, diabetes 6.2%, cerebrovascular diseases 5.5% and septicemia 5.5%, in keeping with the order of the leading causes of death in the general population of Israel during 2014-2016 as recently reported by the Central Bureau of Statistics.On multivariate model Cox regression analysis, male sex, increased body mass index, increased Charlson comorbidity index scores and history of hospitalization in a year prior to death were associated with higher mortality, whereas treatment bDMARDs and cDMARDs were associated with a lower relative risk of death.Conclusion:No clinically relevant increase in mortality rate was observed in PsA patients from the period 2003-2018. The most common causes of specific proportionate mortality rates in our cohort were similar to those in the general population.Disclosure of Interests:None declared

Genetic investigations of 100 inherited cardiac disease-related genes in deceased individuals with schizophrenia.

Cardiac diseases and sudden cardiac death (SCD) are more prevalent in individuals diagnosed with schizophrenia compared to the general population, with especially coronary artery disease (CAD) as the major cardiovascular cause of death. Antipsychotic medications, genetics, and lifestyle factors may contribute to the increased SCD in individuals with schizophrenia. The role of antipsychotic medications and lifestyle factors have been widely investigated, while the genetic predisposition to inherited cardiac diseases in schizophrenia is poorly understood. In this study, we examined 100 genes associated with inherited cardiomyopathies and cardiac channelopathies in 97 deceased individuals diagnosed with schizophrenia for the prevalence of genetic variants associated with SCD. The deceased individuals had various causes of death and were included in the SURVIVE project, a prospective, autopsy-based study of mentally ill individuals in Denmark. This is the first study of multiple inherited cardiac disease-related genes in deceased individuals with diagnosed schizophrenia to shed light on the genetic predisposition to SCD in individuals with schizophrenia. We found no evidence for an overrepresentation of rare variants with high penetrance in inherited cardiac diseases, following the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG) consensus guidelines. However, we found that the deceased individuals had a statistically significantly increased polygenic burden caused by variants in the investigated heart genes compared to the general population. This indicates that common variants with smaller effects in heart genes may play a role in schizophrenia.

The impact of primary health care and specialist physician supply on amenable mortality in Mexico (2000–2015): Panel data analysis using system-Generalized Method of Moments

The study had a three-fold objective: (i) to estimate the amenable mortality rates and trends at a national and state level between 2000 and 2015 in Mexico; (ii) to estimate the contribution and trends of various causes of death to overall amenable mortality; and (iii) to determine the association between health system inputs and amenable mortality for the period 2000–2015. We used a panel dataset for the period 2000–2015. The following health care inputs were used in the analysis: density of general practitioners, specialists and nurses, as well as density of hospital beds. We find that amenable mortality fell from 136 per 100,000 in 2000, to 124.1 per 100,000 in 2015 nationally, with significant heterogeneity in the trends across states. Mortality due to infectious diseases, diseases of childhood, and cardiovascular diseases decreased, while deaths due to other non-communicable diseases, such as diabetes, increased. There was a significant negative association between the density of general practitioners and specialist physicians, and amenable mortality. Our results indicate that reducing the burden of non-communicable diseases must be a health system priority. Improvements in primary health care could lead to improved disease detection and earlier diagnosis which could further reduce amenable mortality in Mexico.

DISPONIBILIDADE DE ALCOÓIS NÃO BEBIVEIS NA RÚSSIA EM 2015-2020: AS POLÍTICAS DE CONTROLE IMPLEMENTADAS DESDE 2005 FORAM EFETIVAS?

Consumption of non-beverage alcohol is an important aspect of hazardous drinking, impacting mortality from various causes of death. Since 2005, non-beverage alcohols in Russia have been the subject of active regulation to control their consumption for drinking. This study was purported to determine whether non-beverage alcohols were available in Russia in 2015–2020 to assess the effectiveness of implemented control policies. During the first wave of the survey between 2015 and 2017, 50 Russian cities of various sizes, types, and locations were surveyed. The second wave was conducted between 2018 and 2020 in 5 cities, which were surveyed during the first wave. Fieldworkers visited various retail outlets and purchased samples of non-beverage alcohols: spirituous liquids with an ethanol content of at least 60% by volume sold at a price of less than 45 roubles per bottle ($0.57, €0.49, £0.44). Up until 2016 various types of non-beverage alcohols known as consumed for drinking were available in retail. The availability of these alcohols differed between cities depending on the level of local enforcement of control regulations. The regulations enacted in response to the 2016 Irkutsk outbreak of mass alcohol poisonings, caused by the consumption of methanol containing fake bath additive “Hawthorn”, removed from the market several types of non-beverage alcohols, significantly reducing their availability since 2017. However, low-cost ethanol sources, such as medicinal tinctures, antiseptics, not denatured eau-de-colognes, remained available in 2017-2020, while new sorts of cheap non-beverage alcohols suitable for drinking were introduced to the market (antiseptics for veterinary use, anti-SARS-CoV-2 hand sanitizers). Illegal alcoholic beverages commonly produced from diverted pharmaceutical/medicinal ethanol were also available in retail networks selling non-beverage alcohols. Since 2005, policies implemented and especially those reinforced and newly enacted in 2017 and later in response to the 2016 Irkutsk outbreak, may have indeed reduced the physical availability of non-beverage alcohols. However, more decisive action is still required to prevent consumption of newly appearing and existing specific sorts of non-beverage alcohols and illegal alcoholic beverages, which are commonly produced from the licit or diverted from the legal market unrecorded illicit pharmaceutical/medicinal ethanol.

Mortality in Metropolises of Ukraine: Historical Parallels with the Study of Yu. O. Korchak-Chepurkivsky

The purpose of this paper is to make a comparative analysis (find historical parallels) of the situation with mortality causes in four cities of Ukraine in 1923–1929 and in our time, by comparing the mortality structure in 1926 and 2019, to identify structural changes and make assumptions regarding their determinants. Based on data from statistical tables of mortality in the four largest cities of the Ukrainian Socialist Soviet Republic (Kyiv, Kharkiv, Dnipropetrovsk, and Odessa) for 1923–1929 and data from the State Statistics Service of Ukraine for 2019 on the distribution of deaths by death cause in the same cities and in Ukraine, the structural shares by main classes were calculated (according to the current classifications). Changes in the contribution of various causes of death to the mortality of the urban population are estimated. The overall progress (the advancement of medical science and practice, the improvement of living conditions (including sanitation and hygiene) and quality of life, the increased population’s awareness of health issues and access to medical care, etc.), immunization programs, the development and production of effective drugs have significantly reduced the mortality and transformed its structure.&#x0D; It is shown that the list of the leading causes, especially their ranks, given in the research of Yu. O. Korchak-Chepurkivsky, differed significantly from the analogous list for modern metropolises of Ukraine. In contrast to the situation in the four largest Ukrainian cities in 2019, with the majority of deaths caused by diseases of the circulatory system (about 65%), almost the same total share (67.4%) of deaths in the above cities in 1926 was determined by five classes (infectious or communicable diseases, diseases of the respiratory and digestive organs, cardiovascular diseases, and diseases of the nervous system and sense organs). The largest share of deaths in the four largest cities of the Ukrainian Socialist Soviet Republic was found to be caused by infectious and parasitic diseases (over 27%). Given that part of the infectious pathology (the diseases of the digestive system and nervous system in the first place) was registered by the then nomenclature in other classes, their contribution to the totality of deaths can be assessed as more significant (at least by 10–15%).&#x0D; The structural share of mortality from infectious and parasitic diseases in the four largest cities has decreased from 27% altogether to nearly 2%. There was a significant transformation in the spectrum of causes: while in 1926 high mortality was due to scarlet fever, whooping cough, typhoid fever and paratyphoid fever evolved to almost zero, in our time its significant part was caused by a new pathology, a disease caused by the human immunodeficiency virus (HIV). At the same time, the significance of tuberculosis as a cause of death is a striking difference between the mortality pattern in Ukrainian cities and the situation in modern developed countries. The decreased structural shares of infectious, respiratory and digestive diseases (some of which are also of infectious etiology), along with the prevalence of pathologies occurring in the perinatal period, congenital malformations, deformities and chromosomal abnormalities, were the largest changes in the infant mortality structure.

EPID-29. CAUSES OF DEATH FOR PRIMARY BRAIN AND CNS TUMOR PATIENTS IN THE UNITED STATES (2001 – 2016): A POPULATION BASED STUDY

Abstract BACKGROUND Population-based data on the various causes of death among Primary Brain and CNS tumor patients are lacking. We evaluated the causes of death for all eligible patients using the National Program of Cancer Registries (NPCR) data. METHODS The population-based cancer survival data collected by the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) were used to analyze the causes of death for patients of all ages with primary brain and CNS tumors diagnosed between 2001 and 2016. Patients for whom the cause of death was not listed on the death certificate or whose state death certificate was not available were excluded. Additional analyses to identify factors associated with brain tumor-specific mortality for the most common malignant (Glioblastoma) and non-malignant (Meningioma) were performed using univariable and multivariable logistic regression analysis. RESULTS Major cause of death for patients with malignant tumors was death due to brain and other CNS tumors (49.29%), and for non-malignant tumors were other benign and malignant tumors (31.5%) and heart disease (17.9%). Overall mortality was 36.4% (n=331,953) in patients with Primary Brain and CNS Tumors during the study period. Specifically, 163,621 (49.29%) patients died due to brain and other CNS tumors. A significant proportion of patients with malignant tumors had brain tumor-specific mortality compared to non-malignant tumors (75.4% in malignant vs 4.2% in non-malignant). The factors associated with brain specific mortality in Glioblastoma patients were Age (p&amp;lt; 0.001), Race (p&amp;lt; 0.001) and Primary Site (p&amp;lt; 0.001). Further, the factors associated with brain specific mortality in Non-malignant Meningioma patients were Age (p&amp;lt; 0.001), Sex (p&amp;lt; 0.001), Race (p&amp;lt; 0.001) and Primary Site (P&amp;lt; 0.001). CONCLUSION Cause of death attributed to the brain tumor was significantly higher in malignant brain tumors compared to non-malignant brain tumors.

Ascertaining cause of mortality among middle-aged and older persons using computer-coded and expert review verbal autopsies in the China Health and Retirement Longitudinal Study

ABSTRACT Background Verbal autopsy is designed to ascertain causes of death that are not registered or certified. Verbal autopsy has been validated in multiple settings but has not been as widely evaluated for older populations as for younger age groups. Objective This study aims to provide empirical evidence of the value of verbal autopsy interviews in the context of population-based surveys of older adults by comparing the cause-of-death assignments derived from two methods of interpreting verbal autopsy data. Methods Data used in this study come from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of older Chinese. We compared 407 causes of death determined using InterVA, which is a computer-coded method, and causes of death as assigned by experts; then evaluated factors that affect the results of the two approaches. Results Among the 407 deaths, neoplasms, cardiac disease, and stroke are the leading causes of death according to both approaches. The consistency of the two approaches is about 45% at the individual level. The primary reason for the mismatch is that no cause of death could be assigned for more than 25% of the sample based on expert review. A higher likelihood of mismatch is associated with advanced age and a long period between death and verbal autopsy interview. Conclusion Both approaches identify the same leading causes of death at the aggregate level, but consistency is relatively low at the individual level. InterVA works well when causes of death are characterized by distinctive signs and symptoms. Grouping the various causes of death with shared etiology or common risk factors may help improve the quality of the ascertainment of causes of death. Open-ended narratives are helpful because they provide information about the circumstances surrounding the death that are not available in the structured verbal autopsy interviews.

Years of potential life lost and productivity costs due to premature mortality from six priority diseases in Tanzania, 2006-2015.

BackgroundMortality statistics are traditionally used to quantify the burden of disease and to determine the relative importance of the various causes of death. Some of the most frequently used indices to quantify the burden of disease are the years of potential life lost (YPLL) and years of potential productive life lost (YPPLL). These two measures reflect the mortality trends in younger age groups and they provide a more accurate picture of premature mortality. This study was carried out to determine YPLL, YPPLL and cost of productivity lost (CPL) due to premature mortality caused by selected causes of deaths in Tanzania.Methods and findingsMalaria, respiratory diseases, HIV/AIDS, tuberculosis, cancers and injuries were selected for this analysis. The number of deaths by sex and age groups were obtained from hospital death registers and ICD-10 reporting forms in 39 public hospitals in Tanzania, covering a period of 2006–2015. The life expectancy method and human capital approach were used to estimate the YPLL, YPPLL and CPL due to premature mortality. During 2006–2015, malaria, HIV/AIDS, tuberculosis, respiratory diseases, HIV+tuberculosis, cancer and injury were responsible for a total of 96,834 hospital deaths, of which 46.4% (n = 57,508) were among individuals in the productive age groups (15–64 years). The reported deaths contributed to 2,850,928 YPLL (female = 1,326,724; male = 1,524,205) with an average of 29 years per death. The average YPLL among females (32) was higher than among males (28). Malaria (YPLL = 38 per death) accounted for over one-third (35%) of the total YPLL. There was a significant increase in YPLL due to the selected underlying causes of death over the 10-year period. Deaths from the selected causes resulted into 1,207,499 YPPLL (average = 21 per death). Overall, HIV/AIDS contributed to the highest YPPLL (323,704), followed by malaria (243,490) and injuries (196,505). While there was a general decrease in YPPLL due to malaria, there was an increase of YPPLL due to HIV/AIDS, respiratory diseases, cancer and injuries during the 10-year period. The total CPL due to the six diseases was US$ 148,430,009 for 10 years. The overall CPL was higher among males than females by 29.1%. Over half (58%) of the losses were due to deaths among males. HIV/AIDS accounted for the largest (29.2%) CPL followed by malaria (17.8%) and respiratory diseases (14.6%). The CPL increased from US$11.4 million in 2006 to US$17.9 million in 2016.ConclusionsThe YPLL, YPPLL and CPL due to premature death associated with the six diseases in Tanzania are substantially high. While malaria accounted for highest YPLL, HIV/AIDS accounted for highest YPPLL and CPL. The overall CPL was higher among males than among females. Setting resource allocation priorities to malaria, HIV/AIDS and respiratory diseases that are responsible for the majority of premature deaths could potentially reduce the costs of productivity loss in Tanzania.

Spatially differentiating the effects of long-term air pollution on specific causes of death from cardiovascular and respiratory mortality in Hong Kong: a territory-wide register-based study

Previous studies have evaluated the effects of air pollution on various causes of death. However, there are few studies directly differentiating the regional effects of air pollution on specific causes of death from cardiovascular and respiratory mortality. It is important to target specific diseases and air pollutants for environmental management, in order to develop a sustainable environment. Therefore, a territory-wide register-based study was developed with cause-specific mortality data in Hong Kong between 2007 and 2014 (n = 257,090). Five groups of decedents were directly compared with the two control groups (cardiovascular and respiratory deaths), separately, based on binomial logistic regressions. Three air pollutants (NO2, PM2.5, black carbon (BC)) were selected to evaluate how spatial distribution of long-term air pollution exposure can induce the difference in mortality risks from two control groups. Based on the results, different air pollutants can contribute to different impact on mortality risk. PM2.5 and BC contributed to higher effects on mortality associated with mental and behavioral disorders than those linked to cardiovascular and respiratory diseases. BC can contribute to a higher mortality risk for mortality associated with diseases of the nervous and digestive systems than with respiratory diseases. There was also a stronger influence of neighborhood PM2.5 on mortality associated with diseases of the genitourinary system than with cardiovascular and respiratory diseases, and a stronger impact of neighborhood NO2 and BC on cancer-related mortality than on respiratory mortality. In conclusion, several air pollutants have greater impact on cause-specific mortality than cardiovascular and respiratory mortality. Therefore, it is necessary to have a comprehensive and systematic investigation to evaluate how different types of air pollutants influence various types of cause-specific mortality. In addition, specific health protocols, enhancement of urban design and improvement of environmental hygiene should be conducted for specific types of air pollution and deprived populations, rather than targeting solely the people with cardiorespiratory diseases.