The Mortality Effects of Reduced Medicaid Coverage Among International Migrants in Hawaii: 2012–2018

2020 ◽  
Vol 110 (8) ◽  
pp. 1205-1207 ◽  
Author(s):  
Teresa Molina ◽  
Tetine Sentell ◽  
Randall Q. Akee ◽  
Alvin Onaka ◽  
Timothy J. Halliday ◽  
...  
Keyword(s):  
Research Design ◽  
Private Insurance ◽  
Free Association ◽  
Mortality Rates ◽  
Japanese Americans ◽  
Medicaid Program ◽  
Mortality Trends ◽  
Crude Mortality ◽  
International Migrants ◽  
The Impact

Objectives. To study the impact on mortality in Hawaii from the revoked state Medicaid program coverage in March 2015 for most Compact of Free Association (COFA) migrants who were nonblind, nondisabled, and nonpregnant. Methods. We computed quarterly crude mortality rates for COFA migrants, Whites, and Japanese Americans from March 2012 to November 2018. We employed a difference-in-difference research design to estimate the impact of the Medicaid expiration on log mortality rates. Results. We saw larger increases in COFA migrant mortality rates than White mortality rates after March 2015. By 2018, the increase was 43% larger for COFA migrants (P = .003). Mortality trends over this period were similar for Whites and Japanese Americans, who were not affected by the policy. Conclusions. Mortality rates of COFA migrants increased after Medicaid benefits expired despite the availability of state-funded premium coverage for private insurance and significant outreach efforts to reduce the impact of this coverage change.

scholarly journals Age- and Sex-Specific In-Hospital Mortality after Myocardial Infarction in Routine Clinical Practice

2010 ◽  
Vol 2010 ◽  
pp. 1-11 ◽  
Author(s):  
Chizobam Ani ◽  
Deyu Pan ◽  
David Martins ◽  
Bruce Ovbiagele
Keyword(s):  
Myocardial Infarction ◽  
Proportional Hazards ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Mortality Trends ◽  
Male Mortality ◽  
Co Morbidity ◽  
The Impact ◽  
Age And Sex

Background. Literature regarding the influence of age/sex on mortality trends for acute myocardial infarction (AMI) hospitalizations is limited to hospitals participating in voluntary AMI registries.Objective. Evaluate the impact of age and sex on in-hospital AMI mortality using a nationally representative hospital sample.Methods. Secondary data analysis using AMI hospitalizations identified from the Nationwide-Inpatient-Sample (NIS). Descriptive and Cox proportional hazards analysis explored mortality trends by age and sex from 1997–2006 while adjusting for the influence of, demographics, co-morbidity, length of hospital stay and hospital characteristics.Results. From 1997–2006, in-hospital AMI mortality rates decreased across time in all subgroups (), except for males aged <55 years. The greatest decline was observed in females aged <55 years, compared to similarly aged males, mortality outcomes were poorer in 1997-1998 (RR 1.47, 95% CI  =  1.30–1.66), when compared with 2005-2006 (RR 1.03, 95% CI  =  0.90–1.18), adjusted value for trend demonstrated a statistically significant decline in the relative AMI mortality risk for females when compared with males (<0.001).Conclusion. Over the last decade, in-hospital AMI mortality rates declined for every age/sex group except males <55 years. While AMI female-male mortality disparity has narrowed, some room for improvement remains.

Abstract P359: High Blood Pressure in African HIV+ Patients Increases Long-Term Mortality

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Gerald S Bloomfield ◽  
Joseph W Hogan ◽  
Alfred Keter ◽  
Thomas L Holland ◽  
Edwin Sang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Regression Models ◽  
Proportional Hazards ◽  
Mortality Rates ◽  
Sub Saharan Africa ◽  
Proportional Hazards Regression ◽  
Crude Mortality ◽  
Sub Saharan ◽  
The Impact

Background: Patients with human immunodeficiency virus (HIV) in the modern era are at risk of developing cardiovascular diseases. High blood pressure (BP) is common in sub-Saharan Africa, however, global attention in the region has been mostly focused on HIV. The impact of BP on mortality among adults with HIV in this region has not been reported. Objective: The objective was to determine the impact of BP on mortality among HIV seropositive (+) adults without acquired immune deficiency syndrome (AIDS) in Kenya. Methods: We conducted a retrospective analysis of de-identified medical records of the Academic Model Providing Access to Healthcare HIV treatment program between 2005 and 2010. We excluded patients with AIDS, who were <16 or >80 years old, or with data out of acceptable ranges. There were 49,475 HIV+ individuals who satisfied inclusion/exclusion criteria (Figure 1). Missing data for key covariates was addressed by inverse probability weighting. We summarize crude mortality rates across BP categories, separately by gender. We used proportional hazards regression models to characterize the effect of BP on mortality, adjusting for baseline demographic and clinical factors. We subdivided the sample according to those who were clinically stable, defined as having ≥CD4 350 or WHO Stage 1. Results: Our sample was 74% (36,616 of 49,475) women. Mortality rates for men and women were 3.8/100 and 1.8/100 person-years, respectively. Crude mortality rate among clinically stable men was higher with systolic BP ≥140 mmHg (3.0, 95% CI: 1.6-5.5) than with normal systolic BP (1.1, 95% CI: 0.7-1.7). In weighted proportional hazards regression models, clinically stable men with systolic BP ≥140 mmHg carried a higher mortality risk than normotensive men (HR: 2.39, 95% CI: 0.94 to 6.08). Conclusions: Blood pressure is an important aspect of the care of HIV+ patients in sub-Saharan Africa. High systolic BP is associated with mortality among clinically stable men without AIDS. Further investigation into cause of death in warranted.

scholarly journals Comparison of Deaths Rates for COVID-19 across Europe During the First Wave of the COVID-19 Pandemic

2020 ◽  
Vol 8 ◽  
Author(s):  
Leonardo Villani ◽  
Martin McKee ◽  
Fidelia Cascini ◽  
Walter Ricciardi ◽  
Stefania Boccia
Keyword(s):  
European Union ◽  
United Kingdom ◽  
Mortality Rates ◽  
The European Union ◽  
Specific Data ◽  
Lombardy Region ◽  
Early Stages ◽  
Crude Mortality ◽  
The Many ◽  
The Impact

Background: Europe overall suffered greatly in the early stages of the COVID-19 pandemic but the impact of different countries varied. Italy was in the forefront, but there too there were differences, with the Lombardy region the epicentre of the pandemic.Methods: We report Crude Mortality Rates (CMRs) from deaths reported as due to COVID-19 and, in five countries where age-specific data are available, Standardized Mortality Rates (SMRs) in the European Union and United Kingdom.Results: As of 30th August 2020, Belgium was the country with the highest cumulative CMR (86.3/100,000), but the Lombardy region reached almost double this figure (167.6/100,000), far ahead of the corresponding figure for the rest of Italy at 37.0/100,000. SMRs could be calculated for five countries (Italy, Portugal, Sweden, Germany, and Netherlands). Among them, Sweden had the highest SMR (61.6/100,000). The corresponding figures for Italy, Netherlands, Portugal and Germany were 50.2, 41.4, 15.9, and 10.1 per 100,000, respectively.Conclusion: It is clear that countries within Europe have performed very differently in their responses to the COVID-19 pandemic, but the many limitations in the available data must be addressed before a definitive assessment of the reasons for these differences can be made.

Mortality Rates, Prevalence of Malnutrition, and Prevalence of Lost Pregnancies among the Drought-Ravaged Population of Tete Province, Mozambique

2007 ◽  
Vol 22 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Andre M.N. Renzaho
Keyword(s):  
Mortality Rate ◽  
Mortality Rates ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
Food Aid ◽  
Emergency Relief ◽  
Humanitarian Response ◽  
Crude Mortality ◽  
The Impact ◽  
Hiv Aids

AbstractBackground:Tete Province, Mozambique has experienced chronic food insecurity and a dramatic fall in livestock numbers due to the cyclic problems characterized by the floods in 2000 and severe droughts in 2002 and 2003. The Province has been a beneficiary of emergency relief programs, which have assisted >22% of the population. However, these programs were not based on sound epidemiological data, and they have not established baseline data against which to assess the impact of the programs.Objective:The objective of this study was to document mortality rates, causes of death, the prevalence of malnutrition, and the prevalence of lost pregnancies after 2.5 years of humanitarian response to the crisis.Methods:A two-stage, 30-cluster household survey was conducted in the Cahora Bassa and Changara districts from 22 October to 08 November 2004. A total of 838 households were surveyed, with a population size of 4,688 people.Results:Anthropometric data were collected among children 6–59 months of age. In addition, crude mortality rates (crude mortality rates), under five mortality rates (under 5 mortality rate), causes of deaths, and prevalence of lost pregnancies were determined among the sample population. The prevalence of malnutrition was 8.0% (95% confidence interval (CI) = 6.2–9.8%) for acute malnutrition, 26.9% (95% CI = 24.0–29.9%) for being underweight, and 37.0% (95% CI = 33.8–40.2%) for chronic malnutrition. Boys were more likely to be under-weight than were girls (odds ratio (OR) = 1.34; 95% CI = 1.00, 1.82;p <0.05) after controlling for a, household size, and food aid beneficiary status. Similarly, children 30–59 months of age were significantly less likely to suffer from acute malnutrition (OR = 0.45; 95% CI = 0.26, 0.79; p <0.01) and less likely to be underweight (OR = 0.37; 95% CI = 0.27, 0.51;p <0.01) than children 6–29 months of a, after adjusting for the other, aforementioned factors. The proportion of lost pregnancies was estimated at 7.7% (95% CI = 4.5–11.0%). A total of 215 deaths were reported during the year preceding the survey. Thirty-nine (18.1%) children <5 years of age died. The CMR was 1.23/10,000/day (95% CI = 1.08–1.38), and an under 5 mortality rate was 1.03/10,000/day (95% CI = 0.71–1.35). Diarrheal diseases, malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) accounted for more than two-thirds of all deaths.Conclusions:The observed CMR in Tete Province, Mozambique is three times higher than the baseline rate for sub-Saharan Africa and 1.4 times higher than the CMR cut-off point used to define excess mortality in emergencies.The current humanitarian response in Tete Province would benefit from an improved alignment of food aid programming in conjunction with diarrheal disease control, HIV/AIDS, and malaria prevention and treatment programs. The impact of the food programs would be improved if mutually acceptable food aid program objectives, verifiable indicators relevant to each objective, and beneficiary targets and selection criteria are developed. Periodic re-assessments and evaluations of the impact of the program and evidenced-based decision-making urgently are needed to avert a chronic dependency on food aid.

P119 The impact of minimal alcohol price policy on premature CVD mortality in Kazakhstan

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
K Davletov ◽  
A Mereke ◽  
S Tussupbekova ◽  
A Tolegenova
Keyword(s):  
Mortality Rates ◽  
Price Policy ◽  
Mortality Decline ◽  
Age Group ◽  
Policy Action ◽  
Mortality Trends ◽  
The Impact ◽  
Alcohol Price ◽  
Cvd Mortality ◽  
Alcohol Sales

Abstract Background In Kazakhstan, premature cardiovascular (CVD) mortality is one of the highest in the world despite the dramatic decline of CVD mortality since 2006.  Our previous research found that alcohol consumption was the main determinant of premature CVD mortality in Kazakhstan and the decrease of alcohol use was the main factor influencing the CVD mortality decline. Purpose With the aim of examining the impact of minimal price changes for strong spirits (vodka) and alcohol sales on premature CVD mortality in 2006-2014, we compared age-specific CVD mortality for the age group 19-49 with changes in the minimal price of strong spirit (vodka) and alcohol sales. Methods Age-specific CVD mortality rates in age group 19-49 in Kazakhstan were obtained from the Global Burden of Disease database and explored with regard to changes in minimal prices of vodka and alcohol sales in Kazakhstan over this period. Results Age-standardized CVD mortality rates in age group 19-49 declined by 47% from 2006 to 2014, for both men and women.  However, we observed the plateauing effect in CVD mortality trend in 2015-2017. These mortality trends coincided with the sharp increase in minimal vodka prices and decrease or flatten in alcohol sales in 2006-2014 period and consequent minimal price decrease and plateauing in 2015-2017 that was accompanied by increase of alcohol sales in this period. Conclusions Our findings indicate that public health measures such as tax increases for strong spirits can be a very effective CVD prevention strategy in Kazakhstan and other former USSR countries, where similar mortality trends can be observed. Unfortunately, this mortality decline was not sustained over time. We believe it happened due to a weakened policy in regard to the minimal alcohol prices.  Therefore, there is much scope for further policy action in this area. Abstract P119 Figure. CVD and Alcohol price

scholarly journals The impact of inequalities and health expenditure on mortality due to oral and oropharyngeal cancer in Brazil

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amanda Ramos da Cunha ◽  
Alessandro Bigoni ◽  
José Leopoldo Ferreira Antunes ◽  
Fernando Neves Hugo
Keyword(s):  
Health Services ◽  
Oropharyngeal Cancer ◽  
Government Expenditure ◽  
Health Spending ◽  
Mortality Rates ◽  
Mortality Data ◽  
Mortality Trends ◽  
Annual Percent Change ◽  
The Government ◽  
The Impact

AbstractThis study aims to assess the magnitude and trend of mortality rates due to oral (OC) and oropharyngeal cancer (OPC) in the 133 Intermediate Geographic Regions (IGR) of Brazil between 1996 and 2018 and to analyze its association with sociodemographic variables and provision of health services. It also aims to compare the trend of mortality from neoplasms that have been reported as associated with HPV (OPC) with the trend of neoplasms that have been reported as not associated with HPV (OC). We obtained mortality data from the Mortality Information System in Brazil and analyzed the trends using the Prais-Winsten method. Then, we assessed the relationship between mortality trends and socioeconomic, health spending, and health services provision variables. The median of the annual percent change of the country’s mortality rates was 0.63% for OC and 0.83% for OPC. Trends in mortality in the IGRs correlated significantly with the Human Development Index and government expenditure on ambulatory health care and hospitalizations. Mortality from both types of cancer decreased in those IGR in which the government spent more on health and in the more socioeconomically developed ones. This study found no epidemiological indication that HPV plays the leading etiological factor in OPC in Brazil.

scholarly journals The Impact of Inequalities and Health Expenditure on Mortality Due to Oral and Oropharyngeal Cancer: A 20-Year Trend Analysis

2020 ◽  
Author(s):  
Amanda Cunha ◽  
Alessandro Bigoni ◽  
José Antunes ◽  
Fernando Hugo
Keyword(s):  
Health Services ◽  
Oropharyngeal Cancer ◽  
Government Expenditure ◽  
Health Spending ◽  
Mortality Rates ◽  
Mortality Data ◽  
Mortality Trends ◽  
Oral And Oropharyngeal Cancer ◽  
The Government ◽  
The Impact

Abstract Objectives: To assess the magnitude and trend of mortality rates due to oral (OC) and oropharyngeal cancer (OPC) in the 133 Intermediate Geographic Regions (IGR) of Brazil between 1996 and 2018 and to analyze its association with sociodemographic variables and provision of health services. It also aims to compare the trend of mortality from neoplasms that have been reported as associated with HPV (OPC) with the trend of neoplasms that have been reported as not associated with HPV (OC). Methods: We obtained mortality data from the Mortality Information System in Brazil and analyzed the trends using the Prais-Winsten method. Then, we assessed the relationship between mortality trends and socioeconomic, health spending, and health services provision variables. Results: The median of the APC of the country’s mortality rates was 0.63% for OC and 0.83% for OPC. Trends in mortality in the IGRs correlated significantly with the Human Development Index and government expenditure on ambulatory health care and hospitalizations. Conclusions: Mortality from both types of cancer decreased in those IGR in which the government spent more on health and in the more socioeconomically developed ones. This study found no epidemiological evidence that HPV plays the leading etiological factor in OPC in Brazil.

MHealth Applications for People with Cognitive Impairment and Their Caregivers: A Scoping Review (Preprint)

2020 ◽  
Author(s):  
Qing Zhao ◽  
Pei Chen ◽  
Yu Zhang ◽  
Haining Liu ◽  
Xianwen Li
Keyword(s):  
Cognitive Impairment ◽  
Sample Size ◽  
Research Design ◽  
Scoping Review ◽  
Life Support ◽  
Small Sample ◽  
Mobile Technologies ◽  
Control Group ◽  
Caregiver Support ◽  
The Impact

BACKGROUND Mobile health application has become an important tool for healthcare systems. One such tool is the delivery of assisting in people with cognitive impairment and their caregivers. OBJECTIVE This scoping review aims to explore and evaluate the existing evidence and challenges on the use of mHealth applications that assisting in people with cognitive impairment and their caregivers. METHODS Nine databases, including PubMed, EMBASE, Cochrane, PsycARTICLES, CINAHL, Web of Science, Applied Science & Technology Source, IEEE Xplore and the ACM Digital Library were searched from inception through June 2020 for the studies of mHealth applications on people with cognitive impairment and their caregivers. Two reviewers independently extracted, checked synthesized data independently. RESULTS Of the 6101 studies retrieved, 64 studies met the inclusion criteria. Three categories emerged from this scoping review. These categories are ‘application functionality’, ‘evaluation strategies’, ‘barriers and challenges’. All the included studies were categorized into 7 groups based on functionality: (1) cognitive assessment; (2) cognitive training; (3) life support; (4) caregiver support; (5) symptom management; (6) reminiscence therapy; (7) exercise intervention. The included studies were broadly categorized into four types: (1) Usability testing; (2) Pilot and feasibility studies; (3) Validation studies; and (4) Efficacy or Effectiveness design. These studies had many defects in research design such as: (1) small sample size; (2) deficiency in active control group; (3) deficiency in analyzing the effectiveness of intervention components; (4) lack of adverse reactions and economic evaluation; (5) lack of consideration about the education level, electronic health literacy and smartphone proficiency of the participants; (6) deficiency in assessment tool; (7) lack of rating the quality of mHealth application. Some progress should be improved in the design of smartphone application functionality, such as: (1) the design of cognitive measurements and training game need to be differentiated; (2) reduce the impact of the learning effect. Besides this, few studies used health behavior theory and performed with standardized reporting. CONCLUSIONS Preliminary results show that mobile technologies facilitate the assistance in people with cognitive impairment and their caregivers. The majority of mHealth application interventions incorporated usability outcome and health outcomes. However, these studies have many defects in research design that limit the extrapolation of research. The content of mHealth application is urgently improved to adapt to demonstrate the real effect. In addition, further research with strong methodological rigor and adequate sample size are needed to examine the feasibility, effectiveness, and cost-effectiveness of mHealth applications for people with cognitive impairment and their caregivers.

scholarly journals Simultaneous Casualty Admissions—Do they Affect Treatment in the Receiving Trauma Center?

2021 ◽  
Author(s):  
Michel Paul Johan Teuben ◽  
Carsten Mand ◽  
Laura Moosdorf ◽  
Kai Sprengel ◽  
Alba Shehu ◽  
...  
Keyword(s):  
Injury Severity ◽  
Damage Control ◽  
Ct Scanning ◽  
Mortality Rates ◽  
Trauma Centers ◽  
Simultaneous Treatment ◽  
Diagnostic Pathway ◽  
Injured Patients ◽  
The Impact ◽  
Mean Time

Abstract Background Simultaneous trauma admissions expose medical professionals to increased workload. The impact of simultaneous trauma admissions on hospital allocation, therapy, and outcome is currently unclear. We hypothesized that multiple admission-scenarios impact the diagnostic pathway and outcome. Methods The TraumaRegister DGU® was utilized. Patients admitted between 2002–2015 with an ISS ≥ 9, treated with ATLS®- algorithms were included. Group ´IND´ included individual admissions, two individuals that were admitted within 60 min of each other were selected for group ´MULT´. Patients admitted within 10 min were considered as simultaneous (´SIM´) admissions. We compared patient and trauma characteristics, treatment, and outcomes between both groups. Results 132,382 admissions were included, and 4,462/3.4% MULTiple admissions were found. The SIM-group contained 1,686/1.3% patients. The overall median injury severity score was 17 and a mean age of 48 years was found. MULT patients were more frequently admitted to level-one trauma centers (68%) than individual trauma admissions were (58%, p < 0.001). Mean time to CT-scanning (24 vs. 26/28 min) was longer in MULT / SIM patients compared to individual admissions. No differences in utilization of damage control principles were seen. Moreover, mortality rates did not differ between the groups (13.1% in regular admissions and 11.4%/10,6% in MULT/SIM patients). Conclusion This study demonstrates that simultaneous treatment of injured patients is rare. Individuals treated in parallel with other patients were more often admitted to level-one trauma centers compared with individual patients. Although diagnostics take longer, treatment principles and mortality are equal in individual admissions and simultaneously admitted patients. More studies are required to optimize health care under these conditions.

scholarly journals The Impact of Bushfire Smoke on Cattle—A Review

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 848
Author(s):  
Benjamin Eid ◽  
David Beggs ◽  
Peter Mansell
Keyword(s):  
Particulate Matter ◽  
Prolonged Exposure ◽  
Negative Impact ◽  
Airborne Particulate Matter ◽  
Mortality Rates ◽  
Airborne Particulate ◽  
Primary Mechanism ◽  
Background Mortality ◽  
Fire Front ◽  
The Impact

In 2019–2020, a particularly bad bushfire season in Australia resulted in cattle being exposed to prolonged periods of smoke haze and reduced air quality. Bushfire smoke contains many harmful pollutants, and impacts on regions far from the fire front, with smoke haze persisting for weeks. Particulate matter (PM) is one of the major components of bushfire smoke known to have a negative impact on human health. However, little has been reported about the potential effects that bushfire smoke has on cattle exposed to smoke haze for extended periods. We explored the current literature to investigate evidence for likely effects on cattle from prolonged exposure to smoke generated from bushfires in Australia. We conducted a search for papers related to the impacts of smoke on cattle. Initial searching returned no relevant articles through either CAB Direct or PubMed databases, whilst Google Scholar provided a small number of results. The search was then expanded to look at two sub-questions: the type of pollution that is found in bushfire smoke, and the reported effects of both humans and cattle being exposed to these types of pollutants. The primary mechanism for damage due to bushfire smoke is due to small airborne particulate matter (PM). Although evidence demonstrates that PM from bushfire smoke has a measurable impact on both human mortality and cardiorespiratory morbidities, there is little evidence regarding the impact of chronic bushfire smoke exposure in cattle. We hypothesize that cattle are not severely affected by chronic exposure to smoke haze, as evidenced by the lack of reports. This may be because cattle do not tend to suffer from the co-morbidities that, in the human population, seem to be made worse by smoke and pollution. Further, small changes to background mortality rates or transient morbidity may also go unreported.

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