جستجوی مقالات مرتبط با کلیدواژه « excess mortality » در نشریات گروه « پزشکی »

Because quantifying the relative contributions of prevention and medical care to the decline in cardiovascular mortality is controversial, at present mortality indicators use a fifty-fifty allocation to fraction avoidable cardiovascular deaths as being partly preventable and partly amenable. The aim of this study was to develop a dynamic approach to estimate the contributions of preventable versus amenable mortality, and to estimate the proportion of amenable mortality due to non-utilisation of care versus suboptimal quality of care.

We calculated the contribution of primary prevention, healthcare utilisation and healthcare quality in Latvia by using Emilia-Romagna (ER) (Italy) as the best performer reference standard. In particular, we considered preventable mortality as the number of cardiovascular deaths that could be avoided if Latvia had the same incidence as ER, and then apportioned non-preventable mortality into the two components of non-utilisation versus suboptimal quality of hospital care based on the presence of hospital admissions in the days before death. This calculation was possible thanks to the availability of the unique patient identifier in the administrative databases of Latvia and ER.

41.5 people per 100 000 population died in Latvia in 2016 from cardiovascular causes amenable to healthcare; about half of these (21.4 per 100 000) had had no contact with acute care settings, while the other half (20.1 per 100 000) had accessed the hospital but received suboptimal-quality healthcare. Another estimated 26.8 deaths per 100 000 population were due to lack of primary prevention. Deaths attributable to suboptimal quality or non-utilisation of hospital care constituted 60.7% of all avoidable cardiovascular mortality.

If research is undertaken to understand the reasons for differences between territories and their possible relevance to lower performing countries, the dynamic assessment of country-specific contributions to avoidable mortality has considerable potential to stimulate cross-national learning and continuous improvement in population health outcomes.

COVID-19 has raised world concern since it emerged in Wuhan, China in December 2019. The direct and indirect death rates in the world and in Iran have increased significantly after the occurrence of this pandemic in the world.

In this study EMR estimated by Multilevel Poison Regression then this estimation compared to the historical trends, to obtain total death related to the COVID-19 in addtion the geographic distribution of EMR has been presented for Iran country.

All-cause mortality count of each province of Iran from March 21, 2013 to June 20, 2020 downloaded from National Organizationfor Civil Registration (NOCR). The data from spring of 2020 (March 20, 2020 to June 20, 2020) remove from data and then the multilevel poison model has been used to estimate all-cause mortality in spring 2020 then excess mortality attributable to COVID-19 (the difference between the numberof registered and expected deaths) has been calculated.

The results of this study showed that Iran’s EMR in spring 2020 was 23% (Male=25%, Female=21%). More result also showed that four category low (EMR≤5%, n=3), moderate (5 %< EMR<20%, n=10), high (20 %< EMR<40%, n=16) and very high (40≤EMR, n=2) EMR.

Due to the diverse EMR in different provinces of Iran, the type of management of provinces with low and moderate EMR can be used as a suitable model to control EMR in provinces with high and very high EMR.

Iran reported its first COVID-19 deaths on February 19, 2020 and announced 1284 deaths with a laboratory-confirmed SARS-CoV-2 infection by March 19, 2020 (end of the winter 1398 SH). We estimated all-cause excess mortality, compared to the historical trends, to obtain an indirect estimate of COVID-19-related deaths.

We assembled time series of the seasonal number of all-cause mortalities from March 21, 2013 (spring of 1392 SH) to March 19, 2020 (winter 1398 SH) for each province of Iran and nationwide with the vital statistics data from the National Organization for Civil Registration (NOCR). We estimated the expected seasonal mortality and excess mortality (the difference between the number of registered and expected deaths). Moreover, we reviewed the provincial number of confirmed cases of COVID-19 to assess their association with excess deaths.

The results of our analysis showed around 7507 (95% CI: 3,350 – 11,664) and 5180 (95% CI: 1,023 – 9,337) all-cause excess mortality in fall and winter, respectively. There were 3778 excess deaths occurred in Qom, Gilan, Mazandaran, and Golestan provinces in the winter, all among the COVID-19 epicenters based on the number of confirmed cases. 

We think most of the excess deaths in the winter were related to COVID-19. Also, we think the influenza epidemic might have been the main reason for the excess mortality in the fall and parts of excess deaths in the winter of 1398 SH. Moreover, a review of all available clinical and paraclinical records and through analyses of the surveillance data for severe acute respiratory infections (SARI) can help to obtain a more accurate estimate of COVID-19 mortality.