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BMJ: The curious case of 600 extra deaths a week

tetano

tetano

Editor, Senior Moderator
Observations
Body Politic
The curious case of 600 extra deaths a week
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5014 (Published 9 August 2013)
Cite this as: BMJ 2013;347:f5014



Nigel Hawkes, freelance journalist, London

nigel.hawkes1@btinternet.com

Nobody knows why mortality has risen so sharply, but the NHS reforms cannot be to blame

Here?s a headline I?m astonished I haven?t already read: ?NHS reforms blamed for 600 extra deaths a week.? That?s the number of additional deaths in England and Wales that occurred in the first half of 2013 when compared with the years immediately preceding the Health and Social Care Act. Nobody knows why deaths have risen so sharply, but imperfect knowledge has seldom stood in the way of the critics of that piece of legislation.

The figures are fairly sensational, given the long experience of steadily falling mortality and rising life expectancy. Starting in 2012 and persisting into the middle of this year, deaths have been consistently higher, and by strikingly big margins, than they were in the years 2008 to 2011. Up to 65 years of age there are no changes, but in older age groups there are sharp increases, especially marked in those aged over 85. A summary of the data by Tom Hennell of the Office for National Statistics shows that mortality of women aged over 85 rose by 5% in 2012, and male mortality in the same age group rose by 3%. ?


http://www.bmj.com/content/347/bmj.f5014
 
The curious case of 600 extra deaths a week

The curious case of 600 extra deaths a week

The curious case of 600 extra deaths a week


Micha?l R Laurent, Geriatrics Registrar

University Hospitals Leuven, Belgium, Herestraat 49, 3000 Leuven


Monitoring excess mortality in Europe
12 August 2013

The Belgian Scientific Institute for Public Health reported 10% excess mortality in June 2013 (corresponding to 700 additional deaths a month) in those aged 65 and older [1]. No likely cause was identified since climatological circumstances, air pollution levels and physician visits were influenza-like illnesses were unremarkable. However, it was expected that the heat wave of July would further contribute to excess mortality.

Belgium is one of the 18 European countries which monitors excess mortality for public health action in the so-called Euro-MOMO project [2]. Excess mortality has been noted in this surveillance system from the last weeks of 2012 all through the first 4 months of 2013, but has returned to normal since week 17.

Inspection of results graphs clearly demonstrates that overall mortality is dominated by people aged 65 and older. The finding reported by Nigel Hawkes that "Up to 65 years of age there are no changes [in mortality], but in older age groups there are sharp increases, especially marked in those aged over 85" is entirely non-specific and consistent with the higher mortality risk with age.

A Danish analysis showed that the influenza activity was remarkably prolonged this winter and associated with higher mortality than in the past 3 seasons, possibly because it was one of the few countries in which H3N2 and influenza B were the main circulating strains, whereas elderly may exhibit some immunity against H1N1 influenza which have been dominant in Denmark since 2009 [3].

Further analyses at the European level is required to investigate recent excess mortality trends. A combination of infectious diseases and climate influences seem a plausible candidate explanation as in previous investigations [4].

References

https://www.wiv-isp.be/news/Pages/NL_SterftecijfersinBelgi?july2013.aspx
http://www.euromomo.eu/index.html
http://www.ssi.dk/English/News/EPI-NEWS/2013/No 23 - 2013.aspx
Mazick A, Gergonne B, Nielsen J et al. Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveill. 2012 Apr 5;17(14). pii: 20138.

Competing interests: None declared

http://www.bmj.com/content/347/bmj.f5014/rr/657411
 
Re: The curious case of 600 extra deaths a week

Re: The curious case of 600 extra deaths a week

tetano said:
The curious case of 600 extra deaths a week


Micha?l R Laurent, Geriatrics Registrar

University Hospitals Leuven, Belgium, Herestraat 49, 3000 Leuven


Monitoring excess mortality in Europe
12 August 2013

The Belgian Scientific Institute for Public Health reported 10% excess mortality in June 2013 (corresponding to 700 additional deaths a month) in those aged 65 and older [1]. No likely cause was identified since climatological circumstances, air pollution levels and physician visits were influenza-like illnesses were unremarkable. However, it was expected that the heat wave of July would further contribute to excess mortality.

...

http://www.bmj.com/content/347/bmj.f5014/rr/657411
Click to expand...


Translation Google

700 deaths due to the heat in June

Le Vif

Source: Belga
Wednesday, August 7, 2013 at 10:54

Mid-June, it was unseasonably warm on MRI. This heat wave caused the death of 700 elderly in Belgium. This is 10% more than expected according to the statistics.

? Belga

The intense heat made it's strong appearance earlier this year. During two days of June, the ozone peak was above 120 micrograms per cubic meter. People who have heart or respiratory problems are particularly affected since the beginning of this summer. The figures from July, a month that has seen a spike in ozone particularly alarming, have not yet been analyzed. It is likely that the mortality of the summer will be higher than last year. In 2012, between early June and late September, there were "only" 985 people died because of the heat.

http://www.levif.be/info/actualite/...-la-chaleur-en-juin/article-4000368268840.htm
 
Re: BMJ: The curious case of 600 extra deaths a week

hmm, I stopped updating UK-deaths in week 7 ... I should do it now

and the Belgian weather ...
---- Belgian temperature doesn't look unusual to me
 
Re: BMJ: The curious case of 600 extra deaths a week

It may be well true that some EU countries reported an H3N2 dominant influenza virus strain during the prolonger 2012-13 winter season, but overall, EU saw H1pdm09 predominance.

It is also true that people over 65 of age are less prone to get infected with this strain but - when infected - they have usually a worst outcome than patients in other classes of age.

Southern European countries also were caught in a perfect storm of bad weather and a nearly collapse of public health care infrastructure, due to the austerity policies applied by respective governments.

In Italy, for example, Emergency departments saw patients on makeshift beds on the deck because no general wards' beds were available: this year there was a huge cut in the inpatients beds.

The universal access to care was also impaired by increasing costs for diagnostics and specialty care, and this is also true for paediatric patients.

Elderly people were caught by a decreased spending capacity, restricted access to care and inclement weather, as well as environmental air pollution at toxic level for most of the winter season.

If you have seen old people wandering around garbage bins in search for vegetable thrown away for markets, then the excess mortality may be viewed in another perspective. GM
 
Re: BMJ: The curious case of 600 extra deaths a week

The data from the Office for National Statistics show that the mortality has increased by 5 per cent in 2012 for men and women over 85 years, while in the first 27 weeks of the 2013 there has been an overall increase of 5.6 per cent. "It's a huge - writes the author of the article -. If it had happened during a flu epidemic, these tens of thousands of deaths would have been attributed to influenza and the controversy would raise. But there is no epidemic, no obvious cause, and even public complaints. IT IS all very strange". Of course a first thoughts turn to the effect of the Health and Social care Act, which has significantly amended the operation of the national health system english, reducing its probably the effectiveness of the services. And more generally, the thought goes to budget cuts and reductions of health staff, that with the crisis are disseminated throughout Europe. But the increase in deaths is also present in Scotland, where the Health and Social care Act is not active.

TWO HYPOTHESES - a survey of the Office for National Statistics has found that the Commission has not received a mortality even more in those areas of the country where health care was already in suffering, as there would have been due to wait whether the increase in deaths was the result of a worsening in health care. Have been advanced so far two hypotheses. One concerns the possible collapse of the 'bonus' that the current olds would have had by being the first generation that has benefited from better conditions of child life (that should explain the steady increase in the average life manifested in all these years). But it is not clear why they should result in a increase of mortality, and not only a stop of the increase in longevity.

The other hypothesis is that it in some infectious disease not yet unveiled. But the statistics carried out by Scottish indicate that the causes of deaths in excess are consequences of cancer, mental disorders and behavioral, diseases of the nervous system and of the sense organs, in addition to respiratory diseases. Which infectious disease could strike simultaneously all of these different components and equipment?

http://www.corriere.it/salute/13_ag...pa_3a9ff966-03f1-11e3-b7de-a2b03b792de4.shtml
 
Re: BMJ: The curious case of 600 extra deaths a week

It is worth remembering that these temperatures are those measured 'in the shade' and that for countries unused to high temperatures, they can have marked effects on the elderly and especially those with pre-existing disease.

I suspect that many of these causes of death could be linked back to flu had a recent flu infection been looked for e.g. people with CV problems are known to have increased risk of death (seen in many clincial studies) when suffering from flu i.e flu often precipitates a crisis in people with pre-existing disease. When someone has a known health problem, especially amongst the elderly, it is rare that authorities look further than the immediately obvious i.e. they would not look for flu as a primary or precipitating cause of death, except when in a heightened alert as in the 2009 pH1N1 pandemic.
 
Re: BMJ: The curious case of 600 extra deaths a week

As for Italy, and only for the summer weeks, we experienced two big heat waves, with widespread rise in temperatures from North to South, even though the worst conditions were surely in the plain areas of North Paeninsula and in the Centre. In these areas, temperatures rose to 100?F during day, with perceived temps above 105?F. Night temps were also higher than average. Economic situation further deteriorated in the second half of '13 (despite pity assurances from Govt), with many more elderly slipped into full poverty and middle age people unemployed and without any kind of welfare support.

Unsanitary living conditions, mental disturbances (due to the loss of job, societal exclusion, despair), increasing in violence and Attacks, is making the picture really grim.

One has to realize the true impact of economic depression in Southern Europe - and in some peripheal Northern countries like Ireland - is not limited to the negative forecasts from Rating Agencies - but there is a very individual and collective impact on livelihood of millions of people.

I understand that - from a scientific journal perspective - these things need an in-depht statistical investigation - but people have to open their eyes or Windows and see the reality of the facts as they are evolving.

The actual situation is mimicking well that we have seen during post '91 collapse of Soviet system, when the entire industrial and production stock was depleted under the strict rules imposed by international financial agencies in order to have granted access to long-term bail-out programs.

GM
 
Re: BMJ: The curious case of 600 extra deaths a week

at the upper end of the 10-year average but lower than the
last severe heatwave in 2003
 

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Re: BMJ: The curious case of 600 extra deaths a week

Translation Google

Updated: Monday, August 19, 2013 8:35 p.m.

Belgium -

Heat: "600 additional deaths in July"

Belga / AFP

High temperatures in July have had an impact on the number of deaths registered during the period.

Thus, according to initial assessments of the Scientific Institute of Public Health, the number of deaths would be higher by 8.5 pc than a "normal" July month , reports the Artsenkrant website. "In absolute terms, we get 600 additional deaths between July 6 and August 4," highlights the Public Health Institute.

This excess mortality is not a surprise, due to the heat wave that hit Europe and the thresholds exceeded ozone concentration. "Based on these data, it was originally thought to be confronted with a mortality of up to 10 per cent, a figure now reduced to 8.5 pc," says the scientific institute that does not yet have final figures.

During a July "normal" - obtained by calculating the average number of deaths during the same month in the last five years - 7,744 deaths are registered in Belgium. However, to date, the counter of the institute is already at 7931 deaths, a figure that could eventually rise to 8,344 deaths.


http://www.lavenir.net/article/detail.aspx?articleid=DMF20130819_00348569
 
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