Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019

Background Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. Methods and Results We used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age‐adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age‐adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle‐aged adults, men, non‐Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age‐adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age‐adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and medium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age‐adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties. Conclusions During the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to address cardiovascular health disparities and outcomes among nonelderly adults.

Trends in Cardiovascular Mortality Related to Atrial Fibrillation in the United States, 2011 to 2018

Background Prevalence of atrial fibrillation (AF) continues to increase and is associated with significant cardiovascular morbidity and mortality. To inform prevention strategies aimed at reducing the burden of AF, we sought to quantify trends in cardiovascular mortality related to AF in the United States. Methods and Results We performed serial cross‐sectional analyses of national death certificate data for cardiovascular mortality related to AF, whereby cardiovascular disease was listed as underlying cause of death and AF as multiple cause of death among adults aged 35 to 84 years using the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research. We calculated age‐adjusted mortality rates per 100 000 population and examined trends over time, estimating average annual percentage change using the Joinpoint Regression Program. Subgroup analyses were performed by race‐sex and across 2 age groups (younger: 35–64 years; older: 65–84 years). A total of 276 373 cardiovascular deaths related to AF were identified in the United States between 2011 and 2018 in decedents aged 35 to 84 years. Age‐adjusted mortality rate increased from 18.0 (95% CI, 17.8–18.2) to 22.3 (95% CI, 22.0–22.4) per 100 000 population between 2011 and 2018. The increase in age‐adjusted mortality rate (average annual percentage change) between 2011 and 2018 was greater among younger decedents (7.4% per year [95% CI, 6.8%–8.0%]) compared with older decedents (3.0% per year [95% CI, 2.6%–3.4%]). Conclusions Cardiovascular deaths related to AF are increasing, especially among younger adults, and warrant greater attention to prevention earlier in the life course.

Incidence and prevalence of sporadic and hereditary MTC in Denmark 1960–2014: a nationwide study

Recent studies have shown a significant increase in the temporal trend of medullary thyroid carcinoma (MTC) incidence. However, it remains unknown to which extent sporadic medullary thyroid carcinoma (SMTC) and hereditary MTC (HMTC) affect the MTC incidence over time. We conducted a nationwide retrospective study using previously described RET and MTC cohorts combined with review of medical records, pedigree comparison and relevant nationwide registries. The study included 474 MTC patients diagnosed in Denmark between 1960 and 2014. In the nationwide period from 1997 to 2014, we recorded a mean age-standardized incidence of all MTC, SMTC and HMTC of 0.19, 0.13 and 0.06 per 100,000 per year, respectively. The average annual percentage change in incidence for all MTC, SMTC and HMTC were 1.0 (P = 0.542), 2.8 (P = 0.125) and −3.1 (P = 0.324), respectively. The corresponding figures for point prevalence at January 1, 2015 were 3.8, 2.5 and 1.3 per 100,000, respectively. The average annual percentage change in prevalence from 1998 to 2015 for all MTC, SMTC and HMTC was 2.8 (P < 0.001), 3.8 (P < 0.001) and 1.5 (P = 0.010), respectively. We found no significant change in the incidence of all MTC, SMTC and HMTC possibly due to our small sample size. However, due to an increasing trend in the incidence of all MTC and opposing trends of SMTC (increasing) and HMTC (decreasing) incidence, it seems plausible that an increase for all MTC seen by others may be driven by the SMTC group rather than the HMTC group.

Tendências e Projeções da Mortalidade pelos Cânceres Específicos ao Gênero no Brasil

Introdução: Os canceres que acometem os órgãos genitais masculinos e femininos, em conjunto com o câncer de mama, são responsáveis por 20% dos óbitos por câncer no mundo. Objetivos: Analisar as tendências e projetar a mortalidade por esses canceres ate o ano de 2030, para o Brasil e regiões. Material e métodos: Estudo de base populacional que analisou os óbitos ocorridos de 1996 a 2010, decorrentes dos canceres de colo do útero, corpo do útero, mama feminina, ovários, vulva, vagina, próstata, pênis e testículos, registrados no Sistema de Informação sobre Mortalidade. Foi aplicada a regressão pelo método Joinpoint utilizando taxas padronizadas por idade para estimar o Annual Percentage Change e o Average Annual Percentage Change; as projeções foram calculadas no programa Nordpred, inscrito no programa R. Resultados: A mortalidade pelos canceres de pênis (APC=1,5% IC95% 0,7;2,3 p<0,05), testículos (APC=1,6% IC95% 0,5;2,8 p<0,05) e ovários (APC=0,8% IC95% 0,1; 1,5 p<0,05) mostrou tendência de aumento; enquanto os canceres de mama (APC=0,4% IC95% -0,2;1,0 p=0,2) e de próstata (AAPC=1,1% IC95% -0,2; 2,4 p=0,1) apresentaram tendência de estabilidade; e, para o câncer de colo do útero, a tendência foi de redução (APC=-1,7% IC95%-2,2; -1,1 p<0,05). A tendência e de redução da mortalidade nas regiões Sul e Sudeste e aumento nas regiões Norte e Nordeste, tendência que seguira ate o ano 2030. Conclusão: Existe uma marcante desigualdade na distribuição da mortalidade pelos canceres genitais no Brasil, e, em 2030, as regiões mais pobres do pais responderão pelas maiores taxas de mortalidade por esses canceres.