I'M A SONIC BOOMER

Tuesday, July 26, 2022

Leading causes of death during Covid

I read an interesting article about the leading Causes of Death in the US During the COVID-19 Pandemic, from March 2020 to October 2021. It was written by Meredith S. Shiels, PhD, MHS1; Anika T. Haque, MPH1; Amy Berrington de González, PhD1; et al Neal D. Freedman, PhD, MPH1 and published online by Jama Internal Medicine online July 5, 2022. Here are some excerpts from the article.

In 2020, heart disease and cancer were the leading causes of death in the US, accounting for 1.29 million deaths, followed by COVID-19, accounting for 350 000 deaths.1-3 The pandemic may also have indirectly led to increases in other causes of death, including heart disease, diabetes, Alzheimer disease, and unintentional injuries.2,4 We examined the leading causes of death in the US, overall and in various age groups, from March 2020 to October 2021.

Methods

We obtained final national death certificate data for 2020 and provisional data for 2021 from the Centers for Disease Control and Prevention (accessed May 5, 20225). We excluded data more recent than October 2021 because they were incomplete. We determined the 5 leading causes of death by year and age group, and compared the period March to December 2020 with the period January to October 2021. Because the data are publicly available, the study did not require institutional review board review.

Results

From March 2020 to October 2021, heart disease (20.1%), cancer (17.5%), COVID-19 (12.2%), accidents (6.2%), and stroke (4.7%) were the most common causes of death in the US. There were 2.875 million deaths in March to December 2020 and 2.855 million deaths in January to October 2021; the 5 leading causes of death were the same in each year. Among those older than 1 year, the number of deaths increased across age groups.

Deaths from cancer, heart disease, and COVID-19 accounted for the largest number of deaths in every group aged 55 years and older. The leading 3 causes of death in these age groups were the same in 2020 and 2021. Among people aged 85 years and older, COVID-19 was ranked as the second leading cause of death in 2020 (110 000 deaths, 12.8% of deaths), and third in 2021 (69 000, 8.9% of deaths). Among those aged 45 to 54 years, COVID-19 was the fourth leading cause of death in 2020 (17 000 deaths, 10.4% of deaths), following heart disease, cancer, and accidents; in 2021, however, it was the leading cause of death (30 000 deaths, 16.8% of deaths).

In both time periods, accidents accounted for the largest number of deaths in every age group 1 to 44 years. Compared with 2020, COVID-19 increased from the fifth (6100 deaths) to the second leading cause of death (13 000 deaths) among those aged 35 to 44 years in 2021, became the fourth leading cause of death in 2021 among those aged 25 to 34 years (5000 deaths), and those aged 15 to 24 years (1100 deaths).

Discussion

From March 2020 to October 2021, COVID-19 accounted for 1 in 8 deaths in the US and was a top 5 cause of death in every age group aged 15 years and older. Cancer and heart disease deaths exceeded COVID-19 deaths overall and in most age groups, whereas accidents were the leading cause of death among those aged 1 to 44 years. Compared with the 2020 time period, deaths from COVID-19 in the 2021 time period decreased in ranking among those aged 85 years or older but increased in ranking among those aged 15 to 54 years, and became the leading cause of death among those aged 45 to 54 years.

The pandemic also has had indirect effects on other causes of death in the US. From 2019 to 2020, death rates increased for heart disease, accidents, stroke, Alzheimer disease, and diabetes. Potential explanations are fear of accessing health care or misattribution of COVID-19 deaths to other causes. Accidental deaths (including drug overdoses and unintentional alcohol poisoning), assault, and suicide remain major causes of death in the US, particularly in younger age groups; the pandemic may have contributed to some of these deaths.

Monday, July 25, 2022

Is Travel worth it

I read a post over at Sightings Over Sixty that asked the question is Travel is it too much trouble. His answer was yes it is, and I tend to agree, but it is something that I have put behind me at this point. My wife cannot travel due to a number of underlying conditions. In fact, she has trouble leaving the house. So, travelling with my wife is not something that I will be doing soon, but I am hopeful that things will get better and we will again be able to travel.

Part of why travel for seniors is troubling is it is very expensive due to the cost of travel insurance, both medical and cancellation. My last trip was from Vancouver to Edmonton for a Celebration of life for three days. Most Canadians do not know this but the health insurance we have in our home province does not help you if you are hospitalized in another province. We know that if we are travelling to another country we need medical insurance, but many forget that we need it if we travel to another province. Because of COVID I also thought I should have cancellation or trip interruptions insurance. There are a lot of joys in getting older, but there are also drawbacks. One of these is that when you hit 75 the cost of both medical travel and trip cancellation insurance goes up. For my 3-day trip, the insurance cost almost half the cost of the ticket. I was not expecting to pay over $300 for insurance in addition to the ticket.

Travel is worth it but only if you travel with good medical travel insurance, which as I understand goes up as we age, so if my wife gets better and we can travel in a few years, we will have to plan for expensive travel insurance as well as the more expensive flight or other travel costs. Today I am happy not to travel as the pent-up demand, according to the news, is not being met by the industry. I read every day of people waiting for planes, or flights being cancelled. I am torn, I would love to travel now, but I am also happy that I cannot, so I dream and plan our next trip and I am putting money away for it now.

Sunday, July 24, 2022

Palliative care

A friend of mine has been fighting a number of issues for the past year and finally, his family decided to follow the doctor's advice and put him into palliative care. The decision was made after my friend had a bad fall, which aggravated his health. A few weeks after the fall, I was told that he had pneumonia and was rushed to the hospital. He is having trouble eating, drinking and swallowing. It is unlikely that he will get to go home. His wish was to have palliative care at home. Due to his current condition that is unlikely to happen.

My friend like most patients requiring palliative care support is known to have complex health services needs and to be a high health system user in the last months of life. Research has shown that referral to specialized palliative services, and the application of a palliative approach by primary care services even when still receiving curative treatments, can lead to a reduction in aggressive intervention at the end of life, reduced emergency room visits and hospitalizations, thereby increasing the quality of life.

Patients often express their wish to have end-of-life care at home. They want to die peacefully in their own home surrounded by their loved ones. However, if they experience acute symptoms such as shortness of breath, inability to eat or drink, or delirium, their caregivers may call 911. In my friend's situation, it led to patients being transferred to the emergency room. In some jurisdictions in Canada, paramedics and palliative care programs allow paramedics to treat those acute symptom needs, avoid transfer to the hospital and ensure continuity of care with the community team. This allows the patient to get the right care, in the right place at the right time. Ultimately, it honours the patient’s wishes for a peaceful death at home.

Palliative care for many is not understood and so people are reluctant to use this service. The earlier a person can take advantage of palliative care the better. The goals of palliative care are to provide comfort and symptom relief when faced with a life-threatening or life-limiting illness. Primary care clinicians are well placed to identify and work with those who may need palliative care, and many regions have palliative home care community programs to support palliative patients and their caregivers. However, both primary and palliative care community programs are often unable to provide urgent care 24/7 and do not have immediate access to resources such as medications. Expansion of the primary health care team to include service providers outside clinical settings and structured hours of care, with the goal of improving access to palliative care services, is needed.