Frank Sorvillo

Changing trends in hepatitis C–related mortality in the United States, 1995‐2004

The disease burden and mortality from hepatitis C are predicted to increase in the United States as the number of persons with long‐standing chronic infection grows. We analyzed hepatitis C mortality rates derived from US Census and multiple‐cause‐of‐death data for 1995‐2004. Deaths were considered hepatitis C–related if: (1) hepatitis C was the underlying cause of death, (2) chronic liver disease was the underlying cause and hepatitis C was a contributing cause, or (3) human immunodeficiency virus was the underlying cause and chronic liver disease and hepatitis C were contributing causes. A total of 56,409 hepatitis C–related deaths were identified. Mortality rates increased 123% during the study period (1.09 per 100,000 persons to 2.44 per 100,000), but average annual increases were smaller during 2000‐2004 than 1995‐1999. After peaking in 2002 (2.57 per 100,000), overall rates declined slightly, but continued to increase among persons aged 55‐64 years. Overall increases were greater among males (144%) than females (81%) and among non‐Hispanic blacks (170%) and Native Americans (241%) compared to non‐Hispanic whites (124%) and Hispanics (84%). The 7,427 hepatitis C deaths in 2004 (mean age: 55 years), corresponded to 148,611 years of potential life lost. The highest mortality rates in 2004 were observed among males, persons aged 45‐54 and 55‐64 years, Hispanics, non‐Hispanic blacks, and non‐Hispanic Native American/Alaska Natives. Conclusion: Overall, hepatitis C mortality has increased substantially since 1995. Despite small declines in recent years, rates have continued to increase among persons aged 55‐64 years. Hepatitis C is an important cause of premature mortality. (HEPATOLOGY 2008.)

The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data.

IntroductionSepsis is the 10th leading cause of death in the United States. The National Center for Health Statistics multiple-cause-of-death (MCOD) dataset is a large, publicly available, population-based source of information on disease burden in the United States. We have analysed MCOD data from 1999 to 2005 to investigate trends, assess disparities and provide population-based estimates of sepsis-associated mortality during this period.MethodsSepsis-associated deaths occurring in the United States from 1999 to 2005 were identified in MCOD data using International Classification of Disease, 10th Revision (ICD-10) codes. Population-based mortality rates were calculated using bridged-race population estimates from the National Center for Health Statistics. Comparisons across age, sex and racial/ethnic groups were achieved by calculating mortality rate ratios.ResultsFrom 1999 to 2005 there were 16,948,482 deaths in the United States. Of these, 1,017,616 were associated with sepsis (6.0% of all deaths). The age-adjusted rate of sepsis-associated mortality was 50.37 deaths per 100,000 (95% confidence interval (CI) = 50.28 to 50.47). There were significant disparities in sepsis-associated mortality in race/ethnicity and sex groups (P < 0.0001). After controlling for age, Asians were less likely than whites to experience sepsis-related death (rate ratio (RR) = 0.78, 95% CI = 0.77 to 0.78), while Blacks (RR = 2.24, 95% CI = 2.23 to 2.24), American Indians/Alaska Natives (RR = 1.24, 95% CI = 1.24 to 1.25) and Hispanics (RR = 1.14, 95% CI = 1.13 to 1.14) were more likely than whites to experience sepsis-related death. Men were at increased risk for sepsis-associated death in all race/ethnicity categories (RR = 1.27, 95% CI = 1.27 to 1.28), but the degree of increased susceptibility associated with being male differed among racial/ethnic groups (P < 0.0001). Although crude sepsis-associated mortality increased by 0.67% per year during the study period (P < 0.0001), the age-adjusted mortality rate decreased by 0.18% per year (P < 0.01).ConclusionsThe rapid rise in sepsis mortality seen in previous decades has slowed, but population ageing continues to drive the growth of sepsis-associated mortality in the United States. Disparities in sepsis-associated mortality mirror those previously reported for sepsis incidence. Sepsis in Asians, Hispanics and American Indian/Alaska Natives should be studied separately because aggregate measures may obscure important differences among these groups.

Current Issues and Considerations Regarding Trichomoniasis and Human Immunodeficiency Virus in African-Americans

SUMMARY Trichomonas vaginalis has long been recognized as one of the most prevalent sexually transmitted infections. However, it is only in recent years that it has been appreciated that Trichomonas may play a critical role in amplifying human immunodeficiency virus (HIV) transmission. Given the evidence that T. vaginalis likely promotes HIV infection, the apparent high level of Trichomonas infection in the African-American community is cause for concern. Even if T. vaginalis increases the risk of HIV transmission by a small or modest amount, it translates into a sizable population effect since Trichomonas is so common in this community. Therefore, control of trichomoniasis may represent an important avenue of control for the prevention of HIV transmission, particularly among African-Americans.

Decreasing Listeriosis Mortality in the United States, 1990–2005

BACKGROUNDnListeria monocytogenes is among the most virulent foodborne pathogens, with 20% of clinical infections resulting in death. To explore listeriosis-associated mortality in the United States and to evaluate prevention efforts, we reviewed vital records over a 16-year period to assess demographic, temporal, and seasonal trends.nnnMETHODSnNonperinatal listeriosis-associated deaths from 1990 through 2005 were identified from multiple-cause-coded death records and were combined with US census data to calculate mortality rates. Poisson regression was used to model time trends, and logistic regression was used to identify comorbid conditions associated with listeriosis on the death record.nnnRESULTSnOf the 37,267,946 deaths occurring in the United States during the 16-year study period, 1178 included listeriosis on the death record. Listeriosis-related mortality rates decreased annually by 10.74% from 1990 through 1996 and by 4.26% from 1996 through 2005. Seasonal trends show a distinct peak in mortality from July through October. After adjustment for age, sex, and race/ethnicity, listeriosis was positively associated with human immunodeficiency virus (HIV) infection (odds ratio, 4.19; 95% confidence interval, 3.06-5.73), lymphoid and hematopoietic cancers (odds ratio, 5.27; 95% confidence interval, 4.47-6.22), and liver disease (odds ratio, 2.05; 95% confidence interval, 1.54-2.73) on the death record.nnnCONCLUSIONSnNonperinatal listeriosis-associated deaths in the United States have decreased, paralleling a decreasing trend in incidence. Strict monitoring of food manufacturing processes, as well as improved treatment for HIV infection, may have played influential roles in preventing human infections. Health care providers should be aware of seasonal listeriosis patterns, as well as conditions predisposing individuals to severe infection and death due to L. monocytogenes infection, to guide strategies for disease management and prevention.

Congenital Cytomegalovirus Mortality in the United States, 1990–2006

Background Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection in the United States disproportionately affecting minority races and those of lower socio-economic class. Despite its importance there is little information on the burden of congenital CMV-related mortality in the US. To measure congenital CMV-associated mortality in the US and assess possible racial/ethnic disparities, we reviewed national death certificate data for a 17-year period. Methods Congenital CMV-associated deaths from 1990 through 2006 were identified from multiple-cause-coded death records and were combined with US census data to calculate mortality rates. Results A total of 777 congenital CMV-associated deaths occurred over the 17-year study period resulting in 56,355 years of age-adjusted years of potential life lost. 71.7% (557) of congenital CMV-associated deaths occurred in infants (age less than 1 year). Age-adjusted mortality rates stratified by race/ethnicity revealed mortality disparities. Age-adjusted rate ratios were calculated for each racial/ethnic group using whites as the reference. Native Americans and African Americans were 2.34 (95% CI, 2.11–2.59) and 1.89 (95% CI, 1.70–2.11) times respectively, more likely to die from congenital CMV than whites. Asians and Hispanics were 0.54 (95% CI, 0.44–0.66) and 0.96 (95% CI, 0.83–1.10) times respectively, less likely to die from congenital CMV than whites. Conclusions/Significance Congenital CMV infection causes appreciable mortality in the US exacting a particular burden among African Americans and Native Americans. Enhanced surveillance and increased screening are necessary to better understand the epidemiology of congenital CMV infection in addition to acceleration of vaccine development efforts.

Declining invasive pneumococcal disease mortality in the United States, 1990-2005.

PCV7 use in the U.S. has led to notable decreases in invasive pneumococcal disease (IPD). We examined PCV7 influence on IPD mortality for all age groups using National Multiple-Cause-of-Death data (1990-2005). Age-specific mortality rates were compared before and after PCV7 use. Average decreases in age-adjusted mortality rates for meningitis and septicemia accelerated post-PCV7, the greatest decline observed in septicemia-related deaths. The youngest and oldest age groups experienced large decreases in age-specific mortality rates after the introduction of PCV7. Mortality rate decline across all age groups strengthens evidence of vaccine-induced herd immunity and provides additional information for cost-benefit analyses of PCV7.

Burden of Alzheimer's Disease–Related Mortality in the United States, 1999–2008

To update and examine Alzheimers disease–related mortality trends according to age, sex, race and ethnicity, geography, and other case characteristics for a 10‐year period.

Neglected Parasitic Infections in the United States: Cysticercosis

Cysticercosis is a potentially fatal and preventable neglected parasitic infection caused by the larval form of Taenia solium. Patients with symptomatic disease usually have signs and symptoms of neurocysticercosis, which commonly manifest as seizures or increased intracranial pressure. Although there are many persons living in the United States who emigrated from highly disease-endemic countries and there are foci of autochthonous transmission of the parasite in the United States, little is known about burden and epidemiology of the disease in this country. In addition, despite advances in the diagnosis and management of neurocysticercosis, there remain many unanswered questions. Improving our understanding and management of neurocysticercosis in the United States will require improved surveillance or focused prospective studies in appropriate areas and allocation of resources towards answering some of the key questions discussed in this report.

Risk Factors for Mortality among Patients with Nonperinatal Listeriosis in Los Angeles County, 1992–2004

BACKGROUNDnListeriosis is a relatively rare foodborne disease with significant public health implications. The causative pathogen, Listeria monocytogenes, grows well in refrigeration, is associated with a case-fatality rate of 20%, and causes an estimated 28% of all foodborne disease-related deaths. Nevertheless, data on the risk factors for listeriosis mortality are limited.nnnMETHODSnUsing the passive surveillance listeriosis database of the County of Los Angeles Department of Public Health, we conducted a 13-year retrospective cohort study to describe nonperinatal listeriosis mortality in Los Angeles County during the period 1992-2004. A nonperinatal listeriosis case was defined as one occurring in a nonpregnant person >42 days of age who resided in Los Angeles County and had a culture positive for L. monocytogenes.nnnRESULTSnUnconditional multivariable logistic regression analysis of 281 nonperinatal listeriosis cases with 29 main effects variables resulted in finding nonhematological malignancy (odds ratio [OR], 5.92; 95% confidence interval [CI], 1.85-18.9), alcoholism (OR, 4.63; 95% CI, 1.36-15.8), age 70 years (OR, 3.44; 95% CI, 1.50-7.87), steroid medication (OR, 3.34; 95% CI, 1.38-8.08), and kidney disease (OR, 2.94; 95% CI, 1.18-7.31) to be statistically significant risk factors for mortality. Other listeriosis mortality risk factors with adjusted odds ratios >1.5 included blood transfusion, asthma, black race, Asian race, use of antibiotics, hypertension, receipt of chemotherapy, and Hispanic race. Patients admitted to the hospital with a diagnosis of sepsis alone had the highest mortality (23.7%), whereas patients with cases of meningitis alone had the lowest mortality (3.13%).nnnCONCLUSIONSnThe findings of this study should be used to help researchers and clinicians focus on specific risk factors to prevent nonperinatal listeriosis-related deaths.

Human echinococcosis mortality in the United States, 1990-2007.

Background Despite the endemic nature of Echinococcus granulosus and Echinococcus multilocularis infection in regions of the United States (US), there is a lack of data on echinococcosis-related mortality. To measure echinococcosis-associated mortality in the US and assess possible racial/ethnic disparities, we reviewed national-death certificate data for an 18-year period. Methodology/Principal Findings Echinococcosis-associated deaths from 1990 through 2007 were identified from multiple-cause-coded death records and were combined with US census data to calculate mortality rates. A total of 41 echinococcosis-associated deaths occurred over the 18-year study period. Mortality rates were highest in males, Native Americans, Asians/Pacific Islanders, Hispanics and persons 75 years of age and older. Almost a quarter of fatal echinococcosis-related cases occurred in residents of California. Foreign-born persons accounted for the majority of echinococcosis-related deaths; however, both of the fatalities in Native Americans and almost half of the deaths in whites were among US-born individuals. Conclusions/Significance Although uncommon, echinococcosis-related deaths occur in the US. Clinicians should be aware of the diagnosis, particularly in foreign-born patients from Echinococcus endemic areas, and should consider tropical infectious disease consultation early.