Unintentional Drowning Mortality Among Individuals Under Age 20 - China, 2013-2021

Introduction

This study seeks to elucidate the evolving trend and identify disparities among subgroups in the mortality rate due to unintentional drowning in individuals under the age of 20 from the timeframe of 2013 to 2021 in China.

Methods

Data retrieved from the National Mortality Surveillance System served as a foundation for estimating the unintentional drowning mortality rate. The inadvertent drowning mortality rate for individuals below the age of 20 was computed, differentiated by categorization groups such as age, gender, areas, and regions within each given year. The linear regression model was employed to calculate the annual percent of change (APC) with its 95% confidence interval (CI), providing a depiction of the mortality rate's shifting trend.

Results

In 2021, the inadvertent drowning fatality rate for individuals under 20 years of age in China was recorded at 3.28 per 100,000. A steady reduction was observed in the national drowning mortality rate from 6.60 per 100,000 in 2013 down to 3.28 per 100,000 in 2021, signifying a cumulative decrease of 50.30% [APC=-9.06% (95% CI: -11.31%, -6.76%)]. Across all sexes, regions, age groups, and residential areas, a consistent decline in mortality rates was evident between 2013 and 2021.

Conclusion

An analysis of the data from 2013 to 2021 reveals a declining trend in the mortality rate due to unintentional drowning among individuals under 20 years of age in China. However, the rate of decline varied when stratified by sex, urban versus rural locations, age-specific groups, and geographical regions.

[Learning from coding data-surgical treatment of benign prostatic syndrome : Big data for BPS]

Benign prostatic syndrome (BPS) is one of the most common urological diseases. Currently, there are numerous surgical methods to treat BPS. The digitalisation of medicine enables new study approaches in healthcare research using digital data from individual treatment pathways. In the present work, BPS-specific longitudinal trend analyses were performed. Treatment-related figures, both with regard to the therapy methods and predefined patient cohorts, could be examined after validating the datasets. This meant that information on relevant characteristics of surgical BPS treatment could be read and calculations made that reflect the overall impact of these processes. In the future, it is expected that increasingly comprehensive, higher-quality digital datasets on different clinical pictures will be available for analytical purposes. Intensification of research projects in this field is desirable. The results thus obtained enable further optimisation steps of certain treatment actions and provide important key figures for the strategy development of a medical facility.

Opioid Prescribing Among Outpatients with Rheumatoid Arthritis

STUDY OBJECTIVES

To examine the outpatient opioid prescribing practices and the factors associated with opioid prescriptions in patient visits with rheumatoid arthritis (RA).

DESIGN

This cross-sectional study used the 2011-2016 National Ambulatory Medical Care Survey. Descriptive weighted analyses were used to examine the trends in opioid prescribing practices for RA. Multivariable logistic regression was used to examine the factors associated with opioid prescriptions among RA visits.

SUBJECTS

Adult patients (>18 years of age) with a primary diagnosis of RA based on the International Classification of Diseases.

RESULTS

According to the national surveys, an average of 4.45 (95% confidence interval [CI], 2.30-6.60) million office visits were made annually for RA. Approximately 24.28% of these visits involved opioid prescriptions. The RA visits involving opioid prescriptions increased from 1.43 million in 2011-2012 to 3.69 million in 2015-2016 (P < .0001). Being in the age group of 50-64 years (odds ratio [OR] = 3.40; 95% CI, 1.29-9.00), being Hispanic or Latino (OR = 2.92, 95% CI, 1.10-7.74), visiting primary physician (OR = 4.67; 95% CI, 1.86-11.75), prescribing of muscle relaxants (OR = 64.32; 95% CI, 9.71-426.09), acetaminophen (OR = 93.40; 95% CI, 26.19-333.04), antidepressants (OR = 6.10; 95% CI, 2.63-14.14), and glucocorticoids (OR = 3.20; 95% CI, 1.61-6.38), were associated with an increased likelihood of receiving opioid prescriptions in RA.

CONCLUSIONS

One in four adult RA visits resulted in opioid prescriptions, and the opioid visits more than doubled during the study period. Several patient and provider factors were associated with the opioid prescribing among RA visits. Understanding these prescribing practices can help to devise strategies for safe opioid prescribing practices in RA.

Decreased Global Interest in Oral Cancer During the COVID-19 Pandemic

Objective:

Oral cancer is one of the most common malignancies in developing countries, but studies using global data are scarce. The aim of this study is to analyze the search interests for oral cancer using mouth cancer, tongue cancer, gum cancer, and lip cancer as common keywords.

Methods:

Internet searches relating to oral cancer from 2010 to 2020, from 250 countries and dependent areas, were retrieved from Google Trends. Color densities in a heat map were used to show geographic differences. Kruskal-Wallis test with post hoc Dunn’s analysis was used to perform yearly comparisons of searches for mouth cancer, tongue cancer, gum cancer, and lip cancer. Search results within 2020 were also compared to determine differences. Forecasting searches from 2021 to 2022 were done by fitting time series models.

Results:

From 29 of 250 (11.6%) countries, the highest search values were observed for mouth cancer in Sri Lanka, Qatar, Bangladesh, Finland, Netherlands, Spain, and France. Compared to 2020, greater searches were seen in 2018 (Mdn = 91%, P = 0.023) and 2019 (Mdn = 94%, P = 0.012) for mouth cancer, and 2019 (Mdn = 17%, P = 0.035) for lip cancer. The relative search volumes for gum cancer and lip cancer were substantially lower than mouth cancer during the COVID-19 pandemic.

Conclusion:

Higher-income countries tend to be more interested in seeking information about oral cancer. Noteworthy decline in the interest in seeking information online for oral cancer may have crucial implications during the COVID-19 pandemic. Google Trends offer an invaluable and inexpensive means for oral cancer surveillance and health-seeking behavior.

Trend analysis and longitudinal clustering of tuberculosis mortality in Asian and North African countries: Results from the global burden of disease 2017 study

Background: Tuberculosis (TB) is still a serious health problem with a remarkable global burden. In this study, we aimed to assess the trend of TB mortality in Asian and North African countries in the period 1990-2017 and provide a new classification according to TB mortality trend.

Methods: TB mortality rates from 1990 to 2017 were extracted from the Global Burden of Disease website for 55 Asian and North African countries. Trend analysis of TB mortality rates for males, females, and the total population was performed using the marginal modeling approach. Moreover, the latent growth mixture modeling (LGMM) framework was applied to classify these 55 countries based on their trend of TB mortality rate.

Results: In the period between 1990 and 2017, South Asia and High Income Asia-Pacific regions had the highest and lowest death rates due to TB, respectively. The marginal modeling results showed that the Asian and North African countries had experienced a downward trend with an intercept of 28.79 (95%CI: 19.64, 37.94) and a slope (mean annual reduction) of -0.67 (95%CI: -0.91, -0.43) per 100,000 the study period. Finally, the LGMM analysis classified these 55 countries into four distinct classes.

Conclusion: In general, our findings revealed that although the countries in Asia and North Africa super region experienced a descending TB mortality trend in the past decades, the slope of this reduction is quite small. Also, our new classification may be better suited for combating TB through future healthcare planning in lieu of the commonly used geographic classifications.

Worldwide Burden of, Risk Factors for, and Trends in Pancreatic Cancer

BACKGROUND & AIMS

We evaluated global and regional burdens of, risk factors for, and epidemiologic trends in pancreatic cancer among groups of different sexes and ages.

METHODS

We used data from the GLOBOCAN database to estimate pancreatic cancer incidence and mortality in 184 countries. We examined the association between lifestyle and metabolic risk factors, extracted from the World Health Organization Global Health Observatory database, and pancreatic cancer incidence and mortality by univariable and multivariable linear regression. We retrieved country-specific age-standardized rates (ASRs) of incidence and mortalities from cancer registries from 48 countries through 2017 for trend analysis by joinpoint regression analysis.

RESULTS

The highest incidence and mortality of pancreatic cancer were in regions with very high (ASRs, 7.7 and 4.9) and high human development indexes (ASRs, 6.9 and 4.6) in 2018. Countries with higher incidence and mortality were more likely to have higher prevalence of smoking, alcohol drinking, physical inactivity, obesity, hypertension, and high cholesterol. From 2008 to 2017, 2007 to 2016, or 2003 to 2012, depending on the availability of the data, there were increases in incidence among men and women in 14 (average annual percent changes [AAPCs], 8.85 to 0.41) and 17 (AAPCs, 6.04 to 0.87) countries, respectively. For mortality, the increase was observed in 8 (AAPCs, 4.20 to 0.55) countries among men and 14 (AAPCs, 5.83 to 0.78) countries among women. Although the incidence increased in 18 countries (AAPCs, 7.83 to 0.91) among individuals 50 years or older, an increasing trend in pancreatic cancer was also identified among individuals younger than 50 years and 40 years in 8 (AAPCs, 8.75 to 2.82) and 4 (AAPCs, 11.07 to 8.31) countries, respectively.

CONCLUSIONS

In an analysis of data from 48 countries, we found increasing incidence and mortality trends in pancreatic cancer, especially among women and populations 50 years or older, but also among younger individuals. More preventive efforts are recommended for these populations.

Alcohol Compliance Checks and Underage Alcohol-Involved Crashes: Evaluation of a Statewide Enforcement Program in South Carolina from 2006 to 2016

OBJECTIVE

This research evaluated the South Carolina Alcohol Enforcement Team impact for reducing retail alcohol access to underage persons to decrease drinking and driving crashes among that population.

METHODS

The natural research experiment used interrupted time-series (ITS) analyses of drinking and driving crashes involving under 21-year-old drivers from July 2006 through December 2016 (126-month period = 4,782 Driving Under Influence [DUI] crashes for under 21-year-old drivers, µ = 38 crashes per month). Additional data analyzed included the monthly total number of retail compliance checks (total during 126-month period = 64,954 compliance checks completed, µ = 515.5 checks per month), the average percentage of underage alcohol purchases (total completed during 126-month period = 8,814 purchases, µ = 70 purchases per month), and a calculated measure of the percent of the population under 21 years old exposed to compliance checks each month. We used drinking and driving crashes for 21-year-old and over drivers as a control time series (total number over a 126-month period = 52,180 DUI crashes for 21 and older drivers, µ = 414.1 crashes per month).

RESULTS

The results show a decline in drinking and driving crashes for drivers under 21 when compliance checks increase, and when compliance checks decline, traffic crashes increase. Stable Alcohol Enforcement Team implementation over 78 months produced an overall 18 to 29% decline in such crashes. A visual examination of the crash time series demonstrated that under-21-age-driver crashes declined during the first wave of implementation and increased following a lag when enforcement declined, which provided additional empirical support for a South Carolina Alcohol Enforcement Team impact on retail alcohol availability. An ITS analysis of the prestable period compared to the stable period was statistically significant (T = -3.78, p < 0.001). A cross-check of these results using single-vehicle nighttime crashes using identical Autoregressive Integrated Moving Average models was also statistically significant (T = -8.18, p < 0.001).

CONCLUSIONS

This longitudinal study provides strong evidence of sustained reductions in alcohol availability to underage youth can subsequently reduce alcohol-related traffic crashes. Reductions found in this study continued over several years, considerably longer than any previous equivalent research has shown.

How Have Experimental Cancer Interventions Evolved over Time?

We performed a trends analysis of experimental cancer interventions. The complete records of 32,623 interventional neoplasm clinical trials involving 454 types of neoplasms from 2000 to 2017 were downloaded from the AACT database. The conditions and drug concepts were normalized using MetaMap. The normalized frequencies (NF) for each type of intervention were calculated and compared. Among 95,440 interventions, 77.4% were drugs, 5.3% were radiation, 6.6% were surgery and 10.6% were other therapies. Among 47,754 arms, 82.8% were mono-type interventions and 17.2% were multi-type interventions. Among 73,889 drug interventions, immunologic factor drugs increased rapidly over the last five years. Both breast cancer and pancreatic cancer have been testing new drugs in clinical trials; however, more drugs have been tested in phase 3 or 4 trials and employed in comparator arms for breast cancer compared to pancreatic cancer. Breast cancer trials showed a more even drug NF distribution than pancreatic cancer trials. The JS Distance among three periods (2000-05 vs. 2006-11 vs. 2012-17) showed unidirectional research progress trend for breast cancer, but reverse trend for pancreatic cancer. This study contributes a large-scale landscape overview of the trends in cancer experimental interventions and a methodology for using public clinical trial summaries for understanding the evolving cancer research.

Analysis of the Filipinos' Interest in Searching Online for Oral Cancer

Objective:

This study analyzed the health-seeking behavior of Filipinos through relative search volume in Google Trends using oral cancer, mouth cancer, tongue cancer, gum cancer, and lip cancer as predetermined search terms.

Methods:

Comma-separated values files containing relative search volumes of search trends pertaining to oral cancer from 2009 to 2019 were assessed. Brown-Forsythe one-way ANOVA was used to measure differences of oral cancer between years and among months. Repeated measures two-way ANOVA measured differences among the searches for mouth cancer, tongue cancer, gum cancer, and lip cancer through the years. Time series models were fitted and used to forecast search interests.

Results:

The results revealed that interests in oral cancer were significantly higher in 2019 (43.75±5.5, p<0.05) compared to 2009 (29.0 ± 6.7). In terms of months, searches were higher in February (45.0 ± 6.6) compared to May (24.8 ± 3.4, p=0.015), June (25.3 ± 4.4, p=0.020), and December (26.5 ± 4.0, p=0.038). Search interests for gum cancer and lip cancer remained significantly lower from 2011 to 2019, and tongue cancer from 2016 to 2018 but approximated mouth cancer in 2019. The forecast shows mouth cancer (31.67%), tongue cancer (23.75%), and lip cancer (3.83%) fluctuating through the year, while gum cancer (8%) will remain steady in 2020.

Conclusion:

Health-seeking behavior through search trends show an increased interest in oral cancer in 2019 and during February. Search interests will fluctuate in 2020, but at the end of the year will decrease for mouth cancer and tongue cancer, will increase for lip cancer, and will remain steady for gum cancer.

Global Trend of Breast Cancer Mortality Rate: A 25-Year Study

Background:

breast cancer is the most common cause of cancer death for women worldwide. In the past two decades, published epidemiological reports in different parts of the world show significant increase in breast cancer mortality rate. The aim of this study was to determine the 25-year trend of breast cancer mortality rate in 7 super regions defined by the Health Metrics and Evaluation (IHME), i.e. Sub-Saharan Africa, North Africa and Middle East, South Asia, Southeast Asia and East Asia and Oceania, Latin America and Caribbean, Central Europe and Eastern Europe and Central Asia, High-income.

Methods:

Our study population consisted of 195 world countries in the IHME pre-defined seven super regions. The age-standardized mortality rates from 1990 to 2015 were extracted from the IHME site. The reference life table for calculating mortality rates was constructed based on the lowest estimated age-specific mortality rates from all locations with populations over 5 million in the 2015 iteration of GBD. To determine the trend of breast cancer mortality rate, a generalized linear mixed model was fitted separately for each IHME region and super region.

Results:

Statistical analysis showed a significant increase for breast cancer mortality rate in all super regions, except for High-income super region. For total world countries, the mean breast cancer mortality rate was 13.77 per 100,000 in 1990 and the overall slope of mortality rate was 0.7 per 100,000 from 1990 to 2015. The results showed that Latin America and Caribbean the highest increasing trend of breast cancer mortality rate during the years 1990 to 2015 (1.48 per 100,000).

Conclusion:

In general, our finding showed a significant increase in breast cancer mortality rate in the world during the past 25 years, which could be due to increase in incidence and prevalence of this cancer. Low this increasing trend is an alarm for health policy makers in all countries, especially in developing countries and low-income regions which experienced sharp slopes of breast cancer mortality rate.

Shifts in Alcohol-Related Diagnoses After the Introduction of International Classification of Diseases, Tenth Revision, Clinical Modification Coding in U.S. Hospitals: Implications for Epidemiologic Research

BACKGROUND

In October 2015, the United States transitioned healthcare diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), to the Tenth Revision (ICD-10-CM). Trend analyses of alcohol-related stays could show discontinuities solely from the change in classification systems. This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses.

METHODS

This analysis used 2014 to 2017 administrative data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases for 17 states. Quarterly ICD-9-CM data from second quarter 2014 through third quarter 2015 were concatenated with ICD-10-CM data from fourth quarter 2015 through first quarter 2017. Quarterly counts of alcohol-related stays were examined overall and then by 6 diagnostic subgroups: withdrawal, abuse, dependence, alcohol-induced mental disorders (AIMD), nonpsychiatric alcohol-induced disease, and intoxication or toxic effects. Within each group, we calculated the difference in the average number of stays between ICD-9-CM and ICD-10-CM coding periods.

RESULTS

On average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, AIMD, and intoxication or toxic effects. For example, the average quarterly number of stays involving AIMD was 170.7% higher in the ICD-10-CM period than in the ICD-9-CM period. This increase was driven in large part by 1 ICD-10-CM code, Alcohol use, unspecified with unspecified alcohol-induced disorder.

CONCLUSIONS

Researchers conducting trend analyses of inpatient stays involving alcohol-related diagnoses should consider how ongoing modifications in the ICD-10-CM code system and coding guidelines might affect their work. An advisable approach for trend analyses across the ICD-10-CM transition is to aggregate diagnosis codes into broader, clinically meaningful groups-including a single global group that encompasses all alcohol-related stays-and then to select diagnostic groupings that minimize discontinuities between the 2 coding systems while providing useful information on this important indicator of population health.