WONDER Database Research Articles

Asian and Pacific Islander cancer mortality trends in the United States between 1999-2020.

e23307 Background: The Asian and Pacific Islander (API) population is the fastest growing in the United States, composing nearly 7% of the US population. Although cancer is the second leading cause of death overall in the U.S., it is the leading cause of death in the API population. Despite this, no study has assessed trends in cancer mortality in API individuals in the US. Our aim was to analyze differences and trends in API cancer mortality in the U.S. between 1999 to 2020. Methods: The CDC WONDER database was used to determine mortality statistics for patients, classified as non-Hispanic Asian or Pacific Islander, with cancer (ICD-10 codes C00-C97) as the underlying cause of death between 1999 and 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths, and were stratified by cancer type, sex, population density, U.S. census region, and age. Joinpoint regression software was used to identify temporal trends. Average annual percent change (APC) was considered statistically significant if p < 0.05. Results: Between 1999 and 2020, cancer accounted for 305,386 deaths in API individuals. During this period, there was a 30% decrease in mortality due cancer and a decrease in APC of -1.5% (p < 0.05). When stratified by cancer site, the largest decrease in APC was in stomach cancer at -3.7% (p < 0.05), and the largest increase was in uterine cancer at 2.6% (p < 0.05). In 1999, males experienced an overall cancer-related AAMR of 151, 48% higher than females at 103; however, by 2020 these differences reduced, with males having a cancer-related AAMR of 105.6 vs API females of 80.9, a 25% difference. Males experienced a larger decrease in APC (-1.8%, p < 0.05), compared with females (-1%, p < 0.05). Rural populations had the largest cancer-related AAMR (113.0) and largest drop in APC (-2%, p < 0.05), compared with urban groups with a cancer-related AAMR of 106.7 and APC drop (-1.3%, p < 0.05). The highest cancer related AAMRs was seen in lung cancer (24.3 in urban vs 25.4 in rural). Liver-cancer related AAMR was highest in urban populations at 10.4 and lowest in rural populations at 8.2. Western census regions had the highest AAMR at 113.7 with an APC decrease of –1.4% and Southern census regions had the lowest AAMR at 90.5 with an APC decrease of –1.2%. Adults aged > 65 experienced the highest cancer related AAMR at 588.2, and adults aged 25-44 demonstrated the lowest AAMR at 14.7. However, adults aged 25-44 experienced the largest decrease in APC at -2% (p < 0.05), compared with adults aged > 65 at -1.4% (p < 0.05). Conclusions: Our study identifies a significant decrease in cancer mortality in API individuals between 1999 and 2020. The largest decrease seen was in stomach cancer; however, uterine cancer mortality has increased. Notably, liver cancer mortality was higher in urban rather than rural groups. Further studies may examine differences amongst API and other racial groups, and potential sources for the disparities seen amongst API individuals.

Suicide deaths involving opioid poisoning in the United States, by sex, 1999-2021.

Suicide remains a leading cause of death in the United States, and recent data suggest suicide deaths involving opioids are increasing. Given unprecedented increases in drug-poisoning deaths, suicidality, and suicide deaths in recent years, an updated examination of the trends in suicide deaths involving opioids is warranted. In this descriptive epidemiologic analysis, we leverage final and provisional mortality data from the US Centers for Disease Control and Prevention's WONDER database to examine trends in suicide deaths involving opioid poisoning from 1999 to 2021 by biological sex. Results reveal complex changes over time: the number and age-adjusted rate of suicide deaths involving opioid poisoning among male and female residents tended to track together, and both increased through 2010, but then diverged, with the number and rate of suicide deaths involving opioid poisoning among female residents outpacing that of male residents. However, the number and rate of suicide deaths involving opioid poisoning among male residents then began to stabilize, while that of female residents declined, closing the sex-based gap. Across all years of data, the proportion of suicide deaths that involved opioid poisoning was consistently higher among female decedents (5.8%-11.0%) compared with male decedents (1.4%-2.8%). Findings have implications for improved suicide prevention and harm reduction efforts. This article is part of a Special Collection on Mental Health.

Contemporary burden and trends of opioid-overdose mortality in New York State

BackgroundLimited research exists on contemporary opioid overdose mortality burden and trends in New York State, with most studies focusing on New York City. This study aimed to assess opioid overdose burden and death trends in New York State by age, sex, race/ethnicity, geographic area, opioid type, and overdose intent from 1999 to 2020. MethodsMortality data were obtained from the Centers for Disease Control and Prevention's WONDER database. Opioid overdose decedents were identified using relevant International Classification of Diseases, 10th Revision codes. Joinpoint regression analyzed trends, estimating annual and average annual percentage changes in age-adjusted mortality rates (AAMR). 95% confidence intervals were derived using the Parametric Method. ResultsFrom 1999 to 2020, New York State recorded 34,109 opioid overdose deaths (AAMR = 7.9 per 100,000 persons; 95% CI: 7.8–7.9). The overall trend increased by 12.6% per year (95% CI: 10.8, 14.4) from 2004 to 2020. Subgroups exhibited varying trends, with an 11.1% yearly increase among Non-Hispanic White persons from 2007 to 2020 (95% CI: 9.0, 13.2), a 24.6% annual rise among Non-Hispanic Black persons from 2012 to 2020 (95% CI: 17.7, 31.8), and an 18.3% increase yearly among Hispanic individuals from 2011 to 2020 (95% CI: 14.0, 22.9). Recent trends have worsened in both males and females, across all age groups, in both New York City (NYC) and areas outside NYC, and for heroin, natural and semisynthetic opioids, and synthetic opioids. ConclusionsOpioid overdose mortality in New York State has worsened significantly in the last two decades. Further research is essential to identify driving factors for targeted public health interventions.

Disparities in Trend of Renal Cell Carcinoma Mortality in the United States.

Renal cell carcinoma (RCC) accounts for 90% of malignant neoplasms of the kidney. In this report, the CDC WONDER database was accessed to retrieve age-adjusted mortality data from 1999 to 2020 due to RCC, defined as ICD-10 Code: C64 Malignant neoplasm of kidney except renal pelvis, for various demographics to investigate trends and potential disparities. In 2020, the overall age-adjusted mortality rate (AAMR) due to RCC in the USA was 42.4 per 1,000,000. The average annual percent change (AAPC) for the USA from 1999 to 2020 was -0.6%. Notably, in 2020, men had a higher AAMR than women, 63.9 compared to 25.7, and a significant difference in AAPC trend was identified between men (-0.5%) and women (-1.0%). When investigating trends according to race in 2020, the Asian population displayed the lowest AAMR at 18.9. When determining AAPC from 1999 to 2020 according to race group, the American Indian group demonstrated the greatest decline in AAPC at -1.3%, followed by the Black (-1.2%) and White populations (-0.5%). The Asian population did not exhibit a significant AAPC. Moreover, the rates between these three groups were statistically significantly different- indicating disparities in trend based on race. This investigation assesses the AAMR for different demographic groups of the USA population to identify disparities and guide resource allocation strategies.

Abstract 1002: Health Insurance Prevalence & Aortic Aneurysm And Dissection Mortality: A Cross-sectional Analysis

The prevalence of health insurance significantly influences the early detection and timely treatment of cardiovascular conditions, which are vital for reducing the risk of morbidity and mortality. In many regions, access to necessary cardiac care, including life-saving interventions and long-term management, hinges on the availability and scope of health insurance. Do disparities in mortality exist in aortic dissection/aneurysm based on the prevalence of health insurance in the USA? We investigated the association between US county-level healthcare coverage prevalence and aortic dissection/aneurysm mortality rates. We queried the CDC Agency for Toxic Substances and Disease Registry to obtain data on the uninsured population, based on 5-year estimates from 2018. To gauge the uninsured population in each US-county, we computed percentile rankings from 0 to 1, with higher values indicating a larger uninsured population. Counties were grouped into 4 quartiles based on these rankings. Mortality data from 1999-2018 was obtained from the CDC WONDER database, using ICD-10 codes: I71 for aortic aneurysm and dissection as the underlying cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the direct method. Risk ratios (RR) were estimated using univariable Poisson regression. The cumulative AAMR within UP-Q1 and UP-Q4 showed no significant differences in mortality and had a corresponding risk ratio (RR) of 0.94 (P >0.05). Among male populations, there was no difference in AAMR between UP-Q4 (AAMR: 5.48 [95% CI, 5.29 - 5.68]) and UP-Q1 (AAMR: 5.77 [95% CI, 5.64 - 5.90]), with a risk ratio of 0.95 (P >0.05). Similarly, among female populations, AAMR in UP-Q4 (AAMR: 2.66 [95% CI, 2.54-2.79]) was similar to UP-Q1 (AAMR: 2.98 [95% CI, 2.91-3.06]) with a risk ratio of 0.89 (P >0.05). Finally, when comparing UP-Q4 with UP-Q1 across all US-census regions and counties using urbanization criteria, no statistically significant differences were found. This study found that in the US, county-level healthcare coverage prevalence didn't impact aortic dissection/aneurysm mortality rates, unlike in other diseases. Therefore, while lack of coverage hinders care access, it's not the sole social determinant of mortality outcomes.

Two decades of influenza and pneumonia mortality trends: Demographics, regional shifts and disparities in the United States: 1999 to 2020

In the 20th century, influenza and pneumonia constituted the largest proportion of infectious disease deaths in the United States. Despite progress in management, US mortality trends for these diseases have not been thoroughly investigated. We aim to examine the patterns of influenza and pneumonia-related deaths among US residents. Crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using influenza and pneumonia mortality data (International Classification of Diseases, 10th revision codes: J09-J18) from the CDC WONDER database. Annual percentage changes with a 95% confidence interval were determined using joinpoint regression analysis. Average annual percentage changes were computed as the weighted average of annual percentage changes. From 1999 to 2020, US influenza and pneumonia deaths totaled 1,257,088 (AAMR: 17.09), with a significantly decreasing AAMR (-2.94). Males had a higher AAMR (20.13) than females (15.02). Non-Hispanic American Indians had the highest AAMR (20.44), while Hispanics had the lowest AAMR (13.91). The Northeast had the highest AAMR (18.02). All other regions had similar AAMRs. Rural regions had a consistently higher AAMR (19.80) than urban regions (AAMR: 16.51). Tailoring interventions towardhigh-risk groups can enhance the effectiveness of preventive measures, vaccination, and healthcare access.

325 The Economic Impact of Pediatric and Adolescent Gunshot Wound Mortality

INTRODUCTION: Gunshot wounds (GSW) are the leading cause of pediatric/adolescent mortality in the United States. The total economic impact of lost productivity has not been previously quantified. METHODS: The CDC WONDER database was utilized to document GSW fatalities of individuals 19 years and younger between 2001-2021. The weighted net present value (NPV) of potential future lost income for each child was calculated based on the Social Security Administration’s estimated NPV of lifetime earnings at age 20, using a 4% discount rate, and factoring in updated US census data on education status, graduation rates, and wage-gaps. Each year’s total lost income was adjusted to 2022 USD using the CPI-W. Sensitivity analysis tested the robustness of our model parameters’ variability on our model results. RESULTS: 64,503 total pediatric/adolescent GSW mortalities have occurred since 2001. Total estimated NPV income loss in 2022 USD is $58.78 Billion. This correlates with an estimated loss to Social Security of $7.29 Billion. Sensitivity analyses found that changes in salary had the highest potential impact on the final outcomes. Overall, the worst-case income scenario (-20% change in base salary) showed an estimated $47 Billion economic loss in 2022 USD. A similar analysis for total pediatric mortality due to neurological disease showed an economic loss of $18.86 Billion. CONCLUSIONS: The economic impact of income lost due to pediatric GSW fatalities between 2001-2021 is estimated to be $58.78 billion, with minimum value of $47 billion after sensitivity analysis. This estimate likely undervalues the total economic impact of pediatric gun violence since it is based on median salaries and excludes medical treatment, long-term disability/morbidity, multiplier effects, or future offspring productivity. The total cost to society of pediatric GSW mortality significantly exceeds all neurologic-related mortality and is too high for physicians and policymakers to ignore.

Disaggregating Asian-American Mortality in Drug-Related Overdoses and Behavioral Disorders: A Cross-Sectional Study.

Asian Americans have been historically underrepresented in the national drug overdose discourse due to their lower substance use and overdose rates compared to other racial/ethnic groups. However, aggregated analyses fail to capture the vast diversity among Asian-American subgroups, obscuring critical disparities. We conducted a cross-sectional study between 2018 and 2021 examining Asian-American individuals within the CDC WONDER database with drug overdoses as the underlying cause of death (n = 3195; ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14) or psychoactive substance-related mental and behavioral disorders as one of multiple causes of death (n = 15,513; ICD-10 codes F10-F19). Proportional mortality ratios were calculated, comparing disaggregated Asian-American subgroups to the reference group (Asian Americans as a single aggregate group). Z-tests identified significant differences between subgroups. Compared to the reference group (0.99%), drug overdose deaths were less prevalent among Japanese (0.46%; p < 0.001), Chinese (0.47%; p < 0.001), and Filipino (0.82%; p < 0.001) subgroups, contrasting with a higher prevalence among Asian Indian (1.20%; p < 0.001), Vietnamese (1.35%; p < 0.001), Korean (1.36%; p < 0.001), and other Asian (1.79%; p < 0.001) subgroups. Similarly, compared to the reference group (4.80%), deaths from mental and behavioral disorders were less prevalent among Chinese (3.18%; p < 0.001), Filipino (4.52%; p < 0.001), and Asian Indian (4.56%; p < 0.001) subgroups, while more prevalent among Korean (5.60%; p < 0.001), Vietnamese (5.64%; p < 0.001), Japanese (5.81%; p < 0.001), and other Asian (6.14%; p < 0.001) subgroups. Disaggregated data also revealed substantial geographical variations in these deaths obscured by aggregated analyses. Our findings revealed pronounced intra-racial disparities, underscoring the importance of data disaggregation to inform targeted clinical and public health interventions.

Trends and disparities in hospice care utilization in testicular cancer in the United States of America from 2003 to 2020: Analysis of CDC WONDER database.

Trends and disparities in hospice care utilization in testicular cancer in the United States of America from 2003 to 2020: Analysis of CDC WONDER database.

Forecasting drug-overdose mortality by age in the United States at the national and county levels

Abstract The drug-overdose crisis in the United States continues to intensify. Fatalities have increased 5-fold since 1999 reaching a record high of 108,000 deaths in 2021. The epidemic has unfolded through distinct waves of different drug types, uniquely impacting various age, gender, race, and ethnic groups in specific geographical areas. One major challenge in designing interventions and efficiently delivering treatment is forecasting age-specific overdose patterns at the local level. To address this need, we develop a forecasting method that assimilates observational data obtained from the CDC WONDER database with an age-structured model of addiction and overdose mortality. We apply our method nationwide and to three select areas: Los Angeles County, Cook County, and the five boroughs of New York City, providing forecasts of drug-overdose mortality and estimates of relevant epidemiological quantities, such as mortality and age-specific addiction rates.

Suicide mortality among individuals in federal prisons compared with the general population: a retrospective cohort study in the USA from 2009 to 2020

IntroductionSuicide is one of the leading causes of death in US prisons. Yet, administrative data lags years behind and reporting rarely accounts for differing age distributions between suicide rates between...

Trends in preferred place of death for prostate cancer in the United States from 2003 to 2020: Analysis of CDC WONDER database.

Trends in preferred place of death for prostate cancer in the United States from 2003 to 2020: Analysis of CDC WONDER database.

Racial disparities in genitourinary cancer mortality trends in the United States, 2000-2020: A CDC database study.

28 Background: Prostate, bladder, and kidney cancers account for substantial burden of cancer incidence and mortality in the United States. In 2020, an estimated 168,000 new cases and 32,000 deaths were attributed to these cancers. Studies examining racial disparities of mortality trends are needed. Methods: We utilized the CDC WONDER database to obtain mortality data for kidney, bladder, and prostate cancers between 2000-2020. Age-adjusted mortality rates per 100,000 persons were calculated and standardized to the Year 2000 US standard population. Rates were stratified by race, including White, Black, Asian/Pacific Islander (API), and American Indian/Alaska Native (AIAN). The National Cancer Institute Joinpoint Regression Program was utilized to calculate average annual percent changes (AAPCs). AAPCs were considered significant if the 95% confidence interval (CI) excluded zero. Results: Over the study period, 318,919 kidney cancer deaths, 150,613 bladder cancer deaths, and 516,508 prostate cancer deaths were identified. Between 2000-2020, amongst all races, mortality from prostate cancer (-1.8%; CI -2.0, -1.6), bladder cancer (-0.3%; CI -0.5, -0.2), and kidney cancer (-1.1%; CI -1.2, -0.9) all significantly declined. Considering racial disparities, prostate cancer mortality fell considerably in all race groups, most significantly among Black (-2.8%, CI -3.2%, -2.4%) and AIAN (-2.4%, CI -2.9%, -1.8%) populations, outpacing reductions in API (-1.7%, CI -2.6%, -0.8%) and White (-1.6%, CI -1.9%, -1.4%) populations. In bladder cancer, the decline in mortality was statistically significant for Black (AAPC: -0.8%, CI -1.1%, -0.6%) and for White, (-0.4%, CI -0.6%, -0.1%), but not for API individuals (-0.3%, CI -0.9%, 0.3%). For kidney cancer, mortality dropped substantially across all examined races, with the steepest decline seen in Black (-1.4%, CI -1.7%, -1.2%) and AIAN (-1.7%, CI -2.5%, -1.0%) compared to White (-1.0%, CI -1.2%, -0.9%) and API (-1.4%, CI -4.2%, 1.6%, non-significant) population. Conclusions: This study represents the most comprehensive population database analysis assessing GU cancer mortality trends. While an overall decline in GU cancer mortality was observed, which was comparatively greater for Black Americans over the past two decades, significant racial disparities continue to persist. Focused and targeted efforts are essential to address these disparities. [Table: see text]

Abstract TMP103: Trends in Ischemic Stroke-Related Mortality in Patients With Type 2 Diabetes in the United States, 1999-2020

Background: The pathological changes in lining of blood vessels associated with diabetes is a well-established risk factor for stroke, some studies suggesting a two times increase in risk compared to non-diabetics. Methods: Death certificates from CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were examined from 1999 to 2020 for ischemic stroke related mortality in patients with type 2 diabetes mellitus (T2DM). Annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by year, sex, and race/ethnicity. Results: From 1999 to 2020 there were 20,941 deaths from ischemic stroke in patients with T2DM. The AAMR remained relatively constant from 0.31 in 1999 to 0.32 in 2004 (APC: -0.78), showing a sharp decline to 0.15 in 2007 (APC: -20.79), a near constant rate of 0.14 in 2007 (APC: -1.05), followed by a rapid increase to 0.44 in 2017 (APC: 44.55), and 0.66 in 2020 (APC: 14.59). Men showed consistently higher AAMR than women in 1999 (AAMR men: 0.34 vs women: 0.29) and 2020 (AAMR men: 0.78 vs women: 0.58). When comparing race, African Americans (AA) presented with a consistently higher AAMR in 1999 (AAMR AA: 0.37 vs white: 0.31) and 2020 (AAMR AA: 0.97 vs white:0.63). Notably, a significant escalation in AAMR occurred from 2016 to 2020, affecting both populations; this trend reached its pinnacle in 2020 (2016 AAMR AA: 0.39 vs. white: 0.27) (2020 AAMR AA: 0.97 vs. white: 0.63). Conclusion: The findings highlight fluctuating trends in AAMRs with distinct shifts observed after 2007. Noteworthy gender and racial disparities in AAMRs were also evident. The study emphasizes the need for ongoing vigilance and focused interventions to address the evolving dynamics of ischemic stroke-related mortality in the T2DM population.

Association Between Online Reviews of Substance Use Disorder Treatment Facilities and Drug-Induced Mortality Rates: Cross-Sectional Analysis

Background Drug-induced mortality across the United States has continued to rise. To date, there are limited measures to evaluate patient preferences and priorities regarding substance use disorder (SUD) treatment, and many patients do not have access to evidence-based treatment options. Patients and their families seeking SUD treatment may begin their search for an SUD treatment facility online, where they can find information about individual facilities, as well as a summary of patient-generated web-based reviews via popular platforms such as Google or Yelp. Web-based reviews of health care facilities may reflect information about factors associated with positive or negative patient satisfaction. The association between patient satisfaction with SUD treatment and drug-induced mortality is not well understood. Objective The objective of this study was to examine the association between online review content of SUD treatment facilities and drug-induced state mortality. Methods A cross-sectional analysis of online reviews and ratings of Substance Abuse and Mental Health Services Administration (SAMHSA)–designated SUD treatment facilities listed between September 2005 and October 2021 was conducted. The primary outcomes were (1) mean online rating of SUD treatment facilities from 1 star (worst) to 5 stars (best) and (2) average drug-induced mortality rates from the Centers for Disease Control and Prevention (CDC) WONDER Database (2006-2019). Clusters of words with differential frequencies within reviews were identified. A 3-level linear model was used to estimate the association between online review ratings and drug-induced mortality. Results A total of 589 SAMHSA-designated facilities (n=9597 reviews) were included in this study. Drug-induced mortality was compared with the average. Approximately half (24/47, 51%) of states had below average (“low”) mortality rates (mean 13.40, SD 2.45 deaths per 100,000 people), and half (23/47, 49%) had above average (“high”) drug-induced mortality rates (mean 21.92, SD 3.69 deaths per 100,000 people). The top 5 themes associated with low drug-induced mortality included detoxification and addiction rehabilitation services (r=0.26), gratitude for recovery (r=–0.25), thankful for treatment (r=–0.32), caring staff and amazing experience (r=–0.23), and individualized recovery programs (r=–0.20). The top 5 themes associated with high mortality were care from doctors or providers (r=0.24), rude and insensitive care (r=0.23), medication and prescriptions (r=0.22), front desk and reception experience (r=0.22), and dissatisfaction with communication (r=0.21). In the multilevel linear model, a state with a 10 deaths per 100,000 people increase in mortality was associated with a 0.30 lower average Yelp rating (P=.005). Conclusions Lower online ratings of SUD treatment facilities were associated with higher drug-induced mortality at the state level. Elements of patient experience may be associated with state-level mortality. Identified themes from online, organically derived patient content can inform efforts to improve high-quality and patient-centered SUD care.

A 22-Year Study to Assess Disparities in Place of Death Among Patients With Diabetes.

Background This study examines disparities in the place of death in patients in the United States with diabetes mellitus (DM) using data from the CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) database covering a 22-year period (1999-2020). Looking at age, gender, ethnicity, and census location, among other variables, the study aims to understand trends and determinants of mortality at home or hospice care compared to mortality at a medical or nursing facilities. Materials and methods An online freely accessible mortality database, CDC WONDER database, was used to collect information regarding DM-related mortality, using the International Classification of Diseases, 11th Revision (ICD-11) code range E10-E14. To investigate patterns in location of death, the research population was split by census regions, racial categories, age groups, and gender. Statistical techniques such as univariate logistic regression and graphical representations were employed. Results Based on a study of 1,674,724 DM-related deaths, medical or nursing facilities recorded higher deaths (1,041,602) compared to home or hospice deaths (572,567). The highest number of deaths in home or hospice setting was recorded for the age group of 75-84 years (146,820), male gender (324,325), Census Region 3 (South) (225,636), and white race (458,690). Among the patients with death at home or a hospice center; the odds were highest for the age group of 55-64 years, male gender, Census Region 4 (West), and American Indian or Alaska Native race. Discussion The results showed a general upward trend in DM patients' deaths at home and in hospice care in the United States. Males, white people, and those in the age group of 75-84 years notably had the highest death rates. Regional differences also came into play, with the South showing the biggest trend in mortality. To better understand the underlying causes of these changes and to increase at-risk groups' access to healthcare facilities, more research is required. Conclusion There is an overall rising trend in home and hospice deaths in the United States for patients with DM, but with a steady dip between the years 2005 and 2010. Patient deaths from DM were categorized by age groups, gender, race, and census regions. The highest mortality trends are exhibited in whites, males, and those aged 75-84 years. Out of the census regions, the South has the highest mortality trend. Further studies could be carried out to determine the reasons for the rising trends in home or hospice deaths in the aforementioned groups and how to provide these groups with better access to healthcare facilities.

County‐level cumulative effect of ambient PM2.5 exposure on the Alzheimer’s disease mortality rate in the west coast regions of the United States

AbstractBackgroundSeveral studies have investigated the relationship between long‐term exposure to fine particulate matter (PM2.5) and the risk of Alzheimer’s disease (AD), yet studies on the cumulative effect of PM2.5 exposure are limited. This study assesses the association between the county‐level cumulative PM2.5 exposure at a level above 35 ug/m3, the safe threshold recommended by the World Health Organization (WHO), on Alzheimer’s mortality in the west coast population of the United States.MethodAnnual county‐level Alzheimer’s disease mortality rates from 2010 to 2019 were obtained from the Centers for Disease Control and Prevention WONDER database, and the cumulative county‐level PM2.5 exposure greater than 35 ug/m3 were derived from publicly accessible data at the Environmental Protection Agency (EPA). Analysis focused on 76 counties for about 48 million people in the states of Washington, Oregon, and California of the US.Analysis was conducted using a Bayesian spatiotemporal linear mixed effects model with the Markov Chain Monte Carlo Simulations. For each county, the log transformed county‐level annual AD mortality rates were regressed against the total number of days with concentration levels of PM2.5 over 35 ug/m3 in the year and its past t years, where t = 1, 2, …, 10 (Figure 1 for t = 10). Each of the 10 regression models was adjusted for thirteen potentially confounding variables including the rate of poverty, percent rural land area, median household income, percent unemployed, percent uninsured, percent obesity, percent smokers, percent excessive drinking, percent African American, percent Asian, percent Hispanic, percent ages under 18, and percent ages 65 and older.ResultResults showed that in periods of three calendar years or longer, having a higher number of days of PM2.5 exceeding the safe level is associated with a higher rate of AD mortality (Figure 2). The results also showed an increasing trend between AD mortality and years of cumulative PM2.5 exposure.ConclusionCumulative PM2.5 exposure at a level above the WHO recommended safe threshold is associated with AD mortality rate in three west coast states of the US.

Unveiling Alarming Trends: Worsening All Cause Mortality in US Adults over 25 with Amyloid 1999-2020 Analysis

Introduction: Amyloidosis is a collective term for conditions with an abnormal extracellular deposition of amyloid protein. Amyloidosis can be classified based on the location of deposition (localized vs systemic) and by the different subtypes of proteins which are created as a result of a variety of diseases (plasma cell dyscrasias, chronic inflammation, nephrotic syndrome, genetic). Depending on the affected organs, amyloidosis can present with, not limited to, hepatomegaly, renal impairment, nerve conduction impairment, cardiac conduction abnormalities, restrictive cardiomyopathy, and multiorgan failure. In the last century there has been an increase in innovations leading to a better understanding of the pathology, diagnostic tests, staging, and treatment options for amyloidosis. Our study aims to compare all cause mortality trends in adults over 25 years old diagnosed with amyloidosis in the United States. Methods: The national mortality trends from 1999 to 2020 for all subtypes of amyloid were analyzed from the CDC WONDER database. The data was extracted using ICD codes E85 (Amyloidosis) with subgroups E85.0 (Non-neuropathic heredofamilial amyloidosis), E85.3 (Secondary systemic amyloidosis), E85.4 (Organ-limited amyloidosis), E85.8 (Other amyloidosis), and E85.9 (Amyloidosis, unspecified. Data was stratified for age groups above 25 years old. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 people and death certificate data was stratified by reported sex, race/ethnicity, and US census region. Results: Between 1999 and 2020 there were 40,015 deaths from amyloid. Our analysis revealed that all-cause AAMR per 100,000 people with amyloid showed an increasing trend between 1999 to 2020 (Figure 1). Subgroup analysis on race/ethnicity revealed the AAMR for the Black population has been consistently higher to other groups (Table 1). On average, from 1999 to 2020, the Black population had the highest AAMR (1.52 AAMR) followed by the White population (0.78 AAMR), Hispanic (0.55 AAMR), and Asian (0.5 AAMR). Further subgroup analysis revealed men have a higher AAMR (1.9 AAMR, 2020) compared to women (0.8 AAMR, 2020). Overall there are similar census region trends of all mortality in Amyloid: North (1.5 AAMR, 2020), Midwest (1.5 AAMR, 2020), South (1.0, AAMR, 2020) and West (1.3 AAMR, 2020). Conclusion: Due to advancement in technology, amyloid diseases are becoming more widely recognized and increasingly diagnosed. Unfortunately, treatment of amyloidosis remains limited to early diagnosis and treatment of the underlying condition. This includes modalities such as chemotherapy and stem cell transplantation for plasma cell dysplasias and TTR stabilizers for hereditary amyloidosis. These trends in increase in AAMR likely reflect the increased awareness/diagnostics of amyloid disease and complications. The African American population may have higher AAMR due to socioeconomic and environmental factors, health disparities, and research bias. We also suspect men have a higher ATTR than women as it has been reported that ATTR and AL Amyloidosis tends to occur more frequently in men than women and is associated with more severe disease (Kroi et al., 2020, Desport et al., 2012). Further research is necessary to expand on the disparities seen with the ultimate goal of providing targeted therapies to reverse this downward trend.

Changing Trends in Sickle Cell Disease-Related Mortality in the United States over Four Decades

Introduction: Sickle cell disease (SCD) causes significant morbidity and early mortality. The Cooperative Study of Sickle Cell Disease estimated median life expectancy for individuals with SCD at 42 years for males and 48 years for females in the early 1990s. However, this calculation was made prior to now standards-of-care in SCD, including routine transcranial doppler screening, pneumococcal prophylaxis, and the introduction of the primary disease-modifying therapy hydroxyurea and the widespread use of chronic blood transfusion. Over the last thirty years, with expanded access to disease modifying therapies, increased evidence exists for the preservation of organ function and less frequent acute vaso-occlusive pain. It remains unclear whether the introduction of these therapies has affected overall SCD-related mortality or the specific causes of death of those with SCD in the United States, particularly in the last decade when the use of hydroxyurea has expanded most significantly. Methods: We used the US mortality statistics for 1979-2020 available publicly through the CDC WONDER database (http://wonder.cdc.gov), which is a compilation of county, state, and national-level mortality statistics derived from death certificates, including age category at death, sex, race, ethnicity, year of death, underlying cause of death, and additional contributing causes using ICD-9 codes for 1979-1998 (282.6 sickle cell anemia- all SCD genotypes were included under one code in ICD-9) and ICD-10 codes for 1999-2020 (D57.0 sickle cell anemia with crisis; D57.1 sickle cell anemia without crisis; D57.2 double heterozygous sickling disorders; D57.8 other sickle cell disorders). We searched the SCD ICD-10 codes listed as underlying cause of death by five-year age groups for Black individuals and all ethnicities, (from Hamideh and Alvarez, Pediatric Blood and Cancer 2013) and compared the crude death rates overall and for each age group to those of 1999-2009. We also searched using the SCD ICD-10 codes included in “the multiple causes of death” to determine the 15 most common ICD categories of death in each 10-year period. Results: For the period 2010-2020, 5272 Black (Hispanic &amp; non-Hispanic) individuals died in the United States with the underlying cause of death listed as one of the ICD-10 SCD codes (see Figure 1A for a map of the crude mortality rate distribution). The crude mortality rate was 1.1 per 100,000 Black individuals, which was significantly lower than the period 1999-2009 (crude rate 1.2 per 100,000, p &amp;lt; 0.0001) (Figure 1B). Of note, similar to prior trends, there is a significant increase in mortality rate in the 15-19 year age group versus 20-24 years (0.9 per 100,000 to 1.4 per 100,000, p &amp;lt; 0.0001) corresponding with the age of transition to adult centers. The mean age at death for all genotypes for 2010-2020 was 43 years (females: 44 years, males: 41 years) versus 39 years for 1999-2009 (females: 40 years, males: 38 years). For the period 2010-2020, 61% of cases listed SCD as the primary cause of death without specificity or proximal cause; for the other 39% of cases when an underlying cause of death was noted, cardiovascular disease was the most common (28%), followed by accidents (7%), cerebrovascular disease (7%), malignancy (6%), septicemia (4.8%), and renal disease (3.8%). The fifteen most common causes of death accounted for 90% of underlying causes of death listed in the SCD population. Conclusion: The sickle cell disease-related mortality rate has significantly declined over the last 40 years, including in the period 1999-2020, corresponding with the introduction of disease modifying therapies, improved SCD care, and decreased infant mortality. This overall improvement, however, provides contrast to the enduring sharp increase in mortality in the young adult years. This demonstrates the critical need to improve the transition process from pediatric to adult care and to emphasize the need for additional support for young adults after they transition to adult SCD care.

Trends in Diffuse Large B-Cell Lymphoma Mortality in the United States: A Comprehensive Review from 2000 to 2020

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of Non-Hodgkin Lymphoma (NHL), accounting for approximately 30% of all cases. While NHL mortality rates have shown a downward trend over the last two decades, comprehensive investigations into DLBCL mortality trends and disparities across racial, ethnic, gender, and geographical categories in the United States are notably scarce. Methods: Utilizing the Centers for Disease Control and Prevention's (CDC) WONDER database we identified all patients who died from NHL and DLBCL from 2000 to 2020. Age-adjusted mortality rates per 100,000 persons (AAMR) were calculated and standardized to the 2000 US census data. The National Cancer Institute (NCI) Joinpoint Regression Program was used to analyze these data to calculate annual percent changes (APCs) and average annual percent changes (AAPCs). Statistically significant changes were confirmed when the confidence interval for the APC or AAPC did not encompass zero. Additionally, subgroup analyses were conducted based on race, ethnicity, gender, and geographic location. Results: The study identified 434,419 NHL and 46,252 DLBCL deaths. NHL mortality showed a statistically significant average annual decrease of 2.5% (95% CI: -2.7 to -2.4). DLBCL mortality trends varied, initially decreasing from 2000 to 2008, then notably increasing from 2008 to 2011, and subsequently rising moderately from 2011 to 2020. This pattern culminated in a statistically significant overall average annual increase of 3.5% (95% CI: 0.4 to 6.7) in DLBCL mortality. Subgroup analyses revealed that males, Blacks, and Asians or Pacific Islanders experienced the most marked upward trends in DLBCL mortality. Both metropolitan and non-metropolitan areas reported an increase in DLBCL mortality, with metropolitan areas showing a more pronounced rise. Conclusion: Representing the most comprehensive analysis of DLBCL mortality trends to date, our study revealed intriguing disparities among the subgroups we investigated, along with an upward trend in mortality rates that departs from previously reported data. The divergence could be attributed, in part, to the expansive population coverage of the database we utilized and the use of death certificates, which may present discrepant results from other cancer registries. These findings underscore the necessity for ongoing research, guiding the development of targeted intervention strategies for DLBCL and informing efforts to bridge the identified disparities.