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2. Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013.
- Author
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Kabudula CW, Houle B, Collinson MA, Kahn K, Gómez-Olivé FX, Clark SJ, and Tollman S
- Subjects
- Adolescent, Adult, Age Factors, Aged, Child, Child, Preschool, Developing Countries, Female, HIV Infections mortality, Humans, Infant, Infant, Newborn, Male, Middle Aged, Population Dynamics, Population Surveillance, Risk Factors, Sex Factors, Socioeconomic Factors, South Africa epidemiology, Tuberculosis mortality, Young Adult, Cause of Death trends, Chronic Disease epidemiology, Communicable Diseases epidemiology, Rural Population statistics & numerical data
- Abstract
Background: Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population., Methods: We estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993-2013., Results: From the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males., Conclusions: This typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory.
- Published
- 2017
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3. Temporal trends and gender differentials in causes of childhood deaths at Ballabgarh, India - Need for revisiting child survival strategies.
- Author
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Krishnan, Anand, Ng, Nawi, Kapoor, Suresh K., Pandav, Chandrakant S., and Byass, Peter
- Subjects
CHILD mortality ,CHILD death ,ECONOMIC trends ,SEX differences (Biology) - Abstract
Background: Relating Information on causes of deaths to implementation of health interventions provides vital information for program planning and evaluation. This paper from Ballabgarh Health and Demographic Surveillance System (HDSS) site in north India looks at temporal trends and gender differentials in the causes of death among under-five children. Methods: Data on causes of death for 1972-74, 1982-84, 1992-94, 2002-04 were taken from existing HDSS publications and database. Physicians' assigned causes of death were based on narratives by lay health worker till 1994 and later by verbal autopsy. Cause Specific Mortality Fractions (CSMF) and Cause Specific Mortality Rates (CSMR) per 1000 live births were calculated for neonatal (<1 month) and childhood (1-59 months) period. Gender difference was estimated by calculating ratio of CSMR between girls and boys. Available information on coverage of childhood interventions in the HDSS was retrieved and compiled. Results: The CSMF of prematurity and sepsis was 32% and 17.6% during neonatal period in 2002-04. The share of infections in all childhood deaths decreased from 55.2% in 1972-74 to 43.6% in 2002-04. All major causes of mortality (malnutrition, diarrhea and acute lower respiratory infection) except injuries showed a steep decline among children and seem to have plateued in last decade. Most of disease specific public health interventions were launched in mid eighties. . Girls reported significantly higher mortality rates for prematurity (RR 1.52; 95% CI 1.01-2.29); diarrhea (2.29; 1.59 - 3.29), and malnutrition (3.37; 2.05 - 5.53). Conclusions: The findings of the study point out to the need to move away from disease-specific to a comprehensive approach and to address gender inequity in child survival through socio-behavioural approaches. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
4. Causes of adult female deaths in Bangladesh: findings from two National Surveys.
- Author
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Nahar Q, El Arifeen S, Jamil K, and Streatfield PK
- Subjects
- Adolescent, Adult, Age Factors, Autopsy, Bangladesh epidemiology, Female, Hospitalization, Humans, International Classification of Diseases, Maternal Death, Middle Aged, Mortality, Premature, Suicide, Surveys and Questionnaires, Violence, Young Adult, Cardiovascular Diseases mortality, Cause of Death trends, Communicable Diseases mortality, Death, Maternal Mortality, Neoplasms mortality
- Abstract
Background: Assessment of causes of death and changes in pattern of causes of death over time are needed for programmatic purposes. Limited national level data exist on the adult female causes of death in Bangladesh., Method: Using data from two nationally representation surveys, the 2001 and 2010 Bangladesh Maternal Mortality Surveys (BMMS), the paper examines the causes of adult female death, aged 15-49 years, and changes in the patterns of these deaths. In both surveys, all household deaths three years prior to the survey were identified. Adult female deaths were then followed by a verbal autopsy (VA) using the WHO structured questionnaire. Two physicians independently reviewed the VA forms to assign a cause of death using the ICD-10; in case of disagreement, a third physician made an independent review and assigned a cause of death., Results: The overall mortality rates for women aged 15-49 in 2001 and 2010 were 182 per 100,000 and 120 per 100,000 respectively. There is a shift in the pattern of causes of death during the period covered by the two surveys. In the 2001 survey, the main causes of death were maternal (20 %), followed by diseases of the circulatory system (15 %), malignancy (14 %) and infectious diseases (13 %). However, in the 2010 survey, malignancies were the leading cause (21 %), followed by diseases of the circulatory system (16 %), maternal causes (14 %) and infectious diseases (8 %). While maternal deaths remained the number one cause of death among 20-34 years old in both surveys, unnatural deaths were the main cause for teenage deaths, and malignancies were the main cause of death for older women. Although there is an increasing trend in the proportion of women who died in hospitals, in both surveys most women died at home (74 % in 2001 and 62 % in 2010)., Conclusion: The shift in the pattern of causes of adult female deaths is in agreement with the overall change in the disease pattern from communicable to non-communicable diseases in Bangladesh. Suicide and other violent deaths as the primary cause of deaths among teenage girls demands specific interventions to prevent such premature deaths. Prevention of deaths due to non-communicable diseases should also be a priority.
- Published
- 2015
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5. Territorial gaps on quality of causes of death statistics over the last forty years in Spain.
- Author
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Cirera, Lluís, Bañón, Rafael-María, Maeso, Sergio, Molina, Puri, Ballesta, Mónica, Chirlaque, María-Dolores, and Salmerón, Diego
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CAUSE of death statistics ,DEATH rate ,PROOF & certification of death ,NOSOLOGY - Abstract
Background: The quality of the statistics on causes of death (CoD) does not present consolidated indicators in literature further than the coding group of ill-defined conditions of the International Classification of Diseases. Our objective was to assess the territorial quality of CoD by reliability of the official mortality statistics in Spain over the years 1980–2019. Methods: A descriptive epidemiological design of four decades (1980-, 1990-, 2000-, and 2010–2019) by region (18) and sex was implemented. The CoD cases, age-adjusted rates and ratios (to all-cause) were assigned by reliability to unspecific and ill-defined quality categories. The regional mortality rates were contrasted to the Spanish median by decade and sex by the Comparative Mortality Ratio (CMR) in a Bayesian perspective. Statistical significance was considered when the CMR did not contain the value 1 in the 95% credible intervals. Results: Unspecific, ill-defined, and all-cause rates by region and sex decreased over 1980–2019, although they scored higher in men than in women. The ratio of ill-defined CoD decreased in both sexes over these decades, but was still prominent in 4 regions. CMR of ill-defined CoD in both sexes exceeded the Spanish median in 3 regions in all decades. In the last decade, women's CMR significantly exceeded in 5 regions for ill-defined and in 6 regions for unspecific CoD, while men's CMR exceeded in 4 and 2 of the 18 regions, respectively on quality categories. Conclusions: The quality of mortality statistics of causes of death has increased over the 40 years in Spain in both sexes. Quality gaps still remain mostly in Southern regions. Authorities involved might consider to take action and upgrading regional and national death statistics, and developing a systematic medical post-grade training on death certification. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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6. Excess non-COVID-19 mortality in Norway 2020–2022.
- Author
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Raknes, Guttorm, Fagerås, Stephanie Jebsen, Sveen, Kari Anne, Júlíusson, Pétur Benedikt, and Strøm, Marianne Sørlie
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COVID-19 pandemic ,CARDIOVASCULAR disease related mortality ,MORTALITY ,DEATH rate ,RESPIRATORY diseases - Abstract
Background: Causes of death other than COVID-19 seem to contribute significantly to the excess mortality observed during the 2020–2022 pandemic. In this study, we explore changes in non-COVID-19 causes of death in Norway during the COVID-19 pandemic from March 2020 to December 2022. Methods: We performed a population-based cross-sectional study on data from the Norwegian Cause of Death Registry. All recorded deaths from 1st January 2010 to 31st December 2022 were included. The main outcome measures were the number of deaths and age-standardised death rate (ASMR) per 100000 population from the major cause of death groups in 2020, 2021 and 2022. The predicted number of deaths and ASMRs were forecasted with a 95% prediction interval constructed from a general linear regression model based on the corresponding number of deaths and rates from the preceding ten prepandemic years (2010–2019). We also examined whether there were deviations from expected seasonality in the pandemic period based on prepandemic monthly data from 2010–2019. The cumulative number of deaths and ASMR were estimated based on monthly mortality data. Results: There was significant excess mortality (number of deaths) in 2021 and 2022 for all causes (3.7% and 14.5%), for cardiovascular diseases (14.3% and 22.0%), and for malignant tumours in 2022 (3.5%). In terms of ASMR, there was excess mortality in 2021 and 2022 for all causes (2.9% and 13.7%), and for cardiovascular diseases (16.0% and 25,8%). ASMR was higher than predicted in 2022 for malignant tumours (2.3%). There were fewer deaths than predicted from respiratory diseases (except COVID-19) in 2020 and 2021, and from dementia in 2021 and 2022. From March 2020 to December 2022, there were cumulatively 3754 (ASMR 83.8) more non-COVID-19 deaths than predicted, of which 3453 (ASMR: 79.6) were excess deaths from cardiovascular disease, 509 (ASMR 4.0) from malignant tumours. Mortality was lower than predicted for respiratory diseases (-1889 (ASMR: -44.3)), and dementia (-530 (ASMR -18.5)). Conclusions: There was considerable excess non-COVID-19 mortality in Norway from March 2020 until December 2022, mainly due to excess cardiovascular deaths. For respiratory diseases and dementia, mortality was lower than predicted. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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7. Disparities in cause-specific mortality by health insurance type and premium: evidence from Korean NHIS-HEALS cohort study, 2002–2019
- Author
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Kim, Ye-Seul, Kim, Joungyoun, Kim, Yonghoon, and Kang, Hee-Taik
- Published
- 2024
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8. Causes of neonatal and maternal deaths in Dhaka slums: implications for service delivery.
- Author
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Khatun F, Rasheed S, Moran AC, Alam AM, Shomik MS, Sultana M, Choudhury N, Iqbal M, and Bhuiya A
- Subjects
- Adolescent, Adult, Autopsy, Bangladesh epidemiology, Female, Humans, Infant, Newborn, Interviews as Topic, Pregnancy, Young Adult, Cause of Death, Infant Mortality, Maternal Health Services, Maternal Mortality, Poverty Areas
- Abstract
Background: Bangladesh has about 5.7 million people living in urban slums that are characterized by adverse living conditions, poor access to healthcare services and health outcomes. In an attempt to ensure safe maternal, neonatal and child health services in the slums BRAC started a programme, MANOSHI, in 2007. This paper reports the causes of maternal and neonatal deaths in slums and discusses the implications of those deaths for Maternal Neonatal and Child Health service delivery., Methods: Slums in three areas of Dhaka city were selected purposively. Data on causes of deaths were collected during 2008-2009 using verbal autopsy form. Two trained physicians independently assigned the cause of deaths., Results: A total of 260 newborn and 38 maternal deaths were identified between 2008 and 2009. The majority (75%) of neonatal deaths occurred during 0-7 days. The main causes of deaths were birth asphyxia (42%), sepsis (20%) and birth trauma (7%). Post partum hemorrhage (37%) and eclampsia (16%) were the major direct causes and hepatic failure due to viral hepatitis was the most prevalent indirect cause (11%) of maternal deaths., Conclusion: Delivery at a health facility with child assessment within a day of delivery and appropriate treatment could reduce neonatal deaths. Maternal mortality is unlikely to reduce without delivering at facilities with basic Emergency Obstetric Care (EOC) and arrangements for timely referral to EOC. There is a need for a comprehensive package of services that includes control of infectious diseases during pregnancy, EOC and adequate after delivery care.
- Published
- 2012
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9. Effects of inappropriate cause-of-death certification on mortality from cardiovascular disease and diabetes mellitus in Tonga.
- Author
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Figueroa, Carah A., Linhart, Christine L., Dearie, Catherine, Fusimalohi, Latu E., Kupu, Sioape, Morrell, Stephen L., and Taylor, Richard J.
- Subjects
CARDIOVASCULAR disease related mortality ,DIABETES ,NOSOLOGY ,ETIOLOGY of diabetes ,DIABETES complications - Abstract
Background: Cardiovascular disease (CVD) and diabetes mellitus are major health issues in Tonga and other Pacific countries, although mortality levels and trends are unclear. We assess the impacts of cause-of-death certification on coding of CVD and diabetes as underlying causes of death (UCoD). Methods: Tongan records containing cause-of-death data (2001–2018), including medical certificates of cause-of-death (MCCD), had UCoD assigned according to International Classification of Diseases 10th revision (ICD-10) coding rules. Deaths without recorded cause were included to ascertain total mortality. Diabetes and hypertension causes were reallocated from Part 1 of the MCCD (direct cause) to Part 2 (contributory cause) if potentially fatal complications were not recorded, and an alternative UCoD was assigned. Proportional mortality by cause based on the alternative UCoD were applied to total deaths then mortality rates calculated by age and sex using census/intercensal population estimates. CVD and diabetes mortality rates for unaltered and alternative UCoD were compared using Poisson regression. Results: Over 2001–18, in ages 35–59 years, alternative CVD mortality was higher than unaltered CVD mortality in men (p = 0.043) and women (p = 0.15); for 2010–18, alternative versus unaltered measures in men were 3.3/10
3 (95%CI: 3.0–3.7/103 ) versus 2.9/103 (95%CI: 2.6–3.2/103 ), and in women were 1.1/103 (95%CI: 0.9–1.3/103 ) versus 0.9/103 (95%CI: 0.8–1.1/103 ). Conversely, alternative diabetes mortality rates were significantly lower than the unaltered rates over 2001–18 in men (p < 0.0001) and women (p = 0.013); for 2010–18, these measures in men were 1.3/103 (95%CI: 1.1–1.5/103 ) versus 1.9/103 (95%CI: 1.6–2.2/103 ), and in women were 1.4/103 (95%CI: 1.2–1.7/103 ) versus 1.7/103 (95%CI: 1.5–2.0/103 ). Diabetes mortality rates increased significantly over 2001–18 in men (unaltered: p < 0.0001; alternative: p = 0.0007) and increased overall in women (unaltered: p = 0.0015; alternative: p = 0.014). Conclusions: Diabetes reporting in Part 1 of the MCCD, without potentially fatal diabetes complications, has led to over-estimation of diabetes, and under-estimation of CVD, as UCoD in Tonga. This indicates the importance of controlling various modifiable risks for atherosclerotic CVD (including stroke) including hypertension, tobacco use, and saturated fat intake, besides obesity and diabetes. Accurate certification of diabetes as a direct cause of death (Part 1) or contributory factor (Part 2) is needed to ensure that valid UCoD are assigned. Examination of multiple cause-of-death data can improve understanding of the underlying causes of premature mortality to better inform health planning. [ABSTRACT FROM AUTHOR]- Published
- 2023
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10. Socioeconomic inequalities in cause specific mortality among older people in France.
- Author
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Menvielle G, Leclerc A, Chastang JF, and Luce D
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- Age Distribution, Aged, Aged, 80 and over, Chronic Disease mortality, Female, France epidemiology, Humans, Longitudinal Studies, Male, Middle Aged, Neoplasms mortality, Proportional Hazards Models, Sex Distribution, Socioeconomic Factors, Cause of Death trends, Educational Status, Healthcare Disparities statistics & numerical data
- Abstract
Background: European comparative studies documented a clear North-South divide in socioeconomic inequalities with cancer being the most important contributor to inequalities in total mortality among middle aged men in Latin Europe (France, Spain, Portugal, Italy). The aim of this paper is to investigate educational inequalities in mortality by gender, age and causes of death in France, with a special emphasis on people aged 75 years and more., Methods: We used data from a longitudinal population sample that includes 1% of the French population. Risk of death (total and cause specific) in the period 1990-1999 according to education was analysed using Cox regression models by age group (45-59, 60-74, and 75+). Inequalities were quantified using both relative (ratio) and absolute (difference) measures., Results: Relative inequalities decreased with age but were still observed in the oldest age group. Absolute inequalities increased with age. This increase was particularly pronounced for cardiovascular diseases. The contribution of different causes of death to absolute inequalities in total mortality differed between age groups. In particular, the contribution of cancer deaths decreased substantially between the age groups 60-74 years and 75 years and more, both in men and in women., Conclusions: This study suggests that the large contribution of cancer deaths to the excess mortality among low educated people that was observed among middle aged men in Latin Europe is not observed among French people aged 75 years and more. This should be confirmed among other Latin Europe countries.
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- 2010
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11. Assessing the disease burden of Yi people by years of life lost in Shilin county of Yunnan province, China.
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Zhou SC, Cai L, Wan CH, Lv YL, and Fang PQ
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- Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Child, Child, Preschool, China epidemiology, Female, Humans, Infant, Life Expectancy, Male, Middle Aged, Mortality, Sex Distribution, Young Adult, Cause of Death, Cost of Illness, Life Tables
- Abstract
Background: Years of Life Lost (YLL) is one of the methods used to estimate the duration of time lost due to premature death. While previous studies of disease burden have been reported using YLL, there have been no studies investigating YLL of Yi people in rural China. Yunnan Province ranks first in terms of Yi people in China. This paper uses YLL to estimate the disease burden of Yi people in Shilin county of Yunnan Province. This study aims to address the differentials about YLL between Yi people and Han people for providing useful information for health planning., Methods: We applied the Global Burden of Disease (GBD) method created by WHO. YLL rate per 1,000 were calculated from medical death certificates in 2003 in Shilin Yi Nationality Autonomous County (Shilin county)., Results: The male had greater YLL rate per 1,000 than did the female almost in each age group. It demonstrated a higher premature mortality burden due to injuries in Shilin county. Among the top non-communicable diseases, respiratory diseases are the most common mortality burden. Yi people are still suffering from maternal conditions, with two times the burden rates of Han people. For Yi people, while malignant neoplasm was one of the least burden of disease for male, it was the greatest for female, which is the opposite to Han people., Conclusion: Strategies of economic development should be reviewed to enhance the prevention and treatment of injuries, maternal conditions and respiratory diseases for Yi people.
- Published
- 2009
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12. Are there gender differences in the geography of alcohol-related mortality in Scotland? An ecological study.
- Author
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Emslie C and Mitchell R
- Subjects
- Adult, Age Factors, Alcohol Drinking epidemiology, Alcoholism epidemiology, Confidence Intervals, Cross-Sectional Studies, Cultural Characteristics, Ecology, Female, Geography, Humans, Incidence, Linear Models, Male, Middle Aged, Probability, Risk Factors, Scotland epidemiology, Severity of Illness Index, Sex Factors, Socioeconomic Factors, Young Adult, Alcohol Drinking mortality, Alcoholism mortality, Cause of Death
- Abstract
Background: There is growing concern about alcohol-related harm, particularly within Scotland which has some of the highest rates of alcohol-related death in western Europe. There are large gender differences in alcohol-related mortality rates in Scotland and in other countries, but the reasons for these differences are not clearly understood. In this paper, we aimed to address calls in the literature for further research on gender differences in the causes, contexts and consequences of alcohol-related harm. Our primary research question was whether the kind of social environment which tends to produce higher or lower rates of alcohol-related mortality is the same for both men and women across Scotland., Methods: Cross-sectional, ecological design. A comparison was made between spatial variation in men's and women's age-standardised alcohol-related mortality rates in Scotland using maps, Moran's Index, linear regression and spatial analyses of residuals. Directly standardised mortality rates were derived from individual level records of death registration, 2000-2005 (n = 8685)., Results: As expected, men's alcohol-related mortality rate substantially exceeded women's and there was substantial spatial variation in these rates for both men and women within Scotland. However, there was little spatial variation in the relationship between men's and women's alcohol-mortality rates (r2 = 0.73); areas with relatively high rates of alcohol-related mortality for men tended also to have relatively high rates for women. In a small number of areas (8 out of 144) the relationship between men's and women's alcohol-related mortality rates was significantly different., Conclusion: In as far as geographic location captures exposure to social and economic environment, our results suggest that the relationship between social and economic environment and alcohol-related harm is very similar for men and women. The existence of a small number of areas in which men's and women's alcohol-related mortality had an different relationship suggests that some places may have unusual drinking cultures. These might prove useful for further investigations into the factors which influence drinking behaviour in men and women.
- Published
- 2009
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13. Methodologies used to estimate tobacco-attributable mortality: a review.
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Pérez-Ríos M and Montes A
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- Humans, Prevalence, Cause of Death, Epidemiologic Methods, Tobacco Use Disorder mortality
- Abstract
Background: One of the most important measures for ascertaining the impact of tobacco on a population is the estimation of the mortality attributable to its use. To measure this, a number of indirect methods of quantification are available, yet there is no consensus as to which furnishes the best information. This study sought to provide a critical overview of the different methods of attribution of mortality due to tobacco consumption., Method: A search was made in the Medline database until March 2005 in order to obtain papers that addressed the methodology employed for attributing mortality to tobacco use., Results: Of the total of 7 methods obtained, the most widely used were the prevalence methods, followed by the approach proposed by Peto et al, with the remainder being used in a minority of studies., Conclusion: Different methodologies are used to estimate tobacco attributable mortality, but their methodological foundations are quite similar in all. Mainly, they are based on the calculation of proportional attributable fractions. All methods show limitations of one type or another, sometimes common to all methods and sometimes specific.
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- 2008
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14. Childhood deaths from external causes in Estonia, 2001-2005.
- Author
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Väli M, Lang K, Soonets R, Talumäe M, and Grjibovski AM
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- Accidents, Traffic mortality, Adolescent, Asphyxia mortality, Autopsy, Child, Child, Preschool, Data Collection methods, Death Certificates, Estonia epidemiology, Female, Humans, Infant, Infant, Newborn, Male, Poisoning mortality, Registries, Suicide statistics & numerical data, Wounds and Injuries classification, Cause of Death trends, Wounds and Injuries mortality
- Abstract
Background: In 2000, the overall rate of injury deaths in children aged 0-14 was 28.7 per 100000 in Estonia, which is more than 5 times higher than the corresponding rate in neighbouring Finland. This paper describes childhood injury mortality in Estonia by cause and age groups, and validates registration of these deaths in the Statistical Office of Estonia against the autopsy data., Methods: The data on causes of all child deaths in Estonia in 2001-2005 were abstracted from the autopsy protocols at the Estonian Bureau of Forensic Medicine. Average annual mortality rates per 100,000 were calculated. Coverage (proportion of the reported injury deaths from the total number of injury deaths) and accuracy (proportion of correctly classified injury deaths) of the registration of causes of death in Statistical Office of Estonia were assessed by comparing the Statistical Office of Estonia data with the data from Estonian Bureau of Forensic Medicine., Results: Average annual mortality from external causes in 0-14 years-old children in Estonia was 19.1 per 100,000. Asphyxia and transport accidents were the major killers followed by poisoning and suicides. Relative contribution of these causes varied greatly between age groups. Intent of death was unknown for more than 10% of injury deaths. Coverage and accuracy of registration of injury deaths by Statistical Office of Estonia were 91.5% and 95.3%, respectively., Conclusion: Childhood mortality from injuries in Estonia is among the highest in the EU. The number of injury deaths in Statistical Office of Estonia is slightly underestimated mostly due to misclassification for deaths from diseases. Accuracy of the Statistical Office of Estonia data was high with some underestimation of intentional deaths. Moreover, high proportion of death with unknown intent suggests underestimation of intentional deaths. Reduction of injury deaths should be given a high priority in Estonia. More information on circumstances around death is needed to enable establishing the intent of death.
- Published
- 2007
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15. Trends in suicide in Scotland 1981 - 1999: age, method and geography.
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Stark C, Hopkins P, Gibbs D, Rapson T, Belbin A, and Hay A
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- Adolescent, Adult, Age Distribution, Aged, Asphyxia mortality, Female, Geography, Humans, Male, Middle Aged, Neck Injuries mortality, Poisoning mortality, Registries, Rural Health statistics & numerical data, Scotland epidemiology, Sex Distribution, Suicide classification, Suicide statistics & numerical data, Urban Health statistics & numerical data, Vehicle Emissions toxicity, Cause of Death trends, Suicide trends
- Abstract
Background: Male suicide rates continued to increase in Scotland when rates in England and Wales declined. Female rates decreased, but at a slower rate than in England and Wales. Previous work has suggested higher than average rates in some rural areas of Scotland. This paper describes trends in suicide and undetermined death in Scotland by age, gender, geographical area and method for 1981 - 1999., Methods: Deaths from suicide and undetermined cause in Scotland from 1981 - 1999 were identified using the records of the General Registrar Office. The deaths of people not resident in Scotland were excluded from the analysis. Death rates were calculated by area of residence, age group, gender, and method. Standardised Mortality Ratios (SMRs) and 95% confidence intervals were calculated for rates by geographical area., Results: Male rates of death by suicide and undetermined death increased by 35% between 1981 - 1985 and 1996 - 1999. The largest increases were in the youngest age groups. All age female rates decreased by 7% in the same period, although there were increases in younger female age groups. The commonest methods of suicide in men were hanging, self-poisoning and car exhaust fumes. Hanging in males increased by 96.8% from 45 per million to 89 per million, compared to a 30.7% increase for self-poisoning deaths. In females, the commonest method of suicide was self-poisoning. Female hanging death rates increased in the time period. Male SMRs for 1981 - 1999 were significantly elevated in Western Isles (SMR 138, 95% CI 112 - 171), Highland (135, CI 125 - 147), and Greater Glasgow (120, CI 115 - 125). The female SMR was significantly high only in Greater Glasgow (120, CI 112 - 128)., Conclusion: All age suicide rates increased in men and decreased in women in Scotland in 1981 - 1999. Previous findings of higher than expected male rates in some rural areas were supported. Rates were also high in Greater Glasgow, one of the most deprived areas of Scotland. There were changes in the methods used, with an increase in hanging deaths in men, and a smaller increase in hanging in women. Altered choice of method may have contributed to the increased male deaths.
- Published
- 2004
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16. The injury mortality burden in Guinea.
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Mamady, Keita, Hongyan Yao, Xujun Zhang, Huiyun Xiang, Hongzhuan Tan, and Guoqing Hu
- Subjects
CHILD mortality statistics ,CHILDREN'S injuries ,CHILDREN'S accidents ,MEDICAL statistics - Abstract
Background: The injury mortality burden of Guinea has been rarely addressed. The paper aimed to report patterns of injury mortality burden in Guinea. Methods: We retrieved the mortality data from the Guinean Annual Health Statistics Report 2007. The information about underlying cause of deaths was collected based on Guinean hospital discharge data, Hospital Mortuary and City Council Mortuary data. The causes of death are coded in the 9
th International Classification of Diseases (ICD-9). Multivariate Poisson regression was used to test the impacts of sex and age on mortality rates. The statistical analyses were performed using Statatm 10.0. Results: In 2007, 7066 persons were reported dying of injuries in Guinea (mortality: 72.8 per 100,000 population). Transportation, fire/burn, falls, homicide and drowning were the five leading causes of fatal injuries for the whole population, accounting for 37%, 22%, 12%, 10% and 6% of total deaths, respectively. In general, age-specific injury causes displayed similar patterns of the whole population except that poisoning replaced falls as a leading cause among children under five years old. Males were at 30-50% more risk of dying from six commonest causes than females and old age groups had higher injury mortality rates than younger age groups. Conclusion: Transportation, fire/burn, falls, homicide, and drowning accounted for the majority of total injury mortality burden in Guinea. Males and old adults were high-risk population of fatal injuries and should be targeted by injury prevention. Lots of work is needed to improve weak capacities for injury control in order to reduce the injury mortality burden. [ABSTRACT FROM AUTHOR]- Published
- 2012
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17. Mortality and cause-of-death reporting and analysis systems in seven pacific island countries.
- Author
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Carter, Karen L., Rao, Chalapati, Lopez, Alan D., and Taylor, Richard
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MORTALITY ,CAUSES of death ,PUBLIC health ,MEDICAL statistics ,COMMUNICABLE diseases ,PROOF & certification of death ,HEALTH & welfare funds - Abstract
Background: Mortality statistics are essential for population health assessment. Despite limitations in data availability, Pacific Island Countries are considered to be in epidemiological transition, with non-communicable diseases increasingly contributing to premature adult mortality. To address rapidly changing health profiles, countries would require mortality statistics from routine death registration given their relatively small population sizes. Methods: This paper uses a standard analytical framework to examine death registration systems in Fiji, Kiribati, Nauru, Palau, Solomon Islands, Tonga and Vanuatu. Results: In all countries, legislation on death registration exists but does not necessarily reflect current practices. Health departments carry the bulk of responsibility for civil registration functions. Medical cause-of-death certificates are completed for at least hospital deaths in all countries. Overall, significantly more information is available than perceived or used. Use is primarily limited by poor understanding, lack of coordination, limited analytical skills, and insufficient technical resources. Conclusion: Across the region, both registration and statistics systems need strengthening to improve the availability, completeness, and quality of data. Close interaction between health staff and local communities provides a good foundation for further improvements in death reporting. System strengthening activities must include a focus on clear assignment of responsibility, provision of appropriate authority to perform assigned tasks, and fostering ownership of processes and data to ensure sustained improvements. These human elements need to be embedded in a culture of data sharing and use. Lessons from this multi-country exercise would be applicable in other regions afflicted with similar issues of availability and quality of vital statistics. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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18. Non-communicable diseases are key to further narrow gender gap in life expectancy in Shanghai, China
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Chen, Hanyi, Zhou, Yi, Sun, Lianghong, Chen, Yichen, Qu, Xiaobin, Chen, Hua, Rajbhandari-Thapa, Janani, and Xiao, Shaotan
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- 2020
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19. Estimating the pattern of causes of death in Papua New Guinea
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Kitur, Urarang, Adair, Tim, Riley, Ian, and Lopez, Alan D.
- Published
- 2019
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20. Clustering of the causes of death in Northeast Iran: a mixed growth modeling
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Talkhi, Nasrin, Emamverdi, Zohreh, Jamali, Jamshid, and Salari, Maryam
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- 2023
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21. Trends in cause of death among patients with renal cell carcinoma in the United States: a SEER-based study
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Zhan, Xiangpeng, Chen, Tao, Liu, Ying, Wan, Hao, Liu, Xiaoqiang, Deng, Xinxi, Fu, Bin, and Xiong, Jing
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- 2023
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22. Declining life expectancy in the Great Lakes region: contributors to Black and white longevity change across educational attainment
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Roberts, Max Tyler, Lim, Sojung, and Reither, Eric N.
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- 2023
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23. Mortality pattern trends and disparities among Chinese from 2004 to 2016
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Zhu, Jicun, Cui, Lingling, Wang, Kehui, Xie, Chen, Sun, Nan, Xu, Fei, Tang, Qixin, and Sun, Changqing
- Published
- 2019
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24. All-cause and cause-specific mortality rates for Kisumu County: a comparison with Kenya, low-and middle-income countries.
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Waruiru, Wanjiru, Oramisi, Violet, Sila, Alex, Onyango, Dickens, Waruru, Anthony, Mwangome, Mary N., Young, Peter W., Muuo, Sheru, Nyagah, Lilly M., Ollongo, John, Ngugi, Catherine, and Rutherford, George W.
- Abstract
Background: Understanding the magnitude and causes of mortality at national and sub-national levels for countries is critical in facilitating evidence-based prioritization of public health response. We provide comparable cause of death data from Kisumu County, a high HIV and malaria-endemic county in Kenya, and compared them with Kenya and low-and-middle income countries (LMICs).Methods: We analyzed data from a mortuary-based study at two of the largest hospital mortuaries in Kisumu. Mortality data through 2019 for Kenya and all LMICs were downloaded from the Global Health Data Exchange. We provided age-standardized rates for comparisons of all-cause and cause-specific mortality rates, and distribution of deaths by demographics and Global Burden of Disease (GBD) classifications.Results: The all-cause age-standardized mortality rate (SMR) was significantly higher in Kisumu compared to Kenya and LMICs (1118 vs. 659 vs. 547 per 100,000 population, respectively). Among women, the all-cause SMR in Kisumu was almost twice that of Kenya and double the LMICs rate (1150 vs. 606 vs. 518 per 100,000 population respectively). Among men, the all-cause SMR in Kisumu was approximately one and a half times higher than in Kenya and nearly double that of LMICs (1089 vs. 713 vs. 574 per 100,000 population). In Kisumu and LMICs non-communicable diseases accounted for most (48.0 and 58.1% respectively) deaths, while in Kenya infectious diseases accounted for the majority (49.9%) of deaths. From age 10, mortality rates increased with age across all geographies. The age-specific mortality rate among those under 1 in Kisumu was nearly twice that of Kenya and LMICs (6058 vs. 3157 and 3485 per 100,000 population, respectively). Mortality from injuries among men was at least one and half times that of women in all geographies.Conclusion: There is a notable difference in the patterns of mortality rates across the three geographical areas. The double burden of mortality from GBD Group I and Group II diseases with high infant mortality in Kisumu can guide prioritization of public health interventions in the county. This study demonstrates the importance of establishing reliable vital registry systems at sub-national levels as the mortality dynamics and trends are not homogeneous. [ABSTRACT FROM AUTHOR]- Published
- 2022
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25. Garbage codes in the Norwegian Cause of Death Registry 1996-2019.
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Ellingsen, Christian Lycke, Alfsen, G. Cecilie, Ebbing, Marta, Pedersen, Anne Gro, Sulo, Gerhard, Vollset, Stein Emil, and Braut, Geir Sverre
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DISEASE progression ,CAUSES of death ,NOSOLOGY ,AUTOPSY ,ACQUISITION of data - Abstract
Background: Reliable statistics on the underlying cause of death are essential for monitoring the health in a population. When there is insufficient information to identify the true underlying cause of death, the death will be classified using less informative codes, garbage codes. If many deaths are assigned a garbage code, the information value of the cause-of-death statistics is reduced. The aim of this study was to analyse the use of garbage codes in the Norwegian Cause of Death Registry (NCoDR).Methods: Data from NCoDR on all deaths among Norwegian residents in the years 1996-2019 were used to describe the occurrence of garbage codes. We used logistic regression analyses to identify determinants for the use of garbage codes. Possible explanatory factors were year of death, sex, age of death, place of death and whether an autopsy was performed.Results: A total of 29.0% (290,469/1,000,128) of the deaths were coded with a garbage code; 14.1% (140,804/1,000,128) with a major and 15.0% (149,665/1,000,128) with a minor garbage code. The five most common major garbage codes overall were ICD-10 codes I50 (heart failure), R96 (sudden death), R54 (senility), X59 (exposure to unspecified factor), and A41 (other sepsis). The most prevalent minor garbage codes were I64 (unspecified stroke), J18 (unspecified pneumonia), C80 (malignant neoplasm with unknown primary site), E14 (unspecified diabetes mellitus), and I69 (sequelae of cerebrovascular disease). The most important determinants for the use of garbage codes were the age of the deceased (OR 17.4 for age ≥ 90 vs age < 1) and death outside hospital (OR 2.08 for unknown place of death vs hospital).Conclusion: Over a 24-year period, garbage codes were used in 29.0% of all deaths. The most important determinants of a death to be assigned a garbage code were advanced age and place of death outside hospital. Knowledge of the national epidemiological situation, as well as the rules and guidelines for mortality coding, is essential for understanding the prevalence and distribution of garbage codes, in order to rely on vital statistics. [ABSTRACT FROM AUTHOR]- Published
- 2022
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26. The political determinants of the health of undocumented immigrants: a comparative analysis of mortality patterns in Switzerland.
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Piccoli, Lorenzo and Wanner, Philippe
- Abstract
Background: The health of undocumented immigrants is an important concern in most societies. However, there is no conclusive evidence that inclusive health care policies lead to better outcomes for this group of the population. The aim of this study is to analyse whether there is an association between inclusive health care policies and the mortality patterns of undocumented immigrants, or the distribution of different causes of death among those who have died.Methods: We analyse individual data concerning the deceased in Switzerland between 2011 and 2017. We proceed in two steps. First, we estimate and compare the patterns of mortality of Swiss citizens, documented immigrants, and undocumented immigrants. Second, we test whether there is an association between cantonal authorities' policies and differing mortality patterns. We use logistic regressions and multinomial regressions to estimate the relationship between legal status and mortality patterns both in Switzerland and across different cantons.Results: We find a difference in the patterns of mortality between undocumented immigrants and the other groups of the population. Specifically, death from circulatory system diseases is twice as frequent among undocumented immigrants compared to documented immigrants and Swiss citizens. However, this difference is smaller in the Swiss cantons that have more inclusive health care policies towards undocumented immigrants.Conclusions: We interpret these results as an indication that policies that expand access to health services lead to better outcomes for undocumented immigrants. This finding has implications for research on civic stratification and public health. Further analysis is needed to evaluate the effects of extending public health care for undocumented immigrants in different contexts. [ABSTRACT FROM AUTHOR]- Published
- 2022
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27. Comparison of machine learning algorithms applied to symptoms to determine infectious causes of death in children: national survey of 18,000 verbal autopsies in the Million Death Study in India.
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Idicula-Thomas, Susan, Gawde, Ulka, and Jha, Prabhat
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MACHINE learning ,CAUSES of death ,AUTOPSY reports ,THANATOLOGY ,CHILD death ,PREDICTION models ,SUPPORT vector machines - Abstract
Background: Machine learning (ML) algorithms have been successfully employed for prediction of outcomes in clinical research. In this study, we have explored the application of ML-based algorithms to predict cause of death (CoD) from verbal autopsy records available through the Million Death Study (MDS).Methods: From MDS, 18826 unique childhood deaths at ages 1-59 months during the time period 2004-13 were selected for generating the prediction models of which over 70% of deaths were caused by six infectious diseases (pneumonia, diarrhoeal diseases, malaria, fever of unknown origin, meningitis/encephalitis, and measles). Six popular ML-based algorithms such as support vector machine, gradient boosting modeling, C5.0, artificial neural network, k-nearest neighbor, classification and regression tree were used for building the CoD prediction models.Results: SVM algorithm was the best performer with a prediction accuracy of over 0.8. The highest accuracy was found for diarrhoeal diseases (accuracy = 0.97) and the lowest was for meningitis/encephalitis (accuracy = 0.80). The top signs/symptoms for classification of these CoDs were also extracted for each of the diseases. A combination of signs/symptoms presented by the deceased individual can effectively lead to the CoD diagnosis.Conclusions: Overall, this study affirms that verbal autopsy tools are efficient in CoD diagnosis and that automated classification parameters captured through ML could be added to verbal autopsies to improve classification of causes of death. [ABSTRACT FROM AUTHOR]- Published
- 2021
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28. Three-year weight change and risk of all-cause, cardiovascular, and cancer mortality among Iranian adults: over a decade of follow-up in the Tehran Lipid and Glucose Study
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Deravi, Niloofar, Moazzeni, Seyyed Saeed, Hasheminia, Mitra, Hizomi Arani, Reyhane, Azizi, Fereidoun, and Hadaegh, Farzad
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- 2022
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29. Validation studies of verbal autopsy methods: a systematic review
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Mahesh, Buddhika P. K., Hart, John D., Acharya, Ajay, Chowdhury, Hafizur Rahman, Joshi, Rohina, Adair, Tim, and Hazard, Riley H.
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- 2022
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30. Analysis of death causes of residents in poverty-stricken Areas in 2020: take Liangshan Yi Autonomous Prefecture in China as an example
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Liao, Rujun, Hu, Lin, Liao, Qiang, Zhu, Tianyu, Yang, Haiqun, and Zhang, Tao
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- 2022
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31. Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths.
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Joshi, Rohina, Hazard, R. H., Mahesh, Pasyodun Koralage Buddhika, Mikkelsen, L., Avelino, F., Sarmiento, Carmina, Segarra, A., Timbang, T., Sinson, F., Diango, Patrick, Riley, I., Chowdhury, H., Asuncion, Irma L., Khanom, G., and Lopez, Alan D.
- Subjects
CAUSES of death ,AUTOPSY ,MEDICAL records ,PHYSICIANS - Abstract
Background: The majority of deaths in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial. MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death. We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths.Method: We conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse. MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire. Auto-Analyse then presented the MHO with the three most likely causes of death. For the pilot, the intervention was scaled-up to 91 municipalities. We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs.Results: Of the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%). For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative. When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the cause of death. Only 13% of the deaths under the intervention had an undetermined cause of death. Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification.Conclusion: Standardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths. [ABSTRACT FROM AUTHOR]- Published
- 2021
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32. Inequalities in changing mortality and life expectancy in Jiading District, Shanghai, 2002-2018.
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Peng, Qian, Zhang, Na, Yu, Hongjie, Shao, Yueqin, Ji, Ying, Jin, Yaqing, Zhong, Peisong, Zhang, Yiying, Wang, Yingjian, Dong, Shurong, Li, Chunlin, Shi, Ying, Zheng, Yingyan, Jiang, Feng, Chen, Yue, Jiang, Qingwu, and Zhou, Yibiao
- Subjects
LIFE expectancy ,MORTALITY ,HEALTH equity ,DEATH rate ,CAUSES of death ,POPULATION health management - Abstract
Background: Improvements of population health in China have been unevenly distributed among different sexes and regions. Mortality Registration System provides an opportunity for timely assessments of mortality trend and inequalities.Methods: Causes of death were reclassified following the method of Global Burden of Disease Study (GBD). Age-standardized mortality rate (ASMR) and ring-map of the rate by town were used to describe inequalities in changing mortality. Life expectancy (LE) and cause-deleted LE were calculated on the basis of life table technique.Results: The burden of death from 2002 to 2018 was dominated by cardiovascular diseases (CVD), neoplasms, chronic respiratory diseases and injuries in Jiading district, accounting for almost 80% of total deaths. The overall ASMR dropped from 407.6/100000 to 227.1/100000, and LE increased from 77.86 years to 82.31 years. Women lived about 3.0-3.5 years longer than men. Besides, a cluster of lower LE was found for CVD in the southeast corner and one cluster for neoplasms in the southern corner of the district. The largest individual contributor to increment in LE was neoplasms, ranged from 2.41 to 3.63 years for males, and from 1.60 to 2.36 years for females.Conclusions: Improvement in health was mainly attributed to the decline of deaths caused by CVD and neoplasms, but was distributed with sex and town. This study served as a reflection of health inequality, is conducive to formulate localized health policies and measures. [ABSTRACT FROM AUTHOR]- Published
- 2021
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33. A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco
- Author
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Hessol, Nancy A., Eng, Monica, Vu, Annie, Pipkin, Sharon, Hsu, Ling C., and Scheer, Susan
- Published
- 2019
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34. Validation of verbal autopsy: determination of cause of deaths in Malaysia 2013.
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Ganapathy, Shubash Shander, Khoo Yi Yi, Omar, Mohd Azahadi, Anuar, Mohamad Fuad Mohamad, Jeevananthan, Chandrika, Rao, Chalapati, and Yi Yi, Khoo
- Subjects
AUTOPSY ,CAUSES of death ,MEDICAL records ,HEART diseases ,PNEUMONIA ,NARRATIVES ,CROSS-sectional method ,STANDARDS - Abstract
Background: Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA) is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study.Methods: A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR) available for a sample of the overall study deaths.Results: Corresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75%) for transport accidents and certain cancers. Moderate sensitivity (50% - 75%) was obtained for ischaemic heart disease (64%) and cerebrovascular disease (72%). The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF) changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good.Conclusion: We can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill-defined mortality causes in vital registration data, and yield more accurate national mortality statistics. [ABSTRACT FROM AUTHOR]- Published
- 2017
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35. Contributors to Wisconsin’s persistent black-white gap in life expectancy
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Roberts, Max T., Reither, Eric N., and Lim, Sojung
- Published
- 2019
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36. Saving lives through certifying deaths: assessing the impact of two interventions to improve cause of death data in Perú
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Miki, Janet, Rampatige, Rasika, Richards, Nicola, Adair, Tim, Cortez-Escalante, Juan, and Vargas-Herrera, Javier
- Published
- 2018
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37. The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: a systematic review
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F. Lucy Wright, Miranda E G Armstrong, Charlie Foster, and Jason Lacombe
- Subjects
Gerontology ,Adult ,Male ,medicine.medical_specialty ,Population ,Health Behavior ,030209 endocrinology & metabolism ,Disease ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk-Taking ,Risk Factors ,Cause of Death ,Neoplasms ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Risk factor ,education ,Exercise ,Life Style ,Aged ,education.field_of_study ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Confounding ,Smoking ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Diet ,Observational Studies as Topic ,Cardiovascular Diseases ,Chronic Disease ,Observational study ,Female ,Biostatistics ,SPS Exercise, Nutrition and Health Sciences ,Sedentary Behavior ,business ,Research Article - Abstract
Background Regular physical activity improves overall health, and has the capacity to reduce risk of chronic diseases and death. However, better understanding of the relationship between multiple lifestyle risk behaviours and disease outcomes is pertinent for prioritising public health messaging. The aim of this systematic review is to examine the association between physical inactivity in combination with additional lifestyle risk behaviours (smoking, alcohol, diet, or sedentary behaviour) for cardiovascular disease, cancer, and all-cause mortality. Methods We searched Ovid Medline, EMBASE, and the Cochrane Register from 1 January 2010 to 12 December 2017, for longitudinal observational studies of adults (18+ years) in the general population with a publication date of 2010 onwards and no language restriction. Main exposure variables had to include a physical activity measure plus at least one other lifestyle risk factor. In total, 25,639 studies were identified. Titles, abstracts and full-text articles of potentially relevant papers were screened for eligibility. Data was extracted and quality assessment was completed using a modified Newcastle-Ottawa Scale (NOS). Results Across the 25 eligible studies, those participants who reported being physically active combined with achieving other health behaviour goals compared to those who were categorised as physically inactive and did not achieve other positive lifestyle goals, were at least half as likely to experience an incident cardiovascular disease (CVD) event, die from CVD, or die from any cause. These findings were consistent across participant age, sex, and study length of follow-up, and even after excluding lower quality studies. We also observed a similar trend among the few studies which were restricted to cancer outcomes. Most studies did not consider epidemiological challenges that may bias findings, such as residual confounding, reverse causality by pre-existing disease, and measurement error from self-report data. Conclusions High levels of physical activity in combination with other positive lifestyle choices is associated with better health outcomes. Applying new approaches to studying the complex relationships between multiple behavioural risk factors, including physical activity, should be a priority. Electronic supplementary material The online version of this article (10.1186/s12889-019-7030-8) contains supplementary material, which is available to authorized users.
- Published
- 2019
38. Smoking prevalence and attributable deaths in Thailand: predicting outcomes of different tobacco control interventions
- Author
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Viroj Tangcharoensathien, Suchunya Aungkulanon, Ratsida Phoncharoen, Chutima Akaleephan, Virasakdi Chongsuvivatwong, Kanitta Bundhamcharoen, and Siriwan Pitayarangsarit
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Psychological intervention ,030209 endocrinology & metabolism ,Public Policy ,Smoking Prevention ,Smoking prevalence ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Environmental health ,Cause of Death ,Epidemiology ,Tobacco ,NCD global target ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,Aged ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Tobacco control ,Smoking ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Thailand ,Health Surveys ,Smoking initiation ,Policy ,Smoking cessation ,Female ,Biostatistics ,business ,Research Article - Abstract
Background Despite substantial positive impacts of Thailand’s tobacco control policies on reducing the prevalence of smoking, current trends suggest that further reductions are needed to ensure that WHO’s 2025 voluntary global target of a 30% relative reduction in tobacco use is met. In order to confirm this hypothesis, we aim to estimate the effect of tobacco control policies in Thailand on the prevalence of smoking and attributed deaths and assess the possibilities of achieving WHO’s 2025 global target. This paper addresses this knowledge gap which will contribute to policy control measures on tobacco control. Results of this study can help guide policy makers in implementing further interventions to reduce the prevalence of smoking in Thailand. Method A Markov chain model was developed to examine the effect of tobacco control policies, such as accessibility restrictions for youths, increased tobacco taxes and promotion of smoking cessation programs, from 2015 to 2025. Outcomes included smoking prevalence and the number of smoking-attributable deaths. Due to the very low prevalence of female smokers in 2014, this study applied the model to estimate the smoking prevalence and attributable mortality among males only. Results Given that the baseline prevalence of smoking in 2010 was 41.7% in males, the target of a 30% relative reduction requires that the prevalence be reduced to 29.2% by 2025. Under a baseline scenario where smoking initiation and cessation rates among males are attained by 2015, smoking prevalence rates will reduce to 37.8% in 2025. The combined tobacco control policies would further reduce the prevalence to 33.7% in 2025 and 89,600 deaths would be averted. Conclusion Current tobacco control policies will substantially reduce the smoking prevalence and smoking-attributable deaths. The combined interventions can reduce the smoking prevalence by 19% relative to the 2010 level. These projected reductions are insufficient to achieve the committed target of a 30% relative reduction in smoking by 2025. Increased efforts to control tobacco use will be essential for reducing the burden of non-communicable diseases in Thailand.
- Published
- 2019
39. How much do the physician review and InterVA model agree in determining causes of death? a comparative analysis of deaths in rural Ethiopia.
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Weldearegawi, Berhe, Melaku, Yohannes Adama, Dinant, Geert Jan, and Spigt, Mark
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CAUSES of death ,AUTOPSY ,PHYSICIANS ,PUBLIC health ,DIAGNOSIS ,DISEASES - Abstract
Background: Despite it is costly, slow and non-reproducible process, physician review (PR) is a commonly used method to interpret verbal autopsy data. However, there is a growing interest to adapt a new automated and internally consistent method called InterVA. This study evaluated the level of agreement in determining causes of death between PR and the InterVA model. Methods: Verbal autopsy data for 434 cases collected between September 2009 and November 2012, were interpreted using both PR and the InterVA model. Cohen's kappa statistic (κ) was used to compare the level of chance corrected case-by-case agreement in the diagnosis reached by the PR and InterVA model. Results: Both methods gave comparable cause specific mortality fractions of communicable diseases (36.6 % by PR and 36.2 % by the model), non-communicable diseases (31.1 % by PR and 38.2 % by the model) and accidents/injuries (12.9 % by PR and 10.1 % by the model). The level of case-by-case chance corrected concordance between the two methods was 0.33 (95 % CI for κ = 0.29-0.34). The highest and lowest agreements were seen for accidents/injuries and non-communicable diseases; with κ = 0.75 and κ = 0.37, respectively. Conclusion: If the InterVA were used in place of the existing PR process, the overall diagnosis would be fairly similar. The methods had better agreement in important public health diseases like; TB, perinatal causes, and pneumonia/ sepsis; and lower in cardiovascular diseases and neoplasms. Therefore, both methods need to be validated against a gold-standard diagnosis of death. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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40. Incorporating competing risk theory into evaluations of changes in cancer survival: making the most of cause of death and routinely linked sociodemographic data
- Author
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Rachael Moorin, Georgia Halkett, Anna K. Nowak, and Cameron M. Wright
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Lung Neoplasms ,Population ,Disease ,Relative survival ,Risk Assessment ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Cancer Survivors ,Risk Factors ,Cause of Death ,Neoplasms ,Internal medicine ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Lung cancer ,education ,Survival analysis ,Aged ,Probability ,Cause of death ,education.field_of_study ,Brain Neoplasms ,business.industry ,lcsh:Public aspects of medicine ,Australia ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Prognosis ,medicine.disease ,Competing risks ,Survival Analysis ,Cancer survival ,Cancer registry ,Survival Rate ,030220 oncology & carcinogenesis ,Female ,Colorectal Neoplasms ,business ,Research Article - Abstract
Background Relative survival is the most common method used for measuring survival from population-based registries. However, the relative survival concept of ‘survival as far as the cancer is concerned’ can be biased due to differing non-cancer risk of death in the population with cancer (competing risks). Furthermore, while relative survival can be stratified or standardised, for example by sex or age, adjustment for a broad range of sociodemographic variables potentially influencing survival is not possible. In this paper we propose Fine and Gray competing risks multivariable regression as a method that can assess the probability of death from cancer, incorporating competing risks and adjusting for sociodemographic confounders. Methods We used whole of population, person-level routinely linked Western Australian cancer registry and mortality data for individuals diagnosed from 1983 to 2011 for major cancer types combined, female breast, colorectal, prostate, lung and pancreatic cancers, and grade IV glioma. The probability of death from the index cancer (cancer death) was evaluated using Fine and Gray competing risks regression, adjusting for age, sex, Indigenous status, socio-economic status, accessibility to services, time sub-period and (for all cancers combined) cancer type. Results When comparing diagnoses in 2008–2011 to 1983–1987, we observed substantial decreases in the rate of cancer death for major cancer types combined (N = 192,641, − 31%), female breast (− 37%), prostate (− 76%) and colorectal cancers (− 37%). In contrast, improvements in pancreatic (− 15%) and lung cancers (− 9%), and grade IV glioma (− 24%) were less and the cumulative probability of cancer death for these cancer types remained high. Conclusion Considering the justifiable expectation for confounder adjustment in observational epidemiological studies, standard methods for tracking population-level changes in cancer survival are simplistic. This study demonstrates how competing risks and sociodemographic covariates can be incorporated using readily available software. While cancer has been focused on here, this technique has potential utility in survival analysis for other disease states.
- Published
- 2020
41. Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993–2013
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Francesc Xavier Gómez-Olivé, Kathleen Kahn, Stephen Tollman, Samuel J. Clark, Chodziwadziwa W. Kabudula, Mark A. Collinson, and Brian Houle
- Subjects
Male ,Rural Population ,Population Dynamics ,HIV Infections ,South Africa ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Epidemiology ,Rural ,030212 general & internal medicine ,Non-communicable diseases, epidemiological transition ,Child ,Cause composition ,Agincourt ,education.field_of_study ,lcsh:Public aspects of medicine ,1. No poverty ,Age Factors ,Public Health, Global Health, Social Medicine and Epidemiology ,Middle Aged ,3. Good health ,Epidemiological transition ,epidemiological transition ,Child, Preschool ,Population Surveillance ,Life course approach ,Female ,InterVA ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Non- mmunicable diseases ,030231 tropical medicine ,Population ,Communicable Diseases ,03 medical and health sciences ,Young Adult ,Sex Factors ,Acquired immunodeficiency syndrome (AIDS) ,Environmental health ,medicine ,HIV/Aids ,Humans ,Tuberculosis ,Verbal autopsy ,Mortality ,education ,Developing Countries ,Aged ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Infant ,lcsh:RA1-1270 ,medicine.disease ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Socioeconomic Factors ,Chronic Disease ,Biostatistics ,business - Abstract
Background Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population. Methods We estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993–2013. Results From the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males. Conclusions This typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4312-x) contains supplementary material, which is available to authorized users.
- Published
- 2017
42. Causes of adult female deaths in Bangladesh: findings from two National Surveys
- Author
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Quamrun Nahar, Peter Kim Streatfield, Kanta Jamil, and Shams El Arifeen
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Adult ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Poison control ,Autopsy ,BMMS ,Violence ,Communicable Diseases ,Young Adult ,International Classification of Diseases ,Cause of Death ,Neoplasms ,Surveys and Questionnaires ,Epidemiology ,Injury prevention ,medicine ,Humans ,Verbal autopsy ,Causes of death ,Cause of death ,Bangladesh ,NCD ,business.industry ,Adult female mortality ,Mortality, Premature ,Mortality rate ,Public Health, Environmental and Occupational Health ,Age Factors ,Middle Aged ,medicine.disease ,Death ,Hospitalization ,Suicide ,Maternal Mortality ,Cardiovascular Diseases ,Maternal Death ,Maternal death ,Female ,business ,Demography ,Research Article - Abstract
Background: Assessment of causes of death and changes in pattern of causes of death over time are needed for programmatic purposes. Limited national level data exist on the adult female causes of death in Bangladesh. Method: Using data from two nationally representation surveys, the 2001 and 2010 Bangladesh Maternal Mortality Surveys (BMMS), the paper examines the causes of adult female death, aged 15–49 years, and changes in the patterns of these deaths. In both surveys, all household deaths three years prior to the survey were identified. Adult female deaths were then followed by a verbal autopsy (VA) using the WHO structured questionnaire. Two physicians independently reviewed the VA forms to assign a cause of death using the ICD-10; in case of disagreement, a third physician made an independent review and assigned a cause of death. Results: The overall mortality rates for women aged 15–49 in 2001 and 2010 were 182 per 100,000 and 120 per 100,000 respectively. There is a shift in the pattern of causes of death during the period covered by the two surveys. In the 2001 survey, the main causes of death were maternal (20 %), followed by diseases of the circulatory system (15 %), malignancy (14 %) and infectious diseases (13 %). However, in the 2010 survey, malignancies were the leading cause (21 %), followed by diseases of the circulatory system (16 %), maternal causes (14 %) and infectious diseases (8 %). While maternal deaths remained the number one cause of death among 20–34 years old in both surveys, unnatural deaths were the main cause for teenage deaths, and malignancies were the main cause of death for older women. Although there is an increasing trend in the proportion of women who died in hospitals, in both surveys most women died at home (74 % in 2001 and 62 % in 2010). Conclusion: The shift in the pattern of causes of adult female deaths is in agreement with the overall change in the disease pattern from communicable to non-communicable diseases in Bangladesh. Suicide and other violent deaths as the primary cause of deaths among teenage girls demands specific interventions to prevent such premature deaths. Prevention of deaths due to non-communicable diseases should also be a priority.
- Published
- 2015
43. The injury mortality burden in Guinea
- Author
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Hongzhuan Tan, Guoqing Hu, Xujun Zhang, Hongyan Yao, Huiyun Xiang, and Keita Mamady
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Population ,Poison control ,Injury ,Cause of death ,Young Adult ,symbols.namesake ,Sex Factors ,Homicide ,Injury prevention ,Epidemiology ,medicine ,Humans ,Poisson Distribution ,Poisson regression ,Mortality ,Child ,education ,Aged ,education.field_of_study ,Drowning ,business.industry ,lcsh:Public aspects of medicine ,Mortality rate ,Age Factors ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Infant ,lcsh:RA1-1270 ,Middle Aged ,Accidents ,Child, Preschool ,symbols ,Wounds and Injuries ,Accidental Falls ,Female ,Guinea ,Burns ,business ,Research Article ,Demography - Abstract
Background The injury mortality burden of Guinea has been rarely addressed. The paper aimed to report patterns of injury mortality burden in Guinea. Methods We retrieved the mortality data from the Guinean Annual Health Statistics Report 2007. The information about underlying cause of deaths was collected based on Guinean hospital discharge data, Hospital Mortuary and City Council Mortuary data. The causes of death are coded in the 9th International Classification of Diseases (ICD-9). Multivariate Poisson regression was used to test the impacts of sex and age on mortality rates. The statistical analyses were performed using Statatm 10.0. Results In 2007, 7066 persons were reported dying of injuries in Guinea (mortality: 72.8 per 100,000 population). Transportation, fire/burn, falls, homicide and drowning were the five leading causes of fatal injuries for the whole population, accounting for 37%, 22%, 12%, 10% and 6% of total deaths, respectively. In general, age-specific injury causes displayed similar patterns of the whole population except that poisoning replaced falls as a leading cause among children under five years old. Males were at 30-50% more risk of dying from six commonest causes than females and old age groups had higher injury mortality rates than younger age groups. Conclusion Transportation, fire/burn, falls, homicide, and drowning accounted for the majority of total injury mortality burden in Guinea. Males and old adults were high-risk population of fatal injuries and should be targeted by injury prevention. Lots of work is needed to improve weak capacities for injury control in order to reduce the injury mortality burden.
- Published
- 2012
44. Road traffic related mortality in Vietnam: Evidence for policy from a national sample mortality surveillance system
- Author
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Nguyen Phuong Hoa, Chalapati Rao, Damian G Hoy, Khieu Thi Quynh Trang, Anh D. Ngo, Peter S. Hill, Ngo, Anh D, Rao, Chalapati, Hoa, Nguyen Phuong, Hoy, Damian G, Trang, Khieu Thi Quynh, and Hill, Peter S
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,verbal autopsy ,Population ,Poison control ,Public Policy ,Occupational safety and health ,Young Adult ,Age Distribution ,Environmental health ,Cause of Death ,Injury prevention ,Epidemiology ,medicine ,Humans ,Verbal autopsy ,Sex Distribution ,helmet law ,Mortality ,education ,Cause of death ,education.field_of_study ,business.industry ,Mortality rate ,lcsh:Public aspects of medicine ,Accidents, Traffic ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,medicine.disease ,mortality ,Helmet law ,Road traffic injuries ,Motorcycles ,road traffic injuries ,Vietnam ,Population Surveillance ,Wounds and Injuries ,Female ,Medical emergency ,Seasons ,business ,Research Article - Abstract
Background Road traffic injuries (RTIs) are among the leading causes of mortality in Vietnam. However, mortality data collection systems in Vietnam in general and for RTIs in particular, remain inconsistent and incomplete. Underlying distributions of external causes and body injuries are not available from routine data collection systems or from studies till date. This paper presents characteristics, user type pattern, seasonal distribution, and causes of 1,061 deaths attributable to road crashes ascertained from a national sample mortality surveillance system in Vietnam over a two-year period (2008 and 2009). Methods A sample mortality surveillance system was designed for Vietnam, comprising 192 communes in 16 provinces, accounting for approximately 3% of the Vietnamese population. Deaths were identified from commune level data sources, and followed up by verbal autopsy (VA) based ascertainment of cause of death. Age-standardised mortality rates from RTIs were computed. VA questionnaires were analysed in depth to derive descriptive characteristics of RTI deaths in the sample. Results The age-standardized mortality rates from RTIs were 33.5 and 8.5 per 100,000 for males and females respectively. Majority of deaths were males (79%). Seventy three percent of all deaths were aged from 15 to 49 years and 58% were motorcycle users. As high as 80% of deaths occurred on the day of injury, 42% occurred prior to arrival at hospital, and a further 29% occurred on-site. Direct causes of death were identified for 446 deaths (42%) with head injuries being the most common cause attributable to road traffic injuries overall (79%) and to motorcycle crashes in particular (78%). Conclusion The VA method can provide a useful data source to analyse RTI mortality. The observed considerable mortality from head injuries among motorcycle users highlights the need to evaluate current practice and effectiveness of motorcycle helmet use in Vietnam. The high number of deaths occurring on-site or prior to hospital admission indicates a need for effective pre-hospital first aid services and timely access to emergency facilities. In the absence of standardised death certification, sustained efforts are needed to strengthen mortality surveillance sites supplemented by VA to support evidence based monitoring and control of RTI mortality.
- Published
- 2012
45. Mortality and cause-of-death reporting and analysis systems in seven pacific island countries
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Richard J. K. Taylor, Alan D. Lopez, Karen Carter, and Chalapati Rao
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Gerontology ,Quality Control ,medicine.medical_specialty ,Economic growth ,Population ,Legislation ,Population health ,Cause of death ,Pacific Islands ,Death Certificates ,Correspondence ,Medicine ,Humans ,Mortality ,education ,education.field_of_study ,Death registration ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Pacific islands ,lcsh:RA1-1270 ,Epidemiological transition ,Analytical skill ,Biostatistics ,business ,Vital statistics - Abstract
Background Mortality statistics are essential for population health assessment. Despite limitations in data availability, Pacific Island Countries are considered to be in epidemiological transition, with non-communicable diseases increasingly contributing to premature adult mortality. To address rapidly changing health profiles, countries would require mortality statistics from routine death registration given their relatively small population sizes. Methods This paper uses a standard analytical framework to examine death registration systems in Fiji, Kiribati, Nauru, Palau, Solomon Islands, Tonga and Vanuatu. Results In all countries, legislation on death registration exists but does not necessarily reflect current practices. Health departments carry the bulk of responsibility for civil registration functions. Medical cause-of-death certificates are completed for at least hospital deaths in all countries. Overall, significantly more information is available than perceived or used. Use is primarily limited by poor understanding, lack of coordination, limited analytical skills, and insufficient technical resources. Conclusion Across the region, both registration and statistics systems need strengthening to improve the availability, completeness, and quality of data. Close interaction between health staff and local communities provides a good foundation for further improvements in death reporting. System strengthening activities must include a focus on clear assignment of responsibility, provision of appropriate authority to perform assigned tasks, and fostering ownership of processes and data to ensure sustained improvements. These human elements need to be embedded in a culture of data sharing and use. Lessons from this multi-country exercise would be applicable in other regions afflicted with similar issues of availability and quality of vital statistics.
- Published
- 2012
46. Causes of neonatal and maternal deaths in Dhaka slums: Implications for service delivery
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Sabrina Rasheed, Allisyn C. Moran, Nuzhat Choudhury, Mohammad Iqbal, Abbas Bhuiya, Mohammad Sohel Shomik, Fatema Khatun, Munira Sultana, and Ashraful Alam
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Service delivery framework ,Population ,Interviews as Topic ,Young Adult ,Pregnancy ,Cause of Death ,Poverty Areas ,Environmental health ,Infant Mortality ,Health care ,Epidemiology ,medicine ,Humans ,Maternal Health Services ,education ,Socioeconomic status ,Bangladesh ,education.field_of_study ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,social sciences ,Infant mortality ,Maternal Mortality ,population characteristics ,Female ,Autopsy ,Biostatistics ,business ,geographic locations ,Research Article - Abstract
Background Bangladesh has about 5.7 million people living in urban slums that are characterized by adverse living conditions, poor access to healthcare services and health outcomes. In an attempt to ensure safe maternal, neonatal and child health services in the slums BRAC started a programme, MANOSHI, in 2007. This paper reports the causes of maternal and neonatal deaths in slums and discusses the implications of those deaths for Maternal Neonatal and Child Health service delivery. Methods Slums in three areas of Dhaka city were selected purposively. Data on causes of deaths were collected during 2008-2009 using verbal autopsy form. Two trained physicians independently assigned the cause of deaths. Results A total of 260 newborn and 38 maternal deaths were identified between 2008 and 2009. The majority (75%) of neonatal deaths occurred during 0-7 days. The main causes of deaths were birth asphyxia (42%), sepsis (20%) and birth trauma (7%). Post partum hemorrhage (37%) and eclampsia (16%) were the major direct causes and hepatic failure due to viral hepatitis was the most prevalent indirect cause (11%) of maternal deaths. Conclusion Delivery at a health facility with child assessment within a day of delivery and appropriate treatment could reduce neonatal deaths. Maternal mortality is unlikely to reduce without delivering at facilities with basic Emergency Obstetric Care (EOC) and arrangements for timely referral to EOC. There is a need for a comprehensive package of services that includes control of infectious diseases during pregnancy, EOC and adequate after delivery care.
- Published
- 2012
47. Physical disease in schizophrenia: a population-based analysis in Spain
- Author
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José María Amate, Carmen Bouza, Teresa López-Cuadrado, and Instituto de Salud Carlos III
- Subjects
Adult ,Male ,Gerontology ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Population ,Comorbidity ,Disease ,Severity of Illness Index ,International Classification of Diseases ,Cause of Death ,Epidemiology ,Severity of illness ,medicine ,Humans ,Hospital Mortality ,education ,Disease burden ,Aged ,Cause of death ,Aged, 80 and over ,education.field_of_study ,business.industry ,lcsh:Public aspects of medicine ,Incidence (epidemiology) ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,medicine.disease ,Hospitalization ,Spain ,Schizophrenia ,Female ,business ,Research Article - Abstract
Background: Physical disease remains a challenge in patients with schizophrenia. Our objective was to determine the epidemiological characteristics and burden of physical disease in hospitalized patients with schizophrenia. Methods: We analyzed the 2004 Spanish National Hospital Discharge Registry, identified records coded for schizophrenia (295.xx) and characterized the physical diseases using the ICD-9 system and the Charlson Index. We also calculated standardized mortality ratios (SMRs) versus the general population adjusted by age and calendar time. Results: A total of 16, 776 cases (mean age: 43 years, 65% males) were considered for analysis. Overall, 61% of cases had at least one ICD-9 physical code and 32% had more than one ICD-9 code. The Charlson index indicated that 20% of cases had a physical disease of known clinical impact and prognostic significance. Physical disease appeared early in life (50% of cases were 15-31 years of age) and increased rapidly in incidence with age. Thus, for patients aged 53 years or more, 84% had at least one physical ICD-9 code. Apart from substance abuse and addiction, the most prevalent diseases were endocrine (16%), circulatory (15%), respiratory (15%), injury-poisoning (11%), and digestive (10%). There were gender-related differences in disease burden and type of disease. In-hospital mortality significantly correlated with age, the Charlson Index and several ICD-9 groups of physical disease. Physical disease was associated with an overall 3.6-fold increase in SMRs compared with the general population. Conclusions: This study provides the first nationally representative estimate of the prevalence and characteristics of physical disease in hospitalized patients with schizophrenia in Spain. Our results indicate that schizophrenia is associated with a substantial burden of physical comorbidities; that these comorbidities appear early in life; and that they have a substantial impact on mortality. This information raises concerns about the consequences and causes of physical disorders in patients with schizophrenia. Additionally, it will help to guide the design and implementation of preventive and therapeutic programs from the viewpoint of clinical care and in terms of healthcare service planning. Funding for this study was provided by the Spanish R&D Grant no. PI06/90571. The funding body had no further role in study design, data collection, analysis, interpretation, writing of the report, or the decision to submit the paper for publication Sí
- Published
- 2010
48. A systematic review of post-deployment injury-related mortality among military personnel deployed to conflict zones
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Bruce H. Jones, Tyson Grier, Joseph J. Knapik, and Roberto E Marin
- Subjects
medicine.medical_specialty ,Warfare ,business.industry ,Mortality rate ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Poison control ,lcsh:RA1-1270 ,Suicide prevention ,Occupational safety and health ,humanities ,Military personnel ,Military Personnel ,Environmental health ,Cause of Death ,Injury prevention ,Epidemiology ,medicine ,Humans ,Wounds and Injuries ,business ,health care economics and organizations ,Cause of death ,Research Article ,Veterans - Abstract
Background This paper reports on a systematic review of the literature on the post-conflict injury-related mortality of service members who deployed to conflict zones. Methods Literature databases, reference lists of articles, agencies, investigators, and other sources were examined to find studies comparing injury-related mortality of military veterans who had served in conflict zones with that of contemporary veterans who had not served in conflict zones. Injury-related mortality was defined as a cause of death indicated by International Classification of Diseases E-codes E800 to E999 (external causes) or subgroupings within this range of codes. Results Twenty studies met the review criteria; all involved veterans serving during either the Vietnam or Persian Gulf conflict. Meta-analysis indicated that, compared with non-conflict-zone veterans, injury-related mortality was elevated for veterans serving in Vietnam (summary mortality rate ratio (SMRR) = 1.26, 95% confidence interval (95%CI) = 1.08–1.46) during 9 to 18 years of follow-up. Similarly, injury-related mortality was elevated for veterans serving in the Persian Gulf War (SMRR = 1.26, 95%CI = 1.16–1.37) during 3 to 8 years of follow-up. Much of the excess mortality among conflict-zone veterans was associated with motor vehicle events. The excess mortality decreased over time. Hypotheses to account for the excess mortality in conflict-zone veterans included post-traumatic stress, coping behaviors such as substance abuse, ill-defined diseases and symptoms, lower survivability in injury events due to conflict-zone comorbidities, altered perceptions of risk, and/or selection processes leading to the deployment of individuals who were risk-takers. Conclusion Further research on the etiology of the excess mortality in conflict-zone veterans is warranted to develop appropriate interventions.
- Published
- 2009
49. Coming home to die? the association between migration and mortality in rural South Africa
- Author
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Paul Welaga, Kobus Herbst, Marie-Louise Newell, Renay Weiner, Victoria Hosegood, and Caterina Hill
- Subjects
Adult ,Male ,Rural Population ,Gerontology ,medicine.medical_specialty ,Adolescent ,030231 tropical medicine ,Human immunodeficiency virus (HIV) ,medicine.disease_cause ,South Africa ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Epidemiology ,Confidence Intervals ,medicine ,Humans ,030212 general & internal medicine ,Mortality ,Socioeconomics ,Proportional Hazards Models ,Acquired Immunodeficiency Syndrome ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Social impact ,1. No poverty ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Emigration and Immigration ,Middle Aged ,Survival Analysis ,3. Good health ,population characteristics ,Female ,Biostatistics ,Rural area ,business ,Rural population ,geographic locations ,Research Article - Abstract
Background Studies on migration often ignore the health and social impact of migrants returning to their rural communities. Several studies have shown migrants to be particularly susceptible to HIV infection. This paper investigates whether migrants to rural households have a higher risk of dying, especially from HIV, than non-migrants. Methods Using data from a large and ongoing Demographic Surveillance System, 41,517 adults, enumerated in bi-annual rounds between 2001 and 2005, and aged 18 to 60 years were categorized into four groups: external in-migrants, internal migrants, out-migrants and residents. The risk of dying by migration status was quantified by Cox proportional hazard regression. In a sub-group analysis of 1212 deaths which occurred in 2000 – 2001 and for which cause of death information was available, the relationship between migration status and dying from AIDS was examined in logistic regression. Results In all, 618 deaths were recorded among 7,867 external in-migrants, 255 among 4,403 internal migrants, 310 among 11,476 out-migrants and 1900 deaths were registered among 17,771 residents. External in-migrants were 28% more likely to die than residents [adjusted Hazard Ratio (aHR) = 1.28, P < 0.001, 95% Confidence Interval (CI) (1.16, 1.41)]. In the sub-group analysis, the odds of dying from AIDS was 1.79 [adjusted Odd ratio (aOR) = 1.79, P = 0.009, 95% CI (1.15, 2.78)] for external in-migrants compared to residents; there was no statistically significant difference in AIDS mortality between residents and out-migrants, [aOR = 1.25, P = 0.533, 95% CI (0.62–2.53)]. Independently, females were more likely to die from AIDS than males [aOR = 2.35, P < 0.001, 95% CI (1.79, 3.08)]. Conclusion External in-migrants have a higher risk of dying, especially from HIV related causes, than residents, and in areas with substantial migration this needs to be taken into account in evaluating mortality statistics and planning health care services.
- Published
- 2009
50. Assessing the disease burden of Yi people by years of life lost in Shilin county of Yunnan province, China
- Author
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Le Cai, Pengqian Fang, Chong Hua Wan, Shang Cheng Zhou, and Yi Ling Lv
- Subjects
Adult ,Male ,Gerontology ,China ,medicine.medical_specialty ,Adolescent ,Poison control ,Young Adult ,Age Distribution ,Life Expectancy ,Cost of Illness ,Cause of Death ,Epidemiology ,medicine ,Humans ,Life Tables ,Mortality ,Sex Distribution ,Child ,Socioeconomics ,health care economics and organizations ,Disease burden ,Aged ,Aged, 80 and over ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Public Health, Environmental and Occupational Health ,Infant ,lcsh:RA1-1270 ,Middle Aged ,Years of potential life lost ,Child, Preschool ,Life expectancy ,Female ,Biostatistics ,business ,Research Article - Abstract
Background Years of Life Lost (YLL) is one of the methods used to estimate the duration of time lost due to premature death. While previous studies of disease burden have been reported using YLL, there have been no studies investigating YLL of Yi people in rural China. Yunnan Province ranks first in terms of Yi people in China. This paper uses YLL to estimate the disease burden of Yi people in Shilin county of Yunnan Province. This study aims to address the differentials about YLL between Yi people and Han people for providing useful information for health planning. Methods We applied the Global Burden of Disease (GBD) method created by WHO. YLL rate per 1,000 were calculated from medical death certificates in 2003 in Shilin Yi Nationality Autonomous County (Shilin county). Results The male had greater YLL rate per 1,000 than did the female almost in each age group. It demonstrated a higher premature mortality burden due to injuries in Shilin county. Among the top non-communicable diseases, respiratory diseases are the most common mortality burden. Yi people are still suffering from maternal conditions, with two times the burden rates of Han people. For Yi people, while malignant neoplasm was one of the least burden of disease for male, it was the greatest for female, which is the opposite to Han people. Conclusion Strategies of economic development should be reviewed to enhance the prevention and treatment of injuries, maternal conditions and respiratory diseases for Yi people.
- Published
- 2009
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