Disparities in mortality rates from aortic aneurysm and dissection by country-level income status and sex

Objective

To investigate the impact of national income level and sex on mortality trends from aortic aneurysm and dissection in addition to all aortic disease as a whole.

Methods

Using data from the World Health Organization mortality database, we conducted an analysis of mortality trends from aortic disease between 2000 and 2019, Countries were categorized into middle-income and high-income countries (MICs and HICs) on the basis of income level. Age-standardized and sex-specific age-standardized mortality rates per 100,000 persons, along with male-to-female mortality ratios, were calculated. Trends over the study period were analyzed using joinpoint regression.

Results

Our analysis comprised 29 MICs and 46 HICs, with an average population of 595 million and 1042 million during the observation period. During the observation period, age-standardized mortality rates from aortic disease decreased to 2.21 (2.17-2.25) and 2.28 (2.26-2.30) in MICs and HICs, respectively (average annual percentage change of -0.5% in MICs and -1.8% in HICs, P < .05 for both). However, mortality rates from aortic dissection increased in HICs from 2000 to 2019 (average annual percentage change of 1.3%, P < .001). Mortality from aortic disease, aortic dissection, and aortic aneurysm were male dominant in MICs and HICs but decreasing trends during the observation periods except for aortic dissection in MICs.

Conclusions

We present the contemporary and comprehensive analysis of global socioeconomic status and aortic diseases mortality. Although trends of mortality from aortic diseases are on the decline in both MICs and HICs, there is a striking increase in mortality for aortic dissection, specifically in HICs.

Temporal Trends of Infant Mortality Secondary to Congenital Heart Disease: National CDC Cohort Analysis (1999-2020)

BACKGROUND

Infant mortality continues to be a significant problem for patients with congenital heart disease (CHD). Limited data exist on the recent trends of mortality in infants with CHD.

METHODS

The CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify deaths occurring within the United States with CHD listed as one of the causes of death between 1999 and 2020. Subsequently, trends were calculated using the Joinpoint regression program (version 4.9.1.0; National Cancer Institute).

RESULTS

A total of 47,015 deaths occurred in infants due to CHD at the national level from the year 1999 to 2020. The overall proportional infant mortality (compared to all deaths) declined (47.3% to 37.1%, average annual percent change [AAPC]: -1.1 [95% CI -1.6 to -0.6, p < 0.001]). There was a significant decline in proportional mortality in both Black (45.3% to 34.3%, AAPC: -0.5 [-0.8 to -0.2, p = 0.002]) and White patients (55.6% to 48.6%, AAPC: -1.2 [-1.7 to -0.7, p = 0.001]), with a steeper decline among White than Black patients. A statistically significant decline in the proportional infant mortality in both non-Hispanic (43.3% to 33.0%, AAPC: -1.3% [95% CI -1.9 to -0.7, p < 0.001]) and Hispanic (67.6% to 57.7%, AAPC: -0.7 [95% CI -0.9 to -0.4, p < 0.001]) patients was observed, with a steeper decline among non-Hispanic infant population. The proportional infant mortality decreased in males (47.5% to 53.1%, AAPC: -1.4% [-1.9 to -0.9, p < 0.001]) and females (47.1% to 39.6%, AAPC: -0.9 [-1.9 to 0.0, p = 0.05]). A steady decline in for both females and males was noted.

CONCLUSION

Our study showed a significant decrease in CHD-related mortality rate in infants and age-adjusted mortality rate (AAMR) between 1999 and 2020. However, sex-based, racial/ethnic disparities were noted, with female, Black, and Hispanic patients showing a lesser decline than male, White, and non-Hispanic patients.

Trends in premature cerebrovascular disease mortality in the Polish population aged 25-64 years, 2000-2016

Background

Many scientific reports have shown a decrease in total cerebrovascular disease (CeVD) mortality over the past few decades, but too little attention has been paid to premature mortality. CeVD accounted for 22.5% and 17.8% of premature cardiovascular disease deaths in Poland, in 2000 and 2016, respectively.

Objective

The aim of the study was to analyse premature CeVD mortality in the Polish population in the recent years, the dynamics of its changes and the potential factors that may have contributed to the decline in mortality. The main goal of the study was to overview the levels and trends in premature CeVD mortality with an emphasis on haemorrhagic, ischaemic and unspecified (not specified as haemorrhagic or ischaemic) stroke.

Material and methods

The analysis was based on a database of the Central Statistical Office of Poland and included data from 2000-2016 on premature cerebrovascular deaths occurring between 25 and 64 years of age (N=104,786). CeVD and haemorrhagic, ischaemic or unspecified stroke were coded with ICD-10 codes I60-I69, I61-I62, I63 and I64, respectively. The analysis included assessment of CeVD deaths distribution and evaluation of age-specific mortality rates in 10-year age groups and age-standardised mortality rates (SMR) in the age group 25-64 years, separately for men and women. Trends in SMRs have been studied in the period 2000-2016.

Results

The number of CeVD deaths decreased by 32.8% in men and 48.8% in women. There was a two-fold decline in CeVD mortality: from 59 to 29 male and from 30 to 12 female per 100,000. In addition, a 2-year increase in the median age of CeVD death was observed (Men: 56.4 to 58.4 years, Women: 56.4 to 58.7 years, p<0.001). A statistically significant decline in mortality (per 100,000) was also noticed for haemorrhagic stroke (Men: 18.7 to 10.4; Women: 9.6 to 3.8), ischaemic stroke (Men: 11.8 to 8.4; Women: 4.7 to 3.0) and unspecified stroke (Men: 19.7 to 3.5; Women: 9.1 to 1.3).

Conclusions

A substantial decline in premature CeVD mortality was observed in the period 2000-2016. Additionally, the number of deaths that could not be classified as haemorrhagic or ischaemic stroke death decreased significantly. The increasingly widespread use of new post-stroke therapies and their availability make it possible to expect a further decrease in CeVD mortality. However, the necessary actions should be taken to compensate for the disparities in CeVD mortality between men and women.

A 22-Year Study to Assess Disparities in Place of Death Among Patients With Diabetes

Background This study examines disparities in the place of death in patients in the United States with diabetes mellitus (DM) using data from the CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) database covering a 22-year period (1999-2020). Looking at age, gender, ethnicity, and census location, among other variables, the study aims to understand trends and determinants of mortality at home or hospice care compared to mortality at a medical or nursing facilities. Materials and methods An online freely accessible mortality database, CDC WONDER database, was used to collect information regarding DM-related mortality, using the International Classification of Diseases, 11th Revision (ICD-11) code range E10-E14. To investigate patterns in location of death, the research population was split by census regions, racial categories, age groups, and gender. Statistical techniques such as univariate logistic regression and graphical representations were employed. Results Based on a study of 1,674,724 DM-related deaths, medical or nursing facilities recorded higher deaths (1,041,602) compared to home or hospice deaths (572,567). The highest number of deaths in home or hospice setting was recorded for the age group of 75-84 years (146,820), male gender (324,325), Census Region 3 (South) (225,636), and white race (458,690). Among the patients with death at home or a hospice center; the odds were highest for the age group of 55-64 years, male gender, Census Region 4 (West), and American Indian or Alaska Native race. Discussion The results showed a general upward trend in DM patients' deaths at home and in hospice care in the United States. Males, white people, and those in the age group of 75-84 years notably had the highest death rates. Regional differences also came into play, with the South showing the biggest trend in mortality. To better understand the underlying causes of these changes and to increase at-risk groups' access to healthcare facilities, more research is required. Conclusion There is an overall rising trend in home and hospice deaths in the United States for patients with DM, but with a steady dip between the years 2005 and 2010. Patient deaths from DM were categorized by age groups, gender, race, and census regions. The highest mortality trends are exhibited in whites, males, and those aged 75-84 years. Out of the census regions, the South has the highest mortality trend. Further studies could be carried out to determine the reasons for the rising trends in home or hospice deaths in the aforementioned groups and how to provide these groups with better access to healthcare facilities.

Trends in sepsis-associated cardiovascular disease mortality in the United States, 1999 to 2022

Purpose

Cardiovascular disease (CVD) is the leading cause of death in the United States, and sepsis significantly contributes to hospitalization and mortality. This study aims to assess the trends of sepsis-associated CVD mortality rates and variations in mortality based on demographics and regions in the US.

Methods

The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to identify CVD and sepsis-related deaths from 1999 to 2022. Data on gender, race and ethnicity, age groups, region, and state classification were statistically analyzed to obtain crude and age-adjusted mortality rates (AAMR). The Joinpoint Regression Program was used to determine trends in mortality within the study period.

Results

During the study period, there were a total of 1,842,641 deaths with both CVD and sepsis listed as a cause of death. Sepsis-associated CVD mortality decreased between 1999 and 2013, from AAMR of 65.7 in 1999 to 58.8 in 2013 (APC -1.06*%, 95% CI: -2.12% to -0.26%), then rose to 74.3 in 2022 (APC 3.23*%, 95% CI: 2.18%-5.40%). Throughout the study period, mortality rates were highest in men, NH Black adults, and elderly adults (65+ years old). The Northeast region, which had the highest mortality rate in the initial part of the study period, was the only region to see a decline in mortality, while the Northwest, Midwest, and Southern regions experienced significant increases in mortality rates.

Conclusion

Sepsis-associated CVD mortality has increased in the US over the past decade, and both this general trend and the demographic disparities have worsened since the onset of the COVID-19 pandemic.

Trends in Mortality Due to Cardiovascular Diseases Among Patients With Parkinson's Disease in the United States: A Retrospective Analysis

BACKGROUND

Parkinson disease (PD) and cardiovascular diseases (CVD) present significant health burdens, particularly among older adults. Patients with PD have an elevated risk of CVD-related mortality. Analyzing mortality trends in this population may help guide focused interventions.

METHODS

Mortality data were extracted from the CDC WONDER database, using ICD-10 code G20 for PD and I00-I99 for CVD. Age-adjusted mortality rates (AAMR) per 100,000 were calculated and trends were examined across variables including gender, year, race, and urbanization, place of death, region, and state. Annual percentage change (APC) with 95% confidence intervals (CI) was computed using Joinpoint regression.

RESULTS

A total of 138 151 CVD-related deaths were reported among individuals with PD. The AAMR decreased from 23.5 in 1999 to 12.7 in 2020, with a notable decline between 1999 and 2014 (APC: -5.13; 95% CI, -5.44 to -4.86), followed by a modest increase from 2014 to 2020 (APC: 1.37; 95% CI, 0.16-3.05). Males exhibited higher AAMRs compared to females (Male AAMR: 22.6 vs. Female AAMR: 10.4). Non-Hispanic (NH) Whites had the highest AAMR (16.1), followed by Hispanics (11.2), NH Asians (10.2), and NH Blacks (9.7). Nonmetropolitan areas showed a higher AAMR (16.3) compared to metropolitan areas (14.9). State-level analysis indicated Nebraska with the highest AAMR (21.4), while Georgia recorded the lowest (9.9).

CONCLUSIONS

CVD-related mortality in PD patients has declined overall, though rates rose slightly from 2014 to 2020. Gender, racial, and geographic disparities highlight the need for targeted strategies to reduce cardiovascular risks in this population.

Explaining International Trends in Mortality on Hemodialysis Through Changes in Hemodialysis Practices in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

RATIONALE & OBJECTIVE

Case-mix adjusted hemodialysis mortality has decreased since 1998. Many factors that influence mortality may have contributed to this trend, and these associations may differ by continental region. We studied changes in hemodialysis facility practices over time and their potential role in mediating changes in patient survival.

STUDY DESIGN

Observational prospective cohort study.

SETTING & PARTICIPANTS

Adult hemodialysis patients treated in 500 hemodialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) between 1999 and 2015 in the United States, Japan, and 4 European countries: Germany, Italy, Spain, and the United Kingdom.

PREDICTORS

Four practice measures at each facility: the percentages of patients with Kt/V≥1.2, interdialytic weight gain [IDWG]<5.7%, phosphorus<6mg/dL, and using arteriovenous fistulas (AVFs).

OUTCOME

Patient survival.

ANALYTICAL APPROACH

Mediation analyses, adjusted for case mix, were conducted using 3-year study phase as the exposure and facility practice measures as potential mediators.

RESULTS

In Europe, we observed a 13% improvement in overall case-mix adjusted survival per decade. Trends in facility practice measures, especially Kt/V and phosphorus, explained 10% improvement in case-mix survival per decade, representing 77% (10% explained of 13% improvement) of the observed improvement. In Japan, 73% of the observed 12%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially Kt/V and IDWG. In the United States, 56% of the observed 47%/decade improvement in case-mix adjusted survival could be attributed to facility practices, especially AVF use and phosphorus control.

LIMITATIONS

Unmeasured changes in the characteristics of the patient population over this period may confound the observed associations.

CONCLUSIONS

The improvements in adjusted hemodialysis patient survival in Europe, Japan, and the United States from 1999 to 2015 can be largely explained by improvements in specific facility practices. Future changes in patient survival may be responsive to further evolution in the implementation of common clinical practices.

PLAIN-LANGUAGE SUMMARY

Case-mix adjusted survival of patients treated with hemodialysis has improved over the last 2 decades in the United States, Japan, and Europe. Some of this improvement can be explained by region-specific changes in 4 dialysis practices, namely increases in the proportions of patients achieving (1) Kt/V≥1.2, (2) serum phosphorus levels<6mg/dL, (3) interdialytic weight gain<5.7% of body weight, and/or (4) use of arteriovenous fistulas as vascular access, with the magnitude varying according to region-specific trends in these practices. These findings suggest that further improvement in these practice measures may be attended by further reductions in mortality among patients treated with maintenance hemodialysis.

Demographic Disparities in Acute Myeloid Leukemia Mortality Trends in the United States

BACKGROUND/AIM

Acute myeloid leukemia (AML) is a hematological malignancy with an overall poor prognosis; however, survival rates vary widely by clinical and demographic characteristics. This study sought to identify historical trends in AML mortality in the US and to identify any disparities by sex, race or ethnicity.

PATIENTS AND METHODS

For each demographic population, the age adjusted mortality rate (AAMR) per 1,000,000 for AML-related deaths from 1999 to 2020 in the United States was accessed from the CDC Wonder Database. These values were then used to calculate the average Annual Percent Change (AAPC) from 1999 to 2020 using the National Cancer Institute (NCI)'s Joinpoint Regression Program (Joinpoint V 4.9.0.0, NCI) with log-linear regression models. Statistical significance for all reported findings was determined using a 2-tailed t-test or parallel pairwise comparison with significance defined as p<0.05.

RESULTS

The overall population had a significant downtrend in mortality rate between 2011 and 2020 with an APC of -0.61% [95% confidence interval (CI)=-1 to -0.2]. In 2020, the AAMR due to AML for males was 32 and for females was 20.2. Females did not have a significant overall AAPC from 1999 to 2020. Males had a significant AAPC of 0.5% (95%CI=0-0.9) from 1999 to 2020, signifying an overall uptrend. In 2020, the White population had the greatest mortality rate (29.6), followed by the Black or African American population (20.9), Asian or Pacific Islander (AAPI) population (18.6), and the American Indian/Alaska Native population (8.8). American Indian and Alaska Native population data could not be reliably compared. No race/ethnic group had a significant AAPC trend from 1999 to 2020. However, parallel pairwise comparison found a significant difference in the trend of mortality rates between the Black or African American and AAPI, Black or African American and White, and White and AAPI populations.

CONCLUSION

Our findings highlight disparities in mortality due to AML and underscore the need for additional resources and support in affected populations and areas.

Mortality Trends due to Falls in the Group of People in Early (65-74 Years) and Late (75+) Old Age in Poland in the Years 2000-2020

The aim of the study was to assess mortality trends due to falls in early (65-74 years) and late (75+) old age groups in Poland in 2000-2020. The study used a database of all deaths due to falls in two age groups. Per 100,000 men in early old age, the crude death rate (CDR) increased from 25.3 in 2000 to 25.9 in 2020. After 2012, a statistically significant decrease was observed (annual percentage change (APC) = -2.3%). Similar trends were noted for standardized death rates (SDR). Among men 75 years and older, the CDR values between the years 2000 and 2005 decreased (APC = -5.9%; p < 0.05), while after 2005, they increased (1.3%; p < 0.05). The SDR value decreased from 160.6 in 2000 to 118.1 in 2020. Among women aged 65-74, the CDRs values between 2000-2020 decreased from 13.9 and 8.2 per 100,000 women. The SDR value decreased from 14.0 to 8.3, respectively (2000-2007: APC = -7.2%; p < 0.05). Among women aged 75+, the CDR value decreased from 151.5 to 111.6 per 100,000 but after 2008, they began to increase (APC = 1.9%; p < 0.05). SDR decreased from 188.9 to 98.0 per 100,000 women. Further research on the mortality in falls is needed in order to implement preventive programs.

Evaluating Disparities in Places of Death in the United States Among Patients With Intellectual Disabilities: A 22-Year Analysis Using the CDC-WONDER Database

Background In the United States, intellectual disabilities are related to higher death rates. Given the relationship between intellectual disabilities and places of death, it is important to evaluate trends and disparities in places of death to direct physician and patient education and improve the chances of patients who will receive end-of-life care to be suitable with their preferences and values. In this study, the data from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database was used to examine mortality trends in places of death of patients with intellectual disabilities in the United States between 1999 and 2020. Methodology The data were collected with the International Classification of Diseases 10th Revision codes F70-F79 (intellectual disability) from the CDC WONDER website on July 20, 2023, to evaluate disparities in places of death. R programming software was used to conduct statistical analysis for predicting death trends in hospice or home care for age groups, genders, census regions, and races. Results In total, 9,432 patients with intellectual disabilities died between 1999 and 2020. The highest number of deaths was in the age group of 55-64 years (2,281) and the lowest was in the age group of 1-4 years (55). The data showed that mortality rates among various demographic groups varied significantly. The age group of 25-34 years was more likely to die in a home/hospice setting (odds ratio (OR) = 2.137, confidence interval (CI) = 1.452, 3.145, p < 0.001), considering 85+ years as the reference age. The age group of 1-4 years had the lowest risk of death at home or hospice (OR = 0.147, CI = 0.108, 0.2, p = 0.001). Conclusions The deaths from intellectual disabilities from 1999 to 2020 were higher in medical facilities than those in home or hospice care. The mortality was higher for older adults, whites, and males in the Midwest and the South regions, as well as in medical faculties compared to other categories.

Interpreting Breast Cancer Mortality Trends Related to Introduction of Mammography Screening: A Simulation Study

Background. Several studies have evaluated the effect of mammography screening on breast cancer mortality based on overall breast cancer mortality trends, with varied conclusions. The statistical power of such trend analyses is, however, not carefully studied. Methods. We estimated how the effect of screening on overall breast cancer mortality is likely to unfold. Because a screening effect is based on earlier treatment, screening can affect only new incident cases after screening introduction. To evaluate the likelihood of detecting screening effects on overall breast cancer mortality time trends, we calculated the statistical power of joinpoint regression analysis on breast cancer mortality trends around screening introduction using simulations. Results. We found that a very gradual increase in population-level screening effect is expected due to prescreening incident cases. Assuming 25% effectiveness of a biennial screening program in reducing breast cancer mortality among women 50 to 69 y of age, the expected reduction in overall breast cancer mortality was 3% after 2 y and reached a long-term effect of 18% after 20 y. In common settings, the statistical power to detect any screening effects using joinpoint regression analysis is very low (<50%), even in an artificial setting of constant risk of baseline breast cancer mortality over time. Conclusions. Population effects of screening on breast cancer mortality emerge very gradually and are expected to be considerably lower than the effects reported in trials excluding women diagnosed before screening. Studies of overall breast cancer mortality time trends have too low statistical power to reliably detect screening effects in most populations. Implications. Researchers and policy makers evaluating mammography screening should avoid using breast cancer mortality trend analysis that does not separate pre- and postscreening incident cases.

HIGHLIGHTS

Population-level mammography screening effects on breast cancer mortality emerge gradually following screening introduction, resulting in very low statistical power of trend analysis.Researchers and policy makers evaluating mammography screening should avoid relying on population-wide breast cancer mortality trends.Expected mammography screening effects at population level are lower than those from screening trials, as many cases of breast cancer fall outside the screening age range.

Change in the Mortality Trend of Hospitalized Patients with Clostridium difficile Infection: A Nation-wide Study

Background According to the Healthcare Cost and Utilization Project (HCUP), mortality in Clostridium difficile infection (CDI) has been rising since 2009, and an upward trend in mortality has been noted. Although there have been studies exploring the incidence of CDI and mortality in the national database, those studies were limited to one particular year. With the advent of newer modalities of diagnosis and treatment for CDI, the recent multiyear trend in disease-specific outcomes from large administrative databases is unknown. Objective To study the recent trend in nationwide hospital admissions and mortality along with hospital outcomes. Methods We queried the identified National Inpatient Sample from 2007 to 2011 to identify patients of age >18 years, with a discharge diagnosis of CDI identified by the International Classification of Diseases, 9th edition (ICD-9), clinical modification codes 008.45, respectively. Results We identified a decline in CDI mortality to 2.67% in 2011 as compared to 3.83% in 2007 (P<0.0001) with CDI as the primary discharge diagnosis and a downward trend in all-cause mortality from 9.2% in 2007 to 7.9% in 2011 (P<0.0001). We identified an upward trend in CDI-related hospital discharges from 2007 (N=325,022) to 2011 (N=333498). Hospital discharges with CDI as a primary discharge diagnosis also increased from 2007 (N=104,123) to 2011 (123,898). The mean length of stay decreased from 7.16 days in 2007 to 6.40 days in 2011 (P 0.0001). CDI was noted to be more common in the elderly (61-80), with a mean age of 68 years. Patients were of Caucasian descent (67%), female (64%), and primarily a Medicare payer (69%). Mean hospital charges increased from $31,551 to 35,654$ (P .04). Of interest, CDI was noted to be more common in large bed-sized non-teaching hospitals (57%) than large bed-sized teaching hospitals (42%). In terms of the geographical distribution of CDI, the southern states of the US had an increased incidence of CDI (36%) and the west coast (16%) had the least incidence. Conclusion  Our study shows an improved trend in-hospital mortality outcomes and a decreased length of stay likely related to the advancement in CDI treatments. Hospital charges were increased from 2007 to 2011 in spite of a decrease in hospital length of stay.

Unincreased mortality of patients with early rheumatoid arthritis compared to the general population in the past 17 years: Analyses from the IORRA cohort

OBJECTIVES

The aim of this article is to investigate the mortality rate of patients with early rheumatoid arthritis (RA) over the past 17 years.

METHODS

Japanese patients with early RA enrolled in the Institute of Rheumatology, Rheumatoid Arthritis cohort from 2001 to 2012 were classified into Groups A (2001-06) and B (2007-12). The standardized mortality ratio (SMR) and 5-year survival rate were calculated.

RESULTS

Groups A and B had 1609 and 1608 patients, of which 167 and 178 patients were lost during follow-up and 47 and 45 deaths were confirmed, respectively. The SMR (95% confidence intervals) for Groups A and B were 0.81 (0.59-1.08) and 0.78 (0.57-1.04), respectively, with the condition that all untraceable patients were alive. Assuming that the mortality rate of untraceable patients was twice as high as that of the general population, the SMR was 0.90 (0.68-1.19) for Group A and 0.92 (0.68-1.23) for Group B. The 5-year survival rates were 96.9% and 97.0% for Groups A and B, respectively.

CONCLUSIONS

The 5-year mortality of patients with early RA has been comparable to that of the general Japanese population. The 5-year survival rate has been stable over the past 17 years.

Disparities in Mortality Trends of Breast Cancer by Racial and Ethnic Status in the United States

BACKGROUND AND AIM

Breast cancer is the most commonly diagnosed malignancy for women and is a leading cause of mortality in women worldwide and in the United States. Recently, new interventions have been developed to improve its prognosis. The aim of this study was to assess the impact of new therapies on racial and ethnic groups in the United States for demographic-based disparities. We assessed the impact of these developments from 1999 to 2020 on age adjusted mortality rate (AAMR), mortality rate trend from 1999 to 2020, average annual percent change (AAPC), and temporal trends, by annual percent change (APC) in the United States for various demographic groups.

PATIENTS AND METHODS

We queried the CDC Wonder database to retrieve mortality rates by race and ethnic group from 1999 to 2020 with breast malignancy as a contributing cause of death.

RESULTS

Between 1999 to 2020, all racial groups presented a significant overall decline in mortality rates: AI/AN [AAPC, -1.6% (95% CI=-2.2% to -1.0%); p<0.01], AAPI [AAPC, -0.5% (95% CI=-1.00% to -0.1%); p<0.01], Black/African American [AAPC, -1.4% (95% CI=-1.6% to -1.2%); p<0.01], and the white population [AAPC, -1.7% (95% CI=-1.8% to -1.5%); p<0.01]. The Black/African American population had a significant lower rate of decline compared to the white population (p<0.01) and Hispanic/Latinx populations had a lower rate of decline compared to those who are non-Hispanic/Latinx (p<0.01).

CONCLUSION

We found that Black/African American population had a significant lower rate of decline compared to the white population and Hispanic/Latinx populations had a lower rate of decline compared to those who are non-Hispanic/Latinx. These differences in mortality trend rates in breast cancer emphasize the need for targeted interventions and resources tailored to specific demographic needs.

Estimation of Excess Mortality in Germany During 2020-2022

Background This study estimates the burden of COVID-19 on mortality in Germany. It is expected that many people have died because of the new COVID-19 virus who otherwise would not have died. Estimating the burden of the COVID-19 pandemic on mortality by the number of officially reported COVID-19-related deaths has been proven to be difficult due to several reasons. Because of this, a better approach, which has been used in many studies, is to estimate the burden of the COVID-19 pandemic by calculating the excess mortality for the pandemic years. An advantage of such an approach is that additional negative impacts of a pandemic on mortality are covered as well, such as a possible pandemic-induced strain on the healthcare system. Methods To calculate the excess mortality in Germany for the pandemic years 2020 to 2022, we compare the reported number of all-cause deaths (i.e., the number of deaths independently of underlying causes) with the number of statistically expected all-cause deaths. For this, the state-of-the-art method of actuarial science, based on population tables, life tables, and longevity trends, is used to estimate the expected number of all-cause deaths from 2020 to 2022 if there had been no pandemic. Results The results show that the observed number of deaths in 2020 was close to the expected number with respect to the empirical standard deviation; approximately 4,000 excess deaths occurred. By contrast, in 2021, the observed number of deaths was two empirical standard deviations above the expected number and even more than four times the empirical standard deviation in 2022. In total, the number of excess deaths in the year 2021 is about 34,000 and in 2022 about 66,000 deaths, yielding a cumulated 100,000 excess deaths in both years. The high excess mortality in 2021 and 2022 was mainly due to an increase in deaths in the age groups between 15 and 79 years and started to accumulate only from April 2021 onward. A similar mortality pattern was observed for stillbirths with an increase of about 9.4% in the second quarter and 19.4% in the fourth quarter of the year 2021 compared to previous years. Conclusions These findings indicate that something must have happened in spring 2021 that led to a sudden and sustained increase in mortality, although no such effects on mortality had been observed during the early COVID-19 pandemic so far. Possible influencing factors are explored in the discussion.

Prostate Cancer Mortality in Peru: An Update from 2003 to 2017

OBJECTIVE

We estimated the mortality trends for prostate cancer in Peru and its geographical areas between 2003 and 2017.

MATERIAL AND METHODS

We obtained recorded prostate cancer deaths from the Peruvian Ministry of Health Database between 2003 and 2017. Age-adjusted mortality rates per 100,000 men-year were computed with the direct method using the world standard SEGI population. We estimated the annual percent change (APC) using the Joinpoint regression program.

RESULTS

A total of 38,617 prostate cancer deaths were reported between 2003 and 2017, with a mortality rate ranging from 18.21 to 19.94 deaths per 100,000 men-year. Since 2006, Peru has experienced a decrease of 2.2 deaths per year, whereas the mortality rate in the coastal region has declined by 2.9% per year.  The highlands and rainforest regions showed stable trends throughout the entire study period. According to provinces, only Moquegua had a significant decrease (APC: -6.0, 95%CI: -11.4, -0.2, p<0.05) from 2003 to 2017.

CONCLUSIONS

Although mortality rates are decreasing, there is a high mortality burden by prostate cancer in Peru and by geographical regions, being mostly concentrated in the coastal region. The rainforest provinces deserve the most attention. Our findings suggest wide health care disparities among the different regions of Peru that need greater public health attention to reduce the burden of mortality by prostate cancer.

Trends in papillary thyroid cancer mortality in Denmark according to stage and education

OBJECTIVE

Few studies exist on trends in papillary thyroid cancer (PTC) survival and mortality according to stage and level of socioeconomic status.

DESIGN

Nationwide cohort study.

PATIENTS AND MEASUREMENTS

Patients diagnosed with PTC during 2000-2015 in Denmark were identified from the Danish Cancer Registry and followed until the end of 2020. We evaluated 5-year all-cause mortality and relative survival according to stage and 5-year mortality rates with corresponding average annual percentage changes (AAPCs) according to stage and education. Finally, we assessed the association between several factors and mortality of PTC using Cox regression.

RESULTS

For the 2006 cases of PTC diagnosed during 2000-2015, relative survival tended to increase and mortality rates tended to decrease for all stages. For localized PTC, mortality rates tended to decrease among individuals with medium education (AAPC = -7.0, 95% confidence interval [CI]: -14.7 to 1.5), but showed an increasing pattern among individuals with long education (AAPC = 19.8, 95% CI: -4.2 to 50.0). For nonlocalized PTC, mortality rates showed a decreasing tendency among individuals with medium and long education (AAPC = -5.5, 95% CI: -13.2 to 2.9, and AAPC = -10.4, 95% CI: -20.8 to 1.4, respectively). Being diagnosed with PTC in a more recent calendar period and long education were associated with a lower mortality rate in the Cox regression analysis.

CONCLUSIONS

A pattern of an increasing relative survival and decreasing mortality rates of PTC across all stages was seen in Denmark during 2000-2015. The decreasing pattern in mortality rates was most evident in individuals with localized stage and medium education, and in individuals with nonlocalized stage and medium or long education.

Prediction of early-onset colorectal cancer mortality rates in the United States using machine learning

INTRODUCTION

The current study, focusing on a significant US (United States) colorectal cancer (CRC) burden, employs machine learning for predicting future rates among young population.

METHODS

CDC WONDER data from 1999 to 2022 was analyzed for CRC-related mortality in patients younger than 56 years. Temporal trends in age-adjusted mortality rates (AAMRs) were assessed via Joinpoint software. Future mortality rates were forecasted using an optimal Autoregressive Integrated Moving Average (ARIMA) model.

RESULTS

From 1999 to 2022, we observed 150,908 deaths with CRC listed as the underlying cause, predominantly in males, with an upward trend in AAMR. The ARIMA model projects an increase in CRC mortality by 2035, estimating an average annual percent change (AAPC) of 1.3% overall, 1% for females, and 1.5% for males.

CONCLUSION

Our study findings emphasize the need for more robust preventive measures to reduce future CRC mortality among younger population. These results have significant implications for public health policies, particularly for males under 56, and underscore the importance of early screening and lifestyle modifications.

Geographical Disparities in Esophageal Cancer Incidence and Mortality in the United States

BACKGROUND

Our previous research on neuroendocrine and gastric cancers has shown that patients living in rural areas have worse outcomes than urban patients. This study aimed to investigate the geographic and sociodemographic disparities in esophageal cancer patients.

METHODS

We conducted a retrospective study on esophageal cancer patients between 1975 and 2016 using the Surveillance, Epidemiology, and End Results database. Both univariate and multivariable analyses were performed to evaluate overall survival (OS) and disease-specific survival (DSS) between patients residing in rural (RA) and urban (MA) areas. Further, we used the National Cancer Database to understand differences in various quality of care metrics based on residence.

RESULTS

N = 49,421 (RA [12%]; MA [88%]). The incidence and mortality rates were consistently higher during the study period in RA. Patients living in RA were more commonly males (p < 0.001), Caucasian (p < 0.001), and had adenocarcinoma (p < 0.001). Multivariable analysis showed that RA had worse OS (HR = 1.08; p < 0.01) and DSS (HR = 1.07; p < 0.01). Quality of care was similar, except RA patients were more likely to be treated at a community hospital (p < 0.001).

CONCLUSIONS

Our study identified geographic disparities in esophageal cancer incidence and outcomes despite the similar quality of care. Future research is needed to understand and attenuate such disparities.

Analysis of Alzheimer's Disease-Related Mortality Rates Among the Elderly Populations Across the United States: An Analysis of Demographic and Regional Disparities from 1999 to 2020

INTRODUCTION

Alzheimer's Disease (AD) is the leading cause of dementia and a significant public health concern, characterized by high incidence, mortality, and economic burden. This study analyzes the mortality patterns and demographic disparities in Alzheimer's disease-related deaths among the elderly population in the United States from 1999 through 2020.

METHODS

Alzheimer's disease mortality data for individuals 65 and older were obtained from the CDC WONDER database, utilizing ICD-10 codes G30.0, G30.1, G30.8, and G30.9 for identification. Demographic and regional variables included age, gender, race/ethnicity, place of death, urban- rural status, and geographic region. Crude death rates (CR) and age-adjusted mortality rates (AAMR) per 100,000 individuals were calculated. Joinpoint Regression Program 5.0.2 was used to analyze trends, calculating Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs).

RESULTS

From 1999 to 2020, 1,852,432 deaths were attributed to AD among individuals aged 65 and older. The AAMR increased from 128.8 in 1999 to 254.3 in 2020, with an AAPC of 2.99% (95% CI = 2.61-3.48). The age-adjusted mortality rate (AAMR) was higher in females (218.5) than in males (163.5). Among racial and ethnic groups, non-Hispanic whites had the highest AAMR, followed by Non-Hispanic Blacks and Hispanics. Regionally, the West reported the highest AAMR, while the Northeast recorded the lowest. Most deaths occurred in nursing homes (57.3%), with a significant portion also occurring at decedents' homes (22.4%).

CONCLUSION

AD mortality rates in the U.S. have risen significantly, with notable disparities across age, gender, race, and geographic regions. These findings highlight the need for targeted interventions and research to address the growing burden of AD, particularly among the most affected demographic groups.

Malignant Neoplasm of the Meninges: A 20-Year Retrospective Study to Assess Trends and Disparities in Place of Death

BACKGROUND

The site of death is a crucial factor associated with the tumor's progression and complications arising from it; therefore, analyzing nationwide patterns in place of death is essential. The present paper aims to evaluate the disparities in place of death for malignant neoplasm of the meninges using the CDC-WONDER (Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research) database over 22 years (1999-2020).

METHODS

CDC-WONDER data from 1999 to 2020 were analyzed to investigate mortality trends related to malignant neoplasm of the meninges. Data selection ensured inclusivity of all races, with confidentiality and death count thresholds considered. Demographics encompassed Census Regions, all genders, races, and 10-year age groups, along with a five-year forecast. Microsoft Excel (Microsoft Corporation, Redmond, Washington) and R Software (R Foundation, Boston, Massachusetts) were used for data processing and statistical analysis, with visualization through ARIMA modeling.

RESULTS

Cumulative home and hospice deaths were analyzed based on overall age, gender, race, and region, demonstrating that home and hospice deaths increased overall, particularly in the 65-74 and 75-84 age groups, and more so in females. White individuals showed increasing trends, while Black or African American individuals remained stable. Regionally, the South had the highest increase, while the Northeast remained stagnant.

CONCLUSION

There is a concerning upward trend in home or hospice deaths among individuals with malignant neoplasm of the meninges, particularly within the 65-84 age group, in females, among White individuals, and in the Southern region. More comprehensive data is needed, and further research must be conducted to understand the underlying causes for the rise in these demographics and to improve healthcare facilities.

Mortality and Years of Life Lost from Diabetes Mellitus in Poland: A Register-Based Study (2000-2022)

BACKGROUND

The aim of the study was to assess mortality and years of life lost from diabetes mellitus in Poland between 2000 and 2022.

METHODS

The database was created from death cards made available for the purposes of this study by Statistics Poland. The study used data on deaths caused by type 1 diabetes mellitus, T1DM (N = 33,328), and type 2 diabetes mellitus, T2DM (N = 113,706). Standardized death rates (SDRs) and standard expected years of life lost per person (SEYLLp) and per death (SEYLLd) were calculated. A time trend analysis was performed using joinpoint models. The annual percentage change (APC) and the average annual percentage change (AAPC) were estimated.

RESULTS

Between 2000 and 2022, 33,328 people died from T1DM in Poland. The SDR rate increased from 6.0 to 8.8 per 100,000 population in the analyzed period. The APC was 1.3% (p < 0.05). SEYLLp rates per 100,000 population were 79.3 in 2000 and 109.2 in 2022. SEYLLd rates were 22.9 and 17.9 years, respectively (APC = -1.0%, p < 0.05). The mean age of those who died from T1DM increased from 66.1 in 2000 to 72.5 in 2022. Between 2000 and 2022, 113,706 people died from T2DM. The SDR increased from 12.5 to 37.7 per 100,00 (APC = 5.5%, p < 0.05). SEYLLp rates were 88.8 and 296.0 per 100,000 population (APC = 6.4%, p < 0.05). SEYLLd rates decreased from 16.9 in 2000 to 13.4 in 2022 (AAPC = -1.0%, p < 0.05). The mean age of those who died from T2DM increased from 73.1 to 78.1 years.

CONCLUSIONS

The study showed a growing problem of diabetes as a cause of death and years of life lost.

Trends of Mortality due to Traumatic Brain Injury in the USA: A Comprehensive Analysis of CDC WONDER Data from 1999 to 2020

Traumatic brain injury (TBI) poses a significant public health challenge in the United States, with diverse causes and outcomes. Understanding the trends in TBI-related mortality is crucial for effective prevention and intervention strategies. This comprehensive analysis utilized data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database, covering the period from 1999 to 2020. Cause-of-death records were examined using the 10th Edition of the International Classification of Diseases and Related Health Problems diagnostic code S06 for TBI-related fatalities. Mortality rates were calculated per 100,000 individuals, adjusted for age and urban/rural status. Joinpoint Regression analysis was employed to identify significant trends over time. Between 1999 and 2020, 1,218,667 TBI-related deaths occurred, with varying mortality rates across demographic groups and geographic regions. Within the overall population, the highest annual average mortality rates were observed in the non-Hispanic (NH) American Indian or Alaska Native cohort, followed by NH white, NH black or African American, Hispanic or Latino, and NH Asian or Pacific Islander groups. Overall, there was an initial decrease in mortality rate from 1999 to 2012, followed by a subsequent significant increase. Males consistently exhibited higher mortality rates than females across all age groups. Disparities were also observed based on race/ethnicity, with NH American Indian or Alaska Native populations showing the highest mortality rates. Regional variations were evident, with the southern region consistently exhibiting the highest mortality rates. Evolving trends in TBI-related mortality in the United States highlight the need for targeted interventions, particularly in high-risk demographic groups and regions.