Tag: JAMA Network

Trends of Heat-Related Deaths in the US, 1999-2023

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama/fullarticle/2822854?guestAccessKey=53b50a89-0945-4117-a662-5e1e1484ebce&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=082624

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We analyzed all deaths from 1999 to 2023 in which the International Statistical Classification of Diseases and Related Health Problems, 10th Revision code was P81 (environmental hyperthermia of newborn), T67 (effects of heat and light), or X30 (exposure to excessive natural heat) as either the underlying cause or as a contributing cause of death, as recorded in the Multiple Cause of Death file. Data were accessed through the Centers for Disease Control and Prevention’s WONDER platform,5 which combines death counts with population estimates produced by the US Census Bureau to calculate mortality rates. For each year, we extracted age-adjusted mortality rates (AAMRs) per 100 000 person-years for heat-related deaths. The AAMR accounts for differences due to age structures, allowing direct comparisons across time. The approach of analyzing cause-specific mortality rates rather than excess mortality is warranted because the excess mortality methodology is subject to confounding from the COVID-19 pandemic from 2020 to 2023. This study used publicly available, deidentified aggregate data; thus, it was not considered human subjects research.

Joinpoint version 5.2.0 (National Cancer Institute) regression6 was used to analyze AAMRs to assess trends and determine elbow points where the trend began to shift to a new trajectory. Results of joinpoint analyses are reported as average annual percentage change (AAPC) in rates with 95% CIs. Statistical significance was defined as 2-sided P < .05. Data were visualized with R version 4.2.2 (R Foundation for Statistical Computing).

Results

From 1999 to 2023, 21 518 deaths were recorded as heat-related underlying or contributing cause of death, with an AAMR of 0.26 per 100 000 person-years (95% CI, 0.24-0.27) (Table). The number of heat-related deaths increased from 1069 (AAMR = 0.38; 95% CI, 0.36-0.40) in 1999 to 2325 (AAMR = 0.62; 95% CI, 0.60-0.65) in 2023, a 117% increase in the number of heat-related deaths and a 63% increase in the AAMR. The lowest number of heat-related deaths in the study period was 311 in 2004, whereas the highest, 2325, was in 2023.

Results of the joinpoint trend analysis showed that during the entire period, the AAMR increased by 3.6% per year (AAPC = 3.6%; 95% CI, 0.1%-7.2%; P = .04) from 1999 to 2023 (Figure). The number of heat-related deaths and AAMR showed year-to-year variability, with spikes in 2006 and 2011, before showing steady increases after 2016. Joinpoint results showed a nonsignificant decrease of 1.4% per year from 1999 to 2016 (AAPC = −1.4%; 95% CI, −4.7% to 2.1%; P = .42), followed by a significant increase of 16.8% per year in the AAMR from 2016 to 2023 (AAPC = 16.8%; 95% CI, 6.4%-28.2%; P = .002).

Author(s): Jeffrey T. Howard, PhD1; Nicole Androne, MS1; Karl C. Alcover, PhD2; et al

Publication Date:  Published online August 26, 2024
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Publication Site: JAMA Network

doi:10.1001/jama.2024.16386

Causal Inference About the Effects of Interventions From Observational Studies in Medical Journals

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama/fullarticle/2818746?guestAccessKey=66ec96e3-d156-46cf-928b-ff8b2a8fc35e&utm_source=silverchair&utm_medium=email&utm_campaign=content_max-jamainternalmedicine&utm_content=olf&utm_term=051324&utm_adv=000004014036

Additional editors’ note: https://jamanetwork.com/journals/jama/fullarticle/2818747?guestAccessKey=8b28cc16-c1e5-4a09-bec6-1f77abfe98db&utm_source=silverchair&utm_medium=email&utm_campaign=content_max-jamainternalmedicine&utm_content=olf&utm_term=051324&utm_adv=000004014036

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Abstract:

Importance  Many medical journals, including JAMA, restrict the use of causal language to the reporting of randomized clinical trials. Although well-conducted randomized clinical trials remain the preferred approach for answering causal questions, methods for observational studies have advanced such that causal interpretations of the results of well-conducted observational studies may be possible when strong assumptions hold. Furthermore, observational studies may be the only practical source of information for answering some questions about the causal effects of medical or policy interventions, can support the study of interventions in populations and settings that reflect practice, and can help identify interventions for further experimental investigation. Identifying opportunities for the appropriate use of causal language when describing observational studies is important for communication in medical journals.

Observations  A structured approach to whether and how causal language may be used when describing observational studies would enhance the communication of research goals, support the assessment of assumptions and design and analytic choices, and allow for more clear and accurate interpretation of results. Building on the extensive literature on causal inference across diverse disciplines, we suggest a framework for observational studies that aim to provide evidence about the causal effects of interventions based on 6 core questions: what is the causal question; what quantity would, if known, answer the causal question; what is the study design; what causal assumptions are being made; how can the observed data be used to answer the causal question in principle and in practice; and is a causal interpretation of the analyses tenable?

Conclusions and Relevance  Adoption of the proposed framework to identify when causal interpretation is appropriate in observational studies promises to facilitate better communication between authors, reviewers, editors, and readers. Practical implementation will require cooperation between editors, authors, and reviewers to operationalize the framework and evaluate its effect on the reporting of empirical research.

Author(s): Issa J. Dahabreh, MD, ScD1,2,3,4,5; Kirsten Bibbins-Domingo, PhD, MD, MAS6,7,8

Publication Date: 9 May 2024

Publication Site: JAMA

doi:10.1001/jama.2024.7741

Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020

Mary Pat Campbell

Link:https://jamanetwork.com/journals/jama/article-abstract/2804822/

JAMA. 2023;329(19):1662-1670. doi:10.1001/jama.2023.7022

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Key Points

Question  How many excess deaths and years of potential life lost for the Black population, compared with the White population, occurred in the United States from 1999 through 2020?

Findings  Based on Centers for Disease Control and Prevention data, excess deaths and years of potential life lost persisted throughout the period, with initial progress followed by stagnation of improvement and substantial worsening in 2020. The Black population had 1.63 million excess deaths, representing more than 80 million years of potential life lost over the study period.

Meaning  After initial progress, excess mortality and years of potential life lost among the US Black population stagnated and then worsened, indicating a need for new approaches.

Author(s): César Caraballo, MD1,2; Daisy S. Massey, BA3; Chima D. Ndumele, PhD4; et al

Publication Date: 16 May 2023

Publication Site: JAMA Network

Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795298

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JAMA Netw Open. 2022;5(8):e2227248. doi:10.1001/jamanetworkopen.2022.27248

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Question  How many cases of COVID-19 in the US have occurred among people experiencing homelessness?

Findings  In this cross-sectional study of 64 US jurisdictional health departments, 26 349 cases of COVID-19 among people experiencing homelessness were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 was lower among people experiencing homelessness than in the general population at state and local levels.

Meaning  The findings suggest that incorporating housing and homelessness status in infectious disease surveillance may improve understanding of the burden of infectious diseases among disproportionately affected groups and aid public health decision-making.

Author(s): Ashley A. Meehan, MPH1; Isabel Thomas, MPH1,2; Libby Horter, MPH1,3; et al

Publication Date: August 18, 2022

Publication Site: JAMA Open Network

Alcohol-Related Deaths During the COVID-19 Pandemic

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama/fullarticle/2790491

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The number of deaths involving alcohol increased between 2019 and 2020 (from 78 927 to 99 017 [relative change, 25.5%]), as did the age-adjusted rate (from 27.3 to 34.4 per 100 000 [relative change, 25.9%]) (Table). Comparatively, deaths from all causes had smaller relative increases in number (from 2 823 460 to 3 353 547 [18.8%]) and rate (from 938.3 to 1094.3 per 100 000 [16.6%]). Alcohol-related deaths accounted for 2.8% of all deaths in 2019 and 3.0% in 2020.

The Figure presents the number of alcohol-related deaths in 2019 and 2020 by month, with provisional data included for the first 6 months of 2021.

Rates increased for all age groups, with the largest increases occurring for people aged 35 to 44 years (from 22.9 to 32.0 per 100 000 [39.7%]) and 25 to 34 years (from 11.8 to 16.1 per 100 000 [37.0%]). Increases in rates were similar for females (from 13.7 to 17.5 per 100 000 [27.3%]) and males (from 42.1 to 52.6 per 100 000 [25.1%]) (Table).

The number of deaths with an underlying cause of alcohol-associated liver diseases increased from 24 106 to 29 504 (22.4%) and the number of deaths with an underlying cause of alcohol-related mental and behavioral disorders increased from 11 261 to 15 211 (35.1%). Opioid overdose deaths involving alcohol as a contributing cause increased from 8503 to 11 969 (40.8%). Deaths in which alcohol contributed to overdoses specifically on synthetic opioids other than methadone (eg, fentanyl) increased from 6302 to 10 032 (59.2%).

Author(s): Aaron M. White, PhD1; I-Jen P. Castle, PhD1; Patricia A. Powell, PhD1; et al

Publication Date: 18 Mar 2022

Publication Site: JAMA Network

More Americans 65 and Under Died from Alcohol-Related Causes Than Covid-19 in 2020, Study Finds

Mary Pat Campbell

Link: https://www.nationalreview.com/news/more-americans-65-and-under-died-from-alcohol-related-causes-than-covid-19-in-2020-study-finds/

Excerpt:

Alcohol-related deaths increased 25 percent from 2019 to 2020, with alcohol-related deaths among adults younger than 65 outnumbering deaths from Covid-19 in the same age group in 2020, a new study found.

Alcohol-related deaths, including from liver disease and accidents, increased to 99,017 in 2020, up from 78,927 the year prior, according to the study performed by researchers with the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health.

While 74,408 Americans ages 16 to 64 died of alcohol-related causes, 74,075 individuals under 65 died of Covid-19, the study found. The rate of increase for alcohol-related deaths in 2020 (25 percent) was greater than the rate of increase of deaths from all causes (16.6 percent).

The study shows just another unintended consequence of Covid-19 lockdowns and mitigation measures.

Author(s): Brittany Bernstein

Publication Date: 22 March 2022

Publication Site: National Review