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In an experiment (N = 206) using skin cancer prevention messages and a 2 (mortality: salient, control) × 2 (freedom-limiting language: freedom-limiting, autonomy-supportive) independent-group design, we tested the terror management health model and integrated its predictions with the theory of psychological reactance. We used a sample of young adults because they are most at risk for excessive tanning. Consistent with the study predictions about proximal defenses, mortality salience significantly increased intentions to wear sunscreen all year around, relative to the control condition. A significant interaction between freedom-limiting language and mortality salience on behavioral intention to purchase high-SPF lotion revealed that, when a freedom-limiting message was paired with mortality salience, intentions to purchase high-SPF lotion were significantly greater as compared to autonomy-supportive language, indicating that mortality salience mitigated the maladaptive effects of reactance. These results add to a growing body of research identifying boundary conditions for reactance effects and, further, point to the utility of directive (albeit freedom-limiting language) in health-prevention messages attempting to communicate deadly health risks. [ABSTRACT FROM AUTHOR]

Aim: To examine the independent and joint associations of oral microbiome diversity and diet quality with risks of all‐cause and cause‐specific mortality. Materials and Methods: We included 7,055 eligible adults from the U.S. National Health and Nutrition Examination Survey (NHANES). Oral microbiome diversity was measured with α‐diversity, including the Simpson Index, observed amplicon sequence variants (ASVs), Faith's phylogenetic diversity, and Shannon–Weiner index. Dietary quality was assessed using the Healthy Eating Index‐2015 (HEI‐2015). Cox proportional hazard models were used to assess the corresponding associations. Results: During a mean follow‐up of 9.0 years, we documented 382 all‐cause deaths. We observed independent associations of oral microbiome diversity indices and dietary quality with all‐cause mortality (hazard ratio [HR] = 0.63; 95% confidence interval [CI]: 0.49–0.82 for observed ASVs; HR = 0.68, 95% CI: 0.52–0.89 for HEI‐2015). Jointly, participants with the highest tertiles of both oral microbiome diversity (in Simpson index) and HEI‐2015 had the lowest hazard of mortality (HR = 0.37, 95% CI: 0.23–0.60). In addition, higher oral microbiome diversity was associated with lower risks of deaths from cardiometabolic disease and cancer. Conclusions: Higher oral microbiome α‐diversity and diet quality were independently associated with lower risk of mortality. [ABSTRACT FROM AUTHOR]

Aim: Elevated body mass index (BMI) presents a significant public health challenge in the United States, contributing to considerable morbidity, mortality and economic burden. This study investigates the health burden of overweight and obesity in the United States from 1990 to 2021, leveraging the Global Burden of Disease data set to analyse trends, disparities and potential determinants of high BMI‐related health outcomes. Materials and Methods: Our study focused on the United States, analysing trends in disability‐adjusted life years (DALY) and deaths attributable to high BMI, defined as a BMI of 25 kg/m2 or higher for adults. Statistical analyses included estimated annual percentage change (EAPC) in age‐standardized DALY rates and age‐standardized death rates. Pearson correlation was performed between EAPCs and the socio‐demographic index (SDI), with significance set at p < 0.05. Results: From 1990 to 2021, age‐standardized DALY rates attributable to high BMI increased by 24.9%, whereas the age‐standardized death rates increased by 5.2%. Age disparities showed DALYs peaking at 60–64 years for males and 65–69 years for females, with deaths peaking at 65–69 years for males and 90–94 years for females. A strong negative correlation was found between the EAPC in age‐standardized DALY and death rates and the SDI. Conclusions: Overweight and obesity significantly impact public health in the United States, especially among older adults and lower socio‐demographic regions. Comprehensive public health strategies integrating behavioural, technological and environmental interventions are crucial. Future research should focus on longitudinal studies, personalized interventions and policy‐driven approaches to address the multifaceted influences on high BMI. [ABSTRACT FROM AUTHOR]

Background: To explore the association between periodontitis and all-cause as well as cause-specific mortality rates in U.S. adults with hyperlipidemia. Methods: Participants were extracted from NHANES during 1988–1994, 1999–2004 and 2009–2014 periods. To assess the association between moderate-to-severe periodontitis and mortality rates for both all-cause and cause-specific mortality, hazard ratios (HRs), time ratios (TRs), and their respective 95% confidence intervals (CIs) were calculated using Cox proportional hazards and Weibull accelerated failure time (AFT) models. Results: Over a median follow-up duration of 11.83 years, 4,623 deaths of 16,848 participants were recorded. Multivariate Cox regression and AFT analyses showed moderate-to-severe periodontitis were associated with an increased risk of all-cause (HR: 1.31, 95% CI: 1.20–1.44, P < 0.001; TR: 0.85, 95% CI: 0.80–0.90, P < 0.001), cardiovascular disease (CVD)-related (HR: 1.36, 95% CI: 1.14–1.63, P = 0.001; TR: 0.83, 95% CI: 0.75–0.92, P < 0.001) and cancer-related mortality (HR: 1.35, 95% CI: 1.12–1.63, P = 0.002; TR: 0.82, 95% CI: 0.72–0.93, P = 0.002). Meanwhile, there was a significant upward trend in the risk of mortality with increasing severity of periodontitis (P for trend < 0.001). Conclusions: Our study highlights the moderate-to-severe periodontitis is associated with an increased risk of all-cause, CVD-related and cancer-related mortality among U.S. adults with hyperlipidemia. And the mortality risk increasing alongside the severity of periodontitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: The historic morbidity and mortality rates of antireflux and hiatal hernia operation are reported as 3% to 21% and 0.2% to 0.5%, respectively. These data come from either large national and population level or small institutional studies, with the former focusing on broad 30-day outcomes while lacking granular data on complications and their severity. Institutional studies tend to focus on long-term and quality-of-life outcomes. Our objective is to describe and evaluate the incidence of 30- and 90-day morbidity and mortality in a large, single-institution dataset. STUDY DESIGN: We retrospectively reviewed 2,342 cases of antireflux and hiatal hernia operation from 2003 to 2020 for intraoperative complications causing postoperative sequelae, as well as morbidity and mortality within 90 days. All complications were graded using the Clavien-Dindo (CD) grading system. The highest grade of complication was used per patient during 30- and 31- to 90-day intervals. RESULTS: Of 2,342 patients, the overall 30-day morbidity and mortality rates were 18.2% (427 of 2,342) and 0.2% (4 of 2,342), respectively. Most of the complications were CD less than 3a at 13.1% (306 of 2,342). In the 31- to 90-day postoperative period, morbidity and mortality rates decreased to 3.1% (78 of 2,338) and 0.09% (2 of 2,338). CD less than 3a complications accounted for 1.9% (42 of 2,338). CONCLUSIONS: Antireflux and hiatal hernia operations are safe with rare mortality and modest rates of morbidity. However, the majority of complications patients experience are minor (CD less than 3a) and are easily managed. A minority of patients will experience major complications (CD 3a or greater) that require additional procedures and management to secure a safe outcome. These data are helpful to inform patients of the risks of operation and guide physicians for optimal consent. [ABSTRACT FROM AUTHOR]

Introduction: Dementia, a term for a range of cognitive impairments impacting memory, thinking, and social abilities, represents a formidable challenge to healthcare systems worldwide. Analysing the temporal trends in dementia‐related mortality among individuals, identifying the populations at high risk, and guiding the implementation of tailored interventions to address the escalating effects of dementia on public health. Methods: Data from CDC WONDER database was examined from 1999 to 2020 for the four causes of dementia mortality: unspecified dementia (F03), Alzheimer's disease (G30), vascular dementia (F01), and other degenerative diseases of nervous system not elsewhere classified (G31). Age‐adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by geographic region, year, age groups, sex, and race/ethnicity. Results: A total of 4,077,973 reported deaths were related to dementia from 1999 to 2020 in the United States. The greatest proportion of deaths was associated with Alzheimer's disease (45.9%), followed by unspecified dementia (43.8%). Very low proportion of deaths were associated with vascular dementia (4.9%) or other neurodegenerative diseases (5.3%). The AAMR increased in two distinct periods: a steep incline from 1999 to 2010 (APC: 6.95, 95% CI: 6.00–7.90), followed by a modest incline till 2020 (APC: 1.41, 95% CI: 0.80–2.04). Overall, females had a higher AAMR than males. AAMRs were highest among NH Whites patients and lowest in NH Asians or Pacific Islanders. A significant geographical difference was also observed among different US census regions. Nearly equal AAMRs were seen in non‐metropolitan areas and metropolitan areas. States with AAMRs in the top 90th percentile included South Carolina, North Carolina, Maine, Tennessee, Georgia, and Alabama while states with AAMRs in the bottom 10th percentile included South Dakota, Florida, Hawaii, New Jersey, District of Columbia, and New York (33.1). Individuals aged above 85 had the highest AAMRs. Most deaths occurred in nursing homes and least in hospice facilities. Conclusion: The dementia related deaths are continuously increasing. Highest AAMRs were observed among the NH White people, females, and in the southern areas of the United States. People aged 85+ were most affected. To stop the rising death rates, targeted interventions and awareness are required for both prevention and treatment of dementia. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the independent and joint associations of vitamin B12 and methylmalonic acid (MMA) with all-cause, cardiovascular disease (CVD), and cancer mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: We included 6797 individuals with MASLD from the U.S. National Health and Nutrition Examination Survey. Serum MMA was measured using gas/liquid chromatography-mass spectrometry. Serum vitamin B12 was measured using commercial kits. The separate and joint associations of dietary intake and serum vitamin B12 (cutoff: 400 pg/mL) and MMA (cutoff: 250 nmol/L) levels with mortality were assessed by Cox proportional hazards regression. Results: During a median follow-up of 9.3 years, 1604 deaths were documented, including 438 from CVD and 365 from cancer. In MASLD patients, dietary intake and serum vitamin B12 did not associate with mortality, while MMA was associated with a 1.35-fold increased risk of all-cause mortality (P-trend < 0.001). The adjusted hazard ratios for the joint association of vitamin B12 and MMA with all-cause and CVD mortality were 1 in the B12lowMMAlow group (reference), 1.02 (0.87–1.20) and 1.15 (0.90–1.47) in the B12highMMAlow group, 1.55 (1.29–1.86) and 1.84 (1.28–2.65) in the B12lowMMAhigh group, and 1.82 (1.49–2.21) and 2.28 (1.40–3.71) in the B12highMMAhigh group, respectively. The joint association was modified by serum folate (P-interaction = 0.001). Conclusions: In MASLD patients, MMA rather than dietary and serum vitamin B12 was positively associated with all-cause mortality. The joint effect of high levels of MMA and vitamin B12 showed the strongest associations with all-cause and CVD mortality, with a significant interaction with serum folate. [ABSTRACT FROM AUTHOR]

Background: Antioxidant and pro-oxidant dietary patterns and lifestyle changes have been considered to play a crucial role in Helicobacter pylori (H. pylori) infection. We conducted this study to investigate the underlying association between oxidative balance score (OBS) and H. pylori infection in the US population. Methods: This was a cross-sectional study according to data from the National Health and Nutrition Examination Survey (1999–2000), and included individuals with complete information about dietary intake and H. pylori serologic testing results. In the present study, we used multivariate logistic regression analysis, smoothed curve fitting, subgroup analyses, and Cox proportional hazards modeling based on demographic and clinical variables to examine the relationship between OBS and H. pylori infection. Results: A total of 3413 individuals participated in our analysis with an average age of 32.31 years. The prevalence of H. pylori infection in the study population was 29.77%. By performing smooth curve fitting analysis, we observed an approximately linear relationship between OBS and H. pylori infection, indicating that lower OBS was associated with higher risk of H. pylori infection, especially in over 60 years of age and non-Hispanic white populations. All-cause mortality was also found lower in individuals with higher OBS levels. Conclusion: In the US population, increased levels of OBS were associated with a reduced risk of H. pylori infection and decreased all-cause mortality. More and further work is still needed to elucidate the precise mechanism of the association between OBS and H. pylori infection. [ABSTRACT FROM AUTHOR]

Despite the substantial evidence on the health effects of short-term exposure to ambient fine particles (PM2.5), including increasing studies focusing on those from wildland fire smoke, the impacts of long-term wildland fire smoke PM2.5 exposure remain unclear. We investigated the association between long-term exposure to wildland fire smoke PM2.5 and nonaccidental mortality and mortality from a wide range of specific causes in all 3,108 counties in the contiguous United States, 2007 to 2020. Controlling for nonsmoke PM2.5, air temperature, and unmeasured spatial and temporal confounders, we found a nonlinear association between 12-mo moving average concentration of smoke PM2.5 and monthly nonaccidental mortality rate. Relative to a month with the long-term smoke PM2.5 exposure below 0.1 µg/m³, nonaccidental mortality increased by 0.16 to 0.63 and 2.11 deaths per 100,000 people per month when the 12-mo moving average of PM2.5 concentration was of 0.1 to 5 and 5+ µg/m³, respectively. Cardiovascular, ischemic heart disease, digestive, endocrine, diabetes, mental, and chronic kidney disease mortality were all found to be associated with long-term wildland fire smoke PM2.5 exposure. Smoke PM2.5 contributed to approximately 11,415 nonaccidental deaths/y (95% CI: 6,754, 16,075) in the contiguous United States. Higher smoke PM2.5-related increases in mortality rates were found for people aged 65 and above. Positive interaction effects with extreme heat were also observed. Our study identified the detrimental effects of long-term exposure to wildland fire smoke PM2.5 on a wide range of mortality outcomes, underscoring the need for public health actions and communications that span the health risks of both short-and long-term exposure. [ABSTRACT FROM AUTHOR]

The majority of occupational lung diseases have long latency periods, with disease manifesting at an older age. We conducted an extensive literature review and analyzed data for age-related mortality, the impact of age on the lungs and occupational lung diseases, changes in the workforce, and considerations for surveillance to maintain a healthy workforce. Age is a major factor in occupational lung diseases, which in turn predisposes older adults to other health conditions and reduces their quality of life and life expectancy. More specifically, age-related changes in the lungs increase the susceptibility to environmental exposure-induced lung injuries and are linked to poor prognosis. Data from the Work-Related Lung Disease Surveillance Report published by the National Institute for Occupational Safety and Health (NIOSH, 2008) indicated that death from occupational lung diseases among U.S. residents peaked in the age group 75--84 years. Interestingly, the age group 65--74 years recorded a substantial number of deaths, second to the age group 75--84 years. This trend represents a shift in U.S. mortality for all diseases, which peaks at ≥85 years. Improved surveillance and early detection will be instrumental in reducing the burden of occupational lung injury in older adults, many of whom are staying in the workforce longer. [ABSTRACT FROM AUTHOR]

Income inequality has been increasing for decades and is now known to be related to many downstream health outcomes, where greater inequality is a predictor of poorer health. Results of investigations into the relationship between income inequality and suicidality have been mixed. This study leverages the most recent data available from the National Longitudinal Mortality Study to investigate the relationship between state-level income inequality and suicide mortality. A series of rigorously controlled logistic regression models, employing multiple measures of inequality, and various suicide mortality case-control specifications are used to investigate the phenomenon. Results indicate that the odds of suicide mortality increase with inequality, and this result is invariant across all models. A reduction in the Gini coefficient from the highest to lowest values of income inequality observed in U.S. states may reduce the odds of suicide mortality by 20 percent to 55 percent or more. Findings have application for social workers and other mental health professionals with respect to clinical assessment and treatment. Likewise, community organizers, policy advocates, and legislators should be aware that policy solutions reducing income inequality in the United States are a mechanism for alleviating the suicide mortality burden. [ABSTRACT FROM AUTHOR]

Objectives. To examine trends in overdose deaths by intent and drug category to better understand the recent decrease in overdose suicides amid the overdose epidemic. Methods. We examined trends in rates of overdose deaths by intent (unintentional, suicide, or undetermined) across 9 drug categories from 1999 to 2022 using US National Vital Statistics System mortality data. Results. Unintentional overdoses involving synthetic opioids, polydrug toxicity involving synthetic opioids, psychostimulants, and cocaine increased exponentially with annual percentage changes ranging from 15.0% to 104.9% during 2010 to 2022. The death rates also increased for suicides involving these drugs, especially for psychostimulants (annual percentage change = 12.9% for 2010–2022; P <.001). However, these drugs accounted for relatively small percentages of overdose suicides. The leading drug categories among suicides were antidepressants, prescription opioids, and benzodiazepines, though these deaths have decreased or leveled off in recent years. Conclusions. Different drugs commonly involved in suicides and unintentional overdoses may contribute to their divergent trends. Public Health Implications. Amid the overdose epidemic, safe storage of medications remains a crucial strategy to prevent overdose suicides. The large increases in suicides involving psychostimulants warrant monitoring. (Am J Public Health. 2024;114(10):1081–1085. https://doi.org/10.2105/AJPH.2024.307745) [ABSTRACT FROM AUTHOR]

Mortality surveillance systems can have limitations, including reporting delays, incomplete reporting, missing data, and insufficient detail on important risk or sociodemographic factors that can impact the accuracy of estimates of current trends, disease severity, and related disparities across subpopulations. The Centers for Disease Control and Prevention used multiple data systems during the COVID-19 emergency response—line-level case‒death surveillance, aggregate death surveillance, and the National Vital Statistics System—to collectively provide more comprehensive and timely information on COVID-19‒associated mortality necessary for informed decisions. This article will review in detail the line-level, aggregate, and National Vital Statistics System surveillance systems and the purpose and use of each. This retrospective review of the hybrid surveillance systems strategy may serve as an example for adaptive informational approaches needed over the course of future public health emergencies. (Am J Public Health. 2024;114(10):1071–1080. https://doi.org/10.2105/AJPH.2024.307743) [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to examine the epidemiological characteristics of very elderly patients (aged over 80 years) with cancer admitted to the intensive care unit (ICU), and to elucidate the association between Acute Physiology Score III (APS‐III) and 28‐day mortality. Method: A retrospective analysis was conducted using data extracted from the Medical Information Mart for Intensive Care IV (MIMIC‐IV) database. Patients aged 80 years and above were assigned to three groups: non‐cancer group, non‐metastatic cancer group, and metastatic cancer group, based on their cancer diagnosis and its extent, Kaplan–Meier curves were constructed among these patient groups. Furthermore, patients were divided into a survival group and a non‐survival group based on their 28‐day survival status after ICU admission. Univariate and multivariate logistic regression analyses were performed to detect the risk factors for 28‐day mortality among these patients. Additionally, this investigation sought to establish a dose–response relationship by exploring the graded association between APS‐III scores and the 28‐day mortalities among patients diagnosed with cancer. Results: A total of 42,037 medical records were screened, from which 11,461 elderly patients aged over 80 years were included, comprising 1020 (8.90%) with non‐metastatic cancer, 537 (4.68%) with metastatic cancer, and 9904 (86.41%) without cancer. Significant differences in 28‐day mortality were observed between both the non‐metastatic and metastatic cancer groups compared to the non‐cancer group (20.98% and 22.35% vs. 15.75%, p < 0.001). However, no statistically significant difference was detected in the 28‐day mortality rate when comparing the non‐metastatic cancer group directly with the metastatic cancer group (20.98% vs. 22.35%, p = 0.576). Univariate analysis revealed significant differences (p < 0.001) in age, gender, BMI, aCCI excluding cancer point, ventilation, presence of cancer, and status of metastatic cancer between the survival and non‐survival groups. In the multivariate logistic regression, the odds ratio (OR) for ventilation was found to be 2.154 (95% CI: 1.799–2.578), cancer conferred an OR of 1.499 (95% CI: 1.137–1.975), metastatic cancer showed an OR of 1.171 (95% CI: 0.745–1.841), APS‐III showed an OR of 1.038 (95% CI: 1.034–1.042). A dose–response relationship was observed, demonstrating that when the APS‐III score exceeded 80 points, the 28‐day mortality rate surpassed 50% among the very elderly cancer patients in ICU. Conclusions: More than one‐tenth of critically ill very elderly patients admitted to the ICU are diagnosed with cancer. Among ICU patients, those with cancer face a short‐term mortality risk approximately 1.5 times higher than those without a cancer diagnosis. Interestingly, while our findings do not indicate an escalated mortality risk due to metastasis within the cancer patient cohort, the presence of cancer itself remains a significant factor influencing ICU mortality rates in this very elderly population. [ABSTRACT FROM AUTHOR]

Jail incarceration remains an overlooked yet crucial component of the U.S. carceral system. Although a growing literature has examined the mortality costs associated with residing in areas with high levels of incarceration, far less is known about how local jails shape this burden at the intersection of race, sex, and age. In this study, I examine the relationship between county-level jail incarceration and age-specific mortality for non-Hispanic Black and White men and women, uniquely leveraging race-specific jail rates to account for the unequal racial distribution of jail exposures. This study finds evidence of positive associations between mortality and jail incarceration: this association peaks in late adulthood (ages 50–64), when increases in jail rates are associated with roughly 3% increases in mortality across all race–sex groups. However, patterns vary at the intersection of race, sex, and age. In particular, I find more marked and consistent penalties among women than among men. Additionally, a distinctly divergent age pattern emerges among Black men, who face insignificant but negative associations at younger ages but steep penalties at older ages—significantly larger among those aged 65 or older relative to their White male and Black female counterparts. Evidence further suggests that the use of race-neutral incarceration measures in prior work may mask the degree of harm associated with carceral contexts, because the jail rate for the total population underestimates the association between jail rates and mortality across nearly all race–age–sex combinations. These findings highlight the need for future ecological research to differentiate between jail and prison incarceration, consider the demographic distribution of incarceration's harms, and incorporate racialized measures of exposure so that we may better capture the magnitude of harm associated with America's carceral state. [ABSTRACT FROM AUTHOR]

This research note reevaluates the occupational health impact of right-to-work (RTW) legislation, incorporating recent developments in causal inference techniques. In an era marked by an uptick in the adoption of anti-union legislation and increases in workplace fatalities and injuries, it is particularly urgent to examine the extent to which RTW laws affect workers' health. Using a state-year-level dataset spanning 28 years and collected from multiple data sources, we apply an innovative generalized synthetic control method to overcome several limitations of the traditional two-way fixed-effects approach to examine the effect of RTW laws on occupational fatal injuries as well as various other health outcomes. Robustness checks were conducted using a wide range of alternative methods for two-way fixed-effects adjustments. In contrast with findings from previous studies, we found null effects on occupational fatal injuries, as well as on all other health outcomes. Overall, our results indicate that findings from previous studies are based on very thin empirical evidence, with potentially underestimated standard errors and unobserved confounders. Our results highlight the importance of revisiting research questions using updated methodological tools. [ABSTRACT FROM AUTHOR]

Background: The relationship between free fatty acids (FFAs) and the risk of mortality remains unclear. There is a scarcity of prospective studies examining the associations between specific FFAs, rather than total concentrations, of their effect on long-term health outcomes. Objective: To evaluate the correlation between different FFAs and all-cause and cardiovascular mortality in a large, diverse, nationally representative sample of adults in the US, and examine how different FFAs may mediate this association. Methods: This cohort study included unsaturated fatty acids (USFA) and saturated fatty acids (SFA) groups in the US National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014 and provided blood samples for FFAs levels. Multiple model calibration was performed using Cox regression analysis for known risk factors to explore the associations between FFAs and all-cause and cardiovascular mortality. Results: In the group of USFA, 3719 people were included, median follow-up, 6.7 years (5.8–7.8 years). In the SFA group, we included 3900 people with a median follow-up, 6.9 years (5.9-8 years). In the USFA group, myristoleic acid (14:1 n-5) (hazard ratio (HR) 1.02 [1.006–1.034]; P = 0.004), palmitoleic acid (16:1 n-7) (HR 1.001 [1.001–1.002]; P < 0.001), cis-vaccenic acid (18:1 n-7) (HR 1.006 [1.003–1.009]; P < 0.001), nervonic acid (24:1 n-9) (HR 1.007 [1.002–1.012]; P = 0.003), eicosatrienoic acid (20:3 n-9) (HR 1.027 [1.009–1.046]; P = 0.003), docosatetraenoic acid (22:4 n-6) (HR 1.024 [1.012–1.036]; P < 0.001), and docosapentaenoic acid (22:5 n-6) (HR 1.019 [1.006–1.032]; P = 0.005) were positively associated with the all-cause mortality, while docosahexaenoic acid (22:6 n-3) had a statistically lower risk of all-cause mortality (HR 0.998 [0.996–0.999]; P = 0.007). Among the SFA group, palmitic acid (16:0) demonstrated a higher risk of all-cause mortality (HR 1.00 [1.00–1.00]; P = 0.022), while tricosanoic acid (23:0) (HR 0.975 [0.959–0.991]; P = 0.002) and lignoceric acid (24:0) (HR 0.992 [0.984–0.999]; P = 0.036) were linked to a lower risk of all-cause mortality. Besides 23:0 and 24:0, the other FFAs mentioned above were linearly associated with the risks of all-cause mortality. Conclusions: In this nationally representative cohort of US adults, some different FFAs exhibited significant associations with risk of all-cause mortality. Achieving optimal concentrations of specific FFAs may lower this risk of all-cause mortality, but this benefit was not observed in regards to cardiovascular mortality. [ABSTRACT FROM AUTHOR]

Simple Summary: The incidence and mortality rates of cancer in the Surveillance, Epidemiology, and End Results (SEER) Program for adolescent and young adult (AYA) patients show distinct patterns among early-onset cancers. For some cancers, AYA cancer rates varied by age group, sex, race, ethnicity and geography. Monitoring the rates and time trends of AYA cancer emphasizes the distinct health concern for this age group. (1) Background: The incidence rate of early onset-cancer (<50) has increased since 1995. Among younger people, cancers in AYAs (aged 15–39 y) are often biologically distinct tumors from those treated in the pediatric and older adult population. The current study describes trends in the United States for the most recent years including the first year of the COVID-19 epidemic. We aimed to describe the recent incidence and mortality trends of cancers in AYAs (aged 15–39 y). (2) Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER 22) from 1 January 2016 to 31 December 2021. Age-adjusted incidence and mortality rates were assessed by SEER*Stat 8.4.3 for major cancer types by sex, race/ethnicity, age, and metropolitan/nonmetropolitan status. Time trends of age-adjusted incidence and mortality rates were examined by sex and metropolitan/nonmetropolitan status. (3) Results: Age-adjusted overall cancer incidence and mortality rates were stable during this study period. The age-adjusted incidence rates declined significantly for ependymoma, melanoma, carcinomas of lung, bronchus, and trachea, unspecified malignant neoplasms, and non-Hodgkin's lymphoma. Significant increases were found for gastrointestinal tract cancers and non-Kaposi sarcomas. The age-adjusted mortality rate decreased for acute myeloid leukemia, melanoma, carcinomas of liver and intrahepatic bile ducts, kidney and, in women, leukemia. For some cancers, rates differed by sex, race, ethnicity, and geography. Monitoring the rates and time trends of AYA cancer emphasizes the distinct health concern for this age group. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis with pathological fractures is a significant public health issue, contributing to morbidity, disability, diminished quality of life, and increased mortality. Understanding mortality trends related to this condition is crucial for developing effective interventions to reduce mortality and improve healthcare outcomes. This study aimed to analyze trends and causes of death associated with osteoporosis and pathological fractures in the United States using a multi-cause approach. Methods: Annual death and age-standardized mortality rate (ASMR) data from 1999 to 2020 were obtained from the Centers for Disease Control and Prevention (CDC) mortality database. Death certificates listing ICD-10 M82 (osteoporosis with pathological fracture) as an underlying or related cause of death were analyzed. Epidemiological data were analyzed, and the ASMR data were calculated for each year, and trends were assessed using the Cochran-Armitage trend test. Results: From 1999 to 2020, there were 40,441 deaths related to osteoporosis with pathological fractures in the United States, with a female-to-male ratio of 5.6:1. Among these, 12,820 deaths (31.7%) listed osteoporosis with pathological fractures as the underlying cause of death (UCD), yielding a female-to-male ASMR ratio of approximately 5.0-7.7:1. When classified as a non-UCD, the ASMR ratio was approximately 4.8–6.2:1. At the same time, we found that the total number of deaths classified as UCD and multiple causes of death (MCD), but the trend ratio of the two groups in different years did not change statistically significant (P > 0.05), and the ASMR of both groups showed a downward trend. The UCD-to-MCD ratio increased between 1999 and 2007, then decreased from 2007 to 2020. As MCD, the number of female deaths was more than that of male, and both showed a decreasing trend, but there was no statistical significance in the change of trend ratio in different years (P > 0.05). Deaths were predominantly concentrated in individuals over 75 years of age, with those over 84 years being the most affected. The number of deaths in different age groups showed a decreasing trend, and the change of trend ratio in different years was statistically significant (P < 0.05). White individuals had the highest number of deaths. The leading causes of death were heart diseases, chronic lower respiratory diseases, and alzheimer's disease. In addition, the number of deaths of patients with prostate cancer and breast cancer showed a significant downward trend, and the change of trend ratio between the two groups in different years was statistically significant (P < 0.05). Conclusions: Although mortality from osteoporosis with pathological fractures is decreasing, anti-osteoporosis therapy remains essential for elderly patients. Healthcare providers should remain vigilant for potential complications, including malignant neoplasms, and ensure timely diagnosis and treatment to further reduce mortality in this population. [ABSTRACT FROM AUTHOR]

Background: Our systematic review aimed to critically evaluate empirical literature describing the association of muscle-strengthening exercise (MSE) with recurrence and/or mortality among breast cancer survivors. Methods: We included English-language empirical research studies examining the association between MSE and recurrence and/or mortality among females diagnosed with breast cancer. Seven databases (MEDLINE, PsycINFO, Embase, Scopus, Web of Science, Cochrane CENTRAL, and CINAHL) were searched in September 2023. Quality was appraised using the Mixed Methods Appraisal Tool. Results are summarized descriptively. Results: Five sources were identified. MSE measurement differed in relation to the description of the MSE (i.e., muscle-strengthening vs. strength training), examples of activities (e.g., sit-ups or push-ups vs. calisthenics vs. circuit training), and exercise frequency (i.e., days vs. times/week). Findings offer provisional evidence that some MSE may lower the hazards of recurrence and mortality. This association may vary by race, weight status, and menopausal status. Conclusions: In summary, limited available evidence suggests that MSE may lower the hazards of recurrence and mortality. More consistent measurement and analyses would help generate findings that are more readily comparable and applicable to inform clinical practice. Further research is needed to improve understanding of the strength and differences of these associations among underserved and underrepresented women. [ABSTRACT FROM AUTHOR]

Introduction: Current guidelines recommend that the International Normalized Ratio (INR) be less than 1.5 prior to spine intervention. Recent studies have shown that an INR > 1.25 is associated worse outcomes following anterior cervical surgery. We sought to determine the risk of complications associated with an INR > 1.25 following elective posterior cervical surgery. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried. Patients undergoing elective posterior cervical surgery from 2012 to 2016 with an INR level within 24 h of surgery were included. Primary outcomes were hematoma requiring surgery, 30-day mortality, and transfusions within 72-hours. There were 815 patients in the INR ≤ 1 cohort (Cohort A), 410 patients in the 1 < INR ≤ 1.25 cohort (Cohort B), and 33 patients in the 1.25 < INR ≤ 1.5 cohort (Cohort C). Results: Cohort C had a higher rate of transfusion (4% Cohort A; 6% Cohort B; 12% Cohort C; p = 0.028) and the rate of mortality within 30 days postoperatively trended toward significance (0.4% Cohort A; 0.5% Cohort B; 3% Cohort C; p = 0.094). There was no significant difference in the rate of postoperative hematoma formation requiring surgery (0.2% Cohort A; 0% Cohort B; 0% Cohort C; p = 0.58). On multivariate analysis, increasing INR was not associated with an increased risk of developing a major complication. Conclusion: An INR > 1.25 but ≤ 1.5 may be safe for posterior cervical surgery. An INR > 1.25 but ≤ 1.5 was associated with a significantly higher rate of transfusions. However, increasing INR was not significantly associated with increased risk of any of the major complications. [ABSTRACT FROM AUTHOR]

AbstractAimMethodsResultsConclusionsGuillain-Barré syndrome (GBS) is an autoimmune neurological disorder, with an estimated 6.4% increase in cases worldwide from 1990 to 2019. We aim to identify the GBS-related mortality trends in the US stratified by age, sex, race, and region.We used data from the CDC-WONDER database to calculate crude (CMR) and age-adjusted mortality rates (AAMRs) per 1,000,000 people. We examined the temporal trends through annual percent change (APC) and the average annual percent change (AAPC) in rates using Joinpoint regression.From 1999 to 2020, a total of 10,097 GBS-related deaths occurred in the US. The AAMR decreased till 2014 (APC: −1.91) but increased back to initial levels by 2020 (APC: 3.77). AAMR was higher in males (1.7) than females (1.1), decreasing till 2015 for females and 2014 for males, but increasing thereafter only for females. Non-Hispanic (NH) American Indians or Alaska Natives displayed the highest AAMR (1.8) while NH Asians or Pacific Islanders displayed the lowest (0.6). AAMRs also varied by region (West: 1.5; South: 1.5; Midwest: 1.4; Northeast: 1.1). Rural regions exhibited a higher AAMR (1.7) than urban regions (1.3). Most deaths occurred in medical facilities (60.99%). The adults aged ≥85 years exhibited an alarmingly high CMR (14.0).While the mortality rates for GBS initially declined till 2014, they climbed back up afterwards. Highest mortality was exhibited by males and NH American Indians or Alaska Natives, residents of rural regions, and adults ≥85 years. Equitable efforts are needed to reduce the burden on high-risk populations. [ABSTRACT FROM AUTHOR]

Background While alcohol consumption is implicated in the development of aortic dissection, the impact of alcohol use disorder (AUD) on the outcomes of type A aortic dissection (TAAD) repair is still largely unexplored. This study aimed to conduct a comprehensive, population-based analysis of effect of AUD on in-hospital outcomes following TAAD repair using National/Nationwide Inpatient Sample, the largest all-payer database in the United States. Methods Patients undergoing TAAD repair were identified in National/Nationwide Inpatient Sample from Q4 2015–2020. Demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status between patients with and without AUD were matched by a 1:3 propensity-score matching. In-hospital outcomes were examined. Results There were 220 patients with AUD who underwent TAAD repair. Meanwhile, 4062 non-AUD patients went under TAAD repair, where 646 of them were matched to all AUD patients. After propensity-score matching, AUD patients had a lower risk of in-hospital mortality (7.76% vs 13.31%, P = 0.03) while there was no difference in transfer-in status or time from admission to operation. However, patients with AUD had a higher rate of respiratory complications (27.40% vs 19.66%, P  = 0.02) and a longer hospital length of stay (16.20 ± 11.61 vs 11.72 ± 1.69 days, P  = 0.01). All other in-hospital outcomes were comparable between AUD and non-AUD patients. Conclusion AUD patients had a lower risk of in-hospital mortality but a higher rate of respiratory complications and a longer LOS. These findings can provide insights into preoperative risk stratification of these patients. Nonetheless, reasons underlying the lower mortality rate in AUD patients and their long-term prognosis require further investigation. [ABSTRACT FROM AUTHOR]

Background: Live dietary microbes have been hypothesized to promoting human health. However, there has been lacking perceptions to crystallize nexus between consumption of foods with live microbes and mortality. Objective: To investigate the association of consumption of foods with medium to high amounts of live microbes with all-cause, cancer-specific, and cardiovascular disease (CVD)-specific mortality. Methods: The data were obtained from the National Health and Nutrition Examination Survey 1999–2018 at baseline linked to the 2019 National Death Index records. Based on consumption of foods that were categorized as either having medium or high microbial content (MedHi foods), participants were classified into three groups. Kaplan–Meier survival curves and multivariable Cox regression models were used to estimate the association of consumption of MedHi foods with mortality. Population-attributable fractions (PAFs) of consumption of MedHi foods in relation to mortality risk were also estimated. Results: A total of 35,299 adults aged ≥ 20 years were included in this study. During a median follow-up of 9.67 years, compared with adults in G1, those in G3 had 16% (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.77–0.90) reduced risk of all-cause mortality, and 23% (HR, 0.77; 95% CI, 0.67–0.89) reduced risk of CVD-specific mortality. The PAF of high (G3) vs. intermediate or low consumption of MedHi foods (G1 + G2) with all-cause and CVD-specific mortality was 3.4% and 4.3%, respectively. Conclusions: Consumption of foods with higher microbial concentrations is associated with a reduced risk of all-cause and CVD-specific mortality in US adults. [ABSTRACT FROM AUTHOR]

Objective: Death from tuberculosis or HIV among people from racial and ethnic minority groups who are aged <65 years is a public health concern. We describe age-adjusted, absolute, and relative death rates from HIV or tuberculosis from 2011 through 2020 by sex, race, and ethnicity among US residents. Methods: We used mortality data from the Centers for Disease Control and Prevention online data system on deaths from multiple causes from 2011 through 2020 to calculate age-adjusted death rates and absolute and relative disparities in rates of death by sex, race, and ethnicity. We calculated corresponding 95% CIs for all rates and determined significance at P <.05 by using z tests. Results: For tuberculosis, when compared with non-Hispanic White residents, non-Hispanic American Indian or Alaska Native residents had the highest level of disparity in rate of death (666.7%). Similarly, as compared with non-Hispanic White female residents, American Indian or Alaska Native female residents had a high relative disparity in death from tuberculosis (620.0%). For HIV, the age-adjusted death rate was more than 8 times higher among non-Hispanic Black residents than among non-Hispanic White residents, and the relative disparity was 735.1%. When compared with non-Hispanic White female residents, Black female residents had a high relative disparity in death from HIV (1529.2%). Conclusion: Large disparities in rates of death from tuberculosis or HIV among US residents aged <65 years based on sex, race, and ethnicity indicate an ongoing unmet need for effective interventions. Intervention strategies are needed to address disparities in rates of death and infection among racial and ethnic minority populations. [ABSTRACT FROM AUTHOR]

Aim: This prospective cohort study investigated the association between periodontal diseases (PDs) and all‐cause and cause‐specific mortality. Materials and Methods: We utilized adult participants recruited from six National Health and Nutrition Examination Survey cycles (1999–2014) and linked mortality data from the National Death Index up to December 2019. Baseline clinical periodontal examinations were performed by trained and calibrated examiners. All‐cause and cause‐specific mortality was modelled through multivariable Cox proportional hazards and Fine–Gray models to account for competing risks. All models were adjusted for demographic and lifestyle variables, clinical measurements and comorbidities. Results: Overall, 15,030 participants were included, with a median length of follow‐up of 9 years. Risk of all‐cause mortality was 22% greater in people with PD than the control group (adjusted hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.12–1.31). Risks of mortality by cardiovascular diseases (CVD), respiratory disease and diabetes were highest in participants with severe PD (CVD—sub‐distribution HR [SHR]: 1.38, 95% CI: 1.16–1.64; respiratory—SHR: 1.62, 95% CI: 1.07–2.45; diabetes—SHR: 1.68, 95% CI: 1.12–2.53). Conclusions: Severe PD is associated with all‐cause and cause‐specific mortality among US adults after multivariable adjustment. [ABSTRACT FROM AUTHOR]

Background Human immunodeficiency virus (HIV)–related opportunistic infections (OIs) cause substantial morbidity and mortality among people with HIV (PWH). US hospitalization and in-hospital mortality rates associated with OIs have not been published using data from the past decade. Methods We analyzed the National Inpatient Sample for the years 2011 through 2018. We used sociodemographic, financial, and hospital-level variables and identified hospitalizations for PWH and OI diagnoses. Using survey-weighted methods, we estimated all OI-related US hospitalization rates and in-hospital mortality per 100 000 PWH and modeled associated factors using survey-based multivariable logistic regression techniques. Results From 2011 to 2018, there were an estimated 1 710 164 (95% confidence interval [CI], 1 659 566–1 760 762) hospital discharges for PWH with 154 430 (95% CI, 148 669–159 717 [9.2%]) associated with an OI, of which 9336 (95% CI, 8813–9857; 6.0%) resulted in in-hospital mortality. Variables associated with higher odds of OI-related hospitalizations (compared to without an OI) included younger age, male sex, non-White race/ethnicity, and being uninsured (all likelihood ratio [LR] P <.001). Higher OI-related mortality was associated with older age (LR P <.001), male sex (LR P =.001), Hispanic race/ethnicity (LR P <.001), and being uninsured (LR P =.009). The OI-related hospitalization rate fell from 2725.3 (95% CI, 2266.9–3183.7) per 100 000 PWH in 2011 to 1647.3 (95% CI, 1492.5–1802.1) in 2018 (P <.001), but the proportion of hospitalizations with mortality was stable (5.9% in 2011 and 2018). Conclusions Our findings indicate an ongoing need for continued funding of HIV testing, health insurance for all PWH, OI screening initiatives, review of current prophylaxis guidelines, and recruitment of more HIV clinicians. [ABSTRACT FROM AUTHOR]

Final annual mortality data from the National Vital Statistics System for a given year are typically released 11 months after the end of the calendar year. Provisional data, which are based on preliminary death certificate data, provide an early estimate of deaths before the release of final data. In 2023, a provisional total of 3,090,582 deaths occurred in the United States. The age-adjusted death rate per 100,000 population was 884.2 among males and 632.8 among females; the overall rate, 750.4, was 6.1% lower than in 2022 (798.8). The overall rate decreased for all age groups. Overall age-adjusted death rates in 2023 were lowest among non-Hispanic multiracial (352.1) and highest among non-Hispanic Black or African American persons (924.3). The leading causes of death were heart disease, cancer, and unintentional injury. The number of deaths from COVID-19 (76,446) was 68.9% lower than in 2022 (245,614). Provisional death estimates provide an early signal about shifts in mortality trends. Timely and actionable data can guide public health policies and interventions for populations experiencing higher mortality. [ABSTRACT FROM AUTHOR]

We investigate how the type of caregiving arrangement is associated with older Americans' outcomes. We use the Health and Retirement Study (2004–2018) and discrete-time event history analysis to assess the odds of institutionalization or death over a 14-year period among older adults with limitations in Activities of Daily Living (ADLs; e.g., bathing). We consider caregiving arrangements as conventional (i.e., spouse or adult child), unconventional (e.g., extended family, employee, friend), or self-directed (i.e., no caregiver). We find a "care paradox" in that self-directing one's own care was associated with a lower risk of institutionalization or death compared with having conventional care (spouse/adult caregiver) and unconventional care (employee). Relative to conventional care, having an employee caregiver was associated with increased risk of institutionalization. Findings are still observed when controlling for level of impairment and various health-related factors. More research is needed to understand older adults who self-direct their own care. [ABSTRACT FROM AUTHOR]

Introduction: Malignant brain tumors are malignancies which are known for their low survival rates. Despite advancements in treatments in the last decade, the disparities in malignant brain cancer mortality among the US population remain unclear. Methods: We analyzed death certificate data from the US CDC WONDER from 1999 to 2020 to determine the longitudinal trends of malignant brain tumor mortality. Malignant brain tumor (ICD-10 C71.0–71.9) was listed as the underlying cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated by standardizing the AAMR to the year 2000 US population. Results: From 1999 to 2020, there were 306,375 deaths due to malignant brain tumors. The AAMR decreased from 5.57 (95% CI, 5.47–5.67) per 100,000 individuals in 1999 to 5.40 (95% CI, 5.31–5.48) per 100,000 individuals in 2020, with an annual percent decrease of −0.05 (95% CI, −0.22, 0.12). Whites had the highest AAMR (6.05 [95% CI, 6.02–6.07] per 100,000 individuals), followed by Hispanics (3.70 [95% CI, 3.64–3.76]) per 100,000 individuals, blacks (3.09 [95% CI, 3.04–3.14] per 100,000 individuals), American Indians (2.82 [95% CI, 2.64–3.00] per 100,000 individuals), and Asians (2.44 [95% CI, 2.38–2.50] per 100,000 individuals). The highest AAMRs were reported in the Midwest region (5.58 [95% CI, 5.54–5.62] per 100,000 individuals) and the rural regions (5.66 [95% CI, 5.61–5.71] per 100,000 individuals). Conclusions: Our study highlights the mortality disparity among different races, geographic regions, and urbanization levels. The findings underscore the importance of addressing the disparities in malignant brain tumors that existed among males, white individuals, and rural populations. [ABSTRACT FROM AUTHOR]

Disability is associated with alcohol misuse and drug overdose death, however, its association with alcohol-induced death remains understudied. To quantify the risk of alcohol-induced death among adults with different types of disabilities in a nationally representative longitudinal sample of US adults. Persons with disabilities were identified among participants ages 18 or older in the Mortality Disparities in American Communities (MDAC) study (n = 3,324,000). Baseline data were collected in 2008 and mortality outcomes were ascertained through 2019 using the National Death Index. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated for the association between disability type and alcohol-induced death, controlling for demographic and socioeconomic covariates. During a maximum of 12 years of follow-up, 4000 alcohol-induced deaths occurred in the study population. In descending order, the following disability types displayed the greatest risk of alcohol-induced death (compared to adults without disability): complex activity limitation (aHR = 1.7; 95% CI = 1.3–2.3), vision limitation (aHR = 1.6; 95% CI = 1.2–2.0), mobility limitation (aHR = 1.4; 95% CI = 1.3–1.7), ≥2 limitations (aHR = 1.4; 95% CI = 1.3–1.6), cognitive limitation (aHR = 1.2; 95% CI = 1.0–1.4), and hearing limitation (aHR = 1.0; 95% CI = 0.9–1.3). The risk of alcohol-induced death varies considerably by disability type. Efforts to prevent alcohol-induced deaths should be tailored to meet the needs of the highest-risk groups, including adults with complex activity (i.e., activities of daily living – "ALDs"), vision, mobility, and ≥2 limitations. Early diagnosis and treatment of alcohol use disorder within these populations, and improved access to educational and occupational opportunities, should be considered as prevention strategies for alcohol-induced deaths. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic, which started in 2020, resulted in greater all‐cause mortality in 2020 and in subsequent years. Whether all‐cause mortality remains elevated in 2023 compared to pre‐pandemic numbers is unknown. Methods and results: The United States (US) Center for Disease Control Wide‐Ranging, Online Data for Epidemiologic Research database was used to compare mortality rates between 2019 and provisional data for 2022 and 2023. Age‐adjusted mortality rates (AAMRs) for all‐cause as well as top causes of mortality were collected. Mortality based on subgroups by sex, age, and ethnicity was also collected. All‐cause AAMRs between 2018 and 2023 per 100,000 individuals were 723.6, 715.2, 835.4, 879.7, (provisionally) 798.8, and (provisionally) 738.3, respectively, with AAMRs in 2023 remaining above 2019 pre‐pandemic levels. Similar trends were noted in subgroups based on sex, ethnicity, and most age groups. Mortality attributed directly to COVID‐19 peaked in 2021 as the 3rd leading cause of death and dropped to the 10th leading cause in 2023. Provisional mortality rate trends for 2023 suggest that rates for diseases of the heart increased during the pandemic but appear to have returned to or dipped below pre‐pandemic levels. Conclusion: Provisional 2023 all‐cause mortality rates in the US have decreased from the 2021 peak associated with the COVID‐19 pandemic but remain above the pre‐pandemic baseline. Mortality from some conditions, including diseases of the heart, appears to have recovered from the impact of the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Regular physical activity (PA) offers numerous benefits, decreasing all-cause mortality (ACM) among the general population. However, its impact on individuals with depression remains unknown. The present study aimed to investigate the correlation between various PA levels and ACM among adult patients with depression in the United States. Data from the National Health and Nutrition Examination Survey from 2007 to 2018, as well as relevant mortality data up to December 31, 2018 were extracted. 4850 adults with depression were incorporated into this cohort study. PA level was quantified based on weekly metabolic equivalent of task (MET-min/week) and categorized into four groups according to the Physical Activity Guidelines for Americans. Weighted Cox proportional-hazards models were leveraged to assess the association of different PA levels with ACM among adults with depression, and adjustments were made for various sociodemographic and health factors. Among the 4850 patients with depression, 503 deaths were noted over a median follow-up of 6.6 years. The weighted Cox regression analysis showed that participants with high-level PA (>1200 MET-min/week) had a markedly lower risk of ACM (HR = 0.48, 95 % CI 0.33 to 0.68) compared to those with no PA (0 MET-min/week). The benefit conferred by the high-level PA group (HR = 0.65, 95CI 0.45 to 0.94) remained significant (p < 0.05) after adjustment for other confounders. PA and some covariates were assessed through self-reported questionnaires. High-level PA has the most pronounced effect on reducing ACM among adult patients with depression, which should be recognized in clinical and public health guidelines. [Display omitted] • High-level physical activity significantly reduces all-cause mortality in depressed patients. • There is a significant nonlinear relationship between the level of physical activity and all-cause mortality. • Male patients with depression may require a higher level of physical activity to gain the benefits. [ABSTRACT FROM AUTHOR]

Objective We evaluated whether more severe back pain phenotypes—persistent, frequent, or disabling back pain—are associated with higher mortality rate among older men. Methods In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from 6 sites in the United States. The primary back pain measure used baseline and Year 5 back pain questionnaire data to characterize participants as having no back pain, nonpersistent back pain, infrequent persistent back pain, or frequent persistent back pain. Secondary measures of back pain from the Year 5 questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific death. Results After the Year 5 exam, during up to 18 years of follow-up (mean follow-up = 10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95% CI = 1.11–1.45). No association was evident after further adjustment for health-related factors, such as self-reported general health and comorbid chronic health conditions (fully adjusted HR = 1.00; 95% CI = 0.86–1.15). Results were similar for cardiovascular deaths and other deaths, but we observed no association of back pain with cancer deaths. Secondary back pain measures, including back-related disability, were associated with increased mortality risk that remained statistically significant in fully adjusted models. Conclusion Although frequent persistent back pain was not independently associated with risk of death in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality rate. Future investigations should evaluate whether improvements in disabling back pain affect general health and well-being or risk of death. [ABSTRACT FROM AUTHOR]

The influence of race and ethnicity on clinical outcomes in medicine are widely acknowledged. However, the effect of race on adult congenital heart disease (ACHD) surgery is not known. We sought to evaluate the possible association between race and outcomes following ACHD operations. Discharge records for patients who underwent ACHD surgery between 2005 and 2014, were isolated from an all-payer voluntary database in the United States. Hierarchical case-mix regression models and sensitivity analyses examined any complication, in-hospital mortality, and discharge disposition (home/non-home) by race (white–WP, black–BP, non-white non-black–NWNB). Of the 174,370 patients (WP: 80.8%, BP: 5.8%, NWNB: 13.4%), black patients were youngest to undergo surgery (WP: 57.9 ± 15.8 years, BP: 50.2 ± 16.1 years, NWNB: 51.6 ± 16.9 years, P < 0.0001), the most likely to have a comorbidity (WP: 70.3%, BP: 74.3%, NWNB: 68.6%, P < 0.0001), and most likely to have had a post-operative cardiac complication (WP: 9.4%, BP: 15.3%, NWNB: 10.9%, P < 0.0001). BP had similar odds of having any complication (AOR = 0.99, 95%CI = 0.94–1.04), while NWNB had significantly decreased odds of a major complication (AOR = 0.90, 95%CI = 0.87–0.93). BP had equivalent in-hospital mortality compared to WP (AOR = 1.03, 95%CI = 0.91–1.18), while NWNB had significantly increased odds of in-hospital mortality (AOR = 1.29, 95%CI = 1.18–1.41). Among survivors, BP were less likely to discharge home (AOR = 0.88, 95%CI = 0.82–0.94), and NWNB were more likely to discharge home than WP (AOR = 1.26, 95%CI = 1.19–1.33). Race and clinical outcomes are associated among patients undergoing surgery for ACHD. Understanding why and how these factors are impactful will help improve care for this complex population. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is linked to immune-mediated pathogenesis and a pro-inflammatory state, leading to accelerated atherosclerosis. This earlier onset of clinical cardiovascular disease poses significant morbidity and mortality. We sought to identify IHD mortality trends in individuals with IBD in the United States (US). Mortality due to ischemic heart diseases (IHD) as the underlying cause of death with the IBD as a contributor of death were queried from death certificates using the CDC database from 1999 to 2020. Yearly crude mortality rates (CMR) were estimated by dividing the death count by the respective population size, reported per 100,000 persons. Mortality rates were adjusted for age using the Direct method and compared by demographic subpopulations. Log-linear regression models were utilized to assess temporal variation (annual percentage change [APC]) in mortality. Age-adjusted mortality rates (AAMR) decreased from 0.11 in 1999 to 0.07 in 2020, primarily between 1999 and 2018 (APC -4.41, p < 0.001). AAMR was higher among male (AAMR 0.08) and White (AAMR 0.08) populations compared to female populations (AAMR 0.06) and Black (AAMR 0.04) populations, respectively. No significant differences were seen when comparing mortality between urban (AAMR 0.07) and rural (AAMR 0.08) regions. Southern US regions (AAMR 0.06) had the lowest mortality rates when compared to the other US census regions: Northeastern (AAMR 0.08), Midwestern (AAMR 0.08), and Western (AAMR 0.08). Disparities in IHD mortality exist among individuals with IBD in the US based on demographic factors, with an overall decline in mortality during the 22-year period. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities. [Display omitted] • Ischemic heart disease mortality in populations with inflammatory bowel disease has decreased in recent years. • Ischemic heart disease mortality disproportionally impacted male and White populations with inflammatory bowel disease. • Southern regions had the lowest ischemic heart disease mortality in populations with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Diverging mortality trends at different ages motivate the monitoring of lifespan inequality alongside life expectancy. Conclusions are ambiguous when life expectancy and lifespan inequality move in the same direction or when inequality measures display inconsistent trends. We propose using nonparametric dominance analysis to obtain a robust ranking of age-at-death distributions. Application to U.S. period life tables for 2006–2021 reveals that, until 2014, more recent years generally dominate earlier years, implying improvement if longer lifespans that are less unequally distributed are considered better. Improvements were more pronounced for non-Hispanic Black and Hispanic individuals than for non-Hispanic White individuals. Since 2014, for all subpopulations—particularly Hispanics—earlier years often dominate more recent years, indicating worsening age-at-death distributions if shorter and more unequal lifespans are considered worse. Dramatic deterioration of the distributions in 2020–2021 during the COVID-19 pandemic is most evident for Hispanic individuals. [ABSTRACT FROM AUTHOR]

Past research suggests that resilience to health hazards increases with age, potentially because less resilient individuals die at earlier ages, leaving behind their more resilient peers. Using lifetime cigarette smoking as a model health hazard, we examined whether accelerated epigenetic aging (indicating differences in the speed of individuals' underlying aging process) helps explain age-related resilience in a nationally representative sample of 3,783 older U.S. adults from the Health and Retirement Study. Results of mediation moderation analyses indicated that participants aged 86 or older showed a weaker association between lifetime cigarette smoking and mortality relative to participants aged 76–85 and a weaker association between smoking and multimorbidity relative to all younger cohorts. This moderation effect was mediated by a reduced association between smoking pack-years and epigenetic aging. This research helps identify subpopulations of particularly resilient individuals and identifies epigenetic aging as a potential mechanism explaining this process. Interventions in younger adults could utilize epigenetic aging estimates to identify the most vulnerable individuals and intervene before adverse health outcomes, such as chronic disease morbidity or mortality, manifest. [ABSTRACT FROM AUTHOR]

Population aging is an important and increasingly relevant area of study for demographers. A growing body of research seeks to determine how long-term changes in births, mortality, and migration—the three drivers of any demographic process—have shaped the present aging situation. Using variable-r decomposition and cohort data, this research note presents a formula for the change in the old-age dependency ratio to determine the extent to which relative changes in births, as well as in mortality and migration rates, contribute to aging. This perspective provides a careful and in-depth picture of aging and contributes to the debate concerning whether changes in births or mortality have had the strongest effect on population aging. When applied to Australia, the United States, and several European populations, the decomposition of the old-age dependency ratio shows that aging occurred in all populations and that changes in both births and mortality contributed to this aging. Analysis of these populations demonstrates that although they differed regarding which of these factors contributed more, changes in births prevailed as the more significant factor. In nearly all populations, migration decreased the rate of population aging. [ABSTRACT FROM AUTHOR]

Background: Studies have shown a bidirectional relationship between asthma and obstructive sleep apnea (OSA). However, there is a paucity of national-level data evaluating the impact of OSA on hospital outcomes in pediatric hospitalizations for asthma. Methods: We analyzed the National Inpatient Sample and Kids Inpatient Database to include all pediatric hospitalizations with a primary diagnosis of asthma between 2003–2016. Using ICD codes, the pediatric asthma cohort was divided into two groups: those with and those without a concomitant diagnosis of OSA. The primary outcomes were in-hospital mortality and the need for mechanical ventilation. The secondary outcomes were the lengths of each hospital stay and total hospitalization charges. Results: We analyzed 1,606,248 hospitalizations during the 14-year study period. The overall prevalence rate of OSA was 0.7%. Patients with asthma and OSA were significantly older (8.2 versus 5.9 years) and were more often male, p < 0.001. The OSA group had several increased comorbidities. The overall mortality rate was 0.03%, and multivariate regression analysis showed that OSA was associated with 4.3 times higher odds of in-hospital mortality (95% CI: 2.4 to 7.6, p < 0.001). Furthermore, OSA was associated with a 5.2 times greater need for mechanical ventilation (95% CI: 4.8 to 5.5, p < 0.001). Linear regression analyses demonstrated that OSA independently contributed an additional 0.82 days to the hospital stay length (95% CI: 0.79 to 0.86, p < 0.001) and an extra 10,479 USD (95% CI: 10,110 to 10,848, p < 0.001) in hospitalization charges. Conclusion: OSA in children admitted with asthma is associated with poor hospital outcomes such as increased mortality risk, the need for mechanical ventilation, and increased healthcare utilization. [ABSTRACT FROM AUTHOR]

Currently, most academic research involving the mortality modeling of multiple populations mainly focuses on factor‐based approaches. Increasingly, these models are enriched with socio‐economic determinants. Yet these emerging mortality models come with little attention to interpretable spatial model features. Such features could be highly valuable to demographers and old‐age benefit providers in need of a comprehensive understanding of the impact of economic growth on mortality across space. To address this, we propose and investigate a family of models that extend the seminal Li‐Lee factor‐based stochastic mortality modeling framework to include both economic growth, as measured by the real gross domestic product (GDP), and spatial patterns of the contiguous United States mortality. Model selection performed on the introduced new class of spatial models shows that based on the AIC criteria, the introduced spatial lag of GDP with GDP (SLGG) model had the best fit. The out‐of‐sample forecast performance of SLGG model is shown to be more accurate than the well‐known Li–Lee model. When it comes to model implications, a comparison of annuity pricing across space revealed that the SLGG model admits more regional pricing differences compared to the Li‐Lee model. [ABSTRACT FROM AUTHOR]

Backgroud: The association between caffeine intake and mortality in prediabetes and diabetes is not well defined. This study was designed to investigate the association between caffeine intake and all-cause mortality and cardiovascular disease (CVD) mortality in adults with prediabetes and diabetes in the United States. Methods: This analysis included 18,914 adult patients with diabetes and prediabetes from the National Health and Nutrition Examination Survey (NHANES) 2003–2018. Follow-up extended to December 31, 2019. Weighted Cox proportional hazards regression models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality and CVD mortality. Results: During 142,460 person-years of follow-up, there were 3,166 cases of all-cause mortality and 1,031 cases of CVD mortality recorded. In the fully adjusted models, caffeine intake showed a significant dose-response association with the risk of all-cause mortality and CVD mortality in individuals with diabetes and prediabetes. When comparing extreme quartiles of caffeine intake, the multivariable-adjusted hazard ratio for all-cause mortality was 0.78 (0.67–0.91) (P for trend = 0.007); however, there was no significant association with the risk of CVD mortality. Results remained consistent in stratified analyses by sex, age, race/ethnicity, education level, family income-poverty ratio, BMI, hypertension, smoking status, alcohol intake, and HEI-2015. Conclusions: This study suggests that caffeine intake is significantly inversely associated with the risk of all-cause mortality in individuals with diabetes and prediabetes. In individuals with prediabetes, there is also a significant inverse association between caffeine intake and CVD events, but this association is not present in those with diabetes. [ABSTRACT FROM AUTHOR]

Objective: An increasing number of studies shown that inadequate energy intake causes an increase in adverse incidents in chronic kidney disease (CKD) patients on low-protein diets (LPD). The study aimed to investigate the relationship between energy intake and cardiovascular mortality in CKD patients on a LPD. Methods: This was a cross-sectional study, a total of 4264 CKD patients were enrolled from the NHANES database between 2009 and 2018. Restricted cubic spline plots and Cox regression analysis were used to analyze the association between energy intake and cardiovascular mortality in CKD patients on a LPD. Additionally, a nomogram was constructed to estimate cardiovascular survival in CKD patients on a LPD. Results: Among CKD patients on a LPD in the United States, 90.05% had an energy intake of less than 25 kcal/kg/day, compared to 36.94% in CKD patients on a non-LPD. Energy intake and cardiovascular mortality showed a linear relationship in CKD patients on a LPD, while a 'U-shaped' relationship was observed in CKD patients on a non-LPD. Multifactorial Cox regression models revealed that for Per-standard deviation (Per-SD) decrement in energy intake, the risk of cardiovascular mortality increased by 41% (HR: 1.41, 95% CI: 1.12, 1.77; P = 0.004) in CKD patients on a LPD. The concordance index of the nomogram was 0.79 (95% CI, 0.75, 0.83). Conclusion: CKD patients, especially those on a LPD, have significantly inadequate energy intake. Lower energy intake is associated with higher cardiovascular mortality in CKD patients on a LPD. [ABSTRACT FROM AUTHOR]

Background: Drawing on prospective data from the National Health and Nutrition Examination Survey (NHANES), our goal was to construct and validate a 5-year survival prediction model for individuals with cognitive impairment (CI). Methods: This study entailed a prospective cohort design utilizing information from the 2011-2014 NHANES dataset, encompassing individuals aged 40 years or older, with updated mortality status as of December 31, 2019. Predictive models within the derivation and validation cohorts were assessed using logistic proportional risk regression, column-line plots, and least absolute shrinkage and selection operator (LASSO) binomial regression models. Results: The study enrolled a total of 1,439 participants (677 men, mean age 69.75 ± 6.71 years), with the derivation and validation cohorts consisting of 1,007 (538 men) and 432 (239 men) individuals, respectively. The 5-year mortality rate stood at 16.12% (n = 232). We devised a 5-item column-line graphical model incorporating age, race, stroke, cardiovascular disease (CVD), and blood urea nitrogen (BUN). The model exhibited an area under the curve (AUC) of 0.772 with satisfactory calibration. Internal validation demonstrated that the column-line graph model displayed strong discrimination, yielding an AUC of 0.733, and exhibited good calibration. Conclusion: To sum up, our study successfully developed and internally validated a 5-item nomogram integrating age, race, stroke, cardiovascular disease, and blood urea nitrogen. This nomogram exhibited robust predictive performance for 5-year mortality in individuals with CI, offering a valuable tool for prognostic evaluation and personalized care planning. [ABSTRACT FROM AUTHOR]

Long-term mortality effects of particulate air pollution have been investigated in a causal analytic frame, while causal evidence for associations with gaseous air pollutants remains extensively lacking, especially for carbon monoxide (CO) and sulfur dioxide (SO2). In this study, we estimated the causal relationship of long-term exposure to nitrogen dioxide (NO2), CO, SO2, and ozone (O3) with mortality. Utilizing the data from National Morbidity, Mortality, and Air Pollution Study, we applied a variant of difference-in-differences (DID) method with conditional Poisson regression and generalized weighted quantile sum regression (gWQS) to investigate the independent and joint effects. Independent exposures to NO2, CO, and SO2 were causally associated with increased risks of total, nonaccidental, and cardiovascular mortality, while no evident associations with O3 were identified in the entire population. In gWQS analyses, an interquartile range-equivalent increase in mixture exposure was associated with a relative risk of 1.067 (95% confidence interval: 1.010–1.126) for total mortality, 1.067 (1.009–1.128) for nonaccidental mortality, and 1.125 (1.060–1.193) for cardiovascular mortality, where NO2 was identified as the most significant contributor to the overall effect. This nationwide DID analysis provided causal evidence for independent and combined effects of NO2, CO, SO2, and O3 on increased mortality risks among the US general population. [ABSTRACT FROM AUTHOR]

We conduct this research with a two-fold aim: providing a quantitative analysis of the opioid epidemic in the United States (U.S.), and exploring the impact of the COVID-19 pandemic on opioid-related mortality. The duration and persistence of the opioid epidemic lends itself to the need for an overarching analysis with extensive scope. Additionally, studying the ramifications of these concurrent severe public health crises is vital for informing policies to avoid preventable mortality. Using data from CDC WONDER, we consider opioid-related deaths grouped by Census Region spanning January 1999 to October 2022 inclusive, and later add on a demographic component with gender-stratification. Through the lens of key events in the opioid epidemic, we build an interrupted time series model to reveal statistically significant drivers of opioid-related mortality. We then employ a counterfactual to approximate trends in the absence of COVID-19, and estimate excess opioid-related deaths (defined as observed opioid-related deaths minus projected opioid-related deaths) associated with the pandemic. According to our model, the proliferation of fentanyl contributed to sustained increases in opioid-related death rates across three of the four U.S. census regions, corroborating existing knowledge in the field. Critically, each region has an immediate increase to its opioid-related monthly death rate of at least 0.31 deaths per 100,000 persons at the start of the pandemic, highlighting the nationwide knock-on effects of COVID-19. There are consistent positive deviations from the expected monthly opioid-related death rate and a sizable burden from cumulative excess opioid-related deaths, surpassing 60,000 additional deaths nationally from March 2020 to October 2022, ∼70% of which were male. These results suggest that robust, multi-faceted measures are even more important in light of the COVID-19 pandemic to prevent overdoses and educate users on the risks associated with potent synthetic opioids such as fentanyl. [ABSTRACT FROM AUTHOR]

Introduction: Melanoma, a deadly form of skin cancer, has witnessed a notable increase in incidence over the past decades. Despite advancements in treatment, it remains a significant cause of cancer mortality. Understanding demographic trends and variations in melanoma mortality is crucial for addressing disparities and implementing effective interventions. Methods: Using the Centers for Disease Control Wide Ranging Online Data for Epidemiologic Research (CDC WONDER) database, we analyzed melanoma mortality data in the United States from 1999 to 2020. Data were stratified by demographic and regional variables, and age-adjusted mortality rates were calculated. Descriptive analysis was performed and Joinpoint regression analysis was employed to identify temporal trends. Results: Between 1999 and 2020, there were 184,416 melanoma-related deaths in the United States Overall, the age-adjusted mortality rate declined from 2.7 to 2.0 per 100,000 people at a rate of -1.3% annually, with significant variations across demographic groups and regions. Men, non-Hispanic White individuals, and those aged > 65 experienced higher mortality rates. Non-Hispanic White individuals noted the steepest decrease in AAMR after 2013 at a rate of -6.1% annually. Disparities were seen by geographic density, with rural populations exhibiting higher mortality compared to their urban and suburban counterparts. Conclusion: The study highlights a significant reduction in melanoma mortality in the U.S. since 2013, potentially attributed to advancements in diagnostic techniques such as dermoscopy and the introduction of immune checkpoint inhibitors. Disparities persist, particularly among rural populations. Targeted interventions focusing on increased screening and education are warranted to further mitigate melanoma mortality and address demographic disparities. [ABSTRACT FROM AUTHOR]