Increased Risk of Death Triggered by Domestic Violence, Hunger, Suicide, Exhausted Health System during COVID-19 Pandemic: Why, How and Solutions

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, just like many other public health emergencies, is a well-established global health burden that has resulted in several changes in routines and lifestyles of people globally. The coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, has directly or indirectly involved in the loss of lives of more than 3.24 million as of 6th May, 2021. The increasing threats posed by this pandemic were subsided by the swift and drastic measures put in place by different countries. As other causes of death before the emergence of COVID-19 still exist, the pandemic has further worsened their impact. The increased risks of COVID-19 deaths are not only due to the health burden it possesses, but also due to some other factors. These factors include domestic violence that becomes rampant, especially during lockdowns; hunger due to low economic development, unemployment, and loss of jobs; suicide due to depression; exhausted health system due to high level of COVID-19 cases and inability to contain it. As we move from the response phase into recovery, the pandemic’s direct and broader impacts on individuals, households, and communities will influence the capacity to recover. An understanding of these impacts is therefore required to develop priorities to support recovery. This paper identifies other causes of death amidst the pandemic, such as domestic violence, hunger, suicide, and exhausted health system, and how to minimize their effects.

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Respiratory-related death in individuals with incident asthma and COPD: a competing risk analysis

BMC Pulmonary Medicine ◽

10.1186/s12890-022-01823-4 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Alicia V. Gayle ◽

Cosetta Minelli ◽

Jennifer K. Quint

Keyword(s):

Causes Of Death ◽

Smoking Status ◽

Excess Risk ◽

Competing Risk ◽

Practice Research ◽

Mortality Data ◽

Clinical Practice Research Datalink ◽

Risk Of Death ◽

Increased Risk ◽

Competing Risk Models

Abstract Background Distinguishing between mortality attributed to respiratory causes and other causes among people with asthma, COPD, and asthma-COPD overlap (ACO) is important. This study used electronic health records in England to estimate excess risk of death from respiratory-related causes after accounting for other causes of death. Methods We used linked Clinical Practice Research Datalink (CPRD) primary care and Office for National Statistics mortality data to identify adults with asthma and COPD from 2005 to 2015. Causes of death were ascertained using death certificates. Hazard ratios (HR) and excess risk of death were estimated using Fine-Gray competing risk models and adjusting for age, sex, smoking status, body mass index and socioeconomic status. Results 65,021 people with asthma and 45,649 with COPD in the CPRD dataset were frequency matched 5:1 with people without the disease on age, sex and general practice. Only 14 in 100,000 people with asthma are predicted to experience a respiratory-related death up to 10 years post-diagnosis, whereas in COPD this is 98 in 100,000. Asthma is associated with an 0.01% excess incidence of respiratory related mortality whereas COPD is associated with an 0.07% excess. Among people with asthma-COPD overlap (N = 22,145) we observed an increased risk of respiratory-related death compared to those with asthma alone (HR = 1.30; 95% CI 1.21–1.40) but not COPD alone (HR = 0.89; 95% CI 0.83–0.94). Conclusions Asthma and COPD are associated with an increased risk of respiratory-related death after accounting for other causes; however, diagnosis of COPD carries a much higher probability. ACO is associated with a lower risk compared to COPD alone but higher risk compared to asthma alone.

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Mortality in Patients With Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Study

Neurology ◽

10.1212/wnl.0000000000012483 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012483

Author(s):

Emily L. Johnson ◽

Gregory L. Krauss ◽

Anna Kucharska-Newton ◽

Alice D. Lam ◽

Rani Sarkis ◽

...

Keyword(s):

Causes Of Death ◽

Excess Mortality ◽

Proportional Hazards ◽

Late Onset ◽

Cox Proportional Hazards ◽

Fee For Service ◽

Atherosclerosis Risk In Communities ◽

Risk Of Death ◽

Increased Risk ◽

Atherosclerosis Risk

ObjectiveTo determine the risk of mortality and causes of death in persons with late-onset epilepsy (LOE) compared to those without epilepsy in a community-based sample, adjusting for demographics and comorbid conditions.MethodsThis is an analysis of the prospective Atherosclerosis Risk in Communities (ARIC) study, initiated in 1987-1989 among 15,792 mostly black and white men and women in 4 U.S. communities. We used Centers for Medicare Services fee-for-service claims codes to identify cases of incident epilepsy starting at or after age 67. We used Cox proportional hazards analysis to identify the hazard of mortality associated with LOE and to adjust for demographics and vascular risk factors. We used death certificate data to identify dates and causes of death.ResultsAnalyses included 9090 participants, of whom 678 developed LOE during median 11.5 years of follow-up after age 67. Participants who developed LOE were at an increased hazard of mortality compared to those who did not, with adjusted hazard ratio 2.39 (95% CI 2.12-2.71). We observed excess mortality due to stroke, dementia, neurologic conditions, and end-stage renal disease in participants with compared to without LOE. Only 4 deaths (1.1%) were directly attributed to seizure-related causes.ConclusionsPersons who develop LOE are at increased risk of death compared to those without epilepsy, even after adjusting for comorbidities. The majority of this excess mortality is due to stroke and dementia.

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Causes of Death in an Acute Psychiatric Inpatient Unit of a Portuguese General Hospital

Acta Médica Portuguesa ◽

10.20344/amp.6905 ◽

2016 ◽

Vol 29 (7-8) ◽

pp. 468 ◽

Cited By ~ 1

Author(s):

Sofia Barbosa ◽

Márcia Sequeira ◽

Sara Castro ◽

Rita Manso ◽

Catarina Klut Câmara ◽

...

Keyword(s):

General Hospital ◽

Causes Of Death ◽

Psychiatric Inpatient ◽

Rare Event ◽

Aneurysm Rupture ◽

Inpatient Unit ◽

Case File ◽

Risk Of Death ◽

Increased Risk ◽

Circulatory System Diseases

Introduction: Psychiatric patients are at increased risk of death from a number of natural and unnatural causes. This study examines the mortality causes of all psychiatric inpatients of an acute psychiatric unit at a general hospital in Portugal for sixteen years (1998 to 2013).Material and Methods: Twenty-one inpatients died at the inpatient unit between 1998 and 2013 (average 1.3 per year). A retrospective study through case-file review was carried to collect demographic characteristics, medical and psychiatry diagnosis. Patients transferred to other wards during their admission were not included.Results: Circulatory system diseases were the most prevalent causes of death, occurring in 2/3 of patients and include pulmonary embolism (n = 6), acute stroke (n = 3), cardiac arrhythmia (n = 2), acute myocardial infarction (n = 1), abdominal aortic aneurysm rupture (n = 1) and heart failure (n = 1). Two patients died with pneumonia and in four cases the cause of death was undetermined. Only one case of suicide was registered.Discussion: Circulatory conditions were the most frequent causes of death in our inpatient unit. Albeit a relatively rare event, inpatient suicide does occur and, in addition to its complex consequences on staff, family and patients should remain a focus for continued prevention.Conclusion: Mortality studies are important for determining quality of health care and to create recommendations for preventive measures.

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Long-term patient survival in ANCA-associated vasculitis

Annals of the Rheumatic Diseases ◽

10.1136/ard.2010.137778 ◽

2010 ◽

Vol 70 (3) ◽

pp. 488-494 ◽

Cited By ~ 390

Author(s):

Oliver Flossmann ◽

Annelies Berden ◽

Kirsten de Groot ◽

Chris Hagen ◽

Lorraine Harper ◽

...

Keyword(s):

Prognostic Factors ◽

Causes Of Death ◽

Patient Survival ◽

First Year ◽

Term Survival ◽

Risk Of Death ◽

Anca Associated Vasculitis ◽

Increased Risk ◽

Age And Sex

BackgroundWegener's granulomatosis and microscopic polyangiitis are antineutrophil cytoplasm antibodies (ANCA)-associated vasculitides with significant morbidity and mortality. The long-term survival of patients with ANCA associated vasculitis treated with current regimens is uncertain.ObjectiveTo describe the long-term patient survival and possible prognostic factors at presentation in an international, multicentre, prospectively recruited representative patient cohort who were treated according to strictly defined protocols at presentation and included the full spectrum of ANCA-associated vasculitis disease.MethodsOutcome data were collected for 535 patients who had been recruited at the time of diagnosis to four randomised controlled trials between 1995 and 2002. Trial eligibility was defined by disease severity and extent, covered the spectrum of severity of ANCA-associated vasculitis and used consistent diagnostic criteria. Demographic, clinical and laboratory parameters at trial entry were tested as potential prognostic factors in multivariable models.ResultsThe median duration of follow-up was 5.2 years and 133 (25%) deaths were recorded. Compared with an age- and sex-matched general population there was a mortality ratio of 2.6 (95% CI 2.2 to 3.1). Main causes of death within the first year were infection (48%) and active vasculitis (19%). After the first year the major causes of death were cardiovascular disease (26%), malignancy (22%) and infection (20%). Multivariable analysis showed an estimated glomerular filtration rate <15 ml/min, advancing age, higher Birmingham Vasculitis Activity Score, lower haemoglobin and higher white cell count were significant negative prognostic factors for patient survival.ConclusionPatients with ANCA-associated vasculitis treated with conventional regimens are at increased risk of death compared with an age- and sex-matched population.

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Epilepsy-associated long-term mortality after aneurysmal subarachnoid hemorrhage

Neurology ◽

10.1212/wnl.0000000000004113 ◽

2017 ◽

Vol 89 (3) ◽

pp. 263-268 ◽

Cited By ~ 9

Author(s):

Jukka Huttunen ◽

Antti Lindgren ◽

Mitja I. Kurki ◽

Terhi Huttunen ◽

Juhana Frösen ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Causes Of Death ◽

University Hospital ◽

Study Cohort ◽

Catchment Population ◽

Risk Of Death ◽

Increased Risk ◽

Long Term Mortality

Objective:To elucidate the epilepsy-associated causes of death and subsequent excess long-term mortality among 12-month survivors of subarachnoid hemorrhage from saccular intracranial aneurysm (SIA-SAH).Methods:The Kuopio SIA Database (kuopioneurosurgery.fi) includes all SIA-SAH patients admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland. The study cohort consists of 779 patients, admitted from 1995 to 2007, who were alive at 12 months after SIA-SAH. Their use of reimbursable antiepileptic drugs and the causes of death (ICD-10) were fused from the Finnish national registries from 1994 to 2014.Results:The 779 12-month survivors were followed up until death (n = 197) or December 31, 2014, a median of 12.0 years after SIA-SAH. Epilepsy had been diagnosed in 121 (15%) patients after SIA-SAH, and 34/121 (28%) had died at the end of follow-up, with epilepsy as the immediate cause of death in 7/34 (21%). In the 779 patients alive at 12 months after SIA-SAH, epilepsy was an independent risk factor for mortality (hazard ratio 1.8, 95% confidence interval 1.1–3.0).Conclusions:Comorbid epilepsy in 12-month survivors of SIA-SAH is associated with increased risk of death in long-term follow-up. Survivors of SIA-SAH require long-term dedicated follow-up, including identification and effective treatment of comorbid epilepsy to prevent avoidable deaths.

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Long-Term Survival, Causes of Death, and Trends in 5-Year Mortality After Intracerebral Hemorrhage: The Tromsø Study

Stroke ◽

10.1161/strokeaha.120.032750 ◽

2021 ◽

Author(s):

Maria Carlsson ◽

Tom Wilsgaard ◽

Stein Harald Johnsen ◽

Liv-Hege Johnsen ◽

Maja-Lisa Løchen ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Intracerebral Hemorrhage ◽

Causes Of Death ◽

Population Based ◽

Term Survival ◽

Long Term Survival ◽

Risk Of Death ◽

Increased Risk

Background and Purpose: Data on long-term survival after intracerebral hemorrhage (ICH) are scarce. In a population-based nested case-control study, we compared long-term survival and causes of death within 5 years in 30-day survivors of first-ever ICH and controls, assessed the impact of cardiovascular risk factors on 5-year mortality, and analyzed time trend in 5-year mortality in ICH patients over 2 decades. Methods: We included 219 participants from the population-based Tromsø Study, who after the baseline participation had a first-ever ICH between 1994 to 2013 and 1095 age- and sex-matched participants without ICH. Cumulative survival was presented using the Kaplan-Meier method. Hazard ratios (HRs) for mortality and for the association between cardiovascular risk factors and 5-year mortality in 30-day survivors were estimated by stratified Cox proportional hazards models. Trend in 5-year mortality was assessed by logistic regression. Results: Risk of death during follow-up (median time, 4.8 years) was increased in the ICH group compared with controls (HR, 1.62 [95% CI, 1.27–2.06]). Cardiovascular disease was the leading cause of death, with a higher proportion in ICH patients (22.9% versus 9.0%; P <0.001). Smoking increased the risk of 5-year mortality in cases and controls (HR, 1.59 [95% CI, 1.15–2.19]), whereas serum cholesterol was associated with 5-year mortality in cases only (HR, 1.39 [95% CI, 1.04–1.86]). Use of anticoagulants at ICH onset increased the risk of death (HR, 2.09 [95% CI, 1.09–4.00]). There was no difference according to ICH location (HR, 1.15 [95% CI, 0.56–2.37]). Five-year mortality did not change during the study period (odds ratio per calendar year, 1.01 [95% CI, 0.93–1.09]). Conclusions: Survival rates were significantly lower in cases than in controls, driven by a 2-fold increased risk of cardiovascular death. Smoking, serum cholesterol, and use of anticoagulant drugs were associated with increased risk of death in ICH patients. Five-year mortality rates in ICH patients remained stable over time.

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Severe hypoglycaemia and absolute risk of cause-specific mortality in individuals with type 2 diabetes: a UK primary care observational study

Diabetologia ◽

10.1007/s00125-020-05223-3 ◽

2020 ◽

Vol 63 (10) ◽

pp. 2129-2139

Author(s):

Francesco Zaccardi ◽

Suping Ling ◽

Claire Lawson ◽

Melanie J. Davies ◽

Kamlesh Khunti

Keyword(s):

Type 2 Diabetes ◽

Index Date ◽

Causes Of Death ◽

Severe Hypoglycaemia ◽

Absolute Risk ◽

Cardiovascular Death ◽

Hypoglycaemic Episode ◽

Risk Of Death ◽

Increased Risk

Abstract Aims/hypothesis Several pathophysiological mechanisms would suggest a causal link between hypoglycaemia and cardiovascular death; conversely, current knowledge would not support a causal relationship with other causes of death. To clarify the nature and the magnitude of the association between hypoglycaemia and death, we investigated the 5 year mortality risks for cardiovascular disease, cancer and other causes in individuals with type 2 diabetes admitted to hospital for a severe hypoglycaemic episode. Methods We defined in the UK Clinical Practice Research Datalink database a prevalent cohort of adults with type 2 diabetes diagnosed between 1 January 1998 and 1 January 2011 (index date), with available linkage to the Office for National Statistics (ONS) and the Hospital Episode Statistics (HES). A hospital admission reporting hypoglycaemia as the underlying cause was identified before the index date in the HES; date and underlying cause of death were obtained from the ONS. We quantified the 5 year risk of cause-specific death in people with and without admission to hospital for severe hypoglycaemia, adjusting for potential confounders and accounting for competing risk. Results Of the 74,610 subjects included in the cohort, 388 (0.5%) were admitted at least once for a severe hypoglycaemic episode; subjects admitted were older, with higher HbA1c and a greater prevalence of multimorbidity. During a median follow-up of 7.1 years, 236 (60.8%) and 18,539 (25.0%) deaths occurred in subjects with and without a previous severe hypoglycaemia, respectively. Non-cardiovascular causes accounted for 71% of all deaths in both subjects with and without hypoglycaemia. In a 60-year-old person with severe hypoglycaemia, the 5 year absolute risk of death, adjusted for age, sex, ethnicity, systolic blood pressure, total cholesterol, HbA1c, BMI, eGFR, smoking status, alcohol consumption and deprivation (Townsend score), was 6.6%, 1.1% and 13.1% for cardiovascular, cancer and other causes, respectively, while the 5 year absolute risk difference compared with a subject without severe hypoglycaemia was 4.7% (95% CI 1.0, 8.3) for cardiovascular, −1.4% (−4.1, 1.4) for cancer and 11.1% (6.1, 16.1) for other causes of death. Results were consistent in models further adjusted for medications and comorbidities (myocardial infarction, stroke, peripheral artery disease, heart failure, atrial fibrillation, cancer), with sulfonylurea and insulin associated with increased mortality rates (from cause-specific hazard ratio of 1.06 [95% CI 0.99, 1.14] for cancer death with use of sulfonylurea to 1.42 [1.29, 1.56] for cardiovascular death with use of insulin). Results were robust to missing data. Conclusions/interpretation The results of this study indicate severe hypoglycaemia as a marker of, rather than causally linked to, an increased risk of long-term mortality. Regardless of the nature of the association, a severe hypoglycaemic episode represents a strong negative prognostic factor in patients with type 2 diabetes.

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Mortality and causes of death among people suspected of driving under the influence and testing positive for multiple substances

Scandinavian Journal of Public Health ◽

10.1177/1403494819894166 ◽

2019 ◽

Vol 48 (8) ◽

pp. 809-816

Author(s):

Karoliina Karjalainen ◽

Jari Haukka ◽

Kristiina Kuussaari ◽

Sanna Hautala ◽

Pekka Hakkarainen

Keyword(s):

General Population ◽

Causes Of Death ◽

Social Background ◽

Reference Population ◽

Elevated Risk ◽

Driving Under The Influence ◽

Finnish Population ◽

Risk Of Death ◽

Increased Risk ◽

Specific Mortality

Aims: Understanding the mortality of drug users using multiple substances is helpful in preventing the harmful effects of polydrug use. We examined overall and cause-specific mortality and differences in mortality based on social background among people suspected of driving under the influence and testing positive for multiple substances (DUIMS) compared with the general Finnish population. Methods: Register data from 785 DUIMS during 2003–2006 were studied, with a reference population ( n = 25,381) drawn from the general Finnish population. The effect of DUIMS on all-cause and cause-specific mortality was estimated using a Poisson regression model. Results: DUIMS had an increased risk of death compared with the general population (MRR 5.3, 95% CI 4.2–6.6). The most common causes of death in DUIMS were poisonings (37.9%) and suicides (13.6%), whereas in the reference population these were cardiovascular diseases (30.8%) and cancer (26.6%). The cause-specific risk of death among DUIMS was higher in all observed causes of death, except for cancer. The effect of DUIMS on mortality was modified by age, employment status and marital status; DUIMS was associated with an elevated risk of death especially in younger age groups and in singles. Conclusions: DUIMS indicates higher mortality, and DUIMS’ profiles in causes of death differ from the general population. Elevated risk for, for instance, suicidal, accidental and violent death among those using multiple substances highlights the need to also pay attention to causes of death other than poisoning/overdose.

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Patient survival and risk of death after prostate cancer treatment in the Brazilian Unified Health System

Revista de Saúde Pública ◽

10.1590/s1518-8787.2017051006766 ◽

2017 ◽

Vol 51 (0) ◽

Author(s):

Sonia Faria Mendes Braga ◽

Mirian Carvalho de Souza ◽

Raphael Romie de Oliveira ◽

Eli Iola Gurgel Andrade ◽

Francisco de Assis Acurcio ◽

...

Keyword(s):

Prostate Cancer ◽

Health System ◽

Cancer Treatment ◽

Clinical Staging ◽

National Database ◽

Patient Death ◽

Factors Associated ◽

Risk Of Death ◽

Unified Health System ◽

Increased Risk

ABSTRACT OBJECTIVE Analyze the probability of specific survival and factors associated with the risk of death of patients with prostate cancer who received outpatient cancer treatment in the Brazilian Unified Health System, Brazil. METHODS Retrospective cohort study using the National Database of Oncology, developed through the deterministic-probabilistic pairing of health information systems: outpatient (SIA), hospital (SIH) and mortality (SIM). The probability of overall and specific survival was estimated by the time elapsed between the date of the first ambulatory treatment, from 2002 to 2003, until the patient’s death or the end of the study. Fine and Gray’s model of competing-risks regression was adjusted according to the variables: age of diagnostic, region of residence, tumor clinical staging, type of outpatient cancer treatment and hospitalization in the assessment of factors associated with risk of patient death. RESULTS Of 16,280 patients studied, the average age was 70 years, approximately 25% died due to prostate cancer and 20% for other causes. The probability of overall survival was 0.50 (95%CI 0.49–0.52) and the specific was 0.70 (95%CI 0.69–0.71). The factors associated with the risk of patient death were: stage III (HR = 1.66; 95%CI 1.39–1.99) and stage IV (HR = 3.49; 95%CI 2.91–4.18), chemotherapy (HR = 2.34; 95%CI 1.76–3.11) and hospitalization (HR = 1.6; 95%CI 1.55–1.79). CONCLUSIONS The late diagnosis of the tumor, palliative treatments, and worse medical condition were factors related to the worst survival and increased risk of death from prostate cancer patients in Brazil.

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Mortality in Psoriatic Arthritis – A Single-center Study from the UK

The Journal of Rheumatology ◽

10.3899/jrheum.100034 ◽

2010 ◽

Vol 37 (10) ◽

pp. 2141-2144 ◽

Cited By ~ 41

Author(s):

CAITRIONA BUCKLEY ◽

CHARLOTTE CAVILL ◽

GORDON TAYLOR ◽

HAZEL KAY ◽

NICOLA WALDRON ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Causes Of Death ◽

Standardized Mortality Ratio ◽

Single Center ◽

National Hospital ◽

Risk Of Death ◽

Increased Risk ◽

Single Center Study ◽

Mortality Ratio ◽

The Uk

Objective.To determine whether the mortality in a cohort of patients with psoriatic arthritis (PsA) from a single center in the UK is significantly different from the general UK population.Methods.Patients who were entered onto the PsA database at the Royal National Hospital for Rheumatic Diseases, Bath, between 1985 and 2007 were included in this study. Information on patient deaths was collected retrospectively. The National Health Service (NHS) Strategic Tracing Service was used to establish which patients were alive and which had died. Date and cause of death were confirmed by death certificates from the Registry of Births, Marriages and Deaths. A standardized mortality ratio (SMR) was calculated by matching the patient data to single-year, 5-year age-banded England and Wales data from the Office of National Statistics.Results.In this cohort of 453 patients with PsA (232 men, 221 women), there were 37 deaths. Sixteen men and 21 women died. The SMR for the men was 67.87% (95% CI 38.79, 110.22), and for the women, 97.01% (95% CI 60.05, 148.92) and the overall SMR for the PsA cohort was 81.82% (95% CI 57.61, 112.78). The leading causes of death in this cohort were cardiovascular disease (38%), diseases of the respiratory system (27%), and malignancy (14%).Conclusion.These results suggest that mortality in our single-center PsA cohort is not significantly different from the general UK population. No increased risk of death was observed in this cohort.

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