Risk factors for excess all-cause mortality during the first wave of the COVID-19 pandemic in England: A retrospective cohort study of primary care data

Background The COVID-19 pandemic’s first wave in England during spring 2020 resulted in an approximate 50% increase in all-cause mortality. Previously, risk factors such as age and ethnicity, were identified by studying COVID-related deaths only, but these were under-recorded during this period. Objective To use a large electronic primary care database to estimate the impact of risk factors (RFs) on excess mortality in England during the first wave, compared with the impact on total mortality during 2015–19. Methods Medical history, ethnicity, area-based deprivation and vital status data were extracted for an average of 4.8 million patients aged 30–104 years, for each year between 18-March and 19-May over a 6-year period (2015–2020). We used Poisson regression to model total mortality adjusting for age and sex, with interactions between each RF and period (pandemic vs. 2015–19). Total mortality during the pandemic was partitioned into "usual" and "excess" components, assuming 2015–19 rates represented "usual" mortality. The association of each RF with the 2020 "excess" component was derived as the excess mortality ratio (EMR), and compared with the usual mortality ratio (UMR). Results RFs where excess mortality was greatest and notably higher than usual were age >80, non-white ethnicity (e.g., black vs. white EMR = 2.50, 95%CI 1.97–3.18; compared to UMR = 0.92, 95%CI 0.85–1.00), BMI>40, dementia, learning disability, severe mental illness, place of residence (London, care-home, most deprived). By contrast, EMRs were comparable to UMRs for sex. Although some co-morbidities such as cancer produced EMRs significantly below their UMRs, the EMRs were still >1. In contrast current smoking has an EMR below 1 (EMR = 0.80, 95%CI 0.65–0.98) compared to its UMR = 1.64. Conclusions Studying risk factors for excess mortality during the pandemic highlighted differences from studying cause-specific mortality. Our approach illustrates a novel methodology for evaluating a pandemic’s impact by individual risk factor without requiring cause-specific mortality data.

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Influenza-attributable deaths, Canada 1990–1999

Epidemiology and Infection ◽

10.1017/s0950268807007923 ◽

2007 ◽

Vol 135 (7) ◽

pp. 1109-1116 ◽

Cited By ~ 73

Author(s):

D. L. SCHANZER ◽

T. W. S. TAM ◽

J. M. LANGLEY ◽

B. T. WINCHESTER

Keyword(s):

Excess Mortality ◽

Influenza Season ◽

Vital Statistics ◽

Attributable Mortality ◽

Mortality Data ◽

Poisson Regression Model ◽

Severe Influenza ◽

All Cause Mortality ◽

Specific Mortality ◽

The Impact

SUMMARYThe number of deaths attributable to influenza is believed to be considerably higher than the number certified by vital statistics registration as due to influenza. Weekly mortality data for Canada from the 1989/1990 to the 1998/1999 influenza seasons were analysed by cause of death, age group, and place of death to estimate the impact of influenza on mortality. A Poisson regression model was found to accurately predict all-cause, as well as cause-specific mortality, as a function of influenza-certified deaths, after controlling for seasonality, and trend. Influenza-attributable deaths were calculated as predicted less baseline-predicted deaths. In summary, throughout the 1990s there were on average just under 4000 deaths attributable to influenza annually (for an influenza-attributable mortality rate of 13/100 000 persons), varying from no detectable excess mortality for the 1990/1991 influenza season, to 6000–8000 influenza-attributable deaths for the more severe influenza seasons of 1997/1998 and 1998/1999. On average, 8% (95% CI 7–10) of influenza-attributable deaths were certified as influenza, although this percentage varied from 4% to 12% from year to year. Only 15% of the influenza-attributable deaths were certified as pneumonia, and for all respiratory causes, 40%. Deaths were distributed over most causes. The weekly pattern of influenza-certified deaths was a good predictor of excess all-cause mortality.

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Association of mushroom consumption with all-cause and cause-specific mortality among American adults: prospective cohort study findings from NHANES III

Nutrition Journal ◽

10.1186/s12937-021-00691-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Djibril M. Ba ◽

Xiang Gao ◽

Joshua Muscat ◽

Laila Al-Shaar ◽

Vernon Chinchilli ◽

...

Keyword(s):

Lower Risk ◽

Proportional Hazards ◽

Total Mortality ◽

Cox Proportional Hazards ◽

Dietary Factors ◽

Mortality Data ◽

Nhanes Iii ◽

Dietary Recall ◽

All Cause Mortality ◽

Specific Mortality

Abstract Background Whether mushroom consumption, which is rich in several bioactive compounds, including the crucial antioxidants ergothioneine and glutathione, is inversely associated with low all-cause and cause-specific mortality remains uncertain. This study aimed to prospectively investigate the association between mushroom consumption and all-cause and cause-specific mortality risk. Methods Longitudinal analyses of participants from the Third National Health and Nutrition Examination Survey (NHANES III) extant data (1988–1994). Mushroom intake was assessed by a single 24-h dietary recall using the US Department of Agriculture food codes for recipe foods. All-cause and cause-specific mortality were assessed in all participants linked to the National Death Index mortality data (1988–2015). We used Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause and cause-specific mortality. Results Among 15,546 participants included in the current analysis, the mean (SE) age was 44.3 (0.5) years. During a mean (SD) follow-up duration of 19.5 (7.4) years , a total of 5826 deaths were documented. Participants who reported consuming mushrooms had lower risk of all-cause mortality compared with those without mushroom intake (adjusted hazard ratio (HR) = 0.84; 95% CI: 0.73–0.98) after adjusting for demographic, major lifestyle factors, overall diet quality, and other dietary factors including total energy. When cause-specific mortality was examined, we did not observe any statistically significant associations with mushroom consumption. Consuming 1-serving of mushrooms per day instead of 1-serving of processed or red meats was associated with lower risk of all-cause mortality (adjusted HR = 0.65; 95% CI: 0.50–0.84). We also observed a dose-response relationship between higher mushroom consumption and lower risk of all-cause mortality (P-trend = 0.03). Conclusion Mushroom consumption was associated with a lower risk of total mortality in this nationally representative sample of US adults.

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Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset

eLife ◽

10.7554/elife.69336 ◽

2021 ◽

Vol 10 ◽

Author(s):

Ariel Karlinsky ◽

Dmitry Kobak

Keyword(s):

New Zealand ◽

Excess Mortality ◽

Mortality Data ◽

Objective Indicator ◽

Death Toll ◽

The World ◽

All Cause Mortality ◽

Expected Mortality ◽

The Impact ◽

Annual Mortality

Comparing the impact of the COVID-19 pandemic between countries or across time is difficult because the reported numbers of cases and deaths can be strongly affected by testing capacity and reporting policy. Excess mortality, defined as the increase in all-cause mortality relative to the expected mortality, is widely considered as a more objective indicator of the COVID-19 death toll. However, there has been no global, frequently-updated repository of the all-cause mortality data across countries. To fill this gap, we have collected weekly, monthly, or quarterly all-cause mortality data from 94 countries and territories, openly available as the regularly-updated World Mortality Dataset. We used this dataset to compute the excess mortality in each country during the COVID-19 pandemic. We found that in several worst-affected countries (Peru, Ecuador, Bolivia, Mexico) the excess mortality was above 50% of the expected annual mortality. At the same time, in several other countries (Australia, New Zealand) mortality during the pandemic was below the usual level, presumably due to social distancing measures decreasing the non-COVID infectious mortality. Furthermore, we found that while many countries have been reporting the COVID-19 deaths very accurately, some countries have been substantially underreporting their COVID-19 deaths (e.g. Nicaragua, Russia, Uzbekistan), sometimes by two orders of magnitude (Tajikistan). Our results highlight the importance of open and rapid all-cause mortality reporting for pandemic monitoring.

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All-cause and cause-specific mortality of social assistance recipients in Norway: A register-based follow-up study

Scandinavian Journal of Public Health ◽

10.1177/1403494809347023 ◽

2009 ◽

Vol 37 (8) ◽

pp. 820-825 ◽

Cited By ~ 13

Author(s):

Sille Ohrem Naper

Keyword(s):

General Population ◽

Rate Ratio ◽

Excess Mortality ◽

Relative Rate ◽

Social Assistance ◽

Total Mortality ◽

Administrative Records ◽

Socially Disadvantaged ◽

Specific Mortality ◽

The Impact

Aims: To investigate the mortality among social assistance recipients, who are among the most marginalized people in Norway. Cause-specific mortality was analysed in an attempt to explain the excess mortality. Previous research has suggested that social disadvantage leads to higher mortality from all causes, whereas others have found substantial variation when studying separate causes. The impact of the various causes will influence policy recommendations. Methods: Data were compiled through linking between Norwegian administrative records. The entire population born between 1935 and 1974 (2,297,621 people) was followed with respect to social assistance and death from 1993 to 2003. Cause-specific, age-standardized mortality rates for social assistance recipients and the rest of the population were calculated, and both the absolute (rate difference) and relative (rate ratio) rates were measured. Results: The rate ratio for total mortality was 3.1 for men and 2.5 for women for the comparison between social assistance recipients and the general population. The mortality among social assistance recipients was higher for all causes, but the magnitude differed considerably, depending on the cause. The rate ratio for men ranged from 1.2 for non-smoking-related cancer to 18.8 for alcohol- and drug-related causes. Alcohol-and drug-related and violent causes together contributed to half of the excess mortality for men and one-third for women. Conclusions: The mortality of this socially disadvantaged group was considerably higher than that of the general population, and this difference reflected mainly drug-related causes.

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The World Mortality Dataset: Tracking excess mortality across countries during the COVID-19 pandemic

10.1101/2021.01.27.21250604 ◽

2021 ◽

Author(s):

Ariel Karlinsky ◽

Dmitry Kobak

Keyword(s):

Excess Mortality ◽

Mortality Data ◽

Objective Indicator ◽

Death Toll ◽

The World ◽

All Cause Mortality ◽

Order Of Magnitude ◽

The Impact ◽

Entire Dataset ◽

Annual Mortality

AbstractComparing the impact of the COVID-19 pandemic between countries or across time is difficult because the reported numbers of cases and deaths can be strongly affected by testing capacity and reporting policy. Excess mortality, defined as the increase in all-cause mortality relative to the recent average, is widely considered as a more objective indicator of the COVID-19 death toll. However, there has been no central, frequently-updated repository of the all-cause mortality data across countries. To fill this gap, we have collected weekly, monthly, or quarterly all-cause mortality data from 77 countries, openly available as the regularly-updated World Mortality Dataset. We used this dataset to compute the excess mortality in each country during the COVID-19 pandemic. We found that in the worst-affected countries the annual mortality increased by over 50%, while in several other countries it decreased by over 5%, presumably due to lockdown measures decreasing the non-COVID mortality. Moreover, we found that while some countries have been reporting the COVID-19 deaths very accurately, many countries have been underreporting their COVID-19 deaths by an order of magnitude or more. Averaging across the entire dataset suggests that the world’s COVID-19 death toll may be at least 1.6 times higher than the reported number of confirmed deaths.

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Fruit and Vegetable Intake and All-Cause Mortality in a Chinese Population: The China Health and Nutrition Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010342 ◽

2021 ◽

Vol 18 (1) ◽

pp. 342

Author(s):

Yuxuan Gu ◽

Yansu He ◽

Shahmir H. Ali ◽

Kaitlyn Harper ◽

Hengjin Dong ◽

...

Keyword(s):

Vegetable Intake ◽

Total Mortality ◽

Negative Association ◽

Mortality Data ◽

Sample Population ◽

Fruit And Vegetable ◽

Nutrition Survey ◽

Related Factors ◽

Health And Nutrition ◽

All Cause Mortality

This study was to investigate the association of long-term fruit and vegetable (FV) intake with all-cause mortality. We utilized data from the China Health and Nutrition Survey (CHNS), a prospective cohort study conducted in China. The sample population included 19,542 adult respondents with complete mortality data up to 31 December 2011. Cumulative FV intake was assessed by 3 day 24 h dietary recalls. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality. Covariates included sociodemographic characteristics, lifestyle factors, health-related factors, and urban index. A total of 1409 deaths were observed during follow-up (median: 14 years). In the fully adjusted model, vegetable intake of the fourth quintile (327~408 g/day) had the greatest negative association with death compared to the lowest quintile (HR = 0.63, 95% CI: 0.53–0.76). Fruit intake of the fifth quintile (more than 126 g/day) had the highest negative association (HR = 0.24, 95% CI: 0.15–0.40) and increasing general FV intake were also negatively associated with all-cause mortality which demonstrated the greatest negative association in the amount of fourth quintile (HR = 0.59, 95% CI: 0.49–0.70) compared to the lowest quintile. To conclude, greater FV intake is associated with a reduced risk of total mortality for Chinese adults. High intake of fruit has a stronger negative association with mortality than differences in intake of vegetables. Our findings support recommendations to increase the intake of FV to promote overall longevity.

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Cardiovascular risk factors during cancer treatment: prevalence, incidence and prognostic relevance

European Heart Journal ◽

10.1093/ehjci/ehaa946.3251 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Caro Codon ◽

T Lopez-Fernandez ◽

C Alvarez-Ortega ◽

P Zamora Aunon ◽

I Rodriguez Rodriguez ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cancer Therapy ◽

Cancer Patients ◽

Individual Risk ◽

Funding Source ◽

Number Of Patients ◽

All Cause Mortality

Abstract Background The actual usefulness of CV risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Design Prospective multicenter study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk. Methods A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years and 2 years after initiation of cancer therapy. Results At baseline, 893 patients (67.4%) presented at least 1 risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity and all-cause mortality [HR 1.79 (95% CI 1.16–2.76) for SCORE 5–9 and HR 4.90 (95% CI 2.44–9.82) for SCORE ≥10 when compared with patients with lower SCORE (0–4)]. Conclusions This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline cardiovascular risk assessment using SCORE predicted severe cardiotoxicity and all-cause mortality. Therefore, its use should be recommended in the evaluation of cancer patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was partially funded by the Fondo Investigaciones Sanitarias (Spain), Centro de Investigaciόn Biomédica en Red Cardiovascular CIBER-CV (Spain)

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Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival

Clinical Kidney Journal ◽

10.1093/ckj/sfaa061 ◽

2020 ◽

Author(s):

Julio Chevarria ◽

Donal J Sexton ◽

Susan L Murray ◽

Chaudhry E Adeel ◽

Patrick O’Kelly ◽

...

Keyword(s):

Risk Factors ◽

Renal Transplant ◽

Graft Failure ◽

Graft Function ◽

Renal Transplant Recipients ◽

Post Transplant ◽

All Cause Mortality ◽

Transplant Function ◽

The Republic ◽

The Impact

Abstract Background Non-traditional cardiovascular risk factors, including calcium and phosphate derangement, may play a role in mortality in renal transplant. The data regarding this effect are conflicting. Our aim was to assess the impact of calcium and phosphate derangements in the first 90 days post-transplant on allograft and recipient outcomes. Methods We performed a retrospective cohort review of all-adult, first renal transplants in the Republic of Ireland between 1999 and 2015. We divided patients into tertiles based on serum phosphate and calcium levels post-transplant. We assessed their effect on death-censored graft survival and all-cause mortality. We used Stata for statistical analysis and did survival analysis and spline curves to assess the association. Results We included 1525 renal transplant recipients. Of the total, 86.3% had hypophosphataemia and 36.1% hypercalcaemia. Patients in the lowest phosphate tertile were younger, more likely female, had lower weight, more time on dialysis, received a kidney from a younger donor, had less delayed graft function and better transplant function compared with other tertiles. Patients in the highest calcium tertile were younger, more likely male, had higher body mass index, more time on dialysis and better transplant function. Adjusting for differences between groups, we were unable to show any difference in death-censored graft failure [phosphate = 1.14, 95% confidence interval (CI) 0.92–1.41; calcium = 0.98, 95% CI 0.80–1.20] or all-cause mortality (phosphate = 1.10, 95% CI 0.91–1.32; calcium = 0.96, 95% CI 0.81–1.13) based on tertiles of calcium or phosphate in the initial 90 days. Conclusions Hypophosphataemia and hypercalcaemia are common occurrences post-kidney transplant. We have identified different risk factors for these metabolic derangements. The calcium and phosphate levels exhibit no independent association with death-censored graft failure and mortality.

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‘Genetics load the gun, but the environment pulls the trigger’: novel, emerging and non-traditional risk factors in cardiovascular disease

British Journal of Cardiac Nursing ◽

10.12968/bjca.2021.0132 ◽

2021 ◽

pp. 1-3

Author(s):

Andrew Richardson

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Environmental Factors ◽

Individual Risk ◽

Traditional Risk Factors ◽

Individual Risk Factors ◽

The Impact

In this article, Andy Richardson, BANCC Educational Advisor, examines several important environmental and individual risk factors for cardiovascular disease. Following on from the meeting of Global Leaders at COP26 in Glasgow, he considers the impact of, and exposure to, environmental factors, including pollution and noise.

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Excess Mortality During the COVID-19 Pandemic in Philadelphia

American Journal of Public Health ◽

10.2105/ajph.2021.306285 ◽

2021 ◽

pp. e1-e6

Author(s):

Megan Todd ◽

Meagan Pharis ◽

Sam P. Gulino ◽

Jessica M. Robbins ◽

Cheryl Bettigole

Keyword(s):

Public Health ◽

Excess Mortality ◽

Poisson Model ◽

People Of Color ◽

Mortality Data ◽

Registration System ◽

Vital Registration System ◽

All Cause Mortality ◽

Race Ethnicity ◽

Excess Deaths

Objectives. To estimate excess all-cause mortality in Philadelphia, Pennsylvania, during the COVID-19 pandemic and understand the distribution of excess mortality in the population. Methods. With a Poisson model trained on recent historical data from the Pennsylvania vital registration system, we estimated expected weekly mortality in 2020. We compared these estimates with observed mortality to estimate excess mortality. We further examined the distribution of excess mortality by age, sex, and race/ethnicity. Results. There were an estimated 3550 excess deaths between March 22, 2020, and January 2, 2021, a 32% increase above expectations. Only 77% of excess deaths (n=2725) were attributed to COVID-19 on the death certiﬁcate. Excess mortality was disproportionately high among older adults and people of color. Sex differences varied by race/ethnicity. Conclusions. Excess deaths during the pandemic were not fully explained by COVID-19 mortality; ofﬁcial counts signiﬁcantly undercount the true death toll. Far from being a great equalizer, the COVID-19 pandemic has exacerbated preexisting disparities in mortality by race/ethnicity. Public Health Implications. Mortality data must be disaggregated by age, sex, and race/ethnicity to accurately understand disparities among groups. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e6. https://doi.org/10.2105/AJPH.2021.306285 )

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