scholarly journals Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults

BMJ ◽  
2019 ◽  
pp. l1778 ◽  
Author(s):  
Olena O Seminog ◽  
Peter Scarborough ◽  
F Lucy Wright ◽  
Mike Rayner ◽  
Michael J Goldacre
Keyword(s):  
Acute Stroke ◽  
Event Rate ◽  
Age Groups ◽  
Case Fatality ◽  
Mortality Rates ◽  
National Database ◽  
Age Group ◽  
Stroke Mortality ◽  
Stroke Event ◽  
Event Rates

Abstract Objectives To study trends in stroke mortality rates, event rates, and case fatality, and to explain the extent to which the reduction in stroke mortality rates was influenced by changes in stroke event rates or case fatality. Design Population based study. Setting Person linked routine hospital and mortality data, England. Participants 795 869 adults aged 20 and older who were admitted to hospital with acute stroke or died from stroke. Main outcome measures Stroke mortality rates, stroke event rates (stroke admission or stroke death without admission), and case fatality within 30 days after stroke. Results Between 2001 and 2010 stroke mortality rates decreased by 55%, stroke event rates by 20%, and case fatality by 40%. The study population included 358 599 (45%) men and 437 270 (55%) women. Average annual change in mortality rate was −6.0% (95% confidence interval −6.2% to −5.8%) in men and −6.1% (−6.3% to −6.0%) in women, in stroke event rate was −1.3% (−1.4% to −1.2%) in men and −2.1% (−2.2 to −2.0) in women, and in case fatality was −4.7% (−4.9% to −4.5%) in men and −4.4% (−4.5% to −4.2%) in women. Mortality and case fatality but not event rate declined in all age groups: the stroke event rate decreased in older people but increased by 2% each year in adults aged 35 to 54 years. Of the total decline in mortality rates, 71% was attributed to the decline in case fatality (78% in men and 66% in women) and the remainder to the reduction in stroke event rates. The contribution of the two factors varied between age groups. Whereas the reduction in mortality rates in people younger than 55 years was due to the reduction in case fatality, in the oldest age group (≥85 years) reductions in case fatality and event rates contributed nearly equally. Conclusions Declines in case fatality, probably driven by improvements in stroke care, contributed more than declines in event rates to the overall reduction in stroke mortality. Mortality reduction in men and women younger than 55 was solely a result of a decrease in case fatality, whereas stroke event rates increased in the age group 35 to 54 years. The increase in stroke event rates in young adults is a concern. This suggests that stroke prevention needs to be strengthened to reduce the occurrence of stroke in people younger than 55 years.

Stroke in Northern Sweden

2003 ◽  
Vol 31 (61_suppl) ◽  
pp. 60-69 ◽  
Author(s):  
Birgitta Stegmayr ◽  
Kjell Asplund
Keyword(s):  
Recurrent Stroke ◽  
Age Groups ◽  
Case Fatality ◽  
Age Group ◽  
Stroke Mortality ◽  
Industrialized Countries ◽  
Northern Sweden ◽  
Stroke Event ◽  
Men And Women ◽  
Event Rates

Background: Stroke is one of the most common causes of death and long-term disability worldwide. Although stroke mortality has decreased in most industrialized countries, there are populations, particularly in East Europe, in which the mortality has increased. The WHO initiated, 20 years ago, the MONICA Project. The aim of the study was to measure trends in coronary heart disease and stroke and to assess the extent to which these were related to changes in known risk factors. Design: The Northern Sweden MONICA stroke study started in 1985 and is still ongoing. All individuals with an acute stroke in the age group 25 - 74 years have been included in the stroke register. Death certificates, discharge records, and GPs' records are screened and validated using strict MONICA criteria. Results: Stroke event rates (first ever and recurrent stroke) per 100,000 and year in the age group 25 - 74 years varied little over the years. Between 1985 and 1998 the annual incidence varied between 318 and 372 in men and between 195 and 240 in women, with no secular trends at all. The 28-day case fatality decreased in both men and women, from 19% to 11%. Logistic regression analyses showed a risk reduction in dying from stroke to 0.55 (p<0.0001) the last year compared with the first, with an absolute annual reduction in case fatality of 3%, in both men and women. In international comparison Northern Sweden shows an intermediately high incidence and one of the lowest case fatality rates of all participating populations. The incidence in subarachnoid haemorrhage was among the highest. Conclusion: The ongoing decline in stroke mortality in Sweden is driven exclusively by declining case fatality, whereas event rates (first ever and recurrent stroke) have remained the same since 1985. This, together with more people entering advanced, stroke-prone age groups, implies that the burden of stroke will continue to increase in Sweden.

Trends in event rates of first and recurrent, fatal and non-fatal acute myocardial infarction, and 28-day case fatality in the Northern Sweden MONICA area 1985 - 98

2003 ◽  
Vol 31 (61_suppl) ◽  
pp. 51-59 ◽  
Author(s):  
Torbjörn Messner ◽  
Vivan Lundberg ◽  
Stina Boström ◽  
Fritz Huhtasaari ◽  
Bo Wikström
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Event Rate ◽  
Disease Incidence ◽  
Age Groups ◽  
Case Fatality ◽  
Northern Sweden ◽  
Day Case ◽  
Men And Women ◽  
Event Rates

Aims: This study looks at trends in event rates of first and recurrent fatal and non-fatal acute myocardial infarction (AMI), and 28-day case fatality in AMI within the Northern Sweden MONICA area. Methods: The AMI event rate and 28-day case fatality in acute myocardial infarction were registered between 1985 and 1998 in the two northernmost counties in Sweden in men and women in the age groups 25 - 64 years. Results: Statistically significant mean annual decreases were found in fatal and non-fatal combined event rates (4% for men and 2.3% for women), fatal event rate (7.1% for men and 5% for women), fatal first acute myocardial infarction (7.1% for men and 4.4% for women), and both non-fatal and fatal recurrent AMI for both sexes (5.5% for both men and women for non-fatal and, for fatal AMI, 7.1% for men and 5.7% for women). In addition, there were significant decreases for men in non-fatal event rate (2.4%), and non-fatal first AMI (1.4%). The decreases in case fatality were small, especially so for women. Conclusions: There is a trend of decreasing event rates in both fatal and non-fatal AMI, and first and recurrent AMI, most pronounced for men. The case fatality also decreased although to a lesser degree, suggesting that the decreasing mortality in ischaemic heart disease mainly is caused by reduced disease incidence.

scholarly journals Estimating effective infection fatality rates during the course of the COVID-19 pandemic in Germany

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christian Staerk ◽  
Tobias Wistuba ◽  
Andreas Mayr
Keyword(s):  
Age Distribution ◽  
Age Groups ◽  
Case Fatality ◽  
Time Dependent ◽  
Temporary Increase ◽  
International Studies ◽  
Age Group ◽  
Fatality Rate ◽  
Substantial Fraction ◽  
Second Wave

Abstract Background The infection fatality rate (IFR) of the Coronavirus Disease 2019 (COVID-19) is one of the most discussed figures in the context of this pandemic. In contrast to the case fatality rate (CFR), the IFR depends on the total number of infected individuals – not just on the number of confirmed cases. In order to estimate the IFR, several seroprevalence studies have been or are currently conducted. Methods Using German COVID-19 surveillance data and age-group specific IFR estimates from multiple international studies, this work investigates time-dependent variations in effective IFR over the course of the pandemic. Three different methods for estimating (effective) IFRs are presented: (a) population-averaged IFRs based on the assumption that the infection risk is independent of age and time, (b) effective IFRs based on the assumption that the age distribution of confirmed cases approximately reflects the age distribution of infected individuals, and (c) effective IFRs accounting for age- and time-dependent dark figures of infections. Results Effective IFRs in Germany are estimated to vary over time, as the age distributions of confirmed cases and estimated infections are changing during the course of the pandemic. In particular during the first and second waves of infections in spring and autumn/winter 2020, there has been a pronounced shift in the age distribution of confirmed cases towards older age groups, resulting in larger effective IFR estimates. The temporary increase in effective IFR during the first wave is estimated to be smaller but still remains when adjusting for age- and time-dependent dark figures. A comparison of effective IFRs with observed CFRs indicates that a substantial fraction of the time-dependent variability in observed mortality can be explained by changes in the age distribution of infections. Furthermore, a vanishing gap between effective IFRs and observed CFRs is apparent after the first infection wave, while an increasing gap can be observed during the second wave. Conclusions The development of estimated effective IFR and observed CFR reflects the changing age distribution of infections over the course of the COVID-19 pandemic in Germany. Further research is warranted to obtain timely age-stratified IFR estimates, particularly in light of new variants of the virus.

scholarly journals Oral Contraceptives Provide Protection against Anterior Cruciate Ligament Tears: A National Database Study of 165,748 Female Patients

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0035
Author(s):  
Steven F. DeFroda ◽  
Steven Louis Bokshan ◽  
Samantha Worobey ◽  
Lauren Ready ◽  
Alan H. Daniels ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Cruciate Ligament ◽  
Age Groups ◽  
National Database ◽  
Control Group ◽  
Protective Effects ◽  
Age Group ◽  
Oral Contraceptive Pills ◽  
Acl Tear ◽  
Chi Squared

Objectives: ACL tears are more prevalent in females than males. One of the factors responsible for this may be the variation in levels of estrogen and progesterone. The purpose of this study was to query a large nationwide database to determine the potentially protective effects of oral contraceptive pills (OCPs) on ACL tears. We hypothesized that females taking OCPs would exhibit ACL tears at lower rates than a matched population of patients not taking OCPs. Methods: The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for all OCP users amongst females aged 15-49. Female experiencing an ACL tear and undergoing surgery (CPT 29888) were compared to a control group of females undergoing surgery for an ACL tear, but not on OCPs. Patients were matched by age and Charlson comorbidity score. Chi-squared testing was used to assess for significant differences in the rate of ACL tears for the OCP and non-OCP users, according to age groups broken down into age intervals of 5 years. Results: There were a total 82,874 patients in both the OCP and non-OCP groups. There were a total of 569 (0.69%) ACL tears in the non-OCP group and 465 (0.56%) in the OCP group (p<0.001). In the non-OCP group, patients aged 15-19 accounted for 29.35% of all ACL tears, whereas, in the OCP group, this same age group only accounted for 13.33% of ACL tears. Among all age groups, the odds ratios for experiencing an ACL tear while on OCP was 0.82 (χ2=0.001, 95% CI 0.72-0.92) (Figure 1) compared to not using OCP. This protective effect was driven primarily by the 15-19 age group (odds ratio 0.37 (χ2<0.001, 95% CI 0.27-0.50)). Conclusion: This investigation utilizing a large national database found that usage of OCPs was associated with an 18% decrease in the risk of ACL tear when compared to a matched population of patients with ACL tears not taking OCPs. These findings were in line with smaller studies which demonstrated similar results. Additionally, it was shown that OCPs were most protective in the 15-19 year old age group, with a 63% reduction in tears in this group. Ongoing randomized trials in patients without ACL tear could help to demonstrate further clinical evidence for OCP usage as a way to modify risk factors for ACL tear. While clinical evidence is limited, there should be strong consideration for OCP usage in elite high school and college aged athletes, especially those who are at risk of ACL tear.

scholarly journals Age, time and cohort factors in mortality from cancer of the cervix

1973 ◽  
Vol 71 (2) ◽  
pp. 253-259 ◽  
Author(s):  
J. C. Barrett
Keyword(s):  
Age Groups ◽  
Mortality Rates ◽  
Age Group ◽  
Mortality Pattern ◽  
England And Wales ◽  
Cancer Of The Cervix

SUMMARYData for mortality from cancer of the cervix in England and Wales by 5-year age groups and four quinquennia (1951–70) are analysed. The logarithms of the mortality rates are regressed on age group, epoch of death and epoch of birth. The factors obtained are considered in relation to particular features of the mortality pattern, such as the reversal of trend in certain age groups.

scholarly journals Invasive Haemophilus influenzae disease in adults

2000 ◽  
Vol 124 (3) ◽  
pp. 441-447 ◽  
Author(s):  
J. SARANGI ◽  
K. CARTWRIGHT ◽  
J. STUART ◽  
S. BROOKES ◽  
R. MORRIS ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Clinical Presentation ◽  
Age Groups ◽  
Case Fatality ◽  
Underlying Disease ◽  
Reference Laboratory ◽  
Age Group ◽  
Childhood Immunization ◽  
Clinical Presentations ◽  
Vaccines For Children

We reviewed retrospectively all invasive Haemophilus influenzae (Hi) infections in adults ascertained from reference laboratory records and notifications from five NHS regions over the 5 years from 1 October 1990, a period encompassing the introduction of routine Hib childhood immunization (October 1992). A total of 446 cases were identified, a rate of 0·73 infections per 105 adults per annum. Though numbers of Hib infections in adults fell after the introduction of Hib vaccines for children (P = 0·035), and there was no increase in infections caused by other capsulated Hi serotypes, total numbers of invasive Hi infections increased due to a large rise in infections caused by non-capsulated Hi (ncHi) strains (P = 0·0067). There was an unexpectedly low rate of infections in those aged 75 years or more (P < 0·0001). The commonest clinical presentations were pneumonia with bacteraemia (227/350, 65%) and bacteraemia alone (62/350, 18%) and the highest rates of disease were in the 65–74 years age group (P < 0·0001). Clinical presentation was not influenced by the capsulation status of the invading Hi strain. 103/350 cases (29%) died within 1 month, and 207/350 (59%) within 6 months of their Hi infection. Case fatality rates were high in all age groups. Pre-existing diseases were noted in 220/350 cases and were associated with a higher case fatality rate (82% vs. 21%, P < 0·0001). After the introduction of Hib immunization in children, invasive Hib infections in unimmunized adults also declined, but the overall rate of invasive Hi disease in adults increased, with most infections now caused by non-capsulated strains. Physicians and microbiologists should be aware of the changing epidemiology, the high associated mortality and high risk of underlying disease. Invasive haemophilus infections in adults should be investigated and treated aggressively.

scholarly journals Mortality from idiopathic pulmonary fibrosis: a temporal trend analysis in Brazil, 1979-2014

2017 ◽  
Vol 43 (6) ◽  
pp. 445-450 ◽  
Author(s):  
Eduardo Algranti ◽  
Cézar Akiyoshi Saito ◽  
Diego Rodrigues Mendonça e Silva ◽  
Ana Paula Scalia Carneiro ◽  
Marco Antonio Bussacos
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Temporal Trend ◽  
Population Aging ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Mortality Rates ◽  
Age Group ◽  
Classification Of Diseases ◽  
And Gender

ABSTRACT Objective: To analyze mortality from idiopathic pulmonary fibrosis (IPF) in Brazil over the period 1979-2014. Methods: Microdata were extracted from the Brazilian National Ministry of Health Mortality Database. Only deaths for which the underlying cause was coded as International Classification of Diseases version 9 (ICD-9) 515 or 516.3 (until 1995) or as ICD version 10 (ICD-10) J84.1 (from 1996 onward) were included in our analysis. Standardized mortality rates were calculated for the 2010 Brazilian population. The annual trend in mortality rates was analyzed by joinpoint regression. We calculated risk ratios (RRs) by age group, time period of death, and gender, using a person-years denominator. Results: A total of 32,092 deaths were recorded in the study period. Standardized mortality rates trended upward, rising from 0.24/100,000 population in 1979 to 1.10/100,000 population in 2014. The annual upward trend in mortality rates had two inflection points, in 1992 and 2008, separating three distinct time segments with an annual growth of 2.2%, 6.8%, and 2.4%, respectively. The comparison of RRs for the age groups, using the 50- to 54-year age group as a reference, and for the study period, using 1979-1984 as a reference, were 16.14 (14.44-16.36) and 6.71 (6.34-7.12), respectively. Men compared with women had higher standardized mortality rates (per 100,000 person-years) in all age groups. Conclusion: Brazilian IPF mortality rates are lower than those of other countries, suggesting underdiagnosis or underreporting. The temporal trend is similar to those reported in the literature and is not explained solely by population aging.

scholarly journals Outpatient antibiotic prescribing and demographic factors associated with state-level septicemia mortality rates in US adults

2018 ◽  
Author(s):  
Edward Goldstein ◽  
Marc Lipsitch
Keyword(s):  
Age Groups ◽  
Group Living ◽  
Antibiotic Use ◽  
Mortality Rates ◽  
Antibiotic Prescribing ◽  
Age Group ◽  
Poverty Level ◽  
Sepsis Mortality ◽  
Elderly Age ◽  
Average Annual Temperature

AbstractBackgroundRates of septicemia/sepsis mortality and hospitalization in the US have risen significantly during the recent years, and antibiotic use may contribute to those rates through various mechanisms.MethodsWe used multivariable linear regression to relate state-specific rates of outpatient prescribing overall for fluoroquinolones, penicillins, macrolides, and cephalosporins between 2013-2014 to state-specific rates of septicemia mortality (ICD-10 codes A40-41 present as either the underlying or contributing causes of death) in each of the following age groups of adults: (18-49y, 50-64y, 65-74y, 75-84y, 85+y) between 2013-2014, adjusting for median household income, average annual temperature, age-specific percentages of state residents who (i) lived below the poverty level, (ii) were African American, (iii) lacked health insurance (in non-elderly age groups), and random effects associated with the different US Health and Human Services (HHS) regions.ResultsRates of penicillin prescribing were positively associated with septicemia mortality rates in the analyses for persons aged 65-74y, 75-84y and over 85y. Rates of cephalosporin prescribing were positively associated with septicemia mortality rates in the analyses for persons aged 18-49y and 65-74y. Rates of fluoroquinolone prescribing were positively associated with septicemia mortality rates in the analyses for persons aged 18-49y. Percent African Americans in a given age group was positively associated with septicemia mortality rates in the analyses for age groups over 65y, and 18-49y. Percent of residents in a given age group living below the poverty level was positively associated with septicemia mortality rates in the analysis for persons aged 65-74y.ConclusionsOur results suggest that rates of penicillin prescribing are associated with rates of septicemia mortality in older US adults, while rates of cephalosporin prescribing are associated with rates of septicemia mortality in persons aged 18-49y and 65-74y, and rates of fluoroquinolone prescribing are associated with rates of septicemia mortality in persons aged 18-49y. Further studies are needed to better understand the potential effect of antibiotic replacement in the treatment of different syndromes, such as replacement of fluoroquinolones by other antibiotics, possibly penicillins and cephalosporins following the recent US FDA guidelines on restriction of fluoroquinolone use, on the rates of sepsis mortality.

scholarly journals Profile of Suspected Cholera Patients during May – November 2017 in Sanaa City Secondary Analysis

2020 ◽  
pp. 40-48
Author(s):  
Mohammed Qassime ◽  
Ryad Al- Nemri ◽  
Mutahar Al- Qassimi
Keyword(s):  
Age Groups ◽  
Secondary Analysis ◽  
Case Fatality ◽  
Health Care Facilities ◽  
Epidemiological Surveillance ◽  
Age Group ◽  
Under Five ◽  
Management Interventions ◽  
Care Facilities ◽  
Control And Management

Introduction: From 27 April to 3 August 2017, 453,175 suspected cholera cases and 1,930 deaths (CFR: 0.4%) have been reported in 95.6% (22/23) of Yemen governorates, and 89.2% (297/333) of the districts. The five most affected governorates were Amanat Al-Asima, Al Hudaydah, Hajjah, Amran and Dhamar with 53% (239,877/453,175) of the cases reported since 27 April 2017. In amanat al Asimah (Sana'a city) 55563 cases 61 deaths are registered in that period with case fatality rate 0.1% and attack rate 1.68% Objectives: To study Profile of suspected cholera patients in Sanaa city. Materials and Methods: A retrospective descriptive study was carried out by using secondary analysis of available data collected from (DTCs), (ORCs) and other health facilities by department of epidemiological surveillance – Sanaa city health office. Results: A total of 92995 suspected cholera patients were included in the study whereas the average age of study subjects was 22.7 years where standard deviation (SD) 18.8 most affected age groups were (15-29),(5-14),(<5) the predominant of the study subjects from Sanaa city (96%) from Ma'ain, Bani-Alhareth, AND Al-Sabain districts Most cases are reported from DTCs (59300), ORCs (29547) Cases starts to appear in week 17 reaches a peak in weeks 24,25  and then slowly decreases. 155 suspected cholera cases were culture positives Conclusion: 1. Cholera is one of the urgent health problems in Sana’a city Cholera distribution is not gender sensitive, the most affected age group is (15-29) years, followed by (5-14) then under five Cases are mainly distributed in Ma'ain, Bani-Alhareth, & Al-Sabain within Sana’a city (50% of the total cases). The main cholera health care facilities are mainly DTCs and ORCs supported by WHO & UNICEF Most of the subjects seek medical care within the first 2 days after onset of symptoms The peak of cholera suspected cases is registered in weeks 24 & 24. Confirmed cholera cases by culture are 155 from 655 specimen tested whereas 1984 are positive by cholera RDT Recommendations:1. More cholera control interventions are necessary and urgent to eradicate it. More field related research must be carried out to guide control and management interventions. Some interventions must be concentrated on the age groups 5-14 & under five and at the most affected areas.

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