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Fernandes F, Turra CM, França GVA, Castro MC. Mortality by Cause of Death in Brazil: A Research Note on the Effects of the COVID-19 Pandemic and Contribution to Changes in Life Expectancy at Birth. Demography 2025; 62:381-404. [PMID: 40136060 DOI: 10.1215/00703370-11862487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
We analyze and quantify the ways the COVID-19 pandemic affected other causes of death in Brazil in 2020 and 2021. We decompose age-standardized mortality rate time series for 2010-2021 into three additive components: trend, seasonal, and remainder. Given the long-term trend and historical seasonal variation, we assume that most of the impact of the COVID-19 pandemic will be left in the remainder. We use a regression model to test this assumption. We decompose the contributions of COVID-19 deaths (direct effect) and those of other causes (indirect effects) to the annual change in life expectancy at birth (e0) from 2017 to 2021. The COVID-19 pandemic not only increased rates for other causes of death but also decreased rates for some causes. Broadly, the remainders mirror the COVID-19 pandemic waves. The direct effects of the pandemic reduced e0 by 1.88 years in 2019-2020 and by 1.77 in 2020-2021. Indirect effects increased e0 by 0.44 in 2019-2020 and had virtually no effect on e0 in 2020-2021. Whether the trajectories of mortality rates and annual gains in e0 will return to prepandemic levels and their interregional gradients depend on whether a nonnegligible number of patients who recovered from COVID-19 will suffer premature mortality.
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Affiliation(s)
- Fernando Fernandes
- Department of Demography, Cedeplar, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cássio M Turra
- Department of Demography, Cedeplar, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Shaikh M, Ota E, Van Gestel R. Childhood Immunization and Competing Mortality Risks in Kenya: A Longitudinal Analysis for Multiparous Mothers. J Pediatr 2023; 262:113590. [PMID: 37419239 DOI: 10.1016/j.jpeds.2023.113590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE To assess the relationship between childhood immunization and mortality risks for nonvaccine-preventable diseases (competing mortality risks, or CMR) in Kenya. STUDY DESIGN A combination of the Global Burden of Disease and Demographic Health Survey data was used to measure basic vaccination status, CMR, and control variables for each child in the Demographic Health Survey data. A longitudinal analysis was performed. This uses within-mother variation between children to compare the vaccine decisions for different children, who are exposed to different mortality risks. The analysis also distinguishes between overall and disease-specific risks. RESULTS The study included 15 881 children born between 2009 and 2013, who were at least 12 months old at the time of interview and not part of a twin birth. Mean basic vaccination rates ranged from 27.1% to 90.2% and mean CMR from 13.00 to 738.32 deaths per 100 000 across different counties. A one-unit increase in mortality risk from diarrhea, the most prevalent disease among children in Kenya, is associated with a 1.1 percentage point decline in basic vaccination status. In contrast, mortality risks for other diseases and HIV increase the likelihood of vaccination. The effect of CMR was found to be stronger for children with higher birth orders. CONCLUSIONS A significant negative correlation between severe CMR and vaccination status was found, which has important implications for immunization policies, particularly in Kenya. Interventions aimed at reducing the most severe CMR, such as diarrhea, and targeted toward multiparous mothers may improve childhood immunization coverage.
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Affiliation(s)
| | - Elsa Ota
- Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - Raf Van Gestel
- Erasmus School of Health Policy and Management, Erasmus School of Economics, Rotterdam, The Netherlands.
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[Years of life lost: known methods and a refined approach using the example of the most frequent causes of death in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1463-1472. [PMID: 34596700 PMCID: PMC8485316 DOI: 10.1007/s00103-021-03424-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 08/31/2021] [Indexed: 11/12/2022]
Abstract
Hintergrund Verlorene Lebensjahre (Years of Life Lost, YLL) sind ein aussagekräftiger, in Deutschland jedoch wenig verwendeter Indikator für die Relevanz von Todesursachen. Es existieren zahlreiche Methoden, mit denen YLL berechnet werden können. Ziel der Arbeit Es werden prototypische Methoden zur Berechnung von YLL vorgestellt und kritisch eingeordnet. Auf dieser Basis wird eine verbesserte Methode vorgeschlagen, die auf der Nutzung von todesursachenbereinigten Sterbetafeln (Cause-Elimination Life Tables, CELT) beruht. Methoden Etablierte Methoden und die hier vorgeschlagene Modifikation werden auf die Sterblichkeit in Deutschland 2018 angewandt. Veränderungen gegenüber 1998 werden anhand der modifizierten Methode dargestellt. Ergebnisse Während nach der Zahl der Sterbefälle Herz-Kreislauf-Erkrankungen im Jahr 2018 die bedeutendste Todesursache waren, war Krebs für die meisten YLL verantwortlich. Unterschiedliche Methoden zur Berechnung der YLL führen zu deutlich abweichenden Rängen bei den weniger bedeutsamen Todesursachen. YLL auf Basis von allgemeinen Sterbetafeln unterschätzen die YLL auf Basis der todesursachenbereinigten Sterbetafeln um bis zu 18,4 % (Herz-Kreislauf-Erkrankungen). Gemessen an den CELT-basierten YLL waren im Jahr 1998 Herz-Kreislauf-Erkrankungen die bedeutsamste Todesursache. Diskussion Die Berechnung von YLL auf der Basis von todesursachenbereinigten Sterbetafeln vermeidet Inkonsistenzen etablierter Methoden und führt zu relevant abweichenden Ergebnissen. Besonderheiten der vorgeschlagenen Methode (Verstoß gegen das Egalitätsprinzip, fehlende Additivität) beeinträchtigen ihren Nutzen als Instrument zur Steuerung der Gesundheitsversorgung nicht. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03424-8) enthalten.
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Autoantibody Seropositivity and Risk for Interstitial Lung Disease in a Prospective Male-Predominant Rheumatoid Arthritis Cohort of U.S. Veterans. Ann Am Thorac Soc 2021; 18:598-605. [PMID: 33026891 DOI: 10.1513/annalsats.202006-590oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rationale: Prior studies investigating associations of rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) seropositivity with risk for rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) have mostly used cross-sectional or case-control designs.Objectives: To determine whether combined autoantibody seropositivity and higher individual autoantibody concentrations were associated with increased risk for RA-ILD in a prospective RA cohort.Methods: Within the Veterans Affairs Rheumatoid Arthritis prospective registry, we performed a cross-sectional study of prevalent ILD and a retrospective cohort study of incident ILD (diagnosed after at least 12 mo of longitudinal follow-up). We used logistic and Cox regression methods to determine whether combined RF/ACPA seropositivity and higher autoantibody concentrations were independently associated with greater risk for prevalent and incident ILD, respectively.Results: Among 2,328 participants (median age 64 yr, 89.3% male), 100 (4.3%) subjects had prevalent ILD at enrollment. During 14,281 patient-years of follow-up, 83 (3.7%) of the remaining 2,228 were subsequently diagnosed with incident ILD (5.8 cases per 1,000 person-years). Patients with combined RF/ACPA seropositivity had a higher probability of prevalent ILD compared with seronegative subjects (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.24-6.78). RF titers demonstrated a monotonic association with prevalent ILD (OR, 2.69; 95% CI, 1.11-6.51 for low-positive [15-45 IU/ml] titers; OR, 3.40; 95% CI, 1.61-7.18 for high-positive [>45 IU/ml] titers; P for trend 0.01). Patients with high-positive (>15 U/ml) ACPA titers were also at higher risk for prevalent ILD (OR, 1.91; 95% CI, 1.04-3.49) compared with ACPA-negative subjects. Combined RF/ACPA seropositivity was not associated with increased risk for incident ILD, nor were high- or low-positive RF or ACPA titers. In a piecewise linear spline model, however, RF titers greater than 90 IU/ml independently correlated with increased risk for incident ILD (hazard ratio, 1.68, 95% CI, 1.02-2.77).Conclusions: Combined RF/ACPA seropositivity and individual autoantibody concentrations were strongly associated with prevalent but not incident RA-ILD. Only patients with RF concentrations >90 IU/ml were observed to be at higher risk of incident RA-ILD.
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Kim H, Lee JT. Inter-mortality displacement hypothesis and short-term effect of ambient air pollution on mortality in seven major cities of South Korea: a time-series analysis. Int J Epidemiol 2021; 49:1802-1812. [PMID: 33211858 DOI: 10.1093/ije/dyaa181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inter-mortality displacement (IMD) between cause-specific mortalities has not been introduced in air pollution epidemiology. Investigation into IMD would provide insights on the actual health burden of air pollution and interpretation of associations. We aimed to investigate IMD regarding short-term effect of air pollution on mortality. METHODS We illustrated manifestations and interpretations of lag-mortality associations. If IMD exists, a net increase of one cause-specific death can be offset by a net decrease of other cause-specific deaths. We conducted a time-series analysis to estimate associations of ambient particulate matter smaller than 10 µm (PM10), ozone (O3), sulphur dioxide (SO2), nitrogen dioxide (NO2) and carbon monoxide (CO) with mortality, considering lags up to the previous 45 days, for seven major cities of South Korea from 2006 to 2013. Attributable mortality cases were identified. RESULTS For O3, respiratory mortality [11 929 cases, 95% empirical confidence interval (eCI), 5358, 17 688 cases] was counterbalanced by cardiovascular mortality (-11 272 cases, 95% eCI: -22 444, -629 cases). All-cause mortality was 37 148 cases (95% eCI: 4448, 68 782 cases). For PM10, respiratory deaths were 9167 cases (95% eCI: 563, 16 521 cases), and cardiovascular deaths were 6929 cases (95% eCI: -11 793, 24 138 cases). Estimates for SO2 were comparable to those for PM10. All-cause mortality attributable to NO2 was explained by short-term mortality displacement. No associations with mortality were found for CO. CONCLUSIONS IMD may exist in the relationship between air pollution and mortality. The actual relationship between air pollution and cause-specific mortality may be masked by IMD.
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Affiliation(s)
- Honghyok Kim
- BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea.,School of the Environment, Yale University, New Haven, CT, USA
| | - Jong-Tae Lee
- BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea.,Department of Environmental Health, Korea University, Seoul, Republic of Korea.,School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
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Bluhmki T, Putter H, Allignol A, Beyersmann J, on behalf of the COMBACTE‐MAGNET consortium. Bootstrapping complex time-to-event data without individual patient data, with a view toward time-dependent exposures. Stat Med 2019; 38:3747-3763. [PMID: 31162707 PMCID: PMC6771611 DOI: 10.1002/sim.8177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/13/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022]
Abstract
We consider nonparametric and semiparametric resampling of multistate event histories by simulating multistate trajectories from an empirical multivariate hazard measure. One advantage of our approach is that it does not necessarily require individual patient data, but may be based on published information. This is also attractive for both study planning and simulating realistic real-world event history data in general. The concept extends to left-truncation and right-censoring mechanisms, nondegenerate initial distributions, and nonproportional as well as non-Markov settings. A special focus is on its connection to simulating survival data with time-dependent covariates. For the case of qualitative time-dependent exposures, we demonstrate that our proposal gives a more natural interpretation of how such data evolve over the course of time than many of the competing approaches. The multistate perspective avoids any latent failure time structure and sampling spaces impossible in real life, whereas its parsimony follows the principle of Occam's razor. We also suggest empirical simulation as a novel bootstrap procedure to assess estimation uncertainty in the absence of individual patient data. This is not possible for established procedures such as Efron's bootstrap. A simulation study investigating the effect of liver functionality on survival in patients with liver cirrhosis serves as a proof of concept. Example code is provided.
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Affiliation(s)
| | - Hein Putter
- Department of Medical Statistics and BioinformaticsLeiden University Medical CenterLeidenThe Netherlands
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Meller M, Beyersmann J, Rufibach K. Joint modeling of progression‐free and overall survival and computation of correlation measures. Stat Med 2019; 38:4270-4289. [DOI: 10.1002/sim.8295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/07/2019] [Accepted: 06/05/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Matthias Meller
- Department of Biostatistics F. Hoffmann‐La Roche Ltd Basel Switzerland
| | | | - Kaspar Rufibach
- Department of Biostatistics F. Hoffmann‐La Roche Ltd Basel Switzerland
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Orsini C. The mortality effects of changing public funding for home health care: An empirical analysis of Medicare home health care in the United States. HEALTH ECONOMICS 2019; 28:921-936. [PMID: 31237098 DOI: 10.1002/hec.3896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
In light of population aging, it is important to understand whether limiting public in-kind transfers to the elderly affects elderly mortality. I focus on home health care-a popular in-kind transfer-and I exploit variation in the Medicare home health care reimbursement that arose in 1997 in the United States to study whether cuts to government coverage of home health care affected elderly mortality. Under the identifying assumptions of the DID model, I find that the cuts affected total mortality for some men but not women, suggesting that changes in home health care can affect elderly mortality and differences in mortality between men and women. For men aged between 65 and 74, the Interim Payment System was associated with an increase in mortality equal to 0.6%, an effect in absolute value comparable to the mortality response to a one percentage point change in unemployment rates and within the range of other estimates of the impact of health insurance on elderly mortality.
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Affiliation(s)
- Chiara Orsini
- Department of Economics, University of Sheffield, Sheffield, UK
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Uchida H, Mito R, Heishi H, Saito M, Odagiri Y, Ohtake K, Yamaki T, Uchida M, Natsume H, Kobayashi J. [Gender Differences in Projected Life Expectancy in Japan (2023-2047) Determined by Bayesian Age-Period-Cohort Analysis]. Nihon Eiseigaku Zasshi 2018; 73:338-353. [PMID: 30270302 DOI: 10.1265/jjh.73.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES In this study, we aimed to (1) determine the effects of age, period, and cohort on mortality rate trends between 1958 and 2012 in Japan and (2) assess gender differences in projected life expectancy (LE) for the 2023-2047 period. METHODS A time trend study was conducted using age-period-cohort (APC) analysis. A Bayesian APC model was fitted to describe mortality rate trends for the 1958-2012 period and to project mortality rates for 2023-2047. LE was predicted by Chiang's method using projected mortality rates. RESULTS Age, period, and cohort effects showed similar patterns between males and females. As time passes, gender differences in projected LE were larger among individuals over 65 years than among those under 65 years. Time series change rates of the extension of projected LE after excluding specific causes of death showed the following: smaller extension of projected LE in males in terms of mortality risk from malignant neoplasms, heart diseases, pneumonia, and accidents (under 65 years) and in females in terms of mortality risk from heart diseases, cerebrovascular diseases, and suicide (over 65 years). CONCLUSIONS Gender differences in projected LE are expected to be smaller before middle age and to be larger among seniors. These projected gender differences stem in part from the lower mortality risk among men than among women from malignant neoplasms, heart diseases, pneumonia, and accidents (under 65 years), and among women compared to men from heart disease, cerebrovascular disease, and suicide (over 65 years).
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Affiliation(s)
- Hiroyuki Uchida
- Division of Clinical Dietetics and Human Nutrition, Graduate School of Pharmaceutical Sciences, Josai University
| | - Ruri Mito
- Division of Pharmaceutics, School of Pharmaceutical Sciences, Faculty of Pharmaceutical Science, Josai University
| | - Hideaki Heishi
- Division of Pharmaceutics, School of Pharmaceutical Sciences, Faculty of Pharmaceutical Science, Josai University
| | - Masafumi Saito
- Division of Clinical Nutrition, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University
| | - Youichi Odagiri
- Division of Public Health Nursing, Graduate School of Nursing, Yamanashi Prefectural University
| | - Kazuo Ohtake
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University
| | - Tutomu Yamaki
- Division of Pharmaceutics, School of Pharmaceutical Sciences, Faculty of Pharmaceutical Science, Josai University
| | - Masaki Uchida
- Division of Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Josai University
| | - Hideshi Natsume
- Division of Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Josai University
| | - Jun Kobayashi
- Division of Clinical Dietetics and Human Nutrition, Graduate School of Pharmaceutical Sciences, Josai University
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Contribution of chronic conditions to functional limitations using a multinomial outcome: results for the older population in Belgium and Brazil. ACTA ACUST UNITED AC 2017; 75:68. [PMID: 29270292 PMCID: PMC5733874 DOI: 10.1186/s13690-017-0235-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022]
Abstract
Background The global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age. The attribution method has been proposed to identify which conditions contribute most to disability using cross-sectional data. Although the original method was based on binary outcomes, we recently proposed an extension to multinomial responses, since different disability levels are often investigated in surveys. This is the first application of the extended method to evaluate differences in the contribution of chronic conditions to functional limitations in the older population of Brazil and Belgium. Methods Representative data from individuals aged ≥65 years who participated in the 2008 or 2013 Health Interview Surveys in Belgium (N = 4521) or in the 2008 National Household Sample Survey in Brazil (N = 28,437) were analysed. Individuals were classified as without, moderate or severe functional limitations, based on three activities of daily living: eating, showering, and toileting. Six chronic conditions common to the surveys – diabetes, heart diseases, musculoskeletal conditions, depression, chronic respiratory diseases, and cancer – were included in the analysis. Separate multinomial additive hazards models by gender for each country were fitted. Results The prevalence of moderate functional limitations was larger in men in Brazil (8.4%) compared to Belgium (6.0%) and similar in women (approximately 12.0%). Conversely, the severe prevalence in men was similar in the two countries (around 8.0%) and higher in women from Belgium (16.6%) than from Brazil (9.1%). Musculoskeletal conditions were the main contributors to the prevalence of functional limitations in men and women in Belgium but only in men and women with moderate functional limitations in Brazil. Depression and heart diseases contributed most to the severe prevalence of functional limitations in men and women in Brazil, respectively. Conclusions Our findings provide a better understanding of differences in the prevalence of different levels of functional limitations in Brazil and Belgium. These differences can be related to differences in socioeconomic conditions, health care access and quality, disease diagnosis, stage of epidemiology transition, life expectancy, and the prevalence of lifestyle risk factors in the two countries. Electronic supplementary material The online version of this article (10.1186/s13690-017-0235-3) contains supplementary material, which is available to authorized users.
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Hoummady S, Hua J, Muller C, Pouchelon JL, Blondot M, Gilbert C, Desquilbet L. Investigation of risk factors for mortality in aged guide dogs: A retrospective cohort study. Prev Vet Med 2016; 132:125-129. [PMID: 27616361 DOI: 10.1016/j.prevetmed.2016.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/01/2016] [Accepted: 09/03/2016] [Indexed: 01/17/2023]
Abstract
The overall median lifespan of domestic dogs has been estimated to 9-12 years, but little is known about risk factors for mortality in aged and a priori healthy dogs. The objective of this retrospective cohort study was to determine which characteristics are associated with mortality in aged and a priori healthy guide dogs, in a retrospective cohort study of 116 guide dogs followed from a systematic geriatric examination at the age of 8-10 years old. A geriatric grid collected the clinical data and usual biological parameters were measured at the time of examination. Univariate (Kaplan-Meier estimates) and multivariable (Cox proportional hazard model) survival analyses were used to assess the associations with time to all-cause death. The majority of dogs were Golden Retrievers (n=48) and Labrador Retrievers (n=27). Median age at geriatric examination was 8.9 years. A total of 76 dogs died during follow-up, leading to a median survival time from geriatric examination of 4.4 years. After adjustment for demographic and biological variables, an increased alanine amionotransferase level (adjusted Hazard Ratio (adjusted HR), 6.2; 95% confidence interval [95%CI], 2.0-19.0; P<0.01), presenting skin nodules (adjusted HR, 1.9; 95% CI, 1.0-3.4; P=0.04), and not being a Labrador Retriever (adjusted HR, 3.3; 95%CI, 1.4-10; P<0.01) were independently associated with a shorter time to death. This study documents independent associations of alanine aminotransferase level, skin nodules and breed with mortality in aged guide dogs. These results may be useful for preventive medical care when conducting a geriatric examination in working dogs.
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Affiliation(s)
- S Hoummady
- UMR-CNRS-MNHN 7179, 1 avenue du Petit Chateau, 91800 Brunoy, France; Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, F-94704 Maisons-Alfort, France.
| | - J Hua
- Dr Locci veterinary clinic, Drancy F-93700, France
| | - C Muller
- Saint Bernard veterinary clinic, Lomme F-59160, France
| | - J L Pouchelon
- Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, F-94704 Maisons-Alfort, France
| | - M Blondot
- Ecole des Chiens Guides de Paris, 105 avenue de Saint-Maurice, F-75015 Paris, France
| | - C Gilbert
- UMR-CNRS-MNHN 7179, 1 avenue du Petit Chateau, 91800 Brunoy, France; Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, F-94704 Maisons-Alfort, France
| | - L Desquilbet
- UMR-CNRS-MNHN 7179, 1 avenue du Petit Chateau, 91800 Brunoy, France; Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, F-94704 Maisons-Alfort, France
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Yokota RTDC, Nusselder WJ, Robine JM, Tafforeau J, Deboosere P, Van Oyen H. Contribution of Chronic Conditions to the Disability Burden across Smoking Categories in Middle-Aged Adults, Belgium. PLoS One 2016; 11:e0153726. [PMID: 27105185 PMCID: PMC4841551 DOI: 10.1371/journal.pone.0153726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/01/2016] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Smoking is considered the single most important preventable cause of morbidity and mortality worldwide, contributing to increased incidence and severity of disabling conditions. The aim of this study was to assess the contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults in Belgium. METHODS Data from 10,224 individuals aged 40 to 60 years who participated in the 1997, 2001, 2004, or 2008 Health Interview Surveys in Belgium were used. Smoking status was defined as never, former (cessation ≥2 years), former (cessation <2 years), occasional light (<20 cigarettes/day), daily light, and daily heavy (≥20 cigarettes/day). To attribute disability to chronic conditions, binomial additive hazards models were fitted separately for each smoking category adjusted for gender, except for former (cessation <2 years) and occasional light smokers due to the small sample size. RESULTS An increasing trend in the disability prevalence was observed across smoking categories in men (never = 4.8%, former (cessation ≥2 years) = 5.8%, daily light = 7.8%, daily heavy = 10.7%) and women (never = 7.6%, former (cessation ≥2 years) = 8.0%, daily light = 10.2%, daily heavy = 12.0%). Musculoskeletal conditions showed a substantial contribution to the disability burden in men and women across all smoking categories. Other important contributors were depression and cardiovascular diseases in never smokers; depression, chronic respiratory diseases, and diabetes in former smokers (cessation ≥2 years); chronic respiratory diseases, cancer, and cardiovascular diseases in daily light smokers; cardiovascular diseases and chronic respiratory diseases in men and depression and diabetes in women daily heavy smokers. CONCLUSIONS Beyond the well-known effect of smoking on mortality, our findings showed an increasing trend of the disability prevalence and different contributors to the disability burden across smoking categories. This information can be useful from a public health perspective to define strategies to reduce disability in Belgium.
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Affiliation(s)
- Renata Tiene de Carvalho Yokota
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
- * E-mail:
| | | | - Jean-Marie Robine
- French Institute of Health and Medical Research (INSERM), Montpellier, France
- École Pratique des Hautes Études, Paris, France
| | - Jean Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Patrick Deboosere
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
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Leukocyte telomere length and mortality in the National Health and Nutrition Examination Survey, 1999-2002. Epidemiology 2016; 26:528-35. [PMID: 26039272 DOI: 10.1097/ede.0000000000000299] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study examined the association between leukocyte telomere length--a marker of cell aging--and mortality in a nationally representative sample of US adults ages 50-84 years. We also examined moderating effects of age, sex, race/ethnicity, and education. METHODS Data were from the National Health and Nutrition Examination Survey, 1999-2002 (n = 3,091). Cox proportional hazards regression was used to estimate the risk of all-cause and cause- specific mortality adjusting for sociodemographic characteristics, smoking, body mass index, and chronic conditions. RESULTS Eight hundred and seventy deaths occurred over an average of 9.5 years of follow-up. In the full sample, a decrease of 1 kilobase pair in telomere length at baseline was marginally associated with a 10% increased hazard of all-cause mortality (hazard ratio [HR]: 1.1, 95% confidence interval [CI]: 0.9, 1.4) and a 30% increased hazard of death due to diseases other than cardiovascular disease or cancer (HR: 1.3, 95% CI: 0.9, 1.9). Among African-American but not white or Mexican-American respondents, a decrease of 1 kilobase pair in telomere length at baseline was associated with a two-fold increased hazard of cardiovascular mortality (HR: 2.0, 95% CI: 1.3, 3.1). There was no association between telomere length and cancer mortality. CONCLUSIONS The association between leukocyte telomere length and mortality differs by race/ethnicity and cause of death.
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Pesola GR, Argos M, Chen Y, Parvez F, Ahmed A, Hasan R, Rakibuz-Zaman M, Islam T, Eunus M, Sarwar G, Chinchilli VM, Neugut AI, Ahsan H. Dipstick proteinuria as a predictor of all-cause and cardiovascular disease mortality in Bangladesh: A prospective cohort study. Prev Med 2015; 78:72-7. [PMID: 26190365 PMCID: PMC4718561 DOI: 10.1016/j.ypmed.2015.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Baseline, persistent, incident, and remittent dipstick proteinuria have never been tested as predictors of mortality in an undeveloped country. The goal of this study was to determine which of these four types of proteinuria (if any) predict mortality. METHODS Baseline data was collected from 2000 to 2002 in Bangladesh from 11,121 adults. Vital status was ascertained over 11-12years. Cox models were used to evaluate proteinuria in relation to all-cause and cardiovascular disease (CVD) mortality. CVD mortality was evaluated only in those with baseline proteinuria. Persistent, remittent, and incident proteinuria were determined at the 2-year exam. RESULTS Baseline proteinuria of 1+ or greater was significantly associated with all-cause (hazard ratio (HR) 2.87; 95% C.I., 1.71-4.80) and CVD mortality (HR: 3.55; 95% C.I., 1.81-6.95) compared to no proteinuria, adjusted for age, gender, arsenic well water concentration, education, hypertension, BMI, smoking, and diabetes mellitus. Persistent 1+ proteinuria had a stronger risk of death, 3.49 (1.64-7.41)-fold greater, than no proteinuria. Incident 1+ proteinuria had a 1.87 (0.92-3.78)-fold greater mortality over 9-10years. Remittent proteinuria revealed no increased mortality. CONCLUSIONS Baseline, persistent, and incident dipstick proteinuria were predictors of all-cause mortality with persistent proteinuria having the greatest risk. In developing countries, those with 1+ dipstick proteinuria, particularly if persistent, should be targeted for definitive diagnosis and treatment. The two most common causes of proteinuria to search for are diabetes mellitus and hypertension.
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Affiliation(s)
- Gene R Pesola
- Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Medicine (Section of Pulmonary/Critical Care), Harlem Hospital affiliated with Columbia University, New York, NY, United States.
| | - Maria Argos
- Dept. of Health Sciences, University of Chicago, IL, United States
| | - Yu Chen
- Dept. of Environmental Medicine, New York University School of Medicine, New York, NY, United States
| | - Faruque Parvez
- Dept. of Environmental Health Sciences, Mailman School of Public Health, Columbia Univ., New York, NY, United States
| | - Alauddin Ahmed
- University of Chicago Research (URB), Ltd., Dhaka, Bangladesh
| | - Rabiul Hasan
- University of Chicago Research (URB), Ltd., Dhaka, Bangladesh
| | | | - Tariqul Islam
- University of Chicago Research (URB), Ltd., Dhaka, Bangladesh
| | - Mahbubul Eunus
- University of Chicago Research (URB), Ltd., Dhaka, Bangladesh
| | - Golam Sarwar
- University of Chicago Research (URB), Ltd., Dhaka, Bangladesh
| | - Vernon M Chinchilli
- Dept. of Public Health Studies, Penn State College of Medicine, Hershey, PA, United States
| | - Alfred I Neugut
- Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Medicine, Columbia University, New York, NY, United States
| | - Habibul Ahsan
- Dept. of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States; Dept. of Health Sciences, University of Chicago, IL, United States; Dept. of Environmental Health Sciences, Mailman School of Public Health, Columbia Univ., New York, NY, United States; University of Chicago Research (URB), Ltd., Dhaka, Bangladesh
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Rehm J, Lachenmeier DW, Room R. Why does society accept a higher risk for alcohol than for other voluntary or involuntary risks? BMC Med 2014; 12:189. [PMID: 25424648 PMCID: PMC4203927 DOI: 10.1186/s12916-014-0189-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Societies tend to accept much higher risks for voluntary behaviours, those based on individual decisions (for example, to smoke, to consume alcohol, or to ski), than for involuntary exposure such as exposure to risks in soil, drinking water or air. In high-income societies, an acceptable risk to those voluntarily engaging in a risky behaviour seems to be about one death in 1,000 on a lifetime basis. However, drinking more than 20 g pure alcohol per day over an adult lifetime exceeds a threshold of one in 100 deaths, based on a calculation from World Health Organization data of the odds in six European countries of dying from alcohol-attributable causes at different levels of drinking. DISCUSSION The voluntary mortality risk of alcohol consumption exceeds the risks of other lifestyle risk factors. In addition, evidence shows that the involuntary risks resulting from customary alcohol consumption far exceed the acceptable threshold for other involuntary risks (such as those established by the World Health Organization or national environmental agencies), and would be judged as not acceptable. Alcohol's exceptional status reflects vagaries of history, which have so far resulted in alcohol being exempted from key food legislation (no labelling of ingredients and nutritional information) and from international conventions governing all other psychoactive substances (both legal and illegal). This is along with special treatment of alcohol in the public health field, in part reflecting overestimation of its beneficial effect on ischaemic disease when consumed in moderation. SUMMARY A much higher mortality risk from alcohol than from other risk factors is currently accepted by high income countries.
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Affiliation(s)
- Jürgen Rehm
- />Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1 Canada
- />Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- />Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- />Institute of Medical Science, University of Toronto, Toronto, Canada
- />Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Dirk W Lachenmeier
- />Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- />Chemisches und Veterinäruntersuchungsamt Karlsruhe, Karlsruhe, Germany
| | - Robin Room
- />Centre for Alcohol Policy Research, Turning Point, Fitzroy, VIC Australia
- />Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Australia
- />Centre for Social Research on Alcohol & Drugs, Stockholm University, Stockholm, Sweden
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Koons DN, Gamelon M, Gaillard JM, Aubry LM, Rockwell RF, Klein F, Choquet R, Gimenez O. Methods for studying cause-specific senescence in the wild. Methods Ecol Evol 2014. [DOI: 10.1111/2041-210x.12239] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David N. Koons
- Department of Wildland Resources and the Ecology Center; Utah State University; 5230 Old Main Hill Logan UT 84322-5230 USA
- Centre d'Ecologie Fonctionnelle et Evolutive; Campus CNRS; UMR 5175; 1919 Route de Mende Montpellier Cedex 5 34293 France
| | - Marlène Gamelon
- Department of Biology, Centre for Biodiversity Dynamics; Norwegian University of Science and Technology; Trondheim N-7491 Norway
| | - Jean-Michel Gaillard
- Laboratoire de Biométrie et Biologie Evolutive; UMR 5558; Université de Lyon; Université Lyon 1 Villeurbanne F-69622 France
| | - Lise M. Aubry
- Department of Wildland Resources and the Ecology Center; Utah State University; 5230 Old Main Hill Logan UT 84322-5230 USA
- Centre d'Ecologie Fonctionnelle et Evolutive; Campus CNRS; UMR 5175; 1919 Route de Mende Montpellier Cedex 5 34293 France
| | - Robert F. Rockwell
- Division of Vertebrate Zoology; American Museum of Natural History; Central Park West at 79th Street New York NY 10024 USA
| | - François Klein
- Office National de la Chasse et de la Faune Sauvage; Centre d'Etude et de Recherche Appliquée Cervidés-Sanglier; 85 bis avenue de Wagram Paris 75008 France
| | - Rémi Choquet
- Centre d'Ecologie Fonctionnelle et Evolutive; Campus CNRS; UMR 5175; 1919 Route de Mende Montpellier Cedex 5 34293 France
| | - Olivier Gimenez
- Centre d'Ecologie Fonctionnelle et Evolutive; Campus CNRS; UMR 5175; 1919 Route de Mende Montpellier Cedex 5 34293 France
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The Relationship between “Protection of” and “Violence Against” Infants and Young Children: The U.S. Experience, 1940–2005. SOCIAL SCIENCES 2014. [DOI: 10.3390/socsci3030394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Webb RT, Lichtenstein P, Dahlin M, Kapur N, Ludvigsson JF, Runeson B. Unnatural deaths in a national cohort of people diagnosed with diabetes. Diabetes Care 2014; 37:2276-83. [PMID: 24848285 DOI: 10.2337/dc14-0005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine risk of unnatural death among people diagnosed with diabetes irrespective of disease type. RESEARCH DESIGN AND METHODS We conducted a matched cohort study of the entire Swedish population using interlinked national registers. From the National Diabetes Register we identified 252,191 people diagnosed with diabetes (type 1 or 2) during 1996-2009. Each cohort member was matched for age, sex, and county of birth to five unaffected individuals randomly sampled from the Total Population Register. Mortality was examined with complete ascertainment, and risk ratios (RRs) for all unnatural deaths and for specific causes (suicide, accident, homicide, and iatrogenic effects) were estimated using conditional fixed-effects Poisson regression. RESULTS Risk of any unnatural death was elevated versus the general population: 77.3 versus 32.1 per 10,000 (RR 2.2 [95% CI 2.1-2.4]), and these deaths occurred at a younger age in the diabetes cohort. Risk was increased for suicide (RR 3.4 [95% CI 3.0-3.8]), accident (RR 2.0 [95% CI 1.9-2.1]), homicide (RR 3.1 [95% CI 1.6-6.1]), and iatrogenic effects (RR 2.4 [95% CI 1.9-3.2]). It was greatly elevated for fatal poisoning from a variety of agents, including psychotropic drugs and "other and unspecified medication," as well as narcotics, alcohol, and carbon monoxide. Almost 9% of all fatal poisoning cases in the diabetes cohort were identified as overdoses of insulin or oral hypoglycemic drugs. CONCLUSIONS Various causes of unnatural death, in particular deliberate and accidental poisonings, occur more frequently among diabetic patients. Before preventive strategies can be implemented, a deeper understanding of the risk factors and causal mechanisms explaining the marked elevations in risk is needed.
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Affiliation(s)
- Roger T Webb
- Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, U.K.
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marie Dahlin
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Navneet Kapur
- Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, U.K
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenDepartment of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
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Klijs B, Nusselder WJ, Looman CW, Mackenbach JP. Educational disparities in the burden of disability: contributions of disease prevalence and disabling impact. Am J Public Health 2014; 104:e141-8. [PMID: 24922134 DOI: 10.2105/ajph.2014.301924] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We assessed the contributions of the prevalence and disabling impact of specific diseases to educational disparities in the prevalence of disability. METHODS We examined a large representative survey of the Dutch population, the Dutch Permanent Survey of Living Conditions (2001-2007; n = 24 883; ages 40-97 years). We attributed the prevalence of disability to chronic diseases by using their empirical associations and assuming independent competing causes of disability. We estimated contributions of prevalence and the disabling impact of diseases to disparities in disability using counterfactuals. RESULTS We found that the prevalence of disability in individuals with only an elementary education was 19 to 20 percentage points higher than that in individuals with tertiary education. Sixty-five percent of this difference could be attributed to specific chronic diseases, but more so to their disabling impact (49%-51%) than to their prevalence (20%-29%). Back pain, neck or arm conditions, and peripheral vascular disease contributed most to the disparity in men, and arthritis, back pain, and chronic nonspecific lung disease contributed most to the disparity in women. CONCLUSIONS Educational disparities in the burden of disability were primarily caused by high disabling impacts of chronic diseases among low educated groups. Tackling disparities might require more effective treatment or rehabilitation of disability in lower socioeconomic groups.
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Affiliation(s)
- Bart Klijs
- At the time of the study, Bart Klijs, Wilma J. Nusselder, Caspar W. Looman, and Johan P. Mackenbach were with the Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. Bart Klijs was also with the Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
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Charvat H, Bossard N, Daubisse L, Binder F, Belot A, Remontet L. Probabilities of dying from cancer and other causes in French cancer patients based on an unbiased estimator of net survival: A study of five common cancers. Cancer Epidemiol 2013; 37:857-63. [DOI: 10.1016/j.canep.2013.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 06/10/2013] [Accepted: 08/13/2013] [Indexed: 11/15/2022]
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Wang GD, Lai DJ, Burau KD, Du XL. Potential gains in life expectancy from reducing heart disease, cancer, Alzheimer's disease, kidney disease or HIV/AIDS as major causes of death in the USA. Public Health 2013; 127:348-56. [PMID: 23507421 DOI: 10.1016/j.puhe.2013.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/06/2012] [Accepted: 01/06/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Potential gains in life expectancy (PGLEs) that give proper consideration to competing risks are an effective indicator for measuring the impact of multiple causes of death on a defined population. This study aimed to assess PGLE by hypothetically reducing the major causes of death in the USA from 2001 to 2008. STUDY DESIGN PGLEs due to the reduction and elimination of heart disease, cancer, Alzheimer's disease, kidney disease or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) were calculated by age, gender and race. METHODS Age-specific mortality rates for the above diseases from the National Center for Health Statistics were used, and multiple decremental life tables were constructed to compute the corresponding PGLEs. RESULTS PGLEs due to the elimination of heart disease, cancer or HIV/AIDS decreased from 2001 to 2008, but PGLEs due to the elimination of Alzheimer's disease or kidney disease increased over time. For heart disease, PGLE in 2001-2008 for all races was 2.78-2.15 for females vs 2.41-2.06 for males. For cancer, PGLE in 2001-2008 for all races was 2.97-2.81 for females vs 3.02-2.85 for males. HIV/AIDS has a greater impact on people of working age, whereas Alzheimer's disease has a greater impact on the elderly population. To compare the impacts of these diseases on life expectancy, partial multiple decremental life tables were constructed, and PGLEs were computed by a partial reduction or complete elimination of various causes of death for the entire life span as well as for certain working ages. CONCLUSION This study outlined a picture of how each category of diseases could affect life expectancy in the US population by age, race or sex. The findings may assist in evaluating current public health improvements, and also provide useful information for directing future research and disease control programmes.
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Affiliation(s)
- G D Wang
- University of Texas School of Public Health, Houston, TX 77030, USA
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Nau C, Firebaugh G. A new method for determining why length of life is more unequal in some populations than in others. Demography 2012; 49:1207-30. [PMID: 23011942 PMCID: PMC4104684 DOI: 10.1007/s13524-012-0133-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Why is there greater variability in individual longevity in some populations than in others? We propose a decomposition method designed to address that question by quantifying the effects of population differences in the spread, allocation, and timing of the principal causes of death. Applying the method to the United States and Sweden, we find that spread effects account for about two-thirds of the greater variance in age at death among American adults, meaning that two-thirds of the U.S.-Sweden difference would persist if the two countries differed only with respect to within-cause variance among adults. The remainder of the difference is due largely to allocation effects, with the greater incidence of homicides and fatal traffic accidents alone accounting for more than one-fourth of the greater variance in age at death among adults in the United States.
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Affiliation(s)
- Claudia Nau
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA,
| | - Glenn Firebaugh
- Department of Sociology, Pennsylvania State University, 206 Oswald Tower, University Park, PA 16802, USA,
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Binbing Yu, Tiwari RC, Feuer EJ. Estimating the personal cure rate of cancer patients using population-based grouped cancer survival data. Stat Methods Med Res 2011; 20:261-74. [PMID: 20181780 PMCID: PMC2888754 DOI: 10.1177/0962280209347046] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer patients are subject to multiple competing risks of death and may die from causes other than the cancer diagnosed. The probability of not dying from the cancer diagnosed, which is one of the patients' main concerns, is sometimes called the 'personal cure' rate. Two approaches of modelling competing-risk survival data, namely the cause-specific hazards approach and the mixture model approach, have been used to model competing-risk survival data. In this article, we first show the connection and differences between crude cause-specific survival in the presence of other causes and net survival in the absence of other causes. The mixture survival model is extended to population-based grouped survival data to estimate the personal cure rate. Using the colorectal cancer survival data from the Surveillance, Epidemiology and End Results Programme, we estimate the probabilities of dying from colorectal cancer, heart disease, and other causes by age at diagnosis, race and American Joint Committee on Cancer stage.
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Affiliation(s)
- Binbing Yu
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD 20892, USA.
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Abreu DMXD, César CC, França EB. [Gender differences in avoidable mortality in Brazil (1983-2005)]. CAD SAUDE PUBLICA 2010; 25:2672-82. [PMID: 20191158 DOI: 10.1590/s0102-311x2009001200014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 09/11/2009] [Indexed: 11/22/2022] Open
Abstract
The aim of the article was to analyze gender differences in mortality in 117 Brazilian municipalities from 1983 to 2005, based on three groups of causes of avoidable death: (1) avoidable through early diagnosis and treatment, (2) avoidable by improvements in quality of treatment and medical care, and (3) ischemic heart disease. The association between avoidable mortality and demographic and socioeconomic conditions and healthcare variables was analyzed through negative binomial regression. The multiple decrement technique was used to evaluate the impact of avoidable causes on life expectancy for men and women. Men showed a higher risk of death for all three groups of avoidable causes, after controlling for selected variables. Women would gain more than men, with an increase of up to five years in life expectancy, if avoidable causes were eliminated by diagnosis and early treatment. Further research is needed in gender-related factors, which may be related to differential mortality rates in men and women.
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Affiliation(s)
- Daisy Maria Xavier de Abreu
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena 190, Belo Horizonte, MG, Brazil.
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Abstract
Based on the findings of retrospective studies, there has been growing interest in the potential therapeutic benefits of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy in patients with heart failure. The first published prospective randomized study of statins in heart failure patients did not demonstrate improved clinical outcomes (death and nonfatal myocardial infarction or stroke) after treatment with 10 mg daily of rosuvastatin when compared with placebo. However, use of rosuvastatin was associated with a reduced risk of hospitalization when compared with placebo and was well tolerated. Until further information becomes available, routine use of statins is not recommended in the heart failure population.
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Affiliation(s)
- Stuart D Katz
- Yale Heart Failure and Transplant Center, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
The population of patients with HIV infection achieving viral suppression on combination antiretroviral therapy is growing, aging, and experiencing a widening spectrum of non-AIDS diseases. Concurrently, AIDS-defining conditions are becoming less common and are variably associated with outcome. Nonetheless, the spectrum of disease experienced by those aging with HIV remains strongly influenced by HIV, its treatment, and the behaviors, conditions, and demographics associated with HIV infection. Our focus must shift from a narrow interest in CD4 counts, HIV-RNA, and AIDS-defining illnesses to determining the optimal management of HIV infection as a complex chronic disease in which the causes of morbidity and mortality are multiple and overlapping. We need a new paradigm of care with which to maximize functional status, minimize frailty, and prolong life expectancy. A composite index that summarizes a patient's risk of morbidity and mortality could facilitate this work and help chart its progress.
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Affiliation(s)
- Amy C Justice
- Yale University Schools of Medicine and Public Health, New Haven, USA.
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Redelings M, Lieb L, Sorvillo F. Years off your life? The effects of homicide on life expectancy by neighborhood and race/ethnicity in Los Angeles county. J Urban Health 2010; 87:670-6. [PMID: 20556528 PMCID: PMC2900567 DOI: 10.1007/s11524-010-9470-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Homicide is one of the leading causes of death in Los Angeles County and is known to be elevated in low-income urban neighborhoods and in black males. However, because homicide occurs primarily among young adults, mortality rate statistics may underrepresent its importance. We estimated the impact of homicide on life expectancy by demographic group and geographic area in Los Angeles County, 2001-2006. Life expectancy estimates were calculated using mortality records and population estimates for Los Angeles County. Cause elimination techniques were used to estimate the impact of homicide on life expectancy. Homicide was estimated to reduce life expectancy by 0.4 years for Los Angeles County residents and by 2.1 years for black males. The impact of homicide on life expectancy was higher in low-income neighborhoods. In some low-income urban neighborhoods, homicide was estimated to decrease life expectancy in black males by nearly 5 years. Homicide causes substantial reductions in life expectancy in Los Angeles County. Its impact is magnified among black males and in low-income urban areas, underscoring the need for homicide reduction in urban centers.
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Affiliation(s)
- Matthew Redelings
- Los Angeles County Department of Public Health, Data Collection and Analysis Unit, Los Angeles, CA, USA.
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Askoxylakis V, Thieke C, Pleger ST, Most P, Tanner J, Lindel K, Katus HA, Debus J, Bischof M. Long-term survival of cancer patients compared to heart failure and stroke: a systematic review. BMC Cancer 2010; 10:105. [PMID: 20307299 PMCID: PMC2851688 DOI: 10.1186/1471-2407-10-105] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/22/2010] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cancer, heart failure and stroke are among the most common causes of death worldwide. Investigation of the prognostic impact of each disease is important, especially for a better understanding of competing risks. Aim of this study is to provide an overview of long term survival of cancer, heart failure and stroke patients based on the results of large population- and hospital-based studies. METHODS Records for our study were identified by searches of Medline via Pubmed. We focused on observed and relative age- and sex-adjusted 5-year survival rates for cancer in general and for the four most common malignancies in developed countries, i.e. lung, breast, prostate and colorectal cancer, as well as for heart failure and stroke. RESULTS Twenty studies were identified and included for analysis. Five-year observed survival was about 43% for all cancer entities, 40-68% for stroke and 26-52% for heart failure. Five-year age and sex adjusted relative survival was 50-57% for all cancer entities, about 50% for stroke and about 62% for heart failure. In regard to the four most common malignancies in developed countries 5-year relative survival was 12-18% for lung cancer, 73-89% for breast cancer, 50-99% for prostate cancer and about 43-63% for colorectal cancer. Trend analysis revealed a survival improvement over the last decades. CONCLUSIONS The results indicate that long term survival and prognosis of cancer is not necessarily worse than that of heart failure and stroke. However, a comparison of the prognostic impact of the different diseases is limited, corroborating the necessity for further systematic investigation of competing risks.
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Affiliation(s)
- Vasileios Askoxylakis
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Thieke
- Department of Radiation Therapy, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Patrick Most
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Judith Tanner
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Katja Lindel
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Marc Bischof
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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The extent and distribution of inequalities in childhood mortality by cause of death according to parental socioeconomic positions: A birth cohort study in South Korea. Soc Sci Med 2009; 69:1116-26. [DOI: 10.1016/j.socscimed.2009.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Indexed: 11/21/2022]
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Brand RE, Greer JB, Zolotarevsky E, Brand R, Du H, Simeone D, Zisman A, Gorchow A, Lee SYC, Roy HK, Anderson MA. Pancreatic cancer patients who smoke and drink are diagnosed at younger ages. Clin Gastroenterol Hepatol 2009; 7:1007-12. [PMID: 19560558 PMCID: PMC2736339 DOI: 10.1016/j.cgh.2009.06.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 06/12/2009] [Accepted: 06/17/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cigarette smoking is an established risk factor for pancreatic cancer, but there is conflicting evidence regarding the effects of alcohol consumption. The effects of cigarettes and alcohol on age of sporadic pancreatic cancer diagnosis have not been examined; we evaluated the independent and synergistic effects of lifetime cigarette smoking and alcohol consumption on age at pancreatic cancer diagnosis in the United States. METHODS We analyzed data on cigarette smoking and alcohol consumption from the IMPAC Services, Inc Cancer Information Resource File (CIRF), collected from June 1, 1993, to December 31, 2003, for 29,239 reported, histologically confirmed cases of pancreatic adenocarcinoma. We also analyzed data on cigarette smoking and alcohol consumption for 820 histologically confirmed cases of pancreatic adenocarcinoma from the University of Michigan Pancreatic Cancer Registry (UMPCR), collected from January 2004 to October 2007. RESULTS Current cigarette smokers were diagnosed at significantly younger ages than never smokers, according to data from the CIRF and UMPCR (8.3 and 6.3 y, respectively); the UMPCR data indicated dose effects. Past and current alcohol consumption were associated with younger age at diagnosis in both databases. Current smokers who were current drinkers were diagnosed significantly earlier (CIRF, 10.2 y; UMPCR, 8.6 y) than abstainers. Past cigarette smoking was associated modestly with younger diagnosis age. CONCLUSIONS Cigarette smoking and alcohol consumption were associated with younger age at pancreatic cancer presentation and have a combined effect on diagnosis age. Past cigarette smoking is less influential. Smoking cessation programs could help prevent pancreatic cancer.
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Affiliation(s)
- Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and University of Pittsburgh Medical Center, Hillman Cancer Center, 5117 Centre Avenue, Pittsburgh, Pennsylvania 15213, USA.
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Abstract
BACKGROUND AND OBJECTIVE In the last two decades, major changes have occurred in both the epidemiology and the healthcare of cancer, which have had a substantial impact on the mortality due to this disease. The objective of this study was to analyze cancer mortality trends in Catalonia in the previous 20 years and to compare these trends with those in Europe. SUBJECTS AND METHODS Mortality data were gathered from the mortality register of the Department of Health of Catalonia, which includes all deaths in Catalonia from 1985-2004. The causes of death are coded according to the International Classification of Diseases (ICD-9 for 1985-1998 and ICD-10 for 1999-2004). The population data used were inter-census (1985-2000), census (2001) and post-census (2002-2004) estimates from the Catalan Institute of Statistics. Ageadjusted rates (AR) (to the world population of 1960) and accumulated rates from 0 to 74 years old were calculated. A Poisson model was adjusted to the AR to estimate the mortality trend and the annual percentage of change was calculated for the years 1985-1994 and 1995- 2004 and for the period 1985-2002 as a whole. RESULTS From 1985-2004, the risk of dying from cancer decreased from 18.54 % to 17.49% in men and from 9.24% to 7.69% in women. The adjusted rate of mortality decreased in cancer of the larynx (2,52%), prostate (1.11%) and stomach (2.89%) in men and in stomach cancer (-3.64) in women. In men, there was a significant increase in mortality from colorectal cancer (an increase of 2.8% to 1994 with subsequent stabilization) and from lung cancer (an increase of 1.36% to 1994 with a subsequent decrease). Cancer of the liver showed a nonsignificant increase until 1994 with a subsequent decrease of 3.13%. In women, breast cancer increased until 1994 (1.48%) and subsequently significantly decreased (2.72%). Lung cancer increased throughout the entire period but this increase was only significant (4,81%) in the last decade. CONCLUSIONS In the last two decades, cancer mortality has shown a general decreasing trend, although mortality from several tumors has substantially increased. Compared with other European countries, Catalonia shows lower cancer mortality in women than in men. Nevertheless, the trends shown in the last decade are similar to those followed by the countries in the best positions.
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Life expectancy and age–period–cohort effects: analysis and projections of mortality in Spain between 1977 and 2016. Public Health 2009; 123:156-62. [DOI: 10.1016/j.puhe.2008.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 09/19/2008] [Accepted: 10/28/2008] [Indexed: 11/20/2022]
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Peterson RKD, Davis RS, Higley LG, Fernandes OA. Mortality risk in insects. ENVIRONMENTAL ENTOMOLOGY 2009; 38:2-10. [PMID: 19791592 DOI: 10.1603/022.038.0102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Understanding how and why insect numbers fluctuate through time and space has been a central theme in ecological research for more than a century. Life tables have been used to understand temporal and spatial patterns in insect numbers. In this study, we estimated cause-of-death probabilities for phytophagous insects using multiple decrement life tables and the irreplaceable mortality analytic technique. Multiple decrement life tables were created from 73 insect life tables published from 1954 to 2004. Irreplaceable mortality (the portion of mortality that cannot be replaced by another cause) from pathogens, predators, and parasitoids was 8.6 +/- 7.2, 7.8 +/- 4.9, and 6.2 +/- 1.6%, respectively. In contrast, the mean irreplaceable mortality from all non-natural enemy mortality factors (mortality from factors other than natural enemies) was 35.1 +/- 4.4%. Irreplaceable mortality from natural enemies was significantly lower compared with non-natural enemy factors. Our results may partially explain cases of unsuccessful efficacy in classical biological control, after successful establishment, by showing low irreplaceable mortality for natural enemies, including 5.2 +/- 1.6% for introduced natural enemies. We suggest that the environment (i.e., the degree of environmental stability) influences the magnitude of the irreplaceable mortality from natural enemies. Our results lead to several testable hypotheses and emphasize that it is not possible to estimate the effect of any mortality factor without considering its interaction with competing mortality factors, which has far-reaching consequences for population biology and applied ecology.
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Affiliation(s)
- Robert K D Peterson
- Department of Land Resources and Environmental Sciences, Montana State University, 334 Leon Johnson Hall, Bozeman, MT 59717-3120, USA.
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Vilaprinyo E, Gispert R, Martínez-Alonso M, Carles M, Pla R, Espinàs JA, Rué M. Competing risks to breast cancer mortality in Catalonia. BMC Cancer 2008; 8:331. [PMID: 19014473 PMCID: PMC2636833 DOI: 10.1186/1471-2407-8-331] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 11/12/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions. METHODS The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death. RESULTS There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945-54 in the 40-49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts. CONCLUSION We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia.
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Affiliation(s)
- Ester Vilaprinyo
- Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Hospitalet de Llobregat Catalonia, Spain.
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Ma Z(S, Bechinski EJ. A survival-analysis-based simulation model for Russian wheat aphid population dynamics. Ecol Modell 2008. [DOI: 10.1016/j.ecolmodel.2008.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ma Z, Krings AW. Multivariate Survival Analysis (I): Shared Frailty Approaches to Reliability and Dependence Modeling. ACTA ACUST UNITED AC 2008. [DOI: 10.1109/aero.2008.4526618] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Race, Occupation, and Lung Cancer: Detecting Disparities With Death Certificate Data. J Occup Environ Med 2007; 49:1257-63. [DOI: 10.1097/jom.0b013e318154c094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brand RM, Jones DD, Lynch HT, Brand RE, Watson P, Ashwathnayaran R, Roy HK. Risk of colon cancer in hereditary non-polyposis colorectal cancer patients as predicted by fuzzy modeling: Influence of smoking. World J Gastroenterol 2006; 12:4485-91. [PMID: 16874859 PMCID: PMC4125634 DOI: 10.3748/wjg.v12.i28.4485] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether a fuzzy logic model could predict colorectal cancer (CRC) risk engendered by smoking in hereditary non-polyposis colorectal cancer (HNPCC) patients.
METHODS: Three hundred and forty HNPCC mismatch repair (MMR) mutation carriers from the Creighton University Hereditary Cancer Institute Registry were selected for modeling. Age-dependent curves were generated to elucidate the joint effects between gene mutation (hMLH1 or hMSH2), gender, and smoking status on the probability of developing CRC.
RESULTS: Smoking significantly increased CRC risk in male hMSH2 mutation carriers (P < 0.05). hMLH1 mutations augmented CRC risk relative to hMSH2 mutation carriers for males (P < 0.05). Males had a significantly higher risk of CRC than females for hMLH1 non smokers (P < 0.05), hMLH1 smokers (P < 0.1) and hMSH2 smokers (P < 0.1). Smoking promoted CRC in a dose-dependent manner in hMSH2 in males (P < 0.05). Females with hMSH2 mutations and both sexes with the hMLH1 groups only demonstrated a smoking effect after an extensive smoking history (P < 0.05).
CONCLUSION: CRC promotion by smoking in HNPCC patients is dependent on gene mutation, gender and age. These data demonstrate that fuzzy modeling may enable formulation of clinical risk scores, thereby allowing individualization of CRC prevention strategies.
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Affiliation(s)
- Rhonda M Brand
- Division of Emergency Medicine, Department of Internal Medicine, Evanston Northwestern Healthcare and Feinberg School of Medicine at Northwestern University, Evanston, IL 60201, USA.
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Lai DJ, Tarwater PM, Hardy RJ. Measuring the impact of HIV/AIDS, heart disease and malignant neoplasms on life expectancy in the USA from 1987 to 2000. Public Health 2006; 120:486-92. [PMID: 16730037 DOI: 10.1016/j.puhe.2005.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 11/11/2005] [Accepted: 12/07/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Quantifying the impact of a disease on society is an important issue for setting priorities for better allocation of healthcare resources and for evaluating the effectiveness of prevention and control of the disease. STUDY DESIGN The potential gains in life expectancy due to the elimination of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), heart disease and malignant neoplasms were compared for the US population by age and ethnicity from 1987 to 2000. METHODS The potential gain in life expectancy after hypothetical elimination of cause-specific deaths is an effective indicator of measuring the impact of a disease on a population. Official age-specific mortality rates, by ethnicity, due to HIV/AIDS, heart disease and malignant neoplasms of the US population from the National Center for Health Statistics were used, and multiple decremental life tables were constructed to find the corresponding potential gains in life expectancy. RESULTS The potential gains in life expectancy for the US population at birth by complete elimination of HIV/AIDS, heart disease and malignant neoplasms were 0.14, 3.71 and 3.06 years in 1987, respectively. In 1995, the potential gain in life expectancy due to the elimination of HIV/AIDS increased from 0.14 years in 1987 and achieved its highest value (0.41 years), whereas the elimination of heart disease and malignant neoplasms led to potential gains in life expectancy of 3.05 and 3.10 years, respectively. Since 1995, the potential gains in life expectancy at birth by eliminating deaths from HIV/AIDS and heart disease have decreased to 0.13 and 2.67 years, respectively, in 2000. However, the potential gain in life expectancy due to elimination of malignant neoplasms remained relatively stable (3.01 years in 2000). It is well known that HIV/AIDS tends to have a greater impact on people of working age, whereas heart disease and malignant neoplasms have a greater impact on people over 65 years of age. To measure the impact of these diseases on life expectancy in people of working age, a partial multiple decremental life table was constructed and the potential gains in life expectancy were computed by partial or complete elimination of various causes of death during the working years. shows the impact on life expectancy of the US working-age population by eliminating deaths from HIV/AIDS, heart disease and malignant neoplasms by race and sex groups. CONCLUSIONS Since 1995, there has been a rapid reduction in the burden of HIV/AIDS on the life expectancy for the US population, especially for black males of working age. These results could provide useful information when evaluating public health improvements and allocating resources for future disease control programmes.
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Affiliation(s)
- D J Lai
- School of Public Health, The University of Texas, Houston, TX 77030, USA.
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Perreault S, Levinton C, Laurier C, Moride Y, Ste-Marie LG, Crott R. Validation of a decision model for preventive pharmacological strategies in postmenopausal women. Eur J Epidemiol 2005; 20:89-101. [PMID: 15756909 DOI: 10.1007/s10654-004-9478-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Benefits and risks of a combined hormone replacement therapy (HRT) based on randomized clinical trial emerged on various disease endpoints in 2002. The Women's Health Initiative (WHI) provides an important health answer for healthy postmenopausal women, such as do not use combined HRT to prevent chronic disease, because of the elevated risk of coronary artery disease (CHD), stroke and venous thromboembolism. In March 2004, the NIH stopped the drugs in the estrogen-alone trial after finding an increase risk of stroke and no effect, neither an increase or a decrease, on risk of CHD after an average of 7 years in the trial. On the other hand, raloxifene, which does not seem to significantly increase the risk of cardiovascular events and could retain skeletal benefits without stimulating endometrial and breast tissue, requires decision-makers since no current data on these disease clinical endpoints have been published. OBJECTIVE To construct a multi-disease model based on patient-specific risk factor profiles, and to validate the multi-disease model with several tools of internal and external validities. METHODS A Markov state model was developed. The risks of these various diseases (including coronary artery disease, stroke, hip fracture and breast cancer) are derived from published hazards proportional models which take into account significant risk factors. Canadian-specific rates and data sources for these transition probabilities are derived from published studies and Canadian Health Statistics. The validation of our model were based on several tools of internal and external validities, such as Canadian life expectancy, population-based incidence rate of diseases, clinical trials and other published life expectancy models. RESULTS First, presumably, small changes in the lifetime probability of dying support the hypothesis that the disease states operate in a largely independent fashion. For instance, the difference in the probability of dying from a particular disease by the complete elimination of a selected disease, such as CHD, stroke or breast cancer, ranged from 0.2 to 2.2% of difference in the lifetime probability of dying of these diseases. Second, we demonstrated that the model adequately predicted the Canadian population lifetable and disease-incidence rates from population-based data among women from 45 to 75 years old. The predictions of the model were cross-checked from non-source data, such as predicted outcomes versus observed outcomes from results of clinical trials. Predicted relative risks of CHD event, breast cancer and hip fracture fell in the reported 95% confidence interval of clinical trials. Finally, predicted treatment benefits are comparable with those of published life expectancy models. CONCLUSIONS The results of the study demonstrated that this multi-disease model, including coronary artery disease, stroke, hip fracture and breast cancer, is a valid model to predict the impact on life expectancy or number of events prevented for preventive pharmacological interventions.
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Abstract
The concept of bias is the lack of internal validity or incorrect assessment of the association between an exposure and an effect in the target population in which the statistic estimated has an expectation that does not equal the true value. Biases can be classified by the research stage in which they occur or by the direction of change in a estimate. The most important biases are those produced in the definition and selection of the study population, data collection, and the association between different determinants of an effect in the population. A definition of the most common biases occurring in these stages is given.
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Abstract
We used the potential gains in life expectancy to quantify the impact of eliminating HIV/AIDS,heart disease and malignant neoplasms on the life expectancy of the population of the USA from 1987 to 1999 by race and sex groups. We previously reported the results from 1987 to 1992,with a focus on the year 1992. This report gives an update to 1999, showing the impact of improvements in the care and treatment of HIV/AIDS in recent years.
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Affiliation(s)
- Dejian Lai
- School of Public Health, University of Texas, Houston, TX, USA
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Llorca J, Delgado-Rodríguez M. Análisis de supervivencia en presencia de riesgos competitivos: estimadores de la probabilidad de suceso. GACETA SANITARIA 2004; 18:391-7. [PMID: 15498410 DOI: 10.1016/s0213-9111(04)71850-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To show the impact of competing risks of death on survival analysis. METHOD We provide an example of survival time without chronic rejection after heart transplantation, where death before rejection acts as a competing risk. Using a computer simulation, we compare the Kaplan-Meier estimator and the multiple decrement model. RESULTS The Kaplan-Meier method overestimated the probability of rejection. Next, we illustrate the use of the multiple decrement model to analyze secondary end points (in our example: death after rejection). Finally, we discuss Kaplan-Meier assumptions and why they fail in the presence of competing risks. CONCLUSIONS Survival analysis should be adjusted for competing risks of death to avoid overestimation of the risk of rejection produced with the Kaplan-Meier method.
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Affiliation(s)
- Javier Llorca
- Medicina Preventiva y Salud Pública. Facultad de Medicina de la Universidad de Cantabria. Santander. Spain
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Miller BG, Hurley JF. Life table methods for quantitative impact assessments in chronic mortality. J Epidemiol Community Health 2003; 57:200-6. [PMID: 12594196 PMCID: PMC1732393 DOI: 10.1136/jech.57.3.200] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Quantitative health impact assessments of chronic mortality, where the impacts are expected to be observed over a number of years, are complicated by the link between death rates and surviving populations. A general calculation framework for quantitative impact assessment is presented, based on standard life table calculation methods, which permits consistent future projections of impacts on mortality from changes in death rates. Implemented as a series of linked spreadsheets, the framework offers complete flexibility in the sex specific, age specific, and year specific patterns of baseline mortality death rates; in the predicted impacts upon these; in the weights or values placed on gains in life; and in the summary measures of impact. Impacts can be differential by cause of death. Some examples are given of predictions of the impacts of reductions in chronic mortality in the populations of England and Wales and of Scotland.
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Affiliation(s)
- B G Miller
- Institute of Occupational Medicine, Edinburgh, UK.
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Abstract
BACKGROUND Mortality from all causes is higher for persons with fewer years of education and for blacks, but it is unknown which diseases contribute most to these disparities. METHODS We estimated cause-specific risks of death from data from the National Health Interview Survey conducted from 1986 through 1994 and from linked vital statistics. Using these risk estimates, we calculated potential years of life lost and potential gains in life expectancy related to specific causes, with stratification according to education level and race. RESULTS Persons without a high-school education lost 12.8 potential life-years per person in the population, as compared with 3.6 for persons who graduated from high school (ratio, 3.5; P<0.001). Ischemic heart disease contributed most (11.7 percent) to the difference according to education in potential life-years lost (with all cardiovascular diseases accounting for 35.3 percent). All cancers accounted for 26.5 percent, including 7.7 percent due to lung cancer; other lung diseases and pneumonia contributed 10.1 percent of the total, whereas human immunodeficiency virus (HIV) disease accounted for none of the difference according to education. The pattern of disparities according to level of income was similar to that according to level of education. Blacks and whites lost 7.0 and 5.2 potential life-years per person, respectively, as a result of deaths from any cause (ratio, 1.35; P<0.001). Cardiovascular diseases accounted for one third of this disparity, in large part because of hypertension (15.0 percent); HIV disease (11.2 percent) contributed almost as much as ischemic heart disease (5.5 percent), stroke (2.8 percent), and cancer (3.4 percent) combined; trauma and diabetes mellitus accounted for 10.7 percent and 8.5 percent, respectively. CONCLUSIONS Although many conditions contribute to socioeconomic and racial disparities in potential life-years lost, a few conditions account for most of these disparities - smoking-related diseases in the case of mortality among persons with fewer years of education, and hypertension, HIV, diabetes mellitus, and trauma in the case of mortality among black persons. These findings have important implications for targeting efforts to reduce existing disparities in mortality rates.
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Affiliation(s)
- Mitchell D Wong
- Division of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles 90095-1736, USA.
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Wohlfahrt J, Andersen PK. Commentary: Secular trends in the context of competing risks. Int J Epidemiol 2001; 30:102-3. [PMID: 11171867 DOI: 10.1093/ije/30.1.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Wohlfahrt
- Department of Epidemiology Research, Danish Epidemiology Science Center, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.
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Llorca J, Delgado-Rodríguez M. Competing risks analysis using Markov chains: impact of cerebrovascular and ischaemic heart disease in cancer mortality. Int J Epidemiol 2001; 30:99-101. [PMID: 11171866 DOI: 10.1093/ije/30.1.99] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A decrease in cerebrovascular disease (CVD) and ischaemic heart disease (IHD) mortality can produce an increase in mortality from other causes, even cancer. This problem is called the competing risks problem. METHODS A Markov chain is used to analyse the interrelation between CVD, IHD and cancer mortalities in Spanish women in 1981 and 1994. We compare the results using two models: discarding CVD and IHD mortality (the elimination model) and substituting CVD and IHD 1981 mortality rates in 1994 figures (the constant model). RESULTS Removing mortality from CVD and IHD increases cancer mortality rates in women aged > or = 70, and the probability of death from cancer rises from 10.7% to 13.3%. In the second model, the use of CVD and IHD 1981 mortality rates in 1994 data yields slightly lower mortality rates and so the impact of CVD and IHD mortality changes in the period 1981 to 1994 is negligible except in elderly women. CONCLUSIONS Although IHD and CVD mortality have decreased in all age groups of Spanish women from 1981 to 1994, this has not had a great impact on cancer mortality.
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Affiliation(s)
- J Llorca
- Division of Preventive Medicine and Public Health, University of Cantabria, School of Medicine, Santander, Spain.
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Llorca J, Delgado-Rodríguez M. Competing risks in absence of independence: impact of AIDS on liver function failure mortality, and lung cancer on ischemic heart disease mortality. J Clin Epidemiol 2000; 53:1145-9. [PMID: 11106888 DOI: 10.1016/s0895-4356(00)00231-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The increase in lung cancer (LC) mortality can produce a decrease in mortality from other causes, including ischemic heart disease (IHD). This problem (called the competing risks problem) has been addressed usually assuming independence between the competing causes of death. Our purpose is to show that assuming dependence of causes of death allows obtaining a better estimation of cumulative mortality. We use a clinical epidemiological example on the impact of AIDS in liver function failure in a cohort of drug users. The competing effect under dependence is 47% higher than under independence. This result is compared with a population-based example on LC and IHD mortalities in Spanish people in 1992. LC and IHD share tobacco smoking as a common risk factor, so independence cannot be assumed. Under the independence assumption, both life expectancy and number of deaths from IHD are underestimated. The difference is small compared to the model computed under dependence and it occurs mainly in the elderly (0.3% more deaths in people aged 70 and over).
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Affiliation(s)
- J Llorca
- Division of Preventive Medicine and Public Health, University of Cantabria School of Medicine, Av. Cardenal Herrera Oria s/n 39011-Santander, Spain.
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Chiang CL. My life as a statistician ***. COMMUN STAT-THEOR M 2000. [DOI: 10.1080/03610920008832523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Llorca J, Delgado-Rodríguez M. [Competing death risks]. GACETA SANITARIA 1999; 13:399-406. [PMID: 10564852 DOI: 10.1016/s0213-9111(99)71391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The death of an individual is not a repetitive event, so if a cause of death overtakes another cause in producing death, mortality rates from the overtaken cause decrease. This phenomenon is known as competing risks of death and it must be taken into account in any cause-specific mortality analysis. In this work the competing risks concept is formalized and some historical data are described. The main parametric tools to analyze competing risks are displayed, with a special look at the Gompertz and Weibull functions. Regarding non-parametric models, the Chiang method is shown and its applicability on both dependent and independent causes of death is discussed. Finally, other tools specially useful in clinical epidemiology are enumerated, including Cox regression, Kaplan-Meier and log-rank methods, as well as the interactions between competing risks and misclassification and selection biases.
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Affiliation(s)
- J Llorca
- Cátedra de Medicina Preventiva y Salud Pública, Facultad de Medicina, Santander, Cantabria, 39011, España
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