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.

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.

scholarly journals Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century

2015 ◽  
Vol 112 (49) ◽  
pp. 15078-15083 ◽  
Author(s):  
Anne Case ◽  
Angus Deaton
Keyword(s):  
United States ◽  
Daily Living ◽  
Hispanic Americans ◽  
The United States ◽  
Mortality Rates ◽  
Hispanic Men ◽  
All Cause Mortality ◽  
Inability To Work ◽  
Education Groups ◽  
Drug And Alcohol

This paper documents a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.

scholarly journals Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System

2018 ◽  
Vol 77 (9) ◽  
pp. 1333-1338 ◽  
Author(s):  
Zachary S Wallace ◽  
Rachel Wallwork ◽  
Yuqing Zhang ◽  
Na Lu ◽  
Frank Cortazar ◽  
...  
Keyword(s):  
United States ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
End Stage Renal Disease ◽  
Granulomatosis With Polyangiitis ◽  
The United States ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

BackgroundRenal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown.MethodsWe identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure.ResultsDuring the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06–0.16).DiscussionRenal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population.

scholarly journals Association of 152 Biomarker Reference Intervals with All-Cause Mortality in Participants of a General United States Survey from 1999 to 2010

2020 ◽  
Author(s):  
Nam Pho ◽  
Arjun K Manrai ◽  
John T Leppert ◽  
Glenn M Chertow ◽  
John P A Ioannidis ◽  
...  
Keyword(s):  
United States ◽  
Mortality Risk ◽  
Diagnostic Tests ◽  
Serum Alkaline Phosphatase ◽  
The United States ◽  
Reference Intervals ◽  
Mortality Data ◽  
Distribution Width ◽  
Risk Of Death ◽  
All Cause Mortality

Abstract Background Physicians sometimes consider whether or not to perform diagnostic testing in healthy people, but it is unknown whether nonextreme values of diagnostic tests typically encountered in such populations have any predictive ability, in particular for risk of death. The goal of this study was to quantify the associations among population reference intervals of 152 common biomarkers with all-cause mortality in a representative, nondiseased sample of adults in the United States. Methods The study used an observational cohort derived from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the United States population consisting of 6 survey waves from 1999 to 2010 with linked mortality data (unweighted N = 30 651) and a median followup of 6.1 years. We deployed an X-wide association study (XWAS) approach to systematically perform association testing of 152 diagnostic tests with all-cause mortality. Results After controlling for multiple hypotheses, we found that the values within reference intervals (10–90th percentiles) of 20 common biomarkers used as diagnostic tests or clinical measures were associated with all-cause mortality, including serum albumin, red cell distribution width, serum alkaline phosphatase, and others after adjusting for age (linear and quadratic terms), sex, race, income, chronic illness, and prior-year healthcare utilization. All biomarkers combined, however, explained only an additional 0.8% of the variance of mortality risk. We found modest year-to-year changes, or changes in association from survey wave to survey wave from 1999 to 2010 in the association sizes of biomarkers. Conclusions Reference and nonoutlying variation in common biomarkers are consistently associated with mortality risk in the US population, but their additive contribution in explaining mortality risk is minor.

scholarly journals COVID-19 and excess mortality in the United States: A county-level analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (5) ◽  
pp. e1003571
Author(s):  
Andrew C. Stokes ◽  
Dielle J. Lundberg ◽  
Irma T. Elo ◽  
Katherine Hempstead ◽  
Jacob Bor ◽  
...  
Keyword(s):  
United States ◽  
Formal Education ◽  
Excess Mortality ◽  
Time Lag ◽  
The United States ◽  
County Level ◽  
Level Variation ◽  
Cross Sectional ◽  
All Cause Mortality ◽  
Excess Deaths

Background Coronavirus Disease 2019 (COVID-19) excess deaths refer to increases in mortality over what would normally have been expected in the absence of the COVID-19 pandemic. Several prior studies have calculated excess deaths in the United States but were limited to the national or state level, precluding an examination of area-level variation in excess mortality and excess deaths not assigned to COVID-19. In this study, we take advantage of county-level variation in COVID-19 mortality to estimate excess deaths associated with the pandemic and examine how the extent of excess mortality not assigned to COVID-19 varies across subsets of counties defined by sociodemographic and health characteristics. Methods and findings In this ecological, cross-sectional study, we made use of provisional National Center for Health Statistics (NCHS) data on direct COVID-19 and all-cause mortality occurring in US counties from January 1 to December 31, 2020 and reported before March 12, 2021. We used data with a 10-week time lag between the final day that deaths occurred and the last day that deaths could be reported to improve the completeness of data. Our sample included 2,096 counties with 20 or more COVID-19 deaths. The total number of residents living in these counties was 319.1 million. On average, the counties were 18.7% Hispanic, 12.7% non-Hispanic Black, and 59.6% non-Hispanic White. A total of 15.9% of the population was older than 65 years. We first modeled the relationship between 2020 all-cause mortality and COVID-19 mortality across all counties and then produced fully stratified models to explore differences in this relationship among strata of sociodemographic and health factors. Overall, we found that for every 100 deaths assigned to COVID-19, 120 all-cause deaths occurred (95% CI, 116 to 124), implying that 17% (95% CI, 14% to 19%) of excess deaths were ascribed to causes of death other than COVID-19 itself. Our stratified models revealed that the percentage of excess deaths not assigned to COVID-19 was substantially higher among counties with lower median household incomes and less formal education, counties with poorer health and more diabetes, and counties in the South and West. Counties with more non-Hispanic Black residents, who were already at high risk of COVID-19 death based on direct counts, also reported higher percentages of excess deaths not assigned to COVID-19. Study limitations include the use of provisional data that may be incomplete and the lack of disaggregated data on county-level mortality by age, sex, race/ethnicity, and sociodemographic and health characteristics. Conclusions In this study, we found that direct COVID-19 death counts in the US in 2020 substantially underestimated total excess mortality attributable to COVID-19. Racial and socioeconomic inequities in COVID-19 mortality also increased when excess deaths not assigned to COVID-19 were considered. Our results highlight the importance of considering health equity in the policy response to the pandemic.

scholarly journals COVID-19 mortality rates for persons with intellectual and developmental disabilities

2021 ◽  
Vol 2 (1) ◽  
pp. 179-183
Author(s):  
Mark D. Davis ◽  
Scott Spreat ◽  
Ryan Cox ◽  
Matthew Holder ◽  
Kathryn M. Burke ◽  
...  
Keyword(s):  
United States ◽  
Developmental Disabilities ◽  
General Population ◽  
General Public ◽  
The United States ◽  
Mortality Rates ◽  
Intellectual And Developmental Disabilities ◽  
Time Points ◽  
Probability Of Death ◽  
Over Time

People with intellectual and developmental disabilities (IDD) appear to have an increased probability of death from COVID-19 once infected. We report infection and mortality rates for people with IDD compared to the general population of eight states at two time points during the COVID-19 pandemic. Note that these eight states contain approximately 1/3 of the population of the United States. These data suggest individuals with IDD are less likely to be infected with the COVID-19 virus (5.62%) than the general public (7.57%). However, while mortality rates for both groups have declined over time, people with IDD are over twice as likely (2.29) to die from the infection as members of the general public.

scholarly journals Drought severity and all-cause mortality rates among adults in the United States: 1968–2014

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Katie M. Lynch ◽  
Robert H. Lyles ◽  
Lance A. Waller ◽  
Azar M. Abadi ◽  
Jesse E. Bell ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Mortality Rates ◽  
Drought Severity ◽  
All Cause Mortality

scholarly journals Racial Disparities in COVID-19 and Excess Mortality in Minnesota

2020 ◽  
Author(s):  
Elizabeth Wrigley-Field ◽  
Sarah Garcia ◽  
Jonathon P. Leider ◽  
Christopher Robertson ◽  
Rebecca Wurtz
Keyword(s):  
United States ◽  
Natural History ◽  
Racial Disparities ◽  
Excess Mortality ◽  
Age Distribution ◽  
The United States ◽  
Mortality Rates ◽  
Racial Groups ◽  
Communities Of Color ◽  
History Of

The COVID-19 pandemic has produced vastly disproportionate deaths for communities of color in the United States. Minnesota seemingly stands out as an exception to this national pattern, with white Minnesotans accounting for 80% of the population and 82% of COVID-19 deaths. We examine confirmed COVID mortality alongside deaths indirectly attributable to the pandemic -- ‘excess mortality’ -- in Minnesota. This analysis reveals profound racial disparities: age-adjusted excess mortality rates for whites are exceeded by a factor of 2.8-5.3 for all other racial groups, with the highest rates among Black, Latino, and Native Minnesotans. The seemingly small disparities in COVID deaths in Minnesota reflect the interaction of three factors: the natural history of the disease whose early toll was heavily concentrated in nursing homes; an exceptionally divergent age distribution in the state; and a greatly different proportion of excess mortality captured in confirmed-COVID rates for white Minnesotans compared with most other groups.

Considering Wellness in Managing Patients with Bipolar Disorder

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S10) ◽  
pp. 7-8 ◽  
Author(s):  
Roger S. McIntyre
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Bipolar Disorder ◽  
Gastric Ulcer ◽  
General Population ◽  
Excess Mortality ◽  
The United States ◽  
Elevated Risk ◽  
Medical Comorbidity ◽  
Common Cause

The 12-month and lifetime prevalences of bipolar I and II disorder in the United States are 2.0% and 3.3%, respectively. Similar to schizophrenia, bipolar disorder is also associated with premature and excess mortality, with an estimated loss of ∼15 years of life expectancy. Most of the excess mortality in individuals with mood disorders results from natural causes, not suicide. Again, similar to schizophrenia, the most common cause of death in patients with bipolar disorder is cardiovascular disease (CVD), which occurs approximately twice as often in this group as in the general population. Although the data are more limited than in schizophrenia, people with bipolar disorder are differentially affected by medical comorbidity. Bipolar disorder is associated with elevated risk of a wide variety of comorbid medical illnesses, including migraine, asthma, chronic bronchitis, hypertension, and gastric ulcer, which compound disability and increase the burden of the disease.

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