scholarly journals Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy: A Regionwide Registry Study

2020 ◽  
pp. ASN.2020060875
Author(s):  
Johan De Meester ◽  
Dirk De Bacquer ◽  
Maarten Naesens ◽  
Bjorn Meijers ◽  
Marie M. Couttenye ◽  
...  
Keyword(s):  
General Population ◽  
Excess Mortality ◽  
Mortality Rates ◽  
Incidence Rates ◽  
Registry Study ◽  
Additional Risk ◽  
Mortality Burden ◽  
Kidney Replacement Therapy ◽  
Expected Mortality ◽  
Chronic Comorbidities

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial.MethodsTo describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19).Results At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015–2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection.ConclusionsMortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic’s overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.

Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?

2017 ◽  
Vol 77 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Marie Holmqvist ◽  
Lotta Ljung ◽  
Johan Askling
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Excess Mortality ◽  
Disease Onset ◽  
Mortality Rates ◽  
Calendar Time ◽  
Risk Of Death ◽  
Quality Register ◽  
Increased Risk ◽  
New Onset

ObjectiveTo investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death.MethodsUsing an extensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onset RA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register.Results17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently.ConclusionsDespite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.

Excess mortality associated with the 2009 pandemic of influenza A(H1N1) in Hong Kong

2011 ◽  
Vol 140 (9) ◽  
pp. 1542-1550 ◽  
Author(s):  
L. YANG ◽  
K. P. CHAN ◽  
B. J. COWLING ◽  
S. S. CHIU ◽  
K. H. CHAN ◽  
...  
Keyword(s):  
Hong Kong ◽  
Influenza A ◽  
Excess Mortality ◽  
Seasonal Influenza ◽  
Mortality Rates ◽  
Timely Manner ◽  
Mortality Burden ◽  
Influenza A H1n1 ◽  
Excess Deaths ◽  
Modelling Approach

SUMMARYReliable estimates of the burden of 2009 pandemic influenza A(pH1N1) cannot be easily obtained because only a small fraction of infections were confirmed by laboratory tests in a timely manner. In this study we developed a Poisson prediction modelling approach to estimate the excess mortality associated with pH1N1 in 2009 and seasonal influenza in 1998–2008 in the subtropical city Hong Kong. The results suggested that there were 127 all-cause excess deaths associated with pH1N1, including 115 with cardiovascular and respiratory disease, and 22 with pneumonia and influenza. The excess mortality rates associated with pH1N1 were highest in the population aged ⩾65 years. The mortality burden of influenza during the whole of 2009 was comparable to those in the preceding ten inter-pandemic years. The estimates of excess deaths were more than twofold higher than the reported fatal cases with laboratory-confirmed pH1N1 infection.

scholarly journals High excess mortality in areas with young and socially vulnerable populations during the COVID-19 outbreak in Stockholm Region, Sweden

2020 ◽  
Vol 5 (10) ◽  
pp. e003595 ◽  
Author(s):  
Amaia Calderón-Larrañaga ◽  
Davide L Vetrano ◽  
Debora Rizzuto ◽  
Tom Bellander ◽  
Laura Fratiglioni ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Excess Mortality ◽  
Age Distribution ◽  
Mortality Rates ◽  
Mortality Data ◽  
Gainful Employment ◽  
Viral Spread ◽  
Lower Socioeconomic ◽  
Expected Mortality ◽  
Old Men

IntroductionWe aimed to describe the distribution of excess mortality (EM) during the first weeks of the COVID-19 outbreak in the Stockholm Region, Sweden, according to age, sex and sociodemographic context.MethodsWeekly all-cause mortality data were obtained from Statistics Sweden for the period 1 January 2015 to 17 May 2020. EM during the first 20 weeks of 2020 was estimated by comparing observed mortality rates with expected mortality rates during the five previous years (N=2 379 792). EM variation by socioeconomic status (tertiles of income, education, Swedish-born, gainful employment) and age distribution (share of 70+-year-old persons) was explored based on Demographic Statistics Area (DeSO) data.ResultsEM was first detected during the week of 23–29 March 2020. During the peak week of the epidemic (6–12 April 2020), an EM of 150% was observed (152% in 80+-year-old women; 183% in 80+-year-old men). During the same week, the highest EM was observed for DeSOs with lowest income (171%), lowest education (162%), lowest share of Swedish-born (178%) and lowest share of gainfully employed residents (174%). EM was further increased in areas with higher versus lower proportion of younger people (magnitude of increase: 1.2–1.7 times depending on socioeconomic measure).ConclusionLiving in areas characterised by lower socioeconomic status and younger populations was linked to excess mortality during the COVID-19 pandemic in the Stockholm Region. These conditions might have facilitated viral spread. Our findings highlight the well-documented vulnerability linked to increasing age and sociodemographic context for COVID-19–related death.

scholarly journals Mortality in Norway and Sweden before and after the Covid-19 outbreak: a cohort study

2020 ◽  
Author(s):  
Frederik E Juul ◽  
Henriette C Jodal ◽  
Ishita Barua ◽  
Erle Refsum ◽  
Ørjan Olsvik ◽  
...  
Keyword(s):  
Excess Mortality ◽  
Mortality Rates ◽  
List Type ◽  
School Closures ◽  
Epidemic Period ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Before And After ◽  
Rate Ratios ◽  
Expected Mortality

AbstractObjectivesNorway and Sweden are similar countries regarding ethnicity, socioeconomics and health care. To combat Covid-19, Norway implemented extensive measures such as school closures and lock-downs, while Sweden has been criticised for relaxed measures against Covid-19. We compared the effect of the different national strategies on all-cause and Covid-19 associated mortality.DesignRetrospective cohort.SettingThe countries Norway and Sweden.ParticipantsAll inhabitants.Main outcome measuresWe calculated weekly mortality rates (MR) with 95% confidence intervals (CI) per 100,000 individuals as well as mortality rate ratios (MRR) comparing the epidemic year (29th July, 2019 to 26th July, 2020) to the four preceding years (July 2015 to July 2019). We also compared Covid-19 associated deaths and mortality rates for the weeks of the epidemic in Norway and Sweden (16th March to 26th July, 2020).ResultsIn Norway, mortality rates were stable during the first three 12-month periods of 2015/16; 2016/17 and 2017/18 (MR 14.8 to 15.1 per 100,000), and slightly lower in the two most recent periods including during epidemic period (2018/19 and 2019/20; 14.5 per 100,000). In Sweden, all-cause mortality was stable during the first three 12-month periods of 2015/16; 2016/17 and 2017/18 (MR 17.2 to 17.5 per 100,000), but lower in the year 2018/19 immediately preceding the epidemic (16.2 per 100,000). Covid-19 associated mortality rates were 0.2 per 100,000 (95%CI 0.1 to 0.4) in Norway and 2.9 (95%CI 1.9 to 3.9) in Sweden. The increase in mortality was confined to individuals in 70 years or older.ConclusionsAll-cause mortality remained unaltered in Norway. In Sweden, the observed increase in all-cause mortality during Covid-19 was partly due to a lower than expected mortality preceding the epidemic and the observed excess mortality, was followed by a lower than expected mortality after the first Covid-19 wave. This may suggest mortality displacement.Strengths and limitations of this studyCompares two similar contries in all aspects but the handling of the Covid-19 epidemicEvaluates the mortality for several years before and during the epidemicProvides a possible explanation of the observed mortality changesDiscusses the socioeconomic effects of the different strategies in the two countriesDoes not evaluate cause-specific mortality

scholarly journals Changes in Excess Mortality from End Stage Renal Disease in the United States from 1995 to 2013

2017 ◽  
Vol 13 (1) ◽  
pp. 91-99 ◽  
Author(s):  
Bethany J. Foster ◽  
Mark M. Mitsnefes ◽  
Mourad Dahhou ◽  
Xun Zhang ◽  
Benjamin L. Laskin
Keyword(s):  
United States ◽  
General Population ◽  
Excess Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Excess Risk ◽  
Calendar Time ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Functioning Kidney

Background and objectivesIndividuals with ESRD have a very high risk of death. Although mortality rates have decreased over time in ESRD, it is unknown if improvements merely reflect parallel increases in general population survival. We, therefore, examined changes in the excess risk of all-cause mortality—over and above the risk in the general population—among people treated for ESRD in the United States from 1995 to 2013. We hypothesized that the magnitude of change in the excess risk of death would differ by age and RRT modality.Design, setting, participants, & measurementsWe used time-dependent relative survival models including data from persons with incident ESRD as recorded in the US Renal Data System and age-, sex-, race-, and calendar year–specific general population mortality rates from the Centers for Disease Control and Prevention. We calculated relative excess risks (analogous to hazard ratios) to examine the association between advancing calendar time and the primary outcome of all-cause mortality.ResultsWe included 1,938,148 children and adults with incident ESRD from 1995 to 2013. Adjusted relative excess risk per 5-year increment in calendar time ranged from 0.73 (95% confidence interval, 0.69 to 0.77) for 0–14 year olds to 0.88 (95% confidence interval, 0.88 to 0.88) for ≥65 year olds, meaning that the excess risk of ESRD-related death decreased by 12%–27% over any 5-year interval between 1995 and 2013. Decreases in excess mortality over time were observed for all ages and both during treatment with dialysis and during time with a functioning kidney transplant (year by age and year by renal replacement modality interactions were both P<0.001), with the largest relative improvements observed for the youngest persons with a functioning kidney transplant. Absolute decreases in excess ESRD-related mortality were greatest for the oldest persons.ConclusionsThe excess risk of all-cause mortality among people with ESRD, over and above the risk in the general population, decreased significantly between 1995 and 2013 in the United States.

scholarly journals Excess mortality due to Covid-19? A comparison of total mortality in 2020 with total mortality in 2016 to 2019 in Germany, Sweden and Spain

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255540
Author(s):  
Bernd Kowall ◽  
Fabian Standl ◽  
Florian Oesterling ◽  
Bastian Brune ◽  
Marcus Brinkmann ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Confidence Intervals ◽  
Excess Mortality ◽  
Total Mortality ◽  
Mortality Rates ◽  
Health Consequences ◽  
Demographic Development ◽  
Standardized Mortality Ratios ◽  
Expected Mortality ◽  
Overall Mortality

Introduction Excess mortality is a suitable indicator of health consequences of COVID-19 because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 with the overall mortality in 2016 to 2019 in Germany, Sweden and Spain. Contrary to other studies, we also took the demographic development between 2016 and 2020 and increasing life expectancy into account. Methods Using death and population figures from the EUROSTAT database, we estimated weekly and cumulative Standardized Mortality Ratios (SMR) with 95% confidence intervals (CI) for the year 2020. We applied two approaches to calculate weekly numbers of death expected in 2020: first, we used mean weekly mortality rates from 2016 to 2019 as expected mortality rates for 2020, and, second, to consider increasing life expectancy, we calculated expected mortality rates for 2020 by extrapolation from mortality rates from 2016 to 2019. Results In the first approach, the cumulative SMRs show that in Germany and Sweden there was no or little excess mortality in 2020 (SMR = 0.976 (95% CI: 0.974–0.978), and 1.030 (1.023–1.036), respectively), while in Spain the excess mortality was 14.8% (1.148 (1.144–1.151)). In the second approach, the corresponding SMRs for Germany and Sweden increased to 1.009 (1.007–1.011) and 1.083 (1.076–1.090), respectively, whereas results for Spain were virtually unchanged. Conclusion In 2020, there was barely any excess mortality in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration of increasing life expectancy.

Mortality related to ambulatory care sensitive hospitalisations in Finland

2020 ◽  
Vol 48 (8) ◽  
pp. 839-846
Author(s):  
Veli-Matti Partanen ◽  
Martti Arffman ◽  
Kristiina Manderbacka ◽  
Ilmo Keskimäki
Keyword(s):  
Primary Care ◽  
General Population ◽  
Ambulatory Care ◽  
Excess Mortality ◽  
Hospital Admissions ◽  
Mortality Rates ◽  
Ambulatory Care Sensitive Conditions ◽  
Ambulatory Care Sensitive Condition ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Aims: Hospitalisations for ambulatory care sensitive conditions are used as an outcome indicator of access to and quality of primary care. Evidence on mortality related to these hospitalisations is scarce. This study analysed the effect of ambulatory care sensitive condition hospitalisations to subsequent mortality and time or geographical trends in the mortality indicating variations in ambulatory care sensitive conditions outcomes. Methods: This retrospective cohort study used individual-level data from national registers concerning ambulatory care sensitive condition hospitalisations. Crude and age-adjusted 365-day mortality rates for the first ambulatory care sensitive condition-related admission were calculated for vaccine-preventable, acute, and chronic ambulatory care sensitive conditions separately, and for three time periods stratified by gender. The mortality rates were also compared to mortality in the general Finnish population to assess the excess mortality related to ambulatory care sensitive condition hospitalisations. Results: The data comprised a total of 712,904 ambulatory care sensitive condition hospital admissions with the crude 365-day mortality rate of 14.2 per 100 person-years. Mortality for those hospitalised for vaccine-preventable conditions was approximately 10-fold compared to the general population and four-fold in chronic and acute conditions. Of the 10 most common ambulatory care sensitive conditions, bacterial pneumonia and influenza and congestive heart failure were associated with highest age-standardised mortality rates. Conclusions: Hospitalisations for ambulatory care sensitive conditions were shown to be associated with excess mortality in patients compared to the general population. Major differences in mortality were found between different types of ambulatory care sensitive condition admissions. There were also minor differences in mortality between hospital districts. These differences are important to consider when using preventable hospital admissions as an indicator of primary care performance.

Measures of disease occurrence

2020 ◽  
pp. 41-46
Author(s):  
Bendix Carstensen
Keyword(s):  
Mortality Rate ◽  
General Population ◽  
Incidence Rate ◽  
Mortality Rates ◽  
Incidence Rates ◽  
Standardized Mortality Ratio ◽  
Newly Diagnosed ◽  
Disease Occurrence ◽  
Mortality Ratio ◽  
Incident Cases

This chapter provides a brief introduction to some of the most common measures of disease occurrence used in epidemiology, both the empirical and theoretical versions of the measures. It begins with the prevalence of a disease in a population, which is the fraction of the population that has the disease at a given date. The chapter then considers mortality rate, incidence rate, standardized mortality ratio (SMR), and survival. Mortality is typically reported as a number of people that have died in a population of a certain size. Incidence rates are defined exactly as mortality rates, where one just counts incident cases, that is, newly diagnosed cases of a particular disease. Meanwhile, the SMR is a measure of the mortality in a group of persons as compared to the general population. Finally, the survival after diagnosis of a disease is defined as the fraction of diagnosed individuals alive at a given time after diagnosis.

More accurate cancer-related excess mortality through correcting background mortality for extra variables

2019 ◽  
Vol 29 (1) ◽  
pp. 122-136 ◽  
Author(s):  
C Touraine ◽  
N Grafféo ◽  
R Giorgi ◽  
Keyword(s):  
Colon Cancer ◽  
General Population ◽  
Excess Mortality ◽  
Relative Survival ◽  
Type Model ◽  
Extended Model ◽  
Piecewise Constant ◽  
Cancer Registry Data ◽  
Background Mortality ◽  
Expected Mortality

Relative survival methods used to estimate the excess mortality of cancer patients rely on the background (or expected) mortality derived from general population life tables. These methods are based on splitting the observed mortality into the excess mortality and the background mortality. By assuming a regression model for the excess mortality, usually a Cox-type model, one may investigate the effects of certain covariates on the excess mortality. Some covariates are cancer-specific whereas others are variables that may influence the background mortality as well. The latter should be taken into account in the background mortality to avoid biases in estimating their effects on the excess mortality. Unfortunately, the available life table might not include such variables and, consequently, might provide inaccurate values of the background mortality. We propose a model that uses multiplicative parameters to correct potentially inaccurate background mortality. The model can be seen as an extension of the frequently used Estève model because we assume a Cox-type model for the excess mortality with a piecewise constant baseline function and introduce additional parameters that multiply the background mortality. The original and the extended model are compared, first in a simulation study, then in an application to colon cancer registry data.

Evaluation of the Risk of Relapse in Classical Hodgkin Lymphoma at Event-Free Survival Time Points and Survival Comparison With the General Population in British Columbia

2016 ◽  
Vol 34 (21) ◽  
pp. 2493-2500 ◽  
Author(s):  
Greg Hapgood ◽  
Yvonne Zheng ◽  
Laurie H. Sehn ◽  
Diego Villa ◽  
Richard Klasa ◽  
...  
Keyword(s):  
General Population ◽  
Relative Survival ◽  
Mortality Rates ◽  
Classical Hodgkin Lymphoma ◽  
Event Free Survival ◽  
Free Survival ◽  
Time Points ◽  
Risk Of Death ◽  
Expected Mortality ◽  
Risk Of Relapse

Purpose Studies in classical Hodgkin lymphoma (cHL) typically measure the time to events from diagnosis. We evaluated the risk of relapse at event-free survival time points in cHL and compared the risk of death to expected mortality rates in British Columbia (BC). Methods The BC Cancer Agency Lymphoid Cancer Database was screened to identify all patients age 16 to 69 years diagnosed with cHL between 1989 and 2012 treated with the chemotherapy regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (or equivalent). We compared the observed mortality to the general population using age-, sex-, and calendar period–generated expected mortality rates from BC life-tables. Relative survival was calculated using a conditional approach and expressed as a standardized mortality ratio of observed-to-expected deaths. Results One thousand four hundred two patients were identified; 749 patients were male (53%), the median age was 32 years, and 68% had advanced-stage disease. The median follow-up time was 8.4 years. Seventy-two percent of relapses occurred within the first 2 years of diagnosis. For all patients, the 5-year risk of relapse from diagnosis was 18.1% but diminished to 5.6% for patients remaining event free at 2 years. For advanced-stage patients who were event free at 2 years, the 5-year risk of relapse was only 7.6%, and for those who were event free at 3 years, it was comparable to that of limited-stage patients (4.1% v 2.5%, respectively; P = .07). Furthermore, international prognostic score ≥ 4 and bulky disease were no longer prognostic in patients who were event free at 1 year. Although the relative survival improved as patients remained in remission, it did not normalize compared with the general population. Conclusion Patients with cHL who are event free at 2 years have an excellent outcome regardless of baseline prognostic factors. All patients with cHL had an enduring increased risk of death compared with the general population.

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