Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyro...Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyroidism.This study aims to attribute the trends in AF/AFL-related mortalities over the past two decades 1999-2020 concerning race and sex and disparity among them.To the best of our knowledge,this is the first study that estimates the trends and mortality due to AF/AFL from 1999-2020 in older adults in the United States.In this 21-year analysis of mortality data,we found a constant increase in mortality rates due to AF/AFL in older adults.From 1999 to 2020,the overall mortality in older adults aged 65 and above,regardless of sex and race,is found to be almost doubled i.e.about a 50.2%increase in the number of deaths due to AF/AFL.Furthermore,other confounding risk factors such has obesity,prior myocardial infarction,inflammation,hypertension,birth weight,diabetes mellitus,hyperthyroidism,hormone replacement therapy in menopausal women increases the risk in the occurrence or recurrent occurrence of AF.展开更多
BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and...BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and a low pregnancy rate,have been identified as contributors to the increased susceptibility to ovarian cancer.Advancements in cancer therapy over the past century,including the emergence of precision oncology,underscore the importance of early detection and tailored interventions,factors particularly critical in ovarian cancer,where late-stage diagnosis remains a persistent barrier to survival.This challenge is compounded by the lack of a universally endorsed screening program,resulting in late-stage identification and widespread metastasis.AIM To evaluate demographic differences in ovarian cancer-related mortality from 1999 to 2020 among adult females aged≥25 years within the United States.METHODS Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to collect de-identified death certificate data for malignant neoplasm of the ovaries related deaths in female adults aged 25 years and older from the year 1999 to 2020.Crude mortality rates and age-adjusted mortality rates(AAMRs)per 100000 people were calculated.Join point regression program was used to assess annual percent changes in mortality trends,with statistical significance set at P value<0.05.RESULTS Between 1999 and 2020,337619 deaths due to ovarian cancer occurred among United States females aged 25 to>85.The AAMR decreased from 14.62 in 1999 to 10.15 in 2020,with significant declines across various demographics.The AAMRs were highest among non-Hispanic White women,i.e.,13.53.Based on region,they were the highest in the Northeast(13.06)and Midwest(12.94).The steepest decline was observed in metropolitan areas as compared to nonmetropolitan ones.The study highlights significant progress in reducing ovarian cancer mortality across age,race/ethnicity,and geographic regions during this period.CONCLUSION The mortality trends for ovarian carcinoma patients showed an overall decrease,with the highest mortality rates observed among older individuals(65 to>85 years)and non-Hispanic Whites.These disparities underscore the need for equitable healthcare access and targeted policy interventions.展开更多
Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance D...Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance Dataset,which covers 2.37 billion person-years.Age-standardized mortality rates(ASMRs)were calculated using Segi’s world standard population and the trends were evaluated via Joinpoint regression.Bayesian age-period-cohort models were used for mortality projections.Contributions of demographic changes(population size and age structure)and risk factors to the mortality burden were quantified using the decomposition analysis.Results:The combined ASMRs for all cancers decreased annually by 2.3%,driven by significant declines in esophageal(4.8%),stomach(4.5%),and liver cancers(2.7%).In contrast,the pancreatic and prostate cancer ASMRs increased by 2.0% and 3.4% annually,respectively.Urban areas demonstrated a more rapid decline in the combined ASMRs for all cancers[average annual percent change(AAPC)=-3.0% in urban areas vs.-2.0% in rural areas],highlighting persistent disparities.Population aging contributed 20%-50% to death increases between 2013 and 2021.The combined ASMRs for all cancers,like the findings of temporal trend analyses,will continue to decrease and the regional(urban and rural)difference is projected to simulate that of the temporal trend through 2030.In fact,cancer deaths are projected to reach 2.4 million by 2030.Conclusions:The cancer burden in China is facing the dual challenges of population aging and urban-rural disparities.It is necessary to prioritize rural screening,control risk factors,such as smoking and diet,and integrate more efficacious cancer prevention and control programmes into the policy to reduce mortality in the future.展开更多
Objective:Human mortality is affected by a lot of different factors.Geographic and demographic variations are two such criteria that play significant importance in establishing the variation in mortality rate.Methods:...Objective:Human mortality is affected by a lot of different factors.Geographic and demographic variations are two such criteria that play significant importance in establishing the variation in mortality rate.Methods:The current work uses data collected from the Centers for Disease Control and Prevention from 2018 to 2021 to study the dependence of mortality on several parameters such as gender,race,and age group.The analysis looks at all the different causes of death registered in the database and shows how they vary with not only the demographic variables mentioned above but also geographic variables such as states in the USA.The variation in trends pre-,during,and post-pandemic is also investigated.The study undertakes several multi-factorial relations such as location-age group,location-gender,age group-gender,and a blanket study across all the racesfor2018-2021.Results:Texas,California,and Florida were analyzed to be the states with the most number of deaths for the majority of causes.The study shows that before the pandemic two of the most critical causes of death identified were Atherosclerotic heart disease and Alzheimer's disease which was outnumbered by coronavirus disease 2019 in years 2020 and 2021 for the age groups of 35-84 years.Conclusion:The outcome of the study clearly shows the irrational availability of data among different ages,states,and races.In addition,it helps to provide interesting insights into how the mortality trends relate to demographic and geographic factors and point out the discrepancies among them.展开更多
Background:Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women.This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in u...Background:Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women.This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.Methods:Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China’s National Disease Surveillance Points system spanning the years 2009 to 2021.Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios,while Joinpoint models with estimated average annual percent changes(AAPC)and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.Results:From 2009 to 2021,there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas.A rising trend in the screening age of 35-64[AAPC:4.0%,95%confidence interval(CI)0.5-7.6,P=0.026]for cervical cancer was noted in rural areas,while a stable trend(AAPC:-0.7%,95%CI-5.8 to 4.6,P=0.780)was observed in urban areas.As for breast cancer,a stable trend(AAPC:0.3%,95%CI-0.3 to 0.9,P=0.280)was observed in rural areas compared to a decreasing trend(AAPC:-2.7%,95%CI-4.6 to-0.7,P=0.007)in urban areas.Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer.Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments,with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas,periods,and regions in China.Conclusions:Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities.Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.展开更多
BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver canc...BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver cancer and liver failure,with Hepatitis B and Hepatitis C being the most common viruses associated with these outcomes.AIM To study viral hepatitis-related mortality trends from 1999 to 2022,focusing on gender,race/ethnicity,age,region,and urban/rural classifications.METHODS We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify viral hepatitis-related deaths in the United States from 1999 to 2022.Data on demographic and regional information were analyzed and stratified by gender,race/ethnicity,age,regional,and urban rural classifications.Using the Joinpoint Regression Program(version 4.9.0.0 used,available from the National Cancer Institute,Bethesda,Maryland)the annual percentage change(APC)and average APC(AAPC)were calculated with 95%CI for extracted Age Adjusted Mortality Rates(AAMR).RESULTS From 1999 to 2022,there were 389916 viral hepatitis-related deaths in the United States.The overall AAMR increased from 1999 to 2013(APC:3.20%;95%CI:2.54-3.99;P<0.001),then declined through 2022(APC:-5.54%;95%CI:-6.75 to-4.47;P<0.001).Males accounted for 70.4%of deaths,with steeper declines in females(AAPC:-0.48%;95%CI:-0.87 to-0.12;P<0.05).The American Indian/Alaska Native population had the highest AAMR(AAPC:2.90%;95%CI:2.30 to 3.68;P<0.001).The population of 65-74 years had the largest increase in overall crude mortality rate(AAPC:3.20%;95%CI:2.77 to 3.85;P<0.001).Mortality was highest in the West(AAPC:-0.78%;95%CI-1.28 to-0.29;P<0.05).Rural AAMR exceeded urban rates after 2015.CONCLUSION This study found significant racial,ethnic,and geographical disparities in viral hepatitis AAMR.Key factors for mortality reduction include patient education,screening,and access to hepatitis vaccination and treatment.展开更多
BACKGROUND Comorbid non-insulin-dependent diabetes mellitus(NIDDM)and stroke sign-ificantly contribute to mortality among older adults.This study examines age-adjusted mortality rates(AAMRs)and disparities by demograp...BACKGROUND Comorbid non-insulin-dependent diabetes mellitus(NIDDM)and stroke sign-ificantly contribute to mortality among older adults.This study examines age-adjusted mortality rates(AAMRs)and disparities by demographics,region,and age groups to identify trends and guide public health efforts.AIM To analyze trends in AAMRs due to comorbid NIDDM and stroke among older adults.The study aims to identify demographic,geographic,and age-related di-sparities to inform targeted public health strategies.METHODS Mortality data from the Centers for Disease Control records were analyzed.AAMRs per 100000 and annual per-centage changes(APCs)with 95%CI were calculated using Joinpoint Regression RESULTS Between 1999 and 2022,209001 deaths among adults aged 55+were attributed to comorbid NIDDM and stroke,with women accounting for 111481 and men 97520 deaths.Urban-rural disparities revealed distinct patterns,with a sharper rise in metropolitan areas post-2014(APC:8.6)as compared to non-metropolitan areas.Racial disparities were pronounced,particularly among the Asian/Pacific Islander population,with a steep increase post-2018(APC:17.6).Age-stratified analysis showed a marked rise in mortality for ages 55-64 and 85+from 2015 onwards(APC:14.3 and 13.5,respectively).Regional trends highlighted the West as having the highest AAMR(14.4),while the Northeast exhibited the lowest(7.0).State-level analysis showed West Virginia with the highest AAMR(18.7)and Nevada the lowest(3.8).CONCLUSION Rising mortality from comorbid NIDDM and stroke underscores increasing disparities across gender,race,age,and regions.Urgent,tailored interventions are required to mitigate these inequities.展开更多
BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-r...BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.AIM To investigate AF-CKD comorbidity and mortality on the national level.METHODS Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years.Age-adjusted mortality rates(AAMRs)per 100000 persons and annual percent change(APC)were calculated,stratified by year,sex,race/ethnicity,and geographic region.RESULTS A total of 110733 deaths occurred among adults(aged 35-85 or more years)related to AF associated with CKD in the United States.Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014(APC:-14.89;95%confidence interval(CI):-30.44 to-4.06),followed by an increase to 10.3 in 2020(APC:9.91;95%CI:6.1-19.62).Men had higher AAMRs than women(men:7.6,95%CI:7.6-7.7).Non-Hispanic White adults had the highest AAMR(7.8),followed by non-Hispanic Black(5).States in the top 90th percentile had approximately four times higher AAMRs than those in the lower 10th percentile.AAMR also varied by region(Midwest:7.6,West:6.7,Northeast:6.3,South:5.6),with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.CONCLUSION Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period,with notable disparities across demographic and geographic factors.Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.展开更多
Diabetes mellitus is a major contributor to kidney failure,with diabetic nephro-pathy being a common microvascular complication.The increasing prevalence of diabetes and its complications suggests a rise in associated...Diabetes mellitus is a major contributor to kidney failure,with diabetic nephro-pathy being a common microvascular complication.The increasing prevalence of diabetes and its complications suggests a rise in associated morbidity and mortality.Recent studies highlight increased mortality related to diabetic kidney disease,with disparities across demographic and geographic groups.Novel pharmacological treatments,including sodium-glucose cotransporter 2 inhibitors,non-steroidal mineralocorticoid receptor antagonists,and glucagon-like peptide-1 agonists,offer promise in slowing disease progression and reducing renal mortality.However,the growing epidemics of obesity and diabetes necessitate prioritizing public health policies focused on primary and secondary prevention,along with comprehensive multidisciplinary care.展开更多
BACKGROUND Autoimmune liver diseases(AiLD)encompass a variety of disorders that target either the liver cells(autoimmune hepatitis,AIH)or the bile ducts[primary biliary cholangitis(PBC),and primary sclerosing cholangi...BACKGROUND Autoimmune liver diseases(AiLD)encompass a variety of disorders that target either the liver cells(autoimmune hepatitis,AIH)or the bile ducts[primary biliary cholangitis(PBC),and primary sclerosing cholangitis(PSC)].These conditions can progress to chronic liver disease(CLD),which is characterized by fibrosis,cirrhosis,and hepatocellular carcinoma.Recent studies have indicated a rise in hospitalizations and associated costs for CLD in the US,but information regarding inpatient admissions specifically for AiLD remains limited.AIM To examine the trends and mortality of inpatient hospitalization of AiLD from 2011 to 2017.METHODS This study is a retrospective analysis utilizing the National Inpatient Sample(NIS)databases.All subjects admitted between 2011 and 2017 with a diagnosis of AiLD(AIH,PBC,PSC)were identified using the International Classification of Diseases(ICD-9)and ICD-10 codes.primary AiLD admission was defined if the first admission code was one of the AiLD codes.secondary AiLD admission was defined as having the AiLD diagnosis anywhere in the admission diagnosis(25 diagnoses).Subjects aged 21 years and older were included.The national estimates of hospitalization were derived using sample weights provided by NIS.χ^(2)tests for categorical data were used.The primary trend characteristics were in-hospital mortality,hospital charges,and length of stay.RESULTS From 2011 to 2017,hospitalization rates witnessed a significant decline,dropping from 83263 admissions to 74850 admissions(P<0.05).The patients hospitalized were predominantly elderly(median 53%for age>65),mostly female(median 59%)(P<0.05),and primarily Caucasians(median 68%)(P<0.05).Medicare was the major insurance(median 56%),followed by private payer(median 27%)(P<0.05).The South was the top geographical distribution for these admissions(median 33%)(P<0.05),with most admissions taking place in big teaching institutions(median 63%)(P<0.05).Total charges for admissions rose from 66031 in 2011 to 78987 in 2017(P<0.05),while the inpatient mortality rate had a median of 4.9%(P<0.05),rising from 4.67%in 2011 to 5.43%in 2017.The median length of stay remained relatively stable,changing from 6.94 days(SD=0.07)in 2011 to 6.51 days(SD=0.06)in 2017(P<0.05).Acute renal failure emerged as the most common risk factor associated with an increased death rate,affecting nearly 68%of patients(P<0.05).CONCLUSION AiLD-inpatient hospitalization showed a decrease in overall trends over the studied years,however there is a significant increase in financial burden on healthcare with increasing in-hospital costs along with increase in mortality of hospitalized patient with AiLD.展开更多
This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer inciden...This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.展开更多
Background Racial disparities in cardiovascular conditions are well documented.Whether similar race-based discrepancies in health outcomes also exist among elderly patients undergoing surgical aortic valve replacement...Background Racial disparities in cardiovascular conditions are well documented.Whether similar race-based discrepancies in health outcomes also exist among elderly patients undergoing surgical aortic valve replacement(SAVR) for aortic stenosis remains understudied.Methods We abstracted data from the National(Nationwide) Inpatient Sample over a 20-year period from 2001 to 2020 using specific ICD-9 and ICD-10 codes.We included patients aged ≥ 60 and ≤ 80 years with races recorded as White,African American,or Hispanic at the time of their hospitalization for surgery.We analyzed and reported the baseline characteristics,risk-adjusted inhospital mortality,and complications stratified by race.Results Of 420,181 patients studied,90.0% identified as White,4.0% as African American and 6.0% as Hispanic.Despite a decrease in overall in-hospital mortality rates from 3.8% between 2001-2005 to 1.8% between 2016-2020,African Americans had higher odds of all-cause in-hospital deaths compared to Whites(a OR = 1.390,P < 0.001).Additionally,they were more likely to experience cardiogenic shock(a OR = 1.241,P < 0.001) and acute kidney injury(a OR = 1.314,P < 0.001) as well as more likely to require organ support such as IABP use(a OR = 1.336,P < 0.001) or invasive mechanical ventilation(a OR = 1.342,P < 0.001).Interestingly,African Americans were less likely to report events of acute ischemic stroke compared to Whites(a OR = 0.852,P < 0.001).Conclusions Despite a reassuring reduction in overall in-hospital mortality rates of geriatric patients undergoing SAVR for aortic stenosis,racial disparities in health outcomes remain pervasive with minorities more likely to report higher in-hospital morbidity and mortality.展开更多
BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains u...BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.展开更多
Objective The Asia-Pacific region has a high chronic obstructive pulmonary disease(COPD)burden,but studies on its trends are limited.Using the Global Burden of Disease(GBD)2019 data,we analyzed COPD trends in 36 count...Objective The Asia-Pacific region has a high chronic obstructive pulmonary disease(COPD)burden,but studies on its trends are limited.Using the Global Burden of Disease(GBD)2019 data,we analyzed COPD trends in 36 countries and territories from 1990 to 2019 and predicted future incidence trends through 2034.Methods COPD data by age and sex from the GBD 2019 database were analyzed for incidence,prevalence,mortality,and disability-adjusted life years(DALY)rates from 1990 to 2019.Joinpoint regression identified significant annual trends,and age-standardized incidence rates were predicted through 2034 using age-period-cohort models.Results The incidence,prevalence,mortality,and disease burden of COPD have been decreasing,and the incidence rates will continue to decrease or remain stable until 2034 in most selected countries and territories,except for a few Southeastern Asian countries.The Lao People’s Democratic Republic and Vietnam are projected to experience an increase in COPD incidence from 165.3 per 100,000 in 2019 to 177 per 100,000 in 2034 and from 179.9 per 100,000 in 2019 to 192.5 per 100,000 in 2034,respectively.Older males had a higher incidence than any other sex or age group.The sex gap in incidence rates continues to widen,though it is smaller and less significant in the younger age group than in those in the older one.Conclusion COPD rates are expected to decline until 2034 but remain a health risk,especially in countries with rising rates.Urgent action on tobacco control,air pollution,and public education is needed.展开更多
Background While China’s socioeconomic transformation has driven divergent trends in gastrointestinal cancers,comprehensive data on esophageal,gastric,and liver cancer burden remain limited.This study examines the gl...Background While China’s socioeconomic transformation has driven divergent trends in gastrointestinal cancers,comprehensive data on esophageal,gastric,and liver cancer burden remain limited.This study examines the global burden of esophageal,gastric,and liver cancers in 2022 and analyzes the trends of age-standardized incidence and mortality rate(ASRs)in China from 2000 to 2018,thereby providing evidence for the formulation of cancer control strategies.Methods The global burden of esophageal,gastric and liver cancers including the estimated number of cases and deaths and the ASRs for incidence and mortality were from GLOBALCAN 2022 dataset.Data from 22 cancer registries in China were employed for the trend analysis of the ASRs for incidence and mortality of these three cancers.The Joinpoint model was used to compute the average annual percentage change(AAPC)of the incidence and mortality of the three cancers from 2000 to 2018.Results Globally,esophageal,gastric and liver cancers accounted for 11.8%of incident cancer cases and 19.1%of cancer deaths.China bore a disproportionately high burden,representing 43.8%,37.0%,and 42.4%of global esophageal,gastric,and liver cancer cases respectively,and 42.1%,39.4%,and 41.7%of corresponding deaths.However,the ASRs for incidence and mortality for all three cancers declined significantly in China(2000–2018),with absolute case numbers decreasing for gastric and esophageal cancers during 2010–2022.Age-specific analysis revealed most pronounced declines in incidence and mortality in populations under 40 years old,with AAPCs of less than–6.0%for esophageal cancer,around–4.0%for gastric cancer,and approximately–2.0%for liver cancer.Conclusions China has achieved remarkable progress in controlling esophageal,gastric and liver cancers,yet these malignancies remain major public health challenges.Future efforts should intensify existing prevention measures while expanding screening programs,particularly for aging populations.These findings offer valuable insights for regions undergoing similar epidemiological transitions.展开更多
BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term...BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.展开更多
Objective:To analyze the trend of major malignant tumor mortality in Shandong Province,eastern China from 1970 to 2021,and to provide the scientific basis for malignant tumor prevention and control.Methods:Cancer mort...Objective:To analyze the trend of major malignant tumor mortality in Shandong Province,eastern China from 1970 to 2021,and to provide the scientific basis for malignant tumor prevention and control.Methods:Cancer mortality data were sourced from three nationwide cause-of-death surveys and the Shandong Death Registration System.Trends in overall mortality and major causes of death were elucidated through indi-cators such as mortality rates and age-adjusted death rates,by comparing findings from the three comprehensive mortality surveys and the Shandong Death Registration System.The difference decomposing method was em-ployed to estimate the contributions of non-demographic and demographic factors to the observed changes in cancer mortality.Results:From 1970 to 2021,the crude mortality rate of malignant tumors witnessed an overall increase in Shan-dong Province.The age-standardized mortality rate initially rose before subsequently declining.The proportion of cancer deaths among all causes of death increased initially and then stabilized at a high level of approximately 25%.Both non-demographic and demographic factors played a role in the rise of the crude cancer mortality rate,with the proportion attributed to demographic factors gradually surpassing that of non-demographic factors.De-spite the continuous increase in the crude mortality rate,the adjusted mortality rate exhibited a downward trend since 1990.Significant changes were observed in the ranking of the mortality rates of major cancers.For exam-ple,the mortality rate of lung cancer exhibited a continuous upward trajectory,ascending from the fifth to the first place and marking a 7.69-fold increase from 1970 to 2021.Conversely,digestive system tumors,including gastric cancer,esophageal cancer,and liver cancer,displayed varying degrees of decline,particularly in the stan-dardized rates,which demonstrated a notable downward trend since 1990.The crude mortality rate of colorectal cancer and breast cancer showed an obvious upward trend,but the standardized rate did not rise significantly.For cervical cancer,both the crude and adjusted mortality rates displayed a pattern of initially decreasing and then increasing.Conclusions:Malignant tumors remain a significant threat to the residents of Shandong Province.The changing trends in various malignant tumors are inconsistent,underscoring the need for tailored intervention strategies to effectively control different types of malignant tumors.展开更多
Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public heal...Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public health interventions and optimizing resource allocation. This study aimed to identify small area level factors associated with all-cause mortality and to map hotspots of excess deaths across a region. The analysis produced relative mortality rates and exceedance probabilities to pinpoint areas with an excess burden of death. Results showed that all-cause mortality was particularly concentrated in the upper central and northern regions of the region, where many rural counties are located. Key factors associated with higher mortality rates included lower median income, younger median age, and a lower percentage of Hispanic population in the counties studied. These findings highlight the importance of addressing income disparity in high-mortality areas, particularly in rural regions, to guide resource allocation and develop targeted interventions that can most effectively reduce mortality rates where they are needed most.展开更多
Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was c...Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.展开更多
Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with ...Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.展开更多
文摘Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyroidism.This study aims to attribute the trends in AF/AFL-related mortalities over the past two decades 1999-2020 concerning race and sex and disparity among them.To the best of our knowledge,this is the first study that estimates the trends and mortality due to AF/AFL from 1999-2020 in older adults in the United States.In this 21-year analysis of mortality data,we found a constant increase in mortality rates due to AF/AFL in older adults.From 1999 to 2020,the overall mortality in older adults aged 65 and above,regardless of sex and race,is found to be almost doubled i.e.about a 50.2%increase in the number of deaths due to AF/AFL.Furthermore,other confounding risk factors such has obesity,prior myocardial infarction,inflammation,hypertension,birth weight,diabetes mellitus,hyperthyroidism,hormone replacement therapy in menopausal women increases the risk in the occurrence or recurrent occurrence of AF.
文摘BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and a low pregnancy rate,have been identified as contributors to the increased susceptibility to ovarian cancer.Advancements in cancer therapy over the past century,including the emergence of precision oncology,underscore the importance of early detection and tailored interventions,factors particularly critical in ovarian cancer,where late-stage diagnosis remains a persistent barrier to survival.This challenge is compounded by the lack of a universally endorsed screening program,resulting in late-stage identification and widespread metastasis.AIM To evaluate demographic differences in ovarian cancer-related mortality from 1999 to 2020 among adult females aged≥25 years within the United States.METHODS Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to collect de-identified death certificate data for malignant neoplasm of the ovaries related deaths in female adults aged 25 years and older from the year 1999 to 2020.Crude mortality rates and age-adjusted mortality rates(AAMRs)per 100000 people were calculated.Join point regression program was used to assess annual percent changes in mortality trends,with statistical significance set at P value<0.05.RESULTS Between 1999 and 2020,337619 deaths due to ovarian cancer occurred among United States females aged 25 to>85.The AAMR decreased from 14.62 in 1999 to 10.15 in 2020,with significant declines across various demographics.The AAMRs were highest among non-Hispanic White women,i.e.,13.53.Based on region,they were the highest in the Northeast(13.06)and Midwest(12.94).The steepest decline was observed in metropolitan areas as compared to nonmetropolitan ones.The study highlights significant progress in reducing ovarian cancer mortality across age,race/ethnicity,and geographic regions during this period.CONCLUSION The mortality trends for ovarian carcinoma patients showed an overall decrease,with the highest mortality rates observed among older individuals(65 to>85 years)and non-Hispanic Whites.These disparities underscore the need for equitable healthcare access and targeted policy interventions.
基金supported by the CAMS Innovation Fund for Medical Sciences(Grant No.2021-I2M-1-011)the Capital’s Funds for Health Improvement and Research(Grant No.CFH2024-2G-40214).
文摘Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance Dataset,which covers 2.37 billion person-years.Age-standardized mortality rates(ASMRs)were calculated using Segi’s world standard population and the trends were evaluated via Joinpoint regression.Bayesian age-period-cohort models were used for mortality projections.Contributions of demographic changes(population size and age structure)and risk factors to the mortality burden were quantified using the decomposition analysis.Results:The combined ASMRs for all cancers decreased annually by 2.3%,driven by significant declines in esophageal(4.8%),stomach(4.5%),and liver cancers(2.7%).In contrast,the pancreatic and prostate cancer ASMRs increased by 2.0% and 3.4% annually,respectively.Urban areas demonstrated a more rapid decline in the combined ASMRs for all cancers[average annual percent change(AAPC)=-3.0% in urban areas vs.-2.0% in rural areas],highlighting persistent disparities.Population aging contributed 20%-50% to death increases between 2013 and 2021.The combined ASMRs for all cancers,like the findings of temporal trend analyses,will continue to decrease and the regional(urban and rural)difference is projected to simulate that of the temporal trend through 2030.In fact,cancer deaths are projected to reach 2.4 million by 2030.Conclusions:The cancer burden in China is facing the dual challenges of population aging and urban-rural disparities.It is necessary to prioritize rural screening,control risk factors,such as smoking and diet,and integrate more efficacious cancer prevention and control programmes into the policy to reduce mortality in the future.
文摘Objective:Human mortality is affected by a lot of different factors.Geographic and demographic variations are two such criteria that play significant importance in establishing the variation in mortality rate.Methods:The current work uses data collected from the Centers for Disease Control and Prevention from 2018 to 2021 to study the dependence of mortality on several parameters such as gender,race,and age group.The analysis looks at all the different causes of death registered in the database and shows how they vary with not only the demographic variables mentioned above but also geographic variables such as states in the USA.The variation in trends pre-,during,and post-pandemic is also investigated.The study undertakes several multi-factorial relations such as location-age group,location-gender,age group-gender,and a blanket study across all the racesfor2018-2021.Results:Texas,California,and Florida were analyzed to be the states with the most number of deaths for the majority of causes.The study shows that before the pandemic two of the most critical causes of death identified were Atherosclerotic heart disease and Alzheimer's disease which was outnumbered by coronavirus disease 2019 in years 2020 and 2021 for the age groups of 35-84 years.Conclusion:The outcome of the study clearly shows the irrational availability of data among different ages,states,and races.In addition,it helps to provide interesting insights into how the mortality trends relate to demographic and geographic factors and point out the discrepancies among them.
基金supported by the High-Level Public Health Specialized Talents Project of Beijing Municipal Health Commission(YFH,2024-3-028)the National Natural Science Foundation of China(YFH,72061137007)SHV is supported,in part,by U.S.National Institutes of Health(P30CA016359).
文摘Background:Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women.This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.Methods:Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China’s National Disease Surveillance Points system spanning the years 2009 to 2021.Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios,while Joinpoint models with estimated average annual percent changes(AAPC)and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.Results:From 2009 to 2021,there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas.A rising trend in the screening age of 35-64[AAPC:4.0%,95%confidence interval(CI)0.5-7.6,P=0.026]for cervical cancer was noted in rural areas,while a stable trend(AAPC:-0.7%,95%CI-5.8 to 4.6,P=0.780)was observed in urban areas.As for breast cancer,a stable trend(AAPC:0.3%,95%CI-0.3 to 0.9,P=0.280)was observed in rural areas compared to a decreasing trend(AAPC:-2.7%,95%CI-4.6 to-0.7,P=0.007)in urban areas.Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer.Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments,with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas,periods,and regions in China.Conclusions:Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities.Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.
文摘BACKGROUND Viral hepatitis is characterized by a group of hepatotropic viruses that contribute to high rates of liver disease and mortality.It is well-documented that viral hepatitis is the leading cause of liver cancer and liver failure,with Hepatitis B and Hepatitis C being the most common viruses associated with these outcomes.AIM To study viral hepatitis-related mortality trends from 1999 to 2022,focusing on gender,race/ethnicity,age,region,and urban/rural classifications.METHODS We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify viral hepatitis-related deaths in the United States from 1999 to 2022.Data on demographic and regional information were analyzed and stratified by gender,race/ethnicity,age,regional,and urban rural classifications.Using the Joinpoint Regression Program(version 4.9.0.0 used,available from the National Cancer Institute,Bethesda,Maryland)the annual percentage change(APC)and average APC(AAPC)were calculated with 95%CI for extracted Age Adjusted Mortality Rates(AAMR).RESULTS From 1999 to 2022,there were 389916 viral hepatitis-related deaths in the United States.The overall AAMR increased from 1999 to 2013(APC:3.20%;95%CI:2.54-3.99;P<0.001),then declined through 2022(APC:-5.54%;95%CI:-6.75 to-4.47;P<0.001).Males accounted for 70.4%of deaths,with steeper declines in females(AAPC:-0.48%;95%CI:-0.87 to-0.12;P<0.05).The American Indian/Alaska Native population had the highest AAMR(AAPC:2.90%;95%CI:2.30 to 3.68;P<0.001).The population of 65-74 years had the largest increase in overall crude mortality rate(AAPC:3.20%;95%CI:2.77 to 3.85;P<0.001).Mortality was highest in the West(AAPC:-0.78%;95%CI-1.28 to-0.29;P<0.05).Rural AAMR exceeded urban rates after 2015.CONCLUSION This study found significant racial,ethnic,and geographical disparities in viral hepatitis AAMR.Key factors for mortality reduction include patient education,screening,and access to hepatitis vaccination and treatment.
文摘BACKGROUND Comorbid non-insulin-dependent diabetes mellitus(NIDDM)and stroke sign-ificantly contribute to mortality among older adults.This study examines age-adjusted mortality rates(AAMRs)and disparities by demographics,region,and age groups to identify trends and guide public health efforts.AIM To analyze trends in AAMRs due to comorbid NIDDM and stroke among older adults.The study aims to identify demographic,geographic,and age-related di-sparities to inform targeted public health strategies.METHODS Mortality data from the Centers for Disease Control records were analyzed.AAMRs per 100000 and annual per-centage changes(APCs)with 95%CI were calculated using Joinpoint Regression RESULTS Between 1999 and 2022,209001 deaths among adults aged 55+were attributed to comorbid NIDDM and stroke,with women accounting for 111481 and men 97520 deaths.Urban-rural disparities revealed distinct patterns,with a sharper rise in metropolitan areas post-2014(APC:8.6)as compared to non-metropolitan areas.Racial disparities were pronounced,particularly among the Asian/Pacific Islander population,with a steep increase post-2018(APC:17.6).Age-stratified analysis showed a marked rise in mortality for ages 55-64 and 85+from 2015 onwards(APC:14.3 and 13.5,respectively).Regional trends highlighted the West as having the highest AAMR(14.4),while the Northeast exhibited the lowest(7.0).State-level analysis showed West Virginia with the highest AAMR(18.7)and Nevada the lowest(3.8).CONCLUSION Rising mortality from comorbid NIDDM and stroke underscores increasing disparities across gender,race,age,and regions.Urgent,tailored interventions are required to mitigate these inequities.
文摘BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.AIM To investigate AF-CKD comorbidity and mortality on the national level.METHODS Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years.Age-adjusted mortality rates(AAMRs)per 100000 persons and annual percent change(APC)were calculated,stratified by year,sex,race/ethnicity,and geographic region.RESULTS A total of 110733 deaths occurred among adults(aged 35-85 or more years)related to AF associated with CKD in the United States.Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014(APC:-14.89;95%confidence interval(CI):-30.44 to-4.06),followed by an increase to 10.3 in 2020(APC:9.91;95%CI:6.1-19.62).Men had higher AAMRs than women(men:7.6,95%CI:7.6-7.7).Non-Hispanic White adults had the highest AAMR(7.8),followed by non-Hispanic Black(5).States in the top 90th percentile had approximately four times higher AAMRs than those in the lower 10th percentile.AAMR also varied by region(Midwest:7.6,West:6.7,Northeast:6.3,South:5.6),with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.CONCLUSION Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period,with notable disparities across demographic and geographic factors.Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.
文摘Diabetes mellitus is a major contributor to kidney failure,with diabetic nephro-pathy being a common microvascular complication.The increasing prevalence of diabetes and its complications suggests a rise in associated morbidity and mortality.Recent studies highlight increased mortality related to diabetic kidney disease,with disparities across demographic and geographic groups.Novel pharmacological treatments,including sodium-glucose cotransporter 2 inhibitors,non-steroidal mineralocorticoid receptor antagonists,and glucagon-like peptide-1 agonists,offer promise in slowing disease progression and reducing renal mortality.However,the growing epidemics of obesity and diabetes necessitate prioritizing public health policies focused on primary and secondary prevention,along with comprehensive multidisciplinary care.
文摘BACKGROUND Autoimmune liver diseases(AiLD)encompass a variety of disorders that target either the liver cells(autoimmune hepatitis,AIH)or the bile ducts[primary biliary cholangitis(PBC),and primary sclerosing cholangitis(PSC)].These conditions can progress to chronic liver disease(CLD),which is characterized by fibrosis,cirrhosis,and hepatocellular carcinoma.Recent studies have indicated a rise in hospitalizations and associated costs for CLD in the US,but information regarding inpatient admissions specifically for AiLD remains limited.AIM To examine the trends and mortality of inpatient hospitalization of AiLD from 2011 to 2017.METHODS This study is a retrospective analysis utilizing the National Inpatient Sample(NIS)databases.All subjects admitted between 2011 and 2017 with a diagnosis of AiLD(AIH,PBC,PSC)were identified using the International Classification of Diseases(ICD-9)and ICD-10 codes.primary AiLD admission was defined if the first admission code was one of the AiLD codes.secondary AiLD admission was defined as having the AiLD diagnosis anywhere in the admission diagnosis(25 diagnoses).Subjects aged 21 years and older were included.The national estimates of hospitalization were derived using sample weights provided by NIS.χ^(2)tests for categorical data were used.The primary trend characteristics were in-hospital mortality,hospital charges,and length of stay.RESULTS From 2011 to 2017,hospitalization rates witnessed a significant decline,dropping from 83263 admissions to 74850 admissions(P<0.05).The patients hospitalized were predominantly elderly(median 53%for age>65),mostly female(median 59%)(P<0.05),and primarily Caucasians(median 68%)(P<0.05).Medicare was the major insurance(median 56%),followed by private payer(median 27%)(P<0.05).The South was the top geographical distribution for these admissions(median 33%)(P<0.05),with most admissions taking place in big teaching institutions(median 63%)(P<0.05).Total charges for admissions rose from 66031 in 2011 to 78987 in 2017(P<0.05),while the inpatient mortality rate had a median of 4.9%(P<0.05),rising from 4.67%in 2011 to 5.43%in 2017.The median length of stay remained relatively stable,changing from 6.94 days(SD=0.07)in 2011 to 6.51 days(SD=0.06)in 2017(P<0.05).Acute renal failure emerged as the most common risk factor associated with an increased death rate,affecting nearly 68%of patients(P<0.05).CONCLUSION AiLD-inpatient hospitalization showed a decrease in overall trends over the studied years,however there is a significant increase in financial burden on healthcare with increasing in-hospital costs along with increase in mortality of hospitalized patient with AiLD.
文摘This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.
文摘Background Racial disparities in cardiovascular conditions are well documented.Whether similar race-based discrepancies in health outcomes also exist among elderly patients undergoing surgical aortic valve replacement(SAVR) for aortic stenosis remains understudied.Methods We abstracted data from the National(Nationwide) Inpatient Sample over a 20-year period from 2001 to 2020 using specific ICD-9 and ICD-10 codes.We included patients aged ≥ 60 and ≤ 80 years with races recorded as White,African American,or Hispanic at the time of their hospitalization for surgery.We analyzed and reported the baseline characteristics,risk-adjusted inhospital mortality,and complications stratified by race.Results Of 420,181 patients studied,90.0% identified as White,4.0% as African American and 6.0% as Hispanic.Despite a decrease in overall in-hospital mortality rates from 3.8% between 2001-2005 to 1.8% between 2016-2020,African Americans had higher odds of all-cause in-hospital deaths compared to Whites(a OR = 1.390,P < 0.001).Additionally,they were more likely to experience cardiogenic shock(a OR = 1.241,P < 0.001) and acute kidney injury(a OR = 1.314,P < 0.001) as well as more likely to require organ support such as IABP use(a OR = 1.336,P < 0.001) or invasive mechanical ventilation(a OR = 1.342,P < 0.001).Interestingly,African Americans were less likely to report events of acute ischemic stroke compared to Whites(a OR = 0.852,P < 0.001).Conclusions Despite a reassuring reduction in overall in-hospital mortality rates of geriatric patients undergoing SAVR for aortic stenosis,racial disparities in health outcomes remain pervasive with minorities more likely to report higher in-hospital morbidity and mortality.
基金Supported by National Natural Science Foundation of China,No.82360136Jiangxi Clinical Research Center for Gastroenterology,No.20223BCG74011.
文摘BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.
基金supported by a major project of the Zhejiang Natural Science Foundation(LD21G030001).
文摘Objective The Asia-Pacific region has a high chronic obstructive pulmonary disease(COPD)burden,but studies on its trends are limited.Using the Global Burden of Disease(GBD)2019 data,we analyzed COPD trends in 36 countries and territories from 1990 to 2019 and predicted future incidence trends through 2034.Methods COPD data by age and sex from the GBD 2019 database were analyzed for incidence,prevalence,mortality,and disability-adjusted life years(DALY)rates from 1990 to 2019.Joinpoint regression identified significant annual trends,and age-standardized incidence rates were predicted through 2034 using age-period-cohort models.Results The incidence,prevalence,mortality,and disease burden of COPD have been decreasing,and the incidence rates will continue to decrease or remain stable until 2034 in most selected countries and territories,except for a few Southeastern Asian countries.The Lao People’s Democratic Republic and Vietnam are projected to experience an increase in COPD incidence from 165.3 per 100,000 in 2019 to 177 per 100,000 in 2034 and from 179.9 per 100,000 in 2019 to 192.5 per 100,000 in 2034,respectively.Older males had a higher incidence than any other sex or age group.The sex gap in incidence rates continues to widen,though it is smaller and less significant in the younger age group than in those in the older one.Conclusion COPD rates are expected to decline until 2034 but remain a health risk,especially in countries with rising rates.Urgent action on tobacco control,air pollution,and public education is needed.
基金supported by the National Natural Science Foundation of China(grant numbers:82273721,82304220)Cooperation Fund of CHCAMS and SZCH(grant number:CFA202201003).
文摘Background While China’s socioeconomic transformation has driven divergent trends in gastrointestinal cancers,comprehensive data on esophageal,gastric,and liver cancer burden remain limited.This study examines the global burden of esophageal,gastric,and liver cancers in 2022 and analyzes the trends of age-standardized incidence and mortality rate(ASRs)in China from 2000 to 2018,thereby providing evidence for the formulation of cancer control strategies.Methods The global burden of esophageal,gastric and liver cancers including the estimated number of cases and deaths and the ASRs for incidence and mortality were from GLOBALCAN 2022 dataset.Data from 22 cancer registries in China were employed for the trend analysis of the ASRs for incidence and mortality of these three cancers.The Joinpoint model was used to compute the average annual percentage change(AAPC)of the incidence and mortality of the three cancers from 2000 to 2018.Results Globally,esophageal,gastric and liver cancers accounted for 11.8%of incident cancer cases and 19.1%of cancer deaths.China bore a disproportionately high burden,representing 43.8%,37.0%,and 42.4%of global esophageal,gastric,and liver cancer cases respectively,and 42.1%,39.4%,and 41.7%of corresponding deaths.However,the ASRs for incidence and mortality for all three cancers declined significantly in China(2000–2018),with absolute case numbers decreasing for gastric and esophageal cancers during 2010–2022.Age-specific analysis revealed most pronounced declines in incidence and mortality in populations under 40 years old,with AAPCs of less than–6.0%for esophageal cancer,around–4.0%for gastric cancer,and approximately–2.0%for liver cancer.Conclusions China has achieved remarkable progress in controlling esophageal,gastric and liver cancers,yet these malignancies remain major public health challenges.Future efforts should intensify existing prevention measures while expanding screening programs,particularly for aging populations.These findings offer valuable insights for regions undergoing similar epidemiological transitions.
文摘BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.
基金funded by the Shandong Science and Technol-ogy Development Plan Project(grant number:2016GSF201231)Med-ical and Health Technology Development Plan of Shandong Province(grant numbers:202012051127,202412051228)National Key Research and Development Program-Precision Medicine Research Key Project(grant number:2016YFC0901300).
文摘Objective:To analyze the trend of major malignant tumor mortality in Shandong Province,eastern China from 1970 to 2021,and to provide the scientific basis for malignant tumor prevention and control.Methods:Cancer mortality data were sourced from three nationwide cause-of-death surveys and the Shandong Death Registration System.Trends in overall mortality and major causes of death were elucidated through indi-cators such as mortality rates and age-adjusted death rates,by comparing findings from the three comprehensive mortality surveys and the Shandong Death Registration System.The difference decomposing method was em-ployed to estimate the contributions of non-demographic and demographic factors to the observed changes in cancer mortality.Results:From 1970 to 2021,the crude mortality rate of malignant tumors witnessed an overall increase in Shan-dong Province.The age-standardized mortality rate initially rose before subsequently declining.The proportion of cancer deaths among all causes of death increased initially and then stabilized at a high level of approximately 25%.Both non-demographic and demographic factors played a role in the rise of the crude cancer mortality rate,with the proportion attributed to demographic factors gradually surpassing that of non-demographic factors.De-spite the continuous increase in the crude mortality rate,the adjusted mortality rate exhibited a downward trend since 1990.Significant changes were observed in the ranking of the mortality rates of major cancers.For exam-ple,the mortality rate of lung cancer exhibited a continuous upward trajectory,ascending from the fifth to the first place and marking a 7.69-fold increase from 1970 to 2021.Conversely,digestive system tumors,including gastric cancer,esophageal cancer,and liver cancer,displayed varying degrees of decline,particularly in the stan-dardized rates,which demonstrated a notable downward trend since 1990.The crude mortality rate of colorectal cancer and breast cancer showed an obvious upward trend,but the standardized rate did not rise significantly.For cervical cancer,both the crude and adjusted mortality rates displayed a pattern of initially decreasing and then increasing.Conclusions:Malignant tumors remain a significant threat to the residents of Shandong Province.The changing trends in various malignant tumors are inconsistent,underscoring the need for tailored intervention strategies to effectively control different types of malignant tumors.
文摘Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public health interventions and optimizing resource allocation. This study aimed to identify small area level factors associated with all-cause mortality and to map hotspots of excess deaths across a region. The analysis produced relative mortality rates and exceedance probabilities to pinpoint areas with an excess burden of death. Results showed that all-cause mortality was particularly concentrated in the upper central and northern regions of the region, where many rural counties are located. Key factors associated with higher mortality rates included lower median income, younger median age, and a lower percentage of Hispanic population in the counties studied. These findings highlight the importance of addressing income disparity in high-mortality areas, particularly in rural regions, to guide resource allocation and develop targeted interventions that can most effectively reduce mortality rates where they are needed most.
文摘Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.
文摘Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.
