Dementia and autopsy-verified causes of death in racially-diverse older Brazilians

Background While dementia has been associated with specific causes of death, previous studies were relatively small autopsy series or population-based studies lacking autopsy confirmation and were restricted to Non-Latinx Whites. Here, we examine the association of dementia with autopsy-verified causes of death in racially-diverse older Brazilians. Methods As part of the Pathology, Alzheimer´s and Related Dementias Study (PARDoS), a community-based study in Brazil, we included 1941 racially-diverse deceased, 65 years or older at death. We conducted a structured interview with legal informants including the Clinical Dementia Rating (CDR) Scale for dementia proximate to death. Causes of death were assessed after full-body autopsy and macroscopic examination of the brain, thoracic and abdominal/pelvic organs. Up to four causes of death were reported for each decedent. Causes of death were classified as circulatory, infectious, cancer and other. Logistic regression was used to determine associations of dementia with cause of death, controlling for age, sex, race, and education. Results Dementia was associated with a higher odds of an infectious cause of death (OR = 1.81, 95%CI:1.45–2.25), and with a lower odds of a circulatory disease as cause of death (OR = 0.69, 95%CI:0.54–0.86) and cancer as cause of death (OR = 0.41, 95%CI:0.24–0.71). Dementia was associated with a higher odds of pneumonia (OR = 1.92, 95%CI:1.53–2.40) and pulmonary embolism (OR = 2.31, 95%CI:1.75–3.05) as causes of death and with a lower odds of acute myocardial infarction (OR = 0.42, 95%CI:0.31–0.56) and arterial disease (OR = 0.76, 95%CI:0.61–0.94) as causes of death. Conclusion Racially-diverse older Brazilians with dementia had a higher odds of an infectious cause of death and a lower odds of cancer and circulatory disease as causes of death than those without dementia.

Download Full-text

Informant-Reported Discrimination, Dementia, and Cognitive Impairment in Older Brazilians

Journal of Alzheimer s Disease ◽

10.3233/jad-201436 ◽

2021 ◽

pp. 1-9

Author(s):

Jose M. Farfel ◽

Lisa L. Barnes ◽

Ana Capuano ◽

Maria Carolina de Moraes Sampaio ◽

Robert S. Wilson ◽

...

Keyword(s):

Cognitive Impairment ◽

Sex Education ◽

The Elderly ◽

Structured Interview ◽

Racially Diverse ◽

Clinical Dementia Rating ◽

Community Based ◽

Poor Cognitive Function ◽

Diagnosis Of Dementia ◽

Everyday Discrimination

Background: Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia. Objective: Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians. Methods: We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer’s and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales. Results: Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 –1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 –1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities. Conclusion: Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.

Download Full-text

Testicular cancer in the cisplatin era: Causes of death and mortality rates in a population-based cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.5006 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 5006-5006

Author(s):

Ragnhild Hellesnes ◽

Tor Åge Myklebust ◽

Sophie D. Fossa ◽

Roy M. Bremnes ◽

Asa Karlsdottir ◽

...

Keyword(s):

General Population ◽

Oral Cavity ◽

Testicular Cancer ◽

Cause Of Death ◽

Causes Of Death ◽

Population Based ◽

Second Cancer ◽

Treatment Data

5006 Background: Previous studies have reported an increased risk of premature mortality in testicular cancer (TC) survivors, probably associated with previous platinum-based chemotherapy (PBCT) or radiotherapy (RT). However, complete data regarding PBCT cycles are lacking in available literature. Using complete TC treatment data, this population-based cohort study aimed to investigate non-TC mortality in relation to TC treatment. Methods: Overall, 5,707 men diagnosed with TC 1980-2009 were included, identified from the Cancer Registry of Norway. Clinical parameters and treatment data were abstracted from medical records and linked with the Norwegian Cause of Death Registry. Causes of death were classified by the European Shortlist. Standardized mortality ratios (SMRs) were calculated to compare the cause-specific mortality in the cohort to an age-matched general population. Age-adjusted hazard ratios (HRs) were estimated to evaluate the impact of number of PBCT cycles on non-TC mortality. Results: During a median follow-up of 18.7 years, 665 (12%) men were registered with non-TC death. The overall excess non-TC mortality was 23% (SMR 1.23, 95% CI 1.14-1.33) compared with the general population, with increased risks after PBCT (SMR 1.23, 95% CI 1.06-1.42) and RT (SMR 1.28, 95% CI 1.15-1.43), but not after surgery (SMR 0.95, 95% CI 0.79-1.14). SMRs increased significantly with increasing follow-up time ≥10 years, and the overall risk of non-TC death reached a maximum after ≥30 years follow-up (SMR 1.64, 95% CI 1.31-2.06). The most important cause of death was non-TC second cancer with an overall SMR of 1.53 (95% CI 1.35-1.73). Increased risks appeared after PBCT (SMR 1.43, 95% CI 1.12-1.83) and RT (SMR 1.59, 95% CI 1.34-1.89). Treatment with PBCT was associated with significantly 1.69-6.78-fold increased SMRs for cancers of the oral cavity/pharynx, esophagus, lung, bladder, and leukemia. After RT, significantly 3.02- 4.91-fold increased SMRs emerged for cancers of the oral cavity/pharynx, stomach, liver, pancreas and bladder. Non-cancer mortality was also increased by 15% (SMR 1.15, 95% CI 1.04-1.27), and excesses appeared after PBCT (1.23, 95% CI 1.03-1.47) and RT (SMR 1.17, 95% CI 1.01-1.34). Importantly, we report excess suicides after PBCT (SMR 1.65, 95% CI 1.01-2.69). Long-term overall cardiovascular mortality was not increased in the study cohort nor according to treatment modality. Compared with surgery, the overall non-TC mortality was increased after 4 (HR 1.41, 95% CI 1.00-1.98) and >4 (HR 2.03, 95% CI 1.24-3.33) PBCT cycles after >10 years of follow-up. Conclusions: TC treatment with PBCT or RT is associated with significantly increased long-term non-TC mortality, with non-TC second cancer being the most important cause of death. Significantly elevated risks for non-TC mortality emerged after ≥4 PBCT cycles after >10 years of follow-up.

Download Full-text

Sickle Cell Disease Mortality in California and Georgia 2004-2008

Blood ◽

10.1182/blood.v124.21.439.439 ◽

2014 ◽

Vol 124 (21) ◽

pp. 439-439

Author(s):

Susan Paulukonis ◽

Todd Griffin ◽

Mei Zhou ◽

James R. Eckman ◽

Robert Hagar ◽

...

Keyword(s):

African American ◽

Cause Of Death ◽

Sickle Cell ◽

Causes Of Death ◽

Mortality Rates ◽

Population Based ◽

Age Group ◽

Death Certificates ◽

Underlying Causes ◽

Underlying Cause Of Death

Abstract On-going public health surveillance efforts in sickle cell disease (SCD) are critical for understanding the course and outcomes of this disease over time. Once nearly universally fatal by adolescence, many patients are living well into adulthood and sometimes into retirement years. Previous SCD mortality estimates have relied on data from death certificates alone or from deaths of patients receiving care in high volume hematology clinics, resulting in gaps in reporting and potentially biased conclusions. The Registry and Surveillance System for Hemoglobinopathies (RuSH) project collected and linked population-based surveillance data on SCD in California and Georgia from a variety of sources for years 2004-2008. These data sources included administrative records, newborn screening reports and health insurance claims as well as case reports of adult and pediatric patients receiving care in the following large specialty treatment centers: Georgia Comprehensive Sickle Cell Center, Georgia Regents University, Georgia Comprehensive Sickle Cell Center at Grady Health Systems and Children's Healthcare of Atlanta in Georgia, and Children's Hospital Los Angeles and UCSF Benioff Children's Hospital Oakland in California. Cases identified from these combined data sources were linked to death certificates in CA and GA for the same years. Among 12,143 identified SCD cases, 640 were linked to death certificates. Combined SCD mortality rates by age group at time of death are compared to combined mortality rates for all African Americans living in CA and GA. (Figure 1). SCD death rates among children up to age 14 and among adults 65 and older were very similar to those of the overall African American population. In contrast, death rates from young adulthood to midlife were substantially higher in the SCD population. Overall, only 55% of death certificates linked to the SCD cases had SCD listed in any of the cause of death fields. Thirty-four percent (CA) and 37% (GA) had SCD as the underlying cause of death. An additional 22% and 20% (CA and GA, respectively) had underlying causes of death that were not unexpected for SCD patients, including related infections such as septicemia, pulmonary/cardiac causes of death, renal failure and stroke. The remaining 44% (CA) and 43% (GA) had underlying causes of death that were either not related to SCD (e.g., malignancies, trauma) or too vague to be associated with SCD (e.g., generalized pulmonary or cardiac causes of death. Figure 2 shows the number of deaths by state, age group at death and whether the underlying cause of death was SCD specific, potentially related to SCD or not clearly related to SCD. While the number of deaths was too small to use for life expectancy calculations, there were more deaths over age 40 than under age 40 during this five year period. This effort represents a novel, population-based approach to examine mortality in SCD patients. These data suggest that the use of death certificates alone to identify deceased cases may not capture all-cause mortality among all SCD patients. Additional years of surveillance are needed to provide better estimates of current life expectancy and the ability to track and monitor changes in mortality over time. On-going surveillance of the SCD population is required to monitor changes in mortality and other outcomes in response to changes in treatments, standards of care and healthcare policy and inform advocacy efforts. This work was supported by the US Centers for Disease Control and Prevention and the National Heart, Lung and Blood Institute, cooperative agreement numbers U50DD000568 and U50DD001008. Figure 1: SCD-Specific & Overall African American Mortality Rates in CA and GA, 2004 – 2008. Figure 1:. SCD-Specific & Overall African American Mortality Rates in CA and GA, 2004 – 2008. Figure 2: Deaths (Count) Among Individuals with SCD in CA and GA, by Age Group and Underlying Cause of Death, 2004-2008 (N=615) Figure 2:. Deaths (Count) Among Individuals with SCD in CA and GA, by Age Group and Underlying Cause of Death, 2004-2008 (N=615) Disclosures No relevant conflicts of interest to declare.

Download Full-text

Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study

BMJ Open ◽

10.1136/bmjopen-2019-035767 ◽

2020 ◽

Vol 10 (8) ◽

pp. e035767

Author(s):

Christopher M DeGiorgio ◽

Ashley Curtis ◽

Armen Carapetian ◽

Dominic Hovsepian ◽

Anusha Krishnadasan ◽

...

Keyword(s):

Heart Disease ◽

Vascular Dementia ◽

Ischaemic Heart Disease ◽

Cause Of Death ◽

Causes Of Death ◽

Mortality Rates ◽

Population Based ◽

All Cause Mortality ◽

The Usa ◽

Underlying Causes

IntroductionEpilepsy mortality rates are rising. It is unknown whether rates are rising due to an increase in epilepsy prevalence, changes in epilepsy causes of death, increase in the lethality or epilepsy or failures of treatment. To address these questions, we compare epilepsy mortality rates in the USA with all-cause and all-neurological mortality for the years 1999 to 2017.ObjectivesTo determine changes in US epilepsy mortality rates versus all-cause mortality, and to evaluate changes in the leading causes of death in people with epilepsy.DesignRetrospective population-based multiple cause-of-death study.Primary outcomeChange in age-adjusted epilepsy mortality rates compared with mortality rates for all-cause and all-neurological mortality.Secondary outcomeChanges in the leading causes of death in epilepsy.ResultsFrom 1999 to 2017, epilepsy mortality rates in the USA increased 98.8%, from 5.83 per million in 1999 to 11.59 per million (95% CI 88.2%–110.0%), while all-cause mortality declined 16.4% from 8756.34 per million to 7319.17 per million (95% CI 16.3% to 16.6%). For the same period, all-neurological mortality increased 80.8% from 309.21 to 558.97 per million (95% CI 79.4%–82.1%). The proportion of people with epilepsy who died due to neoplasms, vascular dementia and Alzheimer’s increased by 52.3%, 210.1% and 216.8%, respectively. During the same period, the proportion who died due to epilepsy declined 27.1%, while ischaemic heart disease as a cause of death fell 42.6% (p<0.001).ConclusionsEpilepsy mortality rates in the USA increased significantly from 1999 to 2017. Likely causes include increases in all-neurological mortality, increased epilepsy prevalence and changes in the underlying causes of death in epilepsy, led by increases in vascular dementia and Alzheimer’s. An important finding is that ischaemic heart disease and epilepsy itself are declining as underlying causes of death in people with epilepsy.

Download Full-text

Causes of Death After Colorectal Cancer Diagnosis: A Population-Based Study

Frontiers in Oncology ◽

10.3389/fonc.2021.647179 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yuqian Feng ◽

Huimin Jin ◽

Kaibo Guo ◽

Harpreet S. Wasan ◽

Shanming Ruan ◽

...

Keyword(s):

Colorectal Cancer ◽

Cause Of Death ◽

Causes Of Death ◽

Total Mortality ◽

Population Based ◽

First Year ◽

Patients With Cancer ◽

Risk Of Death ◽

Common Causes ◽

Standardized Mortality Ratios

Background: Non-cancer causes of death in patients with colorectal cancer (CRC) have not received much attention until now. The purpose of the current study is to investigate the non-cancer causes of death in patients with CRC at different periods of latency.Methods: Eligible patients with CRC were included from the Surveillance, Epidemiology, and End Results (SEER) database, and standardized mortality ratios (SMRs) were calculated using the SEER*Stat software 8.3.8.Results: A total of 475,771 patients with CRC were included, of whom 230,841 patients died during the follow-up period. Within 5 years, CRC was the leading cause of death. Over time, non-cancer causes of death account for an increasing proportion. When followed up for more than 10 years, non-cancer deaths accounted for 71.9% of all deaths worldwide. Cardiovascular diseases were the most common causes of non-cancer deaths, accounting for 15.4% of the total mortality. Patients had a significantly higher risk of death from septicemia within the first year after diagnosis compared with the general population (SMR, 3.39; 95% CI, 3.11–3.69). Within 5–10 years after CRC diagnosis, patients had a significantly higher risk of death from diabetes mellitus (SMR, 1.27; 95% CI, 1.19–1.36). During the course of more than 10 years, patients with CRC had a significantly higher risk of death from atherosclerosis (SMR 1.47; 95% CI, 1.11–1.9).Conclusions: Although CRC has always been the leading cause of death in patients with CRC, non-cancer causes of death should not be ignored. For patients with cancer, we should not only focus on anti-tumor therapies but also pay attention to the occurrence of other risks to prevent and manage them in advance.

Download Full-text

Incidence, Prevalence, Mortality, and Causes of Death in Waldenström Macroglobulinemia in South Korea: A Nationwide, Population-Based Study

Blood ◽

10.1182/blood-2018-99-112773 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5654-5654

Author(s):

Seri Jeong ◽

Seom Gim Kong ◽

Dajung Kim ◽

Ho Sup Lee

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

South Korea ◽

Cell Transplantation ◽

Cause Of Death ◽

Causes Of Death ◽

Population Based ◽

Waldenström Macroglobulinemia ◽

Waldenstrom Macroglobulinemia ◽

Incidence Prevalence

Abstract Backgroud: Studies investigating the epidemiology of Waldenström macroglobulinemia (WM) in Asia are scarce. The aim of this study was to provide the epidemiological and clinical features of WM in South Korea at a national level, including incidence, prevalence, mortality, survival with competing risks, and causes of death. Methods: We used a national, population-based database maintained by the Health Insurance Review and Assessment Service, which includes information on all WM patients, diagnosed based on uniform criteria from 2003 to 2016. Results: The total number of patients newly diagnosed with WM was 429 during study period with a female to-male ratio of 3.2. The incidence from 2003 to 2016 increased from 0.03 to 0.11 per 105, and the prevalence in 2016 was 0.42 per 105. A total of 217 WM patients died during the study period (standardized mortality ratio =22.07) and the overall survival (OS) of WM patients was 47.5%. In the multivariate analysis, a significant factor associated with a worse OS was older age, whereas stem cell transplantation showed a better outcome (hazard ratio = 0.163; P = 0.0109). WM was the most common cause of death (n = 173; 79.7%), followed by other malignant neoplasms (n= 21; 9.7%). Conclusions: The national incidence of WM in Korea, a racially homogeneous country of Asia, was lower than that in previous reports from other countries, reflecting ethnic disparities. However, the incidence increased and mortality was the highest ever reported. The main cause of death was WM itself and stem cell transplantation was considerably effective. This study reflects the need for greater awareness of WM, particularly in Asian countries. Disclosures No relevant conflicts of interest to declare.

Download Full-text

EPID-29. CAUSES OF DEATH FOR PRIMARY BRAIN AND CNS TUMOR PATIENTS IN THE UNITED STATES (2001 – 2016): A POPULATION BASED STUDY

Neuro-Oncology ◽

10.1093/neuonc/noaa215.347 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii84-ii85

Author(s):

Maria Penuela ◽

Nirav Patil ◽

Gino Cioffi ◽

Carol Kruchko ◽

Jill S Barnholtz-Sloan

Keyword(s):

Brain Tumor ◽

Cause Of Death ◽

Causes Of Death ◽

Malignant Tumors ◽

Cancer Registries ◽

Population Based ◽

Cns Tumors ◽

Tumor Patients ◽

Factors Associated ◽

Specific Mortality

Abstract BACKGROUND Population-based data on the various causes of death among Primary Brain and CNS tumor patients are lacking. We evaluated the causes of death for all eligible patients using the National Program of Cancer Registries (NPCR) data. METHODS The population-based cancer survival data collected by the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) were used to analyze the causes of death for patients of all ages with primary brain and CNS tumors diagnosed between 2001 and 2016. Patients for whom the cause of death was not listed on the death certificate or whose state death certificate was not available were excluded. Additional analyses to identify factors associated with brain tumor-specific mortality for the most common malignant (Glioblastoma) and non-malignant (Meningioma) were performed using univariable and multivariable logistic regression analysis. RESULTS Major cause of death for patients with malignant tumors was death due to brain and other CNS tumors (49.29%), and for non-malignant tumors were other benign and malignant tumors (31.5%) and heart disease (17.9%). Overall mortality was 36.4% (n=331,953) in patients with Primary Brain and CNS Tumors during the study period. Specifically, 163,621 (49.29%) patients died due to brain and other CNS tumors. A significant proportion of patients with malignant tumors had brain tumor-specific mortality compared to non-malignant tumors (75.4% in malignant vs 4.2% in non-malignant). The factors associated with brain specific mortality in Glioblastoma patients were Age (p< 0.001), Race (p< 0.001) and Primary Site (p< 0.001). Further, the factors associated with brain specific mortality in Non-malignant Meningioma patients were Age (p< 0.001), Sex (p< 0.001), Race (p< 0.001) and Primary Site (P< 0.001). CONCLUSION Cause of death attributed to the brain tumor was significantly higher in malignant brain tumors compared to non-malignant brain tumors.

Download Full-text

Causes of death and comorbidities in hospitalized patients with COVID-19

Scientific Reports ◽

10.1038/s41598-021-82862-5 ◽

2021 ◽

Vol 11 (1) ◽

Cited By ~ 3

Author(s):

Sefer Elezkurtaj ◽

Selina Greuel ◽

Jana Ihlow ◽

Edward Georg Michaelis ◽

Philip Bischoff ◽

...

Keyword(s):

Cause Of Death ◽

Causes Of Death ◽

Pulmonary Infection ◽

Diffuse Alveolar Damage ◽

University Hospital ◽

Health Conditions ◽

Teaching Hospitals ◽

Increased Risk ◽

Clinical Records ◽

Full Body

AbstractInfection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has been associated with more than two million deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing, which can be reliably established by autopsy only. We performed full body autopsies on 26 patients that had died after SARS-CoV-2 infection and COVID-19 at the Charité University Hospital Berlin, Germany, or at associated teaching hospitals. We systematically evaluated causes of death and pre-existing health conditions. Additionally, clinical records and death certificates were evaluated. We report findings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID-19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to diffuse alveolar damage presented as immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients. Our findings reveal that causes of death were directly related to COVID-19 in the majority of decedents, while they appear not to be an immediate result of preexisting health conditions and comorbidities. We therefore suggest that the majority of patients had died of COVID-19 with only contributory implications of preexisting health conditions to the mechanism of death.

Download Full-text

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

Conflict and Health ◽

10.1186/s13031-021-00385-2 ◽

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.

Download Full-text

Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03512-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qun Miao ◽

Sandra Dunn ◽

Shi Wu Wen ◽

Jane Lougheed ◽

Jessica Reszel ◽

...

Keyword(s):

Socioeconomic Status ◽

Congenital Heart Disease ◽

Heart Disease ◽

Household Income ◽

Congenital Heart ◽

Population Based ◽

Income Poverty ◽

Lower Odds ◽

Logistic Regression Models ◽

Chd Risk

Abstract Background This study aimed to examine the relationships between various maternal socioeconomic status (SES) indicators and the risk of congenital heart disease (CHD). Methods This was a population-based retrospective cohort study, including all singleton stillbirths and live births in Ontario hospitals from April 1, 2012 to March 31, 2018. Multivariable logistic regression models were performed to examine the relationships between maternal neighbourhood household income, poverty, education level, employment and unemployment status, immigration and minority status, and population density and the risk of CHD. All SES variables were estimated at a dissemination area level and categorized into quintiles. Adjustments were made for maternal age at birth, assisted reproductive technology, obesity, pre-existing maternal health conditions, substance use during pregnancy, rural or urban residence, and infant’s sex. Results Of 804,292 singletons, 9731 (1.21%) infants with CHD were identified. Compared to infants whose mothers lived in the highest income neighbourhoods, infants whose mothers lived in the lowest income neighbourhoods had higher likelihood of developing CHD (adjusted OR: 1.29, 95% CI: 1.20–1.38). Compared to infants whose mothers lived in the neighbourhoods with the highest percentage of people with a university or higher degree, infants whose mothers lived in the neighbourhoods with the lowest percentage of people with university or higher degree had higher chance of CHD (adjusted OR: 1.34, 95% CI: 1.24–1.44). Compared to infants whose mothers lived in the neighbourhoods with the highest employment rate, the odds of infants whose mothers resided in areas with the lowest employment having CHD was 18% higher (adjusted OR: 1.18, 95% CI: 1.10–1.26). Compared to infants whose mothers lived in the neighbourhoods with the lowest proportion of immigrants or minorities, infants whose mothers resided in areas with the highest proportions of immigrants or minorities had 18% lower odds (adjusted OR: 0.82, 95% CI: 0.77–0.88) and 16% lower odds (adjusted OR: 0.84, 95% CI: 0.78–0.91) of CHD, respectively. Conclusion Lower maternal neighbourhood household income, poverty, lower educational level and unemployment status had positive associations with CHD, highlighting a significant social inequity in Ontario. The findings of lower CHD risk in immigrant and minority neighbourhoods require further investigation.

Download Full-text