Mortality Trends and Causes of Death in Persons with Sickle Cell Disease in the United States, 1979-2014

Abstract Background: Sickle cell disease (SCD)-related mortality is a significant cause of mortality among Blacks in the United States. Several clinical interventions, such as penicillin prophylaxis, vaccination, and hydroxyurea, have decreased SCD-related mortality over time. This report investigates changes in the causes of death (COD) associated with SCD-related mortality over time and among age groups and compares SCD-related deaths to non-SCD-related deaths to identify changes in the burden of specific COD in order to inform future public health improvement efforts. Methods: SCD-related deaths were examined using the 1979-2014 US multiple COD mortality data. SCD-related deaths were identified as deaths for which an International Classification of Disease 9th revision (ICD-9) or ICD-10 code for SCD (282.6 for ICD-9; D57.0, D57.1, D57.2, D57.8 for ICD-10) was listed anywhere on the death record. Age-specific annual and average annual SCD-related death rates were calculated as the number of deaths per 100,000 corresponding population, with the bridged-race intercensal estimates of the US resident population as the denominator. Because death from SCD is a rare event in races other than Black, the analysis focused on decedents of Black race. Underlying and contributing COD codes were categorized according to their ICD-9 or ICD-10 codes into 20 groups relevant to SCD outcomes, including acute infection complications, cerebrovascular complications, splenic complications, and renal complications. To compare SCD-related deaths to non-SCD deaths, death records not listing an ICD-9 or ICD-10 code for SCD were randomly selected in a 1:1 ratio; non-SCD deaths were matched to SCD deaths by race, sex, age group, year of death, and region of residence. Results: From 1979-2014 there were 23,226 SCD-related deaths reported in the US. The median age at death increased from 28 years in 1979 to 43 years in 2014. The SCD-related average annual death rate trends shifted by time period across various age groups. The average annual SCD-related death rate among children <5 years of age declined from 2.05/100,000 in 1979-1989 to 0.35/100,000 in 2011-2014 (p<.0001). Conversely, the rate among adults ≥60 years of age increased from 1.20/100,000 in 1979-1989 to 1.69/100,000 in 2000-2014 (p<0.0001). Changes in the frequency of various underlying and contributing COD among SCD-related deaths reflects the success of clinical interventions. During the first time period (1979-1989) acute cardiac and infection complications were the most common underlying and contributing COD. In contrast, chronic cardiac complications was most commonly listed as the underlying or contributing COD during the last time period (2010-2014) (Figure 1). The underlying and contributing COD listed among SCD-related deaths also differed by age group (Figure 2). The most common COD among deaths occurring at <5 years of age was acute infection. The most common COD among deaths occurring at ≥60 years of age was cardiac complications. While clinical interventions have shown effect, compared to non-SCD-related deaths, SCD-related deaths remained more likely to be related to COD, such as acute infections, cerebrovascular complications, and renal complications (Figure 3). Conclusions: While utilizing death certificate data alone may misclassify some deaths, the utilization of national data allows the assessment of trends in mortality over several decades and provides information regarding SCD-related mortality trends nationwide. The data presented indicate interventions to prevent acute complications of SCD appear effective during the study period. More research regarding prevention and treatment of chronic complications of SCD is necessary, as persons with SCD are living longer and are more likely to die of chronic complications of their disease. Disclosures No relevant conflicts of interest to declare.

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Mortality Trends and Causes of Death in Persons with Hemophilia in the United States, 1999-2014

Blood ◽

10.1182/blood.v130.suppl_1.755.755 ◽

2017 ◽

Vol 130 (Suppl_1) ◽

pp. 755-755 ◽

Cited By ~ 1

Author(s):

Amanda B. Payne ◽

Nafisa Ghaji ◽

Jason M. Mehal ◽

Christina Chapman ◽

Dana L. Haberling ◽

...

Keyword(s):

Cause Of Death ◽

Cardiac Disease ◽

The United States ◽

Cardiac Complications ◽

Age At Death ◽

Bleeding Events ◽

Mortality Trends ◽

The Us ◽

Icd 10 ◽

Hiv Aids

Abstract Background: Hemophilia, an inherited bleeding disorder, is marked by increased risk of serious bleeding events. Prior to the development of factor concentrates, the most common cause of death among persons with hemophilia (PWH) in the United States (US) was related to bleeding events, and the median age at death was around 25 years (Chorba et al 1994). After the development of factor concentrates, the proportion of deaths caused by bleeding events declined, and the median age at death increased to 57 years (Chorba et al 1994). However, the HIV/AIDS epidemic led to a decrease in the median age at death, and HIV/AIDS became the leading cause of death among PWH (Chorba et al 2001). Development of effective treatment for and prevention of HIV/AIDS has improved outcomes among PWH (Soucie et al 2016); however, national mortality trends among PWH in the US have not been published since 2001. Methods: Hemophilia-related deaths were examined using the 1999-2014 US multiple cause-of-death mortality data. Hemophilia deaths were identified as deaths for which an International Classification of Disease 10th revision, (ICD-10) code for hemophilia (D66, D67) was listed anywhere on the death record. Age-specific annual and average annual hemophilia-related death rates were calculated as the number of deaths per 100,000 corresponding population, with the bridged-race intercensal estimates of the US resident population as the denominator. Underlying and contributing cause of death codes were categorized according to their ICD-10 codes into 22 groups relevant to hemophilia outcomes, including 'blood/coagulation/immune', 'acute cardiac disease', 'chronic cardiac disease', 'cerebrovascular disease', 'hemorrhage', and 'musculoskeletal disease'. To compare hemophilia-related deaths to non-hemophilia deaths, death records not listing an ICD-10 code for hemophilia were randomly selected in a 1:3 ratio; non-hemophilia deaths were matched to hemophilia deaths by race, age group, and year of death. Results: From 1999-2014 there were 2,354 hemophilia-related deaths reported in the US. The hemophilia-related death rate decreased from 0.15 hemophilia-related deaths per 100,000 population to 0.08 hemophilia-related deaths per 100,000 population (rate ratio 0.57 [95% confidence interval 0.46-0.71]). The median age at death increased from 49 years in 1999 to 63 years in 2014. The distribution of underlying and contributing cause of death associated with hemophilia-related deaths reflects an aging population. During the first time period (1999-2002) HIV was most commonly listed as an underlying or contributing cause of death , while chronic cardiac complications was most commonly listed as the underlying or contributing cause of death during the last time period (2011-2014) (Figure 1). The underlying and contributing cause of death listed among hemophilia-related deaths also differed by age group (Figure 2). The most common underlying or contributing cause of death among deaths occurring at <20 years of age was intracranial hemorrhage. The most common underlying or contributing causes of death among deaths occurring between 20 and 69 years of age were HIV and/or hepatitis. The most common underlying or contributing cause of death among deaths occurring at 70+ years of age was chronic cardiac complications. Compared to non-hemophilia-related deaths, deaths related to hemophilia were more likely to be related to HIV, hepatitis, hemorrhage, and intracranial hemorrhage. Interestingly, hemophilia-related deaths were less likely to be related to cardiac complications and cancer than non-hemophilia-related deaths (Figure 3). Conclusions: This report highlights the continued success of interventions to decrease death among PWH. However, this report also highlights possible areas of future research in hemophilia, including monitoring trends in morbidities related to aging, such as cardiac disease and comorbidities due to chronic hepatitis infection. Disclosures Kempton: Genentech: Membership on an entity's Board of Directors or advisory committees.

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Improvement in survival in younger patients with acute lymphoblastic leukemia from the 1980s to the early 21st century

Blood ◽

10.1182/blood-2008-06-164863 ◽

2009 ◽

Vol 113 (7) ◽

pp. 1408-1411 ◽

Cited By ~ 121

Author(s):

Dianne Pulte ◽

Adam Gondos ◽

Hermann Brenner

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Age Groups ◽

Relative Survival ◽

The United States ◽

Period Analysis ◽

Early 21St Century ◽

Time Period ◽

Improvement In Survival ◽

Difficult Issue

Abstract Acute lymphoblastic leukemia (ALL) is an uncommon but highly fatal disease in adults. We used period analysis to data from the Surveillance, Epidemiology, and End Results (SEER) database to disclose changes in outcomes for patients diagnosed with ALL in the United States in the 2 decades between 1980–1984 and 2000–2004. Major improvement in survival was observed for patients less than 60 years of age. Improvement in survival was greater for women than for men, but was significant for both genders. The greatest improvement was seen in patients aged 15 to 19, in whom 5-year relative survival improved from 41.0% to 61.1%, and 10-year survival improved from 33.0% to 60.4%. Lesser but significant improvements were seen for age groups 20–29, 30–44, and 45–59. Survival for patients aged 60 and over remained essentially unchanged at levels around or below 10%, respectively. Survival has improved for patients with ALL over the time period studied, but treatment of older patients remains a difficult issue.

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Monitoring Sexual Violence Trends in Emergency Department Visits Using Syndromic Data From the National Syndromic Surveillance Program—United States, January 2017–December 2019

American Journal of Public Health ◽

10.2105/ajph.2020.306034 ◽

2021 ◽

Vol 111 (3) ◽

pp. 485-493

Author(s):

Ashley Schappell D'Inverno ◽

Nimi Idaikkadar ◽

Debra Houry

Keyword(s):

United States ◽

Emergency Department ◽

Sexual Violence ◽

Syndromic Surveillance ◽

Age Groups ◽

The United States ◽

Emergency Department Visits ◽

Surveillance Program ◽

Time Period ◽

Ed Visits

Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States. Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention’s National Syndromic Surveillance Program data. We stratified the data by sex and age groups. Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years. Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV.

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The Silent Pandemic COVID-19 in the Asymptomatic Population

10.1101/2020.12.29.20248985 ◽

2021 ◽

Author(s):

Robert L. Stout ◽

Steven J. Rigatti

Keyword(s):

Census Data ◽

Acute Infection ◽

Age Groups ◽

The United States ◽

Public Health Official ◽

Health Official ◽

Commercial Laboratory ◽

Lower Case ◽

Case Rate ◽

Us Census

AbstractAs the COVID-19 pandemic continues to ravage the world there is a great need to understand the dynamics of spread. Currently the seroprevalence of asymptomatic COVID-19 doubles every 3 months, this silent epidemic of new infections may be the main driving force behind the rapid increase in SARS-CoV-2 cases.Public health official quickly recognized that clinical cases were just the tip of the iceberg. In fact a great deal of the spread was being driven by the asymptomatically infected who continued to go out, socialize and go to work. While seropositivity is an insensitive marker for acute infection it does tell us about the prevalence COVID-19 in the population.ObjectiveDescribe the seroprevalence of SARS-CoV-2 infection in the United States over time.MethodologyRepeated convenience samples from a commercial laboratory dedicated to the assessment of life insurance applicants were tested for the presence of antibodies to SARS-CoV-2, in several time periods between May and December of 2020. US census data were used to estimate the population prevalence of seropositivity.ResultsThe raw seroprevalence in the May-June, September, and December timeframes were 3.0%, 6.6% and 10.4%, respectively. Higher rates were noted in younger vs. older age groups. Total estimated seroprevalence in the US is estimated at 25.7 million cases.ConclusionsThe seroprevalence of SARS-CoV-2 demonstrates a significantly larger pool of individuals who have contract COVID-19 and recovered, implying a lower case rate of hospitalizations and deaths than have been reported so far.

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The Silent Pandemic COVID-19 in the Asymptomatic Population

10.1101/2020.11.10.20215145 ◽

2020 ◽

Cited By ~ 1

Author(s):

Robert L. Stout ◽

Steven J. Rigatti

Keyword(s):

Census Data ◽

Acute Infection ◽

Age Groups ◽

The United States ◽

Public Health Official ◽

Health Official ◽

Commercial Laboratory ◽

Lower Case ◽

Case Rate ◽

Us Census

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Changes in Liver-related Mortality by Etiology and Sequelae: Underlying Versus Multiple Causes of Death

10.21203/rs.3.rs-96337/v1 ◽

2020 ◽

Author(s):

Ming-Jen Sheu ◽

Fu-Wen Liang ◽

Ching-Yih Lin ◽

Tsung-Hsueh Lu

Keyword(s):

Liver Cancer ◽

Primary Liver Cancer ◽

Relative Rate ◽

Age Groups ◽

The United States ◽

Mortality Data ◽

Mortality Change ◽

Wide Range ◽

Definition Of ◽

Related Mortality

Abstract Background: The expanded definition of liver-related deaths includes a wide range of etiologies and sequelae. We compared the changes in liver-related mortality by etiology and sequelae for different age groups between 2008 and 2018 in the United States using both underlying and multiple cause of death (UCOD and MCOD) data. Methods: We extracted mortality data from the CDC WONDER. Both the absolute (rate difference) and relative (rate ratio and 95% confidence intervals) changes were calculated to quantify the magnitude of change using the expanded definition of liver-related mortality. Result: Using the expanded definition including secondary liver cancer and according to UCOD data, we identified 68,037 liver-related deaths among people aged 20 years and above in 2008 (29 per 100,000) and this increased to 90,635 in 2018 (33 per 100,000), a 13% increase from 2008 to 2018. However, according to MCOD data, the number of deaths was 113,219 (48 per 100,000) in 2008 and increased to 161,312 (58 per 100,000) in 2018, indicating a 20% increase. The increase according to MCOD was mainly due to increase in alcoholic liver disease and secondary liver cancer (liver metastasis) for each age group and hepatitis C virus (HCV) and primary liver cancer among decedents aged 65–74 years. Conclusion: The direction of mortality change (increasing or decreasing) was similar in UCOD and MCOD data in most etiologies and sequelae, except secondary liver cancer. However, the extent of change differed between UCOD and MCOD data.

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Infanticide, Neonaticide and Post-neonaticide: Racial/ethnic Disparities in the United States.

10.21203/rs.3.rs-297298/v1 ◽

2021 ◽

Author(s):

Hamisu M. Salihu ◽

Danielle N Gonzales ◽

Deepa Dongarwar

Keyword(s):

United States ◽

Ethnic Disparities ◽

The United States ◽

Mortality Data ◽

Community Resources ◽

Foreign Born ◽

Healthcare Needs ◽

Time Period ◽

Icd 10 ◽

Recent Trends

Abstract This study aims to assess recent trends and characteristics for infanticide and the sub-groups: neonaticide and post-neonaticide during the time period 2003–2017. Multiple Cause-of-Death Mortality Data were used to identify infanticides in the United States based on ICD-10 codes. Joinpoint regression analysis was used to calculate trends in the rates of infanticide, neonaticide and post-neonaticide during the study period. Logistic regression was used to examine the association between the socio-demographic characteristics and each of the outcomes. During the study period, 4,545 (1.2%) infants were identified as being victims of infanticide. The rates of neonaticide declined by 4.2% over the study period, whereas that of infanticide and post-neonaticide remained statistically unchanged. Males and Non-Hispanic (NH) Blacks were more likely to be victims of infanticide and post-neonaticide, compared to females and NH-Whites respectively, but had similar likelihood of neonaticide. While foreign-born residents exhibited nearly a four-fold increased likelihood of neonaticide, they had about 70% lesser likelihood of post-neonaticide than US born residents. Conclusion: Reasons for the disparities found in this study are multifactorial. We believe that access to healthcare needs to be improved and community resources need to be made more available to address the proposed mechanisms that lead to infanticide.

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Increase in emergency department visits related to cannabis reported using syndromic surveillance system

European Journal of Public Health ◽

10.1093/eurpub/cky272 ◽

2019 ◽

Vol 29 (4) ◽

pp. 621-625 ◽

Cited By ~ 4

Author(s):

G N Noel ◽

A M Maghoo ◽

F F Franke ◽

G V Viudes ◽

P M Minodier

Keyword(s):

Emergency Department ◽

Surveillance System ◽

Syndromic Surveillance ◽

Age Groups ◽

The United States ◽

Cross Sectional Study ◽

Emergency Department Visits ◽

Cross Sectional ◽

Syndromic Surveillance System ◽

Icd 10

Abstract Background Cannabis is illegal in France but, as in many countries, legalization is under debate. In the United States, an increase of emergency department (ED) visits related to cannabis exposure (CE) in infants and adults was reported. In France, a retrospective observational study also suggested an increase of CE in children under 6 years old. This study only included toddlers and the data sources used did not allow repeated analysis for monitoring. Methods Our study aimed to evaluate the trend in visits for CE in ED in patients younger than 27 years old in Southern France. A cross-sectional study using the Electronic Emergency Department Abstracts (EEDA) included in the national Syndromic Surveillance System. CE visits were defined using International Classification of Disease (ICD-10). Results From 2009 to 2014, 16 EDs consistently reported EEDA with <5% missing diagnosis code. Seven hundred and ninety seven patients were admitted for CE including 49 (4.1%) children under 8 years old. From 2009–11 to 2012–14, the rate of CE visits increased significantly across all age groups. The highest increase was in the 8–14 years old (+144%; 1.85–4.51, P < 0.001) and was also significant in children under 8 (0.53–1.06; P = 0.02). Among children under 8, hospitalization rate (75.5% vs. 16.8%; P < 0.001) and intensive care unit admissions (4.1% vs. 0.1%; P < 0.001) were higher compared with patients older than 8 years. Conclusion These trends occurred despite cannabis remaining illegal. EEDA could be useful for monitoring CE in EDs.

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Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children

Circulation ◽

10.1161/circulationaha.120.049836 ◽

2021 ◽

Vol 143 (1) ◽

pp. 78-88

Author(s):

Tarek Alsaied ◽

Adriana H. Tremoulet ◽

Jane C. Burns ◽

Arwa Saidi ◽

Audrey Dionne ◽

...

Keyword(s):

Inflammatory Response ◽

Acute Infection ◽

Gastrointestinal Symptoms ◽

The United States ◽

Cardiovascular Complications ◽

Cardiac Complications ◽

Published Data ◽

Control And Prevention ◽

Cardiac Evaluation ◽

Inflammatory Syndrome

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with substantial cardiovascular implications. Although infection with SARS-CoV-2 is usually mild in children, some children later develop a severe inflammatory disease that can have manifestations similar to toxic shock syndrome or Kawasaki disease. This syndrome has been defined by the US Centers for Disease Control and Prevention as multisystem inflammatory syndrome in children. Although the prevalence is unknown, >600 cases have been reported in the literature. Multisystem inflammatory syndrome in children appears to be more common in Black and Hispanic children in the United States. Multisystem inflammatory syndrome in children typically occurs a few weeks after acute infection and the putative etiology is a dysregulated inflammatory response to SARS-CoV-2 infection. Persistent fever and gastrointestinal symptoms are the most common symptoms. Cardiac manifestations are common, including ventricular dysfunction, coronary artery dilation and aneurysms, arrhythmia, and conduction abnormalities. Severe cases can present as vasodilatory or cardiogenic shock requiring fluid resuscitation, inotropic support, and in the most severe cases, mechanical ventilation and extracorporeal membrane oxygenation. Empirical treatments have aimed at reversing the inflammatory response using immunomodulatory medications. Intravenous immunoglobulin, steroids, and other immunomodulatory agents have been used frequently. Most patients recover within days to a couple of weeks and mortality is rare, although the medium- and long-term sequelae, particularly cardiovascular complications, are not yet known. This review describes the published data on multisystem inflammatory syndrome in children, focusing on cardiac complications, and provides clinical considerations for cardiac evaluation and follow-up.

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Opioid-Related Deaths in Eastern Ontario from 2011 to 2016

Academic Forensic Pathology ◽

10.1177/1925362119851124 ◽

2019 ◽

Vol 9 (1-2) ◽

pp. 51-65

Author(s):

Jacqueline L. Parai ◽

Krista Castonguay ◽

Christopher M. Milroy

Keyword(s):

Age Groups ◽

The United States ◽

Inclusion Criteria ◽

Cross Sectional ◽

Manner Of Death ◽

Period Analysis ◽

Time Period ◽

Eastern Ontario ◽

Sectional Analysis ◽

Age Range

There has been a growing opioid crisis in the United States and Canada. The aim of this study was to analyze trends in opioid-related deaths from the Eastern Ontario Regional Forensic Pathology Unit so that prevention strategies for these deaths can be developed. The analyses included examining the opioids involved and demographic characteristics of the individuals in these deaths so that possible risk factors for opioid-related deaths could be identified. A retrospective cross-sectional analysis of the full autopsy and toxicology data between 2011 and 2016 was conducted. Trends regarding the opioids involved in the death, all opioids reported in the toxicology reports and certain nonopioid drugs reported in the toxicology reports were examined. The distribution of opioid-related death by age-group and manner of death was also conducted. Two hundred seventy-four opioid-related deaths met the inclusion criteria and were examined. The majority of individuals overdosing were male. The most frequent age range for opioid-related deaths was 45 to 54 years with increasing deaths among individuals aged 55 years and older over the period studied. Fentanyl was responsible for most deaths overall when single or multiple opioids were involved. However, hydromorphone involvement was the only opioid to have a statistically significant increase over the time period. Analysis of nonopioid-related drugs revealed extensive use of antidepressants, benzodiazepines, and their metabolites. Accident was the most common manner of death throughout all age groups except for those aged 65 years or older, where suicide was most common.

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