Analysis of the underlying and multiple causes of death for the Kuwaiti population 40 years and over in Kuwait part I: demographics

Improved health care brought about major changes in mortality pattern; life expectancy has increased and the causes of death are more likely to result from chronic diseases, death rarely result from a single cause and the use of the underlying cause of death [UCD] will overlook many of the contributing diseases that are highlighted by multiple cause of death [MCD] analysis. The paper addresses the demographic and non-clinical variables related to the number of causes recorded in the death certificates notification [DCN]. All the DCN for the Kuwaiti population, 40 years or over for the period 1993-2001 were compiled and all the causes up to five additional causes were recorded. A total of 13960 cases [7966 males and 5994 females], reported in the period 1993-2001, were analyzed. The causes of death were provided according to the WHO ICD9. A single cause [UCD] was reported in 5.6% of the cases, 27.1% had 3 causes and 12.5% had 6 causes. The mean number of causes amounted to 3.64 and 3.8 for the males and females. Variability according to the year was not marked. Those dying in the hospitals had a relatively higher mean number of causes compared to those dying in other places, and this was common to the 2 gender groups. A rising trend was seen with age; with the males the 60-, 70- or 80+ age groups had higher mean number of causes compared to the younger groups. With females the means for the 60- and 70- groups were relatively higher than the other groups, the group 40+ was having lower means Compared to the other groups and this was common to the 2 gender groups, particularly with the males. The UCD alone was reported for less than 7% of the causes of death among the Kuwaiti population 40 years or over. Use of multiple cause of death will add a lot of useful information that can be used to highlight several disease conditions not shown by the UCD

Analysis of the underlying and multiple causes of death for the Kuwaiti population 40 years or over part II: causes

Death rarely results from a single cause; it can be caused by a variety of factors. Multiple causes of death [MCD] can provide information about the associations between causes of death revealing common combinations of conditions; moreover they can rectify inconsistencies in the death certificates [DC]. This paper is meant to highlight the importance of multiple causes of death and point out the contributing and associated disease conditions to the underlying cause of death [UCD]. The study was based on analysis of multiple causes of death for the Kuwaiti population 40 years or over in the period 1993-2001 All multiple causes up to 5 in the death certificate notification [DCN] were coded and analyzed. The data were coded according to ICD9 following the WHO rules. The ratios for the MCD/UCD were computed for the groups of diseases and for individual causes exceeding 50 entries. The relative ratios [Observed/Expected] were computed to show the associations between the groups of causes. A total of 13960 DCNs were analyzed, the ratios were low for neoplasms [1.51], followed by respiratory [2.50], nervous [2.97], and digestive conditions [3.01], ILL-defined conditions had the highest ratio [13.40]. Infections and genitourinary diseases had ratios of 4.19 and 4.56. Ranking changed when using MCD; circulatory, endocrinal, nervous and digestive conditions kept their position, with circulatory diseases on the top and nervous conditions occupying position 10. Relative risk [RR] was computed for the different groups; positive RR was found between infections and respiratory, digestive, genitourinary and ill-defined disease conditions. Neoplasms showed positive association was other neoplasms, and endocrine conditions were positively associated with circulatory, respiratory, and genitourinary conditions. A positive association was found between ill-defined conditions with circulatory and other ill-defined conditions. UCD is still essential to analyze historical trends, compare countries, and guide prevention of death; MCD offer a new sight into the study of mortality. The combination of the 2 methodologies is more useful than the isolated use of either approach. The Collection of MCD is essential, there has been major development in the area and soft ware was developed to analyze MCD data. MOH should start the development of data bases for MCD, make them available, and include the highlights in the MOH annual reports. Special reports discussing individual disease conditions particularly neoplasms and circulatory and respiratory conditions should be organized

Low birth weight, and risk factors in Kuwait 2006 a case control study

Low Birth Weight [LBW] and preterm birth [PB] are known risk factors of infant mortality, stunted growth and major morbid conditions for children, adolescents and adults. The association with diabetes, obesity and cerebrovascular disease [CVs] has been frequently reported. The major aim of the study was to assess the magnitude of the LBW in Kuwait, point out the probable risk factors and advice on the mitigations. Material and The study is based on analysis of the 2006 birth data; a case control study in which, 4458 LBW and 4456 normal birth weight [NBW] were compared. The newborn, maternal and environmental variables were elicited. Females had a higher incidence of LBW [52.2%]. More Kuwaiti newborns [63.9%] were included in the LBW group compared to the control and the differences in the distribution were statistically significant. The gestation age amounted to 36.2 and 39.1 weeks for the LBW and NBW. LBW was similar in all the health regions except slightly higher proportion in Farwania [23.9%] and Ahmadi [21.6%]. The incidence per 1000 life birth was lower in the 1992-2008 showed a persistent rise starting from 1995 for the Kuwaiti and the Non Kuwaiti. The age of the mothers were similar, however the difference in the father age was lower in the LBW group. The incidence according to the age of the mother showed a higher incidence with the group, <20 and over 45+. Newborns delivered in the Government hospitals were more likely to have LBW, probably a selection bias since the maternal complicated cases are better handled in the government hospitals. Primigravidas had more LBW [58.1%] compared to the multigravidas [47.6%] a history of a early neonatal deaths abortion, still birth and giving birth to a preterm baby were higher with the LBW mothers. The different pregnancy complications except for cord complications and retained placenta were higher among the LBW. LBW is relatively high and the incidence is growing the development of the obstetric management and innovation of fertility treatment may cause a higher incidence of the extremely low birth weight [ELBW], the proportion is already high and is rising

Low birth weight among Kuwaitis 2002 national pattern

Low birth weight [LBW] is a major determinant of neonatal deaths, it is also a recognized risk of childhood disability, that will compromise the school achievement, and have long term adult health consequences including obesity, type 2 diabetes, hypertension, coronary artery disease and stroke. The principal aim of this study was to estimate the incidence of LBW among Kuwaiti population, point out the pattern and the underlying risk factors from birth certificate notification. Material The present study is based on the analysis of a full year data 2002 for the Kuwaiti births. Notification of birth is mandatory and probably represents total coverage. The demographic information for the parents together with the disease conditions suffered by the mother and any problems with the pregnancy or labor are reported. The gestation in weeks, the weight [gm] of the new born and the length [cm] were registered. The 10th percentile for the weight was 2540 gm very close to the figure 2500 taken to determine the LBW globally, the median was 3240 gm denoting a positive skewness, the proportion of children <2500 amounted to 8.8%, these included the VLBW <1500 [1.3%] and the MLBW 1500-2499 [7.4%]. Significant positive correlation was found between the weight, gestation period and length of the new born. Males had lower proportions of the VLBW [1.3%] and MLBW [6.7%]. The age of the mother and father both significantly affected the incidence of the LBW; the proportions of LBW were higher with the younger age groups. There was no effect for the season but significant differences were found between the different health regions. LBW was lower with better education of the parents and the number of pregnancies decreased. Mothers attending the hospitals, probably at risk, had more of LBW. A past history of preterm, abortion, and heart disease were associated with higher proportions of LBW. The incidence of LBW in Kuwait was higher than that for most developed countries. LBW is a problem of growing dimension in Kuwait. Prevention of LBW though difficult would be a viable option, better maternal care, a follow up study of LBW and the ELBW need to be designed and implemented

Predictors of in-hospital mortality in Kuwait

Background: Many factors affect mortality among hospitalized patients. These include; age, sex, principal diagnosis. presence of co-morbidity, performance of surgical operation, emergency admission and length of hospital stay. Identification of all these factors especially those, which are amenable to improvement would require collection and analysis of data to be able to determine risky patients and give them more attention. This would reduce death rate among those at high risk of dying after hospital admission

Objective: To determine the factors predicting patients' in-hospital mortality and to answer the question "who is at high risk of dying after hospital admission? "

Methods: A case-control study was carried out in Kuwait general hospitals. Data were collected from discharge records of all patients discharged either dead [cases] or routinely alive [controls] from Kuwait six general hospitals in the year 2004. A total of 1980 hospital deaths compared to an equal number of controls discharged alive were enrolled in the present study

Results: The results of the logistic regression revealed that, patients 65 years old and above, non Kuwaitis, widowed and divorced, admitted from emergency department with injury as external cause, having the principal diagnosis septicemia. injury or stroke associated with one of the common comorbid conditions were at higher risk of hospital death than those without these characters. While, patients performing surgical operations were at lower risk of hospital death than non operated patients

Conclusion: To reduce in-hospital mortality. hospitals must pay more attention and aggressive care to old patients, with primary diagnosis of septiceamia, injury and stroke, admitted from emergency department, with comorbid condition as sub-diognosis. as they are more susceptible to dye after hospital admission than other patients