A Wide-Base Population Pyramid And Other Factors Explain Low Mortality In Pakistan During Covid-19 Pandemic.

World is experiencing an unprecedented pandemic of COVID-19 for over a year. This viral infection outbreak originated in December 2019 at Wuhan, China and within three months became a global pandemic. The outbreak has affected over 200 countries and territories of the world. Despite of having well-established health care system, countries such as China, Italy, Iran, Spain, France, Germany and USA have experienced a high death toll in this pandemic. Pakistan although being geographic neighbour of China and Iran, is somehow protected from the otherwise expected high case-fatality of COVID-19. This paper explains what factors have protected Pakistan from a high mortality in this pandemic.

Attributable fraction of tobacco smoking on selected cancer deaths in the past decade using mortality case-control study in Tianjin, China.

INTRODUCTION: This study aims to estimate the impact of smoking-attributable mortality of selected cancers, in the period 2010-2019 in Tianjin, China. METHODS: A case-control study was conducted to assess the smoking-attributed major causes of cancer deaths. Unmatched multiple logistic regression was used to calculate mortality risk ratios. RESULTS: Smoking-attributable cancer deaths were 23709 (28.87%) among adult males and 8648 (13.37%) among adult females in the period 2010-2019 in Tianjin, China. Lung cancer remains the largest cause of smoking-attributable deaths; among men, the death rates were 49.06% of lung cancers, 27.55% of mouth, pharynx, larynx, or esophagus cancers, 13.56% of kidney and other urinary cancers, and 10.11% of liver cancers; among women the corresponding death rates were 31.56% of lung cancers and 10.59% of the mouth, pharynx, larynx, or esophagus cancer, 10.56% of bladder cancers. Smoking-attributed cancer deaths in men increased from 1817 in 2010 to 2695 in 2019; for women, the number remained stable at just over 800 per year during the past decade. CONCLUSIONS: At least one in three cancer deaths in men and one in six in women would be potentially preventable through appropriate control of tobacco smoking in Tianjin, China. Effective control programs against tobacco smoking should be further implemented.

A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts.

OBJECTIVES: To test a structured electronic health record (EHR) case review process to identify diagnostic errors (DE) and diagnostic process failures (DPFs) in acute care. METHODS: We adapted validated tools (Safer Dx, Diagnostic Error Evaluation Research [DEER] Taxonomy) to assess the diagnostic process during the hospital encounter and categorized 13 postulated e-triggers. We created two test cohorts of all preventable cases (n=28) and an equal number of randomly sampled non-preventable cases (n=28) from 365 adult general medicine patients who expired and underwent our institution's mortality case review process. After excluding patients with a length of stay of more than one month, each case was reviewed by two blinded clinicians trained in our process and by an expert panel. Inter-rater reliability was assessed. We compared the frequency of DE contributing to death in both cohorts, as well as mean DPFs and e-triggers for DE positive and negative cases within each cohort. RESULTS: Twenty-seven (96.4%) preventable and 24 (85.7%) non-preventable cases underwent our review process. Inter-rater reliability was moderate between individual reviewers (Cohen's kappa 0.41) and substantial with the expert panel (Cohen's kappa 0.74). The frequency of DE contributing to death was significantly higher for the preventable compared to the non-preventable cohort (56% vs. 17%, OR 6.25 [1.68, 23.27], p<0.01). Mean DPFs and e-triggers were significantly and non-significantly higher for DE positive compared to DE negative cases in each cohort, respectively. CONCLUSIONS: We observed substantial agreement among final consensus and expert panel reviews using our structured EHR case review process. DEs contributing to death associated with DPFs were identified in institutionally designated preventable and non-preventable cases. While e-triggers may be useful for discriminating DE positive from DE negative cases, larger studies are required for validation. Our approach has potential to augment institutional mortality case review processes with respect to DE surveillance.

COVID-19 Inpatient Deaths and Brought-in-Dead Cases in Malaysia.

Coronavirus disease 2019 (COVID-19) deaths can occur in hospitals or otherwise. In Malaysia, COVID-19 deaths occurring outside of the hospital and subsequently brought to the hospital are known as brought-in-dead (BID) cases. To date, the characteristics of BID COVID-19 cases in Malaysia are not clear. The objectives of this study are 2-fold: to explore the characteristics of 29,155 mortality cases in Malaysia and determine the factors associated with the high probability of BID, using the multilevel logistic regression model. Data on COVID-19 mortality cases from the entire country between March 17, 2020 and November 3, 2021 were retrieved from a national open data source. Of the 29,155 COVID-19 mortality cases, 5,903 (20.2%) were BID. A higher probability of BID (p < 0.05) was seen among individuals aged between 18 and 59 years, non-Malaysians, had no comorbidities, did not receive COVID-19 vaccination, and the interval between the date of death and diagnosis. A high prevalence of BID is an alarming public health issue, as this may signal health system failure at one or several levels and, hence, need urgent attention from relevant stakeholders. Based on the findings of this study, increasing the intensity of the vaccination campaign, addressing any issues faced by noncitizens about to COVID-19 management in- and out-of-hospital, increasing the awareness of signs and symptoms of worsening COVID-19 and, hence, the significance of self-monitoring, and determining the potential gaps in the health system may contribute to their increased risk of deaths.

Smoking cessation-associated mortality reduction: A case-control study in Tianjin city, China.

INTRODUCTION: Smoking-attributed mortality is increasing steadily in most developing countries. The aim of the study is to assess the reduction in smoking-associated mortality following cessation. METHODS: Death data were collected from 2016 to 2017. Cases were deaths from pre-defined diseases of interest (65298); controls were deaths from pre-defined non-smoking-related diseases (13527). Case versus control odds ratios for ex-smokers versus smokers were calculated by age, sex, marital status and education with standardized logistic regression. These are described as mortality rate ratios (RRs, calculated as odds ratios), with a group-specific confidence interval (CI). The statistical analysis of the data was conducted from June to August 2019. RESULTS: For deaths from pre-defined non-smoking-related diseases at age 35-59 years, the RRs for quitting smoking 0-4, 5-9 or ≥10 years ago and never smoking were 0.66 (95% CI: 0.55-0.78), 0.58 (95% CI: 0.38-0.88), 0.61 (95% CI: 0.45-0.82), and 0.43 (95% CI: 0.39-0.46), respectively. The same trend was found at ages 60-69 years and 70-79 years. Younger age of quitting (25-44 or 45-64 years) appeared to be associated with greater protection among the age groups: RR was 0.55 (95% CI: 0.42-0.74) and 0.67 (95% CI: 0.56-0.79), respectively, at age 35-59 years. Among the patients who died of lung cancer, the strong protective effect can only be observed when the duration of quitting is ≥10 years. The effect of smoking cessation on the risk of death from cardiovascular disease can be observed when the duration of quitting is 1-5 years. CONCLUSIONS: Longer durations of smoking cessation are associated with progressively lower mortality rates from the diseases of interest, such as lung cancer and other smoking related cancers. For sustainable monitoring of tobacco-attributed mortality, smoking information over decades, such as smoking duration and quit smoking years, should be recorded during registration of death.