Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data

Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to April 2020 and the variation in mortality rates compared with those in 2015–2019 regarding sex, age, and epidemic area. Causes of death were derived from the national cause-of-death register. COVID-19 was the leading cause of death among males and the second leading cause among females. Chronic diseases, such as diabetes and hypertensive, ischemic heart, and cerebrovascular diseases, with decreasing or stable mortality rates in 2015–2019, showed a reversal in the mortality trend. Moreover, mortality due to pneumonia and influenza increased. No increase in neoplasm mortality was observed. Among external causes of death, mortality increased for accidental falls but reduced for transport accidents and suicide. Mortality from causes other than COVID-19 increased similarly in both genders and more at ages 65 years or above. Compared with other areas in Italy, the Lombardy region showed the largest excess in mortality for all leading causes. Underdiagnosis of COVID-19 at the beginning of the pandemic may, to some extent, explain the mortality increase for some causes of death, especially pneumonia and other respiratory diseases.

Mortality among People with Epilepsy: A Retrospective Nationwide Analysis from 2016 to 2019

We estimated age-adjusted mortality and investigated the dominant causes of death as well as comorbidities among people with epilepsy (PWE) in Lithuania, a country with frequent deaths from external causes. From 2016 to 2019, the age-adjusted rate of death among PWE in Lithuania was compared with mortality data in the general population. Each year of analysis, individuals who were diagnosed with epilepsy comprised a retrospective cohort. The standardized mortality ratio (SMR) of PWE varied from 2.93 (95% CI 2.78 to 3.07) to 3.18 (95% CI 3.02 to 3.34). PWE died at least one decade earlier than expected in the general population. The dominant causes of death were cardiovascular diseases (their proportion ranged from 44.8% to 49.3%), cancer (16.7% to 21.3%) and external causes of death (8.5% to 10.9%). The proportion of the latter decreased over time (r = −0.99, p = 0.01), whereas the SMR for external causes of death remained relatively constant. Epilepsy was the underlying cause of death in 163 cases (2.6%), and noted as a condition contributing to death in 1010 cases (15.9%). Cerebrovascular and cardiological conditions and dementia were the most frequent comorbidities among PWE before their death. Epilepsy-unrelated causes of death are relevant contributors to mortality among PWE. There is a need for PWE-oriented societal interventions to reduce the frequency of external deaths beyond the trend in the general population.

Impact of Covid-19 Pandemic on Racial/Ethnic Differences in Mortality by Cause of Death

This paper documents changes in mortality by race and ethnicity between 2019 and 2020. Using age-standardized death rates, it attributes changes for Black, Hispanic, and White populations to various underlying causes of death and shows how these racial and ethnic patterns vary by age and sex. Hispanic individuals had the largest increase in mortality attributed to Covid-19, but Black individuals had the largest increase in all-cause mortality. Exceptionally large increases in mortality from heart disease, diabetes, and external causes of death account for the adverse trend in all-cause mortality within the Black population. For the Black and White populations, percentage increases in all-cause mortality were similar for men and women and for ages 25-64 and 65+. Among the Hispanic population, however, percentage increases in mortality were greatest for working-aged men. Results are very similar when 2020 death rates are compared to those in 2019 and when they are compared to projected 2020 rates based on a time series extrapolation of death rates from 2015 to 2019.

Mortality from injury, overdose and suicide during the 2020 COVID-19 pandemic, March-July, 2020

Introduction The COVID-19 pandemic has been associated with substantial rates of all-cause excess mortality. The contribution of external causes of death to excess mortality including drug overdose, homicide, suicide, and unintentional injuries during the initial outbreak in the United States is less well documented. Methods Using public data published by the National Center for Health Statistics on February 10, 2021, we measured monthly excess mortality (the gap between observed and expected deaths) from five external causes using national-level data published by National Center for Health Statistics; assault (homicide); intentional self-harm (suicide); accidents (unintentional injuries); and motor vehicle accidents. We used seasonal autoregressive integrated moving average (sARIMA) models developed with cause-specific monthly mortality counts and US population data from 2015-2019 and estimated the contribution of individual cause-specific mortality to all-cause excess mortality from March-July 2020. Results From March-July, 2020, 212,825 (95% CI 136,236-290,776) all-cause excess deaths occurred in the US). There were 8,540 excess drug overdoses (all intents) (95% CI 5,106 to 11,975), accounting for 4% of all excess mortality; 1,455 excess homicide deaths (95% CI 708 to 2202, accounting for 0.7% of excess mortality; 5,492 excess deaths due to unintentional accidents occurred (95% CI 85 to 10,899, accounting for 2.6% of excess mortality. Though a non-significantly 135 (95% CI -1361 to 1,630) more MVA deaths were recorded during the study period, a significant decrease in April (525; 95% CI -817 to -233) and significant increases in June-July (965; 95% CI 348 to 1,587) were observed. Suicide deaths were statistically lower than projected by 2,067 (95% CI 941-3,193 fewer deaths). Meaning Excess deaths from drug overdoses, homicide, and addicents occurred during the pandemic but represented a small fraction of all-cause excess mortality. The excess external causes of death, however, still represent thousands of lives lost. Notably, deaths from suicide were lower than expected and therefore did not contribute to excess mortality.

CURRENT TRENDS IN MORTALITY IN INDUSTRIAL CITIES OF THE ARCTIC MACROREGION: SIMILARITIES AND DIFFERENCES

The authors have evaluated dynamics in indicators of standardized mortality and life expectancy in the industrial cities of the Arctic macroregion. Those cities are characterized by a higher mortality rate including mortality from external causes compared to the Russian indicators. The highest mortality from lung cancer is registered in the city of Norilsk. Purpose. To identify trends in life expectancy and main causes of death in a number of cities with the developed industry of the Arctic macroregion, namely: Arkhangelsk, Severodvinsk, Syktyvkar, Norilsk and Novy Urengoy, in comparison with the urban population of Russia as a whole. Material and methods. Analysis of mortality in the selected cities was carried out on the basis of the Rosstat data with a breakdown on sex, age and causes of death for 2008-2019. To level random annual fluctuations, mortality rates were calculated for four three-year periods. The decomposition method was used to analyze contribution of groups of causes of death to changes in life expectancy. Results. Dynamics in life expectancy in the Arctic cities generally follow he national trends with certain differences. Cities in the Arctic macroregion are characterized by a greater contribution of the reduced mortality from external causes to the rise in life expectancy. Moreover, in Norilsk, the contribution of diseases of the circulatory system in both men and women was negative, and it was the decrease in mortality from external causes that contributed to the increase in life expectancy. However, mortality from external causes of death in the Arctic cities remains higher compared to the all-Russia indicator. This city is characterized by higher mortality from neoplasms, (mortality from lung cancer is 1.2-2.5 times higher). Despite the increase in life expectancy in the Arctic cities over the past decade, trends in mortality from some causes of death in some cities remain negative. Conclusion. Trends in mortality in the Arctic cities largely repeat the national ones but are characterized by a number of features that should be taken into account while developing regional measures for effective mortality reduction. A special attention should be focused on such reserve of mortality reduction as diseases of the respiratory and digestive system, neoplasms, infections as well as external causes of death.

Lost years of life as a result of premature mortality in municipal districts of Arkhangelsk oblast in 2010–2019

To solve demographic problems and, in particular, to increase the life expectancy in Arctic regions, analysis of mortality in small territories is of particular relevance. The object of this study is to analyze the intraregional differentiation of mortality based on age-standardized indicator of lost years of life caused by premature mortality in the context of main classes of death’s causes for the period 2010- 2019 in Arkhangelsk region. The standardized indicator of lost years of life has decreased for all ages and all classes of death’s causes in Arkhangelsk region. Dynamic and level of the standardized indicator of lost years of life have big differentiation at municipal level. For example, in urban districts and adjacent areas the reduction in mortality was bigger than in border and peripheral areas. Our study shows that in the structure of lost years of life the first place is occupied by diseases of circulatory system (50.0%), the second – by external causes (19.7%), and the third – by neoplasms (14.3%). The most difficult situation is in the peripheral areas of the region due to higher losses from external causes of death at working age.

Typology of Regions and Cities of Russia by Causes of Death

The problem of the high mortality rate, in comparison with countries with similar living standards, is extremely urgent in Russia. It is especially noticeable at the regional level, where differences in mortality and its structure are enormous. The regions of Russia are at different stages of epidemiological transition. This is expressed in differences in their mortality rates and differences in the structure of causes of death. The regions and largest cities of the country are sometimes diverge radically, which greatly complicates research. This paper presents a typology of regions and large cities of the Russian Federation according to the main classes of causes of death in 2015 and its cartography. The spatial features of mortality according to the main causes of death are determined separately for men and women. The assessment was carried out using classification by demographic indicators (causes of mortality: some infectious and parasitic diseases; tumours; diseases of the circulatory system; respiratory diseases; diseases of the digestive system; external causes of death). The dataset included 250 territorial units: 85 regions (including cities of federal significance) and 165 large cities with populations of over 100,000. Based on the primary statistics, standardised mortality rates were calculated. The classification was carried out according to an algorithm developed by one of the authors. The classification presented allows us to highlight the specific characteristics of individual groups of regions and analyse them with a greater degree of accuracy.

Potential years of life lost in Campinas-Brazil between 2000-2017 due to external causes of death

The Potential Years of Life Lost indicator is an alternative to the use of traditional indicators to evaluate impacts of external causes of death for its ability to evaluate the magnitude of premature death. This study aims to evaluate the impact in the PYLL of premature deaths due to external causes in Campinas, between 2000 and 2017, and to show selectiveness of violence targeting the poor. We performed a cross-sectional epidemiological study describing the PYLL due to external causes in the city of Campinas between 2000 and 2017. Amongst the variables studied, focus was given to the Human Development Index by Neighborhood (HDIN) of each individual (obtained by relating addresses to the official HDIN census), to evaluate impact of poverty in PYLL, mainly in homicides. A total of 12175 people died from external causes between 2000 and 2017. The distribution of the PYLL in the year 2000 indicated a loss of 35.8 years for every 1000 inhabitants with a high decrease until 2005 to an average of 17.45 from 2005 to 2017. Although we observed this decrease in PYLL, analysis by social strata shows disparities between PYLL of the rich and poor. When all external causes were considered, low and very low-HDI population had the most significant PYLL (27 and 30.3 respectively) compared to high and very high-HDI population (18.3 and 9.9 respectively), and when only homicides were taken into account, an even greater disparity was observed between the lower-HDI and higher-HDI stratas (overall average of 16.55 and 5.55 respectively). Through PYLL analysis, we could observe the selectiveness of violence towards the low and very low-HDI population, which shows that, public policies that aim improve population health cannot be restricted to health sectors, but also include socio-economic actions against social inequalities and income concentration. Key messages Although external causes of death seems to be decreasing in Campinas, violence seems to target the poor. Any policy that aims to prevent violent causes of death must necessarily take into account social disparities.

Impact of COVID-19 Lockdown Policy on Homicide, Suicide, and Motor Vehicle Deaths in Peru

Introduction: Although lockdown measures to stop COVID-19 have direct effects on disease transmission, their impact on violent and accidental deaths remains unknown. Our study aims to assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru. Methods: Based on data from the Peruvian National Death Information System, an interrupted time series analysis was performed to assess the immediate impact and change in the trend of COVID-19 lockdown on external causes of death including homicide, suicide, and traffic accidents. The analysis was stratified by sex and the time unit was every 15 days. Results: All forms of deaths examined presented a sudden drop after the lockdown. The biggest drop was in deaths related to traffic accidents, with a reduction of 12.66 deaths per million men per month (95% CI: -15.56, -9.76) and 3.64 deaths per million women per month (95% CI:-5.25, -2.03). Homicide and suicide presented similar level drop in women, while the homicide reduction was twice the size of the suicide reduction in men. The slope in suicide in men during the lock-down period increased by 3.62 deaths per million men per year (95% CI:0.06, 7.18). No other change in slope was detected. Conclusions: Violent and accidental deaths presented a sudden drop after the lockdown was implemented and an increase in suicide in men was observed. Falls in mobility have a natural impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and reveal important characteristics of these events, although we expect all of these changes to be transient.

Excess Mortality Due to External Causes in Women in the South African Mining Industry: 2013–2015

Mining is a recognized high-risk industry with a relatively high occurrence of occupational injuries and disease. In this study, we looked at the differences in mortality between male and female miners in South Africa. Data from Statistics South Africa regarding occupation and cause of death in the combined years 2013–2015 were analyzed. Proportional mortality ratios (PMRs) were calculated to investigate excess mortality due to external causes of death by sex in miners and in manufacturing laborers. Results: Women miners died at a significantly younger age on average (44 years) than all women (60 years), women manufacturers (53 years), and male miners (55 yrs). There was a significantly increased proportion of deaths due to external causes in women miners (12.4%) compared to all women (4.8%) and women manufacturers (4.6%). Significantly increased PMRs were seen in car occupant accidents (467, 95% confidence interval (CI) 151–1447), firearm discharge (464, 95% CI 220–974), and contact with blunt objects (2220 95% CI 833–5915). Conclusion: This descriptive study showed excess deaths in women miners due to external causes. Road accidents, firearm discharge, and contact with blunt objects PMRs were significantly increased. Further research is required to confirm the underlying reasons for external causes of death and to develop recommendations to protect women miners.