WHO Mortality Data Research Articles

Tranexamic acid for trauma in the USA: is prejudice a barrier to saving lives?

The CRASH-2 clinical trial results were published in June, 2010. 1 CRASH-2 trial collaboratorsEffects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376: 23-32 Summary Full Text Full Text PDF PubMed Scopus (1970) Google Scholar , 2 CRASH-2 collaboratorsThe importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011; 377: 1096-1101 Summary Full Text Full Text PDF PubMed Scopus (749) Google Scholar Our global collaboration had randomly allocated 20 211 trauma patients from 274 hospitals in 40 countries to receive tranexamic acid, an antifibrinolytic agent to prevent or reduce bleeding, or placebo. Timely tranexamic acid treatment reduced bleeding deaths by nearly one third and without any side-effects. 1 CRASH-2 trial collaboratorsEffects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376: 23-32 Summary Full Text Full Text PDF PubMed Scopus (1970) Google Scholar , 2 CRASH-2 collaboratorsThe importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011; 377: 1096-1101 Summary Full Text Full Text PDF PubMed Scopus (749) Google Scholar We estimated that widespread use of tranexamic acid could prevent more than 120 000 trauma deaths each year worldwide, with 3500 deaths avoided each year in the USA. 3 Ker K Kiriya J Perel P Edwards P Shakur H Roberts I Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial. BMC Emerg Med. 2012; 12: 3 Crossref PubMed Scopus (61) Google Scholar Within weeks of publication in 2010, the British Army was using tranexamic acid for treatment of trauma on the battlefield. In 2010, the war in Afghanistan was at its worst with thousands of civilian deaths due to violence and injury. 2010 was also a disastrous year for the US Army in this war with 496 soldiers killed. But the US Army was slow to adopt tranexamic acid.

COVID-19 Pandemic: Lessons from Peak Years of Influenza & Suicide Deaths by Age in Ten Western Countries 1979-2016: An Alert for Psychiatry and Children’s Services

Background: The IMF fears the COVID-19 pandemic will create an economic down-turn matching the Great Depression. More recent recessions have led to physical and mental health problems including suicide deaths of young adults (15 - 34). We aim to identify risk patterns of mortality by age from influenza and suicide mortality in peak years from 1979 to 2016 to see if there are lessons to be learned for policy makers and psychiatric services. Method: Using WHO mortality data for 1979-2016 peak years of influenza deaths and suicides are identified in ten Western countries. Death rates per million in each age-band are calculated for both sexes and the percentage of the total deaths accruing in each of five age-bands for influenza and suicides. Ratios of influenza to suicide by age in regard to rates and percentages of deaths indicate differential risk mortality and morbidity patterns. Results: Of the ten country’s average Influenza deaths, 95% occurred in people over 55, including 80% - 85% for the over 75’s. Conversely it was 59% of suicides occurred in peoples aged <55 years. Young adults (15 - 34) influenza to suicide ratios were 1:12.1 and 35 - 54 years ratio 1:9.3. Discussion: IMF predicts major unemployment, which is likely to create mental health problems, including suicide as well as worsening child health outcomes linked to relative poverty. These wider inter-related factors should be considered by policy-makers and mental health services. The age patterns of risk of mortality point towards a cumulative summation of morbidity and mortality risks of the socio-economic consequences of the COVID pandemic.

No change in life expectancy: the devil is in the detail

Abstract Background The rate of improvement in life expectancy in high income countries has slowed down over the past few years, and instances where life expectancy is lower than a year before are increasingly common. This paper aims to analyse changes in life expectancy over the last decade to better understand what causes and age groups contribute to the slowdown. Methods We use WHO mortality data by age and cause to construct life tables, and we use Arriaga decomposition method to analyse the contribution of specific causes and age groups to changes in life expectancy in Australia, Canada, France, Germany, Netherlands, United Kingdom and the United States of America. We look at the change between 2007-2012 and 2012-2017 (or latest available). Results All countries experienced a slowdown in life expectancy in the past 5 years (2012-2017), in comparison to the preceding period. Slowdown in under 65s was particularly pronounced, with younger age groups only contributing minimally (between 0.4 years for males in Germany and -0.4 years for males in the United States) to changes in life expectancy. Among people aged 65 and over, gains ranged between 0.05 years for females in France and 0.6 years for males in the Netherlands. Certain causes of death contributed negatively to change in life expectancy between 2012 and 2017, with notable increases in deaths from accidental poisonings in males (up to -0.09 year in the UK and Canada, and -0.34 in the US) and suicides (up to -0.08 year in Australia and -0.07 in the US). Conclusions While recent slowdown in life expectancy gains in high income countries is often attributed to lack of improvement in people of older ages, we show that, beyond this, there are increases in mortality in younger age groups from external causes, that contribute negatively to change in life expectancy in some countries. This pattern is of a particular concern, as deterioration in preventable mortality points to broader worsening of socio-economic climate. Key messages Improvements in life expectancy in high income countries slowed down markedly over the past few years, but contributing mortality patterns differ for age groups and causes of death across countries. Persistent increases in preventable mortality from certain external causes in younger age groups in Australia, Canada, US and UK point to broader deterioration of socio-economic climate.

Identifying infrastructure risk factors in Africa

The paper aims to provide a critical overview of the infrastructure risk factors in African countries performed within the research project "SaferAfrica - Innovating dialogue and problems appraisal for a safer Africa". The project is funded by the European Commission’s Horizon2020 research and innovation programme. Both macroscopic (generic level) and microscopic (infrastructure element level) potential risk factors were examined and discussed. The macroscopic infrastructure risk factor analysis was based on WHO mortality data and revealed a weak but existent relationship between an extensive road network and fatality rates in African countries. On the other hand, the microscopic infrastructure risk factors analysis, based on technical reports and scientific papers, showed various potential factors, such as low road width, curve radius, low median width, absence of street light etc. Although some research has been carried out in the field of infrastructure risk factors and road safety, the major identified drawback is the lack of available data. Therefore, it is strongly suggested to validate the empirical findings with real-African data. Such an analysis accompanied with reliable and accurate data consists the basis for identifying priority areas for road safety actions and interventions.

A Comparative Study of Suicide Rates among 10-19-Year-Olds in 29 OECD Countries.

ObjectiveThis study had two main objectives: to compare current suicide rates in OECD countries among 10–19-year-olds and to identify patterns of suicide rates based on age, gender and time. Furthermore we investigated the main dimensions that contributed to the variation in child and adolescent suicide rates across countries. MethodsWe combined the WHO mortality data and the population data released by OECD to calculate the suicide rates in 29 OECD countries. A self-organizing map (SOM), k-means clustering analysis, and multi-dimensional scaling were used to classify countries based on similarities in suicide rate structure and to identify the important dimensions accounting for differences among groups. ResultsWe identified significant differences in suicide rates depending on age, sex, country, and time period. Late adolescence and male gender were universal risk factors for suicide, and we observed a general trend of declining suicide rates in OECD countries. The SOM analysis yielded eight types of countries. Most countries showed gender gaps in suicide rates of similar magnitudes; however, there were outliers in which the gender gap was particularly large or small. ConclusionSignificant variation exists with respect to suicide rates and their associated gender gaps in OECD countries.

Burden of gallbladder cancer in Central and South America

Rationale and objectiveGallbladder carcinoma (GBC) is a rare neoplasm yet it is the most common malignancy of the biliary tract and its prognosis is poor. Incidence of GBC is high in some areas of Central and South America and the Caribbean. We described the current burden of GBC in Central and South America (CSA). MethodsWe obtained GBC incidence data from 48 population-based cancer registries in 13 countries in CSA, and national level cancer death data from the WHO mortality data base for 18 countries. We estimated World population age-standardized incidence and mortality rates per 100,000 persons-years, including distribution and incidence rates by anatomic subsite. ResultsGBC rates were the highest in countries located in the Andean region. In 2003–2007, Chile had the highest incidence and mortality rates in CSA (17.1 and 12.9 in females and 7.3 and 6.0 in males, respectively). Females had higher GBC rates than males. The most frequently diagnosed anatomic subsite was gallbladder (60%). Unspecified subsite represented 21% of all cases. Trends in incidence and mortality of GBC remained unchanged in Argentina, Brazil, Chile and Costa Rica in 1998–2008. ConclusionGBC rates varied extensively across the CSA region reflecting, in part, differences in data quality, coverage and healthcare access. Chile had the highest GBC rates in CSA and the world. The large proportion of unspecified cases indicates low precision in diagnosis/registration and highlights the need to promote and improve cancer registration in the region to better understand the burden of GBC in CSA.

A Relational Database of WHO Mortality Data Prepared to Facilitate Global Mortality Research

Detailed world mortality data such as collected by the World Health Organization gives a wealth of information about causes of death worldwide over a time span of 60 year. However, the raw mortality data in text format as provided by the WHO is not directly suitable for systematic research and data mining. In this Data Paper, a relational database is presented that is created from the raw WHO mortality data set and includes mortality rates, an ICD-code table and country reference data. This enriched database, as a corpus of global mortality data, can be readily imported in relational databases but can also function as the data source for other types of databases. The use of this database can therefore greatly facilitate global epidemiological research that may provide new clues to genetic or environmental factors in the origins of diseases.

Unemployment Linked to Increased Suicide Risk Worldwide

Small, mostly single-country studies have shown the deleterious effects of unemployment on suicide risk. These researchers analyzed WHO mortality data and an International Monetary Fund economic outlook database for 2000–2011 to examine the effects of four economic indicators (unemployment, gross domestic product, growth rate, and inflation) on suicide rates across 63 countries, …

Impact of changes in mortality on FRAX-derived fracture probabilities

BackgroundAccurate hip fracture incidence and mortality rates are two essential requirements for FRAX calculators. PurposeTo investigate the effects of change in mortality on FRAX-derived fracture estimates. MethodsLebanese FRAX calculator was updated in 2012 from version 3.00 utilizing WHO mortality data from year 1999, and hip fracture incidence rates from 2007, to version 3.05 utilizing mortality data from 2009, but with identical hip fracture data. FRAX-derived estimates from 679 patients were computed using both FRAX versions and compared. Numbers presented as median [25th–75th] percentiles. ResultsThe 10-year FRAX-derived probability of major osteoporotic fracture and hip fracture increased substantially. Changes were most pronounced in high risk sub-groups. The relative increase in probability of major osteoporotic fracture in individuals with a baseline risk of 10–20% was 79% [19%–127%], and in individuals with a baseline risk >20% it was 125% (N=3). The numbers for relative increase in hip fracture probability were 98% [33%–135%], and 129%, respectively. Similarly, individuals older than 70years had a 125% [89%–150%] relative increase in probability of major osteoporotic fracture and a 122% [95%–145%] relative increase in hip fracture probability. Using the FRAX-based Lebanese guidelines, FRAX 3.05 led to an additional increase in treatment qualification of 3.8 patients per 100 patients, or a relative increase of 24%. ConclusionsUpdates in mortality values increased FRAX-derived estimates, most substantially in older patients, and those at high risk for fracture. The update results in altering individuals' treatment decisions and modifying country wide osteoporosis management. Our results are relevant to the development and update of FRAX models for countries worldwide, and more importantly those with increasing longevity and possible increase in fracture rates.

The Pattern of Mortality in India: An Overview

Mortality data indicate numbers of deaths by place, time and cause. WHO's mortality data reflect deaths registered by national civil registration systems of deaths, with the underlying cause of death coded by the national authority. In accordance with the rules of the International Classification of Diseases, the majority of deaths are caused by infectious and chronic diseases. It is noted at end that hunger and poor nutrition directly or as an underlying cause are responsible for the fatal diseases and thus resulting in the mortality.

Indirectly estimated absolute lung cancer mortality rates by smoking status and histological type based on a systematic review

BackgroundNational smoking-specific lung cancer mortality rates are unavailable, and studies presenting estimates are limited, particularly by histology. This hinders interpretation. We attempted to rectify this by deriving estimates indirectly, combining data from national rates and epidemiological studies.MethodsWe estimated study-specific absolute mortality rates and variances by histology and smoking habit (never/ever/current/former) based on relative risk estimates derived from studies published in the 20th century, coupled with WHO mortality data for age 70–74 for the relevant country and period. Studies with populations grossly unrepresentative nationally were excluded. 70–74 was chosen based on analyses of large cohort studies presenting rates by smoking and age. Variations by sex, period and region were assessed by meta-analysis and meta-regression.Results148 studies provided estimates (Europe 59, America 54, China 22, other Asia 13), 54 providing estimates by histology (squamous cell carcinoma, adenocarcinoma). For all smoking habits and lung cancer types, mortality rates were higher in males, the excess less evident for never smokers. Never smoker rates were clearly highest in China, and showed some increasing time trend, particularly for adenocarcinoma. Ever smoker rates were higher in parts of Europe and America than in China, with the time trend very clear, especially for adenocarcinoma. Variations by time trend and continent were clear for current smokers (rates being higher in Europe and America than Asia), but less clear for former smokers. Models involving continent and trend explained much variability, but non-linearity was sometimes seen (with rates lower in 1991–99 than 1981–90), and there was regional variation within continent (with rates in Europe often high in UK and low in Scandinavia, and higher in North than South America).ConclusionsThe indirect method may be questioned, because of variations in definition of smoking and lung cancer type in the epidemiological database, changes over time in diagnosis of lung cancer types, lack of national representativeness of some studies, and regional variation in smoking misclassification. However, the results seem consistent with the literature, and provide additional information on variability by time and region, including evidence of a rise in never smoker adenocarcinoma rates relative to squamous cell carcinoma rates.

Health planning for the future: comparative risk assessment of five major lifestyle risk factors: evidence from the Wirral, UK

The aim of this study was to quantify and compare the burden of disease attributable to five major lifestyle-related risk factors in a UK Primary Care Trust (Wirral) using World Health Organizations' (WHO) comparative risk assessment (CRA) methodology to demonstrate its practical utility for informing local policy initiatives. WHO CRA methodology was adopted using exposure data from a local lifestyle survey, disease risk factor relationships published by the WHO and local mortality data to calculate risk factor attributable deaths and years of life lost (YLL). Smoking remains by far the leading cause of deaths followed by overweight and obesity and low fruit and vegetable intake. Alcohol ranked last by number of deaths, but second by YLL indicating its high contribution to deaths at younger ages. We have demonstrated the utility of WHO CRA methodology to influence health-related policy-making at a local level. Primary prevention should remain high on the agenda of government initiatives to reduce the future burden of ill health. Future research in this area could look at more in-depth national data to cover a wider range of risk factors addressing some of the methodological and data shortcomings identified in this study.

Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial

BackgroundThe CRASH-2 trial showed that early administration of tranexamic acid (TXA) safely reduces mortality in bleeding in trauma patients. Based on data from the CRASH-2 trial, global mortality data and a systematic literature review, we estimated the number of premature deaths that might be averted every year worldwide through the use of TXA.MethodsWe used CRASH-2 trial data to examine the effect of TXA on death due to bleeding by geographical region. We used WHO mortality data (2008) and data from a systematic review of the literature to estimate the annual number of in-hospital trauma deaths due to bleeding. We then used the relative risk estimates from the CRASH-2 trial to estimate the number of premature deaths that could be averted if all hospitalised bleeding trauma patients received TXA within one hour of injury, and within three hours of injury. Sensitivity analyses were used to explore the effect of uncertainty in the parameter estimates and the assumptions made in the model.ResultsThere is no evidence that the effect of TXA on death due to bleeding varies by geographical region (heterogeneity p = 0.70). Based on WHO data and our systematic literature review, we estimate that each year worldwide there are approximately 400,000 in-hospital trauma deaths due to bleeding. If patients received TXA within one hour of injury then approximately 128,000 (uncertainty range [UR] ≈ 72,000 to 172,000) deaths might be averted. If patients received TXA within three hours of injury then approximately 112,000 (UR ≈ 68,000 to 148,000) deaths might be averted. Country specific estimates show that the largest numbers of deaths averted would be in India and China.ConclusionsThe use of TXA in the treatment of traumatic bleeding has the potential to prevent many premature deaths every year. A large proportion of the potential health gains are in low and middle income countries.

Comparing Possible 'Child-Abuse-Related-Deaths' in England and Wales with the Major Developed Countries 1974-2006: Signs of Progress?

This paper explores ‘child abuse-related deaths’ (CARD) and possible CARD rates of children aged from birth to fourteen years over the period 1974–2006. It uses the latest available WHO mortality data to compare England and Wales outcomes with the other major developed countries (MDC), to see how much progress has been made in reducing actual and possible CARD in England and Wales and the other MDC. The results tell a relative ‘success story’ for England and Wales, whose violent CARD rates of children have never been lower since records began and who have made significantly greater progress in reducing violent possible CARD than the majority of the other MDC. Moreover, England and Wales were only one of four MDC whose CARD deaths, primarily the responsibility of the children protection services (CPS), fell significantly more that ‘All Causes of Death’, the primary responsibility of medicine. Though there is an overlap of services, the greater improvement in the CPS-related deaths than those primarily related to child health reflect well on the CPS. This should help to offset something of the media stereotypes and be a boost for the morale of front line staff of the CPS and the families whom they serve.

A Comparative Study of Children and Adult Homicide Rates in the USA and the Major Western Countries 1974–1999: Grounds for Concern?

The aim of this study is to examine the changing patterns of child homicide in the USA and the other 9 major Western countries between 1974 and 1999. On the basis of standardized WHO mortality data, 5-year mean rates of Baby (<1 year), Infant (1–4), Child (5–14), and General Population Rates for Homicide (GPRH) were analyzed for 1974–78 and 1995–99 for the USA and major Western countries. The analysis provided ratios of change for children's homicide between 1974 and 1999 and ratio of ratios between “adult'” and children's homicide. Over the period USA male Baby homicide rose by 78% and Females 44% with a combined rise in All Children [0–14] homicides of 45%, within the context of a declining adult GPRH. In the 1970s, 3 major Western countries had either higher or similar children's homicide rates to the USA, but by the late 1990s none did. Moreover, between 1974 and 1999, the USA had the biggest rise in Baby (<1) and All Children's deaths, and only France had substantial increases, whereas Baby homicide rates fell significantly in 6 other countries. The findings indicate a worrying deterioration in U.S. child homicides. Possible links with child abuse and explanations for the results are briefly discussed. Urgent case-specific research is required to determine the cause/s for and how to reverse the worsening child homicide situation in the USA.

Smoking. The contribution of smoking to sex differences in life expectancy

Several studies have shown that smoking is a major cause of the lower life expectancy of men compared to women, but there has been no research to assess how far international differences in sex differences in life expectancy and changes in these differences can be accounted for by smoking. This paper gives quantitative estimates of the effects of smoking on sex differences in life expectancy at age 35 years in Denmark, Finland, Norway, Sweden and The Netherlands during 1970–1989. The data on cause-specific mortality by age and sex were obtained from standardized computer-tape transcripts of the WHO mortality data bank. An indirect method based on lung cancer mortality as the indicator of the cumulative effects of smoking was used to estimate the numbers of smoking-attributable deaths in 4 periods. The validity of the method was assessed by comparing the relevant parts of the results with those obtained in 8 national follow-up studies. On average, 2.4 years or more than 40% of the total sex difference in life expectancy in 1970–1974 was estimated to be attributable to smoking in the 5 countries. By 1985–1989 the contribution of smoking dropped to 1.8 years or approximately 30% of the total difference. The contribution of smoking to the sex difference was greatest in The Netherlands and smallest In Sweden. As a result of the decline in smoking-attributable male mortality, the sex difference in life expectancy diminished in Finland In the 1980s. In the other countries the difference continued to grow despite the increase in the loss of female life expectancy caused by smoking.