A standardized ratio for measuring the “suddenness” of events with applications to the four leading causes of violent death and to certain birth defects

Abstract

An index which provides a measure of abrupt or sudden change in epidemic trends is provided. Using this index, a simple comparison of the epidemiology of deaths due to homicides, suicides, motor vehicle accidents, and other accidents is made. One example of the findings is that the trend in accidental deaths over recent years possesses more spontaneity or temporal clustering than the trend in violent nonaccidental deaths. Another application reveals an informative epide‐miologic feature of the birth defects tracheoesophageal fistula and esophageal atresia. Implications of such findings are considered.     

Unnatural deaths in South African platinum miners, 1992-2008

Background

The mortality rate from unnatural deaths for South Africa is nearly double the world average. Reliable data are limited by inaccurate and incomplete ascertainment of specific causes of unnatural death. This study describes trends in causes of unnatural death between 1992 and 2008 in a cohort of South African miners.

Methodology/Principal Findings

The study used routinely-collected retrospective data with cause of death determined from multiple sources including the mine''s human resources database, medical records, death registration, and autopsy. Cause-specific mortality rates and Poisson regression coefficients were calculated by calendar year and age group. The cohort included 40,043 men. One quarter of all 2937 deaths were from unnatural causes (n = 805). Causes of unnatural deaths were road traffic accidents 38% (109/100,000 py), homicides 30% (88/100,000 py), occupational injuries 17% (50/100,000 py), suicides 8% (24/100,000 py), and other accidents 6% (19/100,000 py). Rates of unnatural deaths declined by 2% (95%CI -4%,-1%) per year over the study period, driven by declining rates of road traffic and other accidents. The rate of occupational injury mortality did not change significantly over time (-2% per year, 95%CI -5%,+2%). Unnatural deaths were less frequent in this cohort of workers than in the South African population (IRR 0.89, 95%CI 0.82–0.95), particularly homicides (IRR 0.48, 95%CI 0.42–0.55).

Conclusions/Significance

Unnatural deaths were a common cause of preventable and premature death in this cohort of miners. While unnatural death rates declined between 1992 and 2008, occupational fatalities remained at a high level. Evidence-based prevention strategies to address these avoidable deaths are urgently needed.     

Focus: Preventive Medicine: Variation in Non-external and External Causes of Death in Peru in Relation to the COVID-19 Lockdown

Introduction: Lockdowns are designed to slow COVID-19 transmission, but they may have unanticipated relationships with other aspects of public health. Assessing the overall pattern in population health as a country implements and relaxes a lockdown is relevant, as these patterns may not necessarily be symmetric. We aimed to estimate the changing trends in cause-specific mortality in relation to the 2020 COVID-19 related lockdowns in Peru. Methods: Based on data from the Peruvian National Death Information System (SINADEF), we calculated death rates per 10 million population to assess the trends in mortality rates for non-external and external causes of death (suicides, traffic accidents, and homicides). We compared these trends to 2018-2019, before, during, and after the lockdown, stratified by sex, and adjusted by Peruvian macro-region (Lima & Callao (capital region), Coast, Highland, and Jungle). Results: Non-external deaths presented a distinctive pattern among macro-regions, with an early surge in the Jungle and a later increase in the Highland. External deaths dropped during the lockdown, however, suicides and homicides returned to previous levels in the post-lockdown period. Deaths due to traffic accidents dropped during the lockdown and returned to pre-pandemic levels by December 2020. Conclusions: We found a sudden drop in external causes of death, with suicides and homicides returning to previous levels after the lifting of the lockdown. Non-external deaths showed a differential pattern by macro-region. A close monitoring of these trends could help identify early spikes among these causes of death and take action to prevent a further increase in mortality indirectly affected by the pandemic.     

Identifying Probable Suicide Clusters in Wales Using National Mortality Data

Background

Up to 2% of suicides in young people may occur in clusters i.e., close together in time and space. In early 2008 unprecedented attention was given by national and international news media to a suspected suicide cluster among young people living in Bridgend, Wales. This paper investigates the strength of statistical evidence for this apparent cluster, its size, and temporal and geographical limits.

Methods and findings

The analysis is based on official mortality statistics for Wales for 2000–2009 provided by the UK''s Office for National Statistics (ONS). Temporo-spatial analysis was performed using Space Time Permutation Scan Statistics with SaTScan v9.1 for suicide deaths aged 15 and over, with a sub-group analysis focussing on cases aged 15–34 years. These analyses were conducted for deaths coded by ONS as: (i) suicide or of undetermined intent (probable suicides) and (ii) for a combination of suicide, undetermined, and accidental poisoning and hanging (possible suicides). The temporo-spatial analysis did not identify any clusters of suicide or undetermined intent deaths (probable suicides). However, analysis of all deaths by suicide, undetermined intent, accidental poisoning and accidental hanging (possible suicides) identified a temporo-spatial cluster (p = 0.029) involving 10 deaths amongst 15–34 year olds centred on the County Borough of Bridgend for the period 27^th December 2007 to 19^th February 2008. Less than 1% of possible suicides in younger people in Wales in the ten year period were identified as being cluster-related.

Conclusions

There was a possible suicide cluster in young people in Bridgend between December 2007 and February 2008. This cluster was smaller, shorter in duration, and predominantly later than the phenomenon that was reported in national and international print media. Further investigation of factors leading to the onset and termination of this series of deaths, in particular the role of the media, is required.     

Serum cholesterol concentration and mortality from accidents,suicide, and other violent causes.

OBJECTIVE--To study the association of mortality from accidents, suicides, and other violent deaths with serum cholesterol concentration. DESIGN--Baseline measurements in two randomly chosen independent cohorts were carried out in 1972 and 1977. Mortality was monitored over 10-15 years through the national death registry. SETTING--Eastern Finland. SUBJECTS--The two cohorts comprised men (n = 10,898) and women (n = 11,534) born between 1913 and 1947. There were 193 deaths due to accidents, suicides, and violence among men and 43 among women. MAIN OUTCOME MEASURE--Mortality from accidents, suicides, and other violent deaths was used as the end point. Deaths from these causes were pooled together in the analyses. RESULTS--Serum cholesterol concentration was not associated with mortality from accidents, suicides, and other violent deaths in the univariate analyses or in the proportional hazards regression analyses including smoking, systolic blood pressure, alcohol drinking, and education. In both genders smoking was more prevalent among those who died from accidents, suicides, and other violent causes than from other causes. Frequent use of alcohol increased mortality from these causes. CONCLUSION--The risk of accidents, suicides, and other violent deaths was not related to serum cholesterol concentration, whereas such deaths were more prevalent in smokers and alcohol drinkers.     

Russian mortality trends for 1991-2001: analysis by cause and region

Objectives To investigate trends in Russian mortality for 1991-2001 with particular reference to trends since the Russian economic crisis in 1998 and to geographical differences within Russia.Design Analysis of data obtained from the Russian State statistics committee for 1991-2001. All cause mortality was compared between seven federal regions. Comparison of cause specific rates was conducted for young (15-34 years) and middle aged adults (35-69 years). The number of Russian adults who died before age 70 in the period 1992-2001 and whose deaths were attributable to increased mortality was calculated.Main outcome measures Age, sex, and cause specific mortality standardised to the world population.Results Mortality increased substantially after the economic crisis in 1998, with life expectancy falling to 58.9 years among men and 71.8 years among women by 2001. Most of these fluctuations were due to changes in mortality from vascular disease and violent deaths (mainly suicides, homicides, unintentional poisoning, and traffic incidents) among young and middle aged adults. Trends were similar in all parts of Russia. An extra 2.5-3 million Russian adults died in middle age in the period 1992-2001 than would have been expected based on 1991 mortality.Conclusions Russian mortality was already high in 1991 and has increased further in the subsequent decade. Fluctuations in mortality seem to correlate strongly with underlying economic and societal factors. On an individual level, alcohol consumption is strongly implicated in being at least partially responsible for many of these trends.     

Mortality from unintentional injuries in California, 1985.

In 1985 unintentional injuries were the fourth leading cause of death among California residents, causing 10,380 deaths. They were the leading cause of potential life lost, accounting for 278,109 years lost. This was more than twice the number of years lost due to heart disease and 1 1/2 times the number lost due to cancer. Motor vehicle traffic accidents were the leading cause of unintentional injury deaths, accounting for half (5,158) the deaths. The next two leading causes were poisoning (especially for men aged 25 to 44 years) and falls (especially among persons aged 75 and older). Drowning was second to motor vehicle accidents as a cause of death in children aged 1 to 14 years. California''s age-adjusted injury mortality rates in 1985 were lower in coastal and urban counties than in inland and rural counties, and these rates were generally lower in counties having organized systems of trauma care.     

The Impact of Improving Suicide Death Classification in South Korea: A Comparison with Japan and Hong Kong

IntroductionThe suicide rate of South Korea has increased dramatically during the past decades, as opposed to steadily decreasing trends in Japan and Hong Kong. Although the recent increase of suicide in South Korea may be related to changing socioeconomic conditions and other contextual factors, it may also reflect, in part, a reduction of misidentified suicide cases due to improving classification of manner of death.MethodWe compared the annual proportional change of suicide, undetermined death, and accidental death from South Korea with those of Japan and Hong Kong from 1992 to 2011; a greater proportional change of the manner-of-death categories during the period is indicative of a relatively less stable registration and hence a greater potential for misclassification bias on reported suicide trends. Subgroup analyses stratifying the deaths by methods were also conducted. To estimate the impact, the age-standardized rates of these three death categories in each site were calculated.ResultsWe found that, during the 20-year observation period, the proportional change of suicide, undetermined death, and accidental death in South Korea was significantly greater than Japan and Hong Kong. Similar observations were made in subgroup analyses. While death rates of the three manners in Japan and Hong Kong generally moved in a parallel fashion, the increase of suicide in South Korea occurred concomitantly with a significant reduction of its accidental death rate. 43% of the increase in suicides could be attributed to the decrease in accidental deaths, while 57% of the increase could be due to fundamental causes.ConclusionOur data suggest that, during the mid-1990s and after, the increasing burden of suicide in South Korea initially was masked, in part, by misclassification. Thus, the later apparently rapid increase of suicides reflected steadily improving classification of manner of death, as well as a more fundamental increase in the suicide rate.     

Mentally abnormal offenders: manner of death.

A 23 year follow up of deaths in a population of mentally disordered patients was carried out, and a typical case history is reported. A quarter (71) of the deaths reported were unnatural, verdicts of suicide or accidental death or open verdicts having been recorded. For men in most age groups the proportion of deaths by suicide was two to three times greater than in the general population in 1982; the rate among those aged 25-29 was five times that in the general population. Differences in the rate of unnatural death among diagnostic categories of mental illness were not significant, but the proportion of unnatural deaths among the mentally handicapped will probably eventually be lower than that among psychotic offenders or those with personality disorders. Violent death occurs at an older age in those with affective disorders. Social isolation and alienation add to the handicap of mental disorder in this group of people, and these sometimes difficult but always vulnerable patients must continue to be offered asylum other than prison.     

Are pre-hospital deaths from accidental injury preventable?

OBJECTIVE--To determine what proportion of pre-hospital deaths from accidental injury--deaths at the scene of the accident and those that occur before the person has reached hospital--are preventable. DESIGN--Retrospective study of all deaths from accidental injury that occurred between 1 January 1987 and 31 December 1990 and were reported to the coroner. SETTING--North Staffordshire. MAIN OUTCOME MEASURES--Injury severity score, probability of survival (probit analysis), and airway obstruction. RESULTS--There were 152 pre-hospital deaths from accidental injury (110 males and 42 females). In the same period there were 257 deaths in hospital from accidental injury (136 males and 121 females). The average age at death was 41.9 years for those who died before reaching hospital, and their average injury severity score was 29.3. In contrast, those who died in hospital were older and equally likely to be males or females. Important neurological injury occurred in 113 pre-hospital deaths, and evidence of airway obstruction in 59. Eighty six pre-hospital deaths were due to road traffic accidents, and 37 of these were occupants in cars. On the basis of the injury severity score and age, death was found to have been inevitable or highly likely in 92 cases. In the remaining 60 cases death had not been inevitable and airway obstruction was present in up to 51 patients with injuries that they might have survived. CONCLUSION--Death was potentially preventable in at least 39% of those who died from accidental injury before they reached hospital. Training in first aid should be available more widely, and particularly to motorists as many pre-hospital deaths that could be prevented are due to road accidents.     

Use of antidepressants among people committing suicide in Sweden.

OBJECTIVE--To analyse the outcome of depression in the Swedish population as reflected by the detection of antidepressants in a national forensic toxicological screening programme of unnatural deaths. DESIGN--Antidepressants detected by the National Laboratory of Forensic Chemistry were related to data on use expressed in person years of exposure. SUBJECTS--All 7000 cases of unnatural death with results from forensic toxicological screening in 1990-1; this included 3400 (85%) of the 4000 cases of suicide in Sweden. MAIN OUTCOME MEASURES--Number of findings of antidepressants in the screening programme and number of findings of different antidepressants in relation to their use. RESULTS--Antidepressants were found in 585 screening tests, corresponding to 542 subjects or less than 16% of the 3400 cases of suicide. Newer, less toxic antidepressants were found more often than the older compounds. Toxic concentrations of antidepressants were found in only 190 cases (5.6%). CONCLUSION--A consistent finding in surveys of suicide is that about half of the patients who commit suicide are depressed. The current data suggest that most depressed patients who commit suicide are not taking antidepressants immediately before death. Therapeutic failure may be a greater problem with antidepressants than toxicity as the results did not indicate any advantage of the newer, less toxic antidepressants. All causes of death should be included in risk analyses, thereby providing an estimate of effectiveness as well as toxicity of antidepressants.     

Leading causes of childhood death

The over-all rates of death in childhood decreased five to ten fold during the first half of the century, with the greatest drop occurring in deaths due to infections. The death rate due to accidents has shown a relatively slight decrease; hence, accidents are now the leading cause of childhood death, and in California account for 32 per cent of the deaths in the group 1 to 15 years of age. In California, and among certain insured groups of children, cancer is the leading or second leading cause of death due to disease. There is indication that the incidence of leukemia is increasing in early childhood and in the older age groups.Accidents, the leading cause of childhood death, do not happen; they are caused, and so can be prevented. The medical profession should concern itself much more actively in the field of accident prevention.     

道路交通事故所致骨折特点、致伤机制及其与交通方式关系的研究

研究道路交通事故所致骨折的流行病学特点、骨折的特征及致伤机制;探讨交通方式与骨折的关系及其法医学意义,为预防、控制道路交通事故、交通伤骨折的急救及法医学的鉴定提供重要的依据.本文对2004年昆明市道路交通事故所致骨折518例临床法医鉴定及199例法医病理检验鉴定资料进行系统性分析研究.2005年及2006年.全国与云南省的交通事故数量下降趋势明显.交通事故所致骨折有以下特点:(1)多处、多发性骨折常见;(2)骨折部位呈"离心性分布";(3)暴力传导性骨折明显;(4)骨折刨伤严重,粉碎性及开放性骨折多见,多数需手术治疗;(5)下肢骨折常见,胫腓骨是下肢骨折最常见的部位;(6)四肢多发骨折常发生同侧肢体,摩托车、电动车、自行车驾驶员及乘员和行人发生四肢骨折时以同侧肢体多见,机动车驾驶员及机动车乘员以异侧肢体多见.骨折损伤方式以碰撞为主,其次是摔跌.     

Quantitative Ecological Risk Assessment of Industrial Accidents: The Case of Oil Ship Transportation in the Coastal Tropical Area of Northeastern Brazil

Accidents such as toxic spills can cause massive damage to local ecosystems and hamper the sustainable development of hazardous industries. Models that only consider regularly occurring pollution are unable to truly quantify ecological risks (ecorisks) from these industries. This work presents a methodology capable of quantifying ecorisks related to rare and extreme events such as industrial accidents. We developed a procedure that integrates information from different studies that contributes to characterize ecorisks from industrial accidents: (1) reliability analysis, (2) fate and transport modeling, (3) individual-level toxicological assessment, and (4) population modeling. The methodology is exemplified by an application to oil ship transportation to supply Brazil's Suape industrial complex. A fish population was strategically chosen to represent the ecosystem's health of Suape beach. For the critical accidental scenarios, their frequencies of occurrence were estimated and the space–time evolution of oil simulated. The ecorisks were quantified in terms of time and population probability of fish extinction, categorized and compared against a no-accident scenario. The total ecorisks from all scenarios were presented as a FN curve, where N is the average number of deaths in the population and F the cumulative frequency of accidents with potential to cause N or more deaths.     

Regulation of inducible nitric-oxide synthase by the SPRY domain- and SOCS box-containing proteins

Inducible nitric-oxide synthase (iNOS, NOS2) plays a prominent role in macrophage bactericidal and tumoricidal activities. A relatively large amount of NO produced via iNOS, however, also targets the macrophage itself for apoptotic cell death. To uncover the intrinsic mechanisms of iNOS regulation, we have characterized the SPRY domain- and SOCS box-containing protein 1 (SPSB1), SPSB2, and SPSB4 that interact with the N-terminal region of iNOS in a D-I-N-N-N sequence-dependent manner. Fluorescence microscopy revealed that these SPSB proteins can induce the subcellular redistribution of iNOS from dense regions to diffused expression in a SOCS box-dependent manner. In immunoprecipitation studies, both Elongin C and Cullin-5, components of the multi-subunit E3 ubiquitin ligase, were found to bind to iNOS via SPSB1, SPSB2, or SPSB4. Consistently, iNOS was polyubiquitinated and degraded in a proteasome-dependent manner when SPSB1, SPSB2, or SPSB4 was expressed. SPSB1 and SPSB4 had a greater effect on iNOS regulation than SPSB2. The iNOS N-terminal fragment (residues 1-124 of human iNOS) could disrupt iNOS-SPSB interactions and inhibit iNOS degradation. In lipopolysaccharide-treated macrophages, this fragment attenuated iNOS ubiquitination and substantially prolonged iNOS lifetime, resulting in a corresponding increase in NO production and enhanced NO-dependent cell death. These results not only demonstrate the mechanism of SPSB-mediated iNOS degradation and the relative contributions of different SPSB proteins to iNOS regulation, but also show that iNOS levels are sophisticatedly regulated by SPSB proteins in activated macrophages to prevent overproduction of NO that could trigger detrimental effects, such as cytotoxicity.     

Risk of fatal accidents occurring other than at sea among Icelandic seamen.

OBJECTIVE--To study mortality among seamen, particularly from fatal accidents that occurred other than at sea. DESIGN--Cohort study. SETTING--Iceland. SUBJECTS--27,884 seamen, both fishermen and sailors from the merchant fleet, who had been members of a pension fund from 1958 to 1986. MAIN OUTCOME MEASURES--Cause of death (ICD seventh revision), standardised mortality ratio. RESULTS--Most standardised mortality ratios were greater than 1, being 1.26 for all causes and 1.83 for all external causes. There was no healthy worker effect. The excess of deaths from all external causes included all subcategories of death from accidents, poisonings, and violence and not just accidents at sea (water transport accidents, ICD codes E850-E858). A significant trend was found for length of employment and mortality from all accidents at sea, drowning at sea, accidental poisoning, other accidents, and accidental drowning; correlation coefficients for all causes, all accidents, suicide, and injuries undetermined whether accidentally or purposely inflicted were 0.7-0.8. Compared with seamen who started work during 1968-77, those who started work in 1978 or later had higher mortality from all causes, road traffic accidents, poisoning, other accidents, homicide, and injuries unknown whether accidentally or purposely inflicted, but not from all accidents at sea and accidental drowning. CONCLUSION--Seamen seem to be a special group with a high risk of fatal accidents occurring not only at sea. The association between fatal accidents other than at sea and length of employment as seamen indicates that seamen are modified by their occupation towards hazardous behaviour or a risky lifestyle.     

Structural Basis for Par-4 Recognition by the SPRY Domain- and SOCS Box-Containing Proteins SPSB1, SPSB2, and SPSB4

The mammalian SPRY domain- and SOCS box-containing proteins, SPSB1 to SPSB4, belong to the SOCS box family of E3 ubiquitin ligases. Substrate recognition sites for the SPRY domain are identified only for human Par-4 (ELNNNL) and for the Drosophila orthologue GUSTAVUS binding to the DEAD-box RNA helicase VASA (DINNNN). To further investigate this consensus motif, we determined the crystal structures of SPSB1, SPSB2, and SPSB4, as well as their binding modes and affinities for both Par-4 and VASA. Mutation of each of the three Asn residues in Par-4 abrogated binding to all three SPSB proteins, while changing EL to DI enhanced binding. By comparison to SPSB1 and SPSB4, the more divergent protein SPSB2 showed only weak binding to Par-4 and was hypersensitive to DI substitution. Par-4_(59-77) binding perturbed NMR resonances from a number of SPSB2 residues flanking the ELNNN binding site, including loop D, which binds the EL/DI sequence. Although interactions with the consensus peptide motif were conserved in all structures, flanking sites in SPSB2 were identified as sites of structural change. These structural changes limit high-affinity interactions for SPSB2 to aspartate-containing sequences, whereas SPSB1 and SPSB4 bind strongly to both Par-4 and VASA peptides.     

Years of Life Lost Due to External Causes of Death in the Lodz Province,Poland

Background

The aim of the study is the analysis of years of life lost due to external causes of death, particularly due to traffic accidents and suicides.

Materials and Methods

The study material includes a database containing information gathered from 376,281 death certificates of inhabitants of the Lodz province who died between 1999 and 2010. The Lodz province is characterized by the highest mortality rates in Poland. The SEYLL_p (Standard Expected Years of Life Lost per living person) and the SEYLL_d (per death) indices were used to determine years of life lost. Joinpoint models were used to analyze time trends.

Results

In 2010, deaths due to external causes constituted 6.0% of the total number of deaths. The standardized death rate (SDR) due to external causes was 110.0 per 100,000 males and was five times higher than for females (22.0 per 100,000 females). In 2010, the SEYLL_p due to external causes was 3746 per 100,000 males and 721 per 100,000 females. Among males, suicides and traffic accidents were the most common causes of death (the values of the SEYLL_p were: 1098 years and 887 years per 100,000 people, respectively). Among females, the SEYLL_p values were 183 years due to traffic accidents and 143 years due to suicides (per 100,000 people).

Conclusions

A decrease in the number of years of life lost due to external causes is much higher among females. The authors observe that a growing number of suicides contribute to an increase in the value of the SEYLL_p index. This directly contributes to over-mortality of males due to external causes. The analysis of the years of life lost focuses on the social and economic aspects of premature mortality due to external causes.     

Male facial width is associated with death by contact violence: narrow-faced males are more likely to die from contact violence

Male facial width-to-height ratio (bizygomatic width scaled for face height) is a testosterone-linked trait predictive of reactive aggression, exploitative behavior, cheating, deception, and dominance. We tested whether facial width was systematically related to cause of death in a forensic sample. We hypothesized that wider-faced males, being more aggressive and robust, would be less likely than narrower-faced males to die from contact violence (stabbed, strangled, or bludgeoned to death) compared with other forms of homicide. We tested this hypothesis in a forensic data sample covering 523 male and 339 female skeletons. In these data, men with narrower faces were more likely to have died as a consequence of homicides involving direct physical contact than men with wider faces. No such effect was found for women. This effect was found when considering all causes of mortality and when limiting the sample to homicides. This finding suggests that wider-faced males are less likely to die from male–male physical violence, perhaps because of their formidability. Our findings are discussed with reference to the previous literature indicating that facial width-to-height ratio is a marker for male dominance.     

Cancer-Related Causes of Death among HIV-Infected Patients in France in 2010: Evolution since 2000

Objectives

The current study aimed at describing the distribution and characteristics of malignancy related deaths in human immunodeficiency virus (HIV) infected patients in 2010 and at comparing them to those obtained in 2000 and 2005.

Methods

Data were obtained from three national surveys conducted in France in 2010, 2005 and 2000. The underlying cause of death was documented using a standardized questionnaire fulfilled in French hospital wards involved in the management of HIV infection.

Results

Among the 728 deaths reported in 2010, 262 were cancer-related (36%). After a significant increase from 28% in 2000 to 33% in 2005 and 36% in 2010, cancers represent the leading cause of mortality in HIV infected patients. The proportion of deaths attributed to non-AIDS/non-hepatitis-related cancers significantly increased from 2000 to 2010 (11% of the deaths in 2000, 17% in 2005 and 22% in 2010, p<0.001), while those attributed to AIDS-defining cancers decreased during the same period (16% in 2000, 13% in 2005 and 9% in 2010, p = 0.024). Particularly, the proportion of respiratory cancers significantly increased from 5% in 2000 to 6% in 2005 and 11% in 2010 (p = 0.004). Lung cancer was the most common cancer-related cause of death in 2010 (instead of non-Hodgkin lymphoma so far) and represented the leading cause of death in people living with HIV overall.

Conclusions

Cancer prevention (especially smoking cessation), screening strategies and therapeutic management need to be optimized in HIV-infected patients in order to reduce mortality, particularly in the field of respiratory cancers.