Vital Statistics Mortality Data Research Articles

Pregnancy-Associated Mortality During the Pandemic: Disparities by Rurality

IntroductionIn the US, rural areas experience higher rates of adverse maternal health outcomes, but little data exists on rural/urban differences in pregnancy-associated deaths (PAD, all deaths during pregnancy and postpartum) or rural/urban differences in those deaths during the COVID-19 pandemic. MethodsCross-sectional US vital statistics mortality data from 2018 to 2021 was used to identify PAD (analyzed in 2024). PAD ratios (deaths per 100,000 live births) and 95% confidence intervals (CIs) were calculated by year, cause, and rurality (urban, suburban, rural). The percent change in PAD ratios between the pre-pandemic (2018 and 2019) and pandemic (2020 and 2021) time periods was calculated by rurality. ResultsDuring the pandemic, rural—compared to suburban and urban—areas had the highest pregnancy-associated death ratios due to obstetric causes (53.9 deaths/100,000 live births, 95%CI: 48.8, 59.4), drug-related causes (19.0, 95%CI: 16.0, 22.4), suicide (4.4., 95%CI: 3.0, 6.2), and other causes (the majority of which are motor vehicle accidents, 16.4, 95%CI: 14.0, 19.6). Rural areas experienced increases in all causes of pregnancy-associated death from pre-pandemic (2018 and 2019) to pandemic (2020 and 2021) with increases of 48.1% in obstetric deaths, 115.9% in drug-related deaths, 17.8% in homicide, 25.7% in suicide, and 11.6% in other causes. Rural areas experienced the largest (compared to urban and suburban) increase in drug-related deaths, and only rural areas experienced an increase in suicide during the pandemic. ConclusionsRural areas experience a high burden of pregnancy-associated death, and this inequity was exacerbated during the COVID-19 pandemic.

The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario, Canada: Validation Study.

BackgroundEarly estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province.ObjectiveThis study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality.MethodsCremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario’s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality.ResultsBetween 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data.ConclusionsThe percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies.

Legalization of Medical Cannabis and Site of Death: Evidence From National Vital Statistics Mortality Data.

We examined whether Medical Marijuana Legislation (MML) was associated with site of death. Using state-level data (1992-2018) from the National Vital Statistics System (NVSS), we employed difference-in-differences method to compare changes in death rate among older adults at four sites-nursing home (NH), hospital, home, hospice/other-over time in states with and without MML. Heterogeneity analyses were conducted by timing of MML adoption, and by decedent characteristics. Results show a negative association between MML implementation and NH deaths. Among early adopters (states with weakly regulated programs) and decedents with musculoskeletal disorders, there was a positive association between MML implementation and hospital deaths, whereas among late adopters (states with "medicalized" programs), there was a positive association between MML implementation and hospice deaths. Decline in NH deaths may reflect increased likelihood of transfers due to threat of Federal enforcement, penalties for poor outcomes, and liability concerns. Future studies should examine these associations further.

Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016‒2017.

Objectives. To better understand racial and ethnic disparities in US maternal mortality. Methods. We analyzed 2016-2017 vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths that had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. We examined racial and ethnic disparities both overall and by primary cause. Results. The maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women. Leading causes of maternal death for non-Hispanic Black women were eclampsia and preeclampsia and postpartum cardiomyopathy with rates 5 times those for non-Hispanic White women. Non-Hispanic Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were 2.3 to 2.6 times those for non-Hispanic White women. Together, these 4 causes accounted for 59% of the non-Hispanic Black‒non-Hispanic White maternal mortality disparity. Conclusions. The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period. Many of these deaths are preventable.

Causes contributing to the excess maternal mortality risk for women 35 and over, United States, 2016-2017.

To better understand age-related disparities in US maternal mortality, we analyzed 2016–2017 vital statistics mortality data with cause-of-death literal text (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths which had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. Age-related disparities were examined both overall and by primary cause. Compared to women <35, the 2016–2017 US maternal mortality rate was twice as high for women aged 35–39, four times higher for women aged 40–44, and 11 times higher for women aged 45–54 years. Obstetric hemorrhage was the leading cause of death for women aged 35+ with rates 4 times higher than for women <35, followed by postpartum cardiomyopathy with a 3-fold greater risk. Obstetric embolism, eclampsia/preeclampsia, and Other complications of obstetric surgery and procedures each had a two-fold greater risk of death for women aged 35+. Together these 5 causes of death accounted for 70.9% of the elevated maternal mortality risk for women aged 35+. The excess maternal mortality risk for women aged 35+ was focused among a few causes of death and much of this excess mortality is preventable. Early detection and treatment, as well as continued care during the postpartum year is critical to preventing these deaths. The Alliance for Innovation on Maternal Health has promulgated patient safety bundles with specific interventions that health care systems can adopt in an effort to prevent these deaths.

HIV mortality across the 30 largest U.S. cities: assessing overall trends and racial inequities

ABSTRACT Background Despite decreases in overall HIV mortality in the U.S., large racial inequities persist. Most previous analyses of HIV mortality and mortality inequities have utilized national- or state-level data. Methods Using vital statistics mortality data and American Community Survey population estimates, we calculated HIV mortality rates and Black:White HIV mortality rate ratios (RR) for the 30 most populous U.S. cities at two time points, 2010–2014 (T1) and 2015–2019 (T2). Results Almost all cities (28) had HIV mortality rates higher than the national rate at both time points. At T2, HIV mortality rates ranged from 0.8 per 100,000 (San Jose, CA) to 15.2 per 100,000 (Baltimore, MD). Across cities, Black people were approximately 2–8 times more likely to die from HIV compared to White people at both time points. Over the decade, these racial disparities decreased at the national level (T1: RR = 11.0, T2: RR = 9.8), and in one city (Charlotte, NC). Discussion We identified large geographic and racial inequities in HIV mortality in U.S. urban areas. These city-specific data may motivate change in cities and can help guide city leaders and other health advocates as they implement, test, and support policies and programming to decrease HIV mortality.

Diabetes mortality across the 30 biggest U.S. cities: Assessing overall trends and racial inequities

AimsNational data suggest that diabetes mortality disproportionately affects Blacks compared to whites. We aimed to (1) calculate diabetes mortality rates (where diabetes was an underlying cause of death) among the general population of the U.S. and the largest 30 cities; (2) calculate Black/white mortality rate ratios and rate differences; and (3) compare changes in mortality rates and inequities across two 5-year periods (2008–2012 (T1) and 2013–2017 (T2)). MethodsWe used vital statistics mortality data and American Community Survey population estimates. ResultsThe U.S. diabetes mortality rate at T1 was 20.91 per 100,000, and significantly increased to 21.05 at T2. El Paso had the highest diabetes mortality rate at both time points (T1 = 33.06; T2 = 35.98), while San Francisco had the lowest rate (T1 = 11.41; T2 = 13.18). The U.S. Black mortality rate was 2.21 times higher than the white rate at T2 (95%CI [2.19–2.23]). Eleven cities had significantly higher rate ratios than the U.S. at T2. The Black:white rate ratio in Washington, D.C. was approximately three times higher than the national rate ratio. ConclusionsThis city-level data is important to inform more targeted local policy interventions and programming to promote health equity, particularly within cities with the greatest inequities.

Opioids and Organs: How Overdoses Affect the Supply and Demand for Organ Transplants

As the incidence of fatal drug overdose has quadrupled in the U.S. in the past two decades, patients awaiting organ transplants may be unintended beneficiaries. We use Vital Statistics mortality data, merged with data on the universe of transplant candidates and recipients in the U.S. from the Scientific Registry of Transplant Recipients, to study the extent to which the growth in opioid-related deaths affects the supply of deceased organ donors and transplants. Using two separate identification strategies, we find that opioid-related deaths led to more than 22,000 organ transplants in the U.S. between 2008 and 2018. Although we detect little evidence of demand responses to opioid-induced organ supply shocks, we find that transplant centers are increasingly recovering organs from overdose victims for transplant, with the association between opioid-related deaths and organ donors more than doubling between 2008 and 2018. We also present evidence that transplant candidates appear to be more willing to use organs from those who died of opioid-related causes when organ shortages are relatively severe.

Improving US maternal mortality reporting by analyzing literal text on death certificates, United States, 2016-2017.

Changes in data collection and processing of US maternal mortality data across states over time have led to inconsistencies in maternal death reporting. Our purpose was to identify possible misclassification of maternal deaths and to apply alternative coding methods to improve specificity of maternal causes. We analyzed 2016–2017 US vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We developed an alternative coding strategy to code the “primary cause of death” defined as the most likely cause that led to death. We recoded deaths with or without literal pregnancy mentions to maternal and non-maternal causes, respectively. Originally coded and recoded data were compared for overall maternal deaths and for a subset of deaths originally coded to ill-defined causes. Among 1691 originally coded maternal deaths, 597 (35.3%) remained a maternal death upon recoding and 1094 (64.7%) were recoded to non-maternal causes. The most common maternal causes were eclampsia and preeclampsia, obstetric embolism, postpartum cardiomyopathy, and obstetric hemorrhage. The most common non-maternal causes were diseases of the circulatory system and cancer, similar to the leading causes of death among all reproductive-age women (excluding injuries). Among 735 records originally coded to ill-defined causes, 94% were recoded to more specific, informative causes from literal text. Eighteen deaths originally coded as non-maternal mentioned pregnancy in the literals and were recoded as maternal deaths. Literal text provides more detailed information on cause of death which is often lost during coding. We found evidence of both underreporting and overreporting of maternal deaths, with possible overreporting predominant. Accurate data is essential for measuring the effectiveness of maternal mortality reduction programs.

Pancreatic cancer: Do disparities in mortality rates exist with respect to socioeconomic status?

e19007 Background: Pancreatic cancer continues to have one of the highest mortality rates among major cancer diagnoses with rates greater than 90 percent for all stages and with five year survival rates below 10 percent. With access to treatment modalities such as chemo-radiation, staged surgical interventions and targeted therapies, survival times have increased but due to the costs of these procedures, they may not be accessible to all members of society. Recent studies have shown that lower socioeconomic status is associated with higher mortality rates and lower survival times. With this study we aim to investigate if disparities exist among socioeconomic classes, based on zip code location, in a major multi-ethnic metropolitan city using census data. Methods: Malignant neoplasm mortality data at the ZIP code level was gathered from the New York City Department of Health Vital Statistics Mortality Data from years 2009-2011. NYC population data was gathered from the U.S. Census Bureau 2010 decennial census. We used ordinary least squares regression to assess the independent association between neighborhood median income and neighborhood mortality from malignant neoplasms arising from the pancreas. Results: In 2009-2011, 2,527 deaths from malignant neoplasms arising from the pancreas were recorded across NYC. There is no statistically significant correlation between neighborhood median income and age-adjusted mortality from malignant neoplasms arising from the pancreas for males and for females. For males, there was an R-squared of 0.001721 ( P-value &gt; 0.05). For females, there was an adjusted adjusted R-squared of 9.818e-05 ( P-value &gt; 0.05). Conclusions: Neighborhood median income is not associated with an increase in mortality rate with respect to neoplasms arising from the pancreas.

P135: Frequent emergency department use as an independent factor associated with mortality in substance and opioid misuse: a retrospective analysis of linked databases

Introduction: Substance and opioid misuse present significant illness burdens in Emergency Departments (EDs). Understanding risk factors for mortality in these patients is urgently needed to allow targeted prevention. This studys objective was to determine whether frequent ED use is independently associated with mortality among patients with substance and opioid misuse, and secondarily, whether degree of frequent use influences mortality risk. Methods: This is a retrospective cohort study in Alberta, Canada. National Ambulatory Care Reporting System ED data was linked to Vital Statistics mortality data using postal code, birthdate, and sex. All adults (18 years old at index visit, i.e. first visit made in the study year) with substance or opioid misuse (defined by ICD-10 codes) from April 1, 2012 to March 31, 2013 were included. Frequent use was defined by 5 ED visits in the 12 months prior to index visit. The primary outcome was mortality within 90 days, and secondarily, within 30 days, 365 days, and 2 years post-index visit. Mortality was compared using Kaplan-Meier curves and Cox regression adjusting for age, sex and income. Degree was examined by subcategorizing frequent use into 5-10, 11-15, 16-20, and &gt;20 visits. Results: Overall, 16,389 patients made 24,880 visits for substance misuse, and 1787 patients made 2241 visits for opioid misuse. Frequent vs. non-frequent substance misusers were older, more often female, lower income, more often of rural residence, and arrived more by ambulance for lower acuity visits that were hospitalized less often. Compared to frequent substance misusers, frequent opioid misusers were more often female, of non-rural residence, arrived less often by ambulance, and made higher acuity visits that were hospitalized more often. Among substance misuse patients, 97.1% (95% CI: 96.6, 97.7) of frequent users vs. 98.0% (95% CI: 97.7, 98.2) of non-frequent users were alive at 2 years. Frequent use was significantly associated with mortality at 365 days (HR 1.36 [95% CI: 1.04, 1.77]) and 2 years (HR 1.32 [95% CI: 1.04, 1.67]) but not at 90 or 30 days. Subcategorized by degree, frequent use was significantly associated with mortality only for patients with &gt;20 visits/year at 365 days (HR 1.88 [1.03, 3.44]) and 2 years (HR 1.89 [1.10, 3.22]). Among opioid misuse patients, there was no difference in mortality between frequent and non-frequent ED users at any time point. However, subcategorized by degree, a significant association was seen for those with 16-20 visits/year at 365 days (HR 3.62 [95% CI:1.13, 11.66]), and 2 years (HR 3.37 [95% CI: 1.05, 10.81]). Conclusion: In substance misuse patients, frequent ED use was significantly associated with long-term but not short-term mortality. Mortality risk for substance and opioid misuse patients was concentrated in extremely frequent users suggesting that the highest frequency presenters should be targeted for prevention.

Disproportionately higher unintentional injury mortality among Alaska Native people, 2006–2015

ABSTRACTWe compared rates of unintentional injury (UI) deaths (total and by injury category) among Alaska Native (AN) people to rates of U.S. White (USW) and Alaska White (AKW) populations during 2006–2015. The mortality data for AN and AKW populations were obtained from Alaska Bureau of Vital Statistics and USW mortality data were obtained from WISQARS, the Center for Disease Control and Prevention online injury data program. AN and AKW rates were age-adjusted to the U.S. 2000 Standard Population and rate ratios (RR) were calculated. AN people had higher age-adjusted total UI mortality than the USW (RR = 2.6) and AKW (RR = 2.3) populations. Poisoning was the leading cause of UI death among AN people (35.9 per 100,000), more than twice that of USW (RR = 2.9) and AKW (RR = 2.5). Even greater disparities were found between AN people and USW for: natural environment (RR = 20.7), transport-other land (RR = 12.4), and drowning/submersion (RR = 9.1). Rates of AN UI were markedly higher than rates for either USW or AKW. Identifying all the ways in which alcohol/drugs contribute to UI deaths would aid in prevention efforts. All transportation deaths should be integrated into one fatality rate to provide more consistent comparisons between groups.

Contribution of Opioid-Involved Poisoning to the Change in Life Expectancy in the United States, 2000-2015

This study uses US National Vital Statistics mortality data to assess change in US life expectancy from 2000 to 2015 attributable to opioid-involved poisonings.

Assessing Years of Life Lost Versus Number of Deaths in the United States, 1995-2015.

To assess years of life lost to each cause of death in the United States between 1995 and 2015, and compare it with the number of deaths. We used Vital Statistics mortality data and defined "life-years lost" as remaining life expectancy for each decedent's age, sex, and race. We calculated the share of life-years lost to each cause of death in each year, and examined reasons for changes. In 2015, heart disease caused the most deaths, but cancer caused 23% more life-years lost. Life-years lost to heart disease declined 6% since 1995, whereas life-years lost to cancer increased 16%. The increase for cancer was entirely attributable to population growth and longer life expectancy; had these factors remained constant, life-years lost to heart disease and cancer would have fallen 56% and 38%, respectively. Accidents (including overdoses), suicides, and homicides each caused twice the share of life-years lost as deaths. Measuring life-years lost highlighted racial disparities in heart disease, homicides, and perinatal conditions. Life-years lost may provide additional context for understanding long-term mortality trends.

Killed by Police: Validity of Media-Based Data and Misclassification of Death Certificates in Massachusetts, 2004-2016.

To assess the validity of demographic data reported in news media-based data sets for persons killed by police in Massachusetts (2004-2016) and to evaluate misclassification of these deaths in vital statistics mortality data. We identified 84 deaths resulting from police intervention in 4 news media-based data sources (WGBH News, Fatal Encounters, The Guardian, and The Washington Post) and, via record linkage, conducted matched-pair analyses with the Massachusetts mortality data. Compared with death certificates, there was near-perfect correlation for age in all sources (Pearson r > 0.99) and perfect concordance for gender. Agreement for race/ethnicity ranged from perfect (The Counted and The Washington Post) to high (Fatal Encounters Cohen's κ = 0.92). Among the 78 decedents for whom finalized International Classification of Diseases, 10th Revision (ICD-10), codes were available, 59 (75.6%) were properly classified as "deaths due to legal intervention." In Massachusetts, the 4 media-based sources on persons killed by police provide valid demographic data. Misclassification of deaths due to legal intervention in the mortality data does, however, remain a problem. Replication of the study in other states and nationally is warranted.

Contribution of maternal age and pregnancy checkbox on maternal mortality ratios in the United States, 1978–2012

Maternal mortality ratios (MMR) appear to have increased in the United States over the last decade. Three potential contributing factors are (1) a shifting maternal age distribution, (2) changes in age-specific MMR, and (3) the addition of a checkbox indicating recent pregnancy on the death certificate. To determine the contribution of increasing maternal age on changes in MMR from 1978 to 2012 and estimate the contribution of the pregnancy checkbox on increases in MMR over the last decade. Kitagawa decomposition analyses were conducted to partition the maternal age contribution to the MMR increase into 2 components: changes due to a shifting maternal age distribution and changes due to greater age-specific mortality ratios. We used National Vital Statistics System natality and mortality data. The following 5-year groupings were used: 1978-1982, 1988-1992, 1998-2002, and 2008-2012. Changes in age-specific MMRs among states that adopted the standard pregnancy checkbox onto their death certificate before 2008 (n= 23) were compared with states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (n= 11) to estimate the percentage increase in the MMR due to the pregnancy checkbox. Overall US MMRs for 1978-1982, 1988-1992, and 1998-2002 were 9.0, 8.1, and 9.1 deaths per 100,000 live births, respectively. There was a modest increase in the MMR between 1998-2002 and 2008-2012 in the 11 states that had not adopted the standard pregnancy checkbox on their death certificate by the end of 2012 (8.6 and 9.9 deaths per 100,000, respectively). However, the MMR more than doubled between 1998-2002 and 2008-2012 in the 23 states that adopted the standard pregnancy checkbox (9.0-22.4); this dramatic increase was almost entirely attributable to increases in age-specific MMRs (94.9%) as opposed to increases in maternal age (5.1%), with an estimated 90% of the observed change reflecting the change in maternal death identification rather than a real change in age-specific rates alone. Of all age categories, women ages 40 and older in states that adopted the standard pregnancy checkbox had the largest increase in MMR-from 31.9 to 200.5-a relative increase of 528%, which accounted for nearly one third of the overall increase. An estimated 28.8% of the observed change was potentially due to maternal death misclassification among women ≥40 years. Increasing age-specific maternal mortality seems to be contributing more heavily than a changing maternal age distribution to recent increases in MMR. In states with the standard pregnancy checkbox, the vast majority of the observed change in MMR over the last decade was estimated to be due to the pregnancy checkbox, with the greatest change in MMR occurring in women ages ≥40 years. The addition of a pregnancy checkbox on state death certificates appears to be increasing case identification but also may be leading to maternal death misclassification, particularly for women ages ≥40 years.

How access, appropriateness, and quality of care affect patient outcomes for time-sensitive medical emergencies in British Columbia, Canada

ABSTRACT&#x0D; ObjectivesCox Proportional Hazards models tested the relationship between access to care for time sensitive medical events and 30-day survival while controlling for appropriateness and quality of care.&#x0D; ApproachA population study of all acute myocardial infarction (AMI), trauma, and stroke events treated within British Columbia between April 1st 1999 and March 31st 2013. Data sources included: the Discharge Abstract Database (DAD); a registry file; the Vital Statistics Mortality data; and the Medical Services Plan (MSP) Payment Information.&#x0D; Access to care was estimated with a de-identified residential postal code to hospital distance matrix developed using origin-destination network analysis in ArcGIS 10.2. Appropriateness of care compared national protocols with treatment received. Care that was contraindicated, outdated, or at an inexperienced facility was inappropriate. Quality of care was an outcome measure that used risk-standardized mortality ratios and funnel plots to identify hospitals that offered poor care.&#x0D; ResultsThere were 106,409 AMI, 220,602 trauma, and 88,136 stroke events that occurred during the study period and used in condition specific hierarchical hazards models. Adjusted hazards ratios (aHR) found access to care were not associated with 30-day mortality after controlling for appropriateness and quality of care along with patient (i.e. age, sex, income, rurality, frailty) and system specific (i.e. method of transport, transfer patterns, facility volume, rurality, peer group) characteristics. Appropriate care reduced the hazard of mortality for all three conditions: AMI aHR=0.860 (95% CI=0.792-0.993, p-value=0.0003); stroke aHR=0.448 (95% CI=0.324-0.619, p-value&lt;0.0001) and trauma aHR=0.824 (95% CI=0.703-0.967, p-value=0.0176). Quality of care reduced hazards of mortality for trauma (aHR=0.689, 95% CI=0.586-0.808, p-value&lt;0.0001) and stroke (aHR=0.762, 95% CI=0.689-0.842, p-value&lt;0.0001). Inter-hospital transfers were protective for AMI (aHR=0.513, 95% CI=0.406-0.649, p-value&lt;0.0001) and stroke (aHR=0.768, 95% CI=0.630-0.936, p-value=0.0089) but detrimental for trauma (aHR=1.583, 95%CI=1.310-1.913, p-value&lt;0.0001). Method of transport was also significant. Self-transport was protective for trauma (aHR=0.462, 95% CI=0.417-0.513, p-value&lt;0.0001) and stroke (aHR=0.330, 95% CI=0.301-0.363, p-value&lt;0.0001). Older age was associated with higher mortality rates across all three conditions (p-value&lt;0.0001) and being female increased the hazard of death for AMI (aHR=1.049, 95% CI=1.010-1.088, p-value=0.0125) but was protective for trauma (aHR=0.583, 95% CI=0.551-0.617, p-value&lt;0.0001) events.&#x0D; ConclusionAs health systems evolve to meet the needs of their patients and work to provide equitable care under economic pressure for efficiency, it is important to understand how access, appropriateness and quality of care affect patient outcomes and distribute services accordingly.

Impact of hepatitis B on mortality and specific causes of death in adults with and without HIV co-infection in NYC, 2000-2011.

High rates of immigration from endemic countries contribute to the high chronic hepatitis B (HBV) prevalence in New York City (NYC) compared to the United States overall, i.e. about 1 million individuals. We describe the impact of HBV infection on mortality and specific causes of death in NYC. We matched surveillance and vital statistics mortality data collected from 2000 to 2011 by the New York City Department of Health and Mental Hygiene (DOHMH) and analysed demographics and premature deaths (i.e. whether death occurred at <65 years) in persons with and without chronic HBV or HIV infection (excluding those with hepatitis C). From 2000 to 2011, a total of 588 346 adults died in NYC. Of all decedents, 568 753 (97%) had no report of HIV or HBV, and 4346 (0·7%) had an HBV report. Of HBV-infected decedents, 1074 (25%) were HIV co-infected. Fifty-five percent of HBV mono-infected and 95% of HBV/HIV co-infected decedents died prematurely. HBV disproportionately impacts two subgroups: Chinese immigrants and HIV-infected individuals. These two subgroups are geographically clustered in different neighbourhoods of NYC. Tailoring prevention and treatment messages to each group is necessary to reduce the overall burden of HBV in NYC.

Drug poisoning deaths in the United States, 1999-2012: a statistical adjustment analysis.

BackgroundDrug poisoning mortality in the US has risen rapidly but the drugs involved are frequently unspecified on death certificates.MethodsReported and adjusted proportions of specific drug types involved in fatal drug poisonings were calculated using vital statistics mortality data from 1999 to 2012. The adjusted proportions were those predicted to occur if at least one specific type of drug had been identified on the death certificates of all poisoning fatalities.ResultsAdjusted involvement rates of opioid analgesic mentions in 2012 were 54.3 % (95 % confidence interval [CI]: 53.6 %–55 %), 40.8 % higher than the reported 38.6 % rate. Adjusted rates for all narcotics, other narcotics, sedatives, or psychotropics, and multiple drug use were 81.5 % (95 % CI: 80.9 %–82.2 %), 38.4 % (95 % CI: 37.8 %–39 %), 30 % (95 % CI: 29.4 %–30.7 %), 26 % (95 % CI: 25.4 %–26.6 %) and 42.8 % (95 % CI: 42.1 %–43.5 %) in 2012, compared to reported proportions of 60.7, 27.9, 18.7, 18 and 26.9 %. The adjustments typically had similar or slightly smaller effects on the estimates in 1999, and larger impacts on subcategories of drug types such benzodiazepines and antipsychotic medications. Based on the adjusted proportions, 22,534, 15,933, 12,457, 10,798, and 17,670 drug deaths in 2012 were estimated to involve opioid analgesics, other narcotics, sedatives, psychotropic medications, and drug combinations, compared to death certificate reports of 16,007, 11,567, 7,754, 7,467, and 11,176.ConclusionsDeath certificates substantially understate the involvement of opioid analgesics, sedatives, psychotropics, and drug combinations in fatal drug poisonings. Adjustment procedures that account for cases where only unspecified drugs are reported on death certificates provide more accurate information.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0071-7) contains supplementary material, which is available to authorized users.

COMPARISON BETWEEN TRAFFIC INJURIES RELATED DEATHS AMONG CHILDREN IN CROATIA AND SERBIA

Objective – To compare trends in traffic injury-related deaths among children in Croatia and Serbia from 1995 to 2010. Participants and methods – We used vital statistics mortality data from the Republic of Croatia Central Bureau of Statistics prepared by the Croatian National Institute of Public Health. Population estimates were provided by the Republic of Croatia Central Bureau of Statistics, which is responsible for 10-year census counts and inter census annual estimates. For Serbia we used the data from the Statistical office of the Republic of Serbia, including population estimates. Results – Significant decrease in child traffic injuries mortality rates was achieved in both countries in the analyzed period, Serbia generally having lower rates in the whole period. In both countries the age group between 15 and 19 years was recognized as the most vulnerable population, especially males. Conclusions – Because many actions were launched after the analyzed period the further decrease could be expected that could additionally narrow the gap in mortality rates between Croatia and Serbia, and the most developed countries.