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To determine the association between meaning in life and all-cause and cause-specific mortality, and whether associations vary by depression or sociodemographic factors. Participants were UK Biobank cohort members who reported on their meaning in life in the mental health assessment from October 2016 to July 2017 (N = 153,505). All-cause mortality and cause-specific mortality were identified from ICD-10 codes from national death registries through December 2022. Over the up to six-year follow-up, every standard deviation higher in meaning in life was associated with a 15 % decreased risk of death from any cause (HR = 0.87, 95 % CI = 0.85–0.90, p <.001). The association was attenuated but remained significant accounting for socioeconomic, clinical, and behavioral risk factors (HR = 0.91, 95 % CI = 0.88–0.94, p <.001). Meaning in life was associated with reduced risk of death from 7 of the 8 cause-specific deaths examined: external cause (47 %), respiratory (41 %), nervous (32 %), digestive (25 %), or circulatory (15 %) systems, COVID-19 (28 %), and cancer (8 %). Depression concurrent with the meaning assessment did not explain or moderate these associations, which indicated that meaning was similarly protective when concurrently experiencing psychological distress. The association between meaning and all-cause mortality was similar across age, ethnicity, and socioeconomic status but slightly stronger among female than male participants. Feeling that one's life has meaning is associated with lower risk of mortality, particularly causes of death due to the respiratory system, nervous system, or COVID-19. Given that meaning in life can be modified through intervention, future research could address whether it could be a useful target of intervention. • Meaning in life was associated with lower risk of 7 specific causes of death. • Meaning in life was associated with lower risk of death from Covid-19. • Meaning was associated with lower risk of death from cancer or external causes. • There was lower risk from circulatory, nervous, respiratory, or digestive systems. • Associations were independent of and not moderated by depression. [ABSTRACT FROM AUTHOR]

To reduce the high disease burden caused by air pollution, World Health Organization (WHO) issued a new air quality guideline (AQG) on the 22nd September 2021. A timely quantitative assessment of health benefits by meeting these targets is a key measure to advocate and inform national and regional disease control policies. We collected daily major air pollution data in 315 Chinese cities from the 1st January to the 31st December 2019, and the corresponding annual population and mortality rate in the whole population of each city. Then, the mortality benefits were estimated when daily air pollution levels attained WHO's new AQG targets (15 μg/m3 for PM 2.5 , 25 μg/m3 for NO 2 and 100 μg/m3 for O 3) in 315 Chinese cities and 31 provinces by using pollutant- and cause-specific concentration-response functions. In total, 134,025 (95%CI: 92,768; 173,029) air pollution-associated non-accidental deaths could be avoided in 315 Chinese cities in 2019 by attaining WHO's new AQG targets, with 43,800 (95%CI: 29,945; 55,616) avoidable deaths from PM 2.5 , 58,070 (95%CI: 45,333; 70,714) from NO 2 , and 32,155 (95%CI: 17,490; 46,699) from O 3. Cardiovascular diseases and respiratory diseases accounted for 72,698 (95%CI: 46,561; 101,680) and 17,726 (95%CI: 8603; 26,925) avoidable deaths, respectively. Health benefits from reduction in air pollution levels were 99.26 avoided non-accidental deaths per million population at national level, ranging from 12.48 per million in Tibet to 166.26 per million in Hebei. These findings suggest that the compliance with the WHO updated AQG standards would save substantial amount of air pollution-related premature deaths in China. More stringent air pollution control and management measures are urgently warranted to reduce the disease burden from air pollutants in China, particularly for the worsening O 3 pollution. Reduction in cause-specific deaths (per million) in China by attaining WHO's new air quality guidelines. [Display omitted] • Meeting WHO new Air Quality Guideline can save 134,025 deaths in 315 Chinese cities. • 43,800 avoidable deaths were from PM 2.5 , 58,070 from NO 2 , and 32,155 from O 3. • Stroke, coronary heart disease and COPD explained half of deaths from air pollution. • Mortality benefits by attaining the new targets varied across cities and provinces. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the third most common cancer and the third leading cause of cancer mortality in the United States. Several studies have shown that, in the past two decades, the survival rate of CRC patients has increased substantially due to the improvements in chemotherapy regimens, largely in clinical trial settings. However, it is unclear whether benefits from these improvements can be reproduced in population-based elderly patients. For example it is unclear whether newly developed chemotherapy regimens affect the changing patterns of the leading causes of death among elderly CRC patients. It is also unclear whether the impact on changing patterns of the leading causes of death differs by the presence of comorbidity or chemotherapy-related toxicity. In this study, we used the SEER–Medicare linked dataset of 13 registries (1992–2009) and examined the effects of newly developed chemotherapy regimens, comorbidities, and chemotherapy-related toxicities on the changing patterns of the leading causes of death in elderly patients with colorectal cancer. We hypothesized that the risk of CRC-specific death decreases over time when new and more effective chemotherapy regimens became available.Background Abundant evidences have shown that newly developed chemotherapy regimens improved 5-year survival rate of colorectal cancer (CRC) patients over the past two decades. However, their impact on risk of death from leading causes among elderly patients is still poorly understood. Patients and methods A retrospective cohort study of 69 718 elderly CRC patients with their first primary tumors in 1992–2009, identified from the 12 areas of Surveillance, Epidemiology, and End Results-Medicare linked database with their Medicare claims up to 2010. Multivariate Cox regression models were used to assess the effect of newly developed chemotherapy regimens, comorbidities, and chemotherapy related toxicities on cause-specific death and their temporal patterns among elderly CRC patients. Results The leading causes of death among CRC patients were CRC, circulation disorders, and secondary cancers, which accounted for 51.4%, 25%, and 4.6% of all-cause death, respectively. Patients diagnosed in more recent diagnostic time periods were significantly less likely to die of CRC [period 2: 5-year hazard ratio = 0.94, 95% confidence interval (CI) 0.90–0.97; period 3: 0.86, 0.83–0.90], circulation disorders (period 2: 0.94, 0.88–1.00; period 3: 0.80, 0.75–0.87), and more likely to die of secondary cancer (period 3: 1.42, 1.20–1.68) compared with those diagnosed in period 1. Charlson comorbidities index and the selected pre-existing comorbidities were significantly associated with increased 5-year risk of death from all three leading causes. Both hematological and gastric toxicity were associated with reduced risk of death from CRC and circulation disorders. The association between diagnostic time period and risk reduction in death from CRC depended on chemotherapy treatment (P < 0.0001). Subgroup analyses showed that the chemotherapy-dependent significant risk reduction was seen in patients with stage II–III CRC, patients without comorbidities, and patients without toxicities (P < 0.0001 for all). Conclusion The newly developed chemotherapy regimens were associated with the decreased risk of mortality from CRC. [ABSTRACT FROM PUBLISHER]

Abstract: Approximately 20% of Emergency Department (ED) users discharged home receive a non-causative discharge diagnosis in the category of “Symptoms, signs, abnormal findings, and ill-defined causes,” according to the International Classification of Diseases. The objective of this study was to evaluate the association of these non-causative discharge diagnoses with mortality in general and with violent death and suicide in particular. This is a prospective study; the primary source of data was computer records from the ED at Landspitali University Hospital, Hringbraut, Reykjavik, Iceland over the period 1995–2001. The main discharge diagnoses were recorded according to the International Classification of Diseases. Individuals with a non-causative discharge diagnosis were followed-up for cause-specific mortality through national registries by record linkage and were compared to national mortality rates and the rates of those with causative physical diagnoses. The standardized mortality ratios, hazard ratios, and 95% confidence intervals (CI) were calculated. The data on individuals with a non-causative discharge diagnosis from the ED revealed that the standardized mortality ratio for all causes was 1.57 (95% CI 1.39–1.77) among men and 1.83 (95% CI 1.61–2.08) among women. The hazard ratio for violent death was 1.64 (95% CI 1.07–2.52) and for suicide 2.08 (95% CI 1.02–4.24), adjusted for age and gender, among individuals with a non-causative discharge diagnosis compared to those having causative physical discharge diagnoses. Through analysis of the discharge diagnoses “Symptoms, signs, abnormal findings and ill-defined causes,” this study has identified an association between the group of patients discharged from the ED with a non-causative diagnosis who are at high risk of suicide and who may, through further studies, become subjects for suicide prevention strategies. [Copyright &y& Elsevier]

: PurposeBiochemical failure (BF), defined by a rising prostate-specific antigen (PSA) profile, is an early surrogate of treatment failure. However, little evidence is available to show that BF is associated with death for patents with prostate cancer treated with radiotherapy. We examined the relationship between BF and death from prostate cancer.: Methods and materialsA total of 942 patients were treated between 1987 and 1998 with external beam radiotherapy who had sufficient PSA determinations in follow-up for the analyses described. The median radiation dose was 72 Gy, median PSA was 9.9 ng/mL, and median follow-up was 73 months. The American Society for Therapeutic Radiology and Oncology consensus definition was used to define BF. Kaplan-Meier calculations were from the start of radiotherapy. Cox proportional hazards regression multivariate analyses were used to investigate the association of BF (time-dependent variable) and other factors to distant metastasis (DM), cause-specific death (CSD), and overall death (OD). The year of treatment was included in some of the multivariate analyses to correct for potential unknown factors that may have occurred during the years of the study, such as stage migration.: ResultsBF was observed in 316 patients (34%), and 66 (7%) experienced DM, 32 (3%) died of prostate cancer, and 230 (24%) died overall during the study period. The Kaplan-Meier 5-year rate estimates from the start of treatment for BF, DM, CSD, and OD were 38%, 6%, 3%, and 13%, respectively. All patients with DM had BF. In multivariate analyses, BF was associated with DM and CSD, but not OD. The inclusion of the year of treatment did not alter these relationships.: ConclusionBF, as a time-dependent covariate, was the strongest determinant of DM and was also very significantly related to CSD. The inclusion of the year of treatment had little effect on these associations. Longer follow-up is needed to determine conclusively the relationship of BF to OD. [Copyright &y& Elsevier]