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Eng HM, L. Ellingsen C, Pedersen AG, Alfsen GC. Cause of death certificates in nursing homes: Does quality matter? A retrospective review from two counties in Norway. Scand J Public Health 2024; 52:711-717. [PMID: 37491994 PMCID: PMC11308255 DOI: 10.1177/14034948231187512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
AIMS One half of Norwegians die in nursing homes, where death certificates (DCs) are completed by two types of physicians: in-house physicians or physicians on call. The aims of this study were to examine differences in the quality of DCs due to type of physician and to uncover possible implications of errors for the public statistics. METHODS DCs from the year 2013 from nursing homes in the catchment area of Akershus University Hospital were examined with regard to logical deficiencies, garbage code diagnoses and type of certifying physician. In one third of cases, the registered causes of death were compared to information in the medical records. RESULTS A total of 873 DCs from 24 nursing homes were evaluated. Physicians on call certified 46% of all deaths. Logical deficiencies were found in 34% of all DCs and were more common in DCs from physicians on call. Garbage code diagnoses were used in every third DC, with 'sudden death' or 'cause of death unknown' preferred by physicians on call and 'unspecified pneumonia' preferred by in-house physicians. Comparisons against medical records uncovered missing information in 49% and 35% of DCs from physicians on call and in-house physicians, respectively. A dementia diagnosis was frequently overlooked by both physician types. Garbage code diagnoses were more common in DCs with missing information from medical records. CONCLUSIONS Error rates in DCs in nursing homes in Norway are high. The results raise concerns about the validity of public cause of death statistics.
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Affiliation(s)
- Hanna M. Eng
- Department of Pathology, Akershus University Hospital, Norway
| | | | - Anne G. Pedersen
- Norwegian Cause of Death Registry, Department of Health Registries, Norwegian Institute of Public Health, Norway
| | - G. Cecilie Alfsen
- Department of Pathology, Akershus University Hospital, Norway
- Faculty of Medicine, University of Oslo, Norway
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Walker B, Jani CT, Liu W, Punjwani S, Kareff S, Ceglowski P, Singh H, Mariano M, Salciccioli JD, Borges L, Lopes G. Does a "Western Lifestyle" Confer a Higher Burden of Colorectal Cancer? A Comparison of EU15+ Countries versus Global Trends between 1990 and 2019. Cancers (Basel) 2024; 16:2277. [PMID: 38927980 PMCID: PMC11201493 DOI: 10.3390/cancers16122277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
The incidence of colorectal cancer (CRC) in the U.S. is declining in adults 50 years and older; however, recent studies suggest an increasing disease burden among adults under age 50. This study aims to compare the incidence, mortality, and mortality-to-incidence ratios (MIRs) of CRC in EU15+ countries to determine if similar age-stratified occurrences are observed across these countries with similar "Western lifestyle"-related risk factors. Incidence and mortality rates for CRC between 1990 and 2019 were extracted using the Global Burden of Disease database. The data were age-stratified into groups between ages 25-49, 50-69, and greater than 69 years. We observed that the incidence of CRC increased globally for all age groups, with the highest increase observed for males (75.9%) and females (27.7%) aged 25-49. A similar trend was observed in 15 of the 19 EU15+ countries for males and 16 of the 19 EU15+ countries for females aged 25-49. Global mortality rates decreased for all age groups in females but increased for males in all age groups. This raises concerns regarding potentially modifiable risk factors contributing to increased CRC development and underscores the importance of implementing standardized screening at an earlier stage to ensure adequate detection in the younger population.
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Affiliation(s)
- Bradley Walker
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA; (B.W.); (W.L.); (S.P.); (P.C.); (M.M.); (L.B.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Chinmay T. Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA; (B.W.); (W.L.); (S.P.); (P.C.); (M.M.); (L.B.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA; (S.K.); (G.L.)
| | - Weitao Liu
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA; (B.W.); (W.L.); (S.P.); (P.C.); (M.M.); (L.B.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Shoheera Punjwani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA; (B.W.); (W.L.); (S.P.); (P.C.); (M.M.); (L.B.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Samuel Kareff
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA; (S.K.); (G.L.)
| | - Peter Ceglowski
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA; (B.W.); (W.L.); (S.P.); (P.C.); (M.M.); (L.B.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Melissa Mariano
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA; (B.W.); (W.L.); (S.P.); (P.C.); (M.M.); (L.B.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Justin D. Salciccioli
- Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Lawrence Borges
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA; (B.W.); (W.L.); (S.P.); (P.C.); (M.M.); (L.B.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Gastroenterology, Mount Auburn Hospital, Cambridge, MA 02138, USA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA; (S.K.); (G.L.)
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Lai H, Huang S, Anker SD, von Haehling S, Akishita M, Arai H, Chen L, Hsiao F. The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications. J Cachexia Sarcopenia Muscle 2024; 15:660-670. [PMID: 38291000 PMCID: PMC10995260 DOI: 10.1002/jcsm.13412] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Frailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on health utilization, use of HF-related medications and adverse clinical outcomes (all-cause mortality, all-cause readmissions and HF readmissions) among older HF patients. METHODS A total of 38 843 newly admitted HF patients were identified from Taiwan's National Health Insurance Research Database and categorized into three frailty subgroups (fit, mild frailty and severe frailty) based on the multimorbidity frailty index. Cox regression models and Fine and Gray subdistribution hazard models were used to estimate the impacts of frailty on clinical outcomes at 1 and 2 years of follow-up. Generalized estimating equation models were further conducted to evaluate the associations between longitudinal and time-varying use of HF-related medications and clinical outcomes among distinct frailty subgroups. RESULTS Of 38 843 older HF patients (mean age 80.4 ± 8.5 years, 52.3% females) identified, 68.3% were categorized as frail (47.5% of mild frailty and 20.8% of severe frailty). The median number of readmissions (fit: 1 [inter-quartile range-IQR 2], mild frailty: 1 [IQR 2] and severe frailty: 2 [IQR 3]) increased with the severity of frailty. Only 27.3% of HF patients died of cardiovascular diseases regardless of their frailty status. Compared with the fit group, the severe frailty group was associated with increased risk of all-cause mortality (adjusted hazard ratio 1.16, 95% confidence interval [CI] 1.11-1.21), all-cause readmissions (subdistributional hazard ratio (sHR) 1.21, 95% CI 1.16-1.25) and HF-related readmissions (sHR 1.14, 95% CI 1.09-1.20) at 2 years of follow-up. Those who used triple or more HF-related medications were at lower risk for all-cause readmissions (adjusted odds ratio [aOR] 0.49, 95% CI 0.44-0.54) and HF-related readmissions (aOR 0.42, 95% CI 0.37-0.47) at 2 years of follow-up even in the severe frailty group. CONCLUSIONS Frailty is highly prevalent and associated with increased risk of all-cause mortality, all-cause readmissions and HF readmissions among older HF patients. Those who were using triple or more HF-related medications were at lower risk of adverse clinical outcomes across distinct frailty subgroups. Further studies are needed to optimize the treatment strategies for older HF patients with distinct frailty status.
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Affiliation(s)
- Hsi‐Yu Lai
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Shih‐Tsung Huang
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Stefan D. Anker
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin BerlinBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Centre for Cardiovascular Research (DZHK)partner site Göttingen, GöttingenGöttingenGermany
| | | | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | - Liang‐Kung Chen
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General HospitalTaipeiTaiwan
- Taipei Municipal Gan‐Dau Hospital (Managed by Taipei Veterans General Hospital)TaipeiTaiwan
| | - Fei‐Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of PharmacyCollege of Medicine, National Taiwan UniversityTaipeiTaiwan
- Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
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Jani CT, Ahmed A, Singh H, Mouchati C, Al Omari O, Bhatt PS, Sharma R, Farooq M, Liu W, Shalhoub J, Marshall D, Salciccioli JD, Warner JL, Lam P. Burden of AML, 1990-2019: Estimates From the Global Burden of Disease Study. JCO Glob Oncol 2023; 9:e2300229. [PMID: 37992271 PMCID: PMC10681472 DOI: 10.1200/go.23.00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE AML accounts for 80% of acute leukemia in adults. While progress has been made in treating younger patients in the past 2 decades, there has been limited improvement for older patients until recently. This study examines the global and European Union (EU) 15+ trends in AML between 1990 and 2019. METHODS We extracted age-standardized incidence rates (ASIRs), age-standardized death rates (ASMRs), and disability-adjusted life years, stratified by sex from the Global Burden of Disease Study database, and mortality-to-incidence ratio (MIR) were computed. Trends were compared using Joinpoint regression. RESULTS The findings show a global increase in AML incidence for both sexes from 1990 to 2019. In the EU15+ countries, most countries exhibited an increase in ASIR for both sexes. Joinpoint revealed that globally for male patients, ASIR steadily increased until 2010, remained stable until 2015 followed by a decline till 2019. Similar trends were observed in female patients. For ASMR, although there was an increase globally and in most EU15+ countries, there was a statistically significant decrease in mortality rates globally and in the majority of EU15+ countries in recent years. MIR improved in both sexes globally. On age stratification, AML burden was highest among older groups (55 years and older), while the lowest rates were observed in younger than 20 years. CONCLUSION The findings from our study indicate a global rise in AML incidence and mortality in both sexes and decrease in MIR from 1990 to 2019 suggesting a better survival. However, on Joinpoint analysis, there is no change in MIR in women in the past decade and past 4 years in men indicating plateau in survival trends despite recent advances.
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Affiliation(s)
- Chinmay T. Jani
- Sylvester Comprehensive Cancer Center at University of Miami, Miami, FL
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
| | - Alaaeldin Ahmed
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
| | - Harpreet Singh
- M.D.R Collaborative Group, London, United Kingdom
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI
| | - Christian Mouchati
- M.D.R Collaborative Group, London, United Kingdom
- Department of Neurology, Cleveland Clinic, Cleveland, OH
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
- Department of Pulmonary and Critical Care, Temple University, Philadelphia, PA
| | - Padmanabh S. Bhatt
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
| | - Rajesh Sharma
- Humanities and Social Science, National Institute of Technology Kurukshetra, Haryana, India
| | | | - Weitao Liu
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Joseph Shalhoub
- M.D.R Collaborative Group, London, United Kingdom
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Dominic Marshall
- M.D.R Collaborative Group, London, United Kingdom
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Justin D. Salciccioli
- Department of Medicine, Harvard Medical School, Boston, MA
- M.D.R Collaborative Group, London, United Kingdom
- Department of Pulmonary and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeremy L. Warner
- Center for Clinical Cancer Informatics and Data Science, Legorreta Cancer Center, Brown University, Providence, RI
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI
| | - Prudence Lam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
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5
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Jani CT, Singh H, Abdallah N, Mouchati C, Arora S, Kareff S, Salciccioli J, Thomson CC, Velcheti V. Trends in Lung Cancer Incidence and Mortality (1990-2019) in the United States: A Comprehensive Analysis of Gender and State-Level Disparities. JCO Glob Oncol 2023; 9:e2300255. [PMID: 38127772 PMCID: PMC10752493 DOI: 10.1200/go.23.00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Lung cancer is the leading cause of cancer-related deaths in the United States. This study aims to analyze lung cancer incidence, mortality, and related statistics from 1990 to 2019, focusing on national- and state-level trends and exploring potential disparities between sexes. METHODS The Global Burden of Disease database was used to extract tracheal, bronchus, and lung cancer mortality data from 1990 to 2019 for both males and females and across all states of the United States. Age-standardized incidence rates, age-standardized mortality rates, disability-adjusted life years (DALYs), and mortality-to-incidence indices (MIIs) were studied to assess for gender-based, geographic, and temporal disparities. Joinpoint regression analysis was performed to further evaluate trends. RESULTS The incidence of these cancers in the United States decreased between 1990 and 2019 by 23.35%, with a more significant decline in males (37.73%) than females (1.41%). Similarly, for mortality, a decrease was observed for both sexes combined (26.83%), but much more significantly for males (40.23%) than females (6.01%). The MIIs decreased overall, but there were variations across states. DALYs decreased for both sexes combined, with males experiencing a larger reduction, but an increase was noted in some states for females. CONCLUSION This analysis reveals diverse trends pertaining to the incidence, mortality, and disability burden associated with lung cancer by sex and states in the United States, emphasizing the need for targeted interventions to reduce disparities. These findings contribute to our understanding of the current landscape of lung cancer and can inform future strategies for prevention, early detection, and management.
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Affiliation(s)
- Chinmay T. Jani
- Sylvester Comprehensive Cancer Center at University of Miami, Miami, FL
- MDR Collaborative Group, London, United Kingdom
- Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Harpreet Singh
- MDR Collaborative Group, London, United Kingdom
- Medical College of Wisconsin, Milwaukee, WI
| | - Nour Abdallah
- MDR Collaborative Group, London, United Kingdom
- Cleveland Clinic, Cleveland, OH
| | - Christian Mouchati
- MDR Collaborative Group, London, United Kingdom
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Shreya Arora
- MDR Collaborative Group, London, United Kingdom
- Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Samuel Kareff
- Sylvester Comprehensive Cancer Center at University of Miami, Miami, FL
| | - Justin Salciccioli
- MDR Collaborative Group, London, United Kingdom
- Brigham and Women's Hospital—Harvard Medical School, Boston, MA
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Paladini A, Vallejo R, Guerrero M, Pasqualucci A, Peppin JF, Pergolizzi J, Varrassi G. Answering Big Questions in Pain Medicine. Cureus 2023; 15:e43561. [PMID: 37719539 PMCID: PMC10502917 DOI: 10.7759/cureus.43561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
The future of pain medicine is marked by many questions. What can other nations around the world learn from the opioid crisis that is still affecting the United States? The American opioid experience was mischaracterized and wrongly described, and its causes were misdiagnosed from the outset, leading to its mismanagement and the abandonment of many chronic pain patients to their suffering. There are a few new drugs in the analgesic armamentarium. What new targets do we have in pain medicine? There are many breakthroughs, discoveries, and potential new targets that could add to our analgesic prescribing choices. These include sigma receptors, d-amino acid oxidase, endoplasmic reticulum stress receptors, histone deacetylase, and others. Neuromodulation had been used with varying degrees of success for years, but with a simplistic approach based on the gate theory of pain. Despite our familiarity with neuromodulation and spinal cord stimulators, neuromodulation research indicates that the activation of glial cells may activate the immune system and enhance analgesia. Neuromodulation studies have concentrated on how electricity affects neuronal activity rather than how electrical activity could reduce pain. There are still more frontiers in our battle against pain and some promising avenues for treatments. This narrative review will try to summarize what can be done from the perspective of recent technological and pharmacological developments.
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Affiliation(s)
- Antonella Paladini
- Department of Life, Health & Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
| | - Ricardo Vallejo
- Department of Research, Millennium Pain Center, Bloomington, USA
| | - Marixa Guerrero
- Department of Pain Medicine/ Pain Management, Clínica del Country, Bogota, COL
| | - Alberto Pasqualucci
- Department of Anesthesia and Critical Care, University of Perugia, Perugia, ITA
| | - John F Peppin
- Department of Osteopathic Medicine, Marian University, Indianapolis, USA
| | - Joseph Pergolizzi
- Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Nema Research, Naples, USA
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Huang ST, Chen LK, Hsiao FY. Clinical impacts of frailty on 123,172 people with diabetes mellitus considering the age of onset and drugs of choice: a nationwide population-based 10-year trajectory analysis. Age Ageing 2023; 52:afad128. [PMID: 37505989 DOI: 10.1093/ageing/afad128] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Indexed: 07/30/2023] Open
Abstract
AIMS Frailty substantially increased the risk of adverse clinical outcomes, which was also critical in diabetes management. This study aimed to investigate the interrelationships between the age of onset, frailty, anti-diabetic medications and clinical outcomes in people with diabetes mellitus (DM). METHODS A total of 123,172 people aged 40 years and older who were newly diagnosed with DM were identified and categorised into four frailty subgroups (robust, mild, moderate and severe) based on the multimorbidity frailty index (mFI). Cox proportional hazards models were used to examine associations between frailty and clinical outcomes at different ages of DM onsets (40-64, 65-74, 75-84 and 85+ years). Outcomes of interest included generic outcomes (mortality and unplanned hospitalisation) and DM-related outcomes (cardiovascular disease-related mortality, major adverse cardiovascular events (MACEs), diabetes-related hospitalisation and hypoglycaemia). RESULTS The proportion of frailty increased with age at diagnosis amongst people with incident DM and the mFI scores increased significantly during the 10-year follow-up. Amongst people with diabetes, those with mild, moderate and severe frailty were associated with greater risks of all-cause mortality (mild: adjusted hazard ratio (aHR) 1.69 [95% confidence interval (CI) 1.60-1.80], P < 0.01; moderate: aHR 2.46 [2.29-2.65], P < 0.01; severe frailty: aHR 3.40 [3.16-3.65], P < 0.01) compared with the robust group. Similar results were found in unplanned hospitalisations, cardiovascular disease-related mortality, MACEs and hypoglycaemia. CONCLUSIONS Our study quantified the prevalence of frailty, captured its dynamic changes and examined its impacts on various clinical outcomes amongst people with diabetes at different ages at onset. Frailty assessment and management should be implemented into routine diabetes care.
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Affiliation(s)
- Shih-Tsung Huang
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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8
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Al Busaidi S, Al Alawi AM, Al Masruri R, Al Balushi S, Al-Badi A. Quality of death certification based on the documented underlying cause of death: A retrospective study. J Forensic Leg Med 2023; 97:102547. [PMID: 37307775 DOI: 10.1016/j.jflm.2023.102547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The underlying cause of death (UCOD) documented in the death certificate is a cornerstone in the mortality data that has significant impact on national policies, health system, and socioeconomics. However, a wide range of inaccuracies have been reported worldwide and were linked to multiple factors, including sociodemographic development and lack of physician training. Hence, this study aimed to assess the quality of death certification by reviewing the reported UCOD in the death certificate and study the potential factors that might be associated with inaccuracies. METHODS All in-patient deaths that occurred in the Sultan Qaboos University Hospital from January 2020 to 31 December 2020 were included in this retrospective study. The study investigators reviewed all death certifications that were recorded during the study period for the accuracy of the documented UCOD using a systemic framework recommended by the World Health Organization. RESULTS The study included 384 mortality cases. The mean age at the time of death was 55.7 ± 27.1 years, and 209 (54.3%) cases were men. Approximately 80% (95% confidence interval: 84-76%) of the deceased patients had inaccurate data on the UCOD. Old age (58.1 ± 25.8 vs 46.5 ± 30.1, p < 0.001), death certification by doctor in training (70.8% vs 51.9%, p = 0.001), and admission under the Department of Medicine (68.5% vs 54.4%, p = 0.019) were more common in mortality cases with inaccurate data on the UCOD. Regression analysis confirmed that old age, male sex, and certification by doctor in training were independent predictors of inaccurate data on the UCOD. CONCLUSION Inaccurate data on the UCOD is a prevalent issue in many healthcare settings, especially in the developing countries. Introduction of death certification training in the medical curriculum for medical doctors, implementation of periodic auditing, and provision of feedback are among the evidence-based approaches that are likely to improve the overall accuracy of mortality data.
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Affiliation(s)
- Salim Al Busaidi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
| | - Abdullah M Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
| | - Reema Al Masruri
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Shahad Al Balushi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Amira Al-Badi
- Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
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Trends of kidney cancer burden from 1990 to 2019 in European Union 15 + countries and World Health Organization regions. Sci Rep 2022; 12:22368. [PMID: 36572700 PMCID: PMC9792551 DOI: 10.1038/s41598-022-25485-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022] Open
Abstract
In recent decades, variability in the incidence and mortality of kidney cancer (KC) has been reported. This study aimed to compare trends in incidence, mortality, and disability-adjusted life years (DALY) of KC between the European Union (EU) 15 + countries and 6 World Health Organization (WHO) regions. The data of KC Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and age-standardized DALYs were extracted from the Global Burden of Disease database. Joinpoint regression was employed to examine trends. From 1990 to 2019, the ASIR increased in most countries except for Luxembourg (males), the USA (females) and Austria and Sweden (both sexes). ASIR increased across all 6 WHO regions for both sexes except for females in Americas. The ASMR increased in 10/19 countries for males and 9/19 for females as well across most WHO regions. The mortality-to-incidence ratio (MIR) decreased in all countries and WHO regions. Trends in DALYs were variable across countries and WHO regions. While the incidence and mortality from KC rose in most EU15 + countries and WHO regions from 1990 to 2019, the universal drop in MIR suggests an overall improvement in KC outcomes. This is likely multifactorial, including earlier detection of KC and improved treatments.
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Factors Associated with Major Errors on Death Certificates. Healthcare (Basel) 2022; 10:healthcare10040726. [PMID: 35455903 PMCID: PMC9029766 DOI: 10.3390/healthcare10040726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to investigate errors on death certificates and factors associated with the occurrence of major errors. A retrospective analysis was conducted for six months in 2020 at a university training hospital. Errors were judged as major and minor errors according to the contribution to the process of determining the cause of death. Death certificates were classified into two groups with major errors (ME group) and without major errors (non-ME group). General characteristics of the death certificates, the main cause of death (cancer, cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, genitourinary disease, intentional self-harm, external causes, and other causes), the number of causes of deaths written on the death certificate, and major and minor errors were investigated. The ME group had 127 cases out of 548 death certificates. The number of causes of deaths written on the death certificates and the total number of errors were higher in the ME group than in the non-ME group. Cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, external causes, and other diseases as causes of deaths had higher risks of major errors on death certificates than cancer as a cause of death. The group with cancer as a cause of death had the lowest incidence of major errors and fewer causes of deaths. To reduce major errors, continuous education and feedback are needed for those who are qualified to issue a death certificate.
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Schuster-Bruce J, Jani C, Goodall R, Kim D, Hughes W, Salciccioli JD, Marshall D, Shalhoub J. A Comparison of the Burden of Thyroid Cancer Among the European Union 15+ Countries, 1990-2019: Estimates From the Global Burden of Disease Study. JAMA Otolaryngol Head Neck Surg 2022; 148:350-359. [PMID: 35266977 PMCID: PMC8914910 DOI: 10.1001/jamaoto.2021.4549] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/10/2022] [Indexed: 01/14/2023]
Abstract
Importance The global incidence of thyroid cancer has been increasing rapidly, and this increase has had an attendant burden on health systems. However, it is unclear how the burden of this disease differs among the pre-2004 countries of the European Union (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and the UK), US, Australia, Canada, and Norway (EU15+). Objective To assess the trends in mortality, incidence, and disability-adjusted life-years (DALYs) associated with thyroid cancer between 1990 and 2019 in EU15+ nations. Data analysis was conducted from July 11 to October 11, 2021. Design, Setting, and Participants Observational cross-sectional analysis of the incidence of thyroid cancer was conducted using data obtained from the Global Burden of Disease Study database. Nineteen countries of the EU15+ were included. Exposures Thyroid cancer. Main Outcomes and Measures Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs) and DALYs were extracted for individual EU15+ countries per sex for each of the years from 1990 to 2019, and mortality-to-incidence indexes were computed. Joinpoint regression analysis was used to describe the trends. Results Thirteen of 19 countries (68%) showed an average annual percentage change increase in ASIR across the study period (range, 0.2%-2.5%). Joinpoint regression analysis revealed largely plateauing ASIR trends in recent years across most EU15+ nations since 1990. Between 2011 and 2019, the estimated annual percentage change in the US was 0. Australia, Denmark, and the US were the only countries with increasing ASMR trends with positive average annual percentage changes: Australia, 0.6 (95% CI, 0.2-1.0); Denmark, 1.0 (95% CI, 0.8-1.3); and US, 0.4 (95% CI, 0.4-0.5); the remaining 16 countries showed negative trends (range, -0.2 to -2.1). Disability-adjusted life-years decreased in all EU15+ countries except Australia, Denmark, and the US. Conclusions and Relevance This cross-sectional analysis found that overall, the burden of thyroid cancer across EU15+ countries appears to be decreasing, evidenced by plateauing incidence rates and reductions in mortality and DALYs over the 30-year study period. However, the US and Australia appear to have increasing ASMR and DALY trends. Ongoing observation is required to monitor how changes in international clinical practice guidelines affect thyroid cancer DALYs and mortality.
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Affiliation(s)
- James Schuster-Bruce
- Department of Ear, Nose and Throat and Head & Neck Surgery, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Richard Goodall
- Department of Plastic Surgery, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Dae Kim
- Department of Ear, Nose and Throat and Head & Neck Surgery, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - William Hughes
- St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom
| | - Justin D. Salciccioli
- Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominic Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Park S, Kim SH. Does the Application of International Classification of Disease Codes for the Cause of Death on Death Certificates Reduce Garbage Codes? INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221081433. [PMID: 35384751 PMCID: PMC8990542 DOI: 10.1177/00469580221081433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aimed to determine if applying International Classification of Diseases (ICD) disease codes directly as the cause of death (COD) on death certificates (DCs) instead of writing or typing the COD could reduce the use of garbage codes. METHODS Beginning in April of 2016, a documentation process change was made, retiring the process of hand-writing or typing the COD onto DCs to directly applying ICD disease codes that were registered during the patient's course of treatment. The DCs issued at the emergency department (ED) 1 year before (Pre-code group) and after (Code group) applying ICD disease codes directly on DCs was instituted were retrospectively analyzed. The occurrence of garbage codes along with other major and minor errors was compared between the two groups. The investigation and judgment of errors were performed by four emergency physicians. RESULTS The overall garbage code occurrence in the Code group (25%) was significantly lower than that in the Pre-code group (49%). Fewer garbage codes were used in the Code group with an average of .5 in the Pre-code group and .3 in the Code group. No significant difference was identified in major error occurrences except for in the garbage codes. Minor errors were more common in the Pre-code group than in the Code group. CONCLUSION The overall use of garbage codes on DCs could be reduced by changing the process by which physicians complete DCs, that is, the application of documenting ICD disease codes directly as the COD on DCs.
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Affiliation(s)
- Soobeom Park
- Department of Emergency Medicine,
University of Ulsan College of Medicine, Ulsan University
Hospital, Dong-gu Ulsan, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine,
University of Ulsan College of Medicine, Ulsan University
Hospital, Dong-gu Ulsan, Korea
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Lai HY, Huang ST, Chen LK, Hsiao FY. Development of Frailty Index Using ICD-10 Codes to Predict Mortality and Rehospitalization of Older Adults: An Update of the Multimorbidity Frailty index. Arch Gerontol Geriatr 2022; 100:104646. [DOI: 10.1016/j.archger.2022.104646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/23/2022]
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Lin CW, Huang HY, Chung FT, Lo CY, Huang YC, Wang TW, Yang LY, Pan YB, Chung KF, Wang CH. Emphysema-Predominant COPD Had a Greater 5-Year Mortality and a Worse Annual Decline in Lung Function Than Airway Obstruction-Predominant COPD or Asthma at Initial Same Degree of Airflow Obstruction. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1261. [PMID: 34833478 PMCID: PMC8622286 DOI: 10.3390/medicina57111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: We studied whether the extent of exertional oxygen desaturation and emphysema could cause greater mortality in COPD and asthma independent of airflow obstruction. Materials and Methods: We performed a 5-year longitudinal observational study in COPD and asthma patients who matched for airflow obstruction severity. All subjects performed a 6-min walk test (6MWT) and high-resolution computed tomography (HRCT) and followed spirometry and oxygen saturation (SpO2) during the 6MWT every 3-6 months. Overall survival was recorded. Cumulative survival curves were performed according to the Kaplan-Meier method and compared with the log-rank test. Results: The COPD group had higher emphysema scores, higher Δinspiratory capacities (ICs) and lower SpO2 during the 6MWT, which showed a greater yearly decline in FEV1 (40.6 mL) and forced vital capacity (FVC) (28 mL) than the asthma group (FEV1, 9.6 mL; FVC, 1.2 mL; p < 0.05). The emphysema-predominant COPD group had an accelerated annual decline in lung function and worse survival. The nadir SpO2 ≤ 80% and a higher emphysema score were the strong risk factors for mortality in COPD patients. Conclusions: The greater structural changes with a higher emphysema score and greater desaturation during the 6MWT in COPD may contribute to worse yearly decline in FEV1 and higher five-year mortality than in asthma patients with a similar airflow obstruction. The lowest SpO2 ≤ 80% during the 6MWT and emphysema-predominant COPD were the strong independent factors for mortality in chronic obstructive airway disease patients.
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Affiliation(s)
- Chang-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hung-Yu Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Yu Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Chen Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ting-Wen Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (L.-Y.Y.); (Y.-B.P.)
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (L.-Y.Y.); (Y.-B.P.)
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London & Royal Brompton Hospital, London SW3 6LY, UK;
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Chou MY, Huang ST, Liang CK, Peng LN, Lin YT, Hsiao FY, Chen LK. All-cause mortality, cardiovascular mortality, major cardiovascular events and hypoglycaemia of patients with diabetes onset at an older age: results from the 10-year nationwide cohort study. Age Ageing 2021; 50:2094-2104. [PMID: 34628489 DOI: 10.1093/ageing/afab183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Longitudinal adverse outcomes are unclear among adults with diabetes according to the age of onset. OBJECTIVE To investigate the longitudinal diabetes-related outcomes in adults with new-onset diabetes stratified by age. DESIGN Retrospective cohort study. SETTING Taiwan National Health Insurance Research Database claims data from 2000 to 2015. SUBJECTS In total, 115,751 participants aged ≥40 years with new-onset diabetes in 2003 were recruited and stratified by the ages 40-64 (64.3%), 65-74 (21.2%), 75-84 (11.8%) and ≥85 years (2.7%) at the time of diagnosis. METHODS Time-varying multivariate Cox proportional hazards model adjusted for covariates was used to examine the associations between the ages of the patients at diabetes onset and the outcomes of interest [all-cause mortality, cardiovascular (CV) mortality, major cardiovascular events (MACE) and hypoglycaemia] during a 10-year follow-up period. RESULTS The results showed that compared with those patients aged 40-64 at diagnosis, patients with older-onset diabetes had significantly higher comorbidities (P < 0.01) and a higher diabetes severity (P < 0.01). Patients with older-onset diabetes had a higher risk of all-cause mortality [adjusted hazard ratio (aHR) 2.28, 4.48 and 10.07 in 65-74, 75-84 and ≥85 years old, respectively], CV mortality (aHR = 2.82, 6.06 and 15.91), MACE (aHR = 2.19, 3.01 and 4.15) and hypoglycaemia (aHR = 2.41, 3.59 and 4.62) than patients aged 40-64 during a 10-year follow-up period. CONCLUSIONS Patients with diabetes onset at an older age was associated with increased risks of all-cause mortality, CV mortality, MACE and hypoglycaemia after adjusting for the severity of diabetes and anti-diabetic treatment.
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Affiliation(s)
- Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Geriatric Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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Alipour J, Payandeh A. Common errors in reporting cause-of-death statement on death certificates: A systematic review and meta-analysis. J Forensic Leg Med 2021; 82:102220. [PMID: 34325081 DOI: 10.1016/j.jflm.2021.102220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
The prevalence of death certificate (DC) completion errors is a universal issue. This research aimed to estimate the global prevalence of DC errors by performing a systematic review and meta-analysis. Databases including Web of Science, PubMed, Science Direct, Scopus, and Google search engine were searched by September 4, 2020. Thirty-five articles were included in the final analysis. The exact Clopper-Pearson confidence intervals, heterogeneity assessment, random effects models with Mantel-Haenszel methods were employed using STATA version 14.2 software. Absence of time interval (80.9%), absence/inappropriateness of comorbidities (45.1%), incorrect underlying cause-of-death (COD) statement (38.9%), improper sequence (36.2%), mechanism of death with underlying COD (UCOD) (33.6%), abbreviations (33.0%), mechanism only (23.9%), competing causes (21.5%), two or more condition per line (19.3%), incorrect COD (18.0%), nonspecific or ill-defined condition (16.4%), blanks/repetitive phrases (12.5%), and illegible handwriting (11.6%) were the most prevalent errors, respectively. Lack of or poor training/educating of certifiers, lack of physician understandings about the importance of DC and absence of quality assurance mechanisms were identified as the most significant causes of DC errors. Furthermore, providing ongoing, targeted and interactive training/education, and establishment of quality control and tracking mechanisms for completion of deficient DCs were suggested as the important improving solutions.
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Affiliation(s)
- Jahanpour Alipour
- Health Information Management, Department of Health Information Technology, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Abolfazl Payandeh
- Biostatistics, Department of Biostatistics and Epidemiology, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Chan TM, Chiou MJ, Kuo CF. Adverse pregnancy outcomes in women with Behçet's disease: population-based registry linkage study in Taiwan. Clin Rheumatol 2021; 40:4135-4142. [PMID: 33834360 DOI: 10.1007/s10067-021-05688-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the risks of adverse pregnancy outcomes in women with Behçet's disease (BD) METHODS: Data collected by the Taiwan National Health Insurance Administration between 2001 and 2012 was used for our study. A total of 2,350,339 pregnancies from the Taiwan National Health Insurance database and birth registry were identified. Maternal history of BD in women was ascertained. A comparison was made to determine whether BD increased the risk of health issues associated with pregnancy and fetal outcomes. Using an adjusted generalized estimating equation model, we estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for fetal-neonatal and maternal outcomes. RESULTS There were 99 pregnancies in women with BD and 2,350,240 pregnancies in women without BD. The OR and 95% CI of puerperal cerebrovascular disorders were 12.08 (1.7-85.9), and those of gestational diabetes were 1.89 (1.1-3.25). Both were higher than the values in general pregnant women after adjusting for age, infant sex, urban residence, income, occupation, birth year, and Charlson Comorbidity Index. However, there were no adverse fetal outcomes in pregnant women with BD. CONCLUSIONS Patients with BD have no significant risks of multiple complications except for puerperal cerebrovascular disease and gestational diabetes during pregnancy. Close monitoring of blood sugar is suggested. Furthermore, neonatal outcomes were not influenced by BD. Key Points • Patients with Behçet's disease are at a risk of puerperal cerebrovascular disease and gestational diabetes during pregnancy. • The odds ratio and 95% confidence interval for puerperal cerebrovascular disorders were 12.08 (1.7-85.9), and those for gestational diabetes were 1.89 (1.1-3.25). • Pregnant patients with Behçet's disease have no risks of neonatal outcomes.
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Affiliation(s)
- Tien-Ming Chan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Taoyuan, 333, Taiwan
| | - Meng-Jiun Chiou
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Taoyuan, 333, Taiwan
- Centre for Artificial Intelligence Research in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Taoyuan, 333, Taiwan.
- Centre for Artificial Intelligence Research in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK.
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Wang T, Huang S, Wang C, Lin F, Chen H, Hsiao F. Nationwide trends in incidence, healthcare utilization, and mortality in hospitalized heart failure patients in Taiwan. ESC Heart Fail 2020; 7:3653-3666. [PMID: 32924330 PMCID: PMC7755001 DOI: 10.1002/ehf2.12892] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/28/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022] Open
Abstract
AIMS The objective of this study was to estimate the nationwide annual incidence, healthcare utilization, and mortality among hospitalized heart failure (HF) patients in Taiwan. METHODS AND RESULTS People aged 20 years or older and having been newly admitted for HF between 2010 and 2015 were identified from Taiwan's National Health Insurance Research Database. For 124 816 patients with incident HF hospitalizations between 2010 and 2012, we further analysed their treatment patterns, healthcare utilizations, and mortality during index hospitalization and within 3 years following discharge from the index hospitalization. The age-stratified incidences were declined by 10-20% in people aged 55 years or older, but increased by ~4% among people younger than 44 years old between 2010 and 2015. For all incident hospitalized HF patients, the percentages of patients visiting the emergency room, were rehospitalized, and treated with guideline-directed medical therapy were highest in the first year. Approximately two-thirds of subsequent hospitalizations were due to non-HF and non-cardiovascular causes. The all-cause mortality rate during index hospitalization was 8.5%, whereas the mortality rates at 30 days, 90 days, 180 days, 1 year, 2 years, and 3 years following discharge were 3.5%, 8.9%, 14.4%, 22.5%, 33.9%, and 42.8%, respectively, for those surviving index HF hospitalization. Non-cardiovascular disease-related deaths accounted for nearly 60% of all deaths. CONCLUSIONS Our study reveals that, in contemporary Taiwan, the >10% annual mortality following the first year of hospitalization, 30% deaths occurring outside the hospital, and 60% non-cardiovascular-related deaths, along with the decreasing use of guideline-directed medical therapy, highlight sectors requiring more attention.
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Affiliation(s)
- Tzung‐Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Shih‐Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Chen‐Yu Wang
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Fang‐Ju Lin
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
| | - Ho‐Min Chen
- Health Data Research CenterNational Taiwan UniversityTaipeiTaiwan
| | - Fei‐Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
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Arya V, Page A, Armstrong G, Kumar GA, Dandona R. Estimating patterns in the under-reporting of suicide deaths in India: comparison of administrative data and Global Burden of Disease Study estimates, 2005-2015. J Epidemiol Community Health 2020; 75:jech-2020-215260. [PMID: 33257456 DOI: 10.1136/jech-2020-215260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/17/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND It has been proposed that the National Crime Records Bureau (NCRB), which reports suicides in India, differentially underenumerates suicides by geographic and demographic factors. We assessed the extent of potential underenumeration by comparing suicides recorded in NCRB data with recent estimates of Indian suicides developed by the Global Burden of Disease (GBD) initiative. METHODS Age-standardised suicide rates were calculated for both data sources by sex, age and state, and rate ratios of NCRB to GBD estimates by corresponding strata were compared to ascertain the relative under-reporting in the NCRB report. RESULTS The GBD Study reported an additional 802 684 deaths by suicide (333 558 male and 469 126 female suicide deaths) compared with the NCRB report between 2005 and 2015. Among males, the average under-reporting was 27% (range 21%-31%) per year, and among females, the average under-reporting was 50% (range 47%-54%) per year. Under-reporting was more evident among younger (15-29 years) and older age groups (≥60 years) compared with middle age groups. Indian states belonging to low Socio-Demographic Index (SDI) generally had greater underenumeration compared with middle and high-SDI states. CONCLUSION NCRB data under-report suicides in India, and differentially by sex, age and geographic area, possibly because of lack of community-level reporting of suicides due to social stigma and legal consequences. While the recent decriminalisation of suicide is expected to improve community-level reporting of suicides, suicide prevention policies should be developed, with a priority to address social stigma attached with suicide and suicidal behaviour, especially among females.
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Affiliation(s)
- Vikas Arya
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
- International Association for Suicide Prevention, Washington, DC, USA
| | - Andrew Page
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Alipour J, Karimi A, Hayavi Haghighi MH, Hosseini Teshnizi S, Mehdipour Y. Death certificate errors in three teaching hospitals of Zahedan, southeast of Iran. DEATH STUDIES 2020; 46:1157-1165. [PMID: 32757885 DOI: 10.1080/07481187.2020.1801893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Accurate completion of death certificates is of critical importance for public health policy and statistical purposes. In assessing 936 available death certificates, most contained one or more errors. Minor errors (e.g. absence of time intervals) were more common than major errors (e.g. the use of general terms instead of specific conditions). Providing education, complying with standards established by the World Health Organization, applying quality control of death certificates, and correcting deficient death certificates in the hospitals seem necessary to inform the effectiveness of public health programs, future health policies, quality health planning, and prioritization of health and medical research programs.
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Affiliation(s)
- Jahanpour Alipour
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Health Information Technology Department, Health Information Management, Paramedical School, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Afsaneh Karimi
- Health Information Technology Department, Health Information Management, Paramedical School, Zahedan University of Medical Sciences, Zahedan, Iran
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohamad Hosein Hayavi Haghighi
- Department of Health Information Technology, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, IR, Iran
| | - Saeed Hosseini Teshnizi
- Department of Biostatistics, School of Allied Medical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, IR, Iran
| | - Yousef Mehdipour
- Health Information Technology Department, Torbat Heydarieh University of Medical Sciences, Khorasan Razavi, Iran
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Chou MY, Huang ST, Liang CK, Hsiao FY, Chen LK. Clinical characteristics and 10-year outcomes of diabetes in adults with advancing age at onset: A population cohort. Arch Gerontol Geriatr 2020; 88:104039. [DOI: 10.1016/j.archger.2020.104039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 11/26/2022]
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Death Certification in Northern Alberta: Error Occurrence Rate and Educational Intervention. Am J Forensic Med Pathol 2020; 41:11-17. [PMID: 31977347 DOI: 10.1097/paf.0000000000000527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Errors in death certification can directly affect the decedent's survivors and the public register. We assessed the effectiveness of an educational seminar targeting frequent and important errors identified by local death certificate (DC) evaluation. Retrospective review of 1500 DCs categorized errors and physician specialty. A 60-minute didactic/case-based seminar was subsequently designed for family medicine physician (FAM) participants, with administration of presurvey, immediate post, and 2-month postsurveys. Most DCs were completed by FAM (73%), followed by internists (18%) and surgeons (3%). Error occurrence (EO) rate ranged between 32 and 75% across all specialities. Family medicine physician experienced in palliative care had the lowest EO rate (32%), significantly lower (P < 0.001) than FAM without interest in palliative care (62%), internal medicine (62%), and surgery (75%). Common errors were use of abbreviations (26%), mechanism as underlying cause of death (23%), and no underlying cause of death recorded (22%). Presurvey participants (n = 72) had an overall EO rate of 72% (64% excluding formatting errors). Immediate postsurvey (n = 75) and 2-month postsurvey (n = 24) participants demonstrated significantly lower overall EO (34% and 24%, respectively), compared with the Pre-S (P < 0.05). A 60-minute seminar on death certification reduced EO rate with perceived long-term effects.
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Zhang-Jian SJ, Yang HY, Chiu MJ, Chou IJ, Kuo CF, Huang JL, Yeh KW, Wu CY. Pregnancy outcomes and perinatal complications of Asian mothers with juvenile idiopathic arthritis - a case-control registry study. Pediatr Rheumatol Online J 2020; 18:9. [PMID: 31973755 PMCID: PMC6979350 DOI: 10.1186/s12969-020-0404-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/06/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUNDS In order to provide juvenile idiopathic arthritis (JIA) patients with better pre-conceptional and prenatal counselling, we investigated the obstetrical and neonatal outcomes among women with Asian descent. METHODS Through the linkage of Taiwan National Health Insurance database and National Birth Registry, we established a population-based birth cohort in Taiwan between 2004 and 2014. In a case control study design, first children born to mothers with JIA are identified and matched with 5 non-JIA controls by maternal age and birth year. Conditional logistic regression was used to calculate odds ratios for maternal and neonatal outcomes crude and with adjustment. RESULTS Of the 2,100,143 newborn, 778 (0.037%) were born to JIA mothers. Among them, 549 first-born children were included in this research. Our result suggested that babies born to mothers with JIA were more likely to have low birth body weight, with an adjusted OR of 1.35(95% CI: 1.02 to 1.79) when compared to babies born to mothers without. No differences were observed in other perinatal complications between women with and without JIA including stillbirth, prematurity, or small for gestational age. The rate of adverse obstetrical outcomes such as caesarean delivery, preeclampsia, gestational diabetes, postpartum hemorrhage and mortality were also similar between the two. CONCLUSIONS Adverse obstetrical and neonatal outcomes were limited among Asian mothers with JIA. Intensive care may not be necessary for JIA mothers and their newborns.
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Affiliation(s)
| | - Huang-Yu Yang
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDepartment of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Meng-Jun Chiu
- 0000 0001 0711 0593grid.413801.fCenter for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Jun Chou
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDivision of Neurology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDepartment of Rheumatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jing-Long Huang
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDivision of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- grid.145695.aChang Gung University, College of Medicine, Taoyuan, Taiwan ,0000 0001 0711 0593grid.413801.fDivision of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Chang Gung University, College of Medicine, Taoyuan, Taiwan. .,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Gleich S, Viehöver S, Teipel A, Drubba S, Turlik V, Hirl B. [Death certificates-an underestimated source of information for statistics, judicature, public health, and science]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1415-1421. [PMID: 31686152 DOI: 10.1007/s00103-019-03042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The thorough external examination of a corpse and the correct completion of the death certificate are medical duties with far-reaching consequences. Data obtained from the death certificates are the basis for mortality statistics and for scientific research. They can be helpful in uncovering criminal offences or for the surveillance of medical facilities. For many years the deficiencies of external post-mortem examinations and death certificates have been discussed in professional journals.The important task of analysing all death certificates is performed by the local health authorities. This is the only opportunity for quality control and, if necessary, the doctors who issued the death certificate must be asked for corrections. This also improves the quality of the mortality statistics and contributes to the administration of justice.Additionally, important information for routine duties of the public health authorities can be obtained from the death certificates concerning the monitoring of narcotics, the supervision of medical facilities and the adherence to notification requirements for infectious diseases. Furthermore, death certificates contain relevant data for selected medical research projects.The high information content of death certificates is widely unknown and should be used by the health authorities comprehensively and systematically. Enough qualified staff needs to be allocated to further secure the important task of quality control of death certificates.
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Affiliation(s)
- Sabine Gleich
- Referat für Gesundheit und Umwelt, Landeshauptstadt München, Bayerstr. 28 a, 80335, München, Deutschland.
| | - Sibylle Viehöver
- Referat für Gesundheit und Umwelt, Landeshauptstadt München, Bayerstr. 28 a, 80335, München, Deutschland
| | - Anette Teipel
- Referat für Gesundheit und Umwelt, Landeshauptstadt München, Bayerstr. 28 a, 80335, München, Deutschland
| | - Sabine Drubba
- Referat für Gesundheit und Umwelt, Landeshauptstadt München, Bayerstr. 28 a, 80335, München, Deutschland
| | - Verena Turlik
- Referat für Gesundheit und Umwelt, Landeshauptstadt München, Bayerstr. 28 a, 80335, München, Deutschland
| | - Bertrand Hirl
- Referat für Gesundheit und Umwelt, Landeshauptstadt München, Bayerstr. 28 a, 80335, München, Deutschland
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Chang JH, Kim SH, Lee H, Choi B. Analysis of Errors on Death Certificate for Trauma Related Death. JOURNAL OF TRAUMA AND INJURY 2019. [DOI: 10.20408/jti.2019.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jun Hyuk Chang
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyeji Lee
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Byungho Choi
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Huang HY, Lo CY, Yang LY, Chung FT, Sheng TF, Lin HC, Lin CW, Huang YC, Chang CJ, Chung KF, Wang CH. Maintenance Negative Pressure Ventilation Improves Survival in COPD Patients with Exercise Desaturation. J Clin Med 2019; 8:jcm8040562. [PMID: 31027263 PMCID: PMC6518192 DOI: 10.3390/jcm8040562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 12/28/2022] Open
Abstract
Negative pressure ventilation (NPV), when used as an adjuvant to pulmonary rehabilitation, improves lung function, increases exercise capacity, and reduces exacerbations. The aim of this study was to determine whether maintenance NPV improves long-term clinical outcomes and reduces mortality in patients with chronic obstructive pulmonary disease (COPD). Between 2003 and 2009, 341 patients were treated for COPD either with or without hospital-based NPV. We measured forced expiratory volume in one second (FEV1), 6-min walking distance (6MWD), and oxygen saturation by pulse oximetry (SpO2) during a 6-min walk test (6MWT) every 3–6 months. Desaturation (D) during the 6MWT was defined as a reduction in SpO2 of ≥10% from baseline. The NPV group had a better survival outcome than the Non-NPV group. The 8-year survival probabilities for the NPV and Non-NPV groups were 60% and 20%, respectively (p < 0.01). Baseline desaturation was a significant risk factor for death, and the risk of death increased with desaturation severity (SpO2 80~89: hazard ratios (HR) 2.7, 95% confidence interval (CI) 1.4–5.3; SpO2 < 80: HR 3.1, 95% CI 1.3–7.4). The NPV group had a slower decline in lung function and 6MWD. The NPV + D and Non-NPV+D had a threefold and fourfold increase in the risks of all-cause mortality compared with the NPV-ND, respectively. Maintenance non-invasive NPV reduced long-term mortality in COPD patients. The desaturating COPD patients had an increased mortality risk compared with non-desaturating COPD patients.
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Affiliation(s)
- Hung-Yu Huang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan 330, Taiwan.
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
| | - Chun-Yu Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Te-Fang Sheng
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Chang-Wei Lin
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan 330, Taiwan.
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
| | - Yu-Chen Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Chee-Jen Chang
- Research Services Center for Health Information, Chang Gung University, Taoyuan 333, Taiwan.
| | - Kian Fan Chung
- Experimental Studies, National Heart & Lung Institute, Imperial College London & Biomedical Research Unit, Royal Brompton Hospital, London SW3 6LY, UK.
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
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Jomar RT, Ramos DDO, Fonseca VADO, Junger WL. Effect of the zero-tolerance drinking and driving law on mortality due to road traffic accidents according to the type of victim, sex, and age in Rio de Janeiro, Brazil: An interrupted time series study. TRAFFIC INJURY PREVENTION 2019; 20:227-232. [PMID: 30985221 DOI: 10.1080/15389588.2019.1576035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
Objective: The objective of this study was to estimate the effect of the Brazilian zero-tolerance drinking and driving law on mortality rates due to road traffic accidents according to the type of victim, sex, and age. Methods: An interrupted time series design was used to compare yearly mortality rates due to road traffic accidents in Rio de Janeiro, Brazil, before and after the zero-tolerance drinking and driving law came into effect on June 19, 2008. Yearly mortality rates were compared according to the type of victim: pedestrian, cyclist, motorcyclist, and vehicle occupant. We used the Prais-Winsten procedure of autoregression in the analysis of time series; the outcome of this analysis was the annual percentage change in the rates. Overall and stratified analyses were conducted to investigate whether the zero-tolerance drinking and driving law may have had a distributional effect on mortality rates due to road traffic accidents depending on sex and age group; a significance level of P < .01 was accepted. Results: From 1999 to 2016, there were 15,629 deaths due to road traffic accidents in Rio de Janeiro. The effect of the zero-tolerance drinking and driving law on overall mortality rates due to road traffic accidents in Rio de Janeiro was not statistically significant. However, among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes and aged ≥20 years, the effect of the zero-tolerance drinking and driving law was to decrease mortality due to road traffic accidents at a yearly rate. Conclusion: There is evidence of reduced mortality rates due to road traffic accidents among cyclists and motorcyclists aged ≥60 years and among pedestrians of both sexes aged ≥20 years in the second major Brazilian capital 9 years after the zero-tolerance drinking and driving law was adopted.
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Affiliation(s)
- Rafael Tavares Jomar
- a Coordination of Assistance, National Cancer Institute José Alencar Gomes da Silva , Ministry of Health , Rio de Janeiro , Brazil
| | - Dandara de Oliveira Ramos
- b Center for Data Integration and Knowledge for Health , Gonçalo Moniz Institute, Oswaldo Cruz Foundation , Salvador , Brazil
| | | | - Washington Leite Junger
- d Department of Epidemiology, Institute of Social Medicine , Rio de Janeiro State University , Rio de Janeiro , Brazil
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Viehöver S, Peschel O, Graw M, Gleich S. Ordnungswidrigkeiten bei Leichenschau und Ausstellen der Todesbescheinigung. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0301-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lin YJ, Chiu HY, Chiou MJ, Huang YC, Wei KC, Kuo CF, Hsu JT, Chen PY. Trends in the incidence of primary malignant brain tumors in Taiwan and correlation with comorbidities: A population-based study. Clin Neurol Neurosurg 2017; 159:72-82. [DOI: 10.1016/j.clineuro.2017.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/18/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
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Qaddumi JAS, Nazzal Z, Yacoup ARS, Mansour M. Quality of death notification forms in North West Bank/Palestine: a descriptive study. BMC Res Notes 2017; 10:154. [PMID: 28399918 PMCID: PMC5387246 DOI: 10.1186/s13104-017-2469-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 03/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background The death notification forms (DNFs) are important documents. Thus, inability to fill it properly by physicians will affect the national mortality report and, consequently, the evidence-based decision making. The errors in filling DNFs are common all over the world and are different in types and causes. We aimed to evaluate the quality of DNFs in terms of completeness and types of errors in the cause of death section. Methods A descriptive study was conducted to review 2707 DNFs in North West Bank/Palestine during the year 2012 using data abstraction sheets. SPSS 17.0 was used to show the frequency of major and minor errors committed in filling the DNFs. Results Surprisingly, only 1% of the examined DNFs had their cause of death section filled completely correct. The immediate cause of death was correctly identified in 5.9% of all DNFs and the underlying cause of death was correctly reported in 55.4% of them. The sequence was incorrect in 41.5% of the DNFs. The most frequently documented minor error was “Not writing Time intervals” error (97.0%). Conclusion Almost all DNFs contained at least one minor or major error. This high percentage of errors may affect the mortality and morbidity statistics, public health research and the process of providing evidence for health policy. Training workshops on DNF completion for newly recruited employees and at the beginning of the residency program are recommended on a regular basis. As well, we recommend reviewing the national DNFs to simplify it and make it consistent with updated evidence-based guidelines and recommendation.
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Affiliation(s)
- Jamal A S Qaddumi
- Faculty of Medicine and Health Sciences, An-Najah National University, PO box 7, Nablus, Palestine.
| | - Zaher Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, PO box 7, Nablus, Palestine
| | - Allam R S Yacoup
- Department of anesthesia, An-Najah National University Hospital, Nablus, Palestine
| | - Mahmoud Mansour
- Department of general surgery, Palestine Medical Complex, Ramallah, Palestine
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Medical death certification by forensic physicians in the Netherlands: Validity and interdoctorvariation. J Forensic Leg Med 2016; 43:61-69. [DOI: 10.1016/j.jflm.2016.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 06/30/2016] [Accepted: 07/10/2016] [Indexed: 11/18/2022]
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Mahdavi A, Sedghi S, Sadoghi F, Fard Azar FE. Assessing the Awareness of Agents Involved in Issuance of Death Certificates About Death Registration Rules in Iran. Glob J Health Sci 2015; 7:371-9. [PMID: 26156914 PMCID: PMC4803882 DOI: 10.5539/gjhs.v7n5p371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/20/2014] [Accepted: 12/18/2014] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In the death registration system, issuance of death certificate, as a binding rule, is considered among the major necessities of preparation of death statistics. In order to prepare death statistics that are adequately valid for subsequent applications, it is necessary to properly encode death certificates and fully follow rules on causes underlying death. This study aimed to assess the awareness and performance of agents involved in issuance of death certificate in the national death records system. METHODS It was a descriptive cross-sectional research, which was performed from September 2013 to March 2014 on 96 agents involved in issuance of death certificate Imam Khomeini, Alavi, Fatemi and BuAli education and treatment centers of Ardebil University of Medical Sciences. The population included faculty staff physicians, residents and health information management staffs. The research scale was also a researcher-made questionnaire that questioned the demographic information as well as awareness and performance of participants regarding death certificate coding rules. Research data was analyzed based on descriptive statistics and the chi-square test method in the SPSS software at a confidence level of 95%. FINDINGS A total of 34.42% of participants were aware of the general rules on issuance of death certificates while faculty staff higher specialists (41.67%) and clinical coders (38.34%) with five years of experience demonstrated the highest awareness levels. Only 23 participants (24.6%) were trained to issue death certificates. A total of 76 participants (79.3%) announced their need for learning how to complete death certificate forms on a constant basis. The awareness of participants about the general principle was assessed to be low (30.25%). Moreover, their awareness of selection rules and modification rules was low (27.75%) and moderate (45.25%), respectively. The chi-square test revealed a significant relationship between work experience and awareness of participants about coding rules (P=0.001), but no significant relationship was observed between education and awareness of coding rules (P=0.497). CONCLUSION The awareness of participants about rules on coding death causes and their performance in this field was so satisfactory. That is to say, the awareness of faculty staff and health information management staffs was unexpectedly low. Seemingly, lack of adequate training is an international issue that causes mistakes in the recording of information on mortality. Hence, a short-term solution is to train faculty staff and residents and also revise the training provided to health information management staffs. As a long-term solution it is possible to provide related courses to general practitioner students.
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Antini C, Rajs D, Muñoz-Quezada MT, Mondaca BAL, Heiss G. Reliability of cause of death coding: an international comparison. CAD SAUDE PUBLICA 2015; 31:1473-82. [PMID: 26248102 DOI: 10.1590/0102-311x00099814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 01/21/2015] [Indexed: 11/22/2022] Open
Abstract
This study evaluates the agreement of nosologic coding of cardiovascular causes of death between a Chilean coder and one in the United States, in a stratified random sample of death certificates of persons aged ≥ 60, issued in 2008 in the Valparaíso and Metropolitan regions, Chile. All causes of death were converted to ICD-10 codes in parallel by both coders. Concordance was analyzed with inter-coder agreement and Cohen’s kappa coefficient by level of specification ICD-10 code for the underlying cause and the total causes of death coding. Inter-coder agreement was 76.4% for all causes of death and 80.6% for the underlying cause (agreement at the four-digit level), with differences by the level of specification of the ICD-10 code, by line of the death certificate, and by number of causes of death per certificate. Cohen's kappa coefficient was 0.76 (95%CI: 0.68-0.84) for the underlying cause and 0.75 (95%CI: 0.74-0.77) for the total causes of death. In conclusion, causes of death coding and inter-coder agreement for cardiovascular diseases in two regions of Chile are comparable to an external benchmark and with reports from other countries.
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Affiliation(s)
| | - Danuta Rajs
- Organización Panamericana de la Salud, Chile
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Ong SAK, Lai SH. Certification of Death in Singapore. PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Proper certification of death has legal, social, and epidemiological significance. There is unfortunately little in the existing medical literature relevant to such an important issue in Singapore. With the implementation of the Coroners Act 2010, there has been recent surge in interest in this matter, highlighting a need for additional instruction on the accurate completion of death certificates. This review explains how a death certificate should be filled out, with particular focus on the difference between the terms cause, mechanism, mode, and manner of death. The article is aimed at doctors in Singapore, and highlights legal and practical issues.
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Affiliation(s)
| | - Siang Hui Lai
- Department of Pathology, Singapore General Hospital, Singapore
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Lefeuvre D, Pavillon G, Aouba A, Lamarche-Vadel A, Fouillet A, Jougla E, Rey G. Quality comparison of electronic versus paper death certificates in France, 2010. Popul Health Metr 2014; 12:3. [PMID: 24533639 PMCID: PMC3931487 DOI: 10.1186/1478-7954-12-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 02/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background Electronic death certification was established in France in 2007. A methodology based on intrinsic characteristics of death certificates was designed to compare the quality of electronic versus paper death certificates. Methods All death certificates from the 2010 French mortality database were included. Three specific quality indicators were considered: (i) amount of information, measured by the number of causes of death coded on the death certificate; (ii) intrinsic consistency, explored by application of the International Classification of Disease (ICD) General Principle, using an international automatic coding system (Iris); (iii) imprecision, measured by proportion of death certificates where the selected underlying cause of death was imprecise. Multivariate models were considered: a truncated Poisson model for indicator (i) and binomial models for indicators (ii) and (iii). Adjustment variables were age, gender, and cause, place, and region of death. Results 533,977death certificates were analyzed. After adjustment, electronic death certificates contained 19% [17%-20%] more codes than paper death certificates for people deceased under 65 years, and 12% [11%-13%] more codes for people deceased over 65 years. Regarding deceased under and over 65 respectively, the ICD General Principle could be applied 2% [0%-4%] and 6% [5%-7%] more to electronic than to paper death certificates. The proportion of imprecise death certificates was 51% [46%-56%] lower for electronic than for paper death certificates. Conclusion The method proposed to evaluate the quality of death certificates is easily reproducible in countries using an automatic coding system. According to our criteria, electronic death certificates are better completed than paper death certificates. The transition to electronic death certificates is positive in many aspects and should be promoted.
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Gupta N, Bharti B, Singhi S, Kumar P, Thakur JS. Errors in filling WHO death certificate in children: lessons from 1251 death certificates. J Trop Pediatr 2014; 60:74-8. [PMID: 23902671 DOI: 10.1093/tropej/fmt059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Our objective was to identify the frequency and types of various pediatric death certification errors. All available death certificates (n = 1424, from January to December 2005 and from January to July 2007) were retrieved from medical record library in a tertiary pediatric hospital. These were analyzed retrospectively (66%) and prospectively (34%) for the year 2005 and 2007, respectively. Only 11% of death certificates were filled accurately. In the remaining 89%, the total number of errors ranged from 0-5 per death certificate. The most common major and minor errors were "improper sequencing" (50.3%) and "absence of time interval" (74.7%), respectively. The combination of major and minor errors was observed in 51.9% of the certificates. The frequency of errors was significantly less in prospective data as compared with retrospective data (p < 0.05). Given the high rate of errors, there is an urgent need to design relevant training programs to streamline this dismal situation.
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Affiliation(s)
- Neeraj Gupta
- Department of Neonatology, Maulana Azad Medical College, New Delhi 110002, India
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Al-Kubaisi NJ, Said H, Horeesh NA. Death certification practice in Qatar. Public Health 2013; 127:854-9. [PMID: 24011923 DOI: 10.1016/j.puhe.2012.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 09/09/2012] [Accepted: 12/21/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the knowledge and practice of death certification among physicians in Qatar. STUDY DESIGN Cross-sectional study. METHODS Knowledge and practice of death certification were assessed in a group of 317 physicians, selected at random, using a self-administered questionnaire. RESULTS Only 22.7% of physicians had received formal training in death certification. More than 60% of physicians knew which healthcare workers were entitled to complete the cause of death section of the form, and 37% of physicians were aware of the conditions for referral to a forensic physician. The most common difficulties facing physicians, when completing death certification forms, were dealing with complicated cases (47.3%), lack of training (43.5%) and failure to understand the terms used in the form (39.6%). Only 21.5% of physicians identified the cause of death correctly in the case scenario; 53.2% of physicians made major errors and 62.8% made minor errors. CONCLUSION Lack of training appears to play a major role in the poor completion of death certification forms. Educational/administrative interventions and training activities are needed.
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Affiliation(s)
- N J Al-Kubaisi
- Health Information Section, Public Health Department, Supreme Council of Health, Doha, Qatar.
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Survival impact of serum uric acid levels in children and adolescents. Rheumatol Int 2013; 33:2797-802. [PMID: 23817870 DOI: 10.1007/s00296-013-2808-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 06/17/2013] [Indexed: 12/22/2022]
Abstract
Evidence is limited on the association between hyperuricaemia and mortality in children and adolescents. This study was to investigate this association in the paediatric population. The study included children and adolescents who had undergone serum uric acid (SUA) measurement at the Chang Gung Memorial Hospital between 1997 and 2008. The survival status and cause of death of the included were ascertained by examining the National Death Registry of Taiwan. Hyperuricaemia was defined as a SUA level greater than 7.0 mg/dL. We included 13,241 patients (male, n = 7,454; female, n = 5,787) of mean age 14.3 ± 4.9 years. During the 82,800 person-years of follow-up, 455 deaths were identified, which corresponded to a crude mortality rate of 5.50 deaths per 1,000 person-years. Compared with individuals with a SUA <6.0 mg/dL, those with a SUA of 6.0-8.9, 9.0-11.9 and ≥12 mg/dL had an age- and sex-adjusted HR (95% CI) of 1.02 (0.82-1.26), 1.48 (1.08-2.02) and 4.73 (2.67-8.37). After adjustment for age, sex and history of diabetes mellitus and hypertension, hyperuricaemia was found to be associated with a HR (95% CI) of 1.38 (1.13-1.69; p < 0.001) for all-cause mortality. Hyperuricaemia was associated with an increased risk of mortality due to cardiovascular diseases (HR, 5.0; 95% CI 1.79-13.94; p = 0.001) and kidney diseases (11.71; 3.13-43.78; p < 0.001). Paediatric patients with hyperuricaemia were at increased risk of mortality, especially due to kidney and cardiovascular diseases.
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Chen BK, Yang CY. Temporal trend analysis of avoidable mortality in Taiwan, 1971-2008: overall progress, with areas for further medical or public health investment. BMC Public Health 2013; 13:551. [PMID: 23742049 PMCID: PMC3744173 DOI: 10.1186/1471-2458-13-551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/17/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Avoidable mortality (AM), or "unnecessary untimely death," is considered an indicator of health care quality. We investigated trends in the age-standardized mortality rates (ASMRs) and associated standard expected years of life lost (SEYLL) for deaths amenable to medical care or public health measures in Taiwan from 1971-2008, with an emphasis on identifying areas where additional medical or public health investment may help reduce the burden of AM. METHODS Taiwan's ASMRs per 100,000 for AM and other causes of death were calculated using data from the National Death Certificate Registry in five-year bins from 1971 to 2008. SEYLL rates per 100,000 were calculated annually from 1971 to 2008 using the same data source. RESULTS ASMR for almost all AM and other causes of death declined dramatically from 1971 to 2008 except for lung cancer (16.6% and 7.4% increase among men and women, respectively) and breast cancer (109.8% increase among women). In the same period, SEYLL due to lung cancer increased from 269.2 to 555.7 for men and 249.7 to 342.5 for women. For women, SEYLL due to breast cancer increased from 263.5 in 1971 to 659.3 in 2008. There were gender-specific differences in the reduction (or increase) in AM rates, with women showing larger rates of reduction or smaller rates of increase. Among men, AM fell by 65.9% from 1971-1975 to 2006-2008, and deaths from other causes increased by 15.6%. Among women, AM and deaths from other causes fell by 80.8% and 59.8% respectively. SEYLL decreased, respectively among males and females, from 23,147.3 and 24,081.1 in 1971 to 11,261.8 and 5,929.6 in 2008. CONCLUSION From 1971 to 2008, Taiwan experienced a dramatic reduction in most AM and corresponding SEYLL except for lung cancer (for both males and females) and breast cancer (for females). Additional effort should be devoted to public health measures to combat the rising prevalence of smoking in Taiwan, which may be responsible for the increasing AM from lung cancer. If AM in breast cancer continues unabated in the future, greater policy emphasis on the early detection and treatment of breast cancer may also be warranted.
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Affiliation(s)
- Brian K Chen
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 800 Sumter Street #116, Columbia, SC 29208, USA.
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Kuo CF, See LC, Yu KH, Chou IJ, Chiou MJ, Luo SF. Significance of serum uric acid levels on the risk of all-cause and cardiovascular mortality. Rheumatology (Oxford) 2012; 52:127-34. [PMID: 22923756 DOI: 10.1093/rheumatology/kes223] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess the associations between serum uric acid (SUA) level and mortality. METHODS The study included 354 110 subjects without a history of gout and whose SUA levels were tested at Chang Gung Memorial Hospital in Taiwan. Cox regression models were used to estimate hazard ratios and 95% CIs for mortality in six predefined SUA strata (≤0.17, 0.18-0.29, 0.30-0.41, 0.42-0.53, 0.54-0.65 and ≥0.66 mmol/l), after adjusting for age, sex, SUA stratum, estimated glomerular filtration rate, fasting glucose, total cholesterol and history of hypertension, diabetes mellitus, coronary heart disease, stroke, heart failure or chronic kidney disease. RESULTS There were 33 562 all-cause deaths during the study period. Crude all-cause mortality rates across the SUA strata were 52.5, 19.7, 17.4, 20.0, 28.0 and 41.1 deaths per 1000 person-years. Using the stratum 3 of SUA as a reference, the age- and sex-adjusted hazard ratios (95% CIs) across SUA strata were 2.79 (2.62, 2.96), 1.32 (1.28, 1.36), 1.00, 1.10 (1.07, 1.14), 1.42 (1.37, 1.48) and 2.12 (2.01, 2.23) for all-cause mortality; 2.24 (1.93, 2.59), 1.18 (1.10, 1.27), 1.00, 1.21 (1.14, 1.29), 1.74 (1.60, 1.88) and 2.53 (2.28, 2.81) for cardiovascular mortality and 3.41 (3.11, 3.73), 1.48 (1.42, 1.55), 1.00, 0.88 (0.84, 0.92), 0.91 (0.85, 0.98) and 1.23 (1.11, 1.36) for cancer-related mortality. CONCLUSION Individuals with SUA levels at either extremes are at higher risk for all-cause and cardiovascular mortality. SUA levels of 0.30-0.41 mmol/l were associated with the lowest mortality rate and should be regarded as optimal.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan Township, Taoyuan County 333, Taiwan
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Papanas N, Trypsianis G, Tiaka EK, Manolakis AC, Katsavaki D, Birka S, Natsiopoulos K, Maltezos E, Papazoglou N. Increased Cardiovascular and Renal Disease but not Reduced Life Expectancy Among Diabetic Participants in the General Northern Greek Population. Angiology 2012; 63:443-447. [DOI: 10.1177/0003319711426423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
We compared life expectancy and causes of death based on death certificates of 269 diabetic participants (group A) and 5659 nondiabetic participants (group B) who died from January 1, 1991 to December 31, 2010, in 3 small towns of Northern Greece. Age at death was significantly ( P = .011) higher in group A (77.2 ± 8.7 years) than in group B (75.7 ± 18.9 years). Males with diabetes lived longer with a mean difference of 4.7 (2.8-6.6) years ( P < .001), whereas females without diabetes lived longer, with a mean difference of 2.3 (1.1-5.6) years ( P = .004). Diabetic participants died more frequently of myocardial infarction ( P = .001), chronic renal failure ( P < .001), followed by pneumonia ( P = .010) and hyperosmolar non-ketotic coma ( P < .001). Nondiabetic participants died more frequently of lung cancer ( P < .001), old age ( P < .001), and car accidents ( P = .004). In conclusion, the cardiovascular and renal disease burden among diabetic participants did not reduce life expectancy, especially in men.
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Affiliation(s)
- N. Papanas
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - G. Trypsianis
- Department of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - E. K. Tiaka
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - A. C. Manolakis
- Department of Internal Medicine and Gastroenterology, University of Thessaly, Larissa, Greece
| | | | | | | | - E. Maltezos
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - N. Papazoglou
- Diabetes Centre, General Hospital “Papageorgiou,” Thessaloniki, Greece
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Rheumatoid arthritis prevalence, incidence, and mortality rates: a nationwide population study in Taiwan. Rheumatol Int 2012; 33:355-60. [DOI: 10.1007/s00296-012-2411-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 03/11/2012] [Indexed: 01/17/2023]
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Chandran A, Sousa TRV, Guo Y, Bishai D, Pechansky F. Road traffic deaths in Brazil: rising trends in pedestrian and motorcycle occupant deaths. TRAFFIC INJURY PREVENTION 2012; 13 Suppl 1:11-16. [PMID: 22414123 DOI: 10.1080/15389588.2011.633289] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE According to the World Health Organization, the global burden of road traffic mortality exceeds 1.27 million people annually; over 90 percent occur in low- and middle-income countries. Brazil's road traffic mortality rate of ∼20 per 100,000 is significantly higher than nearby Chile or Argentina. To date, there has been very little information published on road traffic fatalities among vulnerable road users (VRUs) in Brazil. METHODS Road traffic fatality data from 2000 to 2008 were extracted from Brazil's Mortality Information System (SIM). Road traffic deaths were extracted using the International Classification of Diseases (ICD-10) V-codes (V01-V89) and then subcategorized by VRU categories. Information was then disaggregated by gender, age, and region. RESULTS In 2008, 39,211 deaths due to road traffic injuries were recorded in Brazil, resulting in a crude mortality rate of 20.7 per 100,000 inhabitants. Pedestrian mortality averaged 5.46 deaths per 100,000 between 2000 and 2008. The mortality rate for elderly pedestrians (80+ years) is 20.1 per 100,000, over 10 times that of 0- to 9-year-olds. In the past decade, motorcycle occupant mortality has dramatically increased by over 300 percent from 1.5 per 100,000 in 2000 to 4.7 per 100,000 in 2008. The 20- to 29-year age group remains most affected by motorcycle deaths, with a peak fatality rate of 10.76 per 100,000 in 2008. The north and northeast regions, with the lower per capita gross domestic product (GDP), have higher proportions of VRU deaths compared with other regions. CONCLUSIONS Vulnerable road users are contributing an increasing proportion of the road traffic fatalities in Brazil. Nationally, elderly pedestrians are at particularly high risk and motorcycle fatalities are increasing at a rapid rate. Less prosperous regions have higher proportions of VRU deaths. Understanding the epidemiology of road traffic mortality in vulnerable road user categories will better allow for targeted interventions to reduce these preventable deaths.
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Affiliation(s)
- Aruna Chandran
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Cheng TJ, Lee FC, Lin SJ, Lu TH. Improper cause-of-death statements by specialty of certifying physician: a cross-sectional study in two medical centres in Taiwan. BMJ Open 2012; 2:bmjopen-2012-001229. [PMID: 22855626 PMCID: PMC4400800 DOI: 10.1136/bmjopen-2012-001229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the frequency of various types of improper cause-of-death (COD) statements reported on death certificates and whether the frequency differed by specialty of the certifying physician. DESIGN Cross-sectional descriptive study. SETTING 2 medical centres in Tainan, Taiwan. PARTICIPANTS A total of 2520 death certificates issued by 230 physicians. MAIN OUTCOME MEASURES 4 types of improper COD statements based on the criteria of correctness of the COD causal sequence and the level of specificity of underlying COD selected. RESULTS Of 2520 death certificates analysed, 502 (19.9%) had at least one type of improper COD statement. However, only 235 (9.3%) sustained major errors, that is, 91 (3.6%) reported incorrect causal sequence and 144 (5.7%) reported only mechanism(s) of death (such as respiratory failure, heart failure, sepsis and acidosis). The improper reporting rate was highest among nephrologists (53%, 24/45), followed by infectious diseases physicians (45%, 29/65) and was lowest among oncologists (6%, 57/995). CONCLUSIONS About one-fifth issued death certificates sustained improper COD statements and only one-tenth had noteworthy errors that would threaten the quality of COD statistics. The frequency varied by specialty of the certifying physician because physicians in different specialties manage different types of diseases and conditions with contrasting complexities in terms of determining the causal sequence and specificity of COD statements.
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Affiliation(s)
- Tain-Junn Cheng
- Department of Medical Record and Information Management, Occupational
Medicine and Neurology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Occupational Safety, College of Environment, Chia Nan
University of Pharmacy and Science, Tainan, Taiwan
| | - Fang-Chuan Lee
- NCKU Research Center for Health Data and Department of Public Health,
College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shio-Jean Lin
- Department of Pediatrics, National Cheng Kung University Hospital,
Tainan, Taiwan
| | - Tsung-Hsueh Lu
- NCKU Research Center for Health Data and Department of Public Health,
College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kuo CF, See LC, Yu KH, Chou IJ, Chang HC, Chiou MJ, Luo SF. Incidence, cancer risk and mortality of dermatomyositis and polymyositis in Taiwan: a nationwide population study. Br J Dermatol 2011; 165:1273-9. [DOI: 10.1111/j.1365-2133.2011.10595.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kuo CF, Yu KH, See LC, Chou IJ, Tseng WY, Chang HC, Shen YM, Luo SF. Elevated risk of mortality among gout patients: a comparison with the national population in Taiwan. Joint Bone Spine 2011; 78:577-80. [PMID: 21388850 DOI: 10.1016/j.jbspin.2011.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 01/07/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Accumulating evidence suggests that gout is associated with increased overall and cardiovascular mortality. Using data from a large consecutive cohort of gout sufferers who were followed for 8 years, we investigated mortality among gout sufferers and compared the results with data from the general population of Taiwan. METHODS The study comprised 6631 people who had gout diagnosis at outpatient department of the Chang Gung Memorial Hospital in 2000. Survival status and cause of death were ascertained by examining the National Death Registry of Taiwan through 2008. RESULTS During 53,048 person-years of follow-up in 6631 gout patients, 1273 (male, 941; female, 332) deaths were identified, corresponding to the crude mortality rate was 21.3 (male, 20.0; female, 26.1) per 1000 patient-years, which was significantly higher than that of the national population. As compared with the national population of Taiwan in 2000, the all-cause standardized mortality ratio (95% confidence interval) was 1.29 (1.21-1.37) for men and 1.70 (1.53-1.89) for women. Both men and women in this cohort had higher standardized mortality ratios for death due to kidney diseases (men, 3.10; women, 3.54), endocrine and metabolic diseases (men, 2.24; women, 2.71), and cardiovascular diseases (men, 1.58; women, 1.81). Multivariate Cox regression showed no difference in mortality between genders. DISCUSSION/CONCLUSIONS Individuals with gout have increased mortality risk in both sexes; however, the extent of risk increment is higher in women. Kidney diseases, endocrine and metabolic diseases, and cardiovascular diseases are primary causes of death.
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Affiliation(s)
- Chang-Fu Kuo
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan County, Taiwan
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Chang YH, Li CY, Tung TH, Tsai JJ, Lu TH. Age-period-cohort analysis of mortality from epilepsy in Taiwan, 1971-2005. Seizure 2010; 20:240-3. [PMID: 21185206 DOI: 10.1016/j.seizure.2010.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 10/31/2010] [Accepted: 12/03/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Age-period-cohort (APC) analysis could provide useful insight into the interpretation of time trends for disease rates. This study aimed to determine whether the patterns of age, period and cohort effects on epilepsy mortality in Taiwan were similar to those in the US and in England and Wales. METHODS We employed a three-phase APC analysis method developed by Keyes and Li,(7) which conceptualizes the cohort effect as a partial interaction between age and period. The effects of age, period, and cohort were indicated by the relative risk (RR) of mortality rates. RESULTS We found an increase in mortality rates in the elderly from 1981-85 to 2001-05 and no decline in mortality rates for children, adolescents and adults from 1991-95 to 2001-05. According to APC analysis, the RRs increased sharply during adolescence, and leveled off in adulthood, and then increased steeply in the elderly. The RR of period effects decreased from period 1971-1975 to period 1991-1995 and then increased. With the exception of cohort 1911-1915, no significant cohort effects were found. CONCLUSION Despite the limitations of official published mortality data, we still found prominent age effects according to APC analysis, which were similar to the results of a previous study. However, the patterns of period and cohort effects in relation to epilepsy mortality in Taiwan differed from those in England and Wales and in the US.
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Affiliation(s)
- Ya-Hui Chang
- NCKU Research Center for Health Data and Institute of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
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Chang KC, Tsai PS, Hsu MC, Hung SF, Tsai CC, Lu SN. Chronic hepatitis C increased the mortality rates of patients with hepatocellular carcinoma and diabetes mellitus in a triple hepatitis virus endemic community. J Gastroenterol 2010; 45:636-45. [PMID: 20054698 DOI: 10.1007/s00535-009-0189-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 12/08/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND To elucidate the factors associated with mortality rates among older subjects with hepatocellular carcinoma (HCC) and diabetes mellitus (DM) in a triple hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV) endemic community. METHODS A total of 2,909 residents aged>or=45 years were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV) and alanine aminotransaminase (ALT) in 1997. Anti-HDV was detected in HBsAg-positive subjects. Those who expired from HCC and DM were identified from official mortality data sets (1997-2003). Survival was analyzed using the Kaplan-Meier survival curve with log-rank test and the Cox proportional hazard model. RESULTS Forty-one patients died of HCC and 25 of DM during the study period. Multivariate analysis indicated that age>or=65 years (hazard ratio 3.4; 95% confidence interval 1.8-6.4), HBsAg (3.3; 1.7-6.7), anti-HCV (3.8; 1.7-8.5) and ALT>or=40 IU/L (3.7; 1.9-7.0) were independent predictors of HCC mortality, while age>or=65 years (4.8; 2.1-11.0) and anti-HCV (4.2; 1.7-10.6) were two independent predictors of DM mortality. There were synergistic effects of dual viral infections for HCC, but not for DM mortality. CONCLUSIONS Old age and chronic HCV infection increase the risk of HCC and DM mortality. HBsAg and ALT levels are also risk factors for HCC mortality, but not DM. The synergistic effects of dual hepatitis viral infections are demonstrable and warrant further investigation.
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Affiliation(s)
- Kuo-Chin Chang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, #123, Ta Pei Road, Niao Sung 833, Kaohsiung, Taiwan
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Lu TH, Anderson RN, Kawachi I. Trends in frequency of reporting improper diabetes-related cause-of-death statements on death certificates, 1985-2005: An algorithm to identify incorrect causal sequences. Am J Epidemiol 2010; 171:1069-78. [PMID: 20413407 DOI: 10.1093/aje/kwq057] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study aimed to examine the changes in frequency of reporting improper diabetes-related cause-of-death statements on death certificates based on Multiple-Cause Mortality Files of the United States from 1985 to 2005. An algorithm was developed to identify the causes of death with incorrect causal sequences by using decision tables developed by the National Center for Health Statistics. In 1985, 2 or more diagnoses per line were reported on 35% of death certificates with mention of diabetes in Part I of the death certificate. This percentage decreased to 19% in 2005. In contrast, the prevalence of reporting incorrect causal sequences on death certificates on which diabetes was reported in Part I increased from 22% in 1985 to 35% in 2005. The authors suggest that the most plausible explanation of increasing reporting of incorrect causal sequences was the drastic increase of reporting multiple conditions (especially cardiovascular diseases and cancers) among deaths with mention of diabetes, which made the determination of underlying cause of death much more difficult.
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Affiliation(s)
- Tsung-Hsueh Lu
- Institute of Public Health, National Cheng Kung University, Tainan, Taiwan
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Chen CY, Wu PN, Su LW, Chou YJ, Lin KM. Three-year mortality and predictors after release: a longitudinal study of the first-time drug offenders in Taiwan. Addiction 2010; 105:920-7. [PMID: 20148787 DOI: 10.1111/j.1360-0443.2009.02894.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To assess the possible increase in mortality rate and associated socio-demographic and judiciary determinants among first-time drug offenders during the first 3 years after release from correctional facilities. SETTING AND PARTICIPANTS A total of 22 224 male and 4444 female adults who had served a sentence of at least 1 day in correctional facilities for illegal drug-related offences were identified from the judiciary records of the Ministry of Justice, Taiwan. DESIGN AND MEASUREMENTS The underlying causes of death were defined by the International Classification of Diseases, ninth revision. Findings All-cause standardized mortality ratios (SMR) were 7 for schedule I (e.g. heroin) and 3 for schedule II (e.g. methamphetamine) drug offenders, respectively; accidents, suicide and circulatory diseases were three leading causes of death. After release, the risk of death among those drug offenders without subsequent incarceration increased gradually until the 9th month. Those who were aged 30 years or older, had an engagement with a higher-ranked schedule substance or who received severe sentences were two to three times more likely to die. Substantial reduction in the risk of death was linked with re-imprisonment. CONCLUSIONS The SMR estimates for external causes were greater than those for disease-related causes in drug offenders, and schedule I drugs-related mortality rate was twice as high as that with schedule II drugs. In transitioning from the correctional setting to the community, the health needs of drug offenders should be addressed by the provision of continuous, adequate medical care tailored to individual background, medical history and drug experience.
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Affiliation(s)
- Chuan-Yu Chen
- Division of Mental Health and Addiction Medicine, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
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