World Health Organization Mortality Research Articles

The contributions of avoidable causes of death to gender gap in life expectancy and life disparity in the US and Canada: 2001–2019

ObjectivesThis study measures public health policies' and healthcare system's influence, by assessing the contributions of avoidable deaths, on the gender gaps in life expectancy and disparity (GGLD and GGLD, respectively) in the United States (US) and Canada from 2001 to 2019. MethodsTo estimate the GGLE and GGLD, we retrieved age- and sex-specific causes of death from the World Health Organization's mortality database. By employing the continuous-change model, we decomposed the GGLE and GGLD by age and cause of death for each year and over time using females as the reference group. ResultsIn Canada and the US, the GGLE (GGLD) narrowed (increased) by 0.9 (0.2) and 0.2 (0.3) years, respectively. Largest contributor to the GGLE was non-avoidable deaths in Canada and preventable deaths in the US. Preventable deaths had the largest contributions to the GGLD in both countries. Ischemic heart disease contributed to the narrowing GGLE/GGLD in both countries. Conversely, treatable causes of death increased the GGLE/GGLD in both countries. In Canada, “treatable & preventable” as well as preventable causes of death narrowed the GGLE while opposite was seen in the US. While lung cancer contributed to the narrowing GGLE/GGLD, drug-related death contributed to the widening GGLE/GGLD in both countries. Injury-related deaths contributed to the narrowing GGLE/GGLD in Canada but not in the US. The contributions of avoidable causes of death to the GGLE declined in the age groups 55–74 in Canada and 70–74 in the US, whereas the GGLE widened for ages 25–34 in the US. ConclusionCanada experienced larger reduction in the GGLE compared to the US attributed mainly to preventable causes of death. To narrow the GGLE and GGLD, the US needs to address injury deaths. Urgent interventions are required for drug-related death in both countries, particularly among males aged 15–44 years.

Health and economic benefits of meeting WHO air quality guidelines, Western Pacific Region.

To quantify the number of avoidable annual deaths and associated economic benefits from meeting the World Health Organization (WHO) air quality guidelines for ambient concentrations for fine particulate matter (PM2.5) for Member States of the WHO Western Pacific Region. Using the AirQ+ software, we performed a quantitative health impact assessment comparing country-level PM2.5 concentrations with the 2005 and 2021 air quality guidelines recommended maximum concentrations of 10 and 5μg/m3, respectively. We obtained PM2.5 data from the WHO Global Health Observatory (latest available year 2016), and population and mortality estimates from the United Nations World Population Prospects database for the latest 5-year period available (2015-2019), which we averaged to 1-year estimates. A risk estimate for all-cause mortality, based on a meta-analysis, was embedded within AirQ+ software. Our economic assessment used World Bank value of a statistical life adjusted to country-specific gross domestic product (latest available year 2014). Data were complete for 21 of 27 Member States. If these countries achieved the 2021 guidelines for PM2.5, an estimated 3.1 million deaths would be avoided annually, which are 0.4 million more deaths avoided than meeting the 2005 guidelines. China would avoid the most deaths per 100 000 population (303 deaths) and Brunei Darussalam the least (5 deaths). The annual economic benefit per capita ranged from 5781 United States dollars (US$) in Singapore to US$143 in Solomon Islands. Implementing effective measures to reduce PM2.5 emissions would save a substantial number of lives and money across the Region.

A Review and Analysis of the Impact of Homicide Measurement on Cross-National Research

The number of cross-national homicide studies is increasing rapidly. Many scholars, however, do not consider the details of how individual nations and the four main centralized homicide data sources—raw estimates from the World Health Organization (WHO) Mortality Database, adjusted estimates from the WHO Global Health Observatory, United Nations Office on Drugs and Crime, and World Bank World Development Indicators—generate national homicide rates and the impact this may have on results and the scientific record. We tested whether homicide trends, levels, and structural covariates are dependent on data source. We used 1990–2018 data in 5-year groupings and pooled them over time and nation. We utilized exploratory data analysis techniques to look for differences in homicide rates and trends. Then we employed seemingly unrelated regression (SUR) to determine whether associations with homicide of typical structural covariates were dependent on homicide data source. Finally, we examined Wald Tests to determine whether differences in the sizes of the SUR coefficients from each data source were significantly different from zero. We found differences in homicide trends and rates by data source and that associations with homicide rates of structural covariates varied in significance, magnitude, and even direction depending on homicide data source. Cross-national homicideresearch has a promising future for understanding short- and long-term global and regional trends and population-level covariates and constructing theoretical explanations for geographical and temporal variation. However, researchers must better understand how national homicide data are generated by nations and these four data sources. All four systems possess limitations, but homicide data from the WHO Mortality Database present the most attractive option.

Chronic obstructive pulmonary disease (COPD) mortality trends worldwide: An update to 2019.

Chronic obstructive pulmonary disease (COPD) incidence, prevalence, mortality and socioeconomic burden are considerable and vary across countries. The aim of the present study was to update the analysis of COPD mortality worldwide using data from the World Health Organization (WHO) up to 2019. We obtained COPD mortality and population data for 22 European countries and the European Union (EU) as a whole, 10 American countries and six other countries from the WHO mortality database. We calculated age-standardized mortality rates in both sexes and examined trends by country with joinpoint analysis between 1994 and 2019. Between 2005-2007 and 2015-2017, overall COPD mortality decreased in EU men (-16.3%) but increased in women (12.7%) to reach rates of 14.0/100,000 in men and of 6.4/100,000 in women. In the United States, mortality declined in men to 21.3/100,000 but rose in women to 18.3/100,000. Mortality declined in most Latin American countries and all Asian countries, while an increase in Australian women was observed. A steady decrease in COPD mortality was observed in most of countries for men, whilst a different trend was observed in women in several countries. These trends are largely explained by changes in smoking habits, with an additional contribution of air pollution and occupational exposures. Despite past and ongoing tobacco control initiatives, this condition still remains a leading cause of death, in particular in countries with lower socio-demographic indices.

Changes in the rankings of leading causes of death in Japan, Korea, and Taiwan from 1998 to 2018: a comparison of three ranking lists

BackgroundThe ranking lists used by most countries for leading causes of death (CODs) comprise broad category such as cancer, heart disease, and accidents. To provide more specific information, the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME) proposed lists that splitting broad categories into specific categories. We examined the changes in rankings of leading CODs according to different lists in Japan, Korea, and Taiwan from 1998 to 2018.MethodsWe obtained the number of deaths for three countries from the WHO mortality database for 1998, 2008, and 2018. Age-standardized death rates were calculated for rankings 10 leading CODs using WHO 2000 age structure as standard.ResultsThe first leading COD was cancer in Japan, Korea, and Taiwan from 1998 to 2018 based on government list; nevertheless, became stroke based on WHO list, and was stroke and ischemic heart disease based on IHME list. In the WHO and IHME lists, cancer is categorized based on cancer site. The number of cancer sites included in the 10 leading CODs in 2018 was 4, 4, and 3 in Japan, Korea, and Taiwan, respectively according to the WHO list and was 4, 4, and 2, respectively according to IHME list. The only difference was the rank of liver cancer in Taiwan, which was 6th according to WHO list and was 18th according to IHME list. The ranking and number of deaths for some CODs differed greatly between the WHO and IHME lists due to the reallocation of “garbage codes” into relevant specific COD in IHME list.ConclusionsThrough the use of WHO and the IHME lists, the relative importance of several specific and avoidable causes could be revealed in 10 leading CODs, which could not be discerned if the government lists were used. The information is more relevant for health policy decision making.

The Ecological Association between Asbestos Consumption and Asbestos-Related Diseases 15 Years Later.

The Ecological Association between Asbestos Consumption and Asbestos-Related Diseases 15 Years Later.

The debt crisis, austerity measures, and suicide in Greece

AbstractBackgroundHow are economic downturns and suicide related?ObjectiveThis study examines the link between economically driven austerity measures implemented during a recent economic downturn—the Greek debt crisis—and suicide for the population as a whole, as well as for men and women separately.MethodsUtilizing a 50‐nation panel containing annual suicide counts and population demographics for the years 1995–2015 from the World Health Organization's Mortality archive, the analysis employs a synthetic control design, a quasi‐experimental approach that allows us to causally model the relationship between Greece's International Monetary Fund‐imposed austerity measures and suicide, something that has hampered prior research efforts.ResultsFindings show austerity policies corresponded with increased suicide rates in Greece for the population as a whole and for men and women. Robustness tests confirm these results.ConclusionsWe discuss the implications of the findings for the current economic crisis associated with the COVID‐19 pandemic.

The global distribution of pesticide poisoning: Implications for vulnerable populations, environmental health and equality in a shifting global policy climate

BACKGROUND AND AIM: Human poisoning by pesticides has long been seen as a severe public health problem. As early as 1990, a task force of the World Health Organization (WHO) estimated that about one million unintentional pesticide poisonings occur annually, leading to approximately 20,000 deaths. Thirty years on there is no up-to-date picture of global pesticide poisoning despite an increase in global pesticide use. Our aim was to systematically review the prevalence of unintentional, acute pesticide poisoning (UAPP), and to estimate the annual global number of UAPP. METHODS: We carried out a systematic review of the scientific literature published between 2006 and 2018, supplemented by mortality data from WHO. We extracted data from 157 publications and the WHO cause-of-death database, then performed country-wise synopses, and arrived at annual numbers of national UAPP. World-wide UAPP was estimated based on national figures and population data for regions defined by the Food and Agriculture Organization (FAO). RESULTS:In total 141 countries were covered, including 58 by the 157 articles and an additional 83 by data from the WHO Mortality Database. Approximately 740,000 annual cases of UAPP were reported by the extracted publications resulting from 7,446 fatalities and 733,921 non-fatal cases. On this basis, we estimated that about 385 million cases of UAPP occur annually world-wide including around 11,000 fatalities. Based on a worldwide farming population of approximately 860 million this means that about 44% of farmers are poisoned by pesticides every year. CONCLUSIONS:Our study updates outdated figures on world-wide UAPP. Along with other estimates, robust evidence is presented that acute pesticide poisoning is an ongoing major global public health challenge. There is a need to recognize the high burden of non-fatal UAPP, particularly on farmers and farmworkers, and that the current focus solely on fatalities hampers international efforts in risk assessment and prevention of poisoning. KEYWORDS: Pesticide, Poisoning, Occupational, Farmer, Farmworker, Agriculture

Disease Burden, Risk Factors, and Recent Trends of Liver Cancer: A Global Country-Level Analysis

Background: This study aimed to evaluate the updated disease burden, risk factors, and temporal trends of liver cancer based on age, sex, and country. Methods: We estimated the incidence of liver cancer and its attribution to hepatitis B virus (HBV) and hepatitis C virus (HCV) in 2018 based on the Global Cancer Observatory and World Health Organization (WHO) Cancer Causes database. We extracted the prevalence of risk factors from the WHO Global Health Observatory to examine the associations by weighted linear regression. The trend analysis used data from the Cancer Incidence in Five Continents and the WHO mortality database from 48 countries. Temporal patterns of incidence and mortality were calculated using average annual percent change (AAPC) by joinpoint regression analysis. Results: The global incidence of liver cancer was (age-standardized rate [ASR]) 9.3 per 100,000 population in 2018, and there was an evident disparity in the incidence related to HBV (ASR 0.2–41.2) and HCV (ASR 0.4–43.5). A higher HCV/HBV-related incidence ratio was associated with a higher level of alcohol consumption (β 0.49), overweight (β 0.51), obesity (β 0.64), elevated cholesterol (β 0.70), gross domestic product (β 0.20), and Human Development Index (HDI; β 0.45). An increasing trend in incidence was identified in many countries, especially for male individuals, population aged ≥50 years, and countries with a higher HCV/HBV-related liver cancer incidence ratio. Countries with the most drastic increase in male incidence were reported in India (AAPC 7.70), Ireland (AAPC 5.60), Sweden (AAPC 5.72), the UK (AAPC 5.59), and Norway (AAPC 4.87). Conclusion: We observed an overall increasing trend of liver cancer, especially among male subjects, older individuals, and countries with a higher prevalence of HCV-related liver cancer. More efforts are needed in enhancing lifestyle modifications and accessibility of antiviral treatment for these populations. Future studies should investigate the reasons behind these epidemiological changes.

The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review

BackgroundHuman poisoning by pesticides has long been seen as a severe public health problem. As early as 1990, a task force of the World Health Organization (WHO) estimated that about one million unintentional pesticide poisonings occur annually, leading to approximately 20,000 deaths. Thirty years on there is no up-to-date picture of global pesticide poisoning despite an increase in global pesticide use. Our aim was to systematically review the prevalence of unintentional, acute pesticide poisoning (UAPP), and to estimate the annual global number of UAPP.MethodsWe carried out a systematic review of the scientific literature published between 2006 and 2018, supplemented by mortality data from WHO. We extracted data from 157 publications and the WHO cause-of-death database, then performed country-wise synopses, and arrived at annual numbers of national UAPP. World-wide UAPP was estimated based on national figures and population data for regions defined by the Food and Agriculture Organization (FAO).ResultsIn total 141 countries were covered, including 58 by the 157 articles and an additional 83 by data from the WHO Mortality Database. Approximately 740,000 annual cases of UAPP were reported by the extracted publications resulting from 7446 fatalities and 733,921 non-fatal cases. On this basis, we estimate that about 385 million cases of UAPP occur annually world-wide including around 11,000 fatalities. Based on a worldwide farming population of approximately 860 million this means that about 44% of farmers are poisoned by pesticides every year. The greatest estimated number of UAPP cases is in southern Asia, followed by south-eastern Asia and east Africa with regards to non-fatal UAPP.ConclusionsOur study updates outdated figures on world-wide UAPP. Along with other estimates, robust evidence is presented that acute pesticide poisoning is an ongoing major global public health challenge. There is a need to recognize the high burden of non-fatal UAPP, particularly on farmers and farmworkers, and that the current focus solely on fatalities hampers international efforts in risk assessment and prevention of poisoning. Implementation of the international recommendations to phase out highly hazardous pesticides by the FAO Council could significantly reduce the burden of UAPP.

An update on pulmonary embolism-related mortality in Italy (2003-2015)

Data regarding pulmonary embolism (PE)-related mortality in Italy are scarce. We assessed PE-related mortality and its time trend in Italy by using the World Health Organization (WHO) Mortality Database. The vital registration data of Italy from the WHO Mortality Database were analyzed for the period between 2003 and 2015, and compared with time trends in Southern Europe. Death was defined as PE-related when classified with specific codes for PE or limb vein thrombosis listed as the primary cause of death. This coding was based on the International Classification of Diseases, tenth revision. Overall, 28 647 PE-related deaths (10 178 men and 18 469 women) were recorded between 2003 and 2015. The observed age-standardized annual PE-related mortality rates were 2.5 per 100 000 men and 2.8 per 100 000 women. Moreover, PE-related mortality increased with age with a seemingly exponential distribution. Joinpoint regression analysis demonstrated a statistically significant linear decrease in age-standardized PE-related mortality of -0.21 (95% confidence interval -0.27; -0.15) and -0.22 (95% confidence interval -0.28; -0.16) deaths per 100 000 population for men and women, respectively. The Italian age-adjusted mortality rates appeared lower compared to overall Southern Europe, despite a similar decreasing trend over time.

The economic burden of non-communicable disease mortality in the South Pacific: Evidence from Fiji.

Non-communicable diseases (NCDs) have emerged as one of the major endemics in Fiji which is responsible for more than 80 percent of deaths annually. In this study, we estimate the economic burden of non-communicable disease mortality in Fiji. The specific impact of diabetes, cardiovascular disease, chronic respiratory disease and cancer-related mortality on Fiji's output is also investigated using the autoregressive distributed lag bounds tests approach to cointegration. The data used is compiled from Fiji Ministry of Health and Medical Services and World Health Organization's Mortality database. Overall, the study finds that NCD mortality rate together with cardiovascular disease, diabetes, chronic respiratory disease and cancer have a significant negative effect on output per capita of Fiji between 1972 and 2016. A one percentage point increase in NCD-mortality rate reduced output per capita by 0.012 percent. In addition, a percentage point increase in the mortality rates of cardiovascular disease, diabetes, chronic respiratory disease and cancer decreased output per capita by 0.018, 0.01, 0.031, and 0.035 percent, respectively. The findings conclude that NCD poses significant economic burden in Fiji and recommend policy innovations in lessening the high risk of NCD among the Fijian population.

Trends in lung cancer mortality between 2001 and 2017: An observational study in USA and EU.

e19277 Background: The lung is the commonest site of cancer and has the highest worldwide cancer-related mortality. Past two decades has seen advancements in screening technologies and guidelines, as well as new modalities for treatment. Few studies have reported on lung cancer trends in the 21st century. Our study reports and compares trends in lung cancer mortality in the USA and European Union (EU). Methods: We utilized the World Health Organization (WHO) Mortality Database and Center for Disease Control (CDC) Wonder database. We extracted Lung Cancer mortality data from 2001 to 2017 based on ICD 10 system. Crude mortality rates were dichotomized by sex and reported by year. We computed Age Standardized Death Rates (ASDRs) per 100,000 population using the World Standard Population and USA Standard Population. Lung cancer mortality trends were compared using Joinpoint regression analysis. Results: We analyzed a data from a total of 26 EU countries and USA, of which 6 countries had data till 2017, 12 till 2016, 7 till 2015 and 2 till 2014. We observed that mortality in men was down-trending in all countries except Cyprus and Portugal. In females, there was an increase in mortality in 22 countries. Amongst EU nations, most recently (2017) Hungary had the highest ASDRs for both males and females (64.5/100,000 and 31.0/100,000), whereas the lowest mortality was in Sweden for males (17.3/100,000) and Lithuania for the females (7.58/100,000). Latvia had the highest Estimated Annual Percentage Change (EAPC) in male mortality (-9.6%). Based on recent most data, we saw that there was a significantly lower mortality in males amongst European nations that joined the EU pre-2004 as compared to those that joined the EU post-2004 (p = 0.006). In USA, ASDRs in males and females were 44.3/100,000 and 30.6/100,000, respectively, with EAPC of -5.1% and -4.2% in males and females, respectively. Conclusions: For the study period, we observed expected decrease in lung cancer mortality in males. In contrast, there was a gradual rising trend in lung cancer mortality amongst females. In addition, there was substantial variation between nations. USA has shown consistent downtrend since 2001 where as there have been fluctuations in trends in other EU nations.

Trends in malignant melanoma mortality in 31 countries from 1985 to 2015.

Malignant melanoma (MM) causes the highest absolute number of deaths among skin cancers. An up-to-date analysis of international MM mortality trends is required for assessing the burden of disease, and may support the assessment of the effectiveness of new diagnostic, therapeutic and preventative strategies. To report MM mortality trends between 1985 and 2015 using the World Health Organization (WHO) Mortality Database. We used country-level MM mortality data from the WHO Mortality Database for all countries with high usability death registration data. Mortality trends were described using Joinpoint regression modelling. Thirty-one countries met the inclusion criteria. All countries, except the Czech Republic, demonstrated increased age-standardized death rates (ASDRs) in males over the observation period. More countries exhibited decreased or stable MM mortality in females. The median mortality rate for 2013-2015 was 2·57 deaths per 100000 for males and 1·55 per 100000 for females. Australia and Norway had the highest ASDRs for males (5·72 per 100000 and 4·55 per 100000, respectively). Norway and Slovenia had the highest ASDRs for females (3·02 per 100000 and 2·58 per 100000, respectively). MM mortality was greater for males than females in all countries, with sex disparity increasing across the period. Disparity in mortality between older and younger cohorts in several countries was also found. An overall increase in MM mortality over the past 30 years was observed. However, there was notable variation in mortality trends between countries, as well as between males and females, and between different age groups.

Cervical cancer burden in Latin America and the Caribbean: Where are we?

In May 2018, the World Health Organization (WHO) called for the elimination of cervical cancer. To monitor this initiative, we examined cervical cancer incidence and mortality in the Latin America and Caribbean (LAC) region using GLOBOCAN 2018, Cancer Incidence in Five Continents Series, and the WHO Mortality Database. We estimated the number of cases and age-standardized rates (ASRs) for cervical cancer incidence and mortality for 2018. We also presented the ASRs for recorded cervical cancer incidence from the period 2008 to 2012. We calculated annual rates and analyzed trends in cervical cancer incidence and mortality for all ages combined and for the following age groups: 0-29, 30-49, 50-64 and 65+. Finally, we calculated the estimated average annual percentage change in incidence and mortality rates for the past 10 years. In 2018, an estimated 56,000 new cervical cancer cases and 28,000 cervical cancer deaths occurred among women in LAC with great variations between subregions and countries/territories. Overall, trends in cervical cancer incidence and mortality have decreased over the past decade; however, the rates are still above the elimination threshold of 4 per 100,000 in most LAC countries/territories. Despite the encouraging trends observed, achieving the elimination of cervical cancer in the region still requests substantial political commitment and economic effort. Population-based cancer registries are critical in monitoring the elimination initiative.

Examining trends in cardiovascular disease mortality across Europe: how does the introduction of a new European Standard Population affect the description of the relative burden of cardiovascular disease?

BackgroundSome mortality statistics are misleading when comparing between countries due to varying age distributions in their populations. In order to adjust for these differences, age-standardised mortality rates (ASMRs) are often produced. ASMRs allow for comparisons between countries as if both had the same standardised population. We examined whether the updating of the standard population for Europe affected the description of the relative burden between countries in cardiovascular disease (CVD) mortality across the continent.MethodsMortality and population data were obtained from the World Health Organization (WHO) mortality database. ASMRs were calculated using the direct method and two European Standard Populations (ESP): 1976 ESP and 2013 ESP. We investigated differences in ASMR76 (calculated using 1976 ESP) and ASMR13 (calculated using 2013 ESP), changes in rankings of countries between the two ASMRs and differences in trends in CVD mortality in each country for the two ASMRs.ResultsCVD rates calculated using the 1976 ESP were on average half the size of rates calculated using the 2013 ESP. Spearman’s rank coefficient showed that the ranks of countries by ASMRs calculated using the two ESPs were different for both sexes. Joinpoint analyses showed no difference in the direction of trend between ASMR76 and ASMR13 although differences in the magnitude of the change were found in some countries.ConclusionASMRs are commonly used in studying the epidemiology of a disease. It is crucial that policy makers understand the effect of changes in standard populations on these rates. This includes how populations with different age distributions compare to each other. Similar effects may be seen in other diseases that are also more prevalent in older age groups, such as cancer and dementia.

Premature deaths due to head and neck cancers in canada: A nationwide analysis from 1980 to 2010.

To examine if there has been a reduction in premature mortality due to head and neck cancers and their subtypes in the Canadian population between 1980 and 2010. Retrospective database review. Mortality data for head and neck cancers were obtained from the World Health Organization's mortality database. Years of life lost (YLL) was calculated according to Canadian life tables. A new measure, average lifespan shortened (ALSS), was calculated as a ratio of YLL over the expected lifespan. During the period of interest, decreases in age standardized rates of death adjusted to the World Standard Population were observed mainly among men. The adjusted YLL rates remained unchanged with respect to oral cancers in women, but slightly decreased for oral cancers in men and for laryngeal cancers in both sexes. Our new measure of ALSS showed that in 1980, patients with oral cancers lost an average of 20% of their lifespan, whereas in 2010, men and women still lost approximately 20% and 18%, respectively. Patients with laryngeal cancers lost 18% of their lifespan in both sexes in 1980 and 17% in 2010. The ALSS subanalysis showed that the largest gain of lifespan was observed for cancers of the hypopharynx in men and for cancers of the floor of mouth and nasopharynx in women. There appears to be modest improvements in premature mortality due to head and neck cancers in Canada over a 30-year period, with the exception of oral cancers in men. Changes in premature mortality varied slightly by cancer subtypes. NA Laryngoscope, 130:911-917, 2020.

Phosphodiesterase 5 inhibitors for pulmonary hypertension.

Phosphodiesterase 5 inhibitors for pulmonary hypertension.

Epidemiology report: trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data.

AimsThere have been substantial declines in cerebrovascular disease mortality across much of Europe, mirroring trends in deaths from cardiovascular disease as a whole. No study has investigated trends in cerebrovascular disease, and its subtypes within all European countries. This study aimed to examine sex-specific trends in cerebrovascular disease, and three of its sub-types: ischaemic stroke, haemorrhagic stroke, and subarachnoid haemorrhage (SAH), in Europe between 1980 and 2016.Methods and resultsSex-specific mortality data for each country of the World Health Organization (WHO) Europe region were extracted from the WHO global mortality database and analysed using Joinpoint software to examine trends. The number and location of significant joinpoints for each country by sex and subtype was determined using a log-linear model. The annual percentage change within each segment was calculated along with the average annual percentage change over the duration of all available data. The last 35 years have seen large overall declines in cerebrovascular disease mortality rates in the majority of European countries. While these declines have continued steadily in more than half of countries, this analysis has revealed evidence of recent plateauing and even increases in stroke mortality in a number of countries, in both sexes, and in all four geographical sub-regions of Europe. Analysis by stroke sub-type revealed that recent plateauing was most common for haemorraghic stroke and increases were most common for ischaemic stroke.ConclusionThese findings highlight the need for continued research into the inequalities in both current stroke mortality outcomes and trends across Europe, as well as the causes behind any recent plateauing of total cerebrovascular disease or its subtypes.

Relation between mortality trends of cardiovascular diseases and selected cancers in the European Union, in 1970–2017. Focus on cohort and period effects

AimTo characterise mortality trends from major non-communicable diseases in the European Union (EU) analysing data from the World Health Organization (WHO) Mortality Database. MethodsWe obtained EU population and death certification data for major non-communicable diseases, i.e. seven cancer sites (stomach, intestine, pancreas, lung, breast, prostate and haematopoietic), total cancers, coronary heart diseases (CHDs) and cerebrovascular diseases (CVDs) from the WHO Mortality Database over the 1970 and 2012 period. We computed age-standardised rates (world standard population) and applied joinpoint regression models to identify temporal trends and age period cohort (APC) models to disentangle the effects of age, period of death and cohort of birth on mortality. ResultsIn 2012, 2.4 million deaths were recorded in the EU (1.3 million from cancers and 1.1 million from CHD and CVD combined). Over the last decade, mortality from cancer fell by 14% in men and 8% in women, resulting in age-standardised rates of 144 and 88/100,000 persons, respectively, in 2012. The only exceptions to the general downward trends were pancreatic cancer and female lung cancer. Both cardiovascular diseases mortality fell over 35% in both sexes with rates of 60 and 28/100,000 for CHD, and of 30 and 23/100,000 for CVD, in men and women, respectively, in 2012. ConclusionsOverall trends in mortality rates from non-communicable diseases in the EU were favourable, and the joinpoint and APC models indicated these trends are likely to continue in the near future. Lack of progress in tobacco-related mortality in women underlines the importance of female-specific anti-tobacco policies.