Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study)

BACKGROUND

The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.

METHODS

The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.

RESULTS

About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.

CONCLUSIONS

The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Life Expectancy and Causes of Premature Death by Subgroup for Community-Based Action in Marin County, California, 2017-2021

INTRODUCTION

Marin is a medium-sized county in California's San Francisco Bay Area. Despite its historically higher-than-average life expectancy and socioeconomic level, known economic and health disparities by race, ethnicity, and geography became more visible during the COVID-19 pandemic.  Methods: We calculated life expectancy, measured years of potential life lost (YPLLs), and described premature mortality for the five years of 2017-2021 by race, ethnicity, census tract, and resource level (as measured by Healthy Places Index [HPI]) to provide data on inequities to guide community-centered action to reduce premature mortality.  Results: Life expectancy for the county was 85.2 years. The non-Hispanic African American/Black population experienced the lowest life expectancy of 77.1 years, 11.6 years lower than the non-Hispanic Asian population which had the highest life expectancy (88.7 years). There was a 14.9-year difference in life expectancy between the census tracts with the lowest (77.1 years) and highest (92.0 years) estimates. We found a moderate, positive association between census tract resource level (HPI) and life expectancy (r=0.58, p<0.01). The leading causes of premature death were cancer, diseases of the circulatory system, and accidental overdoses, with variation by subgroup.  Conclusion: These data highlight health disparities that persist in Marin County and can inform data-driven public health strategies to narrow gaps in longevity between communities.

Survival of patients with severe mental disorders: Influence of social functioning

BACKGROUND

Patients with severe mental disorders have a high risk of premature death due to the interaction of various factors. Social functioning is a strategic functional factor in understanding the course of psychotic disorders.

AIM

Analyze the relationship between social functioning and its various dimensions and survival during a 10-year follow-up.

METHOD

The Social Functioning Scale (SFS) was administered to 163 close relatives of patients under treatment at a Community Mental Health Unit. Survival was described by Kaplan-Meier analysis and any differences in survival by level of social functioning were found by long-rank analysis. Finally, Cox regression was used to predict premature mortality.

RESULTS

Significant differences in mortality were identified in the interpersonal behavior dimension of social functioning, while there were no significant gender or diagnostic differences in the rest of the dimensions. The interpersonal behavior dimension and age were found to be factors predicting premature death.

CONCLUSION

These findings show the protective effect of social functioning retained by patients with psychotic disorders on their survival, and the need to apply evidence-based psychotherapy focused on recovery of social functioning in the early stages of the disorder.

Health Impacts of Long-Term NO2 Exposure and Inequalities among the Chinese Population from 2013 to 2020

Nitrogen dioxide (NO₂) is associated with mortality and many other adverse health outcomes. In 2021, the World Health Organization established a new NO₂ air quality guideline (AQG) (annual average <10 μg/m³). However, the burden of diseases attributable to long-term NO₂ exposure above the AQG is unknown in China. Nitrogen oxide is a major air pollutant in populous cities, which are disproportionately impacted by NO₂; this represents a form of environmental inequality. We conducted a nationwide risk assessment of premature deaths attributable to long-term NO₂ exposure from 2013 to 2020 based on the exposure-response relationship, high-resolution annual NO₂ concentrations, and gridded population data (considering sex, age, and residence [urban vs rural]). We calculated health metrics including attributable deaths, years of life lost (YLL), and loss of life expectancy (LLE). Inequality in the distribution of attributable deaths and YLLs was evaluated by the Lorenz curve and Gini index. According to the health impact assessments, in 2013, long-term NO₂ exposure contributed to 315,847 (95% confidence interval [CI]: 306,709-319,269) premature deaths, 7.90 (7.68-7.99) million YLLs, and an LLE of 0.51 (0.50-0.52) years. The high-risk subgroup (top 20%) accounted for 85.7% of all NO₂-related deaths and 85.2% of YLLs, resulting in Gini index values of 0.81 and 0.67, respectively. From 2013 to 2020, the estimated health impact from NO₂ exposure was significantly reduced, but inequality displayed a slightly increasing trend. Our study revealed a considerable burden of NO₂-related deaths in China, which were disproportionally frequent in a small high-risk subgroup. Future clean air initiatives should focus not only on reducing the average level of NO₂ exposure but also minimizing inequality.

Payday lenders and premature mortality

Relationships between debt and poor health are worrisome as access to expensive credit expands and population health worsens along certain metrics. We focus on payday lenders as one type of expensive credit and investigate the spatial relationships between lender storefronts and premature mortality rates. We combine causes of death data from the Centers for Disease Control and Prevention (CDC) and payday lender locations at the county-level in the United States between 2000 and 2017. After accounting for county socioeconomic and demographic characteristics, the local presence of payday lenders is associated with an increased incidence risk of all-cause and specific-cause premature mortality. State regulations may attenuate these relationships, which provides insights on policy strategies to mitigate health impacts.

Envisioning the financial and psychological hardships of cancer

Cancer is one of the leading causes of premature death and disability worldwide. With the progress of the health-care system, the cost of cancer treatment is also rising. Poor households suffer disproportionately from the financial burden of cancer treatment, which has pushed many households into poverty. Thus, cancer poses an economic burden for individuals, families, societies, and governments because of the prolonged medical costs, out-of-pocket expenditures, loss of productivity, and premature deaths. Moreover, the psychological breakdown phenomenon and social implications of cancer play a vital role in dealing with cancer patients. The psychological effect of battling with cancer falls not only on the patient but also on the caregivers and family members. With these backgrounds, an attempt is made in this review paper to highlight the implications of cancer on financial and psychological aspects.

Mortality among People with Epilepsy: A Retrospective Nationwide Analysis from 2016 to 2019

We estimated age-adjusted mortality and investigated the dominant causes of death as well as comorbidities among people with epilepsy (PWE) in Lithuania, a country with frequent deaths from external causes. From 2016 to 2019, the age-adjusted rate of death among PWE in Lithuania was compared with mortality data in the general population. Each year of analysis, individuals who were diagnosed with epilepsy comprised a retrospective cohort. The standardized mortality ratio (SMR) of PWE varied from 2.93 (95% CI 2.78 to 3.07) to 3.18 (95% CI 3.02 to 3.34). PWE died at least one decade earlier than expected in the general population. The dominant causes of death were cardiovascular diseases (their proportion ranged from 44.8% to 49.3%), cancer (16.7% to 21.3%) and external causes of death (8.5% to 10.9%). The proportion of the latter decreased over time (r = −0.99, p = 0.01), whereas the SMR for external causes of death remained relatively constant. Epilepsy was the underlying cause of death in 163 cases (2.6%), and noted as a condition contributing to death in 1010 cases (15.9%). Cerebrovascular and cardiological conditions and dementia were the most frequent comorbidities among PWE before their death. Epilepsy-unrelated causes of death are relevant contributors to mortality among PWE. There is a need for PWE-oriented societal interventions to reduce the frequency of external deaths beyond the trend in the general population.

Global Gender Disparities in Premature Death from Cardiovascular Disease, and Their Associations with Country Capacity for Noncommunicable Disease Prevention and Control

This study aimed to describe the prevalence of gender disparity in cardiovascular disease and explore its association with a country’s capacity for controlling noncommunicable diseases. Study data were extracted from the Global Health Estimates, and the Noncommunicable Disease Country Capacity Survey. Age-standardized premature death rates from cardiovascular disease, defined as any death occurring from ages 30 to 70 years, were calculated. Univariate and multivariate general linear regression models were fitted to estimate the correlations between gender disparity and country capacity for noncommunicable disease control. Globally, the premature death rate from cardiovascular diseases was 35.6% higher among men than women in 2000, and the figure hardly changed from 2000 to 2016. The highest gender differences were observed in Europe and high-income countries. The existence of dedicated and multisectoral noncommunicable disease governance bodies and the availability of cardiovascular disease stratification in primary healthcare facilities were positively correlated with gender differences. Conclusively, gender disparities in premature death rates from cardiovascular diseases differed with economic conditions and across geographic regions, with higher relative differences observed in more developed countries. The effects of existing control measures may have plateaued in men but are ongoing among women, especially in more developed countries, widening the gender disparity.

Trends in cancer mortality in China from 2004 to 2018: A nationwide longitudinal study

BACKGROUND

The long-term trend in cancer death in a rapidly developing country provides information for cancer prophylaxis. Here, we aimed to identify the trends in cancer mortality in China during the 2004-2018 period.

METHODS

Using raw data from the national mortality surveillance system of China, we assessed the mortalities of all cancer and site-specific cancers during the 2004-2018 period. The participants were divided into three age groups: ≥65 years, 40-64 years, and ≤39 years. Changing trends in cancer death by gender, residency, and tumor location were estimated using fitting joinpoint models to log-transformed crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs).

RESULTS

Cancer death accounted for 24% of all-cause of death in China during 2014-2018. The CMR of all cancer was 150.0 per 100,000 persons. Cancer was the leading cause of death in the population <65 years. The six major cancer types (lung/bronchus cancer, liver cancer, stomach cancer, esophagus cancer, colorectal cancer, and pancreas cancer) accounted for 75.85% of all cancer deaths. The CMR of all cancer increased while the ASMR decreased during 2014-2018 (P < 0.001). Lung/bronchus cancer and liver cancer were the leading causes of cancer death in the population <65 years, accounting for 45.31% (CMR) and 44.35% (ASMR) of all cancer death, respectively. The ASMR of liver cancer was higher in the 40-64 years population than in the ≥65 years population, in contrast to the other five major cancers. The ASMRs of liver cancer, stomach cancer, and esophagus cancer decreased although they were higher in rural residents than in urban residents; the ASMRs of lung/bronchus cancer, colorectal cancer, and pancreas cancer increased in rural residents although they were higher in urban residents than in rural residents during 2014-2018.

CONCLUSION

Although the ASMR of all cancer decreased in China during 2004-2018, lung/bronchus cancer and liver cancer remained the leading causes of cancer-related premature death. Lung/bronchus cancer, colorectal cancer, and pancreas cancer increased in rural residents.

Adult onset epilepsy is defined by phenotypic clusters with unique comorbidities and risks of death

OBJECTIVE

This study was undertaken to identify clusters of adult onset epilepsy with distinct comorbidities and risks of early and late death.

METHODS

This was a retrospective open cohort study that included all adults meeting a case definition for epilepsy after the Acceptable Mortality Recording date in the Health Improvement Network database for the years 2000-2012 inclusive. Unsupervised agglomerative hierarchical clustering was performed to identify unique clusters of patients based on their predicted risk of early (<4 years of epilepsy diagnosis) and late (≥4 years from diagnosis) mortality and patient-level clinical characteristics.

RESULTS

We identified 10 499 presumed incident cases of epilepsy from 11 194 182 patients. Four phenotypic clusters were identified in the early and late risk periods. Early clusters include older adults with cardiovascular disease and a high risk of death (median predicted risk = 20%, interquartile range [IQR] = 9%-31%), a group with moderate risk of death and cancer (median predicted risk = 6%, IQR = 2%-15%), a group with psychiatric disease/substance use and few somatic comorbidities (median predicted risk = 5%, IQR = 2%-9%), and one with a younger age at onset and few comorbidities (median predicted risk = 4%, IQR = 1%-11%). There was minimal movement of individuals between clusters for those surviving the early risk period. Age- and sex-standardized 3-year mortality ratios were more than sixfold higher than the general population for every cluster, even those primarily comprised of healthy younger adults.

SIGNIFICANCE

Adult onset epilepsy is marked by unique clusters of comorbid conditions and elevated risks of death that form discrete populations for targeted therapeutic interventions. These clusters remain relatively stable between the early and late mortality risk periods. Of particular interest are the clusters marked by young and otherwise healthy adults whose standardized mortality ratio is sixfold higher than general population despite few conventional risk factors for premature death.

Combatting Covid-19. Or, "All Persons Are Equal but Some Persons Are More Equal than Others?"

Vaccines, when available, will prove to be crucial in the fight against Covid-19. All societies will face acute dilemmas in allocating scarce lifesaving resources in the form of vaccines for Covid-19. The author proposes The Value of Lives Principle as a just and workable plan for equitable and efficient access. After describing what the principle entails, the author contrasts the advantage of this approach with other current proposals such as the Fair Priority Model.

Out of Hospital Sudden Death in a Rural Population: Low Rates of ICD Underutilization Among Decedents

BACKGROUND

Implantable cardioverter defibrillators (ICDs) reduce mortality in patients at risk for life-threatening arrhythmias. Implantation of ICDs in rural or economically disadvantaged populations is suspected to be low. This study examined Out of Hospital Premature Natural Death (OHPND) and electronic medical record (EMR) data to identify rates of non-implantation of ICDs among decedents in eastern North Carolina.

METHODS

OHPND cases in 2016 were identified using mortality data and matched with EMRs. Those meeting criteria for ICD implantation based on chart review were adjudicated by two electrophysiologists to determine whether they qualified for implantation. Comorbidity burden was established using Charlson's Comorbidity Index (CCI).

RESULTS

Out of 1316 OHPND cases, 967 (73.4%) had EMR records. Chart review identified 70 (7.2%) potential ICD candidates with a LVEF ≤35 of which 5 (7.1%) did not meet criteria because LVEF subsequently improved. Of the remaining 65 patients, 32 (49.2%) already received an ICD, and 33 patients (50.7%) met criteria but had not received one. Reasons for non-implantation included: limited life expectancy secondary to comorbidities, principally chronic kidney disease (CKD) (N = 11, 17%), physician non-adherence to guidelines (N = 9, 14%), loss to follow-up (N = 7, 11%), patient refusal (N = 5, 8%), and death before commencing medical therapy (N = 1, 2%). Among our cohort of 967 individuals who died unexpectedly, nine (0.9%) patients may have avoided death with an ICD.

CONCLUSION

This study using decedent data shows low rates of ICD-underutilization in a rural population and emphasizes the role of advanced comorbidities such as CKD in ICD-underutilization.

Paediatric sudden unexpected death in epilepsy: A parental report cohort

BACKGROUND

Sudden unexpected death in epilepsy (SUDEP) accounts for a large percentage of deaths in children with epilepsy. Contributing factors to paediatric SUDEP are incompletely understood.

AIMS OF STUDY

The Epilepsy Deaths Register (EDR) is an anonymized register that compiles information on deaths related to epilepsy, across all ages and epilepsy classifications. Using the EDR, we sought to identify key risk factors for SUDEP in children to assist the development of preventive measures.

METHODS

All registrations between the ages of 1 and 16 years were reviewed to identify definite or probable SUDEP. These cases were analysed to identify common demographics, comorbidities, monitoring, treatments and circumstances near to the deaths.

RESULTS

We identified forty-six cases (27 males) of definite or probable SUDEP. Paediatric SUDEP is more common in a 12- to 16-year age group and in those with neuro-disability. Most paediatric SUDEP occurs during apparent sleep. There were four cases with a vagus nerve stimulator. SUDEP can occur early after the onset of seizures.

CONCLUSIONS

This is the largest single cohort of SUDEP reported in children. Reports from caregivers can augment population data. Surveillance in sleep is a priority area of development.

Primary care electronic medical records can be used to predict risk and identify potentially modifiable factors for early and late death in adult onset epilepsy

OBJECTIVE

To use clinically informed machine learning to derive prediction models for early and late premature death in epilepsy.

METHODS

This was a population-based primary care observational cohort study. All patients meeting a case definition for incident epilepsy in the Health Improvement Network database for inclusive years 2000-2012 were included. A modified Delphi process identified 30 potential risk factors. Outcome was early (within 4 years of epilepsy diagnosis) and late (4 years or more from diagnosis) mortality. We used regularized logistic regression, support vector machines, Gaussian naive Bayes, and random forest classifiers to predict outcomes. We assessed model calibration, discrimination, and generalizability using the Brier score, mean area under the receiver operating characteristic curve (AUC) derived from stratified fivefold cross-validation, plotted calibration curves, and extracted measures of association where possible.

RESULTS

We identified 10 499 presumed incident cases from 11 194 182 patients. All models performed comparably well following stratified fivefold cross-validation, with AUCs ranging from 0.73 to 0.81 and from 0.71 to 0.79 for early and late death, respectively. In addition to comorbid disease, social habits (alcoholism odds ratio [OR] for early death = 1.54, 95% confidence interval [CI] = 1.12-2.11 and OR for late death = 2.62, 95% CI = 1.66-4.16) and treatment patterns (OR for early death when no antiseizure medication [ASM] was prescribed at baseline = 1.33, 95% CI = 1.07-1.64 and OR for late death after receipt of enzyme-inducing ASM at baseline = 1.32, 95% CI = 1.04-1.66) were significantly associated with increased risk of premature death. Baseline ASM polytherapy (OR = 0.55, 95% CI = 0.36-0.85) was associated with reduced risk of early death.

SIGNIFICANCE

Clinically informed models using routine electronic medical records can be used to predict early and late mortality in epilepsy, with moderate to high accuracy and evidence of generalizability. Medical, social, and treatment-related risk factors, such as delayed ASM prescription and baseline prescription of enzyme-inducing ASMs, were important predictors.

Chronic Obstructive Pulmonary Disease and Risk of Dementia and Mortality in Lower to Middle Income Countries

Background:

Chronic obstructive pulmonary disease (COPD) is a major disease burden which accounts for 5% of all deaths globally, with most of those (>90%) occurring in lower to middle income countries (LMIC). It is also emerging as an important modifiable dementia risk factor.

Objective:

To address the knowledge gap surrounding the nature of the associations between COPD, dementia, and mortality, and the geographical variation of those associations in LMIC.

Methods:

Data from the 10/66 study surveying 15,394 participants (mean age 74 years, 62% female) across 8 countries was used to estimate the prevalence of self-reported COPD and its association with incident dementia and premature death. Proportional sub-hazards models using a cumulative incidence function were applied to identify the probability of incident dementia onset given the risk of premature death, with estimates pooled across countries via random effect meta-analysis.

Results:

Over the 3-year follow-up, almost 10% of participants developed dementia and 14% were deceased. COPD was not significantly associated with dementia incidence except in Cuba. However, fully adjusted models indicated that individuals with COPD were at a 28% increased risk of premature death, a trend present across most countries when analyzed individually.

Conclusion:

The link between COPD and dementia is currently somewhat different and weaker in LMIC than in developed countries. This may be because premature death in the populations studied mask the development of clinical dementia. Given the global trend toward increased life expectancy, it is critical that the disease burden associated with COPD be addressed without delay if a further rise in dementia prevalence associated with COPD is to be avoided in LMIC.

Perceiving and Addressing the Pervasive Racial Disparity in Abortion

Black women have been experiencing induced abortions at a rate nearly 4 times that of White women for at least 3 decades, and likely much longer. The impact in years of potential life lost, given abortion’s high incidence and racially skewed distribution, indicates that it is the most demographically consequential occurrence for the minority population. The science community has refused to engage on the subject and the popular media has essentially ignored it. In the current unfolding environment, there may be no better metric for the value of Black lives.

Premature Deaths, Statistical Lives, and Years of Life Lost: Identification, Quantification, and Valuation of Mortality Risks

Mortality effects of exposure to air pollution and other environmental hazards are often described by the estimated number of "premature" or "attributable" deaths and the economic value of a reduction in exposure as the product of an estimate of "statistical lives saved" and a "value per statistical life." These terms can be misleading because the number of deaths advanced by exposure cannot be determined from mortality data alone, whether from epidemiology or randomized trials (it is not statistically identified). The fraction of deaths "attributed" to exposure is conventionally derived as the hazard fraction (R - 1)/R, where R is the relative risk of mortality between high and low exposure levels. The fraction of deaths advanced by exposure (the "etiologic" fraction) can be substantially larger or smaller: it can be as large as one and as small as 1/e (≈0.37) times the hazard fraction (if the association is causal and zero otherwise). Recent literature reveals misunderstanding about these concepts. Total life years lost in a population due to exposure can be estimated but cannot be disaggregated by age or cause of death. Economic valuation of a change in exposure-related mortality risk to a population is not affected by inability to know the fraction of deaths that are etiologic. When individuals facing larger or smaller changes in mortality risk cannot be identified, the mean change in population hazard is sufficient for valuation; otherwise, the economic value can depend on the distribution of risk reductions.

[Health Benefit Evaluation for Air Pollution Prevention and Control Action Plan in China]

To quantitatively assess the health benefits brought by the implementation of the Action Plan of Air Pollution Prevention and Control, we firstly analyzed the spatial and temporal changes of PM_2.5 population-weighted concentrations over China from 2013 to 2017. The BenMAP model was used to analyze the differences in premature death between the PM_2.5 baseline scenario in 2013 and the control scenario in 2017 in 338 prefecture-level cities nationwide, so as to quantitatively analyze the number of premature deaths in 31 provinces. The results show that compared with other provinces, the largest reduction in premature deaths due to the significant decrease of PM_2.5 concentration occurred in the Beijing-Tianjin-Hebei region and its surrounding regions, and the environmental health benefits from air quality have been greatly improved. The results show that from 2013 to 2017 the population weighted PM_2.5 concentration was decreasing year by year due to the significant decrease in PM_2.5 concentration; Beijing, Tianjin, Hebei, and the surrounding areas witnessed the largest reduction in premature deaths. In 2017, the number of avoided premature deaths in 280 prefecture-level cities nationwide increased, but declined in 58 cities. Taking the target value of the first phase of the WHO transition period (an annual average PM_2.5 concentration of 35 μg·m^-3) as the control scenario, it is estimated that the number of premature deaths in 2013 was approximately 101293, and in 2017 was approximately 41080. The implementation of the Action Plan helped to avoid approximately 60213 premature deaths. According to the method of 'willingness to pay', the monetary benefits are estimated to be approximately 54.97 billion yuan.

A Pragmatic Epidemiological Approach to Confronting the Genocidal Death Effect of Homicide and Suicide among Young Black Males in the United States

Genocide is a dehumanizing crime that threatens the welfare of any civilized society. Yet, before the annihilation of any targeted human group, the collective outcomes of the genocidal process (e.g., systemic desecrations) and genocidal death effect (e.g., years of mass deaths and death disparities) have often gone undetected, underestimated, or ignored by public health and human rights advocates. From1950-2010, the mass homicide-suicide killings engendering the premature deaths of Black males, ages15-24 years, corroborate that aspects of the genocidal process and genocidal death effect are happening in America. The mass killings of young Black males from these preventable homicide and suicide deaths are ethically alarming, and the determinants of death impacting their premature deaths command immediate primordial prevention and reinforced prevention efforts. An epidemiological genocide prevention matrix is explored as an innovative approach to address, prevent, and research premature deaths resulting from homicide and suicide, and genocidal death effect of young Black males. Undergirded by the Theory of Epidemiologic Transition, this article also examines the mass killings of young Black males through the genocidal and pragmatic lens. Death disparities, determinants of death, and genocidal death effect definitions are operationalized, and the Genocidal Death Effect Conceptual Framework is debuted in this article.

Risk of Cardiovascular Mortality in Relation to Increased Total Serum IgE Levels in Older Adults: A Population-Based Cohort Study

Background: Despite a potential link between immunoglobulin E (IgE) levels and cardiovascular disease, the effect of elevated total IgE levels on long-term mortality risk remains unclear. We prospectively investigated the association between total serum IgE levels and all-cause and cardiovascular mortality in US adults. Methods: We analyzed data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES) and the NHANES (2005–2006) Linked Mortality Public File. The 2005–2006 NHANES data of 1496 older adults aged ≥50 years and who underwent a serum total IgE antibody test in the initial survey were included. Results: After a median follow-up of 119 months, a significant association was observed between total serum IgE levels and cardiovascular mortality, with subjects with the highest total IgE exhibiting a 3.19-fold (HR = 3.19; 95% confidence interval: 1.71–5.96) increase in the risk of cardiovascular mortality compared with those with the lowest total IgE (≤16.80 kU/L). Furthermore, the mortality rate increased with an increase in total IgE levels, regardless of baseline history of cardiovascular diseases (e.g., myocardial infarction, stroke, and noninvasively diagnosed large-vessel peripheral arterial disease). Conclusions: This finding suggests that the elevation of IgE levels may be a risk factor for increased cardiovascular mortality.

Lifestyle Risk Factors and All-Cause and Cardiovascular Disease Mortality: Data from the Korean Longitudinal Study of Aging

This study examined the association between lifestyle risk factors and all-cause and cardiovascular disease (CVD) mortality in 9945 Korea adults (56% women) aged 45 years and older. Smoking, heavy alcohol intake, underweight or obesity, physical inactivity, and unintentional weight loss (UWL) were included as risk factors. During 9.6 ± 2.0 years of follow-up, there were a total of 1530 cases of death from all causes, of which 365 cases were from CVD. Compared to a zero risk factor (hazard ratio, HR = 1), the crude HR of all-cause mortality was 1.864 (95% CI, 1.509–2.303) for one risk factor, 2.487 (95% confidence interval, CI, 2.013–3.072) for two risk factors, and 3.524 (95% CI, 2.803–4.432) for three or more risk factors. Compared to a zero risk factor (HR = 1), the crude HR of CVD mortality was 2.566 (95% CI, 1.550–4.250) for one risk factor, 3.655 (95% CI, 2.211–6.043) for two risk factor, and 5.416 (95% CI, 3.185–9.208) for three or more risk factors. The HRs for all-cause and CVD mortality remained significant even after adjustments for measured covariates. The current findings showed that five lifestyle risk factors, including smoking, at-risk alcohol consumption, underweight/obesity, physical inactivity, and UWL, were significantly associated with an increased risk of all-cause and CVD mortality in Korean adults.

[Perinatal bereavement and support for siblings]

When the premature death of a baby occurs in a family, brothers and sisters need support. Their silence, their absence of questions or reactions must set off alarm bells. The parents, beyond their own bereavement, have a key role to play in enabling their children to integrate this loss into their lives.

Premature Adult Death and Equity Impact of a Reduction of NO₂, PM10, and PM2.5 Levels in Paris-A Health Impact Assessment Study Conducted at the Census Block Level

Background: To support environmental policies aiming to tackle air pollution, quantitative health impact assessments (HIAs) stand out as one of the best decision-making tools. However, no risk assessment studies have quantified or mapped the health and equity impact of air pollution reduction at a small spatial scale. Objectives: We developed a small-area analysis of the impact of air pollution on "premature" death among an adult population over 30 years of age to quantify and map the health and equity impact related to a reduction of air pollution. Methods: All-cause mortality data of an adult population (>30 years) from January 2004 to December 2009 were geocoded at the residential census block level in Paris. Each census block was assigned socioeconomic deprivation levels and annual average ambient concentrations of NO₂, PM₁₀, and PM_2.5. HIAs were used to estimate, at a small-area level, the number of "premature" deaths associated with a hypothetical reduction of NO₂, PM₁₀, and PM_2.5 exposure. In total, considering global dose response function for the three pollutants and socioeconomic deprivation specific dose response function, nine HIAs were performed for NO₂ and six and four HIAs for PM10 and PM2.5, respectively. Finally, a clustering approach was used to quantify how the number of "premature" deaths could vary according to deprivation level. Results: The number of deaths attributable to NO₂, PM₁₀, and PM_2.5 exposure were equal to 4301, 3209, and 2662 deaths, respectively. The most deprived census blocks always appeared as one of the groups most impacted by air pollution. Our findings showed that "premature" deaths attributable to NO₂ were not randomly distributed over the study area, with a cluster of excess "premature" deaths located in the northeastern area of Paris. Discussion: This study showed the importance of stratifying an environmental burden of disease study on the socioeconomic level, in order to take into consideration the modifier effect of socioeconomic status on the air pollution-mortality relationship. In addition, we demonstrated the value of spatial analysis to guide decision-making. This shows the need for tools to support priority-setting and to guide policymakers in their choice of environmental initiatives that would maximize health gains and reduce social inequalities in health.

[Patterns of Mortality from Air Pollutant Emissions in China's Coal-fired Power Plants]

Based on the high-resolution coal-fired power plant emission database, GEOS-Chem Adjoint, a global-regional nested atmospheric chemistry model and its adjoint were applied to analyze PM_2.5-related premature deaths caused by the power sector in six grid regions of China due to air pollutant emissions and subsequent pollution. The results show that power sector-related PM_2.5 pollution caused 106000 (95% CI:68000-132000) premature deaths in 2010, accounting for 9.8% of China's anthropogenic PM_2.5-related premature deaths. The health loss intensity (defined as number of premature deaths caused by a unit of power generation) of small and old units is significantly higher than that of large and new units:units with a capacity below 100 MW reach 62 people·(TW·h)^-1, 2.8 times that of units with a capacity above 600 MW. Similarly, the health loss intensity of units older than thirty years is 58 people·(TW·h)^-1, 2.1 times that of new units. From the perspective of regional grids, the health impact index of Central China is relatively large, reaching 77 people·(TW·h)^-1. Further analysis reveals that transregional power transmission led to a net increase of 680 premature deaths compared with the scenario without transmission in 2010. Our study implies that China should accelerate the pace of phasing out small and old units and optimize the power transmission distribution between grid regions to reduce the overall level of pollution and health losses.

[The Years of Life Lost as a Result of Road Traffic Accidents In Russia in 2000-2012]

The road traumatism and its aftermath are global and increasing problem. In 2014 Russia ranked first position in relation to number of deaths because of road accidents per one million of population among countries being members of the UN European economic commission. The purpose of study is to establish gender age characteristics and dynamics of burden of road traffic mortality in Russia. The non-clinical observation study was carried out covering years of life lost as a result of premature mortality due to road traffic accidents in Russia and standard of life expectancy on one-year age groups for males and females during 2000-2012. In 2012, the age interval of 20-34 years covered 50% of total number of years of life lost because of road traffic accidents in males and 37% in females. During the analyzed period, decreasing of number of years of life lost per thousand males/females occurred in all age groups. The dramatic decreasing of rate of increase of losses during 2007-2009 ended in 2010 and their increasing began factually in all age groups. In case of males aged 15-19 years it was thus much significant that number of years of life lost per thousand of males in 2012 (29.8 years per thousand of males) factually returned to level of 2000 (30.8 years per thousand of males).

Co-occurrence of hypertrophic cardiomyopathy and juvenile myelomonocytic leukemia in a neonate with Noonan syndrome, leading to premature death

We report a case of a neonate with Noonan syndrome presenting with concurrent hypertrophic cardiomyopathy and juvenile myelomonocytic leukemia, which resulted in premature death. Cases with Noonan syndrome diagnosed during the neonatal period might not necessarily show mild clinical course, and premature death is a possible outcome to be considered.

Policy Development and Regulation of Aged Care

Data from both medical and legal investigation can provide significant opportunities for legal and regulatory policy development that in some sectors are often ignored or missed. The provision of safe and high-quality care for the vulnerable, frail older people who live in residential aged care services (often termed nursing homes) in Australia continues to come under enormous scrutiny. The year 2017 saw a plethora of inquiries, some concluded and others ongoing, investigating the safety and care provided to residents. These inquiries have ramifications for the collection and use of data in the development of policy and regulation aimed at improving care within the aged care sector.

Fluoxetine Treatment Induces Seizure Behavior and Premature Death in APPswe/PS1dE9 Mice

Treatment of Alzheimer's disease (AD) patients with the antidepressant fluoxetine is known to improve memory and cognitive function. However, the mechanisms underlying these effects are largely unknown. To unravel these mechanisms, we aimed to treat APPswe/PS1dE9 mice with fluoxetine. Unexpectedly, with time, an increased number of animals displayed seizure behavior and died. Although spontaneous behavioral seizures have been reported previously in this mouse model, the observation of seizures and death consequential to fluoxetine treatment is new. Our results warrant further research on the underlying mechanisms as this may refine the treatment of AD patients.

Mortality in schizophrenia: clinical and serological predictors

Persons with schizophrenia have a reduced life expectancy largely due to death from natural causes. Factors that have been previously associated with excess mortality include cigarette smoking and antipsychotic medication. The role of other environmental factors such as exposure to infectious agents has been the subject of only limited investigation. We prospectively assessed a cohort of persons with schizophrenia with a clinical evaluation and a blood sample from which antibodies to human herpes viruses and Toxoplasma gondii were measured. Mortality was determined with data from the National Death Index following a period of up to 11 years. We examined the role of demographic, serological, and clinical factors on mortality. A total of 25 (5%) of 517 persons died of natural causes. The standardized mortality ratio was 2.80 (95% CI 0.89, 6.38). After adjusting for age and gender, mortality from natural causes was predicted in separate models by cigarette smoking (relative risk [RR] = 4.66, P = .0029); lower cognitive score (RR = 0.96, P = .013); level of antibodies to Epstein-Barr virus (RR = 1.22, P = .0041) and to Herpes Simplex virus type 1 (RR = 1.19, P = .030); immunologic disease (RR = 3.14, P = .044); and genitourinary disease (RR = 2.70; P = .035). Because cigarette smoking confers an almost 5-fold risk of mortality, smoking cessation is an urgent priority. Having an elevated level of antibodies to Epstein-Barr virus and to Herpes Simplex virus type 1 are also significant predictors of death from natural causes.

The Sydney Mental Health Client Mortality Audit: what does it tell us and what are we to do?

OBJECTIVES

To examine the characteristics of those mental health clients of an Australian metropolitan health service who died during a 6 year period, 2005 - 2010.

METHODS

The medical records, and where available, coronial post-mortem examinations were audited for 109 people with schizophrenia who died while they were clients of the mental health service.

RESULTS

The mean age of death for men was 45 years and for women, 47 years, compared to the general population's male and female life expectancy of 79 and 84 years, respectively. About one-half of the deaths were due to suicide (n = 55), followed by natural causes (n = 42; 39%), undetermined causes (n = 7), and accidents or acts of violence (n = 5). Smoking rates, diagnosed diabetes and hypertension were higher in the group that died from natural causes. Morbid obesity (body mass index (BMI) > 35 kg/m(2)) rates were higher in the group that died of natural causes (38%), compared with the suicide group (5%).

CONCLUSIONS

While suicide accounts for the majority of those dying prematurely in this study cohort, it appears that for those who survive the risk of suicide in the earlier period of a chronic psychotic illness, there is yet another threat to life expectancy: death from preventable cardiorespiratory disorders, due to a poor lifestyle and social deprivation.

Correlations in timing of sodium channel expression, epilepsy, and sudden death in Dravet syndrome

Dravet Syndrome (DS) is an intractable genetic epilepsy caused by loss-of-function mutations in SCN1A, the gene encoding brain sodium channel Nav 1.1. DS is associated with increased frequency of sudden unexpected death in humans and in a mouse genetic model of this disease. Here we correlate the time course of declining expression of the murine embryonic sodium channel Nav 1.3 and the rise in expression of the adult sodium channel Nav 1.1 with susceptibility to epileptic seizures and increased incidence of sudden death in DS mice. Parallel studies with unaffected human brain tissue demonstrate similar decline in Nav 1.3 and increase in Nav 1.1 with age. In light of these results, we introduce the hypothesis that the natural loss Nav 1.3 channel expression in brain development, coupled with the failure of increase in functional Nav 1.1 channels in DS, defines a tipping point that leads to disinhibition of neural circuits, intractable seizures, co-morbidities, and premature death in this disease.

Marginal public health gain of screening for colorectal cancer: modelling study, based on WHO and national databases in the Nordic countries

AIMS

To estimate the potential gain of national screening programmes for colorectal cancer (CRC) by stool occult blood testing in the Nordic countries, with comparative reference to the burden of other causes of premature death.

METHODS

Implementation of national screening programmes for CRC was modelled among people 55-74 years in accordance with the 2011 Cochrane review of biannual screening, using the faecal occult blood test (FOBT) for 10 years, resulting in 15% relative risk reduction in CRC deaths among all those invited [intention-to-treat; relative risk 0.85; confidence interval (CI) 0.78 to 0.92]. Our calculations are based on the World Health Organization and national databanks on death causes (ICD-10) and the mid-year number of inhabitants in the target group. For Finland, Denmark, Norway and Sweden, we used data for 2009. For Iceland, due to the population's small size, we calculated mean mortality for the period 2005-2009.

RESULTS

Invitation to a CRC screening programme for 10 years could influence 0.5-0.9% (95%CI 0.4-1.2) of all deaths in the age group 65-74 years. Among the remaining 99% of premature deaths, around 50% were caused by lung cancer, other lung diseases, cardiovascular diseases and accidents, with some national variations.

CONCLUSIONS AND IMPLICATIONS

Establishment of a screening programme for CRC for people aged 55-74 can be expected to affect only a minor proportion of all premature deaths in the Nordic setting. From a public health perspective, prioritizing preventive strategies targeting more prevalent causes of premature death may be a superior approach.