Rising Mortality among Non-Hispanics due to Pancreatic Cancer in the United States. A CDC Database analysis.

PURPOSE: To examine mortality trends among non-Hispanic (NH) adults with pancreatic cancer. METHOD: CDC-WONDER database was used to extract death certificate data on pancreatic cancer-related mortality in NH adults aged ≥ 45 from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were calculated and stratified by year, age, sex, race, and region. RESULTS: From 1999 to 2020, 783,772 deaths occurred among middle-aged (45-64) and older (65-85 +) NH adults. Overall AAMR increased from 31.7 in 1999 to 33.8 in 2020 (APC: 0.35; 95% CI:0.28-0.41). NH older adults had higher AAMRs (67.9) than NH middle-aged adults (12.5). Men consistently had higher AAMRs (37.7) than women (28.4). NH African Americans had the highest AAMRs (40.8) compared to NH Whites (32.1), NH American Indians (23.9), and NH Asians (22.4). Metropolitan areas had a higher AAMR (32.7) than non-metropolitan areas (32.2). The Northeast region had the highest AAMR (34.0) followed by Midwest (33.2), South (32.2), and West (30.1). Delaware, District of Columbia, Louisiana, Michigan, and Mississippi had the highest AAMRs among states. CONCLUSIONS: Pancreatic cancer-related mortality among NH adults has increased from 1999 to 2020. Highest AAMRs were reported in older men, NH African Americans, the Northeastern and metropolitan areas.

Trends in mortality related to kidney failure and diabetes mellitus in the United States: a 1999-2020 analysis.

BACKGROUND: Kidney failure ranks as the tenth leading cause of mortality in the United States (US), frequently arising as a complication associated with diabetes mellitus (DM). METHODS: Trends in DM and kidney failure mortality were assessed using a cross-sectional analysis of death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Crude and age-adjusted mortality rates (AAMR) per 100,000 people and annual percent change (APC) in age-adjusted mortality rate with 95% CI were obtained and measured across different demographic and geographic subgroups. RESULTS: Between 1999 and 2020, a total of 325,515 deaths occurred related to kidney failure and DM. The overall age-adjusted mortality rate showed no significant change between 1999 and 2012, after which it declined until 2015 - 64.8 (95% CI - 75.6 to - 44.8) and has been steadily increasing since. Men had consistently higher age-adjusted mortality rates than women throughout the study duration (overall age-adjusted mortality rate men: 8.1 vs. women: 5.9). Non-Hispanic (NH) Black or African American individuals had the highest overall age-adjusted mortality rate (13.9), followed by non-Hispanic American Indian or Alaskan Native (13.7), Hispanic or Latino (10.3), non-Hispanic Asian or Pacific Islander (6.1), and non-Hispanic White (6.0). Age-adjusted mortality rate also varied by region (overall age-adjusted mortality rate: West:7.5; Midwest: 7.1; South: 6.8; Northeast: 5.8), and non metropolitan areas had higher overall age-adjusted mortality rate (7.5) than small/medium (7.2) and large metropolitan areas (6.4). CONCLUSION: After an initial decline, mortality rose across all the demographic groups from 2015 to 2020, revealing notable disparities in gender, race, and region.

Demographic and geographical trends in chronic lower respiratory diseases mortality in the United States, 1999 to 2020.

Chronic lower respiratory disease (CLRD) related mortality has decreased in the United States due to increasing awareness in the general population and advancing preventative efforts, diagnostic measures, and treatment. However, demographic and regional differences still persist throughout the United States. In this study, we analyzed the temporal trends of demographic and geographical differences in CLRD-related mortality. Data was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Using this data, age-adjusted mortality rates per 100,000 people (AAMR), annual percentage change (APC), and average annual percentage changes with 95% confidence intervals (CIs) were assessed. The Joinpoint Regression Program was used to determine mortality trends between 1999 and 2020 based on demographic and regional groups.During this study period, there were 3,064,049 CLRD-related deaths, with most demographics and regional areas showing an overall decreasing trend. However, higher mortality rates were seen in the non-Hispanic White population and rural areas. Interestingly, mortality rates witnessed a decreasing trend for males throughout the study duration compared to females, who only began to show decreases in mortality during the latter half of the 2010s. Using these results, one can target efforts and build policies to improve CLRD-related mortality and reduce disparities in the coming decades.

Racial/ethnic trends in opioid and polysubstance opioid overdose mortality in adolescents and young adults, 1999-2020.

OBJECTIVES: Previous reports have described variations in opioid overdose mortalities among different race/ethnicity groups. We have analyzed racial/ethnicity trends in opioid and polysubstance opioid overdose mortalities in adolescents and young adults to further characterize differences and potential sub-epidemics within this specific population. METHODS: We used mortality data from the U.S. Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death file from 1999 to 2020. Drug overdose mortalities were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Joinpoint regression was used to examine mortality rates for all opioids, opioids with a stimulant, opioids with benzodiazepines, and opioids with alcohol among racial/ethnic groups (non-Hispanic white, non-Hispanic Black, Hispanic, non-Hispanic other) in adolescents and young adults. RESULTS: The Average Annual Percent Change (AAPC) for mortality due to opioid and polysubstance opioid overdose increased for all racial/ethnic groups where data was available for analysis from 1999 to 2020. For mortality due to any opioid and any opioid with a stimulant, the greatest AAPC was seen among non-Hispanic Blacks. CONCLUSIONS: Unprecedented increases in mortality due to opioid overdose occurred in the last two decades among adolescents and young adults. Heterogenous trends support the notion that the previously defined opioid overdose epidemic "waves" may not accurately depict the effects of the crisis in all race/ethnicity groups. Additionally, alarming increases in opioid-stimulant overdose mortality starting in 2012 further characterize the interrelated effects of the third and fourth waves.

Trends of Acute Myocardial Infarction Mortality in People Over 65 Years Old in the United States From 1999-2020: Insight From the CDC-WONDER Database.

Background Over the past two decades, there have been numerous advances in acute myocardial infarction (AMI) care. We assessed the impact of these advances on the trend of AMI-related mortality. Methods This retrospective analysis of the Centers for Disease Control's Wide-ranging Online Data for Epidemiologic Research (CDC_WONDER) database focused on AMI-related mortality in individuals aged 65 and older in the United States from 1999 to 2020. Trends -n crude and age-adjusted mortality rates (AAMR) were assessed based on socio-demographic and regional variables using Joinpoint Regression software (Joinpoint Regression Program, Version 5.0.2 - May 2023; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute Bethesda, Maryland). Annual percentage change (APC) with 95% confidence intervals (CIs) for the AAMRs were calculated for the line segments linking a Joinpoint using a data-driven weighted Bayesian Information Criterion (BIC) model. Results There were 2,354,971 AMI-related deaths with an overall decline in the AAMR from 474.6 in 1999 to 153.2 in 2020 and an average annual percentage change (AAPC) of -5.3 (95% CI -5.4 to -5.2). Notable declines were observed across gender, race, age groups, and urbanization levels. However, the rate of AMI-related deaths at decedents' homes slowed down between 2008 and 2020 and climbed up between 2018 and 2020. In addition to this, nonmetropolitan areas were found to have a significantly lower decline in mortality when compared to large and medium/small metropolitan areas. Conclusion While there is an overall positive trend in reducing AMI-associated mortality, disparities persist, emphasizing the need for targeted interventions.

Pericardial Diseases Mortality Trends in Brazil From 2000 to 2022.

Background Pericardial diseases manifest in various clinical forms, including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade, with acute pericarditis being the most prevalent. These conditions significantly contribute to mortality rates. Therefore, this article aimed to analyze mortality trends in the Brazilian population based on age and sex, shedding light on the impact of pericardial diseases on public health outcomes. Methods  This is a retrospective time-series analysis of pericardial disease mortality rates in Brazil (2000-2022). Data was obtained from the Department of Informatics of the Unified Health System (DATASUS), and the 10th edition of the International Classification of Diseases (ICD-10) codes: I30, I31, and I32 were included for analysis. We gathered population and demographic data categorized by age range and sex from the Brazilian Institute of Geography and Statistics (IBGE). Subsequently, we computed the age-standardized mortality rate per 100,000 individuals and assessed the annual percentage changes (APCs) and average annual percentage changes (AAPCs) using joinpoint regression, along with their corresponding 95% confidence intervals (CIs). Results  In terms of mortality trends based on sex, overall mortality rates remained stable for males and combined sexes over the study period. However, there was a notable increase in mortality rates among females (AAPC=1.18), particularly between 2020 and 2022, with a significant APC of 27.55. Analyzing pericardial diseases across different age groups (20 to 80 years and above), it wasobserved that mortality rates significantly increased in the 70-79 and 80 years and above age groups throughout the study period (AAPC=1.0339 and AAPC=3.4587, respectively). These two age groups experienced the highest significant rise in mortality between 2020 and 2022. Other age groups did not exhibit a significant change in AAPC. Conclusions  This comprehensive analysis spanning two decades (2000-2022), examined the mortality trends of pericardial diseases in Brazil and revealed relative stability overall. Males exhibited an overall higher mortality number due to pericardial diseases; however, females showed the most significant increase in mortality trend throughout the whole period. In the first segment (2000-2015), mortality rose across all cohorts, which was attributed to substandard healthcare facilities and infectious diseases like tuberculosis. The second segment (2016-2020) saw a decline in mortality, likely due to improved healthcare, particularly the increased availability of echocardiograms. However, the third segment (2020-2022) witnessed a sharp rise in mortality, coinciding with the COVID-19 pandemic, with post-COVID-19 symptoms, particularly pericarditis. Pericarditis-related death rates declined compared to pericardial effusion, and mortality rates correlated directly with age, with older cohorts experiencing higher mortality due to increased comorbidities, and decline in health and immunocompetency.

Deciphering Trends in Cancer Mortality: A Comprehensive Analysis of Brazilian Data From 1979 to 2021 With Emphasis on Breast and Prostate Cancers.

Background: This study examined cancer mortality trends in Brazil from 1979 to 2021, emphasizing breast and prostate cancers. Methods: Utilizing data from the Brazilian Mortality Information System and the Brazilian Institute of Geography and Statistics, it analyzed cancer deaths nationally and regionally, highlighting gender-specific and regional disparities. Results: The research finds that cancer death rates have been growing at an average of 12% per year, contrasting with the population growth rate of 2.2%. This trend is more pronounced in the southern and southeastern regions of Brazil. A comparison of cancer mortality rates between Brazil, the USA, and China reveals that while the Brazilian and Chinese rates exhibit slower growth, the US rate shows a continuous decline since the 1990s. Conclusions: The study adopts a novel approach by focusing on growth rates and employing polynomial interpolation, revealing a deceleration in cancer death growth over the last 15 years across all malignant neoplasms. The study also contextualizes these findings within Brazil's cancer control policies, tracing the evolution of preventive measures and treatment advancements. It highlights the significant role of the National Cancer Institute and the Unified Health System in implementing effective strategies. The decreasing trend in cancer mortality rates in Brazil, despite population growth, illustrates the effectiveness of comprehensive cancer control and prevention measures, underlining their importance in public health policy.

Disparities in Place of Death Among Malnourished Individuals in the United States.

BACKGROUND: Deficiencies or imbalances in a person's intake of nutrients are referred to as malnutrition. Malnutrition remains a significant public health concern in the United States, with potential consequences ranging from chronic disease to mortality. This study aims to assess the disparities in place of death due to malnutrition in the United States from 1999 to 2020, based on variables like age, gender, race, and location, utilizing the Centers for Disease Control and Prevention Information and Communication Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. METHODOLOGY: Data regarding mortality due to malnutrition was extracted for the years 1999-2020 from the CDC WONDER database. Univariate regression analysis was performed to investigate disparities in the place of death based on variables. RESULTS: Between 1999 and 2020, a total of 1,03,962 malnutrition-related deaths were recorded, with 31,023 in home and hospice care, 68,173 in medical and nursing facilities, and 4,766 in other places. The odds of death due to malnutrition at home or hospice were highest for the 85+ age group, female gender, census region 4 (West), and Asian or Pacific Islander race. CONCLUSIONS: This study reveals a rising trend in mortality due to malnutrition in the United States, especially among certain demographic groups and in medical facilities and nursing homes. It emphasizes the need to understand the factors contributing to this increase in mortality rates. Future research should focus on these contributors to combat the rising burden of malnutrition-related mortality in the United States.

Disparities in the Place of Death for Patients With Malignant Neoplasms of the Thyroid Gland.

Introduction This study aims to examine the disparities in the place of death for patients due to thyroid neoplasms and understand the mortality trends. The study also aims to assess the influence of factors like age, gender, geography, and race, thus allowing for the assessment and improvement of end-of-life and palliative care. Methodology The study analyzes thyroid cancer mortality trends from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database, taking into consideration locations of death, medical facilities, home and hospice care, and others. Additional categories such as race, gender, and U.S. census regions were variables chosen to segregate the deaths. Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States) and autoregressive integrated moving average (ARIMA) modeling were used for data analysis. Results The study revealed that around 50% of thyroid cancer patients in the United States passed away at home or in hospice settings, while the other 50% died in medical facilities or nursing homes. Patients aged 65-74 and 75-84 were more likely to die at home or in hospice, and males had a higher likelihood of dying in these settings compared to females. Geographically, individuals in the South and West regions were more inclined to die at home or in hospice. Additionally, racial disparities were observed, with Black or African Americans being less likely than Whites to die in home or hospice settings. Conclusions Socio-demographic factors play a major role in shaping end-of-life care, underscoring the need for tailored interventions. There is also a need for more refined early diagnostic techniques for smaller, localized tumors. Future studies should investigate the relationship between profession and income and the incidence and mortality of thyroid cancer.

Gender Differences in Trends in Incidence and Mortality of Acute Myocardial Infarction in the Small Island Developing State of Barbados.

Objective To determine trends, identify predictors of acute myocardial infarction (AMI) incidence and mortality, and explore performance metrics for AMI care in Barbados. Methods Data on all cases diagnosed with AMI were collected by the Barbados National Registry for Non-Communicable Diseases (BNR) from the island's only tertiary hospital, the Queen Elizabeth Hospital, and the National Vital Registration Department. Participants who survived hospital admission were then followed up at 28 days and one year post event via telephone survey and retrieval of death certificates. Age-standardized incidence and mortality rates were calculated. Determinants of mortality at 28 days were examined in multivariable logistic regression models. Median and interquartile ranges (IQR) were calculated for performance metrics (e.g., time from pain onset to reperfusion). Results In a 10-year period between 2010 and 2019, 4,065 cases of myocardial infarction were recorded. The median age of the sample was 73 years (IQR: 61,83), and approximately half (47%) were female. Over a 10-year period, standardized incidence increased in women on average yearly by three per 100,000 (95% CI: 1 to 6; p=0.02), while in men, the average increase per year was six per 100,000 (95% CI: 4 to 8; p<0.001). There was no increase in 28-day mortality in women; mortality in men increased each year by 2.5 per 100,000 (95% CI: 0.4 to 4.5; p=0.02). The time from arrival at the hospital to the ECG was 44 minutes IQR (20,113). Conclusion AMI incidence and mortality are increasing in Barbados, and men have a higher velocity of mortality rate increase than women, which contradicts global data.

Demographic Disparities in Acute Myeloid Leukemia Mortality Trends in the United States.

BACKGROUND/AIM: Acute myeloid leukemia (AML) is a hematological malignancy with an overall poor prognosis; however, survival rates vary widely by clinical and demographic characteristics. This study sought to identify historical trends in AML mortality in the US and to identify any disparities by sex, race or ethnicity. PATIENTS AND METHODS: For each demographic population, the age adjusted mortality rate (AAMR) per 1,000,000 for AML-related deaths from 1999 to 2020 in the United States was accessed from the CDC Wonder Database. These values were then used to calculate the average Annual Percent Change (AAPC) from 1999 to 2020 using the National Cancer Institute (NCI)'s Joinpoint Regression Program (Joinpoint V 4.9.0.0, NCI) with log-linear regression models. Statistical significance for all reported findings was determined using a 2-tailed t-test or parallel pairwise comparison with significance defined as p<0.05. RESULTS: The overall population had a significant downtrend in mortality rate between 2011 and 2020 with an APC of -0.61% [95% confidence interval (CI)=-1 to -0.2]. In 2020, the AAMR due to AML for males was 32 and for females was 20.2. Females did not have a significant overall AAPC from 1999 to 2020. Males had a significant AAPC of 0.5% (95%CI=0-0.9) from 1999 to 2020, signifying an overall uptrend. In 2020, the White population had the greatest mortality rate (29.6), followed by the Black or African American population (20.9), Asian or Pacific Islander (AAPI) population (18.6), and the American Indian/Alaska Native population (8.8). American Indian and Alaska Native population data could not be reliably compared. No race/ethnic group had a significant AAPC trend from 1999 to 2020. However, parallel pairwise comparison found a significant difference in the trend of mortality rates between the Black or African American and AAPI, Black or African American and White, and White and AAPI populations. CONCLUSION: Our findings highlight disparities in mortality due to AML and underscore the need for additional resources and support in affected populations and areas.

Myelodysplastic syndromes mortality in Spain: a comprehensive age-period-cohort and joinpoint analysis / Mortalidad por síndromes mielodisplásicos en España: análisis integral de cohortes por períodos de edad y de puntos de unión

Objective: The present study aims to assess the mortality trends in myelodysplastic syndromes (MDS) in Spain from 1980 to 2021. Methods: Deaths and mid-year population data were collected from the National Institute of Statistics. We estimated age-standardised mortality rates (ASMRs) per 100,000 person-years for all ages and ages 35–64. Joinpoint regression identified significant changes in mortality trends. The independent effects of age, period and birth cohort on MDS mortality were also examined. Results: MDS-related deaths gradually increased from 36 in 1980 to 1118 in 2021, with an overall increase of 6.6% in age-standardised mortality rates (ASMRs) for both men and women. Joinpoint analysis identified four periods for both men and women: 1980–1987 (stable rates), 1987–1990 (sharp increase), 1990–1999 (slower increase) and 1999–2021 (stable rates). ASMRs (35–64 years) increased by 2.5% over the study period, with a turning point identified in 1996 when rates decreased. Mortality from MDS increases with age and is higher in men. The cohort's relative risk increased until the mid-1950s and then stabilised, whilst the period relative risk increased between 1982 and 1996 and then stabilised. Conclusion: The results of this study indicate a progressive increase in MDS-related deaths in Spain between 1980 and 2021. Notably, this increase was more pronounced in men than in women. Analysis of birth cohort trends revealed shifts in MDS risk, characterised by an increase until the mid-twentieth century, followed by a stabilisation. Using joinpoint analysis, four distinct periods were identified, shedding light on the changing patterns of mortality over time. These findings help to shape future research directions and inform public health strategies. They also provide optimism for advances in MDS treatment and potential reductions in mortality.(AU)

Unraveling disparities: Probing gender, race, and geographic inequities in pulmonary heart disease mortality in the United States: An extensive longitudinal examination (1999-2020) leveraging CDC WONDER data.

This comprehensive study delves into the epidemiological landscape of Pulmonary Heart Disease (PHD) mortality in the United States from 1999 to 2020, leveraging the extensive CDC WONDER database. PHD encompasses conditions affecting the right side of the heart due to lung disorders or elevated pressure in the pulmonary arteries, including pulmonary hypertension, pulmonary embolism, and chronic thromboembolic pulmonary hypertension (CTEPH). Analyzing data from death certificates, demographic characteristics, and geographical segmentation, significant trends emerge. The age-adjusted mortality rates (AAMRs) for PHD-related deaths show a fluctuating pattern, initially decreasing from 1999 to 2006, followed by a steady increase until 2020. Male patients consistently exhibit higher AAMRs than females, with notable disparities observed among racial/ethnic groups and geographic regions. Non-hispanic (NH) Black or African American individuals, residents of specific states like Colorado and the District of Columbia, and those in the Midwest region demonstrate elevated AAMRs. Furthermore, nonmetropolitan areas consistently manifest higher AAMRs than metropolitan areas. These findings underscore the urgent need for intensified prevention and treatment strategies to address the rising mortality associated with PHD, particularly among vulnerable populations. Insights from this study offer valuable guidance for public health initiatives aimed at reducing PHD-related mortality and improving outcomes nationwide.

US exceptionalism? International trends in midlife mortality.

BACKGROUND: Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64 years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. METHODS: We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64 years) age-standardized death rates across 15 major cause-of-death categories. RESULTS: US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54 year and in Canada, Poland and Sweden among for those aged 25-44 years. CONCLUSIONS: The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.

Inter-district and Wealth-related Inequalities in Maternal and Child Health Service Coverage and Child Mortality within Addis Ababa City.

In sub-Saharan Africa, urban areas generally have better access to and use of maternal, newborn, and child health (MNCH) services than rural areas, but previous research indicates that there are significant intra-urban disparities. This study aims to investigate temporal trends and geographic differences in maternal, newborn, and child health service utilization between Addis Ababa's poorest and richest districts and households. A World Bank district-based poverty index was used to classify districts into the top 60% (non-poor) and bottom 40% (poor), and wealth index data from the Ethiopian Demographic and Health Survey (EDHS) was used to classify households into the top 60% (non-poor) and bottom 40% (poor). Essential maternal, newborn, and child health service coverage was estimated from routine health facility data for 2019-2021, and five rounds of the EDHS (2000-2019) were used to estimate child mortality. The results showed that service coverage was substantially higher in the top 60% than in the bottom 40% of districts. Coverage of four antenatal care visits, skill birth attendance, and postnatal care all exceeded 90% in the non-poor districts but only ranged from 54 to 67% in the poor districts. Inter-district inequalities were less pronounced for childhood vaccinations, with over 90% coverage levels across all districts. Inter-district inequalities in mortality rates were considerable. The neonatal mortality rate was nearly twice as high in the bottom 40% of households' as in the top 60% of households. Similarly, the under-5 mortality rate was three times higher in the bottom 40% compared to the top 60% of households. The substantial inequalities in MNCH service utilization and child mortality in Addis Ababa highlight the need for greater focus on the city's women and children living in the poorest households and districts in maternal, newborn, and child health programs.

Disparities in Mortality Trends of Breast Cancer by Racial and Ethnic Status in the United States.

BACKGROUND AND AIM: Breast cancer is the most commonly diagnosed malignancy for women and is a leading cause of mortality in women worldwide and in the United States. Recently, new interventions have been developed to improve its prognosis. The aim of this study was to assess the impact of new therapies on racial and ethnic groups in the United States for demographic-based disparities. We assessed the impact of these developments from 1999 to 2020 on age adjusted mortality rate (AAMR), mortality rate trend from 1999 to 2020, average annual percent change (AAPC), and temporal trends, by annual percent change (APC) in the United States for various demographic groups. PATIENTS AND METHODS: We queried the CDC Wonder database to retrieve mortality rates by race and ethnic group from 1999 to 2020 with breast malignancy as a contributing cause of death. RESULTS: Between 1999 to 2020, all racial groups presented a significant overall decline in mortality rates: AI/AN [AAPC, -1.6% (95% CI=-2.2% to -1.0%); p<0.01], AAPI [AAPC, -0.5% (95% CI=-1.00% to -0.1%); p<0.01], Black/African American [AAPC, -1.4% (95% CI=-1.6% to -1.2%); p<0.01], and the white population [AAPC, -1.7% (95% CI=-1.8% to -1.5%); p<0.01]. The Black/African American population had a significant lower rate of decline compared to the white population (p<0.01) and Hispanic/Latinx populations had a lower rate of decline compared to those who are non-Hispanic/Latinx (p<0.01). CONCLUSION: We found that Black/African American population had a significant lower rate of decline compared to the white population and Hispanic/Latinx populations had a lower rate of decline compared to those who are non-Hispanic/Latinx. These differences in mortality trend rates in breast cancer emphasize the need for targeted interventions and resources tailored to specific demographic needs.

Medical Misadventures as Errors and Mistakes and Motor Vehicular Accidents in the Disproportionate Burden of Childhood Mortality among Blacks/African Americans in the United States: CDC Dataset, 1968-2015.

PURPOSE: Racial disparities in infant mortality in the United States persist after adjustment for known confounders of race and mortality association, as well as heterogeneity assessment. Epidemiologic and clinical data continue to show the survival disadvantages of Black/AA children: when Black/AAs are compared to whites, they are three times as likely to die from all-cause mortality. The persistent inability to remove the variance in race-mortality association is partly due to unobserved, unmeasured, and residual confounding, as well as implicit biases in public health and clinical medicine in health equity transformation. This current epidemiologic-perspective explanatory model study aimed to examine the possible explanation of racial differences in U.S. infant mortality using medical misadventures as errors and mistakes, and infants' involvement in motor vehicular traffic accidents. MATERIALS AND METHOD: Using CDC WONDER ecologic data from 1968 to 2015, we assessed the infant mortality-rate ratio and percent change associated with medical misadventures as well as motor vehicular accidents or trauma. The rate ratio and percent change were estimated using stratification analysis and trend homogeneity, respectively. RESULTS: There was a Black-white racial difference in medical misadventures during the study period. Relative to the years 1968-1978 (rate ratio [RR], 1.43), there was a steady increase in the mortality-rate ratio in 1979-1998 (52%, RR = 1.52), and mortality was more than two times as likely in 1999-2015 (RR = 2.37). However, with respect to motor vehicular accident/trauma mortality, the mortality ratio, although lower among Blacks in 1968-1978 (RR, 0.92), increased in 1979-1998 by 27% (RR = 1.27) but decreased in 1999-2015 (RR, 1.17), though there was still an excess of 17% mortality among Black/AAs. The percent change for medical misadventures indicated an increasing trend from 9.3% in 1998 to 52% in 2015. However, motor vehicular-related mortality indicated a positive trend in 1998 (38.5%) but a negative trend in 2015 (-8.4%). CONCLUSIONS: There were substantial race differentials or variances in infant mortality associated with medical misadventures compared to traffic accidents, and Black/AA children relative to whites experienced a survival disadvantage. These comparative findings are suggestive of medical misadventures and motor vehicular trauma as potential explanations for some of the persistent Black-white disparities in overall infant mortality in the U.S. From these findings, we recommend a national effort to address these issues, thus narrowing the observed disparities in the U.S. infant mortality burden among Black/AAs.

Unincreased mortality of patients with early rheumatoid arthritis compared to the general population in the past 17 years: Analyses from the IORRA cohort.

OBJECTIVES: The aim of this article is to investigate the mortality rate of patients with early rheumatoid arthritis (RA) over the past 17 years. METHODS: Japanese patients with early RA enrolled in the Institute of Rheumatology, Rheumatoid Arthritis cohort from 2001 to 2012 were classified into Groups A (2001-06) and B (2007-12). The standardized mortality ratio (SMR) and 5-year survival rate were calculated. RESULTS: Groups A and B had 1609 and 1608 patients, of which 167 and 178 patients were lost during follow-up and 47 and 45 deaths were confirmed, respectively. The SMR (95% confidence intervals) for Groups A and B were 0.81 (0.59-1.08) and 0.78 (0.57-1.04), respectively, with the condition that all untraceable patients were alive. Assuming that the mortality rate of untraceable patients was twice as high as that of the general population, the SMR was 0.90 (0.68-1.19) for Group A and 0.92 (0.68-1.23) for Group B. The 5-year survival rates were 96.9% and 97.0% for Groups A and B, respectively. CONCLUSIONS: The 5-year mortality of patients with early RA has been comparable to that of the general Japanese population. The 5-year survival rate has been stable over the past 17 years.

Causes of death among Australians with type 1 or type 2 diabetes, 2002-2019.

AIMS: This population-based study sought to explore in detail the conditions driving the diversification in causes of death among people with diabetes. METHODS: We linked Australians with type 1 or type 2 diabetes of all ages on the National Diabetes Services Scheme to the National Death Index for 2002-2019. We investigated the proportional contributions of different causes of death to total deaths over time across eight categories of causes of death, stratified by sex and diabetes type. The underlying causes of death were classified according to the International Classification of Diseases, Tenth Revision codes. RESULTS: Between 2002 and 2019, there was a shift in the causes of death among Australians with diabetes away from cardiovascular disease. The proportion of deaths attributed to cardiovascular disease declined in both sexes (ptrend <0.001), most substantially among women with type 2 diabetes from 48.2% in 2002 to 30.7% in 2019. Among men with type 2 diabetes, cancer replaced cardiovascular disease as the leading cause of death. The proportion of deaths due to dementia increased overall, from 2% in 2002 to over 7% in 2019, and across all age groups, notably from 1% to 4% in those aged 70-79. The proportion of deaths due to falls and Parkinson's disease also increased. CONCLUSIONS: There has been a shift of causes of death among those with diabetes away from cardiovascular disease. The proportion of deaths due to conditions such as dementia and falls is increasing among those with diabetes, which will require consideration when planning future resource allocation.