Climate associations were regional and largely attenuated after multiplicity correction, supporting cautious, hypothesis-generating interpretation, and forecasts suggested a continued rise but showed limited long-horizon calibration.
Abstract
Parkinson disease (PD) is an increasing cause of mortality among older adults, but national studies have generally examined mortality trends, forecasts, spatial variation, or environmental associations separately. We integrated these components to characterize U.S. PD mortality and its regional climate correlates.
This ecological time-series study used CDC WONDER mortality data for U.S. adults aged 65 years or older from 1999 to 2024. Joinpoint regression, exponential smoothing state-space forecasting with rolling-origin validation, state-level Moran's I, lagged count models, nonlinear spline analyses, and principal component analysis of regional climate metrics were applied. Nominal and Benjamini-Hochberg-adjusted
P
values were reported.
From 1999 to 2024, PD deaths increased from 14,225 to 39,671, and the age-adjusted mortality rate increased from 41.42 to 71.58 per 100,000 population (average annual percent change, 1.99%; 95% confidence interval [CI], 1.54%-2.45%;
P
< 0.001). The conditional 2035 projection was 91.35 per 100,000 (95% prediction interval, 75.89–110.89). Across 7,502 rolling-origin predictions, mean absolute error was 9.24, root mean squared error was 12.12, mean bias was -6.48, and 95% interval coverage was 51.7%. State-level spatial autocorrelation was not evident in 2024 (Moran's I = 0.022; permutation
P
= 0.326). Primary lag 0–3 temperature estimates did not remain significant after multiplicity correction (adjusted
P
= 0.304), whereas Northeast lag 0–1 mean and apparent temperature estimates remained significant (rate ratios, 0.920 and 0.932 per 10 degrees F; both adjusted
P
= 0.010). No precipitation or sunlight estimate survived correction (minimum adjusted
P
= 0.142 and 0.308, respectively), and 2 of 72 PCA associations remained significant after correction (adjusted
P
= 0.027 and 0.035).
PD mortality increased markedly among older U.S. adults. Forecasts suggested a continued rise but showed limited long-horizon calibration. Climate associations were regional and largely attenuated after multiplicity correction, supporting cautious, hypothesis-generating interpretation.
Asthma in older adults (≥65 years) represents a growing yet understudied public health burden. Comprehensive spatiotemporal trends and future projections of asthma mortality in this population remain incompletely characterized. This study aimed to characterize the temporal, demographic, and geographic patterns of asthma mortality among U.S. adults aged ≥65 years, project future mortality trends through 2030, and evaluate state-level disparities relative to an empirical mortality frontier.
Using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause of Death data from 1999 to 2020, we examined asthma mortality (ICD-10 J45–J46) among U.S. adults aged ≥65 years. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression was used to characterize temporal changes and estimate annual percent changes (APCs). A non-seasonal ARIMA model was used to project mortality through 2030. State-level ecological associations with the Socio-demographic Index (SDI) and variation relative to an SDI-conditioned LOESS mortality frontier were evaluated.
Between 1999 and 2020, 38,101 asthma-related deaths occurred among adults aged ≥65 years, yielding an overall AAMR of 4.14 (95% CI, 4.09–4.18) per 100,000 population. Mortality declined by 54.5%, from 7.01 per 100,000 in 1999 to 3.19 per 100,000 in 2020. In the overall population, the decline slowed after 2010 (APC, −5.751% during 1999–2010 and −2.194% during 2010–2020). Sex-specific patterns differed: the female decline slowed after 2010, whereas the male decline slowed after 2008 and ceased after 2016. Women had a higher pooled AAMR than men (4.94 vs. 2.91 per 100,000), although the absolute difference between annual sex-specific rates decreased over time. Substantial geographic and racial/ethnic variation persisted. Overall AAMR point estimates were projected to range from 3.02 to 3.46 per 100,000 during 2021–2030. The LOESS-based frontier analysis showed considerable state-level variation in the distance between observed mortality and the empirical mortality benchmark.
Although asthma mortality among U.S. adults aged ≥65 years declined substantially between 1999 and 2020, the decline slowed after 2010, and marked demographic and geographic disparities persisted. These population-level patterns identify groups and regions that may benefit from enhanced surveillance and further investigation. Because the analyses were based on aggregated observational data, the reported associations should not be interpreted as evidence of individual-level or state-level causal relationships.
Tong Feng, Peng-Cheng Zheng, Yue Cao et al.· Frontiers in Medicine· 0 citations
Purpose Chronic kidney disease (CKD) is a major public health concern in the United States, with persistently rising incidence and mortality. This study aimed to quantify geographic and demographic disparities in CKD mortality across the United States and to examine the association between CKD mortality and ambient temperature variation. Patients and Methods CKD deaths and age-adjusted mortality rates (AAMRs) for 1999–2023 were obtained from CDC WONDER and stratified by census region, state, sex, race, age group, and urbanization level. Mortality trends were quantified using joinpoint regression. Primary temperature–mortality analyses used CDC WONDER-linked NLDAS temperature data for 1999–2011, while supplementary descriptive analyses used independently retrieved NLDAS temperature estimates for 2012–2023. Temperature–mortality associations were evaluated using Spearman rank correlations, quasi-Poisson regression models, and distributed lag nonlinear models (DLNMs). Results From 1999 to 2023, 628,937 CKD deaths occurred, with national AAMR increasing steadily. Mortality rates were consistently higher in men and nonmetropolitan areas. AAPC rose fastest in the West and Midwest, though recent AAMR declines were noted in the Northeast and South. Winter mortality exceeded summer across regions. In the primary DLNM analysis, cold exposure at the region-specific 5th percentile was associated with higher cumulative CKD mortality risk, with risk ration (RR) ranging from 1.065 in the Northeast to 1.505 in the Midwest; the association reached statistical significance only in the Midwest (RR 1.505, 95% CI: 1.091–2.075), while hot-exposure estimates at the 95th percentile were generally imprecise and not statistically significant. Conclusion CKD mortality in the United States increased from 1999 to 2023 with marked geographic and demographic disparities. Cold air temperature was associated with higher short-term mortality risk.
Heng Wang, Keyi Fan, Limin Cao et al.· International Journal of Nep...· 0 citations
Objective To characterize temporal trends and sex-specific differences in mortality attributed to thyroid disease as the underlying cause among U.S. adults aged ≥65 years from 1999 to 2023 and to project mortality trajectories through 2030. Methods We used the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database to identify deaths among adults aged ≥65 years in which thyroid disease (International Classification of Diseases, 10th Revision codes E00–E07) was recorded as the underlying cause. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Temporal trends from 1999 to 2023 were evaluated using Joinpoint regression and log-linear models to estimate annual and average annual percent changes (APC/AAPC) and the estimated annual percentage change (EAPC). Autoregressive integrated moving average (ARIMA) and generalized additive models (GAM) were fitted to AAMR data from 1999 to 2020 to generate exploratory projections for 2021–2030. Results A total of 41,660 thyroid disease–attributed deaths were identified. The overall AAMR decreased from 4.690 per 100,000 population in 1999 to 3.482 per 100,000 in 2023. The AAPC was −1.22%, and the EAPC was −1.43%, indicating a sustained decline over the study period. Women consistently had higher AAMRs than men, whereas men experienced a steeper decline in recent years. The ARIMA model projected a generally stable but gradually decreasing mortality trajectory through 2030. In contrast, the GAM captured nonlinear variation and suggested that the decline may attenuate or plateau during certain periods. Conclusion Mortality attributed to thyroid disease among older adults in the United States declined over the past 25 years, although a measurable burden and persistent sex differences remain. These findings support continued surveillance and targeted thyroid assessment and management among high-risk older adults. The forecasting results should be interpreted as exploratory, model-based scenarios that may help inform long-term public health planning rather than as precise predictions of future mortality.
Jiadi Li, Zide Chen· Frontiers in Public Health· 0 citations
OBJECTIVE
To analyse temporal trends in motor neuron disease (MND) mortality in Spain (2000-2024) and disentangle the independent contributions of age, period, and birth cohort effects.
METHODS
A population-based ecological time-series analysis was conducted using nationwide mortality data. Age-standardised mortality rates (ASMR) were analysed using joinpoint regression (ages 0-85+). To isolate underlying drivers and mitigate random variability, age-period-cohort (A-P-C) modelling was applied to a targeted adult cohort (ages 25-84).
RESULTS
A total of 23,663 MND deaths were recorded. Absolute annual deaths rose by 81.1% (682 in 2000 to 1235 in 2024). Men showed a steady upward ASMR trend (AAPC: 0.5%; 95% CI 0.3-0.7). Women showed an initial sharp increase (2000-2003; APC: 7.0%; 95% CI 0.7-19.1) followed by stabilisation (APC: 0.1%; 95% CI -1.3 to 0.5). The A-P-C model revealed strong cohort effects in both sexes, with an inverted U-shaped pattern peaking in the 1950-1955 cohorts, followed by marked declines. Period effects in men showed stability, whilst a moderate secular decline was observed in women. Local trends revealed declines in the younger cohorts and an increase in mortality risks limited to the older age groups (75-84 years).
CONCLUSIONS
The rising absolute MND mortality burden in Spain is primarily driven by population ageing rather than a generalised increase in lifetime risk. Long-term trends are heavily shaped by generational birth-cohort dynamics, showing a notable risk reduction in more recent generations.
L. Cayuela, E. Zapata-Arriaza, A. de Albóniga-Chindurza et al.· Medicina clínica (Ed. impres...· 0 citations
Background: Cardiovascular disease (CVD) remains the leading cause of mortality among older U.S. adults, yet the contribution of neighborhood-based structural racism remains inadequately quantified. This study quantifies the association between the Structural Racism Effect Index (SREI) and CVD mortality among adults aged {greater than or equal to}65 years, evaluating how this relationship varies across U.S. geographic regions to identify key areas for intervention. Methods: This ecological study applied a hierarchical Bayesian spatiotemporal framework to 2017-2020 Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) data to estimate the association between SREI and CVD mortality across 3,007 U.S. counties. SREI was modeled continuously and categorically, adjusting for sociodemographic covariates. Population attributable fractions (PAF) and attributable deaths (AD) quantified the potentially preventable burden and its spatial disparities. Results: From 2017 to 2020, approximately 2.79 million CVD deaths were observed, with significant spatial clustering (Moran's I = 0.35, p < 0.001). Each standard-deviation increase in SREI was associated with 13% higher CVD mortality (IRR: 1.13, 95% CrI: 1.12-1.15). A positive dose-response gradient was observed across SREI quartiles, with mortality 24% higher in the highest quartile than in the lowest (IRR: 1.24, 95% CrI: 1.20-1.28). The PAF was 6.94% (95% CrI: 6.13-7.73), corresponding to 193,472 potentially preventable deaths. High exceedance probabilities (>0.95) were concentrated in the Southeast, Appalachia, and the Midwest. Conclusions: Structural racism is a spatially patterned, dose-dependent predictor of older adult CVD mortality, underscoring the need for public health monitoring and neighborhood-based upstream interventions where disease burden is concentrated. Keywords: Structural Racism Effect Index; Neighborhood disadvantage; Cardiovascular Disease Mortality; Bayesian Spatiotemporal Analysis; Population Attributable Fraction; Health Disparities; Health Equity.
T. Begum, M. Shahjahan, H. Chakraborty· medRxiv· 0 citations
Cardiovascular disease (CVD) is a major public health concern, and its burden and trends require further clarification. This study aimed to compare the CVD burden between China and the global population and provide projections.
Data on CVD metrics from the Global Burden of Disease (GBD) 2021. The Joinpoint regression model was applied to analyze long-term trends in age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and age-standardized disability-adjusted life year (ASDR) rates. Decomposition analysis quantified drivers of change, and autoregressive integrated moving average models projected future trends.
From 1990 to 2021, ASMR and ASDR showed significant downward trends in China and globally. However, the ASIR for CVD in China increased from 783.897 to 811.813 per 100,000, while globally it declined from 878.787 to 787.04 per 100,000, with average annual percent change of 0.105% (95% CI: 0.067%, 0.144%) and –0.353% (95% CI: –0.404%, –0.301%), respectively. The upward trend of ASPR in China exceeded the global level. The crude rates of CVD metrics were low among individuals younger than 40 years and then increased with advancing age; sex differences were also observed. Decomposition analysis highlighted population aging as an important driver of increased CVD incidence in China (total population: 41.88%, male: 24.17%, female: 47.81%). Projections suggested that ASIR in China and globally will continue to rise to 825.94 and 807.96 per 100,000, respectively, by 2036, whereas ASMR and ASDR will continue to decline.
This study revealed a complex CVD epidemiological landscape in China and globally, with increasing ASPR alongside declining ASMR and ASDR. The ASIR of CVD in China remains significant and is projected to continue increasing.
Yue Zhang, Ning Zhang, Chang-Jian Lin· Archives of Medical Science· 0 citations