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Giunta DH, Carvalho de Souza M, Kneipp Dias MB, Szklo M, de Almeida LM. Time trends and age-period-cohort analysis of cervical cancer mortality rate in Brazil. J Cancer Policy 2020; 25:100230. [PMID: 36895140 DOI: 10.1016/j.jcpo.2020.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/28/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cervical cancer (CC) is a common preventable and curable disease that may lead to death. Our aim was to describe the patterns of time trends in CC mortality rates among women in Brazil from 1980 to 2017, and identify the influence of age, period and birth cohort (APC) stratified by region (North NR, Northeast NER, Southeast SER, South SR, Center-Western region CWR). METHODS We performed a time-series analysis using secondary data bases. Crude (MR) and WHO age-standardized CC mortality rates (aMR) were estimated per 100,000 women. We evaluated time trends using permutation joinpoint regression models (JP) and APC models to estimate the effect of APC on MR. RESULTS The JP analysis showed a temporal decrease in all regions, except the NR, which had an annual percentage increase of 0.44 (95%CI 0.2 - 0.7). MR in the NR was 2 to 4 times higher than in the other regions. We observed steady increases in MR with age in the NR and NER. A plateau after age 40 was observed in SER, SR, and CWR. The NR and NER MR ratio stabilized around the year 2000. Birth cohort effect showed decreasing MR ratio from 1900 to 1970 for all regions, except the NR, which showed increasing MR rate from older to more recent cohorts. CONCLUSION We showed relevant differences in cervical MR by region, which may reflect inequality in access to primary and secondary prevention as well as treatment, particularly in the NR.
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Affiliation(s)
- Diego Hernan Giunta
- Internal Medicine Research Unit / Research Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, CP C1199ABB, Argentina.
| | - Mirian Carvalho de Souza
- Population Research Division, National Cancer Institute, Ministry of Health Brazil, R. Marquês de Pombal, 125 - Centro, Rio de Janeiro, RJ 20230-240, Brazil.
| | - Maria Beatriz Kneipp Dias
- Population Research Division, National Cancer Institute, Ministry of Health Brazil, R. Marquês de Pombal, 125 - Centro, Rio de Janeiro, RJ 20230-240, Brazil.
| | - Moyses Szklo
- Population Research Division, National Cancer Institute, Ministry of Health Brazil, R. Marquês de Pombal, 125 - Centro, Rio de Janeiro, RJ 20230-240, Brazil; Division of Epidemiology, The Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Liz Maria de Almeida
- Population Research Division, National Cancer Institute, Ministry of Health Brazil, R. Marquês de Pombal, 125 - Centro, Rio de Janeiro, RJ 20230-240, Brazil.
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202
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Oba K, Shinjo T, Tamashiro M, Matsuoka M, Arasaki O, Arima H, Inoue T. Cause of Death and Associated Factors in Elderly Patients With Atrial Fibrillation - Long-Term Retrospective Study. Circ Rep 2020; 2:490-498. [PMID: 33693274 PMCID: PMC7819663 DOI: 10.1253/circrep.cr-20-0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background:
Oral anticoagulant (OAC) therapy reduces the risk of stroke in patients with atrial fibrillation (AF). This study elucidated the causes of death and related factors in elderly Japanese AF patients. Methods and Results:
Over a median (interquartile range [IQR]) follow-up period of 46 (20–76) months, there were 171 all-cause deaths (28% cardiovascular, 46% non-cardiovascular, and 26% unknown causes) among 389 AF patients (median [IQR] age 80 [74–85] years; CHAD2DS2-VASc score 5 [4–6]). Cox regression analysis indicated that diabetes was associated with an increase in all-cause death (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02–2.13), whereas hypercholesterolemia (HR 0.53; 95% CI 0.35–0.79), pre-existing heart failure (HR 0.67; 95% CI 0.48–0.95), and OAC use (HR 0.62; 95% CI 0.44–0.88) were associated with reductions in all-cause death. Pre-existing heart failure was associated with both cardiovascular (HR 3.03; 95% CI 1.33–8.20) and non-cardiovascular (HR 0.44; 95% CI 0.30–0.65) deaths, in opposite directions. OAC use was associated with a reduction in cardiovascular death (HR 0.34, 95% CI 0.17–0.69). The predominance of non-cardiovascular death and death-related factors were equivalent regardless of when observations started (before 2009 or in 2009 and later). Conclusions:
The predominant cause of death in elderly Japanese AF patients was non-cardiovascular. Distinct clinical factors were associated with cardiovascular and non-cardiovascular death.
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Affiliation(s)
- Kageyuki Oba
- Cardiovascular Medicine, Tomishiro Central Hospital Okinawa Japan
| | | | | | | | - Osamu Arasaki
- Cardiovascular Medicine, Tomishiro Central Hospital Okinawa Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University Fukuoka Japan
| | - Taku Inoue
- Cardiovascular Medicine, Nambu Hospital Okinawa Japan.,Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University Fukuoka Japan
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203
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Ye ZQ, Xie WG, Lu XB, Chen X, Zhao CL, Ruan QF, Zhang W. [Analysis of causes of death and etiological characteristics of skin tissue donors]. Zhonghua Shao Shang Za Zhi 2020; 36:446-50. [PMID: 32594703 DOI: 10.3760/cma.j.cn501120-20190307-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the causes of death and etiological characteristics of skin tissue donors, and to provide reference for allogeneic skin transplantation. Methods: From October 2008 to October 2018, 49 skin tissue donors accepted by the Burn Department of Wuhan Third Hospital met the inclusion criteria of this study, and a cross-sectional study was conducted. According to the cause of death, the donors were divided into accidental death group (19 cases) and non-accidental death group (30 cases). The sex and death age of 49 donors were recorded, and the death age between different sex donors and that of donors between accidental death group and non-accidental death group were compared. Diseases or circumstances that caused the death of donors, hepatitis B, hepatitis C, acquired immunodeficiency syndrome, syphilis virus carrying status, and peripheral blood microbial culture results of 49 donors were recorded, and the detection of blood-borne infectious risk factors of donors between accidental death group and non-accidental death group was compared. Abnormal skin tissue was also selected during allogenic skin graft preparing for pathological examination. Data were statistically analyzed with Mann-Whitney U test and continuity correction chi-square test. Results: (1) Out of the 49 donors in this group, 38 were male (77.55%) and 11 were female (22.45%). The death age was 42.00 (24.00, 55.00) years, and the death age of male donors was similar to that of female donors (Z=0.120, P>0.05). The death age of donors in accidental death group was lower than that in non-accidental death group, but the difference was not statistically significant (Z=-1.581, P>0.05). (2) Among the causes and circumstances of the 49 donors in this group, there were 19 cases (38.78%) of injury, poisoning, and some other consequences of external causes, 11 cases (22.45%) of circulatory system diseases, 9 cases (18.37%) of tumors, 3 cases (6.12%) of nervous system diseases, 2 cases (4.08%) of respiratory system diseases, and 2 cases (4.08%) of congenital malformation, deformation, and chromosome abnormality, 1 case (2.04%) of blood and hematopoietic organ diseases and some diseases related to immune mechanism, 1 case (2.04%) of digestive system disease, and 1 case (2.04%) of genitourinary system disease. (3) There were 9 donors (18.37%) with blood-borne infectious risk factors among the 49 donors in this group, including 8 cases (16.33%) of blood-borne infectious diseases, which were 5 cases (10.20%) of hepatitis B, 2 cases (4.08%) of syphilis, and 1 case (2.04%) of hepatitis C, respectively. Blood microorganism culture was positive in 1 case (2.04%), in which multi-drug resistant Pseudomonas aeruginosa was detected. Risk factors of blood-borne infection were detected in 2 donors in accidental death group, with detection ratio lower than that in non-accidental death group (7 cases), but the difference was not statistically significant (χ(2)=0.562, P>0.05). (4) A total of 8 donors' abnormal skin tissue were selected, including 4 cases of intradermal pigmented nevus, 1 case of scar, 1 case of pseudoepithelioma hyperplasia, 1 case of epidermal verrucous hyperplasia, and 1 case of large amount of pigment granules in dermis. Conclusions: Non-accidental death caused by diseases is the main cause of death of skin tissue donors, and the risk of donor-derived infection of non-accidentally dead donors is slightly higher than that of accidentally dead donors. Before the allogeneic skin is obtained and transplanted, the cause of death of the donor should be carefully investigated, and the health status should be evaluated, so as to avoid the occurrence of donor-derived infection.
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204
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Han S, Liu WP, Mi L, Ji XQ, Fang J, Liu JM, Yin P, Wang LJ, Zhou MG, An T, Zhang YH, Zhu J. [Analysis of risk factors for lymphoma patients dying of cardiovascular disease]. Zhonghua Zhong Liu Za Zhi 2020; 42:660-664. [PMID: 32867458 DOI: 10.3760/cma.j.cn112152-20191229-00853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To understand and explore the risk factors of the death of lymphoma patients from cardiovascular disease. Methods: The medical records and death information of 1 173 patients with lymphoma were collected, cases that died from cardiovascular disease were screened. A binary logistic regression model was used to analyze the independent risk factors of patients with lymphoma died from cardiovascular disease. Results: Among 1 173 patients with lymphoma, 75 (6.4%) died of cardiovascular disease, including 27 cases of coronary heart disease, 25 cases of stroke, 7 cases of hypertension, 5 cases of sudden cardiac death, 4 cases of pulmonary embolism, 3 cases of heart failure, 4 cases of others. Among the patients who survived for more than 5 years, 16.1% (35/217) died of cardiovascular disease. Among those who survived for more than 10 years, 11.7% (7/60) died of cardiovascular disease. Multivariate Logistic regression analysis showed that the primary site of lymphoma (OR=0.521, P=0.039), stage (stage Ⅱ: OR=2.487, P=0.016; stage Ⅲ: OR=3.233, P=0.002) and cardiovascular toxicity in the course of diagnosis and treatment (OR=3.019, P=0.001) are independent influencing factors for the death of cardiovascular disease in patients with lymphoma. Patients whose primary sites of lymphoma were lymph nodes had lower risk of dying from cardiovascular disease, while the patients with stage Ⅱ to Ⅲ stage and cardiovascular toxicity during diagnosis and treatment had higher risk of dying from cardiovascular disease. Conclusions: Cardiovascular disease is an important factor affecting the survival of patients with lymphoma. With the extension of survival time, the risk of dying from cardiovascular disease increases significantly. The primary site, tumor stage, and cardiovascular toxicity that occur during the diagnosis and treatment may be the independent influencing factors for patients with lymphoma that die from cardiovascular disease.
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Affiliation(s)
- S Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - W P Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - L Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - X Q Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - J Fang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - J M Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - P Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - L J Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - M G Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - T An
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Y H Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - J Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
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205
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Kailaheimo-Lönnqvist S, Kotimäki S. Cause of parental death and child's health and education: The role of parental resources. SSM Popul Health 2020; 11:100632. [PMID: 32817879 DOI: 10.1016/j.ssmph.2020.100632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Early parental death has been linked to problems in health and educational path. We added to the literature by examining disability pension and various educational outcomes after external (accident, violence, suicide) or natural parental death during childhood or adolescence, taking into account possible heterogeneous associations by parental resources. Using Finnish register data and linear random-effects models, we analysed outcomes of 90,620 and 88,859 children (paternal and maternal death samples, respectively) born between 1982 and 1990. Results indicated lower educational performance and attainment, and a higher probability of disability pension in the bereaved offspring, especially after external parental death. Half of these connections were explained after adjusting for childhood family characteristics. Having a highly educated surviving parent might protect from negative educational and health outcomes. The findings were partly similar for father's and mother's deaths. We demonstrated that the negative associations between parental death and child wellbeing differ by cause of death and parental resources. Cause of death and overall family circumstances should both be considered when analysing child outcomes after parental loss.
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206
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Lee KJ, Sohn S, Hong K, Kim J, Kim R, Lee S, Youn H, Kim YJ; Vital Statistics Division, Statistics Korea, Daejeon, Korea. Maternal, infant, and perinatal mortality statistics and trends in Korea between 2009 and 2017. Obstet Gynecol Sci 2020; 63:623-30. [PMID: 32756294 DOI: 10.5468/ogs.20081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/28/2020] [Indexed: 12/04/2022] Open
Abstract
Objective To provide updates on maternal, infant, and perinatal mortality using the national population data of South Korea between 2009 and 2017 and describe the mortality rate by target groups, timing, or causes of events to provide a basis for detecting vulnerable populations and ensuring timely medical and political interventions. Methods Pregnancy-related mortality in women, as well as deaths of infants, in South Korea was identified using population data from Statistics Korea. Records from death certificates, cremation reports on infant and fetal deaths, and the complementary cause-of-death investigation system were reviewed for the 2009–2017 period. Results A total of 461 maternal deaths, 11,717 infant deaths, and 12,249 perinatal deaths, including fetal deaths over 28 gestational weeks, were identified from 3,945,159 live births between 2009 and 2017. The maternal mortality ratio was 13.5 deaths per 100,000 live births in 2009 and decreased to 7.8 in 2017. Only the rate of deaths related to hypertensive disorders showed an increasing tendency. Both the infant and perinatal mortality rates improved (from 3.2 deaths per 1,000 live births in 2009 to 2.8 in 2017 and from 3.5 to 2.7, respectively). Among the external causes of infant mortality, assaults including homicides accounted for 25% (n=150), and this proportion was constant throughout the study period. Conclusion Overall improvements were observed in all maternal, infant, and perinatal mortality measures. In-depth analysis and interventions with respect to certain causes, such as hypertensive disorders in mothers or assaults in infants, should be considered priority issues.
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207
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Landes SD, Stevens JD, Turk MA. Cause of death in adults with Down syndrome in the United States. Disabil Health J 2020; 13:100947. [PMID: 32680774 DOI: 10.1016/j.dhjo.2020.100947] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/01/2020] [Accepted: 05/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prior studies report anomalous cause of death patterns for adults with Down syndrome, but do not provide comparison of age trends for specific causes of death between adults with and without Down syndrome, or explore biological sex and racial-ethnic differences in causes of death among adults with Down syndrome. OBJECTIVE To better understand cause of death trends for adults, age 18 and over, with Down syndrome. METHODS Cross-sectional data were from the 2013-2017 US Multiple Cause of Death Mortality files. Adjusted odds ratios were utilized to compare cause of death trends overall, and by age, between adults with (N = 9870) and without (N = 13,323,001) Down syndrome. We also analyzed biological sex and race-ethnic differences in cause of death solely among adults with Down syndrome. RESULTS Although heart disease, dementia and Alzheimer's disease, and cancer were common among adults all adults, death from these diseases was more prominent at younger ages for adults with Down syndrome. Adults with Down syndrome were also more likely to die from influenza and pneumonia, pneumonitis, respiratory failure, and choking at all ages. Distinct biological sex and racial-ethnic differences were present in causes of death among adults with Down syndrome. CONCLUSIONS While efforts to reduce premature mortality for adults with Down syndrome should attend to common risk factors such as heart disease, dementia and Alzheimer's disease, and cancer, it is imperative to afford increased attention to earlier onset of these diseases, as well as increased risk of death from respiratory and swallowing/choking related disorders at all ages.
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208
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Cirera L, Segura A, Hernández I. [Deaths by COVID-19: Not all were registered and others should not be accounted for]. Gac Sanit 2020; 35:590-593. [PMID: 32861466 PMCID: PMC7368921 DOI: 10.1016/j.gaceta.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 10/26/2022]
Abstract
The death counts from COVID-19 have generated public controversy. The regional health councils' need for information regardind the cases, has generated a variety of formats and procedures, used to report this information. Consecuently, this data has not always been communicated in a comparable maner to the Ministry of Health. The compilation of mortality statistics is complex. Central and autonomous public administrations are involved, and not in the same way. The medical death certificate (DC) is the main source of information that allows to specify place of occurrence and causes of death. The on-line registration of the DC in the computerized civil registry and/or digital medical records, would allow to establish a statistical processing circuit, and to obtain a death count more quickly according to causes of death in the event of a health emergency. This requires a multi-level institutional agreement for a total telematics statistic process of death causes in Spain.
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Affiliation(s)
- Lluís Cirera
- Grupo de trabajo Mortalidad, Sociedad Española de Epidemiología, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España.
| | - Andreu Segura
- Médico de Salud Pública, editor invitado de Gaceta Sanitaria y vocal del Consejo Asesor de Salud Pública de Cataluña, Barcelona, España
| | - Ildefonso Hernández
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Universidad Miguel Hernández, Alicante, España
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209
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Yuan P, Xiang J, Borg M, Chen T, Lin X, Peng X, Zheng K. Analysis of lifetime death probability for major causes of death among residents in China. BMC Public Health 2020; 20:1090. [PMID: 32652968 PMCID: PMC7353693 DOI: 10.1186/s12889-020-09201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/02/2020] [Indexed: 11/26/2022] Open
Abstract
Background Cumulative mortality rate and cumulative mortality risk are two commonly used indicators to measure the impact and severity of diseases. However, they are calculated during a defined life span and assume the subject does not die from other causes. This study aims to use a new indicator, lifetime death probability (LDP), to estimate the lifetime death probabilities for the top five leading causes of death in China and explore the regional differences and trends over time. Methods LDPs were calculated using a probability additive formula and abridged life tables. Results In 2014, LDPs for heart disease, cerebrovascular disease, malignancy, respiratory disease, and injury and poisoning were 24.4, 23.7, 19.2, 15.5, and 5.3%, respectively. The LDPs for heart disease and malignancy increased by 7.3 and 0.5%, respectively, compared to those from 2004 to 2005. In contrast, the LDPs for cerebrovascular and respiratory disease decreased by 1.0 and 3.9%, respectively, compared to those in 2004–2005. Across the eastern, central and western regions, malignancy had the highest LDP in the eastern region, cerebrovascular and heart diseases in the central region, and respiratory diseases, and injury and poisoning in the western region. Conclusions LDP is an effective indicator for comparing health outcomes and can be applied for future disease surveillance. Heart disease and malignancy were the two most common causes of death in China, but with regional differences. There is a need to implement targeted measures to prevent chronic diseases in different regions.
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Affiliation(s)
- Ping Yuan
- Fujian Center for Disease Control and Prevention, No.76 Jintai Road, Gulou District, Fuzhou, 350001, Fujian Province, China.,Educational Base, School of Public Health, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Jianjun Xiang
- Educational Base, School of Public Health, Fujian Medical University, Fuzhou, 350005, Fujian Province, China.,School of Public Health, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Matthew Borg
- School of Public Health, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Tiehui Chen
- Fujian Center for Disease Control and Prevention, No.76 Jintai Road, Gulou District, Fuzhou, 350001, Fujian Province, China.,Educational Base, School of Public Health, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Xiuquan Lin
- Fujian Center for Disease Control and Prevention, No.76 Jintai Road, Gulou District, Fuzhou, 350001, Fujian Province, China.,Educational Base, School of Public Health, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Xiane Peng
- Educational Base, School of Public Health, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Kuicheng Zheng
- Fujian Center for Disease Control and Prevention, No.76 Jintai Road, Gulou District, Fuzhou, 350001, Fujian Province, China. .,Educational Base, School of Public Health, Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
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Ketcham SW, Sedhai YR, Miller HC, Bolig TC, Ludwig A, Co I, Claar D, McSparron JI, Prescott HC, Sjoding MW. Causes and characteristics of death in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: a retrospective cohort study. Crit Care 2020; 24:391. [PMID: 32620175 DOI: 10.1186/s13054-020-03108-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
Background Acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) are associated with high in-hospital mortality. However, in cohorts of ARDS patients from the 1990s, patients more commonly died from sepsis or multi-organ failure rather than refractory hypoxemia. Given increased attention to lung-protective ventilation and sepsis treatment in the past 25 years, we hypothesized that causes of death may be different among contemporary cohorts. These differences may provide clinicians with insight into targets for future therapeutic interventions. Methods We identified adult patients hospitalized at a single tertiary care center (2016–2017) with AHRF, defined as PaO2/FiO2 ≤ 300 while receiving invasive mechanical ventilation for > 12 h, who died during hospitalization. ARDS was adjudicated by multiple physicians using the Berlin definition. Separate abstractors blinded to ARDS status collected data on organ dysfunction and withdrawal of life support using a standardized tool. The primary cause of death was defined as the organ system that most directly contributed to death or withdrawal of life support. Results We identified 385 decedents with AHRF, of whom 127 (33%) had ARDS. The most common primary causes of death were sepsis (26%), pulmonary dysfunction (22%), and neurologic dysfunction (19%). Multi-organ failure was present in 70% at time of death, most commonly due to sepsis (50% of all patients), and 70% were on significant respiratory support at the time of death. Only 2% of patients had insupportable oxygenation or ventilation. Eighty-five percent died following withdrawal of life support. Patients with ARDS more often had pulmonary dysfunction as the primary cause of death (28% vs 19%; p = 0.04) and were also more likely to die while requiring significant respiratory support (82% vs 64%; p < 0.01). Conclusions In this contemporary cohort of patients with AHRF, the most common primary causes of death were sepsis and pulmonary dysfunction, but few patients had insupportable oxygenation or ventilation. The vast majority of deaths occurred after withdrawal of life support. ARDS patients were more likely to have pulmonary dysfunction as the primary cause of death and die while requiring significant respiratory support compared to patients without ARDS.
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Liu EK, Yu S, Sulman EP, Kurz SC. Racial and socioeconomic disparities differentially affect overall and cause-specific survival in glioblastoma. J Neurooncol 2020; 149:55-64. [PMID: 32617722 DOI: 10.1007/s11060-020-03572-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The prognostic role of racial and socioeconomic factors in patients with glioblastoma is controversially debated. We aimed to evaluate how these factors may affect survival outcomes in an overall and cause-specific manner using large, national cancer registry cohort data in the temozolomide chemoradiation era. METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with glioblastoma between 2005 and 2016. Overall survival was assessed using Cox proportional hazard models using disease intrinsic and extrinsic factors. Cause-specific mortality was assessed using cumulative incidence curves and modeled using multivariate cumulative risk regression. RESULTS A total of 28,952 patients met the prespecified inclusion criteria and were included in this analysis. The following factors were associated with all-cause mortality: age, calendar year of diagnosis, sex, treatment receipt, tumor size, tumor location, extent of resection, median household income, and race. Asian/Pacific Islanders and Hispanic Whites had lower mortality compared to Non-Hispanic Whites. Cause-specific mortality was associated with both racial and socioeconomic groups. After adjusting for treatment and tumor-related factors, Asian/Pacific and black patients had lower glioblastoma-specific mortality. However, lower median household income and black race were associated with significantly higher non-glioblastoma mortality. CONCLUSIONS Despite the aggressive nature of glioblastoma, racial and socioeconomic factors influence glioblastoma-specific and non-glioblastoma associated mortality. Our study shows that patient race has an impact on glioblastoma-associated mortality independently of tumor and treatment related factors. Importantly, socioeconomic and racial differences largely contribute to non-glioblastoma mortality, including death from other cancers, cardio- and cerebrovascular events.
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Becker WC, Gordon KS, Edelman EJ, Goulet JL, Kerns RD, Marshall BDL, Fiellin DA, Justice AC, Tate JP. Are we missing opioid-related deaths among people with HIV? Drug Alcohol Depend 2020; 212:108003. [PMID: 32417360 DOI: 10.1016/j.drugalcdep.2020.108003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/28/2020] [Accepted: 04/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ascertainment of unnatural and overdose death may be unreliable among individuals with life-limiting conditions such as HIV infection. We sought to determine whether the relationship between opioid use and unnatural death differs among decedents with HIV (DWH) and those without. METHODS Decedents in the Veterans Aging Cohort Study (VACS) from 2002 to 14 were linked to the National Death Index cause of death file. Deaths were classified as unnatural, overdose (a subset of unnatural), or other. We defined opioid use as self-reported illicit use or receipt of prescribed opioids. Treating unnatural and overdose deaths as outcomes, we calculated odds ratios for opioid exposure by HIV status, with and without adjustment for disease severity using VACS Index. RESULTS Among 561 decedents without HIV (DWOH) and 884 DWH, 11 % and 8 % respectively were classified as unnatural deaths and 4 % and 2 % were classified as overdose deaths. Among DWOH, opioid use was associated with 2-fold greater odds of unnatural (OR 2.3; 95 % CI 1.3-4.0) and 4-fold greater odds of overdose death (OR 4.5; 95 % CI 1.5-13.7); in adjusted analyses, opioid use was associated with unnatural death (OR 2.6; 95 % CI 1.3-4.9) and with overdose (OR 4.2; 95 % CI 1.4-12.7). Opioid use was not associated with unnatural or overdose death among DWH. CONCLUSION Opioid use was strongly associated with unnatural and overdose death among DWOH but not among DWH suggesting potential differential misclassification. Caution should be used in interpreting prevalence, incidence and risk factors for unnatural and overdose cause of death among patients with life-limiting conditions such as HIV.
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213
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Yamamoto T, Nakayama M, Miyazaki M, Sato H, Matsushima M, Sato T, Ito S. Impact of lower body mass index on risk of all-cause mortality and infection-related death in Japanese chronic kidney disease patients. BMC Nephrol 2020; 21:244. [PMID: 32605606 PMCID: PMC7325015 DOI: 10.1186/s12882-020-01894-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
Background Several studies have reported that lower body mass index (BMI) is associated with high mortality in patients with chronic kidney disease (CKD). Rate of infection-related death in CKD patients is increasing. However, the relationship between BMI and infection-related death is unclear. Methods Overall, 2648 CKD outpatients (estimated glomerular filtration rate < 60 mL/min and/or presenting with proteinuria) under the care of nephrologists were prospectively followed for 5 years. Patients were stratified by quartile of BMI levels. Data on all-cause mortality before progression to end-stage kidney disease (ESKD) and the cause of death were collected. Results The median follow-up time was 3.9 years (interquartile range, 1.7–5.0); 114 patients died and 308 started renal replacement therapy. The leading causes of death were as follows; cardiovascular (41%), infection-related (21%), and malignancy-related (18%). Advanced age and lower BMI were the significant risk factors for all-cause mortality before progression to ESKD. Advanced age was statistically associated with respective causes of death, while lower BMI was associated with infection-related death only. CKD stage had no significant impact on all-cause or individual mortality. Conclusions Low BMI was associated with significant risk of all-cause mortality and infection-related death, which may indicate the novel clinical target to improve CKD outcomes.
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Affiliation(s)
- Tae Yamamoto
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. .,Research Division of Chronic Kidney Disease and Dialysis Treatment, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. .,Department of Internal Medicine, Sendai City Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Masaaki Nakayama
- Research Division of Chronic Kidney Disease and Dialysis Treatment, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Center for Advanced Integrated Renal Science, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Research Division of Chronic Kidney Disease and Dialysis Treatment, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroshi Sato
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Internal Medicine, JR Sendai Hospital, Sendai, Japan
| | - Masato Matsushima
- Center for Advanced Integrated Renal Science, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Clinical Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshinobu Sato
- Kidney Center, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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214
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Gulati N, Mackie FL, Cox P, Marton T, Heazell A, Morris RK, Kilby MD. Cause of intrauterine and neonatal death in twin pregnancies (CoDiT): development of a novel classification system. BJOG 2020; 127:1507-1515. [PMID: 32359214 DOI: 10.1111/1471-0528.16291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Twin pregnancies have a significantly higher perinatal mortality than singleton pregnancies. Current classification systems for perinatal death lack twin-specific categories, potentially leading to loss of important information regarding cause of death. We introduce and test a classification system designed to assign a cause of death in twin pregnancies (CoDiT). DESIGN Retrospective cross-sectional study. SETTING Tertiary maternity unit in England with a perinatal pathology service. POPULATION Twin pregnancies in the West Midlands affected by fetal or neonatal demise of one or both twins between 1 January 2005 and 31 December 2016 in which postmortem examination was undertaken. METHODS A multidisciplinary panel designed CoDiT by adapting the most appropriate elements of singleton classification systems. The system was tested by assigning cause of death in 265 fetal and neonatal deaths from 144 twin pregnancies. Cause of death was validated by another obstetrician blinded to the original classification. MAIN OUTCOME MEASURES Inter-rater, intra-rater, inter-disciplinary agreement and cause of death. RESULTS Cohen's Kappa demonstrated 'strong' (>0.8) inter-rater, intra-rater and inter-disciplinary agreement (95% CI 0.70-0.91). The commonest cause of death irrespective of chorionicity was the placenta; twin-to-twin transfusion syndrome (TTTS) was the commonest placental cause in monochorionic twins and acute chorioamnionitis in dichorionic twins. CONCLUSIONS This novel classification system records causes of death in twin pregnancies from postmortem reports with high inter-user agreement. We highlight differences in aetiology of death between monochorionic and dichorionic twins. TWEETABLE ABSTRACT New classification system for #twin cause of death 'CoDiT' shows high rater agreement.
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Affiliation(s)
- N Gulati
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - F L Mackie
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
| | - P Cox
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - T Marton
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Aep Heazell
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R K Morris
- Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK.,Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism & Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.,Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Birmingham, UK
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215
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Dijkhuizen LGM, Gelderman HT, Duijst WLJM. Review: The safe handling of a corpse (suspected) with COVID-19. J Forensic Leg Med 2020; 73:101999. [PMID: 32658757 PMCID: PMC7290165 DOI: 10.1016/j.jflm.2020.101999] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 11/20/2022]
Abstract
Introduction Countries around the world are confronted with a rising count of patients that die from COVID-19. Up to this date, there is no scientific evidence that proves that a COVID-19 corpse is still infectious. Different guidelines are being followed worldwide on how to deal with a COVID-19 positive corpse. The aim of this review is to compare different guidelines and literature on best practice for handling a COVID-19 positive corpse. Results The guidelines vary greatly in the use of PPE's and other safety measures especially during autopsy. There is great variation in the use of disinfectant and its concentration. Also recommended funeral services and contact with relatives vary greatly. Conclusion In conclusion, there is very limited scientific evidence on which the researched guidelines are based. It is unclear why some guidelines propose a “business as usual” attitude and others a “code-red” attitude. More scientific evidence is needed to substantiate the handling of COVID-19 positive corpses to make an educated decision on how to safely handle a COVID-19 positive corpse. Little is scientifically known about the behaviour of COVID-19 in a corpse. Little is scientifically known about the infection risk of handling a COVID-19 positive corpse. Worldwide the amount of COVID-19 positive corpses are increasing, making it relevant to handle them with care to keep the risk of transmission of the virus as low as possible. All guidelines are based on the same knowledge, yet implement different safety measures.
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Affiliation(s)
- L G M Dijkhuizen
- Maastricht University, Minderbroedersberg 4-6, 6211, LK, Maastricht, the Netherlands; GGD (Public Health Service) IJsselland, Zeven Alleetjes 1, 8011, CV, Zwolle, the Netherlands.
| | - H T Gelderman
- Maastricht University, Minderbroedersberg 4-6, 6211, LK, Maastricht, the Netherlands; GGD (Public Health Service) IJsselland, Zeven Alleetjes 1, 8011, CV, Zwolle, the Netherlands.
| | - W L J M Duijst
- Maastricht University, Minderbroedersberg 4-6, 6211, LK, Maastricht, the Netherlands; GGD (Public Health Service) IJsselland, Zeven Alleetjes 1, 8011, CV, Zwolle, the Netherlands.
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216
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Chen H, Zhou Y, Sun L, Chen Y, Qu X, Chen H, Rajbhandari-Thapa J, Xiao S. Non-communicable diseases are key to further narrow gender gap in life expectancy in Shanghai, China. BMC Public Health 2020; 20:839. [PMID: 32493253 PMCID: PMC7268263 DOI: 10.1186/s12889-020-08932-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background To address change in the gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change over time. Methods The temporal trend in GGLE was evaluated using retrospective demographic analysis with Joinpoint regression. Causes of death were coded in accordance with the International Classification of Diseases and mapped with the Global Burden of Disease (GBD) cause list. The life table technique and decomposition method were used to express changes in GGLE. Results The trend of GGLE in Shanghai experienced two phases, i.e., a decrease from 8.4 to 4.2 years in the descent phase (1973–1999) and a fluctuation between 4.0 and 4.9 years in the plateau phase (1999–2018). The reduced age-specific mortality rates tended to concentrate to a narrower age range, from age 0–9 and above 30 years in the descent phase to age above 55 years in the plateau phase. Gastroesophageal and liver cancer, communicable, chronic respiratory, and digestive diseases were once the major contributors to narrow GGLE in the descent phase. While, importance should be attached to a widening effect on GGLE by lung cancer, cardiovascular diseases, other neoplasms like colorectal and pancreatic cancer, and diabetes in the recent plateau phase. Conclusions Non-communicable diseases (NCDs) have made GGLE enter a plateau phase from a descent phase in Shanghai, China. Public efforts to reduce excess mortalities for male NCDs, cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes in particular and health policies focused on the middle-aged and elderly population might further narrow GGLE. This will also ensure improvements in health and health equity in Shanghai China.
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Affiliation(s)
- Hanyi Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Yi Zhou
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Lianghong Sun
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Yichen Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Xiaobin Qu
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Hua Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | | | - Shaotan Xiao
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China. .,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China.
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217
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Lim JY, Jung KY, Lee DH, Yang KM, Choi M, Park JP, Lee JH. A prospective study about the discrepancy between postmortem inspections conducted by emergency physicians and forensic pathologists. J Forensic Leg Med 2020; 73:101997. [PMID: 32658755 DOI: 10.1016/j.jflm.2020.101997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In South Korea, most postmortem examination certificates (death certificates) are issued by attending physicians working in the emergency department (ED). However, ED overcrowding has made continuous education and quality control of the postmortem examination certificate difficult. In this context, the National Forensic Service (NFS) is conducting an on-site postmortem inspection (OPI) project. AIMS In this study, we analyzed the discrepancy between postmortem inspection conducted by emergency physicians and forensic pathologists and identified the effects of the OPI project. METHOD The study examined cases where OPIs were conducted by NFS medical examiners (forensic pathologists) on patients who died on arrival or died in the ED where the OPI project is being conducted. The case reports written by emergency physicians were compared with the postmortem examination certificates written by medical examiners to analyze the discrepancy in cause and manner of death between the two groups. RESULT A total of 75 field examinations were conducted during the study period, with a 56% agreement rate between the two groups regarding cause of death. Manner of death was consistent at 73.3% and the most common reason for requesting an OPI was that the cause of death was presumed to be natural, but what that cause may be was unclear. CONCLUSION The discrepancy in postmortem examinations between emergency physicians and medical examiners is attributed to various factors. To ensure more reliable postmortem examinations, emphasis should be placed on improving the death investigation system and quality control activities for physicians.
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Affiliation(s)
- Ji Yeon Lim
- Department of Emergency Medicine, Cheju Halla General Hospital, Jeju, Republic of Korea.
| | - Koo Young Jung
- Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Duk Hee Lee
- Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Kyung-Moo Yang
- Medical Examiner's Office, National Forensic Service, Wonju, Republic of Korea.
| | - Minsung Choi
- Division of Forensic Medicine Investigation, National Forensic Service Seoul Institute, Seoul, Republic of Korea.
| | - Jong-Pil Park
- Department of Forensic Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jae Hee Lee
- Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
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218
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Abstract
OBJECTIVES To determine how often end-stage kidney disease (ESKD) is implicated as a cause of death (COD) at autopsy. METHODS We searched our autopsy database (2007-2017) using queries "end-stage renal disease," "end-stage kidney disease," "ESRD," "chronic renal disease," and "chronic kidney disease." Final diagnosis and summaries were reviewed to determine if ESKD was appropriately correlated with the COD. Cases in which the COD was unrelated to kidney function were excluded. RESULTS Eighty-five patients with a history of ESKD and histologic confirmation thereof were identified. Their CODs were cardiovascular (36%), infection/sepsis (41%), pulmonary (6%), gastrointestinal/hepatic (2%), central nervous system (3%), other systemic disease (7%), and unspecified (5%). ESKD was implicated as a contributing COD in 24 (28%) cases. CONCLUSIONS ESKD is often overlooked at autopsy, particularly in patients with cardiovascular or infectious disease. Accurate documentation of ESKD contributing to mortality is important for education, counseling, record maintenance, and directing research efforts.
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Affiliation(s)
| | - Kammi J Henriksen
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
| | - Anthony Chang
- Department of Pathology, University of Chicago Medical Center, Chicago, IL
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219
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Kellerman QD, Hartoonian N, Beier ML, Leipertz SL, Maynard C, Hostetter TA, Haselkorn JK, Turner AP. Risk Factors for Suicide in a National Sample of Veterans With Multiple Sclerosis. Arch Phys Med Rehabil 2020; 101:1138-1143. [PMID: 32325161 DOI: 10.1016/j.apmr.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine risk factors in the year before suicide in a national sample of United States veterans with multiple sclerosis (MS), as well as means of suicide and receipt of mental health services prior to death. DESIGN Case control study. Individuals in the Veterans Affairs MS National Data Repository were linked to the National Death Index Plus to obtain death records, including specific causes of death. Participants were veterans with MS who died by suicide and randomly selected nonsuicide MS controls (5 per participant) who were alive at the time of the index suicide. Mental health disorders and medical comorbidities were identified in the year before death for suicides and during the identical time period for controls. SETTING Veterans Health Administration. PARTICIPANTS Veterans (N=426) who received treatment for MS in the United States Veterans Health Administration between 1999 and 2011. There were 71 deaths by suicide and 355 randomly selected controls. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Suicide. RESULTS Results from the adjusted multivariable model suggest that the following factors were associated with an increased risk for suicide: male sex (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.35-9.42), depression (OR, 1.82; 95% CI, 1.03-3.23), and alcohol use disorder (OR, 3.10; 95% CI, 1.38-6.96). Half (50.7%) had a mental health appointment in the year before suicide. The primary means of suicide was by firearm (62.0%). CONCLUSIONS Routine assessment of suicide risk in individuals with MS is warranted, particularly for those with recent history of depression or alcohol use disorder.
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Affiliation(s)
| | - Narineh Hartoonian
- VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA
| | - Megan L Beier
- University of Washington Department of Rehabilitation Medicine, Seattle, WA
| | - Steven L Leipertz
- VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA
| | | | - Trisha A Hostetter
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO
| | - Jodie K Haselkorn
- VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA; University of Washington Department of Rehabilitation Medicine, Seattle, WA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA; VA Multiple Sclerosis Center of Excellence West, Seattle, WA; University of Washington Department of Rehabilitation Medicine, Seattle, WA.
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220
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Abstract
BACKGROUND Seafarers are exposed to many occupational risk factors. AIMS To study whether there are differences in mortality between seafarers and other employees, whether there are variations in seafarers' mortality between different seafaring occupations and whether these differences can be explained by sociodemographic factors. METHODS A register-based study of all seafarers aged 25-64 years, resident in Finland in 2000 with minimum 5 years of cumulative seafaring experience on Finnish vessels and other employees, followed for mortality 2001-13. Analysis methods included age standardized death rates, mortality ratios (SMR) and Cox proportional hazard model. RESULTS During the follow-up period 2001-13, there were 81,035 person years and 382 deaths in the cohort of seafarers. Seafarers had 1.3 times higher risk of death (men SMR 132, 95% confidence intervals [CI] 118-147, women SMR 125, 95% CI 99-157) than other employees. Mortality was especially high in alcohol-related causes (men SMR 172, 95% CI 126-233, women SMR 262, 95% CI 131-525) and causes related to smoking. Controlling for sociodemographic characters strengthened the risk compared to other occupations. Mortality was high among male deck and engine crew and among male and female galley personnel. The mortality differences between different seafaring occupations were partly explained by adjustments of sociodemographic characters. CONCLUSIONS Seafarers still have increased mortality among men after adjustment of sociodemographic characters. Results by causes of death suggest that changing practices to enable healthy behaviour are important.
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Affiliation(s)
- H Rinne
- Rehabilitation Foundation, Helsinki, Finland
| | - M Laaksonen
- Finnish Centre for Pensions, Kirjurinkatu, Helsinki, Finland
| | - V Notkola
- Rehabilitation Foundation, Helsinki, Finland
| | - R Shemeikka
- Rehabilitation Foundation, Helsinki, Finland
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221
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Macucha CM, Taunde SA. Domestic homicide in Maputo Province, Mozambique. Forensic Sci Int Synerg 2020; 2:157-61. [PMID: 32518900 DOI: 10.1016/j.fsisyn.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 03/05/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022]
Abstract
Background Domestic Homicide is the most extreme form of domestic violence reported worldwide. Although in Mozambique there are public reports of domestic homicide, no research has been published that describes its pattern. Aim This study aims to describe the pattern of domestic homicides in Maputo Province, Mozambique. Method A cross-sectional descriptive and quantitative approach study was applied using autopsy report data from 2016 to 2017 at the Forensic Medicine Services at Maputo Central Hospital. All cases of domestic homicide were captured in an Excel database and exported to Stata software for analysis. Descriptive statistics was performed for victim's age, sex, education level, relation to the offender, place of occurrence, and means of killing. Logistic regression was applied to investigate associations of intimate partner homicide with these independent variables. Results From a total of 689 autopsies of homicide over the two years, 96 (13.9%) were victims of domestic homicide. Among them, 62 (64.6%) were males and 34 (35.4%) females, with the median age of 38.9 years (range 0-92). Forty (41.7%) victims had primary level education. The residence was the place of the homicide in 45 (46.9%) of the cases. As a means of killing, suffocation was used in 26 cases (27.1%), use of a blunt instrument in 24 (25.0%), and poisoning in 16 (16.7%) cases. Twenty-three (24.0%) cases were victims of intimate partner homicide. From 73 (76.0%) cases of non-intimate partner homicide, 32 (43.8%) were siblicide, 27 (40.0%) were filicide, and 14 (19.2%) parricide. From a multivariable logistic regression, intimate partner homicide was only found to be positively associated to the victim being female (OR = 6.17, 95% CI 1.28-29.79, p-value 0.024). Conclusion This research contributes to the understanding of the pattern of domestic homicide, which will be useful for the identification of preventive measures. More research is necessary to understand the social contexts that lead to domestic homicide.
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Hadush A, Dagnaw F, Getachew T, Bailey PE, Lawley R, Ruano AL. Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system. BMC Pregnancy Childbirth 2020; 20:206. [PMID: 32272930 PMCID: PMC7147013 DOI: 10.1186/s12884-020-02899-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Triangulating findings from MDSR with other sources can better inform maternal health programs. A national Emergency Obstetric and Newborn Care (EmONC) assessment and the Maternal Death Surveillance and Response (MDSR) system provided data to determine the coverage of MDSR implementation in health facilities, the leading causes and contributing factors to death, and the extent to which life-saving interventions were provided to deceased women. METHODS This paper is based on triangulation of findings from a descriptive analysis of secondary data extracted from the 2016 EmONC assessment and the MDSR system databases. EmONC assessment was conducted in 3804 health facilities. Data from interview of each facility leader on MDSR implementation, review of 1305 registered maternal deaths and 679 chart reviews of maternal deaths that happened form May 16, 2015 to December 15, 2016 were included from the EmONC assessment. Case summary reports of 601 reviewed maternal deaths were included from the MDSR system. RESULTS A maternal death review committee was established in 64% of health facilities. 5.5% of facilities had submitted at least one maternal death summary report to the national MDSR database. Postpartum hemorrhage (10-27%) and severe preeclampsia/eclampsia (10-24.1%) were the leading primary causes of maternal death. In MDSR, delay-1 factors contributed to 7-33% of maternal deaths. Delay-2, related to reaching a facility, contributed to 32% & 40% of maternal deaths in the EmONC assessment and MDSR, respectively. Similarly, delay-3 factor due to delayed transfer of mothers to appropriate level of care contributed for 29 and 22% of maternal deaths. From the EmONC data, 72% of the women who died due to severe pre-eclampsia or eclampsia were given anticonvulsants while 48% of those dying of postpartum haemorrhage received uterotonics. CONCLUSION The facility level implementation coverage of MDSR was sub-optimal. Obstetric hemorrhage and severe preeclampsia or eclampsia were the leading causes of maternal death. Delayed arrival to facility (Delay 2) was the predominant contributing factor to facility-based maternal deaths. The limited EmONC provision should be the focus of quality improvement in health facilities.
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Affiliation(s)
| | - Ftalew Dagnaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Patricia E Bailey
- Averting Maternal Death & Disability, Columbia University, New York, NY, USA
| | - Ruth Lawley
- Evidence for Action, Options Consultancy Service, Addis Ababa, Ethiopia
| | - Ana Lorena Ruano
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Toender A, Vestergaard M, Munk-Olsen T, Larsen JT, Kristensen JK, Laursen TM. Risk of diabetic complications and subsequent mortality among individuals with schizophrenia and diabetes - a population-based register study. Schizophr Res 2020; 218:99-106. [PMID: 32029352 DOI: 10.1016/j.schres.2020.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Individuals with schizophrenia often develop diabetes, but little is known about their risk of diabetic complications. We aimed to study incidence of registered diabetic complications and subsequent mortality in individuals with schizophrenia and diabetes compared to individuals with diabetes only. METHODS We conducted a cohort study using nationwide registers and followed all individuals in the entire Danish population diagnosed with diabetes from 1997 to 2017. Incidence rate ratios (IRR) of diabetic complications, all-cause and cause-specific mortality rate ratios (MRR) were estimated by Cox regression comparing individuals diagnosed with schizophrenia and diabetes to individuals diagnosed only with diabetes. RESULTS In a cohort of 239,118 individuals with diagnosed diabetes, the incidence of any diabetic complication was similar in females with schizophrenia and diabetes compared to females with diabetes only; IRR = 0.93 (95%CI: 0.84-1.02), and significantly lower in males; IRR = 0.85 (95%CI: 0.78-0.92). The all-cause mortality for individuals with a diagnosis of a diabetic complication was higher in individuals with schizophrenia and diabetes than in those with diabetes only; MRR = 1.92 (95%CI: 1.65-2.23) for females and MRR = 1.69 (95%CI: 1.49-1.92) for males. Among those without diabetic complications, schizophrenia was also associated with a higher mortality. CONCLUSIONS Individuals with schizophrenia and diabetes had similar or lower rates of diabetic complications, compared to those with diabetes only. Among those with diabetic complications, schizophrenia was associated with higher mortality. Similar, among those without diabetic complications, schizophrenia was also associated with higher mortality. Hence, diabetic complications do not seem to explain the excess mortality seen in individuals with schizophrenia.
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Affiliation(s)
- Anita Toender
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark; Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Denmark
| | | | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark
| | - Janne Tidselbak Larsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark
| | | | - Thomas Munk Laursen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Denmark.
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224
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Li ZR, McCormick TH, Clark SJ. Non-confirming replication of "Performance of InSilicoVA for assigning causes of death to verbal autopsies: multisite validation study using clinical diagnostic gold standards," by Flaxman et al. BMC Med 2020; 18:69. [PMID: 32213178 PMCID: PMC7098138 DOI: 10.1186/s12916-020-01518-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A verbal autopsy (VA) is an interview conducted with the caregivers of someone who has recently died to describe the circumstances of the death. In recent years, several algorithmic methods have been developed to classify cause of death using VA data. The performance of one method-InSilicoVA-was evaluated in a study by Flaxman et al., published in BMC Medicine in 2018. The results of that study are different from those previously published by our group. METHODS Based on the description of methods in the Flaxman et al. study, we attempt to replicate the analysis to understand why the published results differ from those of our previous work. RESULTS We failed to reproduce the results published in Flaxman et al. Most of the discrepancies we find likely result from undocumented differences in data pre-processing, and/or values assigned to key parameters governing the behavior of the algorithm. CONCLUSION This finding highlights the importance of making replication code available along with published results. All code necessary to replicate the work described here is freely available on GitHub.
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Affiliation(s)
- Zehang Richard Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Tyler H McCormick
- Department of Statistics, University of Washington, Seattle, WA, USA
- Department of Sociology, University of Washington, Seattle, WA, USA
| | - Samuel J Clark
- Department of Sociology, The Ohio State University, Columbus, OH, USA.
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225
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Zürcher S, Jackowski C, Schön CA. Circumstances and causes of death of hikers at different altitudes: A retrospective analysis of hiking fatalities from 2003-2018. Forensic Sci Int 2020; 310:110252. [PMID: 32203854 DOI: 10.1016/j.forsciint.2020.110252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The number of hikers and the popularity of hiking in the Alpine region is great. Inevitably linked to this, natural deaths as well as fatal and non-fatal accidents occur. Nevertheless, there is little data available on hiking accidents in particular. This study examines the circumstances of accidents and the causes of death of hikers who have suffered fatal accidents. METHODS Retrospectively, the police files and forensic medical reports of hiking fatalities in the Canton of Berne (Switzerland) from 2003 to 2018 were analyzed. In this process 25 predefined parameters were collected (e.g. manner of death, causes of death, height of fall). Subsequently, all fatal hiking accidents were evaluated and compared by altitude (<1800 m vs. >1800 m). RESULTS 77 fatal hiking accidents were recorded in the given period, all of which were caused by a fall. Over 1800 m significantly more traumatic brain injuries occurred than under 1800 m (85 vs. 62.2 %, p = 0.022). Besides, significantly more accidents occurred during descent in the group above 1800 m than below 1800 m (60.9 vs. 84.8 %, p = 0.041). A large share of accidents occurred off official hiking trails (45.9 vs. 32.5 %). Significantly more equipment shortages were found in the group below 1800 m (32.4 vs. 12.5 %, p = 0.035). The accident victims with equipment shortages were on average 10.35 years younger. CONCLUSION Causes and circumstances of death of hikers differ in some points significantly at different altitudes. Prevention in the form of education about the dangers of hiking off the official hiking trails and equipment shortages could prevent deaths in the future. The education should primarily be aimed at foreign, young and inexperienced hikers.
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Affiliation(s)
- Severin Zürcher
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland.
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland
| | - Corinna A Schön
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, 3012, Bern, Switzerland
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226
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Cobos Muñoz D, de Savigny D, Sorchik R, Bo KS, Hart J, Kwa V, Ngomituje X, Richards N, Lopez AD. Better data for better outcomes: the importance of process mapping and management in CRVS systems. BMC Med 2020; 18:67. [PMID: 32146901 PMCID: PMC7061473 DOI: 10.1186/s12916-020-01522-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite attempts to apply standard methods proven to work in high-income nations, nearly all civil registration and vital statistics (CRVS) systems in low- and middle-income countries are failing to achieve adequate levels of registration completeness or produce the high-quality vital statistics needed to support better health outcomes and monitor progress towards the 2030 Sustainable Development Goals. This suggests that, rather than simple technical issues, these countries are facing additional or different systemic challenges, including duplication of roles and responsibilities, inefficient methods of data collection, and a reluctance to change. APPLYING PROCESS MANAGEMENT Process management is a valuable tool that strengthens the production of vital statistics by providing a visualisation of data flow from start to finish. It helps identify gaps and bottlenecks in the process, allowing stakeholders to work collaboratively to find solutions and target interventions. As part of the Bloomberg Philanthropies Data for Health Initiative at the University of Melbourne, 16 countries were supported in mapping the varied processes required in registering a birth or death. Comparative analysis exposed several limitations in the design of CRVS systems that hinder their performance - from 'passive' systems, to overly complex and fragmented system design, through to poor collaboration and duplication of efforts. CONCLUSIONS The experiences from Myanmar, Papua New Guinea and Rwanda reported in this paper illustrate the benefits of process management to improve CRVS. While these three countries are at different stages of system development, each uniquely benefited. Process management is a useful tool for all CRVS systems, from the most rudimentary to the most developed. It can strengthen CRVS systems and improve the quality and completeness of vital statistics, resulting in more robust, reliable and timely vital statistics for health planning and better monitoring of the 2030 Sustainable Development Goal agenda.
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Affiliation(s)
- Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland. .,University of Basel, Petersplatz 1, Basel, CH-4002, Switzerland.
| | - Don de Savigny
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland.,University of Basel, Petersplatz 1, Basel, CH-4002, Switzerland
| | - Renee Sorchik
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | | | - John Hart
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Viola Kwa
- Data for Health, Port Moresby, Papua New Guinea
| | | | - Nicola Richards
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
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227
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Adair T, Rajasekhar M, Bo KS, Hart J, Kwa V, Mukut MAA, Reeve M, Richards N, Ronderos-Torres M, de Savigny D, Muñoz DC, Lopez AD. Where there is no hospital: improving the notification of community deaths. BMC Med 2020; 18:65. [PMID: 32146904 DOI: 10.1186/s12916-020-01524-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, an estimated two-thirds of all deaths occur in the community, the majority of which are not attended by a physician and remain unregistered. Identifying and registering these deaths in civil registration and vital statistics (CRVS) systems, and ascertaining the cause of death, is thus a critical challenge to ensure that policy benefits from reliable evidence on mortality levels and patterns in populations. In contrast to traditional processes for registration, death notification can be faster and more efficient at informing responsible government agencies about the event and at triggering a verbal autopsy for ascertaining cause of death. Thus, innovative approaches to death notification, tailored to suit the setting, can improve the availability and quality of information on community deaths in CRVS systems. IMPROVING THE NOTIFICATION OF COMMUNITY DEATHS Here, we present case studies in four countries (Bangladesh, Colombia, Myanmar and Papua New Guinea) that were part of the initial phases of the Bloomberg Data for Health Initiative at the University of Melbourne, each of which faces unique challenges to community death registration. The approaches taken promote improved notification of community deaths through a combination of interventions, including integration with the health sector, using various notifying agents and methods, and the application of information and communication technologies. One key factor for success has been the smoothing of processes linking notification, registration and initiation of a verbal autopsy interview. The processes implemented champion more active notification systems in relation to the passive systems commonly in place in these countries. CONCLUSIONS The case studies demonstrate the significant potential for improving death reporting through the implementation of notification practices tailored to a country's specific circumstances, including geography, cultural factors, structure of the existing CRVS system, and available human, information and communication technology resources. Strategic deployment of some, or all, of these innovations can result in rapid improvements to death notification systems and should be trialled in other settings.
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228
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Halonen P, Jakobsson M, Heikinheimo O, Gissler M, Pukkala E. Incidence of lichen sclerosus and subsequent causes of death: a nationwide Finnish register study. BJOG 2020; 127:814-819. [PMID: 32065721 DOI: 10.1111/1471-0528.16175] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the incidence of lichen sclerosus (LS) in women and the all-cause and cause-specific mortality of women with LS. DESIGN Population-based descriptive study. SETTING Finland. POPULATION All Finnish women, including 7790 women diagnosed with LS during the period 1969-2012. METHODS Information gathered from the Finnish Hospital Discharge Register on women with LS was combined with dates and causes of death from Statistics Finland and the Finnish Cancer Registry. Population statistics are from Statistics Finland. MAIN OUTCOME MEASURES Crude and age-adjusted incidence rates of LS and standardised mortality ratios (SMRs). RESULTS The incidence rate of LS adjusted for age (European Standard Population) increased from 14 per 100 000 woman-years in 2003 to 22 per 100 000 woman-years in 2010-2012. The age-specific incidence rate was highest in postmenopausal women (24-53 per 100 000) but was also elevated in girls aged 5-9 years (seven per 100 000). The all-cause mortality of women with LS was lower than in the general female population (SMR 0.84, 95% CI 0.78-0.90), mostly as a result of decreased mortality from circulatory diseases (SMR 0.80, 95% CI 0.72-0.89) and dementia and Alzheimer's disease (SMR 0.75, 95% CI 0.62-0.88). The cancer mortality equalled that of the population, but the vulvar cancer mortality was increased (SMR 28.1, 95% CI 19.3-39.4). CONCLUSIONS Lichen sclerosus is a common disease of elderly women. The overall mortality is decreased whereas the mortality as a result of vulvar cancer is increased. TWEETABLE ABSTRACT The likelihood of getting LS by age 80 years is 1.6%. The mortality of women with LS is reduced compared with that of the population.
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Affiliation(s)
- P Halonen
- Department of Obstetrics and Gynaecology, HUCH Hyvinkää Hospital, Hyvinkää, Finland.,Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland
| | - M Jakobsson
- Department of Obstetrics and Gynaecology, HUCH Hyvinkää Hospital, Hyvinkää, Finland.,Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland
| | - O Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - M Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
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229
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Naghavi M, Richards N, Chowdhury H, Eynstone-Hinkins J, Franca E, Hegnauer M, Khosravi A, Moran L, Mikkelsen L, Lopez AD. Improving the quality of cause of death data for public health policy: are all 'garbage' codes equally problematic? BMC Med 2020; 18:55. [PMID: 32146899 PMCID: PMC7061466 DOI: 10.1186/s12916-020-01525-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mohsen Naghavi
- Institute of Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Seattle, WA, 98121, USA
| | - Nicola Richards
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Hafiz Chowdhury
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | | | - Elisabeth Franca
- University of Minas Gerais, Belo Horizonte, Minas Gerias, 31270-901, Brazil
| | - Michael Hegnauer
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Ardeshir Khosravi
- Ministry of Health and Medical Education, District 2, Eyvanak Blvd, Tehran, Iran
| | - Lauren Moran
- Australian Bureau of Statistics, 295 Ann Street, Brisbane, QLD, 4000, Australia
| | - Lene Mikkelsen
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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230
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Abstract
The Sustainable Development Goal (SDG) agenda offers a major impetus to consolidate and accelerate development in civil registration and vital statistics (CRVS) systems. Strengthening CRVS systems is an SDG outcome in itself. Moreover, CRVS systems are the best - if not essential - source of data to monitor and guide health policy debates and to assess progress towards numerous SDG targets and indicators. They also provide the necessary documentation and proof of identity for service access and are critical for disaster preparedness and response. While there has been impressive global momentum to improve CRVS systems over the past decade, several challenges remain. This article collection provides an overview of recent innovations, progress, viewpoints and key areas in which action is still required - notably around the need for better systems and procedures to notify the fact of death and to reliably diagnose its cause, both for deaths in hospital and elsewhere.
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Affiliation(s)
- Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia.
| | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Nicola Richards
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia
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231
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Abstract
BACKGROUND The need to monitor the Sustainable Development Goals (SDGs) and to have access to reliable and timely mortality data has created a strong demand in countries for tools that can assist them in this. ANACONDA (Analysis of National Causes of Death for Action) is a new tool developed for this purpose which allows countries to assess how accurate their mortality and cause of death are. Applying ANACONDA will increase confidence and capacity among data custodians in countries about their mortality data and will give them insight into quality problems that will assist the improvement process. METHODS ANACONDA builds on established epidemiological and demographic concepts to operationalise a series of 10 steps and numerous sub-steps to perform data checks. Extensive use is made of comparators to assess the plausibility of national mortality and cause of death statistics. The tool calculates a composite Vital Statistics Performance Index for Quality (VSPI(Q)) to measure how fit for purpose the data are. Extracts from analyses of country data are presented to show the types of outputs. RESULTS Each of the 10 steps provides insight into how well the current data is describing different aspects of the mortality situation in the country, e.g. who dies of what, the completeness of the reporting, and the amount and types of unusable cause of death codes. It further identifies the exact codes that should not be used by the certifying physicians and their frequency, which makes it possible to institute a focused correction procedure. Finally, the VSPI(Q) allows periodic monitoring of data quality improvements and identifies priorities for action to strengthen the Civil Registration and Vital Statistics (CRVS) system. CONCLUSIONS ANACONDA has demonstrated the potential to dramatically improve knowledge about disease patterns as well as the functioning of CRVS systems and has served as a platform for galvanising wider CRVS reforms in countries.
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Affiliation(s)
- Lene Mikkelsen
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria 3053 Australia
| | - Kim Moesgaard
- Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Michael Hegnauer
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Alan D. Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria 3053 Australia
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232
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Hart JD, Sorchik R, Bo KS, Chowdhury HR, Gamage S, Joshi R, Kwa V, Li H, Mahesh BPK, Mclaughlin D, Mikkelsen L, Miki J, Napulan R, Rampatige R, Reeve M, Sarmiento C, War NS, Richards N, Riley ID, Lopez AD. Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative. BMC Med 2020; 18:74. [PMID: 32146900 PMCID: PMC7061467 DOI: 10.1186/s12916-020-01519-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/11/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the medical certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification. METHODS The three training strategies evaluated were (1) training of trainers (TOT) in the Philippines, Myanmar, and Sri Lanka; (2) direct training of physicians by the UoM D4H in Papua New Guinea (PNG); and (3) the implementation of an online and basic training strategy in Peru. The evaluation involved an assessment of MCCODs before and after training using an assessment tool developed by the University of Melbourne. RESULTS The TOT strategy led to reductions in incorrectly completed certificates of between 28% in Sri Lanka and 40% in the Philippines. Following direct training of physicians in PNG, the reduction in incorrectly completed certificates was 30%. In Peru, the reduction in incorrect certificates was 30% after implementation and training on an online system only and 43% after training on both the online system and basic medical certification principles. CONCLUSIONS The results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.
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Affiliation(s)
- John D Hart
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia.
| | - Renee Sorchik
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Khin Sandar Bo
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Hafizur R Chowdhury
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Saman Gamage
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Rohina Joshi
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, 2042, Australia
| | - Viola Kwa
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Hang Li
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Buddhika P K Mahesh
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Deirdre Mclaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Lene Mikkelsen
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Janet Miki
- Civil Registration and Vital Statistics, Vital Strategies, Bloomberg Data for Health Initiative, Santiago de Surco, Lima, Peru
| | - Roderick Napulan
- Health Facility Development Bureau, Department of Health, Manila, Philippines
| | - Rasika Rampatige
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Matthew Reeve
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Carmina Sarmiento
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Nang Su War
- John Snow, Inc. (JSI Research & Training Institute, Inc.), Mandalay, Myanmar
| | - Nicola Richards
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Ian D Riley
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
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233
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Hazard RH, Buddhika MPK, Hart JD, Chowdhury HR, Firth S, Joshi R, Avelino F, Segarra A, Sarmiento DC, Azad AK, Ashrafi SAA, Bo KS, Kwa V, Lopez AD. Automated verbal autopsy: from research to routine use in civil registration and vital statistics systems. BMC Med 2020; 18:60. [PMID: 32146903 PMCID: PMC7061477 DOI: 10.1186/s12916-020-01520-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/11/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The majority of low- and middle-income countries (LMICs) do not have adequate civil registration and vital statistics (CRVS) systems to properly support health policy formulation. Verbal autopsy (VA), long used in research, can provide useful information on the cause of death (COD) in populations where physicians are not available to complete medical certificates of COD. Here, we report on the application of the SmartVA tool for the collection and analysis of data in several countries as part of routine CRVS activities. METHODS Data from VA interviews conducted in 4 of 12 countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative, and at different stages of health statistical development, were analysed and assessed for plausibility: Myanmar, Papua New Guinea (PNG), Bangladesh and the Philippines. Analyses by age- and cause-specific mortality fractions were compared to the Global Burden of Disease (GBD) study data by country. VA interviews were analysed using SmartVA-Analyze-automated software that was designed for use in CRVS systems. The method in the Philippines differed from the other sites in that the VA output was used as a decision support tool for health officers. RESULTS Country strategies for VA implementation are described in detail. Comparisons between VA data and country GBD estimates by age and cause revealed generally similar patterns and distributions. The main discrepancy was higher infectious disease mortality and lower non-communicable disease mortality at the PNG VA sites, compared to the GBD country models, which critical appraisal suggests may highlight real differences rather than implausible VA results. CONCLUSION Automated VA is the only feasible method for generating COD data for many populations. The results of implementation in four countries, reported here under the D4H Initiative, confirm that these methods are acceptable for wide-scale implementation and can produce reliable COD information on community deaths for which little was previously known.
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Affiliation(s)
- Riley H Hazard
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.
| | - Mahesh P K Buddhika
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - John D Hart
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Hafizur R Chowdhury
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Sonja Firth
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rohina Joshi
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, 2042, Australia
| | | | | | - Deborah Carmina Sarmiento
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | | | | | - Khin Sandar Bo
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Violoa Kwa
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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234
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Dufayet L, Gorgiard C, Vayssette F, Barbet JP, Hoizey G, Ludes B. Death of an apprentice bodybuilder following 2,4-dinitrophenol and clenbuterol intake. Int J Legal Med 2020; 134:1003-1006. [PMID: 32125503 DOI: 10.1007/s00414-020-02268-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/21/2020] [Indexed: 12/28/2022]
Abstract
We present the case of a 17-year-old man, who died after 2,4-dinitrophenol (DNP) and clenbuterol consumption, which he likely took for physical enhancement. Forensic post-mortem examination revealed a yellowish skin colour and nonspecific signs of asphyxia. Analytical confirmation of the intoxication was obtained in blood and urine, with high levels of DNP and clenbuterol. Both of these substances are used by bodybuilders as DNP enhance lipolysis and clenbuterol has anabolic properties, but their toxicity is underestimated. DNP uncouples oxidative phosphorylation, leading to thermogenesis and even relatively small doses can cause fatal hyperthermia. Clenbuterol is a β2 agonist that causes electrolyte disturbances (hypokalemia and hyperglycemia mostly) and death have been described through coronary vasospasm. Given the circumstances in which the body was found and toxicological results, we believe the cause of death to be fatal hyperthermia from DNP intake. These substances are illegal in many countries, but easily bought online. Through this availability, the last decades have seen an increase of fatal intoxications. Websites selling them are regularly closed by French public authorities and Interpol, but unfortunately it seems insufficient.
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Affiliation(s)
- L Dufayet
- Unité Médico-Judiciaire, APHP Hôpital Hôtel Dieu, Paris, France.
- Centre antipoison de Paris, Fédération de toxicologie Fetox, APHP Hôpital Lariboisière-Fernand Widal, Paris, France.
| | - C Gorgiard
- Unité Médico-Judiciaire, APHP Hôpital Hôtel Dieu, Paris, France
- Institut Médico-Légal, Paris, France
| | | | - J P Barbet
- Service d'Anatomie Pathologique, APHP Hôpital Necker-Enfants Malades, Paris, France
| | - G Hoizey
- Laboratoire TOXLAB, Paris, France
| | - B Ludes
- Institut Médico-Légal, Paris, France
- Université de Paris, BABEL, CNRS, F-75012, Paris, France
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235
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Abstract
OBJECTIVE Death certificates are legal documents containing critical information. Despite the importance of accurate certification, errors remain common. Estimates of error prevalence vary between studies, and error classification systems are often unclear. Relatively few studies have assessed the frequency at which death certification errors occur in US hospitals, and even fewer have attempted a standardized classification of errors based on their severity. In the current study, our objective was to evaluate the frequency of death certification errors at an academic center, implement a standardized method of categorizing error severity, and analyze sources of error to better identify ways to improve death certification accuracy. DESIGN We retrospectively reviewed the accuracy of cause and manner of death certification at our regional academic institution for 179 cases in which autopsy was performed between 2013-2016. We compared non-pathologist physician completed death certificates with the cause and manner of death ultimately determined at autopsy. METHODS Errors were classified via a 5-point scale of increasing error severity. Grades I-IIc were considered minor errors, while III-V were considered severe. Sources of error were analyzed. RESULTS In the majority of cases (85%), death certificates contained ≥ one error, with multiple errors (51%) being more common than single (33%). The most frequent error type was Grade 1 (53%), followed by Grade III (30%), and Grade IIb (18%). The more severe Grade IV errors were seen in 23% of cases; no Grade V errors were found. No amendments were made to any death certificates following finalization of autopsy results during the study period. CONCLUSION This study reaffirms the importance of autopsy and autopsy pathologists in ensuring accurate and complete death certification. It also suggests that death certification errors may be more frequent than previously reported. We propose a method by which death certification errors can be classified in terms of increasing severity. By understanding the types of errors occurring on death certificates, academic institutions can work to improve certification accuracy. Better clinician education, coordination with autopsy pathologists, and implementation of a systematic approach to ensuring concordance of death certificates with autopsy results is recommended.
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Affiliation(s)
- Leah M Schuppener
- University of Wisconsin School of Medicine and Public Health, Department of Pathology and Laboratory Medicine, Madison, Wisconsin USA
| | - Kelly Olson
- University of Wisconsin School of Medicine and Public Health, Department of Pathology and Laboratory Medicine, Madison, Wisconsin USA
| | - Erin G Brooks
- University of Wisconsin School of Medicine and Public Health, Department of Pathology and Laboratory Medicine, Madison, Wisconsin USA
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236
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Abstract
Background Death from bacterial meningitis is rarely attributed to the actual event causing death. The present study therefore categorized and characterized the cause and time of death due to bacterial meningitis. Methods In a cohort of patients > 15 years of age with community acquired bacterial meningitis the medical records were reviewed, and a clinical cause of death categorized into six main categories: 1) CNS complications, 2) Systemic complications, 3) Combination of systemic and CNS complications, 4) Sudden death, 5) Withdrawal of care, or 6) Unknown. Results We identified 358 patients of which 84 (23%) died in-hospital. Causes of death were ascribed to CNS complications in 43%, Systemic complications in 39%, Combined CNS and systemic complications in 4%, Sudden death in 7% and withdrawal of care in 5%. Brain herniation, circulatory failure, intractable seizures and other brain injury were the most common specific causes of death within 14 days from admission (55%). Conclusion Fatal complications due to the primary infection – meningitis - is most common within 14 days of admission. The diversity of complications causing death in meningitis suggest that determining the clinical cause of death is essential to the evaluation of novel treatment strategies.
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Affiliation(s)
- A Sharew
- Department of pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, 3400, Hilleroed, Denmark
| | - J Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - B R Hansen
- Department of Infectious Diseases, University Hospital Copenhagen Hvidovre, Hvidovre, Denmark
| | - H Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - C T Brandt
- Department of pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, 3400, Hilleroed, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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237
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Iida M, Nakasone H, Yamashita T, Inoue M, Ishida Y, Uchiyama H, Katayama Y, Miyamoto T, Yoshioka S, Shiratori S, Mori T, Sawa M, Sugio Y, Fukuda T, Ichinohe T, Atsuta Y, Inamoto Y. Late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation. Blood Cell Ther 2020; 3:11-17. [PMID: 37465377 PMCID: PMC10352032 DOI: 10.31547/bct-2019-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/14/2019] [Indexed: 07/20/2023]
Abstract
By evaluating risks of late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation (HSCT) in Japan, we clarified what we should focus on during follow-up to reduce them. The study cohort included 6,780 patients who had survived for ≥2 years after the first autologous HSCT performed from 1974 to 2012 for hematological diseases. With a median follow-up of 6.0 years among survivors, overall survival probabilities at 5 and 10 years after HSCT were 92% and 83%, respectively. Eight hundred thirty deaths occurred: 451, recurrent primary diseases; 87, subsequent solid cancers; 57, subsequent hematological malignancies; 55, infections; 41, respiratory diseases; 19, cardiovascular diseases; 15, liver diseases; 10, neurological diseases; and 7, kidney/genitourinary diseases (Except small numbers of other causes and missing). According to the log-rank test, the risk of overall mortality was remarkably increased among HSCT recipients compared with the that in the general Japanese population (observed/expected ratio [O/E]=5.4; 95% confidence interval [CI], 5.0-5.8). The risks of cause-specific mortality increased with infection (O/E=6.8; 95% CI, 5.1-8.8), subsequent solid cancers (O/E=1.4; 95% CI, 1.1-1.7), subsequent hematological malignancies (O/E=14.3; 95% CI, 10.8-18.5), kidney/genitourinary diseases (O/E=3.4; 95% CI, 1.4-7.1), respiratory disease (O/E=9.0; 95% CI, 6.5-1.2), and liver diseases (O/E=2.6; 95% CI, 1.4-4.2). Long-term survivors after autologous HSCT are at an increased risk of death due to secondary cancers, infections, and any organ diseases as well as recurrence compared to the general population. When monitoring these patients in the outpatient clinic, it is important for physicians to predict a change in the patient's condition and to start treatment earlier.
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Affiliation(s)
- Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine,Nagakute, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takuya Yamashita
- Department of Hematology, St. Luke's International Hospital, Tokyo, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yasushi Ishida
- Department of Pediatrics, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hitoji Uchiyama
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Toshihiro Miyamoto
- Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Souichi Shiratori
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Yasuhiro Sugio
- Department of Internal Medicine, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation/Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
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238
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Kuri-Morales PA, Castillo-Flores GDD, Castañeda-Prado A, Pacheco-Montes SR. Clinical-epidemiological profile of deaths from influenza with a history of timely vaccination, Mexico 2010-2018. GAC MED MEX 2020; 155:423-429. [PMID: 32091021 DOI: 10.24875/gmm.m20000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Influenza epidemics are of higher risk at the extremes of life and in people with comorbidities. Effective vaccination prevents the occurrence of serious cases and decreases mortality. Objective To describe deaths from influenza with a history of timely vaccination, from the 2010 to the 2018 season in Mexico. Method Cross-sectional, descriptive study where the Influenza Epidemiological Surveillance System database was used. Results From 2010 to 2018, 65 vaccinated individuals died from influenza, from which 55% of cases (n = 36) were due to type A (H1N1), 51% (n = 33) were females, median age was 57 years, 21 % (n = 14) did not meet the operational definition of influenza-like illness or severe acute respiratory infection, 83% (n = 54) had at least one comorbidity, with the most common being diabetes mellitus and hypertension (32% each); 55% (n = 36) of deaths received antiviral treatment and only 8% (n = 5) had no comorbidities and received treatment with oseltamivir. Conclusions Deaths from influenza with timely vaccination represent a very low percentage of the totality. Vaccination against influenza has been a specific prevention strategy that decreases disease burden.
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239
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Han S, Liu WP, Mi L, Ji XQ, Fang J, Liu JM, Yin P, Wang LJ, Zhou MG, Zhu J. [Analysis of the characteristics of second primary malignancy affecting the survival of lymphoma patients]. Zhonghua Zhong Liu Za Zhi 2020; 42:145-149. [PMID: 32135650 DOI: 10.3760/cma.j.issn.0253-3766.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the characteristics of the second primary tumor affecting the survival of patients with lymphoma, and to explore the risk factors of death from the second primary tumor. Methods: The medical records and related death information of 1 173 lymphoma patients who had already died with known causes were collected. The basic causes of death and the characteristics of patients who died of the second primary tumor were analyzed. Cox regression model was used to analyze the risk factors of lymphoma patients who died of the second primary tumor. Results: Among the 1 173 patients who had died, 94 (8.0%) died of the second primary tumor, 935 (79.7%) died of the primary lymphoma and 144 (12.3%) died of other diseases. The second primary tumor accounted for 17.5% (38/217) of all causes of death in patients with the survival period of more than 5 years, and the second primary tumor accounted for 28.3% (17/60) of all causes of death in patients with the survival period of more than 10 years. Among 94 cases who died of second primary tumors, 31 died of lung cancer, 15 died of gastric cancer, 13 died of liver cancer, 9 died of pancreatic cancer, 6 died of colorectal cancer, 6 died of second primary lymphoma and 14 died of other types of tumors. Univariate Cox regression analysis showed that age, first-line treatment effect, and chest or mediastinal radiotherapy were associated with the death from second primary tumors for lymphoma patients (all P<0.05). Multivariate Cox regression analysis showed that the effect of first-line treatment (P=0.030) and the chest or mediastinal radiotherapy (P=0.039) were independent factors for the death of lymphoma patients from the second primary tumor. Conclusions: The second primary tumor is an important factor affecting the survival of lymphoma patients, and the risk of death from second primary tumors increases significantly over time. The effect of first-line treatment and radiotherapy in the chest or mediastinum are independent factors for the death of lymphoma patients from the second primary tumor.
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Affiliation(s)
- S Han
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - W P Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - L Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - X Q Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - J Fang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
| | - J M Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - P Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - L J Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - M G Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - J Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital &Institute, Beijing 100142, China
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240
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Tanguy-Melac A, Denis P, Pestel L, Fagot-Campagna A, Gastaldi-Ménager C, Tuppin P. Intensity of care, expenditure, place and cause of death people with lung cancer in the year before their death: A French population based study. Bull Cancer 2020; 107:308-321. [PMID: 32035648 DOI: 10.1016/j.bulcan.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Health care utilization of people with lung cancer (LC) the last year of life, their causes of death and place of death and the associated expenditure have been poorly described together. Then we conducted an observational study. METHODS People with LC covered by the French health Insurance general scheme (77% of the population) who died in 2015 were identified in the national health data system, together with their health care utilization and, in 95% of cases, their causes of death. RESULTS A total of 22,899 individuals were included (mean age: 68 years, SD±11.4), 72% of whom died in short-stay hospitals (SSH), 4% in hospital-at-home, 8% in Rehab hospital, 2% in skilled nursing homes and 14% at home. One-half of these people had also a chronic respiratory tract disease and 18% another cancer. Hospital palliative care (HPC) was identified for 65% of people, but for only 9% prior to their end-of-life stay. During the last month of life, 49% of people had two or more SSH stays, 15% were admitted to an intensive care unit, 23% received a chemotherapy session (13% during the last 14 days). The main cause of death was cancer for 92% of individuals (LC for 82%) The mean expenditure during the last year of life was €43,329 per individual. DISCUSSION This study indicates high rates of intensive care unit admissions and chemotherapy during the last month of life and a SSH hospital-centered management with intensive use of HPC mainly during the end-of-life stay.
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Affiliation(s)
- Audrey Tanguy-Melac
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Pierre Denis
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Laurence Pestel
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Anne Fagot-Campagna
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Christelle Gastaldi-Ménager
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Philippe Tuppin
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France.
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241
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Mitratza M, Kunst AE, Harteloh PPM, Nielen MMJ, Klijs B. Prevalence of diabetes mellitus at the end of life: An investigation using individually linked cause-of-death and medical register data. Diabetes Res Clin Pract 2020; 160:108003. [PMID: 31911247 DOI: 10.1016/j.diabres.2020.108003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/12/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
AIMS Although diabetes mellitus at the end of life is associated with complex care, its end-of-life prevalence is uncertain. Our aim is to estimate diabetes prevalence in the end-of-life population, to evaluate which medical register has the largest added value to cause-of-death data in detecting diabetes cases, and to assess the extent to which reporting of diabetes as a cause of death is associated with disease severity. METHODS Our study population consisted of deaths in the Netherlands (2015-2016) included in Nivel Primary Care Database (Nivel-PCD; N = 18,162). The proportion of deaths with diabetes (Type 1 or 2) within the last two years of life was calculated using individually linked cause-of-death, general practice, medication, and hospital discharge data. Severity status of diabetes was defined with dispensed medicines. RESULTS According to all data sources combined, 28.7% of the study population had diabetes at the end of life. The estimated end-of-life prevalence of diabetes was 7.7% using multiple cause-of-death data only. Addition of general practice data increased this estimate the most (19.7%-points). Of the cases added by primary care data, 76.3% had a severe or intermediate status. CONCLUSIONS More than one fourth of the Dutch end-of-life population has diabetes. Cause-of-death data are insufficient to monitor this prevalence, even of severe cases of diabetes, but could be enriched particularly with general practice data.
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Affiliation(s)
- Marianna Mitratza
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter P M Harteloh
- Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands
| | - Markus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Bart Klijs
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands
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242
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Liu CF, Hebert P, Wong ES, Nelson K, Maynard C. Midlife mortality in White non-Hispanic male veterans enrolled in Department of Veterans Affairs primary care, 2003-2014. Heliyon 2020; 6:e03328. [PMID: 32051882 PMCID: PMC7002889 DOI: 10.1016/j.heliyon.2020.e03328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/27/2019] [Accepted: 01/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background After years of decline in mortality rates in the United States, there have been increases in mortality rates in White non-Hispanic Americans ages 45–54, due to increases in deaths from suicide, poisoning, and alcoholic liver disease. Objectives To determine whether White non-Hispanic middle age male Veterans enrolled in Department of Veterans Affairs (VA) primary care had increased mortality, as found in the general population. Research design Repeated cross-sectional analysis over 12 years to describe trends in death rates for men across 3 race/ethnicity groups (White non-Hispanic, Black non-Hispanic, Hispanic) and 2 age groups (45–54, 55–64) for the Veteran and general US male populations. Subjects 60 million patient-years for Veterans enrolled in VA primary care from 2003 to 2014 and 1.8 million who died during the study period. Measures All-cause and cause specific death rates for alcoholic liver disease, poisoning, and suicide. Results For White non-Hispanic male Veterans ages 55–64, the increase in all-cause mortality from 2003 to 2014 (+309 deaths/100,000) was accompanied by significant changes in deaths due to poisoning (+30/100,000), alcoholic liver disease (+23/100,000), and suicide (+17/100,000). For US men ages 55–64, all-cause mortality decreased slightly from 2003-2014 (-22 deaths/100,000). However, there were increases in death rates due to poisoning (+17/100,000), alcoholic liver disease (+14/100,000) and suicide (+11/100,000). Conclusions These disturbing findings for White non-Hispanic Veteran men ages 55–64 suggest the critical importance of suicide prevention programs as well as the importance of high quality integrated health care for both Veteran and non-Veteran men.
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Affiliation(s)
- Chuan-Fen Liu
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.,Department of Health Services, University of Washington, Seattle, WA, United States
| | - Paul Hebert
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.,Department of Health Services, University of Washington, Seattle, WA, United States
| | - Edwin S Wong
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.,Department of Health Services, University of Washington, Seattle, WA, United States
| | - Karin Nelson
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.,Department of Medicine, University of Washington, Seattle, WA, United States
| | - Charles Maynard
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.,Department of Health Services, University of Washington, Seattle, WA, United States
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Park HJ, Choi YC, Oh JW, Yi SW. Prevalence, Mortality, and Cause of Death in Charcot-Marie-Tooth Disease in Korea: A Nationwide, Population-Based Study. Neuroepidemiology 2020; 54:313-319. [PMID: 31995800 DOI: 10.1159/000505815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Charcot-Marie-Tooth disease (CMT) is a group of clinically and genetically heterogeneous disorders that primarily affect the peripheral nervous system. Epidemiological studies of CMT have not yet been performed in Korea. OBJECTIVES This study was performed to estimate the prevalence of CMT in Korea and the socioeconomic status, mortality, and causes of death of Korean patients with CMT. METHODS Data on patients with CMT were obtained from the rare intractable disease registry and the National Health Insurance Service for the years 2005-2018. RESULTS During the study period, 2,885 CMT patients were enrolled. The prevalence per 100,000 persons in 2018 was 5.2 (6.1 for men and 4.4 for women), peaking at ages 15-39 years, with almost twice as many men (n = 714) as women (n = 402) in this age group. Of the CMT patients, 226 (7.8%) were receiving medical aid, a public assistance program targeting poor individuals, at the time of diagnosis and 253 (8.8%) at last follow-up or death. From 2005 to 2017, 170 patients died, including 118 men and 52 women. The standardized mortality ratio (SMR) was 1.57 (95% CI 1.34-1.83) for all patients and did not differ in men and women. Age-specific SMR was highest in patients aged under 9 years, gradually declining thereafter. Neurologic disease as a cause of death was significantly more frequent in CMT patients than in the general population. CONCLUSIONS This was the first nationwide epidemiologic study of CMT patients in Korea. This study confirmed the characteristics associated with the prevalence of and mortality from CMT by age and is the first to report the socioeconomic status and causes of death of CMT patients.
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Affiliation(s)
- Hyung Jun Park
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Young-Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Won Oh
- Department of Anatomy, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sang-Wook Yi
- Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea,
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Aboungo V, Kaselitz E, Aborigo R, Williams J, James K, Moyer C. Why do community members believe mothers and babies are dying? Behavioral versus situational attribution in rural northern Ghana. Midwifery 2020; 83:102657. [PMID: 32035341 DOI: 10.1016/j.midw.2020.102657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Rates of maternal and neonatal death remain high in the Global South, especially in Sub-Saharan Africa. In addition, indicators vary significantly by geography. This study aimed to understand what communities in northern Ghana with frequent maternal and newborn deaths or near deaths (near-misses) perceive to be the causes. As part of a larger study, four communities in Ghana's Northern Region were identified as areas with high concentrations of deaths and near-misses of mothers and babies. DESIGN Stakeholders were interviewed using in-depth interviews (IDIs) and focus-group discussions (FGDs). Field workers conducted 12 FGDs and 12 IDIs across a total of 126 participants. SETTING This exploratory descriptive study was conducted in the East Mamprusi District in the Northern Region of Ghana, in the communities of Jawani, Nagboo, Gbangu and Wundua. PARTICIPANTS FGDs were led by trained field workers and attended by traditional chiefs and their elders, members of women's groups, and traditional birth attendants in each of the four study communities. IDIs, or one-on-one interviews, were conducted with traditional healers who manage maternal and neonatal cases, community health nurses, and midwives. MEASUREMENTS AND FINDINGS Qualitative data were audio-recorded, transcribed, and thematically analyzed using the Attride-Sterling analytical framework. Discussions focused on where blame should be attributed for the negative outcomes of mothers and babies - with blame either being directed at the actions or inactions of the mothers (behavioral), or at the larger factors associated with poverty (situational) that necessitate mothers' behavior. For example, some respondents blamed women for their poor diets, while others blamed the lack of money or household support to buy nutritious foods. Blame was rarely attributed to the fathers despite local gender norms of males being the household decision-makers with regard to spending and care-seeking. KEY CONCLUSIONS These findings contribute to a small but growing body of literature on the blaming of mothers for their own deaths and those of their newborns - a phenomenon also described in high-income countries - and is supported by blame attribution theories that explain the self-protective nature of victim-blaming. IMPLICATIONS FOR PRACTICE These results carry important implications for education and intervention design related to maternal and neonatal mortality, including more focused efforts at incorporating men and the larger community. More research is warranted on blame attribution for these adverse outcomes and its effects on the victims.
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Affiliation(s)
- Victoria Aboungo
- Baptist Medical Center, BMC Road Nalerigu via N/R, Gambaga, Ghana
| | - Elizabeth Kaselitz
- Department of Global REACH, University of Michigan Medical School, 1111 Catherine St., Ann Arbor, MI 48109, USA.
| | - Raymond Aborigo
- Navrongo Health Research Center, Navrongo Post office Box 114, Ghana
| | - John Williams
- Navrongo Health Research Center, Navrongo Post office Box 114, Ghana
| | - Kat James
- Department of Learning Health Sciences, University of Michigan Medical School, 1111 Catherine St., Ann Arbor, MI 48109, USA.
| | - Cheryl Moyer
- Department of Global REACH, University of Michigan Medical School, 1111 Catherine St., Ann Arbor, MI 48109, USA; Department of Learning Health Sciences, University of Michigan Medical School, 1111 Catherine St., Ann Arbor, MI 48109, USA; Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA.
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Mosek DP, Sperhake JP, Edler C, Püschel K, Schröder AS. Cases of asphyxia in children and adolescents: a retrospective analysis of fatal accidents, suicides, and homicides from 1998 to 2017 in Hamburg, Germany. Int J Legal Med 2020; 134:1073-1081. [PMID: 31955241 PMCID: PMC7181425 DOI: 10.1007/s00414-020-02248-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Injury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes and circumstances of asphyxia in children and adolescents. METHODS All cases of asphyxia in children and adolescents (0-21 years of age) among the Hamburg Legal Medical Department's autopsy cases from 1998 to 2017 were retrospectively analyzed with special focus on how often external findings were completely absent. RESULTS Among 249 cases of fatal asphyxia, 68% were accidents, 14% were suicides, and 13% were homicides. Most of the cases involved boys. Adolescents and young adults aged 15-21 years represented the main age group. Drowning was the leading mechanism of asphyxia. Younger age was associated with less frequent detection of external signs of asphyxia in the postmortem external examination. Petechial hemorrhages were the most common visible external indication of asphyxia. No external findings indicative of asphyxia were present in 14% of the cases. CONCLUSION Asphyxia in children and adolescents often involves accidents. However, postmortem external examination alone is insufficient to identify asphyxia and the manner of death.
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Affiliation(s)
- Dieu Phuong Mosek
- Department of Internal Medicine, Wilhelmsburger Hospital Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany
| | - Jan Peter Sperhake
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
| | - Carolin Edler
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
| | - Ann Sophie Schröder
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany.
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246
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Calazans JA, Queiroz BL. The adult mortality profile by cause of death in 10 Latin American countries (2000-2016). Rev Panam Salud Publica 2020; 44:e1. [PMID: 31966038 PMCID: PMC6966090 DOI: 10.26633/rpsp.2020.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/03/2019] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the adult mortality profile from eight causes of death in 10 Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Paraguay, Peru, and Uruguay) from 2000 to 2016. Methods The cause of death effect in adult mortality was calculated as the hypothetical gain in the average number of years lived in adulthood (15 to 60 years old), in a cause-deleted life table. Mortality information by cause, sex, and age group came from the World Health Organization. Results Although the adult mortality levels are very different among the 10 countries, the pattern of mortality by cause of death is very similar. All the countries are in the intermediate stages of the epidemiological transition, with chronic degenerative diseases being predominant. Among males, circulatory system diseases and external causes are the most important causes of death in terms of the average number of years lived in adulthood. Among females, the leading causes are circulatory system diseases and neoplasms. Conclusions Some studies have pointed out that Latin America exhibits severe difficulties in moving through some epidemiological transition phases, given the continuing high mortality from chronic diseases and violent deaths. However, between 2000 and 2016, there was a convergence among the 10 analyzed countries around the theoretical limit in the average number of years lived in adulthood. Countries that include Brazil, Colombia, Ecuador, Mexico, Paraguay, and Peru are still further away from this limit, but they have an enormous potential to increase the number of years lived in adulthood in the future.
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Affiliation(s)
- Júlia Almeida Calazans
- Universidade Federal de Minas Gerais Belo Horizonte Belo HorizonteMinas Gerais Brazil Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bernardo Lanza Queiroz
- Universidade Federal de Minas Gerais Belo Horizonte Belo HorizonteMinas Gerais Brazil Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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247
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Abstract
Introduction Appropriate cause of death reporting is vital in the pandemic circumstance for effective planning of the control measures. Accurate reporting and registration of the reason for death are crucial in planning of health programs in turn contributing for the national development. Background All births and deaths occurring across India should be mandatorily registered per the Registration of Births and Deaths Act passed in the year 1969. The act also requires the issuance of cause of death certificate by the doctor attending the departed during his last illness. Data obtained from the cause of death certificate provides cause-specific mortality profile, which is required to analyze the health trends of the population. Review results This article discusses the available guidelines on the appropriate documentation of cause of death in the confirmed or suspected coronavirus disease-2019 (COVID-19) infection resulting into death. Conclusion Proper certification of the cause of death leads to better epidemic surveillance. Scrutiny of the clinical sequences from the cause of death certificate is useful to prioritize the allocation of resources for critical care management and to augment our knowledge about underlying causes resulting in mortality from COVID-19. Clinical significance Dissemination of available guidelines on proper documentation of the cause of death in confirmed/suspected COVID-19 cases will reduce the errors in cause of death reporting. How to cite this article Veeranna CH, Rani S. Cause of Death Certification in COVID-19 Deaths. Indian J Crit Care Med 2020;24(9):863-867.
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Affiliation(s)
- Chandrakanth Hungund Veeranna
- Department of Forensic Medicine and Toxicology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Smitha Rani
- Department of Forensic Medicine and Toxicology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Montgomery M, Conrey E, Okoroh E, Kroelinger C. Estimating the Burden of Prematurity on Infant Mortality: A Comparison of Death Certificates and Child Fatality Review in Ohio, 2009-2013. Matern Child Health J 2019; 24:135-143. [PMID: 31858383 DOI: 10.1007/s10995-019-02851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction Infant mortality is a key population health indicator, and accurate cause of death reporting is necessary to design infant mortality prevention strategies. Death certificates and child fatality review (CFR) both track leading infant causes of death in Ohio but produce different results. Our aim was to determine the frequency and characteristics of differences between the two systems to understand both cause of death ranking systems for Ohio. Methods We linked and analyzed data from death certificates and CFR records for all infant deaths (aged < 1 year) in Ohio during 2009-2013. Death certificate and CFR cause of death assignments were compared. Kappa statistic was used to measure concordance. Death certificate-CFR cause of death pairs were plotted to identify common concordant and discordant pairs. Results A total of 5030 infant deaths with death certificate and CFR records were analyzed. The most common discordant cause of death pair was other perinatal condition on the death certificate and prematurity by CFR (1119). Specific injury categories had higher concordance (kappa 0.71-1.00) than medical categories (kappa 0.00-0.78). Among 456 deaths categorized as sudden infant death syndrome on death certificates, approximately 50% (230) were categorized as missing, unknown, or undetermined by CFR. Discussion Linking death certificate and CFR causes of death provided a more robust understanding of infant causes of death in Ohio. Separately, each system serves distinct and valuable purposes that should be reviewed before selecting one system for ranking leading causes of infant mortality.
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Affiliation(s)
- Martha Montgomery
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mail Stop US12-3, Atlanta, GA, 30333, USA. .,Ohio Department of Health, 246 N. High St, Columbus, OH, 43215, USA.
| | - Elizabeth Conrey
- Ohio Department of Health, 246 N. High St, Columbus, OH, 43215, USA.,Division of Reproductive Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Ekwutosi Okoroh
- Division of Reproductive Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Charlan Kroelinger
- Division of Reproductive Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
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Ossei PPS, Niako N, Ayibor WG, Asante E, Safo KF, Mensah AS, Owusu E, Appiah KL. Review of gunshot fatalities in the Northern part of Ghana; a 6 year forensic autopsy based study. J Forensic Leg Med 2019; 69:101889. [PMID: 32056806 DOI: 10.1016/j.jflm.2019.101889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/15/2019] [Accepted: 12/13/2019] [Indexed: 11/25/2022]
Abstract
Studies on firearm fatalities in some parts of Ghana have been reported. However, the incidence and pattern of firearm fatalities in the Northern sector of Ghana have fled the spotlight. This study aimed at reporting the incidence and pattern of gunshot fatalities autopsied within 2008 and 2013 year. There were 82(91.1%) male and 8(8.9%) female victims of gunshot deaths during the study period with an average of 15 cases annually. Where 60(66.7%) of the victims aged within 21-40; years resembling the pattern observed in several parts of the world. A significant number 28(31.1%) of the victims died of multiple shots or dispersed pellets affecting several parts of the body, followed by a single shot to the chest 18(20.0%), abdomen 17(18.9%), head 14(15.6%). Collectively, entry sites like the neck and upper limb among others accounted for 13(14.4%). Robbery accounted for 44(48.9%) followed by homicides 14(15.6%) cases. Recovered pellets, nature and legal status of firearm involved were also examined, and like in several developing countries, country-made guns played a substantial role in the firearm fatalities with calls to strengthen laws governing gun acquisition and use in the country.
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Affiliation(s)
- P P S Ossei
- Department of Pathology, KSMD, Kwame Nkrumah University of Science and Technology, Kumasi and Komfo Anokye Teaching Hospital, Ghana.
| | - N Niako
- Department of Pathology, KSMD, Kwame Nkrumah University of Science and Technology, Kumasi and Komfo Anokye Teaching Hospital, Ghana
| | - W G Ayibor
- Department of Molecular Medicine, KSMD, Kwame Nkrumah University of Science and Technology, Ghana
| | - E Asante
- Department of Pathology, KSMD, Kwame Nkrumah University of Science and Technology, Kumasi and Komfo Anokye Teaching Hospital, Ghana
| | - K F Safo
- Department of Pathology, KSMD, Kwame Nkrumah University of Science and Technology, Kumasi and Komfo Anokye Teaching Hospital, Ghana
| | - A S Mensah
- Department of Pathology, KSMD, Kwame Nkrumah University of Science and Technology, Kumasi and Komfo Anokye Teaching Hospital, Ghana
| | - E Owusu
- Department of Pathology, KSMD, Kwame Nkrumah University of Science and Technology, Kumasi and Komfo Anokye Teaching Hospital, Ghana
| | - K L Appiah
- Department of Pathology, KSMD, Kwame Nkrumah University of Science and Technology, Kumasi and Komfo Anokye Teaching Hospital, Ghana
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Chowdhury HR, Flaxman AD, Joseph JC, Hazard RH, Alam N, Riley ID, Lopez AD. Robustness of the Tariff method for diagnosing verbal autopsies: impact of additional site data on the relationship between symptom and cause. BMC Med Res Methodol 2019; 19:232. [PMID: 31823728 PMCID: PMC6905113 DOI: 10.1186/s12874-019-0877-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 11/22/2019] [Indexed: 11/14/2022] Open
Abstract
Background Verbal autopsy (VA) is increasingly being considered as a cost-effective method to improve cause of death information in countries with low quality vital registration. VA algorithms that use empirical data have an advantage over expert derived algorithms in that they use responses to the VA instrument as a reference instead of physician opinion. It is unclear how stable these data driven algorithms, such as the Tariff 2.0 method, are to cultural and epidemiological variations in populations where they might be employed. Methods VAs were conducted in three sites as part of the Improving Methods to Measure Comparable Mortality by Cause (IMMCMC) study: Bohol, Philippines; Chandpur and Comila Districts, Bangladesh; and Central and Eastern Highlands Provinces, Papua New Guinea. Similar diagnostic criteria and cause lists as the Population Health Metrics Research Consortium (PHMRC) study were used to identify gold standard (GS) deaths. We assessed changes in Tariffs by examining the proportion of Tariffs that changed significantly after the addition of the IMMCMC dataset to the PHMRC dataset. Results The IMMCMC study added 3512 deaths to the GS VA database (2491 adults, 320 children, and 701 neonates). Chance-corrected cause specific mortality fractions for Tariff improved with the addition of the IMMCMC dataset for adults (+ 5.0%), children (+ 5.8%), and neonates (+ 1.5%). 97.2% of Tariffs did not change significantly after the addition of the IMMCMC dataset. Conclusions Tariffs generally remained consistent after adding the IMMCMC dataset. Population level performance of the Tariff method for diagnosing VAs improved marginally for all age groups in the combined dataset. These findings suggest that cause-symptom relationships of Tariff 2.0 might well be robust across different population settings in developing countries. Increasing the total number of GS deaths improves the validity of Tariff and provides a foundation for the validation of other empirical algorithms.
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Affiliation(s)
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jonathan C Joseph
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Riley H Hazard
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Nurul Alam
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ian Douglas Riley
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
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