Differential declines in syphilis-related mortality in the United States, 2000-2014.

BACKGROUND: After reaching an all time low in 2000, the rate of syphilis in the United States has been steadily increasing. Parallel benchmarking of the disease's mortality burden has not been undertaken. METHODS: Using ICD-10 classification, all syphilis-related deaths in the national Multiple Cause of Death dataset were examined for the period 2000-2014. Descriptive statistics and age-adjusted mortality rates were generated. Poisson regression was performed to analyze trends over time. A matched case-control analysis was conducted to assess the associations between syphilis-related deaths and comorbid conditions listed in the death records. RESULTS: A total of 1,829 deaths were attributed to syphilis; 32% (n = 593) identified syphilis as the underlying cause of death. Most decedents were men (60%) and either black (48%) or white (39%). Decedents aged ≥85 years had the highest average mortality rate (0.47 per 100,000 population; 95% confidence interval [CI], 0.42-0.52). For the sampled period, the average annual decline in mortality was -2.90% (95% CI, -3.93% to -1.87%). However, the average annual percent change varied across subgroups of interest. CONCLUSIONS: Declines in U.S. syphilis mortality suggest early detection and improved treatment access likely helped attenuate disease progression; however, increases in the disease rate since 2000 may be offsetting the impact of these advancements.

Burden of Alzheimer's disease-related mortality in the United States, 1999-2008.

OBJECTIVES: To update and examine Alzheimer's disease-related mortality trends according to age, sex, race and ethnicity, geography, and other case characteristics for a 10-year period. DESIGN: Trend and comparative analyses of the U.S. multiple-cause-of-death records for 1999 to 2008. SETTING: United States. PARTICIPANTS: Participants were decedents with Alzheimer's disease (AD) coded as underlying or associated cause of death; decedents with other forms of dementia or cognitive disorder were excluded. MEASUREMENTS: Case frequency, age-specific death rates, and crude and age-adjusted mortality rates were estimated for all AD decedents from the sampled period. Measures of AD mortality burden were compared with those of other leading causes of death (e.g., diabetes mellitus, stroke). RESULTS: From 1999 to 2008, 879,281 AD-related deaths were identified. The age-adjusted mortality rate for AD increased from 45.3 per 100,000 population (95% confidence interval (CI) = 45.0-45.7) in 1999 to 50.0 per 100,000 population (95% CI = 49.7-50.3) in 2008. The average age at death was 85.9. Differences in AD-related deaths varied according to sex, race and ethnicity, and geography. The number of AD-related deaths and age-specific mortality for persons aged 85 and older (n = 532,338, 1,096.6 per 100,000 population) were comparable with those from the same age group who died from diabetes mellitus (n = 488,593, 1,006.5 per 100,000 population). CONCLUSION: The burden of AD-related mortality was substantial for the period 1999 to 2008. This burden is expected to grow rapidly as the baby boomer generation ages. Findings from this study may have important implications for present and future planning in medicine, social services, public policy, and public health.