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Determining causes of deaths (CODs) occurred outside of civil registration and vital statistics systems is challenging. A technique called verbal autopsy (VA) is widely adopted to gather information on deaths in practice. A VA consists of interviewing relatives of a deceased person about symptoms of the deceased in the period leading to the death, often resulting in multivariate binary responses. While statistical methods have been devised for estimating the cause-specific mortality fractions (CSMFs) for a study population, continued expansion of VA to new populations (or "domains") necessitates approaches that recognize between-domain differences while capitalizing on potential similarities. In this article, we propose such a domain-adaptive method that integrates external between-domain similarity information encoded by a prespecified rooted weighted tree. Given a cause, we use latent class models to characterize the conditional distributions of the responses that may vary by domain. We specify a logistic stick-breaking Gaussian diffusion process prior along the tree for class mixing weights with node-specific spike-and-slab priors to pool information between the domains in a data-driven way. The posterior inference is conducted via a scalable variational Bayes algorithm. Simulation studies show that the domain adaptation enabled by the proposed method improves CSMF estimation and individual COD assignment. We also illustrate and evaluate the method using a validation dataset. The article concludes with a discussion of limitations and future directions. [ABSTRACT FROM AUTHOR]

We provide new evidence on the causal effect of higher education on mortality. Our empirical strategy exploits the reduction in college openings introduced by the Pinochet regime after the 1973 coup in Chile, which led to a sharp downward kink in college enrollment among those cohorts reaching college age in the following years. Using administrative data from the vital statistics, we document an upward kink in the age-specific yearly mortality rate of individuals in the affected cohorts. We estimate a negative effect of college on mortality between ages 34–74, which is larger for men, but also sizable for women. Individuals in the affected cohorts experience worse labor market outcomes, are more likely to be enrolled in the public health system, and report lower consumption of health services. This suggests that economic disadvantage and limited access to care play an important mediating role in the link between higher education and mortality. [ABSTRACT FROM AUTHOR]

Background Foreign-born populations in the United States have markedly increased, yet cancer trends remain unexplored. Survey-based Population-Adjusted Rate Calculator (SPARC) is a new tool for evaluating nativity differences in cancer mortality. Methods Using SPARC, we calculated 3-year (2016-2018) age-adjusted mortality rates and rate ratios for common cancers by sex, age group, race and ethnicity, and nativity. Trends by nativity were examined for the first time for 2006-2018. Traditional cancer statistics draw populations from decennial censuses. However, nativity-stratified populations are from the American Community Surveys, thus involve sampling errors. To rectify this, SPARC employed bias-corrected estimators. Death counts came from the National Vital Statistics System. Results Age-adjusted mortality rates were higher among US-born populations across nearly all cancer types, with the largest US-born, foreign-born difference observed in lung cancer among Black women (rate ratio = 3.67, 95% confidence interval [CI] = 3.37 to 4.00). The well-documented White–Black differences in breast cancer mortality existed mainly among US-born women. For all cancers combined, descending trends were more accelerated for US-born compared with foreign-born individuals in all race and ethnicity groups with changes ranging from –2.6% per year in US-born Black men to stable (statistically nonsignificant) among foreign-born Black women. Pancreas and liver cancers were exceptions with increasing, stable, or decreasing trends depending on nativity and race and ethnicity. Notably, foreign-born Black men and foreign-born Hispanic men did not show a favorable decline in colorectal cancer mortality. Conclusions Although all groups show beneficial cancer mortality trends, those with higher rates in 2006 have experienced sharper declines. Persistent disparities between US-born and foreign-born individuals, especially among Black people, necessitate further investigation. [ABSTRACT FROM AUTHOR]

Mammalian carnivores are often vulnerable to the conversion of natural habitat. Although some species might be frequent in anthropogenic areas, it is not entirely clear how they use modified landscapes, particularly in tropical agroecosystems. Here, we investigated how Puma (Puma concolor) and Maned Wolf (Chrysocyon brachyurus) used three disturbed areas in southeastern Brazil. We sampled 205 camera stations and estimated species occupancy (Ψ) and detection probabilities (p), interpreted as probability of use and frequency of use, respectively. Our models predicted that both species extensively used the study areas (model-averaged probability of use of 0.65 for pumas and 0.50 for maned wolves). Puma frequency of use was higher in stations further from human structures and areas of savanna. Maned Wolf frequency of use was lower in forest-dominated stations and in a more protected and forested study area. Puma probability of use was high in stations closer to watercourses, while Maned Wolf probability of use was higher in unpaved roads and stations farther from human structures. Our findings suggest that pumas and maned wolves may be able to adapt their use of space in agroecosystems featuring riparian corridors and unpaved roads. Nevertheless, our data also reveal possible impacts to carnivore populations in these systems, such as the degradation of riparian environments, road mortality, and human construction avoidance. Thus, some caution is warranted in considering highly modified environments as safe habitats for large carnivores, until further data on the density and vital rates of these species in agricultural-dominated areas have been quantified. [ABSTRACT FROM AUTHOR]

Background Research on continuity of care (CoC) is mainly conducted in primary care and has received little acknowledgment in other levels of care. This study sought to investigate CoC across care levels for patients with selected chronic diseases, along with its association with mortality. Methods In a registry-based cohort study, patients with ≥1 consultation in primary or specialist healthcare or hospital admission with asthma, chronic obstructive pulmonary disease (COPD), diabetes mellitus, or heart failure in 2012 were linked to disease-related consultation data in 2013–2016. CoC was measured by Usual Provider of Care index (UPC) and Bice–Boxermann continuity of care score (COCI). Values equal to one were categorized into one group and the rest into three equal groups (tertiles). The association with mortality was determined by Cox regression models. Results The highest mean UPCtotal was measured for patients with diabetes mellitus (0.58) and the lowest for those with asthma (0.46). The population with heart failure had the highest death rate (26.5). In adjusted Cox regression analyses for COPD, mortality was 2.6 times higher (95% CI 2.25–3.04) for patients in the lowest tertile of continuity compared to those with UPCtotal = 1. Patients with diabetes mellitus and heart failure showed similar results. Conclusion CoC was moderate to high for disease-related contacts across care levels. A higher mortality associated with lower CoC was observed for patients with COPD, diabetes mellitus, and heart failure. A similar, but not statistically significant trend was found for patients with asthma. This study suggests that higher CoC across levels of care can decrease mortality. [ABSTRACT FROM AUTHOR]

The study of a species' thermal tolerance and vital rates responses provides useful metrics to characterize its vulnerability to ocean warming. Under prolonged thermal stress, plastic and adaptive processes can adjust the physiology of organisms. Yet it is uncertain whether the species can expand their upper thermal limits to cope with rapid and extreme changes in environmental temperature. In this study, we reared the marine copepod Paracartia grani at control (19°C) and warmer conditions (25°C) for >18 generations and assessed their survival and fecundity under short-term exposure to a range of temperatures (11–34°C). After multigenerational warming, the upper tolerance to acute exposure (24 h) increased by 1–1.3°C, although this enhancement decreased to 0.3–0.8°C after longer thermal stress (7 days). Warm-reared copepods were smaller and produced significantly fewer offspring at the optimum temperature. No shift in the thermal breadth of the reproductive response was observed. Yet the fecundity rates of the warm-reared copepods in the upper thermal range were up to 21-fold higher than the control. Our results show that chronic warming improved tolerance to stress temperatures and fecundity of P. grani , therefore, enhancing its chances to persist under extreme heat events. [ABSTRACT FROM AUTHOR]

Radon-222 (Rn-222) exhalation rate is vital for estimating radiation risk from many kinds of materials. AlphaGUARD measures the radon concentration based on the ionization chamber principle, which is currently recognized as a reference instrument to measure radon. In China, measurements of radon exhalation rate are performed by AlphaGUARD operated in flow-through mode on a reference device to verify measurement accuracy. These measurements are performed in both open and closed loop. AlphaGUARD can fast rapidly the variation of the radon concentration in the chamber, which is tightly pressed against the surface of the medium to accumulate the exhaled radon. When the model is used to obtain the radon exhalation rate, the radon exhalation rates obtained by nonlinear data fitting on the measured radon concentrations are similar to the reference value of the device. The difference of radon exhalation rate values of six measurements is small. [ABSTRACT FROM AUTHOR]

Background To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. Methods Total, sex- and age-specific weekly all-cause mortality for 2015–2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015–2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. Results Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the <45 age group. Conclusions This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies. [ABSTRACT FROM AUTHOR]

Populations face a suite of anthropogenic stressors acting simultaneously, which can combine additively or interact to have complex effects on population persistence. Yet we still know relatively little about the mechanisms underlying population-level responses to multifactorial combinations of stressors because multiple stressor impacts across organisms' life cycles have not been systematically considered in population models. Specifically, different anthropogenic stressors can have variable effects across an organism's life cycle, resulting in non-intuitive results for long-term population persistence. For example, synergistic or antagonistic interactions might exacerbate or alleviate the effects of stressors on population dynamics, and different life-history stages or vital rates might contribute unequally to long-term population growth rates. Demographic modelling provides a framework to incorporate individual vital rate responses to multiple stressors into estimates of population growth, which will allow us to make more informed predictions about population-level responses to novel combinations of anthropogenic change. Without integrating stressors' interactive effects across the entire life cycle on population persistence, we may over- or underestimate threats to biodiversity and risk missing conservation management actions that could reduce species' vulnerability to stress. [ABSTRACT FROM AUTHOR]

Introduction Penile prosthesis implantation (PPI) is a treatment option recommended in clinical guidelines for erectile dysfunction (ED). However, a limited number of urologists perform PPI procedures in the United States. Aim To quantify the number of insured men with ED in the United States and project the number of potential candidates for PPI in 2022. Methods An Excel-based disease impact model was constructed using a top-down estimation approach. The starting US male population consisted of adult men from 2022 US Census data after exclusion of age-specific mortality rates from the National Vital Statistics Reports. Men with health insurance were included in the model based on insurance status data from the US Census database. ED prevalence and ED treatment rates were obtained from administrative claims data analyses—the Merative MarketScan Commercial Database (18-64 years) and the 5% Medicare Standard Analytical Files (≥65 years)—and literature-based estimates of patient-reported ED prevalence. Outcomes The number of men with ED in the United States and the number of potential candidates for PPI were estimated. Results By utilizing ED prevalence based on administrative claims, an estimated 8.3% of insured men (10,302,540 estimated men [8,882,548 aged 18-64 years and 1,419,992 aged ≥65 years]) had a diagnosis of ED and sought ED care, out of 124,318,519 eligible US men aged ≥18 years in 2022. An estimated 17.1% of men with an ED diagnosis claim could benefit from PPI in 2022 (1,759,248 men aged ≥18 years). Patient self-reported ED prevalence across all ages ranged from 5.1% to 70.2%. Scenario analyses applying the patient self-reported ED prevalence range revealed the number of men in the United States who could benefit from PPI could have been higher than 1.7 million if their ED symptoms were diagnosed by health care providers. Clinical Implications Most men with ED in the United States are undertreated, and many could benefit from PPI. Strengths and Limitations This analysis is a US population–level estimation. However, given this study utilized a variety of assumptions, the results may vary if different model assumptions are applied. Conclusions This disease impact model estimated that approximately 10.3 million men were diagnosed with ED by their health care providers and sought ED care in the United States in 2022. Of those, 1.7 million men could be PPI candidates and benefit from the treatment option. [ABSTRACT FROM AUTHOR]

Background Sudden infant death syndrome (SIDS) still remains one of the leading causes of infant death worldwide, especially in high-income countries. To date, however, there is no detailed information on the global health burden of SIDS. Aims To characterize the global disease burden of SIDS and its trends from 1990 to 2019 and to compare the burden of SIDS according to the socio-demographic index (SDI). Design Systematic analysis based on the Global Burden of Disease (GBD) 2019 data. Methods Epidemiological data of 204 countries from 1990 to 2019 were collected via various methods including civil registration and vital statistics in the original GBD study. Estimates for mortality and disease burden of SIDS were modeled. Crude mortality and mortality rates per 100 000 population were analyzed. Disability-adjusted life years (DALYs) and DALY rates were also assessed. Results In 2019, mortality rate of SIDS accounted for 20.98 [95% Uncertainty Interval, 9.15–46.16] globally, which was a 51% decrease from 1990. SIDS was most prevalent in Western sub-Saharan Africa, High-income North America and Oceania in 2019. The burden of SIDS was higher in males than females consistently from 1990 to 2019. Higher SDI and income level was associated with lower burden of SIDS; furthermore, countries with higher SDI and income had greater decreases in SIDS burden from 1990 to 2019. Conclusions The burden of SIDS has decreased drastically from 1990 to 2019. However, the improvements have occurred disproportionately between regions and SDI levels. Focused preventive efforts in under-resourced populations are needed. [ABSTRACT FROM AUTHOR]

Official statistics in Australia and the United States show large recent increases in dementia mortality rates. In this study, we assessed whether these trends are biased by an increasing tendency of medical certifiers (predominantly physicians) to report on the death certificate that dementia was a direct cause of death. Regression models of multiple-cause-of-death data in Australia (2006–2016) and the United States (2006–2017) were constructed to adjust dementia mortality rates for changes in death certification practices. Compared with official statistics, the recent increase in adjusted age-standardized dementia death rates was less than half as large in Australia and about two-thirds as large in the United States. Further adjustment for changes in reporting of dementia anywhere on the death certificate implied even lower increases in dementia mortality. Declines in reporting of cardiovascular diseases as comorbid conditions also contributed to rises in dementia mortality rates. The increasing likelihood of dementia's being reported as directly leading to death largely explains recent increases in dementia mortality rates in both countries. However, studies have found that reported dementia on death certificates remains low compared with clinical evaluations of its prevalence. Improved guidance and training for certifiers in reporting of dementia on death certificates will help standardize mortality statistics within and between countries. [ABSTRACT FROM AUTHOR]

CDC WONDER is a web-based tool for the dissemination of epidemiologic data collected by the National Vital Statistics System. While CDC WONDER has built-in privacy protections, they do not satisfy formal privacy protections such as differential privacy and thus are susceptible to targeted attacks. Given the importance of making high-quality public health data publicly available while preserving the privacy of the underlying data subjects, we aim to improve the utility of a recently developed approach for generating Poisson-distributed, differentially private synthetic data by using publicly available information to truncate the range of the synthetic data. Specifically, we utilize county-level population information from the US Census Bureau and national death reports produced by the CDC to inform prior distributions on county-level death rates and infer reasonable ranges for Poisson-distributed, county-level death counts. In doing so, the requirements for satisfying differential privacy for a given privacy budget can be reduced by several orders of magnitude, thereby leading to substantial improvements in utility. To illustrate our proposed approach, we consider a dataset comprised of over 26,000 cancer-related deaths from the Commonwealth of Pennsylvania belonging to over 47,000 combinations of cause-of-death and demographic variables such as age, race, sex, and county-of-residence and demonstrate the proposed framework's ability to preserve features such as geographic, urban/rural, and racial disparities present in the true data. [ABSTRACT FROM AUTHOR]

Objectives The articles examines the contribution of internal socioeconomic disparities in mortality to the U.S. international disadvantage in life expectancy at birth. Methods Using individual death records from the U.S. national vital statistics system for years 1982–2019 and data for other countries from the Human Mortality Database, we compare age-specific death rates and life expectancy between counties classified into 10 socioeconomic categories and 20 high-income countries. We also calculate the number of years of life lost in each socioeconomic decile in relation to the comparison set. Results There is a clear and increasing socioeconomic gradient of mortality in the United States, but the growing divergence in internal mortality trends does not explain the rising gap between the country and its peers. In 2019, even American women in the most socioeconomically advantaged decile lived shorter lives, while only 10% of men in the most affluent decile fared better than their peers. The long-standing U.S. disadvantage in young adult mortality has been growing and the country's previous advantage in mortality at ages 75 years and older has virtually disappeared for all but for Americans in the most affluent counties. Discussion The similar age pattern of differences in mortality rates between each socioeconomic deciles and the comparison group suggests that the underlying factors might be the same. The role of external causes (including drug overdoses) for middle-aged adults and a slowing down in progress to control cardiovascular diseases at older ages at the national level are consistent with this pattern. [ABSTRACT FROM AUTHOR]

The copepod Calanus finmarchicus was investigated in four Subpolar Basins, Labrador, Irminger, Iceland, and Norwegian Seas, during spring, covering the time of ascent, grazing, and initiation of reproduction in the area. Lipid content, spawning activity, and stage composition and vital rates, such as egg and faecal pellet production were measured and linked to environmental parameters. Specific egg- and faecal pellet production rates varied with diatom biomass and were negatively correlated with temperature. Comparison of the various biological indicators revealed different life history traits C. finmarchicus has adopted in the different basins. In Labrador Sea, the females have invested in large eggs compared to the remaining basins. Labrador and Irminger Sea C. finmarchicus invest in size that we propose to be adaptation to cope with warmer overwintering habitats resulting in larger potential lipid storage capacity, while the Iceland and Norwegian Sea females can invest their remaining lipid storage in spring to fuel lipid-driven egg production. Grazing pressure on the phytoplankton community was estimated and compared between copepod and two dominating groups of protozooplankton; ciliates and heterotrophic dinoflagellates. Despite approximately the same biomass in the upper 100 m, the grazing impact of the protozoan grazers was an order of magnitude higher than the C. finmarchicus dominated mesozooplankton. This illustrates the importance to also include the smallest grazers when studying the spring bloom in high latitude marine ecosystems if the fate of the primary production should be fully understood. [ABSTRACT FROM AUTHOR]

Field transplant experiments can improve our understanding of the effects of climate on distributions of plants versus a milieu of biotic factors which may be mediated by climate. We use a transplant experiment to test how survival and growth of a mountain-top daisy (Podolepis robusta), when planted within and outside its current local range, varies as a function of individual plant size, elevation, aspect and the presence of other vegetation. We expected a home-site advantage for the species, with highest survival and growth within the species' current elevational limits, and a decline in vital rates above (due to physiological limitations) and below (due to competition with near-neighbours) these limits. Transplant survival during the beginning of the census was high (89 %), though by the third growing season, 36 % of initial transplants were remaining. Elevation had a significant negative effect on individual mortality rates; plants growing at higher elevations had a lower estimated hazard rate and thus, higher survival relative to those planted at elevations below the current lower limit of the distribution. By contrast, we detected no significant effect of elevation on growth rates. Small vegetation gaps had no effect on growth rates, though we found a negative, but non-significant, effect on mortality rates. Aspect had a very strong impact on growth. Plants transplanted to cool aspects had a significantly lower growth rate relative to transplants growing on a warm aspect. Conversely, aspect was not a significant predictor of individual mortality rates. Restrictions on the local distribution of P. robusta appear to be governed by mortality drivers at lower elevation and by growth drivers associated with aspect. We highlight that our ability to understand the drivers of distributions in current and future climates will be limited if contextual- and individual-level plant responses remain understudied. [ABSTRACT FROM AUTHOR]

Techniques for positive re-identification of finfish are well developed and are used to estimate vital rates, migration patterns and stock structure. Fluorochrome dyes, like nontoxic calcein, have been used with success to mark hard parts of fish and the shells of some molluscs. Yet, despite the commercial and ecological importance of the eastern oyster Crassostrea virginica , a systematic evaluation of the effectiveness of calcein for marking this species does not exist. In this study, methods that have been used for marking freshwater mussels with calcein were tested on 2-week- and 2-month-old juvenile C. virginica and on 3-year-old adult C. virginica. Individuals were immersed in 250 mg l−1 of calcein for 24 h either once (single treatment) or three times (triple treatment), and then observed to determine whether marks were visible, how long they remained visible and whether calcein influenced growth and mortality of the different age classes. Results indicated that all marked individuals were recognizable under blue light, that multiple distinct marks were possible on juveniles and that marks on juveniles could remain visible for 3.75 years. Growth of juveniles and adults treated with calcein was not significantly different from controls after 11 months. Survivorship did not differ between treated and control individuals for all treatments and ages, except the 2-month-old juvenile oysters that were immersed three times. Results indicate that calcein is an effective and safe marking technique for juvenile oysters from robust cohorts, and could be used to enhance studies of growth, mortality, larval transport and settlement in situ. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate algorithms for predicting 30-day fatal and nonfatal opioid-related overdose using statewide data sources including prescription drug monitoring program data, Hospital Discharge Data System data, and Tennessee (TN) vital records. Current overdose prevention efforts in TN rely on descriptive and retrospective analyses without prognostication.Materials and Methods: Study data included 3 041 668 TN patients with 71 479 191 controlled substance prescriptions from 2012 to 2017. Statewide data and socioeconomic indicators were used to train, ensemble, and calibrate 10 nonparametric "weak learner" models. Validation was performed using area under the receiver operating curve (AUROC), area under the precision recall curve, risk concentration, and Spiegelhalter z-test statistic.Results: Within 30 days, 2574 fatal overdoses occurred after 4912 prescriptions (0.0069%) and 8455 nonfatal overdoses occurred after 19 460 prescriptions (0.027%). Discrimination and calibration improved after ensembling (AUROC: 0.79-0.83; Spiegelhalter P value: 0-.12). Risk concentration captured 47-52% of cases in the top quantiles of predicted probabilities.Discussion: Partitioning and ensembling enabled all study data to be used given computational limits and helped mediate case imbalance. Predicting risk at the prescription level can aggregate risk to the patient, provider, pharmacy, county, and regional levels. Implementing these models into Tennessee Department of Health systems might enable more granular risk quantification. Prospective validation with more recent data is needed.Conclusion: Predicting opioid-related overdose risk at statewide scales remains difficult and models like these, which required a partnership between an academic institution and state health agency to develop, may complement traditional epidemiological methods of risk identification and inform public health decisions. [ABSTRACT FROM AUTHOR]

Bioenergetic models describe the processes through which animals acquire energy from resources in the environment and allocate it to different life history functions. They capture some of the fundamental mechanisms regulating individuals, populations and ecosystems and have thus been used in a wide variety of theoretical and applied contexts. Here, I review the development of bioenergetic models for marine mammals and their application to management and conservation. For these long-lived, wide-ranging species, bioenergetic approaches were initially used to assess the energy requirements and prey consumption of individuals and populations. Increasingly, models are developed to describe the dynamics of energy intake and allocation and predict how resulting body reserves, vital rates and population dynamics might change as external conditions vary. The building blocks required to develop such models include estimates of intake rate, maintenance costs, growth patterns, energy storage and the dynamics of gestation and lactation, as well as rules for prioritizing allocation. I describe how these components have been parameterized for marine mammals and highlight critical research gaps. Large variation exists among available analytical approaches, reflecting the large range of life histories, management needs and data availability across studies. Flexibility in modelling strategy has supported tailored applications to specific case studies but has resulted in limited generality. Despite the many empirical and theoretical uncertainties that remain, bioenergetic models can be used to predict individual and population responses to environmental change and other anthropogenic impacts, thus providing powerful tools to inform effective management and conservation. [ABSTRACT FROM AUTHOR]

Background: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate to provide annual updates on cancer incidence and mortality and trends by cancer type, sex, age group, and racial/ethnic group in the United States. In this report, we also examine trends in stage-specific survival for melanoma of the skin (melanoma).Methods: Incidence data for all cancers from 2001 through 2017 and survival data for melanoma cases diagnosed during 2001-2014 and followed-up through 2016 were obtained from the Centers for Disease Control and Prevention- and National Cancer Institute-funded population-based cancer registry programs compiled by the North American Association of Central Cancer Registries. Data on cancer deaths from 2001 to 2018 were obtained from the National Center for Health Statistics' National Vital Statistics System. Trends in age-standardized incidence and death rates and 2-year relative survival were estimated by joinpoint analysis, and trends in incidence and mortality were expressed as average annual percent change (AAPC) during the most recent 5 years (2013-2017 for incidence and 2014-2018 for mortality).Results: Overall cancer incidence rates (per 100 000 population) for all ages during 2013-2017 were 487.4 among males and 422.4 among females. During this period, incidence rates remained stable among males but slightly increased in females (AAPC = 0.2%, 95% confidence interval [CI] = 0.1% to 0.2%). Overall cancer death rates (per 100 000 population) during 2014-2018 were 185.5 among males and 133.5 among females. During this period, overall death rates decreased in both males (AAPC = -2.2%, 95% CI = -2.5% to -1.9%) and females (AAPC = -1.7%, 95% CI = -2.1% to -1.4%); death rates decreased for 11 of the 19 most common cancers among males and for 14 of the 20 most common cancers among females, but increased for 5 cancers in each sex. During 2014-2018, the declines in death rates accelerated for lung cancer and melanoma, slowed down for colorectal and female breast cancers, and leveled off for prostate cancer. Among children younger than age 15 years and adolescents and young adults aged 15-39 years, cancer death rates continued to decrease in contrast to the increasing incidence rates. Two-year relative survival for distant-stage skin melanoma was stable for those diagnosed during 2001-2009 but increased by 3.1% (95% CI = 2.8% to 3.5%) per year for those diagnosed during 2009-2014, with comparable trends among males and females.Conclusions: Cancer death rates in the United States continue to decline overall and for many cancer types, with the decline accelerated for lung cancer and melanoma. For several other major cancers, however, death rates continue to increase or previous declines in rates have slowed or ceased. Moreover, overall incidence rates continue to increase among females, children, and adolescents and young adults. These findings inform efforts related to prevention, early detection, and treatment and for broad and equitable implementation of effective interventions, especially among under resourced populations. [ABSTRACT FROM AUTHOR]

In the accompanying article, Mosites et al. (Am J Epidemiol. 2021;190(11):2432–2436) evaluate data sources that enumerate people experiencing homelessness in the United States with respect to their strengths and limitations for conducting epidemiologic research in homeless populations. We largely agree with their key arguments, yet offer additional points that provide important context about these data for researchers and other stakeholders. Overall, we believe that it is possible to address many of the noted shortcomings of these data, and once addressed, the data could be more effectively leveraged to improve the health, housing stability, and quality of life of people experiencing homelessness. [ABSTRACT FROM AUTHOR]

Background To achieve elimination of hepatitis C virus (HCV) infection, limited resources can be best allocated through estimation of "care cascades" among groups disproportionately affected. In San Francisco and elsewhere, these groups include young (age ≤ 30 years) people who inject drugs (YPWID), men who have sex with men who inject drugs (MSM-IDU), and low-income trans women. Methods We developed cross-sectional HCV care cascades for YPWID, MSM-IDU, and trans women using diverse data sources. Population sizes were estimated using an inverse variance-weighted average of estimates from the peer-reviewed literature between 2013 and 2019. Proportions of past/current HCV infection, diagnosed infection, treatment initiation, and evidence of cure (sustained virologic response at 12 weeks posttreatment) were estimated from the literature using data from 7 programs and studies in San Francisco between 2015 and 2020. Results The estimated number of YPWID in San Francisco was 3748; 58.4% had past/current HCV infection, of whom 66.4% were diagnosed with current infection, 9.1% had initiated treatment, and 50% had confirmed cure. The corresponding figures for the 8135 estimated MSM-IDU were: 29.4% with past/current HCV infection, 70.3% diagnosed with current infection, 28.4% initiated treatment, and 38.9% with confirmed cure. For the estimated 951 low-income trans women, 24.8% had past/current HCV infection, 68.9% were diagnosed with current infection, 56.5% initiated treatment, and 75.5% had confirmed cure. Conclusions In all 3 populations, diagnosis rates were relatively high; however, attention is needed to urgently increase treatment initiation in all groups, with a particular unmet need among YPWID. [ABSTRACT FROM AUTHOR]

Background although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. Objective to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients' 30-day survival. Design observational study nested in the Delirium Day project, with 30-day follow-up. Setting acute medical wards (n  = 118) and rehabilitation wards (n  = 46) in Italy. Subjects a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards. Methods a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days. Results overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45–1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41–1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27–2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33–2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28–2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting. Conclusions in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality. [ABSTRACT FROM AUTHOR]

Preconception health care is heralded as an essential method of improving pregnancy health and outcomes. However, access to health care for low-income US women of reproductive age has been limited because of a lack of health insurance. Expansions of Medicaid program eligibility under the Affordable Care Act (as well as prior expansions in some states) have changed this circumstance and expanded health insurance coverage for low-income women. These Medicaid expansions provide an opportunity to assess whether obtaining health insurance coverage improves prepregnancy and pregnancy health and reduces prevalence of adverse pregnancy outcomes. We tested this hypothesis using vital statistics data from 2011–2017 on singleton births to female US residents aged 15–44 years. We examined associations between preconception exposure to Medicaid expansion and measures of prepregnancy health, pregnancy health, and pregnancy outcomes using a difference-in-differences empirical approach. Increased Medicaid eligibility was not associated with improvements in prepregnancy or pregnancy health measures and did not reduce the prevalence of adverse birth outcomes (e.g. prevalence of preterm birth increased by 0.1 percentage point (95% confidence interval: −0.2, 0.3)). Increasing Medicaid eligibility alone may be insufficient to improve prepregnancy or pregnancy health and birth outcomes. Preconception programming in combination with attention to other structural determinants of pregnancy health is needed. [ABSTRACT FROM AUTHOR]

Background: With recent evidence for the increasing risk of young-onset colorectal cancer (yCRC), we had the objective to evaluate the incidence of yCRC in 1-year age increments, particularly focusing around the screening age of 50 years.Methods: We conducted a longitudinal study using linked administrative health databases in British Columbia, Canada, including a provincial cancer registry, inpatient and outpatient visits, and vital statistics from January 1, 1986, to December 31, 2016. We calculated incidence rates per 100 000 at every age from 20 to 60 years and estimated annual percent change in incidence (APCi) of yCRC using joinpoint regression analysis.Results: We identified 3614 individuals with yCRC (49.9% women). The incidence of CRC steadily increased from 20 to 60 years, with a marked increase from 49 to 50 years (incidence rate ratio = 1.19, 95% confidence interval [CI] = 1.04 to 1.34). Furthermore, there was a trend of increased incidence of yCRC among women (APCi = 0.79%, 95% CI = 0.22% to 1.36%) and men (APCi = 2.17%, 95% CI = 1.59% to 2.76%). Analyses stratified by age yielded APCis of 2.49% (95% CI = 1.36% to 3.63%) and 0.12% (95% CI = -0.54% to 0.79%) for women aged 30-39 years and 40-49 years, respectively, and 2.97% (95% CI = 1.65% to 4.31%) and 1.86% (95% CI = 1.19% to 2.53%) for men.Conclusions: Our findings indicate a steady increase over 1-year age increments in the risk of yCRC during the years approaching and beyond screening age. These findings highlight the need to raise awareness as well as continue discussions regarding considerations of lowering the screening age. [ABSTRACT FROM AUTHOR]

GraphAge-adjusted cancer death rates are for all cancer sites combined for the years 2016-2020, all races (includes Hispanics), both sexes, all ages. Death rates (deaths per 100,000 population per year) are age-adjusted to the 2000 US standard population (19 age groups: <1, 1-4, 5-9, ..., 80-84, 85+).Source: Cancer death data were provided by the National Vital Statistics System, population counts for the denominators are based on census population as modified by the National Cancer Institute (NCI), and the map was created by the State Cancer Profiles website (statecancerprofiles.cancer.gov). [Extracted from the article]

Objective: We aimed to analyse age-standardised mortality trends in Japan among blue-and white-collar male workers aged 25-64 years, by major causes of mortality from 1980 to 2015. Methods: Five-yearly mortality data were extracted from occupation-specific vital statistics maintained by the Japanese Ministry of Health, Labour and Welfare. A time series study was conducted among employed men aged 25-64 years. Age-standardised mortality trends by occupational category were calculated separately for all cancers, ischaemic heart disease, cerebrovascular disease and suicide. Poisson regression analysis was performed to analyse mortality trends by occupational category for each cause. Results: Mortality rates for all cancers and ischaemic heart disease were higher among white-collar workers than blue-collar workers throughout the 35-year study period. The gap in the mortality rates for all four causes of death among blue-and white-collar workers widened in 2000 after Japan's economic bubble burst in the late 1990s. Simultaneously, suicide mortality rates among white-collar workers increased sharply and have remained higher than among blue-collar workers. Conclusions: White-collar male workers in Japan have a higher risk of mortality than male blue-collar workers. However, despite substantial differences, significant progress has been made in recent years in reducing mortality across all occupations in Japan. [ABSTRACT FROM AUTHOR]

Populations of many vertebrates are declining and geographic ranges contracting, largely as a consequence of anthropogenic threats. Many reports of such decline, however, lack the breadth and detail to narrow down its causes. Here we describe population decline in the Common Loon (Gavia immer), a charismatic aquatic bird, based on systematic resighting and measurement of a marked population. During our 27-year investigation, age-adjusted chick mass has fallen by 11%, mortality among young and old chicks has increased by 31% and 82%, respectively, and fledging success has declined by 26%. Meanwhile, the return rate of marked nonbreeders ("floaters") has plunged by 53%, and the adult population overall has declined by 22%. Consistent with the thinning ranks of floaters, the rate of territory eviction has decreased by 52% during the study. Despite the decline in floaters, territory occupancy remains unchanged. However, a matrix model, updated with recent estimates for breeding success, juvenile survival, and senescence, yields a recalculated deterministic population growth rate (λ) of 0.94 for our study population, which suggests that declines in vital rates could lead to a loss of 52% of the current population and a decline of 37% in territory occupancy by 2031. Lack of data on floaters in other upper Midwest and New England loon populations leaves their status in doubt. LAY SUMMARY The adult loon population in northern Wisconsin has declined by 22% over the past 27 years. Numbers of chicks and chick mass have declined significantly. The population of young nonbreeders (floaters) has plummeted by 46%. Despite these steep declines, there has been no measurable drop in the number of territorial pairs. The hidden nature of the Wisconsin decline points out that floater populations can mask major drops in breeding populations and throws into question population trends in other loon populations, whose floater populations are largely unknown. [ABSTRACT FROM AUTHOR]

The black-headed duck (Heteronetta atricapilla) of South America is the only known avian obligate brood parasite with precocial offspring. In Argentina, it relies on two species of coots as primary hosts, which typically reject 35–65% of duck eggs. We show that environmentally driven increases in host egg rejection behavior lead to substantial reductions in the reproductive success of the brood parasite. Episodes of flooding and vegetation loss caused dramatic shifts in host egg-rejection behavior, resulting in rejection (85–95%) of almost all duck eggs. Coots respond to fluctuating water levels by building up their nest, raising their own eggs but leaving duck eggs behind. Coots can apparently recognize parasitic duck eggs, but large-scale rejection is triggered only when hosts must actively make a choice. We use a simple population model to illustrate the unique demographic challenges that black-headed ducks face with their parasitic lifestyle and to explore the potential impact of environmentally induced escalation of egg rejection. Using the best available estimates for key vital rates, we show that obligate parasitism may provide a demographically precarious existence for black-headed ducks, even under benign environmental conditions. Environmentally mediated increases in egg rejection rates by hosts could impact significantly the viability of this enigmatic species of brood parasitic duck. Our results demonstrate that egg rejection rates are not fixed properties of host populations or individuals but are strongly influenced by social and ecological factors. Shifts in these environmental drivers could have important and unforeseen demographic consequences for brood parasites. [ABSTRACT FROM AUTHOR]

Objective: Minority oversampling is a standard approach used for adjusting the ratio between the classes on imbalanced data. However, established methods often provide modest improvements in classification performance when applied to data with extremely imbalanced class distribution and to mixed-type data. This is usual for vital statistics data, in which the outcome incidence dictates the amount of positive observations. In this article, we developed a novel neural network-based oversampling method called actGAN (activation-specific generative adversarial network) that can derive useful synthetic observations in terms of increasing prediction performance in this context.Materials and Methods: From vital statistics data, the outcome of early stillbirth was chosen to be predicted based on demographics, pregnancy history, and infections. The data contained 363 560 live births and 139 early stillbirths, resulting in class imbalance of 99.96% and 0.04%. The hyperparameters of actGAN and a baseline method SMOTE-NC (Synthetic Minority Over-sampling Technique-Nominal Continuous) were tuned with Bayesian optimization, and both were compared against a cost-sensitive learning-only approach.Results: While SMOTE-NC provided mixed results, actGAN was able to improve true positive rate at a clinically significant false positive rate and area under the curve from the receiver-operating characteristic curve consistently.Discussion: Including an activation-specific output layer to a generator network of actGAN enables the addition of information about the underlying data structure, which overperforms the nominal mechanism of SMOTE-NC.Conclusions: actGAN provides an improvement to the prediction performance for our learning task. Our developed method could be applied to other mixed-type data prediction tasks that are known to be afflicted by class imbalance and limited data availability. [ABSTRACT FROM AUTHOR]

Background Mortality associated with hepatitis C virus (HCV) has been well-documented nationally, but an examination across regions and jurisdictions may inform health-care planning. Methods To document HCV-associated deaths sub-nationally, we calculated age-adjusted, HCV-associated death rates and compared death rate ratios (DRRs) for 10 US regions, 50 states, and Washington, D.C. using the national rate and described rate changes between 2016 and 2017 to determine variability. We examined the mean age at HCV-associated death, and rates and proportions by sex, race/ethnicity, and birth year. Results In 2017, there were 17 253 HCV-associated deaths, representing 4.13 (95% confidence interval [CI], 4.07–4.20) deaths/100 000 standard population, in a significant, 6.56% rate decline from 4.42 in 2016. Age-adjusted death rates significantly surpassed the US rate for the following jurisdictions: Oklahoma; Washington, D.C.; Oregon; New Mexico; Louisiana; Texas; Colorado; California; Kentucky; Tennessee; Arizona; and Washington (DRRs, 2.87, 2.77, 2.24, 1.62, 1.57, 1.46, 1.36, 1.35, 1.35, 1.35, 1.32, and 1.32, respectively; P <.05). Death rates ranged from a low of 1.60 (95% CI, 1.07–2.29) in Maine to a high of 11.84 (95% CI, 10.82–12.85) in Oklahoma. Death rates were highest among non-Hispanic (non-H) American Indians/Alaska Natives and non-H Blacks, both nationally and regionally. The mean age at death was 61.4 years (range, 56.6 years in West Virginia to 64.1 years in Washington, D.C.), and 78.6% of those who died were born during 1945–1965. Conclusions In 2016–2017, the national HCV-associated mortality declined but rates remained high in the Western and Southern regions and Washington, D.C. and among non-H American Indians/Alaska Natives, non-H Blacks, and Baby Boomers. These data can inform local prevention and control programs to reduce the HCV mortality burden. [ABSTRACT FROM AUTHOR]

Eastern hemlock (Tsuga canadensis) is declining throughout the eastern United States due to hemlock woolly adelgid (Adelges tsugae Annand), an invasive insect from Asia. In the southern Appalachians, hemlock is concentrated in moist ravines and its decline threatens riparian ecosystems. Previous research on this invasion has focused on adelgid control and how hemlock decline affects community composition or forest processes; few studies have evaluated the consequences for demography of obligate riparian species. The Louisiana Waterthrush (Parkesia motacilla) is an obligate riparian species that could be sensitive to hemlock condition in this region, but how individuals respond to decline is currently unknown. To address this knowledge gap, we leveraged recent adelgid treatment efforts in Great Smoky Mountains National Park to evaluate the relationship(s) between hemlock decline and waterthrush habitat selection (foraging and nest site) and vital rates (nest and adult survival). We found that hemlock decline was unrelated to foraging habitat selection and apparent adult survival, but was related to nest site selection through an interaction with percent ground cover of exposed live tree roots: birds selected for nest sites in areas with more exposed live roots but only when hemlock was in poor condition. Nest survival was lower in areas where deciduous species (vs. evergreen species) dominated the understory, suggesting that adelgid invasion could indirectly impact waterthrush fitness depending on how vegetative succession proceeds following hemlock decline. Our results suggest that the short-term consequences of adelgid invasion on this riparian avian species are minimal in this area, but these relationships are likely dynamic and dependent on local habitat features and the predator community response to hemlock decline. [ABSTRACT FROM AUTHOR]

This analysis describes specific gaps in the quality of health care in Central Africa and assesses the association between quality of clinical care and mortality at age 2-59 months. Regionally representative facility and household surveys for the Democratic Republic of the Congo, Cameroon and Central African Republic were collected between 2012 and 2016. These data are novel in linking facilities with households in their catchment area. Compliance with diagnostic and danger sign protocols during sick-child visits was observed by trained assessors. We computed facility- and district-level compliance indicators for patients aged 2-59 months and used multivariate multi-level logistic regression models to estimate the association between clinical assessment quality and mortality at age 2-59 months in the catchment areas of the observed facilities. A total of 13 618 live births were analysed and 1818 sick-child visits were directly observed and used to rate 643 facilities. Eight percent of observed visits complied with 80% of basic diagnostic protocols, and 13% of visits fully adhered to select general danger sign protocols. A 10% greater compliance with diagnostic protocols was associated with a 14.1% (adjusted odds ratio (aOR) 95% CI: 0.025-0.244) reduction in the odds of mortality at age 2-59 months; a 10% greater compliance with select general danger sign protocols was associated with a 15.3% (aOR 95% CI: 0.058-0.237) reduction in the same odds. The results of this article suggest that compliance with recommended clinical protocols remains poor in many settings and improvements in mortality at age 2-59 months could be possible if compliance were improved. [ABSTRACT FROM AUTHOR]

The physiology of invertebrates inhabiting many coastal ecosystems is challenged by strong temporal fluctuations in salinity. We investigated how food availability influences vital rates in the tropical cyclopoid copepod Apocyclops royi subjected to different salinities (5–32 PSU). We hypothesized that (i) mortality decreases and egg production rate increases with food availability; (ii) under suboptimal salinity, mortality increases and the egg production rate is reduced and (iii) the threshold concentration for egg production (the lowest food concentration where egg production is initiated) shifts to higher food concentrations when challenged by salinity. Surprisingly, A. royi survived, ingested food and produced eggs at all tested salinities. Mortality rate was, however, dependent on salinity level, but not on food availability. Mortality increased (~12% h−1) during short-term (1 h) salinity acclimatization to 5 PSU and during the following 24-h incubations (~5% d−1) compared with higher salinities. Feeding and egg production rates increased with food availability up to an optimum at all salinity levels, with no effect of salinity on the lowest food concentration initiating egg production. This reveals a high-salinity tolerance by A. royi and may partly explain why this particular copepod is so successful compared with its congeners in occupying extreme habitats. [ABSTRACT FROM AUTHOR]

Knowledge of the spatiotemporal variability of abundance and vital rates is essential to the conservation of wildlife populations. In Pacific Northwest forests, previous small mammal research has focused on estimating abundance; few studies have focused on vital rates. We used robust design temporal symmetry models and live-trapping data collected 2011–2016 at nine sites to estimate apparent annual survival, population growth rate, and recruitment of Humboldt's flying squirrels (Glaucomys oregonensis) and Townsend's chipmunks (Neotamias townsendii) in a late-successional forest of the Cascade Mountains of Oregon, United States. We also estimated the proportional contribution of apparent annual survival and recruitment to population growth rate. Covariates previously associated with abundance were also associated with vital rates for Townsend's chipmunks, but less so for Humboldt's flying squirrels. Apparent annual survival was nearly constant (range = 0.47 to 0.51) among years and sites for Humboldt's flying squirrels but was consistently lower and more variable among years for Townsend's chipmunks (range = 0.13 to 0.31). Recruitment was variable among years for both species. Apparent annual survival generally contributed more than recruitment to the population growth rate of Humboldt's flying squirrels. For Townsend's chipmunks, recruitment consistently contributed more than apparent annual survival to population growth rate. These findings suggest that life history strategies differed for these co-occurring species. This study demonstrates substantial temporal variation in vital rates and some differences in abundance and vital rate habitat associations, suggesting that habitat suitability inferences based on short time series or variation in abundance could be misleading. [ABSTRACT FROM AUTHOR]

Terrestrial orchid life-cycles are complex and dependent on pollinators and mycorrhizal associates. Worldwide, orchid populations are declining because of urbanization, atmospheric nitrogen deposition and climate change. To advance understanding of the factors determining orchid population viability, we review knowledge about orchid demography, life histories and population dynamics. Orchids can produce thousands of seeds, although few survive to reach maturity, with mortality rates declining from juvenile to adult life states. Flowering and fruiting rates vary widely between years, and many populations, especially of deceptive species, are pollen- and seed-limited. Many species have long lifespans and periods of vegetative dormancy and exhibit costs associated with reproduction, sprouting, vegetative dormancy, growth and size. Population growth rates range from 0.50–2.92 (mean: 0.983 ± 0.026). Although vital rates can fluctuate widely between years and be strongly correlated, these correlations have little impact on population dynamics. Variation in spatial density of fungi and microsite quality, limited dispersal and competition generate density dependence in vital rates. Future research should elucidate the roles of biotic and abiotic factors on population dynamics to underpin effective management for conservation. Understanding the impact of idiosyncratic individual plant behaviour on population dynamics will also improve demographic parameter estimation, including population growth rate and net reproductive rate. [ABSTRACT FROM AUTHOR]

Background: The substantial decline in cardiovascular-disease (CVD) mortality in high-income countries has underpinned their increasing longevity over the past half-century. However, recent evidence suggests this long-term decline may have stagnated, and even reversed in younger populations. We assess recent CVD-mortality trends in high-income populations and discuss the findings in relation to trends in risk factors.Methods: We used vital statistics since 2000 for 23 high-income countries published in the World Health Organization Mortality Database. Age-standardized CVD death rates by sex for all ages, and at ages 35-74 years, were calculated and smoothed using LOWESS regression. Findings were contrasted with the Global Burden of Disease (GBD) Study.Results: The rate of decline in CVD mortality has slowed considerably in most countries in recent years for both males and females, particularly at ages 35-74 years. Based on the latest year of data, the decline in the CVD-mortality rate at ages 35-74 years was <2% (about half the annual average since 2000) for at least one sex in more than half the countries. In North America (US males and females, Canada females), the CVD-mortality rate even increased in the most recent year. The GBD Study estimates, after correcting for misdiagnoses, suggest an even more alarming reversal, with CVD death rates rising in seven countries for at least one sex in 2017. The rate of decline and initial level of CVD mortality appear largely unrelated.Conclusions: A significant slowdown in CVD-mortality decline is now apparent across high-income countries with diverse epidemiological environments. High and increasing obesity levels, limited potential future gains from further reducing already low smoking prevalence, especially in English-speaking countries, and persistent inequalities in mortality risk pose significant challenges for public policy to promote better cardiovascular health. [ABSTRACT FROM AUTHOR]

There has been a recent renewed interest in the study of firm size distributions and firm growth rate distributions. Gibrat's law assumes firm growth rates are independent and identically distributed and that size is determined by a first-order integrated process, leaving the size distribution log-normal. This article analyzes these distribution patterns in an empirical context, questioning the foundation of this model. In a cross-section analysis of four industries using Danish data, we show that the foundation and the outcome of Gibrat's law are empirically far-fetched. In particular, significant deviations from normality are found. [ABSTRACT FROM AUTHOR]

Introduction: Obesity and overweight, defined as body mass index (BMI) of 30.0 and above or 25.0-29.9, respectively, are of significant concern to the military population, due to their associated comorbidities and potential for impaired readiness. In 2016, the US Army reported a prevalence of 17.3% obesity and 52.9% overweight among soldiers, despite both physical demands of the job and Department of Defense (DoD) guidelines which recommend separation from service for those unable to meet body composition standards. This study examines the health service utilization of active duty, male Army soldiers in order to determine the prevalence of obesity and overweight and to estimate the effects of these conditions on readiness.Materials and Methods: This was a cross-sectional study utilizing fiscal year (FY) 2015 TRICARE claims and military treatment facility (MTF) encounter data obtained from the Military Health System Data Repository (MDR), for 467,732 US Army male Soldiers on active duty. We obtained basic demographic information (age, race, and rank) from the Defense Enrollment Eligibility Reporting System (DEERS). Next, we calculated BMI for this cohort by matching patients to their vital statistics of height and weight measurements. Finally, we obtained their health service utilization by querying and matching patients to their healthcare claims in 2015 by major diagnostic category.Findings: More than half (51.2%) of subjects had overweight, 28.9% had normal weight, 19.7% had obesity, and less than 1% had underweight. Soldiers with overweight and obesity were most common among the 25-34 years age range and enlisted ranks. Normal weight and underweight soldiers had a median of 7 healthcare visits in FY 2015, compared with 8 for soldiers with overweight and 12 for those with obesity. Soldiers with obesity, but not overweight, had a disproportionately greater number of healthcare encounters for diagnostic categories including musculoskeletal; mental health; ear, nose, and throat; and endocrine system. In contrast, soldiers with obesity had disproportionately fewer healthcare encounters for multiple significant trauma and for infectious and parasitic diseases.Conclusions: More than 70% of soldiers had overweight or obesity in FY 2015, showing the highest prevalence yet measured for these conditions. Previous reports of lower prevalence may be due to the inclusion of circumference-based body fat assessments, which have been criticized for inaccuracy. In our study, disproportionately high health service use by soldiers with obesity suggests decreased readiness, as these soldiers may experience both poorer health and lose necessary training time due to increased provider visits. Proportional usage by soldiers with overweight suggests the protective effect of regular physical activity, though these soldiers should be monitored to ensure that they do not progress to obesity. Additional research should establish the burden of cost, absenteeism, and presenteeism of obesity on the MHS, as well as developing more appropriate field tests for body fat assessment and BMI standards to better support military readiness. [ABSTRACT FROM AUTHOR]

Background The aim of the study is 2-fold. Firstly, it attempts to investigate the potential impact of major political and economic changes on inequalities in all-cause mortality among men and women with different levels of education in three Eastern European countries. Secondly, to identify changes in contribution of smoking and drinking to educational differences in all-cause mortality. Study covers the period from 1982 to 2013. Methods Data were collected in 2013–14 as a part of the PrivMort retrospective cohort study. Participants in Russia, Belarus and Hungary provided information on their educational attainment, health-related behaviors and vital statistics of their close relatives (N = 179 691). Odds ratios for mortality and relative indices of inequality (RII) were estimated for individuals aged 20–65 years, stratifying by three levels of educational attainment: higher, secondary and less than secondary education. Results Those in lower educational groups were significantly more likely to die, through most time periods and sub-groups. The RII increased over time in all countries and both genders, except for Hungarian men. Alcohol consumption and smoking have increasingly contributed to educational inequalities in mortality during this period. Conclusion Educational inequalities in mortality in these Eastern European countries have increased during recent decades. Smoking and alcohol consumption, two major health-related behaviors, made a significant contribution to these increases in inequality. [ABSTRACT FROM AUTHOR]

Interest in plague and mortality in seventeenth-century London was fed by the weekly and yearly Bills of Mortality, and by the composite or commemorative plague bills issued in epidemic years. Some surviving examples are annotated, suggesting keen engagement with the content. This article identifies one such annotator as the city law-officer and bibliophile, Richard Smyth (1590–1675), and sets this identification in the context of Smyth's personal experience of plague, and of his book-collecting, reading and writing on the subject of plague, demography and vital statistics. Taken together Smyth's activities illuminate the important role that print and text played in shaping responses to a fearsome and recurrent feature of early modern London life. [ABSTRACT FROM AUTHOR]

We describe our experience in several settings, following a suggestion in 1983 to add questions on the smoking status of the deceased on the UK death certificate as an effective way to monitor the evolution of the smoking epidemic. In South Africa in 1997 and in Tianjin Municipality, China, in 2010, questions about the smoking habits of the deceased were inserted on the official death certificates. In both places a system now exists to routinely collect information on smoking status in relation to causes of death. Results from two million South African and 300 000 Chinese deceased individuals have been reported, and the sample size in both places continues to grow. An unsuccessful attempt was made in 2008 to insert smoking questions on the Australian death notification forms but comments and concerns from the registrars of births, marriages and deaths have international applicability. In both China and South Africa, inserting questions on smoking on the death notification forms was not a trivial task-in each it required, as a minimum, significant commitment from several government agencies. Benefits, however, include a better local understanding of the smoking epidemic and allowing for planning and monitoring of tobacco control programmes. Documenting the varied experiences of collecting information on smoking on death notification forms is useful to those wishing to introduce such questions in their own settings. This is pertinent especially at a time when vital registration systems are being improved, with an aim to monitoring sustainable development goals. [ABSTRACT FROM AUTHOR]

Background: Mortality data at the population level are often aggregated in age classes, for example 5-year age groups with an open-ended interval for the elderly aged 85+. Capturing detailed age-specific mortality patterns and mortality time trends from such coarsely grouped data can be problematic at older ages, especially where open-ended intervals are used.Methods: We illustrate the penalized composite link model (PCLM) for ungrouping to model cancer mortality surfaces. Smooth age-specific distributions from data grouped in age classes of adjacent calendar years were estimated by constructing a two-dimensional regression, based on B-splines, and maximizing a penalized likelihood. We show the applicability of the proposed model, analysing age-at-death distributions from cancers of all sites in Denmark from 1980 to 2014. Data were retrieved from the Danish Cancer Society and the Human Mortality Database.Results: The main trends captured by PCLM are: (i) a decrease in cancer mortality rates after the 1990s for ages 50-75; (ii) a decrease in cancer mortality in later cohorts for young ages, especially, and very advanced ages. Comparing the raw data by single year of age, with the PCLM-ungrouped distributions, we clearly illustrate that the model fits the data with a high level of accuracy.Conclusions: The PCLM produces detailed smooth mortality surfaces from death counts observed in coarse age groups with modest assumptions, that is Poisson distributed counts and smoothness of the estimated distribution. Hence, the method has great potential for use within epidemiological research when information is to be gained from aggregated data, because it avoids strict assumptions about the actual distributional shape. [ABSTRACT FROM AUTHOR]

Mortality estimates of the 1918 influenza pandemic vary considerably, and recent estimates have suggested that there were 50 million to 100 million deaths worldwide. We investigated the global mortality burden using an indirect estimation approach and 2 publicly available data sets: the Human Mortality Database (13 countries) and data extracted from the records of the Statistical Abstract for British India. The all-cause Human Mortality Database was used to estimate mortality annually for 1916–1921 for detailed age groups. Three different calculation methods were applied to the data (low, medium, and high scenarios), and we used a multilevel regression model to control for distorting factors (e.g. war and the underlying time trend in mortality). Total pandemic mortality was an estimated 15 million deaths worldwide in 1918 (n = 2.5 million in 1919) after including the rates for British India and controlling for wars and the underlying mortality trend. According to our validity analysis, simulations of total number of deaths being greater than 25 million are not realistic based on the underlying mortality rates included in Human Mortality Database and in British India. Our results suggest the global death impact of the 1918 pandemic was important (n = 17.4 million) but not as severe as most frequently cited estimates. [ABSTRACT FROM AUTHOR]

Background Starting in 2008 recession affected many European countries and especially Greece. Previous studies have reported increases in low birth weight, preterm birth and stillbirth rates in Greece during early crisis. In our study we used data on births from 1980 to 2014 that allowed us to distinguish recent changes, which could possibly be attributed to the financial crisis, from long term trends, and controlled for maternal age and country of origin as potential confounders. Our study covered a longer period (up to 2014) than what has been studied before and looked separately at the effect of early and established crisis. Methods We used national vital statistics data from 1980 to 2014. We performed age standardization and calculated age standardized rates and standardized rate ratios (SRRs) for perinatal factors for three time periods (pre-crisis, early crisis and established crisis) for Greek and non-Greek women. Results We found an increase in low birth weight deliveries independent of maternal age and origin and an increased stillbirth rate in Greek women younger than 25 in early (RR = 1.42 95%CI: 1.12–1.80) and established crisis periods (RR = 1.36 95%CI: 1.07–1.72) compared with pre-crisis. Non-Greek women have also been affected, with their advantage regarding birth outcomes becoming less profound in the established crisis period (low birth weight: established crisis SRR = 0.84 95%CI: 0.82–0.87, pre-crisis SRR = 0.79 95% CI: 0.76– 0.81). Conclusions The financial crisis has possibly adversely affected perinatal factors in Greece. Our results highlight the need of appropriate public health interventions and family support policies, especially for younger people, unemployed and immigrants. [ABSTRACT FROM AUTHOR]

Although the population of Ghana is young and generally youthful, there is evidence of rapid increases in the size of the elderly cohort. Although demographic projections estimate that the proportion of the population younger than 15 years will experience continuous decline overtime due in part to decline in fertility, the rise in the elderly population is expected to also continue due to declining mortality rates resulting in longevity. Unfortunately, the growth in the elderly proportion of the population is occurring at the same time traditional systems of protection and care for the aged are breaking down on account of urbanization, socioeconomic development, and globalization. This has implications for public policy and the overall wellbeing of the elderly. This paper provides a snapshot overview of the demographic dynamics of Ghana focusing on the characteristics of aging, the challenges confronting the elderly, policy interventions, and gaps, as well as some pertinent issues including emerging research that are shaping deliberations about the elderly in the country. [ABSTRACT FROM AUTHOR]

Painted Buntings [Passerina ciris} have been declining In the southeastern United States since the 1970s. A recent demographic assessment highlighted the Importance of estimating demographic parameters, which have received little attention to date. The dearth of Information Is troublesome because attempts to reverse declining trends require a better understanding of the relationship between habitat quality and age- and sex-specific survival and recruitment rates. We used capture-mark-recapture data collected from 2007 to 2015 on Bald Head Island (BHI) and at Hammocks Beach State Park (HBSP) In North Carolina, USA, to estimate local age- and sex-specific annual survival rates and local population size and recruitment rates using programs MARK and LOLASURVIV. Juveniles had lower local survival rates than adults (HBSP: 0.28 ± 0.14 vs. 0.67 ± 0.06; BHI: 0.28 ± 0.04 vs. 0.57 ± 0.02). Local annual survival rates for males on BHI (0.50 ± 0.03) were lower than those for females (0.57 ± 0.02). Age-specific differences were consistent with known differential age-dependent survival skills, and sex-specific differences were consistent with the potential Influence of sexual dlchromlsm. Conservative estimates of population size on BHI averaged 101 juveniles and 263 adults annually. Annual In situ reproductive recruitment averaged 28 Individuals plus an additional 120 new Immigrants, Indicating successful reproduction and connectivity with neighboring coastal populations. Local adult survival estimates from our 2 North Carolinian study populations were similar to high-end estimates from across the eastern and western range of the species (~0.60). Finite observed population growth rate estimates between the BHI population (X 1.10) and a South Carolinian population (X = 0.87) underscore the potential role of differential habitat quality and the Importance of Information from multiple sites, Including nonbreeding grounds, for proper Inferences about the status of the species. Reported vital rates provide a stronger foundation on which to base habitat quality as assessed with demographic parameters and to guide Painted Bunting conservation regionally. [ABSTRACT FROM AUTHOR]