Excess mortality associated with the COVID-19 pandemic in Latvia : a population-level analysis of all-cause and noncommunicable disease deaths in 2020

Funding Information: The study was funded by the National Research Program to mitigate the consequences of COVID-19 within the project “Impact of the COVID-19 pandemic on the health care system and public health in Latvia; strengthening the preparedness of the health sector for future epidemics” (VPP-COVID-2020/1-0011). Publisher Copyright: © 2022, The Author(s).BACKGROUND: Age-standardised noncommunicable disease (NCD) mortality and the proportion of the elderly population in Latvia are high, while public health and health care systems are underresourced. The emerging COVID-19 pandemic raised concerns about its detrimental impact on all-cause and noncommunicable disease mortality in Latvia. We estimated the timing and number of excess all-cause and cause-specific deaths in 2020 in Latvia due to COVID-19 and selected noncommunicable diseases. METHODS: A time series analysis of all-cause and cause-specific weekly mortality from COVID-19, circulatory diseases, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases from the National Causes of Death Database from 2015 to 2020 was used by applying generalised additive modelling (GAM) and joinpoint regression analysis. RESULTS: Between weeks 14 and 52 (from 1 April to 29 December) of 2020, a total of 3111 excess deaths (95% PI 1339 - 4832) were estimated in Latvia, resulting in 163.77 excess deaths per 100 000. Since September 30, with the outbreak of the second COVID-19 wave, 55% of all excess deaths have occurred. Altogether, COVID-19-related deaths accounted for only 28% of the estimated all-cause excess deaths. A significant increase in excess mortality was estimated for circulatory diseases (68.91 excess deaths per 100 000). Ischemic heart disease and cerebrovascular disease were listed as the underlying cause in almost 60% of COVID-19-contributing deaths. CONCLUSIONS: All-cause mortality and mortality from circulatory diseases significantly increased in Latvia during the first pandemic year. All-cause excess mortality substantially exceeded reported COVID-19-related deaths, implying COVID-19-related mortality during was significantly underestimated. Increasing mortality from circulatory diseases suggests a negative cumulative effect of COVID-19 exposure and reduced access to healthcare services for NCD patients.publishersversionPeer reviewe

Consumption of thyroid medications as an indicator of increase of thyroid morbidity in Latvia from 2011 to 2014

Funding Information: EU Horizon 2020 research and innovation programme under grant agreement No 634453; project EUthyroid. The authors thank the EUthyroid project leader Henry Völzke and the work package leader Betina H. Thuesen for designing, planning and managing the project and, in particular, morbidity data collection. Publisher Copyright: © 2019 Ieva Kalere et al., published by Sciendo 2019.The most common autoimmune disorders with clinically opposite manifestations are hypothyroidism in Hashimoto's thyroiditis and hyperthyroidism in Graves' disease. The healthcare burden of thyroid disease is substantial, resulting in substantial health care costs. The aim of the present analysis is to assess the use of thyroid medications in Latvia from 2011 to 2014 by age and gender. Our study used reimbursed medication prescriptions data, collected by the National Health Service of Latvia. The main indicator was the number of prevalent users of thyroid medications each year from 2011 to 2014, stratified by age and gender. From 2011 to 2014, the number of thyroxine users per 100 000 revealed a statistically significant increase in all age and gender groups, except in 0- to 9-year-old girls. The number of Thiamazole users among men increased in the age group from 40 to 89 years and in women age groups above 49 years. Increasing sales of both thyroid hormones and antithyroid medications are also observed in Estonia and Lithuania, indicating that growing thyroid morbidity is an issue in the whole region. The substantial increase in number of patients highlights the necessity for national guidelines on the use of thyroid function tests and standards of medical care.publishersversionPeer reviewe

Intervences plānošana dzīvesveida maiņai: Rokasgrāmata sabiedrības veselības veicināšanā iesaistītajiem speciālistiem

Projektā piedalījās: • Flensburgas Lietišķo zinātņu akadēmija (Vācija) – vadošais partneris; • Flensburgas pilsētas pašvaldība (Vācija); • Igaunijas Ģimenes ārstu biedrība (Igaunija); • Tallinas Tehnoloģiju universitāte (Igaunija); • SIA “ScanBalt” (Igaunija); • Turku pilsētas pašvaldība (Somija); • Seinajoki Lietišķo zinātņu universitāte (Somija); • Seinajoki Sociālās un primārās veselības aprūpes centrs (Somija); • Rīgas Stradiņa universitāte (Latvija); • Liepājas pilsētas pašvaldība (Latvija); • SIA “Telemedica” (Latvija); • Lietuvas Sociālo zinātņu universitāte (Lietuva); • Veselības izglītības un slimību profilakses centrs (Lietuva); • Poznaņas pilsētas pašvaldība (Polija). No Latvijas BaltCityPrevention projektā strādāja: • Rīgas Stradiņa universitātes Sabiedrības veselības institūta pārstāvji: projekta zinātniskā vadītāja asoc. prof., Dr. med. Inese Gobiņa, pētnieces: Santa Pildava, Dita Heiberga un Elīna Millere, projekta vadītājs Aigars Miezītis, projekta vadītāja asistente Margarita Apine; • Liepājas pilsētas pašvaldības administrācijas Vides, veselības un sabiedrības līdzdalības daļas vadītāja Elīna Tolmačova un veselības veicināšanas koordinētāja Anete Kopštāla; • SIA “Telemedica” projektu vadītāja Ance Balode. Plašāka informācija par projektu: www.baltcityprevention.eu. Šī publikācija un tiešsaistes kurss par intervences modeļa lietošanu ir atrodami projekta platformā: www.betterprevention.eu.Izdevumā “Intervences plānošana dzīvesveida maiņai” ir apvienoti Interreg Baltijas jūras reģiona programmas projektā BaltCityPrevention izstrādātie materiāli un to praktiskā izmantošanā gūtā pieredze. Projektā kopīgi strādāja 14 partnerorganizācijas no sešām valstīm, lai laika posmā no 2017. gada nogales līdz 2020. gada septembrim, sadarbojoties ar maziem un vidējiem uzņēmumiem un pielietojot vai izstrādājot e-rīkus, rastu intervences mērķgrupas līdzdalībā balstītu pieeju dzīvesveida radītu slimību profilaksei. Izdevumā aprakstītas projektā izstrādātā intervences modeļa lietošanas vadlīnijas un dzīvesveida maiņai individuālā vai grupu līmenī pielietojamie e-rīki.Finansētājs - INTERREG Baltijas jūras reģiona programma, kuru finansē Eiropas Savienības Reģionālās attīstības fonds

Mortality trends in type 1 diabetes:a multicountry analysis of six population-based cohorts

AIMS/HYPOTHESIS: Mortality has declined in people with type 1 diabetes in recent decades. We examined how the pattern of decline differs by country, age and sex, and how mortality trends in type 1 diabetes relate to trends in general population mortality. METHODS: We assembled aggregate data on all-cause mortality during the period 2000–2016 in people with type 1 diabetes aged 0–79 years from Australia, Denmark, Latvia, Scotland, Spain (Catalonia) and the USA (Kaiser Permanente Northwest). Data were obtained from administrative sources, health insurance records and registries. All-cause mortality rates in people with type 1 diabetes, and standardised mortality ratios (SMRs) comparing type 1 diabetes with the non-diabetic population, were modelled using Poisson regression, with age and calendar time as quantitative variables, describing the effects using restricted cubic splines with six knots for age and calendar time. Mortality rates were standardised to the age distribution of the aggregate population with type 1 diabetes. RESULTS: All six data sources showed a decline in age- and sex-standardised all-cause mortality rates in people with type 1 diabetes from 2000 to 2016 (or a subset thereof), with annual changes in mortality rates ranging from −2.1% (95% CI −2.8%, −1.3%) to −5.8% (95% CI −6.5%, −5.1%). All-cause mortality was higher for male individuals and for older individuals, but the rate of decline in mortality was generally unaffected by sex or age. SMR was higher in female individuals than male individuals, and appeared to peak at ages 40–70 years. SMR declined over time in Denmark, Scotland and Spain, while remaining stable in the other three data sources. CONCLUSIONS/INTERPRETATION: All-cause mortality in people with type 1 diabetes has declined in recent years in most included populations, but improvements in mortality relative to the non-diabetic population are less consistent. GRAPHICAL ABSTRACT: [Image: see text] ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00125-022-05659-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users

Tips for calculating and displaying risk-standardized hospital outcomes in Stata

A major challenge of outcomes research is measuring hospital perfor- mance using readily available administrative data. When the outcome measure is mortality or morbidity, rates are adjusted to account for preexisting conditions that may confound their assessment. However, the concept of “risk-adjusted” out- comes is frequently misunderstood. In this article, we try to clarify things, and we describe Stata tools for appropriately calculating and displaying risk-standardized outcome measures. We offer practical guidance and illustrate the application of these tools to an example based on real data (30-day mortality following acute myocardial infarction in Latvia)

Tips for calculating and displaying risk-standardized hospital outcomes in Stata

A major challenge of outcomes research is measuring hospital performance using readily available administrative data. When the outcome measure is mortality or morbidity, rates are adjusted to account for preexisting conditions that may confound their assessment. However, the concept of risk-adjusted outcomes is frequently misunderstood. In this article, we try to clarify things, and we describe Stata tools for appropriately calculating and displaying risk-standardized outcome measures. We offer practical guidance and illustrate the application of these tools to an example based on real data (30-day mortality following acute myocardial infarction in Latvia)

Implementation of health promoting policies through tailored interventions at health promoting schools and municipalities in Latvia

Schools and municipalities play an important role in local health promotion. The Institute of Public Health at Rıga Stradiņš University in collaboration with the National Centre of Disease Prevention and Control carried out an online survey for studying the experiences and needs of health-promoting schools and municipalities in Latvia in implementing health promotion interventions. The aim of this study was to explore the context for developing new intervention model for a health behaviour change model within the Interreg BaltCityPrevention project “Innovative Lifestyle-Related Disease Prevention Model in the Baltic Sea Region.” Totally 112 municipalities and 100 schools within the National Health Promoting Networks were targeted. Only schools and municipalities that had previous experiences in health promotion intervention development were included in the analysis. This study showed that school-aged children were the most prevalent target group for the both schools and municipality interventions. The interventions in physical activity and nutrition used to be the most common areas for health behaviour changes. Health promotion schools and municipalities reported several significant differences in experienced difficulties and expected future needs in implementing health promotion interventions, which should be considered for increasing the capacity for better health promotion for both schools and municipalities in Latvia

Pre-existing diabetes mellitus and all-cause mortality in cancer patients: a register-based study in Latvia

<p><b>Background:</b> Most studies from high income countries consistently report that preexisting diabetes reduces overall survival of cancer patients. We examined this association in a retrospective cohort study using two nation-wide population-based data sets in Latvia.</p> <p><b>Material and methods:</b> The Cancer Register, linked with the Diabetes Register and Causes of Death Database, was the first data source used to select 22,936 men and 25,338 women with cancer diagnosed from 2009 to 2013. The follow-up period ended on 28 February 2015. The National Health Service data served as a second data source, which was used to select 10,130 men and 13,236 women with cancer as the main diagnosis, who were discharged from oncology hospitals from 2009 to 2012. Prescriptions of reimbursed antidiabetic medications indicated prior diabetes status. The follow-up period started at the date of discharge and ended on 31 December 2013. A Cox proportional hazards model was used to assess association between preexisting diabetes and all-cause mortality, adjusted for age.</p> <p><b>Results:</b> Men with preexisting diabetes had better overall short-term survival: the age-adjusted hazard ratios (95% CI) were 0.86 (0.79–0.93) for the first year and 0.89 (0.80–0.98) for the first two years after cancer diagnosis according to the disease register and health service data, respectively. After three full follow-up years, their relative mortality increased, with an age-adjusted hazard ratio of 1.60 (1.28–1.99). Among women, preexisting diabetes was associated with slightly higher all-cause mortality during the entire follow-up period, with age-adjusted hazard ratios of 1.17 (1.10–1.24) for the disease register data and 1.11 (1.02–1.21) for the health service data.</p> <p><b>Conclusion:</b> Interestingly, we found better overall survival of diabetic men during the first years after cancer diagnosis. We hypothesize that access to health services may be advantageous to diabetic patients who are in close contact with the healthcare system.</p

Burden and centralised treatment in Europe of rare tumours: results of RARECAREnet - a population-based study

Background Rare cancers pose challenges for diagnosis, treatments, and clinical decision making. Information about rare cancers is scant. The RARECARE project defined rare cancers as those with an annual incidence of less than six per 100 000 people in European Union (EU). We updated the estimates of the burden of rare cancers in Europe, their time trends in incidence and survival, and provide information about centralisation of treatments in seven European countries. Methods We analysed data from 94 cancer registries for more than 2 million rare cancer diagnoses, to estimate European incidence and survival in 2000–07 and the corresponding time trends during 1995–2007. Incidence was calculated as the number of new cases divided by the corresponding total person-years in the population. 5-year relative survival was calculated by the Ederer-2 method. Seven registries (Belgium, Bulgaria, Finland, Ireland, the Netherlands, Slovenia, and the Navarra region in Spain) provided additional data for hospitals treating about 220 000 cases diagnosed in 2000–07. We also calculated hospital volume admission as the number of treatments provided by each hospital rare cancer group sharing the same referral pattern. Findings Rare cancers accounted for 24% of all cancers diagnosed in the EU during 2000–07. The overall incidence rose annually by 0.5% (99·8% CI 0·3–0·8). 5-year relative survival for all rare cancers was 48·5% (95% CI 48·4 to 48·6), compared with 63·4% (95% CI 63·3 to 63·4) for all common cancers. 5-year relative survival increased (overall 2·9%, 95% CI 2·7 to 3·2), from 1999–2001 to 2007–09, and for most rare cancers, with the largest increases for haematological tumours and sarcomas. The amount of centralisation of rare cancer treatment varied widely between cancers and between countries. The Netherlands and Slovenia had the highest treatment volumes. Interpretation Our study benefits from the largest pool of population-based registries to estimate incidence and survival of about 200 rare cancers. Incidence trends can be explained by changes in known risk factors, improved diagnosis, and registration problems. Survival could be improved by early diagnosis, new treatments, and improved case management. The centralisation of treatment could be improved in the seven European countries we studied. Funding The European Commission (Chafea)