scholarly journals Towards reducing variations in infant mortality and morbidity: a population-based approach

2016 ◽  
Vol 4 (1) ◽  
pp. 1-218 ◽  
Author(s):  
David Field ◽  
Elaine Boyle ◽  
Elizabeth Draper ◽  
Alun Evans ◽  
Samantha Johnson ◽  
...  
Keyword(s):  
Infant Mortality ◽  
Early Life ◽  
Developmental Outcomes ◽  
Research Programme ◽  
Mortality Rates ◽  
Population Based ◽  
Childhood Mortality ◽  
Mortality And Morbidity ◽  
Future Work

BackgroundOur aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity.ObjectiveTo undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates.DesignTwo interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies.SettingCohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester.Data sourcesFor stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies.Main outcome measuresDetailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies.ResultsThe deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs.ConclusionsHealth professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background.Future workFuture work could include studies to improve our understanding of how deprivation increases the risk of mortality and morbidity in early life and investigation of longer-term outcomes and interventions in at-risk LMPT infants to improve future attainment.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

scholarly journals Stillbirth, newborn and infant mortality: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

2019 ◽  
Vol 48 (Supplement_1) ◽  
pp. i54-i62 ◽  
Author(s):  
Ana M B Menezes ◽  
Fernando C Barros ◽  
Bernardo L Horta ◽  
Alicia Matijasevich ◽  
Andréa Dâmaso Bertoldi ◽  
...  
Keyword(s):  
Black Women ◽  
Infant Mortality ◽  
Low Income ◽  
Causes Of Death ◽  
Mortality Rates ◽  
Population Based ◽  
Birth Cohorts ◽  
Mortality Trends ◽  
Death Rates ◽  
Economic Inequalities

Abstract Background Infant-mortality rates have been declining in many low- and middle-income countries, including Brazil. Information on causes of death and on socio-economic inequalities is scarce. Methods Four birth cohorts were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. Surveillance in hospitals and vital registries, accompanied by interviews with doctors and families, detected fetal and infant deaths and ascertained their causes. Late-fetal (stillbirth)-, neonatal- and post-neonatal-death rates were calculated. Results All-cause and cause-specific death rates were reduced. During the study period, stillbirths fell by 47.8% (from 16.1 to 8.4 per 1000), neonatal mortality by 57.0% (from 20.1 to 8.7) and infant mortality by 62.0% (from 36.4 to 13.8). Perinatal causes were the leading causes of death in the four cohorts; deaths due to infectious diseases showed the largest reductions, with diarrhoea causing 25 deaths in 1982 and none in 2015. Late-fetal-, neonatal- and infant-mortality rates were higher for children born to Brown or Black women and to low-income women. Absolute socio-economic inequalities based on income—expressed in deaths per 1000 births—were reduced over time but relative inequalities—expressed as ratios of mortality rates—tended to remain stable. Conclusion The observed improvements are likely due to progress in social determinants of health and expansion of health care. In spite of progress, current levels remain substantially greater than those observed in high-income countries, and social and ethnic inequalities persist.

scholarly journals A Systematic Review of Longitudinal Cohort Studies Examining Unintentional Injury in Young Children

2018 ◽  
Vol 5 ◽  
pp. 2333794X1877421 ◽  
Author(s):  
Mark R. Zonfrillo ◽  
James G. Linakis ◽  
Eunice S. Yang ◽  
Michael J. Mello
Keyword(s):  
Systematic Review ◽  
Young Children ◽  
Cohort Studies ◽  
Early Life ◽  
Unintentional Injury ◽  
Population Based ◽  
Incidence Rates ◽  
Early Life Exposures ◽  
Injury Definition

Objective. Injury is the leading cause of death and long-term disability in children. Longitudinal cohorts are designed to follow subjects longitudinally in order to determine if early-life exposures are related to certain health outcomes. Methods. We conducted a systematic review to identify studies of children from birth through 5 years who were followed longitudinally with unintentional injury as an outcome of interest. Results. Of the 1892 unique references based on the search criteria, 12 (published between 2000 and 2013) were included. The studies varied on the population of focus, injury definition, and incidence rates. Existing studies that longitudinally follow children aged 0 to 5 years are limited in number, scope, and generalizability. Conclusions. Further study using population-based longitudinal cohorts is necessary to more comprehensively estimate incidence of injury in young children.

scholarly journals Long-Term Trends in Unintentional Fall Mortality in China: A Population-Based Age-Period-Cohort Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Zhenkun Wang ◽  
Youzhen Hu ◽  
Fang Peng
Keyword(s):  
Public Health Problem ◽  
Mortality Rates ◽  
Population Based ◽  
Mortality Data ◽  
Major Public Health Problem ◽  
Age Group ◽  
Men And Women ◽  
Long Term Trends ◽  
Unintentional Falls

Background: Unintentional falls seriously threaten the life and health of people in China. This study aimed to assess the long-term trends of mortality from unintentional falls in China and to examine the age-, period-, and cohort-specific effects behind them.Methods: This population-based multiyear cross-sectional study of Chinese people aged 0–84 years was a secondary analysis of the mortality data of fall injuries from 1990 to 2019, derived from the Global Burden of Disease Study 2019. Age-standardized mortality rates of unintentional falls by year, sex, and age group were used as the main outcomes and were analyzed within the age-period-cohort framework.Results: Although the crude mortality rates of unintentional falls for men and women showed a significant upward trend, the age-standardized mortality rates for both sexes only increased slightly. The net drift of unintentional fall mortality was 0.13% (95% CI, −0.04 to 0.3%) per year for men and −0.71% (95% CI, −0.96 to −0.46%) per year for women. The local drift values for both sexes increased with age group. Significant age, cohort, and period effects were found behind the mortality trends of the unintentional falls for both sexes in China.Conclusions: Unintentional falls are still a major public health problem that disproportionately threatens the lives of men and women in China. Efforts should be put in place urgently to prevent the growing number of fall-related mortality for men over 40 years old and women over 70 years old. Gains observed in the recent period, relative risks (RRs), and cohort RRs may be related to improved healthcare and better education.

Regional Contribution of Previable Infant Deaths to Infant Mortality Rates in the United States

2019 ◽  
Author(s):  
MacKenzie Lee ◽  
Eric S. Hall ◽  
Meredith Taylor ◽  
Emily A. DeFranco
Keyword(s):  
United States ◽  
Infant Mortality ◽  
Infant Death ◽  
The United States ◽  
Mortality Rates ◽  
Population Based ◽  
Infant Mortality Rate ◽  
Infant Deaths ◽  
Live Births ◽  
Healthy People 2020

Objective Lack of standardization of infant mortality rate (IMR) calculation between regions in the United States makes comparisons potentially biased. This study aimed to quantify differences in the contribution of early previable live births (<20 weeks) to U.S. regional IMR. Study Design Population-based cohort study of all U.S. live births and infant deaths recorded between 2007 and 2014 using Centers for Disease Control and Prevention's (CDC's) WONDER database linked birth/infant death records (births from 17–47 weeks). Proportion of infant deaths attributable to births <20 vs. 20 to 47 weeks, and difference (ΔIMR) between reported and modified (births ≥20 weeks) IMRs were compared across four U.S. census regions (North, South, Midwest, and West). Results Percentages of infant deaths attributable to birth <20 weeks were 6.3, 6.3, 5.3, and 4.1% of total deaths for Northeast, Midwest, South, and West, respectively, p < 0.001. Contribution of < 20-week deaths to each region's IMR was 0.34, 0.42, 0.37, and 0.2 per 1,000 live births. Modified IMR yielded less regional variation with IMRs of 5.1, 6.2, 6.6, and 4.9 per 1,000 live births. Conclusion Live births at <20 weeks contribute significantly to IMR as all result in infant death. Standardization of gestational age cut-off results in more consistent IMRs among U.S. regions and would result in U.S. IMR rates exceeding the healthy people 2020 goal of 6.0 per 1,000 live births.

Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study

2012 ◽  
Vol 116 (4) ◽  
pp. 825-834 ◽  
Author(s):  
Ole Solheim ◽  
Asgeir Store Jakola ◽  
Sasha Gulati ◽  
Tom Børge Johannesen
Keyword(s):  
Quality Indicator ◽  
Mortality Rates ◽  
Population Based ◽  
Intracranial Tumor ◽  
Surgical Mortality ◽  
Intracranial Tumors ◽  
Perioperative Mortality ◽  
Term Survival ◽  
Long Term Survival

Object Surgical mortality is a frequent outcome measure in studies of volume-outcome relationships, and the Agency for Healthcare Research and Quality has endorsed surgical mortality after craniotomies as an Inpatient Quality Indicator. Still, the frequency and causes of 30-day mortality after neurosurgical procedures have not been much explored. The authors sought to study the frequency and possible causes of death following primary intracranial tumor operations. They also sought to explore a possible predictive value of perioperative mortality rates from neurosurgical centers in relation to long-term survival. Methods Using population-based data from the Norwegian cancer registry, the authors identified 15,918 primary operations for primary CNS tumors treated in Norway in the period from August 1955 through December 2008. Patients were followed up until death, emigration, or September 2009. Causes of mortality as indicated on death certificates were studied. Factors associated with an increased risk of perioperative death were identified. Results The overall risk of perioperative death after first-time surgery for primary intracranial tumors is currently 2.2% and has decreased over the last decades. An age ≥ 70 years and histopathological entities with poor long-term prognoses are risk factors. Overlapping lesions are also associated with excess risk, indicating that lesion size or multifocality may matter. The overall risk of perioperative death is also higher in biopsy cases than in resection cases. Perioperative mortality rates of the 4 Norwegian neurosurgical centers were not predictive of their respective long-term survival rates. Conclusions Although considered surgically related if they occur within the first 30 days of surgery, most early postoperative deaths can happen independent of the handiwork of the operating surgeon or anesthesiologist. Overall prognosis of the disease seems to be a strong predictor of perioperative death—perhaps not surprisingly since the 30-day mortality rate is merely the intonation of the Kaplan-Meier curve. Both referral and treatment policies at a neurosurgical center will therefore markedly affect such early outcomes, but early deaths may not necessarily reflect overall quality of care or long-term results. The low incidence of perioperative death in intracranial tumor surgery also greatly limits the statistical power in comparative analyses, such as between published patient series or between centers and certainly between surgeons. Therefore the authors question the value of perioperative mortality rates as a quality indicator in modern neurosurgery for tumors.

scholarly journals euHeart: personalized and integrated cardiac care using patient-specific cardiovascular modelling

2011 ◽  
Vol 1 (3) ◽  
pp. 349-364 ◽  
Author(s):  
Nic Smith ◽  
Adelaide de Vecchi ◽  
Matthew McCormick ◽  
David Nordsletten ◽  
Oscar Camara ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Computational Modelling ◽  
Population Based ◽  
Individual Variability ◽  
Western Society ◽  
Patient Specific ◽  
Mortality And Morbidity ◽  
Multi Scale ◽  
Cardiac Pump Function

The loss of cardiac pump function accounts for a significant increase in both mortality and morbidity in Western society, where there is currently a one in four lifetime risk, and costs associated with acute and long-term hospital treatments are accelerating. The significance of cardiac disease has motivated the application of state-of-the-art clinical imaging techniques and functional signal analysis to aid diagnosis and clinical planning. Measurements of cardiac function currently provide high-resolution datasets for characterizing cardiac patients. However, the clinical practice of using population-based metrics derived from separate image or signal-based datasets often indicates contradictory treatments plans owing to inter-individual variability in pathophysiology. To address this issue, the goal of our work, demonstrated in this study through four specific clinical applications, is to integrate multiple types of functional data into a consistent framework using multi-scale computational modelling.

scholarly journals Клиническая и нейрофизиологическая характеристика неонатального периода детей, родившихся от ранних преждевременных родов

2019 ◽  
pp. 32-38
Keyword(s):  
Infant Mortality ◽  
Neonatal Period ◽  
Mortality Rates ◽  
Mortality And Morbidity ◽  
Typical Sample ◽  
High Infant Mortality ◽  
Nervous System Function ◽  
Quality Of Medical Care ◽  
Neurological Pathology

In recent years, there has been a decrease in perinatal and infant mortality rates in the world due to improvements in the quality of medical care for children born in early pre-term birth (32 and less weeks of gestation) (Baranov A.A., Namazova-Baranova L.S., Kurenkov A.L., etc., 2014). Complications of prematurity are the main causes of high infant mortality and morbidity in premature infants, the risk of complications increases with severity of immaturity (Sakharova E.S., 2017). Objective – to study the clinical and neurophysiological features of the neonatal period in children born at the gestational age of 32 weeks or less. Materials and methods: a cohort prospective study of the physical, neurological and neurophysiological status of 85 children born at the age of up to 32 weeks of pregnancy was conducted by a typical sample. Eelectroencephalography (Neuro-Facilities Copyright © 201-2018 Neurosoft) was performed, visual and auditory potentials were determined (Neuro-SPECTR Copyright © 2012-2018 Neurosoft), NSG. Results: on the basis of the obtained data, the dependence of the state of health and severity of neurological pathology on the period of gestation at birth, the severity of hypoxia and the severity of brain damage at birth was confi rmed. It was found out that the main manifestation of the nervous system function in children born at 32 and less weeks of gestation at 38-40 weeks of post-conceptual age is neurophysiological immaturity.

Predicting developmental outcomes in middle childhood from early life language and parenting experiences

2020 ◽  
Author(s):  
Jelena O'Reilly ◽  
Katrina d'Apice ◽  
Sophie von Stumm
Keyword(s):  
Middle Childhood ◽  
Early Life ◽  
Life Experiences ◽  
Behavioral Outcomes ◽  
Developmental Outcomes ◽  
Language Ability ◽  
Digital Audio ◽  
Early Experiences ◽  
Families With Children

Children’s early experiences of language and parenting are thought to have pervasive, long-term influence on their development. Using digital audio-recorders, we collected 3 full days of naturalistic observations from 107 British families with children aged 2 to 4 years, who we followed up four years later when the children were 5 to 8 years old. We found that children’s early life experiences of language and parenting were not significantly associated with their language ability, academic performance, and behavioral outcomes. Our findings suggest that children’s differences in development may be less affected by early life experiences of language and parenting, at least typical ones, than previously assumed.

scholarly journals Trends in the association between educational assortative mating, infant and child mortality in Nigeria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tolulope Ariyo ◽  
Quanbao Jiang
Keyword(s):  
High Education ◽  
Infant Mortality ◽  
Assortative Mating ◽  
Child Mortality ◽  
Child Survival ◽  
Mortality Rates ◽  
Childhood Mortality ◽  
Low Education ◽  
Infant And Child Mortality ◽  
Educational Assortative Mating

Abstract Background Existing knowledge has established the connection between maternal education and child survival, but little is known about how educational assortative mating (EAM), relates to childhood mortality. We attempt to examine this association in the context of Nigeria. Methods Data was obtained from the 2008, 2013, and 2018 waves of the Nigeria Demographic and Health Survey, which is a cross-sectional study. The sample includes the analysis of 72,527 newborns within the 5 years preceding each survey. The dependent variables include the risk of a newborn dying before 12 months of age (infant mortality), or between the age of 12–59 months (child mortality). From the perspective of the mother, the independent variable, EAM, includes four categories (high-education homogamy, low-education homogamy, hypergamy, and hypogamy). The Cox proportional hazard regression was employed for multivariate analyses, while the estimation of mortality rates across the spectrum of EAM was obtained through the synthetic cohort technique. Results The risk of childhood mortality varied across the spectrum of EAM and was particularly lowest among those with high-education homogamy. Compared to children of mothers in low-education homogamy, children of mothers in high-education homogamy had 25, 31 to 19% significantly less likelihood of infant mortality, and 34, 41, and 57% significantly less likelihood of child mortality in 2008, 2013 and 2018 survey data, respectively. Also, compared to children of mothers in hypergamy, children of mothers in hypogamous unions had 20, 12, and 11% less likelihood of infant mortality, and 27, 36, and 1% less likelihood of child mortality across 2008, 2013 and 2018 surveys, respectively, although not significant at p < 0.05. Both infant and child mortality rates were highest in low-education homogamy, as expected, lowest in high-education homogamy, and lower in hypogamy than in hypergamy. Furthermore, the trends in the rate declined between 2008 and 2018, and were higher in 2018 than in 2013. Conclusion This indicates that, beyond the absolute level of education, the similarities or dissimilarities in partners’ education may have consequences for child survival, alluding to the family system theory. Future studies could investigate how this association varies when marital status is put into consideration.

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