scholarly journals Changing mortality trends in countries and cities of the UK: a population-based trend analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038135
Author(s):  
David Walsh ◽  
Gerry McCartney ◽  
Jon Minton ◽  
Jane Parkinson ◽  
Deborah Shipton ◽  
...  
Keyword(s):  
Trend Analysis ◽  
Causes Of Death ◽  
Age Groups ◽  
Mortality Rates ◽  
Population Based ◽  
Secondary Outcome ◽  
Mortality Trends ◽  
Relative Index ◽  
Index Of Inequality ◽  
The Uk

ObjectivesPreviously improving life expectancy and all-cause mortality in the UK has stalled since the early 2010s. National analyses have demonstrated changes in mortality rates for most age groups and causes of death, and with deprived populations most affected. The aims here were to establish whether similar changes have occurred across different parts of the UK (countries, cities), and to examine cause-specific trends in more detail.DesignPopulation-based trend analysis.Participants/settingWhole populations of countries and selected cities of the UK.Primary and secondary outcome measuresEuropean age-standardised mortality rates (calculated by cause of death, country, city, year (1981–2017), age group, sex and—for all countries and Scottish cities—deprivation quintiles); changes in rates between 5-year periods; summary measures of both relative (relative index of inequality) and absolute (slope index of inequality) inequalities.ResultsChanges in mortality from around 2011/2013 were observed throughout the UK for all adult age groups. For example, all-age female rates decreased by approximately 4%–6% during the 1980s and 1990s, approximately 7%–9% during the 2000s, but by <1% between 2011/2013 and 2015/2017. Equivalent figures for men were 4%–7%, 8%–12% and 1%–3%, respectively. This later period saw increased mortality among the most deprived populations, something observed in all countries and cities analysed, and for most causes of death: absolute and relative inequalities therefore increased. Although similar trends were seen across all parts of the UK, particular issues apply in Scotland, for example, higher and increasing drug-related mortality (with the highest rates observed in Dundee and Glasgow).ConclusionsThe study presents further evidence of changing mortality in the UK. The timing, geography and socioeconomic gradients associated with the changes appear to support suggestions that they may result, at least in part, from UK Government ‘austerity’ measures which have disproportionately affected the poorest.

scholarly journals Stillbirth, newborn and infant mortality: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

2019 ◽  
Vol 48 (Supplement_1) ◽  
pp. i54-i62 ◽  
Author(s):  
Ana M B Menezes ◽  
Fernando C Barros ◽  
Bernardo L Horta ◽  
Alicia Matijasevich ◽  
Andréa Dâmaso Bertoldi ◽  
...  
Keyword(s):  
Black Women ◽  
Infant Mortality ◽  
Low Income ◽  
Causes Of Death ◽  
Mortality Rates ◽  
Population Based ◽  
Birth Cohorts ◽  
Mortality Trends ◽  
Death Rates ◽  
Economic Inequalities

Abstract Background Infant-mortality rates have been declining in many low- and middle-income countries, including Brazil. Information on causes of death and on socio-economic inequalities is scarce. Methods Four birth cohorts were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. Surveillance in hospitals and vital registries, accompanied by interviews with doctors and families, detected fetal and infant deaths and ascertained their causes. Late-fetal (stillbirth)-, neonatal- and post-neonatal-death rates were calculated. Results All-cause and cause-specific death rates were reduced. During the study period, stillbirths fell by 47.8% (from 16.1 to 8.4 per 1000), neonatal mortality by 57.0% (from 20.1 to 8.7) and infant mortality by 62.0% (from 36.4 to 13.8). Perinatal causes were the leading causes of death in the four cohorts; deaths due to infectious diseases showed the largest reductions, with diarrhoea causing 25 deaths in 1982 and none in 2015. Late-fetal-, neonatal- and infant-mortality rates were higher for children born to Brown or Black women and to low-income women. Absolute socio-economic inequalities based on income—expressed in deaths per 1000 births—were reduced over time but relative inequalities—expressed as ratios of mortality rates—tended to remain stable. Conclusion The observed improvements are likely due to progress in social determinants of health and expansion of health care. In spite of progress, current levels remain substantially greater than those observed in high-income countries, and social and ethnic inequalities persist.

scholarly journals Patterns of amenable child mortality over time in 34 member countries of the Organisation for Economic Co-operation and Development (OECD): evidence from a 15-year time trend analysis (2001–2015)

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027909 ◽  
Author(s):  
Maria Michela Gianino ◽  
Jacopo Lenzi ◽  
Marco Bonaudo ◽  
Maria Pia Fantini ◽  
Roberta Siliquini ◽  
...  
Keyword(s):  
Trend Analysis ◽  
Child Mortality ◽  
Time Trend ◽  
Universal Access ◽  
Age Groups ◽  
Mortality Rates ◽  
Secondary Outcome ◽  
Annual Number ◽  
Amenable Mortality ◽  
Specific Distribution

ObjectivesTo analyse the trends of amenable mortality rates (AMRs) in children over the period 2001–2015.DesignTime trend analysis.SettingThirty-four member countries of the Organisation for Economic Co-operation and Development (OECD).ParticipantsMidyear estimates of the resident population aged ≤14 years.Primary and secondary outcome measuresUsing data from the WHO Mortality Database and Nolte and McKee’s list, AMRs were calculated as the annual number of deaths over the population/100 000 inhabitants. The rates were stratified by age groups (<1, 1–4, 5–9 and 10–14 years). All data were summarised by presenting the average rates for the years 2001/2005, 2006/2010 and 2011/2015.ResultsThere was a significant decline in children’s AMRs in the <1 year group in all 34 OECD countries from 2001/2005 to 2006/2010 (332.78 to 295.17/100 000; %Δ −11.30%; 95% CI −18.75% to −3.85%) and from 2006/2010 to 2011/2015 (295.17 to 240.22/100 000; %Δ −18.62%; 95% CI −26.53% to −10.70%) and a slow decline in the other age classes. The only cause of death that was significantly reduced was conditions originating in the early neonatal period for the <1 year group. The age-specific distribution of causes of death did not vary significantly over the study period.ConclusionsThe low decline in amenable mortality rates for children aged ≥1 year, the large variation in amenable mortality rates across countries and the insufficient success in reducing mortality from all causes suggest that the heath system should increase its efforts to enhance child survival. Promoting models of comanagement between primary care and subspecialty services, encouraging high-quality healthcare and knowledge, financing universal access to healthcare and adopting best practice guidelines might help reduce amenable child mortality.

scholarly journals Mortality beyond emergency threshold in a silent crisis– results from a population-based mortality survey in Ouaka prefecture, Central African Republic, 2020

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Eve Robinson ◽  
Lawrence Lee ◽  
Leslie F. Roberts ◽  
Aurelie Poelhekke ◽  
Xavier Charles ◽  
...  
Keyword(s):  
Central African Republic ◽  
Causes Of Death ◽  
Maternal Mortality Ratio ◽  
Mortality Rates ◽  
Population Based ◽  
Access To Healthcare ◽  
Mortality Data ◽  
Humanitarian Emergency ◽  
The World ◽  
Mortality Survey

Abstract Background The Central African Republic (CAR) suffers a protracted conflict and has the second lowest human development index in the world. Available mortality estimates vary and differ in methodology. We undertook a retrospective mortality study in the Ouaka prefecture to obtain reliable mortality data. Methods We conducted a population-based two-stage cluster survey from 9 March to 9 April, 2020 in Ouaka prefecture. We aimed to include 64 clusters of 12 households for a required sample size of 3636 persons. We assigned clusters to communes proportional to population size and then used systematic random sampling to identify cluster starting points from a dataset of buildings in each commune. In addition to the mortality survey questions, we included an open question on challenges faced by the household. Results We completed 50 clusters with 591 participating households including 4000 household members on the interview day. The median household size was 7 (interquartile range (IQR): 4—9). The median age was 12 (IQR: 5—27). The birth rate was 59.0/1000 population (95% confidence interval (95%-CI): 51.7—67.4). The crude and under-five mortality rates (CMR & U5MR) were 1.33 (95%-CI: 1.09—1.61) and 1.87 (95%-CI: 1.37–2.54) deaths/10,000 persons/day, respectively. The most common specified causes of death were malaria/fever (16.0%; 95%-CI: 11.0–22.7), violence (13.2%; 95%-CI: 6.3–25.5), diarrhoea/vomiting (10.6%; 95%-CI: 6.2–17.5), and respiratory infections (8.4%; 95%-CI: 4.6–14.8). The maternal mortality ratio (MMR) was 2525/100,000 live births (95%-CI: 825—5794). Challenges reported by households included health problems and access to healthcare, high number of deaths, lack of potable water, insufficient means of subsistence, food insecurity and violence. Conclusions The CMR, U5MR and MMR exceed previous estimates, and the CMR exceeds the humanitarian emergency threshold. Violence is a major threat to life, and to physical and mental wellbeing. Other causes of death speak to poor living conditions and poor access to healthcare and preventive measures, corroborated by the challenges reported by households. Many areas of CAR face similar challenges to Ouaka. If these results were generalisable across CAR, the country would suffer one of the highest mortality rates in the world, a reminder that the longstanding “silent crisis” continues.

scholarly journals Association between socioeconomic position and diabetic foot ulcer outcomes: a population-based cohort study in South Korea

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jeong Hyun Ha ◽  
Heejin Jin ◽  
Ji-Ung Park
Keyword(s):  
Prognostic Factors ◽  
South Korea ◽  
Socioeconomic Position ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Mortality Rates ◽  
Population Based ◽  
Adverse Outcomes ◽  
Secondary Outcome

Abstract Background Low socioeconomic position (SEP) is associated with a high incidence of diabetic foot ulcers (DFUs). However, reports on the association between SEP and DFU outcomes are limited. Therefore, in this study, we investigated this association and determined the prognostic factors of DFU outcomes. Methods The total cohort comprised 976,252 individuals. Using probability sampling, we randomly selected a sample of patients by reviewing the data from the Health Insurance Review and Assessment Service database of South Korea during 2011–2015. Residence, household income, and insurance type represented SEP. The primary outcome was amputation, and the secondary outcome was mortality. A multivariate model was applied to identify the predictive factors. Amputation-free survival and overall survival were calculated using the Kaplan-Meier method. Results Among 976,252 individuals in the cohort, 1362 had DFUs (mean age 62.9 ± 12.2 years; 42.9% were women). Overall amputation and mortality rates were 4.7 and 12.3%, respectively. Male sex (hazard ratio [HR], 2.41; p < 0.01), low SEP (HR 5.13, 5.13; p = 0.018), ophthalmopathy (HR, 1.89; p = 0.028), circulatory complications (HR, 2.14; p = 0.020), and institutional type (HR, 1.78; p = 0.044) were prognostic factors for amputation. Old age (HR, 1.06; p < 0.01), low SEP (HR, 2.65; p < 0.01), ophthalmopathy (HR, 1.74; p < 0.01), circulatory complications (HR, 1.71; p < 0.01), and institution type (HR 1.84; p < 0.01) were predictors of mortality. Conclusions DFU patients with a low SEP are strongly associated with increased amputation and mortality rates. Along with age and comorbidities, SEP could provide the basis for risk assessment of adverse outcomes in DFU. Providing targeted care for this population considering SEP may improve the prognosis.

scholarly journals Descriptive-epidemiological characteristics of lung cancer in Serbia

2008 ◽  
Vol 61 (1-2) ◽  
pp. 16-21 ◽  
Author(s):  
Natasa Maksimovic ◽  
Kyriakos Spanopoulos
Keyword(s):  
Lung Cancer ◽  
Direct Method ◽  
Age Groups ◽  
Malignant Tumour ◽  
Mortality Rates ◽  
Malignant Tumours ◽  
Mortality Trends ◽  
Incidence And Mortality ◽  
The Republic ◽  
Epidemiological Characteristics

Introduction. Lung cancer represents the most common malignant tumour among men, and appears more and more frequently among women in many countries worldwide. The aims of this descriptive epidemiological study were to evaluate the mortality trends of all malignant tumours and lung cancer in Central Serbia from 1990 to 1999, and to estimate the incidence, mortality and the basic demographic characteristics of lung cancer in Central Serbia in 1999. Material and methods. The source of data concerning cancer cases in 1999 was the Cancer Registry of Central Serbia, while data of the Republic Statistics Institute were used for the analysis of mortality trends for the period 1990-1999. All rates were standardized by the direct method, to the world standard population. Confidence intervals for mortality rates were assessed with 95% level of probability. Linear regression coefficient was determined by Fisher's test. Results. The mortality rates showed rising tendencies for both lung cancer (y=-1876.26+0.96x, p=0.028 for men; y=654.78U).33x, p-0.001 for women) and all malignant tumours (y=-4139.88+2.15x, p=0.163 for men; y=3649.68 + 1.88x, p=0.016 for women), with statistically significant increase being observed for all trends, except all malignant tumours among men. In the year 1999, lung cancer ranked first among men and third among women, with 29.2% and 10.3% of cancer mortality respectively. The age-specific mortality rates were much higher in men in all age groups. Mortality increased with age and the highest rates were found in the age group 70-74 for both sexes. The highest incidence and mortality rates were reported in Belgrade, Moravicki and Sumadijski district. .

scholarly journals Characteristics of mortality in the Orenburg region population in 2011-2017

2020 ◽  
Vol 5 (2) ◽  
pp. 99-104
Author(s):  
Evgenii L. Borschuk ◽  
Dmitrii N. Begun ◽  
Tatyana V. Begun
Keyword(s):  
Mortality Rate ◽  
Causes Of Death ◽  
Age Groups ◽  
Circulatory System ◽  
Mortality Rates ◽  
Female Population ◽  
Orenburg Region ◽  
The Third ◽  
Circulatory System Diseases ◽  
External Causes

Objectives - to study the mortality indicators, their dynamics and structure, in the population of the Orenburg region in the period of 2011-2017. Material and methods. The study was conducted using the data from the territorial authority of statistics in the Orenburg region in the period from 2011 to 2017. The analytical, demographic and statistical methods were implemented for the study of the demographic indicators. Results. Cities and municipal settlements of the Orenburg region with high mortality indicators were included in the second and fourth clusters during the cluster analysis. The first and third clusters included cities and municipal settlements with an average mortality. The most favorable position has the Orenburg area with the lowest mortality rate in the region in 2017 - 8.4%. The dynamics of mortality rates among the male and female population tends to decrease, more pronounced dynamics is in men. Though, the male population is characterized by higher mortality rates in all age groups. The leading position among the causes of death is taken by diseases of the circulatory system (46.3% of the total mortality). The second position is occupied by tumors (17.2%), the third - by external causes (8.4%). Mortality from circulatory system diseases and from external causes has reduced. The dynamics of mortality from tumors does not change significantly. The rank of leading causes of death is not identical in the clusters: in the third and fourth clusters, the other causes occupy the second place in the structure of mortality, while tumors occupy the third. Conclusion. In the Orenburg region, the mortality rate is higher than overage in the Russian Federation by 0.9 per 1000 people. The study revealed significant territorial differences in the mortality rates. In general, the mortality among men in all age groups is higher than the mortality of women. The mortality rate from diseases of the circulatory system plays the leading role in the structure of mortality, but has the tendency for decline. Until 2006, the mortality from external causes ranked the second place, now the second place is taken by death from tumors The mortality from external causes is decreasing; mortality from tumors does not change significantly. The obtained results could be used by local authorities in developing the program of public health protection and assessing its effectiveness.

Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

2020 ◽  
Vol 34 (10) ◽  
pp. 1393-1401
Author(s):  
Luke Mondor ◽  
Walter P Wodchis ◽  
Peter Tanuseputro
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Terminal Illness ◽  
Home Visits ◽  
Population Based ◽  
Relative Index ◽  
Deprived Neighbourhoods ◽  
Location Of Death ◽  
Index Of Inequality

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

scholarly journals Can changes in spending on health and social care explain the recent mortality trends in Scotland? A protocol for an observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036025
Author(s):  
Christina Wraw ◽  
Jon Minton ◽  
Rory Mitchell ◽  
Grant M A Wyper ◽  
Clare Campbell ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Social Care ◽  
Linear Regression Analysis ◽  
Mortality Rates ◽  
Secondary Outcome ◽  
Service Research ◽  
Mortality Trends ◽  
Data Set ◽  
Health And Social Care ◽  
The Absolute

IntroductionThere have been steady reductions in mortality rates in the majority of high-income countries, including Scotland, since 1945. However, reductions in mortality rates have slowed down since 2012–2014 in these nations; and have reversed in some cases. Deaths among those aged 55+ explain a large amount of these changing mortality trends in Scotland. Increased pressures on health and social care services have been suggested as one factor explaining these changes. This paper outlines a protocol for the approach to testing the extent to which health and social care pressures can explain recent mortality trends in Scotland. Although a slower rate of mortality improvements have affected people of all ages, certain ages have been more negatively affected than the others. The current analyses will be run by age-band to test if the service pressure-mortality link varies across age-group.Methods and analysisThis will be an observational ecological study based on the Scottish population. The exposures of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in real terms per capita spending on social and healthcare services between 2011 and 2017. The outcome of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in age-standardised mortality rate between 2012 and 2018 for men and women separately. The units of analysis will be the 32 local authorities and the 14 territorial health boards. The analyses will be run for both all age-groups combined and for the following age bands: <1, 1–15, 16–44, 45–64, 65–74, 75–84 and 85+.A series of descriptive analyses will summarise the distribution of health and social care expenditure and mortality trends between 2011 and 2018. Linear regression analysis will be used to investigate the direct association between health care spending and mortality rates.Ethics and disseminationThe data used in this study will be publicly available and aggregated and will not be individually identifiable; therefore, ethical committee approval is not needed. This work will not result in the creation of a new data set. On completion, the study will be stored within the National Health Service research governance system. All of the results will be published once they have been shared with partner agencies.

Incidence, Mortality, and Spatiotemporal Distribution of Cutaneous Malignant Melanoma Cases Across Canada

2019 ◽  
Vol 23 (4) ◽  
pp. 394-412 ◽  
Author(s):  
Feras M. Ghazawi ◽  
Michelle Le ◽  
François Lagacé ◽  
Janelle Cyr ◽  
Nebras Alghazawi ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Age Groups ◽  
Population Based ◽  
Geographic Region ◽  
Cutaneous Malignant Melanoma ◽  
Steady Increase ◽  
Mortality Trends ◽  
Incidence And Mortality ◽  
Future Burden ◽  
Melanoma Mortality

Background: We recently reported a steady increase in the incidence and mortality of cutaneous malignant melanoma (CMM) in Canada during 1992-2010. Objectives: The objective of this article is to examine the distribution of Canadian CMM patients at the level of provinces, cities, and forward sortation area (FSA) postal codes. Methods: Using 3 Canadian population-based registries, we conducted an in-depth examination of the incidence and mortality trends for 72 565 Canadian CMM patients over the period 1992-2010. Results: We found that among 20- to 39-year-olds, the incidence of CMM in women (7.17 per 100 000 individuals) was significantly higher than in men (4.60 per 100 000 individuals per year). Women age 80 years and older had an incidence of CMM (58.46 cases per 100 000 women per year) more than 4 times greater than the national average (12.29 cases per 100 000 population per year) and a corresponding high mortality rate (20.18 deaths per 100 000 women per year), when compared with the Canadian melanoma mortality of 2.4 deaths per 100 000 per year. In other age groups men had higher incidence and corresponding melanoma mortality rates. We also studied CMM incidence by province, city, and FSA postal codes and identified several high-incidence communities that were located near the coast/waterfronts. In addition, plotting latitude measures for cities and FSAs vs CMM incidence rate confirmed the inverse relationship between geographical latitude and incidence of melanoma in Canada (slope = –0.22 ± 0.05). Conclusions: This research may help develop sex-, age- and geographic region-specific recommendations to decrease the future burden of CMM in Canada.

scholarly journals Ecologic association between influenza and COVID-19 mortality rates in European countries

2020 ◽  
Vol 148 ◽  
Author(s):  
S. Petti ◽  
B. J. Cowling
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
Confidence Interval ◽  
The Elderly ◽  
Mortality Rates ◽  
Population Based ◽  
Control Measures ◽  
Mortality Trends ◽  
Cardiovascular Disease Mortality ◽  
Disease Mortality

Abstract Ecologic studies investigating COVID-19 mortality determinants, used to make predictions and design public health control measures, generally focused on population-based variable counterparts of individual-based risk factors. Influenza is not causally associated with COVID-19, but shares population-based determinants, such as similar incidence/mortality trends, transmission patterns, efficacy of non-pharmaceutical interventions, comorbidities and underdiagnosis. We investigated the ecologic association between influenza mortality rates and COVID-19 mortality rates in the European context. We considered the 3-year average influenza (2014–2016) and COVID-19 (31 May 2020) crude mortality rates in 34 countries using EUROSTAT and ECDC databases and performed correlation and regression analyses. The two variables – log transformed, showed significant Spearman's correlation ρ = 0.439 (P = 0.01), and regression coefficients, b = 0.743 (95% confidence interval, 0.272–1.214; R2 = 0.244; P = 0.003), b = 0.472 (95% confidence interval, 0.067–0.878; R2 = 0.549; P = 0.02), unadjusted and adjusted for confounders (population size and cardiovascular disease mortality), respectively. Common significant determinants of both COVID-19 and influenza mortality rates were life expectancy, influenza vaccination in the elderly (direct associations), number of hospital beds per population unit and crude cardiovascular disease mortality rate (inverse associations). This analysis suggests that influenza mortality rates were independently associated with COVID-19 mortality rates in Europe, with implications for public health preparedness, and implies preliminary undetected SARS-CoV-2 spread in Europe.

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