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Background: External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood. Methods: Individual level data from national health registries in Denmark (1978–2001), Finland (1987–2003), Norway (1967–2002), and Sweden (1974–2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016–2018. Gestational age was categorized as "very/moderately preterm" (23–33 weeks), "late preterm" (34–36 weeks), "early term" (37–38 weeks), "full term" (39–41 weeks), and "post term" (42–44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country's estimates in meta-analyses. Results: Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99–1.24) for males and 1.55 (95% CI 1.28–1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04–1.18) and 1.15 (95% CI 1.02–1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34–2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99–1.53] and 1.29 [95% CI 1.16–1.45], respectively) and females (HRs 1.53 [95% CI 0.97–2.41] and 1.35 [95% CI 1.07–1.71], respectively, with some heterogeneity across countries). Conclusions: Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males. [ABSTRACT FROM AUTHOR]

This study aimed to analyse deaths due to external causes in males in northwest Slovakia. This was a cross-sectional autopsy study. The autopsy registry provided information on fatalities in males in northwest Slovakia due to external causes in 2015. Data were analysed by age, cause of death and blood alcohol concentration (BAC), and the contribution to overall mortality was calculated. From a total of 305 fatalities, the dominant cause of death was unintentional (other than traffic; 56.7%), followed by intentional (26.6%) and traffic (16.7%). A BAC of ≥0.5 g/kg was found in 43.9% of deaths. Lower levels of BACs (0.5–1.9 g/kg) were observed in relatively high proportions among the younger (aged ≤34 years) and older (aged ≥65 years) males (17.9% and 14.0%, respectively), as well as in the traffic and intentional injury cause of death categories (23.5% and 19.8%, respectively). Male deaths due to external causes had a 6.2% contribution to overall mortality in northwest Slovakia. Alcohol intoxication frequently co-occurs with fatalities from external causes, including at lower BACs, indicating the harmful role of alcohol at all concentrations. [ABSTRACT FROM AUTHOR]

To examine the relationship between Veterans' housing instability and mortality by homicide, suicide, and unintentional injury, this retrospective study examined administrative data from Veterans Health Administration (VHA) patients who responded to the Homelessness Screening Clinical Reminder (HSCR) between October 1, 2012 and September 30, 2016 and were searched through the National Death Index (NDI) for date and cause of death (N = 5,850,044). Analyses calculated survival time and compared mortality for three groups—(1) stably housed Veterans, (2) unstably housed Veterans, and (3) Veterans at imminent risk for housing instability—using adjusted Cox proportional hazards models. Stably housed Veterans had a significantly longer median survival time (3.3 years) than unstably housed Veterans and those at imminent risk for housing instability (2.5 and 2.6 years, respectively). Unstably housed Veterans and those at imminent risk for housing instability had greater risk of all-cause mortality (Adjusted Hazard Ratio [aHR] = 1.69 and 1.48, respectively) and of dying by homicide (aHR = 3.01 and 2.65, respectively), suicide (aHR = 1.75 and aHR = 1.80, respectively), and unintentional injury (aHR = 3.13 and aHR = 1.92, respectively) compared with stably housed Veterans. More proactive measures are needed to prevent external causes of mortality among Veterans who are unstably housed or at imminent risk for housing instability. [ABSTRACT FROM AUTHOR]

Objectives: To compare mortality by cancer sites and by other specific causes of death, and the prevalence of risk behaviors in farmers and non-farmers in Spain. Methods: Mortality by cause of death was calculated based on a longitudinal study with 10-years follow-up of 9.5 million men and 6 million women aged 20–64 years who were employed in 2001. The prevalence of risk behaviors was calculated from the 2001 National Health Survey in the 6464 employed men and 5573 employed women aged 20–64. The study subjects were grouped as farmers and non-farmers. For each cause of death, we estimated the ratio of age-standardized mortality rates, and for each risk behavior we estimated the age-standardized prevalence ratio in farmers versus non-farmers. Results: In men, the mortality rate for most cancer sites did not differ significantly between farmers and non-farmers, except for cancers of the lip, oral cavity, stomach, larynx and skin epidermoid carcinoma—which was higher in farmers—and cancers of the liver, pancreas and mesothelioma—which was lower in farmers. In contrast, farmers had a higher rate of mortality from most other diseases and from external causes of death. In women, farmers showed lower mortality from lung cancer, breast cancer and chronic lower respiratory disease, and higher mortality from external causes. The prevalence of smoking, excessive alcohol consumption, physical inactivity and obesity was higher in farmers than in non-farmers, except smoking and excessive alcohol consumption in women where prevalence was lower in farmers. Conclusions: Findings are different from those found in other studies. In men, greater exposure to the sun and the higher prevalence of risk behaviors in farmers could explain their excess mortality from some cancer sites and the other causes of death. However, other factors may be behind this excess risk of mortality from these causes, given that farmers did not show higher mortality from some cancers related to smoking. In women, no differences were observed in mortality rate for majority of causes of death between farmers and non-farmers. [ABSTRACT FROM AUTHOR]

Background: We present a method for reclassifying external causes of death categorized as "event of undetermined intent" (EUIs) into non-transport accidents, suicides, or homicides. In nations like Russia and the UK the absolute number of EUIs is large, the EUI death rate is high, or EUIs comprise a non-trivial proportion of all deaths due to external causes. Overuse of this category may result in (1) substantially underestimating the mortality rate of deaths due to specific external causes and (2) threats to the validity of studies of the patterns and causes of external deaths and of evaluations of the impact of interventions meant to reduce them. Methods: We employ available characteristics about the deceased and the event to estimate the most likely cause of death using multinomial logistic regression. We use the set of known non-transport accidents, suicides, and homicides to calculate an mlogit-based linear score and an estimated classification probability (ECP). This ECP is applied to EUIs, with varying levels of minimal classification probability. We also present an optional second step that employs a population-level adjustment to reclassify deaths that remain undetermined (the proportion of which varies based on the minimal classification probability). We illustrate our method by applying it to Russia. Between 2000 and 2011, 521,000 Russian deaths (15 % percent of all deaths from external causes) were categorized as EUIs. We used data from anonymized micro-data on the ~3 million deaths from external causes. Our reclassification model used 10 decedent and event characteristics from the computerized death records. Results: Results show that during this period about 14 % of non-transport accidents, 13 % of suicides, and 33 % of homicides were officially categorized as EUIs. Our findings also suggest that 2011 levels of non-transport accidents and suicides would have been about 24 % higher and of homicide about 82 % higher than that reported by official vital statistics data. Conclusions: Overuse of the external cause of death classification "event of undetermined intent" may indicate questionable quality of mortality data on external causes of death. This can have wide-ranging implications for families, medical professionals, the justice system, researchers, and policymakers. With our classification probability set as equal to or higher than 0.75, we were able to reclassify about two-thirds of EUI deaths in our sample. Our optional additional step allowed us to redistribute the remaining unclassified EUIs. Our method can be applied to data from any nation or sub-national population in which the EUI category is employed. [ABSTRACT FROM AUTHOR]

This study aimed to develop models based on Verbal Autopsy (VA) data and to estimate correct number of deaths from external causes in Thailand from 1996 to 2009. Logistic regression was used to create models of the three external causes of death classified by province, gender-age group and Vital registration (VR) cause-location group. Receiver operating characteristic (ROC) curves were used to validate the models by matching the number of reported deaths to the number of deaths predicted by the models. The models provided accurate prediction results, with false positive error rates 1.6%, 2.0% and 0.6% and sensitivities 73.8%, 46.3% and 62.0%, respectively. The results reveal that under-reporting of external causes of death increased over the 14-year period. Our statistical method confirms that the Thai 2005 VA data can be used to estimate external causes of death from VR report in Thailand to allow for the under-reporting rate. [ABSTRACT FROM AUTHOR]