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Excess Deaths During the COVID-19 Pandemic in Southern Iran: Estimating the Absolute Count and Relative Risk Using Ecological Data
Mohammadreza Zakeri, Alireza Mirahmadizadeh, Habibollah Azarbakhsh, Seyed Sina Dehghani, Maryam Janfada, Mohammad Javad Moradian, Leila Moftakhar, Mehdi Sharafi, Alireza Heiran
J Prev Med Public Health. 2024;57(2):120-127.   Published online February 7, 2024
DOI: https://doi.org/10.3961/jpmph.23.198
  • 1,383 View
  • 94 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran.
Methods
The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic.
Results
Our study found that there were 5571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR, 1.26; 95% confidence interval [CI], 1.19 to 1.33), as well as in specific age groups such as those aged 35-49 (RR, 1.21; 95% CI, 1.12 to 1.32), 50-64 (RR, 1.38; 95% CI, 1.28 to 1.49), and ≥65 (RR, 1.29; 95% CI, 1.12 to 1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR, 1.17; 95% CI, 1.11 to 1.22).
Conclusions
There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.
Summary
Key Message
During the first year of the COVID-19 pandemic in southern Iran, there was a notable increase in excess deaths, representing a 33.29% rise compared to expected figures. Approximately half of these excess deaths were directly attributed to COVID-19. Moreover, the pandemic heightened the risk of death across all causes by 26%, with specific age groups, notably those aged 50-64, experiencing heightened vulnerability. Notably, cardiovascular diseases emerged as a significant contributor to excess mortality during this period, while decreases were observed in deaths related to chronic respiratory diseases and cancers.
Vaccination Status and In-hospital Mortality Among Adults With COVID-19 in Jakarta, Indonesia: A Retrospective Hospital-based Cohort Study
Hotma Martogi Lorensi Hutapea, Pandji Wibawa Dhewantara, Anton Suryatma, Raras Anasi, Harimat Hendarwan, Mondastri Korib Sudaryo, Dwi Gayatri
J Prev Med Public Health. 2023;56(6):542-551.   Published online October 30, 2023
DOI: https://doi.org/10.3961/jpmph.23.360
  • 1,141 View
  • 91 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Prospective studies on vaccination status and mortality related to coronavirus disease 2019 (COVID-19) in low-resource settings are still limited. We assessed the association between vaccination status (full, partial, or none) and in-hospital mortality among COVID-19 patients at most hospitals in Jakarta, Indonesia during the Delta predomination wave.
Methods
We conducted a retrospective cohort study among hospitalized COVID-19 patients who met the study criteria (>18 years old and admitted for inpatient treatment because of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection). We linked individual-level data in the hospital admission database with vaccination records. Several socio-demographic and clinical characteristics were also analyzed. A Cox proportional hazards regression model was used to explore the association between vaccination status and in-hospital mortality in this patient group.
Results
In total, 40 827 patients were included in this study. Of these, 70% were unvaccinated (n=28 543) and 19.3% (n=7882) died during hospitalization. The mean age of the patients was 49 years (range, 35-59), 53.2% were female, 22.0% had hypertension, and 14.2% were treated in the intensive care unit, and the median hospital length of stay across the group was 9 days. Our study showed that the risk of in-hospital mortality among fully and partially vaccinated patients was lower than among unvaccinated adults (adjusted hazard ratio [aHR], 0.43; 95% confidence interval [CI], 0.40 to 0.47 and aHR, 0.70; 95% CI, 0.64 to 0.77, respectively).
Conclusions
Vaccinated patients had fewer severe outcomes among hospitalized adults during the Delta wave in Jakarta. These features should be carefully considered by healthcare professionals in treating adults within this patient group.
Summary
Key Message
During the COVID-19 pandemic the Delta variant of SARS-CoV-2 was dominating and challenging. Vaccination is one of many approaches to control the pandemic. We assessed the association between vaccination status and in-hospitalized mortality in COVID-19 patients. We found that vaccination status was associated with lower mortality, and fully vaccinated patients experienced lower risk of in-hospitalized mortality compared to partially vaccinated ones.
Sleep Duration, Comorbidities, and Mortality in Korean Health Examinees: A Prospective Cohort Study
Sukhong Min, Woo-Kyoung Shin, Katherine De la Torre, Dan Huang, Hyung-Suk Yoon, Aesun Shin, Ji-Yeob Choi, Daehee Kang
J Prev Med Public Health. 2023;56(5):458-466.   Published online September 26, 2023
DOI: https://doi.org/10.3961/jpmph.23.311
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  • 83 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The association between long sleep duration and mortality is frequently attributed to the confounding influence of comorbidities. Nevertheless, past efforts to account for comorbidities have yielded inconsistent outcomes. The objective of this study was to evaluate this relationship using a large prospective cohort in Korea.
Methods
The study included 114 205 participants from the Health Examinees Study, who were followed for a median of 9.1 years. A composite comorbidity score was developed to summarize the effects of 21 diseases. Using Cox proportional hazards regression, hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cancer, and cardiovascular mortality associated with sleep duration were estimated. These estimates were adjusted for socio-demographic factors, lifestyle factors, body mass index, and comorbidity score. Additionally, a stratified analysis by subgroups with and without comorbidities was conducted.
Results
Throughout the follow-up period, 2675 deaths were recorded. After all adjustments, an association was observed between a sleep duration of 8 hours or more and all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). However, no such association was detected in the stratified analysis for the subgroups based on comorbidity status.
Conclusions
Long sleep duration was found to be associated with all-cause mortality among Koreans, even after adjusting for comorbidities. Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.
Summary
Korean summary
- 한국의 대규모 코호트 자료를 이용, 긴 수면 시간과 사망률 간의 연관성이 동반 상병으로 인한 교란 효과로 인한 것인지를 검토하였다. - 수면 시간과 총 사망률, 암 사망률, 심혈관질환 사망률 간의 연관성을 확인하였고, 이 중 총 사망률과 긴 수면 시간이 동반 상병 지수로 보정 한 뒤에도 유의한 연관성을 보였다.
Key Message
Using a large prospective cohort in Korea, the association between long sleep duration and mortality was evaluated, after adjusting for the confounding influence of comorbidities. When 114,205 participants from the Health Examinees Study were followed for a median of 9.1 years, sleep duration of 8 hours or more were found to be associated with all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.
Effect Modification of Kidney Function on the Non-linear Association Between Serum Calcium Levels and Cardiovascular Mortality in Korean Adults
Jung-Ho Yang, Sun-Seog Kweon, Young-Hoon Lee, Seong-Woo Choi, So-Yeon Ryu, Hae-Sung Nam, Hye-Yeon Kim, Min-Ho Shin
J Prev Med Public Health. 2023;56(3):282-290.   Published online May 31, 2023
DOI: https://doi.org/10.3961/jpmph.23.068
  • 1,529 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
This study aimed to evaluate the potential interaction between kidney function and the non-linear association between serum calcium levels and cardiovascular disease (CVD) mortality.
Methods
This study included 8927 participants enrolled in the Dong-gu Study. Albumin-corrected calcium levels were used and categorized into 6 percentile categories: <2.5th, 2.5-25.0th, 25.0-50.0th, 50.0-75.0th, 75.0-97.5th, and >97.5th. Restricted cubic spline analysis was used to examine the non-linear association between calcium levels and CVD mortality. Cox proportional hazard regression was used to estimate hazard ratios (HRs) for CVD mortality according to serum calcium categories. All survival analyses were stratified by the estimated glomerular filtration rate.
Results
Over a follow-up period of 11.9±2.8 years, 1757 participants died, of whom 219 died from CVD. A U-shaped association between serum calcium and CVD mortality was found, and the association was more evident in the low kidney function group. Compared to the 25.0-50.0th percentile group for serum calcium levels, both low and high serum calcium tended to be associated with CVD mortality (<2.5th: HR, 6.23; 95% confidence interval [CI], 1.16 to 33.56; >97.5th: HR, 2.56; 95% CI, 0.76 to 8.66) in the low kidney function group. In the normal kidney function group, a similar association was found between serum calcium levels and CVD mortality (<2.5th: HR, 1.37; 95% CI, 0.58 to 3.27; >97.5th: HR, 1.65; 95% CI, 0.70 to 3.93).
Conclusions
We found a non-linear association between serum calcium levels and CVD mortality, suggesting that calcium dyshomeostasis may contribute to CVD mortality, and kidney function may modify the association.
Summary
Korean summary
- 혈중 칼슘 농도와 심혈관 질환에 의한 사망은 U자형의 비선형 연관성을 보였다. - 혈중 칼슘 농도와 심혈관 질환에 의한 사망의 비선형 연관성은 신기능이 정상인 그룹보다 신기능이 낮은 그룹에서 더 유의하게 나타났다.
Determinant Factors of Mortality in Pre-elderly and Elderly Patients With COVID-19 in Jakarta, Indonesia
Thresya Febrianti, Ngabila Salama, Inggariwati , Dwi Oktavia
J Prev Med Public Health. 2023;56(3):231-237.   Published online May 31, 2023
DOI: https://doi.org/10.3961/jpmph.23.008
  • 1,789 View
  • 134 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Objectives
This study aimed to identify risk factors associated with coronavirus disease 2019 (COVID-19) mortality in pre-elderly and elderly individuals in Jakarta, Indonesia.
Methods
We employed a case-control study design, utilizing secondary data from the Epidemiology Surveillance, Immunization Prevention, and Disease Control Sections of the DKI Jakarta Provincial Health Office, collected from December 2020 to January 2021. The study included 188 cases and an equal number of controls. Cases were COVID-19 patients confirmed to have died, as reported by hospitals and communities and subsequently verified by healthcare workers. Control subjects were patients who completed a 14-day isolation period and had been officially declared recovered by healthcare professionals. The dependent variable was the mortality of COVID-19 patients in the January 2021 period. The independent variables consisted of demographic data (age and sex), clinical symptoms (cough, runny nose, anosmia, diarrhea, headaches, abdominal pain, muscle pain, and nausea/vomiting), and comorbidities (hypertension, heart disease, and diabetes). Multivariate analysis was conducted using multiple logistic regression.
Results
The multiple logistic regression analysis revealed several factors associated with COVID-19 fatalities in Jakarta: age of 60 years or older (odds ratio [OR], 4.84; 95% CI, 3.00 to 7.80), male (OR, 2.38; 95% CI, 2.41 to 3.68), dyspnea (OR, 3.93; 95% CI, 2.04 to 7.55), anosmia (OR, 0.13; 95% CI, 0.04 to 0.46), and heart disease (OR, 4.38; 95% CI, 1.04 to 18.46).
Conclusions
The control and prevention of COVID-19 among elderly individuals require particular vigilance. When a COVID-19 case is detected within this demographic, prompt treatment and medication administration are crucial to mitigate the presenting symptoms.
Summary

Citations

Citations to this article as recorded by  
  • Tuberculosis Coinfection among COVID-19 Patients: Clinical Presentation and Mortality in a Tertiary Lung Hospital in Indonesia
    Heni Muflihah, Fajar A. Yulianto, Rina, Edi Sampurno, Astri Ferdiana, Santun B. Rahimah
    The International Journal of Mycobacteriology.2024; 13(1): 58.     CrossRef
Changes in the Hospital Standardized Mortality Ratio Before and During the COVID-19 Pandemic: A Disaggregated Analysis by Region and Hospital Type in Korea
EunKyo Kang, Won Mo Jang, Min Sun Shin, Hyejin Lee, Jin Yong Lee
J Prev Med Public Health. 2023;56(2):180-189.   Published online March 20, 2023
DOI: https://doi.org/10.3961/jpmph.22.479
  • 1,815 View
  • 91 Download
AbstractAbstract AbstractSummary PDF
Objectives
The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic.
Methods
This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients’ in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type.
Results
The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4).
Conclusions
This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.
Summary
Korean summary
코로나19 대유행 지역은 비감염 지역과 달리 2019년에 비해 2020년에 HSMR이 크게 증가했고, 상대적으로 병상 수가 적은 종합병원에서 HSMR이 증가했다. 코로나19 대응에 참여하는 병원은 병원 규모와 관계없이 HSMR이 낮은 경향을 보였다. 감염병 유행 시 병원의 과도한 업무량이 부여되지 않게하고 인력을 적절하게 고용하여 조정하는 것이 필요하다.
The Effect of Cognitive Impairment on the Association Between Social Network Properties and Mortality Among Older Korean Adults
Eunji Kim, Kiho Sung, Chang Oh Kim, Yoosik Youm, Hyeon Chang Kim
J Prev Med Public Health. 2023;56(1):31-40.   Published online November 22, 2022
DOI: https://doi.org/10.3961/jpmph.22.350
  • 4,373 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
This study investigated the effect of cognitive impairment on the association between social network properties and mortality among older Korean adults.
Methods
This study used data from the Korean Social Life, Health, and Aging Project. It obtained 814 older adults’ complete network maps across an entire village in 2011-2012. Participants’ deaths until December 31, 2020 were confirmed by cause-of-death statistics. A Cox proportional hazards model was used to assess the risks of poor social network properties (low degree centrality, perceived loneliness, social non-participation, group-level segregation, and lack of support) on mortality according to cognitive impairment.
Results
In total, 675 participants (5510.4 person-years) were analyzed, excluding those with missing data and those whose deaths could not be verified. Along with cognitive impairment, all social network properties except loneliness were independently associated with mortality. When stratified by cognitive function, some variables indicating poor social relations had higher risks among older adults with cognitive impairment, with adjusted hazard ratios (HRs) of 2.12 (95% confidence interval [CI], 1.34 to 3.35) for social nonparticipation, 1.58 (95% CI, 0.94 to 2.65) for group-level segregation, and 3.44 (95% CI, 1.55 to 7.60) for lack of support. On the contrary, these effects were not observed among those with normal cognition, with adjusted HRs of 0.73 (95% CI, 0.31 to 1.71), 0.96 (95% CI, 0.42 to 2.21), and 0.95 (95% CI, 0.23 to 3.96), respectively.
Conclusions
The effect of social network properties was more critical among the elderly with cognitive impairment. Older adults with poor cognitive function are particularly encouraged to participate in social activities to reduce the risk of mortality.
Summary
Korean summary
고령인구에서의 불충분한 사회연결망 특성은 높은 사망 위험과 연관이 있었으며, 이는 인지기능이 저하된 그룹에서 그렇지 않은 군에 비해 더 높게 관찰되었다. 특히, 인지기능이 저하된 노인에서 사회활동들에 참여하지 않는 것, 한정된 소집단에만 속하는 것, 주변으로부터 도움을 받지 못하는 것은 높은 사망 위험과 연관이 있기 때문에, 이들의 사회연결망을 강화하는 것이 사망 위험을 낮추는 데 도움이 될 수 있다.
Projection of Cancer Incidence and Mortality From 2020 to 2035 in the Korean Population Aged 20 Years and Older
Youjin Hong, Sangjun Lee, Sungji Moon, Soseul Sung, Woojin Lim, Kyungsik Kim, Seokyung An, Jeoungbin Choi, Kwang-Pil Ko, Inah Kim, Jung Eun Lee, Sue K. Park
J Prev Med Public Health. 2022;55(6):529-538.   Published online October 17, 2022
DOI: https://doi.org/10.3961/jpmph.22.128
  • 3,451 View
  • 193 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
This study aimed to identify the current patterns of cancer incidence and estimate the projected cancer incidence and mortality between 2020 and 2035 in Korea.
Methods
Data on cancer incidence cases were extracted from the Korean Statistical Information Service from 2000 to 2017, and data on cancer-related deaths were extracted from the National Cancer Center from 2000 to 2018. Cancer cases and deaths were classified according to the International Classification of Diseases, 10th edition. For the current patterns of cancer incidence, age-standardized incidence rates (ASIRs) and age-standardized mortality rates were investigated using the 2000 mid-year estimated population aged over 20 years and older. A joinpoint regression model was used to determine the 2020 to 2035 trends in cancer.
Results
Overall, cancer cases were predicted to increase from 265 299 in 2020 to 474 085 in 2035 (growth rate: 1.8%). The greatest increase in the ASIR was projected for prostate cancer among male (7.84 vs. 189.53 per 100 000 people) and breast cancer among female (34.17 vs. 238.45 per 100 000 people) from 2000 to 2035. Overall cancer deaths were projected to increase from 81 717 in 2020 to 95 845 in 2035 (average annual growth rate: 1.2%). Although most cancer mortality rates were projected to decrease, those of breast, pancreatic, and ovarian cancer among female were projected to increase until 2035.
Conclusions
These up-to-date projections of cancer incidence and mortality in the Korean population may be a significant resource for implementing cancer-related regulations or developing cancer treatments.
Summary
Korean summary
최근 고령화 시대로 접어들고 암의 위험요인들에 대한 노출률이 변화함에 따라 암의 발생률 및 사망률에 대해서 관찰하는 것은 중요한 일이 되었다. 따라서, 본 연구는 한국인에서 2035년까지의 암에 대한 발생률과 사망률을 Joinpoint regression 모델을 이용하여 예측하였다. 남성에서는 전립선암, 여성에서는 유방암이 연령표준화 발생률이 가장 높았으며 대부분의 연령표준화 사망률은 감소하는 것으로 예상되지만 여성의 유방암, 췌장암, 난소암이 증가될 것으로 예상된다.

Citations

Citations to this article as recorded by  
  • Changes in metabolic syndrome and risk of breast and endometrial cancers according to menopause
    Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park
    Epidemiology and Health.2023; : e2023049.     CrossRef
Spatio-temporal Distribution of Suicide Risk in Iran: A Bayesian Hierarchical Analysis of Repeated Cross-sectional Data
Seyed Saeed Hashemi Nazari, Kamyar Mansori, Hajar Nazari Kangavari, Ahmad Shojaei, Shahram Arsang-Jang
J Prev Med Public Health. 2022;55(2):164-172.   Published online February 10, 2022
DOI: https://doi.org/10.3961/jpmph.21.385
  • 2,686 View
  • 126 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
We aimed to estimate the space-time distribution of the risk of suicide mortality in Iran from 2006 to 2016.
Methods
In this repeated cross-sectional study, the age-standardized risk of suicide mortality from 2006 to 2016 was determined. To estimate the cumulative and temporal risk, the Besag, York, and Mollié and Bernardinelli models were used.
Results
The relative risk of suicide mortality was greater than 1 in 43.0% of Iran’s provinces (posterior probability >0.8; range, 0.46 to 3.93). The spatio-temporal model indicated a high risk of suicide in 36.7% of Iran’s provinces. In addition, significant upward temporal trends in suicide risk were observed in the provinces of Tehran, Fars, Kermanshah, and Gilan. A significantly decreasing pattern of risk was observed for men (β, -0.013; 95% credible interval [CrI], -0.010 to -0.007), and a stable pattern of risk was observed for women (β, -0.001; 95% CrI, -0.010 to 0.007). A decreasing pattern of suicide risk was observed for those aged 15-29 years (β, -0.006; 95% CrI, -0.010 to -0.0001) and 30-49 years (β, -0.001; 95% CrI, -0.018 to -0.002). The risk was stable for those aged >50 years.
Conclusions
The highest risk of suicide mortality was observed in Iran’s northwestern provinces and among Kurdish women. Although a low risk of suicide mortality was observed in the provinces of Tehran, Fars, and Gilan, the risk in these provinces is increasing rapidly compared to other regions.
Summary

Citations

Citations to this article as recorded by  
  • Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study
    Masoud Ghadipasha, Ramin Talaie, Zohreh Mahmoodi, Salah Eddin Karimi, Mehdi Forouzesh, Masoud Morsalpour, Seyed Amirhosein Mahdavi, Seyed Shahram Mousavi, Shayesteh Ashrafiesfahani, Roya Kordrostami, Nahid Dadashzadehasl
    Frontiers in Psychiatry.2024;[Epub]     CrossRef
Socioeconomic Predictors of Diabetes Mortality in Japan: An Ecological Study Using Municipality-specific Data
Tasuku Okui
J Prev Med Public Health. 2021;54(5):352-359.   Published online August 14, 2021
DOI: https://doi.org/10.3961/jpmph.21.215
  • 3,811 View
  • 150 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality.
Methods
Diabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis.
Results
The geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile.
Conclusions
Socioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.
Summary

Citations

Citations to this article as recorded by  
  • Worldwide burden and trends of diabetes among people aged 70 years and older, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019
    Shimin Jiang, Tianyu Yu, Dingxin Di, Ying Wang, Wenge Li
    Diabetes/Metabolism Research and Reviews.2024;[Epub]     CrossRef
  • The Effect of Neighborhood Deprivation on Mortality in Newly Diagnosed Diabetes Patients: A Countrywide Population-Based Korean Retrospective Cohort Study, 2002–2013
    Kyoung-Hee Cho, Juyeong Kim, Young Choi, Tae-Hyun Kim
    International Journal of Environmental Research and Public Health.2022; 19(7): 4324.     CrossRef
  • Depression, cognitive dysfunction and other factors associated with 5-year overall mortality in type 2 diabetes mellitus: a pilot prospective observational study
    E. G. Starostina, M. N. Volodina, I. V. Starostin
    Diabetes mellitus.2022; 25(4): 327.     CrossRef
Brief Report
Age-period-cohort Analysis of Cardiovascular Disease Mortality in Japan, 1995-2018
Tasuku Okui
J Prev Med Public Health. 2020;53(3):198-204.   Published online April 14, 2020
DOI: https://doi.org/10.3961/jpmph.20.037
  • 5,135 View
  • 171 Download
  • 14 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
This study aimed to analyze the mortality of heart disease (HD), ischemic heart disease (IHD), and cerebrovascular disease (CeVD) through an age-period-cohort (APC) analysis.
Methods
We used data on mortality due to cardiovascular disease from 1995 to 2018 in Japan, as determined by Vital Statistics. Age groups from 0 years to 99 years were defined by 5-year increments, and cohorts were defined for each age group of each year with a 1-year shift. We used Bayesian APC analysis to decompose the changes in the diseases’ mortality rates into age, period, and cohort effects.
Results
The period effects for all diseases decreased during the analyzed periods for both men and women. The cohort effects for men increased substantially in cohorts born from around 1940 to the 1970s for all types of cardiovascular diseases. The cohort effects of HD decreased in the cohorts born in the 1970s or later for both men and women. Regarding IHD and CeVD, either a non-increase or decrease of cohort effects was confirmed for cohorts born in the 1970s or later for men, but the effects for women showed a continuously increasing trend in the cohorts born in the 1960s or later.
Conclusions
The cohort effects for IHD and CeVD showed increasing trends in younger generations of women. This suggests that preventive approaches against cardiovascular diseases are needed, particularly for women.
Summary

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Original Articles
Estimating Influenza-associated Mortality in Korea: The 2009-2016 Seasons
Kwan Hong, Sangho Sohn, Byung Chul Chun
J Prev Med Public Health. 2019;52(5):308-315.   Published online August 23, 2019
DOI: https://doi.org/10.3961/jpmph.19.156
  • 21,341 View
  • 324 Download
  • 14 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes.
Methods
Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype.
Results
Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus–associated influenza or pneumonia deaths were more common in those under 65 years old.
Conclusions
Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.
Summary
Korean summary
계절 인플루엔자는 심각한 호흡기 합병증으로 진행할 수 있어 질병 부담의 추산이 중요한 질병이다. 현재까지는 연령별, 인플루엔자 연관 사망을 정확하게 추산하기 어려웠으나, 본 연구에서는 이를 추산하기 위해 고안된 다양한 방법 중 음이항 회귀 분석을 이용하여 2009년부터 2016년간 인플루엔자 아형별 연관 사망을 추산하였다. 그 결과, 전체 사망자 중 65세 미만에서 약 6,774명, 65세 이상에서 약 30,414명의 연간 인플루엔자 사망이 추산되었고, 이는 특히 인플루엔자 아형 중 전체 연령에서 A(H3N2) 연관 사망이 가장 많은 비율을 차지했다.

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Effects of Air Pollution on Public and Private Health Expenditures in Iran: A Time Series Study (1972-2014)
Pouran Raeissi, Touraj Harati-Khalilabad, Aziz Rezapour, Seyed Yaser Hashemi, Abdoreza Mousavi, Saeed Khodabakhshzadeh
J Prev Med Public Health. 2018;51(3):140-147.   Published online May 14, 2018
DOI: https://doi.org/10.3961/jpmph.17.153
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  • 19 Crossref
AbstractAbstract PDF
Objectives
Environmental pollution is a negative consequence of the development process, and many countries are grappling with this phenomenon. As a developing country, Iran is not exempt from this rule, and Iran pays huge expenditures for the consequences of pollution. The aim of this study was to analyze the long- and short-run impact of air pollution, along with other health indicators, on private and public health expenditures.
Methods
This study was an applied and developmental study. Autoregressive distributed lag estimating models were used for the period of 1972 to 2014. In order to determine the co-integration between health expenditures and the infant mortality rate, fertility rate, per capita income, and pollution, we used the Wald test in Microfit version 4.1. We then used Eviews version 8 to evaluate the stationarity of the variables and to estimate the long- and short-run relationships.
Results
Long-run air pollution had a positive and significant effect on health expenditures, so that a 1.00% increase in the index of carbon dioxide led to an increase of 3.32% and 1.16% in public and private health expenditures, respectively. Air pollution also had a greater impact on health expenditures in the long term than in the short term.
Conclusions
The findings of this study indicate that among the factors affecting health expenditures, environmental quality and contaminants played the most important role. Therefore, in order to reduce the financial burden of health expenditures in Iran, it is essential to reduce air pollution by enacting and implementing laws that protect the environment.
Summary

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Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan
Muhammad Tariq Karim, Sumera Inam, Tariq Ashraf, Nadia Shah, Syed Omair Adil, Kashif Shafique
J Prev Med Public Health. 2018;51(2):71-82.   Published online February 19, 2018
DOI: https://doi.org/10.3961/jpmph.17.189
  • 8,920 View
  • 199 Download
  • 1 Crossref
AbstractAbstract PDF
Objectives
Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. Methods: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. Results: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). Conclusions: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.
Summary

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C-reactive Protein Concentration Is Associated With a Higher Risk of Mortality in a Rural Korean Population
Jung Hyun Lee, Hyungseon Yeom, Hyeon Chang Kim, Il Suh, Mi Kyung Kim, Min-Ho Shin, Dong Hoon Shin, Sang-Baek Koh, Song Vogue Ahn, Tae-Yong Lee, So Yeon Ryu, Jae-Sok Song, Hong-Soon Choe, Young-Hoon Lee, Bo Youl Choi
J Prev Med Public Health. 2016;49(5):275-287.   Published online August 23, 2016
DOI: https://doi.org/10.3961/jpmph.16.025
  • 9,303 View
  • 201 Download
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
C-reactive protein (CRP), an inflammatory biomarker, has been widely used as a preclinical marker predictive of morbidity and mortality. Although many studies have reported a positive association between CRP and mortality, uncertainty still remains about this association in various populations, especially in rural Korea.
Methods
A total of 23 233 middle-aged participants (8862 men and 14 371 women) who were free from cardiovascular disease, cancer, and acute inflammation (defined by a CRP level ≥10 mg/L) were drawn from 11 rural communities in Korea between 2005 and 2011. Blood CRP concentration was analyzed as a categorical variable (low: 0.0-0.9 mg/L; intermediate: 1.0-3.0 mg/L; high: 3.1-9.9 mg/L) as well as a continuous variable. Each participant’s vital status through December 2013 was confirmed by death statistics from the National Statistical Office. Cox proportional hazard models were used to assess the independent association between CRP and mortality after adjusting for other risk factors.
Results
The total quantity of observed person-years was 57 975 for men and 95 146 for women, and the number of deaths was 649 among men and 367 among women. Compared to the low-CRP group, the adjusted hazard ratio for all-cause mortality of the intermediate group was 1.17 (95% confidence interval [CI], 0.98 to 1.40) for men and 1.27 (95% CI, 1.01 to 1.61) for women, and the corresponding values for the high-CRP group were 1.98 (95% CI, 1.61 to 2.42) for men and 1.41 (95% CI, 1.03 to 1.95) for women. Similar trends were found for CRP evaluated as a continuous variable and for cardiovascular mortality.
Conclusions
Higher CRP concentrations were associated with higher mortality in a rural Korean population, and this association was more prominent in men than in women.
Summary

Citations

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JPMPH : Journal of Preventive Medicine and Public Health