Adapting and validating the log quadratic model to derive under-five age- and cause-specific mortality (U5ACSM): a preliminary analysis

Background The mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without high functioning vital registration systems could benefit from estimates of age- and cause-specific mortality to inform health programming, however, to date the causes of under-five death have only been described for broad age categories such as for neonates (0–27 days), infants (0–11 months), and children age 12–59 months. Methods We adapt the log quadratic model to mortality patterns for children under five to all-cause child mortality and then to age- and cause-specific mortality (U5ACSM). We apply these methods to empirical sample registration system mortality data in China from 1996 to 2015. Based on these empirical data, we simulate probabilities of mortality in the case when the true relationships between age and mortality by cause are known. Results We estimate U5ACSM within 0.1–0.7 deaths per 1000 livebirths in hold out strata for life tables constructed from the China sample registration system, representing considerable improvement compared to an error of 1.2 per 1000 livebirths using a standard approach. This improved prediction error for U5ACSM is consistently demonstrated for all-cause as well as pneumonia- and injury-specific mortality. We also consistently identified cause-specific mortality patterns in simulated mortality scenarios. Conclusion The log quadratic model is a significant improvement over the standard approach for deriving U5ACSM based on both simulation and empirical results.

Causes of Death during the First COVID-19 Pandemic Wave in Italy: A Comparison with Some European Countries

Studies comparing cause-of-death patterns across countries during the COVID-19 outbreak are still lacking although such studies would contribute to the understanding of the direct and indirect effect of the virus on mortality. In this report, we compare the mortality pattern observed in Italy during the first pandemic wave (March–April 2020) with that of some European countries. We calculated cause-specific, age-standardized mortality ratios (SMR) for Spain, England, and Sweden for the two mentioned months from 2016 to 2020, using already published data. Although Italy presented the highest crude overall mortality rate (267 per 100,000 population), age-adjusted ratios showed that all-cause and COVID-19 mortality in Italy were higher than in Sweden but lower than in the other two countries. Some causes had a similar increase in 2020 compared to previous years in all countries, i.e., endocrine diseases (especially diabetes), dementia and Alzheimer’s (in general mental disorders), and hypertensive heart diseases. Conversely, respiratory diseases, in particular pneumonia and influenza, increased to a greater extent in Italy. This latter result could be, in part, related to the underreporting of COVID-19 on death certificates during the first period of the pandemic, when Italy was the first European country severely hit by the virus.

Mortality Pattern of In-Born vs Out-Born Neonates - Comparative Study of Neonates Admitted to Special New Born Care Units of a Tertiary Care Hospital of Hilly Region of North India

BACKGROUND The high incidence of global neonatal mortality has triggered several efforts to improve facility-based neonatal care but despite these many advances in perinatal and neonatal care, the outcomes achievable at different levels are comparable. This study was undertaken to compare the mortality pattern among both the inborn and outborn neonates admitted to the special new born care units (SNCU)s of tertiary care hospital of Shimla city, in the hilly state of Himachal Pradesh. METHODS A cross-sectional study involving a record review of all neonates admitted to the specialized neonatal care units of the paediatric ward of IGMC, Shimla & Kamla Nehru Hospital (KNH) over five years from January 2016 to December 2020 was conducted. The most important causes of mortality and its associated factors were analysed, and a statistical inference was made. RESULTS Among the 4018 outborn neonates admitted to the SNCU of the pediatric ward of IGMC, Shimla, 2440 (60.73 %) were males and 1578 (39.27 %) were females while 6607 inborn neonates were admitted to the SNCU of KNH Shimla and among them 3655 (55.32 %) were males and 2952 (44.68 %) were females. In the outborn SNCU of IGMC Shimla, 307 (7.64 %) died while in the inborn SNCU of KNH Shimla, 366 (5.54 %) neonates died over a span of 5 years. In outborn SNCU of IGMC Shimla, a maximum of 110 (35.83 %) neonates died due to sepsis/pneumonia/meningitis, followed by 60 (19.54 %) due to respiratory distress syndrome and 50 (16.29 %) due to HIE/moderate-severe birth asphyxia while in case of inborn SNCU of KNH, maximum deaths of 115 (31.42 %) were due to respiratory distress syndrome, followed by 93 (25.41 %) due to sepsis/pneumonia/meningitis and 69 (18.85 %) due to HIE/moderate-severe birth asphyxia. At outborn SNCU of IGMC, Shimla, most of the neonates who died 118 (38.44 %) weighed about 1500-2499 gm, while in inborn SNCU of KNH, Shimla, most of the neonates 147 (40.16 %) had weight between 1000-1499 gm. At outborn SNCU of IGMC Shimla, 131 (42.67 %) were preterm while at inborn SNCU of KNH, 305 (83.3 %) were preterm. CONCLUSIONS Sepsis, birth asphyxia and RDS are the important causes of mortality, which must be urgently addressed. Improving antenatal care, improved access to health facilities, early identification of danger signs, timely referral, capacity building, can reduce neonatal mortality. KEY WORDS Comparison, Neonatal Mortality, SNCUs, Tertiary Care Hospital, Inborn Neonate, Outborn Neonate.

Regional differences in cardiac mortality rates in Russia: the role of statistical features

Aim. To analyze the contribution of cardiac causes to all-cause mortality, to characterize the differences in standardized mortality rates (SMRs) in Russian regions, as well as to identify promising directions for improving establishment of cardiovascular death and its coding.Material and methods. We used the Federal State Statistics Service (Rosstat) data on the mortality rate and the average annual population in one-year age groups for 2019. To calculate the SMR, the European Standard Population was used. For each cardiac death, the SMR from 23 causes was calculated, which were combined into 4 groups, and for each of these groups, the regional mean and standard deviation of SMR in Russian regions were estimated.Results. In 2019, the cardiac SMR in Russian regions was 301,02±77,67, which corresponded to 30,5±5,8% of all death causes. At the same time, the coefficient of variation of regional cardiac SMR was 25,8%. In general, in 60,9±13,8% of cases, the cause of cardiac death was chronic diseases, mainly related to atherosclerosis. The proportion of deaths from acute types of coronary artery disease was 17,3±9,7%, deaths not associated with atherosclerosis (heart defects, myocardial diseases, etc.) — 17,5±8,2%, deaths associated with hypertension — 4,2±5,2%. The coefficient of variation of regional SMR was 34,66, 64,47, 50,99 and 122,7, respectively.Conclusion. Significant regional differences in SMR from certain cardiac causes and groups of causes, as well as their contribution to mortality pattern, were revealed. It is necessary to continue the research on the methodology of statistical recording of certain cardiovascular diseases.

Assessment of Mortality Pattern Based on Autopsy in Victims of Road Traffic Accident

Background: The Trauma and road accident is considered as major cause mortality in the young adults’ populations around the world. The understanding the importance of forensic investigation of un-natural deaths, accidental injuries and suicidal cases is required by medical staff and patients’ family members. Objective: To asses of mortality pattern based on autopsy in victims of road traffic accident Study Design: Retrospective study Place and Duration of the Study: Medicolegal Section of Liaquat University Hospital Hyderabad, Pakistan from 1st January 2018 to 31st December 2019. Methodology: Six hundred and twenty nine autopsies were included. Deaths due to road traffic accident were included. Results: There were 472 males and 157 females between 31 to 50 years. Two hundred and forty nine patients were admitted in ICU. Two hundred and fourteen patients had affected head region followed by face 104 injuries. While 74 had affected neck, 67 affected thorax, 63 affected abdominal region, 52 affected spine and 55 had affected lower extremities.173 were died due to damage of central nervous system. The damages were due to car accident was 62, motorbike 73, rickshaw 22 and other reasons 14. One hundred and forty patients were died due to fracture of skull. Conclusion: The mortalities rates are under reported in majority of accidental cases due to lacking of autopsies procedures. Keywords: Autopsy, Assessment, Mortality pattern, Road traffic accident

Warmer water increases early body growth of northern pike (Esox lucius) but mortality has larger impact on decreasing body sizes

Large fish species often display truncated size distributions related to harvest. In addition, temperature, food availability and density-dependence affect body growth, and together with natural mortality influence population size structure. Here we study changes in body growth, size distributions and mortality in both harvested and non-harvested populations of northern pike over 50 years along the Baltic Sea coast and in Lake Mälaren, Sweden. For coastal pike, body growth has increased coincidentally with increasing water temperatures, yet in the last two decades there has been a decrease of larger individuals. In Lake Mälaren, in contrast, size distributions and body growth were stationary despite similar increases in water temperature. A dominance of slow-growing individuals in older age-classes was evident in all studied populations, also in the no-take zone, suggesting other factors than fishing contribute to the mortality pattern. We propose that increasing temperatures have favoured body growth in coastal areas, but this has been counteracted by increased mortality, causing pike sizes to decline. To regain larger coastal pike, managers need to consider multiple measures that reduce mortality.

An observational study on pattern of mortalities as per ICD-10 classification system in a tertiary care hospital in India

Background: Records of vital events like death constitute an important component of the Health Information System. Patterns of mortality decline that occur with the demographic transition is a change in the distribution of deaths by cause away from a pattern dominated by communicable diseases toward one in which non-communicable diseases account for the overwhelming majority of deaths. Aims and Objective: To identify the mortality pattern in Burdwan Medical College as per ICD-10 classification in the year 2017.The study also evaluated socio-demographic distribution and causes of deaths during that period. Materials and Methods: It was an Institution based retrospective observational study. Complete enumeration of all hospital records of medically certified deaths of in-patients from different departments except the Paediatrics who died in 2017 was done. The underlying cause of death was classified according to I.C.D 10th revision, version 16. Information collected included also the demographic characteristics like age, gender, date of admission, place of residence and date of death for the study. Results: In this study, most of the deaths were seen in males (59.99%), with a sex ratio of female to male deaths to be 667 per thousand. The major proportion of deaths was in the age group of 55 to 64 years (23.53%). The percentage distribution of ten major cause groups of death for the period from January to December during 2017 reveals that the group “Diseases of the Circulatory System” had occupied the position of the top-most killer and it had maintained the trend throughout the year with the highest rate in the month of March (43.9%). The cause of death was more in Non-Communicable diseases (Chapter IX, Chapter XIX) compared to that of Communicable diseases. Conclusion: Procedures for death certification and coding of underlying causes of death need to be streamlined to improve reliability of registration data needed for epidemiological research or public health policy formulation.

Long-term trends in cancer mortality in the Republic of Moldova

Introduction. Cancer is the second cause-of-death mortality pattern in the Republic of Moldova. The study of both cancer mortality by age and its detailed causes is an important tool for evidence-based public health policy. The study aims at comparing recent changes in cancer mortality with long-term trends, depending on specific causes and age. Material and methods. This study was carried out on the reconstructed 1965-2018 death time series, according to the 10th revision of the International Classification of Diseases. Standardized death rates were computed. Results. After a gradual increase in the ‘70s and ‘80s of the last century, cancer mortality rate showed “reversed” patterns and started to decline in the ‘90s. This decline was due to the data quality issue and to the competing risks of dying from other causes sensitive to the social and economic circumstances of the ‘90s. Since the beginning of the millennium, cancer mortality has resumed its growth that continues up to now. Despite the increasing overall trend in cancer mortality rate during 1965-2018, the analysis by age and specific causes revealed opposite trends. Conclusions. The malignant neoplasms specific for certain sites and age groups (stomach, uterus, leukaemia in children) showed, however some therapeutic progress, while the situation for other tumour sites (lung, breast, and intestine) worsened significantly. The moderate decrease in lung cancer in the 1990s should be cautiously interpreted.