Lost years, mortality burden: the impact of COVID-19 pandemic on premature death due to road traffic accidents in a northern state in Malaysia.

BACKGROUND: This study addresses the persistent global burden of road traffic fatalities, particularly in middle-income countries like Malaysia, by exploring the impact of the COVID-19 pandemic on Road Traffic Accident (RTA) fatalities in Perak state, Malaysia, with a secondary focus on applying Years of Life Lost (YLL) to understand the implications of these premature deaths. METHODOLOGY: The cross-sectional study retrospectively reviewed certified RTA fatalities from 2018 to 2021, individually counting fatalities in accidents and excluding cases with incomplete death profiles. Data were collected from all Forensic Departments in the government hospitals in Perak. RTA fatalities were confirmed by medical officers/physicians following established procedures during routine procedures. A total of 2517 fatal accident and victim profiles were transcribed into data collection form after reviewing death registration records and post-mortem reports. Inferential analyses were used for comparison between pre- and during COVID-19 pandemic. The standard expected YLL was calculated by comparing the age of death to the external standard life expectancy curve taking into consideration of age and gender in Malaysia. RESULTS: This study included 2207 (87.7%) of the RTA fatalities in Perak State. The analysis revealed a decreasing trend in RTA deaths from 2018 to 2021, with a remarkable Annual Percent Change (APC) of -25.1% in 2020 compared to the pre-pandemic year in 2019 and remained stable with lower APC in 2021. Comparison between pre-pandemic (2018-2019) and pandemic years (2020-2021) revealed a difference in the fatality distribution with a median age rise during the pandemic (37.7 (IQR: 22.96, 58.08) vs. 41.0 (IQR: 25.08, 61.00), p = 0.002). Vehicle profiles remained consistent, yet changes were observed in the involvement of various road users, where more motorcycle riders and pedestrian were killed during pandemic (p = 0.049). During pandemic, there was a decline in vehicle collisions, but slight increase of the non-collision accidents and incidents involving pedestrians/animals (p = 0.015). A shift in accident from noon till midnight were also notable during the pandemic (p = 0.028). YLL revealed differences by age and gender, indicating a higher YLL for females aged 30-34 during the pandemic. CONCLUSION: The decline in RTA fatalities during COVID-19 pandemic underscores the influence of pandemic-induced restrictions and reduced traffic. However, demographic shifts, increased accident severity due to risky behaviors and gender-specific impacts on YLL, stress the necessity for improved safety interventions amidst evolving dynamics.

Association of waist circumference and BMI with premature death in young and middle-aged population.

Introduction: Premature death is a global health indicator, significantly impacted by obesity, especially in young and middle-aged population. Both body mass index (BMI) and waist circumference (WC) assess obesity, with WC specifically indicating central obesity and showing a stronger relationship with mortality. However, despite known associations between BMI and premature death, as well as the well-recognized correlation between WC and adverse health outcomes, the specific relationship between WC and premature death remains unclear. Therefore, focusing on young and middle-aged individuals, this study aimed to reliably estimate independent and combined associations between WC, BMI and premature death, thereby providing causal evidence to support strategies for obesity management. Methods: This study involved 49,217 subjects aged 18-50 years in the United States from 1999 to 2018 National Health and Nutrition Examination Survey (NHANES). Independent and combined associations between WC and BMI with premature death across sex and age stratum were examined by Cox regression. Survey weighting and inverse probability weighting (IPW) were further considered to control selection and confounding bias. Robustness assessment has been conducted on both NHANES and China Health and Retirement Longitudinal Study (CHARLS) data. Results: A linear and positive relationship between WC and all-cause premature death was found in both males and females, with adjusted HRs of 1.019 (95%CI = 1.004-1.034) and 1.065 (95%CI = 1.039-1.091), respectively. Nonlinear relationships were found with respect to BMI and all-cause premature death. For females aged 36-50 with a BMI below 28.6 kg/m2, the risk of premature death decreased as BMI increased, indicated by adjusted HRs of 0.856 (95%CI = 0.790-0.927). Joint analysis showed among people living with obesity, a larger WC increased premature death risk (HR = 1.924, 95%CI = 1.444-2.564). Discussion: WC and BMI exhibited prominent associations with premature death in young and middle-aged population. Maintaining an appropriate WC and BMI bears significant implications for preventing premature death.

Depression and the Risk of Dementia and All-Cause Mortality Among Japanese Older Adults: A 9-Year Longitudinal Study From JAGES.

BACKGROUND: This study aims to investigate the association and dose-response relationship between depression, dementia, and all-cause mortality based on a national cohort study of older adults in Japan. METHODS: We conducted a longitudinal study of 44,546 participants ≥65 years from 2010-2019 Japanese Gerontological Evaluation Study. The Geriatric Depression Scale-15 was used to assess depressive symptoms and the long-term care insurance was used to assess dementia. Fine-Gray models and Cox proportional hazard models were used to explore the effect of depression severity on the incidence of dementia and all-cause mortality, respectively. Causal mediation analysis were used to explore the extent of association between dementia-mediated depression and all-cause mortality. RESULTS: We found that both minor and major depressive symptoms were associated with the increased cumulative incidence of dementia and all-cause mortality, especially major depressive symptoms (p < .001). The multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia were 1.25 (1.19-1.32) for minor depressive symptoms and 1.42 (1.30-1.54) for major depressive symptoms in comparison to non-depression; p for trend < .001. The multivariable-adjusted HRs and 95% CIs for all-cause mortality were 1.27 (1.21-1.33) for minor depressive symptoms and 1.51 (1.41-1.62) for major depressive symptoms in comparison to non-depression; p for trend < .001. Depression has a stronger impact on dementia and all-cause mortality among the younger group. In addition, dementia significantly mediated the association between depression and all-cause mortality. DISCUSSION: Interventions targeting major depression may be an effective strategy for preventing dementia and premature death.

Socio-economic factors related to premature death from colorectal cancer in Santiago de Chile, 2014-2018: a cross-sectional study.

OBJECTIVES: In Chile, colorectal cancer (CRC) is the fourth cause of death by cancer. Few studies have evaluated the role of contextual and individual socio-economic variables associated with premature death by CRC (<70 years). We analyzed the association between socio-economic factors (at individual and contextual levels) and premature death from CRC in Santiago de Chile. STUDY DESIGN: This was a cross-sectional study. METHODS: We analyzed deaths from CRC between 2014 and 2018 using data published by the Ministry of Health. Individual predictors were sex, marital status, and educational level. Contextual variable included the Social Priority Index (SPI) of the commune where the deceased lived. The association was assessed through multilevel logistic regression models. RESULTS: During the period, 4762 deaths occurred (51.7% women); 39.3% were premature. At the individual level, male sex (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20-1.53) and single marital status (OR 1.45; 95% CI 1.24-1.68) were associated with premature death from CRC. Primary or lower education was a protective factor (OR 0.53; 95% CI 0.47-0.60). At the contextual level, communes with a higher SPI were three times more at risk than those with a lower SPI (OR 3.13; 95% CI 2.15-4.57). CONCLUSIONS: This study showed that individual and contextual socio-economic variables are related to premature death from CRC. Residing in communes with greater socio-economic vulnerability was associated with greater risk. To reduce this gap, it is urgent to design and implement structural policies to reduce social inequities and improve access to health care.

Mortality Burden Due to Short-term Exposure to Fine Particulate Matter in Korea.

OBJECTIVES: Excess mortality associated with long-term exposure to fine particulate matter (PM2.5) has been documented. However, research on the disease burden following short-term exposure is scarce. We investigated the cause-specific mortality burden of short-term exposure to PM2.5 by considering the potential non-linear concentration-response relationship in Korea. METHODS: Daily cause-specific mortality rates and PM2.5 exposure levels from 2010 to 2019 were collected for 8 Korean cities and 9 provinces. A generalized additive mixed model was employed to estimate the non-linear relationship between PM2.5 exposure and cause-specific mortality levels. We assumed no detrimental health effects of PM2.5 concentrations below 15 µg/m3. Overall deaths attributable to short-term PM2.5 exposure were estimated by summing the daily numbers of excess deaths associated with ambient PM2.5 exposure. RESULTS: Of the 2 749 704 recorded deaths, 2 453 686 (89.2%) were non-accidental, 591 267 (21.5%) were cardiovascular, and 141 066 (5.1%) were respiratory in nature. A non-linear relationship was observed between all-cause mortality and exposure to PM2.5 at lag0, whereas linear associations were evident for cause-specific mortalities. Overall, 10 814 all-cause, 7855 non-accidental, 1642 cardiovascular, and 708 respiratory deaths were attributed to short-term exposure to PM2.5. The estimated number of all-cause excess deaths due to short-term PM2.5 exposure in 2019 was 1039 (95% confidence interval, 604 to 1472). CONCLUSIONS: Our findings indicate an association between short-term PM2.5 exposure and various mortality rates (all-cause, non-accidental, cardiovascular, and respiratory) in Korea over the period from 2010 to 2019. Consequently, action plans should be developed to reduce deaths attributable to short-term exposure to PM2.5.

Diabetes mellitus as a cause of premature death in small areas of Spain by socioeconomic level from 2016 to 2020: A multiple-cause approach.

OBJECTIVE: This study aimed to assess premature mortality due to Diabetes in small areas of Spain between 2016 and 2020, and its relationship with socioeconomic level and the immediate cause of death. As a secondary objective, we evaluated the effect of the Covid 19 pandemic. METHODS: This was an ecological study of premature mortality due to Diabetes from 2016 to 2020, with a focus on small areas. All deaths in people under 75 years of age due to Diabetes as the underlying cause were included RESULTS: The final sample comprised 7382 premature deaths in 5967 census tracts. Women living in census tracts with an high level of deprivation(RR=2.40) were at a significantly higher risk. Mortality from Diabetes increased with deprivation, especially people aged 0-54(RR=2.40). People with an immediate cause of death related to a circulatory disease, living in census tracts with an high level of deprivation(RR=3.86) was associated with a significantly greater risk of death with underlying Diabetes. When a disease of the circulatory system was recorded as the immediate cause of death, being 65-74 years (RR=71.01) was associated with a significantly higher risk of premature mortality. CONCLUSIONS: Living in geographic areas with higher levels of socioeconomic deprivation is associated with a higher risk of premature death from Diabetes in Spain. This relationship has a greater impact on women, people under 54 years, and people at risk of death caused directly by diseases of the circulatory system. Premature mortality due to diabetes saw a modest increase in 2020.

Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study).

BACKGROUND: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Probability and trend of premature death of four major chronic diseases in Linyi City in 2013-2021 / 公共卫生与预防医学

Objective To analyze the mortality rate and probability of premature death caused by four major noninfectious chronic diseases (NCDs)in Linyi City from 2013 to 2021, and to provide data support for scientific formulation of chronic disease prevention and control strategy. Methods The mortality data of major chronic diseases in Linyi City from 2013 to 2021 were analyzed. The crude mortality, age-standardized mortality and premature death probability were calculated. The annual percent change (APC) was adopted to analyze the temporal trend of mortality and probability of premature death. Results The average annual crude mortality of four major NCDs was 538.98/100,000, and the age-standardized mortality was 387.3/100,000. The crude mortality rate increased from 517.37/100 000 in 2013 to 563.13/100 000 in 2021 (APC=0.89％, P=0.01). The age-standardized mortality rate decreased from 410.19/100,000 to 364.92/100,000 (APC=-1.8％, P=0.01). The crude mortality and age-standardized mortality of four major NCDs in males were higher than those in females (P<0.05). The average annual probability of premature death caused by four major NCDs was 13.37%. The probability of premature death decreased from 14.49％ in 2013 to 12.32％ in 2021（APC=-2.1％, P=0.00）. From 2013 to 2021, the probability of premature death from malignant tumors, cardiovascular and cerebrovascular diseases, and chronic respiratory diseases in Linyi City dropped from 6.14%, 7.47%, and 1.21% to 5.52%, 6.46%, and 0.5%, respectively (APCs were -1.2%, -2.1%, and -11.3%, respectively, and P values were 0.04, 0.00, and 0.00, respectively). The probability of premature death from diabetes remained stable. The probability of premature death caused by four major NCDs in males was higher than that in females (P<0.05). Conclusion The probability of premature death of the four major NCDs in Linyi has showed a downward trend during 2013-2021. It is suggested to strengthen the prevention and control of diabetes in the next step.

Tobacco smoke and all-cause mortality and premature death in China: a cohort study.

BACKGROUND: Tobacco smoke is associated with several diseases, and identified as the second leading risk factor for death from any cause worldwide. The relationship of tobacco smoke to mortality or premature death is not yet available from contemporary cohorts after 2010 in China. This study aimed to investigate the smoking behavior and the relationship of tobacco smoke to mortality and premature death among a nationally representative cohort starting from 2011 in China. METHODS: The nationally representative datasets (China Health and Retirement Longitudinal Study, CHARLS, 2011-2012) was employed and linked with follow-up data (2013). CHARLS was an ongoing nationally representative survey, which longitudinally followed up subjects aged over 45 years. Smoking status (non-smoker, ex-smoker, smoker, pack-years of smoking, age at starting and ceasing smoking) was used as independent variable, and all-cause mortality, premature death (defined as mortality before age 72.7 years in men and 76.9 years in women) were used as dependent variables. The Cox's proportional hazards regression mode was used to estimate the effect of tobacco smoke and pack-years of smoking on all-cause mortality and premature death. RESULTS: A total of 16,701 subjects were included. The association between tobacco smoker (hazard ratio [HR] = 1.37, 95%CI = 1.02, 1.83) / ex-smoker (HR = 1.75, 95%CI = 1.24, 2.46) and all-cause mortality was significant. Tobacco smoker (HR = 1.58, 95%CI = 1.04, 2.39) and ex-smoker (HR = 2.25, 95%CI = 1.38, 3.66) was associated with increase in the risk of premature death. Pack-years of smoking ≥ 30 was associated with increased risk of premature death compared with non-smokers in total (HR = 1.59, 95%CI = 1.03, 2.43) and women (HR = 3.38, 95%CI = 1.22, 9.38). Additionally, our results also revealed that there was a linear trend between pack-years of smoking and premature death in total (P = 0.002) and women (P = 0.010). CONCLUSION: This study found a negative effect of smoking status on all-cause mortality and premature death among a contemporary and nationally representative data in China. The correlation between pack-years of smoking and premature death and the trend of pack-years of smoking with premature death was also identified.

Comparative mortality risks in two independent bipolar cohorts.

OBJECTIVES: To compare mortality rates in bipolar disorder with common causes of mortality. METHODS: Observational data from the Prechter Longitudinal Study of Bipolar Disorder (PLS-BD) of 1128 participants including 281 controls was analyzed using logistical regression to quantify mortality rates in comparison with common comorbidities and causes of death. Outcome and treatment measures, including ASRM, GAD-7, PHQ-9 and medication use were used to stratify those with bipolar disorder (BD) that are alive or deceased. A larger cohort of 10,735 existing BD patients with 7,826 controls (no psychiatric diagnosis) from the University of Michigan Health (U-M Health) clinics was used as replication, observational secondary data analysis. RESULTS: The mortality rates are significantly different between those with BD and controls in both PLS-BD and U-M Health. Those with BD and are deceased have a higher percentage of elevated depression measures but show no difference in mania or anxiety measures nor medication use patterns. In both cohorts, a diagnosis of BD increases the odds of mortality greater than history of smoking or being older than ≥ 60-years of age. CONCLUSION: BD was found to increase odds of mortality significantly and beyond that of a history of smoking. This finding was replicated in an independent sample.

The Burden of Premature Mortality in Southern Iran during 2004-2019 Using Standard Expected Years of Life Lost: A Population-Based Study.

Background: Traditionally, mortality rates are used to estimate public health problems and determine the relative significance of different causes of mortality, but they cannot necessarily determine the burden of premature death. We aimed to investigate the 16-year trend of burden of premature mortality in Southern Iran. Methods: In this cross-sectional study, all deaths due to various causes of death in Fars Province from the electronic population-based death registration system (EDRS) were obtained. Crude and age-standardized mortality rate, Years of Life Lost (YLL) and YLL rate data were calculated and to examine the trend, joinpoint regression was used. Results: During the study period, 281,903 deaths occurred, of which, 59.85% (n=168,735) occurred in men. Also, 42.18% of these deaths (n=118,610) occurred due to cardiovascular diseases (CVDs). The total number of YLLs due to premature death was 4,154,828 years. Of these, 2,591,564 years (62.37%) were in men. The highest number of YLL was due to CVDs, external causes of death and cancer. Trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -2.1% (95% CI -2.6 to -1.6, P<0.001) for males, -0.9% (95% CI -1.4 to -0.4, P=0.002) (P=0.002) for females. Conclusion: Although the trend of premature death has been decreasing during the years of study, but the seven major causes of premature death in 2004 to 2019 were non-communicable diseases, especially ischemic heart diseases, stroke, external cause of morbidity, and cancer. Furthermore, our findings indicate a change in the role of non-communicable diseases in premature mortality in recent years.

Early mortality in German patients with lung cancer: risk factors associated with 30-and 60-day mortality.

Despite therapeutic advances, early mortality in lung cancer is still prevalent. In this study, we aimed to assess risk factors for 30- and 60-day mortality in German lung cancer patients. In this retrospective cross-sectional analysis, we used data of lung cancer patients treated at LMU Hospital Munich between 2015 and 2019. We categorized patients into 30-day mortality, 60 day-mortality, and longer survival. We used Student's t-test and ANOVA to compare means and Chi2-test to compare frequencies. We used logistic regression analysis to identify factors associated with a risk for early mortality. Of the 2454 lung cancer patients, 2.0% (n = 50) died within 30 and 1.7% (n = 41) within 30 to 60 days of diagnosis. Older age and advanced stage at diagnosis were significantly associated with early mortality in the univariate and the multivariate analysis. Patients in the 30-day mortality group significantly more often did not receive tumor-directed therapy. They were also more likely to die in an acute care setting compared to the 60-day mortality group. The group of patients who died unexpectedly (12.0%) was dominantly female, with a high proportion of patients with unintentional weight loss at the time of diagnosis. Our results suggest that in the treatment of patients with lung cancer there is a need for a greater focus on older patients. Moreover, physicians should pay special attention to females with recent weight loss and patients with a comorbidity of diabetes mellitus or renal impairment. Engaging a case manager focused on detecting patients with the above characteristics could help improve overall care.

Measuring the urban-rural and spatiotemporal heterogeneity of the drivers of PM2.5-attributed health burdens in China from 2008 to 2021 using high-resolution dataset.

Urbanization has been considered a driver of PM2.5 pollution and the attributed health burden. This study systematically measured the spatiotemporal and urban-rural heterogeneity of PM2.5-attributed health burden drivers, including income, population, baseline mortality rate, and PM2.5 level. The results reveal the significantly positive contribution of disposable income and the periodical and urban-rural differentiation of population contribution to PM2.5-attributed health burden. The difference in driver performance due to socioeconomic development and urbanization stages might be an important determinant for different or even opposite results of previous studies. Policymaking for mitigating PM2.5-attributed health risk could incorporate the re-assessment and driver determination for PM2.5-attributed health burden into the construction and development plan from the overall urbanization perspective. The urbanization-perspective driver decomposition could be synergized with the flow analysis, equality evaluation, and policy benefit estimation to achieve further direction-determining and quantitative assessment of the urban-rural PM2.5 health risk management strategies.

The effect of alcohol consumption on all-cause mortality in 70-year-olds in the context of other lifestyle risk factors: results from the Gothenburg H70 birth cohort study.

BACKGROUND: In this study, we examined the effect of alcohol, as well as the combined effect of seven lifestyle factors, on all-cause mortality in older adults (baseline age 70 years). METHODS: Data was derived from the population-based Gothenburg H70 Birth Cohort study, including 1124 participants from the 2014-16 examination. Risk consumption was defined as > 98 g alcohol per week, and hazardous drinking was based on the Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C). Cox regression models were used to examine the individual effect of alcohol consumption, as well as the combined effect of seven lifestyle risk factors (high alcohol consumption, lifetime smoking, unhealthy Body Mass Index, insufficient physical activity, sedentary behavior, insufficient/prolonged sleep, unhealthy dietary pattern) on all-cause mortality. RESULTS: During a mean follow-up of 7.7 years, 81 (7.2%) participants died. Neither risk consumption nor hazardous drinking were associated with elevated mortality, but hazardous drinking was associated with an increased risk of mortality in those with insufficient physical activity. Those with at least five lifestyle risk factors had an increased all-cause mortality compared to those fulfilling criteria for a maximum of one lifestyle risk factor. High alcohol consumption showed a relatively minor impact on this risk, while physical activity and unhealthy dietary pattern had an independent effect on mortality. CONCLUSIONS: In this particular sample, there was no independent effect of alcohol on the risk of 8-year all-cause mortality. However, an interaction effect of physical activity was observed. It may be that high alcohol consumption per se is less important for mortality among older adults. However, a combination of several unhealthy lifestyle behaviors was linked to a substantial increase in the risk of mortality in Swedish older adults. Also, it has to be emphasized that high alcohol consumption may have other adverse health effects apart from mortality among older adults.

Años de vida perdidos y distribución espacial de la mortalidad por incidente vial en Medellín, 2010-2020

Objetivo: Estimar los años potenciales de vida perdidos y la distribución espacial de la mortalidad por incidente vial según modo de transporte en Medellín 2010-2020, como línea base para la implementación de la estrategia Visión Cero, de la Organización Mundial de la Salud, en la movilidad de la ciudad. Metodología: Estudio retrospectivo y descriptivo de corte transversal, con fuente secundaria. El cálculo de los años potenciales de vida perdidos se hizo tomando como edad límite la esperanza de vida al nacer de Colombia, según año y género. El análisis espacial se realizó a partir de la dirección del incidente; la representación de la densidad de Kernel fue por el método de clasificación estándar-cuantil, y las zonas de influencia se crearon por el método búfer de anillos múltiples, con distancias de 500 y 1000 metros. Resultados: Medellín, entre 2010 y 2020, registró 2988 muertes por incidente vial. Quienes más murieron fueron los peatones, con 1423 (47,6 %) muertes, seguidos por los motociclistas, con 1295 (43,3 %). Los años potenciales de vida perdidos fueron 98 787. Las comunas de mayor concentración en muerte de peatones fueron: Candelaria, Buenos Aires y Manrique; en motociclistas, la mayor concentración se evidenció en el sistema vial del río. Por zonas de influencia, los peatones fallecidos en un radio de 1000 metros del sistema vial del río fueron 688 (49,8 %), y los motociclistas, 636 (52,2 %). Conclusión: Los motociclistas fueron quienes murieron más jóvenes y más años dejaron de vivir. Politraumatismos son diagnósticos constantes de muerte, pero lesiones en cabeza, cráneo y tórax son más letales en peatones y motociclistas.

Objective: To estimate the potential years of life lost and the spatial distribution of mortality from road incidents by mode of transport in Medellín 2010-2020, as a baseline for the implementation of the Vision Zero strategy of the World Health Organization in the city's mobility. Methodology: This is a retrospective and descriptive cross-sectional study, with a secondary source. The calculation of the potential years of life lost was made using the life expectancy at birth in Colombia as the age limit, according to year and gender. The spatial analysis was carried out from the direction of the incident; Kernel density was represented by the standard-quantile classification method, and the zones of influence were created by the multiple ring buffer method, with distances of 500 and 1000 meters. Results: Between 2010 and 2020, Medellín registered 2,988 deaths due to road incidents. Those who died the most were pedestrians, with 1,423 (47.6%) deaths, followed by motorcyclists, with 1,295 (43.3%). Potential years of life lost were 98,787. The zones (comunas) with the highest concentration of pedestrian deaths were: Candelaria, Buenos Aires and Manrique; in motorcyclists, the highest concentration was evidenced in the river road system. By areas of influence, pedestrians killed within a radius of 1,000 meters from the river road system were 688 (49.8%), and motorcyclists, 636 (52.2%). Conclusion: Motorcyclists were the ones who died the youngest and the most years they stopped living. Polytrauma is a constant diagnosis of death, but injuries to the head, skull and thorax are more lethal in pedestrians and motorcyclists.

Objetivo: Estimar os anos potenciais de vida perdidos e a distribuição espacial da mortalidade por incidente de trânsito segundo o modo de transporte em Medellín 2010-2020, como linha base para a implementação da estratégia Visão Zero, da Organização Mundial da Saúde, na mobilidade da cidade. Metodologia: Estudo retrospectivo e descritivo de corte transversal, com fonte secundária. O cálculo dos anos potenciais de vida perdidos foi feito considerando como idade limite a esperança de vida ao nascer da Colômbia, segundo ano e gênero. A análise espacial realizou-se a partir do local do incidente; a representação da densidade de Kernel foi pelo método de classificação padrão-quantil, e as zonas de influência criaram-se pelo método buffer de anéis múltiplos, com distâncias de 500 e 1000 metros. Resultados: Medellín, entre 2010 e 2020, registrou 2988 mortes por incidente de trânsito. O maior número de mortes foi de pedestres, sendo 1423 (47,6%), seguido pelo de motoqueiros, sendo 1295 (43,3%). Os anos potenciais de vida perdidos foram 98.787. As localidades com maior concentração de mortes de pedestres foram: Candelaria, Buenos Aires e Manrique; no caso dos motoqueiros, a maior concentração evidenciou-se no sistema viário do rio. Por zonas de influência, os pedestres falecidos em um raio de 1000 metros do sistema viário do rio foram 688 (49,8%), e os motoqueiros 636 (52,2%). Conclusão: Os motoqueiros foram quem morreram mais novos e mais anos deixaram de viver. Politraumatismos são diagnósticos constantes de morte, mas lesões na cabeça, no crâneo e no tórax são mais letais em pedestres e motoqueiros.

Tracing the sources of PM2.5-related health burden in China.

Fine particulate matter (PM2.5) poses a major environmental risk to human health. We estimated PM2.5-related premature deaths in 30 Chinese provinces in 2020 using an integrated exposure response model based on monitored concentrations and obtained regional and sectoral contributions based on the atmospheric transport of the atmospheric transport contribution matrix. From the perspective of regional- and sectoral-scale effects, the results revealed that 740,140 [95% confidence interval (CI):646,538-839,968] premature deaths were related to PM2.5 in 2020, mainly in East (30%), Central (18%), and North (15%) China. Manufacturing activity was found to be the major cause of PM2.5-related premature deaths, accounting for over 50% of the deaths. From the perspective of the interregional atmospheric transport effect, although local emissions were the major source of PM2.5-related premature deaths in all regions, non-local emissions contributed approximately 30%. The overall trend in the net atmospheric transport direction was from north to south. In particular, the Guangdong, Guangxi, and Hainan provinces of South China received contributions of more than 40% from non-local provinces, mainly from the East and Central China. Combined with economic data, the regions and sectors with the highest PM2.5-related premature deaths per unit output or consumption include the manufacturing and household sectors in North and Northeast China and transportation, agriculture, and electricity in Central China. Therefore, from the perspective of the above three impacts, although the potential impact of PM2.5 pollution on health in China has decreased with the decrease in PM2.5 concentration in the past decade owing to strict air pollution control, the central and northern parts of China are still the key areas requiring air pollution control. The health impacts of air pollution associated with the rapid development of China's manufacturing industry in the post-pandemic era cannot be ignored.

Sexual Assault Victimization in Premature Female Mortalities: Evidence from the National Longitudinal Study of Adolescent to Adult Health.

Previous research has documented many behavioral problems associated with being a female victim of sexual assault, but little attention has been devoted to whether this experience might be related to premature mortalities. We investigated this utilizing the National Longitudinal Study of Adolescent to Adult Health survey, collected from over 10,000 adolescent females in 1995, whose premature deaths (n = 65) were noted in 2007 in National Death Index records. Significant associations were found between females with a substance misuse history and their premature deaths, but not with being a sexual assault victim. The subset of respondents (n = 208) evincing both these characteristics showed significantly higher risks of dying prematurely, as did those females with early histories of drug misuse alone. Yet, adolescent females with histories of drug misuse who also attempted suicide (n = 214) did not show similar elevated risks of dying prematurely compared to others without these experiences. This exploratory evidence points to an affinity between both being a female sexual assault victim and having an early history of misusing drugs, putting such people at heightened risks for dying prematurely, suggesting the potential benefits of counseling and supportive services for those so affected.

Chronic diseases attributable to a diet rich in processed meat in Brazil: Burden and financial impact on the healthcare system.

Background: The consumption of processed meat causes negative impacts on health; however, this burden for the population living in developing countries is less explored. This study aimed to describe the burden of chronic noncommunicable diseases (NCDs) attributed to a diet rich in processed meat between 1990 and 2019 in Brazil and its federative units and the financial burden on the Unified Health System (SUS) in 2019. Methods: Secondary data from the Global Burden of Disease (GBD) and SUS Information Systems were used in this ecological study. The metrics to assess the burden of NCDs attributable to processed meat consumption were disability-adjusted life years (DALYs) and deaths. The age-standardized rates were presented per 100,000 inhabitants with 95% uncertainty intervals (95% UI). The cost of hospitalizations and outpatient procedures covered by SUS for the treatment of NCDs attributable to processed meat consumption was estimated using the population-attributable fraction. Both burdens were estimated for both sex and stratified by sex, specific cause, and federative units. Results: The age-standardized DALY rates attributable to a diet rich in processed meat increased between 1990 (75.31/100,000 [95% UI: 34.92-139.65]) and 2019 (79.35/100,000 [95% UI: 42.84-126.25]); while mortality rates remained stable between 1990 (2.64/100,000 [95% UI: 1.17-5.21) and 2019 (2.36/100,000 [95% UI: 1.22-4.09]). The cost of hospitalization and outpatient procedures in Brazil for NCDs attributable to the consumption of processed meat was approximately US$ 9,4 million, of which US$ 6,1 million was spent on ischemic heart disease, US$ 3,1 million on colorectal cancer, and US$ 200 thousand on type 2 diabetes mellitus. Conclusion: The NCD burden did not decrease during the years evaluated, while the financial burden was high in 2019, with higher treatment costs for ischemic heart disease. These results can guide political, economic, and health education interventions to advance the fight against NCDs.

Health Impacts of Long-Term NO2 Exposure and Inequalities among the Chinese Population from 2013 to 2020.

Nitrogen dioxide (NO2) is associated with mortality and many other adverse health outcomes. In 2021, the World Health Organization established a new NO2 air quality guideline (AQG) (annual average <10 µg/m3). However, the burden of diseases attributable to long-term NO2 exposure above the AQG is unknown in China. Nitrogen oxide is a major air pollutant in populous cities, which are disproportionately impacted by NO2; this represents a form of environmental inequality. We conducted a nationwide risk assessment of premature deaths attributable to long-term NO2 exposure from 2013 to 2020 based on the exposure-response relationship, high-resolution annual NO2 concentrations, and gridded population data (considering sex, age, and residence [urban vs rural]). We calculated health metrics including attributable deaths, years of life lost (YLL), and loss of life expectancy (LLE). Inequality in the distribution of attributable deaths and YLLs was evaluated by the Lorenz curve and Gini index. According to the health impact assessments, in 2013, long-term NO2 exposure contributed to 315,847 (95% confidence interval [CI]: 306,709-319,269) premature deaths, 7.90 (7.68-7.99) million YLLs, and an LLE of 0.51 (0.50-0.52) years. The high-risk subgroup (top 20%) accounted for 85.7% of all NO2-related deaths and 85.2% of YLLs, resulting in Gini index values of 0.81 and 0.67, respectively. From 2013 to 2020, the estimated health impact from NO2 exposure was significantly reduced, but inequality displayed a slightly increasing trend. Our study revealed a considerable burden of NO2-related deaths in China, which were disproportionally frequent in a small high-risk subgroup. Future clean air initiatives should focus not only on reducing the average level of NO2 exposure but also minimizing inequality.

Overrepresentation of In-Home, Natural Deaths Among Individuals Treated for Mental Illnesses in New York State.

OBJECTIVE: The authors compared rates of in-home, natural death among individuals receiving treatment for mental illnesses with those in the general population. METHODS: Two data sets were used to determine the prevalence of in-home, natural deaths in the general population and among those receiving treatment for mental illnesses in New York State, outside New York City, for the period 2016-2018. RESULTS: Overall, 37% of natural deaths among individuals receiving mental health treatment occurred in the home, compared with 26% in the general population. Earlier death was also apparent; for example, 26.4% of in-home deaths among those receiving mental health treatment were among those ages 45-54 years, compared with 5.5% in the general population. In-home, natural deaths were also higher among non-Hispanic Black and Hispanic subpopulations. CONCLUSIONS: These findings suggest a need for programmatic and policy advances to reduce disparities in general health care for those living with mental illnesses. Additional analyses are warranted.