The COVID-19 pandemic stimulated the interest of scientists, decision makers and the general public in short-term mortality fluctuations caused by epidemics and other natural or man-made disasters. To address this interest and provide a basis for further research, in May 2020, the Short-term Mortality Fluctuations data series was launched as a new section of the Human Mortality Database. At present, this unique data resource provides weekly mortality death counts and rates by age and sex for 38 countries and regions. The main objective of this paper is to detail the web-based application for visualizing and analyzing the excess mortality based on the Short-term Mortality Fluctuation data series. The application yields a visual representation of the database that enhances the understanding of the underlying data. Besides, it enables the users to explore data on weekly mortality and excess mortality across years and countries. The contribution of this paper is twofold. First, to describe a visualization tool that aims to facilitate research on short-term mortality fluctuations. Second, to provide a comprehensive open-source software solution for demographic data to encourage data holders to promote their datasets in a visual framework.
Background Identifying individuals with low grip strength is an initial step in many operational definitions of sarcopenia. As evidence indicates that contemporaneous Russian populations may have lower mean levels of grip strength than other populations in northern Europe, we aimed to: compare grip strength in Russian and Norwegian populations by age and sex; investigate whether height, body mass index, education, smoking status, alcohol use and health status explain observed differences and; examine implications for case-finding low muscle strength. Methods We used harmonized cross-sectional data on grip strength and covariates for participants aged 40–69 years from the Russian Know Your Heart study (KYH) (n = 3833) and the seventh survey of the Norwegian Tromsø Study (n = 5598). Maximum grip strength (kg) was assessed using the same protocol and device in both studies. Grip strength by age, sex and study was modelled using linear regression and between-study differences were predicted from these models. Sex-specific age-standardized differences in grip strength and in prevalence of low muscle strength were estimated using the European population standard of 2013. Results Normal ranges of maximum grip strength in both studies combined were 33.8 to 67.0 kg in men and 18.7 to 40.1 kg in women. Mean grip strength was higher among Tromsø than KYH study participants and this difference did not vary markedly by age or sex. Adjustment for covariates, most notably height, attenuated between-study differences but these differences were still evident at younger ages. For example, estimated between-study differences in mean grip strength in fully adjusted models were 2.2 kg [95% confidence interval (CI) 1.4, 3.1] at 40 years and 1.0 kg (95% CI 0.5, 1.5) at 65 years in men (age × study interaction P = 0.09) and 1.1 kg (95% CI 0.4, 1.9) at age 40 years and 0.2 kg (95% CI 0.7, 0.3) at 65 years in women (age × study interaction P < 0.01). Conclusions We found between-study differences in mean grip strength that are likely to translate into greater future risk of sarcopenia and poorer prospects of healthy ageing for Russian than Norwegian study participants. For example, the average Russian participant had a similar level of grip strength to a Norwegian participant 7 years older. Our findings suggest these differences may have their origins in childhood highlighting the need to consider interventions in early life to prevent sarcopenia
This article addresses two unresolved methodological issues related to prior research on Russia that was based on census-unlinked data and did not account for the substantial increase in the share of death records with missing information on education. The study uses a proportional mortality analysis method relying on a case–control framework, together with a plausible imputation-based solution for the redistribution of the unknown education on death records. The new results suggest that high levels of inequality persist, but they do not support recent findings indicating that the educational gap in life expectancy has substantially widened.
OBJECTIVE To estimate the changes in life expectancy and years of life lost in 2020 associated with the covid-19 pandemic. DESIGN Time series analysis. SETTING 37 upper-middle and high income countries or regions with reliable and complete mortality data. PARTICIPANTS Annual all cause mortality data from the Human Mortality Database for 2005-20, harmonised and disaggregated by age and sex. MAIN OUTCOME MEASURES Reduction in life expectancy was estimated as the difference between observed and expected life expectancy in 2020 using the Lee-Carter model. Excess years of life lost were estimated as the difference between the observed and expected years of life lost in 2020 using the World Health Organization standard life table.
There is considerable variation in mortality rates from myocardial infarction (MI) across high-income countries, some of which may be artefactual. Methods: Time trends in mortality rates from ischaemic heart disease (IHD) and MI were analysed for a set of high-income countries from the end of the 1970s. Using individuallevel mortality data from Russia (2005–2017) and Norway (2005–2016), we investigated factors associated with the proportion of total IHD deaths certiﬁed as due to MI. Results: In most countries, MI mortality rates have dramatically declined from the 1970s. However, the share of MI in total IHD deaths varies substantially across countries. In Russia, only 12% of IHD deaths had MI assigned as the underlying cause vs 63% in Norway. IHD deaths occurring outside of hospital without autopsy were far less likely to be assigned as MI in Russia (2%) than in Norway (59%). Conclusions: Although established international criteria for MI require speciﬁc clinical or post-mortem evidence, it appears that certifying specialists in different countries may interpret these criteria differently. At one extreme, Russian doctors may only assign MI as a cause of death when there is speciﬁc pathophysiological evidence. At the other extreme, their counterparts in Norway may be willing to specify MI as the cause even when this evidence is not available. Internationally established criteria for MI diagnosis are challenging to apply for out-of-hospital deaths. Differences between countries in how certiﬁers interpret these criteria may account for at least some of the international variation in MI mortality rates.
Abstract Objective To estimate the direct and indirect effects of the covid-19 pandemic on mortality in 2020 in 29 high income countries with reliable and complete age and sex disaggregated mortality data.
Design Time series study of high income countries.
Setting Austria, Belgium, Czech Republic, Denmark, England and Wales, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Lithuania, the Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Scotland, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, and United States.
Participants Mortality data from the Short-term Mortality Fluctuations data series of the Human Mortality Database for 2016-20, harmonised and disaggregated by age and sex.
Interventions Covid-19 pandemic and associated policy measures.
Main outcome measures Weekly excess deaths (observed deaths versus expected deaths predicted by model) in 2020, by sex and age (0-14, 15-64, 65-74, 75-84, and ≥85 years), estimated using an over-dispersed Poisson regression model that accounts for temporal trends and seasonal variability in mortality.
Results An estimated 979 000 (95% confidence interval 954 000 to 1 001 000) excess deaths occurred in 2020 in the 29 high income countries analysed. All countries had excess deaths in 2020, except New Zealand, Norway, and Denmark. The five countries with the highest absolute number of excess deaths were the US (458 000, 454 000 to 461 000), Italy (89 100, 87 500 to 90 700), England and Wales (85 400, 83 900 to 86 800), Spain (84 100, 82 800 to 85 300), and Poland (60 100, 58 800 to 61 300). New Zealand had lower overall mortality than expected (−2500, −2900 to −2100). In many countries, the estimated number of excess deaths substantially exceeded the number of reported deaths from covid-19. The highest excess death rates (per 100 000) in men were in Lithuania (285, 259 to 311), Poland (191, 184 to 197), Spain (179, 174 to 184), Hungary (174, 161 to 188), and Italy (168, 163 to 173); the highest rates in women were in Lithuania (210, 185 to 234), Spain (180, 175 to 185), Hungary (169, 156 to 182), Slovenia (158, 132 to 184), and Belgium (151, 141 to 162). Little evidence was found of subsequent compensatory reductions following excess mortality.
Conclusion Approximately one million excess deaths occurred in 2020 in these 29 high income countries. Age standardised excess death rates were higher in men than women in almost all countries. Excess deaths substantially exceeded reported deaths from covid-19 in many countries, indicating that determining the full impact of the pandemic on mortality requires assessment of excess deaths. Many countries had lower deaths than expected in children <15 years. Sex inequality in mortality widened further in most countries in 2020.
Objective: To validate a novel artificial-intelligence electrocardiogram algorithm(AI-ECG) to detect left ventricular systolic dysfunction (LVSD) in an external population. Background: LVSD, even when asymptomatic, confers increased morbidity and mortality. We recently derived AI-ECG to detect LVSD using ECGs based on a large sample of patients treated at the Mayo Clinic. Methods: We performed an external validation study with subjects from the Know Your Heart Study, a crosssectional study of adults aged 35–69 years residing in two cities in Russia, who had undergone both ECG and transthoracic echocardiography. LVSD was defined as left ventricular ejection fraction ≤ 35%. We assessed the performance of the AI-ECG to identify LVSD in this distinct patient population. Results: Among 4277 subjects in this external population-based validation study, 0.6% had LVSD (compared to 7.8% of the original clinical derivation study). The overall performance of the AI-ECG to detect LVSD was robust with an area under the receiver operating curve of 0.82.When using the LVSD probability cut-off of 0.256 from the original derivation study, the sensitivity, specificity, and accuracy in this population were 26.9%, 97.4%, 97.0%, respectively. Other probability cut-offs were analysed for different sensitivity values. Conclusions: The AI-ECG detected LVSDwith robust test performance in a population thatwas very different from that used to develop the algorithm. Population-specific cut-offs may be necessary for clinical implementation. Differences in population characteristics, ECG and echocardiographic data quality may affect test performance.
This chapter provides an overview of global trends in longevity and survival at older ages, with a special focus on global and regional disparities. In particular, existing evidence regarding potential data and estimation challenges will be critically assessed. The chapter also aims at summarizing the mixed evidence on the determinants of longevity at older ages. Our insights into global longevity trends suggest that longevity improvements have been highly uneven between and within the global regions. The reported results highlight the growing divergence in survival at age 65 and at age 80 among the most advanced high-income countries. Meanwhile, model-based estimates indicate that the majority of developing countries have probably not reached the phase in which systematic improvements in survival at older ages are occurring. The evidence is even more complex and problematic for global changes in the prevalence of diseases, risk factors, and disability. Epidemiological studies indicate that the burden of cardiovascular and other noncommunicable diseases is increasing in developing countries. It also appears that in many developed countries, smoking rates are decreasing and the obesity epidemic is stabilizing. Yet even the elderly in some high-income countries have unfavorable longevity profiles, as a substantial proportion of their remaining life expectancy is spent with chronic conditions or disability. More efforts are needed to obtain reliable and internationally comparable data on health and survival at old age in all global regions.
Objective The aim of the study is to assess changes in heart structure and function associated with heavy alcohol use by comparing echocardiographic indices in a population-based sample to those in patients admitted to an inpatient facility with severe alcohol problems. Methods and results We used data from the Know Your Heart study (2015–2017) which is a cross-sectional study that recruited 2479 participants aged 35–69 years from the general population of the city of Arkhangelsk in Northwest Russia and 278 patients from the Arkhangelsk Regional Psychiatric Hospital with a primary diagnosis related to chronic alcohol use (narcology clinic subsample). The drinking patterns of the population-based sample were characterised in detail. We used regression models controlling for age, sex, smoking, education and waist to hip ratio to evaluate the differences in echocardiographic indices in participants with different drinking patterns. The means of left ventricular end-diastolic diameter and indexed left atrial systolic diameter were increased among heavy drinkers (narcology clinic subsample), while mean left ventricular ejection fraction was decreased in this group compared with the population-based sample. In contrast, the harmful and hazardous drinkers in the population-based sample did not differ from non-problem drinkers with respect to echocardiographic indices of systolic and diastolic function. Conclusions Extremely heavy drinking is associated with a specific set of structural and functional abnormalities of the heart that may be regarded as precursors of alcohol-related dilated cardiomyopathy.
The Human Mortality Database (HMD, www.mortality.org) is the world’s leading data resource on mortality in developed countries. The HMD is a collaborative project of the Department of Demography at the University of California, Berkeley (UCB) and the Max Planck Institute for Demographic Research (MPIDR) in Rostock, Germany. The main purposes of the HMD are to document the longevity revolution of the modern era and to facilitate research into its causes and consequences by providing high-quality data to researchers, students, journalists, policy analysts, and others interested in the history of human longevity. As of 2019, this unique open-access collection provides detailed, high-quality mortality and population data for 40 countries. The database is still growing.
In Russia, cardiovascular disease (CVD) mortality is high and the mortality gap between men and women is large. Conventional risk factors cannot explain these phenomena. Ventricular arrhythmia (VA) is an important contributor to the death toll in community-based populations. The study examines the prevalence and the mortality impacts of VA in men and women and the role of VA in the male mortality excess at older ages.
This is a secondary analysis of data from the Stress, Aging, and Health in Russia (SAHR) study that was fielded in 2007–9 in Moscow (1800 individuals, mean age 68.8 years), with mean mortality follow-up of 7.4 years (416 deaths, 248 CVD deaths). Indicators reflecting the frequency and the complexity of VA were derived from 24-h ambulatory ECG recordings. Other covariates were: socio-demographic characteristics, conventional risk factors, markers of inflammation, reported myocardial infarction, and stroke. The impacts of VA and other variables on CVD and all-cause mortality among men and women were estimated with the proportional hazard models. We assessed the contributions of VAs to the male–female mortality gap using hazard models that do and do not include groups of the predictors. Logistic models were used to assess the associations between VA and other biomarkers.
VAs were about twice as prevalent among men as among women. In both sexes, they were significantly associated with CVD and all-cause mortality independently of conventional risk factors. The highest hazard ratios (HRs) for CVD death were found for the runs of ventricular premature complexes (VPCs) HR = 2.45, 95% CI 1.63–3.68 for men and 2.75, 95% CI 1.18–6.40 for women. The mortality impacts of the polymorphic VPCs were significant among men only (HR = 1.50, 95% CI 1.08–2.07). VA indicators can potentially explain 12.3% and 9.1% of the male–female gaps in mortality from CVD and all causes, respectively. VAs were associated with ECG-registered ischemic problems and reported MI, particularly among men.
VA indicators predicted mortality in older Muscovites independently of other risk factors, and have the potential to explain a non-trivial share of the excess male mortality. The latter may be related to more severe coronary problems in men compared to women.
Russia has a high burden of suicide and alcohol-attributable mortality. However there have been few studies of the epidemiology of depression.
The study population was 5077 men and women aged 35-69 years from a cross-sectional population based survey in the cities of Arkhangelsk and Novosibirsk (2015-17). Moderate depression was defined as Patient Health Questionnaire-9 (PHQ-9) score≥10. Risk factors considered were socio-demographic factors (age, sex, marital status, living alone, education, employment status, financial constraints); health behaviours (smoking, alcohol use) and psycho-social factors (life events and social support).
After mutual adjustment for all other factors, there was evidence that PHQ-9≥10 was associated with sex (higher in women), financial constraints, employment status, being a non-drinker, problem drinking, smoking, not having enough people to confide in and the number of life events in the past 6 months. Employment status was more strongly associated in men (OR 1.84 (95%CI 1.17, 2.88)) than women (OR 1.15 95% CI 0.86, 1.55). The effect size was particularly striking for financial constraints (odd ratio over 3 times higher in those with not enough money for food and clothes compared to no financial constraints), problem drinking (OR 1.72 (1.12, 2.65) among drinkers with CAGE score of 2 and 2.25 (95% CI 1.42, 3.57) in those with score ≥3 compared to zero) and life events (85% higher odds in those experiencing one life event and over 4 times higher odds in those experiencing 3 or more life events) all of which demonstrated a dose-response with PHQ-9>=10
The study was cross-sectional in nature therefore temporal relationships could not be assessed.
We have identified here a range of risk factors for depression among the Russian general population consistent with findings from other populations. The strikingly strong association with financial constraints indicates the importance of social inequality for the burden of depression.
Background: A non-invasive, easy-to-access marker of accelerated cardiac ageing would provide novel insights into the mechanisms and aetiology of cardiovascular disease (CVD) as well as contribute to risk stratification of those who have not had a heart or circulatory event. Our hypothesis is that differences between an ECG-predicted and chronologic age of participants (δage) would reflect accelerated or decelerated cardiovascular ageing Methods: A convolutional neural network model trained on over 700,000 ECGs from the Mayo Clinic in the U.S.A was used to predict the age of 4,542 participants in the Know Your Heart study conducted in two cities in Russia (2015-2018). Thereafter, δage was used in linear regression models to assess associations with known CVD risk factors and markers of cardiac abnormalities. Results: The biomarker δage (mean: +5.32 years) was strongly and positively associated with established risk factors for CVD: blood pressure, body mass index (BMI), total cholesterol and smoking. Additionally, δage had strong independent positive associations with markers of structural cardiac abnormalities: N-terminal pro b-type natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin T (hs-cTnT) and pulse wave velocity, a valid marker of vascular ageing. Conclusion: The difference between the ECG-age obtained from a convolutional neural network and chronologic age (δage) contains information about the level of exposure of an individual to established CVD risk factors and to markers of cardiac damage in a way that is consistent with it being a biomarker of accelerated cardiovascular (vascular) ageing. Further research is needed to explore whether these associations are seen in populations with different risks of CVD events, and to better understand the underlying mechanisms involved.
Dissimilarities in the approaches used to certify or code underlying causes of death may diminish the usefulness and reliability of cause-of-death statistics. Consistency of cause-specific mortality data within a given country can be regarded as one of the criteria for evaluating data quality. In the present paper, we assess the subnational consistency of cause-of-death statistics in four countries: Russia, Germany, the U.S., and France. We estimate the shares of major groups of causes in the mortality structures of subnational entities (regions), and compare them with the inter-regional average values. Next, we visualize the deviations on heat map matrices. This allows us to pinpoint the cases that deviate the most with respect to regions and causes of death, as well as the causes with high levels of within-country variability, and the regions with unique mortality structure. Among the countries that we examined, France has the most consistent cause-of-death data across its regions, while Russia has the largest number of outliers. We also found that causes of death that do not have strict diagnostic criteria (e.g., ill-defined) tend to display higher variability, while the shares of causes that are easier to diagnose as underlying are more stable across the regions.
Even in countries with very good statistical systems, routine population statistics that cover individuals of very high ages are often problematic, as the proportion of erroneous cases increases sharply with age. The desire to measure human mortality at extreme ages was the main motivation for the establishment of the International Database on Longevity (IDL). The IDL is a uniquely valuable source of information on extreme human longevity. It provides high-quality age-validated individual-level data on the ages of semi-supercentenarians and supercentenarians. Moreover, the IDL is the only database that provides such data without age-ascertainment bias. It obtains its candidates from records of government agencies to ensure that there is no dependency between the probability of being included and age. Candidates who meet strict criteria for the validity of their age (date of their birth) are then included in the IDL. Nevertheless, the IDL does not include exhaustive sets of validated supercentenarians and semi-supercentenarians for any country, because it is nearly impossible to find documents that would allow for the validation of the ages of all of the individuals on the list. As of August 2017, the IDL has records on 1,304 validated supercentenarians and 18,590 semi-supercentenarians from 15 countries. The first person in the IDL collection who attained age 110 was born in 1852 and died in 1962 in Quebec, while the last person was born in 1906 and attained age 110 in 2016. This chapter introduces the database and explains its purpose and principles. We also describe the data structure and provide an overview of the information available.
The COVID-19 pandemic has revealed substantial coverage and quality gaps in existing international and national statistical monitoring systems. It is striking that obtaining timely, accurate, and comparable across countries data in order to adequately respond to unexpected epidemiological threats is very challenging. The most robust and reliable approach to quantify the mortality burden due to short-term risk factors is based on estimating weekly excess deaths. This approach is more reliable than monitoring deaths with COVID-19 diagnosis or calculating incidence or fatality rates afected by numerous problems such as testing coverage and comparability of diagnostic approaches. In response to the emerging data challenges, a new data resource on weekly mortality has been established. The Short-term Mortality Fluctuations (STMF, available at www.mortality.org) data series is the frst international database providing open-access harmonized, uniform, and fully documented data on weekly all-cause mortality. The STMF online vizualisation tool provides an opportunity to perform a quick assessment of the excess weekly mortality in one or several countries by means of an interactive graphical interface.
Introduction Compared with many other countries Russia has a high prevalence of diabetes in men and women. However, contrary to what is found in most other populations, the risk is greater among women than men. The reasons for this are unclear. Research design and methods Prevalence and risk factors for diabetes at ages 40–69 years were compared in two population-based studies: Know Your Heart (KYH) (Russia, 2015–2018, n=4121) and the seventh wave of the Tromsø Study (Tromsø 7) (Norway, 2015–2016, n=17 649). Diabetes was defined by the level of glycated hemoglobin and/or self-reported diabetes and/or diabetes medication use. Marginal structural models were used to estimate the role of key risk factors for diabetes in differences between the studies. Results Age-standardized prevalence of diabetes was higher in KYH compared with Tromsø 7 in men (11.6% vs 6.2%) and in women (13.2% vs 4.3%). Age-adjusted ORs for diabetes in KYH compared with Tromsø 7 were 2.01 (95% CI 1.68 to 2.40) for men and 3.66 (95% CI 3.13 to 4.26) for women. Adiposity (body mass index and waist circumference) explained none of this effect for men but explained 46.0% (39.6, 53.8) for women. Addition of smoking and C reactive protein, as further mediators, slightly increased the percentage explained of the difference between studies to 55.5% (46.5, 66.0) for women but only to 9.9% (−0.6, 20.8) for men. Conclusions Adiposity is a key modifiable risk factor that appears to explain half of the almost threefold higher female prevalence of diabetes in Russia compared with Norway, but none of the twofold male difference.
To investigate whether the introduction of Minimum Unit Pricing (MUP) in Scotland on 1 May 2018 was reflected in changes in the likelihood of alcohol‐related queries submitted to an internet search engine and in particular whether there was any evidence of increased interest in purchasing of alcohol from outside Scotland.
Observational study in which individual queries to the internet Bing search engine for 2018 in Scotland and England were captured and analysed. Fluctuations over time in the likelihood of specific topic searches were examined. The patterns seen in Scotland were contrasted with those in England.
Scotland and England.
People who used the Bing search engine during 2018.
Numbers of daily queries submitted to Bing in 2018 on eight alcohol‐related topics expressed as a proportion of queries on that day on any topic. These daily likelihoods were smoothed using a 14‐day moving average for Scotland and England separately.
There were substantial peaks in queries about MUP itself, cheap sources of alcohol and online alcohol outlets at the time of introduction of MUP in May 2018 in Scotland but not England. These were relatively short‐lived. Queries related to intoxication and alcohol problems did not show a MUP peak but were appreciably higher in Scotland than in England throughout 2018.
Analysis of internet search engine queries appears to show that a fraction of people in Scotland may have considered circumventing minimum unit pricing in 2018 by looking for online alcohol retailers. The overall higher levels of queries related to alcohol problems in Scotland compared with England mirrors the corresponding differences in alcohol consumption and harms between the countries.