Socio-economic factors related to premature death from colorectal cancer in Santiago de Chile, 2014-2018: a cross-sectional study

OBJECTIVES

In Chile, colorectal cancer (CRC) is the fourth cause of death by cancer. Few studies have evaluated the role of contextual and individual socio-economic variables associated with premature death by CRC (<70 years). We analyzed the association between socio-economic factors (at individual and contextual levels) and premature death from CRC in Santiago de Chile.

STUDY DESIGN

This was a cross-sectional study.

METHODS

We analyzed deaths from CRC between 2014 and 2018 using data published by the Ministry of Health. Individual predictors were sex, marital status, and educational level. Contextual variable included the Social Priority Index (SPI) of the commune where the deceased lived. The association was assessed through multilevel logistic regression models.

RESULTS

During the period, 4762 deaths occurred (51.7% women); 39.3% were premature. At the individual level, male sex (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20-1.53) and single marital status (OR 1.45; 95% CI 1.24-1.68) were associated with premature death from CRC. Primary or lower education was a protective factor (OR 0.53; 95% CI 0.47-0.60). At the contextual level, communes with a higher SPI were three times more at risk than those with a lower SPI (OR 3.13; 95% CI 2.15-4.57).

CONCLUSIONS

This study showed that individual and contextual socio-economic variables are related to premature death from CRC. Residing in communes with greater socio-economic vulnerability was associated with greater risk. To reduce this gap, it is urgent to design and implement structural policies to reduce social inequities and improve access to health care.

Diabetes mellitus as a cause of premature death in small areas of Spain by socioeconomic level from 2016 to 2020: A multiple-cause approach

OBJECTIVE

This study aimed to assess premature mortality due to Diabetes in small areas of Spain between 2016 and 2020, and its relationship with socioeconomic level and the immediate cause of death. As a secondary objective, we evaluated the effect of the Covid 19 pandemic.

METHODS

This was an ecological study of premature mortality due to Diabetes from 2016 to 2020, with a focus on small areas. All deaths in people under 75 years of age due to Diabetes as the underlying cause were included RESULTS: The final sample comprised 7382 premature deaths in 5967 census tracts. Women living in census tracts with an high level of deprivation(RR=2.40) were at a significantly higher risk. Mortality from Diabetes increased with deprivation, especially people aged 0-54(RR=2.40). People with an immediate cause of death related to a circulatory disease, living in census tracts with an high level of deprivation(RR=3.86) was associated with a significantly greater risk of death with underlying Diabetes. When a disease of the circulatory system was recorded as the immediate cause of death, being 65-74 years (RR=71.01) was associated with a significantly higher risk of premature mortality.

CONCLUSIONS

Living in geographic areas with higher levels of socioeconomic deprivation is associated with a higher risk of premature death from Diabetes in Spain. This relationship has a greater impact on women, people under 54 years, and people at risk of death caused directly by diseases of the circulatory system. Premature mortality due to diabetes saw a modest increase in 2020.

Mortality Burden Due to Short-term Exposure to Fine Particulate Matter in Korea

OBJECTIVES

Excess mortality associated with long-term exposure to fine particulate matter (PM2.5) has been documented. However, research on the disease burden following short-term exposure is scarce. We investigated the cause-specific mortality burden of short-term exposure to PM2.5 by considering the potential non-linear concentration-response relationship in Korea.

METHODS

Daily cause-specific mortality rates and PM2.5 exposure levels from 2010 to 2019 were collected for 8 Korean cities and 9 provinces. A generalized additive mixed model was employed to estimate the non-linear relationship between PM2.5 exposure and cause-specific mortality levels. We assumed no detrimental health effects of PM2.5 concentrations below 15 μg/m3. Overall deaths attributable to short-term PM2.5 exposure were estimated by summing the daily numbers of excess deaths associated with ambient PM2.5 exposure.

RESULTS

Of the 2 749 704 recorded deaths, 2 453 686 (89.2%) were non-accidental, 591 267 (21.5%) were cardiovascular, and 141 066 (5.1%) were respiratory in nature. A non-linear relationship was observed between all-cause mortality and exposure to PM2.5 at lag0, whereas linear associations were evident for cause-specific mortalities. Overall, 10 814 all-cause, 7855 non-accidental, 1642 cardiovascular, and 708 respiratory deaths were attributed to short-term exposure to PM2.5. The estimated number of all-cause excess deaths due to short-term PM2.5 exposure in 2019 was 1039 (95% confidence interval, 604 to 1472).

CONCLUSIONS

Our findings indicate an association between short-term PM2.5 exposure and various mortality rates (all-cause, non-accidental, cardiovascular, and respiratory) in Korea over the period from 2010 to 2019. Consequently, action plans should be developed to reduce deaths attributable to short-term exposure to PM2.5.

Tobacco smoke and all-cause mortality and premature death in China: a cohort study

BACKGROUND

Tobacco smoke is associated with several diseases, and identified as the second leading risk factor for death from any cause worldwide. The relationship of tobacco smoke to mortality or premature death is not yet available from contemporary cohorts after 2010 in China. This study aimed to investigate the smoking behavior and the relationship of tobacco smoke to mortality and premature death among a nationally representative cohort starting from 2011 in China.

METHODS

The nationally representative datasets (China Health and Retirement Longitudinal Study, CHARLS, 2011-2012) was employed and linked with follow-up data (2013). CHARLS was an ongoing nationally representative survey, which longitudinally followed up subjects aged over 45 years. Smoking status (non-smoker, ex-smoker, smoker, pack-years of smoking, age at starting and ceasing smoking) was used as independent variable, and all-cause mortality, premature death (defined as mortality before age 72.7 years in men and 76.9 years in women) were used as dependent variables. The Cox's proportional hazards regression mode was used to estimate the effect of tobacco smoke and pack-years of smoking on all-cause mortality and premature death.

RESULTS

A total of 16,701 subjects were included. The association between tobacco smoker (hazard ratio [HR] = 1.37, 95%CI = 1.02, 1.83) / ex-smoker (HR = 1.75, 95%CI = 1.24, 2.46) and all-cause mortality was significant. Tobacco smoker (HR = 1.58, 95%CI = 1.04, 2.39) and ex-smoker (HR = 2.25, 95%CI = 1.38, 3.66) was associated with increase in the risk of premature death. Pack-years of smoking ≥ 30 was associated with increased risk of premature death compared with non-smokers in total (HR = 1.59, 95%CI = 1.03, 2.43) and women (HR = 3.38, 95%CI = 1.22, 9.38). Additionally, our results also revealed that there was a linear trend between pack-years of smoking and premature death in total (P = 0.002) and women (P = 0.010).

CONCLUSION

This study found a negative effect of smoking status on all-cause mortality and premature death among a contemporary and nationally representative data in China. The correlation between pack-years of smoking and premature death and the trend of pack-years of smoking with premature death was also identified.

Comparative mortality risks in two independent bipolar cohorts

OBJECTIVES

To compare mortality rates in bipolar disorder with common causes of mortality.

METHODS

Observational data from the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD) of 1128 participants including 281 controls was analyzed using logistical regression to quantify mortality rates in comparison with common comorbidities and causes of death. Outcome and treatment measures, including ASRM, GAD-7, PHQ-9 and medication use were used to stratify those with bipolar disorder (BD) that are alive or deceased. A larger cohort of 10,735 existing BD patients with 7,826 controls (no psychiatric diagnosis) from the University of Michigan Health (U-M Health) clinics was used as replication, observational secondary data analysis.

RESULTS

The mortality rates are significantly different between those with BD and controls in both PLS-BD and U-M Health. Those with BD and are deceased have a higher percentage of elevated depression measures but show no difference in mania or anxiety measures nor medication use patterns. In both cohorts, a diagnosis of BD increases the odds of mortality greater than history of smoking or being older than ≥ 60-years of age.

CONCLUSION

BD was found to increase odds of mortality significantly and beyond that of a history of smoking. This finding was replicated in an independent sample.

Early mortality in German patients with lung cancer: risk factors associated with 30-and 60-day mortality

Despite therapeutic advances, early mortality in lung cancer is still prevalent. In this study, we aimed to assess risk factors for 30- and 60-day mortality in German lung cancer patients. In this retrospective cross-sectional analysis, we used data of lung cancer patients treated at LMU Hospital Munich between 2015 and 2019. We categorized patients into 30-day mortality, 60 day-mortality, and longer survival. We used Student's t-test and ANOVA to compare means and Chi2-test to compare frequencies. We used logistic regression analysis to identify factors associated with a risk for early mortality. Of the 2454 lung cancer patients, 2.0% (n = 50) died within 30 and 1.7% (n = 41) within 30 to 60 days of diagnosis. Older age and advanced stage at diagnosis were significantly associated with early mortality in the univariate and the multivariate analysis. Patients in the 30-day mortality group significantly more often did not receive tumor-directed therapy. They were also more likely to die in an acute care setting compared to the 60-day mortality group. The group of patients who died unexpectedly (12.0%) was dominantly female, with a high proportion of patients with unintentional weight loss at the time of diagnosis. Our results suggest that in the treatment of patients with lung cancer there is a need for a greater focus on older patients. Moreover, physicians should pay special attention to females with recent weight loss and patients with a comorbidity of diabetes mellitus or renal impairment. Engaging a case manager focused on detecting patients with the above characteristics could help improve overall care.

Measuring the urban-rural and spatiotemporal heterogeneity of the drivers of PM2.5-attributed health burdens in China from 2008 to 2021 using high-resolution dataset

Urbanization has been considered a driver of PM2.5 pollution and the attributed health burden. This study systematically measured the spatiotemporal and urban-rural heterogeneity of PM2.5-attributed health burden drivers, including income, population, baseline mortality rate, and PM2.5 level. The results reveal the significantly positive contribution of disposable income and the periodical and urban-rural differentiation of population contribution to PM2.5-attributed health burden. The difference in driver performance due to socioeconomic development and urbanization stages might be an important determinant for different or even opposite results of previous studies. Policymaking for mitigating PM2.5-attributed health risk could incorporate the re-assessment and driver determination for PM2.5-attributed health burden into the construction and development plan from the overall urbanization perspective. The urbanization-perspective driver decomposition could be synergized with the flow analysis, equality evaluation, and policy benefit estimation to achieve further direction-determining and quantitative assessment of the urban-rural PM2.5 health risk management strategies.

The effect of hepatitis C-associated premature deaths on labour productivity losses in Spain: a ten-year analysis

Hepatitis C virus (HCV) infection causes a substantial economic burden, not only in terms of healthcare costs, but also in labour productivity losses. The main objective of this study is to provide objective and comparable information about the trend in labour productivity losses caused by premature HCV-associated deaths in Spain in recent years (2009-2018). We used nationwide data from several official sources to create a simulation model based on the human capital approach and to estimate the flows in labour productivity losses due to deaths identified in the period considered. Based on a pessimistic scenario, the annual number of deaths due to HCV infections decreased by 19.7% between 2009 and 2018. The years of potential labour productive life lost (YPLPLL) decreased by 38.1%. That reduction led to a decrease in annual labour productivity losses from €236 million in 2009 to €156 million in 2018 (-33.8%). The aggregate HCV-related labour productivity losses between 2009 and 2018 ranged from €1742 million (optimistic scenario) to €1949 million (pessimistic scenario), with an intermediate estimation of €1846 million (moderately optimistic scenario). These results show a substantial reduction in annual deaths, working-age deaths, YPLPLL, and labour productivity losses associated with HCV infection over this period.

The Burden of Premature Mortality in Southern Iran during 2004-2019 Using Standard Expected Years of Life Lost: A Population-Based Study

Background

Traditionally, mortality rates are used to estimate public health problems and determine the relative significance of different causes of mortality, but they cannot necessarily determine the burden of premature death. We aimed to investigate the 16-year trend of burden of premature mortality in Southern Iran.

Methods

In this cross-sectional study, all deaths due to various causes of death in Fars Province from the electronic population-based death registration system (EDRS) were obtained. Crude and age-standardized mortality rate, Years of Life Lost (YLL) and YLL rate data were calculated and to examine the trend, joinpoint regression was used.

Results

During the study period, 281,903 deaths occurred, of which, 59.85% (n=168,735) occurred in men. Also, 42.18% of these deaths (n=118,610) occurred due to cardiovascular diseases (CVDs). The total number of YLLs due to premature death was 4,154,828 years. Of these, 2,591,564 years (62.37%) were in men. The highest number of YLL was due to CVDs, external causes of death and cancer. Trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -2.1% (95% CI -2.6 to -1.6, P<0.001) for males, -0.9% (95% CI -1.4 to -0.4, P=0.002) (P=0.002) for females.

Conclusion

Although the trend of premature death has been decreasing during the years of study, but the seven major causes of premature death in 2004 to 2019 were non-communicable diseases, especially ischemic heart diseases, stroke, external cause of morbidity, and cancer. Furthermore, our findings indicate a change in the role of non-communicable diseases in premature mortality in recent years.

The effect of alcohol consumption on all-cause mortality in 70-year-olds in the context of other lifestyle risk factors: results from the Gothenburg H70 birth cohort study

BACKGROUND

In this study, we examined the effect of alcohol, as well as the combined effect of seven lifestyle factors, on all-cause mortality in older adults (baseline age 70 years).

METHODS

Data was derived from the population-based Gothenburg H70 Birth Cohort study, including 1124 participants from the 2014-16 examination. Risk consumption was defined as  > 98 g alcohol per week, and hazardous drinking was based on the Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C). Cox regression models were used to examine the individual effect of alcohol consumption, as well as the combined effect of seven lifestyle risk factors (high alcohol consumption, lifetime smoking, unhealthy Body Mass Index, insufficient physical activity, sedentary behavior, insufficient/prolonged sleep, unhealthy dietary pattern) on all-cause mortality.

RESULTS

During a mean follow-up of 7.7 years, 81 (7.2%) participants died. Neither risk consumption nor hazardous drinking were associated with elevated mortality, but hazardous drinking was associated with an increased risk of mortality in those with insufficient physical activity. Those with at least five lifestyle risk factors had an increased all-cause mortality compared to those fulfilling criteria for a maximum of one lifestyle risk factor. High alcohol consumption showed a relatively minor impact on this risk, while physical activity and unhealthy dietary pattern had an independent effect on mortality.

CONCLUSIONS

In this particular sample, there was no independent effect of alcohol on the risk of 8-year all-cause mortality. However, an interaction effect of physical activity was observed. It may be that high alcohol consumption per se is less important for mortality among older adults. However, a combination of several unhealthy lifestyle behaviors was linked to a substantial increase in the risk of mortality in Swedish older adults. Also, it has to be emphasized that high alcohol consumption may have other adverse health effects apart from mortality among older adults.

Overrepresentation of In-Home, Natural Deaths Among Individuals Treated for Mental Illnesses in New York State

OBJECTIVE

The authors compared rates of in-home, natural death among individuals receiving treatment for mental illnesses with those in the general population.

METHODS

Two data sets were used to determine the prevalence of in-home, natural deaths in the general population and among those receiving treatment for mental illnesses in New York State, outside New York City, for the period 2016-2018.

RESULTS

Overall, 37% of natural deaths among individuals receiving mental health treatment occurred in the home, compared with 26% in the general population. Earlier death was also apparent; for example, 26.4% of in-home deaths among those receiving mental health treatment were among those ages 45-54 years, compared with 5.5% in the general population. In-home, natural deaths were also higher among non-Hispanic Black and Hispanic subpopulations.

CONCLUSIONS

These findings suggest a need for programmatic and policy advances to reduce disparities in general health care for those living with mental illnesses. Additional analyses are warranted.

Tracing the sources of PM2.5-related health burden in China

Fine particulate matter (PM2.5) poses a major environmental risk to human health. We estimated PM2.5-related premature deaths in 30 Chinese provinces in 2020 using an integrated exposure response model based on monitored concentrations and obtained regional and sectoral contributions based on the atmospheric transport of the atmospheric transport contribution matrix. From the perspective of regional- and sectoral-scale effects, the results revealed that 740,140 [95% confidence interval (CI):646,538-839,968] premature deaths were related to PM2.5 in 2020, mainly in East (30%), Central (18%), and North (15%) China. Manufacturing activity was found to be the major cause of PM2.5-related premature deaths, accounting for over 50% of the deaths. From the perspective of the interregional atmospheric transport effect, although local emissions were the major source of PM2.5-related premature deaths in all regions, non-local emissions contributed approximately 30%. The overall trend in the net atmospheric transport direction was from north to south. In particular, the Guangdong, Guangxi, and Hainan provinces of South China received contributions of more than 40% from non-local provinces, mainly from the East and Central China. Combined with economic data, the regions and sectors with the highest PM2.5-related premature deaths per unit output or consumption include the manufacturing and household sectors in North and Northeast China and transportation, agriculture, and electricity in Central China. Therefore, from the perspective of the above three impacts, although the potential impact of PM2.5 pollution on health in China has decreased with the decrease in PM2.5 concentration in the past decade owing to strict air pollution control, the central and northern parts of China are still the key areas requiring air pollution control. The health impacts of air pollution associated with the rapid development of China's manufacturing industry in the post-pandemic era cannot be ignored.

Sexual Assault Victimization in Premature Female Mortalities: Evidence from the National Longitudinal Study of Adolescent to Adult Health

Previous research has documented many behavioral problems associated with being a female victim of sexual assault, but little attention has been devoted to whether this experience might be related to premature mortalities. We investigated this utilizing the National Longitudinal Study of Adolescent to Adult Health survey, collected from over 10,000 adolescent females in 1995, whose premature deaths (n = 65) were noted in 2007 in National Death Index records. Significant associations were found between females with a substance misuse history and their premature deaths, but not with being a sexual assault victim. The subset of respondents (n = 208) evincing both these characteristics showed significantly higher risks of dying prematurely, as did those females with early histories of drug misuse alone. Yet, adolescent females with histories of drug misuse who also attempted suicide (n = 214) did not show similar elevated risks of dying prematurely compared to others without these experiences. This exploratory evidence points to an affinity between both being a female sexual assault victim and having an early history of misusing drugs, putting such people at heightened risks for dying prematurely, suggesting the potential benefits of counseling and supportive services for those so affected.

Health impacts of PM2.5 originating from residential wood combustion in four nordic cities

Background

Residential wood combustion (RWC) is one of the largest sources of fine particles (PM_2.5) in the Nordic cities. The current study aims to calculate the related health effects in four studied city areas in Sweden, Finland, Norway, and Denmark.

Methods

Health impact assessment (HIA) was employed as the methodology to quantify the health burden. Firstly, the RWC induced annual average PM_2.5 concentrations from local sources were estimated with air pollution dispersion modelling. Secondly, the baseline mortality rates were retrieved from the national health registers. Thirdly, the concentration-response function from a previous epidemiological study was applied. For the health impact calculations, the WHO-developed tool AirQ + was used.

Results

Amongst the studied city areas, the local RWC induced PM_2.5 concentration was lowest in the Helsinki Metropolitan Area (population-weighted annual average concentration 0.46 µg m^− 3) and highest in Oslo (2.77 µg m^− 3). Each year, particulate matter attributed to RWC caused around 19 premature deaths in Umeå (95% CI: 8–29), 85 in the Helsinki Metropolitan Area (95% CI: 35–129), 78 in Copenhagen (95% CI: 33–118), and 232 premature deaths in Oslo (95% CI: 97–346). The average loss of life years per premature death case was approximately ten years; however, in the whole population, this reflects on average a decrease in life expectancy by 0.25 (0.10–0.36) years. In terms of the relative contributions in cities, life expectancy will be decreased by 0.10 (95% CI: 0.05–0.16), 0.18 (95% CI: 0.07–0.28), 0.22 (95% CI: 0.09–0.33) and 0.63 (95% CI: 0.26–0.96) years in the Helsinki Metropolitan Area, Umeå, Copenhagen and Oslo respectively. The number of years of life lost was lowest in Umeå (172, 95% CI: 71–260) and highest in Oslo (2458, 95% CI: 1033–3669).

Conclusions

All four Nordic city areas have a substantial amount of domestic heating, and RWC is one of the most significant sources of PM_2.5. This implicates a substantial predicted impact on public health in terms of premature mortality. Thus, several public health measures are needed to reduce the RWC emissions.

RBM20S639G mutation is a high genetic risk factor for premature death through RNA-protein condensates

Dilated cardiomyopathy (DCM) is a heritable and genetically heterogenous disease often idiopathic and a leading cause of heart failure with high morbidity and mortality. DCM caused by RNA binding motif protein 20 (RBM20) mutations is diverse and needs a more complete mechanistic understanding. RBM20 mutation S637G (S639G in mice) is linked to severe DCM and early death in human patients. In this study, we generated a RBM20 S639G mutation knock-in (KI) mouse model to validate the function of S639G mutation and examine the underlying mechanisms. KI mice exhibited severe DCM and premature death with a ~ 50% mortality in two months old homozygous (HM) mice. KI mice had enlarged atria and increased ANP and BNP biomarkers. The S639G mutation promoted RBM20 trafficking and ribonucleoprotein (RNP) granules in the sarcoplasm. RNA Seq data revealed differentially expressed and spliced genes were associated with arrhythmia, cardiomyopathy, and sudden death. KI mice also showed a reduction of diastolic stiffness and impaired contractility at both the left ventricular (LV) chamber and cardiomyocyte levels. Our results indicate that the RBM20 S639G mutation leads to RNP granules causing severe heart failure and early death and this finding strengthens the novel concept that RBM20 cardiomyopathy is a RNP granule disease.

Years of Life Lost due to Suicide in Southern Iran 2011-18: A Population-Based Study

BACKGROUND

Suicide is a major public health concern with diversity in epidemiological aspects and applied methods. In this study, we estimate years of life lost (YLLs) related to completed suicidal in the Fars province, southern Iran.

METHODS

Our study included data of all mortality events during 2011-2018 from Fars Suicide Surveillance System (FSSS). The validity of qualitative and quantitative variables was assessed through contrasting data between different sources and phone call justification. Case-fatality rates, age-specific and gender-specific mortality rates, ASR (age standardized rate), and YLLs through WHO's 2015 "YLL template" were calculated.

RESULTS

During the study period, 2384 mortalities with a mean age of 32.73±15.65 had been registered. Most of them were males (male: 70.05% vs. female: 29.95%; male-female ratio: 2.33), hanging was the most frequent method (29.94%), and an increasing pattern in successful suicidal attempts was observed. The total YLLs were calculated to be 58669 years (14.71 per 1000 persons). Regardless of year or gender, suicide had the largest YLLs amongst those aged 15-29 years.

CONCLUSION

Regarding the increasing trend in YLLs and observing the highest rate of successful suicidal attempts amongst active and productive members of community, a comprehensive inter organizational reaction is demanded.

The casual effects of COVID-19 lockdown on air quality and short-term health impacts in China

The outbreak of coronavirus (COVID-19) has forced China to lockdown many cities and restrict transportation, industrial, and social activities. This provides a great opportunity to look at the impacts of pandemic quarantine on air quality and premature death due to exposure to air pollution. In this study, we applied the difference-in-differences (DID) model to quantify the casual impacts of COVID-19 lockdown on air quality at 278 cities across China. A widely used exposure-response function was further utilized to estimate the short-term health impacts associated with changes in PM_2.5 due to lockdown. Results show that lockdown has caused drastic reduction in air pollution level in terms of all criteria pollutants except ozone. On average, concentrations of PM_2.5, PM₁₀, NO₂, SO₂ and CO are estimated to drop by 14.3 μg/m³, 22.2 μg/m³, 17.7 μg/m³, 2.9 μg/m³, and 0.18 mg/m³ as the result of lockdown. Cities with more confirmed cases of COVID-19 are related to stronger responses in air quality, despite that similar lockdown measures were implemented by the local governments. The improvement of air quality caused by COVID-19 lockdown in northern cities is found to be smaller than that of southern cities. Avoided premature death associated with PM_2.5 exposures over the 278 cities was estimated to be 50.8 thousand. Our results re-emphasize the effectiveness of emission controls on air quality and associated health impacts. The high cost of lockdown, still high level of air pollution during lockdown and smaller effects in northern cities implies that source-specific mitigation policies are needed for continuous and sustainable reduction of air pollution.

Economic damage cost of premature death due to fine particulate matter in Seoul, Korea

Analyzing the economic value of the damage to human health caused by environmental risks has become an essential research focus, given the increasing necessity for effective decision-making. Since logical and rational analyses such as cost-benefit and cost-utility analyses will likely gain importance in future policymaking, the evaluation of economic costs becomes necessary. Among the various types of air pollutants, fine particulate matter (PM) is reported as closely related to mortality. To reduce result uncertainty by improving the methodology of risk assessment or the economic evaluation of fine PM, risk control measures are required for high-priority areas. This study addresses this issue by estimating the relative risk of PM_2.5 while calculating the economic loss cost arising from acute death due to fine PM exposure in Seoul, Korea. The value of statistical life of one person's willingness to pay for mortality risk reduction is calculated to estimate the economic loss cost at each current level of exposure. The estimated economic loss cost due to all-cause mortality during 2016-2018 totaled approximately USD 1307.9 million per year; the costs of loss from respiratory and cardiovascular mortalities were USD 128.1 million per year and USD 426.9 million, respectively. Based on these results, this study concludes that the standards for PM_2.5 are more effective than the ones established for PM₁₀ in terms of economic value.

Association Between Frequency of Eating Away-From-Home Meals and Risk of All-Cause and Cause-Specific Mortality

BACKGROUND

Dining out is a popular activity worldwide. Evidence on the association between eating meals away from home and long-term health outcomes is still limited.

OBJECTIVE

The objective of this study was to examine the association of frequency of eating meals prepared away from home with all-cause and cause-specific mortality.

PARTICIPANTS/SETTING

This study included 35,084 adults aged 20 years or older from the National Health and Nutritional Examination Survey 1999-2014, who reported their dietary habits including frequency of eating meals prepared away from home in a questionnaire during face-to-face household interviews.

MAIN OUTCOME MEASURES

All-cause mortality, cardiovascular mortality, and cancer mortality were ascertained by linkage to death records through December 31, 2015.

STATISTICAL ANALYSES PERFORMED

Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios of mortality from all-cause, cardiovascular, and cancer mortality.

RESULTS

During 291,475 person-years of follow-up, 2,781 deaths occurred, including 511 deaths from cardiovascular disease and 638 death from cancer. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, and body mass index, the hazard ratio of mortality among participants who ate meals prepared away from home very frequently (2 meals or more per day) compared with those who seldom ate meals prepared away from home (fewer than 1 meal/wk) was 1.49 (95% CI 1.05 to 2.13) for all-cause mortality, 1.18 (95% CI 0.55 to 2.55) for cardiovascular mortality, and 1.67 (95% CI 0.87 to 3.21) for cancer mortality.

CONCLUSIONS

Frequent consumption of meals prepared away from home is significantly associated with increased risk of all-cause mortality. The association of eating meals prepared away from home with cardiovascular mortality and cancer mortality warrants additional investigation.

Human influenza A virus causes myocardial and cardiac-specific conduction system infections associated with early inflammation and premature death

AIMS

Human influenza A virus (hIAV) infection is associated with important cardiovascular complications, although cardiac infection pathophysiology is poorly understood. We aimed to study the ability of hIAV of different pathogenicity to infect the mouse heart, and establish the relationship between the infective capacity and the associated in vivo, cellular and molecular alterations.

METHODS AND RESULTS

We evaluated lung and heart viral titres in mice infected with either one of several hIAV strains inoculated intranasally. 3D reconstructions of infected cardiac tissue were used to identify viral proteins inside mouse cardiomyocytes, Purkinje cells, and cardiac vessels. Viral replication was measured in mouse cultured cardiomyocytes. Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were used to confirm infection and study underlying molecular alterations associated with the in vivo electrophysiological phenotype. Pathogenic and attenuated hIAV strains infected and replicated in cardiomyocytes, Purkinje cells, and hiPSC-CMs. The infection was also present in cardiac endothelial cells. Remarkably, lung viral titres did not statistically correlate with viral titres in the mouse heart. The highly pathogenic human recombinant virus PAmut showed faster replication, higher level of inflammatory cytokines in cardiac tissue and higher viral titres in cardiac HL-1 mouse cells and hiPSC-CMs compared with PB2mut-attenuated virus. Correspondingly, cardiac conduction alterations were especially pronounced in PAmut-infected mice, associated with high mortality rates, compared with PB2mut-infected animals. Consistently, connexin43 and NaV1.5 expression decreased acutely in hiPSC-CMs infected with PAmut virus. YEM1L protease also decreased more rapidly and to lower levels in PAmut-infected hiPSC-CMs compared with PB2mut-infected cells, consistent with mitochondrial dysfunction. Human IAV infection did not increase myocardial fibrosis at 4-day post-infection, although PAmut-infected mice showed an early increase in mRNAs expression of lysyl oxidase.

CONCLUSION

Human IAV can infect the heart and cardiac-specific conduction system, which may contribute to cardiac complications and premature death.

General health and mortality in Tourette syndrome and chronic tic disorder: A mini-review

Current knowledge on the general somatic health and causes of death in Tourette syndrome and chronic tic disorder is very limited. Here, we review the available literature on the topic, while highlighting strengths and weaknesses of the studies conducted to date. These previous works have suggested associations between Tourette syndrome and chronic tic disorder and a range of health conditions, including autoimmune disorders, common allergies and respiratory diseases, sleep difficulties, and metabolic and cardiovascular outcomes. Additionally, the risk of mortality in tic disorders might be higher than that of the general population, but specific causes of death have rarely been studied, except for substance use-related deaths and suicide, which are significantly higher in individuals with Tourette syndrome and chronic tic disorder. Many of these emerging findings require replication and extension but, taken together, they suggest that that it might be sensible to monitor the general health and suicide risk of individuals with Tourette syndrome or chronic tic disorder across the lifespan. We suggest further avenues for research on this topic.

Burden of rabies in Mali

Rabies is the most dreaded neglected zoonosis worldwide. It affects mostly developing countries with limited access to post-exposure prophylaxis and a low coverage of dog vaccination.

OBJECTIVE

This study estimates the burden of human rabies in Mali from the extrapolation of animal bite surveillance, mostly dogs, in the region of Sikasso and the District of Bamako in 2016 and 2017.

MATERIAL AND METHODS

Monte Carlo simulations of a series of interconnected probabilities were used to estimate the burden of rabies. The data was collected from cross-sectional surveys of 8775 households of which 4172 were in the District of Bamako and 4603 in the region of Sikasso. Further data was collected in health centres and from the respective veterinary services.

RESULTS

We estimate that in the year 2016 133 [95% Confidence Interval (95%CI) 87-186] people died and that 5'366 [95%CI 3'510-7'504] years of life (YLL) were lost and in 2017 et 136 [95%CI 96-181] people died and that 5530 [IC 95% 3'913-7'377] YLLs were lost. The loss of income was estimated at 3.2 million USD [95%CI 2,1-4,5] en 2016, and 3,3 million USD [95%CI 2,3-4,4] in 2017. This represents the highest financial loss from rabies, followed by the cost of postexposure prophylaxis (PEP) of 86'848 $USD and 89'371 $ USD respectively. From the whole cost of rabies in Mali, 92% of the cost in 2016 and 94% of those in 2017 were attributable to premature mortality and the cost of help seeking. The proportion of cost of PEP was 3% in 2016 and 2017 of the total cost of disease. The cost related to dog vaccination changed from 3% to 1% in the same time period.

CONCLUSION

This study shows that despite the possibility of preventing human rabies by PEP, its burden remains important in Malian communities. Rabies control by mass vaccination of dogs is hardly done and access to PEP is difficult. However, Rabies elimination by mass vaccination of dogs has been demonstrated to be feasible. Hence a coordinated regional effort between countries by funding dog mass vaccination and full access to PEP can eliminate rabies in West Africa.

Burden of disease from transportation noise and motor vehicle crashes: Analysis of data from Houston, Texas

BACKGROUND

Transportation systems have an essential role in satisfying individuals' needs for mobility and accessibility. Yet, they have been linked to several adverse health impacts, with a large, but modifiable, burden of disease. Among the several transportation-related health risk factors, this study focused on transportation-related noise as an emerging exposure whose burden of disease remains partially recognized. We compared premature deaths potentially attributable to transportation-related noise with deaths from motor vehicle crashes, a well-researched and widely recognized transportation risk factor.

METHOD

We employed a standard burden of disease assessment framework to quantify premature cardiovascular diseases mortality attributable to transportation-related (road and aviation) noise at the census tract level (n = 592) in Houston, Texas. The results were compared to motor vehicle crash fatalities, which are routinely observed and collected in the study area. We also investigated the distribution of premature deaths across the city and explored the relationship between household median income and premature deaths attributable to transportation-related noise.

RESULTS

We estimated 302 (95% CI: 185-427) premature deaths (adults 30-75 years old) attributable to transportation-related noise in Houston, compared to 330 fatalities from motor vehicle crashes (adults younger than 75 years old). Transportation-related noise and motor vehicle crashes were responsible for 1.7% and 1.9% of all-cause premature deaths in Houston, respectively. Households with lower median income had a higher risk of adverse exposure and premature deaths potentially attributable to transportation-related noise. A larger number of premature deaths was associated with living in the central business district and the vicinity of highways and airports.

CONCLUSION

This study highlighted the significant contribution of transportation-related noise and motor vehicle crashes to premature deaths in the city of Houston. The analogy between the estimated premature deaths attributable to transportation-related noise and motor vehicle crashes showed that the health impacts of transportation-related noise were as significant as motor vehicle crashes. The estimated premature death rate attributable to transportation-related noise was also comparable to the death rate caused by suicide, influenza, or pneumonia in the US. There is an urgent need for imposing policies to reduce transportation noise emissions and human exposures and to equip health impact assessment tools with a noise burden of disease analysis function.

Sick leave, disability, and mortality in acute hepatic porphyria: a nationwide cohort study

Background

Acute hepatic porphyria (AHP) consists of three rare metabolic disorders. We investigated the risk of long-term sick leave, disability pension, and premature death in individuals with AHP compared to the general population.

Methods

In a nationwide cohort study from 1992 to 2017, records of 333 persons (total person-years = 6728) with a confirmed AHP diagnosis were linked to several national compulsory registries (reference population = 5,819,937). We conducted survival analyses to assess additional risk.

Results

Persons with AHP had higher risks of accessing long-term sick leave (adjusted hazard ratio (aHR): 1.5, 95% confidence interval (CI): 1.3, 1.7) and disability pension (aHR: 1.9, CI: 1.5, 2.4). The risk was highest in persons who had been hospitalised for acute attacks, while no additional risk was observed in asymptomatic AHP gene mutation carriers. The median age when accessing disability pension was 45 years, 21 years younger than the general population. AHP was associated with increased risk of mortality due to hepatocellular carcinoma (adjusted mortality rate ratio (aMRR): 84.4, CI: 37.8, 188.2), but no overall increased risk of premature death was observed.

Conclusions

Persons with symptomatic AHP were at increased risk of accessing long-term sick leave and disability pension but not of premature death.

Life Expectancy of White and Non-White Elite Heavyweight Boxers

BACKGROUND

In post-industrial countries, ethnic minorities suffer poorer health and premature deaths. The present study examined ethnic differences in life expectancy and related features among elite heavyweight boxers.

METHODS

Dates of birth and death, anthropometry, and championship years were gathered from media archives for champions and challengers (never been a champion) between years 1889 and 2019. Cox regression adjusted for age at contest, nationality, BMI, champion/challenger status, and number of contests was used to assess survival.

RESULTS

All 237 boxers, 83 champions (37.3% whites) and 154 challengers (61.0% whites), who contested for heavyweight championships were identified. By 2019, 110 (75 whites, 34 non-whites) were known to have died. Non-white boxers died at an earlier age than whites boxers (mean ± SD = 59.8 ± 14.2 years versus 67.3 ± 16.4 years, p = 0.018) and had shorter survival: HR = 2.13 (95% CI = 1.4-3.3). Among non-white boxers, deaths were higher from neurological disorders: OR = 8.2 (95% CI = 1.3-13.5) and accidents: OR = 15.1 (95% CI = 2.3-98.2), while death from natural causes was lower: OR = 0.2 (95% CI = 0.03-0.8). After boxing careers, fewer non-white boxers had non-manual jobs (34.4% versus 71.8%) than manual (34.4% versus 19.7%) or were unemployed (28.1% versus 2.8%). Reported substance abuse was similar across ethnicity (8.0% versus 8.8%) but conviction rates were higher among non-white boxers (17.6%) than white (1.3%).

CONCLUSIONS

Compared with white boxers, non-white boxers tend to die younger with excess neurological and accidental deaths, and they have lower social positions in later life. Sporting authorities should reappraise the wisdom of permitting head injuries in sport and monitor and support the health and wellbeing of sports men and women after retirement.

Premature death and risk of cardiovascular disease in young-onset diabetes: a 23-year follow-up of the Da Qing Diabetes Study

OBJECTIVE

This study aimed to investigate premature mortality and the risk of cardiovascular disease (CVD) in Chinese adults with diabetes diagnosed before the age of 45 years.

METHODS

A total of 519 participants with normal glucose tolerance (NGT) and 630 with newly diagnosed diabetes mellitus (DM) were recruited in 1986 in the Da Qing Diabetes Study. In 2009, the participants were followed up to assess mortality and CVD events. The subjects were stratified into four subgroups according to age and diabetes status: age <45 years with NGT (NGT_<45y), age <45 years with DM (DM_<45y), age ≥45 years with NGT (NGT_≥45y), and age ≥45 years with DM (DM_≥45y). The risk of death and CVD events in patients with young-onset DM and elder subjects with NGT were compared to show the extent of premature death and CVD in the DM participants.

RESULTS

During the 23-year follow-up, 26 (10.40%) participants in NGT_<45y, 72 (34.12%) in DM_<45y, 74 (30.58%) in NGT_≥45y, and 266 (68.73%) in DM_≥45y died, including 13 (5.20%), 36 (17.06%), 24 (9.92%), and 128 (33.07%) death attributed to CVD. The corresponding rates of CVD events were 56 (22.40%), 90 (42.65%), 89 (36.78), and 213 (55.04%). It also showed that the risk of all-cause death (HR 1.23, 95% CI 0.88-1.71) or CVD events (HR 1.25, 95% CI 0.93-1.69) did not differ significantly between the DM_<45y and NGT_≥45y groups after adjusting for sex, smoking, body mass index, systolic blood pressure, total cholesterol and previous history of CVD. Of note, participants in the DM_<45y group had an higher risk of CVD mortality compared with that in the NGT_≥45y group (HR 1.76, 95% CI 1.04-2.98), although the mean age in the former group was 12 years lesser than that in the latter group (39.01 ± 5.00 vs 51.45 ± 5.14).

CONCLUSIONS

Young-onset diabetes is a risk factor for the premature death and cardiovascular disease. Early prevention and intensive treatment are warrented in patients with young-onset diabetes.

Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders: a 42-year follow-up

BACKGROUND

We need to better understand how the use of different substances and psychiatric comorbidity influence premature death generally and cause-specific death by overdose, intoxication and somatic disorders in people with substance use disorders.

METHOD

A cohort of 1405 patients consecutively admitted to a Swedish detoxification unit for substance use disorders in 1970-1995 was followed-up for 42 years. Substances were identified by toxicological analyses. Mortality figures were obtained from a national registry. Causes of death were diagnosed by forensic autopsy in 594 patients deceased by 2012. Predictions were calculated by competing risks analysis.

RESULTS

Forty-two per cent of the cohort died during follow-up; more men than women (46.3% vs 30.4%). The standardised mortality ratio (SMR) was calculated as the ratio of observed deaths in males and females in specific age groups in the cohort versus expected deaths in corresponding groups in the general population. SMR was 5.68 for men (CI 95%; 5.04-6.11) and 4.98 (CI 95%; 4.08-5.88) for women. The crude mortality rate (number of deaths divided by number of person observation years) was 2.28% for men and 1.87% for women. Opiates predicted increased risk of premature death while amphetamine and cannabis predicted lower risk. Comorbid psychiatric disorders were identified in 378 cases and personality disorders in 763 cases. Primary psychoses or mood/depression and anxiety disorders predicted a higher risk of premature mortality. Death by overdose was predicted by male gender, younger age at admission to substance treatment, opiate use, and comorbid depression and anxiety syndromes. Cannabis and amphetamine use predicted a lower risk of overdose. Death by intoxication was predicted by male gender, use of sedatives/hypnotics or alcohol/mixed substances, primary psychoses and depression/anxiety syndromes. Premature death by somatic disorder was predicted by male gender and alcohol/mixed abuse.

CONCLUSION

Psychiatric comorbid disorders were important risk factors for premature drug-related death. Early identification of these factors may be life-saving in the treatment of patients with substance use disorders.

Handgrip strength, depression, and all-cause mortality in Korean older adults

Background

Decreased muscle strength and/or depression with aging are emerging as important public health concerns in both developed and developing countries. This study investigated the effects of low handgrip strength (HGS) and depression on the risk of all-cause mortality in Korean older adults.

Methods

Data from 13,901 Korean adults (57% women) who participated in the 2008 baseline survey and completed the 2011 follow-up assessments were used.

Results

In total, the current findings showed that individuals with depression only and individuals with low HGS plus depression had significantly higher risks of all-cause mortality (hazard ratio (HR) = 1.366, 95% confidence interval (CI) = 1.033–1.807, p = 0.029 and HR = 1.961, 95% CI = 1.409–2.736, p < 0.001, respectively) even after adjustments for all the measured covariates, compared with individuals with high HGS plus no depression (HR = 1). Gender-stratified analysis showed that men with depression only and men with depression plus low HGS had significantly higher risks of all-cause mortality (HR = 1.376, 95% CI =1.029–1.841, p = 0.031 and HR = 1.861, 95% CI = 1.306–2.651, p = 0.001, respectively) even after adjustments for all the measured covariates, compared with individuals with no depression plus high HGS (HR = 1). In women, however, the joint effect of depression and low HGS only remained significant at borderline (HR = 2.603, 95% CI = 0.981–6.908, p = 0.055) when adjusted for all the confounders.

Conclusion

The current finding suggested that depression and low HGS were significantly and synergistically associated with the increased risk of premature death from all causes in the Korean geriatric population.

Focusing on the premature death of redeployed miners in China: an analysis of cause-of-death information from non-communicable diseases

Background

Reducing premature deaths is an important step towards achieving the World Health Organization’s sustainable development goal. Redeployed miners are more prone to disease or premature death due to the special occupational characteristics. Our aims were to describe the deaths of redeployed miners, assess the losses due to premature death and identify their main health problems. All the records of individuals were obtained from Fuxin Mining Area Social Security Administration Center. Year of life lost (YLL) and average year of life lost were used to assess the loss due to premature death. YLL rates per 1000 individuals were considered to compare deaths from different populations.

Results

Circulatory system diseases contributed the most years of life lost in the causes of death, followed by neoplasms. But average year of life lost in neoplasms was 6.85, higher than circulatory system diseases, 5.63. Cerebrovascular disease and ischemic heart disease were the main causes of death in circulatory system diseases. And average years of life lost in cerebrovascular disease and ischemic heart disease were 5.85 and 5.62, higher than those in other circulatory system diseases. Lung cancer was the principal cause of death in neoplasms. Average year of life lost in liver cancer was 7.92, the highest in neoplasms.

Conclusions

For redeployed miners, YLL rates per 1000 individuals in cerebrovascular disease, ischemic heart disease and lung cancer were higher than those in other populations, especially in men. It is important to attach importance to the health of redeployed miners, take appropriate measures to reduce premature death and achieve the sustainable development goal. Our findings also contribute to a certain theoretical reference for other countries that face or will face the same problem.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0450-5) contains supplementary material, which is available to authorized users.

Correlates of risk factors for reduced life expectancy in schizophrenia: Is it possible to develop a predictor profile?

Patients with schizophrenia have significantly greater mortality rates than the general population, with an estimated reduced lifespan of 10-20 years. We previously reported on a link between impairment in cognition and premature death in a prospective 20-year study. Patients who had died prematurely showed neurocognitive impairment in nine different cognitive tests compared to those who did not. Based on those findings, in this study the surviving patients in the cohort were divided into three different groups based on neurocognitive impairment and compared on symptom severity including remission status, RAND-36, weight and BMI at onset of illness and baseline of the study, and medical/physical symptomatology (i.e., blood pressure, symptom awareness, vertigo and orthostatic symptoms). Differences were most prominent between the cognitively unimpaired and severely cognitively impaired (SCI) groups, with remission, negative symptoms, general symptoms and PANSS total scores differing. For SF-36 (RAND) Physical functioning and Role limitations due to physical health subscales the SCI were worst. The findings indicate that greater impairments in cognitive ability during the illness are associated with several potential indicators of risk for early mortality. Together these factors may be of guidance for establishing an algorithm to detect patients at risk of premature death early in their illness.

Excess mortality in children born to opioid-addicted parents: A national register study in Taiwan

BACKGROUND

Young offspring of individuals with opioid use disorders have great exposure to a wide array of social disadvantages and stressors. This study aimed to investigate excess mortality before the age of six and predictors of premature death in children born to opioid-involved parents.

METHODS

A total of 3210 children born between 2004 and 2009 to parents with opioid use disorders (roughly a quarter of whom were born after parental methadone treatment enrollment) were identified in Taiwan. Information concerning sociodemographic characteristics, history of medical condition, and survival status was obtained through data linkage with the National Health Insurance Database and death registration. The age-, birth year-, and sex-adjusted standardized mortality ratios (SMRs) and survival analyses were used to assess risk estimates and evaluate predictors.

RESULTS

The overall SMR for children with opioid-involved parents was 2.31 (95% confidence interval [CI] = 1.68-3.10), with the estimate reaching 4.23 (95% CI = 2.37-6.97) when the causes of death were unnatural (e.g., injury and accident). The most salient predictors of premature death were low birth weight and paternal opioid problem severity, which increased risk of premature death 2.5--5.2-fold (all P < 0.05). Being born after parents enrolled in methadone treatment was slightly associated with a reduced risk of death in those mothered by opioid users (adjusted hazard ratio = 0.30).

CONCLUSION

The elevated risk of premature death in the offspring of opioid-addicted parents suggests the need to prioritize resource allocation to safeguard this marginalized and vulnerable segment of the pediatric population.

Associations of vitamin D with insulin resistance, obesity, type 2 diabetes, and metabolic syndrome

The aim of this study is to determine the relationships of vitamin D with diabetes, insulin resistance obesity, and metabolic syndrome. Intra cellular vitamin D receptors and the 1-α hydroxylase enzyme are distributed ubiquitously in all tissues suggesting a multitude of functions of vitamin D. It plays an indirect but an important role in carbohydrate and lipid metabolism as reflected by its association with type 2 diabetes (T2D), metabolic syndrome, insulin secretion, insulin resistance, polycystic ovarian syndrome, and obesity. Peer-reviewed papers, related to the topic were extracted using key words, from PubMed, Medline, and other research databases. Correlations of vitamin D with diabetes, insulin resistance and metabolic syndrome were examined for this evidence-based review. In addition to the well-studied musculoskeletal effects, vitamin D decreases the insulin resistance, severity of T2D, prediabetes, metabolic syndrome, inflammation, and autoimmunity. Vitamin D exerts autocrine and paracrine effects such as direct intra-cellular effects via its receptors and the local production of 1,25(OH)₂D₃, especially in muscle and pancreatic β-cells. It also regulates calcium homeostasis and calcium flux through cell membranes, and activation of a cascade of key enzymes and cofactors associated with metabolic pathways. Cross-sectional, observational, and ecological studies reported inverse correlations between vitamin D status with hyperglycemia and glycemic control in patients with T2D, decrease the rate of conversion of prediabetes to diabetes, and obesity. However, no firm conclusions can be drawn from current studies, because (A) studies were underpowered; (B) few were designed for glycemic outcomes, (C) the minimum (or median) serum 25(OH) D levels achieved are not measured or reported; (D) most did not report the use of diabetes medications; (E) some trials used too little (F) others used too large, unphysiological and infrequent doses of vitamin D; and (G) relative paucity of rigorous clinical data on the effects of vitamin D sufficiency on non-calcium endpoints. Although a large number of observational studies support improving T2D, insulin resistance, obesity, and metabolic syndrome with vitamin D adequacy, there is a lack of conclusive evidence from randomized control clinical trials that, these disorders are prevented following optimization of serum levels of 25(OH)D. However, none of the currently conducted clinical studies would resolve these issues. Thus, specifically designed, new clinical studies are needed to be conducted in well-defined populations, following normalizing the serum vitamin D levels in vitamin D deficient prediabetes subjects, to test the hypothesis that hypovitaminosis D worsens these disorders and correction would alleviate it.

Non-musculoskeletal benefits of vitamin D

The aim of this study is to determine and critically evaluate the plausible relationships of vitamin D with extra-skeletal tissues in humans. Severe vitamin D deficiency results in rickets in children and osteomalacia in adults; these beneficial effects in the musculoskeletal system and certain physiological functions are well understood. Nevertheless, mounting reports support additional beneficial effects of vitamin D, outside the musculoskeletal system. This review explores the recent advances in knowledge about the non-skeletal effects of vitamin D. Peer-reviewed papers were extracted from research databases using key words, to assess correlations between vitamin D and extra-skeletal diseases and conditions. As per the guidelines of the Preferred Reporting Items for Systematic Reviews (PRISMA); general interpretations of results are included; taking into consideration the broader evidence and implications. This review summarizes current knowledge of the effects of vitamin D status on extra-skeletal tissues with special attention given to relationships between vitamin D status and various diseases commonly affecting adults; the effects of intervention with vitamin D and exposure to sunlight. Evidence suggests that vitamin D facilitates the regulation of blood pressure; and cardiac; endothelial; and smooth muscle cell functions; playing an important role in cardiovascular protection. In addition; 1,25(OH)₂D improves immunity; subdues inflammation; and reduces the incidence and severity of common cancers; autoimmune diseases and infectious diseases. Almost all adequately powered; epidemiological and biological studies that use; adequate doses of vitamin D supplementation in D-deficient populations have reported favorable outcomes. These studies have concluded that optimizing 25(OH)D status improves the functionality of bodily systems; reduces comorbidities; improves the quality of life; and increases survival. Although accumulating evidence supports biological associations of vitamin D sufficiency with improved physical and mental functions; no definitive evidence exists from well-designed; statistically powered; randomized controlled clinical trials. Nevertheless, most studies point to significant protective effects of vitamin D in humans when the minimum 25(OH)D serum level exceeds 30ng/mL and is maintained throughout the year.

Ambient PM2.5 Exposure and Mortality Due to Lung Cancer and Cardiopulmonary Diseases in Polish Cities

Air pollution, one of ten most important causes of premature mortality worldwide, remains a major issue also in the EU, with more than 400,000 premature deaths due to exposure to PM_2.5 reported yearly. The issue is particularly significant in Poland, where there is the highest concentration of PM_2.5 among the UE countries. This study focused on the proportion of mortality due to lung cancer and cardiopulmonary diseases attributable to PM_2.5 in eleven biggest Polish cities in the years 2006-2011. The findings demonstrate that the mean annual concentration of PM_2.5 varied from 14.3 to 52.5 μg/m³. The average population attributable fractions varied from 0.195 to 0.413 in case of lung cancer and from 0.130 to 0.291 for cardiopulmonary diseases. Such substantial values of this ratio translate into a considerable number of deaths, which ranged between 9.6 and 22.8 cases for lung cancer and 48.6 to 136.6 cases for cardiopulmonary diseases per 100,000 inhabitants. We conclude that the impact of PM_2.5 concentration on the incidence of premature deaths is unduly high in Polish cities.

Premature mortality due to nephrotic syndrome and the trend in nephrotic syndrome mortality in Japan, 1995-2014

BACKGROUND

This study analysed the trend in mortality from nephrotic syndrome in Japan from 1995 to 2013. Moreover, to better understand premature death from nephrotic syndrome, the average years of life lost due to nephrotic syndrome were estimated.

METHODS

National death certificate data were evaluated. Age-standardised mortality rates from nephrotic syndrome were calculated by direct standardisation using the World Standard Population. Trends for average annual changes in percentages were determined by joinpoint regression analysis. Average years of life lost were estimated by dividing total years of life lost by the number of deaths from nephrotic syndrome. Years of life lost were estimated by the constant end-point method, with 65 years as the endpoint. Average years of life lost due to malignant neoplasms, the leading cause of death in Japan, were estimated for comparison.

RESULTS

There were 9945 deaths (4872 men and 5073 women) during the study period. The numbers of deaths and crude overall mortality rates increased, while age-standardised mortality rates continuously decreased, for both sexes. The annual percentage changes were -1.9% [95% confidence interval (CI), -2.3 to -1.4%] for men and -3.5% (95% CI -4.1 to -2.9%) for women. The average years of life lost due to nephrotic syndrome decreased during the study period, but were greater than for patients who died of malignant neoplasm.

CONCLUSIONS

Mortality and premature mortality rates from nephrotic syndrome significantly decreased in Japan between 1995 and 2014. Despite these improvements, nephrotic syndrome patients ≤65 years of age still have a poor prognosis.

[Leading causes of death during the induction therapy in pediatric patients with acute lymphoblastic leukemia]

BACKGROUND

Leukemias are the leading cause of childhood cancer. In most developed countries 1-2% of patients die during remission induction; however, in developing countries, this figure is higher and the causes of death apparently vary among the populations studied. The aim was to determine the cause of death during remission induction in pediatric patients with acute lymphoblastic leukemia (ALL) in the hospital "Dr. Gaudencio González Garza" of Centro Médico Nacional La Raza from January 1, 2009, to December 31, 2014.

METHODS

A retrospective cohort study was carried out and a descriptive statistical analysis was performed.

RESULTS

During the study period, a total of 463 patients with ALL were diagnosed, out of which 5.4% died (n = 25). Among the patients who died, 64% (n = 16) were female and 60% had high-risk clinical features at diagnosis. The main causes of death were septic shock and bleeding.

CONCLUSIONS

Early mortality was five times higher than the one reported for developed countries, while the causes of death did not differ. Close monitoring is necessary to detect and promptly treat complications secondary to chemotherapy toxicity in Mexican pediatric patients with ALL.

Why are some patients with Duchenne muscular dystrophy dying young: An analysis of causes of death in North East England

INTRODUCTION

Duchenne muscular dystrophy (DMD) is the most common inherited muscle disease in children. Recent years have seen an increase in age of survival into adulthood following the introduction of proactive standards of care. We reviewed mortality in DMD in our population in order to identify potential underlying risk factors for premature death and improve clinical care.

METHOD

A retrospective case note review of all deaths in the DMD population over the last 10 years in North East England. We identified 2 groups of patients: patients who died from underlying cardiac and/or respiratory failure (group 1) and patients who died unexpectedly in the absence of underlying cardio-respiratory failure (group 2).

RESULTS

Detailed information was available on 21 patients. Mean age of death in group 1 (17 patients) was 23.9 (14.4-39.5) years, in group 2 (4 patients) 14 (12.7-14.9) years. Causes of death in group 2 were acute pneumonia, cardiac arrest, acute respiratory distress and multi-organ failure. Across both groups we identified concerns regarding respiratory failure, inadequate nutrition, non-attendance at appointments, suboptimal coordination of care and decreased psychological wellbeing. In group 2, fat embolism, cardiac arrhythmia and adrenal insufficiency were also potential contributing factors.

CONCLUSIONS

The main cause of death in DMD in our population remains cardio-respiratory failure. Four patients (19%) died in their teenage years in the absence of severe cardiorespiratory failure. A more thorough understanding of the impact of DMD and its treatment on all organs systems is required to minimise the risk of an untimely death.

Latin American Clinical Epidemiology Network Series - Paper 5: Years of life lost due to premature death in traffic accidents in Bogota, Colombia

OBJECTIVE

This study aimed to quantify the number of years of life lost in traffic accidents in Bogota, Colombia.

STUDY DESIGN AND SETTING

The years of life lost were calculated using the 'age-standardized expected years of life lost' method, the table of Japanese adjusted life expectancy and the database of the Institute of Legal Medicine and Forensic Science between September 2012 and August 2013.

RESULTS

During a period of 1 year, 430 people died and 10,056.3 years of life were lost in Bogota due to traffic accidents.

CONCLUSION

The mortality burden of traffic accidents in Bogota is high. Further studies are required in order to characterize the accidents and develop effective policy decisions.

Environmentally induced, occupational diseases with emphasis on chronic kidney disease of multifactorial origin affecting tropical countries

BACKGROUND

Environmentally induced, occupational diseases are increasing worldwide, especially in rural agricultural communities. Poverty-associated malnutrition, environmental hazards and pollution, and lack of access to clean water, safe sanitation, and modern healthcare facilities are often associated with these chronic illnesses.

METHOD

The authors systematically reviewed occupational public health issues that have been related to the environment. General interpretations of results were included as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Pertinent publications from research databases were reviewed on (A) the risk-benefits, (B) the prevalence of risk factors for various diseases, (C) the benefits of not ignoring the risk factors (i.e., broader evidence), and (D) the risks, effects, and outcomes of different types of interventions. The authors used chronic kidney disease of multifactorial origin (CKDmfo) as an example to explore the theme. Emphasis was given to the regions with emerging economies and developing countries located in the vicinity of the equator.

FINDINGS

Geographical, socio-economic and aetiological similarities exist for many chronic non-communicable diseases that are affecting tropical countries around the equator. The authors identified manufacturing, mining, and agriculture as the biggest polluters of the environment. In addition, deforestation and associated soil erosion, overuse of agrochemicals, and irresponsible factory discharge (e.g., chemicals and paint, from rubber and textile factories, etc.), all contribute to pollution. To decrease the escalating incidences of environmentally induced diseases, governments should work proactively to protect the environment, especially watersheds, and take steps to minimise harmful occupational exposures and strictly enforce environmental regulations.

CONCLUSION

Creating public awareness of environmental issues and their relationship to public health is essential. This includes regular monitoring and periodic publication of the quality of water, air and soil; preventing deforestation and man-made soil erosion, increasing forest and ground cover, preventing occupational injuries, judicious and safe use of agrochemicals, sustainable agriculture and development programs, and implementing legislation to protect and conserve water heriage and the environment. These actions are essential both for a healthier environment and for the health of the people who live in that environment. Such measures would also decrease public health threats from such, including global-warming-related erratic environmental changes and the occurrence and the spread of non-communicable diseases, such as CKDmfo.

Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study

BACKGROUND

Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death.

METHODS

We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models.

RESULTS

We identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for smoking was 31 % (95 % confidence interval (CI), 31-32 %) and 14 % (95 % CI, 12-16 %) for poor diet. Important contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8-12 %) and high blood pressure (9 %; 95 % CI, 7-11 %). AFs for physical inactivity and excessive alcohol intake were 7 % and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55-59 %), being 35 % (95 % CI, 32-37 %) among never smokers and 74 % (95 % CI, 73-75 %) among current smokers.

CONCLUSIONS

While smoking remains the predominant risk factor for premature death in Europe, poor diet, overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed.

Mortality in schizophrenia and bipolar disorder: Clinical and serological predictors

Persons with schizophrenia and with bipolar disorder have a reduced life expectancy due largely to death from natural causes. The reasons for this increased mortality have not been completely defined. We prospectively assessed a cohort of persons with schizophrenia and one with bipolar disorder with a clinical evaluation and a blood sample from which immune and infectious disease markers were measured. Mortality was determined with data from the National Death Index following a period of up to 14years. We examined the role of demographic, clinical, and serological factors on mortality in bivariate and multivariate models. A total of 43/710 (6.1%) persons with schizophrenia and 12/406 (3.0%) with bipolar disorder died of natural causes. In the schizophrenia group, mortality was predicted by the following variables in a multivariate model: cigarette smoking (RR=6.93, 95% CI 1.59, 30.1, p=0.0099); autoimmune disorder (RR=8.08, 95% CI 2.50, 26.1, p=0.00047); gastrointestinal disorder (GI) (RR=3.53, 95% CI 1.43, 8.69 p=0.0061); and reduced maternal education (RR=0.84, 95% CI 0.72, 0.97), p=0.018. The combination of smoking and an autoimmune disorder yielded an unadjusted relative risk of 18.1 for mortality, and the combination of smoking and a GI disorder an unadjusted relative risk of 9.45, compared with individuals with neither risk factor. In the bipolar disorder group, significant bivariate predictors of mortality included lower cognitive score (RR=0.95, p=.0085) and the presence of type 1 or 2 diabetes (RR=3.90, p=.026). Given the extraordinary high risk of death due to smoking in schizophrenia, smoking cessation remains an urgent priority.

The interactive effects of type 2 diabetes mellitus and schizophrenia on all-cause mortality: The Fremantle Diabetes Study

In a study of the effects of type 2 diabetes and schizophrenia on mortality in 1296 community-based diabetic patients followed for a mean±SD 12.9±6.1years and in 5159 matched non-diabetic residents, 0.4% of each group had schizophrenia. Patients with both conditions had a six-fold adjusted increased risk of death.

Productivity loss due to premature mortality caused by blood cancer: a study based on patients undergoing stem cell transplantation

INTRODUCTION

Stem cell transplantation has been used for many years to treat haematological malignancies that could not be cured by other treatments. Despite this medical breakthrough, mortality rates remain high. Our purpose was to evaluate labour productivity losses associated with premature mortality due to blood cancer in recipients of stem cell transplantations.

METHODS

We collected primary data from the clinical histories of blood cancer patients who had undergone stem cell transplantation between 2006 and 2011 in two Spanish hospitals. We carried out a descriptive analysis and calculated the years of potential life lost and years of potential productive life lost. Labour productivity losses due to premature mortality were estimated using the Human Capital method. An alternative approach, the Friction Cost method, was used as part of the sensitivity analysis.

RESULTS

Our findings suggest that, in a population of 179 transplanted and deceased patients, males and people who die between the ages of 30 and 49 years generate higher labour productivity losses. The estimated loss amounts to over €31.4 million using the Human Capital method (€480,152 using the Friction Cost method), which means an average of €185,855 per death. The highest labour productivity losses are produced by leukaemia. However, lymphoma generates the highest loss per death.

CONCLUSIONS

Further efforts are needed to reduce premature mortality in blood cancer patients undergoing transplantations and reduce economic losses.

Prevalence of schizophrenia disability and associated mortality among Chinese men and women

Schizophrenia is a major cause of psychiatric disability in China. In the present study, we estimated total and age-specific prevalence of both schizophrenia disability and associated mortality among Chinese women and men. We further examined whether sex differences in prevalence were attributable to mortality differences between men and women. Data from the Second China National Sample Survey on Disability (2006) and the 2007-2010 follow-up studies were utilized. Possibly psychiatrically disabled individuals were administered the World Health Organization Disability Assessment Schedule, Version II and the ICD-10 Symptom Checklist for Mental Disorders by trained clinical psychiatrists. In total, 0.37% of men and 0.44% of women were living with schizophrenia disability in China. We did not find statistically significant differences in the 4-year cumulative mortality between men and women. Overall standardized mortality ratios for the age groups of 18-29, 30-39, 40-49, 50-59, 60-69, and 70+ years were 120.89, 29.56, 15.06, 9.16, 10.57, and 4.95, respectively. In conclusion, mortality differences between men and women were unlikely to be a major contributor to sex differences in prevalence. Premature death among younger individuals experiencing schizophrenia disability warrants urgent attention.

Bariatric surgery for severely obese adolescents

Severe obesity is increasing in adolescents and is associated with cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnoea, polycystic ovarian syndrome and a range of musculoskeletal problems. Premature death is the inevitable outcome of persistent severe obesity in adolescents. In adults with severe obesity, medical and lifestyle interventions have been shown to be expensive and less effective in terms of weight loss than has bariatric surgery. The single completed randomised controlled trial in adolescents shows the same outcome. This is supported by meta analyses of bariatric surgery in adolescent subjects. A more aggressive approach to severe obesity, utilising bariatric surgery in selected cases, within the context of a multi-disciplinary team, is required.