medRxiv - Public and Global Health最新文献

{"title":"Indications and Outcomes of Intravitreal Bevacizumab Injection in a Community Eye Hospital, Nepal","authors":"Sunil Thakali, Mohini Shrestha, Aleena Gauchan, Hom Bahadur Gurung, Manish Poudel","doi":"10.1101/2024.07.31.24311307","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311307","url":null,"abstract":"Intravitreal bevacizumab(IVB) injection, is a humanized monoclonal antibody that has been in use for the treatment of retinal diseases, very cheaply, especially for developing countries like Nepal. This is a retrospective study designed to evaluate the indications and outcomes of IVB at Hetauda Community Eye Hospital from 2019 to 2022. In this study, among 247 patients including 260 eyes with a follow-up rate of 221 patients involving 234 eyes, the mean patient age was 64.4 years, with male predominance of 56.1%. Thus, IVB was used principally in the treatment of diabetic retinopathy, neovascular age-related macular degeneration(nAMD), and branch retinal vein occlusion(BRVO). The results indicated significant improvements in central macular thickness and visual acuity with respect to diabetic retinopathy, nAMD, and BRVO. The study thus puts forth the effectiveness of IVB in improving visual outcomes and reducing central macular thickness(CMT) in a resource-constrained setting; hence, its use should be implemented as a viable treatment option within such an environment.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IDENTIFYING PLAUSIBLE RANGES FOR DIFFERENTIAL VACCINE EFFICACY ACROSS HIGH- AND LOW-INCOME SETTINGS: A SYSTEMATIC REVIEW, DESCRIPTIVE META-ANALYSIS, AND ILLUSTRATIVE EVIDENCE ANALYSIS","authors":"Esther Nyadzua Katama, Katherine E Gallagher, Anoop Shah, James D Nokes, David A McAllister","doi":"10.1101/2024.07.31.24310913","DOIUrl":"https://doi.org/10.1101/2024.07.31.24310913","url":null,"abstract":"Background\u0000Randomized clinical trials provide the highest standard of evidence about vaccine efficacy. Modelling exercises such as in evidence synthesis and health economic models where efficacy estimates are combined with other data to obtain effectiveness and cost-effectiveness estimates help inform policy decisions. The main challenge with such sensitivity analyses is in deciding on which assumptions to model. Purpose\u0000To identify plausible ranges for differential vaccine efficacy across high- and low-income settings.\u0000Data Sources and Study Selection\u0000MEDLINE, EMBASE, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO- ICTRP) were searched for multi-site randomized clinical trials of bacterial and viral vaccines. Articles were restricted to those where at least one trial had included a low- or lower-middle-income setting, published in English, and conducted in humans. Methods\u0000A Bayesian random-effects meta-analysis was used to estimate the difference in vaccine efficacy in high- (high or upper middle) and low- (low or lower middle) income settings. A single hierarchical model that included all trials was used so that the degree to which estimates of vaccine efficacy against different diseases influenced one another was estimated from the observed data. Results\u0000Across 65 eligible trials (37 high-income, 21 low-income, and 7 both) covering 7 pathogens, only one trial reported efficacy estimates stratified by setting. Trials were similar in terms of design across settings. There was evidence of heterogeneity by vaccine target, typhoid vaccine demonstrated higher vaccine efficacy in low-income settings than in high-income settings but for all other vaccines, the point estimates indicated efficacy was lower in low-income settings; however, all credible intervals crossed the null. Conclusions\u0000The percentage of trials in low-income settings poorly reflects the burden of disease experienced in low-income settings. While there is evidence of lower vaccine efficacy in low-income settings relative to high-income settings, the credible intervals were very wide. Vaccine efficacy trials should report treatment effects stratified by settings. Keywords\u0000Bayesian analysis, illustrative evidence synthesis, vaccine efficacy, policy.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and efficacy of long-lasting insecticidal nets for malaria control in Africa: Systematic review and meta-analysis of randomized controlled trials","authors":"Dereje Bayissa Demissie, Getahun Fetensa Hirko, Tilahun Desta, Firew Tiruneh Tiyare","doi":"10.1101/2024.07.31.24311306","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311306","url":null,"abstract":"Background: This systematic review and meta-analysis aims to compare the effectiveness and efficacy of pyriproxyfen, chlorfenapyr, and piperonyl butoxide long-lasting insecticidal nets (LLINs) with pyrethroid-only LLINs for malaria control in Africa, as pyrethroid resistance threatens the effectiveness of these nets in controlling malaria.\u0000Method: The protocol was registered in PROSPERO (CRD42024499800). The extracted data from eligible studies were pooled using the random effects model and expressed as a risk ratio (RR) with a 95% confidence interval (CI) by using Excel and STATA 17. Result: A study involving 21,916 households from 11 randomized controlled trials found using chlorfenapyr and piperonyl butoxide LLINs post-intervention for 6 months to 36 months significantly reduced the risk of malaria infection compared to pyrethroid-only nets. The chlorfenapyr treatment group had a 10% reduction in malaria infection risk, with a pooled overall prevalence of 25.96 per 100 children in the chlorfenapyr group and 32.38 per 100 children in the piperonyl butoxide group compared to 41.60 per 100 children in the control Pyrethroid-only group. This meta-analysis determined entomological outcomes effectiveness and efficacy showed they effectively reduced vector density per household per night and mean inoculation rates, with a 23% reduction in chlorfenapyr, a 7% reduction in pyrethroid-only treatments, and a 12% reduction in piperonyl butoxide treatments groups. Conclusion: This study found that chlorfenapyr and piperonyl butoxide treatments significantly reduced malaria infection risk in children in African countries. The review emphasizes the effectiveness of malaria control measures in preventing infection, anaemia, vector density, and inoculation rates. The study found that chlorfenapyr (CFP) long-lasting insecticidal nets (LLINs) are highly effective and superiorly efficacious in reducing malaria infection, case incidence, and anemia among children, as well as reducing mean indoor vector density, mean entomological inoculation rate, and sporozoite rate compared to pyriproxyfen (PPF) long-lasting insecticidal nets (LLINs) in Africa. The study found that chlorfenapyr (CFP) and piperonyl butoxide (PBO) long-lasting insecticidal nets (LLINs) are highly effective and efficacious in reducing malaria infection, case incidence, and anaemia among children, as well as reducing indoor vector density, inoculation rate, and sporozoite rate in Africa as compared to pyrethroid-only LLINs. The evidence generated found that piperonyl butoxide (PBO) long-lasting insecticidal nets effectively and efficaciously reduce indoor vector density, entomological inoculation rate, and sporozoite rate of malaria parasites compared to Pyriproxyfen (PPF) LLINs, but no significant difference was found in malaria infection reduction among children who use piperonyl butoxide (PBO) versus Pyriproxyfen (PPF) long-lasting insecticidal nets in Africa.\u0000The study found that chlorfenapyr (CF","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-physical Intimate Partner Violence and Long-term Public Healthcare Costs in a Representative Sample of Canadian Women","authors":"Nicholas Metheny, Gabriel John Dusing, Beverley M. Essue, Patricia O'Campo","doi":"10.1101/2024.07.31.24311289","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311289","url":null,"abstract":"This study investigated the impact of non-physical intimate partner violence (IPV), including emotional and verbal abuse, and coercive/controlling behaviors, on Ontario Health Insurance Plan costs, the universal healthcare provider in the province of Ontario, Canada. Women exposed to non-physical IPV alone had 17% higher healthcare costs over 10 years compared to those not exposed, translating to CA$686 million in additional annual costs, challenging the perception that non-physical IPV is less harmful than physical forms. We argue for prevention of non-physical IPV and improved screening in healthcare settings is vital to mitigate its long-term impacts on individuals and healthcare systems.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explaining the Variance in Cardiovascular Health Indicators among Asian Americans: A Comparison of Demographic, Socioeconomic, and Ethnicity","authors":"Lalaine Sevillano, Adrian M Bacong, Dale Maglalang","doi":"10.1101/2024.07.30.24311252","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311252","url":null,"abstract":"BACKGROUND: The Asian American (AA) population is the fastest-growing major racial or ethnic group in the U.S. Typically treated as a monolith in research, disaggregated data show disproportionate cardiovascular disease (CVD) burden among certain AA ethnic groups. This analysis aimed to identify which factors explain variance in cardiovascular health among AA ethnic groups. METHODS: We analyzed pooled 2010-2018 National Health Interview Survey cross-sectional data from Chinese, Asian Indian, Filipino, and Other Asian adults in the U.S. Coronary heart disease, heart attack, and stroke were the CVD outcomes of interest. Covariates included sociodemographic characteristics, CVD-related health behaviors (e.g., smoking tobacco, physical inactivity), and health conditions (e.g., diabetes, hypertension). The distribution of self-reported CVD outcomes and covariates were examined among the full AA sample and disaggregated ethnic groups. Variance explained by sociodemographic, health behaviors, and health conditions were calculated based on the adjusted R-squared from a series of five models for each CVD health outcome.\u0000RESULTS: Of the 10,353 AAs in the sample, 53% identified as female and 86% between the ages of 18-64 years old. Compared to the aggregate AA sample and the other ethnic groups, Filipinos had a higher burden of any CVD outcome (5.9%), particularly for coronary heart disease (4.0%) and heart attack (2.5%).The combination of all predictors explained at most 13% of variance, with sociodemographic characteristics accounting for at least half of the variance explained among all participants. Health behaviors explained a greater amount of additional variance for all CVD outcomes among Asian Indians, including an additional 3.1% for stroke. Inversely, existing health conditions were significant predictors of CVD for all AA ethnic groups compared to Asian Indians. CONCLUSIONS: There is heterogeneity in CVD outcomes and related risk factors in AA ethnic groups, emphasizing the need for culturally-tailored prevention and intervention strategies.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which Components of the Haemodynamic Response to Active Stand Predict Cardiovascular Disease and Mortality? Data From The Irish Longitudinal Study on Ageing","authors":"Belinda Hernandez, Adam Dyer, Cathal McCrory, Louise Newman, Ciarán Finucane, Rose Anne Kenny","doi":"10.1101/2024.07.30.24311251","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311251","url":null,"abstract":"Background: An integrated haemodynamic response during standing may serve as an integrative marker of neuro-cardiovascular function. Individual components of both heart rate (HR) and blood pressure (BP) responses to active stand (AS) have been linked with cardiovascular disease (CVD) and mortality. We assessed longitudinal associations between entire HR/BP response curves during AS, incident CVD and mortality over 12 years. Methods: Beat-to-beat measurements of dynamic HR/BP responses to AS were conducted in 4,336 individuals (61.5±8.2 years; 53.7% female). Functional Principal Components Analysis was applied to HR/BP response curves and their association with CVD and mortality assessed. We hypothesised that integrating BP/HR information from the entire haemodynamic response curve may uncover novel associations with both CVD and mortality. Results: Higher systolic BP (SBP) before AS and blunted recovery of SBP during AS was associated with all-cause mortality over 12-years (Hazard Ratio [HR]: 1.14; 1.04, 1.26; p=0.007). Higher baseline/peak HR and lower HR from 30 seconds post stand onwards were associated with lower mortality due to circulatory causes (HR: 0.78; 0.64, 0.95; p = 0.013). Higher HR throughout AS was associated with mortality from other causes (HR: 1.48; 1.22, 1.80; p<0.001). Findings persisted on robust covariate adjustment. Conclusions: We observed distinct relationships between HR/BP responses to AS and 12-year incident CVD and mortality. Integrating the entire haemodynamic response may reveal more nuanced relationships between HR/BP responses to AS, CVD and mortality - serving as an integrative marker of neuro-cardiovascular health in midlife and beyond.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biofortification and Fortification of Wheat Flour: Qualitative analysis for implementation and acceptance","authors":"Rahima Yasin, Zahra Padhani, Mushtaque Mirani, Muhammad Khan Jamali, Mahwish Memon, Sana Khatoon, Riya Rai, Areeba Rahman, Anushka Attaullahjan, Jai K. Das","doi":"10.1101/2024.07.31.24311298","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311298","url":null,"abstract":"Background: This paper comprehensively investigates various aspects of dietary behaviors relating to the usage of wheat flour and sociocultural preferences embedded within rural communities and aims to bridge health gaps resulting from zinc deficiency by introducing zinc bio-fortified and fortified flour in Pakistan.\u0000Method: A household and a market study was conducted in Ghotki and Tando Muhammad Khan districts in Sindh, Pakistan. Various stakeholders involved in the wheat-flour industry including farmers, seed suppliers, owners of atta-chakkis and flour mills, grocers and flour merchants, bakers and hoteliers, consumers, and agronomists were interviewed to gauge their knowledge of bio-fortified and fortified wheat-flour.\u0000Results: Wheat-flour is a staple food item in Pakistan, however, agricultural output in Pakistan varies across all provinces. Factors that hinder agricultural productivity include a shortfall of essential resources such as irrigation water, superior quality seeds and fertilizers, and machinery. Farmers use primitive methods of farming as they do not have access to modern technologies, information, or training. Wheat flour market vendors and consumers lack awareness of bio-fortified and fortified wheat flour products and believe the only way to create a customer-base is by ensuring that fortified wheat products are available to all and competitively priced compared to traditional options. Additionally, participants misconstrue the process of fermentation and perceive it as unhealthy. The lack of financial resources and awareness restricts adequate promotion of nutrient-rich food products amongst stakeholders involved in the wheat flour industry. Mass awareness campaigns, education and government incentives could bridge the gaps present and encourage wider adoption of bio-fortified and fortified wheat flour. Conclusion: Policy makers and communities can draw on the recommendations made in this paper to introduce and promote zinc bio-fortified and fortified flour in settings where zinc deficiency is prevalent.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Life Simple Seven's influence on brain health outcomes: The intersection of lifestyle and dementia","authors":"Diandra N Denier-Fields, Ronald E Gangnon, Leonardo A Rivera-Rivera, Tobey J Betthauser, Barbara B Bendlin, Sterling C Johnson, Corinne D Engelman","doi":"10.1101/2024.07.29.24311179","DOIUrl":"https://doi.org/10.1101/2024.07.29.24311179","url":null,"abstract":"INTRODUCTION: Lifestyle factors have been studied for dementia risk, but few have comprehensively assessed both Alzheimer's disease (AD) and cerebrovascular disease (CBVD) pathologies. Our research aims to determine the relationships between lifestyle and various dementia pathologies, challenging conventional research paradigms.\u0000METHODS: Analyzing 1231 Wisconsin Registry for Alzheimer's Prevention (WRAP) study participants, we focused on Life Simple Seven (LS7) score calculations from questionnaire data and clinical vitals. We assessed brain health indicators including CBVD, AD, and cognition.\u0000RESULTS: Higher LS7 scores were associated with better CBVD outcomes, including lower percent white matter hyperintensities and higher cerebral blood flow, and higher Preclinical Alzheimer's Composite 3 and Delayed Recall scores. No significant associations were observed between LS7 scores and AD markers of amyloid and tau accumulation. DISCUSSION: This study provides evidence that the beneficial effects of LS7 on cognition are primarily mediated through cerebrovascular pathways rather than direct influences on AD pathology.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of interventions for modal shift to walking and bike riding: a systematic review with meta-analysis","authors":"Lauren Pearson, Matthew J Page, Robyn Gerhard, Nyssa Clarke, Meghan Winters, Adrian Bauman, Laolu Arogundade, Ben Beck","doi":"10.1101/2024.07.29.24311197","DOIUrl":"https://doi.org/10.1101/2024.07.29.24311197","url":null,"abstract":"Objective: To assess the efficacy of interventions aimed at increasing walking and cycling. Design: Systematic review with meta–analysis\u0000Study selection: The electronic databases MEDLINE, PsycINFO and Web of Science were searched from inception on 22nd May 2023. Eligible study designs included randomised and non–randomised studies of interventions with specific study design features that enabled estimation of causality. No restrictions on type of outcome measurement, publication date or population age were applied.\u0000Data extraction and synthesis: Two reviewers independently extracted data and conducted quality assessment with Joanna Briggs Quality Assessment tools. Studies were categorised by intervention types described within the Behaviour Change Wheel. Where possible, random–effects meta–analyses were used to synthesise results within intervention types. Main outcome measures: The main outcome of interest was modal shift to active modes (walking and cycling). Other outcomes of interest included cycling and walking duration, frequency and counts, active transport duration and frequency, and moderate to vigorous physical activity duration (MVPA). Results: 106 studies that assessed the impact of an intervention on walking, cycling or active transport overall were included. Findings demonstrate that physical environmental restructure interventions, such as protected bike lanes and traffic calming infrastructure, were effective in increasing cycling duration (OR = 1.70, 95% CI 1.20– 2.22; 2 studies). Other intervention types, including individually tailored behavioural programmes, and provision of e-bikes were also effective for increasing cycling frequency (OR = 1.33, 95% CI 1.23– 1.43; 1 study) and duration (OR = 1.13, 95% CI 1.02–1.22, 1 study). An intensive education programme intervention demonstrated a positive impact on walking duration (OR = 1.96, 95% CI 1.68 – 2.21; 1 study). An individually tailored behavioural programme (OR = 1.23, 95% CI 1.08 – 1.40; 3 studies) and community walking programme (OR = 1.15, 95% CI 1.14 – 1.17; 1 study) also increased the odds of increased walking duration. This body of research would benefit from more rigour in study design to limit lower quality evidence with the potential for bias. Conclusions: This review provides evidence for investment in high–quality active transportation infrastructure, such as protected bike lanes, to improve cycling and active transport participation overall. It also provides evidence for investment in other non–infrastructure interventions. Further research to understand which combinations of intervention types are most effective for modal shift are needed. Active transport research needs to include more robust trials and evaluations with consistent outcome measures to improve quality of evidence and provide evidence on which interventions (or combinations of interventions) are most effective. Study registration: PROSPERO CRD42023445982","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"1412 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causes of excess deaths in the US relative to other wealthy nations, 1999-2020: a population autopsy","authors":"Jacob Bor, Rafeya V Raquib, David Himmelstein, Steffie Woolhandler, Andrew C Stokes","doi":"10.1101/2024.07.26.24311071","DOIUrl":"https://doi.org/10.1101/2024.07.26.24311071","url":null,"abstract":"Importance: The US has higher mortality rates than other wealthy nations. Objective: To determine causes of death responsible for excess mortality in the US compared to other wealthy nations and how the causes involved in this survival gap have changed over time. Design: Repeat cross-sectional study, 1999 to 2020. Setting: United States and 12 other wealthy nations.\u0000Participants: All residents.\u0000Exposures: Residing in the US versus other wealthy nations.\u0000Main outcome and measures: Excess US mortality in each year due to specific causes of death using data from the World Health Organization Mortality Database. Differences between the US and other wealthy nations were quantified for each cause of death as: (1) the number of excess US deaths (i.e., deaths that would have been averted if US death rates equaled the average rates of other wealthy nations); (2) years of life lost (YLL) resulting from excess US deaths; and (3) the ratio of observed deaths to expected deaths if US mortality rates equaled the average of other wealthy nations. Results: 10,856,851 excess US deaths occurred between 1999 and 2020. In 2019, prior to the COVID-19 pandemic, there were 637,682 excess US deaths, with leading causes including circulatory diseases (41% of total), mental and nervous system disorders (25%), diabetes, renal, and metabolic diseases (15%), drug poisonings, alcohol-related deaths, and suicide (13%), respiratory disease (12%), and transportation accidents (5%). Over two decades, excess US deaths due to drug poisonings, alcohol and suicide increased from -5,937 in 1999 to 109,015 in 2020. In 2019, deaths from drug poisonings were 6.7 times higher in the US than in peer countries. Circulatory mortality accounted for the largest absolute number of excess US deaths in nearly every year. In 2020, one in 5 excess US deaths were attributed to COVID-19.\u0000Conclusions and Relevance: The US had substantially higher death rates than other wealthy nations between 1999 and 2020, despite having similar access to advanced medical technology. Many of these excess US deaths could likely be avoided by adopting health and social policies that have benefited peer countries.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141776547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}