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This paper presents a variant of the survival function proposed by Wong and Tsui, in which we include a component reflecting heterogeneity among individuals (frailty), together with a covariate describing the influence of certain characteristics of individuals on the response variable. Using mortality statistics for the entire Spanish population, we estimated survival functions according to the variants of the model considered, also determining life expectancies and mortality ratios at each age. The advantage of the proposed variant is that it incorporates gender differences, by including sex as a covariate. Furthermore, it reflects the intrinsic randomness of individuals. With this approach, additional parameters must be considered, but all were found to be significant.

The numbers of COVID-19 cases and deaths are currently attracting worldwide attention. Different web resources publish these data for countries and their regions. The data are available to everyone and are updated in almost real-time mode. The rapid collection of data on cases and deaths and the open access of these data clearly provide important advantages in combating the epidemic, predicting its spread, and planning containment measures. An important area of research on the COVID-19 epidemic is the comparison of countries and territories by their levels of morbidity, lethality, and mortality. Given the opportunities opening up today for data analysis, it is crucially important to understand according to what criteria the data are collected. This paper discusses the key issues of collecting data on COVID-19 cases and deaths and raises the question of data comparability across countries. It shows that countries differ significantly in their approaches to reporting COVID-19 cases and deaths. The data comparability across countries can be influenced, among other things, by the availability of tests, the criteria adopted by the country for testing for the virus (both while the patient is alive and post-mortem), and approaches to determining the cause of death and recording COVID-19 deaths in those with pre-existing chronic conditions. Different approaches to recording COVID-19 cases and deaths across countries, as well as their changes over time, pose significant limitations to our ability to assess the spread of the epidemic. These limitations should be taken into account when performing the analysis of COVID-19 morbidity and mortality. Ignoring these limitations can significantly distort our understanding of the spread of the epidemic across different territories.

Absztrakt: A COVID–19-járvány mindenkit, szakembert és laikust egyaránt váratlanul érintett, jóllehet egy világméretű pandémia lehetőségét egyrészről az epidemiológusok, infektológusok, másrészről szociológusok, kommunikációs, sőt társadalmi szokásokkal foglalkozó viselkedéstudományi szakemberek elméletben már régóta elképzelhetőnek tartották. Mégis, szembesülve a „real-time” történésekkel, a napi fertőzöttségi és mortalitási statisztikákkal, szinte mindenki tudatlannak, illetve zavaróan tapasztalatlannak érzi magát. A jelen összefoglalás tudományos evidenciákról kíván áttekintést nyújtani. A 2020. március végén összeállított, korántsem teljességre törekedő anyag természetesen nem kevés olyan elemet tartalmaz, amely pár hét múlva meghaladott lesz. A szerzők remélik, hogy egy legközelebbi publikációban mindannyian sokkal jobb és reménytelibb kilátásokról tudósíthatunk. Orv Hetil. 2020; 161(17): 644–651.

Introduction Appropriate cause of death reporting is vital in the pandemic circumstance for effective planning of the control measures. Accurate reporting and registration of the reason for death are crucial in planning of health programs in turn contributing for the national development. Background All births and deaths occurring across India should be mandatorily registered per the Registration of Births and Deaths Act passed in the year 1969. The act also requires the issuance of cause of death certificate by the doctor attending the departed during his last illness. Data obtained from the cause of death certificate provides cause-specific mortality profile, which is required to analyze the health trends of the population. Review results This article discusses the available guidelines on the appropriate documentation of cause of death in the confirmed or suspected coronavirus disease-2019 (COVID-19) infection resulting into death. Conclusion Proper certification of the cause of death leads to better epidemic surveillance. Scrutiny of the clinical sequences from the cause of death certificate is useful to prioritize the allocation of resources for critical care management and to augment our knowledge about underlying causes resulting in mortality from COVID-19. Clinical significance Dissemination of available guidelines on proper documentation of the cause of death in confirmed/suspected COVID-19 cases will reduce the errors in cause of death reporting. How to cite this article Veeranna CH, Rani S. Cause of Death Certification in COVID-19 Deaths. Indian J Crit Care Med 2020;24(9):863-867.

Absztrakt: A krónikus obstruktív tüdőbetegség (COPD) világszerte előkelő helyet foglal el a morbiditási és mortalitási statisztikákban. A COPD megelőzhető és kezelhető betegség, kialakulásáért döntően a dohányzás tehető felelőssé. A prevenció kulcsfontosságú, de korlátozottan kivitelezhető, így a rizikó meghatározása és a korai noninvazív diagnosztika révén lehetne tovább csökkenteni a COPD miatti halálozást. A fejlődő diagnosztikus technikák ellenére az optimális szűrővizsgálat felfedezése még várat magára. Kellően szenzitív és specifikus biomarkerek felfedezése megfelelő eszközt adhat a klinikus kezébe a betegség korai diagnosztizálásához, a differenciáldiagnosztikához, a fenotipizáláshoz és a prognózis becsléséhez. Közleményünkben a COPD vonatkozásában a közelmúltban felfedezett potenciális fehérje és glikán biomarkereket foglaljuk össze. Orv Hetil. 2020; 161(4): 123–128.

Objectives-This report presents a mortality profile of the U.S. non-Hispanic American Indian or Alaska Native (AIAN) population for 2019. Standard mortality statistics, adjusted for race and Hispanic-origin misclassification on death certificates, are provided along with comparisons with the three major U.S. populations: non-Hispanic white, non-Hispanic black, and Hispanic.

Since the emergence of the COVID-19 pandemic, the mortality statistics are constantly changing globally. Mortality statistics analysis has vital implications to implement evidence-based policy recommendations. This study aims to study the demographic characteristics, patterns, determinants, and the main causes of death during the first half of 2020, in the Kingdom of Saudi Arabia (KSA). Methodology: A retrospective descriptive study targeted all death (29,291) registered in 286 private and governmental health settings, from all over KSA. The data was extracted from the ministry of health’s death records after the ethical approval. The International Classification of Diseases (ICD-10) and WHO grouping, were used to classify the underlying causes of deaths. The collected data were analyzed using the appropriate tables and graphs. Results: 7055 (24.9%) died at the middle age (40–59 year), and 19,212 (65.6%) were males, and 18,110 (61.8%) were Saudi. The leading causes of deaths were non-communicable diseases (NCDs) 15,340 (62.1%), mainly Cardiovascular diseases (CVDs) 10,103 (34.5%). There was a significant relationship between the main causes of deaths and sex (p < 0.05) and nationality (p = 0.01). Conclusion: NCDs mainly CVDs are the leading cause of death. The COVID-19 mortalities were mainly in males, and old age > 55 year. The lockdown was associated with a reduction in the NCDs and Road traffic accidents mortalities.

Objectives Inaccuracies in cause-of-death information in death certificates can reduce the validity of national death statistics and result in poor targeting of resources to reduce morbidity and mortality in people with HIV. Our objective was to measure the sensitivity, specificity, and agreement between multiple causes of deaths from death certificates obtained from the National Death Index (NDI) and causes determined by expert physician review. Methods Physician specialists determined the cause of death using information collected from the medical records of 50 randomly selected HIV-infected people who died in San Francisco from July 1, 2016, through May 31, 2017. Using expert review as the gold standard, we measured sensitivity, specificity, and agreement. Results The NDI had a sensitivity of 53.9% and a specificity of 66.7% for HIV deaths. The NDI had a moderate sensitivity for non–AIDS-related infectious diseases and non–AIDS-related cancers (70.6% and 75.0%, respectively) and high specificity for these causes (100.0% and 94.7%, respectively). The NDI had low sensitivity and high specificity for substance abuse (27.3% and 100.0%, respectively), heart disease (58.3% and 86.8%, respectively), hepatitis B/C (33.3% and 97.7%, respectively), and mental illness (50.0% and 97.8%, respectively). The measure of agreement between expert review and the NDI was lowest for HIV (κ = 0.20); moderate for heart disease (κ = 0.45) and hepatitis B/C (κ = 0.40); high for non–AIDS-related infectious diseases (κ = 0.76) and non–AIDS-related cancers (κ = 0.72); and low for all other causes of death (κ < 0.35). Conclusions Our findings support education and training of health care providers to improve the accuracy of cause-of-death information on death certificates.

Estimating excess mortality allows quantification of overall pandemic impact. For recent decades, mortality data are easily accessible for most industrialized countries, but only a few countries have continuous data available for longer periods. Since Spain, Sweden, and Switzerland were militarily neutral and not involved in combat during both world wars, these countries have monthly all-cause mortality statistics available for over 100 years with no interruptions. We show that during the COVID-19 pandemic in 2020, Spain, Sweden and Switzerland recorded the highest aggregated monthly excess mortality (17%, 9% and 14%) since the 1918 influenza pandemic (53%, 33% and 49%), when compared to respective expected values. For Sweden and Switzerland, the highest monthly spikes in 2020 almost reached those of January 1890. These findings emphasize the historical dimensions of the ongoing pandemic and support the notion of a pandemic disaster memory gap.One-Sentence SummaryDuring the COVID-19 pandemic in 2020, Spain, Sweden, and Switzerland recorded their highest monthly excess and all-cause mortality levels since the 1918 influenza pandemic, emphasizing the historical dimension of the ongoing pandemic.

Pravno-medicinski, smrt nastupa prestankom funkcije moždanog debla u kojem se nalaze centri za disanje i prestankom rada srca čija je normalna funkcija presudna za funkcioniranje ostatka organizma. Utvrđivanjem uzroka smrti često se utvrđuje i način smrti, prirodna ili nasilna smrt. Obdukcija je jedini siguran način utvrđivanja uzroka nagle ili iznenadne neobjašnjive prirodne smrti, a obdukcijski nalaz jedini prihvatljiv za korištenje u pravne svrhe i za naknadnu analizu (vještačenje). U istraživanje su uključene sve osobe preminule od prirodnih smrti, utvrđene obdukcijom na Zavodu za sudsku medicinu i kriminalistiku Rijeka u vremenskom razdoblju od 2015. do 2019. godine. Od potrebnih parametara su korišteni spol, dob i organski sustavi. Najveći broj prirodnih smrti zabilježen je u 2017. godini, dok je prema 2019. godini zamijećen silazni trend. Od ukupno 605 osoba koje su umrle prirodnom smrću, 437 osoba bilo je muškog spola (71%), dok je preostalih 175 osoba bilo ženskog spola (29%). S obzirom na dob, najviše ih je u starijim dobnim skupinama kao što su dobne skupine 61-70 sa 160 (26%) i 71-80 sa 152 (25%) zabilježena smrtna slučaja. Uzrok najvećeg broja prirodnih smrti su bolesti iz skupine bolesti krvožilnog sustava (I00-I99) s 495 (82%) smrtnih slučajeva. Slijede bolesti iz skupina bolesti dišnog sustava (J00-J99) s 34 (6%), bolesti živčanog sustava (G00-G99) s 26 (4%), bolesti probavnog sustava (K00-K99) s 24 (4%) i novotvorine (C00-D48) s 20 (3%) zabilježenih smrtnih slučajeva. Skupina „ostale bolesti i stanja“ predstavlja ostale organske sustave čije su pripadajuće bolesti, kao i određena stanja zabilježena kod svega 6 (1%) smrtnih slučajeva., In terms of medicine and law, death occurs by ceasing the function of the brain stem, in which there are respiratory control centers and cessation centers of the heart, the normal function of which is crucial for the functioning of the rest of the organism. Determining the cause of death often also determines the manner of death, natural or violent death. An autopsy is the only sure way to determine the cause of sudden or sudden unexplained natural death, and the autopsy report is the only one acceptable for use for legal purposes and for subsequent analysis (expert opinion). The study included all persons who died from natural causes, determined by autopsy at the Institute of Forensic Medicine and Criminalistics Rijeka in the period from 2015 to 2019. Of the necessary parameters, sex, age and organic systems were used. The highest number of natural deaths was recorded in 2017, while according to 2019 a downward spiral was observed. Of the 605 people who died of natural causes, 437 were male (71%), while the remaining 175 were female (29%). In terms of age, the majority are in older age groups such as the 61-70 age group with 160 (26%) and 71-80 with 152 (25%) recorded fatality. The largest number of natural deaths was caused by diseases from the group of diseases of the circulatory system (I00-I99) with 495 (82%) deaths. The following are diseases of respiratory system (J00-J99) with 34 (6%), diseases of the nervous system (G00-G99) with 26 (4%), diseases of the digestive system (K00-K99) with 24 (4%) and neoplasms (C00-D48) with 20 (3%) reported deaths. The group "other diseases and conditions" represents other organic systems whose diseases, as well as certain conditions, record only 6 (1%) deaths.

This paper studies trends in female homicide victimization in Spain from 1910 to 2014 and puts them in relation with several indicators of the evolution of women’s roles and status in the society. According to mortality statistics, female homicide victimization followed an overall upward trend interrupted only during the periods in which the country lived under dictatorships. Measures of women’s roles and status in society show a change from traditional to non-traditional roles since the 1960s. A multivariate autoregression analysis suggests that the female homicide victimization trend is correlated mainly with opportunity-based and non-gender sensitive variables.

Malaria is responsible for majority of the morbidity and mortality statistics reflected by tropical diseases. Whilst effectively managed in most parts of the globe, it remains a scourge on the African continent where most cases of the disease are diagnosed annually. Plants have played a leading role as a source of malarial drugs which continue to dominate the clinical landscape today. Most if not all of these discoveries have as their basis evidence which can be traced back to traditional medicine. There is likewise precedence for the use of Amaryllidaceae plants in traditional medicinal approaches towards malaria. The chief phytochemical principles of the Amaryllidaceae are its isoquinoline alkaloids which are responsible for its diverse biological properties. These alkaloids may be divided into major and minor groups based on their distinguishing structural features as well as their natural abundance and distribution in the family. Whilst much has been written about the biological and chemical properties of the major alkaloid groups of the Amaryllidaceae, relatively little is known or understood about its minor alkaloid groups. This review focuses on the antiplasmodial activities described in the literature for the minor alkaloid group members of the Amaryllidaceae against various strains of the malarial pathogen Plasmodium falciparum . Three database platforms (Google Scholar, SciFinder and Scopus) were utilized for the literature search. Articles were accessed from journals licensed to the University of KwaZulu-Natal, or directly via the respective corresponding authors. Also considered are structural elements of these alkaloids which may be used to explain such activities as well as to provide a foundation in attempts to modulate activities. In addition, evidence is provided on the molecular basis to these effects which could guide efforts in drug discovery.

Морталитетната статистика по причини за смрт е основен показател на здавствената состојба на населението во една земја. Нејзината валидност во целост е базирана на точноста на Лекарските извештаи за причина на смрт (ЛИПС) што претставуваат нејзин основен извор на податици. Цел на ова истражување е да се утврди точноста на лекарските извештаи со впишано КВЗ (I10 - I50) како основна причина за смрт во Градската општа болница „8ми Септември“ во Скопје. Материјал и методи: Истражувањето представува квантитативна аналитичка студија на пресек имплементирана во Градската општа болница „8ми Септември“ - Скопје во периодот од јануари 2015 до декември 2016 година. Во истражувањето беа анализирани ЛИПС-овите кои согласно МКБ10 беа со впишано КВЗ (I10 - I50) како основна причина за смрт. Опфатени беа 121 пациент на возраст од 24 до 84 години кои починале во периодот 0 - 28 дена од хоспитализацијата и тоа независно од полот и другите социо-демографски карактеристики. Анализата на точноста на ЛИПС-овите, беше направена согласно стандардизиран образец од MONICA проектот. Резултати: Просечната возраст на починатите во целиот примерок изнесуваше 72,41±9,14 [95% CI (70.71-74,11)] години. Tочно пополнети ЛИПС-ови биле 67 (56,3%), неточно 22 (18,5%) и делумно точно 30 (25,2%). Нема сигнификантна асоцијација (p>0,05) меѓу полот на испитаниците и точноста на впишување на примарната причина за смрт. Утврдена е сигнификантно (p

The article provides information about the fire deaths and fire injuries in the world at the beginning of the XXI century. An estimate of the total number of fire deaths and fire injuries on Earth was made. According to the data of Center of Fire Statistics (CFS) of International Association of Fire and Rescue services (CTIF) total number of fire deaths in the world can be estimated at 100–120 thous. inh. per year and total number of fire injuries at 300–350 thous. inh. per year. CFS CTIF received data from fire services of the countries. The values of the fire death risk (by 54 countries) and fire injury risk (by 43 countries) are presented. It is shown that the fire injury risk is 3–4 times higher than the fire death risk. The data on mortality in the world from fire, heat and hot substances according to the World Health Organization (WHO) is given — an average of 189 thousand people per year (for the period of 2000–2016). A comparison of statistics on the death of people from fire, heat and hot substances according to WHO data and fire deaths according to the CPS CTIF in 35 countries in 2012 and in 17 countries of the world in 2016 was made. The total data set for the countries represented varies by 35–45 %. For the first time, sufficiently reliable estimates of fire deaths and fire injuries in the world were obtained.

With the advancements of geospatial technologies, geospatial datasets of fine particulate matter (PM2.5) and mortality statistics are increasingly used to examine the health effects of PM2.5. Choices of these datasets with difference geographic characteristics (e.g., accuracy, scales, and variations) in disease burden studies can significantly impact the results. The objective of this study is to revisit the estimations of PM2.5-attributable mortality by taking advantage of recent advancements in high resolution mapping of PM2.5concentrations and fine scale of mortality statistics and to explore the impacts of new data sources, geographic scales, and spatial variations of input datasets on mortality estimations. We estimate the PM2.5-mortality for the years of 2000, 2005, 2010 and 2015 using three PM2.5 concentration datasets [Chemical Transport Model (CTM), random forests-based regression kriging (RFRK), and geographically weighted regression (GWR)] at two resolutions (i.e., 10 km and 1 km) and mortality rates at two geographic scales (i.e., regional-level and county-level). The results show that the estimated PM2.5-mortality from the 10 km CTM-derived PM2.5 dataset tend to be smaller than the estimations from the 1 km RFRK- and GWR-derived PM2.5 datasets. The estimated PM2.5-mortalities from regional-level mortality rates are similar to the estimations from those at county level, while large deviations exist when zoomed into small geographic regions (e.g., county). In a scenario analysis to explore the possible benefits of PM2.5 concentrations reduction, the uses of the two newly developed 1 km resolution PM2.5 datasets (RFRK and GWR) lead to discrepant results. Furthermore, we found that the change in PM2.5 concentration is the primary factor that leads to the PM2.5-attributable mortality decrease from 2000 to 2015. The above results highlight the impact of the adoption of input datasets from new sources with varied geographic characteristics on the PM2.5-attributable mortality estimations and demonstrate the necessity to account for these impact in future disease burden studies. Capsule We revisited the estimations of PM2.5-attributable mortality with advancements in PM2.5 mapping and mortality statistics, and demonstrated the impact of geographic characteristics of geospatial datasets on mortality estimations.

В 2016 г. в Москве, по данным полиции, в дорожно-транспортных происшествиях (далее ДТП) погиб 561 человек, тогда как согласно данным органов статистики (если опираться на подход Всемирной организации здравоохранения (далее ВОЗ) к агрегации кодов МКБ-10 для определения числа умерших в ДТП, используемый в базе данных «Здоровье для всех») – 790 человек. Для понимания тенденций дорожно-транспортной смертности и для разработки обоснованных и эффективных мер по ее предотвращению необходимы надежные данные, поэтому важно понять причины расхождения чисел погибших в ДТП в Москве по разным официальным источникам информации. Цель исследования – выявить причины, обусловливающие несовпадение чисел погибших по данным полиции и государственной статистики смертности, с помощью связывания записей о погибших в ДТП в Москве в 2016 г. на индивидуальном уровне. В исследовании использованы данные органов статистики о 1 891 016 умерших от всех причин смерти и данные полиции о 20 302 погибших в ДТП в России в 2016 г. Оба массива информации представляли собой индивидуальные неперсонифицированные записи о погибших. В результате их сопоставления было получено 944 записи с упоминанием Москвы хотя бы в одном из двух источников данных, из которых 699 записей можно рассматривать как связанные, 245 как несвязанные. В 6% связанных записей код причины смерти, не относится к той группе кодов, которые ВОЗ использует для определения числа умерших в ДТП в базе данных «Здоровье для всех», а в 35% связанных записей регион регистрации ДТП отличался от региона регистрации смерти. Из 561 записи полиции о погибших 84% было связано с данными государственной статистики смертности, а из 790 умерших по данным органов статистики 80% записей связано с данными полиции.

Background The vital registration system is universally recognized as the main source of mortality data which is essential for policy formulation, proper interventions and resource allocation to address priority health challenges. To improve availability and quality of mortality statistics by strengthening the vital registration system, understanding the current vital registration system is essential. This study identified challenges in generating reliable mortality statistics in the vital registration system of Myanmar. Methods Qualitative methods were used to collect data in two selected townships of Mandalay Region. Grey literature related to the management of mortality registration was reviewed; in-depth interviews of sixteen key informants and fourteen focus group discussions were conducted with those involved in death registration at the local level, such as healthcare providers, local administrators and knowledgeable adults in households where deaths occurred during the past three years. Thematic analysis was performed to identify system barriers in the death registration process. Results Weaknesses in the death registration system are classified in three areas: a) administrative which includes the lack of enforcement of mandatory death registration, limited issuance of death certificates and no formal mandatory notification of death events by households and; b) technical which includes absence of proper and regular on-the-job trainings, ineffective cause-of-death certification practice for deaths in the communities and the absence of routine data plausibility checks at the local level; and c) societal which includes poor community awareness and inadequate participation in death registration. Conclusion The study highlighted challenges in the death registration system at the operational level, which undermines the achievement of a satisfactory level of completeness and accuracy of mortality data. We recommend establishing a strong legal framework, improving technical capacities and raising public awareness and cooperation to strengthen the system that can generate reliable mortality statistics. Electronic supplementary material The online version of this article (10.1186/s12889-019-6671-y) contains supplementary material, which is available to authorized users.

Background The study aims to assess two approaches that apply the empirical completeness method to generate age-specific mortality statistics from incomplete death registration systems. Methods We use the empirical completeness method to calculate all-age death registration completeness, which is used with a model life table to generate mortality statistics and age-specific completeness using (1) the conventional method and (2) the equivalent deaths method. The results are compared with a capture-recapture (C-RC) study and three alternative mortality estimates for Brazilian states, and C-RC studies in Thailand, Oman and Vietnam, which independently estimate the level and age pattern of mortality or completeness. Results The empirical completeness method produces similar estimates of all-age completeness of registration to the C-RC studies. Compared with C-RC studies, at 15-59 years, the conventional method’s estimates of mortality and completeness are more concordant, while at 60-84 years the equivalent death method’s estimates are closer. Estimates of life expectancy from the two approaches each have similar concordance with the C-RC studies. For male adult mortality in Brazilian states, there is relatively strong average correlation of this study's estimates with three alternative estimates. Conclusions The two approaches produce mortality statistics from incomplete data that are mostly concordant with C-RC studies, and can be most usefully applied to subnational populations.

BackgroundWe set out in this paper to compare Covid-19 results by country to better understand the factors leading to the differing results found internationally.MethodsWe used publicly available large datasets to explore differences by country for Covid-19 mortality statistics. We continuously challenged our projections with reality and numbers from countries around the world, allowing us to refine our models and better understand the progression of the epidemic. All our predictions and findings were discussed and validated from a clinical viewpoint.ResultsWhile no lockdown resulted in higher mortality, the difference between strict lockdown and lax lockdown was not terribly different and favored lax lockdown. Only one of the top 44 countries had long and strict restrictions. Strict restrictions were more common in the worst performing countries in terms of Covid mortality. The United States had both the largest economic growth coupled with the largest rate of mortality. Those who did well economically, had lower mortality and less pressure on their population. Yet they had less mortality than average and less than their neighbors.ConclusionsCountries with the least restrictions fared best economically. Some of them fared well in terms of mortality, even better than neighboring countries with similar social structures and more severe restrictions. The mortality rates in the USA, however, appeared to suffer from very high obesity rates. Norway and the northern European countries have less strict restrictions from the rest of Europe and had lower mortality rates. COVID-19 mortality was associated with vitamin D status.

When mortality statistics are reported for fatal diseases, they reflect the ratio of the overall mortality within the target population which is impacted from the disease in question. Reporting overall mortality leads to erroneous predictions since cohorts with different frailties are impacted at different rates. In this paper, we study methods for predicting mortality under varying conditions with the goal of removing the impact of hidden heterogeneity from the parameter estimates.

During the Russian influenza pandemic, which reached the United States in late 1889, US public health officials attempted to document the number of deaths associated with this disease outbreak. A historical perspective illuminates the complex categories used to classify deaths from influenza-associated diseases; substantial changes in weekly, monthly, and yearly death totals; and thoughtful efforts by health officials to measure the epidemic as it happened. The 1114 influenza deaths reported by the Connecticut State Board of Health in the 3 years after the January 1890 outbreak must be supplemented by the notable increases in the number of deaths from respiratory diseases, which elevates the likely toll to more than 7000 deaths during the epidemic. Whereas historians of public health have primarily examined efforts to control communicable diseases, this case study of mortality statistics reported by town officials and analyzed by the Connecticut State Board of Health demonstrates how officers of the local boards of health also responded to unexpected outbreaks of a familiar disease such as influenza. Understanding how organizations measured influenza-associated mortality illustrates an important stage in the development of American public health and also makes an important contribution to studying pandemics in history.

Objectives-This report presents complete period life tables for each of the 50 states and the District of Columbia by sex based on age-specific death rates in 2018. Methods-Data used to prepare the 2018 state-specific life tables include 2018 final mortality statistics; July 1, 2018 population estimates based on the 2010 decennial census; and 2018 Medicare data for persons aged 66-99. The methodology used to estimate the state-specific life tables is the same as that used to estimate the 2018 national life tables, with some modifications. Results-Among the 50 states and the District of Columbia, Hawaii had the highest life expectancy at birth, 81.0 years in 2018, and West Virginia had the lowest, 74.4 years. Life expectancy at age 65 ranged from 17.5 years in Kentucky to 21.1 years in Hawaii. Life expectancy at birth was higher for females in all states and the District of Columbia. The difference in life expectancy between females and males ranged from 3.8 years in Utah to 6.2 years in New Mexico.

Background According to the WHO, over 300 people drown every week in Nigeria. However, this figure excludes drownings caused by watercraft accidents and flood disasters. Research indicates that the WHO vastly underestimates drowning mortality because of this. Understanding the true extent of the drowning crisis in Nigeria is crucial to engaging stakeholders to implement prevention strategies. Aim To assess the extent of underreporting of drowning mortality by the WHO in Nigeria. Methods Vanguard news online database was searched for articles reporting fatal drowning incidents between 2009–2019. The causes or circumstances of each incident were extracted to create a sample of drowning victims. Causes of drowning were coded according to the ICD-10, with inclusion of all-cause drowning codes. Drownings caused by codes classified by the WHO as drowning deaths were compared to all-cause drowning deaths to estimate the extent of underreporting. Results 346 drowning victims were sampled from 98 articles. 54.9% (n=175) of drownings were caused by watercraft accidents. Flood disasters, intentional causes and land transport accidents caused 5.3% (n=17), 1.5% (n=5) and 1.3% (n=4) of drownings respectively. The cumulative proportion of drownings caused by activities or circumstances not classified by the WHO as drowning deaths was 63.0% (n=201). Conclusion & Learning Outcomes The WHO underestimates the drowning burden in Nigeria by at least 50%. All-cause drowning codes must be included in mortality statistics to state the true extent of the global drowning crisis. Watercraft accidents are a major cause of drowning in Nigeria; immediate targeted prevention strategies are needed

Mortality statistics based on underlying cause of death are challenged by increased life expectancy and the growing share of population reaching ages associated with frequent multi-morbidity (with death likely resulting from interactions between multiple diseases). We provide a novel way of analysing causes of death: accounting for all causes mentioned on death certificates and summarizing this information along two dimensions emblematic of ageing populations-multi-morbidity and frailty. We implement this classification for all deaths at ages 50+ in Italy in 2014. Multi-morbid processes represent the majority of deaths, rising from 43 per cent at ages 50-54 to 63 per cent at ages 85-89. Multi-morbidity at death is more frequent among males, although age patterns are identical for both sexes. About one in four deaths involves frailty symptoms, rising to 45 per cent at ages 95+. Mortality rates involving frailty are very similar for both sexes. Supplementary material is available for this article at: https://doi.org/10.1080/00324728.2020.1820558.

Researchers are struggling to tally mortality statistics as the pandemic rages. Here’s how they gauge the true toll of the coronavirus outbreak. Researchers are struggling to tally mortality statistics as the pandemic rages. Here’s how they gauge the true toll of the coronavirus outbreak.

Background Quality of cause-of-death information is fundamental for health planning. Traditionally, this quality has been assessed by the analysis of ill-defined causes from chapter XVIII of the International Classification of Diseases - 10th revision (ICD-10). However, studies have considered other useless diagnoses for public health purposes, defined, in conjunction with ill-defined causes, as garbage codes (GC). In Brazil, despite the high completeness of the Mortality Information System, approximately 30% of deaths are attributable to GCs. This study aims to analyze the frequency of GCs in Belo Horizonte municipality, the capital of Minas Gerais state, Brazil. Methods Data of deaths from 2011 to 2013 in Belo Horizonte were analyzed. GCs were classified according to the GBD 2015 study list. These codes were classified in: a) GCs from chapter XVIII of ICD-10 (GC-R), and b) GC from other chapters of ICD-10 (GC-nonR). Proportions of GC were calculated by sex, age, and place of occurrence. Results In Belo Horizonte, from the total of 44,123 deaths, 5.5% were classified as GC-R. The majority of GCs were GC-nonR (25% of total deaths). We observed a higher proportion of GC in children (1 to 4 years) and in people aged over 60 years. GC proportion was also higher in females, except in the age-groups under 1 year and 30-59 years. Home deaths (n = 7,760) had higher proportions of GCs compared with hospital deaths (n = 30,182), 36.9% and 28.7%, respectively. The leading GCs were the GC-R other ill-defined and unspecified causes of death (ICD-10 code R99)), and the GCs-nonR unspecified pneumonia (J18.9), unspecified stroke (I64), and unspecified septicemia (A41.9). Conclusions Analysis of GCs is essential to evaluate the quality of mortality information. Key messages Analysis of ill-defined causes (GC-R) is not sufficient to evaluate the quality of information on causes of death. Causes of death analysis should consider the total GC, in order to advance the discussion and promote adequate intervention on the quality of mortality statistics.

We believe that forensic medicine should play a significant role in the COVID-19 pandemic. Forensic pathologists should ask and answer various questions through autopsy cases during the COVID-19 period, thus providing a significant contribution to science. Some of the potential roles of forensic medicine in this issue include: determining the exact cause of death among the deceased who were SARS-CoV-2 positive, contribution to the accuracy of mortality statistics, understanding pathological mechanisms of COVID-19, tracking the presence of the virus over time, survival of the virus after death as well as dealing with medicolegal issues. A detailed multidisciplinary analysis of autopsy samples would undoubtedly help understand this new illness and its clinical management. Therefore, autopsies during the COVID-19 pandemic should not be an exception, but certainly a rule.

Boka and Wainer discuss to estimate the number of deaths caused by COVID-19 To monitor burials in the city of London, London's Worshipful Company of Parish Clerks gathered weekly mortality statistics These reports were dubbed the London Bills of Mortality and were instituted toward the latter half of the 16th century Over time, their content grew to include baptisms and the causes of the deaths reported The statistics they contained found many purposes A principal use was to provide Londoners with an early warning of the arrival of any pestilence or plague that had begun to establish itself, but there were other, more-surprising uses

Resumen: La exactitud en el número de defunciones por COVID-19 ha generado polémica pública. La urgencia en disponer de esta información conjuntamente con otros datos para valorar la pandemia, ha inducido una variedad de procedimientos y formatos de modo que los datos no siempre se han tramitado de forma comparable al Ministerio de Sanidad. La elaboración de las estadísticas de mortalidad es compleja. Intervienen varias administraciones centrales y autonómicas, y no de la misma manera. La principal fuente de información es el certificado médico de defunción (CD) que permite distinguir por lugar de ocurrencia y causas de muerte. La inscripción telemática del CD en el ya informatizado registro civil y/o en la historia clínica digital, permitiría disponer de un circuito de procesamiento estadístico, y obtener con celeridad del recuento de fallecidos según causa ante una emergencia sanitaria. Para ello, se requiere un acuerdo institucional multilateral en España. Abstract: The death counts from COVID-19 have generated public controversy. The regional health councils’ need for information regardind the cases, has generated a variety of formats and procedures, used to report this information. Consecuently, this data has not always been communicated in a comparable maner to the Ministry of Health. The compilation of mortality statistics is complex. Central and autonomous public administrations are involved, and not in the same way. The medical death certificate (DC) is the main source of information that allows to specify place of occurrence and causes of death. The on-line registration of the DC in the computerized civil registry and/or digital medical records, would allow to establish a statistical processing circuit, and to obtain a death count more quickly according to causes of death in the event of a health emergency. This requires a multi-level institutional agreement for a total telematics statistic process of death causes in Spain.

Mortality rates have significant differences between regions of the Russian Federation. Standardized mortality rates (SMR) are influenced by many factors, including diagnosis criteria and causes of death.Analysis of coefficient of variation of SMR from malignant neoplasms compared with other causes of death in the subjects of Russian Federation.The study formed 3 comparison groups: malignant neoplasms, other causes and causes of death, presented in ICD-10 to indicate conditions that do not have clear diagnostic criteria and rules for its use, as well as unspecified and not recommended for use in mortality statistics. To calculate SMR out of 79 reasons selected from the «Brief nomenclature of causes of death of Russian Statistic Bureau (RosStat)», the European standard was used. The accuracy of differences between the groups was evaluated using one-way analysis of variance with pairwise comparison and Bonferroni correction.In the group of malignant neoplasms, there were significant differences in the coefficients of SMR variability between the subgroup of neoplasms with an exact indication of localization and the subgroup of malignant neoplasms of other and inaccurately defined localizations. However, even the causes of death from malignant neoplasms that do not have sufficiently clear application criteria have a significantly less pronounced coefficient of SMR variability compared to the other two groups. The causes of death, starting in the RosStat nomenclature with the words «other diseases», and the causes associated with the diseases presented in ICD-10 to indicate conditions that do not have clear diagnostic criteria and rules of its use, as well as unspecified and not recommended for use, had practically the same high level of SMR variability coefficient. A certain contribution to the differences in regional SMR indicators from specific causes can be affected by the inconsistency of the criteria for diagnosing diseases and choosing the initial cause of death.To obtain the correct indicators of mortality from individual causes / groups of causes, we need unified generally accepted definitions and rules for the application of conditions presented in ICD-10, which do not have clear diagnostic criteria, as well as unspecified; and as well as rejection of statistics not recommended for use because of the initial causes of mortality.Показатели смертности населения имеют существенные различия между регионами Российской Федерации. На стандартизованные коэффициенты смертности (СКС) влияют многие факторы, включая критерии установления диагноза и причины смерти.Анализ коэффициента вариации СКС от злокачественных новообразований по сравнению с другими причинами смерти в субъектах РФ.В исследовании сформированы 3 группы сравнения: злокачественные новообразования, другие/прочие причины и причины смерти, представленные в МКБ-10 для обозначения состояний, не имеющих четких критериев диагностики и правил применения, а также неуточненных и не рекомендованных к применению в статистике смертности. Для расчета СКС от 79 причин, отобранных из «Краткой номенклатуры причин смерти Росстата», использовали Европейский стандарт. Достоверность различий между группами оценивали с помощью однофакторного дисперсионного анализа с попарным сравнением и поправкой Бонферрони.В группе злокачественных новообразований имелись достоверные различия коэффициентов вариабельности СКС между подгруппой новообразований с точным указанием локализации и подгруппой злокачественных новообразований других и неточно обозначенных локализаций. Однако даже причины смерти от злокачественных новообразований, не имеющих достаточно четких критериев применения, имеют значительно менее выраженный коэффициент вариабельности СКС по сравнению с двумя другими группами. Причины смерти, начинающиеся по номенклатуре Росстата со слов «другие заболевания», и причины, связанные с заболеваниями, представленными в МКБ-10 для обозначения состояний, не имеющих четких критериев диагностики и правил применения, а также неуточненных и не рекомендованных к применению, имели практически одинаковый высокий уровень коэффициента вариабельности СКС. Определенный вклад в различия региональных показателей СКС от конкретных причин может влиять несогласованность критериев диагностики заболеваний и выбора первоначальной причины смерти.Для получения корректных показателей смертности населения от отдельных причин/групп причин требуются единые общепринятые дефиниции и правила применения в качестве первоначальных причин смерти, представленных в МКБ-10 состояний, не имеющих четких критериев диагностики, а также неуточненных, и отказ от нерекомендованных к применению в статистике смертности.

Objective To analyse mortality statistics in the United Kingdom during the initial phases of the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic and to understand the impact of the pandemic on national mortality. Methods Retrospective review of weekly national mortality statistics in the United Kingdom over the past 5 years, including subgroup analysis of respiratory mortality rates. Results During the early phases of the SARS-CoV-2 pandemic in the first months of 2020, there were consistently fewer deaths per week compared with the preceding 5 years. This pattern was not observed at any other time within the past 5 years. We have termed this phenomenon the “SARS-CoV-2 paradox.” We postulate potential explanations for this seeming paradox and explore the implications of these data. Conclusions Paradoxically, but potentially importantly, lower rather than higher weekly mortality rates were observed during the early stages of the SARS-CoV-2 pandemic. This paradox may have implications for current and future healthcare utilisation. A rebound increase in non-SARS-CoV-2 mortality later this year might coincide with the peak of SARS-CoV-2 admissions and mortality.

SummaryBackgroundThe Covid-19 pandemic affects mortality directly through infection as well as through changes in the social, environmental and healthcare determinants of health. The impacts on mortality are likely to vary, in both magnitude and timing, by age and sex. Our aim was to estimate the total mortality impacts of the pandemic, by sex, age group and week.MethodsWe developed an ensemble of 16 Bayesian models that probabilistically estimate the weekly number of deaths that would be expected had the Covid-19 pandemic not occurred. The models account for seasonality of death rates, medium-long-term trends in death rates, the impact of temperature on death rates, association of death rates in each week on those in preceding week(s), and the impact of bank holidays. We used data from January 2010 through mid-February 2020 (i.e., week starting 15th February 2020) to estimate the parameters of each model, which was then used to predict the number of deaths for subsequent weeks as estimates of death rates if the pandemic had not occurred. We subtracted these estimates from the actual reported number of deaths to measure the total mortality impact of the pandemic.ResultsIn the week that began on 21st March, the same week that a national lockdown was put in place, there was a >92% probability that there were more deaths in men and women aged ≥45 years than would occur in the absence of the pandemic; the probability was 100% from the subsequent week. Taken over the entire period from mid-February to 8th May 2020, there were an estimated ~ 49,200 (44,700-53,300) or 43% (37-48) more deaths than would be expected had the pandemic not taken place. 22,900 (19,300-26,100) of these deaths were in females (40% (32-48) higher than if there had not been a pandemic), and 26,300 (23,800-28,700) in males (46% (40-52) higher). The largest number of excess deaths occurred among women aged >85 years (12,400; 9,300-15,300), followed by men aged >85 years (9,600; 7,800-11,300) and 75-84 years (9,000; 7,500-10,300).The cause of death assigned to the majority (37,295) of these excess deaths was Covid-19. There was nonetheless a >99.99% probability that there has been an increase in deaths assigned to other causes in those aged ≥45 years. However, by the 8th of May, the all-cause excess mortality had become virtually equal to deaths assigned to Covid-19, and non-Covid excess deaths had diminished to close to zero, or possibly become negative, in all age-sex groups.InterpretationThe death toll of Covid-19 pandemic, in middle and older ages, is substantially larger than the number of deaths reported as a result of confirmed infection, and was visible in vital statistics when the national lockdown was put in place. When all-cause mortality is considered, the mortality impact of the pandemic on men and women is more similar than when comparing deaths assigned to Covid-19 as underlying cause of death.

BackgroundCoding of underlying causes of death from death certificates is a process that is nowadays undertaken mostly by humans with potential assistance from expert systems, such as the Iris software. It is, consequently, an expensive process that can, in addition, suffer from geospatial discrepancies, thus severely impairing the comparability of death statistics at the international level. The recent advances in artificial intelligence, specifically the rise of deep learning methods, has enabled computers to make efficient decisions on a number of complex problems that were typically considered out of reach without human assistance; they require a considerable amount of data to learn from, which is typically their main limiting factor. However, the CépiDc (Centre d’épidémiologie sur les causes médicales de Décès) stores an exhaustive database of death certificates at the French national scale, amounting to several millions of training examples available for the machine learning practitioner.ObjectiveThis article investigates the application of deep neural network methods to coding underlying causes of death.MethodsThe investigated dataset was based on data contained from every French death certificate from 2000 to 2015, containing information such as the subject’s age and gender, as well as the chain of events leading to his or her death, for a total of around 8 million observations. The task of automatically coding the subject’s underlying cause of death was then formulated as a predictive modelling problem. A deep neural network−based model was then designed and fit to the dataset. Its error rate was then assessed on an exterior test dataset and compared to the current state-of-the-art (ie, the Iris software). Statistical significance of the proposed approach’s superiority was assessed via bootstrap.ResultsThe proposed approach resulted in a test accuracy of 97.8% (95% CI 97.7-97.9), which constitutes a significant improvement over the current state-of-the-art and its accuracy of 74.5% (95% CI 74.0-75.0) assessed on the same test example. Such an improvement opens up a whole field of new applications, from nosologist-level batch-automated coding to international and temporal harmonization of cause of death statistics. A typical example of such an application is demonstrated by recoding French overdose-related deaths from 2000 to 2010.ConclusionsThis article shows that deep artificial neural networks are perfectly suited to the analysis of electronic health records and can learn a complex set of medical rules directly from voluminous datasets, without any explicit prior knowledge. Although not entirely free from mistakes, the derived algorithm constitutes a powerful decision-making tool that is able to handle structured medical data with an unprecedented performance. We strongly believe that the methods developed in this article are highly reusable in a variety of settings related to epidemiology, biostatistics, and the medical sciences in general.