Rural-Urban and Within-Rural Differences in COVID-19 Mortality Trends

Since late-2020, COVID-19 mortality rates have been higher in rural than in urban America, but there has also been substantial within-rural heterogeneity. Using data from USA Facts, we compare COVID-19 mortality trends between U.S. urban (nonmetro) and rural (metro) counties from March 2020 to May 2021. We then compare trends within rural counties across different types of labor markets defined by county economic dependence (farming, mining, manufacturing, government, recreation, and nonspecialized) and by metropolitan adjacency. As of May 22, 2021, the cumulative COVID-19 mortality rate was 199.3 per 100,000 population in rural counties compared to 175.8 in urban counties. Net of controls, rural counties experienced a 3% higher average daily increase in COVID-19 mortality rates than urban counties over the study period. Rural mortality rates have been highest in the South, Southwest, and Great Plains. Both overall and within rural counties, mortality rates were highest in farming-dependent counties and lowest in recreation-dependent counties. Interaction models demonstrate that the protective buffer for recreation counties was even stronger for remote rural counties (those not adjacent to metro areas.

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Cervical cancer mortality trends in Brazil: 1980-2009

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2013000300017 ◽

2013 ◽

Vol 29 (3) ◽

pp. 599-608 ◽

Cited By ~ 10

Author(s):

Carolina Maciel Reis Gonzaga ◽

Ruffo Freitas-Junior ◽

Aline Almeida Barbaresco ◽

Edesio Martins ◽

Bruno Teixeira Bernardes ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Mortality ◽

Census Data ◽

Mortality Rates ◽

Downward Trend ◽

Mortality Trends ◽

Cervical Cancer Mortality ◽

Geographic Regions ◽

Using Data ◽

Series Study

The objective was to describe time trends in cervical cancer mortality rates in Brazil as a whole and in the country's major geographic regions and States from 1980 to 2009. This was an ecological time series study using data recorded in the Mortality Information System (SIM) and census data collected by the Brazilian Institute of Geography and Statistics (IBGE). Analysis of mortality trends was performed using Poisson regression. Cervical cancer mortality rates in Brazil tended to stabilize. In the geographic regions, a downward trend was observed in the South (-4.1%), Southeast (-3.3%), and Central-West (-1%) and an upward trend in the Northeast (3.5%) and North (2.7%). The largest decreases were observed in the States of São Paulo (5.1%), Rio Grande do Sul, Espírito Santo, and Paraná (-4.0%). The largest increases in mortality trends occurred in Paraíba (12.4%), Maranhão (9.8%), and Tocantins (8.9%). Cervical cancer mortality rates stabilized in the country as a whole, but there was a downward trend in three geographic regions and 10 States, while two geographic regions and another 10 States showed increasing rates.

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Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019

Journal of the American Heart Association ◽

10.1161/jaha.121.021682 ◽

2021 ◽

Author(s):

Sourbha S. Dani ◽

Ahmad N. Lone ◽

Zulqarnain Javed ◽

Muhammad S. Khan ◽

Muhammad Zia Khan ◽

...

Keyword(s):

United States ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Mortality Rate ◽

The United States ◽

Mortality Rates ◽

Percentage Change ◽

Annual Percentage Change ◽

Rural Counties ◽

Average Annual Percentage Change

Background Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. Methods and Results We used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age‐adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age‐adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle‐aged adults, men, non‐Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age‐adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age‐adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and medium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age‐adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties. Conclusions During the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to address cardiovascular health disparities and outcomes among nonelderly adults.

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Current and Future Burden of Prostate Cancer in Songkhla, Thailand: Analysis of Incidence and Mortality Trends From 1990 to 2030

Journal of Global Oncology ◽

10.1200/jgo.17.00128 ◽

2018 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Christian S. Alvarez ◽

Shama Virani ◽

Rafael Meza ◽

Laura S. Rozek ◽

Hutcha Sriplung ◽

...

Keyword(s):

Prostate Cancer ◽

Birth Cohort ◽

Developed Countries ◽

Mortality Rates ◽

Incidence Rates ◽

Mortality Trends ◽

Annual Percent Change ◽

Public Health Burden ◽

Incidence And Mortality ◽

Using Data

Purpose Prostate cancer is the second most common malignancy among men worldwide, and it poses a significant public health burden that has traditionally been limited mostly to developed countries. However, the burden of the disease is expected to increase, affecting developing countries, including Thailand. We undertook an analysis to investigate current and future trends of prostate cancer in the province of Songkhla, Thailand, using data from the Songkhla Cancer Registry from 1990 to 2013. Methods Joinpoint regression analysis was used to examine trends in age-adjusted incidence and mortality rates of prostate cancer and provide estimated annual percent change (EAPC) with 95% CIs. Age-period-cohort (APC) models were used to assess the effect of age, calendar year, and birth cohort on incidence and mortality rates. Three different methods (Joinpoint, Nordpred, and APC) were used to project trends from 2013 to 2030. Results Eight hundred fifty-five cases of prostate cancer were diagnosed from 1990 to 2013 in Songkhla, Thailand. The incidence rates of prostate cancer significantly increased since 1990 at an EAPC of 4.8% (95% CI, 3.6% to 5.9%). Similarly, mortality rates increased at an EAPC of 5.3% (95% CI, 3.4% to 7.2%). The APC models suggest that birth cohort is the most important factor driving the increased incidence and mortality rates of prostate cancer. Future incidence and mortality of prostate cancer are projected to continue to increase, doubling the rates observed in 2013 by 2030. Conclusion It is critical to allocate resources to provide care for the men who will be affected by this increase in prostate cancer incidence in Songkhla, Thailand, and to design context-appropriate interventions to prevent its increasing burden.

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Mortality trends for all causes of cancer in Mato Grosso State, Brazil

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1136 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Vieira Gomes ◽

B da Silva Nalin de Souza ◽

D V de Lima ◽

A c de Souza Andrade ◽

J C de Souza Oliveira ◽

...

Keyword(s):

Mortality Rate ◽

Cancer Control ◽

Mortality Rates ◽

Regional Disparities ◽

The State ◽

World Population ◽

Mortality Trends ◽

Mato Grosso ◽

Increasing Trend ◽

Control And Prevention

Abstract Background Cancer is the second leading cause of death in Brazil, being the most common breast, lung, colorectal, cervix and pancreas among women and lung, prostate, colorectal, stomach and esophagus among men. The mortality trends for all causes of cancer in Brazil have been increased, with variations between sexes and regions. The objective was to analyze standardized mortality trend rates for all causes of cancer in Mato Grosso State, Brazil, from 2000 to 2015. Methods This is a descriptive, ecological, time-series study using data from the Mortality Information System, made available by the Department of Health of the Mato Grosso State. Deaths from cancer of all ages were selected, whose basic cause was identified by the letter “C” from the 10th revision of International Classification of Diseases. The direct method of standardization was performed with the 1960 world population and expected deaths were estimated. To estimate the trend, the annual percentage variation (APV) was calculated using the ratio regression coefficient/2000 mortality rate, for the state and its five macroregions. Results From 2000 to 2015, 28.525 deaths from cancer occurred in the state residents. There was an increasing trend in the mortality rates for all causes of cancer, with APV of 0.81% (p = 0.001). Considering the macroregions, the south (APV = 1.12%; p = 0.01), north (APV = 1.51%; p = 0.01) and east (APV = 1.82%; p = 0.01) had an increasing trend and the west (APV = 0.51%; p = 0.44) and the center-north (APV = 0.46%; p = 0.12) had a stable trend. Conclusions Mato Grosso follows the Brazilian cancer mortality increased trend. Variation in mortality rates found among different macroregions of the state and no decreased rates reveal regional disparities and the importance of cancer control and prevention in the state. Key messages Mortality rate for all causes of cancer increased in Mato Grosso State, Brazil, from 2000 to 2015. Variation in mortality trends by macroregions of the Mato Grosso State reveals regional disparities and the importance of cancer control and prevention in the state.

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Rank Indices Method and its use for the comparative analysis of population health data

Hygiene and Sanitation ◽

10.18821/00169900-2016-95-3-306-311 ◽

2019 ◽

Vol 95 (3) ◽

pp. 306-311

Author(s):

A. M. Bolshakov ◽

Vyacheslav Krutko ◽

T. M. Smirnova ◽

S. V. Chankov

Keyword(s):

Public Health ◽

Comparative Analysis ◽

Mortality Rate ◽

Life Expectancy ◽

Calculation Method ◽

Mortality Rates ◽

Health Data ◽

Mortality Trends ◽

Economic Determinants ◽

The Social

There is presented a calculation method aimed to elevate the informative value of the integral indices of the social and hygienic monitoring for purposes of comparative analysis. The method of rank indices is based on the ranking of monitoring objects on the values ofprimary indices on the base of which there are calculated the integral such indices as, for example, life expectancy. There are presented results of the use of this method for the comparative analysis of mortality rate in WHO Member States for the period of 1990-2011. There were revealed special features of mortality trends which cannot be detected when using only mortality rates or the life expectancy. In particular, for Russia there was shown that, in spite of the downward trend in child and adolescent mortality rate observed in the last decade, the country's world rankings for these indices fail to achieve the level of 1990. This means that the competitiveness of the country, sharply declined in the 90's, was not restored until now. There are described some features of the use of the method of rank indices for the analysis of indices of the environment state, public health and its socio-economic determinants.

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Abstract P365: Turning in the Mortality Trends from Coronary Heart Disease in Japan: Age-Specific Analysis of the Regional Difference in Japan from 1969 to 2007

Circulation ◽

10.1161/circ.129.suppl_1.p365 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Akira Okayama ◽

Nagako Okuda ◽

Hirotsugu Ueshima

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Mortality Rate ◽

Old Age ◽

Urban Population ◽

Mortality Rates ◽

Vital Statistics ◽

Age Group ◽

Mortality Trends ◽

Younger Generation

Objective: To examine the recent mortality trends of coronary heart disease (CHD), we compared the age specific CHD mortality trends in Japan and in urban and in the rest of Japan, respectively using Vital Statistics. Methods and Results: We compared CHD mortality rates in all Japan, the urban population (20 million) and in the rest of Japan (100 million) from 1969 to 2007 for 30 to 69 years of age. In 1969 [[Unable to Display Character: ‑]] 1970, the age[[Unable to Display Character: ‑]]adjusted CHD mortality rate was 57.7 per 100,000 for men and 25.9 for women in Japan, and was the same as those of the urban population (59.2 for men and 26.8 for women) and the rest of Japan (57.3 for men and 25.9 for women). The CHD mortality rate in the rest of Japan decreased to 28.4 for men and 7.6 for women in 2006-2007. Although CHD mortality rate in the urban population also decreased to 39.9 for men and 10.1 for women in 2006 - 2007, the decline was much smaller. Trends in age-specific CHD mortality rates was compared between Period I (1969 - 1978), Period II (1981- 1994) and period III (1996 - 2007). Among men in Japan and in the rest of Japan, the decline in the mortality rate for the 30 to 49[[Unable to Display Character: ‑]]year[[Unable to Display Character: ‑]]old[[Unable to Display Character: ‑]]age group was initially observed in Period I and II, and has turned to increase significantly (p<0.001) in the Period III while continuous declining trends in 50-59 and 60-69 year old-age-group. Trends in urban population went ahead, changes in the declining trends was observed both the Period II and III among 30-49 year-old-age group and period III among 50-59 year-old-age group while continuous decline was observed among 60-69 year-old-age group. Similar trends were observed among women. These trends coincide with the increase in the fat intake mainly among younger generation. Conclusions: Observed increase in CHD mortality of men in Japan among younger generation proceeded by those in the urban population may predict the future increase in CHD mortality in Japan.

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Mortality Rates and Trends in Massachusetts Before 1860

The Journal of Economic History ◽

10.1017/s002205070007546x ◽

1972 ◽

Vol 32 (1) ◽

pp. 184-213 ◽

Cited By ~ 48

Author(s):

Maris A. Vinovskis

Keyword(s):

United States ◽

Nineteenth Century ◽

Mortality Rate ◽

The United States ◽

Mortality Rates ◽

Mortality Data ◽

Different Types ◽

Long Term Trends ◽

Different Sources

The study of mortality rates and trends in the United States before 1860 has been rather unsystematic to date. Most scholars have been content to estimate the mortality rate at some point in time and only a few serious efforts have been made to ascertain the long-term trends in mortality. Particularly lacking are efforts to relate estimates of mortality in the seventeenth and eighteenth centuries to those of the nineteenth century. In addition, the few studies that have attempted to discuss long-term trends in American mortality have been forced to rely on estimates of mortality gathered from different sources and based on different techniques of analysis. Unfortunately, almost no efforts have been made to estimate possible biases introduced when comparing mortality data from different types of records.

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O24 Risk of death during the 2020 UK COVID-19 epidemic and annual influenza seasons among people with vasculitis compared to the general population: a whole-population study using data from the NDRS and the RECORDER project

Rheumatology ◽

10.1093/rheumatology/keab246.023 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Megan Rutter ◽

Peter C Lanyon ◽

Matthew J Grainge ◽

Richard B Hubbard ◽

Emily J Peach ◽

...

Keyword(s):

Mortality Rate ◽

General Population ◽

Mortality Rates ◽

Published Data ◽

Research Support ◽

Risk Of Death ◽

Crude Mortality Rate ◽

Crude Mortality ◽

Increased Risk ◽

Using Data

Abstract Background/Aims To quantify the risk of death among people with vasculitis during the UK 2020 COVID-19 epidemic compared with baseline risk, risk during annual influenza seasons and risk of death in the general population during COVID-19. Methods We performed a cohort study using data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) under their legal permissions (CAG 10-02(d)/2015). Coded diagnoses for vasculitis (ANCA-associated vasculitis, Takayasu arteritis, Behçet's disease, and giant cell arteritis) were identified from Hospital Episode Statistics from 2003 onwards. Previous coding validation work demonstrated a positive predictive value >85%. The main outcome measure was age-standardised mortality rates (ASMRs) for all-cause death. ONS published data were used for general population mortality rates. Results We identified 55,110 people with vasculitis (median age 74.9 (IQR 64.1-82.7) years, 68.0% female) alive 01 March 2020. During March-April 2020, 892 (1.6%) died of any cause. The crude mortality rate was 9773.0 (95% CI 9152.3-10,435.9) per 100,000 person-years. The ASMR was 2567.5 per 100,000 person-years, compared to 1361.1 (1353.6-1368.7) in the general population (see table). The ASMR in March-April 2020 was 1.4 times higher than the mean ASMR for March-April 2015-2019 (1965.6). The increase in deaths during March-April 2020 occurred at a younger age than in the general population. We went on to investige the effect of previous influenza seasons. The 2014/15 season saw the greatest excess all-cause mortality nationally in recent years, and there were 624 deaths in 38,888 people (6472.5 person-years) with vasculitis in our data (crude mortality rate 9640.8 (8913.3-10427.7); The ASMR was 2657.6, which was marginally higher than the ASMR among people with vasculitis recorded during March-April 2020 during the COVID-19 pandemic. Conclusion People with vasculitis are at increased risk of death during circulating COVID-19 and influenza epidemics. The ASMR among people with vasculitis was high both during the 2014/15 influenza season and during the first wave of the COVID-19 epidemic. COVID-19 vaccination and annual influenza vaccination for people with vasculitis are both important, regardless of patient age. Disclosure M. Rutter: None. P.C. Lanyon: Grants/research support; PCL has received funding for research from Vifor Pharma.. M.J. Grainge: None. R.B. Hubbard: None. E.J. Peach: Grants/research support; EJP has received funding for research from Vifor Pharma. M. Bythell: None. J. Aston: None. S. Stevens: None. F.A. Pearce: Grants/research support; FAP has received funding for research from Vifor Pharma..

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Abstract 16654: Covid - 19 - Acute Myocardial Infarction and Heart Failure Mortality Trends in a Non-epicenter Region

Circulation ◽

10.1161/circ.142.suppl_3.16654 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mahathi Indaram ◽

Mark Doyle ◽

Sarah Wiswall ◽

Indu G Poornima

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Hospital Admissions ◽

Acute Decompensated Heart Failure ◽

Mortality Rates ◽

Absolute Number ◽

Delayed Presentation ◽

Mortality Trends ◽

True Incidence ◽

The Absolute

Introduction: As the novel coronavirus gained acceleration, there are several reports of a decreasing number of hospital admissions for acute myocardial infarctions (AMI) worldwide. It is unclear if this is due to an actual decrease in their incidence or due to patients avoiding hospital visits during the pandemic. We examined the trends in admissions for AMI, acute decompensated heart failure (HF) and their associated mortality in an integrated health system (7 hospitals) in Pittsburgh (Pennsylvania), a non-epicenter region. Hypothesis: If patients are presenting late due to avoiding hospitals, AMI and HF would be associated with increased mortality rates. Methods: We collected data on the total number of admissions and deaths related to AMI (ST and non-ST elevation), HF using ICD-10 codes, during the period of January-April 2020. We compared this with data from the same period in 2018, 2019. Mortality rate was calculated as deaths per 100 admissions. Results: There were 505 AMI admissions in January-April 2020 and 37 died compared to 23 deaths amongst 645 admissions in the same period of 2018 and 2019 (averaged). Similarly, there were 1030 HF admissions in January-April 2020 and 46 died in comparison to 39 deaths amongst 1280 admissions in 2018 and 2019 (averaged). The absolute number of AMI and HF admissions was lower in 2020 (p<0.05, p<0.01). There was no difference in absolute number of deaths attributed to HF or AMI between 2020 and the preceding years (p=0.3). However, mortality rate was higher for HF in 2020 compared to prior 2 years. Conclusions: In this non-epicenter region, there was a significant decrease in admissions for AMI and HF in 2020 compared to 2018-2019 while the absolute number of deaths were similar. Similar mortality rates for AMI across the years suggests that patients were presenting appropriately and that the true incidence was likely low. However, higher mortality rate with HF may suggest a delayed presentation albeit without accounting for confounders.

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Follow-up of an age-period-cohort analysis on alcohol-related mortality trends in Sweden 1970–2015 with predictions to 2025

Scandinavian Journal of Public Health ◽

10.1177/1403494817752521 ◽

2018 ◽

Vol 47 (4) ◽

pp. 446-451 ◽

Cited By ~ 2

Author(s):

Måns Rosén ◽

Bengt Haglund

Keyword(s):

Cohort Analysis ◽

Mortality Rates ◽

Birth Cohorts ◽

Mortality Trends ◽

Swedish Population ◽

Higher Alcohol ◽

Alcohol Policies ◽

Using Data ◽

Related Mortality

Background and aims: Several studies have indicated that birth cohorts are important in explaining trends in alcohol-related mortality. An earlier study from Sweden with data up to 2002 showed that birth cohorts that grew up under periods of more liberal alcohol policies had higher alcohol-related mortality than those cohorts growing up under more restrictive time periods. In spite of increasing alcohol consumption, predictions in 2002 also indicated lower alcohol-related mortality in the future. The aim of this study is to follow-up whether the effects of birth cohorts and the predictions made for Sweden still holds using data up to 2015. Method: The study comprised an age-period-cohort analysis and predictions based on population predictions from Statistics Sweden. The analysis was based on all alcohol-related deaths in the Swedish population between 1969 and 2015 for the cohorts born in the decades 1920 through 1990. Data were restricted to people 15–84 years of age. In total, the analysis covered 68,341 deaths and more than 284 million person-years. Results: Male and female cohorts born in the 1940s to 1950s exhibited the highest alcohol-related mortality, while those born in the 1970s continued to have the lowest alcohol-related mortality rates. The predicted mortality rates for males are still anticipated to decrease somewhat through 2025. Conclusions: The updated age-period-cohort analysis further supports the importance of focusing on restrictive alcohol policies targeting adolescents.

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