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Lawrence WR, Freedman ND, McGee-Avila JK, Berrington de González A, Chen Y, Emerson MA, Gee GC, Haozous EA, Haque AT, Inoue-Choi M, Jackson SS, Lord B, Nápoles AM, Pérez-Stable EJ, Vo JB, Williams F, Shiels MS. Trends in Mortality From Poisonings, Firearms, and All Other Injuries by Intent in the US, 1999-2020. JAMA Intern Med 2023; 183:849-856. [PMID: 37399025 PMCID: PMC10318548 DOI: 10.1001/jamainternmed.2023.2509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/30/2023] [Indexed: 07/04/2023]
Abstract
Importance Although deaths due to external causes are a leading cause of mortality in the US, trends over time by intent and demographic characteristics remain poorly understood. Objective To examine national trends in mortality rates due to external causes from 1999 to 2020 by intent (homicide, suicide, unintentional, and undetermined) and demographic characteristics. External causes were defined as poisonings (eg, drug overdose), firearms, and all other injuries, including motor vehicle injuries and falls. Given the repercussions of the COVID-19 pandemic, US death rates for 2019 and 2020 were also compared. Design, Setting, and Participants Serial cross-sectional study using national death certificate data obtained from the National Center for Health Statistics and including all external causes of 3 813 894 deaths among individuals aged 20 years or older from January 1, 1999, to December 31, 2020. Data analysis was conducted from January 20, 2022, to February 5, 2023. Exposures Age, sex, and race and ethnicity. Main Outcomes and Measures Trends in age-standardized mortality rates and average annual percentage change (AAPC) in rates calculated by intent (suicide, homicide, unintentional, and undetermined), age, sex, and race and ethnicity for each external cause. Results Between 1999 and 2020, there were 3 813 894 deaths due to external causes in the US. From 1999 to 2020, poisoning death rates increased annually (AAPC, 7.0%; 95% CI, 5.4%-8.7%). From 2014 to 2020, poisoning death rates increased the most among men (APC, 10.8%; 95% CI, 7.7%-14.0%). During the study period, poisoning death rates increased in all the racial and ethnic groups examined; the most rapid increase was among American Indian and Alaska Native individuals (AAPC, 9.2%; 95% CI, 7.4%-10.9%). During the study period, death rates for unintentional poisoning had the most rapid rate of increase (AAPC, 8.1%; 95% CI, 7.4%-8.9%). From 1999 to 2020, firearm death rates increased (AAPC, 1.1%; 95% CI, 0.7%-1.5%). From 2013 to 2020, firearm mortality increased by an average of 4.7% annually (95% CI, 2.9%-6.5%) among individuals aged 20 to 39 years. From 2014 to 2020, mortality from firearm homicides increased by an average of 6.9% annually (95% CI, 3.5%-10.4%). From 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, and homicide due to firearms and all other injuries. Conclusions and Relevance Results of this cross-sectional study suggest that from 1999 to 2020, death rates due to poisonings, firearms, and all other injuries increased substantially in the US. The rapid increase in deaths due to unintentional poisonings and firearm homicides is a national emergency that requires urgent public health interventions at the local and national levels.
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Affiliation(s)
- Wayne R. Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jennifer K. McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Marc A. Emerson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles
| | - Emily A. Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico
| | - Anika T. Haque
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Sarah S. Jackson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Brittany Lord
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Anna M. Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Eliseo J. Pérez-Stable
- Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Jacqueline B. Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Haque AT, Berrington de González A, Chen Y, Haozous EA, Inoue-Choi M, Lawrence WR, McGee-Avila JK, Nápoles AM, Pérez-Stable EJ, Taparra K, Vo JB, Freedman ND, Shiels MS. Cancer mortality rates by racial/ethnic groups in the United States, 2018-2020. J Natl Cancer Inst 2023:7131083. [PMID: 37074947 DOI: 10.1093/jnci/djad069] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/02/2023] [Accepted: 04/15/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Starting in 2018, national death certificates included a new racial classification system that accounts for multiple-race decedents and separates Native Hawaiian and Pacific Islander (NHPI) individuals from Asian individuals. We estimated cancer death rates across updated racial/ethnic categories, sex, and age. METHODS Age-standardized U.S. cancer mortality rates and rate ratios from 2018-2020 among ≥20-year-olds were estimated with national death certificate data by race/ethnicity, sex, age, and cancer site. RESULTS In 2018, there were approximately 597,000 cancer deaths, 598,000 in 2019, and 601,000 in 2020. Among men, cancer death rates were highest in Black men (298.2/100,000; n = 105,632), followed by White (250.8; n = 736,319), American Indian/Alaska Native (AI/AN) (249.2; n = 3,376), NHPI (205.6; n = 1,080), Latino (177.2; n = 66,167), and Asian (147.9; n = 26,591) men. Among women, Black women had the highest cancer death rates (206.5/100,000; n = 104,437), followed by NHPI (192.1; n = 1,141), AI/AN (189.9; n = 3,239), White (183.0; n = 646,865), Latina (128.4; n = 61,579), and Asian women (111.4; n = 26,396). The highest death rates by age group occurred among NHPI individuals aged 20-49 years, and Black individuals aged 50-69 and ≥70 years. Asian individuals had the lowest cancer death rates across age groups. Compared to Asian individuals, total cancer death rates were 39% higher in NHPI men and 73% higher in NHPI women. CONCLUSIONS There were striking racial/ethnic disparities in cancer death rates during 2018-2020. Separating NHPI and Asian individuals revealed large differences in cancer mortality between two groups that were previously combined in vital statistics data.
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Affiliation(s)
- Anika T Haque
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | | | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Emily A Haozous
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, United States
| | - Maki Inoue-Choi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Jennifer K McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, United States
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, United States
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Abstract
Using national death certificate data for 2020 and provisional data for 2021 from the Centers for Disease Control and Prevention, this cross-sectional study examines the leading causes of death in the US, overall and in various age groups.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Anika T Haque
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Shiels MS, Haque AT, Haozous EA, Albert PS, Almeida JS, García-Closas M, Nápoles AM, Pérez-Stable EJ, Freedman ND, Berrington de González A. Racial and Ethnic Disparities in Excess Deaths During the COVID-19 Pandemic, March to December 2020. Ann Intern Med 2021; 174:1693-1699. [PMID: 34606321 PMCID: PMC8489677 DOI: 10.7326/m21-2134] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although racial/ethnic disparities in U.S. COVID-19 death rates are striking, focusing on COVID-19 deaths alone may underestimate the true effect of the pandemic on disparities. Excess death estimates capture deaths both directly and indirectly caused by COVID-19. OBJECTIVE To estimate U.S. excess deaths by racial/ethnic group. DESIGN Surveillance study. SETTING United States. PARTICIPANTS All decedents. MEASUREMENTS Excess deaths and excess deaths per 100 000 persons from March to December 2020 were estimated by race/ethnicity, sex, age group, and cause of death, using provisional death certificate data from the Centers for Disease Control and Prevention (CDC) and U.S. Census Bureau population estimates. RESULTS An estimated 2.88 million deaths occurred between March and December 2020. Compared with the number of expected deaths based on 2019 data, 477 200 excess deaths occurred during this period, with 74% attributed to COVID-19. Age-standardized excess deaths per 100 000 persons among Black, American Indian/Alaska Native (AI/AN), and Latino males and females were more than double those in White and Asian males and females. Non-COVID-19 excess deaths also disproportionately affected Black, AI/AN, and Latino persons. Compared with White males and females, non-COVID-19 excess deaths per 100 000 persons were 2 to 4 times higher in Black, AI/AN, and Latino males and females, including deaths due to diabetes, heart disease, cerebrovascular disease, and Alzheimer disease. Excess deaths in 2020 resulted in substantial widening of racial/ethnic disparities in all-cause mortality from 2019 to 2020. LIMITATIONS Completeness and availability of provisional CDC data; no estimates of precision around results. CONCLUSION There were profound racial/ethnic disparities in excess deaths in the United States in 2020 during the COVID-19 pandemic, resulting in rapid increases in racial/ethnic disparities in all-cause mortality between 2019 and 2020. PRIMARY FUNDING SOURCE National Institutes of Health Intramural Research Program.
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Affiliation(s)
- Meredith S Shiels
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Anika T Haque
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Emily A Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, New Mexico (E.A.H.)
| | - Paul S Albert
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Jonas S Almeida
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Montserrat García-Closas
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
| | - Anna M Nápoles
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland (A.M.N., E.J.P.)
| | - Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland (A.M.N., E.J.P.)
| | - Neal D Freedman
- National Cancer Institute, Rockville, Maryland (M.S.S., A.T.H., P.S.A., J.S.A., M.G., N.D.F., A.B.D.)
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Hussain M, Sikder ZU, Wahed MA, Haque AT, Jahan F. Zinc concentration of breast milk and its diurnal variation in Bangladeshi mothers. Bangladesh Med Res Counc Bull 1996; 22:70-3. [PMID: 9103659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Little is known about the zinc content of breast milk in developing countries. Zinc content in breast milk was analyzed in 34 mothers of low socio-economic status; 17 were primiparae and 17 multiparae. Women in their 6th to 36th week of lactation provided 3 samples of breast milk at different times within a single day. The mean zinc concentration in breast milk (micrograms/ml) was 1.89 +/- 0.64 with a range from 0.17 to 4.38 micrograms/ ml. Zinc content in the morning, midday and evening samples were 2.1 +/- 0.84, 1.74 +/- 0.53, 1.84 +/- 0.69 respectively. There was significant variation between morning and midday samples (p = 0.038). Maternal age, parity, nutritional status or age of the child did not affect the zinc content of milk in the population studied.
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Affiliation(s)
- M Hussain
- Department of Pediatric Medicine, Dhaka Shishu (Children) Hospital, Bangladesh
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