Adverse Effects of Medical Treatment Mortality Associated With Age, Region

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Despite a reduction in age-standardized mortality in the US, there has been an increased risk of mortality from the adverse effects of medical treatments.
Despite a reduction in age-standardized mortality in the US, there has been an increased risk of mortality from the adverse effects of medical treatments.

A reduction in age-standardized mortality due to adverse effects of medical treatment was observed in the US from 1990 to 2016. However, an increased risk of mortality from adverse effects of medical treatment was linked to advancing age and regional differences, according to a study published in JAMA Network Open.

The investigators of this cohort study sought to quantify how mortality associated with adverse effects of medical treatment has changed over time using data from the Global Burden of Diseases, Injuries, and Risk Factors 2016 study, and how health loss trends are stratified by age group, gender, and US state of residence.

The investigators assessed data from 1990 to 2016 on an estimated 123,603 deaths due to adverse effects of medical treatment from the Global Burden of Diseases, Injuries, and Risk Factors 2016 study. The primary outcome measure was mortality associated with adverse effects of medical treatment, and cause-of-death was classified using the International Classification of Diseases (ICD) codes. In secondary analyses, the ICD framework was used to categorize the nature of adverse events and the cause-of-death chain was evaluated for associations with other diseases and injuries.

While the absolute number of deaths due to adverse effects of medical treatment increased from 1990 to 2016, this increase was attributed to population growth and aging. Over the same time period, the national age-standardized mortality rate associated with adverse effects of medical treatment actually decreased by 21.4% (95% uncertainty interval [UI], 1.3%-32.2%), from 1.46 deaths per 100,000 population (95% UI, 1.09-1.76) in 1990 to 1.15 deaths per 100,000 population (95% UI, 1.0-1.6) in 2016.

While gender had no impact, age at death and state of residence were factors that had a considerable effect on mortality rates associated with adverse effects of medical treatment. Patients aged over 70 years had a mortality rate of 7.93 deaths per 100,000 population (95% UI, 7.23-11.45), which was 20 times greater than patients aged 15 to 49 years (0.38 deaths per 100,000 population; 95% UI, 0.34-0.43). Geographic variables showed that California had the lowest age-standardized mortality rate associated with adverse effects of medical treatment (0.84 deaths per 100,000 population; 95% UI, 0.57-1.47) while Mississippi had the highest mortality rate (1.67 deaths per 100,000 population; 95% UI, 1.19-2.03). In a secondary analysis, 63.6% of deaths from adverse effects were associated with surgical and perioperative events, 14% with medical management, 8.9% with adverse drug events, 8.5% with misadventure, and 4.5% with medical or surgical devices.

Limitations to study included using ICD-coded death certificates and assigning each death to a single underlying cause, which may not capture contributing factors or reliably identify medical harm. Additionally, it is likely that many deaths due to adverse effects of medical treatment may not have been captured because of unintentional omissions in documentation practices or “motivated misreporting” to avoid implication.

In conclusion, the researchers suggested that, because surgical and perioperative events were the most commonly reported adverse effects, regional differences in surgical volume may drive interstate variability.

Multiple authors declare associations with the pharmaceutical industry. Please see the original reference for a full list of authors' disclosures.

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Reference                    

Sunshine JE, Meo N, Kassebaum NJ, Collison ML, Mokdad AH, Naghavi M. Association of adverse effects of medical treatment with mortality in the United States: A secondary analysis of the global burden of diseases, injuries, and risk factors studyJAMA Netw Open. 2019;2(1):e187041.

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