Category: Mortality

A Woke Panic on Maternal Mortality

Mary Pat Campbell

Link: https://www.city-journal.org/a-woke-panic-on-black-maternal-mortality

Excerpt:

The Centers for Disease Control and Prevention has created the public concern about black maternal mortality. In February, the CDC released data showing that the maternal mortality rate for black women is 2.9 times higher than the rate for white women. It’s a worrisome statistic, yet the CDC’s own data, as well as a study from the CDC Foundation, provide crucial (and generally unreported) context.

To be clear, even a single death of a pregnant woman is one too many. But the overwhelming majority of women survive motherhood: in 2020, according to the CDC, 861 women in the United States died related to pregnancy, out of a total of about 3.6 million births—a rate of 0.02 percent. Just over 350 were white, while just under 300 were black. Scientifically speaking, it’s hard to draw society-wide conclusions from such a small sample. It’s even harder when you recognize that the CDC statistics include deaths that occurred up to a year after delivery, as well as those caused by underlying and preexisting medical conditions that pregnancy may have aggravated. And the CDC admits that the systems for identifying mortality rates are prone to error.

….

The panel found that less than about a third of the preventable deaths, across all races, were attributable to individual providers. It did not cite racial bias as the reason. Yet the academic and media narrative leads to the assumption that black mothers are dying because doctors and nurses are racist. This leads to a corresponding claim that black mothers would die less often if they saw black doctors, which some call “racial concordance.” These are strange assertions, since Hispanic maternal mortality is lower than the rate for whites, which wouldn’t be true if medical professionals were racist. Yet these claims are still being used to justify discriminatory and dangerous policies across health care.

Author(s): Stanley Goldfarb, Benita Cotton-Orr

Publication Date: 18 Nov 2022

Publication Site:

Catch up on the Actuaries Institute’s COVID-19 Mortality Working Group’s latest analysis of excess deaths.

Mary Pat Campbell

Link: https://www.actuaries.digital/2022/11/03/covid-19-mortality-working-group-another-month-of-high-excess-mortality-in-july-2022/

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Excerpt:

In summary:

  • Total excess mortality for the month of July 2022 is estimated at 16% (+2,600 deaths), relative to expected mortality at pre-pandemic levels.
  • Total excess mortality for the first seven months of 2022 is 14% (+13,700 deaths).
  • Around half of the excess mortality for the first seven months of 2022 is due to COVID-19 (+7,100 deaths) with remaining excess of +6,600 due to the remaining causes.
  • October 2022 has the lowest COVID-19 surveillance deaths of any month in 2022.
  • We estimate that COVID-19 deaths will result in excess mortality of around 6% (+2,800) for August to October 2022, with overall excess mortality likely to be higher than this.
  • We continue to expect that COVID-19 will be the third leading cause of death in Australia in 2022.

Author(s): COVID-19 MORTALITY WORKING GROUP

Publication Date: 3 Nov 2022

Publication Site: Actuaries Digital

Group Life COVID-19 Mortality Survey Report

Mary Pat Campbell

Link: https://www.soa.org/4a368a/globalassets/assets/files/resources/research-report/2022/group-life-covid-19-mortality-03-2022-report.pdf

Graphic:

Excerpt:

Tables 2.1 through 2.41 display high-level incidence results for the second quarter of 2020 through the first quarter of 2022 compared to the 2017-2019 baseline period for each combination of (a) incurred/reported basis and (b) count/amount basis as of March 31, 2022. In these tables, the number of COVID-19 claims has not been adjusted for seasonality, but the ratios to baseline have been adjusted for seasonality.


Note that additional data reported in April and May 2022 indicated that the 1Q 2022 excess mortality would likely complete downward from the 19.9% shown below using March data. The fully complete 1Q 2022 excess mortality is expected to remain above 15%.

….

The 24-month period of April 2020 through March 2022 showed the following Group Life mortality results:
• Estimated reported Group Life claim incidence rates were up 20.0% on a seasonally-adjusted basis
compared to 2017–2019 reported claims.
• Estimated incurred Group Life incidence rates were 20.9% higher than baseline on a seasonally-adjusted
basis. As noted above, the incurred incidence rates in February and March 2022 are based on fairly
incomplete data, so they are subject to change and should not be fully relied upon at this point.

Author(s):

Thomas J. Britt, FSA, MAAA
Paul Correia, FSA, MAAA
Patrick Hurley, FSA, MAAA
Mike Krohn, FSA, CERA, MAAA
Tony LaSala, FSA, MAAA
Rick Leavitt, ASA, MAAA
Robert Lumia, FSA, MAAA
Cynthia S. MacDonald, FSA, MAAA, SOA
Patrick Nolan, FSA, MAAA, SOA
Steve Rulis, FSA, MAAA
Bram Spector, FSA, MAAA

Publication Date: August 2022

Publication Site: SOA

Deaths Among Older Adults Due to COVID-19 Jumped During the Summer of 2022 Before Falling Somewhat in September

Mary Pat Campbell

Link: https://www.kff.org/coronavirus-covid-19/issue-brief/deaths-among-older-adults-due-to-covid-19-jumped-during-the-summer-of-2022-before-falling-somewhat-in-september/

Graphic:

Excerpt:

As of the week ending October 1, 2022, the United States has lost nearly 1.1 million lives to COVID-19, of which about 790,000 are people ages 65 and older. People 65 and older account for 16% of the total US population but 75% of all COVID deaths to date. Vaccinations, boosters, and treatments have led to a substantial decline in severe disease, hospitalizations, and deaths from COVID-19, but with booster uptake lagging, deaths for older adults rose again during the summer of 2022.

From April to July 2022, the number of deaths due to COVID increased for all ages but rose at a faster rate for older than younger adults and stayed high through August 2022, with deaths due to COVID topping 11,000 in both July and August among people 65 and older. While COVID deaths began to drop again in September, they were still higher for those ages 65 and older than in April or May; for those younger than 65, deaths dropped below their April levels.

The rise in deaths is primarily a function of increasing cases due to the more transmissible Omicron variant. Other factors include relatively low booster uptake, compared to primary vaccination, and waning vaccine immunity, underscoring the importance of staying up to date on vaccination. On September 1st, CDC recommended a new, updated booster for all those ages 12 and older, but particularly for those who are older.

Author(s): Meredith Freed Follow @meredith_freed on Twitter , Tricia Neuman Follow @tricia_neuman on Twitter , Jennifer Kates Follow @jenkatesdc on Twitter , and Juliette Cubanski Follow @jcubanski on Twitter

Publication Date: 6 Oct 2022

Publication Site: Kaiser Family Foundation

A colonoscopy study has some wondering if they should have the procedure. What you should know

Mary Pat Campbell

Link: https://www.cnn.com/2022/10/10/health/colonoscopy-study-q-and-a-wellness/index.html

Excerpt:

What did this new study show about the effectiveness of colonoscopies?

In this study, about 12,000 people in Sweden, Poland and Norway got colonoscopies. They saw a 31% reduction in their risk of colon cancer and a 50% reduction in their risk of dying from colon cancer compared with people who were not invited to get a colonoscopy.

Was that about what would be expected?

Some US studies have suggested that colonoscopies are even more effective. One study followed nearly 90,000 health care professionals for 22 years. Some of them chose to receive a screening colonoscopy, and some did not. The researchers estimated that screening colonoscopy was associated with a 40% reduction in the risk of getting colon cancer and a 68% reduction in the risk of dying of colon cancer.

Why would there be different success rates in the three European countries compared with the US?

Dominitz says one reason might be that most people in the European study didn’t have sedation when they got their colonoscopies. Only 23% of the patients in the European study received sedation, but virtually everyone having a colonoscopy in the US gets it. Colonoscopies can be uncomfortable, and doctors might, without even realizing it, be less thorough if people are in pain. Thoroughness – getting the scope into the folds and crevices of the colon – is important for finding growths called polyps. The more polyps doctors are able to find, the more they can reduce the person’s risk of being diagnosed with or dying from colon cancer.

Author(s): Elizabeth Cohen

Publication Date: 11 Oct 2022

Publication Site: CNN

Old Age Mortality Experience Study Report

Mary Pat Campbell

Link: https://www.soa.org/resources/experience-studies/2022/old-age-mortality/

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Excerpt:

The Society of Actuaries (SOA) Research Institute released a report that examines older age mortality (OAM) with a focus on attained ages 70 and above. The report helps determine whether refinements were needed in the 2015 Valuation Basic Tables. Analysis was performed by sex, issue age and attained age, issue year cohorts, smoking risk classification, benefit band, select vs ultimate period, and interactions.

Author(s):

Old Age Mortality Subgroup of the Individual Life Experience Committee

Publication Date: October 2022

Publication Site: Society of Actuaries

The Economic Cost of Gun Violence

Mary Pat Campbell

Link: https://everytownresearch.org/report/the-economic-cost-of-gun-violence/

Graphic:

Excerpt:

  • Taxpayers, survivors, families, and employers pay an average of $7.79 million daily in health care costs, including immediate and long-term medical and mental health care, plus patient transportation/ambulance costs related to gun violence, and lose an estimated $147.32 million per day related to work missed due to injury or death. 
  • American taxpayers pay $30.16 million every day in police and criminal justice costs for investigation, prosecution, and incarceration. 
  • Employers lose an average of $1.47 million on a daily basis in productivity, revenue, and costs required to recruit and train replacements for victims of gun violence.
  • Society loses $1.34 billion daily in quality-of-life costs from the suffering and lost well-being of gun violence victims and their families.

Author(s):

Publication Date: 19 July 2022

Publication Site: Everytown Research

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

Mary Pat Campbell

Link: https://bjsm.bmj.com/content/56/17/975

Abstract:

Objectives Balance quickly diminishes after the mid-50s increasing the risk for falls and other adverse health outcomes. Our aim was to assess whether the ability to complete a 10- s one-legged stance (10-second OLS) is associated with all-cause mortality and whether it adds relevant prognostic information beyond ordinary demographic, anthropometric and clinical data.

Methods Anthropometric, clinical and vital status and 10-s OLS data were assessed in 1702 individuals (68% men) aged 51–75 years between 2008 and 2020. Log-rank and Cox modelling were used to compare survival curves and risk of death according to ability (YES) or inability (NO) to complete the 10-s OLS test.

Results Overall, 20.4% of the individuals were classified as NO. During a median follow-up of 7 years, 7.2% died, with 4.6% (YES) and 17.5% (NO) on the 10-s OLS. Survival curves were worse for NO 10-s OLS (log-rank test=85.6; p<0.001). In an adjusted model incorporating age, sex, body mass index and comorbidities, the HR of all-cause mortality was higher (1.84 (95% CI: 1.23 to 2.78) (p<0.001)) for NO individuals. Adding 10-s OLS to a model containing established risk factors was associated with significantly improved mortality risk prediction as measured by differences in −2 log likelihood and integrated discrimination improvement.

Conclusions Within the limitations of uncontrolled variables such as recent history of falls and physical activity, the ability to successfully complete the 10-s OLS is independently associated with all-cause mortality and adds relevant prognostic information beyond age, sex and several other anthropometric and clinical variables. There is potential benefit to including the 10-s OLS as part of routine physical examination in middle-aged and older adults.

Author(s): Araujo CG, de Souza e Silva CG, Laukkanen JA, et al

Publication Date:

Publication history
Accepted April 19, 2022
First published June 21, 2022.
Online issue publication
August 24, 2022

Publication Site: British Journal of Sports Medicine

Citation:

Araujo CG, de Souza e Silva CG, Laukkanen JA, et al

Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals

British Journal of Sports Medicine 2022;56:975-980.

doi: http://dx.doi.org/10.1136/bjsports-2021-105360

State Surgeon General Dr. Joseph A. Ladapo Issues New mRNA COVID-19 Vaccine Guidance

Mary Pat Campbell

Link: https://content.govdelivery.com/accounts/FLDOH/bulletins/3312697

Guidance: https://floridahealthcovid19.gov/wp-content/uploads/2022/10/20221007-guidance-mrna-covid19-vaccines-doc.pdf?utm_medium=email&utm_source=govdelivery

Analysis: https://floridahealthcovid19.gov/wp-content/uploads/2022/10/20221007-guidance-mrna-covid19-vaccines-analysis.pdf?utm_medium=email&utm_source=govdelivery

Graphic:

Excerpt:

Today, State Surgeon General Dr. Joseph A. Ladapo has announced new guidance regarding mRNA vaccines. The Florida Department of Health (Department) conducted an analysis through a self-controlled case series, which is a technique originally developed to evaluate vaccine safety.

This analysis found that there is an 84% increase in the relative incidence of cardiac-related death among males 18-39 years old within 28 days following mRNA vaccination. With a high level of global immunity to COVID-19, the benefit of vaccination is likely outweighed by this abnormally high risk of cardiac-related death among men in this age group. Non-mRNA vaccines were not found to have these increased risks.

As such, the State Surgeon General recommends against males aged 18 to 39 from receiving mRNA COVID-19 vaccines. Those with preexisting cardiac conditions, such as myocarditis and pericarditis, should take particular caution when making this decision.

Author(s): Joseph A. Ladapo

Publication Date: 7 Oct 2022

Publication Site: Florida Dept of Health

Reductions in US life expectancy during the COVID-19 pandemic by race and ethnicity: Is 2021 a repetition of 2020?

Mary Pat Campbell

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9432732/

Graphic:

Abstract:

COVID-19 had a huge mortality impact in the US in 2020 and accounted for most of the overall reduction in 2020 life expectancy at birth. There were also extensive racial/ethnic disparities in the mortality impact of COVID-19 in 2020, with the Black and Latino populations experiencing reductions in life expectancy at birth over twice as large as that of the White population. Despite continued vulnerability of these populations, the hope was that widespread distribution of effective vaccines would mitigate the overall mortality impact and reduce racial/ethnic disparities in 2021. In this study, we quantify the mortality impact of the COVID-19 pandemic on 2021 US period life expectancy by race and ethnicity and compare these impacts to those estimated for 2020. Our estimates indicate that racial/ethnic disparities have persisted, and that the US population experienced a decline in life expectancy at birth in 2021 of 2.2 years from 2019, 0.6 years more than estimated for 2020. The corresponding reductions estimated for the Black and Latino populations are slightly below twice that for Whites, suggesting smaller disparities than those in 2020. However, all groups experienced additional reductions in life expectancy at birth relative to 2020, and this apparent narrowing of disparities is primarily the result of Whites experiencing proportionately greater increases in mortality in 2021 compared with the corresponding increases in mortality for the Black and Latino populations in 2021. Estimated declines in life expectancy at age 65 increased slightly for Whites between 2020 and 2021 but decreased for both the Black and Latino populations, resulting in the same overall reduction (0.8 years) estimated for 2020 and 2021.

Author(s): Theresa Andrasfay, Noreen Goldman

Publication Date: 31 Aug 2022

Publication Site: PLOS ONE

Citation: Andrasfay T, Goldman N. Reductions in US life expectancy during the COVID-19 pandemic by race and ethnicity: Is 2021 a repetition of 2020? PLoS One. 2022 Aug 31;17(8):e0272973. doi: 10.1371/journal.pone.0272973. PMID: 36044413; PMCID: PMC9432732.

Drowning Prevention: How the American Academy of Pediatrics is failing our children

Mary Pat Campbell

Link: https://authenticpediatrics.substack.com/p/drowning-prevention-how-the-american

Excerpt:

In June 2021 I co-authored an article with drowning prevention parent advocate Nicole Hughes on the subject of water competency in 1-4 year old children and which national swim lesson program methodology aimed to teach this highest risk age group survival skills to best protect against an unplanned submersion.

The purpose of this article was to provide parents and primary care pediatricians with a direct comparison of popular formal swim lesson curriculums of the American Red Cross, YMCA, and Infant Swim Resource (ISR) to inform them on which program better aligns with the parent’s goals for water competency for their young child.

A secondary objective of this commentary was to highlight the methodology of survival swim as a type of formal swim program that in many ways appears superior for this high risk age group due to its ability to teach independent back floating and swim float swim without flotation devices. Despite being the only prominent formal swim lesson program that does this for the under 4 year olds, the AAP without any evidence has come out guns blazing against it.

This is evidenced by the recent parent article in JAMA Pediatrics which states: “Teaching children to swim is important, and the American Academy of Pediatrics has recommended swim lessons as early as age 1 year to provide another protection layer. However, infant swim classes such as Infant Swimming Resource have not been shown to lower the risk of drowning. As an alternative, families may seek out parent-child water play classes to gain familiarity and comfort with being around water together.”

Yet despite the lack of data on benefit vs. harm for each type of formal swim lessons, the AAP feels justified to advocate against ISR survival swim while advocating for Mommy and Me group swim lessons with the goal of comfort over survival.

One year after the publication of our article, the American Academy of Pediatrics authors of the 2019 Policy on Drowning Prevention submitted a Letter to the Editor to Contemporary Pediatrics criticizing our article to which we responded in an Author Response. For unexplained reasons neither letter was published by the journal of record.

Due to the importance of advancing this conversation to better understand the likely benefit and lack of harm of survival swim as a crucial layer of drowning prevention protection, I will publish both the AAP Letter to Editor and Author Response below. It is my hope that you read both. When reading, please do so within the context of an AAP that willingly advocates for non-pharmacological interventions (NPI) such mandatory masking of children for prevention of COVID-19 – stating that there is no evidence that it causes harm or developmental delays while willingly advocating against ISR survival swim – stating that it is harmful and lacks evidence of benefit without any such evidence to make either claim.

Author(s): Todd R Porter

Publication Date: 1 Oct 2022

Publication Site: Authentic Pediatrics at substack

Guns Aren’t a Public Health Issue

Mary Pat Campbell

Link: https://reason.com/video/2022/09/30/guns-arent-a-public-health-issue/

Graphic:

Excerpt:

The takeaway from the story of Dickey, Rosenberg, and the 1993 gun study at the center of the piece is that the congressman was correct to begin with. The CDC shouldn’t be studying gun violence.

Titled “Gun Ownership as a Risk Factor for Homicide in the Home” and published in The New England Journal of Medicine, the 1993 study looked at 388 people who had been killed in their homes and matched them to 388 neighbors of similar age, sex, and race. One hundred and seventy-four of the victims lived in houses where at least one gun was present versus only 139 of the matched controls.

With scary music and breathless claims, the video tells viewers that if you had a gun in your house, you were 200 percent more likely to be killed with a gun in your home and 400 percent more likely to kill yourself. 

These are both exaggerations and misstatements of the study results. It didn’t address suicide risk at all, nor gun homicides. It found households in which a resident had been murdered at home by any means had a 25 percent greater frequency of having a gun, not 200 percent. But this doesn’t mean owning a gun increases your risk of being killed by 25 percent. 

This is a classic statistical error known as the “base rate fallacy” and is particularly important when studying rare events, like people murdered in their homes. Suppose 10 people are murdered in their homes, and five of those homes had guns. A matched set of 10 people who were not murdered in their homes found only four homes had guns. So there are 25 percent more guns in the homes of murder victims than matched nonmurder victims (Five vs. four).

But what if you put those 20 people in the context of another million, none of whom were murdered in their homes, half of whom had guns in their homes and half of whom didn’t. The rate for gun owners to be murdered at home becomes five out of 500,009, while the rate for non-gun owners becomes five out of 500,011. So now we find that the risk is 0.0004 percent higher.

In other words, being murdered in your home means you have a 25 percent higher chance of having a gun, but having a gun means you have only a 0.0004 percent greater chance of being murdered in your home. Those are not the same thing.

The finding that owning a gun made study subjects less safe was also a conclusion selected from much stronger statistical results that didn’t fit the authors’ political views and, thus, weren’t mentioned in the study. Yes, 25 percent more victims’ homes had guns than control homes, but 38 percent more victims had controlled security access to their property. Why not lobby against gates as a public health matter? Twenty times as many victims had gotten in trouble at work because of drinking, so why worry about guns when drinking at work is two orders of magnitude more dangerous? Renting and living alone were far more dangerous than having a gun. Victims were less likely than controls to own a rifle or a shotgun, so why not a government program to trade in handguns for long guns?

Author(s): JOHN OSTERHOUDT AND AARON BROWN

Publication Date: 30 Sept 2022

Publication Site: Reason