Transformation of Mortality by Sex in the Four Biggest Cities in Ukraine

Large cities concentrate a substantial part of the educated, highly qualified, and economically active populations. Such social “selection” with the peculiarities of lifestyle determines the distinctive characteristics of the level and structure of mortality. Even though data on deaths by causes of death for the large cities are available in Ukraine, very few studies have analyzed cause-specific mortality in these cities. The objective of the study is to make a comparative analysis of mortality from the most influential causes of death in large cities. The novelty lies in the comparative analysis done for Dnipro, Kyiv, Lviv, Odesa, and Kharkiv for the first time. The study uses the direct method of standardization to calculate standardized death rates by sex in 2005-2019. The results indicate lower all-cause mortality rates for the large city residents compared to the corresponding average country-level indicators. Kyiv, Lviv, and Odesa have lower death rates compared to Dnipro and Kharkiv. In Kyiv and Lviv, this is attributed to lower mortality from almost all major causes of death, while in Odesa this mainly resulted from the extremely low ischemic heart disease mortality. Relatively high mortality from circulatory diseases is observed in Kharkiv and Dnipro. However, in Dnipro, this is associated with a high death rate from coronary heart disease and a very low contribution of cerebrovascular disease, whereas in Kharkiv coronary and cerebrovascular disease death rates are quite high. Mortality rates from diseases of the digestive system in the large cities are found to be the closest to the average in Ukraine (except for Lviv). The neoplasms are the only large group of diseases with a mortality rate that exceeds the average level in Ukraine, in particular for women. Overall, the death rates from most of the causes of death in the large cities demonstrated a positive trend in 2005-2019, with some exceptions. External causes and infectious diseases showed the most decrease while mortality from AIDS and ill-defined causes increased. Also, there were uncertain dynamics of deaths due to suicide and injuries with undetermined intent. Given some specific mortality differences between the cities, some concerns have been raised over the accuracy of the coding of diagnoses. In particular, unusually low mortality from ischemic heart disease was found in Odesa and from cerebrovascular disease in Dnipro, very rare deaths from alcoholic liver disease in Odesa, accidental alcohol poisoning in Kyiv, and a group of other liver diseases in Dnipro. We also assume misclassification of suicides as injuries with undetermined intent in Kharkiv. Our findings highlight the importance of the implementation of automated coding and selection of causes of death that can minimize the number of subjective decisions made by coders and lead to significant improvements in the quality of data.

Mortality by Causes of Death in Metropolices of Ukraine

Large cities concentrate a substantial part of the educated, highly qualified, and economically active populations. Such social “selection” with the peculiarities of lifestyle determines the distinctive characteristics of the level and structure of mortality. Even though data on deaths by causes of death for the large cities are available in Ukraine, very few studies have analyzed cause-specific mortality in these cities. The objective of the study is to make a comparative analysis of mortality from the most influential causes of death in large cities. The novelty lies in the comparative analysis done for Dnipro, Kyiv, Lviv, Odesa, and Kharkiv for the first time. The study uses the direct method of standardization to calculate standardized death rates by sex in 2005-2019. The results indicate lower all-cause mortality rates for the large city residents compared to the corresponding average country-level indicators. Kyiv, Lviv, and Odesa have lower death rates compared to Dnipro and Kharkiv. In Kyiv and Lviv, this is attributed to lower mortality from almost all major causes of death, while in Odesa this mainly resulted from the extremely low ischemic heart disease mortality. Relatively high mortality from circulatory diseases is observed in Kharkiv and Dnipro. However, in Dnipro, this is associated with a high death rate from coronary heart disease and a very low contribution of cerebrovascular disease, whereas in Kharkiv coronary and cerebrovascular disease death rates are quite high. Mortality rates from diseases of the digestive system in the large cities are found to be the closest to the average in Ukraine (except for Lviv). The neoplasms are the only large group of diseases with a mortality rate that exceeds the average level in Ukraine, in particular for women. Overall, the death rates from most of the causes of death in the large cities demonstrated a positive trend in 2005-2019, with some exceptions. External causes and infectious diseases showed the most decrease while mortality from AIDS and ill-defined causes increased. Also, there were uncertain dynamics of deaths due to suicide and injuries with undetermined intent. Given some specific mortality differences between the cities, some concerns have been raised over the accuracy of the coding of diagnoses. In particular, unusually low mortality from ischemic heart disease was found in Odesa and from cerebrovascular disease in Dnipro, very rare deaths from alcoholic liver disease in Odesa, accidental alcohol poisoning in Kyiv, and a group of other liver diseases in Dnipro. We also assume misclassification of suicides as injuries with undetermined intent in Kharkiv. Our findings highlight the importance of the implementation of automated coding and selection of causes of death that can minimize the number of subjective decisions made by coders and lead to significant improvements in the quality of data.

Development and Validation of a Syndrome Definition for Suspected Nonfatal Unintentional/Undetermined Intent Stimulant-Involved Overdoses

Objectives To monitor stimulant-involved overdose (SOD) trends, the Centers for Disease Control and Prevention (CDC) developed and evaluated the validity of a syndromic surveillance definition for suspected nonfatal, unintentional/undetermined intent stimulant-involved overdose (UUSOD). Methods We analyzed all emergency department (ED) visits in CDC’s surveillance system that met the UUSOD syndrome definition (January 2018–December 2019). We classified visits as true positive, possible, or not UUSODs after reviewing diagnosis codes and chief complaints. We first assessed whether visits were acute SODs, subsequently classifying acute SODs by intent. The percentage of true-positive UUSODs did not include intentional or possibly intentional visits. We considered all visits with UUSOD diagnosis codes to be acute SODs and reviewed them for intent. We manually reviewed and double-coded a 10% random sample of visits without UUSOD diagnosis codes using decision rules based on signs and symptoms. The overall percentage of true-positive UUSODs was a weighted average of the percentage of true-positive UUSODs based on diagnosis codes and the percentage of true-positive UUSODs determined by manually reviewing visits without codes. Results During 2018-2019, 40 045 ED visits met the syndrome definition for UUSOD. Approximately half (n = 18 793; 46.9%) of 40 045 visits had UUSOD diagnosis codes, indicating acute SOD; of these, 98.6% (n = 18 534) were true-positive UUSODs. Of 2125 manually reviewed visits without UUSOD diagnosis codes, 32.6% (n = 693) were true-positive UUSODs, 54.2% (n = 1151) were possible UUSODs, and 13.2% (n = 281) were not UUSODs. Overall, 63.6% of visits were true-positive UUSODs, 29.3% were possible UUSODs, and 7.1% were not UUSODs. Practice Implications CDC’s UUSOD definition may assist in surveillance efforts with further refinement to capture data on SOD clusters and trends.

Sociodemographic Analysis of Suicide Rates Among Older Adults Living in Ecuador: 1997–2019

Background: Despite most suicides occurring in low-and-middle-income countries (LAMICs), limited reports on suicide rates in older adults among LAMICs are available. In Ecuador, high suicide rates have been reported among adolescents. Little is known about the epidemiology of suicides among older adults in Ecuador.Aim: To examine the sociodemographic characteristics of suicides among older adults living in Ecuador from 1997 to 2019.Methods: An observational study was conducted using Ecuador's National Institute of Census and Statistics database from 1997 to 2019 in Ecuadorians aged 60 and older. International Classification of Diseases 10th Revision (ICD-10) (X60-X84)-reported suicide deaths were included in addition to deaths of events of undetermined intent (Y21-Y33). Sex, age, ethnicity, educational level, and method of suicide were analyzed. Annual suicide rates were calculated per 100,000 by age, sex, and method. To examine the trends in rates of suicide, Joinpoint analysis using Poisson log-linear regression was used.Results: Suicide rates of female older adults remained relatively stable between 1997 and 2019 with an average annual percentage increase of 2.4%, while the male rates increased between 2002 and 2009, 2014 and 2016, and maintained relatively stable within the past 3 years (2017–2019). The annual age-adjusted male suicide rate was 29.8 per 100,000, while the female suicide rate was 5.26 per 100,000 during the study period. When adding deaths of undetermined intent, the annual male rate was 60.5 per 100,000, while the same rate was 14.3 for women. The most common suicide method was hanging (55.7%) followed by self-poisoning (26.0%). The highest suicide numbers were reported in urban districts, men, and those with lower education status.Conclusion: This study contributes to building the baseline for further studies on suicide rates of older adults in Ecuador. Results highlight priority areas of suicide prevention. By examining suicide trends over 23 years, findings can help inform policy and future interventions targeting suicide prevention.

Alcohol and drug abuse as a manifestation of social stress due to the COVID-19 pandemic

During the pandemic, deaths associated with mental health deterioration due to social stress have contributed to excess mortality. The purpose of the study is to evaluate changes in mortality from causes associated with social stress during the pandemic in Moscow. The analysis is based on the Rosstat statistics and RFS-EMIAS database (Medical death certificates issued by the Moscow health institutions) in 2019-2020. Deaths from mental disorders and suicides during the maximum and minimum excess mortality in Moscow in 2020 were compared to 2019 (May and December, when mortality exceeded the 2019 indicators by 57.2% and 56.7%, and July with the 7.1%) excess. First, the excess mortality from mental disorders in these months was almost entirely due to disorders related to alcohol and drug abuse. Second, alcohol and drug abuse also results in deaths from poisoning. This necessitates a joint evaluation of deaths associated with alcohol and drugs (from mental disorders and poisoning). The evaluation shows that excess deaths from alcohol abuse in men in May 2020 compared to May 2019 equaled to 65%, falling down to 52.3% in July, followed by its maximum (2.5-fold) in December. Females show a steady increase: 52.9%, 76.5% and 2.1-fold, respectively. Distribution by sex of the total deaths associated with drug addiction (mental disorders and poisoning) was reversed: a steady increase in males (55.4% in May, 67% in July and 2.1-fold in December) and a significant decrease in females: 63.6%, 31.6% and 2.7-fold, respectively. Third, the pandemic has paradoxically affected deaths from suicide (including hangings, falls and undetermined intent poisoning). In men, excess deaths equaled to zero in May, 1.2% in July and decreased by 20.6% in December. The female excess suicidal mortality increased: 13.5%, 30.6% and 36.7%, respectively. Thus, the male reaction to social stress caused by the pandemic was passive (alcohol and drug abuse), while the female reaction was aggravated by suicides. Key messages During the pandemic, deaths associated with mental health deterioration due to social stress contributed to excess mortality. Alcohol and drug abuse results in deaths not only due to mental disorders.

Inconsistencies in Overdose Suicide Death Investigation Practice and Potential Remedies Using Technology: A Centers for Disease Control and Prevention Consultation Meeting Summary

Introduction: It is widely accepted that suicides—which account for more than 47 500 deaths per year in the United States—are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as accidents or undetermined intent. Methods: Virtual and in-person meetings were held with suicidologists and DSI experts from five states (Spring-Summer 2017) to explore how features of a hypothetical electronic DSI tool may help address these challenges. Results: Participants envisioned a mobile DSI application for cell phones, tablets, or laptop computers. Features for systematic information collection, scene description, and guiding key informant interviews were perceived as useful for less-experienced investigators. Discussion: Wide adoption may be challenging due to differences in DSI standards, practices, costs, data privacy and security, and system integration needs. However, technological tools that support consistent and complete DSIs could strengthen the information needed to accurately identify overdose suicides.

Accuraatheid van de door de Vlaamse overheid gepubliceerde statistiek van de doodsoorzaken: een forensische benadering

A study into the accuracy of the published cause of death statistics by the government of Flanders, Belgium The cause of death (COD) stated on death certificates is the key component to compose COD statistics in Belgium. The aim of the study was to ascertain whether CODs of homicides as confirmed by autopsy by the Department of Forensic Sciences (DoFS) at the University of Leuven were reported as such in government statistics. Out of 455 autopsies performed by the DoFS between 01/01/2010 and 31/12/2013, 64 medicolegal homicides were retained, which in turn were cross-referenced with a provided list of all deaths in the same period by the government. Applying the ICD-10 (International Classification of Diseases, 10th revision) methodology to the study population, 97% of the attained codes fell under the section ‘Assault’. This concerned only 78% when coded by the government. The remaining were located under the less specific section ‘Event of undetermined intent’. One homicide was coded by the government as a death by natural causes and one death was not accounted for. Specific training for physicians on correctly filling out death certificates, a more user-friendly certificate and systematic feedback of autopsy findings to government agencies are proposed in order to increase the accuracy of COD statistics.

Health Care Worker Violent Deaths in the Workplace: A Summary of Cases From the National Violent Death Reporting System

Background: Violent workplace deaths among health care workers (HCWs) remain understudied in the extant literature despite the potential for serious long-term implications for staff and patient safety. This descriptive study summarized the number and types of HCWs who experienced violent deaths while at work, including the location in which the fatal injury occurred. Methods: Cases were identified from the Centers for Disease Control and Prevention’s National Violent Death Reporting System between 2003 and 2016. Coded variables included type of HCW injured, type of facility, and location within the facility and perpetrator type among homicides. Frequencies were calculated using Excel. Findings: Among 61 HCW deaths, 32 (52%) were suicides and 21 (34%) were homicides; eight (13%) were of undetermined intent. The occupations of victims included physicians (28%), followed by nurses (21%), administration/support operations (21%), security and support services (16%), and therapists and technicians (13%). Most deaths occurred in hospitals (46%) and nonresidential treatment services (20%). Within facility, locations included offices/clinics (20%) and wards/units (18%). Among homicide perpetrators, both Type II (perpetrator was client/patient/family member) and Type IV (personal relationship to perpetrator) were equally common (33%). Conclusion/ Applications to Practice: Suicide was more common than homicide among HCW fatal injuries. Workplace violence prevention programs may want to consider both types of injuries. Although fatal HCW injuries are rare, planning for all types of violent deaths could help minimize consequences for staff, patients, and visitors.

Trends in method-specific suicide in Brazil from 2000 to 2017

Purpose Understanding long-term patterns of suicide methods can inform public health policy and prevention strategies. In Brazil, firearm-related policies may be one salient target for suicide prevention. This study describes trends in method-specific suicide at the national and state-levels in Brazil, with a particular focus on firearm-related suicides. Methods Brazilian mortality data for suicide and undetermined intent among people aged 10 years and older between 2000 and 2017 were obtained from the National Mortality Information System. We examined national and state-level trends in age-standardised suicide rates for hanging, self-poisoning, firearms, jumping from a high place, other, and unspecified methods. We also compared total rates of mortality from suicide and undetermined intent over the period. Applying Joinpoint regression, we tested changes in trends of firearm-specific suicide rates. Results The total suicide rate increased between 2000 and 2017. Rates of hanging, self-poisoning by drugs or alcohol and jumping from a high place showed the largest increases, while firearm-specific suicide rates decreased over the study period. Trends in methods of suicide varied by sex and state. Conclusion It is of public health concern that suicide rates in Brazil have risen this millennium. Restricting access to firearms might be an effective approach for reducing firearm-specific suicides, especially in states where firearm availability remains particularly high. Treatment and management of substance misuse may also be an important target for suicide prevention policies. More work is needed to understand the causes of rising suicide rates in Brazil and to improve the mental health of the population.

MORTALITY FROM EXTERNAL CAUSES AMONG THE RUSSIAN POPULATION AND SPECIFICS OF ITS REGISTRATION

The study is substantiated: first, by extremely high mortality rates from external causes in Russia compared to the Western Europe and, second, by problems related to its registration. The purpose of this study is to track evolution of mortality from external causes in Russia against the background of processes in the Western Europe, as well as explore the problem of its registration in the context of the leading risk factors. Material and methods. To analyze situation in Russia, the authors used the Rosstat data calculated in the FAISS-Potential system. To assess situation in the Western Europe (the European Union until May 2004), the authors used information available from the European Mortality Database. Unfortunately, the European Database data are limited to 2015. The authors also used age-specific and standardized (European standard population) indicators by causes of death in line with the ICD-10. Results and discussion The study shows that, first, decline in mortality from injury and poisoning in the 2000s in Russia was determined by all major age groups and external causes, while the rate of positive trends in Russia usually outpaced the Western European ones. Second, injury of undetermined intent turned out to be the exception; against the background of abnormally high mortality rates injury with undetermined intent demonstrated a minimum rate of decline in indicators. Third, mortality from external causes in Russia is associated with deaths from symptoms, signs and ill-defined conditions, at least in working-ages. Fourth, these circumstances have resulted in distortion of the mortality from external causes by the following aspects: in terms of ill-defined conditions its scale is distorted; in terms of injury with undetermined intent – distorted is its structure. Both of these factors jeopardize the real scale of deaths from external causes as well as rates of the observed trends in mortality from injury and poisoning both in general and by individual causes, including homicides and suicides. Fifth, the abnormally high and ever-increasing share of alcohol poisoning with undetermined intent calls for an update of the diagnoses: all alcohol poisoning should be considered as accidents, each diagnosis of "alcohol poisoning with undetermined intent" should be subject to a thorough analysis in the professional community. Sixth, the abnormally low number of deaths due to drug abuse suggests a systematic underestimation: to assess the real scale of drug-related deaths, a fundamental revision of approaches to their diagnosis is required. Seventh, currently Russia needs to develop a system of complete registration of deaths associated with the leading risk factors - alcohol and drugs, based on both deaths from external causes and deaths from somatic pathologies. Eighth, it takes a comprehensive update of the existing regulatory framework to eliminate these problems that have acquired a chronic nature in Russia, unfortunately. This update should be a complex one, aimed at taking into account the results of forensic medical examinations by statistical authorities on the one hand, and law enforcement agencies on the other hand, and be based on ICD – 10.