scholarly journals Unexplained mortality during the US COVID-19 pandemic: retrospective analysis of death certificate data and critical assessment of excess death calculations

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e050361
Author(s):  
Kathleen A Fairman ◽  
Kellie J Goodlet ◽  
James D Rucker ◽  
Roy S Zawadzki
Keyword(s):  
Cause Of Death ◽  
Death Certificate ◽  
A Priori ◽  
Respiratory Illness ◽  
Cross Sectional ◽  
Excess Death ◽  
Death Certificate Data ◽  
Policy Information ◽  
Sectional Analysis ◽  
Excess Deaths

ObjectivesCause-of-death discrepancies are common in respiratory illness-related mortality. A standard epidemiological metric, excess all-cause death, is unaffected by these discrepancies but provides no actionable policy information when increased all-cause mortality is unexplained by reported specific causes. To assess the contribution of unexplained mortality to the excess death metric, we parsed excess deaths in the COVID-19 pandemic into changes in explained versus unexplained (unreported or unspecified) causes.DesignRetrospective repeated cross-sectional analysis, US death certificate data for six influenza seasons beginning October 2014, comparing population-adjusted historical benchmarks from the previous two, three and five seasons with 2019–2020.Setting48 of 50 states with complete data.Participants16.3 million deaths in 312 weeks, reported in categories—all causes, top eight natural causes and respiratory causes including COVID-19.Outcome measuresChange in population-adjusted counts of deaths from seasonal benchmarks to 2019–2020, from all causes (ie, total excess deaths) and from explained versus unexplained causes, reported for the season overall and for time periods defined a priori: pandemic awareness (19 January through 28 March); initial pandemic peak (29 March through 30 May) and pandemic post-peak (31 May through 26 September).ResultsDepending on seasonal benchmark, 287 957–306 267 excess deaths occurred through September 2020: 179 903 (58.7%–62.5%) attributed to COVID-19; 44 022–49 311 (15.2%–16.1%) to other reported causes; 64 032–77 054 (22.2%–25.2%) unexplained (unspecified or unreported cause). Unexplained deaths constituted 65.2%–72.5% of excess deaths from 19 January to 28 March and 14.1%–16.1% from 29 March through 30 May.ConclusionsUnexplained mortality contributed substantially to US pandemic period excess deaths. Onset of unexplained mortality in February 2020 coincided with previously reported increases in psychotropic use, suggesting possible psychiatric or injurious causes. Because underlying causes of unexplained deaths may vary by group or region, results suggest excess death calculations provide limited actionable information, supporting previous calls for improved cause-of-death data to support evidence-based policy.

Commercial Fishing as an Occupational Determinant of Opioid Overdoses and Deaths of Despair in Two Massachusetts Fishing Ports, 2000–2014

2021 ◽  
pp. 104829112110234
Author(s):  
Scott Fulmer ◽  
Shruti Jain ◽  
David Kriebel
Keyword(s):  
United States ◽  
Cause Of Death ◽  
Death Certificate ◽  
The United States ◽  
Opioid Overdose ◽  
Commercial Fishing ◽  
Opioid Epidemic ◽  
Death Certificate Data ◽  
Deaths Of Despair

The opioid epidemic has had disproportionate effects across various sectors of the population, differentially impacting various occupations. Commercial fishing has among the highest rates of occupational fatalities in the United States. This study used death certificate data from two Massachusetts fishing ports to calculate proportionate mortality ratios of fatal opioid overdose as a cause of death in commercial fishing. Statistically significant proportionate mortality ratios revealed that commercial fishermen were greater than four times more likely to die from opioid poisoning than nonfishermen living in the same fishing ports. These important quantitative findings suggest opioid overdoses, and deaths to diseases of despair in general, deserve further study in prevention, particularly among those employed in commercial fishing.

scholarly journals Nutritional status, survival and mortality in Alzheimer patients - a cross-sectional study

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 137
Author(s):  
Elizama de Gregorio ◽  
Dayanna Hartmann Cambruzzi Mendes ◽  
Luan Henrique Patrzyk ◽  
Luana Felski ◽  
Guilherme Barroso Langoni de Freita ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Cause Of Death ◽  
Death Certificate ◽  
National Health System ◽  
Cross Sectional Study ◽  
Death Certificates ◽  
Sectional Study ◽  
Cross Sectional ◽  
Myocardium Infarction ◽  
Strong Relation

Introduction: Dementia is a common health problem in elderly people, Alzheimer disease (AD) being the most prevalent. AD can be considered as a cause of death and must be registered on the death certificate of the patients. However, most of the time, the main cause of death registered is not related to AD, but as an underlying or contributing cause. For example, individuals who have AD and die from myocardium infarction. This study aimed to analyze if nutritional status was associated with survival and mortality for AD, and if AD was reported as actual cause of death on the death certificate Methods: The study was carried out as a cross-sectional study with elderly citizens of the community registered in the National Health System (SUS), with cognitive, nutritional, biochemical and hematological evaluations of 30 AD patients in Guarapuava, Paraná state, Brazil. Results: Significant differences were not observed between live and dead patients when evaluated considering the methods applied. Only 22% of the death certificates stated death due to AD. The patient’s cause of death showed a strong relation to respiratory issues; potential explanations based on immunological, biochemical and comorbidity were not confirmed on this study. Conclusions: AD was not declared as the cause of death in the majority of certificates, contributing to the underreporting and reducing the information of death due to AD in the country.

Place of death and associated factors: a population-based study using death certificate data

2019 ◽  
Vol 29 (4) ◽  
pp. 608-615 ◽  
Author(s):  
María José Cabañero-Martínez ◽  
Andreu Nolasco ◽  
Inmaculada Melchor ◽  
Manuel Fernández-Alcántara ◽  
Julio Cabrero-García
Keyword(s):  
Marital Status ◽  
Cause Of Death ◽  
Death Certificate ◽  
Population Based ◽  
Place Of Death ◽  
Population Based Study ◽  
Urbanization Level ◽  
Sociodemographic Variables ◽  
Death Certificate Data ◽  
At Home

Abstract Background Although studies suggest that most people prefer to die at home, not enough is known about place of death patterns by cause of death considering sociodemographic factors. The objective of this study was to determine the place of death in the population and to analyze the sociodemographic variables and causes of death associated with home as the place of death. Methods Cross-sectional population-based study. All death certificate data on the residents in Spain aged 15 or over who died in Spain between 2012 and 2015 were included. We employed multinomial logistic regression to explore the relation between place of death, sociodemographic variables and cause of death classified according to the International Classification of Diseases, 10th revision, and to conditions needing palliative care. Results Over half of all deaths occurred in hospital (57.4%), representing double the frequency of deaths that occurred at home. All the sociodemographic variables (sex, educational level, urbanization level, marital status, age and country of birth) were associated with place of death, although age presented the strongest association. Cause of death was the main predictor with heart disease, neurodegenerative disease, Alzheimer’s disease, dementia and senility accounting for the highest percentages of home deaths. Conclusions Most people die in hospital. Cause of death presented a stronger association with place of death than sociodemographic variables; of these latter, age, urbanization level and marital status were the main predictors. These results will prove useful in planning end-of-life care that is more closely tailored to people’s circumstances and needs.

scholarly journals Half a million excess deaths in the Iraq war: Terms and conditions may apply

2017 ◽  
Vol 4 (4) ◽  
pp. 205316801773264 ◽  
Author(s):  
Michael Spagat ◽  
Stijn van Weezel
Keyword(s):  
Iraq War ◽  
Sampling Design ◽  
Death Certificate ◽  
Future Research ◽  
Violent Death ◽  
Death Rates ◽  
Excess Death ◽  
The University ◽  
The Relationship ◽  
Excess Deaths

Hagopian et al. (2013) published a headline-grabbing estimate for the Iraq war of half a million excess deaths, i.e. deaths that would not have happened without the war. We reanalyse the data from the University Collaborative Iraq Mortality Study and refute their dramatic claim. The Hagopian et al. (2013) estimate has four main defects: i) most importantly, it conflates non-violent deaths with violent ones; ii) it fails to account for the stratified sampling design of the UCIMS; iii) it fully includes all reported deaths regardless of death certificate backing, even when respondents say they have a death certificate but cannot produce one when prompted; iv) it adds approximately 100,000 speculative deaths not supported by data. Thus, we reject the 500,000 estimate. Indeed, we find that the UCIMS data cannot even support a claim that the number of non-violent excess deaths in the Iraq war has been greater than zero. We recommend future research to follow our methodological lead in two main directions; supplement traditional excess death estimates with excess death estimates for non-violent deaths alone, and use differences-in-differences estimates to uncover the relationship between violence and non-violent death rates.

scholarly journals Uncertainty and the reporting of intellectual disability on death certificates: a cross-sectional study of US mortality data from 2005 to 2017

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e045360
Author(s):  
Scott D Landes ◽  
Margaret A Turk ◽  
Erin Bisesti
Keyword(s):  
Intellectual Disability ◽  
Cause Of Death ◽  
Death Certificate ◽  
Medical Personnel ◽  
Vital Statistics ◽  
Bivariate Analysis ◽  
Mortality Data ◽  
Time Of Death ◽  
Cross Sectional ◽  
Underlying Cause Of Death

ObjectiveTo investigate whether uncertainty surrounding the death is associated with the inaccurate reporting of intellectual disability as the underlying cause of death.DesignNational Vital Statistics System 2005–2017 US Multiple Cause-of-Death Mortality files.SettingUSA.ParticipantsAdults with an intellectual disability reported on their death certificate, aged 18 and over at the time of death. The study population included 26 555 adults who died in their state of residence between 1 January 2005 and 31 December 2017.Primary outcome and measuresDecedents with intellectual disability reported on their death certificate were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for intellectual disability (F70–79). Bivariate analysis and multilevel logistic regression models were used to investigate whether individual-level and state-level characteristics indicative of increased uncertainty at the time of death were associated with the inaccurate reporting of intellectual disability as the underlying cause of death.ResultsInaccurate reporting of intellectual disability as the underlying cause of death was associated with sociodemographic characteristics, death context characteristics and comorbidities indicative of an increased amount of uncertainty surrounding the death. Most striking were increased odds of having intellectual disability reported as the underlying cause of death for decedents who had a choking event (OR=14.7; 95% CI 12.9 to 16.6, p<0.001), an external cause of death associated with a high degree of uncertainty, reported on their death certificate.ConclusionIt is imperative that medical personnel not let increased uncertainty lead to the inaccurate reporting of intellectual disability as the underlying cause of death as this practice obscures cause of death trends for this population. Instead, even in instances when increased uncertainty surrounds the death, certifiers should strive to accurately identify the disease or injury causing death, and report the disability in Part II of the death certificate.

scholarly journals Death Audit –An Experience In Medicine Ward

2015 ◽  
Vol 32 (3) ◽  
pp. 137-141
Author(s):  
MF Abedin ◽  
MJ Abedin ◽  
AFMH Uddin ◽  
MI Mujumdar ◽  
RS Chowdhury ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Death Certificate ◽  
Research Work ◽  
World Health ◽  
Admission Diagnosis ◽  
Time Intervals ◽  
Cross Sectional ◽  
Medicine Department ◽  
The Government ◽  
Time Of Admission

Recently Directorate General of Health Services provided a circular to maintain death audit in every department of health sector (Public health-2/ESD-01/ information/2008/454). Death audit is important because it gives an understanding to what happens and why. This helps to go beyond rates and ratios to determine the inciting factors and to take measures how deaths could have been avoided7. This study was designed to find out relation between some factors like age, sex, causes, diurnal variation, duration of hospital stay with death pattern in adult medicine units, in a tertiary health facility and major error in death certification as described by WHO like mechanism of death listed without an underlying cause, improper sequencing of events and competing cause of death, minor errors like abbreviation, absence of time intervals and mechanism of death followed by underlying legitimate cause of death8 .Methodology: This was a cross-sectional study carried out in medicine department of Mitford hospital, Dhaka from March 2010 to August 2010. During this period a total of 100 consecutive deaths except those who were brought dead included in this study. Death certificate play a important role to make successful death audit. Our existing death certificate which is supplied by the government of Bangladesh was not adequate enough to fulfill the format of cause of death section based on the recommendation of the World Health Organization. More over our doctor are not trained enough for appropriate fulfillment of death certificate. Major errors are mechanism of death listed without an underlying cause, Improper sequencing, Competing cause and minor errors are using abbreviations, absence of time intervals, mechanism of death followed by underlying legitimate cause of death. Definition of major & minor errors in death certificate are shown in Table(I)). Ethical clearance was obtained from the concerned authority to conduct the research work. We used purposive non probability sampling for collection of cases. Our inclusion criteria was all death during study period & exclusion criteria was Brought dead. We developed a network with nurses, internee and midlevel doctors so that one of us could reach the hospital within half an hour of a death. After taking permission from hospital authority necessary data were collected from hospital case records, admission register, case files A checklist was designed to record profile of patients, time of admission, diagnosis at the time of admission , time of death and cause of death. Data were analyzed by SPSS where necessary.Results: During the study period a total 13,123 (Male-5249, 40%; Female-7874,60%) patients were admitted in the medicine department of Sir Salimullah Medical College (SSMC) and Mitford Hospital. Among them consecutive 100 deaths in medicine ward were analyzed under death audit. Among 100 deaths 48% were male(n=48) and 52% were female(n=52). The age range was 15-85 years. The highest incidence of death occurred in 56- 65 years group. This group represents 24% of total death. Within this group 66.7%(N=16) were male and 33.3%(N=8) were female. As shown in table (II).J Bangladesh Coll Phys Surg 2014; 32: 137-141

scholarly journals Social capital, tolerance of diversity and adherence to Mediterranean diet: the Rhea Mother–Child Cohort in Crete, Greece

2014 ◽  
Vol 18 (7) ◽  
pp. 1300-1307 ◽  
Author(s):  
George Kritsotakis ◽  
Leda Chatzi ◽  
Maria Vassilaki ◽  
Vaggelis Georgiou ◽  
Manolis Kogevinas ◽  
...  
Keyword(s):  
Social Capital ◽  
Mediterranean Diet ◽  
A Priori ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Mediterranean Diet Adherence ◽  
Similar Dose ◽  
The Mediterranean ◽  
Study Participants ◽  
Sectional Analysis

AbstractObjectiveTo estimate the associations of individual maternal social capital and social capital dimensions (Participation in the Community, Feelings of Safety, Value of Life and Social Agency, Tolerance of Diversity) with adherence to the Mediterranean diet during pregnancy.DesignThis is a cross-sectional analysis of data from a prospective mother–child cohort (Rhea Study). Participants completed a social capital questionnaire and an FFQ in mid-pregnancy. Mediterranean diet adherence was evaluated through an a priori score ranging from 0 to 8 (minimal–maximal adherence). Maternal social capital scores were categorized into three groups: the upper 10 % was the high social capital group, the middle 80 % was the medium and the lowest 10 % was the low social capital group. Multivariable log-binomial and linear regression models adjusted for confounders were performed.SettingHeraklion, Crete, Greece.SubjectsA total of 377 women with singleton pregnancies.ResultsHigh maternal Total Social Capital was associated with an increase of almost 1 point in Mediterranean diet score (highest v. lowest group: β coefficient=0·95, 95 % CI 0·23, 1·68), after adjustment for confounders. Similar dose–response effects were noted for the scale Tolerance of Diversity (highest v. lowest group: adjusted β coefficient=1·08, 95 % CI 0·39, 1·77).ConclusionsIndividual social capital and tolerance of diversity are associated with adherence to the Mediterranean diet in pregnancy. Women with higher social capital may exhibit a higher sense of obligation to themselves and to others that may lead to proactive nutrition-related activities. Less tolerant women may not provide the opportunity to new healthier, but unfamiliar, nutritional recommendations to become part of their regular diet.

scholarly journals Evaluation of winter pressures on general practice in Manchester: a cross-sectional analysis of nine GP practices

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101138
Author(s):  
Sinead Millwood ◽  
Peter Tomlinson ◽  
Jon Hopwood
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Seasonal Variation ◽  
Secondary Care ◽  
Hospital Admissions ◽  
Respiratory Illness ◽  
Cross Sectional ◽  
Support Unit ◽  
The North ◽  
Sectional Analysis

Background: The Nuffield Trust’s report on NHS winter pressure highlights a lack of data for primary care, with a consequential focus on secondary care. Aim: To quantify seasonal variation in workload in primary and secondary care. Design and Setting: Analysis of data for nine GP practices in Greater Manchester with a patient population of 75,421. Method: Descriptive and comparative analyses were performed for winter and summer periods in 2018-19. Data were obtained from the North of England Clinical Support Unit (NECSU) via the Rapid Actionable Insight Driving Reform (RAIDR) toolkit, and EMIS Enterprise clinical audit tools. Results: Accident & Emergency (A&E) attendances increased by 4% (p= 0.035) during winter with no difference in the number of hospital admissions (p=0.668). The number of problems seen in General practice increased by 61% (p<0.001), as did the number of GP consultations 61% (p<0.001). Respiratory diagnoses saw the greatest seasonal variation accounting for 10% in winter, 4% in summer (p<0.001). Self-referral accounted for 70% of A&E attendance in winter, 63% in summer (p<0.001). GP referral accounted for 7% in winter, 6% in summer (p=0.002). Conclusion: General practice observed a greater seasonal increase in presenting patients compared to secondary care. We recommend any winter pressures strategy target both respiratory illness and patients who self-refer to A&E. Transferring 50% of self-referrals in Manchester to GP appointments would achieve a £2.3 million cost saving. Increasing provision in primary care requires funding and increased appointments, but more importantly improved patient opportunities to easily access timely advice and assistance.

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