scholarly journals 846. Trend Analysis of Cause-Specific Mortality among HIV-Infected Veterans: A 35-Year Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S513-S513
Author(s):  
Kartavya J Vyas
Keyword(s):  
Cohort Study ◽  
Sudden Death ◽  
Opportunistic Infection ◽  
Causes Of Death ◽  
Medical Center ◽  
Mortality Rates ◽  
Hiv Diagnosis ◽  
Annual Percent Change ◽  
Standard Population ◽  
Specific Mortality

Abstract Background The aims are to estimate the rates for, and examine the trends of, all-cause and cause-specific mortality since the beginning of the epidemic, in an effort to better forecast future mortality patterns and potentially prevent premature death. Methods All patients in the HIV Atlanta VA Cohort Study (HAVACS), an ongoing, open cohort of all HIV-infected veterans who ever sought or are seeking care at the Atlanta VA Medical Center, with a documented HIV diagnosis between January 1982 and December 2016 are included. All-cause and cause-specific mortality rates are calculated annually and for the study period, and age-adjusted to the 2000 U.S. standard population. Join-point regression analyses are performed to calculate annual percent changes (APC) and 95% CIs during periods of time when significant changes in trends are observed. Results The analytic sample consisted of 4,674 patients; of whom 1,752 (36.8%) died. The age-adjusted all-cause mortality rate per 100 PY (95% CI) is 19.0 (9.9, 28.2); this rate decreased 45.2% annually from 1983 to 1987, and thereafter became relatively stable. The age-adjusted mortality rates for AIDS–opportunistic infection (aIR=19.0, 95% CI=17.0, 21.0), cardiovascular (aIR=16.2, 95% CI=9.2, 23.1; APC=-2.0), infection (aIR=20.7, 95% CI=10.3, 31.1), liver (aIR=13.8, 95% CI=9.7, 18.0; APC=-0.6), pulmonary (aIR=24.6, 95% CI=3.4, 45.8; APC=-0.3), renal (aIR=17.6, 95% CI=11.1, 24.1; APC=-1.3), and violence (aIR=14.7, 95% CI=9.2, 20.2; APC=-2.8) have all decreased since the beginning of the epidemic, most markedly for AIDS–opportunistic infection (APC=-18.0; 95% CI=-31.9, -1.4) and infection (APC=-3.4; 95% CI=-6.5, -0.3). In contrast, the age-adjusted mortality rates for AIDS–opportunistic malignancy (aIR=32.4, 95% CI=15.9, 48.9; APC=1.5), malignancy (aIR=13.2, 95% CI=6.2, 20.2; APC=1.1), and sudden death (aIR=9.6, 95% CI=6.1, 13.1; APC=32.2) have increased since the beginning of the epidemic. Figure 1. Joinpoint regression analysis of age-adjusted mortality rates in the HAVACS cohort, 1982-2016 (n=4,674). AIDS, acquired immune deficiency syndrome; APC, annual percent change; HAVACS, HIV Atlanta VA Cohort Study; HIV, human immunodeficiency virus; PY, person-years. *Statistically significant at α=0.05. 1. 2000 U.S. standard population; excludes deaths for which the date is unknown (n=46). 2. Coding Causes of Death in HIV (CoDe) protocol adapted to classify causes of death; AIDS-related illnesses refers to an appended list of AIDS-defining illnesses (1993 definition). 3. Pulmonary infections included in pulmonary, not infection. 4. Hepatocellular carcinoma included in liver, not malignancy. Conclusion HIV-infected veterans are experiencing decreasing mortality rates due to almost all causes of death, principally infections; however, increasing mortality rates due to malignancies and sudden death are observed. Identifying risk factors for those causes on the rise may help realign resources and mitigate disease burden in this population. Disclosures All Authors: No reported disclosures

scholarly journals EXCESS MORTALITY FROM COVID-19. WEEKLY EXCESS DEATH RATES BY AGE AND SEX FOR SWEDEN AND ITS MOST AFFECTED REGION

2020 ◽  
Author(s):  
Karin Modig ◽  
Anders Ahlbom ◽  
Marcus Ebeling
Keyword(s):  
Causes Of Death ◽  
Excess Mortality ◽  
National Level ◽  
Mortality Rates ◽  
Regional Level ◽  
Death Rates ◽  
Excess Death ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Age And Sex

Abstract Background Sweden has one of the highest numbers of COVID-19 deaths per inhabitant globally. However, absolute death counts can be misleading. Estimating age- and sex-specific mortality rates is necessary in order to account for the underlying population structure. Furthermore, given the difficulty of assigning causes of death, excess all-cause mortality should be estimated to assess the overall burden of the pandemic. Methods By estimating weekly age- and sex-specific death rates during 2020 and during the preceding five years, our aim is to get more accurate estimates of the excess mortality attributed to COVID-19 in Sweden, and in the most affected region Stockholm. Results Eight weeks after Sweden’s first confirmed case, the death rates at all ages above 60 were higher than for previous years. Persons above age 80 were disproportionally more affected, and men suffered greater excess mortality than women in ages up to 75 years. At older ages, the excess mortality was similar for men and women, with up to 1.5 times higher death rates for Sweden and up to 3 times higher for Stockholm. Life expectancy at age 50 declined by less than 1 year for Sweden and 1.5 years for Stockholm compared to 2019. Conclusions The excess mortality has been high in older ages during the pandemic, but it remains to be answered if this is because of age itself being a prognostic factor or a proxy for comorbidity. Only monitoring deaths at a national level may hide the effect of the pandemic on the regional level.

Cause-specific mortality rates in patients with COPD in primary care: a prospective analysis of the Birmingham COPD Cohort Study

2020 ◽  
Author(s):  
Shamil Haroon ◽  
Andrew Dickens ◽  
Peymane Adab ◽  
Alexandra Enocson ◽  
David Fitzmaurice ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Mortality Rates ◽  
Prospective Analysis ◽  
Specific Mortality

scholarly journals Persistent and extreme outliers in causes of death by state, 1999-2013

2015 ◽  
Author(s):  
Francis P Boscoe
Keyword(s):  
United States ◽  
Heart Disease ◽  
Causes Of Death ◽  
The United States ◽  
Mortality Rates ◽  
National Rate ◽  
Common Causes ◽  
Specific Mortality

In the United States, state-specific mortality rates that are high relative to national rates can result from legitimate reasons or from variability in coding practices. This paper identifies instances of state-specific mortality rates that were at least twice the national rate in each of three consecutive five-year periods (termed persistent outliers), along with rates that were at least five times the national rate in at least one five-year period (termed extreme outliers). The resulting set of 71 outliers, 12 of which appeared on both lists, illuminates mortality variations within the country, including some that are amenable to improvement either because they represent preventable causes of death or highlight weaknesses in coding techniques. Because the approach used here is based on relative rather than absolute mortality, it is not dominated by the most common causes of death such as heart disease and cancer.

scholarly journals Underlying causes of death with changing mortality among adults in the United States, 2013-2017

2020 ◽  
Author(s):  
Xin Hu ◽  
Yong Lin ◽  
Lanjing Zhang
Keyword(s):  
Causes Of Death ◽  
The United States ◽  
Nutritional Deficiencies ◽  
Accidental Poisoning ◽  
Linear Regression Models ◽  
Mortality Trends ◽  
Annual Percent Change ◽  
Percent Change ◽  
Specific Mortality ◽  
Underlying Causes

AbstractOverall mortality among U.S. adults was stable in the past years, while racial disparity was found in 10 leading causes of death or age-specific mortality in U.S. Blacks or African Americans. However, the trends in sex- and race-adjusted age-standardized cause-specific mortality are poorly understood. This study was aimed at identifying the UCD with sex- and race-adjusted, age-standardized mortality that was changing in recent years. We extracted the data of underlying causes of death (UCD) from the Multiple Cause of Death database of the Centers for Disease Control and Prevention (CDC). Multivariable log-linear regression models were used to estimate trends in sex- and race-adjusted, age-standardized mortality during 2013-2017. A total of 31,029,133 deaths were identified. Among the list of 113 UCD compiled by the CDC, there were 29 UCD with upward trend, 33 UCD with downward trend and 56 UCD with no significant trend. The 2 UCD with largest annual percent change were both nutrition related (annual percent change= 17.73, 95% CI [15.13-20.33] for malnutrition and annual percent change= 17.49, 95% CI [14.94-20.04] for Nutritional deficiencies), followed by Accidental poisoning and exposure to noxious substances. This study thus reported the UCD with changing mortality in recent years, which was sex- and race-adjusted and age-standardized. More efforts and resources should be focused on understanding, prevention and control of the mortality linked to these UCD. Continuous monitoring of mortality trends is recommended.

Transformation of Mortality by Sex in the Four Biggest Cities in Ukraine

2021 ◽  
pp. 60-79
Author(s):  
N. O. RYNGACH ◽  
P. E. SHEVCHUK
Keyword(s):  
Heart Disease ◽  
Comparative Analysis ◽  
Ischemic Heart Disease ◽  
Cerebrovascular Disease ◽  
Causes Of Death ◽  
Mortality Rates ◽  
Death Rates ◽  
Large Cities ◽  
Undetermined Intent ◽  
Specific Mortality

Large cities concentrate a substantial part of the educated, highly qualified, and economically active populations. Such social “selection” with the peculiarities of lifestyle determines the distinctive characteristics of the level and structure of mortality. Even though data on deaths by causes of death for the large cities are available in Ukraine, very few studies have analyzed cause-specific mortality in these cities. The objective of the study is to make a comparative analysis of mortality from the most influential causes of death in large cities. The novelty lies in the comparative analysis done for Dnipro, Kyiv, Lviv, Odesa, and Kharkiv for the first time. The study uses the direct method of standardization to calculate standardized death rates by sex in 2005-2019. The results indicate lower all-cause mortality rates for the large city residents compared to the corresponding average country-level indicators. Kyiv, Lviv, and Odesa have lower death rates compared to Dnipro and Kharkiv. In Kyiv and Lviv, this is attributed to lower mortality from almost all major causes of death, while in Odesa this mainly resulted from the extremely low ischemic heart disease mortality. Relatively high mortality from circulatory diseases is observed in Kharkiv and Dnipro. However, in Dnipro, this is associated with a high death rate from coronary heart disease and a very low contribution of cerebrovascular disease, whereas in Kharkiv coronary and cerebrovascular disease death rates are quite high. Mortality rates from diseases of the digestive system in the large cities are found to be the closest to the average in Ukraine (except for Lviv). The neoplasms are the only large group of diseases with a mortality rate that exceeds the average level in Ukraine, in particular for women. Overall, the death rates from most of the causes of death in the large cities demonstrated a positive trend in 2005-2019, with some exceptions. External causes and infectious diseases showed the most decrease while mortality from AIDS and ill-defined causes increased. Also, there were uncertain dynamics of deaths due to suicide and injuries with undetermined intent. Given some specific mortality differences between the cities, some concerns have been raised over the accuracy of the coding of diagnoses. In particular, unusually low mortality from ischemic heart disease was found in Odesa and from cerebrovascular disease in Dnipro, very rare deaths from alcoholic liver disease in Odesa, accidental alcohol poisoning in Kyiv, and a group of other liver diseases in Dnipro. We also assume misclassification of suicides as injuries with undetermined intent in Kharkiv. Our findings highlight the importance of the implementation of automated coding and selection of causes of death that can minimize the number of subjective decisions made by coders and lead to significant improvements in the quality of data.

6129Temporal trends and patterns in cause-specific mortality and hospitalisations after incident heart failure: a longitudinal analysis of 86,000 individuals

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Conrad ◽  
A Judge ◽  
D Canoy ◽  
J G Cleland ◽  
J J V McMurray ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Mortality ◽  
Causes Of Death ◽  
Mortality Rates ◽  
Failure Diagnosis ◽  
The Past ◽  
Specific Mortality ◽  
Heart Failure Diagnosis ◽  
Respiratory Conditions ◽  
Overall Mortality

Abstract Background The past two decades have brought considerable improvements in heart failure care. Clinical trials have demonstrated effectiveness of several different treatments in reducing mortality and hospitalisations, and observational studies have shown that these treatments are increasingly being used in many countries. Little is known about whether these changes have been reflected in patient outcomes in routine clinical settings. Methods We used anonymised electronic health records that link information from primary care, secondary care, and the national death registry to investigate 86,000 individuals with newly diagnosed heart failure between 2002 and 2013 in the UK. We computed all-cause and cause-specific mortality rates and number of hospitalisations in the first year following diagnosis. We used Poisson regression models to calculate category-specific rate ratios and 95% confidence intervals, adjusting for patients' age, sex, region, socioeconomic status and 17 major comorbidities. Findings One year after initial heart failure diagnosis, all-cause mortality rates were high (32%) and did not change significantly over the period of study (adjusted rate ratio (RR) 2013 vs 2002: 0.94 [0.88, 1]). Overall rates masked diverging trends in cause-specific outcomes: a decline in cardiovascular mortality (RR: 0.74 [0.68, 0.81]) was offset by an increase in non-cardiovascular mortality (RR: 1.28 [1.17, 1.39]), largely due to infections and chronic respiratory conditions. Sub-group analyses further showed that overall mortality declined among patients under 80 years of age (RR 2013 vs 2002: 0.79 [0.71, 0.88]), although not in older age groups (RR 2013 vs 2002: 0.97 [0.9, 1.06]). After cardiovascular causes (43%), the major causes of death identified in 2013 were neoplasms (15%), respiratory conditions (12%), and infections (11%). Hospital admissions within a year of heart failure diagnosis were common (1.15 hospitalisations per patient-year at risk), changed little over time (RR: 0.96 [0.92, 0.99]), and were largely (60%) due to non-cardiovascular causes. Interpretation Despite increased use of life-saving interventions, overall mortality and hospitalisations following a new diagnosis of heart failure have changed little over the past decade. Improved prognosis among young and middle-aged patients marks an important achievement and attests of complex barriers to progress in elderly patients. The shift from cardiovascular to non-cardiovascular causes of death suggest that management of associated comorbidities might offer additional opportunities to improve patients' prognosis. Acknowledgement/Funding British Heart Foundation, National Institute for Health Research, UK Research and Innovation.

scholarly journals A Lower CD4 Count Predicts Most Causes of Death except Cardiovascular Deaths. The Austrian HIV Cohort Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12532
Author(s):  
Gisela Leierer ◽  
Armin Rieger ◽  
Brigitte Schmied ◽  
Mario Sarcletti ◽  
Angela Öllinger ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Diseases ◽  
Causes Of Death ◽  
Mortality Rates ◽  
Observation Time ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Cd4 Counts ◽  
Period 2 ◽  
All Cause Mortality

(1) Objective: To investigate changes in mortality rates and predictors of all-cause mortality as well as specific causes of death over time among HIV-positive individuals in the combination antiretroviral therapy (cART) era. (2) Methods: We analyzed all-cause as well as cause-specific mortality among the Austrian HIV Cohort Study between 1997 and 2014. Observation time was divided into five periods: Period 1: 1997–2000; period 2: 2001–2004; period 3: 2005–2008; period 4: 2009–2011; and period 5: 2012–2014. Mortality rates are presented as deaths per 100 person-years (d/100py). Potential risk factors associated with all-cause mortality and specific causes of death were identified by using multivariable Cox proportional hazard models. Models were adjusted for time-updated CD4, age and cART, HIV transmission category, population size of residence area and country of birth. To assess potential nonlinear associations, we fitted all CD4 counts per patient using restricted cubic splines with truncation at 1000 cells/mm3. Vital status of patients was cross-checked with death registry data. (3) Results: Of 6848 patients (59,704 person-years of observation), 1192 died: 380 (31.9%) from AIDS-related diseases. All-cause mortality rates decreased continuously from 3.49 d/100py in period 1 to 1.40 d/100py in period 5. Death due to AIDS-related diseases, liver-related diseases and non-AIDS infections declined, whereas cardiovascular diseases as cause of death remained stable (0.27 d/100py in period 1, 0.10 d/100py in period 2, 0.16 d/100py in period 3, 0.09 d/100py in period 4 and 0.14 d/100py in period 5) and deaths due to non-AIDS-defining malignancies increased. Compared to latest CD4 counts of 500 cells/mm3, lower CD4 counts conferred a higher risk of deaths due to AIDS-related diseases, liver-related diseases, non-AIDS infections and non-AIDS-defining malignancies, whereas no significant association was observed for cardiovascular mortality. Results were similar in sensitivity analyses where observation time was divided into two periods: 1997–2004 and 2005–2014. (4) Conclusion: Since the introduction of cART, risk of death decreased and causes of death changed. We do not find evidence that HIV-positive individuals with a low CD4 count are more likely to die from cardiovascular diseases.

scholarly journals All-cause mortality and causes of death in the Swiss Hepatitis C Cohort Study

2019 ◽  
Author(s):  
Maroussia Roelens ◽  
Barbara Bertisch ◽  
Darius Moradpour ◽  
Andreas Cerny ◽  
Nasser Semmo ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Cohort Study ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Causes Of Death ◽  
Death Registry ◽  
Slow Progression ◽  
Specific Mortality ◽  
Over Time ◽  
Related Mortality

AbstractBackground & AimsWith the introduction of direct-acting antiviral agents (DAA), mortality rates and causes of death among persons with hepatitis C virus (HCV) infection are likely to change over time. However, the emergence of such trends may be delayed by the relatively slow progression of chronic hepatitis C. To date, detailed analyses of cause-specific mortality among HCV-infected persons over time remain limited.MethodsWe evaluated changes in causes of death among the Swiss Hepatitis C Cohort Study (SCCS) participants, from 2008 to 2016. We analysed risk factors for all-cause and cause-specific mortality, accounting for changes in treatment, fibrosis stage and use of injectable drugs over time. Mortality ascertainment was completed by linking lost-to-follow-up participants to the Swiss Federal Statistical Office (SFSO) death registry.ResultsWe included 4,700 SCCS participants, of whom 478 died between 2008 and 2016. Linkage to the SFSO death registry substantially improved the information on causes of death (from 42% of deaths with unknown cause to 10% after linkage). Leading causes of death were liver failure (crude death rate 4.4/1000 person-years), liver cancer (3.4/1000 p-yrs) and non-liver cancer (2.8/1000 p-yrs), with an increasing proportion of cancer-related deaths over time. Cause-specific analysis showed that persons with sustained virologic response (SVR) were less at risk for liver-related mortality than those never treated or treated unsuccessfully.ConclusionsAlthough the expected decrease in mortality is not yet observable, causes of death among HCV-infected persons evolved over time. With the progressive widening of guidelines for DAA use, liver-related mortality is expected to decline in the future. Continued monitoring of cause-specific mortality will remain important to assess the long-term effect of DAA and to design effective interventions.Lay summaryLeading causes of death among persons with hepatitis C virus (HCV) infection in the Swiss Hepatitis C Cohort study evolved over the past years, with an increasing proportion of cancer-related deaths. The positive impact of new potent anti-HCV drugs on mortality among HCV-infected persons is not yet observable, due to both the slow progression of chronic hepatitis C and the progressive relaxation of guidelines for the use of those new drugs.

scholarly journals Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001–2016: a retrospective cohort study

Diabetologia ◽  
2020 ◽  
Vol 63 (4) ◽  
pp. 757-766 ◽  
Author(s):  
Hongjiang Wu ◽  
Eric S. H. Lau ◽  
Ronald C. W. Ma ◽  
Alice P. S. Kong ◽  
Sarah H. Wild ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hong Kong ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mortality Rates ◽  
Secular Trends ◽  
Specific Mortality

scholarly journals All-Cause Mortality and Causes of Death in the Swiss Hepatitis C Cohort Study (SCCS)

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Maroussia Roelens ◽  
Barbara Bertisch ◽  
Darius Moradpour ◽  
Andreas Cerny ◽  
Nasser Semmo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hepatitis C ◽  
Causes Of Death ◽  
Antiviral Agents ◽  
Virologic Response ◽  
Direct Acting Antiviral ◽  
Effective Interventions ◽  
Specific Mortality ◽  
Over Time ◽  
Related Mortality

Abstract Background With direct-acting antiviral agents (DAAs), mortality rates and causes of death among persons with hepatitis C virus (HCV) infection may change over time. However, the emergence of such trends may be delayed by the slow progression of chronic hepatitis C. To date, detailed analyses of cause-specific mortality among HCV-infected persons over time remain limited. Methods We evaluated changes in causes of death among Swiss Hepatitis C Cohort Study (SCCS) participants from 2008 to 2016. We analyzed risk factors for all-cause and cause-specific mortality, accounting for changes in treatment, fibrosis stage, and use of injectable drugs over time. Mortality ascertainment was completed by linking lost-to-follow-up participants to the Swiss Federal Statistical Office death registry. Results We included 4700 SCCS participants, of whom 478 died between 2008 and 2016. The proportion of unknown causes of death decreased substantially after linkage, from 42% to 10%. Leading causes of death were liver failure (crude death rate 4.4/1000 person-years), liver cancer (3.4/1000 person-years), and nonliver cancer (2.8/1000 person-years), with an increasing proportion of cancer-related deaths over time. Cause-specific analysis showed that persons with sustained virologic response were less at risk for liver-related mortality than those never treated or treated unsuccessfully. Conclusions Although the expected decrease in mortality is not yet observable, causes of death among HCV-infected persons have evolved over time. With the wider use of DAAs, liver-related mortality is expected to decline in the future. Continued monitoring of cause-specific mortality will remain important to assess the long-term effect of DAAs and design effective interventions.

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