Summary Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. Funding Bill & Melinda Gates Foundation.
Civil registration and vital statistics (CRVS) systems comprise two interdependent components: civil registration (CR) and vital statistics (VS). Civil registration records the occurrence and characteristics of vital events in a population, including births, deaths, fetal deaths, and cause of death information.1 Vital statistics compile and process the data derived from civil registration to analyze mortality trends, and track demographic patterns, such as birth and death rates.2
Brendan D Carson, Colin M. Orians, Elizabeth E. Crone
Viruses have the potential to impact host populations, but our picture of host-virus relationships is largely colored by virulent pathogens that lead to easily detectable epizootic events. Modern molecular methods have demonstrated that viruses are ubiquitous in animal populations, and the influence of these "cryptic" viruses is largely unexplored. Insects provide an ideal system to examine population-level impacts of novel, "cryptic" viruses-short generation times allow for meaningful population-level field studies over a relatively short timeframe, and their abundance and small size facilitate experimental manipulation across each life stage. Many insect species are capable of high population growth rates, potentially buffering them from pathogen-driven declines in the face of high pathogen prevalence. We explored the impacts of a recently detected non-occluded densovirus (Junonia coenia DV, JcDV) on the demography of a nymphalid butterfly, Euphydryas phaeton (Baltimore checkerspot). E. phaeton populations are known to have the capacity for rapid growth and to exhibit large, often unexplained population fluctuations. We used a field mesocosm experiment to measure the vital rates of E. phaeton under a range of levels of viral exposure over 2 years (2021 and 2022) and used these vital rates to parameterize a demographic model of population growth in each year. We found that JcDV reduced E. phaeton post-diapause larval survival, skewed sex ratios toward a male bias, and reduced fecundity in surviving females. JcDV reduced estimated population growth rates in both years, but only led to population decline in 2022. This increased impact was associated with a substantial regional drought, suggesting that the potential for this non-occluded virus to cause population decline is influenced by climatic factors. The findings of our controlled study parallel trends observed in a wild population of E. phaeton, supporting the hypothesis that JcDV can drive population decline. This study demonstrates that cryptic viruses likely influence butterfly population dynamics, especially when their effects are compounded with additional environmental stressors.
Readmission is a vital component of healthcare quality and is one of the core group metrics for quality-dependent outcomes. Currently, variables predictive of readmission following elective craniotomies for intracranial tumors in the pediatric population are not known. We sought to identify such variables in our population of children and young adults. All elective craniotomies for tumor resection performed at our children’s hospital from January 1, 2010, through December 31, 2022, were included for review, excluding those patients > 21 years of age. Demographic, clinical, and procedural covariates for each elective craniotomy for tumor resection were collected. Readmission was defined as readmission for any reason and to any service following discharge from the index admission (i.e., elective craniotomy). Readmission events were characterized as occurring within 90 days from discharge. A total of 1,276 patients underwent a total of 1,497 elective craniotomies for tumor resection. The median age of the population at their index operations was 9.45 years, of which 58.5% of patients were male, 68.5% Caucasian, and 76.5% had private insurance. Most tumor resections were supratentorial (63.4%). There were 208 (13.9%) readmissions within 90 days of index operation, with 154 (74%) of those returning within the first 30 days. Bivariate analysis identified a number of associations, but multivariate testing found four significant predictors: age 0 to < 5 years (OR 1.55, p = 0.02), surgical time (OR 1.002, p = 0.02), high tumor grade (OR 3.15, p = 0.03), and return to the neurosurgical OR due to postoperative event (POE) (OR 2.81, p = 0.005). Utilizing our large pediatric tumor database, we identified key drivers of readmission following elective tumor resection. These were young children (0 to < 5 years), surgical time, high tumor grade, and return to the neurosurgical OR due to POE, of which high tumor grade was the strongest. Future studies are warranted to explore the specific ways that these predictors increase readmission risk.
Corine Driessens, Peter W.F. Smith, Kim Markham-Jones
et al.
Objective
This project aimed to uncover key factors that shape young people’s (YP) mental health care utilization. The Andersen’s Behavioral Model of Health Care Utilization was adapted in co-production, providing a framework for the predisposing characteristics, enabling resources, and perceived/evaluated need factors hypothesized to influence young people’s mental health care utilization.
Methods
The project is a secondary data analysis project with strong emphasis on YP involvement. YoungMinds and young researchers facilitated the co-production of an analysis plan with YP who had lived experience. This analysis plan was used to analyse existing data (Longitudinal Study of YP in England, also known as NEXT STEPS). Cohort data was linked to administrative health care data (Hospital Episode Statistics) to obtain objective measures of mental health care utilization. As this cohort is subjective to mental health related attrition, logistic regression models in combination with missing-not-at-random methodology was used to determine factors impacting mental health service utilization.
Results
The insights and experiences shared by YP in three workshops were captured in the YP’s model of secondary health care utilization for common mental health problems. NEXT STEPS-HES linked data showed that approximately 10% of the participants reporting common mental health problems between age 14 to 25 accessed secondary mental health services. The main predictor of utilization of secondary mental health services between age 17 to 25 is having a common mental health diagnosis before age 17. Interaction with social services and educational welfare at age 16 also facilitates utilization of mental health care services. Findings align with existing literature showing that women are more likely to utilize secondary mental health care services compared to men.
Conclusion
Despite growing recognition of mental health challenges among young people (YP), the findings indicate that only one in ten YP reporting common mental health problems utilized services. Secondary mental health care use was not only influenced by perceived mental wellbeing but also by societal perceptions and expectations.
Increasing temperatures and shifting precipitation patterns are major components of climate change. Yet, the demographic responses of plants to such changes remain poorly known. We used 20 years of demographic monitoring data (1990–2009) on native Cirsium undulatum (wavyleaf thistle) from two Sandhills prairie sites in the central Great Plains, USA, to assess long- and short-term effects of weather variation on ramet dynamics. C. undulatum is a deeply taprooted, short-lived perennial plant that can vegetatively reproduce rosette-like ramets. Since field evidence over the full length of the 20 years documented the recruitment and fate of rosettes, we evaluated ramet vital rates and dynamics. We first estimated annual recruitment, survival, and between-stage transitions. These vital rates were used to develop a matrix population model to calculate annual asymptotic population growth rates (λt). We then fitted a functional linear model to explore the effect of temperature, precipitation, and standardized precipitation evapotranspiration index (SPEI), an integrated measure of drought intensity, on ramet demographic rates. Finally, we developed a population viability analysis (PVA) model to evaluate the persistence of the ramet population under worst- and best-case scenarios of future drought events. The results revealed that at the drier site, Arapaho, wetter than normal years over the previous 19 months increased five parameters and decreased one. Seedling recruitment, flowering single rosette sprouts and λt increased with positive SPEI; and single rosette survival and multiple rosette stasis increased with precipitation. Retrogression from multiple rosette to single rosette was reduced when precipitation decreased. Additionally, higher-than-normal temperatures between 18–12-months period before the population census significantly increased the flowering probability of single rosettes. At the second site, Niobrara, only seedling recruitment was significantly increased by positive SPEI. The PVA indicated C. undulatum ramet populations will likely persist even with an increase in drought frequency. Synthesis: This study provides a relatively rare long-term study of the effect of weather variables on demographic rates and plant persistence. Our simulations suggest that plants evolved in highly variable and droughty environments like C. undulatum will be resilient to increases in drought with climate change.
Estelle Lowry, Ian Shuttleworth, Peter Wilgar
et al.
ObjectiveThe Northern Ireland Longitudinal Study (NILS) is a complex administrative data linkage system. Since its launch in 2006, it has expanded in both breadth and depth, allowing the development of new research agendas which deliver insights into the population of Northern Ireland and how their lives have changed over time. MethodsThe NILS uses a medical card spine to link census and other administrative datasets resulting in a cohort of c515,000 people representing approx. 28% of medical card registrations. It was originally created based on 2001 Census data, and has since undergone subsequent linkages with Census 2011, 1981 (partial), 1991 and most recently Census 2021 data resulting in a rich dataset spanning 40 years. This is bridged by further routine linkages to vital events and the provision of distinct linkage projects (DLP’s) enables opportunities for in depth exploration of health and social care. ResultsThe 2021 Census introduced several new questions, alongside those asked for the second or subsequent time. This offers new opportunities for research topics such as sexual identity, national identity, passports held, religion, demographics, energy-efficient households, and health. We observe an aging population, housing tenure shows considerably higher proportions of shared ownership in later years, and the proportion of those holding a United Kingdom passport only had decreased at the time of the most recent Census. The number of people stating a long-term health condition has also increased. The Census serves as a valuable tool to examine the impact of the past decade, during which society has faced unprecedented events such as Brexit, the global pandemic, and crises in housing and cost-of-living. ConclusionsWe present an updated cohort profile, showcasing characteristics of the 2021 Census population, alongside highlighting recent research. As part of the wider UK Census Longitudinal Studies, the NILS aligns with the Scottish and ONS Longitudinal Studies, facilitating cross-UK analysis. New remote access arrangements can further widen our user base.
This paper discusses anniversary events that we consider important in the field of demography in 2024–2025, including the birthdays of notable figures and significant conference dates, such as the International Conference on Population and Development (ICPD) held in Cairo, Egypt in 1994, as well as notable publications.
Manas V. Pustake, Kunal Sharma, Lakshmi Kattamuri
et al.
Background: Hematological malignancies pose a significant public health burden, with atrial fibrillation/flutter (AF/AFL) increasingly recognized as a critical comorbidity due to shared risk factors, cancer-related inflammation, and cardiotoxic treatments. It contributes to increased mortality in cancer patients through thromboembolic events, heart failure, and treatment interruptions. Despite this, long-term trends in AF/AFL-associated mortality in hematological cancer populations remain underexplored. This study examines two-decade mortality trends among U.S. patients with hematological malignancies and comorbid AF/AFL, identifying temporal inflection points and demographic disparities using national vital statistics data. Methods: We conducted a cross-sectional analysis utilizing mortality data (2000-2020) extracted from the CDC's National Vital Statistics System Wide-Ranging Online Data for Epidemiologic Research (NVSS-WONDER) platform, identifying all deaths where hematological malignancies (ICD-10 C81-C96) were the underlying cause and atrial fibrillation or flutter (ICD-10 I48) was listed as either an underlying or contributing cause; we excluded cases lacking complete demographic data (age, sex, race, ethnicity) to enable a complete-case analysis. Using the National Cancer Institute's Joinpoint Regression Software (v4.9), we applied joinpoint regression models to pinpoint statistically significant inflection points (joinpoints) in annual mortality trends, calculating annual percent changes (APC) with 95% confidence intervals (CIs) to quantify trend magnitude. Model assumptions were verified with testing for autocorrelation using the Durbin-Watson statistic and assessing homoscedasticity via the Breusch-Pagan test. Furthermore, we constructed Poisson regression models based on pre-joinpoint trend segments to forecast expected mortality rates and computed observed-to-predicted mortality ratios to evaluate significant deviations from established trends; all statistical procedures, including assumption testing and Poisson modeling, were executed using IBM SPSS Statistics version 26. Significance level was set to α=0.05. Results: A total of 31,720 cases were identified. The mean age at death was 79.82 years (SD = 9.25; 95% CI: 79.71–79.92). The age distribution was left-skewed (skewness = −0.66), with 25% of deaths occurring before age 74 (IQR = 12 years). Demographic Disparities: Males constituted 57.2% (18,133/31,720) of deaths. Deaths among males increased by 379% (from 341 in 1999 to 1,633 in 2020), compared with a 220% increase among females (from 338 to 1,083). Non-Hispanic Whites accounted for 89.8% of deaths (28,479/31,720; crude rate: 0.6 per 100,000). Non-Hispanic Black individuals had a higher crude mortality rate (0.2 per 100,000) than other racial/ethnic groups (0.1 per 100,000). Mortality Trends: Joinpoint regression identified four inflection points (2002, 2005, 2011, 2014), dividing the study period into five distinct phases.1999–2002: Rapid increase (APC = 8.10%; 95% CI: 5.3–11.0,p < 0.001).2003–2005: Slower growth (APC = 2.54%; 95% CI: 0.8–4.3, p = 0.006).2006–2011: Sharp resurgence (APC = 7.94%; 95% CI: 6.2–9.7, p < 0.001).2012–2014: Moderate rise (APC = 5.90%; 95% CI: 3.1–8.8, p < 0.001).2015–2020: Accelerated climb (APC = 7.58%; 95% CI: 6.0–9.2, p < 0.001). Total deaths increased 299.7% (679 in 1999 to 2,716 in 2020). Observed-to-predicted ratios consistently exceeded 1.0 post-2011, confirming sustained upward deviations.Conclusion: Mortality among patients with hematological malignancies and comorbid AF/AFL increased by 300% from 1999 to 2020, with accelerating trends after 2011. Key drivers include aging populations, prolonged cancer survivorship exposing patients to cardiotoxic therapies, and improved AF/AFL detection. Pronounced sex disparities (3.6-fold greater mortality increase in males) and racial inequities (highest absolute burden among Non-Hispanic Whites) highlight the need for sex-specific cardio-oncology protocols and targeted screening in high-risk populations. The identified inflection points likely correspond to:Introduction of novel targeted therapies (e.g., proteasome inhibitors, 2003–2005).Updated AF management guidelines (2010–2014)Immune checkpoint inhibitor adoption (post-2015). Future initiatives should integrate cardiovascular risk mitigation into hematological cancer management and address demographic disparities via tailored interventions.
Demographic analyses provide valuable insights that can significantly enhance reintroduction planning and decision‐making, helping to improve the likelihood of reintroduction success. We developed a model to evaluate the chances of success for a reintroduction of the endangered Barbary macaque (Macaca sylvanus). The model incorporates age‐specific vital rates estimated from 11 years of demographic data on a wild population, reductions in survival and reproduction due to potential release costs, demographic and environmental stochasticity, reinforcement releases, and catastrophic events. Based on the available individuals considered as best candidates for reintroduction, we compared extinction risks under two release strategies. One strategy entails releasing all individuals as one large social group, while the other entails forming and releasing two smaller, separate groups. Our results suggest that the best strategy for Barbary macaques is to release two separate social groups, for which extinction risks remain low (< 5% in the absence of catastrophic events) as long as survival suffers minimal release costs. Sensitivity testing showed that extinction risks are more sensitive to changes in release costs on survival than on reproduction, and that sensitivity to initial sex ratio depends on initial group size. Extinction risk is dramatically affected by catastrophic events, although it is not highly sensitive to variations in the probability of occurrence of such events. Reinforcement releases help counter the effects of high release costs on survival, thus considerably improving probabilities of population persistence. Our model presents highly promising prospects for the successful reintroduction of a Barbary macaque population, and for the conservation of this species, which is the only extant nonhuman primate in North Africa.
Efforts to track the mortality and public health impact of the coronavirus disease (COVID-19) in Uganda have been hampered by weak Civil registration and vital statistics (CRVS) system and suboptimal health seeking behaviors or patterns. Evaluating unexplained increases in all-cause mortality provides a complete picture of the impact of COVID-19 pandemic and guide public health policies and resource allocation to protect the most vulnerable populations. The longitudinal population cohort data on demographic events and socioeconomic status collected from 2015 to 2021 within the Iganga Mayuge Health and Demographic Surveillance System (IMHDSS) was used. Number of deaths and person years at risk were counted for each quarter of the year from January 2015 to December 2021 and classified as “pre-pandemic” (before January 2020), and “during pandemic” (January 2020 to December 2021). Crude mortality rates were computed comparing the two periods. Time series model was used to estimate excess mortality and to locate the exact time when excess deaths occurred. Cox Proportional Hazard model was used to estimate the Hazard ratio associated with death. A total of 132,367 individuals were followed up from 2015 to 2021 and 3,424 deaths were registered. Slightly more than a half of all deaths (53%, n = 1,827) were male, and 65.4% (n = 2,238) were rural residents. Children under five years had a significantly higher CMR during COVID-19 period of 18.9, (95% CI 17.2–20.8) per 1000 person compared to 12.5 (95% CI 11.6–13.4) per 1000 person years before COVID-19. The risk of dying among children under 5 years compared to those aged between 5 and 14 years was higher during the COVID-19 pandemic period (aHR = 18.0, 95% CI 13.6–24.0) than pre-pandemic (aHR = 10.4, 95% CI 8.8–12.3). The COVID-19 pandemic increased all-cause mortality in the Iganga Mayuge HDSS population cohort in Eastern Uganda, particularly among children under five, likely due to restricted healthcare access and economic disruptions. Pandemic response measures should prioritize vulnerable populations at higher risk of malnutrition and preventable diseases to mitigate future negative impacts.
The General Happiness Index is a vital indicator for reflecting the mental wellbeing of the community and monitoring the changes and trends in various factors that contribute to the index. This data was collected through a repeated cross-sectional survey from 2018 to 2024, which was deemed valuable because of its comprehensive record of the changes of the mental wellbeing of the general population in response to different traumatic events. Such data provided possibilities for policymakers, health and social care researchers and the Government to investigate the impact of those traumatic events and associated salient predictors on mental wellbeing. The dataset encompassed 10,070 responses from the public between 2018 and 2024, who have been through several major sociopolitical and pandemic-related events in Hong Kong, namely social unrest in 2019, five waves of COVID-19 outbreaks from 2020 to 2022, and post-pandemic psychosocial issues in 2023 and 2024. The questionnaires comprised the demographics, individual happiness, the 4-item LIFE mental capital scale, personal values, social well-being, satisfaction with external environmental factors, physical and mental health status, and depressive symptoms. Data was collected through online and/or in-person interviews, subject to social conditions and infectious disease outbreaks. Data verification was performed, and additional computations (i.e., mean of mental capital and satisfaction with external environmental factors) were added to enhance interpretability.
Research data indicate an increase in the risk of cardiovascular events (CVEs) with unhealthy diet.Aim. To assess the impact of diet on the development of cardiovascular events in the Russian population.Material and methods. The prospective cohort included representative samples of 10 Russian regions (n=17175, 6767 men and 10408 women aged 25-64 years), examined in 2012-2014 as part of the ESSE-RF study. The diet was studied by the frequency of consumption of the main food groups. The vital status of the cohort was clarified every 2 years. The follow-up period was 6 years. Kaplan-Meier survival curves were used to analyze survival, and the Cox proportional hazards model was used to assess the risk of CVEs.Results. Analysis of Kaplan-Meier curves showed better survival before the CVEs in the general population with daily consumption of cottage cheese (p=0,0029), cheese (p=0,00017), red meat (p=0,036) and the presence of the healthy eating model in the diet (p=0,013). A decrease in survival before the CVE onset was noted with excess salt intake (ESI) in the diet (p=0,0038) and the habit of adding salt to food (p=0,0032).Among men, a decrease in survival before the CVE onset was noted with ESI (p=0,018) and the habit of adding salt to food (p=0,047), and an increase — with regular consumption of red meat (p=0,00027). Among women, daily consumption of red meat (p=0,038), cheese (p=0,026), cottage cheese (p=0,019), as well as rare consumption of fatty dairy products (sour cream/cream) (p=0,04) delay the CVE onset. In the general population, in a univariate Cox proportional hazards analysis, daily cheese consumption and healthy eating model significantly reduce the risk of CVEs — 0,74 (0,61-0,89) and 0,78 (0,65-0,94), respectively, and excess salt and adding salt to food increase the CVE risk — 1,33 (1,12-1,59) and 1,33 (1,111,58), respectively. However, after introducing correction for socio-demographic indicators and risk factors, the significance is lost. In men, adding salt to food significantly increases the risk of cardiovascular events as follows: odds ratio 1,34 (1,04-1,73). Other eating habits are significant only in univariate analysis and lose their significance after introducing corrections.Conclusion. Adding salt to food significantly increases the risk of cardiovascular events among men of active working age.
Laila AlGhalawin, Mukhtar J Alomar, Shahad Al Bassam
et al.
Purpose Rheumatoid arthritis (RA) doubles the morbidity of cardiovascular disease (CVD) and leads to a 50% increase in mortality compared to the general population. This study aims to estimate the CVD incidence among RA patients in Saudi Arabia (SA), vital for assessing CVD burdens within this group. Patients and Methods This retrospective study took place at two centers in the Eastern Province of SA, including all adult RA patients who visited the rheumatology clinic from 2016 to 2021 and were prescribed disease-modifying antirheumatic drugs (DMARDs). CVD incidence was determined by the diagnosis of ischemic heart disease (IHD), stroke/transient ischemic attack (TIA), venous thromboembolism (VTE), heart failure (HF), and arrhythmia post-RA diagnosis. Additional data collected included demographics, CVD risk factors, comorbidities, RA-related factors, and medication usage. Results The study comprised 651 patients, 80.5% of whom were females with an average age of 51. The overall CVD incidence was 11.2 per 1000 person-years, with males experiencing five times more incidents than females. The prevalence of CVD risk factors included 18.7% with hypertension, 7.8% with hyperlipidemia, 18.9% with diabetes, and 42.9% with obesity. Significant predictors of CVD were male gender and RA duration, with adjusted odds ratios (aOR) of 3.17 (95% CI 1.10 to 9.14, P=0.033) and 64.81 (95% CI 3.68 to 1140.6, P=0.004), respectively. Conclusion This unique study from SA examined the CVD incidence in RA patients, identifying long disease duration and male gender as significant predictors. Effective reduction of CVD risk in RA patients requires aggressive management of modifiable risk factors and regular risk assessments.
OBJECTIVE: To demonstrate the analytical value of a cubic parameterization of the age curve of fertility and to explore its features, especially its usefulness in separating fertility level and fertility timing. METHODS: Using mathematical analysis, the cubic fertility curve is derived and examined in both continuous and discrete forms. RESULTS: The cubic curve for replacement level fertility is found and expressed in terms of the mean age of fertility. That baseline cubic birth rate density, proportionately adjusted for the level of fertility, is shown to plausibly fit observed birth rates and imply a new approximation for their implicit stable growth rate. Because the proposed cubic model separates the effects of fertility level (quantum) and fertility timing (tempo), it leads to new period/cohort and population momentum relationships and provides a structure for relating fertility trajectories to birth sequences in changing rate models. CONTRIBUTION: The cubic parameterization can simplify the representation of age curves of fertility rates while capturing their essential features. With a proportional adjustment at all ages to reflect fertility level, the cubic model can separate level and timing effects and permit numerous analytical applications. Of note, those applications include a new and superior approach to how changes in period tempo with constant quantum affect cohort fertility.
The new tendency in Urban Green Spaces (UGS) design is to establish sustainable and health-promoting public parks – often described as the new (second) generation of public parks. The possibilities of wider implementation of the new generation of public parks are presented as an example of a recently constructed or revitalized park in the Pomerania region. This paper discusses three public parks in the Pomerania region – Public Municipal Parks in Rumia, Reda and Wejherowo. In this study, the main research question was whether the selected parks promote the well-being of inhabitants as well as sustainability. The parks were assessed using a standardized tool – the universal standard of health-promoting urban places. All three parks are places for physical, mental and social restoration of neighborhood communities, as well as ecological education. Thus, they can be regarded as health-affirming urban places
Understanding the dynamics of movements between different demographic events is essential for informing effective population management strategies. This study aims to characterize the trajectories of demographic and other vital events within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). Thus, it intends to unravel patterns and trends that can guide the development of targeted policies and interventions to address the population’s evolving needs. Using a continuous-time homogeneous multi-state Markov model, longitudinal data from 223,350 individuals in Korogocho and Viwandani urban slums, we study the enumeration, births, deaths, and migrations among urban poor in Nairobi, shedding light on population dynamics and movements over time, disaggregated by gender. Findings indicate a positive net migration in population per thousand in 2002, dropping in 2004, with Viwandani consistently showing higher birth rates than Korogocho. Males generally have higher death rates than females. Females from Viwandani are 39.0% more likely to exit after enumeration compared to Korogocho, while males are 35.6% more likely to move from enumeration to exit compared to males from Korogocho. Both genders from Viwandani have a decreased likelihood of moving from birth to death compared to Korogocho. Our findings provide unique insights into migration in urban Kenya, the frequency and movement to different demographic events and any gender differences that warrant strategic policies for effective population and health planning in Africa. These findings can inform the design of effective health interventions that are often affected by migration and population growth.
Introduction Infant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases. Methods We conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data. Results Studies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources. Conclusions Prospective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly.
Social and environmental justice organisations have silenced discourse on human overpopulation due to fear of any association with reproductive coercion, but in doing so they have failed to acknowledge the oppressive role of pronatalism in undermining reproductive autonomy. Pronatalism, which comprises cultural and institutional forces that compel reproduction, is far more widespread, and as damaging to individual liberties as attempts to limit reproduction. The failure to recognise the enormity of pronatalism has led to the wholesale abandonment of voluntary, rights-based efforts toward a sustainable population despite widespread scientific agreement that population growth is a major driver of multiple cascading environmental crises. We examine the full range of patriarchal, cultural, familial, religious, economic and political pronatalist pressures, and argue that the reluctance to address population as a driver of the ecological crisis serves the very pronatalist forces that undermine reproductive autonomy. We posit that addressing overpopulation, and the pronatalism that drives it, must be central to international conservation and development efforts to elevate reproductive rights while also promoting planetary health.