scholarly journals Clinical and epidemiological variability in severe sepsis: an ecological study

2018 ◽  
Vol 72 (8) ◽  
pp. 741-745 ◽  
Author(s):  
J Priyanka Vakkalanka ◽  
Karisa K Harland ◽  
Morgan B Swanson ◽  
Nicholas M Mohr
Keyword(s):  
Severe Sepsis ◽  
Case Fatality Rate ◽  
Ecological Study ◽  
Case Fatality ◽  
Mortality Rates ◽  
Incidence Rates ◽  
Administrative Database ◽  
Fatality Rate ◽  
Diagnostic Coding ◽  
Hospital Administrative

BackgroundTo assess clinical and epidemiological trends of severe sepsis.MethodsEcological study of patients presenting to the emergency department with severe sepsis or septic shock between 2005 and 2013. Patients were identified using the state-wide hospital administrative database. Key outcomes included incidence rates (IRs) and mortality rates (per 1000 population) by age and medically underserved areas (MUAs), sepsis case fatality rate (deaths per 100 sepsis cases), and proportions of transfer and comorbidities.ResultsThere were 154 019 sepsis cases identified. In 2005, 85+ yo in non-MUAs had a 44% increase in IR compared with those in MUAs, and this difference rose to 74% by 2013. Mortality rates were 1.6 (95% CI 1.3 to 1.8) times greater among 85+ yo in non-MUAs. Mortality rates increased by 1.8% annually, while the sepsis case fatality rate decreased by 7.7%. The proportion of transfer among sepsis cases decreased by 2.1% per year (3.8% in non-MUAs, 0.7% in MUAs).ConclusionsSepsis incidence varies geographically, and access to healthcare is one proposed mechanism that may explain heterogeneity. Over time, we may be capturing higher acuity sepsis cases with better recognition and management, as well as observing differential diagnostic coding documentation by location.

Impact of a multifaceted intervention to improve emergency care on newborn and child health outcomes in Rwanda

2021 ◽  
Author(s):  
Celestin Hategeka ◽  
Larry D Lynd ◽  
Cynthia Kenyon ◽  
Lisine Tuyisenge ◽  
Michael R Law
Keyword(s):  
Time Series ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Mortality Rates ◽  
Fatality Rate ◽  
Paediatric Hospital ◽  
Child Health Outcomes ◽  
And Child Health

Abstract Implementing context-appropriate neonatal and paediatric advanced life support management interventions has increasingly been recommended as one of the approaches to reduce under-five mortality in resource-constrained settings like Rwanda. One such intervention is ETAT+, which stands for Emergency Triage, Assessment and Treatment plus Admission care for severely ill newborns and children. In 2013, ETAT+ was implemented in Rwandan district hospitals. We evaluated the impact of the ETAT+ intervention on newborn and child health outcomes. We used monthly time-series data from the DHIS2-enabled Rwanda Health Management Information System from 2012 to 2016 to examine neonatal and paediatric hospital mortality rates. Each hospital contributed data for 12 and 36 months before and after ETAT+ implementation, respectively. Using controlled interrupted time-series analysis and segmented regression model, we estimated longitudinal changes in neonatal and paediatric hospital mortality rates in intervention hospitals relative to matched concurrent control hospitals. We also studied changes in case fatality rate specifically for ETAT+-targeted conditions. Our study cohort consisted of 7 intervention hospitals and 14 matched control hospitals contributing 142 424 neonatal and paediatric hospital admissions. After controlling for secular trends and autocorrelations, we found that the ETAT+ implementation had no statistically significant impact on the rate of all-cause neonatal and paediatric hospital mortality in intervention hospitals relative to control hospitals. However, the case fatality rate for ETAT+-targeted neonatal conditions decreased immediately following implementation by 5% (95% confidence interval: −9.25, −0.77) and over time by 0.8% monthly (95% confidence interval: −1.36, −0.25) in intervention hospitals compared with control hospitals. Case fatality rate for ETAT+-targeted paediatric conditions did not decrease following the ETAT+ implementation. While ETAT+ focuses on improving the quality of hospital care for both newborns and children, we only found an impact on neonatal hospital mortality for ETAT+-targeted conditions that should be interpreted with caution given the relatively short pre-intervention period and potential regression to the mean.

Morbidity, mortality and spatial distribution of meningococcal disease, 1974–2007

2009 ◽  
Vol 137 (11) ◽  
pp. 1631-1640 ◽  
Author(s):  
M. HOWITZ ◽  
L. LAMBERTSEN ◽  
J. B. SIMONSEN ◽  
J. J. CHRISTENSEN ◽  
K. MØLBAK
Keyword(s):  
Risk Factors ◽  
Spatial Distribution ◽  
Meningococcal Disease ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Incidence Rates ◽  
Fatality Rate ◽  
Risk Of Death ◽  
Increased Risk ◽  
High Age

SUMMARYTo identify determinants for mortality and sequelae and to analyse the spatial distribution of meningococcal disease, we linked four national Danish registries. In the period 1974–2007, 5924 cases of meningococcal disease were registered. Our analysis confirms known risk factors for a fatal meningococcal disease outcome, i.e. septicaemia and high age (>50 years). The overall case-fatality rate was 7·6%; two phenotypes were found to be associated with increased risk of death; C:2a:P1.2,5 and B:15:P1.7,16. B:15:P1.7,16 was also associated with excess risk of perceptive hearing loss. The incidence rates of meningococcal disease were comparable between densely and less densely populated areas, but patients living further from a hospital were at significantly higher risk of dying from the infection. To improve control of meningococcal disease, it is important to understand the epidemiology and pathogenicity of virulent ‘successful clones’, such as C:2a:P1.2,5 and B:15:P1.7,16, and, eventually, to develop vaccines against serogroup B.

Temporal trends in stroke incidence and case-fatality rates in Arcadia, Greece: A sequential, prospective, population-based study

2021 ◽  
pp. 174749302199559
Author(s):  
Eleni Karantali ◽  
Konstantinos Vemmos ◽  
Evangelos Tsampalas ◽  
Konstantinos Xynos ◽  
Persefoni Karachalia ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Temporal Trends ◽  
Case Fatality ◽  
Population Based ◽  
Incidence Rates ◽  
European Population ◽  
Fatality Rate ◽  
Population Based Study ◽  
Stroke Incidence ◽  
Southern Greece

Background Stroke incidence and case-fatality are reported to decline in high-income countries during the last decades. Epidemiological studies are important for health services to organize prevention and treatment strategies. Aims The aim of this population-based study was to determine temporal trends of stroke incidence and case-fatality rates of first-ever stroke in Arcadia, a prefecture in southern Greece. Methods All first-ever stroke cases in the Arcadia prefecture were ascertained using the same standard criteria and multiple overlapping sources in three study periods: from November 1993 to October 1995; 2004; and 2015–2016. Crude and age-adjusted to European population incidence rates were compared using Poisson regression. Twenty-eight days case fatality rates were estimated and compared using the same method. Results In total, 1315 patients with first-ever stroke were identified. The age-standardized incidence to the European population was 252 per 100,000 person-years (95% CI 231–239) in 1993/1995, 252 (95% CI 223–286) in 2004, and 211 (192–232) in 2015/2016. The overall age- and sex-adjusted incidence rates fell by 16% (incidence rates ratio 0.84, 95% CI: 0.72–0.97). Similarly, 28-day case-fatality rate decreased by 28% (case fatality rate ratio = 0.72, 95% CI: 0.58–0.90). Conclusions This population-based study reports a significant decline in stroke incidence and mortality rates in southern Greece between 1993 and 2016.

scholarly journals Differences by country-level income in COVID-19 cases, deaths, case-fatality rates, and rates per million population in the first five months of the pandemic

2020 ◽  
Author(s):  
Wrishmeen Sabawoon
Keyword(s):  
Low Income ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Incidence Rates ◽  
High Income ◽  
Fatality Rate ◽  
Middle Income ◽  
Death Rates ◽  
Middle Income Countries ◽  
Country Level

Abstract Objective: To describe differences by country-level income in COVID-19 cases, deaths, case-fatality rates, incidence rates, and death rates per million population. Methods: Publicly available data on COVID-19 cases and deaths from December 31, 2019 to June 3, 2020 were analyzed. Kruskal-Wallis tests were used to examine associations of country-level income with COVID-19 cases, deaths, case-fatality rates, incidence rates, and death rates. Results: A total of 380,803 deaths out of 6,348,204 COVID-19 cases were reported from 210 countries and territories globally in the period under study, and the global case-fatality rate was 6.0%. Of the total globally reported cases and deaths, the percentages of cases and deaths were 59.9% and 75.0% for high-income countries, and 30.9% and 20.7% for upper-middle-income countries. Countries in higher-income categories had higher incidence rates and death rates. Between April and May, the incidence rates in higher-income groups of countries decreased, but in other groups, it increased. Conclusions In the first five months of the COVID-19 pandemic, most cases and deaths were reported from high-income and upper-middle-income countries, and those countries had higher incidence rates and death rates per million population than did lower-middle and low-income countries. Keywords: COVID-19, incidence rate, death rate, case fatality rate, income, and country

scholarly journals A new method to calculate the instant case fatality rate of COVID-19 in Wuhan and Hubei of China

2020 ◽  
Author(s):  
Lei Cao ◽  
Ting-ting Huang ◽  
Jun-xia Zhang ◽  
Qi Qin ◽  
Si-yu Liu ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Large Deviation ◽  
Case Fatality ◽  
Mortality Rates ◽  
Fatality Rate ◽  
Cure Rate ◽  
Wuhan City ◽  
Notification Data ◽  
And Control ◽  
Case Notification

Abstract The worst-hit area of coronavirus disease 2019 (COVID-19) in China was Wuhan City and its affiliated Hubei Province, where the outbreak has been well controlled. The case fatality rate (CFR) is the most direct indicator to evaluate the hazards of an infectious disease. However, most reported CFR on COVID-19 represent a large deviation from reality. We aimed to establish a more accurate way to estimate the CFR of COVID-19 in Wuhan and Hubei and compare it to the reality. The daily case notification data of COVID-19 from December 8, 2019, to May 1, 2020, in Wuhan and Hubei were collected from the bulletin of the Chinese authorities. The instant CFR of COVID-19 was calculated from the numbers of deaths and the number of cured cases, the two numbers occurred on the same estimated diagnosis dates. The instant CFR of COVID-19 was 1.3%-9.4% in Wuhan and 1.2%-7.4% in Hubei from January 1 to May 1, 2020. It has stabilized at 7.69% in Wuhan and 6.62% in Hubei since early April. The cure rate was between 90.1% and 98.8% and finally stabilized at 92.3% in Wuhan and stabilized at 93.5% in Hubei. The mortality rates were 34.5/100 000 in Wuhan and 7.61/100 000 in Hubei. In conclusion, this approach reveals a way to accurately calculate the CFR, which may provide a basis for the prevention and control of infectious diseases.

scholarly journals Epidemiological philosophy of pandemics

2021 ◽  
Vol 8 (7) ◽  
pp. 3255
Author(s):  
Tareef Fadhil Raham
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Mortality Rates ◽  
Positive Influence ◽  
Fatality Rate ◽  
Regression Analyses ◽  
Background Theory ◽  
Very High ◽  
Testing Coverage

Background: During  the COVID-19 pandemic, clinicians have struggled to understand why case fatality rates vary among countries. The role of clusters of infections in COVID-19 severity is well known before, furthermore the case overload was attributed to increased COVID-19 mortality in certain locations. The background theory in this study was the  already existing evidence that an increased viral load (density of infection) leads to more fatalities. The aim of this study was to find the correlation between high number of cases and high mortality (MR) in different countries and to find the correlation of MR with case fatality rate (CFR).Methods: We chose thirty-one countries with testing coverage levels of >400,0000 tests/M and populations greater than 1 million inhabitants. We used ANOVA regression analyses to test the associations.Results: There was a very highly significant correlation between MR and the total number of cases/million population inhabitants (M) (p=0.0000). The CRF changed with a change in the MR. A very high positive influence of the COVID-19 MR on the CFR (p= 0.0000).Conclusions: Increased number of cases per million inhabitants is associated with increased MR. Increased MR is associated with increased CFR. These findings explain variable mortality rates in relation to CFR and to the number of cases/M. This evidence gives us an idea of the behavior of epidemics in general. This  will help in the development of infection control policies.

scholarly journals Oxygen and Mortality in COVID-19 Pneumonia: A Comparative Analysis of Supplemental Oxygen Policies and Health Outcomes Across 26 Countries

2021 ◽  
Vol 9 ◽  
Author(s):  
Fatma Mansab ◽  
Harry Donnelly ◽  
Albrecht Kussner ◽  
James Neil ◽  
Sohail Bhatti ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Case Fatality ◽  
Mortality Rates ◽  
Supplemental Oxygen ◽  
Fatality Rate ◽  
National Mortality ◽  
Bivariate Association ◽  
The Uk ◽  
The Relationship ◽  
Mortality Estimates

Introduction: Hypoxia is the main cause of morbidity and mortality in COVID-19. During the COVID-19 pandemic, some countries have reduced access to supplemental oxygen, whereas other nations have maintained and even improved access to supplemental oxygen. We examined whether variation in the nationally determined oxygen guidelines had any association with national mortality rates in COVID-19.Methods: Three independent investigators searched for, identified, and extracted the nationally recommended target oxygen levels for the commencement of oxygen in COVID-19 pneumonia from the 29 worst affected countries. Mortality estimates were calculated from three independent sources. We then applied both parametric (Pearson's R) and non-parametric (Kendall's Tau B) tests of bivariate association to determine the relationship between case fatality rate (CFR) and target SpO2, and also between potential confounders and CFR.Results: Of the 26 nations included, 15 had employed conservative oxygen strategies to manage COVID-19 pneumonia. Of them, Belgium, France, USA, Canada, China, Germany, Mexico, Spain, Sweden, and the UK guidelines advised commencing oxygen when oxygen saturations (SpO2) fell to 91% or less. A statistically significant correlation was found between SpO2 and CFR both parametrically (R = −0.53, P < 0.01) and non-parametrically (−0.474, P < 0.01).Conclusion: Our study highlights the disparity in oxygen provision for COVID-19 patients between the nations analysed. In those nations that pursued a conservative oxygen strategy, there was an association with higher national mortality rates. We discuss the potential reasons for such an association.

scholarly journals Predictors of Covid-19 case fatality rate: An ecological study

2021 ◽  
Vol 65 ◽  
pp. 102319
Author(s):  
Osama Y. Alshogran ◽  
Shoroq M. Altawalbeh ◽  
Sayer I. Al-Azzam ◽  
Reema Karasneh
Keyword(s):  
Case Fatality Rate ◽  
Ecological Study ◽  
Case Fatality ◽  
Fatality Rate

scholarly journals Ecologic correlation between underlying population level morbidities and COVID-19 case fatality rate among countries infected with SARS-CoV-2

2020 ◽  
Author(s):  
Evaezi Okpokoro ◽  
Victoria Igbinomwanhia ◽  
Elima Jedy-Agba ◽  
Gbenga Kayode ◽  
Ezenwa James Onyemata ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Tobacco Use ◽  
Negative Correlation ◽  
Case Fatality Rate ◽  
Ecological Study ◽  
Case Fatality ◽  
Population Level ◽  
Hiv Prevalence ◽  
Fatality Rate

AbstractBackgroundThe ongoing Coronavirus disease 2019 (COVID-19) pandemic is unprecedented in scope. High income countries (HIC) seemingly account for the majority of the mortalities considering that these countries have screened more persons. Low middle income countries (LMIC) countries may experience far worse mortalities considering the existence of a weaker health care system and the several underlying population level morbidities. As a result, it becomes imperative to understand the ecological correlation between critical underlying population level morbidities and COVID-19 case fatality rates (CFR).MethodThis is an ecological study using data on COVID-19 cases, prevalence of COPD, prevalence of tobacco use, adult HIV prevalence, quality of air and life expectancy. We plotted a histogram, performed the Shapiro-Wilk normality test and used spearman correlation to assess the degree of correlation between COVID-19 case fatality rate (CFR) and other covariates mentioned above.ResultAs at the 31st of March 2020, there were a total of 846,281 cases of COVID-19 from 204 countries and a global case fatality rate of 5% (range 0% to 29%). Angola and Sudan both had the highest CFR of 29%, while Italy had the highest number of deaths (i.e. 12,428) as at 31st of March 2020. Adult HIV prevalence has a significant but weak negative correlation with CFR (correlation coefficient = - 0.24, p value =0.01) while all the other variables have positive correlation with CFR due to COVID-19 though not statistically significant. Of the 204 countries analyzed, only 11 countries (i.e. 5%) had complete datasets across all 5 population level morbidities (i.e. prevalence of COPD, prevalence of tobacco use, life expectancy, quality of air, and adult HIV prevalence variables). Correlations of CFR from these 11 countries were similar to that from the 204 countries except for the correlation with quality of air and prevalence of tobacco use. Conclusion: While we interpret our data with caution given the fact that this is an ecological study, our findings suggest that population level factors such as prevalence of COPD, prevalence of tobacco use, life expectancy and quality of air are positively correlated with CFR from COVID-19 but, adult HIV prevalence has a weak and negative correlation with COVID-19 CFR and would require extensive research.

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