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BACKGROUND: The proportion of older people is increasing worldwide. Leading causes of death must be understood for the organization of medical and social care. AIM: This study aimed to identify and discuss the leading causes of death in older people and old age based on data from medical death certificates. MATERIAL AND METHODS: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the system of the Unified State Register of Civil Status Records), all cases in which diseases were indicated as the initial cause of death (all codes of external causes, injuries, and poisoning were excluded) were selected. From a total of 109,126 deceased individuals, 90,269 (82.7%) were ≥60 years old. Eighteen groups of initial causes of death were made (95.2% of deaths from diseases);40,442 (44.8%) medical death certificates were issued by the Bureau of Forensic Medicine. RESULTS: Five leading causes of death were COVID-19 (24.2%), pathologies associated with cognitive impairment and dementia (21.15%;aged 60–69 years, 6.02%;aged ≥100 years, 63.5%), chronic ischemic heart disease (18.6%), malignant neoplasms (10.7%;aged 60–69 years, 16.7%;aged ≥100 years, 1.46%), and acute cerebrovascular accident (6.2%). The contribution of causes such as acute forms of coronary artery disease, stroke, hypertension, diabetes mellitus, COVID-19, and others is low in older people. Only 30% of the medical death certificates have their part II completed. The probability of filling out part II of the medical death certificate is influenced by age, place of death, place of issuance of the medical death certificates (in the Bureau of Forensic Medicine less than in other medical organizations), and teaching staff. With age, the proportion of MCAs issued by the Bureau of Forensic Medicine is increasing. Medical death certificates often use codes that are not analogous to clinical diagnoses. CONCLUSION: The contribution of individual causes (and groups of causes) of death changes with age. For a better understanding of the leading causes of death, a multidisciplinary consensus is needed in determining the criteria and validity of the use of the International Statistical Classification of Diseases and Health-Related Problems, Tenth revision, codes. © 2023 Case reportS. All rights reserved.
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INTRODUCTION: We previously reported an increase in respiratory mortality in 2020 in Spain after COVID-19. It is unclear if this rise is sustained in the longer-term. We aimed to determine whether respiratory mortality in 2021 in Spain returned to pre-pandemic levels. MATERIAL AND METHODS: In an observational, large study using official National Institute of Statistics data, we explored deaths due to respiratory diseases, that is, all causes of death by the standard WHO list of diseases of the respiratory system plus COVID-19, tuberculosis and lung cancer. Using the latest available official data of Spain, we analyzed changes in the mortality pattern in Spain from January 2019 to December 2021. We endorsed STROBE guidance for observational research. RESULTS: There were 98,714 deaths due to respiratory diseases in 2021 in Spain, corresponding to 21.9% of all deaths, becoming second in the ranking of causes of death. Respiratory diseases mortality in Spain has not returned to pre-pandemic levels in 2021, still with an increase of 30.3% (95% CI 30.2-30.4) compared to rates in 2019. All respiratory-specific causes of death decreased in 2021, except for lung cancer, that increased in women and decreased in men compared to 2019 (both p<0.05). In a multivariate analysis some established risk factors for respiratory diseases mortality were confirmed, such as male gender and older age; further, an association with reduced mortality in rural Spain was observed, still with a large geographical variability. CONCLUSIONS: The COVID-19 pandemic has had a lasting impact on deaths due to respiratory diseases and certain specific causes of death in 2021, and it has disproportionately affected certain regions.
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Purpose We aimed to compare mortality rates in people with epilepsy in Wales during the pandemic with pre-pandemic rates. Methods We performed a retrospective study using populationscale anonymised health records. We identified deaths in people with epilepsy (DPWE), those with a diagnosis of epilepsy, and deaths associ- ated with epilepsy (DAE), where epilepsy was recorded as a cause of death. We compared death rates in 2020 with average rates in 2015-2019 using Poisson models. Results There were 188 DAE and 628 DPWE in Wales in 2020 (death rates: 7.7/100,000/year and 25.7/100,000/year). The average rates for DAE and DPWE from 2015 to 2019 were 5.8/100,000/year and 23.8/100,000/year, respectively. Death rate ratios (2020 compared to 2015-2019) for DAE were 1.34 (95%CI 1.14-1.57, p<0.001) and for DPWE were 1.08 (0.99-1.17, p = 0.09). The death rate ratios for non- COVID deaths (deaths without COVID mentioned on death certificates) for DAE were 1.17 (0.99-1.39, p = 0.06) and for DPWE were 0.96 (0.87-1.05, p = 0.37). Conclusions The significant increase in DAE in Wales during 2020 could be explained by the direct effect of COVID-19 infection. Non-COVID-19 deaths have not increased significantly but further work is needed to assess the longer-term impact.
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Background: Although a high prevalence of pulmonary embolism (PE) has been reported as a complication during severe COVID-19 infections in critical ill patients, nationwide data of hospitalized patients with COVID-19 with PE is still limited. Thus, we sought to analyze seasonal trends and predictors of in-hospital case-fatality in patients with COVID-19 and PE in Germany. Method(s): We used the German nationwide inpatient sample to analyze all data on hospitalizations for COVID-19 patients with and without PE in Germany during the year 2020 and to compare changes of PE prevalence to 2019. Result(s):We analyzed data of 176,137 hospitalizations because of COVID- 19 in 2020. Among those, PE was recorded in 1.9% (n=3,362) of discharge or death certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%). The case-fatality rate increased with patients' age peaking in the 9th life-decade. Regardless of COVID-19, 196,203 inpatients were diagnosed with PE in Germany between 2019 and 2020. The number of PE hospitalizations were widely equally distributed between both years (98,485 vs. 97,718), while the case-fatality rate of all patients with PE was slightly lower in 2019 compared to 2020 (12.7% vs. 13.1%, P<0.001). In contrast, considerable differences in prevalence and case-fatality were demonstrated in 2020 regarding PE patients with and without COVID-19 infection (28.7% vs. 13.1%, P<0.001) (Figure 1). A COVID-19-infection was associated with a 2.8-fold increased risk of casefatality in patients with PE (OR 2.81, 95% CI 1.66-2.12, P<0.001). Conclusion(s): In Germany, the prevalence of PE events complicating hospitalizations was similar in 2019 and 2020. However, the fatality rate among patients with COVID-19-associated PE was substantially higher than that in those without either COVID-19 or PE, indicating an additive prognostic effect of these two conditions.
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Background: The COVID-19 pandemic caused a large number of excess deaths. COVID-19 emerged as a prothrombotic disease often complicated by pulmonary embolism (PE). In light of this, we hypothesized that PErelated mortality rates (stable before the pandemic) would be characterized by an increasing trend following the COVID-19 outbreak. Purpose(s): To investigate the mortality rates associated with PE among deaths with or without COVID-19 during the 2020 pandemic in the United States (US). Method(s): For this retrospective epidemiological study, we analyzed public medically certified vital registration data (death certificates encompassing underlying and multiple causes of death) from the Mortality Multiple Cause-of-Death database provided by the Division of Vital Statistics of the US Centers for Disease Control and Prevention (CDC;US, 2018-20). We investigated the time trends in monthly PE-related crude mortality rates for 2018-2019 and for 2020 (the latter associated vs. not associated with COVID-19), utilizing annual national population totals from the US Census Bureau. Second, we calculated the PE-related proportionate mortality among COVID-19 deaths (overall and limited to autopsy-based diagnosis). We performed subgroup analyses based on age groups, sex and race. Result(s): During 2020, 49,423 deaths in association with PE were reported, vs. 39,450 in 2019 and 38,215 in 2018. The crude PE-related mortality rate without COVID-19 was 13.3 per 100,000 population in 2020 compared to 11.7 in 2018 and 12.0 in 2019 (Figure 1A). The PE-related mortality rate with COVID-19 was 1.6 per 100,000 population in 2020. Among non- COVID-19-related deaths, the crude PE-related mortality rate was higher in women;among COVID-19-related deaths, it was higher in men. PE-related mortality rates were approximately two-fold higher among black (vs. white) general population irrespective of COVID-19 status (Figures 1B and 1C). Among COVID-19 deaths, PE-related deaths corresponded to 1.4% of total;the value rose to 6.0% when an autopsy was performed. This figure was higher in men and its time evolution is depicted in Figure 2A. The proportionate mortality of PE in COVID-19 deaths was higher for younger age groups (15-44 years) compared to non-COVID-19-related deaths (Figure 2B). Conclusion(s): In 2020, an overall 20%-increase in PE-related mortality was reported, not being limited to patients with COVID-19. Our findings could be interpreted in the context of undiagnosed COVID-19 cases, uncounted late sequelae, and possibly sedentary lifestyle and avoidance of healthcare facilities during the pandemic that may have prevented timely diagnosis and treatment of other diseases. Whether vaccination programs had an impact on PE-associated mortality in the year 2021, remains to be determined.
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OBJECTIVE: Determination of the leading causes of death based on data from primary medical death certificates (MDCs) depending on the place of death. MATERIAL AND METHODS: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the USR registry office system) for 2021, all cases were selected in which diseases were indicated as the primary cause of death (PCD); all codes of external causes, injuries and poisonings were excluded. A total of 109.126 cases, 50.6% died in the hospital, 34% died at home, and 16.4% died elsewhere. Bureau of Forensic Medical Examination (BFME) issued 45.2% of MSS. Taking into account the frequency of use of ICD codes, the clinical similarity of individual codes, 20 groups were formed, which accounted for 90.1% of deaths from diseases. RESULTS: The frequency of registration of individual groups of causes of death largely depends on the place of death. 5 leading groups of causes of death were established: 1) in general from COVID-19 23.55%, chronic ischemic heart disease (CIHD-1) without postinfarction cardiosclerosis, aneurysm and ischemic cardiomyopathy (CMP) 14.5%, from encephalopathy indefinite (EI) 11.4%, malignant neoplasms (MN) 11.3%, stroke 6.2%; 2) in a hospital from COVID-19 45%, stroke 10%, MN 8.3%; CIHD-1 7.1%, CIHD with a history of MI/ischemic CMP 2.7%; 3) at home from CIHD-1 21.8%, EI 21.5%, MN 15.5%, from diseases associated with alcohol 3.3% and brain cyst 3.3%; 4) elsewhere from CIHD-1 22.7%, EI 21.6%, MN 12%, from other forms of acute coronary artery disease 5.4%, alcohol-associated diseases 4.8%. Acute MI ranked 6th among deaths in general - 2.7%. PCD is also associated with the place of issue of the MDCs - 90% of the MDC with the indication of EI and «other degenerative diseases of the nervous system¼ as the cause of death were issued by the BFME. Not a single MDC issued by the BFME contained such PCDs as "old age" or "brain cyst". CONCLUSION: The nosological structure of the causes of death and the issuance of individual ICD codes in the MDC as a PCD varies significantly depending on the place of death and the issuance of the MDC. The reasons need to be further clarified. The use of codes that are not permitted for use has been registered.
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Death Certificates , Stroke , Humans , Cause of Death , COVID-19 , Cysts , Moscow/epidemiology , Myocardial Ischemia , NeoplasmsABSTRACT
During the COVID-19 pandemic the third section of the medical examination could be performed on simulation patients and simulators. Their use is also beneficial in forensic medicine, as a higher level of standardization and comparability of examination performance is achieved, and the use of real corpses is often not justifiable for medicolegal reasons. This case reports on the advantages and disadvantages of a simulation in the state examination in which a death certificate was to be completely filled out on the basis of an external postmortem examination on the simulator and an external anamnesis.
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Introduction: Heart disease (HD) death rates have been declining for decades. Updated trend data for 2010-2020 are needed to inform clinical and public health practice. Method(s): We obtained age-standardized death rates per 100,000 population from the US Centers for Disease Control and Prevention's WONDER database, which aggregates death certificate data from the National Vital Statistics System. Among adults aged >=35 years, HD deaths were defined by underlying cause of death International Classification of Diseases, 10th revision codes. We calculated percent change between 2010, 2019, and 2020 death rates overall and by HD subtypes and demographic subgroups. Result(s): HD death rates declined during 2010-2019 and increased in 2020 across age, sex, and race and ethnicity groups. The national HD death rate declined by 9.8% from 2010 to 2019 (347.3 vs. 313.0 per 100,000) and increased by 4.1% in 2020 to 325.9 per 100,000, which approximated the 2015 rate (326.5 per 100,000). Coronary heart disease accounted for 55% of total HD deaths in 2020. Among non-Hispanic Black adults, the HD death rate declined by 10.4% during from 2010 to 2019 and increased by 11.2% in 2020, returning the 2020 HD death rate (440.7 per 100,000) to approximately the 2010 rate (442.4 per 100,000). Among adults aged 35-54 and 55-74 years, HD death rates declined from 2010 to 2019 (35-54: 5.5%, 55-74: 2.3% decline) and increased in 2020 (35-54: 12.0%, 55-74: 7.8% increase), resulting in a higher HD death rate in 2020 (35-54: 54.1, 55-74: 297.3 per 100,000) than in 2010 (35-54: 51.1, 55-74: 282.5 per 100,000). Conclusion(s): National declines in HD death rates had reversed by 2020 during the Coronavirus Disease-2019 pandemic. Setbacks represented approximately 5 years of lost progress among all adults and >=10 years of lost progress among non-Hispanic Black adults and younger adults. Clinical and public health efforts may need to be modified to reverse negative trends in HD mortality. (Figure Presented).
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INTRODUCTION: COVID-19-related organ dysfunction is increasingly recognized as sepsis, & sepsis has been reported as the most common proximate cause of death among COVD-19 patients in autopsy studies. Thus, the COVID-19 pandemic is expected to affect substantially the epidemiology of sepsis. However, the contribution of COVID-19 to sepsis-related mortality in the United States (US) is unknown. METHOD(S): We used the CDC WONDER Multiple Cause of Death database to identify decedents with a diagnosis of sepsis during 2015-2019 and with diagnoses of COVID-19, sepsis, or both during 2020. Sepsis was identified using previously reported ICD-10 code-based taxonomy. COVID-19 was identified by ICD-10 code U071. Negative binomial regression was used on the 2015-2019 data to forecast the number of sepsis-related deaths in 2020. We then compared the number of observed vs expected sepsis-related deaths in 2020. In addition, we examined the reporting of a diagnosis of COVID-19 among decedents with sepsis and the proportion of a diagnosis of sepsis among those with COVID-19. The latter analyses were then repeated across the Department of Health and Human Services (HHS) Regions. RESULT(S): In 2020, there were 242,630 sepsis-related deaths, 384,536 COVID-19-related deaths, & 35,057 deaths with both diagnoses. The expected number of sepsis-related deaths for 2020 was 207,175 (95% CI 205,929-208,429), with the ratio of observed to expected deaths 1.17 (95%CI 1.16-1.18). COVID-19-related deaths comprised 15.0% of all observed sepsis-related deaths, ranging from 8.1% (HHS Region 10) to 18.2% (HHS Region 2). A diagnosis of sepsis was reported in 9.1% of all COVID-19-related deaths, varying from 6.6% (HHS Region 2) to 12.5% (HHS Region 9). CONCLUSION(S): Sepsis-related mortality was reported in less than 1 in 10 COVID-19-related deaths in the US during 2020, with the frequency of sepsis diagnoses varying nearly 2-fold across HHS regions. Although the number of COVID-19-related deaths far exceeded sepsis-related mortality, the contribution of the former to the latter, based on death certificates, was relatively minor. Our findings suggest substantial underdocumentation and possibly underrecognition of sepsis among COVID-19 decedents, likely contributing to varying coding practices during the first year of the pandemic.
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Background/Aim: Since the COVID-19 pandemic, emergency departments across the United States have seen an increase in patients seeking care for psychiatric complaints to include suicidal ideation and attempts. A recent national study reported that the suicide rate has decreased since 2018 but this decrease may not be equal across all age groups and ethnicities especially the younger aged. Using mortality data from the National Vital Statistics System (NVSS), we investigated the trends in the suicide death rate among those aged 10-19 by gender, ethnicity and mode of suicide between 2015-2020. Method(s): We identified individuals with intentional self-harm reported on death certificates as a leading cause of death or contributory cause of death from 2015-2020 using ICD-10 codes *U03,X60-X84,Y87.0. Annual percent change was calculated;ANOVA was used to determine differences. Result(s): From 2015 to 2020, overall, there were 16,600 (12,310 males;4,290 females) deaths from suicide among those aged 10-19;average age was 16.6+/- 2.1 males;16.02+/- 2.22 females, 84% of males had some college;77% females had some college;99% were single in both groups. Non-Hispanic whites accounted for over 50% of all suicides followed by Hispanics at >20%. The number of deaths by suicide increased over time for males but decreased for females- both groups' age at death decreased over time. By ethnicity, both non-Hispanic black males and females saw a significant increase in their suicide rates from 10.3% (2015) to 12.3% (2020, P=0.03) males and 11.1% to 13.9% (P=0.05) females. Similar findings were noted for Hispanic males (13.3% to 18.3%, P=0.0001) and females (18.7% to 23.4%, P=0.006) while suicide rates decreased for non-Hispanic whites and Asians. The top three most frequent modes of suicide for females were hanging, strangulation and suffocation (>50%);discharge of firearms (>20%) and intentional self-poisoning by and exposure to drugs and other biological substances (>15%). The largest increase of over 250% was intentional self-poisoning (suicide) by and exposure to other and unspecified solid or liquid substances and their vapors. For males the top three most frequent methods used for suicide were discharge of firearms (>50%);hanging, strangulation and suffocation (>35%) and intentional self-poisoning by and exposure to drugs and other biological substances (>15%) while the largest increase (100%) was the same as for females- intentional self-poisoning (suicide) by and exposure to other and unspecified solid or liquid substances and their vapors. Conclusion(s): Although suicide deaths have been reported to be decreasing, we found among those aged 10-19, suicide rates were increasing for both non-Hispanic blacks and Hispanic males and females but not for whites or Asians. The most vulnerable time may be when this age group starts college suggesting more support is needed for those transitioning from home for the first time. The large increase of 250% for females and 100% for males related to intentional self-poisoning and correlation with exposure and access to drugs and other biological substances requires further investigation as well. This includes evaluating the role of social media platforms particularly during the COVID-19 pandemic in promoting and facilitating access to drugs and biological substances. No, authors do not have interests to disclose Copyright © 2022
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Purpose: CMS introduced new performance metrics for Organ Procurement Organizations (OPO). CDC death records define donation eligible deaths, the denominator of the donation and transplant rate metrics. The COVID-19 pandemic has had an unprecedented and geographically varied impact on United States death statistics. Thus, we examined the potential impact of COVID-19 on the calculation of the OPO performance metrics. Method(s): Eligible deaths include hospitalized decedents with "donation appropriate" diagnoses. We extracted death certificate data from the CDC WONDER system for baseline years (2015-2019) and the CDC COVID Data Tracker (after 2019). CDC aggregates data by state and broad disease groups including Circulatory Death (CD), death from Cerebrovascular Disease ICD-10 i60-i69 and Ischemic Heart Disease ICD-10 i20-i25. Deaths related to COVID (ICD-10 U07.1) were separately grouped. The proportion of CD during the pandemic was compared to baseline and correlated with COVID. Result(s): At baseline, CD accounted for 66.2% of OPO eligible deaths, increasing markedly in 2020 and 2021. (Figure A) The week of April 11, 2020, the national proportion of CD peaked at +23.8% over baseline, paralleling the dramatic increase in the proportion of deaths due to COVID (20%). Early in the pandemic, the proportion of CD and COVID deaths were strongly correlated (2020 r=.44). This attenuated over time (2021: r=.25). The CD and COVID death association evolved as the pandemic spread geographically. (Figure B) In 2020, the change in proportion of CD varied from New York (+20.6%) to Massachusetts (-6.5%). The COVID - CD correlation was highest in the Northeast and Florida, (New Jersey [.78], New York [.75] and Florida [.75]). By 2021, the change in proportion of CD was highest in Mississippi (+14.5%) and lowest in West Virginia (-28.6%), while the COVID - CD correlation diminished and spread west (Florida [.65], Tennessee [.54] and California [.53]. Conclusion(s): Accurate eligible death assessment has been difficult, leading to a shift in calculations based on ICD-10 coded death certificates instead of OPO reported deaths. CD constitutes 2/3 of recorded donation eligible deaths historically, which has been substantially, but variably, impacted by the COVID-19 pandemic. Thus, these metrics based on CDC data may be sensitive to unanticipated and uneven shocks such as disease outbreaks, leading to inaccurate estimates of donor potential. CMS metrics should be refined to better account for external shocks such as the COVID-19 pandemic. (Figure Presented).
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Background: The COVID-19 pandemic has caused unprecedented disruptions in medical care, especially in those with cancer. Prior studies have demonstrated a higher risk of mortality in patients with cancer and COVID-19, which could be due to factors such as immunosuppression and higher burden of co-morbidities. However, there are limited studies examining the impact of sociodemographic factors including race, gender, rurality, and region on mortality in patients with COVID-19 and cancer. This study aims to characterize and analyze sociodemographic trends in COVID-19 mortality in patients with cancer. Methods: Data on patients with COVID-19 and cancer listed on death certificates from the Multiple Cause of Death Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database were extracted. Age-adjusted mortality rates (AAMR) were calculated and compared across sociodemographic groups. Results: A total of 18,467 total deaths occurred in patients with COVID-19 and cancer listed on multiple cause of death certificates in 2020, with overall AAMR of 4.4 (95% CI: 4.4-4.5). AAMR for patients with COVID-19 and cancer was significantly higher in Non-Hispanic (NH) Black or African American (7, 95% CI: 6.8- 7.3), NH American Indian or Alaska Native (6.4, 95% CI: 5.4-7.3), and Hispanic or Latino (5.4, 95% CI: 5.2-5.7) groups than NH White (4, 95% CI: 3.9-4.1) and NH Asian or Pacific Islander (2.5, 95% CI: 2.3-2.7). AAMR was also higher in males (5.9, 95% CI: 5.8-6.1) and those in Northeast (5.6, 95% CI: 5.4-5.8) and Midwest (5.3, 95% CI: 5.2-5.5) census regions. Those in medium metro counties had significantly lower AAMR (3.8, 95% CI: 3.7-4) compared to other locations based on the NCHS Urban-Rural Classification Scheme for Counties. Conclusions: AAMR in patients with any cancer and COVID-19 was significantly higher in NH Black or African American, NH American Indian or Alaskan, and Hispanic or Latino race/ethnicity groups, as well as in males. Regional and rurality disparities also exist. This study highlights persistent disparities in COVID-19 and cancer outcomes and identifies groups at higher risk of mortality. Future studies examining sociodemographic trends in COVID-19 mortality in patients with specific cancers are necessary.
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BACKGROUND: In the US, spikes in drug overdose deaths overlapping with the COVID-19 pandemic create concern that persons who use drugs are especially vulnerable. This study aimed to compare the trends in opioid overdose deaths and characterize opioid overdose deaths by drug subtype and person characteristics pre-COVID (2017-2019) and one-year post-COVID-19 emergence (2020). METHODS: We obtained death certificates on drug overdose deaths in Arkansas from January 1, 2017, through December 31, 2020. Our analyses consisted of an interrupted time-series and segmented regression analysis to assess the impact of COVID-19 on the number of opioid overdose deaths. RESULTS: The proportion of opioid overdose deaths increased by 36% post-COVID emergence (95% CI: 14%, 59%). The trend in overdose deaths involving synthetic narcotics other than methadone, such as fentanyl and tramadol, has increased since 2018 (74 in 2018 vs 79 in 2019; p=0.02 and 79 in 2019 versus 158 in 2020; p = 0.03). Opioid overdose deaths involving methamphetamine have more than doubled (36 in 2019 vs 82 in 2020; p = 0.06) despite remaining steady from 2018 to 2019. Synthetic narcotics have surpassed methamphetamine (71% vs. 37%) as the leading cause of opioid overdose deaths in Arkansas during the pandemic. This study found that synthetic narcotics are the significant drivers of the increase in opioid overdose deaths in Arkansas during the pandemic. CONCLUSIONS: The co-occurrence of the COVID-19 pandemic and the drug abuse epidemic further highlights the increased need for expanding awareness and availability of resources for treating substance use disorders.
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COVID-19 , Drug Overdose , Methamphetamine , Opiate Overdose , Substance-Related Disorders , Tramadol , Humans , Opiate Overdose/epidemiology , Analgesics, Opioid , Arkansas/epidemiology , Pandemics , Fentanyl , Methadone , NarcoticsABSTRACT
The strengthening of civil registration and vital statistics (RCEV) systems is essential to assess the impact of health interventions and the effects of health emergencies. Peru faced the COVID-19 pandemic, in the process of strengthening the RCEV system, in which the implementation of SINADEF stood out, which allowed it to improve the quality and coverage of information on mortality. A compilation of information from various public information sources was carried out to calculate the coverage of mortality in Peru for the period 2012 to 2019. The coverage of deaths with medical certification rose from 57.65% in 2016 to 71.6% in 2019 and improved in all regions of Peru at the national level, additionally, online certification of deaths rose from 29% in 2017 to 86% in 2020. The SINADEF has made it possible to implement a rapid mortality surveillance system and measure the excess mortality that is occurring in the context of the pandemic.
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It is well known that the quality of death certificates determines the accuracy of public health mortality data. In the light of a pandemic, forensic pathologists must understand the true definition of a COVID-19 death and the requirements for filling out the death certificate, as these are critical for maintaining accurate and trustworthy mortality data. To determine the scope and evolution of the COVID-19 epidemic, accurate death certification is critical. We believe that COVID-19 should be enlisted under part II or section "note" (if it exists in DC form in a particular country) of the DC in all suicide instances and putrefied bodies with positive autopsy swabs for SARS-CoV-2. In addition to our suggestions for the completion of the DC in some COVID-19 instances, we feel that forensic pathologists should follow the WHO criteria for proper DC completion in COVID-19 cases. Better physician education at this stage of the pandemic would increase adherence to existing (WHO and CDC) standards. As a result, forensic pathologists with competence in death certification could help by teaching treating physicians in this area.
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COVID-19 , Death Certificates , Autopsy , COVID-19/epidemiology , Cause of Death , Humans , Pandemics , SARS-CoV-2ABSTRACT
Background/Aims Patients with inflammatory arthritis were identified as a potentially vulnerable group during the COVID-19 pandemic, with recommendations from the UK government to shield. We set out to describe the risks of COVID-19 according to initial treatment strategy amongst patients recruited to the National Early Inflammatory Arthritis Audit (NEIAA). Methods NEIAA is an observational cohort design. It includes adults in England with a new diagnosis of inflammatory arthritis between May 2018 and March 2021. The outcomes of interest were death due to COVID-19 (COVID-19 stated on a death certificate) and hospitalisation due to COVID-19 (primary admission reason or nosocomial acquisition), identified using NHS Digital linkage. Cox proportional hazards models were used to calculate hazard ratios, with adjustment for patient factors (age, gender, smoking status, comorbidity) and disease factors (seropositivity, disease severity (DAS28), patient-reported disability (HAQ) and functional impact (MSK-HQ)) recorded at baseline. Individuals were considered at risk from February 2020 or date of diagnosis (whichever was later) and censored at a COVID-19 event, May 2021 or death (whichever was sooner). Results 14,127 patients were included. Mean age was 57 (+/-16);62% were female. Smoking status: 19% current;29% ex-smokers. Comorbidities: 19% hypertension;9% diabetes;and 9% lung disease. Overall, 20% had two or more comorbidities. Rheumatoid Factor or CCP antibodies were positive in 56%. At presentation, mean scores were 4.6 (+/-1.5) for DAS28, 1.1 (+/-0.7) for HAQ and 25 (+/-11) for MSK-HQ. Initial DMARD therapy was known for 13,682/14,127 patients;methotrexate was most common (54%), then hydroxychloroquine (23%) and sulfasalazine (11%). There were 143 COVID-19 hospital admissions and 47 deaths, corresponding to incidence rates per 100 person-years for hospitalisation: 0.94 (95% CI: 0.79-1.10) and death: 0.31 (95% CI: 0.23-0.41). Increasing age, male gender, diabetes, hypertension, lung disease and smoking status all predicted COVID-19 events. Higher baseline DAS28 predicted COVID-19 admission (HR 1.24 (95% CI: 1.10-1.39)) and mortality (HR 1.33 (95% CI: 1.09-1.63)). Higher HAQ predicted both COVID-19 admission and death. Seropositivity was not a significant predictor of any COVID- 19 event, nor was MSK-HQ. Unadjusted, corticosteroids associated with COVID-19 death (HR 2.29 (95% CI: 1.02-5.13)), and sulfasalazine monotherapy associated with COVID-19 admission (HR 1.93 (95% CI: 1.04-3.56)). In adjusted models, associations for corticosteroids and sulfasalazine were no longer significant. Only age, smoking status, and comorbidities independently predicted COVID-19 events. Conclusion The burden of COVID-19 amongst early arthritis patients was substantial during the pandemic. Patient characteristics and rheumatoid disease severity at diagnosis appear to be the more important predictors of COVID-19 events than initial treatment strategy. An important limitation is that we have not looked at treatment changes over time, and must acknowledge that many patients, especially those recruited in 2019, may have changed therapy prior to the pandemic.
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In adults, COVID-19 infection increases the risk of thrombotic events. Hospitals worldwide reported a poorer prognosis for patients who did not receive venous thromboembolism (VTE) prophylaxis, in comparison to those who did. This finding instigated UK hospitals to form their own local policies on VTE prophylaxis in COVID-19 positive patients, to prevent death and complications secondary to clot formation. Due to older age, multiple co-morbidities, decreased mobility and increased frailty, nursing home residents with confirmed COVID-19 have an increased thrombotic risk. Therefore, a primary thromboprophylactic (TP) strategy was formulated (see figure 1) and applied to COVID-19 positive residents in Islington nursing homes. This included the prescribing of apixaban 2.5 mg twice daily if there were no contraindications. The guideline included a risk versus benefit assessment tool, prescribing advice and monitoring recommendations. It was also stated that the prescribing of apixaban for this indication would be considered as off-label use. The guideline was amended following the role out of the COVID-19 vaccination programme with the addition of 'residents who have been doubly vaccinated and become COVID positive but are asymptomatic will not require VTE prophylaxis as the vaccines have demonstrated some protection against severe illness from COVID-19'. The aim of this service evaluation is to review the implementation of this thromboprophylactic strategy. This included the number of residents prescribed TP, the incidence of bleeding or thrombotic complications, as well as number of deaths relating to COVID-19. Data were retrospectively collected from six nursing homes between November 2020 and April 2021 from GP electronic medical records (EMIS). Fifty-one residents tested positive for COVID-19 during this time. Six deceased residents were eliminated from the audit as their electronic records were not available to determine thromboprophylactic status. Additionally, two residents were excluded as they were admitted to hospital and 12 residents were already in receipt of anticoagulation. The 12 residents who were already prescribed anticoagulation prior to their positive COVID test were on anticoagulation for the treatment of AF. From these 12 residents, three died with COVID-19 reported on their death certificates. Of the 31 residents included, there were 12 males and 19 [SZ4] females and the median age was 79 years (range: 46-101). All residents had at least one co-morbidity which would increase their VTE risk. Twenty-three (74%) residents were prescribed TP in line with the guidelines. Of these, three died from COVID-19. The remaining eight residents were not prescribed TP. Of these eight, two died from COVID-19. The most common reasons for not prescribing thromboprophylaxis included residents on end-of-life care, high bleeding risk or lack of locum GP awareness of the guidelines. There were no reported bleeding events in residents prescribed TP. There were no thrombotic events in residents prescribed TP. The accuracy of the cause of death recorded for the deceased residents was limited, due to the absence of postmortem examinations. The numbers of residents included in this audit was too small to provide statistical relevance. Apixaban may be a safe option for residents in nursing homes who are COVID-19 positive and are considered to have a high risk of thrombosis..
ABSTRACT
Background: End-stage kidney disease (ESKD) impacts more than 785,000 Americans and often occurs with multiple comorbid conditions, especially cardiovascular diseases, which are the most common cause of death (COD) in ESKD. Many complications directly arise from ESKD, but its deadly impact can be overlooked. At our institution, the death certificate is completed by clinicians and a majority by clinical house staff. We reviewed the death certificates of ESKD autopsies to understand the clinicians' perspectives on the range of CODs in this clinical setting. Design: We searched our database for autopsies of adult ESKD patients (2012-2021) that had accessible death certificates. COVID-positive cases were excluded. We evaluated the COD section of death certificates and correlated them with autopsy findings. The frequency of autopsy findings directly identifying CODs or resulting in amendments of death certificates was also noted. Results: Of 68 autopsy reports, the majority of CODs reported in death certificates were related to sepsis/infection (30%), and cardiovascular diseases (26%). There was no documentation of ESKD in the majority (78%,53/68) of death certificates. Of these 53 cases, 89% had COD either due to fatal complications of ESKD (98%) or increased mortality of another comorbid condition due to the underlying ESKD. The remaining 11% had COD unrelated to ESKD. Among the fatal complications of ESKD, cardiovascular complications were the most commonly noted (72%) followed by sepsis (20%). Autopsy findings were used to identify the COD on death certificates in only 6% of cases. No amendments were made on any of these death certificates. Conclusions: ESRD is often not mentioned in death certificates, which underestimates its mortality burden. The death certificate is a source for mortality statistics and used by government for public health policy and allocation of research funding. Hence, accurate accounting of death certificates is essential for this complex and silent disease.
ABSTRACT
Objective: To analyze the causes of death by diseases of the respiratory system in Spain in 2020, with special interest in COVID-19; also its trends and determinants, and compare them with 2019. Material and methods: Retrospective cohort study. The coding of all those causes of death by diseases of the respiratory system were regrouped. A descriptive analysis of all deaths and by gender, age, and the 17 Autonomous Communities (CC.AA.) was performed. Also, odds ratios of death in crude and multivariate analysis by logistic regression were estimated. Results: In Spain in 2020, 60,358 deaths were attributed to "COVID-19 virus identified" and another 14,481 to "COVID-19 virus not identified (suspicious)". Regrouping the specific causes of death, in 2020 the diseases of the respiratory system caused a total of 139,880 deaths, which corresponds to 28.3% of all deaths in Spain. Compared to 2019, an increase of 68.5% was observed. By gender, deaths by diseases of the respiratory system were higher in men (32.0%) than in women (24.6%), although in specific causes the percentage was higher in women with suspected COVID-19, asthma, respiratory insufficiency and other diseases of the respiratory system. Finally, the variables associated with death from COVID-19 in the multivariate analysis were being male, increasing age (maximum at 80 years), completed studies up to secondary level, employed, and single or widowed marital status, although with a marked variation by CC.AA. Conclusions: In Spain in 2020, COVID-19 produced a large increase (68.5%) in deaths by diseases of the respiratory system compared to the previous year.
Objetivo: Analizar las causas de muerte por enfermedades del aparato respiratorio en España durante el año 2020, con especial interés en COVID-19; también sus tendencias y determinantes, y compararlas con el año 2019. Material y métodos: Estudio de cohortes retrospectivo. Se reagrupó la codificación de todas aquellas causas de muerte por enfermedades del aparato respiratorio. Se realizó un análisis descriptivo de todas las defunciones por sexo, edad en las 17 Comunidades Autónomas (CC. AA.). Además, se estimaron las odds ratios de muerte en análisis crudo y multivariado por regresión logística. Resultados: En España en el año 2020 se atribuyeron 60.358 muertes a «COVID-19 virus identificado¼ y otras 14.481 a «COVID-19 virus no identificado (sospechoso)¼. Reagrupando las causas específicas de muerte, en el año 2020 las enfermedades del aparato respiratorio provocaron un total de 139.880 muertes, lo que corresponde al 28,3% de todas las muertes en España. En comparación con el año 2019, se observó un aumento del 68,5%. Por género, las defunciones por enfermedades del aparato respiratorio fueron mayores en los varones (32,0%) que en las mujeres (24,6%), aunque en causas específicas el porcentaje fue mayor en mujeres en COVID-19 sospechosa, asma, insuficiencia respiratoria y otras enfermedades del aparato respiratorio. Finalmente, las variables asociadas a la muerte por COVID-19 en el análisis multivariante fueron el género masculino, el aumento de la edad (máximo a los 80 años), estudios completados hasta secundaria y el estado civil soltero o viudo, aunque con una marcada variación por CC. AA. Conclusiones: En España en el año 2020 la COVID-19 produjo un gran incremento (68,5%) de muertes por enfermedades del aparato respiratorio en comparación con el año anterior.