Life expectancy of HIV-positive individuals on combination antiretroviral therapy in Canada.

PubMed

Patterson, Sophie; Cescon, Angela; Samji, Hasina; Chan, Keith; Zhang, Wendy; Raboud, Janet; Burchell, Ann N; Cooper, Curtis; Klein, Marina B; Rourke, Sean B; Loutfy, Mona R; Machouf, Nima; Montaner, Julio S G; Tsoukas, Chris; Hogg, Robert S

2015-07-17

We sought to evaluate life expectancy and mortality of HIV-positive individuals initiating combination antiretroviral therapy (ART) across Canada, and to consider the potential error introduced by participant loss to follow-up (LTFU). Our study used data from the Canadian Observational Cohort (CANOC) collaboration, including HIV-positive individuals aged ≥18 years who initiated ART on or after January 1, 2000. The CANOC collaboration collates data from eight sites in British Columbia, Ontario, and Quebec. We computed abridged life-tables and remaining life expectancies at age 20 and compared outcomes by calendar period and patient characteristics at treatment initiation. To correct for potential underreporting of mortality due to participant LTFU, we conservatively estimated 30% mortality among participants lost to follow-up. 9997 individuals contributed 49,589 person-years and 830 deaths for a crude mortality rate of 16.7 [standard error (SE) 0.6] per 1000 person-years. When assigning death to 30% of participants lost to follow-up, we estimated 1170 deaths and a mortality rate of 23.6 [SE 0.7] per 1000 person-years. The crude overall life expectancy at age 20 was 45.2 [SE 0.7] and 37.5 [SE 0.6] years after adjusting for LTFU. In the LTFU-adjusted analysis, lower life expectancy at age 20 was observed for women compared to men (32.4 [SE 1.1] vs. 39.2 [SE 0.7] years), for participants with injection drug use (IDU) history compared to those without IDU history (23.9 [SE 1.0] vs. 52.3 [SE 0.8] years), for participants reporting Aboriginal ancestry compared to those with no Aboriginal ancestry (17.7 [SE 1.5] vs. 51.2 [SE 1.0] years), and for participants with CD4 count <350 cells/μL compared to CD4 count ≥350 cells/μL at treatment initiation (36.3 [SE 0.7] vs. 43.5 [SE 1.3] years). Life expectancy at age 20 in the calendar period 2000-2003 was lower than in periods 2004-2007 and 2008-2012 in the LTFU-adjusted analyses (30.8 [SE 0.9] vs. 38.6 [SE 1.0] and 54.2 [SE 1.4]). Life expectancy and mortality for HIV-positive individuals receiving ART differ by calendar period and patient characteristics at treatment initiation. Failure to consider LTFU may result in underestimation of mortality rates and overestimation of life expectancy.

Age of Migration Differentials in Life Expectancy with Cognitive Impairment: 20-Year Findings From the Hispanic-EPESE.

PubMed

Garcia, Marc A; Saenz, Joseph L; Downer, Brian; Chiu, Chi-Tsun; Rote, Sunshine; Wong, Rebeca

2017-05-09

To examine differences in life expectancy with cognitive impairment among older Mexican adults according to nativity (U.S.-born/foreign-born) and among immigrants, age of migration to the United States. This study employs 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent cognitively healthy and cognitively impaired prior to death among older Mexican adults residing in the southwestern United States. We combine age-specific mortality rates with age-specific prevalence of cognitive impairment, defined as a Mini-Mental Status Exam score of less than 21 points to calculate Sullivan-based life table models with and without cognitive impairment in later life. Foreign-born Mexican immigrants have longer total life expectancy and comparable cognitive healthy life expectancy regardless of gender compared to U.S.-born Mexican-Americans. However, the foreign-born spend a greater number of years after age 65 with cognitive impairment relative to their U.S.-born counterparts. Furthermore, we document an advantage in life expectancy with cognitive impairment and proportion of years after age 65 cognitively healthy among mid-life immigrant men and women relative to early- and late-life migrants. The relationship between nativity, age of migration, and life expectancy with cognitive impairment means that the foreign-born are in more need of support and time-intensive care in late life. This issue merits special attention to develop appropriate and targeted screening efforts that reduce cognitive decline for diverse subgroups of older Mexican-origin adults as they age. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Modeling absolute differences in life expectancy with a censored skew-normal regression approach

PubMed Central

Clough-Gorr, Kerri; Zwahlen, Marcel

2015-01-01

Parameter estimates from commonly used multivariable parametric survival regression models do not directly quantify differences in years of life expectancy. Gaussian linear regression models give results in terms of absolute mean differences, but are not appropriate in modeling life expectancy, because in many situations time to death has a negative skewed distribution. A regression approach using a skew-normal distribution would be an alternative to parametric survival models in the modeling of life expectancy, because parameter estimates can be interpreted in terms of survival time differences while allowing for skewness of the distribution. In this paper we show how to use the skew-normal regression so that censored and left-truncated observations are accounted for. With this we model differences in life expectancy using data from the Swiss National Cohort Study and from official life expectancy estimates and compare the results with those derived from commonly used survival regression models. We conclude that a censored skew-normal survival regression approach for left-truncated observations can be used to model differences in life expectancy across covariates of interest. PMID:26339544

Comparing population health in the United States and Canada

PubMed Central

2010-01-01

Background The objective of the paper is to compare population health in the United States (US) and Canada. Although the two countries are very similar in many ways, there are potentially important differences in the levels of social and economic inequality and the organization and financing of and access to health care in the two countries. Methods Data are from the Joint Canada/United States Survey of Health 2002/03. The Health Utilities Index Mark 3 (HUI3) was used to measure overall health-related quality of life (HRQL). Mean HUI3 scores were compared, adjusting for major determinants of health, including body mass index, smoking, education, gender, race, and income. In addition, estimates of life expectancy were compared. Finally, mean HUI3 scores by age and gender and Canadian and US life tables were used to estimate health-adjusted life expectancy (HALE). Results Life expectancy in Canada is higher than in the US. For those < 40 years, there were no differences in HRQL between the US and Canada. For the 40+ group, HRQL appears to be higher in Canada. The results comparing the white-only population in both countries were very similar. For a 19-year-old, HALE was 52.0 years in Canada and 49.3 in the US. Conclusions The population of Canada appears to be substantially healthier than the US population with respect to life expectancy, HRQL, and HALE. Factors that account for the difference may include access to health care over the full life span (universal health insurance) and lower levels of social and economic inequality, especially among the elderly. PMID:20429875

Homicides In Mexico Reversed Life Expectancy Gains For Men And Slowed Them For Women, 2000–10

PubMed Central

Aburto, José Manuel; Beltrán-Sánchez, Hiram; García-Guerrero, Victor Manuel; Canudas-Romo, Vladimir

2017-01-01

Life expectancy in Mexico increased for more than six decades but then stagnated in the period 2000–10. This decade was characterized by the enactment of a major health care reform—the implementation of the Seguro Popular de Salud (Popular Health Insurance), which was intended to provide coverage to the entire Mexican population—and by an unexpected increase in homicide mortality. We assessed the impact on life expectancy of conditions amenable to medical service—those sensitive to public health policies and changes in behaviors, homicide, and diabetes—by analyzing mortality trends at the state level. We found that life expectancy among males deteriorated from 2005 to 2010, compared to increases from 2000 to 2005. Females in most states experienced small gains in life expectancy between 2000 and 2010. The unprecedented rise in homicides after 2005 led to a reversal in life expectancy increases among males and a slowdown among females in most states in the first decade of the twenty-first century. PMID:26733705

The New Demographic Transition: Most Gains in Life Expectancy Now Realized Late in Life

PubMed Central

Eggleston, Karen N.; Fuchs, Victor R.

2013-01-01

The share of increases in life expectancy realized after age 65 was only about 20 percent at the beginning of the 20th century for the US and 16 other countries at comparable stages of development; but that share was close to 80 percent by the dawn of the 21st century, and is almost certainly approaching 100 percent asymptotically. This new demographic transition portends a diminished survival effect on working life. For high-income countries at the forefront of the longevity transition, expected lifetime labor force participation as a percent of life expectancy is declining. Innovative policies are needed if societies wish to preserve a positive relationship running from increasing longevity to greater prosperity. PMID:25076810

Closing the Gaps: competing estimates of Indigenous Australian life expectancy in the scientific literature

PubMed Central

Rosenstock, Amanda; Mukandi, Bryan; Zwi, Anthony B; Hill, Peter S

2013-01-01

Objective: Closing the gap in life expectancy between Indigenous and other Australians within a generation is central to national Indigenous reform policy (Closing the Gap). Over time, various methods of estimating Indigenous life expectancy and with that, the life expectancy gap, have been adopted with differing, albeit non-comparable results. We present data on the extent of the gap and elucidate the pattern of use and interpretations of the different estimates of the gap, between 2007 and 2012. Methods: An extensive search was conducted for all peer-reviewed health publications citing estimates of and/or discussing the life expectancy of Indigenous Australians, for the period 2007–2012. Results: Five predominant patterns of citation of the gap estimates were identified: 20 years, 17 years, 15–20 years, 13 years, and 11.5 years for males and 9.7 years for females. Some authors misinterpret the most recent estimates as reflecting improvement from the 17-year figure, rather than the result of different methods of estimation. Support for the direct methods used to calculate Indigenous life expectancy is indicated. Conclusions and Implications: A specific estimate of the life expectancy gap has not been established among stakeholders in Indigenous health. Agreement on the magnitude of the gap is arguably needed in order to evaluate strategies aimed at improving health outcomes for Indigenous Australians. Moreover, measuring progress towards ‘closing the gap’ depends on the availability of comparable estimates, using the same techniques of measurement to assess changes over time. PMID:23895479

Continuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness.

PubMed

Kerlikowske, K; Salzmann, P; Phillips, K A; Cauley, J A; Cummings, S R

1999-12-08

Mammography is recommended and is cost-effective for women aged 50 to 69 years, but the value of continuing screening mammography after age 69 years is not known. In particular, older women with low bone mineral density (BMD) have a lower risk of breast cancer and may benefit less from continued screening. To compare life expectancy and cost-effectiveness of screening mammography in elderly women based on 3 screening strategies. Decision analysis and cost-effectiveness analysis using a Markov model. General population of women aged 65 years or older. The analysis compared 3 strategies: (1) Undergoing biennial mammography from age 65 to 69 years; (2) undergoing biennial mammography from age 65 to 69 years, measurement of distal radial BMD at age 65 years, discontinuing screening at age 69 years in women in the lowest BMD quartile for age, and continuing biennial mammography to age 79 years in those in the top 3 quartiles of distal radius BMD; and (3) undergoing biennial mammography from age 65 to 79 years. Deaths due to breast cancer averted, life expectancy, and incremental cost-effectiveness ratios. Compared with discontinuing mammography screening at age 69 years, measuring BMD at age 65 years in 10000 women and continuing mammography to age 79 years only in women with BMD in the top 3 quartiles would prevent 9.4 deaths and add, on average, 2.1 days to life expectancy at an incremental cost of $66773 per year of life saved. Continuing mammography to age 79 years in all 10000 elderly women would prevent 1.4 additional breast cancer deaths and add only 7.2 hours to life expectancy at an incremental cost of $117689 per year of life saved compared with only continuing mammography to age 79 years in women with BMD in the top 3 quartiles. This analysis suggests that continuing mammography screening after age 69 years results in a small gain in life expectancy and is moderately cost-effective in those with high BMD and more costly in those with low BMD. Women's preferences for a small gain in life expectancy and the potential harms of screening mammography should play an important role when elderly women are deciding about screening.

Living healthier for longer: Comparative effects of three heart-healthy behaviors on life expectancy with and without cardiovascular disease

PubMed Central

2009-01-01

Background Non-smoking, having a normal weight and increased levels of physical activity are perhaps the three key factors for preventing cardiovascular disease (CVD). However, the relative effects of these factors on healthy longevity have not been well described. We aimed to calculate and compare the effects of non-smoking, normal weight and physical activity in middle-aged populations on life expectancy with and without cardiovascular disease. Methods Using multi-state life tables and data from the Framingham Heart Study (n = 4634) we calculated the effects of three heart healthy behaviours among populations aged 50 years and over on life expectancy with and without cardiovascular disease. For the life table calculations, we used hazard ratios for 3 transitions (No CVD to CVD, no CVD to death, and CVD to death) by health behaviour category, and adjusted for age, sex, and potential confounders. Results High levels of physical activity, never smoking (men), and normal weight were each associated with 20-40% lower risks of developing CVD as compared to low physical activity, current smoking and obesity, respectively. Never smoking and high levels of physical activity reduced the risks of dying in those with and without a history of CVD, but normal weight did not. Never-smoking was associated with the largest gains in total life expectancy (4.3 years, men, 4.1 years, women) and CVD-free life expectancy (3.8 and 3.4 years, respectively). High levels of physical activity and normal weight were associated with lesser gains in total life expectancy (3.5 years, men and 3.4 years, women, and 1.3 years, men and 1.0 year women, respectively), and slightly lesser gains in CVD-free life expectancy (3.0 years, men and 3.1 years, women, and 3.1 years men and 2.9 years women, respectively). Normal weight was the only behaviour associated with a reduction in the number of years lived with CVD (1.8 years, men and 1.9 years, women). Conclusions Achieving high levels of physical activity, normal weight, and never smoking, are effective ways to prevent cardiovascular disease and to extend total life expectancy and the number of years lived free of CVD. Increasing the prevalence of normal weight could further reduce the time spent with CVD in the population. PMID:20034381

Life Expectancy in Police Officers: A Comparison with the U.S. General Population

PubMed Central

Violanti, John M.; Hartley, Tara A.; Gu, Ja K.; Fekedulegn, Desta; Andrew, Michael E.; Burchfiel, Cecil M.

2016-01-01

Previous epidemiological research indicates that police officers have an elevated risk of death relative to the general population overall and for several specific causes. Despite the increased risk for mortality found in previous research, controversy still exists over the life expectancy of police officers. The goal of the present study was to compare life expectancy of male police officers from Buffalo New York with the U.S. general male population utilizing an abridged life table method. On average, the life expectancy of Buffalo police officers in our sample was significantly lower than the U.S. population (mean difference in life expectancy =21.9 years; 95% CI: 14.5-29.3; p<0.0001). Life expectancy of police officers was shorter and differences were more pronounced in younger age categories. Additionally, police officers had a significantly higher average probability of death than did males in the general population (mean difference= 0.40; 95% CI: 0.26,-0.54; p<0.0001). The years of potential life lost (YPLL) for police officers was 21 times larger than that of the general population (Buffalo male officers vs. U.S. males = 21.7, 95% CI: 5.8-37.7). Possible reasons for shorter life expectancy among police are discussed, including stress, shift work, obesity, and hazardous environmental work exposures. PMID:24707585

Temporal polyethism, life expectancy, and entropy of workers of the ant Ectatomma vizottoi Almeida, 1987 (Formicidae: Ectatomminae).

PubMed

Santana Vieira, Alexsandro; Desidério Fernandes, Wedson; Fernando Antonialli-Junior, William

2010-05-01

We investigated the changes in the behavioral repertoire over the course of life and determined the life expectancy and entropy of workers of the ant Ectatomma vizottoi. Newly emerged ants were individually marked with model airplane paint for observation of behaviors and determination of the age and life expectancy. Ants were divided into two groups: young and old workers. The 36 behaviors observed were divided into eight categories. Workers exhibit a clear division of tasks throughout their lives, with young workers performing more tasks inside the colony and old workers, outside, unlike species that have small colonies. This species also exhibits an intermediate life expectancy compared to workers of other species that are also intermediary in size. This supports the hypothesis of a relationship between size and maximum life expectancy, but it also suggests that other factors may also be acting in concert. Entropy value shows a high mortality rate during the first life intervals.

[Mortality due to traffic injuries and its impact on life expectancy: a comparison between Mexico and Spain].

PubMed

González-Pérez, Guillermo Julián; Vega-López, María Guadalupe; Cabrera-Pivaral, Carlos Enrique

2015-09-01

To determine the impact of mortality due to motor vehicle traffic injuries (MVTI) compared with other causes of death on life expectancy in Mexico and Spain during the three-year periods 2000-2002 and 2010-2012 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. Based on official death and population data, abridged life tables in Mexico and Spain were constructed for the three-year periods studied. Temporary life expectancy and YLEL for persons aged 15 to 75 years were calculated by selected causes (MVTI, diabetes mellitus, malignant neoplasms and ischemic heart diseases) and age groups in each three-year period. In Spain, YLEL decreased in both sexes from all the causes studied, especially MVTI; this reduction was greater in the younger ages. In addition, temporary life expectancy increased. In Mexico, YLEL due to MVTI increased in men, mainly in young people, and remained unchanged among women. Temporary life expectancy declined in men but increased slightly among women. The reduction in YLEL due to MVTI in Spain has contributed to increased life expectancy. By contrast, the increase in YLEL due to MVTI among Mexican men has contributed to the decline in male life expectancy. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

[Heath and political regimes: presidential or parliamentary government for Colombia?].

PubMed

Idrovo, Alvaro J

2007-01-01

Changing the presidential regime for a parliamentarian one is currently be-ing discussed in Colombia. This preliminary study explores the potential effects on health of both presidential and parliamentary regimes by using world-wide data. An ecological study was undertaken using countries from which comparable information concerning life-expectancy at birth, political regime, economic development, inequality in income, social capital (as measured by general-ised trust or Corruption Perceptions Index), political rights, civil freedom and cultural diversity could be obtained. Life-expectancy at birth and macro-determinants were compared between both political regimes. The co-relationship between these macro-determinants was estimated and the relationship between political regimen and life-expectancy at birth was estimated using robust regression. Crude analysis revealed that parliamentary countries have greater life-expectancy at birth than countries having a presidential regime. Significant co-relationships between all macro-determinants were observed. No differential effects were observed between both political regimes regarding life-expectancy at birth in multiple robust regressions. There is no evidence that presidential or parliamentary regimes provide greater levels of health for the population. It is suggested that public health policies be focused on other macro-determinants having more known effects on health, such as income inequality.

Treating Chronically Ill Diabetic Patients with Limited Life Expectancy: Implications for Performance Measurement

PubMed Central

Woodard, LeChauncy D.; Landrum, Cassie R.; Urech, Tracy H.; Profit, Jochen; Virani, Salim S.; Petersen, Laura A.

2012-01-01

Background/Objectives To validly assess quality-of-care differences among providers, performance measurement programs must reliably identify and exclude patients for whom the quality indicator may not be desirable, including those with limited life expectancy. We developed an algorithm to identify patients with limited life expectancy and examined the impact of limited life expectancy on glycemic control and treatment intensification among diabetic patients. Design We identified diabetic patients with coexisting congestive heart failure, chronic obstructive pulmonary disease, dementia, end-stage liver disease, and/or primary/metastatic cancers with limited life expectancy. To validate our algorithm, we assessed 5-year mortality among patients identified as having limited life expectancy. We compared rates of meeting performance measures for glycemic control between patients with and without limited life expectancy. Among uncontrolled patients, we examined the impact of limited life expectancy on treatment intensification within 90 days. Setting 110 Veterans Administration facilities; October 2006 – September 2007 Participants 888,628 diabetic patients Measurements Hemoglobin A1c (HbA1c) <9%; treatment intensification within 90 days Results 29,016 (3%) patients had limited life expectancy. Adjusting for age, 5-year mortality was 5 times higher among patients with limited life expectancy than those without. Patients with limited life expectancy had poorer glycemic control (77.1% vs. 78.1%) and less frequent treatment intensification (20.9% vs. 28.6%) than patients without, even after controlling for patient-level characteristics (odds ratio [OR]=0.84; 95% confidence interval [CI]=0.81-0.86 and OR=0.71; 95% CI=0.67-0.76, respectively). Conclusion Patients with limited life expectancy were slightly, but significantly less likely than those without to have HbA1c levels controlled and to receive treatment intensification, suggesting that providers treat these patients less aggressively. Quality measurement and performance-based reimbursement systems should acknowledge the different needs of this population. PMID:22260627

A revised method for calculation of life expectancy tables from individual death records which provides increased accuracy at advanced ages.

PubMed

Mathisen, R W; Mazess, R B

1981-02-01

The authors present a revised method for calculating life expectancy tables for populations where individual ages at death are known or can be estimated. The conventional and revised methods are compared using data for U.S. and Hungarian males in an attempt to determine the accuracy of each method in calculating life expectancy at advanced ages. Means of correcting errors caused by age rounding, age exaggeration, and infant mortality are presented

Question order sensitivity of subjective well-being measures: focus on life satisfaction, self-rated health, and subjective life expectancy in survey instruments.

PubMed

Lee, Sunghee; McClain, Colleen; Webster, Noah; Han, Saram

2016-10-01

This study examines the effect of question context created by order in questionnaires on three subjective well-being measures: life satisfaction, self-rated health, and subjective life expectancy. We conducted two Web survey experiments. The first experiment (n = 648) altered the order of life satisfaction and self-rated health: (1) life satisfaction asked immediately after self-rated health; (2) self-rated health immediately after life satisfaction; and (3) two items placed apart. We examined their correlation coefficient by experimental condition and further examined its interaction with objective health. The second experiment (n = 479) asked life expectancy before and after parental mortality questions. Responses to life expectancy were compared by order using ANOVA, and we examined interaction with parental mortality status using ANCOVA. Additionally, response time and probes were examined. Correlation coefficients between self-rated health and life satisfaction differed significantly by order: 0.313 (life satisfaction first), 0.508 (apart), and 0.643 (self-rated health first). Differences were larger among respondents with chronic conditions. Response times were the shortest when self-rated health was asked first. When life expectancy asked after parental mortality questions, respondents reported considering parents more for answering life expectancy; and respondents with deceased parents reported significantly lower expectancy, but not those whose parents were alive. Question context effects exist. Findings suggest placing life satisfaction and self-rated health apart to avoid artificial attenuation or inflation in their association. Asking about parental mortality prior to life expectancy appears advantageous as this leads respondents to consider parental longevity more, an important factor for true longevity.

Life Expectancy and Cause-Specific Mortality in Type 2 Diabetes: A Population-Based Cohort Study Quantifying Relationships in Ethnic Subgroups.

PubMed

Wright, Alison K; Kontopantelis, Evangelos; Emsley, Richard; Buchan, Iain; Sattar, Naveed; Rutter, Martin K; Ashcroft, Darren M

2017-03-01

This study 1 ) investigated life expectancy and cause-specific mortality rates associated with type 2 diabetes and 2 ) quantified these relationships in ethnic subgroups. This was a cohort study using Clinical Practice Research Datalink data from 383 general practices in England with linked hospitalization and mortality records. A total of 187,968 patients with incident type 2 diabetes from 1998 to 2015 were matched to 908,016 control subjects. Abridged life tables estimated years of life lost, and a competing risk survival model quantified cause-specific hazard ratios (HRs). A total of 40,286 deaths occurred in patients with type 2 diabetes. At age 40, white men with diabetes lost 5 years of life and white women lost 6 years compared with those without diabetes. A loss of between 1 and 2 years was observed for South Asians and blacks with diabetes. At age older than 65 years, South Asians with diabetes had up to 1.1 years' longer life expectancy than South Asians without diabetes. Compared with whites with diabetes, South Asians with diabetes had lower adjusted risks for mortality from cardiovascular (HR 0.82; 95% CI 0.75, 0.89), cancer (HR 0.43; 95% CI 0.36, 0.51), and respiratory diseases (HR 0.60; 95% CI 0.48, 0.76). A similar pattern was observed in blacks with diabetes compared with whites with diabetes. Type 2 diabetes was associated with more years of life lost among whites than among South Asians or blacks, with older South Asians experiencing longer life expectancy compared with South Asians without diabetes. The findings support optimized cardiovascular disease risk factor management, especially in whites with type 2 diabetes. © 2017 by the American Diabetes Association.

Disparities of Potential Gains in Life Expectancy Development between the Slovak Republic and the Czech Republic.

PubMed

Vagašová, Tatiana; Gavurová, Beáta

2017-12-01

The purpose of this paper is to determine how many years a person could be expected to live if a specific cause of death was eliminated, and to compare potential gains in life expectancy (PGLEs) between Slovakia (SVK) and the Czech Republic (CZE). PGLEs were computed from mortality reports (1996-2013) for deaths from the main groups of chronic diseases, namely ischaemic heart disease (IHD), cerebrovascular diseases (CVD), cancer (CA), diabetes mellitus (DM), and chronic respiratory diseases (CRD) for the Slovak and Czech populations in five-year age groups. Country comparative analysis was conducted by constructing rate ratios of PGLEs. In 2013, life expectancy at birth for the Slovak and Czech populations was 76.5 and 78.3 years. Overall trends of standardised mortality rates of chronic diseases roughly paralleled the PGLEs trend. During 1996-2013, SVK reported the highest PGLEs of IHD at an average of 4.54 years, compared to PGLEs of CA reaching a value of 3.61 years in CZE. The PGLEs of IHD showed the largest gap between SVK and CZE, with an average of 1.65 higher values in SVK. With the elimination of CVD as the third most influential disease in both countries, PGLEs decreased from 1.65 to 0.93 years in CZE; a negligible drop from 1.13 to 1.05 was recorded in SVK. The lowest impacts on life expectancy were recorded in DM and CRD. However, since 2005 these trends have deteriorated in CZE. In 2013, IHD had a similar impact on life expectancy in all age groups in SVK and a decreasing impact among 50-54 year olds in CZE. Similarly to SVK, people in CZE aged 45-49 could gain 0.94 years in LE after CVD elimination, which is nearly the same as at birth. The higher the life expectancy after elimination of the cause of death is, the higher the impact of the disease on life expectancy. Health prevention programs should be mainly aimed at CA mortality in CZE, while the highest burden of IHD is seen in SVK. Copyright© by the National Institute of Public Health, Prague 2017.

Receipt of Cancer Screening Is a Predictor of Life Expectancy.

PubMed

Goodwin, James S; Sheffield, Kristin; Li, Shuang; Tan, Alai

2016-11-01

Obtaining cancer screening on patients with limited life expectancy has been proposed as a measure for low quality care for primary care physicians (PCPs). However, administrative data may underestimate life expectancy in patients who undergo screening. To determine the association between receipt of screening mammography or PSA and overall survival. Retrospective cohort study from 1/1/1999 to 12/31/2012. Receipt of screening was assessed for 2001-2002 and survival from 1/1/2003 to 12/31/2012. Life expectancy was estimated as of 1/1/03 using a validated algorithm, and was compared to actual survival for men and women, stratified by receipt of cancer screening. A 5 % sample of Medicare beneficiaries aged 69-90 years as of 1/1/2003 (n = 906,723). Receipt of screening mammography in 2001-2002 for women, or a screening PSA test in 2002 for men. Survival from 1/1/2003 through 12/31/2012. Subjects were stratified by life expectancy based on age and comorbidity. Within each stratum, the subjects with prior cancer screening had actual median survivals higher than those who were not screened, with differences ranging from 1.7 to 2.1 years for women and 0.9 to 1.1 years for men. In a Cox model, non-receipt of screening in women had an impact on survival (HR = 1.52; 95 % CI = 1.51, 1.54) similar in magnitude to a diagnosis of complicated diabetes or heart failure, and was comparable to uncomplicated diabetes or liver disease in men (HR = 1.23; 1.22, 1.25). Receipt of cancer screening is a powerful marker of health status that is not captured by comorbidity measures in administrative data. Because life expectancy algorithms using administrative data underestimate the life expectancy of patients who undergo screening, they can overestimate the problem of cancer screening in patients with limited life expectancy.

Losing ground--Swedish life expectancy in a comparative perspective.

PubMed

Drefahl, Sven; Ahlbom, Anders; Modig, Karin

2014-01-01

In the beginning of the 1970s, Sweden was the country where both women and men enjoyed the world's longest life expectancy. While life expectancy continues to be high and increasing, Sweden has been losing ground in relation to other leading countries. We look at life expectancy over the years 1970-2008 for men and women. To assess the relative contributions of age, causes of death, and smoking we decompose differences in life expectancy between Sweden and two leading countries, Japan and France. This study is the first to use this decomposition method to observe how smoking related deaths contribute to life expectancy differences between countries. Sweden has maintained very low mortality at young and working ages for both men and women compared to France and Japan. However, mortality at ages above 65 has become considerably higher in Sweden than in the other leading countries because the decrease has been faster in those countries. Different trends for circulatory diseases were the largest contributor to this development in both sexes but for women also cancer played a role. Mortality from neoplasms has been considerably low for Swedish men. Smoking attributable mortality plays a modest role for women, whereas it is substantially lower in Swedish men than in French and Japanese men. Sweden is losing ground in relation to other leading countries with respect to life expectancy because mortality at high ages improves more slowly than in the leading countries, especially due to trends in cardiovascular disease mortality. Trends in smoking rates may provide a partial explanation for the trends in women; however, it is not possible to isolate one single explanatory factor for why Sweden is losing ground.

Gender, nutritional status and disability-free life expectancy among older people in Santiago, Chile

PubMed Central

Albala, Cecilia; Lera, Lydia; Leyton, Bárbara; Angel, Bárbara; Sánchez, Hugo

2018-01-01

Background This study was aimed to estimate life expectancy (LE), disability-free life expectancy (DFLE) and disabled life expectancy (DLE) among older adults from Santiago, Chile, and to determine the existence of differences by gender and by body mass index (BMI) categories in these indicators. Methods A sample of 1216 people aged 60 or more, from the Chilean cohort of the Study of Health, Ageing and Well-Being was recruited in 2000; two follow-up assessments were carried out in a 10-year period. Functional limitation was assessed through self-report of difficulties in activities of daily living, instrumental activities of daily living and mobility. BMI was determined with measured weight and height. Multistate life tables were employed to estimate LE and healthy life expectancy (HLE). Results At 60 years, women could expect to live on average an additional 20.4 years (95% CI 19.0–21.6), and men an additional 16.4 years (95% CI 14.9–17.7). Total LE was longer among women at all ages, but they had a higher proportion of disabled years to be lived compared to men, with a difference of 14% at 60 years, and 10% at 90 years. There were no significant differences in LE, DFLE and DLE between BMI categories. Discussion Despite a longer LE, Chilean older women expect to live a higher proportion of years with disabilities, compared to men. Public health programs should address factors affecting LE of older men, and those associated with disability among older women. PMID:29590148

Homicides In Mexico Reversed Life Expectancy Gains For Men And Slowed Them For Women, 2000-10.

PubMed

Aburto, José Manuel; Beltrán-Sánchez, Hiram; García-Guerrero, Victor Manuel; Canudas-Romo, Vladimir

2016-01-01

Life expectancy in Mexico increased for more than six decades but then stagnated in the period 2000-10. This decade was characterized by the enactment of a major health care reform-the implementation of the Seguro Popular de Salud (Popular Health Insurance), which was intended to provide coverage to the entire Mexican population-and by an unexpected increase in homicide mortality. We assessed the impact on life expectancy of conditions amenable to medical service-those sensitive to public health policies and changes in behaviors, homicide, and diabetes-by analyzing mortality trends at the state level. We found that life expectancy among males deteriorated from 2005 to 2010, compared to increases from 2000 to 2005. Females in most states experienced small gains in life expectancy between 2000 and 2010. The unprecedented rise in homicides after 2005 led to a reversal in life expectancy increases among males and a slowdown among females in most states in the first decade of the twenty-first century. Project HOPE—The People-to-People Health Foundation, Inc.

Gender difference in health expectancy trends in Greenland.

PubMed

Mairey, Isabelle; Bjerregaard, Peter; Brønnum-Hansen, Henrik

2014-12-01

The population of Greenland comprises almost 31,000 Inuit Greenlanders aged 20-65. The purpose of this study was to estimate trends in expected life years between age 20 and 65 in good and poor health, and to compare changes between men and women since the mid-1990s. Partial life expectancy was calculated and combined with prevalence data on self-rated health, longstanding illness and musculoskeletal diseases derived from health surveys carried out in 1993-94, 1999-2001 and 2005-10. Trends for men and women were compared and changes were decomposed into contributions from changes in mortality and disability. Partial life expectancy increased by 2.2 years for men and 0.8 years for women during the entire period. However, expected lifetime in self-rated good health decreased by 3.3 years for men and by 4.6 years for women (p<0.01). For men, life expectancy without longstanding illness increased by 4.7 years (p<0.001). The increase for women by 1.4 years was non-significant (p=0.29). Expected lifetime without musculoskeletal diseases increased significantly by 4.5 years for men and by 1.9 years for women. The development of expected lifetime without longstanding illness supports the theory of compression of morbidity, but as the trend direction differs according to which measure for health is used, a definite conclusion cannot be drawn. The different rate of development of partial life expectancy and expected lifetime in good health between men and women is remarkable, and has reduced the gender gap. The results call for special concern about the women's health in Greenland. © 2014 the Nordic Societies of Public Health.

Improving life expectancy: how many years behind has the USA fallen? A cross-national comparison among high-income countries from 1958 to 2007

PubMed Central

Verguet, Stéphane; Jamison, Dean T

2013-01-01

Objective Many studies have documented higher mortality levels in the USA compared to other high-income nations. We add to this discussion by quantifying how many years behind comparison countries the USA has fallen and by identifying when US mortality rates began to diverge. Design We use full life tables, for men and women, for 17 high-income countries including the USA. We extract the life expectancy at birth and compute the mortality rates for each 5-year age group from birth up to age 80. Using the metric of how many ‘years behind’ a country has fallen, we compare US mortality levels with those in other high-income countries (‘comparators’). Results We report life expectancy for 17 high-income countries, for the period 1958–2007. Up to the late 1970s, US men and especially women closely tracked comparators in life expectancy. In the late 1970s in the USA, most strikingly women began to diverge from comparators so that the US female life expectancy in 2007 corresponded to that of the comparators’ average 10 years earlier. Mortality rates also began to diverge from the late 1970s, and the largest mortality gap was in the 15–49 age group, for both men and women, where the USA had fallen about 40 years behind the comparators by 2007. Conclusions Some causes proposed for the relatively high US mortality today—racial differences, lack of universal health insurance, US exceptionalism—changed little while the mortality gap emerged and grew. This suggests that explanations for the growing gap lie elsewhere. Quantification of how many years behind the USA has fallen can help provide clues about where to look for potential causes and remedies. PMID:23833143

Family (Dis)Advantage and Life Course Expectations*

PubMed Central

Johnson, Monica Kirkpatrick; Hitlin, Steven

2016-01-01

Optimistic assessments of life chances can positively influence life outcomes, but conflicting theories suggest these assessments either reflect structural privilege or develop as a result of childhood hardship. In addition, competing hypotheses suggest that these assessments may matter differently depending on who holds them. We examine whether family socioeconomic status shapes adolescents’ expectations about how successful their lives will turn out. We distinguish generalized life expectations (GLE), capturing anticipated success in life across multiple domains, from intergenerational comparative expectations (ICE), which register expectations about improvement relative to observed success within the respondent’s family lineage. We find that adolescents from higher socioeconomic status families are simultaneously more optimistic about their likely success in life (GLE) but less likely to anticipate relative improvement in life success across generations (ICE). Holding high GLE in combination with low ICE predicted doing better in adulthood across a range of health, attainment, and well-being outcomes, though in most cases high GLE, regardless of ICE, was the key. These beneficial patterns are, for the most part, at least as beneficial for socioeconomically disadvantaged youth as they are for advantaged youth. PMID:28408766

Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age

PubMed Central

Ciaranello, Andrea L.; Doherty, Kathleen; Penazzato, Martina; Lindsey, Jane C.; Harrison, Linda; Kelly, Kathleen; Walensky, Rochelle P.; Essajee, Shaffiq; Losina, Elena; Muhe, Lulu; Wools-Kaloustian, Kara; Ayaya, Samuel; Weinstein, Milton C.; Palumbo, Paul; Freedberg, Kenneth A.

2015-01-01

Background: The International Maternal, Pediatric, and Adolescent Clinical Trials P1060 trial demonstrated superior outcomes for HIV-infected children less than 3 years old initiating antiretroviral therapy (ART) with lopinavir/ritonavir compared to nevirapine, but lopinavir/ritonavir is four-fold costlier. Design/methods: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model, with published and P1060 data, to project outcomes under three strategies: no ART; first-line nevirapine (with second-line lopinavir/ritonavir); and first-line lopinavir/ritonavir (second-line nevirapine). The base-case examined South African children initiating ART at age 12 months; sensitivity analyses varied all key model parameters. Outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios [ICERs; dollars/year of life saved ($/YLS)]. We considered interventions with ICERs less than 1× per-capita gross domestic product (South Africa: $7500)/YLS as ‘very cost-effective,’ interventions with ICERs below 3× gross domestic product/YLS as ‘cost-effective,’ and interventions leading to longer life expectancy and lower lifetime costs as ‘cost-saving’. Results: Projected life expectancy was 2.8 years with no ART. Both ART regimens markedly improved life expectancy and were very cost-effective, compared to no ART. First-line lopinavir/ritonavir led to longer life expectancy (28.8 years) and lower lifetime costs ($41 350/person, from lower second-line costs) than first-line nevirapine (27.6 years, $44 030). First-line lopinavir/ritonavir remained cost-saving or very cost-effective compared to first-line nevirapine unless: liquid lopinavir/ritonavir led to two-fold higher virologic failure rates or 15-fold greater costs than in the base-case, or second-line ART following first-line lopinavir/ritonavir was very ineffective. Conclusions: On the basis of P1060 data, first-line lopinavir/ritonavir leads to longer life expectancy and is cost-saving or very cost-effective compared to first-line nevirapine. This supports WHO guidelines, but increasing access to pediatric ART is critical regardless of the regimen used. PMID:25870982

Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age.

PubMed

Ciaranello, Andrea L; Doherty, Kathleen; Penazzato, Martina; Lindsey, Jane C; Harrison, Linda; Kelly, Kathleen; Walensky, Rochelle P; Essajee, Shaffiq; Losina, Elena; Muhe, Lulu; Wools-Kaloustian, Kara; Ayaya, Samuel; Weinstein, Milton C; Palumbo, Paul; Freedberg, Kenneth A

2015-06-19

The International Maternal, Pediatric, and Adolescent Clinical Trials P1060 trial demonstrated superior outcomes for HIV-infected children less than 3 years old initiating antiretroviral therapy (ART) with lopinavir/ritonavir compared to nevirapine, but lopinavir/ritonavir is four-fold costlier. We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model, with published and P1060 data, to project outcomes under three strategies: no ART; first-line nevirapine (with second-line lopinavir/ritonavir); and first-line lopinavir/ritonavir (second-line nevirapine). The base-case examined South African children initiating ART at age 12 months; sensitivity analyses varied all key model parameters. Outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios [ICERs; dollars/year of life saved ($/YLS)]. We considered interventions with ICERs less than 1× per-capita gross domestic product (South Africa: $7500)/YLS as 'very cost-effective,' interventions with ICERs below 3× gross domestic product/YLS as 'cost-effective,' and interventions leading to longer life expectancy and lower lifetime costs as 'cost-saving'. Projected life expectancy was 2.8 years with no ART. Both ART regimens markedly improved life expectancy and were very cost-effective, compared to no ART. First-line lopinavir/ritonavir led to longer life expectancy (28.8 years) and lower lifetime costs ($41 350/person, from lower second-line costs) than first-line nevirapine (27.6 years, $44 030). First-line lopinavir/ritonavir remained cost-saving or very cost-effective compared to first-line nevirapine unless: liquid lopinavir/ritonavir led to two-fold higher virologic failure rates or 15-fold greater costs than in the base-case, or second-line ART following first-line lopinavir/ritonavir was very ineffective. On the basis of P1060 data, first-line lopinavir/ritonavir leads to longer life expectancy and is cost-saving or very cost-effective compared to first-line nevirapine. This supports WHO guidelines, but increasing access to pediatric ART is critical regardless of the regimen used.

Social inequalities in health expectancy and the contribution of mortality and morbidity: the case of Irish Travellers.

PubMed

Abdalla, Safa; Kelleher, Cecily; Quirke, Brigid; Daly, Leslie

2013-12-01

The health expectancy of Irish Travellers, a disadvantaged indigenous minority group in Ireland has not been previously estimated. This study aimed to examine health expectancy inequalities between Irish Travellers and the general population. We used Sullivan's life table method to construct healthy life expectancy (HLE) and disability-free life expectancy (DFLE). The All-Ireland Traveller Health Study provided Irish Traveller population's mortality and health data. Vital registration, census and comparable national survey health data were used for the general population. We calculated the absolute and relative life expectancy, HLE and DFLE gaps between Irish Travellers and the general population and decomposed the HLE and DFLE gaps into mortality and morbidity contributions. Irish Travellers had consistently lower HLE and DFLE than the general population. The health expectancy gap displayed notable age and gender variations and was wider than the life expectancy gap. Mortality contributed more than morbidity to the health expectancy gap in men but not in women. This study illustrated the true extent of health inequalities experienced by an indigenous minority in Europe, clarifying the importance of reducing the burden of non-fatal disabling conditions for addressing these inequalities. The health expectancy measure used has application for other similar indigenous minorities elsewhere.

How Important Are Health Care Expenditures for Life Expectancy? A Comparative, European Analysis.

PubMed

van den Heuvel, Wim J A; Olaroiu, Marinela

2017-03-01

The relationship between health care expenditures and health care outcomes, such as life expectancy and mortality, is complex. Research outcomes show different and contradictory results on this relationship. How and why health care expenditures affect health outcomes is not clear. A causal link between the two is not proven. Without such knowledge, effects of increase/decrease in health care expenses on health outcomes may be overestimated/underestimated. This study analyzes the relationship between life expectancy at birth and expenditures on health care, taking into account expenditures of social production and education, as well as the quantity and quality of health care provisions and lifestyles. This is a cross-sectional study, analyzing national data of 31 European countries. First, the bivariate correlation between the dependent variable and independent variables are calculated and described. Next a forward linear regression analysis is applied. The data are derived from standardized, comparative data bases as available in the Organisation for Economic Co-operation and Development and Eurostat. Health care expenditures are assessed as a percentage of the Gross Domestic Product (GDP). Health care expenditures are not the main determinant of life expectancy at birth, but social protection expenditures are. The regression analysis shows that in countries that spend a high percentage of their GDP on social protection, that have fewer curative beds and low infant mortality, whose citizens report fewer unmet health care needs and drink less alcohol, citizens have a significant longer life expectancy. To realize high life expectancy of citizens, policy measures have to be directed on investment in social protection expenditures, on improving quality of care, and on promoting a healthy life style. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Smoking, physical inactivity and obesity as predictors of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study.

PubMed

Stenholm, Sari; Head, Jenny; Kivimäki, Mika; Kawachi, Ichiro; Aalto, Ville; Zins, Marie; Goldberg, Marcel; Zaninotto, Paola; Magnuson Hanson, Linda; Westerlund, Hugo; Vahtera, Jussi

2016-08-01

Smoking, physical inactivity and obesity are modifiable risk factors for morbidity and mortality. The aim of this study was to examine the extent to which the co-occurrence of these behaviour-related risk factors predict healthy life expectancy and chronic disease-free life expectancy in four European cohort studies. Data were drawn from repeated waves of four cohort studies in England, Finland, France and Sweden. Smoking status, physical inactivity and obesity (body mass index ≥30 kg/m 2 ) were examined separately and in combination. Health expectancy was estimated by using two health indicators: suboptimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years. Compared with men and women with at least two behaviour-related risk factors, those with no behaviour-related risk factors could expect to live on average8 years longer in good health and 6 years longer free of chronic diseases between ages 50 and 75. Having any single risk factor was also associated with reduction in healthy years. No consistent differences between cohorts were observed. Data from four European countries show that persons with individual and co-occurring behaviour-related risk factors have shorter healthy life expectancy and shorter chronic disease-free life expectancy. Population level reductions in smoking, physical inactivity and obesity could increase life-years lived in good health. © The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association.

Month of birth and life expectancy: role of gender and age in a comparative approach

NASA Astrophysics Data System (ADS)

Lerchl, Alexander

2004-09-01

The effects of month of birth (MOB) on life expectancy of a German subpopulation was investigated. Data from people who died in North Rhine Westphalia in the years 1984 (n=188,515) and 1999 (n=188,850) were analyzed. For comparative purposes, all deaths that occurred at an age of <50 years were excluded (1984: 8.4%; 1999: 6.2%). In general, individuals born in May through July had the lowest age at death (1984: 75.27±0.09 years; 1999: 77.58±0.09 years), while those born between October and December had the highest (1984: 75.98±0.08 years; 1999: 78.35±0.09 years), supporting earlier findings. The observed amplitudes (differences between highest and lowest values) were more pronounced in men than in women. When comparing these data of MOB effects on life expectancy with earlier findings in Australia, Austria, Denmark, Ukraine, and the USA, it is evident that a negative correlation exists between the average age at death and the MOB amplitudes. Separate analyses by gender, possible for the data from Germany, the Ukraine, and the USA, revealed a significant negative correlation for men, but not for women. A new hypothesis is therefore presented describing an influence of life quality, as reflected by average life expectancy, on the extent of MOB effects; for example, seasonally variable sensitivities during pregnancy/early childhood.

How long do patients with chronic disease expect to live? A systematic review of the literature

PubMed Central

Salem, Joseph

2016-01-01

Objective To systematically identify and summarise the literature on perceived life expectancy among individuals with non-cancer chronic disease. Setting Published and grey literature up to and including September 2016 where adults with non-cancer chronic disease were asked to estimate their own life expectancy. Participants From 6837 screened titles, 9 articles were identified that met prespecified criteria for inclusion. Studies came from the UK, Netherlands and USA. A total of 729 participants were included (heart failure (HF) 573; chronic obstructive pulmonary disease (COPD) 89; end-stage renal failure 62; chronic kidney disease (CKD) 5). No papers reporting on other lung diseases, neurodegenerative disease or cirrhosis were found. Primary and secondary outcome measures All measures of self-estimated life expectancy were accepted. Self-estimated life expectancy was compared, where available, with observed survival, physician-estimated life expectancy and model-estimated life expectancy. Meta-analysis was not conducted due to the heterogeneity of the patient groups and study methodologies. Results Among patients with HF, median self-estimated life expectancy was 40% longer than predicted by a validated model. Outpatients receiving haemodialysis were more optimistic about prognosis than their nephrologists and overestimated their chances of surviving 5 years. Patients with HF and COPD were approximately three times more likely to die in the next year than they predicted. Data available for patients with CKD were of insufficient quality to draw conclusions. Conclusions Individuals with chronic disease may have unrealistically optimistic expectations of their prognosis. More research is needed to understand how perceived life expectancy affects behaviour. Meanwhile, clinicians should attempt to identify each patient's prognostic preferences and provide information in a way that they can understand and use to inform their decisions. Trial registration number CRD42015020732. PMID:28039288

Life Expectancy and Years of Potential Life Lost After Acute Myocardial Infarction by Sex and Race: A Cohort-Based Study of Medicare Beneficiaries.

PubMed

Bucholz, Emily M; Normand, Sharon-Lise T; Wang, Yun; Ma, Shuangge; Lin, Haiqun; Krumholz, Harlan M

2015-08-11

Most studies of sex and race differences after acute myocardial infarction (AMI) have not taken into account differences in life expectancy in the general population. Years of potential life lost (YPLL) is a metric that takes into account the burden of disease and can be compared by sex and race. This study sought to determine sex and race differences in long-term survival after AMI using life expectancy and YPLL to account for differences in population-based life expectancy. Using data from the Cooperative Cardiovascular Project, a prospective cohort study of Medicare beneficiaries hospitalized for AMI between 1994 and 1995 (N = 146,743), we calculated life expectancy and YPLL using Cox proportional hazards regression with extrapolation using exponential models. Of the 146,743 patients with AMI, 48.1% were women and 6.4% were black; the average age was 75.9 years. Post-AMI life expectancy estimates were similar for men and women of the same race but lower for black patients than white patients. On average, women lost 10.5% (SE 0.3%) more of their expected life than men, and black patients lost 6.2% (SE 0.6%) more of their expected life than white patients. After adjustment, women still lost an average of 7.8% (0.3%) more of their expected life than men, but black race became associated with a survival advantage, suggesting that racial differences in YPLL were largely explained by differences in clinical presentation and treatment between black and white patients. Women and black patients lost more years of life after AMI, on average, than men and white patients, an effect that was not explained in women by clinical or treatment differences. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Well-being, life satisfaction and capabilities of flood disaster victims

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Ootegem, Luc, E-mail: Luc.VanOotegem@UGent.be; SHERPPA–Ghent University; Verhofstadt, Elsy

The individual well-being of flood disaster victims is examined making use of two concepts: life satisfaction and perceived capabilities in life. These concepts are compared in two samples: a representative sample of Flemish respondents and a specific sample of people that have been the victim of a pluvial flood. Well-being as life satisfaction is found not to be related to past or expected future flooding, whereas well-being as capabilities in life is negatively related to both past and expected future flooding. - Highlights: • Well-being as life satisfaction is not related to past or expected future flooding. • Well-being asmore » capabilities in life is negatively related to flooding. • A disaster can scare people for the future because of the scars that it provokes. • Assess the impact of a disaster not only by monetary damage and life satisfaction.« less

Healthy life expectancy and the correlates of self-rated health in Bangladesh in 1996 and 2002.

PubMed

Tareque, Md Ismail; Saito, Yasuhiko; Kawahara, Kazuo

2015-03-31

Life expectancy (LE) at birth has increased steadily in Bangladesh since its independence. When people live longer, quality of life becomes a central issue. This study examines whether healthy life expectancy (HLE) at ages 15, 25, 35, and 45 is keeping pace with LE at those ages between 1996 and 2002. It also seeks to investigate the correlates of self-rated health (SRH) in 1996 and 2002. We used data from the World Values Survey conducted in 1996 and 2002 among individuals 15 years and older. The Sullivan method was used to compute HLE. Socio-demographic differences and their association with different states of health were examined by chi-square and Pearson's correlation tests. Multiple linear regression models were fitted to examine the correlates of SRH. The results show that perceived health improved between 1996 and 2002. For males, statistically significant increases in the expected number of years lived in good SRH were found. Proportionally, in 2002, both males and females at ages 15, 25, 35 and 45 expected more life years in good health and fewer life years in fair and poor health than did their counterparts in 1996. Comparatively, males expected fewer life years spent in good health but a much larger proportion of expected life in good health than did females. Finally, in multivariate analyses, life satisfaction was the only factor found to be significantly and positively associated with SRH for males and females in both years, although in both years the association was much more pronounced for females than for males. This study documented changes in HLE during 1996-2002. Women outlive men, but they have a lower quality of life and are more likely to live a greater part of their remaining life in poor SRH. Life satisfaction as well as other significant factors associated with SRH should be promoted, with special attention given to women, to improve healthy life expectancy and the quality of life of the Bangladeshi people.

Eliciting Survival Expectations of the Elderly in Low-Income Countries: Evidence From India.

PubMed

Delavande, Adeline; Lee, Jinkook; Menon, Seetha

2017-04-01

We examine several methodological considerations when eliciting probabilistic expectations in a developing country context using the Longitudinal Ageing Study in India (LASI). We conclude that although, on average, individuals are able to understand the concept of probability, responses are sensitive to framing effects and to own versus hypothetical-person effects. We find that overall, people are pessimistic about their survival probabilities compared with state-specific life tables and that socioeconomic status does influence beliefs about own survival expectations as found in previous literature in other countries. Higher levels of education and income have a positive association with survival expectations, and these associations persist even when conditioning on self-reported health. The results remain robust to several alternative specifications. We then compare the survival measures with objective measures of health. We find that activities of daily life, height, and low hemoglobin levels covary with subjective expectations in expected directions.

The impact of petrochemical industrialisation on life expectancy and per capita income in Taiwan: an 11-year longitudinal study.

PubMed

Chen, Ya-Mei; Lin, Wan-Yu; Chan, Chang-Chuan

2014-03-12

Petrochemical industries have been identified as important sources of emissions of chemical substances, and adverse health outcomes have been reported for residents who live nearby. The purpose of the current study was to examine the adverse effects of petrochemical industrialization in Taiwan on the life expectancy and personal income of people living in nearby communities. This study compared life expectancies and personal income between one industrial county (Yunlin County) and one reference county (Yilan County), which had no significant industrial activity that might emit pollutants, in Taiwan through analysis of 11 year long and publicly available data. Data from before and after the petrochemical company in the industrial county started (year 1999) operating were compared. Residents of the industrialized county had lesser increases in life expectancy over time than did residents of a similar but less-industrialized county, with difference means ranging from 0.89 years (p<0.05) to 1.62 years (p<0.001) at different stages. Male residents were more vulnerable to the effects of industrialization. There were no significant differences in individual income between the two counties. Countries, including Taiwan and the U.S., embracing petrochemical industries now face the challenge of environmental injustice. Our findings suggested that life expectancy lengthening was slowed and income growth was stalled for residents living in the industrial communities.

Political and social determinants of life expectancy in less developed countries: a longitudinal study

PubMed Central

2012-01-01

Background This study aimed to examine the longitudinal contributions of four political and socioeconomic factors to the increase in life expectancy in less developed countries (LDCs) between 1970 and 2004. Methods We collected 35 years of annual data for 119 LDCs on life expectancy at birth and on four key socioeconomic indicators: economy, measured by log10 gross domestic product per capita at purchasing power parity; educational environment, measured by the literacy rate of the adult population aged 15 years and over; nutritional status, measured by the proportion of undernourished people in the population; and political regime, measured by the regime score from the Polity IV database. Using linear mixed models, we analyzed the longitudinal effects of these multiple factors on life expectancy at birth with a lag of 0-10 years, adjusting for both time and regional correlations. Results The LDCs' increases in life expectancy over time were associated with all four factors. Political regime had the least influence on increased life expectancy to begin with, but became significant starting in the 3rd year and continued to increase, while the impact of the other socioeconomic factors began strong but continually decreased over time. The combined effects of these four socioeconomic and political determinants contributed 54.74% - 98.16% of the life expectancy gains throughout the lag periods of 0-10 years. Conclusions Though the effect of democratic politics on increasing life expectancy was relatively small in the short term when compared to the effects of the other socioeconomic factors, the long-term impact of democracy should not be underestimated. PMID:22280469

Political and social determinants of life expectancy in less developed countries: a longitudinal study.

PubMed

Lin, Ro-Ting; Chen, Ya-Mei; Chien, Lung-Chang; Chan, Chang-Chuan

2012-01-27

This study aimed to examine the longitudinal contributions of four political and socioeconomic factors to the increase in life expectancy in less developed countries (LDCs) between 1970 and 2004. We collected 35 years of annual data for 119 LDCs on life expectancy at birth and on four key socioeconomic indicators: economy, measured by log10 gross domestic product per capita at purchasing power parity; educational environment, measured by the literacy rate of the adult population aged 15 years and over; nutritional status, measured by the proportion of undernourished people in the population; and political regime, measured by the regime score from the Polity IV database. Using linear mixed models, we analyzed the longitudinal effects of these multiple factors on life expectancy at birth with a lag of 0-10 years, adjusting for both time and regional correlations. The LDCs' increases in life expectancy over time were associated with all four factors. Political regime had the least influence on increased life expectancy to begin with, but became significant starting in the 3rd year and continued to increase, while the impact of the other socioeconomic factors began strong but continually decreased over time. The combined effects of these four socioeconomic and political determinants contributed 54.74% - 98.16% of the life expectancy gains throughout the lag periods of 0-10 years. Though the effect of democratic politics on increasing life expectancy was relatively small in the short term when compared to the effects of the other socioeconomic factors, the long-term impact of democracy should not be underestimated.

Associations between urban sprawl and life expectancy in the United States

USGS Publications Warehouse

Hamidi, Shima; Ewing, Reid; Tatalovich, Zaria; Grace, James B.; Berrigan, David

2018-01-01

In recent years, the United States has had a relatively poor performance with respect to life expectancy compared to the other developed nations. Urban sprawl is one of the potential causes of the high rate of mortality in the United States. This study investigated cross-sectional associations between sprawl and life expectancy for metropolitan counties in the United States in 2010. In this study, the measure of life expectancy in 2010 came from a recently released dataset of life expectancies by county. This study modeled average life expectancy with a structural equation model that included five mediators: annual vehicle miles traveled (VMT) per household, average body mass index, crime rate, and air quality index as mediators of sprawl, as well as percentage of smokers as a mediator of socioeconomic status. After controlling for sociodemographic characteristics, this study found that life expectancy was significantly higher in compact counties than in sprawling counties. Compactness affects mortality directly, but the causal mechanism is unclear. For example, it may be that sprawling areas have higher traffic speeds and longer emergency response times, lower quality and less accessible health care facilities, or less availability of healthy foods. Compactness affects mortality indirectly through vehicle miles traveled, which is a contributor to traffic fatalities, and through body mass index, which is a contributor to many chronic diseases. This study identified significant direct and indirect associations between urban sprawl and life expectancy. These findings support further research and practice aimed at identifying and implementing changes to urban planning designed to support health and healthy behaviors.

Associations between Urban Sprawl and Life Expectancy in the United States

PubMed Central

Ewing, Reid; Tatalovich, Zaria; Berrigan, David

2018-01-01

In recent years, the United States has had a relatively poor performance with respect to life expectancy compared to the other developed nations. Urban sprawl is one of the potential causes of the high rate of mortality in the United States. This study investigated cross-sectional associations between sprawl and life expectancy for metropolitan counties in the United States in 2010. In this study, the measure of life expectancy in 2010 came from a recently released dataset of life expectancies by county. This study modeled average life expectancy with a structural equation model that included five mediators: annual vehicle miles traveled (VMT) per household, average body mass index, crime rate, and air quality index as mediators of sprawl, as well as percentage of smokers as a mediator of socioeconomic status. After controlling for sociodemographic characteristics, this study found that life expectancy was significantly higher in compact counties than in sprawling counties. Compactness affects mortality directly, but the causal mechanism is unclear. For example, it may be that sprawling areas have higher traffic speeds and longer emergency response times, lower quality and less accessible health care facilities, or less availability of healthy foods. Compactness affects mortality indirectly through vehicle miles traveled, which is a contributor to traffic fatalities, and through body mass index, which is a contributor to many chronic diseases. This study identified significant direct and indirect associations between urban sprawl and life expectancy. These findings support further research and practice aimed at identifying and implementing changes to urban planning designed to support health and healthy behaviors. PMID:29701644

Associations between Urban Sprawl and Life Expectancy in the United States.

PubMed

Hamidi, Shima; Ewing, Reid; Tatalovich, Zaria; Grace, James B; Berrigan, David

2018-04-26

In recent years, the United States has had a relatively poor performance with respect to life expectancy compared to the other developed nations. Urban sprawl is one of the potential causes of the high rate of mortality in the United States. This study investigated cross-sectional associations between sprawl and life expectancy for metropolitan counties in the United States in 2010. In this study, the measure of life expectancy in 2010 came from a recently released dataset of life expectancies by county. This study modeled average life expectancy with a structural equation model that included five mediators: annual vehicle miles traveled (VMT) per household, average body mass index, crime rate, and air quality index as mediators of sprawl, as well as percentage of smokers as a mediator of socioeconomic status. After controlling for sociodemographic characteristics, this study found that life expectancy was significantly higher in compact counties than in sprawling counties. Compactness affects mortality directly, but the causal mechanism is unclear. For example, it may be that sprawling areas have higher traffic speeds and longer emergency response times, lower quality and less accessible health care facilities, or less availability of healthy foods. Compactness affects mortality indirectly through vehicle miles traveled, which is a contributor to traffic fatalities, and through body mass index, which is a contributor to many chronic diseases. This study identified significant direct and indirect associations between urban sprawl and life expectancy. These findings support further research and practice aimed at identifying and implementing changes to urban planning designed to support health and healthy behaviors.

Perceived Life Expectancy Is Associated with Colorectal Cancer Screening in England.

PubMed

Kobayashi, Lindsay C; von Wagner, Christian; Wardle, Jane

2017-06-01

Cancer screening is a behavior that represents investment in future health. Such investment may depend on how much 'future' a person expects. The purpose of this study was to investigate the prospective association between perceived personal life expectancy and participation in fecal occult blood test screening for colorectal cancer (CRC) in a national program. Data were from interviews with 3975 men and women in the English Longitudinal Study of Ageing (ELSA) within the eligible age range for the national screening program (60 to 74 years). Perceived life expectancy was indexed as the individual's estimate of their chance of living another 10-15 years (exact time varied by age), assessed in 2008/2009. Participation in CRC screening from 2010 to 2012/2013 was assessed in 2012/2013. Logistic regression was used to estimate the association between perceived life expectancy and screening participation, adjusted for numeracy and known mortality risk factors. Overall, 71% of respondents (2817/3975) reported completing at least one fecal occult blood test (FOBt) during the follow-up. Screening uptake was 76% (1272/1683) among those who estimated their 10-15-year life expectancy as 75-100%, compared with 52% (126/243) among those who estimated theirs as 0-25% (adjusted OR 1.74, 95% CI 1.29-2.34). A longer perceived life expectancy is associated with greater likelihood of participating in CRC screening in England. However, half of people with a low perceived life expectancy still participated in screening. Given that CRC screening is recommended for adults with a remaining life expectancy of ≥10 years, future research should investigate how to communicate the aims of screening more effectively.

Watchful waiting with periodic liver biopsy versus immediate empirical therapy for histologically mild chronic hepatitis C. A cost-effectiveness analysis.

PubMed

Wong, J B; Koff, R S

2000-11-07

Not all patients with histologically mild chronic hepatitis C progress to cirrhosis. To compare no antiviral treatment, periodic liver biopsy with subsequent antiviral treatment for moderate hepatitis or cirrhosis, and immediate antiviral therapy. Cost-effectiveness analysis. Clinical trial data and published studies. Hepatitis C virus-infected patients with histologically mild hepatitis. Lifetime. Societal. Immediate combination antiviral treatment or biopsy every 3 years plus combination antiviral therapy for moderate hepatitis or cirrhosis. Life expectancy, quality-adjusted life expectancy, and costs. Over 20 years, biopsy every 3 years with treatment of moderate hepatitis would avoid treatment in 50% of the cohort and would result in an 18% likelihood of cirrhosis compared with 16% for immediate treatment and 27% for no antiviral therapy. Immediate antiviral treatment should increase life expectancy by 1.0 quality-adjusted life-year compared with biopsy management. Over an average lifetime, biopsy management would lead to six liver biopsies costing $6200; immediate antiviral treatment would cost $5100 less than biopsy management because of savings related to biopsy and prevention of future hepatitis C-related morbidity. Immediate therapy was cost-effective compared with biopsy management and had a cost-effectiveness ratio of $7000 compared with no antiviral therapy. When age, sex, genotype, and estimates of histologic progression or compliance with follow-up are varied, immediate therapy should result in an increase of at least 0. 8 quality-adjusted life-year compared with biopsy management. For histologically mild chronic hepatitis C, initial combination treatment compared with periodic liver biopsy should reduce the future risk for cirrhosis, prolong life, and be cost-effective.

Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries.

PubMed

Laursen, Thomas Munk; Wahlbeck, Kristian; Hällgren, Jonas; Westman, Jeanette; Ösby, Urban; Alinaghizadeh, Hassan; Gissler, Mika; Nordentoft, Merete

2013-01-01

Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler's method. The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter. Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years.

Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries

PubMed Central

Laursen, Thomas Munk; Wahlbeck, Kristian; Hällgren, Jonas; Westman, Jeanette; Ösby, Urban; Alinaghizadeh, Hassan; Gissler, Mika; Nordentoft, Merete

2013-01-01

Objective Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler’s method. Results The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter. Conclusion Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years. PMID:23826212

Potential years lost and life expectancy in adults with newly diagnosed epilepsy.

PubMed

Granbichler, Claudia A; Zimmermann, Georg; Oberaigner, Willi; Kuchukhidze, Giorgi; Ndayisaba, Jean-Pierre; Taylor, Alexandra; Luef, Gerhard; Bathke, Arne C; Trinka, Eugen

2017-11-01

Studies using relative measures, such as standardized mortality ratios, have shown that patients with epilepsy have an increased mortality. Reports on more direct and absolute measure such as life expectancy are sparse. We report potential years lost and how life expectancy has changed over 40 years in a cohort of patients with newly diagnosed epilepsy. We analyzed life expectancy in a cohort of adult patients diagnosed with definite epilepsy between 1970 and 2010. Those with brain tumor as cause of epilepsy were excluded. By retrospective probabilistic record linkage, living or death status was derived from the national death registry. We estimated life expectancy by a Weibull regression model using gender, age at diagnosis, epilepsy etiology, and year of diagnosis as covariates at time of epilepsy diagnosis, and 5, 10, 15, and 20 years after diagnosis. Results were compared to the general population, and 95% confidence intervals are given. There were 249 deaths (105 women, age at death 19.0-104.0 years) in 1,112 patients (11,978.4 person-years, 474 women, 638 men). A substantial decrease in life expectancy was observed for only a few subgroups, strongly depending on epilepsy etiology and time of diagnosis: time of life lost was highest in patients with symptomatic epilepsy diagnosed between 1970 and 1980; the impact declined with increasing time from diagnosis. Over half of the analyzed subgroups did not differ significantly from the general population. This effect was reversed in the later decades, and life expectancy was prolonged in some subgroups, reaching a maximum in those with newly diagnosed idiopathic and cryptogenic epilepsy between 2001 and 2010. Life expectancy is reduced in symptomatic epilepsies. However, in other subgroups, a prolonged life expectancy was found, which has not been reported previously. Reasons may be manifold and call for further study. © 2017 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

Life expectancy of colon, breast, and testicular cancer patients: an analysis of US-SEER population-based data.

PubMed

Capocaccia, R; Gatta, G; Dal Maso, L

2015-06-01

Cancer survivorship is an increasingly important issue in cancer control. Life expectancy of patients diagnosed with breast, colon, and testicular cancers, stratified by age at diagnosis and time since diagnosis, is provided as an indicator to evaluate future mortality risks and health care needs of cancer survivors. The standard period life table methodology was applied to estimate excess mortality risk for cancer patients diagnosed in 1985-2011 from SEER registries and mortality data of the general US population. The sensitivity of life expectancy estimates on different assumptions was evaluated. Younger patients with colon cancer showed wider differences in life expectancy compared with that of the general population (11.2 years in women and 10.7 in men at age 45-49 years) than older patients (6.3 and 5.8 at age 60-64 years, respectively). Life expectancy progressively increases in patients surviving the first years, up to 4 years from diagnosis, and then starts to decrease again, approaching that of the general population. For breast cancer, the initial drop in life expectancy is less marked, and again with wider differences in younger patients, varying from 8.7 at age 40-44 years to 2.4 at ages 70-74 years. After diagnosis, life expectancy still decreases with time, but less than that in the general population, slowly approaching that of cancer-free women. Life expectancy of men diagnosed with testicular cancer at age 30 years is estimated as 45.2 years, 2 years less than cancer-free men of the same age. The difference becomes 1.3 years for patients surviving the first year, and then slowly approaches zero with increasing survival time. Life expectancy provides meaningful information on cancer patients, and can help in assessing when a cancer survivor can be considered as cured. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Socioeconomic, remoteness and sex differences in life expectancy in New South Wales, Australia, 2001-2012: a population-based study.

PubMed

Stephens, Alexandre S; Gupta, Leena; Thackway, Sarah; Broome, Richard A

2017-01-10

Despite being one of the healthiest countries in the world, Australia displays substantial mortality differentials by socioeconomic disadvantage, remoteness and sex. In this study, we examined how these mortality differentials translated to differences in life expectancy between 2001 and 2012. Population-based study using mortality and estimated residential population data from Australia's largest state, New South Wales (NSW), between 2001 and 2012. Age-group-specific death rates by socioeconomic disadvantage quintile, remoteness (major cities vs regional and remote areas), sex and year were estimated via Poisson regression, and inputted into life table calculations to estimate life expectancy. Life expectancy decreased with increasing socioeconomic disadvantage in males and females. The disparity between the most and least socioeconomically deprived quintiles was 3.77 years in males and 2.39 years in females in 2012. Differences in life expectancy by socioeconomic disadvantage were mostly stable over time. Gender gaps in life expectancy ranged from 3.50 to 4.93 years (in 2012), increased with increasing socioeconomic disadvantage and decreased by ∼1 year for all quintiles between 2001 and 2012. Overall, life expectancy varied little by remoteness, but was 1.8 years higher in major cities compared to regional/remote areas in the most socioeconomically deprived regions in 2012. Socioeconomic disadvantage and sex were strongly associated with life expectancy. The disparity in life expectancy across the socioeconomic spectrum was larger in males and was stable over time. In contrast, gender gaps reduced for all quintiles between 2001 and 2012, and a remoteness effect was evident in 2012, but only for those living in the most deprived areas. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Reduced tobacco consumption, improved diet and life expectancy for 1988-1998: analysis of New Zealand and OECD data.

PubMed

Laugesen, Murray; Grace, Randolph C

2017-06-02

We compared changes in tobacco consumption and diet in relation to changes in life expectancy in 1988-1998 in 22 OECD (Organisation for Economic Cooperation and Development) countries. Between 1985 and 1995 using regression analysis we estimated differences in tobacco consumption per adult and the differences in the sum of atherogenic and thrombogenic indices against life expectancy. Each index was derived from the various fats per gram of food from standard texts, and from the annual measurements of fat in the food balance sheets of each country. In 1985-1995, New Zealand showed the largest decrease in tobacco consumption per adult (41%) and the greatest decrease (except for Switzerland) in the sum of atherogenic and thrombogenic indices (17%) as a measure of diet. New Zealand ranked first for life expectancy increases from 1988-1998 for men (3.2 years), women (2.8 years) and both sexes combined. Regression analyses revealed that increases in life expectancy across the OECD for males, but not females, were strongly associated with decreases in tobacco consumption, with a weaker effect of diet improvement. These results suggest that reduced tobacco consumption in 1985-1995 likely contributed to New Zealand's gains in life expectancy from 1988-1998.

Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010.

PubMed

Livingstone, Shona J; Levin, Daniel; Looker, Helen C; Lindsay, Robert S; Wild, Sarah H; Joss, Nicola; Leese, Graham; Leslie, Peter; McCrimmon, Rory J; Metcalfe, Wendy; McKnight, John A; Morris, Andrew D; Pearson, Donald W M; Petrie, John R; Philip, Sam; Sattar, Naveed A; Traynor, Jamie P; Colhoun, Helen M

2015-01-06

Type 1 diabetes has historically been associated with a significant reduction in life expectancy. Major advances in treatment of type 1 diabetes have occurred in the past 3 decades. Contemporary estimates of the effect of type 1 diabetes on life expectancy are needed. To examine current life expectancy in people with and without type 1 diabetes in Scotland. We also examined whether any loss of life expectancy in patients with type 1 diabetes is confined to those who develop kidney disease. Prospective cohort of all individuals alive in Scotland with type 1 diabetes who were aged 20 years or older from 2008 through 2010 and were in a nationwide register (n=24,691 contributing 67,712 person-years and 1043 deaths). Differences in life expectancy between those with and those without type 1 diabetes and the percentage of the difference due to various causes. Life expectancy at an attained age of 20 years was an additional 46.2 years among men with type 1 diabetes and 57.3 years among men without it, an estimated loss in life expectancy with diabetes of 11.1 years (95% CI, 10.1-12.1). Life expectancy from age 20 years was an additional 48.1 years among women with type 1 diabetes and 61.0 years among women without it, an estimated loss with diabetes of 12.9 years (95% CI, 11.7-14.1). Even among those with type 1 diabetes with an estimated glomerular filtration rate of 90 mL/min/1.73 m2 or higher, life expectancy was reduced (49.0 years in men, 53.1 years in women) giving an estimated loss from age 20 years of 8.3 years (95% CI, 6.5-10.1) for men and 7.9 years (95% CI, 5.5-10.3) for women. Overall, the largest percentage of the estimated loss in life expectancy was related to ischemic heart disease (36% in men, 31% in women) but death from diabetic coma or ketoacidosis was associated with the largest percentage of the estimated loss occurring before age 50 years (29.4% in men, 21.7% in women). Estimated life expectancy for patients with type 1 diabetes in Scotland based on data from 2008 through 2010 indicated an estimated loss of life expectancy at age 20 years of approximately 11 years for men and 13 years for women compared with the general population without type 1 diabetes.

Estimated Life Expectancy in a Scottish Cohort With Type 1 Diabetes, 2008-2010

PubMed Central

Livingstone, Shona J.; Levin, Daniel; Looker, Helen C.; Lindsay, Robert S.; Wild, Sarah H.; Joss, Nicola; Leese, Graham; Leslie, Peter; McCrimmon, Rory J.; Metcalfe, Wendy; McKnight, John A.; Morris, Andrew D.; Pearson, Donald W. M.; Petrie, John R.; Philip, Sam; Sattar, Naveed A.; Traynor, Jamie P.; Colhoun, Helen M.

2015-01-01

IMPORTANCE Type 1 diabetes has historically been associated with a significant reduction in life expectancy. Major advances in treatment of type 1 diabetes have occurred in the past 3 decades. Contemporary estimates of the effect of type 1 diabetes on life expectancy are needed. OBJECTIVE To examine current life expectancy in people with and without type 1 diabetes in Scotland. We also examined whether any loss of life expectancy in patients with type 1 diabetes is confined to those who develop kidney disease. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort of all individuals alive in Scotland with type 1 diabetes who were aged 20 years or older from 2008 through 2010 and were in a nationwide register (n=24 691 contributing 67 712 person-years and 1043 deaths). MAIN OUTCOMES AND MEASURES Differences in life expectancy between those with and those without type 1 diabetes and the percentage of the difference due to various causes. RESULTS Life expectancy at an attained age of 20 years was an additional 46.2 years among men with type 1 diabetes and 57.3 years among men without it, an estimated loss in life expectancy with diabetes of 11.1 years (95% CI, 10.1-12.1). Life expectancy from age 20 years was an additional 48.1 years among women with type 1 diabetes and 61.0 years among women without it, an estimated loss with diabetes of 12.9 years (95% CI, 11.7-14.1). Even among those with type 1 diabetes with an estimated glomerular filtration rate of 90 mL/min/1.73m2 or higher, life expectancy was reduced (49.0 years in men, 53.1 years in women) giving an estimated loss from age 20 years of 8.3 years (95% CI, 6.5-10.1) for men and 7.9 years (95% CI, 5.5-10.3) for women. Overall, the largest percentage of the estimated loss in life expectancy was related to ischemic heart disease (36% in men, 31% in women) but death from diabetic coma or ketoacidosis was associated with the largest percentage of the estimated loss occurring before age 50 years (29.4% in men, 21.7% in women). CONCLUSIONS AND RELEVANCE Estimated life expectancy for patients with type 1 diabetes in Scotland based on data from 2008 through 2010 indicated an estimated loss of life expectancy at age 20 years of approximately 11 years for men and 13 years for women compared with the general population without type 1 diabetes. PMID:25562264

Impact of Pregnancy-Related Deaths on Female Life Expectancy in Zambia: Application of Life Table Techniques to Census Data

PubMed Central

Banda, Richard; Sandøy, Ingvild Fossgard; Fylkesnes, Knut; Janssen, Fanny

2015-01-01

Introduction Since 2000, the world has been coalesced around efforts to reduce maternal mortality. However, few studies have estimated the significance of eliminating maternal deaths on female life expectancy. We estimated, based on census data, the potential gains in female life expectancy assuming complete elimination of pregnancy-related mortality in Zambia. Methods We used data on all-cause and pregnancy-related deaths of females aged 15–49 reported in the Zambia 2010 census, and evaluated, adjusted and smoothed them using existing and verified techniques. We used associated single decrement life tables, assuming complete elimination of pregnancy-related deaths to estimate the potential gains in female life expectancy at birth, at age 15, and over the ages 15–49. We compared these gains with the gains from eliminating deaths from accidents, injury, violence and suicide. Results Complete elimination of pregnancy-related deaths would extend life expectancy at birth among Zambian women by 1.35 years and life expectancy at age 15 by 1.65 years. In rural areas, this would be 1.69 years and 2.19 years, respectively, and in urban areas, 0.78 years and 0.85 years. An additional 0.72 years would be spent in the reproductive age group 15–49; 1.00 years in rural areas and 0.35 years in urban areas. Eliminating deaths from accidents, injury, suicide and violence among women aged 15–49 would cumulatively contribute 0.55 years to female life expectancy at birth. Conclusion Eliminating pregnancy-related mortality would extend female life expectancy in Zambia substantially, with more gains among adolescents and females in rural areas. The application of life table techniques to census data proved very valuable, although rigorous evaluation and adjustment of reported deaths and age was necessary to attain plausible estimates. The collection of detailed high quality cause-specific mortality data in future censuses is indispensable. PMID:26513160

The increase of firearm mortality and its relationship with the stagnation of life expectancy in Mexico.

PubMed

González-Pérez, Guillermo Julián; Vega-López, María Guadalupe; Flores-Villavicencio, María Elena

2017-09-01

This study analyzes firearms mortality (FA) and their impact on life expectancy in Mexico -compared to other causes of deaths- during the three-year periods 2000-2002 and 2010-2012 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. Based on official death and population data, abridged life tables in Mexico were constructed for the three-year periods studied. Temporary life expectancy and YLEL for aged 15 to 75 by selected causes and age groups were calculated in each three-year period. Among men, FA mortality went from being the cause less YLEL caused in 2000-2002 to be the main cause of YLEL between 15 and 75 years in 2010-2012. Among women, YLEL for FA mortality had a higher relative growth. In both sexes, the greatest increase in YLEL by FA mortality was between 20 and 34 years. Findings indicate that the increase in FA mortality, especially among young people, has substantially contributed to the stagnation of life expectancy in recent years, and even his decline in the case of men. This reflects that violence linked to the FA is not only a security problem but also a collective health problem that must be copied in an interdisciplinary and intersectoral form if it is to increase the life expectancy of the country.

Forecasting Spanish natural life expectancy.

PubMed

Guillen, Montserrat; Vidiella-i-Anguera, Antoni

2005-10-01

Knowledge of trends in life expectancy is of major importance for policy planning. It is also a key indicator for assessing future development of life insurance products, substantiality of existing retirement schemes, and long-term care for the elderly. This article examines the feasibility of decomposing age-gender-specific accidental and natural mortality rates. We study this decomposition by using the Lee and Carter model. In particular, we fit the Poisson log-bilinear version of this model proposed by Wilmoth and Brouhns et al. to historical (1975-1998) Spanish mortality rates. In addition, by using the model introduced by Wilmoth and Valkonen we analyze mortality-gender differentials for accidental and natural rates. We present aggregated life expectancy forecasts compared with those constructed using nondecomposed mortality rates.

Life Expectancy of Brazilian Neurosurgeons.

PubMed

Botelho, Ricardo Vieira; Jardim Miranda, Bárbara Cristina; Nishikuni, Koshiro; Waisberg, Jaques

2018-06-01

Life expectancy (LE) refers to the number of years that an individual is expected to survive. Emphasis is frequently placed on the relationship between LE and the conditions under which a population lives, but fewer studies have investigated the relationship between stress factors associated with specific professions and their effects on LE. The aim of this study is to evaluate Brazilian neurosurgeons' life expectancies (BNLEs) and compare them with those of physicians (both Brazilian and foreign) from other fields, as well as with Brazilian nondoctors. The Brazilian Society of Neurosurgery death registry was used to obtain data that compared LEs from non-neurosurgeon physicians, as described in the national and international literature. BNLEs were also compared with the LEs of Brazilian citizens. Fifty-one neurosurgeons died between 2009 and 2016. All were males. The mean age at death was 68.31 ± 17.71 years. Among all-cause mortality, the breakdown was 20% cardiovascular diseases, 39% malignancies, 10% external factors, 6% gastrointestinal disorders, 12% neurologic illnesses, and 14% unknown causes. BNLE was shorter than LE of male Brazilian citizens. LE was similar among neurosurgeons and other doctors but shorter compared with Brazilian citizens. Further research is needed to provide data that can add to and confirm these results. Copyright © 2018 Elsevier Inc. All rights reserved.

A state-level analysis of life expectancy in Mexico (1990-2006).

PubMed

Peláez, Oscar; Guijarro, Marta; Arias, Mercedes

2010-11-01

Using a methodology similar to that proposed by Barro & Sala-i-Martin (1995), it is found that, in the period 1990-2006, there was strong convergence among state-level life expectancy series, but a distancing in life expectancy in the Mexican Republic compared with more developed countries, especially during the new millennium. The interior convergence had taken place at the expense of the exterior; that is, not so much as a result of an improvement in living conditions in the poorer states, but more due to the low performance of the richer states. The causes of this situation are explained using the concept of 'epidemiological transition'.

The impact of petrochemical industrialisation on life expectancy and per capita income in Taiwan: an 11-year longitudinal study

PubMed Central

2014-01-01

Background Petrochemical industries have been identified as important sources of emissions of chemical substances, and adverse health outcomes have been reported for residents who live nearby. The purpose of the current study was to examine the adverse effects of petrochemical industrialization in Taiwan on the life expectancy and personal income of people living in nearby communities. Methods This study compared life expectancies and personal income between one industrial county (Yunlin County) and one reference county (Yilan County), which had no significant industrial activity that might emit pollutants, in Taiwan through analysis of 11 year long and publicly available data. Data from before and after the petrochemical company in the industrial county started (year 1999) operating were compared. Results Residents of the industrialized county had lesser increases in life expectancy over time than did residents of a similar but less-industrialized county, with difference means ranging from 0.89 years (p < 0.05) to 1.62 years (p < 0.001) at different stages. Male residents were more vulnerable to the effects of industrialization. There were no significant differences in individual income between the two counties. Conclusions Countries, including Taiwan and the U.S., embracing petrochemical industries now face the challenge of environmental injustice. Our findings suggested that life expectancy lengthening was slowed and income growth was stalled for residents living in the industrial communities. PMID:24621018

Comparative study of disability-free life expectancy across six low- and middle-income countries.

PubMed

Chirinda, Witness; Chen, He

2017-04-01

There is a knowledge gap about the disability-free life expectancy (DFLE) in low- and middle-income countries. The present study aimed to compute and compare DFLE in six such countries, and examine sex differences in DFLE in each country. Based on data from the World Health Organization Study on Global Aging and Adult Health wave 1 survey, we used the Sullivan method to estimate DFLE among persons aged years 50 years and older. Disability was divided into moderate disability and severe disability during the calculation. Of the six countries, China had the highest DFLE and lowest expected average lifetime with disability. India had the lowest DFLE and highest life years with moderate and severe disability. In each country, women live longer than men, but with more disabilities in both absolute and proportional terms. The huge sex difference in Russia requires special attention. In addition, most of the life expectancy lived with disability was spent with severe disability, rather than moderate disability. The study has shed some light on the disparities across the six countries with regard to DFLE at old ages. The low percentage of DFLE in life expectancy in some countries, such as India, calls for effective policies on healthy aging. The "sex disability-survival paradox" in DFLE is supported by our results. To differentiate the severity of disability should be routine in calculating DFLE. Geriatr Gerontol Int 2017; 17: 637-644. © 2016 Japan Geriatrics Society.

The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting

PubMed Central

Bennett, James E; Li, Guangquan; Foreman, Kyle; Best, Nicky; Kontis, Vasilis; Pearson, Clare; Hambly, Peter; Ezzati, Majid

2015-01-01

Summary Background To plan for pensions and health and social services, future mortality and life expectancy need to be forecast. Consistent forecasts for all subnational units within a country are very rare. Our aim was to forecast mortality and life expectancy for England and Wales' districts. Methods We developed Bayesian spatiotemporal models for forecasting of age-specific mortality and life expectancy at a local, small-area level. The models included components that accounted for mortality in relation to age, birth cohort, time, and space. We used geocoded mortality and population data between 1981 and 2012 from the Office for National Statistics together with the model with the smallest error to forecast age-specific death rates and life expectancy to 2030 for 375 of England and Wales' 376 districts. We measured model performance by withholding recent data and comparing forecasts with this withheld data. Findings Life expectancy at birth in England and Wales was 79·5 years (95% credible interval 79·5–79·6) for men and 83·3 years (83·3–83·4) for women in 2012. District life expectancies ranged between 75·2 years (74·9–75·6) and 83·4 years (82·1–84·8) for men and between 80·2 years (79·8–80·5) and 87·3 years (86·0–88·8) for women. Between 1981 and 2012, life expectancy increased by 8·2 years for men and 6·0 years for women, closing the female–male gap from 6·0 to 3·8 years. National life expectancy in 2030 is expected to reach 85·7 (84·2–87·4) years for men and 87·6 (86·7–88·9) years for women, further reducing the female advantage to 1·9 years. Life expectancy will reach or surpass 81·4 years for men and reach or surpass 84·5 years for women in every district by 2030. Longevity inequality across districts, measured as the difference between the 1st and 99th percentiles of district life expectancies, has risen since 1981, and is forecast to rise steadily to 8·3 years (6·8–9·7) for men and 8·3 years (7·1–9·4) for women by 2030. Interpretation Present forecasts underestimate the expected rise in life expectancy, especially for men, and hence the need to provide improved health and social services and pensions for elderly people in England and Wales. Health and social policies are needed to curb widening life expectancy inequalities, help deprived districts catch up in longevity gains, and avoid a so-called grand divergence in health and longevity. Funding UK Medical Research Council and Public Health England. PMID:25935825

Exenatide versus insulin glargine in patients with type 2 diabetes in the UK: a model of long-term clinical and cost outcomes.

PubMed

Ray, Joshua A; Boye, Kristina S; Yurgin, Nicole; Valentine, William J; Roze, Stéphane; McKendrick, Jan; Tucker, Daniel M D; Foos, Volker; Palmer, Andrew J

2007-03-01

The aim of this study was to evaluate the long-term clinical and economic outcomes associated with exenatide or insulin glargine, added to oral therapy in individuals with type 2 diabetes inadequately controlled with combination oral agents in the UK setting. A published and validated computer simulation model of diabetes was used to project long-term complications, life expectancy, quality-adjusted life expectancy and direct medical costs. Probabilities of diabetes-related complications were derived from published sources. Treatment effects and patient characteristics were extracted from a recent randomised controlled trial comparing exenatide with insulin glargine. Simulations incorporated published quality of life utilities and UK-specific costs from 2004. Pharmacy costs for exenatide were based on 20, 40, 60, 80 and 100% of the US value (as no price for the UK was available at the time of analysis). Future costs and clinical benefits were discounted at 3.5% annually. Sensitivity analyses were performed. In the base-case analysis exenatide was associated with improvements in life expectancy of 0.057 years and in quality-adjusted life expectancy of 0.442 quality-adjusted life years (QALYs) versus insulin glargine. Long-term projections demonstrated that exenatide was associated with a lower cumulative incidence of most cardiovascular disease (CVD) complications and CVD-related death than insulin glargine. Using the range of cost values, evaluation results showed that exenatide is likely to fall in a range between dominant (cost and life saving) at 20% of the US price and cost-effective (with an ICER of 22,420 pounds per QALY gained) at 100% of the US price, versus insulin glargine. Based on the findings of a recent clinical trial, long-term projections indicated that exenatide is likely to be associated with improvement in life expectancy and quality-adjusted life expectancy compared to insulin glargine. The results from this modelling analysis suggest that that exenatide is likely to represent good value for money by generally accepted standards in the UK setting in individuals with type 2 diabetes inadequately controlled on oral therapy.

Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis.

PubMed

Hall, Rasheeda K; Myers, Evan R; Rosas, Sylvia E; O'Hare, Ann M; Colón-Emeric, Cathleen S

2017-06-07

Although arteriovenous fistulas have been found to be the most cost-effective form of hemodialysis access, the relative benefits of placing an arteriovenous fistula versus an arteriovenous graft seem to be least certain for older adults and when placed preemptively. However, older adults' life expectancy is heterogeneous, and most patients do not undergo permanent access creation until after dialysis initiation. We evaluated cost-effectiveness of arteriovenous fistula placement after dialysis initiation in older adults as a function of age and life expectancy. Using a hypothetical cohort of patients on incident hemodialysis with central venous catheters, we constructed Markov models of three treatment options: ( 1 ) arteriovenous fistula placement, ( 2 ) arteriovenous graft placement, or ( 3 ) continued catheter use. Costs, utilities, and transitional probabilities were derived from existing literature. Probabilistic sensitivity analyses were performed by age group (65-69, 70-74, 75-79, 80-84, and 85-89 years old) and quartile of life expectancy. Costs, quality-adjusted life-months, and incremental cost-effectiveness ratios were evaluated for up to 5 years. The arteriovenous fistula option was cost effective compared with continued catheter use for all age and life expectancy groups, except for 85-89 year olds in the lowest life expectancy quartile. The arteriovenous fistula option was more cost effective than the arteriovenous graft option for all quartiles of life expectancy among the 65- to 69-year-old age group. For older age groups, differences in cost-effectiveness between the strategies were attenuated, and the arteriovenous fistula option tended to only be cost effective in patients with life expectancy >2 years. For groups for which the arteriovenous fistula option was not cost saving, the cost to gain one quality-adjusted life-month ranged from $2294 to $14,042. Among older adults, the cost-effectiveness of an arteriovenous fistula placed within the first month of dialysis diminishes with increasing age and lower life expectancy and is not the most cost-effective option for those with the most limited life expectancy. Copyright © 2017 by the American Society of Nephrology.

Older Adults’ Views and Communication Preferences About Cancer Screening Cessation

PubMed Central

Schoenborn, Nancy L.; Lee, Kimberley; Pollack, Craig E.; Armacost, Karen; Dy, Sydney M.; Bridges, John F. P.; Xue, Qian-Li; Wolff, Antonio C.; Boyd, Cynthia

2017-01-01

IMPORTANCE Older adults with limited life expectancy are frequently screened for cancer even though it exposes them to risks of screening with minimal benefit. Patient preferences may be an important contributor to continued screening. OBJECTIVE To examine older adults’ views on the decision to stop cancer screening when life expectancy is limited and to identify older adults’ preferences for how clinicians should communicate recommendations to cease cancer screening. DESIGN, SETTING, AND PARTICIPANTS In this semistructured interview study, we interviewed 40 community-dwelling older adults (≥ 65 years) recruited at 4 clinical programs affiliated with an urban academic medical center. MAIN OUTCOMES AND MEASURE We transcribed the audio recorded discussions and analyzed the transcripts using standard techniques of qualitative content analysis to identify major themes and subthemes. RESULTS The participants’ average age was 75.7 years. Twenty-three participants (57.5%) were female; 25 (62.5%) were white. Estimated life expectancy was less than 10 years for 19 participants (47.5%). We identified 3 key themes. First, participants were amenable to stopping cancer screening, especially in the context of a trusting relationship with their clinician. Second, although many participants supported using age and health status to individualize the screening decision, they did not often understand the role of life expectancy. All except 2 participants objected to a Choosing Wisely statement about not recommending cancer screening in those with limited life expectancy, often believing that clinicians cannot accurately predict life expectancy. Third, participants preferred that clinicians explain a recommendation to stop screening by incorporating individual health status but were divided on whether life expectancy should be mentioned. Specific wording of life expectancy was important; many felt the language of “you may not live long enough to benefit from this test” was unnecessarily harsh compared with the more positive messaging of “this test would not help you live longer.” CONCLUSIONS AND RELEVANCE Although research and clinical practice guidelines recommend using life expectancy to inform cancer screening, older adults may not consider life expectancy important in screening and may not prefer to hear about life expectancy when discussing screening. The described communication preferences can help inform future screening discussions. Better delineating patient-centered approaches to discuss screening cessation is an important step toward optimizing cancer screening in older adults. PMID:28604917

Trends in healthy life expectancy in Hong Kong SAR 1996-2008.

PubMed

Cheung, Karen Siu Lan; Yip, Paul Siu Fai

2010-12-01

Although Hong Kong has one of the best life expectancy (LE) records in the world, second only to Japan for women, we know very little about the changes in the health status of the older adult population. Our article aims to provide a better understanding of trends in both chronic morbidity and disability for older men and women. The authors compute chronic morbidity-free and disability-free life expectancy and the proportion of both in relation to total LE using the Sullivan method to examine whether Hong Kong older adults are experiencing a compression of morbidity and disability and whether there is any gender difference in relation to mortality and morbidity. The results of this study show that Hong Kong women tend to outlive Hong Kong men but are also more likely to suffer from a 'double disadvantage', namely more years of life with more chronic morbidity and disability. There has also been a significant expansion of chronic morbidity, as chronic morbidity-free life expectancy (CMFLE) decreased substantially for both genders from 1996 to 2008. Although disability-free life expectancy (DFLE) increased during this period, it increased at a slower pace compared to LE. The proportion of life without chronic morbidity also declined remarkably during these 12 years. Among the advanced ages, the proportion of remaining life in good health without disability has decreased since 1996, indicating a relative expansion of disability.

[Waiting list in general and digestive surgery: patient expectations, quality of life during waiting time and overall satisfaction].

PubMed

Parés, D; Duran, E; Hermoso, J; Comajuncosas, J; Gris, P; Lopez-Negre, J L; Urgellés, J; Orbeal, R; Vallverdú, H; Jimeno, J

2013-01-01

The structural resources of the National Health system are limited, and therefore early surgery cannot be performed on all patients. The objective was to analyse the satisfaction perceived by the patient as regards the delay of treatment by waiting list of three types of surgery. The influence of expectations on waiting times, and impaired quality of life due to the clinical symptoms during the delay, were studied. A prospective study was conducted using a postal questionnaire. We compared the expectations (scale of 1 to 5), the impact on quality of life for symptoms (scale of 1 to 5) and the level of patient satisfaction (scale of 1 to 5) with respect to time on the waitng list for cholelithiasis, inguinal hernia and haemorrhoids. The predictors of patient dissatisfaction were analysed. A total of 57 patients were included. When comparing the characteristics of patients with and without satisfaction over time on the waiting list, days on the waiting list (P=.044), the change in the quality of life due to the symptoms (P=.028), and expectations (P<.001) were significantly different between the two groups. In the multivariate analysis, the expectation was associated with patient dissatisfaction as regards the time on waiting list (OR: 3.14 95% CI: 5.91 to 220.73, P<.001). The level of patient dissatisfaction is associated with expectations about time in waiting list. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

What has contributed to the change in life expectancy in Italy between 1980 and 1992?

PubMed

Ngongo, K N; Nante, N; Chenet, L; McKee, M

1999-07-01

Life expectancy at birth in southern Europe is known to be greater than expected in comparison with levels of economic development. This has been attributed to the 'Mediterranean diet'. There are, however, concerns that this comparative advantage is being lost. This paper examines the factors underlying changing life expectancy in Italy since 1980. The subjects of this analysis are obtained from data on all deaths in Italy between 1980 and 1992. Change in age specific death rates is calculated from selected causes and, using the method developed by Pollard, the contribution of deaths from different causes and at different ages to changing life expectancy at birth is estimated. Between 1980 and 1992, life expectancy at birth increased by 2.70 years for men and 2.75 years for women. Death rates have fallen among children and those over 40. In contrast, death rates have increased among men aged between 20 and 39 and have increased very slightly among women aged 25-29. Falling death rates from ischaemic heart disease are continuing to contribute to increasing life expectancy. Death rates from lung and breast cancer are rising among women but are compensated for by falling death rates from other cancers. Among men, falling death rates from cancer at younger ages are being offset by increases at older ages. The rising death rate among younger men is almost entirely due to AIDS, with accidents also making a small contribution. Life expectancy in Italy has improved throughout the 1980s, largely driven by falling death rates from cardiovascular diseases. Here are, however, some worrying trends, most notably the rising death rate among young men, due almost entirely to AIDS. The changing pattern of mortality has some similarities with Spain, another Mediterranean country, but there are also important differences.

Changing mortality patterns in East and West Germany and Poland. II: Short-term trends during transition and in the 1990s

PubMed Central

Nolte, E.; Shkolnikov, V.; McKee, M.

2000-01-01

OBJECTIVES—To examine trends in life expectancy at birth and age and cause specific patterns of mortality in the former German Democratic Republic (GDR) and Poland during political transition and throughout the 1990s in both parts of Germany and in Poland.
METHODS—Decomposition of life expectancy by age and cause of death. Changes in life expectancy during transition by cause of death were examined using data for 1988/89 and 1990/91 for the former GDR and Poland; examination of life expectancy changes after transition were based on 1992-97 data for Germany and 1991-96 data for Poland.
RESULTS—In both the former GDR and Poland male life expectancy at birth declined by almost one year during transition, mainly attributable to rising death rates from external causes and circulatory diseases. Female life expectancy in Poland deteriorated by 0.3 years, largely attributable to increasing circulatory mortality among the old, while in East German female rising death rates in children and young adults were nearly outbalanced by declining circulatory mortality among those over 70. Between 1991/92 and 1996/97, male life expectancy at birth increased by 2.4 years in the former GDR, 1.2 years in old Federal Republic, and 2.0 years in Poland (women: 2.3, 0.9, and 1.2 years). In East Germany and Poland, the overall improvement was largely attributable to falling mortality among men aged 40-64, while those over 65 contributed the largest proportion to life expectancy gains in women. The change in deaths among men aged 15-39 accounted for 0.4 of a year to life expectancy at birth in East Germany and Poland, attributable largely to greater decreases from external causes. Among those over 40, absolute contributions to changing life expectancy were greater in the former GDR than in the other two entities in both sexes, largely attributable to circulatory diseases. A persisting East-west life expectancy gap in Germany of 2.1 years in men in 1997 was largely attributable to external causes, diseases of the digestive system and circulatory diseases. Higher death rates from circulatory diseases among the elderly largely explain the female life expectancy gap of approximately one year.
CONCLUSIONS—This study provides further insights into the health effects of political transition. Post-transition improvements in life expectancy and mortality have been much steeper in East Germany compared with Poland. Changes in dietary pattern and, in Germany, medical care may have been important factors in shaping post-transition mortality trends. 


Keywords: mortality trends; Germany; Poland; transition PMID:11076985

Survival Differences among Native-Born and Foreign-Born Older Adults in the United States

PubMed Central

Dupre, Matthew E.; Gu, Danan; Vaupel, James W.

2012-01-01

Background Studies show that the U.S. foreign-born population has lower mortality than the native-born population before age 65. Until recently, the lack of data prohibited reliable comparisons of U.S. mortality by nativity at older ages. This study provides reliable estimates of U.S. foreign-born and native-born mortality at ages 65 and older at the end of the 20th century. Life expectancies of the U.S. foreign born are compared to other developed nations and the foreign-born contribution to total life expectancy (TLE) in the United States is assessed. Methods Newly available data from Medicare Part B records linked with Social Security Administration files are used to estimate period life tables for nearly all U.S. adults aged 65 and older in 1995. Age-specific survival differences and life expectancies are examined in 1995 by sex, race, and place of birth. Results Foreign-born men and women had lower mortality at almost every age from 65 to 100 compared to native-born men and women. Survival differences by nativity were substantially greater for blacks than whites. Foreign-born blacks had the longest life expectancy of all population groups (18.73 [95% confidence interval {CI}, 18.15–19.30] years at age 65 for men and 22.76 [95% CI, 22.28–23.23] years at age 65 for women). The foreign-born population increased TLE in the United States at older ages, and by international comparison, the U.S. foreign born were among the longest-lived persons in the world. Conclusion Survival estimates based on reliable Medicare data confirm that foreign-born adults have longer life expectancy at older ages than native-born adults in the United States. PMID:22615929

Trends in life expectancy by education in Norway 1961-2009.

PubMed

Steingrímsdóttir, Olöf Anna; Næss, Øyvind; Moe, Joakim Oliu; Grøholt, Else-Karin; Thelle, Dag Steinar; Strand, Bjørn Heine; Bævre, Kåre

2012-03-01

Educational attainment and longevity are strongly related. Large population studies covering long periods to provide evidence of trends in educational inequalities regarding life expectancy are scarce though, especially prior to the 1980s. Our objective was to document changes in life expectancy by education in Norway in the period 1961-2009, and to determine whether the patterns differ between sexes. This is a register-based population study of all Norwegian residents over 34 years, with data from the National Central Population Registry and the National Education Database. For each calendar year during 1961-2009, death rates by 1 year age groups were calculated separately for each sex and three educational categories (primary, secondary and tertiary). Annual life tables were used to calculate life expectancy at age 35 (e ( 35 )) and survival probability for the three age-intervals 35-44, 45-64, and 65-90. All education groups increased their e ( 35 ) over time, but inequalities in e ( 35 ) between tertiary and primary educational categories widened 5.3 years for men and 3.2 years for women during the study period. The probability for women with primary education to survive to age 64 did not improve from 1961 to 2009. The gain in life expectancy lagged about 10 years in lower compared to higher education groups which might suggest that improvements in life sustaining factors reach different segments of the population at different times. The widening of the gap seems to have partly tapered off over the last two decades, and the changes in life expectancy should be followed carefully in the future to document the development.

Challenges in Providing End-of-Life Care for People with Intellectual Disability: Health Services Access

ERIC Educational Resources Information Center

Wark, Stuart; Hussain, Rafat; Müller, Arne; Ryan, Peta; Parmenter, Trevor

2017-01-01

Background: Increasing life expectancy for people with intellectual disability is resulting in greater need for end-of-life care services. However, limited knowledge is available regarding what barriers to accessing end-of-life care support are evident, particularly comparatively across rural and metropolitan locations. Methods: Focus group…

Quantifying the burden of disease due to premature mortality in Hong Kong using standard expected years of life lost.

PubMed

Plass, Dietrich; Chau, Patsy Yuen Kwan; Thach, Thuan Quoc; Jahn, Heiko J; Lai, Poh Chin; Wong, Chit Ming; Kraemer, Alexander

2013-09-18

To complement available information on mortality in a population Standard Expected Years of Life Lost (SEYLL), an indicator of premature mortality, is increasingly used to calculate the mortality-associated disease burden. SEYLL consider the age at death and therefore allow a more accurate view on mortality patterns as compared to routinely used measures (e.g. death counts). This study provides a comprehensive assessment of disease and injury SEYLL for Hong Kong in 2010. To estimate the SEYLL, life-expectancy at birth was set according to the 2004 Global Burden of Disease study at 82.5 and 80 years for females and males, respectively. Cause of death data for 2010 were corrected for misclassification of cardiovascular and cancer causes. In addition to the baseline estimates, scenario analyses were performed using alternative assumptions on life-expectancy (Hong Kong standard life-expectancy), time-discounting and age-weighting. To estimate a trend of premature mortality a time-series analysis from 2001 to 2010 was conducted. In 2010 524,706.5 years were lost due to premature death in Hong Kong with 58.3% of the SEYLL attributable to male deaths. The three overall leading single causes of SEYLL were "trachea, bronchus and lung cancers", "ischaemic heart disease" and "lower respiratory infections" together accounting for about 29% of the overall SEYLL. Further, self-inflicted injuries (5.6%; ranked 5) and liver cancer (4.9%; ranked 7) were identified as important causes not adequately captured by classical mortality measures. Scenario analyses highlighted that by using a 3% time-discount rate and non-uniform age-weights the SEYLL dropped by 51.6%. Using Hong Kong's standard life-expectancy values resulted in an overall increase of SEYLL by 10.8% as compared to the baseline SEYLL. Time-series analysis indicates an overall increase of SEYLL by 6.4%. In particular, group I (communicable, maternal, perinatal and nutritional) conditions showed highest increases with SEYLL-rates per 100,000 in 2010 being 1.4 times higher than 2001. The study stresses the mortality impact of diseases and injuries that occur in earlier stages of life and thus presents the SEYLL measure as a more sensitive indicator compared to classical mortality indicators. SEYLL provide useful additional information and supplement available death statistics.

Quantifying the burden of disease due to premature mortality in Hong Kong using standard expected years of life lost

PubMed Central

2013-01-01

Background To complement available information on mortality in a population Standard Expected Years of Life Lost (SEYLL), an indicator of premature mortality, is increasingly used to calculate the mortality-associated disease burden. SEYLL consider the age at death and therefore allow a more accurate view on mortality patterns as compared to routinely used measures (e.g. death counts). This study provides a comprehensive assessment of disease and injury SEYLL for Hong Kong in 2010. Methods To estimate the SEYLL, life-expectancy at birth was set according to the 2004 Global Burden of Disease study at 82.5 and 80 years for females and males, respectively. Cause of death data for 2010 were corrected for misclassification of cardiovascular and cancer causes. In addition to the baseline estimates, scenario analyses were performed using alternative assumptions on life-expectancy (Hong Kong standard life-expectancy), time-discounting and age-weighting. To estimate a trend of premature mortality a time-series analysis from 2001 to 2010 was conducted. Results In 2010 524,706.5 years were lost due to premature death in Hong Kong with 58.3% of the SEYLL attributable to male deaths. The three overall leading single causes of SEYLL were “trachea, bronchus and lung cancers”, “ischaemic heart disease” and “lower respiratory infections” together accounting for about 29% of the overall SEYLL. Further, self-inflicted injuries (5.6%; ranked 5) and liver cancer (4.9%; ranked 7) were identified as important causes not adequately captured by classical mortality measures. Scenario analyses highlighted that by using a 3% time-discount rate and non-uniform age-weights the SEYLL dropped by 51.6%. Using Hong Kong’s standard life-expectancy values resulted in an overall increase of SEYLL by 10.8% as compared to the baseline SEYLL. Time-series analysis indicates an overall increase of SEYLL by 6.4%. In particular, group I (communicable, maternal, perinatal and nutritional) conditions showed highest increases with SEYLL-rates per 100,000 in 2010 being 1.4 times higher than 2001. Conclusions The study stresses the mortality impact of diseases and injuries that occur in earlier stages of life and thus presents the SEYLL measure as a more sensitive indicator compared to classical mortality indicators. SEYLL provide useful additional information and supplement available death statistics. PMID:24044523

Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan

PubMed Central

Chang, Kun-Chia; Wang, Jung-Der; Saxon, Andrew; Matthews, Abigail G.; Woody, George; Hser, Yih-Ing

2017-01-01

Aims This study compared the cause-specific standardized mortality ratios (SMRs) and expected years of life lost (EYLL) among opioid-dependent individuals in the United States and Taiwan. Methods Survival data came from two cohorts followed until 2014: The U.S. data were based on a randomized trial of 1,267 opioid-dependent participants enrolled between 2006 and 2009; the Taiwan data were from a study of 983 individuals that began in 2006, when opioid agonist treatment (OAT) was implemented in Taiwan. SMRs were calculated for each national cohort and compared. Kaplan-Meier estimation was performed on the survival data, then lifespans were extrapolated to 70 years (840 months) to estimate life expectancy using a semi-parametric method. EYLLs for both cohorts were estimated by subtracting their life expectancies from the age- and gender-matched referents within the general population of their respective country. Results Compared with age- and gender- matched referents, the SMRs were 3.2 for the U.S. sample and 7.8 for the Taiwan sample; the EYLLs were 7.7 and 16.4 years, respectively. Half of decedents died of unnatural causes in both cohorts; overdose deaths predominated in the U.S. and suicide in Taiwan. Conclusions Our study identified differences by country in EYLL and causes of deaths. These findings suggest that intervention strategies to reduce mortality risk by overdose (particularly in the U.S.) and suicide (particularly in Taiwan) are urgently needed in these countries. PMID:28160734

Socioeconomic factors and mortality in urban settings: the case of Barcelona, Spain.

PubMed Central

Borrell, C; Arias, A

1995-01-01

STUDY OBJECTIVE--This study aimed to describe the relationship between health and socioeconomic indicators in the 38 neighbourhoods of the city of Barcelona, Spain. DESIGN--Mortality data for 1983-89 and socioeconomic data for each of the 38 neighbourhoods of Barcelona were used. Mortality indicators used were the comparative mortality figure, the ratio of potential years of life lost, and life expectancy at birth. Socioeconomic indicators were the percentage of unemployed, the percentage of illiteracy, monthly telephone usage, the average power and age of cars, and the average rateable value of buildings and of land. The statistical correlation between socioeconomic indicators and mortality indicators was studied by Spearman's rank correlation coefficient. SETTING--The 38 neighbourhoods of Barcelona, Spain. MEASUREMENTS AND MAIN RESULTS--The comparative mortality figure ranged from 87.41-152.43 and the ratio of potential years of life lost from 74.94-237.31 in both sexes. Both the absolute difference and the ratio of the value for the neighbourhood with lowest mortality and that with highest mortality were larger when premature mortality was examined. Life expectancy at birth ranged from 64.77-75.32 years in men and 75.04-81.51 in women. All correlations between mortality and socioeconomic indicators were high and statistically significant: the higher the unemployment and illiteracy levels and the older the cars, the greater the comparative mortality figure and ratio of potential years of life lost, and the lower the life expectancy (negative correlations). Conversely, the higher the telephone use, the more powerful the cars, and the greater the rateable value, the lower the mortality (negative correlations) and the greater the life expectancy. These correlations were greater in males than in females. The highest correlations were with illiteracy. CONCLUSIONS--This study has detected significant differences in mortality in a large town in the Mediterranean region of Europe. Images PMID:7499987

Impact of bariatric surgery on life expectancy in severely obese patients with diabetes: A Decision analysis

PubMed Central

Schauer, Daniel P.; Arterburn, David E.; Livingston, Edward H.; Coleman, Karen J.; Sidney, Steve; Fisher, David; O'Connor, Patrick; Fischer, David; Eckman, Mark H.

2014-01-01

Objective To create a decision analytic model to estimate the balance between treatment risks and benefits for severely obese patients with diabetes. Summary Background Data Bariatric surgery leads to many desirable metabolic changes, but long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified. Methods We developed a Markov state transition model with multiple Cox proportional hazards models and logistic regression models as inputs to compare bariatric surgery versus no surgical treatment for severely obese diabetic patients. The model is informed by data from three large cohorts: 1) 159,000 severely obese diabetic patients (4,185 had bariatric surgery) from 3 HMO Research Network sites, 2) 23,000 subjects from the Nationwide Inpatient Sample (NIS), and 3) 18,000 subjects from the National Health Interview Survey linked to the National Death Index. Results In our main analyses, we found that a 45 year-old female with diabetes and a BMI of 45 kg/m2 gained an additional 6.7 years of life expectancy with bariatric surgery (38.4 years with surgery vs. 31.7 without). Sensitivity analyses revealed that the gain in life expectancy decreased with increasing BMI, until a BMI of 62 kg/m2 is reached, at which point nonsurgical treatment was associated with greater life expectancy. Similar results were seen for both men and women in all age groups. Conclusions For most severely obese patients with diabetes, bariatric surgery appears to improve life expectancy; however, surgery may reduce life expectancy for the super obese with BMIs over 62 kg/m2. PMID:25844968

Long-Term Exposure to Ozone and Life Expectancy in the United States, 2002 to 2008

PubMed Central

Li, Chaoyang; Balluz, Lina S.; Vaidyanathan, Ambarish; Wen, Xiao-Jun; Hao, Yongping; Qualters, Judith R.

2016-01-01

Abstract Long-term exposure to ground-level ozone is associated with increased risk of morbidity and mortality. The association remains uncertain between long-term exposure to ozone and life expectancy. We assessed the associations between seasonal mean daily 8-hour maximum (8-hr max) ozone concentrations measured during the ozone monitoring seasons and life expectancy at birth in 3109 counties of the conterminous U.S. during 2002 to 2008. We used latent class growth analysis to identify latent classes of counties that had distinct mean levels and rates of change in ozone concentrations over the 7-year period and used linear regression analysis to determine differences in life expectancy by ozone levels. We identified 3 classes of counties with distinct seasonal mean daily 8-hr max ozone concentrations and rates of change. When compared with the counties with the lowest ozone concentrations, the counties with the highest ozone concentrations had 1.7- and 1.4-year lower mean life expectancy in males and females (both P < 0.0001), respectively. The associations remained statistically significant after controlling for potential confounding effects of seasonal mean PM2.5 concentrations and other selected environmental, demographic, socio-economic, and health-related factors (both P < 0.0001). A 5 ppb higher ozone concentration was associated with 0.25 year lower life expectancy in males (95% CI: −0.30 to −0.19) and 0.21 year in females (95% CI: −0.25 to −0.17). We identified 3 classes of counties with distinct mean levels and rates of change in ozone concentrations. Our findings suggest that long-term exposure to a higher ozone concentration may be associated with a lower life expectancy. PMID:26886595

Years of life gained due to leisure-time physical activity in the U.S.

PubMed

Janssen, Ian; Carson, Valerie; Lee, I-Min; Katzmarzyk, Peter T; Blair, Steven N

2013-01-01

Physical inactivity is an important modifiable risk factor for noncommunicable disease. The degree to which physical activity affects the life expectancy of Americans is unknown. This study estimated the potential years of life gained due to leisure-time physical activity in the U.S. Data from the National Health and Nutrition Examination Survey (2007-2010); National Health Interview Study mortality linkage (1990-2006); and U.S. Life Tables (2006) were used to estimate and compare life expectancy at each age of adult life for inactive (no moderate to vigorous physical activity); somewhat-active (some moderate to vigorous activity but <500 MET minutes/week); and active (≥ 500 MET minutes/week of moderate to vigorous activity) adults. Analyses were conducted in 2012. Somewhat-active and active non-Hispanic white men had a life expectancy at age 20 years that was ~2.4 years longer than that for the inactive men; this life expectancy advantage was 1.2 years at age 80 years. Similar observations were made in non-Hispanic white women, with a higher life expectancy within the active category of 3.0 years at age 20 years and 1.6 years at age 80 years. In non-Hispanic black women, as many as 5.5 potential years of life were gained due to physical activity. Significant increases in longevity were also observed within somewhat-active and active non-Hispanic black men; however, among Hispanics the years-of-life-gained estimates were not significantly different from 0 years gained. Leisure-time physical activity is associated with increases in longevity. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Years of Life Gained Due to Leisure-Time Physical Activity in the United States

PubMed Central

Janssen, Ian; Carson, Valerie; Lee, I-Min; Katzmarzyk, Peter T.; Blair, Steven N.

2013-01-01

Background Physical inactivity is an important modifiable risk factor for non-communicable disease. The degree to which physical activity affects the life expectancy of Americans is unknown. This study estimated the potential years of life gained due to leisure-time physical activity across the adult lifespan in the United States. Methods Data from the National Health and Nutrition Examination Survey (2007–2010), National Health Interview Study mortality linkage (1990–2006), and US Life Tables (2006) were used to estimate and compare life expectancy at each age of adult life for inactive (no moderate-to-vigorous physical activity), somewhat active (some moderate-to-vigorous activity but <500 metabolic equivalent min/week) and active (≥500 metabolic equivalent min/week of moderate-to-vigorous activity) adults. Analyses were conducted in 2012. Results Somewhat active and active non-Hispanic white men had a life expectancy at age 20 that was around 2.4 years longer than the inactive men; this life expectancy advantage was 1.2 years at age 80. Similar observations were made in non-Hispanic white women, with a higher life expectancy within the active category of 3.0 years at age 20 and 1.6 years at age 80. In non-Hispanic black women, as many as 5.5 potential years of life were gained due to physical activity. Significant increases in longevity were also observed within somewhat active and active non-Hispanic black men; however, among Hispanics the years of life gained estimates were more variable and not significantly different from 0 years gained. Conclusions Leisure-time physical activity is associated with increases in longevity in the United States. PMID:23253646

Social inequalities in life expectancy and mortality during the transition period of economic crisis (1993–2010) in Korea

PubMed Central

2012-01-01

Backgrounds This study examines social inequalities in life expectancy and mortality during the transition period of the Korean economic crisis (1993–2010) among Korean adults aged 40 and over. Methods Data from the census and the national death file from the Statistics Korea are employed to calculate life expectancy and age-specific-death-rates (ASDR) by age, gender, and educational attainment for five years: 1993, 1995, 2000, 2005, and 2010. Absolute and relative differences in life expectancy and Age-Specific Death Rates by educational attainment were utilized as proxy measures of social inequality. Results Clear educational gradient of life expectancy was observed at age 40 by both sexes and across five time periods (1993, 1995, 2000, 2005, and 2010). The gradient became notably worse in females between 1993 and 2010 compared to the trend in males. The educational gradient was also found for ASDR in all five years, but it was more pronounced in working age groups (40s and 50s) than in elderly groups. The relative disadvantage of ASDR among working age Korean adults, both males and females, became substantially worse over time. Conclusions Social inequalities in life expectancy and ASDR of the working age group across socioeconomic status over time were closely related to the widening of the social difference created by the macroeconomic crisis and the expansion of neo-liberalism in Korea. PMID:23171369

Interpretation and expectations among mothers of children with anxiety disorders: associations with maternal anxiety disorder.

PubMed

Orchard, Faith; Cooper, Peter J; Phil, D; Creswell, Cathy

2015-02-01

Models of the development and maintenance of childhood anxiety suggest an important role for parent cognitions: that is, negative expectations of children's coping abilities lead to parenting behaviors that maintain child anxiety. The primary aims of the current study were to (1) compare expectations of child vulnerability and coping among mothers of children with anxiety disorders on the basis of whether or not mothers also had a current anxiety disorder, and (2) examine the degree to which the association between maternal anxiety disorder status and child coping expectations was mediated by how mothers interpreted ambiguous material that referred to their own experience. The association between interpretations of threat, negative emotion, and control was assessed using hypothetical ambiguous scenarios in a sample of 271 anxious and nonanxious mothers of 7- to 12-year-old children with an anxiety disorder. Mothers also rated their expectations when presented with real life challenge tasks. There was a significant association between maternal anxiety disorder status and negative expectations of child coping behaviors. Mothers’ self-referent interpretations were found to mediate this relationship. Responses to ambiguous hypothetical scenarios correlated significantly with responses to real life challenge tasks. Treatments for childhood anxiety disorders in the context of parental anxiety disorders may benefit from the inclusion of a component to directly address parental cognitions. Some inconsistencies were found when comparing maternal expectations in response to hypothetical scenarios with real life challenges. This should be addressed in future research.

Interpretation and Expectations Among Mothers of Children with Anxiety Disorders: Associations With Maternal Anxiety Disorder

PubMed Central

Orchard, Faith; Cooper, Peter J; Creswell, Cathy

2015-01-01

Background Models of the development and maintenance of childhood anxiety suggest an important role for parent cognitions: that is, negative expectations of children's coping abilities lead to parenting behaviors that maintain child anxiety. The primary aims of the current study were to (1) compare expectations of child vulnerability and coping among mothers of children with anxiety disorders on the basis of whether or not mothers also had a current anxiety disorder, and (2) examine the degree to which the association between maternal anxiety disorder status and child coping expectations was mediated by how mothers interpreted ambiguous material that referred to their own experience. Methods The association between interpretations of threat, negative emotion, and control was assessed using hypothetical ambiguous scenarios in a sample of 271 anxious and nonanxious mothers of 7- to 12-year-old children with an anxiety disorder. Mothers also rated their expectations when presented with real life challenge tasks. Results There was a significant association between maternal anxiety disorder status and negative expectations of child coping behaviors. Mothers’ self-referent interpretations were found to mediate this relationship. Responses to ambiguous hypothetical scenarios correlated significantly with responses to real life challenge tasks. Conclusions Treatments for childhood anxiety disorders in the context of parental anxiety disorders may benefit from the inclusion of a component to directly address parental cognitions. Some inconsistencies were found when comparing maternal expectations in response to hypothetical scenarios with real life challenges. This should be addressed in future research. PMID:25763427

Modeling and forecasting U.S. sex differentials in mortality.

PubMed

Carter, L R; Lee, R D

1992-11-01

"This paper examines differentials in observed and forecasted sex-specific life expectancies and longevity in the United States from 1900 to 2065. Mortality models are developed and used to generate long-run forecasts, with confidence intervals that extend recent work by Lee and Carter (1992). These results are compared for forecast accuracy with univariate naive forecasts of life expectancies and those prepared by the Actuary of the Social Security Administration." excerpt

Socio-economic factors & longevity in a cohort of Kerala State, India.

PubMed

Sauvaget, Catherine; Ramadas, Kunnambath; Fayette, Jean-Marie; Thomas, Gigi; Thara, Somanathan; Sankaranarayanan, Rengaswamy

2011-05-01

Even though Kerala State is well-known for its egalitarian policies in terms of healthcare, redistributive actions and social reforms, and its health indicators close to those of high-resource countries despite a poor per-capita income, it is not clear whether socio-economic disparities in terms of life expectancy are observed. This study was therefore carried out to study the impact of socio-economic level on life expectancy in individuals living in Kerala. A cohort of 1,67,331 participants aged 34 years and above in Thiruvananthapuram district, having completed a lifestyle questionnaire at baseline in 1995, was followed up for mortality and cause of death until 2005. Survival estimates were based on the participants' vital status and death rates were calculated separately for men and women and for several socio-economic factors, stratified by age. At 40 years, men and women were expected to live another 34 and 37 years, respectively. Life expectancy varied across the participants' different socio-economic categories: those from high income households with good housing conditions, materially privileged households and small households, had a 2-3 years longer life expectancy as compared to the deprived persons. Also, those who went to college lived longer than the illiterates. The gaps between categories were wider in men than in women. Socio-economic disparity in longevity was observed: wealthy people from Kerala State presented a longer life expectancy.

Life expectancy in individuals with type 2 diabetes: implications for annuities.

PubMed

Price, Hermione C; Clarke, Philip M; Gray, Alastair M; Holman, Rury R

2010-01-01

Insurance companies often offer people with diabetes ''enhanced impaired life annuity'' at preferential rates, in view of their reduced life expectancy. To assess the appropriateness of ''enhanced impaired life annuity'' rates for individuals with type 2 diabetes. Patients. There were 4026 subjects with established type 2 diabetes (but not known cardiovascular or other life-threatening diseases) enrolled into the UK Lipids in Diabetes Study. Measurements. Estimated individual life expectancy using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model. Subjects were a mean (SD) age of 60.7 (8.6) years, had a blood pressure of 141/83 (17/10) mm Hg, total cholesterol level of 4.5 (0.75) mmol/L, HDL cholesterol level of 1.2 (0.29) mmol/L, with median (interquartile range [IQR]) known diabetes duration of 6 (3-11) years, and HbA(1c) of 8.0% (7.2-9.0). Sixty-five percent were male, 91% white, 4% Afro-Caribbean, 5% Indian-Asian, and 15% current smokers. The UKPDS Outcomes Model median (IQR) estimated age at death was 76.6 (73.8-79.5) years compared with 81.6 (79.4-83.2) years, estimated using the UK Government Actuary's Department data for a general population of the same age and gender structure. The median (IQR) difference was 4.3 (2.8-6.1) years, a remaining life expectancy reduction of almost one quarter. The highest value annuity identified, which commences payments immediately for a 60-year-old man with insulin-treated type 2 diabetes investing 100,000, did not reflect this difference, offering 7.4K per year compared with 7.0K per year if not diabetic. The UK Government Actuary's Department data overestimate likely age at death in individuals with type 2 diabetes, and at present, ''enhanced impaired life annuity'' rates do not provide equity for people with type 2 diabetes. Using a diabetes-specific model to estimate life expectancy could provide valuable information to the annuity industry and permit more equitable annuity rates for those with type 2 diabetes.

Stereotactic Body Radiotherapy Versus Surgery for Medically Operable Stage I Non-Small-Cell Lung Cancer: A Markov Model-Based Decision Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Louie, Alexander V.; Rodrigues, George, E-mail: george.rodrigues@lhsc.on.ca; Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON

Purpose: To compare the quality-adjusted life expectancy and overall survival in patients with Stage I non-small-cell lung cancer (NSCLC) treated with either stereotactic body radiation therapy (SBRT) or surgery. Methods and Materials: We constructed a Markov model to describe health states after either SBRT or lobectomy for Stage I NSCLC for a 5-year time frame. We report various treatment strategy survival outcomes stratified by age, sex, and pack-year history of smoking, and compared these with an external outcome prediction tool (Adjuvant{exclamation_point} Online). Results: Overall survival, cancer-specific survival, and other causes of death as predicted by our model correlated closely withmore » those predicted by the external prediction tool. Overall survival at 5 years as predicted by baseline analysis of our model is in favor of surgery, with a benefit ranging from 2.2% to 3.0% for all cohorts. Mean quality-adjusted life expectancy ranged from 3.28 to 3.78 years after surgery and from 3.35 to 3.87 years for SBRT. The utility threshold for preferring SBRT over surgery was 0.90. Outcomes were sensitive to quality of life, the proportion of local and regional recurrences treated with standard vs. palliative treatments, and the surgery- and SBRT-related mortalities. Conclusions: The role of SBRT in the medically operable patient is yet to be defined. Our model indicates that SBRT may offer comparable overall survival and quality-adjusted life expectancy as compared with surgical resection. Well-powered prospective studies comparing surgery vs. SBRT in early-stage lung cancer are warranted to further investigate the relative survival, quality of life, and cost characteristics of both treatment paradigms.« less

[Educational status and life expectancy in patients with chronic non-communicable diseases].

PubMed

Villarreal-Hernández, Liliana del Sagrario; Romo-Martínez, Jesús Eduardo

2014-01-01

Suffering a non communicable chronic disease in combination with low educational level and low economic income develops a synergy, which contributes to a poor prognostic about the expectancy of life. A better educational level may improve the life expectancy. The objective of this research was to explore this relation. A retrospective cohort study from January 1, 1999, to December 31, 2011, was performed. We included 2306 patients obtained from the information system in mortality of Family Medicine Unit 3 of the Instituto Mexicano del Seguro Social in Guadalajara, Jalisco. The main measures were average age-at-death and educational level. We used Student's t, chi-squared test and relative risk (RR) calculations for statistical analysis. The average age-at-death for those who had a low educational level (n = 1936) was 73.24 ± 12.18 years, while for those who had a satisfactory level of education (n = 370) was 63.47 ± 14.51 years, estimating a mean difference of 9.77 years with p < 0.001. Having a low educational level and not reaching life expectancy compared to the satisfactory level meant a RR = 0.24 (IC 95 % = 0.19, 0.30). The projected linear regression for each educational grade showed that patients lost 2.5 years of life. Diabetes accompanied by a low educational level showed a double probability of not reaching the expectation of life.

What type of rural? Assessing the variations in life expectancy at birth at small area-level for a small population province using classes of locally defined settlement types.

PubMed

Terashima, Mikiko; Read Guernsey, Judith; Andreou, Pantelis

2014-02-13

Although efforts have been made to articulate rural-urban health inequalities in recent years, results have been inconsistent due to different geographical scales used in these studies. Small-area level investigations of health inequalities will likely show more detailed pictures of health inequalities among diverse rural communities, but they are difficult to conduct, particularly in a small population region. The objectives of this study were: 1) to compare life expectancy at birth for females and males across small-areas classified by locally defined settlement types for a small province in Canada; 2) to assess whether any of the settlement types explains variations in life expectancy over and above the extent of socioeconomic disadvantage and social isolation; and 3) to examine variations in life expectancies within a (larger) area unit used as the basis of health inequality investigations in previous studies. Seven settlement types were determined for the 'community' units based on population per-kilometre-road density and settlement forms. Mean life expectancies at birth for both genders were compared by settlement type, both for the entire province and within the Halifax Regional Municipality--the province's only census designated metropolitan area, but also contains rural settlements. Linear regression analyses were conducted to assess the statistical associations between life expectancy and the settlement types, adjusting for indicators of community-level deprivation. While types of communities considered as 'rural' generally had lower life expectancy for both genders, the effects of living in any settlement type were attenuated once adjusted for socioeconomic deprivation and social isolation. An exception was the village and settlement cluster type, which had additionally negative effects on health for females. There were some variations observed within the Halifax Regional Municipality, suggesting the importance of further investigating a variety of health and disease outcomes at smaller area-levels than those employed in previous studies. This paper highlighted the importance of further articulating the differences in the characteristics of rural at finer area-levels and the differential influence they may have on health. Further efforts are desirable to overcome various data challenges in order to extend the investigation of health inequalities to hard-to-study provinces.

Job strain and loss of healthy life years between ages 50 and 75 by sex and occupational position: analyses of 64 934 individuals from four prospective cohort studies.

PubMed

Magnusson Hanson, Linda L; Westerlund, Hugo; Chungkham, Holendro S; Vahtera, Jussi; Rod, Naja H; Alexanderson, Kristina; Goldberg, Marcel; Kivimäki, Mika; Stenholm, Sari; Platts, Loretta G; Zins, Marie; Head, Jenny

2018-05-07

Poor psychosocial working conditions increase the likelihood of various types of morbidity and may substantially limit quality of life and possibilities to remain in paid work. To date, however, no studies to our knowledge have quantified the extent to which poor psychosocial working conditions reduce healthy or chronic disease-free life expectancy, which was the focus of this study. Data were derived from four cohorts with repeat data: the Finnish Public Sector Study (Finland), GAZEL (France), the Swedish Longitudinal Occupational Survey of Health (Sweden) and Whitehall II (UK). Healthy (in good self-rated health) life expectancy (HLE) and chronic disease-free (free from cardiovascular disease, cancer, respiratory disease and diabetes) life expectancy (CDFLE) was calculated from age 50 to 75 based on 64 394 individuals with data on job strain (high demands in combination with low control) at baseline and health at baseline and follow-up. Multistate life table models showed that job strain was consistently related to shorter HLE (overall 1.7 years difference). The difference in HLE was more pronounced among men (2.0 years compared with 1.5 years for women) and participants in lower occupational positions (2.5 years among low-grade men compared with 1.7 years among high-grade men). Similar differences in HLE, although smaller, were observed among those in intermediate or high occupational positions. Job strain was additionally associated with shorter CDFLE, although this association was weaker and somewhat inconsistent. These findings suggest that individuals with job strain have a shorter health expectancy compared with those without job strain. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan.

PubMed

Chang, Kun-Chia; Wang, Jung-Der; Saxon, Andrew; Matthews, Abigail G; Woody, George; Hser, Yih-Ing

2017-05-01

This study compared the cause-specific standardized mortality ratios (SMRs) and expected years of life lost (EYLL) among opioid-dependent individuals in the United States and Taiwan. Survival data came from two cohorts followed until 2014: The U.S. data were based on a randomized trial of 1267 opioid-dependent participants enrolled between 2006 and 2009; the Taiwan data were from a study of 983 individuals that began in 2006, when opioid agonist treatment (OAT) was implemented in Taiwan. SMRs were calculated for each national cohort and compared. Kaplan-Meier estimation was performed on the survival data, then lifespans were extrapolated to 70 years (840 months) to estimate life expectancy using a semi-parametric method. EYLLs for both cohorts were estimated by subtracting their life expectancies from the age- and gender-matched referents within the general population of their respective country. Compared with age- and gender-matched referents, the SMRs were 3.2 for the U.S. sample and 7.8 for the Taiwan sample; the EYLLs were 7.7 and 16.4 years, respectively. Half of decedents died of unnatural causes in both cohorts; overdose deaths predominated in the U.S. and suicide in Taiwan. Our study identified differences by country in EYLL and causes of deaths. These findings suggest that intervention strategies to reduce mortality risk by overdose (particularly in the U.S.) and suicide (particularly in Taiwan) are urgently needed in these countries. Copyright © 2016 Elsevier B.V. All rights reserved.

Modeling Individual Patient Preferences for Colorectal Cancer Screening Based on Their Tolerance for Complications Risk.

PubMed

Taksler, Glen B; Perzynski, Adam T; Kattan, Michael W

2017-04-01

Recommendations for colorectal cancer screening encourage patients to choose among various screening methods based on individual preferences for benefits, risks, screening frequency, and discomfort. We devised a model to illustrate how individuals with varying tolerance for screening complications risk might decide on their preferred screening strategy. We developed a discrete-time Markov mathematical model that allowed hypothetical individuals to maximize expected lifetime utility by selecting screening method, start age, stop age, and frequency. Individuals could choose from stool-based testing every 1 to 3 years, flexible sigmoidoscopy every 1 to 20 years with annual stool-based testing, colonoscopy every 1 to 20 years, or no screening. We compared the life expectancy gained from the chosen strategy with the life expectancy available from a benchmark strategy of decennial colonoscopy. For an individual at average risk of colorectal cancer who was risk neutral with respect to screening complications (and therefore was willing to undergo screening if it would actuarially increase life expectancy), the model predicted that he or she would choose colonoscopy every 10 years, from age 53 to 73 years, consistent with national guidelines. For a similar individual who was moderately averse to screening complications risk (and therefore required a greater increase in life expectancy to accept potential risks of colonoscopy), the model predicted that he or she would prefer flexible sigmoidoscopy every 12 years with annual stool-based testing, with 93% of the life expectancy benefit of decennial colonoscopy. For an individual with higher risk aversion, the model predicted that he or she would prefer 2 lifetime flexible sigmoidoscopies, 20 years apart, with 70% of the life expectancy benefit of decennial colonoscopy. Mathematical models may formalize how individuals with different risk attitudes choose between various guideline-recommended colorectal cancer screening strategies.

[Social, economic and psychological issues as cardiovascular disease risk factors].

PubMed

Spácil, J

2009-11-01

The highest mortality in developed countries is, according to the data from our as well as international literature, among people from low socioeconomic backgrounds. No recent data are available for the Czech Republic. We compared the estimated median life expectancy in 2001-2005 with the proportion of people with basic education only and with the proportion of unemployed in all regions within the Czech Republic. We confirmed significant negative correlation--people in regions with low socioeconomic status had lower estimated median life expectancy. Despite the decline in the total and cardiovascular mortality in particular in the Czech Republic over the last 20 years, the highest mortality and shortest medium life expectancy continue to persist in the regions with the lowest socioeconomic status as measured by the educational status and unemployment.

Diminished Disease-Free Survival After Lobectomy: Screening Implications.

PubMed

Reich, Jerome M; Kim, Jong S; Asaph, James W

2015-09-01

The aim of this study was to estimate the effect of lobectomy on life expectancy in healthy smokers and consider the implications for lung cancer screening. In a retrospective cohort study that provided a minimum of 15 years of follow-up, we analyzed lung cancer survival, all-cause survival, and fatality (1-survival) of 261 persons with stage I non-small-cell lung cancer who underwent lobectomy at Portland Providence Medical Center between 1978 and 1994. We: (1) compared 5-year disease-free fatality (non-lung-cancer fatality) with lung cancer fatality; and (2) based on actuarial data that demonstrated life expectancy equivalence of the healthiest smokers (whom we assumed would be comparable with subjects judged eligible for lobectomy) in the US population, we compared their long-term, disease-free survival (our primary end point) with actuarial expectations by computing the Kaplan-Meier survival function of the differences between lifetimes since surgery in disease-free persons versus matched, expected remaining lifetimes in the US population. (1) Five-year disease-free fatality (16.1%) was 58% as high as 5-year lung cancer fatality (27.6%); (2) disease-free survival was reduced by 6.9-years (95% confidence interval, 5.5-8.3), 41% of actuarial life expectancy (17 years). The divergence from expected survival took place largely after 6 years of follow-up. Lobectomy materially diminishes long-term disease-free survival in the healthiest smokers--persons judged healthy enough to tolerate major surgery and to have sufficient pulmonary reserve to sustain loss of one-fifth of their lung tissue. In screened populations, diminished survival in overdiagnosed persons will offset, to an undetermined extent, the mortality benefit imparted by preemption of advanced lung cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

[Deaths and life expectancy losses attributable to diet high in sodium in China].

PubMed

Liu, S W; Cai, Y; Zeng, X Y; Yin, P; Qi, J L; Liu, Y N; Liu, J M; Zhao, Z P; Zhang, M; Wang, L M; Wang, L J; Xue, M; Zhou, M G

2017-08-10

Objective: To quantitatively estimate the deaths and life expectancy losses attributable to diet high in sodium in China, and examine the gains and shifts under different control scenarios of sodium consumption. Methods: Based on data from the cause-of-death through the National Mortality Surveillance System, and 24 hours urinary sodium values from Global Burden of Disease study on Chinese's estimates, population attributable fractions with the framework of comparative risk assessment were used to analyze the deaths and life expectancy losses due to diet high in sodium. The same methods were followed to examine the gains and shifts under different control scenarios of sodium consumption. Results: In 2013, 1 430 (940 for men and 490 for women) thousand deaths were attributable to diet high in sodium, accounting for 15.6% (17.4% for men and 13.0% for women) of all-cause deaths in China, which causing 2.17 (2.49 for men and 1.71 for women) years of life expectancy loss. Diet with high sodium in 2013 caused 1 200, 50 and 180 thousand deaths from cardiovascular disease, chronic kidney disease and stomach cancer respectively, accounting for 31.5%, 30.8% and 64.8% of those specific causes. Comparing to the baseline in 2013, if the targets of 10% decrease of sodium consumption by 2020 and 15% by 2030 for Chinese chronic disease prevention and treatment planning, and 30% decrease by 2030 for WHO non-communicable disease monitoring framework are achieved, 220, 340 and 730 thousand deaths will be averted, which may gain 0.30, 0.45 and 0.95 years of life expectancy, respectively. Conclusions: As one of the leading risk factors, diet high in sodium had caused heavy burden of disease from cardiovascular disease, chronic kidney disease and stomach cancer on Chinese residents. Intervention programs on sodium-reduction are urgently needed in China and related cost-effectiveness is highly expected.

Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model.

PubMed

Wang, Han-I; Aas, Eline; Howell, Debra; Roman, Eve; Patmore, Russell; Jack, Andrew; Smith, Alexandra

2014-03-01

Acute myeloid leukemia (AML) can be diagnosed at any age and treatment, which can be given with supportive and/or curative intent, is considered expensive compared with that for other cancers. Despite this, no long-term predictive models have been developed for AML, mainly because of the complexities associated with this disease. The objective of the current study was to develop a model (based on a UK cohort) to predict cost and life expectancy at a population level. The model developed in this study combined a decision tree with several Markov models to reflect the complexity of the prognostic factors and treatments of AML. The model was simulated with a cycle length of 1 month for a time period of 5 years and further simulated until age 100 years or death. Results were compared for two age groups and five different initial treatment intents and responses. Transition probabilities, life expectancies, and costs were derived from a UK population-based specialist registry-the Haematological Malignancy Research Network (www.hmrn.org). Overall, expected 5-year medical costs and life expectancy ranged from £8,170 to £81,636 and 3.03 to 34.74 months, respectively. The economic and health outcomes varied with initial treatment intent, age at diagnosis, trial participation, and study time horizon. The model was validated by using face, internal, and external validation methods. The results show that the model captured more than 90% of the empirical costs, and it demonstrated good fit with the empirical overall survival. Costs and life expectancy of AML varied with patient characteristics and initial treatment intent. The robust AML model developed in this study could be used to evaluate new diagnostic tools/treatments, as well as enable policy makers to make informed decisions. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Comparing efficacy of reduced-toxicity allogeneic hematopoietic cell transplantation with conventional chemo-(immuno) therapy in patients with relapsed or refractory CLL: a Markov decision analysis.

PubMed

Kharfan-Dabaja, M A; Pidala, J; Kumar, A; Terasawa, T; Djulbegovic, B

2012-09-01

Despite therapeutic advances, relapsed/refractory CLL, particularly after fludarabine-based regimens, remains a major challenge for which optimal therapy is undefined. No randomized comparative data exist to suggest the superiority of reduced-toxicity allogeneic hematopoietic cell transplantation (RT-allo-HCT) over conventional chemo-(immuno) therapy (CCIT). By using estimates from a systematic review and by meta-analysis of available published evidence, we constructed a Markov decision model to examine these competing modalities. Cohort analysis demonstrated superior outcome for RT-allo-HCT, with a 10-month overall life expectancy (and 6-month quality-adjusted life expectancy (QALE)) advantage over CCIT. Although the model was sensitive to changes in base-case assumptions and transition probabilities, RT-allo-HCT provided superior overall life expectancy through a range of values supported by the meta-analysis. QALE was superior for RT-allo-HCT compared with CCIT. This conclusion was sensitive to change in the anticipated state utility associated with the post-allogeneic HCT state; however, RT-allo-HCT remained the optimal strategy for values supported by existing literature. This analysis provides a quantitative comparison of outcomes between RT-allo-HCT and CCIT for relapsed/refractory CLL in the absence of randomized comparative trials. Confirmation of these findings requires a prospective randomized trial, which compares the most effective RT-allo-HCT and CCIT regimens for relapsed/refractory CLL.

A multigene prognostic assay for selection of adjuvant chemotherapy in patients with T3, stage II colon cancer: impact on quality-adjusted life expectancy and costs.

PubMed

Hornberger, John; Lyman, Gary H; Chien, Rebecca; Meropol, Neal J

2012-12-01

Uncertainty exists regarding appropriate and affordable use of adjuvant chemotherapy in stage II colon cancer (T3, proficient DNA mismatch repair). This study aimed to estimate the effectiveness and costs from a US societal perspective of a multigene recurrence score (RS) assay for patients recently diagnosed with stage II colon cancer (T3, proficient DNA mismatch repair) eligible for adjuvant chemotherapy. RS was compared with guideline-recommended clinicopathological factors (tumor stage, lymph nodes examined, tumor grade, and lymphovascular invasion) by using a state-transition (Markov) lifetime model. Data were obtained from published literature, a randomized controlled trial (QUick And Simple And Reliable) of adjuvant chemotherapy, and rates of chemotherapy use from the National Cooperative Cancer Network Colon/Rectum Cancer Outcomes study. Life-years, quality-adjusted life expectancy, and lifetime costs were examined. The RS is projected to reduce adjuvant chemotherapy use by 17% compared with current treatment patterns and to increase quality-adjusted life expectancy by an average of 0.035 years. Direct medical costs are expected to decrease by an average of $2971 per patient. The assay was cost saving for all subgroups of patients stratified by clinicopathologic factors. The most influential variables affecting treatment decisions were projected years of life remaining, recurrence score, and patients' disutilities associated with adjuvant chemotherapy. Use of the multigene RS to assess recurrence risk after surgery in stage II colon cancer (T3, proficient DNA mismatch repair) may reduce the use of adjuvant chemotherapy without decreasing quality-adjusted life expectancy and be cost saving from a societal perspective. These findings need to be validated in additional cohorts, including studies of clinical practice as assay use diffuses into nonacademic settings. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Moxie matters: associations of future orientation with active life expectancy.

PubMed

Laditka, Sarah B; Laditka, James N

2017-10-01

Being oriented toward the future has been associated with better future health. We studied associations of future orientation with life expectancy and the percentage of life with disability. We used the Panel Study of Income Dynamics (n = 5249). Participants' average age in 1968 was 33.0. Six questions repeatedly measured future orientation, 1968-1976. Seven waves (1999-2011, 33,331 person-years) measured disability in activities of daily living for the same individuals, whose average age in 1999 was 64.0. We estimated monthly probabilities of disability and death with multinomial logistic Markov models adjusted for age, sex, race/ethnicity, childhood health, and education. Using the probabilities, we created large populations with microsimulation, measuring disability in each month for each individual, age 55 through death. Life expectancy from age 55 for white men with high future orientation was age 77.6 (95% confidence interval 75.5-79.0), 6.9% (4.9-7.2) of those years with disability; results with low future orientation were 73.6 (72.2-75.4) and 9.6% (7.7-10.7). Comparable results for African American men were 74.8 (72.9-75.3), 8.1 (5.6-9.3), 71.0 (69.6-72.8), and 11.3 (9.1-11.7). For women, there were no significant differences associated with levels of future orientation for life expectancy. For white women with high future orientation 9.1% of remaining life from age 55 was disabled (6.3-9.9), compared to 12.4% (10.2-13.2) with low future orientation. Disability results for African American women were similar but statistically significant only at age 80 and over. High future orientation during early to middle adult ages may be associated with better health in older age.

The Cost-Effectiveness of Tuberculosis Preventive Therapy for HIV-Infected Individuals in Southern India: A Trial-Based Analysis

PubMed Central

Pho, Mai T.; Swaminathan, Soumya; Kumarasamy, Nagalingeswaran; Losina, Elena; Ponnuraja, C.; Uhler, Lauren M.; Scott, Callie A.; Mayer, Kenneth H.; Freedberg, Kenneth A.; Walensky, Rochelle P.

2012-01-01

Background Regimens for isoniazid-based preventive therapy (IPT) for tuberculosis (TB) in HIV-infected individuals have not been widely adopted given concerns regarding efficacy, adherence and drug resistance. Further, the cost-effectiveness of IPT has not been studied in India. Methods We used an HIV/TB model to project TB incidence, life expectancy, cost and incremental cost-effectiveness of six months of isoniazid plus ethambutol (6EH), thirty-six months of isoniazid (36H) and no IPT for HIV-infected patients in India. Model input parameters included a median CD4 count of 324 cells/mm3, and a rate ratio of developing TB of 0.35 for 6EH and 0.22 for 36H at three years as compared to no IPT. Results of 6EH and 36H were also compared to six months of isoniazid (6H), three months of isoniazid plus rifampin (3RH) and three months of isoniazid plus rifapentine (3RPTH). Results Projected TB incidence decreased in the 6EH and 36H regimens by 51% and 62% respectively at three-year follow-up compared to no IPT. Without IPT, projected life expectancy was 136.1 months at a lifetime per person cost of $5,630. 6EH increased life expectancy by 0.8 months at an additional per person cost of $100 (incremental cost-effectiveness ratio (ICER) of $1,490/year of life saved (YLS)). 36H further increased life expectancy by 0.2 months with an additional per person cost of $55 (ICER of $3,120/YLS). The projected clinical impact of 6EH was comparable to 6H and 3RH; however when compared to these other options, 6EH was no longer cost-effective given the high cost of ethambutol. Results were sensitive to baseline CD4 count and adherence. Conclusions Three, six and thirty-six-month regimens of isoniazid-based therapy are effective in preventing TB. Three months of isoniazid plus rifampin and six-months of isoniazid are similarly cost-effective in India, and should be considered part of HIV care. PMID:22558301

A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States.

PubMed

Chiu, Chi-Tsun; Hayward, Mark; Saito, Yasuhiko

2016-10-01

This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States. This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables. Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles. Japan's compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States. © The Author(s) 2016.

The impact of healthcare spending on health outcomes: A meta-regression analysis.

PubMed

Gallet, Craig A; Doucouliagos, Hristos

2017-04-01

While numerous studies assess the impact of healthcare spending on health outcomes, typically reporting multiple estimates of the elasticity of health outcomes (most often measured by a mortality rate or life expectancy) with respect to healthcare spending, the extent to which study attributes influence these elasticity estimates is unclear. Accordingly, we utilize a meta-data set (consisting of 65 studies completed over the 1969-2014 period) to examine these elasticity estimates using meta-regression analysis (MRA). Correcting for a number of issues, including publication selection bias, healthcare spending is found to have the greatest impact on the mortality rate compared to life expectancy. Indeed, conditional on several features of the literature, the spending elasticity for mortality is near -0.13, whereas it is near to +0.04 for life expectancy. MRA results reveal that the spending elasticity for the mortality rate is particularly sensitive to data aggregation, the specification of the health production function, and the nature of healthcare spending. The spending elasticity for life expectancy is particularly sensitive to the age at which life expectancy is measured, as well as the decision to control for the endogeneity of spending in the health production function. With such results in hand, we have a better understanding of how modeling choices influence results reported in this literature. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pivot tables for mortality analysis, or who needs life tables anyway?

PubMed

Wesley, David; Cox, Hugh F

2007-01-01

Actuarial life-table analysis has long been used by life insurance medical directors for mortality abstraction from clinical studies. Ironically, today's life actuary instead uses pivot tables to analyze mortality. Pivot tables (a feature/function in MS Excel) collapse various dimensions of data that were previously arranged in an "experience study" format. Summary statistics such as actual deaths, actual and expected mortality (usually measured in dollars), and calculated results such as actual to expected ratios, are then displayed in a 2-dimensional grid. The same analytic process, excluding the dollar focus, can be used for clinical mortality studies. For raw survival data, especially large datasets, this combination of experience study data and pivot tables has clear advantages over life-table analysis in both accuracy and flexibility. Using the SEER breast cancer data, we compare the results of life-table analysis and pivot-table analysis.

Swedish medical students' expectations of their future life

PubMed Central

Andersson, Jenny; Johansson, Eva E.; Verdonk, Petra; Lagro-Janssen, Antoine; Hamberg, Katarina

2011-01-01

Objectives: To investigate future life expectations among male and female medical students in their first and final year. Methods The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories. Results Students’ written answers were coded, categorized and clustered into four themes: “Work”, “Family”, “Leisure” and “Quality of personal life”. Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students. Conclusions Today’s medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.

Clinical and economic benefits of integrated pump/CGM technology therapy in patients with type 1 diabetes in Colombia.

PubMed

Gomez, Ana Maria; Alfonso-Cristancho, Rafael; Orozco, John Jairo; Lynch, Peter Matthew; Prieto, Diana; Saunders, Rhodri; Roze, Stephane; Valencia, Juan Esteban

2016-11-01

To assess the long-term clinical and economic impact of integrated pump/CGM technology therapy as compared to multiple daily injections (MDI), for the treatment of type 1 diabetes (T1D) in Colombia. The CORE Diabetes Model was used to simulate a hypothetical cohort of patients with T1D. Mean baseline characteristics were taken from a clinical study conducted in Colombia and a healthcare payer perspective was adopted, with a 5% annual discount rate applied to both costs and outcomes. The integrated pump/CGM improved mean life expectancy by 3.51 years compared with MDI. A similar increase occurred in mean quality-adjusted life expectancy with an additional 3.81 quality-adjusted life years (QALYs). Onset of diabetes-related complications was also delayed as compared to MDI, and mean survival time free of complication increased by 1.74 years with integrated pump/CGM. Although this increased treatment costs of diabetes as compared to MDI, savings were achieved thanks to reduced expenditure on diabetes-related complications. The estimated incremental cost-effectiveness ratio (ICER) for SAP was Colombian Pesos (COP) 44,893,950 (approximately USD$23,200) per QALY gained. Improved blood glucose control associated to integrated pump/CGM results in a decreased incidence of diabetes-related complications and improves life expectancy as compared to MDI. Using recommended thresholds from the World Health Organization and previous coverage decisions about health technologies in Colombia, it is a cost-effective alternative to MDI for the treatment of type 1 diabetes in Colombia. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

Health Improvements Have Been More Rapid and Widespread in China than in India: A Comparative Analysis of Health and Socioeconomic Trends from 1960 to 2011

PubMed Central

Singh, Gopal K.; Liu, Jihong

2012-01-01

Objectives We examined differences between China and India in key health and socioeconomic indicators, including life expectancy, infant and child mortality, non-communicable disease mortality from cancer, cardiovascular diseases (CVD), and diabetes, Human Development Index, Gender Inequality Index, material living conditions, and health expenditure. Methods Data on health and social indicators came from various World Health Organization and United Nations databases on global health and development statistics, including the GLOBOCAN cancer database. Mortality trends were modeled by log-linear regression, and differences in rates and relative risks were tested for statistical significance. Results Although both countries have made marked improvements, India lags behind China on several key health indicators. Differential rates of mortality decline during 1960-2009 have led to a widening health gap between China and India. In 2009 the infant mortality rate in India was 50 deaths per 1,000 live births, 3 times greater than the rate for China. Sixty-six out of 1,000 Indian children died before reaching their 5th birthday, compared with 19 children in China. China’s life expectancy is 9 years longer than India’s. Life expectancy at birth in India increased from 42 years in 1960 to 65 years in 2009, while life expectancy in China increased from 47 years in 1960 to 74 years in 2009. Major health concerns for China include high rates of stomach, liver, and lung cancer, CVD, and smoking prevalence. Globally, India ranked 90th and China 102nd in life satisfaction. Conclusions and Public Health Implications India’s less favorable health profile compared to China is largely attributable to its higher rates of mortality from communicable diseases and maternal and perinatal conditions. Further health gains can be achieved by reducing social inequality, greater investments in human development and health services, and by prevention and control of chronic-disease risks such as hypertension, smoking, obesity, and physical inactivity. PMID:27621957

Why is the gender gap in life expectancy decreasing? The impact of age- and cause-specific mortality in Sweden 1997-2014.

PubMed

Sundberg, Louise; Agahi, Neda; Fritzell, Johan; Fors, Stefan

2018-04-13

To enhance the understanding of the current increase in life expectancy and decreasing gender gap in life expectancy. We obtained data on underlying cause of death from the National Board of Health and Welfare in Sweden for 1997 and 2014 and used Arriaga's method to decompose life expectancy by age group and 24 causes of death. Decreased mortality from ischemic heart disease had the largest impact on the increased life expectancy of both men and women and on the decreased gender gap in life expectancy. Increased mortality from Alzheimer's disease negatively influenced overall life expectancy, but because of higher female mortality, it also served to decrease the gender gap in life expectancy. The impact of other causes of death, particularly smoking-related causes, decreased in men but increased in women, also reducing the gap in life expectancy. This study shows that a focus on overall changes in life expectancies may hide important differences in age- and cause-specific mortality. It also emphasizes the importance of addressing modifiable lifestyle factors to reduce avoidable mortality.

Life Expectancy Among U.S.-born and Foreign-born Older Adults in the United States: Estimates From Linked Social Security and Medicare Data.

PubMed

Mehta, Neil K; Elo, Irma T; Engelman, Michal; Lauderdale, Diane S; Kestenbaum, Bert M

2016-08-01

In recent decades, the geographic origins of America's foreign-born population have become increasingly diverse. The sending countries of the U.S. foreign-born vary substantially in levels of health and economic development, and immigrants have arrived with distinct distributions of socioeconomic status, visa type, year of immigration, and age at immigration. We use high-quality linked Social Security and Medicare records to estimate life tables for the older U.S. population over the full range of birth regions. In 2000-2009, the foreign-born had a 2.4-year advantage in life expectancy at age 65 relative to the U.S.-born, with Asian-born subgroups displaying exceptionally high longevity. Foreign-born individuals who migrated more recently had lower mortality compared with those who migrated earlier. Nonetheless, we also find remarkable similarities in life expectancy among many foreign-born subgroups that were born in very different geographic and socioeconomic contexts (e.g., Central America, western/eastern Europe, and Africa).

Long and happy living: Trends and patterns of happy life expectancy in the U.S., 1970–2000

PubMed Central

Yang, Yang

2013-01-01

This study assesses the trends and differentials in length of quality life in the U.S. population as measured by happy life expectancy in 1970, 1980, 1990, and 2000. The analysis combines age-specific prevalence rates of subjective well-being from a large nationally representative survey and life table estimates of mortality in decennial Census years. Employing the period prevalence-rate life table method—Sullivan method, the analysis finds evidence for improvement in quality of life in the U.S. Happy life expectancy largely increased in both absolute terms (number of years) and relative terms (proportion of life) over time at all adult ages examined. And increases in total life expectancy were mainly contributed by increases in expectancy in happy years rather than unhappy years. Happy life expectancy is longer than active life expectancy. And there has been greater compression of unhappiness than compression of morbidity. There are substantial differentials in happy life expectancy by sex and race because of differential prevalence rates of happiness. Women and whites had longer years of total and happy life expectancies at most ages and dates, while men and blacks had greater proportions of happy life expectancies across the three decades. Although race differentials generally decreased at older ages and with time, relative disadvantages of blacks persisted. PMID:19227700

CD4+ T-cell-guided structured treatment interruptions of antiretroviral therapy in HIV disease: projecting beyond clinical trials.

PubMed

Yazdanpanah, Yazdan; Wolf, Lindsey L; Anglaret, Xavier; Gabillard, Delphine; Walensky, Rochelle P; Moh, Raoul; Danel, Christine; Sloan, Caroline E; Losina, Elena; Freedberg, Kenneth A

2010-01-01

International trials have shown that CD4+ T-cell-guided structured treatment interruptions (STI) of antiretroviral therapy (ART) lead to worse outcomes than continuous treatment. We simulated continuous ART and STI strategies with higher CD4+ T-cell interruption/reintroduction thresholds than those assessed in actual trials. Using a model of HIV, we simulated cohorts of African adults with different baseline CD4+ T-cell counts (< or = 200; 201-350; and 351-500 cells/microl). We varied ART initiation criteria (immediate; CD4+ T-cell count < 350 cells/microl or > or = 350 cells/microl with severe HIV-related disease; and CD4+ T-cell count <200 cells/microl or > or = 200 cells/microl with severe HIV-related disease), and ART interruption/reintroduction thresholds (350/250; 500/350; and 700/500 cells/microl). First-line therapy was non-nucleoside reverse transcriptase inhibitor (NNRTI)-based and second-line therapy was protease inhibitor (PI)-based. STI generally reduced life expectancy compared with continuous ART. Life expectancy increased with earlier ART initiation and higher interruption/reintroduction thresholds. STI reduced life expectancy by 48-69 and 11-30 months compared with continuous ART when interruption/reintroduction thresholds were 350/250 and 500/350 cells/microl, depending on ART initiation criteria. When patients interrupted/reintroduced ART at 700/500 cells/microl, life expectancies ranged from 2 months lower to 1 month higher than continuous ART. STI-related life expectancy increased with decreased risk of virological resistance after ART interruptions. STI with NNRTI-based regimens was almost always less effective than continuous treatment, regardless of interruption/reintroduction thresholds. The risks associated with STI decrease only if patients start ART earlier, interrupt/reintroduce treatment at very high CD4+ T-cell thresholds (700/500 cells/microl) and use first-line medications with higher resistance barriers, such as PIs.

Health-related quality of life in children and adolescents with spinal muscular atrophy in the Czech Republic.

PubMed

Kocova, Helena; Dvorackova, Olga; Vondracek, Petr; Haberlova, Jana

2014-06-01

Spinal muscular atrophy is a rare hereditary neuromuscular disorder (with a prevalence of 1 per 30,000) that greatly debilitates patients and, in most cases, shortens their life expectancy. Although there is no causal therapy, improvements in symptomatic therapy have extended patients' life expectancy and increased their quality of life. Unfortunately, the advancements in care vary from country to country. To improve the care for children with spinal muscular atrophy in the Czech Republic, we created a survey to obtain the baseline information about their quality of life and compared the data with equivalent data from the United States. We used the Pediatric Quality of Life Inventory 3.0 Neuromuscular Measurement Model, which is a health-related quality of life questionnaire specific to children with neuromuscular disorders. The survey was conducted on 35 children with genetically proven spinal muscular atrophy and their parents. Compared with the US data, the Czech data generally show a lower quality of life, mainly in the family resources part. The greatest score was achieved in the section about communication. Altogether, the parents' scores are lower than those of the children. In the Czech Republic, patients with spinal muscular atrophy and, especially their parents, have a significantly lower quality of life compared with US patients, mostly because of economic factors and a lack of social support. Our results reveal areas toward which improvement should be directed. The need for family support through social care as well as civic, patient, or organizational support is accentuated. Copyright © 2014 Elsevier Inc. All rights reserved.

Estimating the life expectancy of companion dogs in Japan using pet cemetery data.

PubMed

Inoue, Mai; Kwan, Nigel C L; Sugiura, Katsuaki

2018-05-24

The life expectancy provides valuable information about population health. The life expectancies were evaluated in 12,039 dogs which were buried or cremated during January 2012 to March 2015. The data of dogs were collected at the eight animal cemeteries in Tokyo. The overall life expectancy of dogs was 13.7 (95% confidence interval (CI): 13.7-13.8) years. The probability of death was high in the first year of life, lowest in the fourth year, and increased exponentially after four years of age like Gompertz curve in semilog graph. The life expectancy of companion dogs in Tokyo has increased 1.67fold from 8.6 years to 13.7 years over the past three decades. Canine crossbreed life expectancy (15.1 years, 95% CI 14.9-15.3) was significantly greater than pure breed life expectancy (13.6 years, 95% CI 13.5-13.7, P<0.001). The life expectancy for male and for female dogs were 13.6 (95% CI: 13.5-13.7) and 13.5 (95% CI: 13.4-13.6) years, respectively, with no significant difference (P=0.099). In terms of the median age of death and life expectancy for major breeds, Shiba had the highest median age of death (15.8 years), life expectancy (15.5 years) and French Bulldog had the lowest median age of death (10.2 years), life expectancy (10.2 years). When considering life expectancy alone, these results suggest that the health of companion dogs in Japan has significantly improved over the past 30 years.

Modelling changes in small area disability free life expectancy: trends in London wards between 2001 and 2011.

PubMed

Congdon, Peter

2014-12-20

Existing analyses of trends in disability free life expectancy (DFLE) are mainly at aggregate level (national or broad regional). However, major differences in DFLE, and trends in these expectancies, exist between different neighbourhoods within regions, so supporting a small area perspective. However, this raises issues regarding the stability of conventional life table estimation methods at small area scales. This paper advocates a Bayesian borrowing strength technique to model trends in mortality and disability differences across 625 small areas in London, using illness data from the 2001 and 2011 population Censuses, and deaths data for two periods centred on the Census years. From this analysis, estimates of total life expectancy and DFLE are obtained. The spatio-temporal modelling perspective allows assessment of whether significant compression or expansion of morbidity has occurred in each small area. Appropriate models involve random effects that recognise correlation and interaction effects over relevant dimensions of the observed deaths and illness data (areas, ages), as well as major spatial trends (e.g. gradients in health and mortality according to area deprivation category). Whilst borrowing strength is a primary consideration (and demonstrated by raised precision for estimated life expectancies), so also is model parsimony. Therefore, pure borrowing strength models are compared with models allowing selection of random age-area interaction effects using a spike-slab prior, and in fact borrowing strength combined with random effects selection provides better fit. Copyright © 2014 John Wiley & Sons, Ltd.

Socially disparate trends in lifespan variation: a trend study on income and mortality based on nationwide Danish register data.

PubMed

Brønnum-Hansen, Henrik

2017-05-17

Social inequality trends in life expectancy are not informative as to changes in social disparity in the age-at-death distribution. The purpose of the study was to investigate social differentials in trends and patterns of adult mortality in Denmark. Register data on income and mortality from 1986 to 2014 were used to investigate trends in life expectancy, life disparity and the threshold age that separates 'premature' and 'late' deaths. Mortality compression was quantified and compared between income quartiles. Since 1986, male life expectancy increased by 4.2 years for the lowest income quartile and by 8.4 years for the highest income quartile. The clear compression of mortality apparent in the highest income quartile did not occur for the lowest income quartile. Premature and late deaths accounted both by 2.1 years of the increase in life expectancy in the lowest income quartile and by 6.0 and 2.4 years, respectively, in the highest income quartile. Life expectancy increased by 5.2 years among women in the lowest income quartile, 2.4 years due to premature deaths and 2.8 years due to late deaths. The gain in life expectancy among women in the highest income quartile of 5.6 years was distributed by 5.0 and 0.6 years due to premature and late deaths, respectively. The study demonstrates that the increasing social gap in mortality appears differently in the change of the age-at-death distribution. Thus, no compression of mortality was seen in the lowest income quartile. The results do not provide support for a uniformly extension of pension age for all. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Trends Over 4 Decades in Disability-Free Life Expectancy in the United States.

PubMed

Crimmins, Eileen M; Zhang, Yuan; Saito, Yasuhiko

2016-07-01

To examine changes over 40 years (1970-2010) in life expectancy, life expectancy with disability, and disability-free life expectancy for American men and women of all ages. We used mortality rates from US Vital Statistics and data on disability prevalence in the community-dwelling population from the National Health Interview Survey; for the institutional population, we computed disability prevalence from the US Census. We used the Sullivan method to estimate disabled and disability-free life expectancy for 1970, 1980, 1990, 2000, and 2010. Over the 40 years, there was a steady increase in both disability-free life expectancy and disabled life expectancy. At birth, increases in disabled life and nondisabled life were equal for men (4.5 years); for women, at birth the increase in life with disability (3.6 years) exceeded the increase in life free of disability (2.7 years). At age 65 years, the increase in disability-free life was greater than the increase in disabled life. Across the life cycle, there was no compression of morbidity, but at age 65 years some compression occurred.

Trends in U.S. life expectancy gradients: the role of changing educational composition.

PubMed

Hendi, Arun S

2015-06-01

I examined age patterns and the role of shifting educational distributions in driving trends in educational gradients in life expectancy among non-Hispanic Whites between 1991 and 2005. Data were from the 1986-2004 National Health Interview Survey with mortality follow-up through 2006. Life expectancies were computed by sex, period and education. Age decompositions of life expectancy gradients and composition-adjusted life expectancies were computed to account for age patterns and shifting educational distributions. Life expectancy at age 25 among White men increased for all education groups, decreased among the least-educated White women and increased among White women with college degrees. Much of the decline in measured life expectancy for White women with less than a high school education comes from the 85+ age group. Educational gradients in life expectancy widened for White men and women. One-third of the gradient is due to ages below 50. Approximately 26% (0.7 years) and 87% (0.8 years) of the widening of the gradient in life expectancy between ages 25 and 85 for White women and men is attributable to shifting education distributions. Over half of the decline in temporary life expectancy among the least-educated White women is due to compositional change. Life expectancy has increased among White men for all education groups and has decreased among White women with less than a high school education, though not to the extent reported in previous studies. The fact that a large proportion of the change in education-specific life expectancy among women is due to the 85+ age group suggests changes in institutionalization may be affecting estimates. Much of the change in education-specific life expectancy and the growth in the educational gradient in life expectancy is due to the shifting distribution of individuals across education categories. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Treatment options for patients with acute myeloid leukemia with a matched sibling donor: a decision analysis.

PubMed

Sung, Lillian; Buckstein, Rena; Doyle, John J; Crump, Michael; Detsky, Allan S

2003-02-01

The role of allogeneic bone marrow transplantation (BMT) in the consolidation of young adults with acute myeloid leukemia (AML) with matched sibling donors (MSD) is controversial. Although BMT is associated with increased event free survival compared with intensive chemotherapy (CT) consolidation, BMT also is associated with increased treatment-related mortality and likely decreased quality of life and life expectancy in patients who do not develop recurrent disease. The authors used decision analysis to compare three strategies for maximizing quality-adjusted life years (QALYs) in patients with AML in first remission with an MSD: BMT All, BMT None (consolidation CT only), or BMT in high-risk patients, as defined by baseline cytogenetic testing (Test strategy). A second decision-analysis tree was then constructed that compared BMT with CT specifically for patients with intermediate cytogenetics. Using expected QALYs as the outcome measure, the Test, BMT All, and BMT None strategies were associated with 20.10 QALYs, 19.63 QALYs, and 18.38 QALYs, respectively. Thus, the Test strategy, with CT for low-risk patients and BMT for intermediate risk and high-risk patients, was expected to be the optimal strategy. In the intermediate cytogenetic decision analysis, although the expected QALY for BMT recipients was higher compared with CT recipients (19.78 QALYs vs. 18.75 QALYs), because of uncertainty in variable estimates, the optimal choice was less clear. CT consolidation is a reasonable option for patients with AML who have favorable cytogenetics, even if an MSD is available. This model provides a framework from which patients with AML and their physicians can make decisions about consolidation therapy. Copyright 2003 American Cancer Society.DOI 10.1002/cncr.11098

Life expectancy and national income in Europe, 1900-2008: an update of Preston's analysis.

PubMed

Mackenbach, Johan P; Looman, Caspar Wn

2013-08-01

In the past, upward shifts of the so-called Preston curve, which relates life expectancy to national income, have contributed importantly to worldwide increases in life expectancy. These shifts were due to rapid diffusion of knowledge and technology for infectious disease control from high-income to low-income countries. We assessed to what extent life expectancy growth in Europe has been accompanied by upward shifts in the relation between national income and life expectancy in later parts of the 20th century, when progress in cardiovascular disease control was the main driver of life expectancy growth. Data on national income (gross domestic product per capita, in 1990 international dollars), life expectancy and cause-specific mortality covering the period 1900-2008 were extracted from international data banks. (Change in) life expectancy and age-standardized mortality was regressed on (change in) national income, and the regression parameters were used to estimate the contribution to rising life expectancy and declining mortality in Europe as a whole of changes in national income vs shifts in the relation between national income and health outcomes. Large upward shifts in the relation between national income and life expectancy only occurred before 1960, and were due to rapid declines in mortality from infectious diseases which were independent of rises in national income. These shifts account for between two-thirds and four-fifths of the increase in life expectancy in Europe as a whole during this period. After 1960, upward shifts in the relation between national income and life expectancy were much smaller, and contributed only between one-quarter and one-half to the increase in life expectancy in Europe as a whole. During the latter period, declines in mortality from cardiovascular disease were mainly attributable to increases in national income. In contrast to earlier periods, recent life expectancy growth in European countries appears to have been dependent on their economic growth. More rapid diffusion of knowledge and technology for cardiovascular disease control from higher- to lower-income countries in Europe may be needed to close the East-West life expectancy gap, but it is unlikely that this can be achieved in the absence of more equal economic conditions.

Aging in the Americas: Disability-free Life Expectancy Among Adults Aged 65 and Older in the United States, Costa Rica, Mexico, and Puerto Rico.

PubMed

Payne, Collin F

2018-01-11

To estimate and compare disability-free life expectancy (DFLE) and current age patterns of disability onset and recovery from disability between the United States and countries in Latin America and the Caribbean. Disability is measured using the activities of daily living scale. Data come from longitudinal surveys of older adult populations in Costa Rica, Mexico, Puerto Rico, and the United States. Age patterns of transitions in and out of disability are modeled with a discrete-time logistic hazard model, and a microsimulation approach is used to estimate DFLE. Overall life expectancy for women aged 65 is 20.11 years in Costa Rica, 19.2 years in Mexico, 20.4 years in Puerto Rico, and 20.5 years in the United States. For men, these figures are 19.0 years in Costa Rica, 18.4 years in Mexico, 18.1 years in Puerto Rico, and 18.1 years in the United States. Proportion of remaining life spent free of disability for women at age 65 is comparable between Mexico, Puerto Rico, and the United States, with Costa Rica trailing slightly. Male estimates of DFLE are similar across the four populations. Though the older adult population of Latin America and the Caribbean lived many years exposed to poor epidemiological and public health conditions, their functional health in later life is comparable with the older adult population of the United States. © The Author(s) 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Poverty and mortality among the elderly: measurement of performance in 33 countries 1960-92.

PubMed

Wang, J; Jamison, D T; Bos, E; Vu, M T

1997-10-01

This paper analyses the effect of income and education on life expectancy and mortality rates among the elderly in 33 countries for the period 1960-92 and assesses how that relationship has changed over time as a result of technical progress. Our outcome variables are life expectancy at age 60 and the probability of dying between age 60 and age 80 for both males and females. The data are from vital-registration based life tables published by national statistical offices for several years during this period. We estimate regressions with determinants that include GDP per capita (adjusted for purchasing power), education and time (as a proxy for technical progress). As the available measure of education failed to account for variation in life expectancy or mortality at age 60, our reported analyses focus on a simplified model with only income and time as predictors. The results indicate that, controlling for income, mortality rates among the elderly have declined considerably over the past three decades. We also find that poverty (as measured by low average income levels) explains some of the variation in both life expectancy at age 60 and mortality rates among the elderly across the countries in the sample. The explained amount of variation is more substantial for females than for males. While poverty does adversely affect mortality rates among the elderly (and the strength of this effect is estimated to be increasing over time), technical progress appears far more important in the period following 1960. Predicted female life expectancy (at age 60) in 1960 at the mean income level in 1960 was, for example 18.8 years; income growth to 1992 increased this by an estimated 0.7 years, whereas technical progress increased it by 2.0 years. We then use the estimated regression results to compare country performance on life expectancy of the elderly, controlling for levels of poverty (or income), and to assess how performance has varied over time. High performing countries, on female life expectancy at age 60, for the period around 1990, included Chile (1.0 years longer life expectancy), China (1.7 years longer), France (2.0 years longer), Japan (1.9 years longer), and Switzerland (1.3 years longer). Poorly performing countries included Denmark (1.1 years shorter life expectancy than predicted from income), Hungary (1.4 years shorter), Iceland (1.2 years shorter), Malaysia (1.6 years shorter), and Trinidad and Tobago (3.9 years shorter). Chile and Switzerland registered major improvements in relative performance over this period; Norway, Taiwan and the USA, in contrast showed major declines in performance between 1980 and the early 1990s.

Characterization of Dementia and Alzheimer’s Disease in an Older Population: Updated Incidence and Life Expectancy With and Without Dementia

PubMed Central

Tom, Sarah E.; Hubbard, Rebecca A.; Crane, Paul K.; Haneuse, Sebastien J.; Bowen, James; McCormick, Wayne C.; McCurry, Susan; Larson, Eric B.

2015-01-01

Objectives. We estimated dementia incidence rates, life expectancies with and without dementia, and percentage of total life expectancy without dementia. Methods. We studied 3605 members of Group Health (Seattle, WA) aged 65 years or older who did not have dementia at enrollment to the Adult Changes in Thought study between 1994 and 2008. We estimated incidence rates of Alzheimer’s disease and dementia, as well as life expectancies with and without dementia, defined as the average number of years one is expected to live with and without dementia, and percentage of total life expectancy without dementia. Results. Dementia incidence increased through ages 85 to 89 years (74.2 cases per 1000 person-years) and 90 years or older (105 cases per 1000 person-years). Life expectancy without dementia and percentage of total life expectancy without dementia decreased with age. Life expectancy with dementia was longer in women and people with at least a college degree. Percentage of total life expectancy without dementia was greater in younger age groups, men, and those with more education. Conclusions. Efforts to delay onset of dementia, if successful, would likely benefit older adults of all ages. PMID:25033130

Correlation of sex ratio at birth with health and socioeconomic indicators.

PubMed

Grech, Victor

2018-03-01

The sex ratio at birth (male divided by total live births: M/T) has been mooted as a potential sentinel health indicator. Several metrics indicate individual countries' health and socioeconomic status. In this study, in all available countries (where such data was accessible), M/T and these indicators were compared in order to ascertain whether better (vis-à-vis health and socioeconomic status) levels of these indicators were associated with higher M/T in available countries. The following were obtained (by country) from various sources: M/T, infant mortality rate, under 5 years mortality rate, fertility rate, Human Development Index, gross domestic product per capita, life expectancy for both sexes, females, males, as well as both sexes Health Adjusted Life Expectancy (HALE). Pearson correlation was performed comparing M/T and these indicators. Despite weak correlation values, all except for the Human Development Index (HDI) correlated with M/T at statistically significant levels. A decrease in mortality and an increase in life expectancy and GDP/capita are indicators of socioeconomic wellbeing. In this study, mortality was negatively correlated with M/T. Life expectancy and GDP/capita were both positively correlated with M/T, indicating that M/T may also serve as a surrogate health indicator, and incidentally, also supporting the Trivers-Willard hypothesis. Improving economies lead to increasing education, which in turns tends to lower fertility rate in association with a declining M/T. In conclusion, the global correlation of health and socioeconomic indicators with M/T suggests that M/T may be a useful sentinel health indicator. Copyright © 2018 Elsevier B.V. All rights reserved.

Physician and parent perceptions of prognosis and end-of-life experience in children with advanced heart disease.

PubMed

Balkin, Emily M; Wolfe, Joanne; Ziniel, Sonja I; Lang, Peter; Thiagarajan, Ravi; Dillis, Shay; Fynn-Thompson, Francis; Blume, Elizabeth D

2015-04-01

Little is known about how physician and parent perspectives compare regarding the prognosis and end-of-life (EOL) experience of children with advanced heart disease (AHD). The study's objective was to describe and compare parent and physician perceptions regarding prognosis and EOL experience in children with AHD. This was a cross-sectional survey study of cardiologists and bereaved parents. Study subjects were parents and cardiologists of children with primary cardiac diagnoses who died in a tertiary care pediatric hospital between January 2007 and December 2009. Inclusion required both physician and parent to have completed surveys respective to the same patient. A total of 31 parent/physician pairs formed the analytic sample. Perceptions were measured of cardiologists and bereaved parents regarding the EOL experience of children with AHD. Nearly half of parents and physicians felt that patients suffered 'a great deal,' 'a lot,' or 'somewhat' at EOL, but there was no agreement between them. At diagnosis, parents more often expected complete repair and normal lifespan while the majority of physicians expected shortened lifespan without normal quality of life. Parents who expected complete repair with normal life were more likely to report 'a lot' of suffering at EOL (p=0.002). In 43% of cases, physicians reported that the parents were prepared for the way in which their child died, while the parents reported feeling unprepared. Both parents and physicians perceive suffering at EOL in patients who die of AHD. Moreover, parent expectations at diagnosis may influence perceptions of suffering at EOL. Physicians overestimate the degree of parent preparedness for their child's death.

Residential Area Life Expectancy: Association With Outcomes and Processes of Care for Patients With ESRD in the United States.

PubMed

Schold, Jesse D; Flechner, Stuart M; Poggio, Emilio D; Augustine, Joshua J; Goldfarb, David A; Sedor, John R; Buccini, Laura D

2018-03-07

The effects of underlying noncodified risks are unclear on the prognosis of patients with end-stage renal disease (ESRD). We aimed to evaluate the association of residential area life expectancy with outcomes and processes of care for patients with ESRD in the United States. Retrospective cohort study. Adult patients with incident ESRD between 2006 and 2013 recorded in the US Renal Data System (n=606,046). The primary exposure was life expectancy in the patient's residential county estimated by the Institute for Health Metrics and Evaluation. Death, placement on the kidney transplant wait list, living and deceased donor kidney transplantation, and posttransplantation graft loss. Median life expectancies of patients' residences were 75.6 (males) and 80.4 years (females). Compared to the highest life expectancy quintile and adjusted for demographic factors, disease cause, and multiple comorbid conditions, the lowest quintile had adjusted HRs for mortality of 1.20 (95% CI, 1.18-1.22); placement onto the waiting list, 0.68 (95% CI, 0.67-0.70); living donor transplantation, 0.53 (95% CI, 0.51-0.56); posttransplantation graft loss, 1.35 (95% CI, 1.27-1.43); and posttransplantation mortality, 1.29 (95% CI, 1.19-1.39). Patients living in areas with lower life expectancy were less likely to be informed about transplantation, be under the care of a nephrologist, or receive an arteriovenous fistula as the initial dialysis access. Results remained consistent with additional adjustment for zip code-level median income, population size, and urban-rural locality. Potential residual confounding and attribution of effects to individuals based on residential area-level data. Residential area life expectancy, a proxy for socioeconomic, environmental, genetic, and behavioral factors, was independently associated with mortality and process-of-care measures for patients with ESRD. These results emphasize the underlying effect on health outcomes of the environment in which patients live, independent of patient-level factors. These findings may have implications for provider assessments. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Life expectancy and disparity: an international comparison of life table data

PubMed Central

Zhang, Zhen; van Raalte, Alyson A

2011-01-01

Objectives To determine the contribution of progress in averting premature deaths to the increase in life expectancy and the decline in lifespan variation. Design International comparison of national life table data from the Human Mortality Database. Setting 40 developed countries and regions, 1840–2009. Population Men and women of all ages. Main outcome measure We use two summary measures of mortality: life expectancy and life disparity. Life disparity is a measure of how much lifespans differ among individuals. We define a death as premature if postponing it to a later age would decrease life disparity. Results In 89 of the 170 years from 1840 to 2009, the country with the highest male life expectancy also had the lowest male life disparity. This was true in 86 years for female life expectancy and disparity. In all years, the top several life expectancy leaders were also the top life disparity leaders. Although only 38% of deaths were premature, fully 84% of the increase in life expectancy resulted from averting premature deaths. The reduction in life disparity resulted from reductions in early-life disparity, that is, disparity caused by premature deaths; late-life disparity levels remained roughly constant. Conclusions The countries that have been the most successful in averting premature deaths have consistently been the life expectancy leaders. Greater longevity and greater equality of individuals' lifespans are not incompatible goals. Countries can achieve both by reducing premature deaths. PMID:22021770

Cost effectiveness of peginterferon alpha-2b plus ribavirin versus interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis C.

PubMed

Siebert, U; Sroczynski, G; Rossol, S; Wasem, J; Ravens-Sieberer, U; Kurth, B M; Manns, M P; McHutchison, J G; Wong, J B

2003-03-01

Peginterferon alpha-2b plus ribavirin therapy in previously untreated patients with chronic hepatitis C yields the highest sustained virological response rates of any treatment strategy but is expensive. To estimate the cost effectiveness of treatment with peginterferon alpha-2b plus ribavirin compared with interferon alpha-2b plus ribavirin for initial treatment of patients with chronic hepatitis C. Individual patient level data from a randomised clinical trial with peginterferon plus ribavirin were applied to a previously published and validated Markov model to project lifelong clinical outcomes. Quality of life and economic estimates were based on German patient data. We used a societal perspective and applied a 3% annual discount rate. Compared with no antiviral therapy, peginterferon plus fixed or weight based dosing of ribavirin increased life expectancy by 4.2 and 4.7 years, respectively. Compared with standard interferon alpha-2b plus ribavirin, peginterferon plus fixed or weight based dosing of ribavirin increased life expectancy by 0.5 and by 1.0 years with incremental cost effectiveness ratios of 11,800 euros and 6600 euros per quality adjusted life year (QALY), respectively. Subgroup analyses by genotype, viral load, sex, and histology showed that peginterferon plus weight based ribavirin remained cost effective compared with other well accepted medical treatments. Peginterferon alpha-2b plus ribavirin should reduce the incidence of liver complications, prolong life, improve quality of life, and be cost effective for the initial treatment of chronic hepatitis C.

Working life tables, Bangladesh 1981.

PubMed

Matin, K A

1986-06-01

Data from the 1981 Bangladesh Population Census were used to construct life tables for working men and women. Bangladesh has a dependency burden of 109 dependents to 100 economically active population. Labor force participation rates in 1981 were 74.1/100 population aged 10 years and over for males and 4.3/100 population aged 10 years and over for females. The age-specific economic activity rates provided the essential link in translating life table data to working life table data. It was calculated that a newborn Bangladesh male had a working life expectancy of 37.8 years and an overall life expectancy of 50.0 years; working life expectancy peaks at 44.2 years at 10 years of age. A newborn female has a working life expectancy of 1.8 years and an overall life expectancy of 49.0 years; a maximum working life expectancy of 2.4 years is obtained at 10 years of age. In the period 1962-81, male working life expectancy registered a slight decline at all ages, while female working life expectancy increased by about 6 months for ages up to 30 years. Mortality accounts for a loss of about 10% of gross years of active life in the 10-69-year goups and 20% in the 10-79-year age group. The male working life expectancy values for Bangladesh in 1981 correspond well with those found in India in 1971, Pakistan in 1978, and Sri Lanka in 1971. However, there is wide divergency in terms of female working life expectancy values: such rates were significantly higher in Sri Lanka and India than in Bangladesh up to the age of 30 years, after which point there was little divergence.

Evaluating natural resource amenities in a human life expectancy production function

Treesearch

Neelam C. Poudyal; Donald G. Hodges; J.M. Bowker; H.K. Cordell

2009-01-01

This study examined the effect of natural resource amenities on human life expectancy. Extending theexisting model of the life expectancy production function, and correcting for spatial dependence, weevaluated the determinants of life expectancy using county level data. Results indicate that after controlling

Relative importance of demographic, socioeconomic and health factors on life expectancy in low- and lower-middle-income countries.

PubMed

Mondal, Md Nazrul Islam; Shitan, Mahendran

2014-01-01

We attempted to identify the pathways by which demographic changes, socioeconomic inequalities, and availability of health factors influence life expectancy in low- and lower-middle-income countries. Data for 91 countries were obtained from United Nations agencies. The response variable was life expectancy, and the determinant factors were demographic events (total fertility rate and adolescent fertility rate), socioeconomic status (mean years of schooling and gross national income per capita), and health factors (physician density and human immunodeficiency virus [HIV] prevalence rate). Path analysis was used to determine the direct, indirect, and total effects of these factors on life expectancy. All determinant factors were significantly correlated with life expectancy. Mean years of schooling, total fertility rate, and HIV prevalence rate had significant direct and indirect effects on life expectancy. The total effect of higher physician density was to increase life expectancy. We identified several direct and indirect pathways that predict life expectancy. The findings suggest that policies should concentrate on improving reproductive decisions, increasing education, and reducing HIV transmission. In addition, special attention should be paid to the emerging need to increase life expectancy by increasing physician density.

Relative Importance of Demographic, Socioeconomic and Health Factors on Life Expectancy in Low- and Lower-Middle-Income Countries

PubMed Central

Mondal, Md. Nazrul Islam; Shitan, Mahendran

2014-01-01

Background We attempted to identify the pathways by which demographic changes, socioeconomic inequalities, and availability of health factors influence life expectancy in low- and lower-middle-income countries. Methods Data for 91 countries were obtained from United Nations agencies. The response variable was life expectancy, and the determinant factors were demographic events (total fertility rate and adolescent fertility rate), socioeconomic status (mean years of schooling and gross national income per capita), and health factors (physician density and human immunodeficiency virus [HIV] prevalence rate). Path analysis was used to determine the direct, indirect, and total effects of these factors on life expectancy. Results All determinant factors were significantly correlated with life expectancy. Mean years of schooling, total fertility rate, and HIV prevalence rate had significant direct and indirect effects on life expectancy. The total effect of higher physician density was to increase life expectancy. Conclusions We identified several direct and indirect pathways that predict life expectancy. The findings suggest that policies should concentrate on improving reproductive decisions, increasing education, and reducing HIV transmission. In addition, special attention should be paid to the emerging need to increase life expectancy by increasing physician density. PMID:24390415

Life Expectancy Among U.S.-born and Foreign-born Older Adults in the United States: Estimates From Linked Social Security and Medicare Data

PubMed Central

Mehta, Neil K.; Elo, Irma T.; Engelman, Michal; Lauderdale, Diane S.; Kestenbaum, Bert M.

2016-01-01

In recent decades, the geographic origins of America’s foreign-born population have become increasingly diverse. The sending countries of the U.S. foreign-born vary substantially in levels of health and economic development, and immigrants have arrived with distinct distributions of socioeconomic status, visa type, year of immigration, and age at immigration. We use high-quality linked Social Security and Medicare records to estimate life tables for the older U.S. population over the full range of birth regions. In 2000–2009, the foreign-born had a 2.4-year advantage in life expectancy at age 65 relative to the U.S.-born, with Asian-born subgroups displaying exceptionally high longevity. Foreign-born individuals who migrated more recently had lower mortality compared with those who migrated earlier. Nonetheless, we also find remarkable similarities in life expectancy among many foreign-born subgroups that were born in very different geographic and socioeconomic contexts (e.g., Central America, western/eastern Europe, and Africa). PMID:27383845

Association between lifestyle factors and quality-adjusted life years in the EPIC-NL cohort.

PubMed

Fransen, Heidi P; May, Anne M; Beulens, Joline W J; Struijk, Ellen A; de Wit, G Ardine; Boer, Jolanda M A; Onland-Moret, N Charlotte; Hoekstra, Jeljer; van der Schouw, Yvonne T; Bueno-de-Mesquita, H Bas; Peeters, Petra H M

2014-01-01

The aim of our study was to relate four modifiable lifestyle factors (smoking status, body mass index, physical activity and diet) to health expectancy, using quality-adjusted life years (QALYs) in a prospective cohort study. Data of the prospective EPIC-NL study were used, including 33,066 healthy men and women aged 20-70 years at baseline (1993-7), followed until 31-12-2007 for occurrence of disease and death. Smoking status, body mass index, physical activity and adherence to a Mediterranean-style diet (excluding alcohol) were investigated separately and combined into a healthy lifestyle score, ranging from 0 to 4. QALYs were used as summary measure of healthy life expectancy, combining a person's life expectancy with a weight for quality of life when having a chronic disease. For lifestyle factors analyzed separately the number of years living longer in good health varied from 0.12 year to 0.84 year, after adjusting for covariates. A combination of the four lifestyle factors was positively associated with higher QALYs (P-trend <0.0001). A healthy lifestyle score of 4 compared to a score of 0 was associated with almost a 2 years longer life in good health (1.75 QALYs [95% CI 1.37, 2.14]).

Mortality inequality in populations with equal life expectancy: Arriaga's decomposition method in SAS, Stata, and Excel.

PubMed

Auger, Nathalie; Feuillet, Pascaline; Martel, Sylvie; Lo, Ernest; Barry, Amadou D; Harper, Sam

2014-08-01

Life expectancy is used to measure population health, but large differences in mortality can be masked even when there is no life expectancy gap. We demonstrate how Arriaga's decomposition method can be used to assess inequality in mortality between populations with near equal life expectancy. We calculated life expectancy at birth for Quebec and the rest of Canada from 2005 to 2009 using life tables and partitioned the gap between both populations into age and cause-specific components using Arriaga's method. The life expectancy gap between Quebec and Canada was negligible (<0.1 years). Decomposition of the gap showed that higher lung cancer mortality in Quebec was offset by cardiovascular mortality in the rest of Canada, resulting in identical life expectancy in both groups. Lung cancer in Quebec had a greater impact at early ages, whereas cardiovascular mortality in Canada had a greater impact at older ages. Despite the absence of a gap, we demonstrate using decomposition analyses how lung cancer at early ages lowered life expectancy in Quebec, whereas cardiovascular causes at older ages lowered life expectancy in Canada. We provide SAS/Stata code and an Excel spreadsheeet to facilitate application of Arriaga's method to other settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment

PubMed Central

Bor, Jacob; Herbst, Abraham J; Newell, Marie-Louise; Bärnighausen, Till

2013-01-01

The scale-up of antiretroviral therapy (ART) is expected to raise adult life expectancy in populations with high HIV prevalence. Using data from a population cohort of over 101,000 individuals in rural KwaZulu-Natal, South Africa, we measured changes in adult life expectancy for 2000–2011. In 2003, the year before ART became available in the public sector health system, adult life expectancy was 49.2 years; by 2011, adult life expectancy had increased to 60.5 years – an 11.3-year gain. Based on standard monetary valuation of life, the survival benefits of ART far outweigh the costs of providing treatment in this community. These gains in adult life expectancy signify the social value of ART and have implications for investment decisions of individuals, governments, and donors. PMID:23430655

Noncommunicable disease mortality and life expectancy in immigrants to Israel from the former Soviet Union: country of origin compared with host country.

PubMed

Ott, Jördis Jennifer; Paltiel, Ari M; Becher, Heiko

2009-01-01

To assess the influence of country of origin effects and of adjustment and selection processes by comparing noncommunicable disease mortality and life expectancy among migrants to Israel from the former Soviet Union (FSU) with noncommunicable disease mortality and life expectancy among Israelis and the population of the Russian Federation. Data from 926,870 FSU-immigrants who migrated to Israel between 1990 and 2003 (study cohort) were analysed. Life expectancy was calculated for the study cohort, all Israelis, and the population of the Russian Federation. Age-standardized death rates were calculated for grouped causes of death. FSU immigrants were additionally compared with other Israelis and with inhabitants of the Russian Federation using cause-specific standardized mortality ratios (SMRs). Life expectancy at age 15 years in 2000-2003 was 61.0 years for male and 67.0 years for female FSU immigrants to Israel. Age-standardized death rates for FSU immigrants in Israel were similar to those of other Israelis and much lower than those of inhabitants of the Russian Federation. Relative to Israelis, the study cohort had a higher SMR for neoplasms, and particularly for stomach cancer. Mortality from brain cancer was higher when immigrants were compared to the Russian Federation (SMR: 1.71, 95% confidence interval, CI: 1.50-1.94 for males; SMR: 1.77, 95% CI: 1.56-2.02 for females), whereas mortality from stomach cancer was lower among immigrants relative to the Russian Federation (SMR: 0.43, 95% CI: 0.40-0.47 for males; SMR: 0.56, 95% CI: 0.52-0.61 for females). Mortality from external causes was lower among immigrants relative to the population of the Russian Federation (SMR: 0.20, 95% CI: 0.19-0.21 for males; SMR: 0.35, 95% CI: 0.33-0.37 for females) but significantly higher relative to other Israelis (SMR: 1.41, 95% CI: 1.35-1.47 for males; SMR: 1.08, 95% CI: 1.02-1.15). Noncommunicable disease mortality among FSU immigrants to Israel is lower than in the population of the Russian Federation. Mortality rates in FSU immigrants, particularly from circulatory diseases, have rapidly adjusted and have become similar to those of the destination country. However, immigrants from the FSU have considerably higher mortality than other Israelis from external causes and some noncommunicable diseases such as cancer. Mortality rates in these diaspora migrants show a mixed picture of rapid assimilation together with persistent country of origin effects, as well as the effects of adjustment hardships.

ANALYSIS OF TRENDS IN LIFE EXPECTANCIES AND PER CAPITA GROSS DOMESTIC PRODUCT AS WELL AS PHARMACEUTICAL AND NON-PHARMACEUTICAL HEALTHCARE EXPENDITURES.

PubMed

Hermanowski, Tomasz; Bystrov, Victor; Staszewska-Bystrova, Anna; Szafraniec-Buryło, Sylwia I; Rabczenko, Daniel; Kolasa, Katarzyna; Orlewska, Ewa

2015-01-01

Life expectancy is a common measure of population health. Macro-perspective based on aggregated data makes it possible to approximate the impact of different levels of pharmaceutical expenditure on general population health status and is often used in cross-country comparisons. The aim of the study was to determine whether there are long-run relations between life expectancy, total healthcare expenditures, and pharmaceutical expenditures in OECD countries. Common trends in per capita gross domestic products (GDPs) (excluding healthcare expenditures), per capita healthcare expenditures (excluding pharmaceutical expenditures), per capita pharmaceutical expenditures, and life expectancies of women and men aged 60 and 65 were analyzed across OECD countries. Short-term effect of pharmaceutical expenditure onto life expectancy was also estimated by regressing the deviations of life expectancies from their long-term trends onto the deviations of pharmaceutical and non-pharmaceutical health expenditures, as well as GDP from their trends. The dataset was created on the basis of OECD Health Data for 34 countries and the years 1991-2010. Life expectancy variables were used as proxies for the health outcomes, whereas the pharmaceutical and healthcare expenditures represented drug and healthcare consumption, respectively. In general, both expenditures and life expectancies tended to increase in all of the analyzed countries; however, the growth rates differed across the countries. The analysis of common trends indicated the existence of common long-term trends in life expectancies and per capita GDP as well as pharmaceutical and non-pharmaceutical healthcare expenditures. However, there was no evidence that pharmaceutical expenditures provided additional information about the long-term trends in life expectancies beyond that contained in the GDP series. The analysis based on the deviations of variables from their long-term trends allowed concluding that pharmaceutical expenditures significantly influenced life expectancies in the short run. Non-pharmaceutical healthcare expenditures were found to be significant in one out of four models (for life expectancy of women aged 65), while GDPs were found to be insignificant in all four models. The results of the study indicate that there are common long-term trends in life expectancies and per capita GDP as well as pharmaceutical and non-pharmaceutical healthcare expenditures. The available data did not reveal any cause- effect relationship. Other factors, for which the systematic data were not available, may have determined the increase in life expectancy in OECD countries. Significant positive short-term relations between pharmaceutical expenditures and life expectancies in OECD countries were found. The significant short-term effect of pharmaceutical expenditures onto life expectancy means that an increase of pharmaceutical expenditures above long-term trends would lead to a temporary increase in life expectancy above its corresponding long-term trend. However, this effect would not persist as pharmaceutical expenditures and life expectancy would converge to levels determined by the long-term trends.

HIV cure strategies: how good must they be to improve on current antiretroviral therapy?

PubMed

Sax, Paul E; Sypek, Alexis; Berkowitz, Bethany K; Morris, Bethany L; Losina, Elena; Paltiel, A David; Kelly, Kathleen A; Seage, George R; Walensky, Rochelle P; Weinstein, Milton C; Eron, Joseph; Freedberg, Kenneth A

2014-01-01

We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART). We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY. For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving. Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.

The Association Between Income and Life Expectancy in the United States, 2001-2014.

PubMed

Chetty, Raj; Stepner, Michael; Abraham, Sarah; Lin, Shelby; Scuderi, Benjamin; Turner, Nicholas; Bergeron, Augustin; Cutler, David

2016-04-26

The relationship between income and life expectancy is well established but remains poorly understood. To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation. Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy. Pretax household earnings as a measure of income. Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas. The sample consisted of 1,408,287,218 person-year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61,175 per year). There were 4,114,380 deaths among men (mortality rate, 596.3 per 100,000) and 2,694,808 deaths among women (mortality rate, 375.1 per 100,000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r = -0.69, P < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and government expenditures (r = 0.57, P < .001). In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics.

The contribution of cancer incidence, stage at diagnosis and survival to racial differences in years of life expectancy.

PubMed

Wong, Mitchell D; Ettner, Susan L; Boscardin, W John; Shapiro, Martin F

2009-04-01

African Americans have higher cancer mortality rates than whites. Understanding the relative contribution of cancer incidence, stage at diagnosis and survival after diagnosis to the racial gap in life expectancy has important implications for directing future health disparity interventions toward cancer prevention, screening and treatment. We estimated the degree to which higher cancer mortality among African Americans is due to higher incidence rates, later stage at diagnosis or worse survival after diagnosis. Stochastic model of cancer incidence and survival after diagnosis. Surveillance and Epidemiology End Result cancer registry and National Health Interview Survey data. Life expectancy if African Americans had the same cancer incidence, stage and survival after diagnosis as white adults. African-American men and women live 1.47 and 0.91 fewer years, respectively, than whites as the result of all cancers combined. Among men, racial differences in cancer incidence, stage at diagnosis and survival after diagnosis account for 1.12 (95% CI: 0.52 to 1.36), 0.17 (95% CI: -0.03 to 0.33) and 0.21 (95% CI: 0.05 to 0.34) years of the racial gap in life expectancy, respectively. Among women, incidence, stage and survival after diagnosis account for 0.41 (95% CI: -0.29 to 0.60), 0.26 (95% CI: -0.06 to 0.40) and 0.31 (95% CI: 0.05 to 0.40) years, respectively. Differences in stage had a smaller impact on the life expectancy gap compared with the impact of incidence. Differences in cancer survival after diagnosis had a significant impact for only two cancers-breast (0.14 years; 95% CI: 0.05 to 0.16) and prostate (0.05 years; 95% CI 0.01 to 0.09). In addition to breast and colorectal cancer screening, national efforts to reduce disparities in life expectancy should also target cancer prevention, perhaps through smoking cessation, and differences in survival after diagnosis among persons with breast and prostate cancer.

The effect of individual differences and manipulated life expectancies on the willingness to engage in sexual coercion.

PubMed

Dunkel, Curtis S; Mathes, Eugene

2011-12-16

The role of the individual difference variables of mate value, short-term and long-term mating preferences, and life history strategy along with the manipulated variable of life expectancy were used to predict differences in the willingness to engage in sexually coercive behaviors. Short-term preferences and long-term preferences were correlated with the willingness to engage in sexual coercion at all life expectancies. Life history strategy was correlated with the willingness to engage in sexual coercion at only the shortest and longest life expectancies. Most importantly short-term and long-term mating preferences interacted with life expectancy to predict the willingness to engage in sexually coercive behaviors. Short life expectancies increased willingness in individuals with high short-term and low long-term preferences. The results are discussed in terms of the varying theories of sexual coercion with emphasis put on a life history approach.

Health inequalities in Ethiopia: modeling inequalities in length of life within and between population groups.

PubMed

Tranvåg, Eirik Joakim; Ali, Merima; Norheim, Ole Frithjof

2013-07-11

Most studies on health inequalities use average measures, but describing the distribution of health can also provide valuable knowledge. In this paper, we estimate and compare within-group and between-group inequalities in length of life for population groups in Ethiopia in 2000 and 2011. We used data from the 2011 and 2000 Ethiopia Demographic and Health Survey and the Global Burden of Disease study 2010, and the MODMATCH modified logit life table system developed by the World Health Organization to model mortality rates, life expectancy, and length of life for Ethiopian population groups stratified by wealth quintiles, gender and residence. We then estimated and compared within-group and between-group inequality in length of life using the Gini index and absolute length of life inequality. Length of life inequality has decreased and life expectancy has increased for all population groups between 2000 and 2011. Length of life inequality within wealth quintiles is about three times larger than the between-group inequality of 9 years. Total length of life inequality in Ethiopia was 27.6 years in 2011. Longevity has increased and the distribution of health in Ethiopia is more equal in 2011 than 2000, with length of life inequality reduced for all population groups. Still there is considerable potential for further improvement. In the Ethiopian context with a poor and highly rural population, inequality in length of life within wealth quintiles is considerably larger than between them. This suggests that other factors than wealth substantially contribute to total health inequality in Ethiopia and that identification and quantification of these factors will be important for identifying proper measures to further reduce length of life inequality.

Health inequalities in Ethiopia: modeling inequalities in length of life within and between population groups

PubMed Central

2013-01-01

Background and objectives Most studies on health inequalities use average measures, but describing the distribution of health can also provide valuable knowledge. In this paper, we estimate and compare within-group and between-group inequalities in length of life for population groups in Ethiopia in 2000 and 2011. Methods We used data from the 2011 and 2000 Ethiopia Demographic and Health Survey and the Global Burden of Disease study 2010, and the MODMATCH modified logit life table system developed by the World Health Organization to model mortality rates, life expectancy, and length of life for Ethiopian population groups stratified by wealth quintiles, gender and residence. We then estimated and compared within-group and between-group inequality in length of life using the Gini index and absolute length of life inequality. Results Length of life inequality has decreased and life expectancy has increased for all population groups between 2000 and 2011. Length of life inequality within wealth quintiles is about three times larger than the between-group inequality of 9 years. Total length of life inequality in Ethiopia was 27.6 years in 2011. Conclusion Longevity has increased and the distribution of health in Ethiopia is more equal in 2011 than 2000, with length of life inequality reduced for all population groups. Still there is considerable potential for further improvement. In the Ethiopian context with a poor and highly rural population, inequality in length of life within wealth quintiles is considerably larger than between them. This suggests that other factors than wealth substantially contribute to total health inequality in Ethiopia and that identification and quantification of these factors will be important for identifying proper measures to further reduce length of life inequality. PMID:23845045

Evaluating natural resource amenities in a human life expectancy production function

Treesearch

Neelam C. Poudyal; Donald G. Hodges; J.M. Bowker; H.K. Cordell

2009-01-01

This study examined the effect of natural resource amenities on human life expectancy. Extending the existing model of the life expectancy production function, and correcting for spatial dependence, we evaluated the determinants of life expectancy using county level data. Results indicate that after controlling for socio-demographic and economic factors, medical...

Subjective Life Expectancy Among College Students.

PubMed

Rodemann, Alyssa E; Arigo, Danielle

2017-09-14

Establishing healthy habits in college is important for long-term health. Despite existing health promotion efforts, many college students fail to meet recommendations for behaviors such as healthy eating and exercise, which may be due to low perceived risk for health problems. The goals of this study were to examine: (1) the accuracy of life expectancy predictions, (2) potential individual differences in accuracy (i.e., gender and conscientiousness), and (3) potential change in accuracy after inducing awareness of current health behaviors. College students from a small northeastern university completed an electronic survey, including demographics, initial predictions of their life expectancy, and their recent health behaviors. At the end of the survey, participants were asked to predict their life expectancy a second time. Their health data were then submitted to a validated online algorithm to generate calculated life expectancy. Participants significantly overestimated their initial life expectancy, and neither gender nor conscientiousness was related to the accuracy of these predictions. Further, subjective life expectancy decreased from initial to final predictions. These findings suggest that life expectancy perceptions present a unique-and potentially modifiable-psychological process that could influence college students' self-care.

Increased Life Expectancy in New York City, 2001-2010: An Exploration by Cause of Death and Demographic Characteristics.

PubMed

Li, Wenhui; Maduro, Gil A; Begier, Elizabeth M

2016-01-01

New York City's (NYC's) life expectancy gains have been greater than those seen nationally. We examined life-expectancy changes over the past decade in selected NYC subpopulations and explored which age groups and causes of death contributed most to the increases. We calculated life expectancy with 95% confidence intervals (CIs) for 2001-2010 by sex and race/ethnicity. Life expectancy was decomposed by age group and cause of death. Logistic regressions were conducted to reinforce the results from decomposition by controlling confounders. Overall, NYC residents' life expectancy at birth increased from 77.9 years (95% CI, 77.8-78.0) in 2001 to 80.9 years (95% CI, 80.8-81.0) in 2010. Decreases in deaths from heart disease, cancer, and HIV disease accounted for 50%, 16%, and 11%, respectively, of the gains. Decreased mortality in older age groups (≥65 years) accounted for 45.6% of the overall change. Life expectancy increased for both sexes, across all racial/ethnic groups, and for both the US-born and the foreign-born. Disparities in life expectancy decreased as overall life expectancy increased. Decreased mortality among older adults and from heart disease, cancer, and HIV infection accounted for most of the increases.

Life expectancy--a commentary on this life table variable.

PubMed

Singer, Richard B

2005-01-01

In 1992, I wrote an article on a method of modifying the Decennial US Life Table to accommodate any pattern of excess mortality expressed in terms of excess death rate (EDR), for the specific purpose of calculating the reduced life expectancy, e. I believe this was the first article published in the Journal of Insurance Medicine (JIM) that dealt specifically with life expectancy as an index of survival and risk appraisal, never used in the classification of extra mortality risk in applicants for life insurance. In this commentary, I discuss the 1989-91 US Decennial Life Table in detail. I link the subject matter of the 1992 article with several more recent articles that also focus on the utility of life expectancy in underwriting structured settlement annuities and preparing reports on life expectancy for an attorney in a tort case. A few references are given for further reading on life table methodology and its use in the most accurate estimate of life expectancy, given the inherent limitations of the life table and the limited duration of follow-up studies.

A Multicenter, Open-label Study of CMX001 Treatment of Serious Diseases or Conditions Caused by dsDNA Viruses

ClinicalTrials.gov

2013-08-28

Male or Female Patients With a Serious or Immediately Life-threatening; Disease or Condition Caused by CMV, ADV, HSV, VAVC, VARV or; Monkeypox Viruses(s) Who Have a Life Expectancy of ≥ 2 Weeks and for; Whom no Comparable or Satisfactory Alternative Therapy is Available

Comparative durability of timber bridges in the USA

Treesearch

James P. Wacker; Brian K. Brashaw

2017-01-01

As engineers begin to utilize life-cycle-cost design approaches for timber bridges, there is a necessity for more reliable data about their durability and expected service life. This paper summarizes a comprehensive effort to assess the current condition of more than one hundred timber highway bridge superstructures throughout the United States. This national study was...

Educational differences in life expectancy over five decades among the oldest old in Norway.

PubMed

Kinge, Jonas Minet; Steingrímsdóttir, Ólöf Anna; Moe, Joakim Oliu; Skirbekk, Vegard; Næss, Øyvind; Strand, Bjørn Heine

2015-11-01

Socioeconomic inequalities in life expectancy have been shown among the middle aged and the youngest of the old individuals, but the situation in the oldest old is less clear. The aim of this study was to investigate trends in life expectancy at ages 85, 90 and 95 years by education in Norway in the period 1961-2009. This was a register-based population study including all residents in Norway aged 85 and over. Individual-level data were provided by the Central Population Register and the National Education Database. For each decade during 1961-2009, death rates by 1-year age groups were calculated separately for each sex and three educational categories. Annual life tables were used to calculate life expectancy at ages 85 (e85), 90 (e90) and 95 (e95). Educational differentials in life expectancy at each age were non-significant in the early decades, but became significant over time. For example, for the decade 2000-9, a man aged 90 years with primary education had a life expectancy of 3.4 years, while a man with tertiary education could expect to live for 3.8 years. Similar numbers in women were 4.1 and 4.5 years, respectively. Even among 95-year-old men, statistically significant differences in life expectancy were found by education in the two last decades. Education matters regarding remaining life expectancy also for the oldest old in Norway. Life expectancy at these ages is low, so a growth of 0.5 years in the life expectancy differential is sizeable. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Decennial trends and inequalities in healthy life expectancy: The HUNT Study, Norway.

PubMed

Storeng, Siri H; Krokstad, Steinar; Westin, Steinar; Sund, Erik R

2018-02-01

Norway is experiencing a rising life expectancy combined with an increasing dependency ratio - the ratio of those outside over those within the working force. To provide data relevant for future health policy we wanted to study trends in total and healthy life expectancy in a Norwegian population over three decades (1980s, 1990s and 2000s), both overall and across gender and educational groups. Data were obtained from the HUNT Study, and the Norwegian Educational Database. We calculated total life expectancy and used the Sullivan method to calculate healthy life expectancies based on self-rated health and self-reported longstanding limiting illness. The change in health expectancies was decomposed into mortality and disability effects. During three consecutive decades we found an increase in life expectancy for 30-year-olds (~7 years) and expected lifetime in self-rated good health (~6 years), but time without longstanding limiting illness increased less (1.5 years). Women could expect to live longer than men, but the extra life years for females were spent in poor self-rated health and with longstanding limiting illness. Differences in total life expectancy between educational groups decreased, whereas differences in expected lifetime in self-rated good health and lifetime without longstanding limiting illness increased. The increase in total life expectancy was accompanied by an increasing number of years spent in good self-rated health but more years with longstanding limiting illness. This suggests increasing health care needs for people with chronic diseases, given an increasing number of elderly. Socioeconomic health inequalities remain a challenge for increasing pensioning age.

The Association Between Income and Life Expectancy in the United States, 2001–2014

PubMed Central

Chetty, Raj; Stepner, Michael; Abraham, Sarah; Lin, Shelby; Scuderi, Benjamin; Turner, Nicholas; Bergeron, Augustin; Cutler, David

2016-01-01

Importance The relationship between income and mortality is well established but remains poorly understood. Objectives To measure the level, temporal trend, and geographic variability in the association between income and life expectancy, and identify factors related to small area variation in this association. Design and Setting Income data for the US population were obtained from 1.4 billion de-identified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy. Main Outcomes and Measures Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas. Results The sample consisted of 1 408 287 218 person-year observations (mean age at which individuals were analyzed, 53.0 years; median household earnings among working individuals, $61 175 per year [mean, $97 725 per year]). Among those aged 40 to 76 years, there were 4 114 380 deaths among men (mortality rate, 596.3 per 100 000) and 2 694 808 deaths among women (mortality rate, 375.1 per 100 000). The analysis yielded four results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but increased by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the difference for both sexes). Third, life expectancy varied substantially across local areas. For individuals in the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r = −0.69, P < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and local government expenditures (r = 0.57, P < .001). Conclusions and Relevance In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics. PMID:27063997

Decomposing cross-country differences in quality adjusted life expectancy: the impact of value sets.

PubMed

Heijink, Richard; van Baal, Pieter; Oppe, Mark; Koolman, Xander; Westert, Gert

2011-06-23

The validity, reliability and cross-country comparability of summary measures of population health (SMPH) have been persistently debated. In this debate, the measurement and valuation of nonfatal health outcomes have been defined as key issues. Our goal was to quantify and decompose international differences in health expectancy based on health-related quality of life (HRQoL). We focused on the impact of value set choice on cross-country variation. We calculated Quality Adjusted Life Expectancy (QALE) at age 20 for 15 countries in which EQ-5D population surveys had been conducted. We applied the Sullivan approach to combine the EQ-5D based HRQoL data with life tables from the Human Mortality Database. Mean HRQoL by country-gender-age was estimated using a parametric model. We used nonparametric bootstrap techniques to compute confidence intervals. QALE was then compared across the six country-specific time trade-off value sets that were available. Finally, three counterfactual estimates were generated in order to assess the contribution of mortality, health states and health-state values to cross-country differences in QALE. QALE at age 20 ranged from 33 years in Armenia to almost 61 years in Japan, using the UK value set. The value sets of the other five countries generated different estimates, up to seven years higher. The relative impact of choosing a different value set differed across country-gender strata between 2% and 20%. In 50% of the country-gender strata the ranking changed by two or more positions across value sets. The decomposition demonstrated a varying impact of health states, health-state values, and mortality on QALE differences across countries. The choice of the value set in SMPH may seriously affect cross-country comparisons of health expectancy, even across populations of similar levels of wealth and education. In our opinion, it is essential to get more insight into the drivers of differences in health-state values across populations. This will enhance the usefulness of health-expectancy measures.

Impact of particulate air pollution on quality-adjusted life expectancy in Canada.

PubMed

Coyle, Douglas; Stieb, Dave; Burnett, Richard T; DeCivita, Paul; Krewski, Daniel; Chen, Yue; Thun, Michael J

Air pollution and premature death are important public health concerns. Analyses have repeatedly demonstrated that airborne particles are associated with increased mortality and estimates have been used to forecast the impact on life expectancy. In this analysis, we draw upon data from the American Cancer Society (ACS) cohort and literature on utility-based measures of quality of life in relation to health status to more fully quantify the effects of air pollution on mortality in terms of quality-adjusted life expectancy. The analysis was conducted within a decision analytic model using Monte Carlo simulation techniques. Outcomes were estimated based on projections of the Canadian population. A one-unit reduction in sulfate air pollution would yield a mean annual increase in Quality-Adjusted Life Years (QALYs) of 20,960, with gains being greater for individuals with lower educational status and for males compared to females. This suggests that the impact of reductions in sulfate air pollution on quality-adjusted life expectancy is substantial. Interpretation of the results is unclear. However, the potential gains in QALYs from reduced air pollutants can be contrasted to the costs of policies to bring about such reductions. Based on a tentative threshold for the value of health benefits, analysis suggests that an investment in Canada of over 1 billion dollars per annum would be an efficient use of resources if it could be demonstrated that this would reduce sulfate concentrations in ambient air by 1 microg/m(3). Further analysis can assess the efficiency of targeting such initiatives to communities that are most likely to benefit.

Worklife expectancy in a cohort of Danish employees aged 55-65 years - comparing a multi-state Cox proportional hazard approach with conventional multi-state life tables.

PubMed

Pedersen, Jacob; Bjorner, Jakob Bue

2017-11-15

Work life expectancy (WLE) expresses the expected time a person will remain in the labor market until he or she retires. This paper compares a life table approach to estimating WLE to an approach based on multi-state proportional hazards models. The two methods are used to estimate WLE in Danish members and non-members of an early retirement pensioning (ERP) scheme according to levels of health. In 2008, data on self-rated health (SRH) was collected from 5212 employees 55-65 years of age. Data on previous and subsequent long-term sickness absence, unemployment, returning to work, and disability pension was collected from national registers. WLE was estimated from multi-state life tables and through multi-state models. Results from the multi-state model approach agreed with the life table approach but provided narrower confidence intervals for small groups. The shortest WLE was seen for employees with poor SRH and ERP membership while the longest WLE was seen for those with good SRH and no ERP membership. Employees aged 55-56 years with poor SRH but no ERP membership had shorter WLE than employees with good SRH and ERP membership. Relative WLE reversed for the two groups after age 57. At age 55, employees with poor SRH could be expected to spend approximately 12 months on long-term sick leave and 9-10 months unemployed before they retired - regardless of ERP membership. ERP members with poor SRH could be expected to spend 4.6 years working, while non-members could be expected to spend 7.1 years working. WLE estimated through multi-state models provided an effective way to summarize complex data on labor market affiliation. WLE differed noticeably between members and non-members of the ERP scheme. It has been hypothesized that while ERP membership would prompt some employees to retire earlier than they would have done otherwise, this effect would be partly offset by reduced time spent on long-term sick leave or unemployment. Our data showed no indication of such an effect, but this could be due to residual confounding and self-selection of people with poor health into the ERP scheme.

Mortality and life expectancy of professional fire fighters in Hamburg, Germany: a cohort study 1950 – 2000

PubMed Central

Wagner, Norbert L; Berger, Jürgen; Flesch-Janys, Dieter; Koch, Peter; Köchel, Anja; Peschke, Michel; Ossenbach, Trude

2006-01-01

Background The healthy worker effect may hide adverse health effects in hazardous jobs, especially those where physical fitness is required. Fire fighters may serve as a good example because they sometimes are severely exposed to hazardous substances while on the other hand their physical fitness and their strong health surveillance by far exceeds that of comparable persons from the general population. Methods To study this effect a historic cohort study was conducted to assess mortality and life expectancy of professional fire fighters of the City of Hamburg, Germany. Fire departments and trade unions questioned the validity of existing studies from outside Germany because of specific differences in the professional career. No mortality study had been conducted so far in Germany and only few in Europe. Information on all active and retired fire fighters was extracted from personnel records. To assure completeness of data the cohort was restricted to all fire fighters being active on January 1, 1950 or later. Follow up of the cohort ended on June 30th 2000. Vital status was assessed by personnel records, pension fund records and the German residence registries. Mortality of fire fighters was compared to mortality of the Hamburg and German male population by means of standardized mortality ratios. Life expectancy was calculated using life table analysis. Multivariate proportional hazard models were used to assess the effect of seniority, time from first employment, and other occupational characteristics on mortality. Results The cohort consists of 4640 fire fighters accumulating 111796 person years. Vital status could be determined for 98.2% of the cohort. By the end of follow up 1052 person were deceased. Standardized Mortality Ratio (SMR) for the total cohort was 0.79 (95% CI, 0.74–0.84) compared to Hamburg reference data and 0.78 (95% CI, 0.74–0.83) compared to National German reference data. Conditional life expectancy of a 30 year old fire fighter was 45.3 years as compared to 42.9 year of a German male in normal population. Job tasks, rank status and early retirement negatively influenced mortality. For fire fighters with comparably short duration of employment the mortality advantage diminished with longer time since first employment. SMR of persons who retired early was 1.25 (95% CI, 1.13–1.60) in reference to the general German population and the SMR of 1.71 (1.18–2.50) in the multivariate regression model. Conclusion A strong healthy worker effect was observed for the cohort, which diminished with longer time since first employment for fire fighters with shorter duration of employment, as expected. The negative effects on mortality of job tasks, rank status and in particular early retirement indicate the presence of undetermined and specific risks related to occupational hazards of fire fighters. PMID:17020604

[Development of technologies of population health management in Kazakhstan based on an integrated assessment of the combined exposure to environmental factors].

PubMed

Sraubaev, E N; Serik, B

2013-01-01

At present there is overdue necessity of an integral approach to the assessment of health status and the impact of environmental factors on it, in the development of science-based management decisions and programs on improvement of the health status of the population of Kazakhstan and in the increase in life expectancy from the birth and healthy life expectancy. The purpose of the proposed program--improving health and increasing life expectancy from the birth and healthy life expectancy of the population of Kazakhstan. Based on a meta-analysis to justify the target age group in which an implementation of complex of preventive measures will increase both the life expectancy from the birth and healthy life expectancy, to perform a comprehensive health screening for the basic classes of diseases and behavioral characteristics of the target group in the course of a multicentre studies to give a comprehensive hygienic characteristics of the ecological status of the studied regions and to develop the Health Passport of the region, to develop a model of the combined effects of environmental factors on health; to create a theoretical model for the calculation of life expectancy from the birth and healthy life expectancy, taking into account the limits of modifiability of factors that affect them, and justify a comprehensive program of management decisions on modification of factors, to carry out pilot studies on the development and validation technological (managemental) solutions to control modifiable factors that affect life expectancy from the birth and healthy life expectancy.

Economic evaluation of posaconazole versus fluconazole or itraconazole in the prevention of invasive fungal infection in high-risk neutropenic patients in Sweden.

PubMed

Lundberg, Johan; Höglund, Martin; Björkholm, Magnus; Åkerborg, Örjan

2014-07-01

In patients undergoing induction chemotherapy for acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS), posaconazole has been proven more effective in the prevention of invasive fungal infection (IFI) than fluconazole or itraconazole (standard azoles) The current analysis seeks to estimate the cost effectiveness of prophylactic posaconazole compared with standard azoles in AML or MDS patients with severe chemotherapy-induced neutropenia in Sweden. A decision-analytic model was used to estimate life expectancy, costs, and quality-adjusted life-years (QALYs). Efficacy data were derived from a phase III clinical trial. Life expectancy and quality of life data were collected from the literature. A modified Delphi method was used to gather expert opinion on resource use for an IFI. Unit costs were captured from hospital and pharmacy pricelists. A probabilistic sensitivity analysis (PSA) was used to investigate the impact of uncertainty in the model parameters on the cost-effectiveness results. The estimated mean direct cost per patient with posaconazole prophylaxis was 46,893 Swedish kronor (SEK) (€5,387) and SEK50,017 (€5,746) with standard azoles. Prophylaxis with posaconazole resulted in 0.075 QALYs gained compared with standard azoles. At a cost-effectiveness threshold of SEK500,000/QALY the PSA demonstrated a more than 95 % probability that posaconazole is cost effective versus standard azoles for the prevention of IFI in high-risk neutropenic patients in Sweden. Given the assumptions, methods, and data used, posaconazole is expected to be cost effective compared with standard azoles when used as antifungal prophylaxis in AML or MDS patients with chemotherapy-induced prolonged neutropenia in Sweden.

26 CFR 1.401(a)(9)-9 - Life expectancy and distribution period tables.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 5 2014-04-01 2014-04-01 false Life expectancy and distribution period tables... Plans, Etc. § 1.401(a)(9)-9 Life expectancy and distribution period tables. Q-1. What is the life...)(9)? A-1 The following table, referred to as the Single Life Table, is used for determining the life...

Cost-effectiveness of insulin aspart versus human soluble insulin in type 2 diabetes in four European countries: subgroup analyses from the PREDICTIVE study.

PubMed

Palmer, James L; Goodall, Gordon; Nielsen, Steffen; Kotchie, Robert W; Valentine, William J; Palmer, Andrew J; Roze, Stéphane

2008-05-01

To evaluate the long-term health economic outcomes associated with insulin aspart (IAsp) compared to human soluble insulin (HI) in type 2 diabetes patients on basal-bolus therapy in Sweden, Spain, Italy and Poland. A published computer simulation model of diabetes was used to predict life expectancy, quality-adjusted life expectancy and incidence of diabetes-related complications. Baseline cohort characteristics (age 61.6 years, duration of diabetes 13.2 years, 45.1% male, HbA(1c) 8.2%, BMI 29.8 kg/m(2)) and treatment effects were derived from the PREDICTIVE observational study. Country-specific complication costs were derived from published sources. The analyses were run over 35-year time horizons from third-party payer perspectives in Spain, Italy and Poland and from a societal perspective in Sweden. Future costs and clinical benefits were discounted at country-specific discount rates. Sensitivity analyses were performed. IAsp was associated with improvements in discounted life expectancy and quality-adjusted life expectancy, and a reduced incidence of most diabetes-related complications versus HI in all four settings. IAsp was associated with societal cost-savings in Sweden (SEK 2470), direct medical cost-savings in Sweden and Spain (SEK 8248 and euro 1382, respectively), but increased direct costs in Italy (euro 2235) and Poland (euro 743). IAsp was associated with improved quality-adjusted life expectancy in Sweden (0.077 QALYs), Spain (0.080 QALYs), Italy (0.120 QALYs) and Poland (0.003 QALYs). IAsp was dominant versus HI in both Sweden and Spain, would be considered cost-effective in Italy with an incremental cost-effectiveness ratio of euro 18,597 per QALY gained, but would not be considered cost-effective in Poland.

Gender differences in life expectancy with and without disability among older adults in Ecuador.

PubMed

Egüez-Guevara, Pilar; Andrade, Flávia Cristina Drumond

2015-01-01

Knowledge on disability's impact among older women and men in Ecuador is limited. This paper provides gender-specific estimates of disability prevalence, life expectancy with and without disability, and the factors associated with gender differences in disability at older age in Ecuador (2009-2010). Data from the Health, Well-Being, and Aging Survey (SABE) Ecuador 2009 was used. Participants were 4480 men and women aged 60 and over. Life expectancy with and without disability was calculated using the Sullivan method. Logistic regression analyses were used to explore gender differences in disability prevalence. Two disability measures, indicating limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), were used. 60-year-old women in Ecuador can expect to live 16.3 years without ADL limitations compared to 16.9 years for men. Life expectancy without IADL limitations was 12.5 years for women and 15.5 years for men. At age 60, women's length of life with ADL and IADL disability was higher (7.9 years for women vs. 4.9 years for men with ADL, and 11.7 years for women vs. 6.3 years for men with IADL). After controlling for socioeconomic characteristics, chronic conditions and lifestyle factors, gender differences in ADL disability were not statistically significant. However, older women were 58% more likely (OR=1.58, 95% CI 1.27, 1.95) to report having IADL limitations than men, even after including control variables. Interventions should tackle chronic disease, physical inactivity, and socioeconomic differences to reduce women's vulnerability to disability in older age. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Taxation and life expectancy in Western Europe.

PubMed

Bagger, P J

2004-06-01

With the exception of Denmark, life expectancy in Western Europe has shown a significant increase over the last decades. During that period of time overall taxation has increased in most of the countries, especially in Denmark. We, therefore, examined whether taxation could influence life expectancy in Western Europe. We used information on the sum of income tax and employees' social contribution in percentage of gross wage earnings from the OECD database and data on disability adjusted life expectancy at birth from the World Health Organization database. We arbitrarily only included countries with populations in excess of 4 millions and thereby excluded smaller countries where tax exemption is part of the national monetary policy. We found that disability adjusted life expectancy at birth was inversely correlated to the total tax burden in Western Europe. We speculate whether a threshold exists where high taxes exert a negative influence on life expectancy despite increased welfare spending. The study suggests that tax burden should be considered among the multiple factors influencing life expectancy.

Re-Evaluating the Possible Increased Risk of HIV Acquisition With Progestin-Only Injectables Versus Maternal Mortality and Life Expectancy in Africa: A Decision Analysis.

PubMed

Rodriguez, Maria Isabel; Gaffield, Mary E; Han, Leo; Caughey, Aaron B

2017-12-28

The association between increased risk of HIV acquisition and use of progestin-only injectables (POIs) is controversial. We sought to compare the competing risks of maternal mortality and HIV acquisition with use of POIs using updated data on this association and considering an expanded number of African countries. We designed a decision-analytic model to compare the benefits and risks of POIs on the competing risks of maternal mortality and HIV acquisition on life expectancy for women in 9 African countries. For the purposes of this analysis, we assumed that POIs were associated with an increased risk of HIV acquisition (hazards ratio of 1.4). Our primary outcome was life-years and the population was women of reproductive age (15-49 years) in these countries, who did not have HIV infection and were not currently planning a pregnancy. Probabilities for each variable included in the model, such as HIV incidence, access to antiretroviral therapy, and contraceptive prevalence, were obtained from the literature. Univariate and multivariate sensitivity analyses were performed to check model assumptions and explore how uncertainty in estimates would affect the model results. In all countries, discontinuation of POIs without replacement with an equally effective contraceptive method would result in decreased life expectancy due to a significant increase in maternal deaths. While the removal of POIs from the market would result in the prevention of some new cases of HIV, the life-years gained from this are mitigated due to the marked increase in neonatal HIV cases and maternal mortality with associated life-years lost. In all countries, except South Africa, typical-use contraceptive failure rates with POIs would need to exceed 39%, and more than half of women currently using POIs would have to switch to another effective method, for the removal of POIs to demonstrate an increase in total life-years. Women living in sub-Saharan Africa cope with both high rates of HIV infection and high rates of pregnancy-related maternal death relative to the rest of the world. Based on the most current estimates, our model suggests that removal of POI contraception from the market without effective and acceptable contraception replacement would have a net negative effect on maternal health, life expectancy, and mortality under a variety of scenarios. © Rodriguez et al.

12 Ways to Make a Difference for Your Grandchild with Autism

ERIC Educational Resources Information Center

Krumins, Jennifer

2008-01-01

Nothing can compare with the boundless love that a grandparent feels for their grandchild. The gift of grandchildren is one of life's greatest blessings. But life does not always deliver its blessings in the package one expects. The diagnosis of autism is for many a jolt into a new world. For parents, the diagnosis tears their hearts and brings…

Geographical variation in life expectancy at birth in England and Wales is largely explained by deprivation.

PubMed

Woods, Laura M; Rachet, Bernard; Riga, Michael; Stone, Noell; Shah, Anjali; Coleman, Michel P

2005-02-01

To describe the population mortality profile of England and Wales by deprivation and in each government office region (GOR) during 1998, and to quantify the influence of geography and deprivation in determining life expectancy. Construction of life tables describing age specific mortality rates and life expectancy at birth from death registrations and estimated population counts. Life tables were created for (a) quintiles of income deprivation based on the income domain score of the index of multiple deprivation 2000, (b) each GOR and Wales, and (c) every combination of deprivation and geography. England and Wales.PATIENTS/ PARTICIPANTS: Residents of England and Wales, 1998. Life expectancy at birth varies with deprivation quintile and is highest in the most affluent groups. The differences are mainly attributable to differences in mortality rates under 75 years of age. Regional life expectancies display a clear north-south gradient. Linear regression analysis shows that deprivation explains most of the geographical variation in life expectancy. Geographical patterns of life expectancy identified within these data for England and Wales in 1998 are mainly attributable to variations in deprivation status as defined by the IMD 2000 income domain score.

Predicting Life Expectancy for Pirfenidone in Idiopathic Pulmonary Fibrosis.

PubMed

Fisher, Mark; Nathan, Steven D; Hill, Christian; Marshall, Jade; Dejonckheere, Fred; Thuresson, Per-Olof; Maher, Toby M

2017-03-01

Conducting an adequately powered survival study in idiopathic pulmonary fibrosis (IPF) is challenging due to the rare nature of the disease and the need for extended follow-up. Consequently, registration trials of IPF treatments have not been designed to estimate long-term survival. To predict life expectancy for patients with IPF receiving pirfenidone versus best supportive care (BSC) in a population that met the inclusion criteria of patients enrolled in the ASCEND and CAPACITY trials. Kaplan-Meier survival data for pirfenidone and BSC were obtained from randomized controlled clinical studies (CAPACITY, ASCEND), an open-label extension study (RECAP), and the Inova Fairfax Hospital database. Data from the Inova registry were matched to the inclusion criteria of the CAPACITY and ASCEND trials. Life expectancy was estimated by the area under the curve of parametric survival distributions fit to the Kaplan-Meier data. Mean (95% confidence interval) life expectancy was calculated as 8.72 (7.65-10.15) years with pirfenidone and 6.24 (5.38-7.18) years with BSC. Therefore, pirfenidone improved life expectancy by 2.47 (1.26-4.17) years compared with BSC. In addition, treatment with pirfenidone recuperated 25% of the expected years of life lost due to IPF. Sensitivity analyses found that results were sensitive to the choice of parametric survival distribution, and alternative piecewise and parametric approaches. This analysis suggests that this population of patients with IPF has an improved life expectancy if treated with pirfenidone compared with BSC. This study was funded by InterMune International AG, a wholly owned Roche subsidiary since 2014. Fisher was previously employed by InterMune UK, a wholly owned Roche subsidiary, until July 2015. He is currently employed by FIECON, which has received funding from F. Hoffmann-La Roche for consulting services. Nathan has received consulting fees from Roche-Genentech and Boehringer Ingelheim. He is also on the speakers' bureau for Roche-Genentech and Boehringer Ingelheim and has received research funding from both companies. Hill was previously employed by InterMune UK until October 2014. Hill and Marshall are employees of MAP BioPharma, which has received funding from F. Hoffmann-La Roche for consulting services. Dejonckheere and Thuresson are employees of F. Hoffmann-La Roche. Maher has received grants, consulting fees, and speaker fees from GlaxoSmithKline and UCB, and grants from Novartis. He has also received consulting fees and speaker fees from AstraZeneca, Bayer, Biogen Idec, Boehringer Ingelheim, Cipla, Lanthio, InterMune International AG, F. Hoffmann-La Roche, Sanofi-Aventis, and Takeda. Maher is supported by a National Institute for Health Research Clinician Scientist Fellowship (NIHR Ref: CS: -2013-13-017). Study concept and design were contributed by Fisher, Hill, Marshall, and Dejonckheere. Fisher, Nathan, and Thuresson collected the data, along with Hill and Marshall. Data interpretation was performed by Fisher, Maher, Nathan, and Dejonckheere. The manuscript was written primarily by Fisher, along with Maher and Dejonckheere, and revised by Fisher and Maher, along with the other authors.

Relationships between the Active Aging Index and Disability-Free Life Expectancy: A Case Study in the Rajshahi District of Bangladesh.

PubMed

Tareque, Md Ismail; Hoque, Nazrul; Islam, Towfiqua Mahfuza; Kawahara, Kazuo; Sugawa, Makiko

2013-12-01

Life expectancy has increased considerably throughout the world. In Bangladesh, life expectancy has increased from about 53 years in 1975 to 69 years in 2010. However, it is unknown whether the increase in life expectancy is simultaneously accompanied by an increase in disability-free life expectancy (DFLE). The purpose of the study described in this article was to explore the relationship between life expectancy and DFLE in the Rajshahi District of Bangladesh by examining the relationships between the Active Aging Index (AAI) and DFLE. The study fi ndings suggest that urban, more-educated, elderly males are more active in all aspects of life and have longer DFLE. Females are found to outlive males but are more likely to live a greater part of their remaining life with disability. Positive correlations between the AAI and DFLE suggest that older adults could enjoy more DFLE by involving themselves in active aging activities.

Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.

PubMed

Rothberg, Michael B; Virapongse, Anunta; Smith, Kenneth J

2007-05-15

A vaccine to prevent herpes zoster was recently approved by the United States Food and Drug Administration. We sought to determine the cost-effectiveness of this vaccine for different age groups. We constructed a cost-effectiveness model, based on the Shingles Prevention Study, to compare varicella zoster vaccination with usual care for healthy adults aged >60 years. Outcomes included cost in 2005 US dollars and quality-adjusted life expectancy. Costs and natural history data were drawn from the published literature; vaccine efficacy was assumed to persist for 10 years. For the base case analysis, compared with usual care, vaccination increased quality-adjusted life expectancy by 0.0007-0.0024 quality-adjusted life years per person, depending on age at vaccination and sex. These increases came almost exclusively as a result of prevention of acute pain associated with herpes zoster and postherpetic neuralgia. Vaccination also increased costs by $94-$135 per person, compared with no vaccination. The incremental cost-effectiveness ranged from $44,000 per quality-adjusted life year saved for a 70-year-old woman to $191,000 per quality-adjusted life year saved for an 80-year-old man. For the sensitivity analysis, the decision was most sensitive to vaccine cost. At a cost of $46 per dose, vaccination cost <$50,000 per quality-adjusted life year saved for all adults >60 years of age. Other variables related to the vaccine (duration, efficacy, and adverse effects), postherpetic neuralgia (incidence, duration, and utility), herpes zoster (incidence and severity), and the discount rate all affected the cost-effectiveness ratio by >20%. The cost-effectiveness of the varicella zoster vaccine varies substantially with patient age and often exceeds $100,000 per quality-adjusted life year saved. Age should be considered in vaccine recommendations.

Cost-Effectiveness of Transcatheter Aortic Valve Replacement With a Self-Expanding Prosthesis Versus Surgical Aortic Valve Replacement

PubMed Central

Reynolds, Matthew R.; Lei, Yang; Wang, Kaijun; Chinnakondepalli, Khaja; Vilain, Katherine A.; Magnuson, Elizabeth A.; Galper, Benjamin Z.; Meduri, Christopher U.; Arnold, Suzanne V.; Baron, Suzanne J.; Reardon, Michael J.; Adams, David H.; Popma, Jeffrey J.; Cohen, David J.

2016-01-01

Background Prior studies of the cost-effectiveness of transcatheter aortic valve replacement (TAVR) have been based primarily on a single balloon-expandable system. Objectives The goal of this study was to evaluate the cost-effectiveness of TAVR with a self-expanding prosthesis compared with surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and high surgical risk. Methods We performed a formal economic analysis on the basis of individual, patient-level data from the CoreValve U.S. High Risk pivotal trial. Empirical data regarding survival and quality of life (QOL) over 2 years, and medical resource use and hospital costs through 12 months were used to project life expectancy, quality-adjusted life expectancy, and lifetime medical costs in order to estimate the incremental cost-effectiveness of TAVR versus SAVR from a U.S. perspective. Results Relative to SAVR, TAVR reduced initial length of stay an average of 4.4 days, decreased the need for rehabilitation services at discharge, and resulted in superior 1-month QOL. Index admission and projected lifetime costs were higher with TAVR than with SAVR (differences $11,260 and $17,849 per patient, respectively), whereas TAVR was projected to provide a lifetime gain of 0.32 quality-adjusted life-years (QALYs; 0.41 life-years [LYs]) with 3% discounting. Lifetime incremental cost-effectiveness ratios (ICERs) were $55,090 per QALY gained and $43,114 per LY gained. Sensitivity analyses indicated that a reduction in the initial cost of TAVR by ~$1,650 would lead to an ICER <$50,000/QALY gained. Conclusions In a high-risk clinical trial population, TAVR with a self-expanding prosthesis provided meaningful clinical benefits compared with SAVR, with incremental costs considered acceptable by current U.S. standards. With expected modest reductions in the cost of index TAVR admissions, the value of TAVR compared with SAVR in this patient population would become high. PMID:26764063

Parameter and model uncertainty in a life-table model for fine particles (PM2.5): a statistical modeling study

PubMed Central

Tainio, Marko; Tuomisto, Jouni T; Hänninen, Otto; Ruuskanen, Juhani; Jantunen, Matti J; Pekkanen, Juha

2007-01-01

Background The estimation of health impacts involves often uncertain input variables and assumptions which have to be incorporated into the model structure. These uncertainties may have significant effects on the results obtained with model, and, thus, on decision making. Fine particles (PM2.5) are believed to cause major health impacts, and, consequently, uncertainties in their health impact assessment have clear relevance to policy-making. We studied the effects of various uncertain input variables by building a life-table model for fine particles. Methods Life-expectancy of the Helsinki metropolitan area population and the change in life-expectancy due to fine particle exposures were predicted using a life-table model. A number of parameter and model uncertainties were estimated. Sensitivity analysis for input variables was performed by calculating rank-order correlations between input and output variables. The studied model uncertainties were (i) plausibility of mortality outcomes and (ii) lag, and parameter uncertainties (iii) exposure-response coefficients for different mortality outcomes, and (iv) exposure estimates for different age groups. The monetary value of the years-of-life-lost and the relative importance of the uncertainties related to monetary valuation were predicted to compare the relative importance of the monetary valuation on the health effect uncertainties. Results The magnitude of the health effects costs depended mostly on discount rate, exposure-response coefficient, and plausibility of the cardiopulmonary mortality. Other mortality outcomes (lung cancer, other non-accidental and infant mortality) and lag had only minor impact on the output. The results highlight the importance of the uncertainties associated with cardiopulmonary mortality in the fine particle impact assessment when compared with other uncertainties. Conclusion When estimating life-expectancy, the estimates used for cardiopulmonary exposure-response coefficient, discount rate, and plausibility require careful assessment, while complicated lag estimates can be omitted without this having any major effect on the results. PMID:17714598

Parameter and model uncertainty in a life-table model for fine particles (PM2.5): a statistical modeling study.

PubMed

Tainio, Marko; Tuomisto, Jouni T; Hänninen, Otto; Ruuskanen, Juhani; Jantunen, Matti J; Pekkanen, Juha

2007-08-23

The estimation of health impacts involves often uncertain input variables and assumptions which have to be incorporated into the model structure. These uncertainties may have significant effects on the results obtained with model, and, thus, on decision making. Fine particles (PM2.5) are believed to cause major health impacts, and, consequently, uncertainties in their health impact assessment have clear relevance to policy-making. We studied the effects of various uncertain input variables by building a life-table model for fine particles. Life-expectancy of the Helsinki metropolitan area population and the change in life-expectancy due to fine particle exposures were predicted using a life-table model. A number of parameter and model uncertainties were estimated. Sensitivity analysis for input variables was performed by calculating rank-order correlations between input and output variables. The studied model uncertainties were (i) plausibility of mortality outcomes and (ii) lag, and parameter uncertainties (iii) exposure-response coefficients for different mortality outcomes, and (iv) exposure estimates for different age groups. The monetary value of the years-of-life-lost and the relative importance of the uncertainties related to monetary valuation were predicted to compare the relative importance of the monetary valuation on the health effect uncertainties. The magnitude of the health effects costs depended mostly on discount rate, exposure-response coefficient, and plausibility of the cardiopulmonary mortality. Other mortality outcomes (lung cancer, other non-accidental and infant mortality) and lag had only minor impact on the output. The results highlight the importance of the uncertainties associated with cardiopulmonary mortality in the fine particle impact assessment when compared with other uncertainties. When estimating life-expectancy, the estimates used for cardiopulmonary exposure-response coefficient, discount rate, and plausibility require careful assessment, while complicated lag estimates can be omitted without this having any major effect on the results.

Persistent social inequality in life expectancy and disability-free life expectancy: Outlook for a differential pension age in Denmark?

PubMed

Brønnum-Hansen, Henrik; Eriksen, Mette Lindholm; Andersen-Ranberg, Karen; Jeune, Bernard

2017-06-01

The state old-age pension in Denmark increases to keep pace with the projected increase in average life expectancy (LE) without any regard to the social gap in LE and expected lifetime in good health. The purpose of this study was to compare changes in LE and disability-free life expectancy (DFLE) between groups of Danes with high, medium and low levels of education. Nationwide register data on education and mortality were combined with data from the Surveys of Health, Ageing and Retirement in Europe (SHARE) surveys in 2006-2007, 2010-2011 and 2013-2014 and the DFLE by educational level was estimated by Sullivan's method for each of these three time points. Between 2006-2007 and 2013-2014, LE among 65-year-old men and women with a low educational level increased by 1.3 and 1.0 years, respectively, and by 1.4 and 1.3 years for highly educated men and women. The gap in LE between people with high and low levels of education remained more than 2 years. In 2006-2007, 65-year-old men with a high level of education could expect 3.2 more years without disability than men of the same age with a low level of education. In 2013-2014, the difference was 2.9 years. For women, the results were 3.7 and 3.4 years, respectively. With the persistent social inequality in LE of more than 2 years and the continuous gap between high and low educational groups in DFLE of about 3 years, a differential pension age is recommended.

Decomposition of educational differences in life expectancy by age and causes of death among South Korean adults.

PubMed

Jung-Choi, Kyunghee; Khang, Young-Ho; Cho, Hong-Jun; Yun, Sung-Cheol

2014-06-05

Decomposition of socioeconomic inequalities in life expectancy by ages and causes allow us to better understand the nature of socioeconomic mortality inequalities and to suggest priority areas for policy and intervention. This study aimed to quantify age- and cause-specific contributions to socioeconomic differences in life expectancy at age 25 by educational level among South Korean adult men and women. We used National Death Registration records in 2005 (129,940 men and 106,188 women) and national census data in 2005 (15, 215, 523 men and 16,077,137 women aged 25 and over). Educational attainment as the indicator of socioeconomic position was categorized into elementary school graduation or less, middle or high school graduation, and college graduation or higher. Differences in life expectancy at age 25 by educational level were estimated by age- and cause-specific mortality differences using Arriaga's decomposition method. Differences in life expectancy at age 25 between college or higher education and elementary or less education were 16.23 years in men and 7.69 years in women. Young adult groups aged 35-49 in men and aged 25-39 in women contributed substantially to the differences between college or higher education and elementary or less education in life expectancy. Suicide and liver disease were the most important causes of death contributing to the differences in life expectancy in young adult groups. For older age groups, cerebrovascular disease and lung cancer were important to explain educational differential in life expectancy at 25-29 between college or higher education and middle or higher education. The contribution of the causes of death to socioeconomic inequality in life expectancy at age 25 in South Korea varied by age groups and differed by educational comparisons. The age specific contributions for different causes of death to life expectancy inequalities by educational attainment should be taken into account in establishing effective policy strategies to reduce socioeconomic inequalities in life expectancy.

Decomposition of socio-economic differences in life expectancy at birth by age and cause of death among 4 million South Korean public servants and their dependents.

PubMed

Khang, Young-Ho; Yang, Seungmi; Cho, Hong-Jun; Jung-Choi, Kyunghee; Yun, Sung-Cheol

2010-12-01

Differences in life expectancy at birth across social classes can be more easily interpreted as a measure of absolute inequalities in survival. This study quantified age- and cause-specific contributions to life expectancy differences by income among 4 million public servants and their dependents in South Korea (9.1% of the total Korean population). Using 9-year mortality follow-up data (208,612 deaths) on 4,055,150 men and women aged 0-94 years, with national health insurance premiums imposed proportionally based on monthly salary as a measure of income, differences in life expectancy at birth by income were estimated by age- and cause-specific mortality differences using Arriaga's decomposition method. Life expectancy at birth gradually increased with income. Differences in life expectancy at birth between the highest and the lowest income quartile were 6.22 years in men and 1.74 years in women. Mortality differentials by income among those aged ≥50 years contributed most substantially (80.4% in men and 85.6% in women) to the socio-economic differences in life expectancy at birth. In men, cancers (stomach, liver and lung), cardiovascular diseases (stroke), digestive diseases (liver cirrhosis) and external causes (transport accidents and suicide) were important contributors to the life expectancy differences. In women, the contribution of ill-defined causes was most important. Cardiovascular diseases (stroke and hypertensive disease) and external causes (transport accidents and suicide) also contributed to the life expectancy differences in women while the contributions of cancers and digestive diseases were minimal. Reductions in socio-economic differentials in mortality from stroke and external causes (transport accidents and suicide) among middle-aged and older men and women would significantly contribute to equalizing life expectancy among income groups. Policy efforts to reduce mortality differentials in major cancers (stomach, liver and lung) and liver cirrhosis are also important for eliminating Korean men's socio-economic inequalities in life expectancy.

Long-Term Effects of Tetanus Toxoid Inoculation on the Demography and Life Expectancy of the Cayo Santiago Rhesus Macaques

PubMed Central

KESSLER, MATTHEW J.; PACHECO, RAISA HERNÁNDEZ; RAWLINS, RICHARD G.; RUIZ-LAMBRIDES, ANGELINA; DELGADO, DIANA L.; SABAT, ALBERTO M.

2014-01-01

Tetanus was a major cause of mortality in the free-ranging population of rhesus monkeys on Cayo Santiago prior to 1985 when the entire colony was given its first dose of tetanus toxoid. The immediate reduction in mortality that followed tetanus toxoid inoculation (TTI) has been documented, but the long-term demographic effects of eliminating tetanus infections have not. This study uses the Cayo Santiago demographic database to construct comparative life tables 12 years before, and 12 years after, TTI. Life tables and matrix projection models are used to test for differences in: (i) survival among all individuals as well as among social groups, (ii) long-term fitness of the population, (iii) age distribution, (iv) reproductive value, and (v) life expectancy. A retrospective life table response experiment (LTRE) was performed to determine which life cycle transition contributed most to observed changes in long-term fitness of the population post-TTI. Elimination of clinical tetanus infections through mass inoculation improved the health and well-being of the monkeys. It also profoundly affected the population by increasing survivorship and long-term fitness, decreasing the differences in survival rates among social groups, shifting the population’s age distribution towards older individuals, and increasing reproductive value and life expectancy. These findings are significant because they demonstrate the long-term effects of eradicating a major cause of mortality at a single point in time on survival, reproduction, and overall demography of a naturalistic population of primates. PMID:25230585

Validation of the Social Security Administration Life Tables (2004-2014) in Localized Prostate Cancer Patients within the Surveillance, Epidemiology, and End Results database.

PubMed

Preisser, Felix; Bandini, Marco; Mazzone, Elio; Nazzani, Sebastiano; Marchioni, Michele; Tian, Zhe; Saad, Fred; Pompe, Raisa S; Shariat, Shahrokh F; Heinzer, Hans; Montorsi, Francesco; Huland, Hartwig; Graefen, Markus; Tilki, Derya; Karakiewicz, Pierre I

2018-05-22

Accurate life expectancy estimation is crucial in clinical decision-making including management and treatment of clinically localized prostate cancer (PCa). We hypothesized that Social Security Administration (SSA) life tables' derived survival estimates closely follow observed survival of PCa patients. To test this relationship, we examined 10-yr overall survival rates in patients with clinically localized PCa and compared it with survival estimates derived from the SSA life tables. Within the Surveillance, Epidemiology, and End Results database (2004), we identified patients aged >50-<90yr. Follow-up was at least 10 yr for patients who did not die of disease or other causes. Monte Carlo method was used to define individual survival in years, according to the SSA life tables (2004-2014). Subsequently, SSA life tables' predicted survival was compared with observed survival rates in Kaplan-Meier analyses. Subgroup analyses were stratified according to treatment type and D'Amico risk classification. Overall, 39191 patients with localized PCa were identified. At 10-yr follow-up, the SSA life tables' predicted survival was 69.5% versus 73.1% according to the observed rate (p<0.0001). The largest differences between estimated versus observed survival rates were recorded for D'Amico low-risk PCa (8.0%), brachytherapy (9.1%), and radical prostatectomy (8.6%) patients. Conversely, the smallest differences were recorded for external beam radiotherapy (1.7%) and unknown treatment type (1.6%) patients. Overall, SSA life tables' predicted life expectancy closely approximate observed overall survival rates. However, SSA life tables' predicted rates underestimate by as much as 9.1% the survival in brachytherapy patients, as well as in D'Amico low-risk and radical prostatectomy patients. In these patient categories, an adjustment for the degree of underestimation might be required when counseling is provided in clinical practice. Social Security Administration (SSA) life tables' predicted life expectancy closely approximate observed overall survival rates. However, SSA life tables' predicted rates underestimate by as much as 9.1% the survival in brachytherapy patients, as well as in D'Amico low-risk and radical prostatectomy patients. Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis

PubMed Central

Moore, Steven C.; Patel, Alpa V.; Matthews, Charles E.; Berrington de Gonzalez, Amy; Park, Yikyung; Katki, Hormuzd A.; Linet, Martha S.; Weiderpass, Elisabete; Visvanathan, Kala; Helzlsouer, Kathy J.; Thun, Michael; Gapstur, Susan M.; Hartge, Patricia; Lee, I-Min

2012-01-01

Background Leisure time physical activity reduces the risk of premature mortality, but the years of life expectancy gained at different levels remains unclear. Our objective was to determine the years of life gained after age 40 associated with various levels of physical activity, both overall and according to body mass index (BMI) groups, in a large pooled analysis. Methods and Findings We examined the association of leisure time physical activity with mortality during follow-up in pooled data from six prospective cohort studies in the National Cancer Institute Cohort Consortium, comprising 654,827 individuals, 21–90 y of age. Physical activity was categorized by metabolic equivalent hours per week (MET-h/wk). Life expectancies and years of life gained/lost were calculated using direct adjusted survival curves (for participants 40+ years of age), with 95% confidence intervals (CIs) derived by bootstrap. The study includes a median 10 y of follow-up and 82,465 deaths. A physical activity level of 0.1–3.74 MET-h/wk, equivalent to brisk walking for up to 75 min/wk, was associated with a gain of 1.8 (95% CI: 1.6–2.0) y in life expectancy relative to no leisure time activity (0 MET-h/wk). Higher levels of physical activity were associated with greater gains in life expectancy, with a gain of 4.5 (95% CI: 4.3–4.7) y at the highest level (22.5+ MET-h/wk, equivalent to brisk walking for 450+ min/wk). Substantial gains were also observed in each BMI group. In joint analyses, being active (7.5+ MET-h/wk) and normal weight (BMI 18.5–24.9) was associated with a gain of 7.2 (95% CI: 6.5–7.9) y of life compared to being inactive (0 MET-h/wk) and obese (BMI 35.0+). A limitation was that physical activity and BMI were ascertained by self report. Conclusions More leisure time physical activity was associated with longer life expectancy across a range of activity levels and BMI groups. Please see later in the article for the Editors' Summary PMID:23139642

[Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030].

PubMed

Zeng, X Y; Li, Y C; Liu, J M; Liu, Y N; Liu, S W; Qi, J L; Zhou, M G

2017-12-06

Objective: To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. Methods: We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. Results: If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively). Conclusion: Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

7 CFR 1735.43 - Payments on loans.

Code of Federal Regulations, 2011 CFR

2011-01-01

... date no later than the remaining economic life of the facilities financed by the loan, plus three years..., equals the expected composite economic life of the facilities to be financed, as calculated by RUS; expected composite economic life means the depreciated life plus three years. The expected composite...

Ethnic and gender specific life expectancies of the Singapore population, 1965 to 2009 – converging, or diverging?

PubMed Central

2013-01-01

Background The increase in life expectancy and the persistence of expectancy gaps between different social groups in the 20th century are well-described in Western developed countries, but less well documented in the newly industrialised countries of Asia. Singapore, a multiethnic island-state, has undergone a demographic and epidemiologic transition concomitant with economic development. We evaluate secular trends and differences in life expectancy by ethnicity and gender in Singapore, from independence to the present. Methods Period abridged life tables were constructed to derive the life expectancy of the Singapore population from 1965 to 2009 using data from the Department of Statistics and the Registry of Births and Deaths, Singapore. Results All 3 of Singapore’s main ethnic groups, and both genders, experienced an increase in life expectancy at birth and at 65 years from 1965 to 2009, though at substantially different rates. Although there has been a convergence in life expectancy between Indians and Chinese, the (substantial) gap between Malays and the other two ethnic groups has remained. Females continued to have a higher life expectancy at birth and at 65 years than males throughout this period, with no evidence of convergence. Conclusions Ethnic and gender differences in life expectancy persist in Singapore despite its rapid economic development. Targeted chronic disease prevention measures and health promotion activities focusing on people of Malay ethnicity and the male community may be needed to remedy this inequality. PMID:24160733

Associations of Smoking, Physical Inactivity, Heavy Drinking, and Obesity with Quality-Adjusted Life Expectancy among US Adults with Depression.

PubMed

Jia, Haomiao; Zack, Matthew M; Gottesman, Irving I; Thompson, William W

2018-03-01

To examine associations between four health behaviors (smoking, physical inactivity, heavy alcohol drinking, and obesity) and three health indices (health-related quality of life, life expectancy, and quality-adjusted life expectancy (QALE)) among US adults with depression. Data were obtained from the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System data. The EuroQol five-dimensional questionnaire (EQ-5D) health preference scores were estimated on the basis of extrapolations from the Centers for Disease Control and Prevention's healthy days measures. Depression scores were estimated using the eight-item Patient Health Questionnaire. Life expectancy estimates were obtained from US life tables, and QALE was estimated from a weighted combination of the EQ-5D scores and the life expectancy estimates. Outcomes were summarized by depression status for the four health behaviors (smoking, physical inactivity, heavy alcohol drinking, and obesity). For depressed adults, current smokers and the physically inactive had significantly lower EQ-5D scores (0.040 and 0.171, respectively), shorter life expectancy (12.9 and 10.8 years, respectively), and substantially less QALE (8.6 and 10.9 years, respectively). For nondepressed adults, estimated effects were similar but smaller. Heavy alcohol drinking among depressed adults, paradoxically, was associated with higher EQ-5D scores but shorter life expectancy. Obesity was strongly associated with lower EQ-5D scores but only weakly associated with shorter life expectancy. Among depressed adults, physical inactivity and smoking were strongly associated with lower EQ-5D scores, life expectancy, and QALE, whereas obesity and heavy drinking were only weakly associated with these indices. These results suggest that reducing physical inactivity and smoking would improve health more among depressed adults. Copyright © 2018. Published by Elsevier Inc.

Using subjective expectations to forecast longevity: do survey respondents know something we don't know?

PubMed

Perozek, Maria

2008-02-01

Old-age mortality is notoriously difficult to predict because it requires not only an understanding of the process of senescence-which is influenced by genetic, environmental, and behavioral factors-but also a prediction of how these factors will evolve. In this paper I argue that individuals are uniquely qualified to predict their own mortality based on their own genetic background, as well as environmental and behavioral risk factors that are often known only to the individual. Given this private information, individuals form expectations about survival probabilities that may provide additional information to demographers and policymakers in their challenge to predict mortality. From expectations data from the 1992 Health and Retirement Study (HRS), I construct subjective, cohort life tables that are shown to predict the unusual direction of revisions to U.S. life expectancy by gender between 1992 and 2004: that is, for these cohorts, the Social Security Actuary (SSA) raised male life expectancy in 2004 and at the same lowered female life expectancy, narrowing the gender gap in longevity by 25% over this period. Further, although the subjective life expectancies for men appear to be roughly in line with the 2004 life tables, the subjective expectations of women suggest that female life expectancies estimated by the SSA might still be on the high side.

Health-adjusted life expectancy in Canada.

PubMed

Bushnik, Tracey; Tjepkema, Michael; Martel, Laurent

2018-04-18

Over the past century, life expectancy at birth in Canada has risen substantially. However, these gains in the quantity of life say little about gains in the quality of life. Health-adjusted life expectancy (HALE), an indicator of quality of life, was estimated for the household and institutional populations combined every four years from 1994/1995 to 2015. Health status was measured by the Health Utilities Index Mark 3 instrument in two national population health surveys, and was used to adjust life expectancy. The percentage of the population living in health-related institutions was estimated based on the Census of Population. Attribute-deleted HALE was calculated to determine how various aspects of health status contributed to the differences between life expectancy and HALE. HALE has increased in Canada. Greater gains among males have narrowed the gap between males and females. The ratio of HALE to life expectancy changed little for males, and a marginal improvement was observed for females aged 65 or older. Mobility problems and pain, the latter mainly among females, accounted for an increased share of the burden of ill health over time. Exclusion of the institutional population significantly increased the estimates of HALE and yielded higher ratios of HALE to life expectancy. Although people are living longer, the share of years spent in good functional health has remained fairly constant. Data for both the household and institutional populations are necessary for a complete picture of health expectancy in Canada.

Not all built the same? A comparative study of electoral systems and population health.

PubMed

Patterson, Andrew C

2017-09-01

Much literature depicts a worldwide democratic advantage in population health. However, less research compares health outcomes in the different kinds of democracy or autocracy. In an examination of 179 countries as they existed between 1975 and 2012, advantages in life expectancy and infant health appear most reliably for democracies that include the principle of proportional representation in their electoral rules. Compared to closed autocracies, they had up to 12 or more years of life expectancy on average, 75% less infant mortality, and double the savings in overall mortality for most other age groups. Majoritarian democracies, in contrast, did not experience longitudinal improvements in health relative to closed autocracies. Instead their population health appeared to be on par with or even superseded by competitive autocracies in most models. Findings suggest that the principle of proportional representation may be good for health at the national level. Implications and limitations are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Life Expectancy and Lifetime Health Care Expenditures for Type 1 Diabetes: A Nationwide Longitudinal Cohort of Incident Cases Followed for 14 Years.

PubMed

Ou, Huang-Tz; Yang, Chen-Yi; Wang, Jung-Der; Hwang, Jing-Shiang; Wu, Jin-Shang

2016-12-01

To assess additional life expectancy (LE), expected years of life lost , and lifetime health care expenditures after type 1 diabetes diagnosis, stratified by sex and age of first diagnosis (early: 0-12 years; late: 13-40 years). A longitudinal cohort of patients with diabetes was constructed from Taiwan's National Health Insurance Research Database of 1999 to 2012. The survival functions for diabetic patients and age- and sex-matched general population were estimated by using a semiparametric extrapolation method with annual life tables. The average monthly health care expenditures were multiplied by the corresponding monthly survival rates and summed to calculate the lifetime health care expenditures. Cox proportional hazard models were constructed to corroborate the effects of sex and age, after being adjusted for comorbidities, complications, and calendar years. A total of 2386 cases (45% early diagnosis, 49% males) were identified. An additional LE after diabetes diagnosis was 45.12 years, with an estimated 17.63 years of life lost. The predicted total and diabetes-related lifetime costs were $56,939 and $102,140, respectively. Early diagnosed patients had a longer LE and lower health care spending compared with those of late-diagnosed patients. Male patients had a shorter LE and a higher expected years of life lost than the female patients, which corresponded to lower lifetime costs for the former. The Cox model results for overall mortality corroborated these trends. Early detection of type 1 diabetes and sex-specific strategies would probably improve long-term health outcomes and save on the cost of diabetes care. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Favorable ecological circumstances promote life expectancy in chimpanzees similar to that of human hunter-gatherers☆

PubMed Central

Wood, Brian M.; Watts, David P.; Mitani, John C.; Langergraber, Kevin E.

2017-01-01

Demographic data on wild chimpanzees are crucial for understanding the evolution of chimpanzee and hominin life histories, but most data come from populations affected by disease outbreaks and anthropogenic disturbance. We present survivorship data from a relatively undisturbed and exceptionally large community of eastern chimpanzees (Pan troglodytes schweinfurthii) at Ngogo, Kibale National Park, Uganda. We monitored births, deaths, immigrations, and emigrations in the community between 1995 and 2016. Using known and estimated ages, we calculated survivorship curves for the whole community, for males and females separately, and for individuals ≤2 years old when identified. We used a novel method to address age estimation error by calculating stochastic survivorship curves. We compared Ngogo life expectancy, survivorship, and mortality rates to those from other chimpanzee communities and human hunter-gatherers. Life expectancy at birth for both sexes combined was 32.8 years, far exceeding estimates of chimpanzee life expectancy in other communities, and falling within the range of human hunter-gatherers (i.e., 27–37 years). Overall, the pattern of survivorship at Ngogo was more similar to that of human hunter-gatherers than to other chimpanzee communities. Maximum lifespan for the Ngogo chimpanzees, however, was similar to that reported at other chimpanzee research sites and was less than that of human-hunter gatherers. The absence of predation by large carnivores may contribute to some of the higher survivorship at Ngogo, but this cannot explain the much higher survivorship at Ngogo than at Kanyawara, another chimpanzee community in the same forest, which also lacks large carnivores. Higher survivorship at Ngogo appears to be an adaptive response to a food supply that is more abundant and varies less than that of Kanyawara. Future analyses of hominin life history evolution should take these results into account. PMID:28366199

Potential cost-effectiveness of universal access to modern contraceptives in Uganda.

PubMed

Babigumira, Joseph B; Stergachis, Andy; Veenstra, David L; Gardner, Jacqueline S; Ngonzi, Joseph; Mukasa-Kivunike, Peter; Garrison, Louis P

2012-01-01

Over two thirds of women who need contraception in Uganda lack access to modern effective methods. This study was conducted to estimate the potential cost-effectiveness of achieving universal access to modern contraceptives in Uganda by implementing a hypothetical new contraceptive program (NCP) from both societal and governmental (Ministry of Health (MoH)) perspectives. A Markov model was developed to compare the NCP to the status quo or current contraceptive program (CCP). The model followed a hypothetical cohort of 15-year old girls over a lifetime horizon. Data were obtained from the Uganda National Demographic and Health Survey and from published and unpublished sources. Costs, life expectancy, disability-adjusted life expectancy, pregnancies, fertility and incremental cost-effectiveness measured as cost per life-year (LY) gained, cost per disability-adjusted life-year (DALY) averted, cost per pregnancy averted and cost per unit of fertility reduction were calculated. Univariate and probabilistic sensitivity analyses were performed to examine the robustness of results. Mean discounted life expectancy and disability-adjusted life expectancy (DALE) were higher under the NCP vs. CCP (28.74 vs. 28.65 years and 27.38 vs. 27.01 respectively). Mean pregnancies and live births per woman were lower under the NCP (9.51 vs. 7.90 and 6.92 vs. 5.79 respectively). Mean lifetime societal costs per woman were lower for the NCP from the societal perspective ($1,949 vs. $1,987) and the MoH perspective ($636 vs. $685). In the incremental analysis, the NCP dominated the CCP, i.e. it was both less costly and more effective. The results were robust to univariate and probabilistic sensitivity analysis. Universal access to modern contraceptives in Uganda appears to be highly cost-effective. Increasing contraceptive coverage should be considered among Uganda's public health priorities.

Impact of demographic change, socioeconomics, and health care resources on life expectancy in Cambodia, Laos, and Myanmar.

PubMed

Chan, Moon Fai; Taylor, Beverly Joan

2013-05-01

Demographic and socioeconomic changes and the availability of health care resources were collected to examine the impacts on life expectancy in Cambodia, Laos, and Myanmar. An ecological design collecting 29 years (1980-2008) data for three Southeast Asian countries. Life expectancy, demographics, socioeconomic status, and health care resources were collected. The structural equation model indicates that more available health care resources and socioeconomic advantages were more likely to increase life expectancy. By contrast, demographic change was more likely to increase life expectancy by way of health care resources. Results show that factors that had direct impacts on life expectancy in all three countries were socioeconomic status and health care resources. Demographic changes had an indirect influence on life expectancy via health care resources. These findings suggest that policymakers should be focusing on how to remove the barriers that impede access to health care services during economic downturns. In addition, how to increase preventive care for the populations that have less access to health care in communities. © 2012 Wiley Periodicals, Inc.

Socioeconomic inequalities in life and health expectancies around official retirement age in 10 Western-European countries.

PubMed

Majer, I M; Nusselder, W J; Mackenbach, J P; Kunst, A E

2011-11-01

Discussions on raising pension eligibility age focus more on improvement in life expectancy (LE) and health expectancy measures than on socioeconomic differences in these measures. Therefore, this study assesses the level of socioeconomic differences in these two measures in Western-Europe. Data from seven annual waves (1995-2001) of the European Community Household Panel were used. Health and socioeconomic information was collected using standardised questionnaires. Health was measured in terms of disability in daily activities. Socioeconomic status was determined as education level at baseline. Multi-state Markov modelling was applied to obtain age-specific transition rates between health states for every country, educational level and gender. The multi-state life table method was used to estimate LE and disability free life expectancy (DFLE) according to country, educational level and gender. When comparing high and low educational levels, differences in partial DFLE between the ages 50 and 65 years were 2.1 years for men and 1.9 years for women. At age 65 years, for LE the difference between high and low educated groups was 3 years for men and 1.9 years for women, and for DFLE the difference between high and low educated groups was 4.6 years for men and 4.4 years for women. Similar patterns were observed in all countries, although inequalities tended to be greater in the southern countries. Educational inequalities, favouring the higher educated, exist on both sides of the retirement eligibility age. Higher educated persons live longer in good health before retirement and can expect to live longer afterwards.

Life expectancy in bipolar disorder.

PubMed

Kessing, Lars Vedel; Vradi, Eleni; Andersen, Per Kragh

2015-08-01

Life expectancy in patients with bipolar disorder has been reported to be decreased by 11 to 20 years. These calculations are based on data for individuals at the age of 15 years. However, this may be misleading for patients with bipolar disorder in general as most patients have a later onset of illness. The aim of the present study was to calculate the remaining life expectancy for patients of different ages with a diagnosis of bipolar disorder. Using nationwide registers of all inpatient and outpatient contacts to all psychiatric hospitals in Denmark from 1970 to 2012 we calculated remaining life expectancies for values of age 15, 25, 35 ⃛ 75 years among all individuals alive in year 2000. For the typical male or female patient aged 25 to 45 years, the remaining life expectancy was decreased by 12.0-8.7 years and 10.6-8.3 years, respectively. The ratio between remaining life expectancy in bipolar disorder and that of the general population decreased with age, indicating that patients with bipolar disorder start losing life-years during early and mid-adulthood. Life expectancy in bipolar disorder is decreased substantially, but less so than previously reported. Patients start losing life-years during early and mid-adulthood. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The effect of smoking on the duration of life with and without disability, Belgium 1997–2011

PubMed Central

2014-01-01

Background Smoking is the single most important health threat yet there is no consistency as to whether non-smokers experience a compression of years lived with disability compared to (ex-)smokers. The objectives of the manuscript are (1) to assess the effect of smoking on the average years lived without disability (Disability Free Life Expectancy (DFLE)) and with disability (Disability Life Expectancy (DLE)) and (2) to estimate the extent to which these effects are due to better survival or reduced disability in never smokers. Methods Data on disability and mortality were provided by the Belgian Health Interview Survey 1997 and 2001 and a 10 years mortality follow-up of the survey participants. Disability was defined as difficulties in activities of daily living (ADL), in mobility, in continence or in sensory (vision, hearing) functions. Poisson and multinomial logistic regression models were fitted to estimate the probabilities of death and the prevalence of disability by age, gender and smoking status adjusted for socioeconomic position. The Sullivan method was used to estimate DFLE and DLE at age 30. The contribution of mortality and of disability to smoking related differences in DFLE and DLE was assessed using decomposition methods. Results Compared to never smokers, ex-smokers have a shorter life expectancy (LE) and DFLE but the number of years lived with disability is somewhat larger. For both sexes, the higher disability prevalence is the main contributing factor to the difference in DFLE and DLE. Smokers have a shorter LE, DFLE and DLE compared to never smokers. Both higher mortality and higher disability prevalence contribute to the difference in DFLE, but mortality is more important among males. Although both male and female smokers experience higher disability prevalence, their higher mortality outweighs their disability disadvantage resulting in a shorter DLE. Conclusion Smoking kills and shortens both life without and life with disability. Smoking related disability can however not be ignored, given its contribution to the excess years with disability especially in younger age groups. PMID:25026981

Urban-rural differences in disability-free life expectancy in Bangladesh using the 2010 HIES data.

PubMed

Islam, Md Shariful; Tareque, Md Ismail; Mondal, Md Nazrul Islam; Fazle Rabbi, Ahbab Mohammad; Khan, Hafiz T A; Begum, Sharifa

2017-01-01

Research on health expectancy has been carried out in Bangladesh but none of it has examined the differences in Disability-Free Life Expectancy (DFLE) between urban and rural setting in context of rapid urbanization of Bangladesh in past decades. The present study aims to estimate DFLE for people of all ages living in urban and rural areas in Bangladesh, and to examine the differences in DFLE between these two areas. Data from the Sample Vital Registration System 2010 and the Bangladesh Household Income and Expenditure Survey (HIES) 2010 were used in this study. The Sullivan method was applied to estimate DFLE in Bangladesh. Higher rates of mortality and disability were observed in rural areas compared to urban areas with few exceptions. Statistically significant differences in DFLE were revealed from birth to age 15 years for both sexes between urban and rural areas. Urban males had a longer life expectancy (LE), longer DFLE and shorter LE with disability both in number and proportion when compared to rural males. Rural females at age 20+ years had a longer LE than urban females but urban females had a longer DFLE and a shorter LE with disability in both number and proportion at all ages than did rural females. This study demonstrates that there were clear inequalities in LE, DFLE and LE with disability between rural and urban areas of Bangladesh along with age-specific differences as well. These findings may serve as useful and benchmark for intervention and policy implications for reducing the gap in health outcomes.

Working Life and Retirement Expectancies at Age 50 by Social Class: Period and Cohort Trends and Projections for Finland.

PubMed

Leinonen, Taina; Martikainen, Pekka; Myrskylä, Mikko

2018-01-11

The balance between the amount of time spent in work and in retirement underlies the long-term sustainability of the social security system. We examined socioeconomic differences in how increasing longevity is distributed between labor market statuses in Finland. We used register data and the Sullivan method to analyze life expectancy at age 50 spent in different labor market statuses over the period 1989-2012 and across cohorts born in 1938-1953. We projected the future mortality and labor market participation rates of partially observed cohorts. Both working life expectancy at age 50 and the share of remaining life spent in work have increased across periods following the recession of the early 1990s, and across successive cohorts. The trends were similar across the social classes, but there were large differences in the numbers of years spent in various states: for the most recent period and the youngest cohort, we find that compared with upper non-manual employees, male and female manual workers were expected to spend 3.6-3.7 fewer years in work, 1.7-4.7 fewer years in statutory retirement, and 3.2-3.9 more years in other forms of nonemployment. Our finding that the share of remaining life at age 50 spent in work is increasing implies that pressure on the welfare system is not as severe as is commonly thought. © The Author(s) 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

49 CFR 639.23 - Calculation of purchase or construction cost.

Code of Federal Regulations, 2010 CFR

2010-10-01

... realistic current market conditions; and (3) Based on the expected useful life of the asset in mass... expected useful life of a revenue vehicle is the useful life which is established by FTA for recipients of..., the applicant is responsible for establishing a reasonable expected useful life. If the recipient does...

Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy

PubMed Central

May, Margaret T.; Gompels, Mark; Delpech, Valerie; Porter, Kholoud; Orkin, Chloe; Kegg, Stephen; Hay, Phillip; Johnson, Margaret; Palfreeman, Adrian; Gilson, Richard; Chadwick, David; Martin, Fabiola; Hill, Teresa; Walsh, John; Post, Frank; Fisher, Martin; Ainsworth, Jonathan; Jose, Sophie; Leen, Clifford; Nelson, Mark; Anderson, Jane; Sabin, Caroline

2014-01-01

Objective: The objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART). Methods: Patients aged more than 20 years who started ART during 2000–2010 (excluding IDU) in HIV clinics contributing to the UK CHIC Study were followed for mortality until 2012. We determined the latest CD4+ cell count and viral load before ART and in each of years 1–5 of ART. For each duration of ART, life tables based on estimated mortality rates by sex, age, latest CD4+ cell count and viral suppression (HIV-1 RNA <400 copies/ml), were used to estimate expected age at death for ages 20–85 years. Results: Of 21 388 patients who started ART, 961 (4.5%) died during 110 697 person-years. At start of ART, expected age at death [95% confidence interval (CI)] of 35-year-old men with CD4+ cell count less than 200, 200–349, at least 350 cells/μl was 71 (68–73), 78 (74–82) and 77 (72–81) years, respectively, compared with 78 years for men in the general UK population. Thirty-five-year-old men who increased their CD4+ cell count in the first year of ART from less than 200 to 200–349 or at least 350 cells/μl and achieved viral suppression gained 7 and 10 years, respectively. After 5 years on ART, expected age at death of 35-year-old men varied from 54 (48–61) (CD4+ cell count <200 cells/μl and no viral suppression) to 80 (76–83) years (CD4+ cell count ≥350 cells/μl and viral suppression). Conclusion: Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4+ cell count significantly improve their life expectancy if they have a good CD4+ cell count response and undetectable viral load. PMID:24556869

How much downside? Quantifying the relative harm from tobacco taxation

PubMed Central

Wilson, N; Thomson, G; Tobias, M; Blakely, T

2004-01-01

Objective: To estimate the loss of life expectancy attributable to tobacco taxation (via financial hardship and flow-on health effect) in New Zealand. Design: Data were used on the gradients in life expectancy and smoking by neighbourhood socioeconomic deprivation and survey data on tobacco expenditure. Three estimates were modelled of the percentage of the crude association of neighbourhood deprivation with life expectancy that might be mediated via financial hardship: 100%, 50%, and 25% (best estimate). From this information the impact of tobacco taxation on life expectancy was estimated. Main results: For the total population, the estimated loss of life expectancy due to tobacco tax ranged from 0.005 years to 0.027 years. For people living in the most deprived 30% of neighbourhoods, the range was 0.009 to 0.044 years (that is, 3 to 16 days of lost life expectancy). For the total population the loss of life expectancy attributable to tobacco tax ranged from 119 to 460 times less than that attributable to deprivation. The loss of life expectancy attributable to tobacco tax was 42 to 257 times less than that attributable to smoking. Conclusions: The estimated harm to life expectancy from tobacco taxation (via financial hardship) is orders of magnitude smaller than the harm from smoking. Although the analyses involve a number of simplistic assumptions, this conclusion is likely to be robust. Policy makers should be reassured that tobacco taxation is likely to be achieving far more benefit than harm in the general population and in socioeconomically deprived populations. PMID:15143110

Mortality pattern and life expectancy of Seventh-Day Adventists in the Netherlands.

PubMed

Berkel, J; de Waard, F

1983-12-01

The mortality pattern of Seventh-Day Adventists (SDAs) in the Netherlands was assessed during a ten-year study period, 1968-1977. Of 522 deceased SDAs the causes of death of 482 could be ascertained. Standardized Mortality Ratios (SMR) for total mortality (SMR = 0,45), cancer (SMR = 0,50) and cardiovascular diseases (SMR = 0,41) as well as for various subgroups differed significantly from the total Dutch population. Mean age at death as well as life-expectation at baptism were significantly higher in SDAs, both in males and females, as compared with Dutch males and females. A health survey among a sample of the total SDA population and a group of 'friend' controls' was done in order to try to explain the differences in mortality pattern and life expectancy. It is concluded that evidence was found for the thesis that abstinence from cigarette smoking is the main factor explaining the low mortality from ischaemic heart diseases among SDAs, while presumably an appropriate (prudent) diet confers additional benefit for example on colon cancer mortality.

Politics and population health: Testing the impact of electoral democracy.

PubMed

Patterson, Andrew C; Veenstra, Gerry

2016-07-01

This study addresses questions of whether and why electoral democracies have better health than other nations. After devising a replicable approach to missing data, we compare political, economic, and health-related data for 168 nations collected annually from 1960 through 2010. Regression models estimate that electoral democracies have 11 years of longer life expectancy on average and 62.5% lower rates of infant mortality. The association with life expectancy reduces markedly after controlling for GDP, while a combination of factors may explain the democratic advantage in infant health. Results suggest that income inequality associates independently with both health outcomes but does not mediate their associations with democracy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Trends in the gap in life expectancy between Arabs and Jews in Israel between 1975 and 2004.

PubMed

Na'amnih, Wasef; Muhsen, Khitam; Tarabeia, Jalal; Saabneh, Ameed; Green, Manfred S

2010-10-01

To examine trends in the Arab-Jew life expectancy gap in Israel during 1975-2004 and to determine the contribution of age groups and causes of death to changes in the gap. Data on life expectancy and mortality rates by cause of death, for Arabs and Jews, were obtained from the Israel Central Bureau of Statistics. Standard life table techniques were used for decomposition analysis to explore the contribution to changes in the life expectancy gap. While life expectancy of Arabs was lower than Jews during 1975-2004, there was a decline in this gap during 1975-98. However, during the following years the gap increased and the difference in 2004 was 3.2 years for men and 4 years for women. During 2000-04, the main causes of death contributing to the gap in life expectancy were chronic diseases, mainly heart disease and diabetes. Heart disease mortality contributed mostly to the overall life expectancy gap for males and females, accounting for 0.89 and 1.17 years, respectively. The age group >65 years contributed most to the gap (1.33 years among males, and 2.42 years among females). Following a period of reduction, the gap in life expectancy at birth between Arabs and Jews in Israel has started to widen. These findings indicate the need for increased attention to primary prevention and disease management in the Arab population. Reducing social and individual risk factors for major causes of death should be a national priority.

Leading Causes of Death Contributing to Decrease in Life Expectancy Gap Between Black and White Populations: United States, 1999-2013.

PubMed

Kochanek, Kenneth D; Anderson, Robert N; Arias, Elizabeth

2015-11-01

Life expectancy at birth has increased steadily since 1900 to a record 78.8 years in 2013. But differences in life expectancy between the white and black populations still exist, despite a decrease in the life expectancy gap from 5.9 years in 1999 to 3.6 years in 2013. Differences in the change over time in the leading causes of death for the black and white populations have contributed to this decrease in the gap in life expectancy. Between 1999 and 2013, the decrease in the life expectancy gap between the black and white populations was mostly due to greater decreases in mortality from heart disease, cancer, HIV disease, unintentional injuries, and perinatal conditions among the black population. Similarly, the decrease in the gap between black and white male life expectancy was due to greater decreases in death rates for HIV disease, cancer, unintentional injuries, heart disease, and perinatal conditions in black males. For black females, greater decreases in diabetes death rates, combined with decreased rates for heart disease and HIV disease, were the major causes contributing to the decrease in the life expectancy gap with white females. The decrease in the gap in life expectancy between the white and black populations would have been larger than 3.6 years if not for increases in death rates for the black population for aortic aneurysm, Alzheimer’s disease, and maternal conditions. For black males, the causes that showed increases in death rates over white males were hypertension, aortic aneurysm, diabetes, Alzheimer’s disease, and kidney disease, while the causes that showed increases in death rates for black females were Alzheimer’s disease, maternal conditions, and atherosclerosis. This NCHS Data Brief is the second in a series of data briefs that explore the causes of death contributing to differences in life expectancy between detailed ethnic and racial populations in the United States. The first data brief focused on the racial differences in life expectancy for a single year, 2010 (3). All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Comparison of Subjective Wellbeing and Positive Future Expectations in Between Working and Nonworking Adolescents in Turkey.

PubMed

Karaca, Semra; Karakoc, Ayse; Bingol, Fadime; Eren, Nurhan; Andsoy, Isil Isik

2016-02-01

Wellbeing is one's evaluation and judgment of one's life. It consists of 3 dimensions: positive affectivity, negative affectivity, and life satisfaction. This study aimed to compare the subjective wellbeing and positive future expectations between working and nonworking adolescents. The study was designed as descriptive and comparative. The study sample consisted of 420 working and 482 nonworking adolescents (n = 902) aged 15 - 20 years, who were randomly recruited from two occupational education centers in Istanbul, Turkey and two high schools (formal educations) in the same district. Adolescent subjective wellbeing scale (ASWS) total mean (SD) scores for working adolescents and nonworking adolescents were 48.76 (9.50) and 49.72 (8.01), respectively. In addition, positive future expectations scale (PFES) total mean (SD) scores for working adolescents and nonworking adolescents were 18.71 (4.50) and 19.06 (3.49), respectively. In this study, no significant difference was found between the general wellbeing (scale total median score) scores of the working and nonworking adolescent groups (Z = 1.01, P = 0.315). However, significant differences were found in the family relations satisfaction (Z = 3.23, P = 0.002) and relations with significant others (Z = 2.85, P = 0.004) subscales of the ASWS. A positive relationship was found between adolescent subjective wellbeing and positive future expectations. It was found that nonworking adolescents scored higher on the dimensions of "family relations" and "relations with significant others" of subjective wellbeing compared to those dimensions in working adolescents.

Life expectancy living with HIV: recent estimates and future implications.

PubMed

Nakagawa, Fumiyo; May, Margaret; Phillips, Andrew

2013-02-01

The life expectancy of people living with HIV has dramatically increased since effective antiretroviral therapy has been available, and still continues to improve. Here, we review the latest literature on estimates of life expectancy and consider the implications for future research. With timely diagnosis, access to a variety of current drugs and good lifelong adherence, people with recently acquired infections can expect to have a life expectancy which is nearly the same as that of HIV-negative individuals. Modelling studies suggest that life expectancy could improve further if there were increased uptake of HIV testing, better antiretroviral regimens and treatment strategies, and the adoption of healthier lifestyles by those living with HIV. In particular, earlier diagnosis is one of the most important factors associated with better life expectancy. A consequence of improved survival is the increasing number of people with HIV who are aged over 50 years old, and further research into the impact of ageing on HIV-positive people will therefore become crucial. The development of age-specific HIV treatment and management guidelines is now called for. Analyses on cohort studies and mathematical modelling studies have been used to estimate life expectancy of those with HIV, providing useful insights of importance to individuals and healthcare planning.

Measuring Burden of Unhealthy Behaviours Using a Multivariable Predictive Approach: Life Expectancy Lost in Canada Attributable to Smoking, Alcohol, Physical Inactivity, and Diet.

PubMed

Manuel, Douglas G; Perez, Richard; Sanmartin, Claudia; Taljaard, Monica; Hennessy, Deirdre; Wilson, Kumanan; Tanuseputro, Peter; Manson, Heather; Bennett, Carol; Tuna, Meltem; Fisher, Stacey; Rosella, Laura C

2016-08-01

Behaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death. A predictive algorithm for 5 y risk of death-the Mortality Population Risk Tool (MPoRT)-was developed and validated using the 2001 to 2008 Canadian Community Health Surveys. There were approximately 1 million person-years of follow-up and 9,900 deaths in the development and validation datasets. After validation, MPoRT was used to predict future mortality and estimate the burden of smoking, alcohol, physical inactivity, and poor diet in the presence of sociodemographic and other risk factors using the 2010 national survey (approximately 90,000 respondents). Canadian period life tables were generated using predicted risk of death from MPoRT. The burden of behavioural risk factors attributable to life expectancy was estimated using hazard ratios from the MPoRT risk model. The MPoRT 5 y mortality risk algorithms were discriminating (C-statistic: males 0.874 [95% CI: 0.867-0.881]; females 0.875 [0.868-0.882]) and well calibrated in all 58 predefined subgroups. Discrimination was maintained or improved in the validation cohorts. For the 2010 Canadian population, unhealthy behaviour attributable life expectancy lost was 6.0 years for both men and women (for men 95% CI: 5.8 to 6.3 for women 5.8 to 6.2). The Canadian life expectancy associated with health behaviour recommendations was 17.9 years (95% CI: 17.7 to 18.1) greater for people with the most favourable risk profile compared to those with the least favourable risk profile (88.2 years versus 70.3 years). Smoking, by itself, was associated with 32% to 39% of the difference in life expectancy across social groups (by education achieved or neighbourhood deprivation). Multivariable predictive algorithms such as MPoRT can be used to assess health burdens for sociodemographic groups or for small changes in population exposure to risks, thereby addressing some limitations of more commonly used measurement approaches. Unhealthy behaviours have a substantial collective burden on the life expectancy of the Canadian population.

Measuring Burden of Unhealthy Behaviours Using a Multivariable Predictive Approach: Life Expectancy Lost in Canada Attributable to Smoking, Alcohol, Physical Inactivity, and Diet

PubMed Central

Perez, Richard; Taljaard, Monica; Hennessy, Deirdre; Wilson, Kumanan; Tanuseputro, Peter; Bennett, Carol; Tuna, Meltem; Fisher, Stacey; Rosella, Laura C.

2016-01-01

Background Behaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death. Methods A predictive algorithm for 5 y risk of death—the Mortality Population Risk Tool (MPoRT)—was developed and validated using the 2001 to 2008 Canadian Community Health Surveys. There were approximately 1 million person-years of follow-up and 9,900 deaths in the development and validation datasets. After validation, MPoRT was used to predict future mortality and estimate the burden of smoking, alcohol, physical inactivity, and poor diet in the presence of sociodemographic and other risk factors using the 2010 national survey (approximately 90,000 respondents). Canadian period life tables were generated using predicted risk of death from MPoRT. The burden of behavioural risk factors attributable to life expectancy was estimated using hazard ratios from the MPoRT risk model. Findings The MPoRT 5 y mortality risk algorithms were discriminating (C-statistic: males 0.874 [95% CI: 0.867–0.881]; females 0.875 [0.868–0.882]) and well calibrated in all 58 predefined subgroups. Discrimination was maintained or improved in the validation cohorts. For the 2010 Canadian population, unhealthy behaviour attributable life expectancy lost was 6.0 years for both men and women (for men 95% CI: 5.8 to 6.3 for women 5.8 to 6.2). The Canadian life expectancy associated with health behaviour recommendations was 17.9 years (95% CI: 17.7 to 18.1) greater for people with the most favourable risk profile compared to those with the least favourable risk profile (88.2 years versus 70.3 years). Smoking, by itself, was associated with 32% to 39% of the difference in life expectancy across social groups (by education achieved or neighbourhood deprivation). Conclusions Multivariable predictive algorithms such as MPoRT can be used to assess health burdens for sociodemographic groups or for small changes in population exposure to risks, thereby addressing some limitations of more commonly used measurement approaches. Unhealthy behaviours have a substantial collective burden on the life expectancy of the Canadian population. PMID:27529741

Life expectancy of modular Ti6Al4V hip implants: influence of stress and environment.

PubMed

Chandra, A; Ryu, J J; Karra, P; Shrotriya, P; Tvergaard, V; Gaisser, M; Weik, T

2011-11-01

Stress dependent electrochemical dissolution is identified as one of the key mechanisms governing surface degradation in fretting and crevice corrosion of biomedical implants. The present study focuses on delineating the roles of mechanical stress and chemical conditions on the life expectancy of modular hip implants. First, material removal on a stressed surface of Ti6Al4V subjected to single asperity contact is investigated experimentally to identify the influence of contact load, in-plane stress and chemical environment on mean wear rates. A range of known stress levels are applied to the specimen while its surface is mechanically stimulated in different non-reactive to oxidizing aqueous environments. Evolution of surface degradation is monitored, and its mechanism is elucidated. This phase allows estimation of Preston Constant which is later used in the analysis. Second phase of the work is semi-analytical and computational, where, based on the estimated Preston constant and other material and process parameters, the scratch propensity (consisting of magnitude of scratch depth and their frequency per unit area) due to micro-motion in modular hip implants is estimated. The third phase views these scratches as initial notches and utilizes a mixed-mode fatigue crack propagation model to estimate the critical crack length for onset of instability. The number of loading cycles needed to reach this critical crack length is then labeled as the expected life of the implant under given mechanical and chemical conditions. Implications of different material and process conditions to life expectancy of orthopedic implants are discussed. It is observed that transverse micro-motion, compared to longitudinal micro-motion, plays a far more critical role in determining the implant life. Patient body weight, as well as proximity of the joint fluid to its iso-electric point play key roles in determining wear rates and associated life expectancies of modular hip implants. Sustained aeration of joint fluid, as well as proper tolerancing of mating surfaces, along with a proper choice of material microstructure may be utilized to extend implant life. Copyright © 2011 Elsevier Ltd. All rights reserved.

Exploring the Presence of a Deaf American Cultural Life Script

ERIC Educational Resources Information Center

Clark, M. Diane; Daggett, Dorri J.

2015-01-01

Cultural life scripts are defined as culturally shared expectations that focus on a series of events that are ordered in time. In these scripts, generalized expectations for what to expect through the life course are outlined. This study examined the possibility of a Deaf American Life Script developed in relationship to the use of a visual…

Estimating increment-decrement life tables with multiple covariates from panel data: the case of active life expectancy.

PubMed

Land, K C; Guralnik, J M; Blazer, D G

1994-05-01

A fundamental limitation of current multistate life table methodology-evident in recent estimates of active life expectancy for the elderly-is the inability to estimate tables from data on small longitudinal panels in the presence of multiple covariates (such as sex, race, and socioeconomic status). This paper presents an approach to such an estimation based on an isomorphism between the structure of the stochastic model underlying a conventional specification of the increment-decrement life table and that of Markov panel regression models for simple state spaces. We argue that Markov panel regression procedures can be used to provide smoothed or graduated group-specific estimates of transition probabilities that are more stable across short age intervals than those computed directly from sample data. We then join these estimates with increment-decrement life table methods to compute group-specific total, active, and dependent life expectancy estimates. To illustrate the methods, we describe an empirical application to the estimation of such life expectancies specific to sex, race, and education (years of school completed) for a longitudinal panel of elderly persons. We find that education extends both total life expectancy and active life expectancy. Education thus may serve as a powerful social protective mechanism delaying the onset of health problems at older ages.

Development of a patient-centred conceptual framework of health-related quality of life in neuromyelitis optica: a qualitative study.

PubMed

Methley, Abigail M; Mutch, Kerry; Moore, Perry; Jacob, Anu

2017-02-01

Neuromyelitis optica (NMO) is an auto-immune disease that can cause severe visual and mobility impairments. Research on health-related quality of life (HRQoL) in NMO is scarce, limiting knowledge on factors influencing HRQoL and support needs. This study provides the first qualitative exploration of HRQoL in NMO, conducted to provide a conceptual framework for the development of an NMO patient-reported outcome measure. Fifteen people with NMO (aged 18-74; 11 women, 4 men) participated in semi-structured interviews; data were analysed using constant comparative analysis. HRQoL in NMO is a multifaceted concept incorporating highly subjective perceptions of normality and meaning. Four major themes were identified: impact of physical symptoms on daily living, utilizing support to achieve independence, expectations for life and meaningful roles in life and purpose. Themes highlighted the importance of perceived normality, and its relationship to attaining life goals comparable to peers, as underpinning evaluations of HRQoL. Many people with severe disability reported a high HRQoL, suggesting the inappropriateness of assuming a negative HRQoL on the basis of an individual's neurological impairment. These findings further the conceptual understanding of HRQoL in NMO, informing patient-care approaches and the development of an NMO-specific patient-reported outcome measure. © 2015 The Authors. Health Expectation published by John Wiley & Sons Ltd.

Okinawa: an exception to the social gradient of life expectancy in Japan.

PubMed

Cockerham, W C; Yamori, Y

2001-01-01

This paper examines why the social gradient of life expectancy does not apply in Japan when Okinawa is considered. The social gradient thesis links differences in longevity to social rank, with people and populations in higher status hierarchical positions having lower mortality and longer life expectancies than those beneath them in the social scale. Japan has been cited as a major example of this thesis in that Japanese life expectancy improved dramatically as Japan rose to the top echelon of nations in economic rank in the late 20th century. Thus it follows that Japan's most affluent and leading prefectures should be the major catalysts behind the nation's rise in life expectancy as well to the number one position in the world. However, this is not the case as life expectancy in Okinawa, Japan's poorest prefecture, exceeds that of Japan as a whole. We find that the social gradient of life expectancy does not apply at the prefectural level and question its validity for geographical areas. We suggest that healthy lifestyles, especially diet and the social support of family and friends, are more important than sense of hierarchy for longevity in Okinawa.

Life Expectancy and Cause of Death in Popular Musicians: Is the Popular Musician Lifestyle the Road to Ruin?

PubMed

Kenny, Dianna T; Asher, Anthony

2016-03-01

Does a combination of lifestyle pressures and personality, as reflected in genre, lead to the early death of popular musicians? We explored overall mortality, cause of death, and changes in patterns of death over time and by music genre membership in popular musicians who died between 1950 and 2014. The death records of 13,195 popular musicians were coded for age and year of death, cause of death, gender, and music genre. Musician death statistics were compared with age-matched deaths in the US population using actuarial methods. Although the common perception is of a glamorous, free-wheeling lifestyle for this occupational group, the figures tell a very different story. Results showed that popular musicians have shortened life expectancy compared with comparable general populations. Results showed excess mortality from violent deaths (suicide, homicide, accidental death, including vehicular deaths and drug overdoses) and liver disease for each age group studied compared with population mortality patterns. These excess deaths were highest for the under-25-year age group and reduced chronologically thereafter. Overall mortality rates were twice as high compared with the population when averaged over the whole age range. Mortality impacts differed by music genre. In particular, excess suicides and liver-related disease were observed in country, metal, and rock musicians; excess homicides were observed in 6 of the 14 genres, in particular hip hop and rap musicians. For accidental death, actual deaths significantly exceeded expected deaths for country, folk, jazz, metal, pop, punk, and rock.

Evaluation of Life Events in Major Depression: Assessing Negative Emotional Bias.

PubMed

Girz, Laura; Driver-Linn, Erin; Miller, Gregory A; Deldin, Patricia J

2017-05-01

Overly negative appraisals of negative life events characterize depression but patterns of emotion bias associated with life events in depression are not well understood. The goal of this paper is to determine under which situations emotional responses are stronger than expected given life events and which emotions are biased. Depressed (n = 16) and non-depressed (n = 14) participants (mean age = 41.4 years) wrote about negative life events involving their own actions and inactions, and rated the current emotion elicited by those events. They also rated emotions elicited by someone else's actions and inactions. These ratings were compared with evaluations provided by a second, 'benchmark' group of non-depressed individuals (n = 20) in order to assess the magnitude and direction of possible biased emotional reactions in the two groups. Participants with depression reported greater anger and disgust than expected in response to both actions and inactions, whereas they reported greater guilt, shame, sadness, responsibility and fear than expected in response to inactions. Relative to non-depressed and benchmark participants, depressed participants were overly negative in the evaluation of their own life events, but not the life events of others. A standardized method for establishing emotional bias reveals a pattern of overly negative emotion only in depressed individuals' self-evaluations, and in particular with respect to anger and disgust, lending support to claims that major depressives' evaluations represent negative emotional bias and to clinical interventions that address this bias. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Long-term effects of tetanus toxoid inoculation on the demography and life expectancy of the Cayo Santiago rhesus macaques.

PubMed

Kessler, Matthew J; Hernández Pacheco, Raisa; Rawlins, Richard G; Ruiz-Lambrides, Angelina; Delgado, Diana L; Sabat, Alberto M

2015-02-01

Tetanus was a major cause of mortality in the free-ranging population of rhesus monkeys on Cayo Santiago prior to 1985 when the entire colony was given its first dose of tetanus toxoid. The immediate reduction in mortality that followed tetanus toxoid inoculation (TTI) has been documented, but the long-term demographic effects of eliminating tetanus infections have not. This study uses the Cayo Santiago demographic database to construct comparative life tables 12 years before, and 12 years after, TTI. Life tables and matrix projection models are used to test for differences in: (i) survival among all individuals as well as among social groups, (ii) long-term fitness of the population, (iii) age distribution, (iv) reproductive value, and (v) life expectancy. A retrospective life table response experiment (LTRE) was performed to determine which life cycle transition contributed most to observed changes in long-term fitness of the population post-TTI. Elimination of clinical tetanus infections through mass inoculation improved the health and well-being of the monkeys. It also profoundly affected the population by increasing survivorship and long-term fitness, decreasing the differences in survival rates among social groups, shifting the population's age distribution towards older individuals, and increasing reproductive value and life expectancy. These findings are significant because they demonstrate the long-term effects of eradicating a major cause of mortality at a single point in time on survival, reproduction, and overall demography of a naturalistic population of primates. © 2014 Wiley Periodicals, Inc.

An economic analysis of life expectancy by gender with application to the United States.

PubMed

Leung, Michael C M; Zhang, Jie; Zhang, Junsen

2004-07-01

This paper presents an economic model to explain the behavior of life expectancy of both sexes. It explicitly examines the relationship between the gender gap in life expectancy and the gender gap in pay. It shows that as the latter narrows over the course of economic development, the former may initially expand but will eventually shrink. Simulation results from our model accord with the behavior of life expectancy for both sexes since the 1940s in the United States.

Adult Mortality Attributable to Preventable Risk Factors for Non-Communicable Diseases and Injuries in Japan: A Comparative Risk Assessment

PubMed Central

Ikeda, Nayu; Inoue, Manami; Iso, Hiroyasu; Ikeda, Shunya; Satoh, Toshihiko; Noda, Mitsuhiko; Mizoue, Tetsuya; Imano, Hironori; Saito, Eiko; Katanoda, Kota; Sobue, Tomotaka; Tsugane, Shoichiro; Naghavi, Mohsen; Ezzati, Majid; Shibuya, Kenji

2012-01-01

Background The population of Japan has achieved the longest life expectancy in the world. To further improve population health, consistent and comparative evidence on mortality attributable to preventable risk factors is necessary for setting priorities for health policies and programs. Although several past studies have quantified the impact of individual risk factors in Japan, to our knowledge no study has assessed and compared the effects of multiple modifiable risk factors for non-communicable diseases and injuries using a standard framework. We estimated the effects of 16 risk factors on cause-specific deaths and life expectancy in Japan. Methods and Findings We obtained data on risk factor exposures from the National Health and Nutrition Survey and epidemiological studies, data on the number of cause-specific deaths from vital records adjusted for ill-defined codes, and data on relative risks from epidemiological studies and meta-analyses. We applied a comparative risk assessment framework to estimate effects of excess risks on deaths and life expectancy at age 40 y. In 2007, tobacco smoking and high blood pressure accounted for 129,000 deaths (95% CI: 115,000–154,000) and 104,000 deaths (95% CI: 86,000–119,000), respectively, followed by physical inactivity (52,000 deaths, 95% CI: 47,000–58,000), high blood glucose (34,000 deaths, 95% CI: 26,000–43,000), high dietary salt intake (34,000 deaths, 95% CI: 27,000–39,000), and alcohol use (31,000 deaths, 95% CI: 28,000–35,000). In recent decades, cancer mortality attributable to tobacco smoking has increased in the elderly, while stroke mortality attributable to high blood pressure has declined. Life expectancy at age 40 y in 2007 would have been extended by 1.4 y for both sexes (men, 95% CI: 1.3–1.6; women, 95% CI: 1.2–1.7) if exposures to multiple cardiovascular risk factors had been reduced to their optimal levels as determined by a theoretical-minimum-risk exposure distribution. Conclusions Tobacco smoking and high blood pressure are the two major risk factors for adult mortality from non-communicable diseases and injuries in Japan. There is a large potential population health gain if multiple risk factors are jointly controlled. Please see later in the article for the Editors' Summary PMID:22291576

The effect of life expectancy on aggression and generativity: a life history perspective.

PubMed

Dunkel, Curtis S; Mathes, Eugene; Papini, Dennis R

2010-09-23

Following a model that is inclusive of both dispositional and situational influences on life-history behaviors and attitudes, the effect of life expectancies on aggression and generativity was examined. Consistent with the hypotheses it was found that shorter life expectancies led to an increase in the desire to aggress and a decrease in the desire to engage in generative behaviors. The results are discussed in terms of how life history theory can be used to frame research on person-situation interactions.

Bring out your dead!: A study of income inequality and life expectancy in the United States, 2000-2010.

PubMed

Hill, Terrence D; Jorgenson, Andrew

2018-01-01

We test whether income inequality undermines female and male life expectancy in the United States. We employ data for all 50 states and the District of Columbia and two-way fixed effects to model state-level average life expectancy as a function of multiple income inequality measures and time-varying characteristics. We find that state-level income inequality is inversely associated with female and male life expectancy. We observe this general pattern across four measures of income inequality and under the rigorous conditions of state-specific and year-specific fixed effects. If income inequality undermines life expectancy, redistribution policies could actually improve the health of states. Copyright © 2017 Elsevier Ltd. All rights reserved.

Single Older Women Who Applied for the Giving Life More Lustre Course: Are They the Target Group that Was Aimed for?

ERIC Educational Resources Information Center

Kremers, Ismay P.; Steverink, Nardi; Albersnagel, Frans A.; Slaets, Joris P. J.

2007-01-01

The present study investigated whether the women who applied for the self-management of well-being course Giving life more LUSTRE can be considered the target group that was intended. By comparing the course applicants with a random sample of community dwelling single women, it was found that, as expected, course applicants scored worse on…

Modelling the costs and consequences of treating paediatric faecal impaction in Australia.

PubMed

Guest, Julian F; Clegg, John P

2006-01-01

To compare the costs and consequences of using oral macrogol 3350 plus electrolytes (macrogol 3350; Movicol) compared to enemas/suppositories, manual evacuation and naso-gastric administration of macrogol (NGA-PEG) lavage solution in treating paediatric faecal impaction in Australia. A decision model was constructed using published clinical outcomes, utilities and clinician-derived resource utilisation estimates. The model was used to determine the expected Commonwealth and parent costs associated with each treatment over the period of disimpaction and 12 weeks post-disimpaction, in Australian dollars at 2003/2004 prices. 92% of oral macrogol 3350-treated patients are expected to be disimpacted within 6 days following initial treatment, compared with 79% of patients treated with enemas and suppositories who are expected to be disimpacted within 8 days. All patients are expected to be disimpacted within 5 days following a manual evacuation and within 2 days following NGA-PEG. The level of health gain at 12 weeks post-disimpaction irrespective of treatment for disimpaction and subsequent maintenance is expected to be the same; the expected quality-adjusted life years (QALYs) being 0.20 (95% CI: 0.17; 0.23). Starting treatment with oral macrogol 3350 in an outpatient setting is expected to lead to a Commonwealth cost of $758, compared to $1838 with NGA-PEG, $2125 with enemas and suppositories, $3931 with oral macrogol 3350 in an inpatient setting and $4478 with manual evacuation. Resource use associated with maintenance following initial disimpaction is expected to be broadly similar, irrespective of initial laxative. Hence, the expected Commonwealth cost is primarily affected by the treatment used to initially disimpact a patient. Expected parents' costs are expected to be comparable irrespective of treatment ranging from $89 to $112 per patient. Within the limitations of our model, using oral macrogol 3350 in an outpatient setting for treating faecally impacted children affords a cost effective alternative compared to the other treatments investigated.

Population Well-Being Measures Help Explain Geographic Disparities In Life Expectancy At The County Level

PubMed Central

Arora, Anita; Spatz, Erica; Herrin, Jeph; Riley, Carley; Roy, Brita; Kell, Kenneth; Coberley, Carter; Rula, Elizabeth; Krumholz, Harlan M.

2016-01-01

Geographic disparities in life expectancy are substantial and not fully explained by differences in race and socioeconomic status. To develop policies that address these inequalities, it is essential to identify other factors that account for this variation. In this study we investigated whether population well-being—a comprehensive measure of physical, mental, and social health—helps explain geographic variation in life expectancy. At the county level, we found that for every 1-standarddeviation (4.2-point) increase in the well-being score, life expectancy was 1.9 years higher for females and 2.6 years higher for males. Life expectancy and well-being remained positively associated, even after race, poverty, and education were controlled for. In addition, well-being partially mediated the established associations of race, poverty, and education with life expectancy. These findings highlight well-being as an important metric of a population’s health and longevity and as a promising focus for intervention. PMID:27834249

Parenting responsibility expectations of senior Australian dental students: do the next generations' family responsibilities impact workforce planning?

PubMed

Alsharif, Ala'a; Kruger, Estie; Tennant, Marc

2012-10-01

Over the past twenty-five years, there has been a substantial increase in work-based demands, thought to be due to an intensifying, competitive work environment. However, more recently, the question of work-life balance is increasingly attracting attention. The purpose of this study was to discover the attitudes of the next generation of dentists in Australia to parenting responsibility and work-life balance perceptions. Questionnaires on work-life balance were distributed to all fourth-year students at three dental schools in Australia. A total of 137 (76 percent) surveys were completed and returned. Most respondents indicated that they would take time off to focus on childcare, and just over half thought childcare should be shared by both parents. Thirty-seven percent felt that a child would have a considerable effect on their careers. Differences were seen in responses when compared by gender. The application of sensitivity analysis to workforce calculations based around changing societal work-life expectations can have substantial effects on predicting workforce data a decade into the future. It is not just the demographic change to a more feminized workforce in Australia that can have substantial effect, but also the change in social expectations of males in regards to parenting.

Longevity in Slovenia: Past and potential gains in life expectancy by age and causes of death.

PubMed

Lotrič Dolinar, Aleša; Došenović Bonča, Petra; Sambt, Jože

2017-06-01

In Slovenia, longevity is increasing rapidly. From 1997 to 2014, life expectancy at birth increased by 7 and 5 years for men and women, respectively. This paper explores how this gain in life expectancy at birth can be attributed to reduced mortality from five major groups of causes of death by 5-year age groups. It also estimates potential future gains in life expectancy at birth. The importance of the five major causes of death was analysed by cause-elimination life tables. The total elimination of individual causes of death and a partial hypothetical adjustment of mortality to Spanish levels were analysed, along with age and cause decomposition (Pollard). During the 1997-2014 period, the increase in life expectancy at birth was due to lower mortality from circulatory diseases (ages above 60, both genders), as well as from lower mortality from neoplasms (ages above 50 years) and external causes (between 20 and 50 years) for men. However, considering the potential future gains in life expectancy at birth, by far the strongest effect can be attributed to lower mortality due to circulatory diseases for both genders. If Spanish mortality rates were reached, life expectancy at birth would increase by more than 2 years, again mainly because of lower mortality from circulatory diseases in very old ages. Life expectancy analyses can improve evidence-based decision-making and allocation of resources among different prevention programmes and measures for more effective disease management that can also reduce the economic burden of chronic diseases.

Power-Efficient, High-Current-Density, Long-Life Thermionic Cathode Developed for Microwave Amplifier Applications

NASA Technical Reports Server (NTRS)

Wintucky, Edwin G.

2002-01-01

A power-efficient, miniature, easily manufactured, reservoir-type barium-dispenser thermionic cathode has been developed that offers the significant advantages of simultaneous high electron-emission current density (>2 A/sq cm) and very long life (>100,000 hr of continuous operation) when compared with the commonly used impregnated-type barium-dispenser cathodes. Important applications of this cathode are a wide variety of microwave and millimeter-wave vacuum electronic devices, where high output power and reliability (long life) are essential. We also expect it to enable the practical development of higher purveyance electron guns for lower voltage and more reliable device operation. The low cathode heater power and reduced size and mass are expected to be particularly beneficial in traveling-wave-tube amplifiers (TWTA's) for space communications, where future NASA mission requirements include smaller onboard spacecraft systems, higher data transmission rates (high frequency and output power) and greater electrical efficiency.

COMPARISON OF RANDOM AND SYSTEMATIC SITE SELECTION FOR ASSESSING ATTAINMENT OF AQUATIC LIFE USES IN SEGMENTS OF THE OHIO RIVER

EPA Science Inventory

This report is a description of field work and data analysis results comparing a design comparable to systematic site selection with one based on random selection of sites. The report is expected to validate the use of random site selection in the bioassessment program for the O...

Sex and life expectancy.

PubMed

Seifarth, Joshua E; McGowan, Cheri L; Milne, Kevin J

2012-12-01

A sexual dimorphism in human life expectancy has existed in almost every country for as long as records have been kept. Although human life expectancy has increased each year, females still live longer, on average, than males. Undoubtedly, the reasons for the sex gap in life expectancy are multifaceted, and it has been discussed from both sociological and biological perspectives. However, even if biological factors make up only a small percentage of the determinants of the sex difference in this phenomenon, parity in average life expectancy should not be anticipated. The aim of this review is to highlight biological mechanisms that may underlie the sexual dimorphism in life expectancy. Using PubMed, ISI Web of Knowledge, and Google Scholar, as well as cited and citing reference histories of articles through August 2012, English-language articles were identified, read, and synthesized into categories that could account for biological sex differences in human life expectancy. The examination of biological mechanisms accounting for the female-based advantage in human life expectancy has been an active area of inquiry; however, it is still difficult to prove the relative importance of any 1 factor. Nonetheless, biological differences between the sexes do exist and include differences in genetic and physiological factors such as progressive skewing of X chromosome inactivation, telomere attrition, mitochondrial inheritance, hormonal and cellular responses to stress, immune function, and metabolic substrate handling among others. These factors may account for at least a part of the female advantage in human life expectancy. Despite noted gaps in sex equality, higher body fat percentages and lower physical activity levels globally at all ages, a sex-based gap in life expectancy exists in nearly every country for which data exist. There are several biological mechanisms that may contribute to explaining why females live longer than men on average, but the complexity of the human life experience makes research examining the contribution of any single factor for the female advantage difficult. However, this information may still prove important to the development of strategies for healthy aging in both sexes. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Developmental changes and gender effects on motivational constructs based on the expectancy-value model in Czech and United States students regarding learning of science, mathematics, and other subjects

NASA Astrophysics Data System (ADS)

Yang, Eun-Mi

This study employed American and Czech student samples to investigate the motivational constructs used in Eccles and Wigfield's (1983) expectancy-value model. To predict achievement behavior, the model specifies relationships among expectancy for-success and task value, task-specific self-concept, perception of task-difficulty, perceptions of social environment, and interpretations and attributions for past events in relation to the social world. Czech and American students (n = 1,145) in grades 4--12 were the participants in this study. The causal relationships among the constructs were tested to investigate structural similarities and differences in the models for both countries. This study also explored developmental changes, gender, and national differences in the students' motivational beliefs for these motivational constructs: Expectancy for Success, Intrinsic Interest Value, Task-specific Self-concept, Perception of Task-difficulty, and Perceived Vocational Gender Dominance for science, mathematics, and other school subjects. The findings indicated that, for both countries, with respect to changes over grade level, compared to the younger students, the older students showed lower motivational beliefs for most subject areas except reading. However, the Czech students in grades 6--8 showed more positive motivational beliefs in life science and social studies than did the Czech students in other grade levels. In comparing genders, the male students exhibited more positive motivational beliefs in physical science than did the female students, and female students showed more positive motivational beliefs in reading than did the male students. For life science, the Czech female students rated Intrinsic Interest Value and Task-specific Self-concept higher than did their peer male students. The American students' motivational beliefs in reading were more positive than were Czech students', and the Czech students held more positive motivational beliefs in life science than did the American students. With minor variations for each country, the expectancy-value model provided a reasonable tool for understanding the causal relationships among the motivational beliefs. For the Czech sample, Perception of Task-difficulty was a strong negative predictor for Expectancy for Success for most school subjects except life science whereas, for the American sample, it was a weak but significant negative predictor for Intrinsic Interest Value for most school subjects except social studies. Implications for science education are discussed.

Life expectancy and life expectancy with disability of normal weight, overweight, and obese smokers and nonsmokers in Europe.

PubMed

Majer, Istvan M; Nusselder, Wilma J; Mackenbach, Johan P; Kunst, Anton E

2011-07-01

The goal of this study was to estimate life expectancy (LE) and LE with disability (LwD) among normal weight, overweight, and obese smokers and nonsmokers in Western Europe. Data from four waves (1998-2001) of the European Community Household Panel (ECHP) were used; a standardized multipurpose annual longitudinal survey. Self-reported health and socioeconomic information was collected repeatedly using uniform questionnaires for 66,331 individuals in nine countries. Health status was measured in terms of disability in daily activities. Multistate Markov (MSM) models were applied to obtain hazard ratios (HRs) and age-specific transition rates according to BMI and smoking status. Multistate life tables were computed using the predicted transition probabilities to estimate LE and LwD. Significant associations were observed between disability incidence and BMI (HR = 1.15 for overweight, HR = 1.64 for obese, compared to normal weight). The risk of mortality was negatively associated with overweight status among disabled (HR = 0.77). Overweight people had higher LE than people with normal-weight and obesity. Among women, overweight and obese nonsmokers expect 3.6 and 6.1 more years of LwD than normal weight persons, respectively. In contrast, daily smokers expect lower LE but a similar LwD. The same patterns were observed among people with high education and those with low education. To conclude, daily smoking is associated with mortality more than with disability, whereas obesity is associated with disability more than with mortality. The findings suggest that further tobacco control would contribute to increasing LE, while tackling the obesity epidemic is necessary to prevent an expansion of disability.

5 CFR 1650.13 - Monthly payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... monthly payment amount calculated based on life expectancy. Payments based on life expectancy are determined using the factors set forth in the Internal Revenue Service life expectancy tables codified at 26... in one of the following manners: (1) A specific dollar amount. The amount elected must be at least...

5 CFR 1650.13 - Monthly payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... monthly payment amount calculated based on life expectancy. Payments based on life expectancy are determined using the factors set forth in the Internal Revenue Service life expectancy tables codified at 26... in one of the following manners: (1) A specific dollar amount. The amount elected must be at least...

The ethics of life expectancy.

PubMed

Small, Robin

2002-08-01

Some ethical dilemmas in health care, such as over the use of age as a criterion of patient selection, appeal to the notion of life expectancy. However, some features of this concept have not been discussed. Here I look in turn at two aspects: one positive--our expectation of further life--and the other negative--the loss of potential life brought about by death. The most common method of determining this loss, by counting only the period of time between death and some particular age, implies that those who die at ages not far from that one are regarded as losing very little potential life, while those who die at greater ages are regarded as losing none at all. This approach has methodological advantages but ethical disadvantages, in that it fails to correspond to our strong belief that anyone who dies is losing some period of life that he or she would otherwise have had. The normative role of life expectancy expressed in the 'fair innings' attitude arises from a particular historical situation: not the increase of life expectancy in modern societies, but a related narrowing in the distribution of projected life spans. Since life expectancy is really a representation of existing patterns of mortality, which in turn are determined by many influences, including the present allocation of health resources, it should not be taken as a prediction, and still less as a statement of entitlement.

Patients with Testicular Cancer Undergoing CT Surveillance Demonstrate a Pitfall of Radiation-induced Cancer Risk Estimates: The Timing Paradox

PubMed Central

Eisenberg, Jonathan D.; Lee, Richard J.; Gilmore, Michael E.; Turan, Ekin A.; Singh, Sarabjeet; Kalra, Mannudeep K.; Liu, Bob; Kong, Chung Yin; Gazelle, G. Scott

2013-01-01

Purpose: To demonstrate a limitation of lifetime radiation-induced cancer risk metrics in the setting of testicular cancer surveillance—in particular, their failure to capture the delayed timing of radiation-induced cancers over the course of a patient’s lifetime. Materials and Methods: Institutional review board approval was obtained for the use of computed tomographic (CT) dosimetry data in this study. Informed consent was waived. This study was HIPAA compliant. A Markov model was developed to project outcomes in patients with testicular cancer who were undergoing CT surveillance in the decade after orchiectomy. To quantify effects of early versus delayed risks, life expectancy losses and lifetime mortality risks due to testicular cancer were compared with life expectancy losses and lifetime mortality risks due to radiation-induced cancers from CT. Projections of life expectancy loss, unlike lifetime risk estimates, account for the timing of risks over the course of a lifetime, which enabled evaluation of the described limitation of lifetime risk estimates. Markov chain Monte Carlo methods were used to estimate the uncertainty of the results. Results: As an example of evidence yielded, 33-year-old men with stage I seminoma who were undergoing CT surveillance were projected to incur a slightly higher lifetime mortality risk from testicular cancer (598 per 100 000; 95% uncertainty interval [UI]: 302, 894) than from radiation-induced cancers (505 per 100 000; 95% UI: 280, 730). However, life expectancy loss attributable to testicular cancer (83 days; 95% UI: 42, 124) was more than three times greater than life expectancy loss attributable to radiation-induced cancers (24 days; 95% UI: 13, 35). Trends were consistent across modeled scenarios. Conclusion: Lifetime radiation risk estimates, when used for decision making, may overemphasize radiation-induced cancer risks relative to short-term health risks. © RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121015/-/DC1 PMID:23249573

Structured settlement annuities, part 2: mortality experience 1967--95 and the estimation of life expectancy in the presence of excess mortality.

PubMed

Singer, R B; Schmidt, C J

2000-01-01

the mortality experience for structured settlement (SS) annuitants issued both standard (Std) and substandard (SStd) has been reported twice previously by the Society of Actuaries (SOA), but the 1995 mortality described here has not previously been published. We describe in detail the 1995 SS mortality, and we also discuss the methodology of calculating life expectancy (e), contrasting three different life-table models. With SOA permission, we present in four tables the unpublished results of its 1995 SS mortality experience by Std and SStd issue, sex, and a combination of 8 age and 6 duration groups. Overall results on mortality expected from the 1983a Individual Annuity Table showed a mortality ratio (MR) of about 140% for Std cases and about 650% for all SStd cases. Life expectancy in a group with excess mortality may be computed by either adding the decimal excess death rate (EDR) to q' for each year of attained age to age 109 or multiplying q' by the decimal MR for each year to age 109. An example is given for men age 60 with localized prostate cancer; annual EDRs from a large published cancer study are used at duration 0-24 years, and the last EDR is assumed constant to age 109. This value of e is compared with e from constant initial values of EDR or MR after the first year. Interrelations of age, sex, e, and EDR and MR are discussed and illustrated with tabular data. It is shown that a constant MR for life-table calculation of e consistently overestimates projected annual mortality at older attained ages and underestimates e. The EDR method, approved for reserve calculations, is also recommended for use in underwriting conversion tables.

Life expectancy in a birth cohort of Boxers followed up from weaning to 10 years of age.

PubMed

van Hagen, Marjan A E; Ducro, Bart J; van den Broek, Jan; Knol, Bart W

2005-09-01

To determine mortality rate over time, risk factors for death, and heritability of life expectancy in Boxers. 1,733 purebred Boxers born in The Netherlands between January 1994 and March 1995. Dogs were followed up from weaning (ie, 49 days of age) to 10 years of age through use of a written questionnaire sent to owners every 6 months. Mortality rate over time, risk factors potentially associated with death, and heritability of life expectancy were examined by use of a proportional hazards model based on the Weibull distribution. stimated mortality rate during the 10-year study period for this birth cohort of Boxers was 45%. The probability of surviving to 5 years of age was 88%; the probability of surviving to 10 years of age was 55%. Estimated effective heritability of life expectancy was 0.076, meaning that in this population, an estimated 76% of the observed variation in life expectancy could be attributed to genetic differences among dogs that were passed from parents to their offspring. Results suggest that cumulative incidence of death from weaning to 10 years of age among this birth cohort of Boxers was 45%. The estimated heritability of life expectancy suggested that life expectancy can be improved by use of selective breeding.

[Income inequality, corruption, and life expectancy at birth in Mexico].

PubMed

Idrovo, Alvaro Javier

2005-01-01

To ascertain if the effect of income inequality on life expectancy at birth in Mexico is mediated by corruption, used as a proxy of social capital. An ecological study was carried out with the 32 Mexican federative entities. Global and by sex correlations between life expectancy at birth were estimated by federative entity with the Gini coefficient, the Corruption and Good Government Index, the percentage of Catholics, and the percentage of the population speaking indigenous language. Robust linear regressions, with and without instrumental variables, were used to explore if corruption acts as intermediate variable in the studied relationship. Negative correlations with Spearman's rho near to -0.60 (p < 0.05) and greater than -0.66 (p < 0.05) between life expectancy at birth, the Gini coefficient and the population speaking indigenous language, respectively, were observed. Moreover, the Corruption and Good Government Index correlated with men's life expectancy at birth with Spearman's rho -0.3592 (p < 0.05). Regressions with instruments were more consistent than conventional ones and they show a strong negative effect (p < 0.05) of income inequality on life expectancy at birth. This effect was greater among men. The findings suggest a negative effect of income inequality on life expectancy at birth in Mexico, mediated by corruption levels and other related cultural factors.

A cost-effectiveness analysis of combination antiplatelet therapy for high-risk acute coronary syndromes: clopidogrel plus aspirin versus aspirin alone.

PubMed

Schleinitz, Mark D; Heidenreich, Paul A

2005-02-15

Although clopidogrel plus aspirin is more effective than aspirin alone in preventing subsequent vascular events in patients with unstable angina, the cost-effectiveness of this combination has yet to be examined in this high-risk population. To determine the cost-effectiveness of clopidogrel plus aspirin compared with aspirin alone. Cost-utility analysis. Published literature. Patients with unstable angina and electrocardiographic changes or non-Q-wave myocardial infarction. time horizon: Lifetime. Societal. Combination therapy with clopidogrel, 75 mg/d, plus aspirin, 325 mg/d, for 1 year, followed by aspirin monotherapy, was compared with lifelong aspirin therapy, 325 mg/d. Lifetime costs, life expectancy in quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio. Patients treated with aspirin alone lived 9.51 QALYs after their initial event and incurred expenses of 127,700 dollars; the addition of clopidogrel increased life expectancy to 9.61 QALYs and costs to 129,300 dollars. The incremental cost-effectiveness ratio for clopidogrel plus aspirin compared with aspirin alone was 15,400 dollars per QALY. The analysis of 1 year of therapy was robust to all sensitivity analyses. In the probabilistic sensitivity analysis, fewer than 3% of simulations resulted in cost-effectiveness ratios over 50,000 dollars per QALY. The cost-effectiveness of longer combination therapy depends critically on the balance of thrombotic event rates, durable efficacy, and the increased bleeding rate in patients taking clopidogrel. This analysis may not apply to patients with severe heart failure, those undergoing long-term anticoagulant therapy, those recently managed with revascularization, or those undergoing short-term treatment with glycoprotein IIb/IIIa inhibitors. In patients with high-risk acute coronary syndromes, 1 year of therapy with clopidogrel plus aspirin results in greater life expectancy than aspirin alone, at a cost within the traditional limits of cost-effectiveness. The durable efficacy of clopidogrel relative to the risk for hemorrhage should be further explored before more protracted therapy can be recommended.

Describing the population health burden of depression: health-adjusted life expectancy by depression status in Canada.

PubMed

Steensma, C; Loukine, L; Orpana, H; McRae, L; Vachon, J; Mo, F; Boileau-Falardeau, M; Reid, C; Choi, B C

2016-10-01

Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL) on the overall population. Health-adjusted life expectancy (HALE) is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population. We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS) participants 20 years and older (n = 12 373) were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007-2009). The Canadian Community Health Survey (2009/10) provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex. For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2-43.8) compared to 57.0 years (95% CI: 56.8-57.2) for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5-41.5) for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6-54.0) for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The 14.8 fewer years of HALE observed for men with depression equated to a 13.0-year HRQOL gap and a 1.8-year mortality gap. The population of adult men and women with depression in Canada had substantially lower healthy life expectancy than those without depression. Much of this gap is explained by lower levels of HRQOL, but premature mortality also plays a role.

Cumulative Childhood Adversity, Educational Attainment, and Active Life Expectancy Among U.S. Adults

PubMed Central

Montez, Jennifer Karas; Hayward, Mark D.

2015-01-01

Studies of the early-life origins of adult physical functioning and mortality have found that childhood health and socioeconomic context are important predictors, often irrespective of adult experiences. However, these studies have generally assessed functioning and mortality as distinct processes and used cross-sectional prevalence estimates that neglect the interplay of disability incidence, recovery, and mortality. Here, we examine whether early-life disadvantages both shorten lives and increase the number and fraction of years lived with functional impairment. We also examine the degree to which educational attainment mediates and moderates the health consequences of early-life disadvantages. Using the 1998–2008 Health and Retirement Study, we examine these questions for non-Hispanic whites and blacks aged 50–100 years using multistate life tables. Within levels of educational attainment, adults from disadvantaged childhoods lived fewer total and active years, and spent a greater portion of life impaired compared with adults from advantaged childhoods. Higher levels of education did not ameliorate the health consequences of disadvantaged childhoods. However, because education had a larger impact on health than did childhood socioeconomic context, adults from disadvantaged childhoods who achieved high education levels often had total and active life expectancies that were similar to or better than those of adults from advantaged childhoods who achieved low education levels. PMID:24281740

Potential health gains and health losses in eleven EU countries attainable through feasible prevalences of the life-style related risk factors alcohol, BMI, and smoking: a quantitative health impact assessment.

PubMed

Lhachimi, Stefan K; Nusselder, Wilma J; Smit, Henriette A; Baili, Paolo; Bennett, Kathleen; Fernández, Esteve; Kulik, Margarete C; Lobstein, Tim; Pomerleau, Joceline; Boshuizen, Hendriek C; Mackenbach, Johan P

2016-08-05

Influencing the life-style risk-factors alcohol, body mass index (BMI), and smoking is an European Union (EU) wide objective of public health policy. The population-level health effects of these risk-factors depend on population specific characteristics and are difficult to quantify without dynamic population health models. For eleven countries-approx. 80 % of the EU-27 population-we used evidence from the publicly available DYNAMO-HIA data-set. For each country the age- and sex-specific risk-factor prevalence and the incidence, prevalence, and excess mortality of nine chronic diseases are utilized; including the corresponding relative risks linking risk-factor exposure causally to disease incidence and all-cause mortality. Applying the DYNAMO-HIA tool, we dynamically project the country-wise potential health gains and losses using feasible, i.e. observed elsewhere, risk-factor prevalence rates as benchmarks. The effects of the "worst practice", "best practice", and the currently observed risk-factor prevalence on population health are quantified and expected changes in life expectancy, morbidity-free life years, disease cases, and cumulative mortality are reported. Applying the best practice smoking prevalence yields the largest gains in life expectancy with 0.4 years for males and 0.3 year for females (approx. 332,950 and 274,200 deaths postponed, respectively) while the worst practice smoking prevalence also leads to the largest losses with 0.7 years for males and 0.9 year for females (approx. 609,400 and 710,550 lives lost, respectively). Comparing morbidity-free life years, the best practice smoking prevalence shows the highest gains for males with 0.4 years (342,800 less disease cases), whereas for females the best practice BMI prevalence yields the largest gains with 0.7 years (1,075,200 less disease cases). Smoking is still the risk-factor with the largest potential health gains. BMI, however, has comparatively large effects on morbidity. Future research should aim to improve knowledge of how policies can influence and shape individual and aggregated life-style-related risk-factor behavior.

Reconceptualizing Agency within the Life Course: The Power of Looking Ahead1

PubMed Central

Hitlin, Steven; Johnson, Monica Kirkpatrick

2015-01-01

Empirical treatments of agency have not caught up with theoretical explication; empirical projects almost always focus on concurrent beliefs about one’s ability to act successfully without sufficiently attending to temporality. We suggest that understanding the modern life course necessitates a multidimensional understanding of subjective agency involving a) perceived capacities and b) perceived life-chances, or expectations about what life holds in store. We also suggest that a proper understanding of agency’s potential power within a life course necessitates moving beyond the domain-specific expectations more typical of past sociological work. Utilizing the Youth Development Study (YDS), we employ a scale of general life expectations in adolescence to explore the potential influence of a general sense of optimistic life-expectations in addition to the traditional agency-as-efficacy approach on a range of important outcomes. PMID:26166833

Cost-effectiveness of apixaban vs warfarin for secondary stroke prevention in atrial fibrillation

PubMed Central

Easton, J. Donald; Johnston, S. Claiborne; Kim, Anthony S.

2012-01-01

Objective: To compare the cost-effectiveness of apixaban vs warfarin for secondary stroke prevention in patients with atrial fibrillation (AF). Methods: Using standard methods, we created a Markov decision model based on the estimated cost of apixaban and data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial and other trials of warfarin therapy for AF. We quantified the cost and quality-adjusted life expectancy resulting from apixaban 5 mg twice daily compared with those from warfarin therapy targeted to an international normalized ratio of 2–3. Our base case population was a cohort of 70-year-old patients with no contraindication to anticoagulation and a history of stroke or TIA from nonvalvular AF. Results: Warfarin therapy resulted in a quality-adjusted life expectancy of 3.91 years at a cost of $378,500. In comparison, treatment with apixaban led to a quality-adjusted life expectancy of 4.19 years at a cost of $381,700. Therefore, apixaban provided a gain of 0.28 quality-adjusted life-years (QALYs) at an additional cost of $3,200, resulting in an incremental cost-effectiveness ratio of $11,400 per QALY. Our findings were robust in univariate sensitivity analyses varying model inputs across plausible ranges. In Monte Carlo analysis, apixaban was cost-effective in 62% of simulations using a threshold of $50,000 per QALY and 81% of simulations using a threshold of $100,000 per QALY. Conclusions: Apixaban appears to be cost-effective relative to warfarin for secondary stroke prevention in patients with AF, assuming that it is introduced at a price similar to that of dabigatran. PMID:22993279

Early hospital discharge of infants born to group B streptococci-positive mothers: a decision analysis.

PubMed

Berger, M B; Xu, X; Williams, J A; Van de Ven, C J M; Mozurkewich, E L

2012-03-01

To compare the cost-effectiveness of an additional 24-hour inpatient observation for asymptomatic term neonates born to group B streptococcus (GBS)-colonised mothers with adequate intrapartum antibiotic prophylaxis (IAP) after an initial 24-hour in-hospital observation. Cost-effectiveness analysis from a societal perspective. United States. Asymptomatic term neonates born to GBS-colonised mothers with IAP after an initial 24-hour in-hospital observation. Monte Carlo simulation for a decision tree model incorporating the following chance events: development of GBS sepsis during the second 24 hours of life, development of GBS sepsis between 48 hours and 7 days of life, prompt versus delayed treatment for sepsis, neonatal mortality and long-term health sequelae. Expected cost and quality-adjusted life years (QALYs), Incremental cost-effectiveness ratio (ICER). Delayed, versus early, hospital discharge results in similar mean expected QALYs, but substantially higher expected cost. The mean difference in QALY is 0.00016 (95% CI 0.00005-0.00040), whereas the mean difference in cost is $1170.96 (95% CI $750.13-1584.32). The ICER is estimated to be $9,771,520.87 per QALY (95% CI $2,573,139.89-24,407,017.82). The proportion of early-onset GBS that develops during the second 24 hours of life, the cost of 24 hours of inpatient observation, and the probability of long-term sequelae following prompt versus delayed treatment play important roles in determining the cost-effectiveness of delayed hospital discharge. Cost-effectiveness analysis suggests that with adequate IAP, discharging asymptomatic term neonates to home after 24 hours is the preferred approach compared with 48 hours inpatient observation. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Inequalities in healthy life expectancy by Brazilian geographic regions: findings from the National Health Survey, 2013.

PubMed

Szwarcwald, Célia Landmann; Souza Júnior, Paulo Roberto Borges de; Marques, Aline Pinto; Almeida, Wanessa da Silva de; Montilla, Dalia Elena Romero

2016-11-17

The demographic shift and epidemiologic transition in Brazil have drawn attention to ways of measuring population health that complement studies of mortality. In this paper, we investigate regional differences in healthy life expectancy based on information from the National Health Survey (PNS), 2013. In the survey, a three-stage cluster sampling (census tracts, households and individuals) with stratification of the primary sampling units and random selection in all stages was used to select 60,202 Brazilian adults (18 years and over). Healthy life expectancies (HLE) were estimated by Sullivan's method according to sex, age and geographic region, using poor self-rated health for defining unhealthy status. Logistic regression models were used to investigate socioeconomic and regional inequalities in poor self-rated health, after controlling by sex and age. Wide disparities by geographic region were found with the worst indicators in the North and Northeast regions, whether considering educational attainment, material deprivation, or health care utilization. Life expectancy at birth for women and men living in the richest regions was 5 years longer than for those living in the less wealthy regions. Modeling the variation across regions for poor self-rated health, statistically significant effects (p < 0.001) were found for the North and Northeast when compared to the Southeast, even after controlling for age, sex, diagnosis of at least one non-communicable chronic disease, and schooling or socioeconomic class. Marked regional inequalities in HLE were found, with the loss of healthy life much higher among residents of the poorest regions, especially among the elderly. By combining data on self-rated health status and mortality in a single indicator, Healthy Life Expectancy, this study demonstrated the excess burden of poor health experienced by populations in the less wealthy regions of Brazil. To mitigate the effects of social exclusion, the development of strategies at the regional level is essential to provide health care to all persons in need, reduce risk exposures, support prevention policies for adoption of healthy behaviors. Such strategies should prioritize population groups that will experience the greatest impact from such interventions.

Life expectancy inequalities in the elderly by socioeconomic status: evidence from Italy.

PubMed

Lallo, Carlo; Raitano, Michele

2018-04-12

Life expectancy considerably increased in most developed countries during the twentieth century. However, the increase in longevity is neither uniform nor random across individuals belonging to various socioeconomic groups. From an economic policy perspective, the difference in mortality by socioeconomic conditions challenges the fairness of the social security systems. We focus on the case of Italy and aim at measuring differences in longevity at older ages by individuals belonging to different socioeconomic groups, also in order to assess the effective fairness of the Italian public pension system, which is based on a notional defined contribution (NDC) benefit computation formula, whose rules do not take into account individual heterogeneity in expected longevity. We use a longitudinal dataset that matches survey data on individual features recorded in the Italian module of the EU-SILC, with information on the whole working life and until death collected in the administrative archives managed by the Italian National Social Security Institute. In more detail, we follow until 2009 a sample of 11,281 individuals aged at least 60 in 2005. We use survival analysis and measure the influence of a number of events experienced in the labor market and individual characteristics on mortality. Furthermore, through Kaplan-Meier simulations of hypothetical social groups, adjusted by a Brass relational model, we estimate and compare differences in life expectancy of individuals belonging to different socioeconomic groups. Our findings confirm that socioeconomic status strongly predicts life expectancy even in old age. All estimated models show that the prevalent type of working activity before retirement is significantly associated with the risk of death, even when controlling for dozens of variables as proxies of individual demographic and socioeconomic characteristics. The risk of death for self-employed individuals is 26% lower than that of employees, and life expectancy at 60 differs by five years between individuals with opposite socioeconomic statuses. Our study is the first that links results based on a micro survival analysis on subgroups of the elderly population with results related to the entire Italian population. The extreme differences in mortality risks by socioeconomic status found in our study confirm the existence of large health inequalities and strongly question the fairness of the Italian public pension system.

Comparison of Subjective Wellbeing and Positive Future Expectations in Between Working and Nonworking Adolescents in Turkey

PubMed Central

Karaca, Semra; Karakoc, Ayse; Bingol, Fadime; Eren, Nurhan; Andsoy, Isil Isik

2016-01-01

Background: Wellbeing is one’s evaluation and judgment of one’s life. It consists of 3 dimensions: positive affectivity, negative affectivity, and life satisfaction. Objectives: This study aimed to compare the subjective wellbeing and positive future expectations between working and nonworking adolescents. Patients and Methods: The study was designed as descriptive and comparative. The study sample consisted of 420 working and 482 nonworking adolescents (n = 902) aged 15 - 20 years, who were randomly recruited from two occupational education centers in Istanbul, Turkey and two high schools (formal educations) in the same district. Results: Adolescent subjective wellbeing scale (ASWS) total mean (SD) scores for working adolescents and nonworking adolescents were 48.76 (9.50) and 49.72 (8.01), respectively. In addition, positive future expectations scale (PFES) total mean (SD) scores for working adolescents and nonworking adolescents were 18.71 (4.50) and 19.06 (3.49), respectively. In this study, no significant difference was found between the general wellbeing (scale total median score) scores of the working and nonworking adolescent groups (Z = 1.01, P = 0.315). However, significant differences were found in the family relations satisfaction (Z = 3.23, P = 0.002) and relations with significant others (Z = 2.85, P = 0.004) subscales of the ASWS. Conclusions: A positive relationship was found between adolescent subjective wellbeing and positive future expectations. It was found that nonworking adolescents scored higher on the dimensions of “family relations” and “relations with significant others” of subjective wellbeing compared to those dimensions in working adolescents. PMID:27195141

Trends in the contribution of major causes of death to the black-white life expectancy gap by US state.

PubMed

Riddell, Corinne A; Morrison, Kathryn T; Kaufman, Jay S; Harper, Sam

2018-06-01

Life expectancy has increased in the United States over many decades. The difference in life expectancy between black and white Americans has also decreased, but some states have made much more progress towards racial equality than others. This paper describes the pattern of contributions of six major causes of death to the black-white life expectancy gap within US states and the District of Columbia between 1969 and 2013, and identifies states diverging from the overall pattern. Across multiple causes, the District of Columbia, Illinois, Wisconsin, and Michigan had the highest contributions to black-white inequality, while New York, Massachusetts, and Rhode Island had the lowest contributions and have either achieved or are the closest to achieving black-white equality in life expectancy. Copyright © 2018 Elsevier Ltd. All rights reserved.

Happier countries, longer lives: an ecological study on the relationship between subjective sense of well-being and life expectancy.

PubMed

Evans, Grahame F; Soliman, Elsayed Z

2017-08-01

The relationship between sense of well-being and longevity is not well-established across populations of varying levels of socioeconomic status. We sought to examine the relationship between happiness, or subjective sense of well-being and life expectancy using data from 151 countries. This analysis is based on the 2012 Happy Planet Index project conducted by the Center of Well-Being of the New Economics Foundation, based in the United Kingdom. Well-being data for each country were taken from responses to the 'Ladder of Life' question in the 2012 Gallup World Poll in which participants were asked to rate their quality of life on a scale from 1 (worst possible life) to 10 (best possible life). Life expectancy and gross domestic product data were taken from the 2011 United Nations records. Ecological footprint data were taken from Global Footprint Network records. Subjective sense of well-being was highly correlated with life expectancy (Pearson correlation r = 0.71, p < 0.0001). In a multivariable linear regression model adjusted for gross domestic product, ecological footprint, and population, each 1 unit of the well-being scale was associated with an increase in life expectancy of 4.0 years (95% confidence interval = 2.7-5.3). In conclusion, better sense of well-being has a strong relationship with life expectancy regardless of economic status or population size, suggesting that governments should foster happiness in order to support long-living populations.

How many years of life did the fall of the Berlin Wall add? A projection of East German life expectancy.

PubMed

Vogt, Tobias C

2013-01-01

In the two decades since reunification, East Germans have experienced a large increase in life expectancy and a convergence with the West German mortality level. This gain in life expectancy appears even more impressive if we assume a different scenario in which the Berlin Wall did not fall, and the old East Germany still existed. This analysis takes into account that East German mortality would not have remained static without reunification. Thus, it shows how many years of life expectancy were actually added by the fall of the Berlin Wall. The analysis shows the improvements for single age groups by projecting life expectancy based on mortality levels during the 1970s and 1980s using the Lee-Carter method. I use national-level data for both sexes for East Germany before reunification. I find that, without reunification, current life expectancy at birth among East Germans would be 4.0 years lower for females and 5.7 years lower for males. I also show that older East Germans were the main demographic beneficiaries of reunification. Female and male mortality improvements in the age groups above 60 contributed up to 80% to the actual gains in life expectancy. Had the Berlin Wall not fallen, East German mortality would not have remained static but improved at a far slower rate. Thus, this counterfactual approach shows for the first time how many years of life were actually gained by reunification and how much of these gains were attributable to mortality improvements among the elderly. Copyright © 2013 S. Karger AG, Basel.

Multiple chronic conditions and life expectancy: a life table analysis.

PubMed

DuGoff, Eva H; Canudas-Romo, Vladimir; Buttorff, Christine; Leff, Bruce; Anderson, Gerard F

2014-08-01

The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy. We analyze life expectancy in Medicare beneficiaries by number of chronic conditions. A retrospective cohort study using single-decrement period life tables. Medicare fee-for-service beneficiaries (N=1,372,272) aged 67 and older as of January 1, 2008. Our primary outcome measure is life expectancy. We categorize study subjects by sex, race, selected chronic conditions (heart disease, cancer, chronic obstructive pulmonary disease, stroke, and Alzheimer disease), and number of comorbid conditions. Comorbidity was measured as a count of conditions collected by Chronic Conditions Warehouse and the Charlson Comorbidity Index. Life expectancy decreases with each additional chronic condition. A 67-year-old individual with no chronic conditions will live on average 22.6 additional years. A 67-year-old individual with 5 chronic conditions and ≥10 chronic conditions will live 7.7 fewer years and 17.6 fewer years, respectively. The average marginal decline in life expectancy is 1.8 years with each additional chronic condition-ranging from 0.4 fewer years with the first condition to 2.6 fewer years with the sixth condition. These results are consistent by sex and race. We observe differences in life expectancy by selected conditions at 67, but these differences diminish with age and increasing numbers of comorbid conditions. Social Security and Medicare actuaries should account for the growing number of beneficiaries with multiple chronic conditions when determining population projections and trust fund solvency.

Oncology Fellows' Career Plans, Expectations, and Well-Being: Do Fellows Know What They Are Getting Into?

PubMed Central

Shanafelt, Tait D.; Raymond, Marilyn; Horn, Leora; Moynihan, Tim; Collichio, Frances; Chew, Helen; Kosty, Michael P.; Satele, Daniel; Sloan, Jeff; Gradishar, William J.

2014-01-01

Purpose To evaluate the career plans, professional expectations, and well-being of oncology fellows compared with actual experiences of practicing oncologists. Methods US oncology fellows taking the 2013 Medical Oncology In-Training Examination (MedOnc ITE) were invited to participate in an optional postexamination survey. The survey evaluated fellows' career plans and professional expectations and measured burnout, quality of life (QOL), fatigue, and satisfaction with work-life balance (WLB) using standardized instruments. Fellows' professional expectations and well-being were compared with actual experiences of US oncologists assessed simultaneously. Results Of the 1,637 oncology fellows in the United States, 1,373 (83.9%) took the 2013 MedOnc ITE. Among these, 1,345 (97.9%) completed the postexamination survey. The frequency of burnout among fellows decreased from 43.3% in year 1 to 31.7% in year 2 and 28.1% in year 3 (P < .001). Overall, the rate of burnout among fellows and practicing oncologists was similar (34.1% v 33.7%; P = .86). With respect to other dimensions of well-being, practicing oncologists had lower fatigue (P < .001) and better overall QOL scores (P < .001) than fellows but were less satisfied with WLB (P = .0031) and specialty choice (P < .001). Fellows' expectations regarding future work hours were 5 to 6 hours per week fewer than oncologists' actual reported work hours. Levels of burnout (P = .02) and educational debt (P ≤ .004) were inversely associated with ITE scores. Fellows with greater educational debt were more likely to pursue private practice and less likely to plan an academic career. Conclusion Oncology fellows entering practice trade one set of challenges for another. Unrealized expectations regarding work hours may contribute to future professional dissatisfaction, burnout, and challenges with WLB. PMID:25049326

Oncology fellows’ career plans, expectations, and well-being: do fellows know what they are getting into?

PubMed

Shanafelt, Tait D; Raymond, Marilyn; Horn, Leora; Moynihan, Tim; Collichio, Frances; Chew, Helen; Kosty, Michael P; Satele, Daniel; Sloan, Jeff; Gradishar, William J

2014-09-20

To evaluate the career plans, professional expectations, and well-being of oncology fellows compared with actual experiences of practicing oncologists. US oncology fellows taking the 2013 Medical Oncology In-Training Examination (MedOnc ITE) were invited to participate in an optional postexamination survey. The survey evaluated fellows’ career plans and professional expectations and measured burnout, quality of life (QOL), fatigue, and satisfaction with work-life balance (WLB) using standardized instruments. Fellows’ professional expectations and well-being were compared with actual experiences of US oncologists assessed simultaneously. Of the 1,637 oncology fellows in the United States, 1,373 (83.9%) took the 2013 MedOnc ITE. Among these, 1,345 (97.9%) completed the postexamination survey. The frequency of burnout among fellows decreased from 43.3% in year 1 to 31.7% in year 2 and 28.1% in year 3 (P < .001). Overall, the rate of burnout among fellows and practicing oncologists was similar (34.1% v. 33.7%; P = .86). With respect to other dimensions of well-being, practicing oncologists had lower fatigue (P < .001) and better overall QOL scores (P < .001) than fellows but were less satisfied with WLB (P = .0031) and specialty choice (P < .001). Fellows’ expectations regarding future work hours were 5 to 6 hours per week fewer than oncologists’ actual reported work hours. Levels of burnout (P = .02) and educational debt (P < or =.004) were inversely associated with ITE scores. Fellows with greater educational debt were more likely to pursue private practice and less likely to plan an academic career. Oncology fellows entering practice trade one set of challenges for another. Unrealized expectations regarding work hours may contribute to future professional dissatisfaction, burnout, and challenges with WLB.

Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans - United States, 1999-2015.

PubMed

Cunningham, Timothy J; Croft, Janet B; Liu, Yong; Lu, Hua; Eke, Paul I; Giles, Wayne H

2017-05-05

Although the overall life expectancy at birth has increased for both blacks and whites and the gap between these populations has narrowed, disparities in life expectancy and the leading causes of death for blacks compared with whites in the United States remain substantial. Understanding how factors that influence these disparities vary across the life span might enhance the targeting of appropriate interventions. Trends during 1999-2015 in mortality rates for the leading causes of death were examined by black and white race and age group. Multiple 2014 and 2015 national data sources were analyzed to compare blacks with whites in selected age groups by sociodemographic characteristics, self-reported health behaviors, health-related quality of life indicators, use of health services, and chronic conditions. During 1999-2015, age-adjusted death rates decreased significantly in both populations, with rates declining more sharply among blacks for most leading causes of death. Thus, the disparity gap in all-cause mortality rates narrowed from 33% in 1999 to 16% in 2015. However, during 2015, blacks still had higher death rates than whites for all-cause mortality in all groups aged <65 years. Compared with whites, blacks in age groups <65 years had higher levels of some self-reported risk factors and chronic diseases and mortality from cardiovascular diseases and cancer, diseases that are most common among persons aged ≥65 years. To continue to reduce the gap in health disparities, these findings suggest an ongoing need for universal and targeted interventions that address the leading causes of deaths among blacks (especially cardiovascular disease and cancer and their risk factors) across the life span and create equal opportunities for health.

Pictorial Representation of Illness and Self Measure (PRISM): A novel visual instrument to measure quality of life in dermatological inpatients.

PubMed

Mühleisen, Beda; Büchi, Stefan; Schmidhauser, Simone; Jenewein, Josef; French, Lars E; Hofbauer, Günther F L

2009-07-01

To validate the PRISM (Pictorial Representation of Illness and Self Measure) tool, a novel visual instrument, for the assessment of health-related quality of life in dermatological inpatients compared with the Dermatology Life Quality Index (DLQI) and the Skindex-29 questionnaires and to report qualitative information on PRISM. In an open longitudinal study, PRISM and Skindex-29 and DLQI questionnaires were completed and HRQOL measurements compared. Academic dermatological inpatient ward. The study population comprised 227 sequential dermatological inpatients on admission. Patients completed the PRISM tool and the Skindex-29 and DLQI questionnaires at admission and discharge. PRISM Self-Illness Separation (SIS) score; Skindex-29 and DLQI scores; and qualitative PRISM information by Mayring inductive qualitative context analysis. The PRISM scores correlated well with those from the Skindex-29 (rho = 0.426; P < .001) and DLQI (rho = 0.304; P < .001) questionnaires. Between PRISM and Skindex-29 scores, the highest correlations were for dermatitis (rho = 0.614) and leg ulcer (rho = 0.554), and between PRISM and DLQI scores, the highest correlations were for psoriasis (rho = 0.418) and tumor (rho = 0.399). The PRISM tool showed comparable or higher sensitivity than quality of life questionnaires to assess changes in the burden of suffering during hospitalization. Inductive qualitative context analysis revealed impairment of adjustment and self-image as major aspects. Patients overall expected symptomatic and functional improvement. In patients with psoriasis and leg ulcers, many expected no treatment benefit. The PRISM tool proved to be convenient and reliable for health-related quality of life assessment, applicable for a wide range of skin diseases, and correlated with DLQI and Skindex-29 scores. With the PRISM tool, free-text answers allow for the assessment of individual information and potentially customized therapeutic approaches.

Favorable ecological circumstances promote life expectancy in chimpanzees similar to that of human hunter-gatherers.

PubMed

Wood, Brian M; Watts, David P; Mitani, John C; Langergraber, Kevin E

2017-04-01

Demographic data on wild chimpanzees are crucial for understanding the evolution of chimpanzee and hominin life histories, but most data come from populations affected by disease outbreaks and anthropogenic disturbance. We present survivorship data from a relatively undisturbed and exceptionally large community of eastern chimpanzees (Pan troglodytes schweinfurthii) at Ngogo, Kibale National Park, Uganda. We monitored births, deaths, immigrations, and emigrations in the community between 1995 and 2016. Using known and estimated ages, we calculated survivorship curves for the whole community, for males and females separately, and for individuals ≤2 years old when identified. We used a novel method to address age estimation error by calculating stochastic survivorship curves. We compared Ngogo life expectancy, survivorship, and mortality rates to those from other chimpanzee communities and human hunter-gatherers. Life expectancy at birth for both sexes combined was 32.8 years, far exceeding estimates of chimpanzee life expectancy in other communities, and falling within the range of human hunter-gatherers (i.e., 27-37 years). Overall, the pattern of survivorship at Ngogo was more similar to that of human hunter-gatherers than to other chimpanzee communities. Maximum lifespan for the Ngogo chimpanzees, however, was similar to that reported at other chimpanzee research sites and was less than that of human-hunter gatherers. The absence of predation by large carnivores may contribute to some of the higher survivorship at Ngogo, but this cannot explain the much higher survivorship at Ngogo than at Kanyawara, another chimpanzee community in the same forest, which also lacks large carnivores. Higher survivorship at Ngogo appears to be an adaptive response to a food supply that is more abundant and varies less than that of Kanyawara. Future analyses of hominin life history evolution should take these results into account. Copyright © 2017 Elsevier Ltd. All rights reserved.

Potential Cost-Effectiveness of Universal Access to Modern Contraceptives in Uganda

PubMed Central

Babigumira, Joseph B.; Stergachis, Andy; Veenstra, David L.; Gardner, Jacqueline S.; Ngonzi, Joseph; Mukasa-Kivunike, Peter; Garrison, Louis P.

2012-01-01

Background Over two thirds of women who need contraception in Uganda lack access to modern effective methods. This study was conducted to estimate the potential cost-effectiveness of achieving universal access to modern contraceptives in Uganda by implementing a hypothetical new contraceptive program (NCP) from both societal and governmental (Ministry of Health (MoH)) perspectives. Methodology/Principal Findings A Markov model was developed to compare the NCP to the status quo or current contraceptive program (CCP). The model followed a hypothetical cohort of 15-year old girls over a lifetime horizon. Data were obtained from the Uganda National Demographic and Health Survey and from published and unpublished sources. Costs, life expectancy, disability-adjusted life expectancy, pregnancies, fertility and incremental cost-effectiveness measured as cost per life-year (LY) gained, cost per disability-adjusted life-year (DALY) averted, cost per pregnancy averted and cost per unit of fertility reduction were calculated. Univariate and probabilistic sensitivity analyses were performed to examine the robustness of results. Mean discounted life expectancy and disability-adjusted life expectancy (DALE) were higher under the NCP vs. CCP (28.74 vs. 28.65 years and 27.38 vs. 27.01 respectively). Mean pregnancies and live births per woman were lower under the NCP (9.51 vs. 7.90 and 6.92 vs. 5.79 respectively). Mean lifetime societal costs per woman were lower for the NCP from the societal perspective ($1,949 vs. $1,987) and the MoH perspective ($636 vs. $685). In the incremental analysis, the NCP dominated the CCP, i.e. it was both less costly and more effective. The results were robust to univariate and probabilistic sensitivity analysis. Conclusion/Significance Universal access to modern contraceptives in Uganda appears to be highly cost-effective. Increasing contraceptive coverage should be considered among Uganda's public health priorities. PMID:22363480

Why the racial gap in life expectancy is declining in the United States

PubMed Central

Firebaugh, Glenn; Acciai, Francesco; Noah, Aggie J.; Prather, Christopher; Nau, Claudia

2014-01-01

BACKGROUND Blacks have lower life expectancy than whites in the United States. That disparity could be due to racial differences in the causes of death, with blacks being more likely to die of causes that affect the young, or it could be due to differences in the average ages of blacks and whites who die of the same cause. Prior studies fail to distinguish these two possibilities. OBJECTIVE In this study we determine how much of the 2000–10 reduction in the racial gap in life expectancy resulted from narrowing differences in the cause-specific mean age at death for blacks and whites, as opposed to changing cause-specific probabilities for blacks and whites. METHOD We introduce a method for separating the difference-in-probabilities and difference-inage components of group disparities in life expectancy. RESULTS Based on the new method, we find that 60% of the decline in the racial gap in life expectancy from 2000 to 2010 was attributable to reduction in the age component, largely because of declining differences in the age at which blacks and whites die of chronic diseases. CONCLUSION Our findings shed light on the sources of the declining racial gap in life expectancy in the United States, and help to identify where advances need to be made to achieve the goal of eliminating racial disparities in life expectancy. PMID:25580083

26 CFR 1.401(a)(9)-8 - Special rules.

Code of Federal Regulations, 2010 CFR

2010-04-01

... employee's death may be made over a beneficiary's life expectancy in accordance with section 401(a)(9)(B...)-9 or using the joint life expectancy of the employee and a spousal alternate payee in the... employee will be made in accordance with the 5-year rule in section 401(a)(9)(B)(ii) or the life expectancy...

Are Differences in Disability-Free Life Expectancy by Gender, Race, and Education Widening at Older Ages?

PubMed Central

Solé-Auró, Aïda; Beltrán-Sánchez, Hiram; Crimmins, Eileen M.

2018-01-01

To examine change from 1991 to 2001 in disability-free life expectancy in the age range 60–90 by gender, race, and education in the United States. Mortality is estimated over two 10-year follow-up periods for persons in the National Health Interview Surveys of 1986/1987 and 1996/1997. Vital status is ascertained through the National Death Index. Disability prevalence is estimated from the National Health and Nutrition Examination Surveys of 1988–1994 and 1999–2002. Disability is defined as ability to perform four activities of daily living without difficulty. Disability-free life expectancy increased only among white men. Disabled life expectancy increased for all groups—black and white men and women. Racial differences in disability-free life expectancy widened among men; gender differences were reduced among whites. Expansion of socioeconomic differentials in disability-free life at older ages occurred among white men and women and black women. The 1990s was a period where the increased years of life between ages 60 and 90 were concentrated in disabled years for most population groups. PMID:29681672

Are Expectations the Missing Link between Life History Strategies and Psychopathology?

PubMed

Kavanagh, Phillip S; Kahl, Bianca L

2018-01-01

Despite advances in knowledge and thinking about using life history theory to explain psychopathology there is still a missing link. That is, we all have a life history strategy, but not all of us develop mental health problems. We propose that the missing link is expectations - a mismatch between expected environmental conditions (including social) set by variations in life history strategies and the current environmental conditions. The mismatch hypothesis has been applied at the biological level in terms of health and disease and we believe that it can also be applied more broadly at the psychological level in terms of perceived expectations in the social environment and the resulting distress-psychopathology-that manifests when our expectations are not met.

Investigating the impact of the English health inequalities strategy: time trend analysis.

PubMed

Barr, Ben; Higgerson, James; Whitehead, Margaret

2017-07-26

Objective  To investigate whether the English health inequalities strategy was associated with a decline in geographical health inequalities, compared with trends before and after the strategy. Design  Time trend analysis. Setting  Two groups of lower tier local authorities in England. The most deprived, bottom fifth and the rest of England. Intervention  The English health inequalities strategy-a cross government strategy implemented between 1997 and 2010 to reduce health inequalities in England. Trends in geographical health inequalities were assessed before (1983-2003), during (2004-12), and after (2013-15) the strategy using segmented linear regression. Main outcome measure  Geographical health inequalities measured as the relative and absolute differences in male and female life expectancy at birth between the most deprived local authorities in England and the rest of the country. Results  Before the strategy the gap in male and female life expectancy between the most deprived local authorities in England and the rest of the country increased at a rate of 0.57 months each year (95% confidence interval 0.40 to 0.74 months) and 0.30 months each year (0.12 to 0.48 months). During the strategy period this trend reversed and the gap in life expectancy for men reduced by 0.91 months each year (0.54 to 1.27 months) and for women by 0.50 months each year (0.15 to 0.86 months). Since the end of the strategy period the inequality gap has increased again at a rate of 0.68 months each year (-0.20 to 1.56 months) for men and 0.31 months each year (-0.26 to 0.88) for women. By 2012 the gap in male life expectancy was 1.2 years smaller (95% confidence interval 0.8 to 1.5 years smaller) and the gap in female life expectancy was 0.6 years smaller (0.3 to 1.0 years smaller) than it would have been if the trends in inequalities before the strategy had continued. Conclusion  The English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. Since the strategy ended, inequalities have started to increase again. The strategy may have reduced geographical health inequalities in life expectancy, and future approaches should learn from this experience. The concerns are that current policies are reversing the achievements of the strategy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mental models of adherence: parallels in perceptions, values, and expectations in adherence to prescribed home exercise programs and other personal regimens.

PubMed

Rizzo, Jon; Bell, Alexandra

2018-05-09

A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients customarily use to adhere to other activities may inform strategies to promote prescribed home exercise adherence.

[Prediction of life expectancy for prostate cancer patients based on the kinetic theory of aging of living systems].

PubMed

Viktorov, A A; Zharinov, G M; Neklasova, N Ju; Morozova, E E

2017-01-01

The article presents a methodical approach for prediction of life expectancy for people diagnosed with prostate cancer based on the kinetic theory of aging of living systems. The life expectancy is calculated by solving the differential equation for the rate of aging for three different stage of life - «normal» life, life with prostate cancer and life after combination therapy for prostate cancer. The mathematical model of aging for each stage of life has its own parameters identified by the statistical analysis of healthcare data from the Zharinov's databank and Rosstat CDR NES databank. The core of the methodical approach is the statistical correlation between growth rate of the prostate specific antigen level (PSA-level) or the PSA doubling time (PSA DT) before therapy, and lifespan: the higher the PSA DT is, the greater lifespan. The patients were grouped under the «fast PSA DT» and «slow PSA DT» categories. The satisfactory matching between calculations and experiment is shown. The prediction error of group life expectancy is due to the completeness and reliability of the main data source. A detailed monitoring of the basic health indicators throughout the each person life in each analyzed group is required. The absence of this particular information makes it impossible to predict the individual life expectancy.

Socio-economic determinants of life expectancy in Nigeria (1980 - 2011).

PubMed

Sede, Peter I; Ohemeng, Williams

2015-01-01

Attainment of 70 years life expectancy by 2020 is one of the millennium development goals in Nigeria. This study examined the socio-economic determinants of life expectancy in Nigeria using data from 1980-2011. Judging from the endogeneity feature of the variables, A VAR and VECM frameworks were employed. Socio-economic features were proxy by secondary school enrolment, government expenditure on health, per capita income, unemployment rate and the Naira foreign exchange rate. It was found that, the conventional socio-economic variables such as per capita income, education and government expenditure on health considered to be highly effective in determining life expectancy of developing countries are not significant in the case of Nigeria. The study however suggests that, life expectancy in Nigeria could be improved if attention is given to quality of government health expenditure, unemployment and measures to halt the depreciation of the Nigerian Naira against major foreign currency.

Mortality of White Americans, African Americans, and Canadians: The Causes and Consequences for Health of Welfare State Institutions and Policies

PubMed Central

Kunitz, Stephen J; Pesis-Katz, Irena

2005-01-01

The life expectancy of African Americans has been substantially lower than that of white Americans for as long as records are available. The life expectancy of all Americans has been lower than that of all Canadians since the beginning of the 20th century. Until the 1970s this disparity was the result of the low life expectancy of African Americans. Since then, the life expectancy of white Americans has not improved as much as that of all Canadians. This article discusses two issues: racial disparities in the United States, and the difference in life expectancy between all Canadians and white Americans. Each country's political culture and institutions have shaped these differences, especially national health insurance in Canada and its absence in the United States. The American welfare state has contributed to and explains these differences. PMID:15787952

Financial inequality and gender in older people.

PubMed

Vlachantoni, Athina

2012-06-01

Gender inequalities in the financial resources in later life result from the combined effect of women's atypical life courses, which include interrupted employment records and periods of care provision, and the fact that pension systems have generally been slow in mitigating 'diversions' from continuous and full-time working lives. Gender differentials in financial resources can often result in a greater likelihood of facing poverty for older women compared to older men, and such risk can be experienced for longer periods for women, as a result of their higher life expectancy on average. For example, across the EU-27, 16% of men compared to 23% of women aged 65 and over faced a poverty risk, and at age 65, men can expect to live another 17 years on average, while women another 21 years. Although modern pension systems are increasingly recognising the diversity of women's patterns of paid and unpaid work, for example by accounting for periods of childcare in the calculation of the state pension, research continues to show a 'penalty' for women who have spent significant periods of their life providing care to children or dependent adults in and outside the household. Reducing such penalty is particularly important as population ageing and an increasing demand for formal and informal care are likely to present challenges with critical policy implications for societies and individuals alike. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Higher limb asymmetry in deceased human fetuses and infants with aneuploidy

PubMed Central

Bots, Jessica; ten Broek, Clara M. A.; Belien, Jeroen A. M.; Bugiani, Marianna; Galis, Frietson; Van Dongen, Stefan

2014-01-01

Aneuploidies cause gene-dosage imbalances that presumably result in a generalized decreased developmental homeostasis, which is expected to be detectable through an increase in fluctuating asymmetry (FA) of bilateral symmetric traits. However, support for the link between aneuploidy and FA is currently limited and no comparisons among different aneuploidies have been made. Here, we study FA in deceased human fetuses and infants from a 20-year hospital collection. Mean FA of limb bones was compared among groups of aneuploidies with different prenatal and postnatal survival chances and two reference groups (normal karyogram or no congenital anomalies). Limb asymmetry was 1.5 times higher for aneuploid cases with generally very short life expectancies (trisomy 13, trisomy 18, monosomy X, triploidy) than for trisomy 21 patients and both reference groups with higher life expectancies. Thus, FA levels are highest in groups for which developmental disturbances have been highest. Our results show a significant relationship between fluctuating asymmetry, human genetic disorders and severity of the associated abnormalities. PMID:24424506

Combined statistical analyses for long-term stability data with multiple storage conditions: a simulation study.

PubMed

Almalik, Osama; Nijhuis, Michiel B; van den Heuvel, Edwin R

2014-01-01

Shelf-life estimation usually requires that at least three registration batches are tested for stability at multiple storage conditions. The shelf-life estimates are often obtained by linear regression analysis per storage condition, an approach implicitly suggested by ICH guideline Q1E. A linear regression analysis combining all data from multiple storage conditions was recently proposed in the literature when variances are homogeneous across storage conditions. The combined analysis is expected to perform better than the separate analysis per storage condition, since pooling data would lead to an improved estimate of the variation and higher numbers of degrees of freedom, but this is not evident for shelf-life estimation. Indeed, the two approaches treat the observed initial batch results, the intercepts in the model, and poolability of batches differently, which may eliminate or reduce the expected advantage of the combined approach with respect to the separate approach. Therefore, a simulation study was performed to compare the distribution of simulated shelf-life estimates on several characteristics between the two approaches and to quantify the difference in shelf-life estimates. In general, the combined statistical analysis does estimate the true shelf life more consistently and precisely than the analysis per storage condition, but it did not outperform the separate analysis in all circumstances.

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016.

PubMed

2017-09-16

Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Life Expectancy and Human Capital Investments: Evidence from Maternal Mortality Declines. NBER Working Paper No. 13947

ERIC Educational Resources Information Center

Jayachandran, Seema; Lleras-Muney, Adriana

2008-01-01

Longer life expectancy should encourage human capital accumulation, since a longer time horizon increases the value of investments that pay out over time. Previous work has been unable to determine the empirical importance of this life-expectancy effect due to the difficulty of isolating it from other effects of health on education. We examine a…

Long-term Cost-effectiveness of Two GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus in the Italian Setting: Liraglutide Versus Lixisenatide.

PubMed

Hunt, Barnaby; Kragh, Nana; McConnachie, Ceilidh C; Valentine, William J; Rossi, Maria C; Montagnoli, Roberta

2017-07-01

Maintaining glycemic control is the key treatment target for patients with type 2 diabetes mellitus. In addition, the glucagon-like peptide-1 (GLP-1) receptor agonists may be associated with other favorable treatment characteristics, such as reduction in body weight and reduced risk of hypoglycemia compared with traditional diabetes interventions. The aim of the present analysis was to compare the long-term cost-effectiveness of 2 GLP-1 receptor agonists, liraglutide 1.8 mg and lixisenatide 20 μg (both administered once daily), in the treatment of patients with type 2 diabetes failing to achieve glycemic control with metformin monotherapy in the Italian setting. The IMS CORE Diabetes Model was used to project long-term clinical outcomes and subsequent costs (in 2015 Euros [€]) associated with liraglutide 1.8 mg versus lixisenatide 20 μg treatment in a cohort with baseline characteristics derived from the open-label LIRA-LIXI trial (Efficacy and Safety of Liraglutide Versus Lixisenatide as Add-on to Metformin in Subjects With Type 2 Diabetes; NCT01973231) over patient lifetimes from the perspective of a health care payer. Efficacy data were taken from the 26-week end points of the same trial, including changes in glycated hemoglobin, body mass index, serum lipid levels, and hypoglycemic event rates. Outcomes projected included life expectancy, quality-adjusted life expectancy, cumulative incidence and time to onset of diabetes-related complications, and direct medical costs. Outcomes were discounted at 3% annually, and sensitivity analyses were performed. Liraglutide 1.8 mg was associated with improved discounted life expectancy (14.07 vs 13.96 years) and quality-adjusted life expectancy (9.18 vs 9.06 quality-adjusted life years [QALYs]) compared with lixisenatide 20 μg. These improvements were mostly attributable to a greater reduction in glycated hemoglobin level with liraglutide 1.8 mg versus lixisenatide 20 μg, leading to reduced incidence and increased time to onset of diabetes-related complications. Compared with lixisenatide 20 μg, liraglutide 1.8 mg was associated with increased total costs over patient lifetimes (€41,623 vs €41,380), but this was offset by lower costs of treating diabetes-related complications (€26,682 vs €27,476). Liraglutide 1.8 mg was associated with an incremental cost-effectiveness ratio of €2001 per QALY gained versus lixisenatide 20 μg. At a willingness-to-pay threshold of €30,000 per QALY gained, liraglutide 1.8 mg had a probability of 77.2% of being cost-effective. Based on long-term projections, liraglutide 1.8 mg is likely to be considered cost-effective compared with lixisenatide 20 μg for the treatment of patients with type 2 diabetes in Italy. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

Meeting the Institute of Medicine’s 2030 US Life Expectancy Target

PubMed Central

Kindig, David; Nobles, Jenna; Zidan, Moheb

2018-01-01

Objectives To quantify the improvement in US life expectancy required to reach parity with high-resource nations by 2030, to document historical precedent of this rate, and to discuss the plausibility of achieving this rate in the United States. Methods We performed a demographic analysis of secondary data in 5-year periods from 1985 to 2015. Results To achieve the United Nations projected mortality estimates for Western Europe in 2030, the US life expectancy must grow at 0.32% a year between 2016 and 2030. This rate has precedent, even in low-mortality populations. Over 204 country-periods examined, nearly half exhibited life-expectancy growth greater than 0.32%. Of the 51 US states observed, 8.2% of state-periods demonstrated life-expectancy growth that exceeded the 0.32% target. Conclusions Achieving necessary growth in life expectancy over the next 15 years despite historical precedent will be challenging. Much all-cause mortality is structured decades earlier and, at present, older-age mortality reductions in the United States are decelerating. Addressing mortality decline at all ages will require enhanced political will and a strong commitment to equity improvement in the US population. PMID:29161064

How did national life expectation related to school years in developing countries - an approach using panel data mining.

PubMed

Jian, Wen-Shan; Huang, Chen-Ling; Iqbal, Usman; Nguyen, Phung-Anh; Hsiao, George; Li, Hsien-Chang

2014-03-01

The purpose of the study was to probe into the changes in life expectancy associated with schooling years found by the Organization for Economic Co-operation and Development (OECD). The study was based on the OECD database from the period 2000 to 2006. The data of thirty countries were constructed to allow comparisons over time and across these countries. Panel data analysis was used to estimate the relationship of national education, as defined as school years, with life expectancy. The control factors considered were numbers of practicing physicians, practicing nurses, hospital beds, and GDP. We used fixed effects of both country and time through linear regression, the coefficient of school years in relation to life expectancy was statistically significant but negative. This finding is not in accord with the hypothesis that investing in human capital through education stimulates better health outcomes. Within developing countries, educational attainment is no longer keeping the same pace with life expectancy as before. Therefore, we suggest that an effective education policy should cover diverse topics, for example, balancing economic growth and mental hygiene, to improve national life expectancy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Diverging Life Expectancies and Voting Patterns in the 2016 US Presidential Election.

PubMed

Bor, Jacob

2017-10-01

To assess whether voting patterns in the 2016 US presidential election were correlated with long-run trends in county life expectancy. I examined county-level voting data from the 2008 and 2016 presidential elections and assessed Donald Trump's share of the 2016 vote, change in the Republican vote share between 2008 and 2016, and changes in absolute numbers of Democratic and Republican votes. County-level estimates of life expectancy at birth were obtained for 1980 and 2014 from the Institute for Health Metrics and Evaluation. Changes in county life expectancy from 1980 to 2014 were strongly negatively associated with Trump's vote share, with less support for Trump in counties experiencing greater survival gains. Counties in which life expectancy stagnated or declined saw a 10-percentage-point increase in the Republican vote share between 2008 and 2016. Residents of counties left out from broader life expectancy gains abandoned the Democratic Party in the 2016 presidential election. Since coming to power, the Trump administration has proposed cuts to health insurance for the poor, social programs, health research, and environmental and worker protections, which are key determinants of population health. Health gaps likely will continue to widen without significant public investment in population health.

Healthy life expectancy of oral squamous cell carcinoma patients aged 75years and older.

PubMed

Yamada, Shin-Ichi; Kurita, Hiroshi; Tomioka, Takahiro; Ohta, Ryousuke; Yoshimura, Nobuhiko; Nishimaki, Fumihiro; Koyama, Yoshihito; Kondo, Eiji; Kamata, Takahiro

2017-01-01

Healthy life expectancy, an extension of the concept of life expectancy, is a summary measure of population health that takes into account the mortality and morbidity of a population. The aim of the present study was to retrospectively analyze the self-reliance survival times of oral squamous cell carcinoma (OSCC) patients. One hundred and twelve patients aged 75years or older with primary OSCC were included and examined at Shinshu University Hospital. To investigate healthy life expectancy, OSCC patients older than 75years were divided into 3 groups: 75-79, 80-84, and older than 85years. The Kaplan-Meier method was used to estimate the median times of healthy life expectancy. The Log-rank test was used to test significant differences between actual curves. The median self-reliance survival times of patients aged 75-79, 80-84, and older than 85years were 5.7, 1.6, and 1.4years, respectively. Most patients with early stage cancers underwent curative treatments and showed a health expectancy of more than 5years. In patients with advanced cancers, health expectancy was poor (less than one year), except among patients aged 75-79years who underwent standard treatments. It seems that in patients with advanced cancers, health expectancy was poor (less than 1year), except among patients aged 75-79years who underwent standard treatments. In elderly patients, healthy life expectancy (self-reliance survival time) may be one of the measures of patient prognosis as well as overall survival times. Copyright © 2016 Elsevier Ltd. All rights reserved.

Early-life mortality risks in opposite-sex and same-sex twins: a Danish cohort study of the twin testosterone transfer hypothesis

PubMed Central

Ahrenfeldt, Linda Juel; Larsen, Lisbeth Aagaard; Lindahl-Jacobsen, Rune; Skytthe, Axel; Hjelmborg, Jacob v.B.; Möller, Sören; Christensen, Kaare

2017-01-01

Purpose To investigate the twin testosterone transfer (TTT) hypothesis by comparing early-life mortality risks of opposite-sex (OS) and same-sex (SS) twins during the first 15 years of life. Methods We performed a population-based cohort study to compare mortality in OS and SS twins. We included 68,629 live-born Danish twins from 1973 to 2009 identified through the Danish Twin Registry and performed piecewise stratified Cox regression and log-binomial regression. Results Among 1933 deaths, we found significantly higher mortality for twin boys than for twin girls. For both sexes, OS twins had lower mortality than SS twins; the difference persisted for the first year of life for boys and for the first week of life for girls. Conclusions Although the mortality risk for OS boys was in the expected direction according to the TTT hypothesis, the results for OS girls pointed in the opposite direction, providing no clear evidence for the TTT hypothesis. PMID:28024904

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.

PubMed

Wang, G D; Lai, D J; Burau, K D; Du, X L

2013-04-01

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. 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. 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. 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. 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. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Using the 21-gene assay to guide adjuvant chemotherapy decision-making in early-stage breast cancer: a cost-effectiveness evaluation in the German setting.

PubMed

Blohmer, J U; Rezai, M; Kümmel, S; Kühn, T; Warm, M; Friedrichs, K; Benkow, A; Valentine, W J; Eiermann, W

2013-01-01

The 21-gene assay (Oncotype DX Breast Cancer Test (Genomic Health Inc., Redwood City, CA)) is a well validated test that predicts the likelihood of adjuvant chemotherapy benefit and the 10-year risk of distant recurrence in patients with ER+, HER2- early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Germany. A Markov model was developed to make long-term projections of distant recurrence, survival, quality-adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative, or up to 3 node-positive early-stage breast cancer. Scenarios using conventional diagnostic procedures or the 21-gene assay to inform treatment recommendations for adjuvant chemotherapy were modeled based on a prospective, multi-center trial in 366 patients. Transition probabilities and risk adjustment were based on published landmark trials. Costs (2011 Euros (€)) were estimated from a sick fund perspective based on resource use in patients receiving chemotherapy. Future costs and clinical benefits were discounted at 3% annually. The 21-gene assay was projected to increase mean life expectancy by 0.06 years and quality-adjusted life expectancy by 0.06 quality-adjusted life years (QALYs) compared with current clinical practice over a 30-year time horizon. Clinical benefits were driven by optimized allocation of adjuvant chemotherapy. Costs from a healthcare payer perspective were lower with the 21-gene assay by ∼€561 vs standard of care. Probabilistic sensitivity analysis indicated that there was an 87% probability that the 21-gene assay would be dominant (cost and life saving) to standard of care. Country-specific data on the risk of distant recurrence and quality-of-life were not available. Guiding decision-making on adjuvant chemotherapy using the 21-gene assay was projected to improve survival, quality-adjusted life expectancy, and be cost saving vs the current standard of care women with ER+, HER2- early-stage breast cancer.

Measuring health: a practical challenge with a philosophical solution?

PubMed

Shroufi, Amir; Chowdhury, Rajiv; Aston, Louise M; Pashayan, Nora; Franco, Oscar H

2011-03-01

With the current demographic shift being experienced by populations globally, almost linear increases in life expectancy have been seen and can be expected. However, increases in healthy life expectancy may not keep pace. Among older populations the proportion of time spent in less than full health tends to increase. As a result, the accurate valuation of life spent in states less than full health will become increasingly important. Different techniques and approaches have been used to measure health in populations. The use of summary measures of population health such as DALYs (Disability Adjusted Life Years) has become common, and is widely used to compare health between populations and to evaluate the potential impact of interventions in economic analyses. Most of the commonly used summary measures of health express some measure of life lived in full health and life lived with disability or in a state of sub-optimal health. Critical to the construction of summary health measures are values assigned to health states. Current tools used in determining these values include the standard gamble, time trade off, person trade off, and the visual analogue scale. However, these techniques all have the disadvantage of incorporating individual biases (derived from particular characteristics specific to individuals or populations) into the process through which health state valuations are derived. As a consequence health states are often not directly comparable between populations, since characteristics such as nationality and ethnicity can influence how health states are valued. Furthermore, health can be judged differently by those of different ages, with the young often assigning a lower value to life lived at less than full health compared to older people. The challenge of obtaining opinions which are not influenced by an individual's own circumstances is not new. This issue was encountered and described by the American philosopher John Rawls in 'A Theory of Justice' (1971), in which he employed a thought experiment called 'the veil of ignorance' as a means of overcoming this problem. In this thought experiment an individual is asked to make decisions about distributive justice by imagining they are behind a 'veil of ignorance', whereby they are unaware of their own position in society. Here we discuss how current methods for deriving health state values may incorporate a veil of ignorance approach, and how this may benefit the comparability of the health state valuations produced. We also propose how such methods may be operationalized. Considering these issues, we propose that a new society with new needs and a progressively growing interest in maintaining adequate health requires appropriate measures of health. These measures should facilitate derivation of objective measures of health that are comparable to those acquired in other populations, irrespective of age, gender, disease status, ethnicity and geographical location. Promoting and improving health demands adequate measures of health and the application of the Rawlsian veil of ignorance approach could be an effective alternative. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Variations in life expectancy between rural and urban areas of England, 2001-07.

PubMed

Kyte, Lynsey; Wells, Claudia

2010-01-01

This study was part of a wider project commissioned by the Department for Environment, Food and Rural Affairs (Defra) to examine inequalities in health outcomes in rural areas. It investigated variations in life expectancy at birth between rural and urban areas of England, taking the effect of deprivation into account. The study aimed to produce results which provide specific evidence of the needs of rural communities, as they have often been overlooked in previous research. The Rural and Urban Area Classification (RUAC) 2004 and the Index of Multiple Deprivation (IMD) 2007 were used to categorise area types at the Lower Super Output Area (LSOA) level. Population and mortality data used were produced by the Office for National Statistics (ONS). Abridged life tables were constructed to calculate period life expectancy at birth for males and females, for the years 2001 to 2007 combined. Confidence intervals (95%) were also produced. For the 2001-07 period, life expectancy at birth in England was 76.9 years for males and 81.3 years for females. However, when deprivation was examined, results between the most deprived and least deprived quintiles varied by 7.8 years for men and 5.4 years for women.Overall, life expectancy was higher in rural areas than in urban areas. Deprivation had a considerable impact on the results and wide inequalities were evident, particularly in men and in urban areas. In both area types, males living in the less deprived quintiles had similar life expectancies to females living in the more deprived quintiles.Within rural area types, life expectancy was higher in village and dispersed settlements than in town and fringe areas. There were large differences between the fourth and fifth (most deprived) quintiles in village and dispersed settlements, which shows that there may be acute pockets of deprivation within this area type that need to be addressed.In terms of sparsity, there was little difference in life expectancy between densely and less densely populated localities within rural and urban areas. However, variations were observed when deprivation was taken into account and greater differences were evident in less sparse areas than in sparse areas. There were clear inequalities in life expectancy between rural and urban areas in England. There were also intricate differences within area types, which can be overlooked when only examining differences between them. The results were consistent with the findings of previous studies and demonstrated that it is important to examine differences in life expectancy in both area and deprivation contexts.

Locus of control and academic efficacy in the thoughts of life and death of young Quebec university students.

PubMed

Labelle, Réal; Lachance, Lise

2003-01-01

This study evaluated the role of control and efficacy expectations in the thoughts of life and death of 50 male and 50 female university students and investigated sex differences in this regard. It followed a correlational design and employed measures of tridimensional locus of control, expectations of academic efficacy, thoughts of life and death. A comparison of means revealed that male students did not differ from their female counterparts on any of the variables under study. Stepwise regression coefficients indicated that the two cognitive factors accounted more for thoughts of death than for thoughts of life; expectations of academic efficacy were the single variable that most explained variance. Regression equations by sex showed that thoughts of life were associated with internality and expectations of academic efficacy in females, and that thoughts of death were associated with expectations of academic inefficacy in males. The university counseling personnel should be especially sensitive to youths presenting with expectations of externality and of academic inefficacy. The latter variable seems to be particularly important, regardless of sex.

Optimal threshold estimator of a prognostic marker by maximizing a time-dependent expected utility function for a patient-centered stratified medicine.

PubMed

Dantan, Etienne; Foucher, Yohann; Lorent, Marine; Giral, Magali; Tessier, Philippe

2018-06-01

Defining thresholds of prognostic markers is essential for stratified medicine. Such thresholds are mostly estimated from purely statistical measures regardless of patient preferences potentially leading to unacceptable medical decisions. Quality-Adjusted Life-Years are a widely used preferences-based measure of health outcomes. We develop a time-dependent Quality-Adjusted Life-Years-based expected utility function for censored data that should be maximized to estimate an optimal threshold. We performed a simulation study to compare estimated thresholds when using the proposed expected utility approach and purely statistical estimators. Two applications illustrate the usefulness of the proposed methodology which was implemented in the R package ROCt ( www.divat.fr ). First, by reanalysing data of a randomized clinical trial comparing the efficacy of prednisone vs. placebo in patients with chronic liver cirrhosis, we demonstrate the utility of treating patients with a prothrombin level higher than 89%. Second, we reanalyze the data of an observational cohort of kidney transplant recipients: we conclude to the uselessness of the Kidney Transplant Failure Score to adapt the frequency of clinical visits. Applying such a patient-centered methodology may improve future transfer of novel prognostic scoring systems or markers in clinical practice.

Extending Depot Length and Intervals for DDG 51 Class Ships: Examining the 72 Month Operational Cycle

DTIC Science & Technology

2016-01-01

tenance period to achieve planned expected service life ( ESL ), as well as the length, workload, and periodicity of a continuous maintenance...a ship’s service life but extends the length of each deployment. Figure 2.1 compares the number of deployments that can be made over the ESL of...ships in different cycle lengths. The ESL of DDG-51 Arleigh Burke–class destroyers Flight I and II is 35 years, and Flight IIA has an ESL of 40 years

A Scoping Review of Health Disparities in Autism Spectrum Disorder

ERIC Educational Resources Information Center

Bishop-Fitzpatrick, Lauren; Kind, Amy J. H.

2017-01-01

Individuals with autism spectrum disorder (ASD) experience increased morbidity and decreased life expectancy compared to the general population, and these disparities are likely exacerbated for those individuals who are otherwise disadvantaged. We conducted a review to ascertain what is known about health and health system quality (e.g., high…

A Multigene Test Could Cost-Effectively Help Extend Life Expectancy for Women at Risk of Hereditary Breast Cancer.

PubMed

Li, Yonghong; Arellano, Andre R; Bare, Lance A; Bender, Richard A; Strom, Charles M; Devlin, James J

2017-04-01

The National Comprehensive Cancer Network recommends that women who carry gene variants that confer substantial risk for breast cancer consider risk-reduction strategies, that is, enhanced surveillance (breast magnetic resonance imaging and mammography) or prophylactic surgery. Pathogenic variants can be detected in women with a family history of breast or ovarian cancer syndromes by multigene panel testing. To investigate whether using a seven-gene test to identify women who should consider risk-reduction strategies could cost-effectively increase life expectancy. We estimated effectiveness and lifetime costs from a payer perspective for two strategies in two hypothetical cohorts of women (40-year-old and 50-year-old cohorts) who meet the National Comprehensive Cancer Network-defined family history criteria for multigene testing. The two strategies were the usual test strategy for variants in BRCA1 and BRCA2 and the seven-gene test strategy for variants in BRCA1, BRCA2, TP53, PTEN, CDH1, STK11, and PALB2. Women found to have a pathogenic variant were assumed to undergo either prophylactic surgery or enhanced surveillance. The incremental cost-effectiveness ratio for the seven-gene test strategy compared with the BRCA1/2 test strategy was $42,067 per life-year gained or $69,920 per quality-adjusted life-year gained for the 50-year-old cohort and $23,734 per life-year gained or $48,328 per quality-adjusted life-year gained for the 40-year-old cohort. In probabilistic sensitivity analysis, the seven-gene test strategy cost less than $100,000 per life-year gained in 95.7% of the trials for the 50-year-old cohort. Testing seven breast cancer-associated genes, followed by risk-reduction management, could cost-effectively improve life expectancy for women at risk of hereditary breast cancer. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-effectiveness analysis of a patient-centered care model for management of psoriasis.

PubMed

Parsi, Kory; Chambers, Cindy J; Armstrong, April W

2012-04-01

Cost-effectiveness analyses help policymakers make informed decisions regarding funding allocation of health care resources. Cost-effectiveness analysis of technology-enabled models of health care delivery is necessary to assess sustainability of novel online, patient-centered health care models. We sought to compare cost-effectiveness of conventional in-office care with a patient-centered, online model for follow-up treatment of patients with psoriasis. Cost-effectiveness analysis was performed from a societal perspective on a randomized controlled trial comparing a patient-centered online model with in-office visits for treatment of patients with psoriasis during a 24-week period. Quality-adjusted life expectancy was calculated using the life table method. Costs were generated from the original study parameters and national averages for salaries and services. No significant difference existed in the mean change in Dermatology Life Quality Index scores between the two groups (online: 3.51 ± 4.48 and in-office: 3.88 ± 6.65, P value = .79). Mean improvement in quality-adjusted life expectancy was not significantly different between the groups (P value = .93), with a gain of 0.447 ± 0.48 quality-adjusted life years for the online group and a gain of 0.463 ± 0.815 quality-adjusted life years for the in-office group. The cost of follow-up psoriasis care with online visits was 1.7 times less than the cost of in-person visits ($315 vs $576). Variations in travel time existed among patients depending on their distance from the dermatologist's office. From a societal perspective, the patient-centered online care model appears to be cost saving, while maintaining similar effectiveness to standard in-office care. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Defining the urban area for cross national comparison of health indicators: the EURO-URHIS 2 boundary study.

PubMed

Higgerson, James; Birt, Christopher A; van Ameijden, Erik; Verma, Arpana

2017-05-01

Despite much research focusing on the impact of the city condition upon health, there still remains a lack of consensus over what constitutes an urban area (UA). This study was conducted to establish comparable boundaries for the UAs participating in EURO-URHIS 2, and to test whether the sample reflected the heterogeneity of urban living. Key UA contacts ( n = 28) completed a cross-sectional questionnaire, which included where available comparison between Urban Audit city and larger urban zone (LUZ) boundaries and public health administration areas (PHAAs). Additionally, broad health and demographic indicators were sought to test for heterogeneity of the EURO-URHIS 2 sample. Urban Audit city boundaries were found to be suitable for data collection in 100% ( n = 21) of UAs where Urban Audit data were available. The remainder ( n = 7) identified PHAA boundaries akin to the 'city' level. Heterogeneity was observed in the sample for population size and infant mortality rate. Heterogeneity could not be established for male and female life expectancy. This study was able to establish comparable boundaries for EURO-URHIS 2 data collection, with the 'city' area being selected for data collection. The homogeneity of life expectancy indicators was reflective of sub-regional similarities in life expectancy, whilst population estimates and rates of infant mortality indicated the presence of heterogeneity within the sample. Future work would trial these methods with a larger number of indicators and for a larger number of UAs. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Violence deaths and its impact on life expectancy: a comparison between Mexico and Brazil.

PubMed

González-Pérez, Guillermo Julián; Vega-López, María Guadalupe; Souza, Edinilsa Ramos de; Pinto, Liana Wernersbach

2017-09-01

Using official data, this study analyzed violent deaths (homicide, suicide, events of undetermined intent and deaths due to legal intervention) in Brazil and Mexico in the three-year periods 2002-2004 and 2012-14, the impact of these causes of death on life expectancy in both countries and the role of the different age groups in years of life expectancy lost (YLEL). Abridged life tables were constructed for both countries for both periods. Temporary life expectancy and YLEL between zero and 80 years by selected causes and age groups were calculated for each triennium. The leading cause of YLEL among men was homicide in both periods in Brazil (1.5 years) and in the second period in Mexico (one year). Violent deaths (VD) accounted for around 16% of YLEL in Brazil and 13% in Mexico in 2012-2014. Among women, YLEL due to homicides and suicides showed the greatest relative increase in both countries, although VD accounted for barely 3% of total YLEL. The highest percentage of YLEL due to VDwas found among the 15 to 29 year age groups in both countries and for both sexes. The increase in rates of VD in Mexico, above all among young people, has curbed further increases in life expectancy in recent years, especially among men. Likewise, the high rates of VD in Brazil in both periods have hindered the growth of life expectancy.

Faster Increases in Human Life Expectancy Could Lead to Slower Population Aging

PubMed Central

2015-01-01

Counterintuitively, faster increases in human life expectancy could lead to slower population aging. The conventional view that faster increases in human life expectancy would lead to faster population aging is based on the assumption that people become old at a fixed chronological age. A preferable alternative is to base measures of aging on people’s time left to death, because this is more closely related to the characteristics that are associated with old age. Using this alternative interpretation, we show that faster increases in life expectancy would lead to slower population aging. Among other things, this finding affects the assessment of the speed at which countries will age. PMID:25876033

Patient Perspectives on Engagement in Recovery after Hip Fracture: A Qualitative Study

PubMed Central

Stott-Eveneshen, Sarah; Fleig, Lena; McAllister, Megan; Ashe, Maureen C.

2017-01-01

Purpose. To understand older adults' engagement in their recovery experience and rehabilitation after a fall-related hip fracture. Method. 50 community-dwelling older adults recovering from a recent (3–12 months) hip fracture (32 women, 18 men) participated in telephone interviews using a semistructured format at 6 and 12 months after recruitment into the study. Interviews were conducted as part of a mixed-methods study designed to test the effect of a postoperative hip fracture management program (B4 Clinic). Results. Three substantive themes were identified in the qualitative data: (1) managing expectations; (2) engaging in physical activity; and (3) there is life after fracture. Participants shared valuable insight into how their expectations for their recovery period compared to their lived experience and the role of physical activity in their ability to return to their prefracture activities. Conclusions. Our findings reflect older adults' expectations for recovery from hip fracture. Encouraging engagement in rehabilitative exercises and addressing expectations prior to hospital discharge may improve patients' adherence to rehabilitation programs, functional outcomes, and postoperative quality of life. Implications for rehabilitation include the necessity for early and ongoing engagement of rehabilitation professionals. PMID:28409031

The effect of smoking on the healthy life expectancy of Palestinian men in the West Bank: a cross-sectional study.

PubMed

Brønnum-Hansen, Henrik; Jonassen, Marie; Shaheen, Amira; Duraidi, Mohammed; Qalalwa, Khaled; Jeune, Bernard

2018-02-21

The high prevalence of smoking (40%) in men living in the West Bank of the occupied Palestinian territory is a major challenge for the Palestinian health authorities. The aim of this study was to estimate life expectancy and the average lifetime with and without chronic disease in men living in the West Bank who had never smoked, were ex-smokers, or were smokers. We used a life table for the male population in the West Bank and Danish relative risk estimates for death for smokers and ex-smokers versus never smokers and data from the 2010 Palestinian Family Survey. We estimated expected life time with and without chronic disease, and the contributions from the mortality and morbidity effects to smoking-related differences in average lifetime with and without chronic disease were assessed by decomposition. The life expectancy of a Palestinian man aged 15 years who would never start smoking was 59·5 years, of which 41·1 years (95% CI 40·3-41·9) were expected to be without chronic disease. Ex-smokers could expect 57·9 years of remaining life time, 37·7 years (35·9-39·4) of which would be without chronic disease. For life-long heavy smokers, the expected lifetime was 52·6 years, of which 38·5 years (37·3-39·7) would be without chronic disease. Of the total loss of 6·9 years of life expectancy in heavy smokers, the mortality effect accounted for 2·5 years without disease and 4·4 years with disease, whereas the morbidity effect was negligible. The morbidity component of the decomposition accounted for 1·7 years with disease for moderate smokers and 2·9 years without disease for ex-smokers. The high prevalence of smoking causes a considerable loss of life-years and life time without chronic disease. We recommend that the Palestinian health authorities enforce an anti-smoking law. None. Copyright © 2018 Elsevier Ltd. All rights reserved.

A varied pattern of change of the sex differential in survival in the G7 countries.

PubMed

Trovato, Frank; Heyen, Nils B

2006-05-01

Over the course of the 20th century the sex differential in life expectancy at birth in the industrialized countries has widened considerably in favour of women. Starting in the early 1970s, the beginning of a reversal in the long-term pattern of this differential has been noted in some high-income countries. This study documents a sustained pattern of narrowing of this measure into the later part of the 1990s for six of the populations that comprise the G7 countries: Canada, France, Germany, Italy, England and Wales (as representative of the United Kingdom) and USA. For Japan, a persistence of widening sex differences in survival is noted. The sex differences in life expectancy are decomposed over roughly three decades (early 1970s to late 1990s) from the point of view of four major cause-of-death categories: circulatory diseases, cancers, accidents/violence/suicide, and 'other' (residual) causes. In the six countries where the sex gap has narrowed, this has resulted primarily from reduced sex differences in circulatory disease mortality, and secondarily from reduced differences in male and female death rates due to accidents, violence and suicide combined. In some of the countries sex differentials in cancer mortality have been converging lately, and this has also contributed to a narrowing of the difference in life expectancy. In Japan, males have been less successful in reducing their survival disadvantage in relation to Japanese women with regard to circulatory disease and cancer; and in the case of accidents/violence/suicide, male death rates increased during the 1990s. These trends explain the divergent pattern of the sex difference in life expectation in Japan as compared with the other G7 nations.

Welfare state regimes and population health: integrating the East Asian welfare states.

PubMed

Abdul Karim, Syahirah; Eikemo, Terje A; Bambra, Clare

2010-01-01

Epidemiological studies have consistently shown that population health varies significantly by welfare state regime. However, these studies have focused exclusively on the welfare states of Europe, North America and Australasia. This focus ignores the existence of welfare states in other parts of the world, specifically in East Asia. This study therefore investigates whether the association between population health (Infant Mortality Rates and Life Expectancy at birth) and welfare state regimes is still valid when the welfare states of East Asia are added into the analysis. It also examines whether population health is worse in the East Asian welfare states. Infant Mortality Rates and Life Expectancy at birth as well as GDP per capita and social and health expenditures as a percentage of GDP were examined in 30 welfare states, categorised into six different regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern, Eastern European and East Asian). ANOVA analysis showed significant differences by welfare state regime in the magnitude of IMR, LE, SE, HE and GDP per capita. However, when controlling for GDP per capita in the ANCOVA analyses, only Life Expectancy (R(2)=0.58, adjusted R(2)=0.47, p<0.05) and Social Expenditure (R(2)=0.70, adjusted R(2)=0.61, p<0.05) differed significantly by welfare state regime. 47% of the variation in Life Expectancy was explained by welfare state regime type. Further, the East Asian welfare states did not have the worst health outcomes. The study concludes by highlighting the need to expand comparative health analysis both in terms of the range of countries examined and also in terms of incorporating other societal and public health factors-towards a 'public health regime' analysis.

Quality of life following liver transplantation: a comparative study between Familial Amyloid Neuropathy and liver disease patients

PubMed Central

2009-01-01

Background It has been demonstrated in many studies that quality of life can be improved after liver transplantation in patients with liver disease. Nevertherless quality of life improvement in specific groups of transplantated patients such as those with Familial Amyloid Polineuropathy hasn't yet been explored. The present study aimed to compare the change in quality of life following liver transplantation between patients with Familial Amyloid Polineuropathy (FAP) and patients with liver disease. Results Patient's mental quality of life showed an improvement in all liver disease patients, and a worsening in FAP patients, resulting in a significant difference between the two groups. Regarding physical quality of life, although a similar improvement was seen in both groups, FAP patients had significantly less improvement than the sub-group of decompensated liver disease (Child-Pugh B and C). Conclusion It is concluded that liver transplantation has a less beneficial impact in FAP patient's physical quality of life, probably because they are not so much disabled by their disease at the moment of liver transplantation. The lesser improvement in mental quality of life of FAP patients may be due to their particular psychological profile and greater expectations towards transplantation. PMID:19604387

Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero, One and Five in India: A Decomposition Analysis.

PubMed

Dubey, Manisha; Ram, Usha; Ram, Faujdar

2015-01-01

Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover. We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981-2009 for 16 Indian states by sex (comprising of India's 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover. India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women). For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1-59 months in high child mortality areas can help India to attain this crossover early.

Renal Mass Biopsy to Guide Treatment Decisions for Small Incidental Renal Tumors: A Cost-effectiveness Analysis1

PubMed Central

Gervais, Debra A.; Hartman, Rebecca I.; Harisinghani, Mukesh G.; Feldman, Adam S.; Mueller, Peter R.; Gazelle, G. Scott

2010-01-01

Purpose: To evaluate the effectiveness, cost, and cost-effectiveness of using renal mass biopsy to guide treatment decisions for small incidentally detected renal tumors. Materials and Methods: A decision-analytic Markov model was developed to estimate life expectancy and lifetime costs for patients with small (≤4-cm) renal tumors. Two strategies were compared: renal mass biopsy to triage patients to surgery or imaging surveillance and empiric nephron-sparing surgery. The model incorporated biopsy performance, the probability of track seeding with malignant cells, the prevalence and growth of benign and malignant tumors, treatment effectiveness and costs, and patient outcomes. An incremental cost-effectiveness analysis was performed to identify strategy preference under a willingness-to-pay threshold of $75 000 per quality-adjusted life-year (QALY). Effects of changes in key parameters on strategy preference were evaluated in sensitivity analysis. Results: Under base-case assumptions, the biopsy strategy yielded a minimally greater quality-adjusted life expectancy (4 days) than did empiric surgery at a lower lifetime cost ($3466), dominating surgery from a cost-effectiveness perspective. Over the majority of parameter ranges tested in one-way sensitivity analysis, the biopsy strategy dominated surgery or was cost-effective relative to surgery based on a $75 000-per-QALY willingness-to-pay threshold. In two-way sensitivity analysis, surgery yielded greater life expectancy when the prevalence of malignancy and propensity for biopsy-negative cancers to metastasize were both higher than expected or when the sensitivity and specificity of biopsy were both lower than expected. Conclusion: The use of biopsy to guide treatment decisions for small incidentally detected renal tumors is cost-effective and can prevent unnecessary surgery in many cases. © RSNA, 2010 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10092013/-/DC1 PMID:20720070

[Influence of venom immunotherapy on anxiety level of being re-stung].

PubMed

Sacha, Małgorzata; Czarnobilska, Ewa; Stobiecki, Marcin; Dyga, Wojciech

2012-01-01

Hymenoptera venom allergy is related to higher risk of potential life -threatening anaphylactic reactions, which leads to anxiety and decreased quality of life. The aim of this paper was: 1) estimation of fear level of being re-stung among venom allergy adults treated with venom specific immunotherapy (VIT)--before and during treatment; 2) estimation of expectation of outcome of VIT as compared to level of anxiety of being re-strug, in the Visual Analogue Scale--VAS score; 3) identification of factors influencing changes in the fear level among patients during VIT. The study group comprised 42 patients (18 women, 24 men) in the mean age 42.6 years, with bee or vespid allergy, who had been qualified to the VIT treatment with Alutard SQ. Visual Analogue Scale--VAS and the Expectation of Outcome Questionnaire were used. The demographic data were collected. The VAS score before VIT for insect venom allergic patients was 8.8 (SD = 0.9). It decreased after achieving maintenance dose to 3.1 (SD = 1.6) and was significantly lower in men (p < 0.05). Score achieved in the Expectation of Outcome Questionnaire was for each question 2.2 (SD = 1.5) and there was correlation with VAS score during VIT. The patients with insect venom allergy, who undergo a serious allergic reaction (SR) as a result of being stung and who are qualified to VIT, have a high level of anxiety of being re-stung. Achieving the maintenance dose of VIT, results in a significant decrease of anxiety level in women and men, significantly so in men. There is a significant correlation between VAS score and the Expectation of Outcome Questionnaire results during VIT. Both VAS for anxiety level and the Expectation of Outcome Questionnaire can be simple, easily available and useful instruments helping to estimate quality of life. VIT significantly decreases the patients level of anxiety of being restung and improves their quality of life.

"Healthy" Human Development Indices

ERIC Educational Resources Information Center

Engineer, Merwan; Roy, Nilanjana; Fink, Sari

2010-01-01

In the Human Development Index (HDI), life expectancy is the only indicator used in modeling the dimension "a long and healthy life". Whereas life expectancy is a direct measure of quantity of life, it is only an indirect measure of healthy years lived. In this paper we attempt to remedy this omission by introducing into the HDI the morbidity…

Social Cognitive Predictors of Interest in Research Among Life Sciences Academics

NASA Astrophysics Data System (ADS)

Sawitri, Dian R.; Nurtjahjanti, Harlina; Prasetyo, Anggun R.

2018-02-01

Research interest is the degree to which an individual is interested in conducting research-related activities. Nowadays, Indonesian higher education academics are expected to be research productive, especially those in life sciences. However, what predicts interest in research among life sciences academics is rarely known. We surveyed 240 life sciences academics (64.6% female, mean age = 31.91 years) from several higher degree institutions in Indonesia, using interest in research, research self-efficacy, and research outcome expectations questionnaires. We used social cognitive career theory which proposes that individual’s interests are the results of the interaction between one’s self-efficacy beliefs and outcome expectations overtime. Structural equation modelling demonstrated that research self-efficacy was directly and indirectly associated with interest in research via research outcome expectations. Understanding the social cognitive predictors of interest in research contributes to an understanding of the associations between research self-efficacy, outcome expectations, and interest in research. Recommendations for life sciences academics, faculties, and higher education institutions are discussed.

Life expectancies for individuals with psychiatric diagnoses.

PubMed

Hannerz, H; Borgå, P; Borritz, M

2001-09-01

The aim of the study was to estimate life expectancies in different diagnostic groups for individuals treated as inpatients at Swedish psychiatric clinics. All individuals, older than 18 y and alive on the first of January 1983, who had been registered in the National Hospital Discharge Registry by a psychiatric clinic in 1978-82, were monitored for mortality during 1983 by using the National Cause of Death Registry. The study group consisted of 91 385 men and 77 217 women. The patients were divided into nine diagnostic groups according to the principal diagnosis registered at the latest discharge. Actuarial mathematics was used to construct life expectancy tables, which present the number of years expected to live, by gender and diagnostic group. Expectancies of life were significantly shortened for both genders and in all nine diagnostic groups (with one exception). Mental disorders in general are life shortening. This fact should be recognised in community health when setting health priorities. It should also be addressed in curricula as well as in treatment and preventive programmes.

The cultural life script of Qatar and across cultures: effects of gender and religion.

PubMed

Ottsen, Christina Lundsgaard; Berntsen, Dorthe

2014-01-01

Cultural life scripts (CLS) are culturally shared cognitive representations of the expected order and timing of important life events in a prototypical life. Through three studies data from Qatar were analysed and compared to previously collected data from Denmark, Turkey, and the US. In Study 1 we examined the CLS of Qatar in order to determine whether the clear segregation of men and women as well as the centrality of religion in this society would influence the CLS. A total of 55 Qatari undergraduates completed the standard CLS task, imaging a Qatari infant of their own as well as the opposite gender. In Study 2 important personal life story events were collected from 83 Qatari undergraduates in order to explore the overlap between remembered life events and CLS events. Study 3 was a reanalysis of CLS data from Denmark, Turkey, and the US. There was a considerable overlap of events across cultures, but we also found that the Qatari CLS showed more gender differences and contained more religious and positive events compared to the other three countries.

Quality of life and personality traits in patients with colorectal cancer.

PubMed

Glavić, Zeljko; Galić, Slavka; Krip, Marija

2014-06-01

The aim of this study was to determine whether it is possible to predict quality of life in patients with colorectal cancer on the basis of personality dimensions from the Five-factor model. The study included 56 patients with colorectal cancer (40 men and 16 women), aged 48-87. The following instruments were used: the Questionnaire on General Information and Lifestyle Habits, the Quality of Life Scale, and the Neo Five-Factor Inventory. The results of overall quality of life estimations of colorectal cancer patients were comparable to those of healthy people. Contrary to expectations, extraversion was not a significant quality of life predictor. Neuroticism as a personality trait was the only variable which consistently proved to be highly significant across analyses in the prediction of total quality of life, satisfaction with past life, future expectations, and comparison with others. Key determinants of neuroticism are a proneness to experiencing negative affects which makes adaptation difficult, a proneness to irrational ideas, reduced impulse control, ineffective coping strategies, the perception of poor control over oneself and others, and deeming one's own resources to be insufficient to adequately cope with stress, thus resulting in a more negative quality of life estimation. These results support the conclusion that cognitive-behavioral interventions aimed at changing negative attributions, reducing tension and negative affects, acquiring more effective coping strategies, strengthening perceived personal control, redefining and re-conceptualizing quality of life, and seeking/receiving more adequate social support could lead to an improved quality of life in patients with colorectal cancer.

Life history strategies of fish species and biodiversity in eastern USA streams

USGS Publications Warehouse

Meador, Michael R.; Brown, Larry M.

2015-01-01

Predictive models have been used to determine fish species that occur less frequently than expected (decreasers) and those that occur more frequently than expected (increasers) in streams in the eastern U.S. Coupling life history traits with 51 decreaser and 38 increaser fish species provided the opportunity to examine potential mechanisms associated with predicted changes in fish species distributions in eastern streams. We assigned six life history traits – fecundity, longevity, maturation age, maximum total length, parental care, and spawning season duration – to each fish species. Decreaser species were significantly smaller in size and shorter-lived with reduced fecundity and shorter spawning seasons compared to increaser species. Cluster analysis of traits revealed correspondence with a life history model defining equilibrium (low fecundity, high parental care), opportunistic (early maturation, low parental care), and periodic (late maturation, high fecundity, low parental care) end-point strategies. Nearly 50 % of decreaser species were associated with an intermediate opportunistic-periodic strategy, suggesting that abiotic factors such as habitat specialization and streamflow alteration may serve as important influences on life history traits and strategies of decreaser species. In contrast, the percent of increaser species among life history strategy groups ranged from 21 to 32 %, suggesting that life history strategies of increaser species were more diverse than those of decreaser species. This study highlights the utility of linking life history theory to biodiversity to better understand mechanisms that contribute to fish species distributions in the eastern U.S.

Job stressors and coping in health professions.

PubMed

Heim, E

1991-01-01

In spite of their knowledge about stressors, health hazards and coping, health professionals are in general not aware of their own health risks. In an attempt to clarify the issue results of our own studies are compared to the relevant literature. A survey on 1,248 Swiss nurses confirmed the major stressors known: ethical conflicts about appropriate patient care, team conflicts, role ambiguity, workload and organizational deficits. In doctors workload and shortage of time, combined with specific responsibility in decision making, are most prominent. Nevertheless, job satisfaction is still high in both professions. Health hazards in doctors are considerable, although life expectancy has improved and is comparable to the general public, but still lower as compared to other professionals. Depression and substance abuse are related to higher suicide rates. The specific role strain of female doctors is responsible for health risks with an alarming 10 years lower life expectancy than in the general population. Little is known about specific health hazards in nurses, except for burnout. A lack of coping research in the field makes conclusions difficult. Our own studies show limited coping skills in nurses, but good buffering effect in 1,700 Swiss dentists.

Diverging Life Expectancies and Voting Patterns in the 2016 US Presidential Election

PubMed Central

2017-01-01

Objectives. To assess whether voting patterns in the 2016 US presidential election were correlated with long-run trends in county life expectancy. Methods. I examined county-level voting data from the 2008 and 2016 presidential elections and assessed Donald Trump’s share of the 2016 vote, change in the Republican vote share between 2008 and 2016, and changes in absolute numbers of Democratic and Republican votes. County-level estimates of life expectancy at birth were obtained for 1980 and 2014 from the Institute for Health Metrics and Evaluation. Results. Changes in county life expectancy from 1980 to 2014 were strongly negatively associated with Trump’s vote share, with less support for Trump in counties experiencing greater survival gains. Counties in which life expectancy stagnated or declined saw a 10-percentage-point increase in the Republican vote share between 2008 and 2016. Conclusions. Residents of counties left out from broader life expectancy gains abandoned the Democratic Party in the 2016 presidential election. Since coming to power, the Trump administration has proposed cuts to health insurance for the poor, social programs, health research, and environmental and worker protections, which are key determinants of population health. Health gaps likely will continue to widen without significant public investment in population health. PMID:28817322

Mortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden

PubMed Central

Westman, J; Wahlbeck, K; Laursen, T M; Gissler, M; Nordentoft, M; Hällgren, J; Arffman, M; Ösby, U

2015-01-01

Objective To analyse mortality and life expectancy in people with alcohol use disorder in Denmark, Finland and Sweden. Method A population-based register study including all patients admitted to hospital diagnosed with alcohol use disorder (1 158 486 person-years) from 1987 to 2006 in Denmark, Finland and Sweden. Results Life expectancy was 24–28 years shorter in people with alcohol use disorder than in the general population. From 1987 to 2006, the difference in life expectancy between patients with alcohol use disorder and the general population increased in men (Denmark, 1.8 years; Finland, 2.6 years; Sweden, 1.0 years); in women, the difference in life expectancy increased in Denmark (0.3 years) but decreased in Finland (−0.8 years) and Sweden (−1.8 years). People with alcohol use disorder had higher mortality from all causes of death (mortality rate ratio, 3.0–5.2), all diseases and medical conditions (2.3–4.8), and suicide (9.3–35.9). Conclusion People hospitalized with alcohol use disorder have an average life expectancy of 47–53 years (men) and 50–58 years (women) and die 24–28 years earlier than people in the general population. PMID:25243359

Cost-effectiveness analysis of lopinavir/ritonavir and atazanavir+ritonavir regimens in the CASTLE study.

PubMed

Simpson, Kit N; Rajagopalan, Rukmini; Dietz, Birgitta

2009-02-01

The purpose of the study was to conduct a cost-effectiveness analysis and budget impact analysis comparing lopinavir with ritonavir (LPV/r) and atazanavir plus ritonavir (ATV+RTV) for antiretroviral-naïve patients with a baseline CD4+ T-cell distribution and total cholesterol (TC) profile as reported in the CASTLE study. This decision analysis study used a previously published Markov model of HIV disease, incorporating coronary heart disease (CHD) events to compare the short- and long-term budget impacts and CHD consequences expected for the two regimens. Patients were assumed to have a baseline CHD risk of 4.6% (based on demographic data) and it was also assumed that 50% of the population in the CASTLE study were smokers. The CHD risk differences (based on percent of patients with TC >240 mg/dL) in favor of ATV+RTV resulted in an average improvement in life expectancy of 0.031 quality-adjusted life years (QALYs) (11 days), and an incremental cost-effectiveness ratio of $1,409,734/QALY. Use of the LPV/r regimen saved $24,518 and $36,651 at 5 and 10 years, respectively, with lifetime cost savings estimated at $38,490. A sensitivity analysis using a cohort of all smokers on antihypertensive medication estimated an average improvement in life expectancy of 31 quality-adjusted days in favor of ATV+RTV, and a cost-effectiveness ratio of $520,861/QALY: a ratio that is still above the acceptable limit within the US. The use of an LPV/r-based regimen in antiretroviral-naïve patients with a baseline CHD risk similar to patients in the CASTLE study appears to be a more cost-effective use of resources compared with an ATV+RTV-based regimen. The very small added CHD risk predicted by LPV/r treatment is more than offset by the substantial short- and long-term cost savings expected with the use of LPV/r in antiretroviral-naïve individuals with average to moderately elevated CHD risk.

Correlated genetic effects on reproduction define a domestication syndrome in a forest tree

PubMed Central

Santos-del-Blanco, Luis; Alía, Ricardo; González-Martínez, Santiago C; Sampedro, Luis; Lario, Francisco; Climent, José

2015-01-01

Compared to natural selection, domestication implies a dramatic change in traits linked to fitness. A number of traits conferring fitness in the wild might be detrimental under domestication, and domesticated species typically differ from their ancestors in a set of traits known as the domestication syndrome. Specifically, trade-offs between growth and reproduction are well established across the tree of life. According to allocation theory, selection for growth rate is expected to indirectly alter life-history reproductive traits, diverting resources from reproduction to growth. Here we tested this hypothesis by examining the genetic change and correlated responses of reproductive traits as a result of selection for timber yield in the tree Pinus pinaster. Phenotypic selection was carried out in a natural population, and progenies from selected trees were compared with those of control trees in a common garden experiment. According to expectations, we detected a genetic change in important life-history traits due to selection. Specifically, threshold sizes for reproduction were much higher and reproductive investment relative to size significantly lower in the selected progenies just after a single artificial selection event. Our study helps to define the domestication syndrome in exploited forest trees and shows that changes affecting developmental pathways are relevant in domestication processes of long-lived plants. PMID:25926884

Lifetime costs for peritoneal dialysis and hemodialysis in patients in Taiwan.

PubMed

Kao, Tze-Wah; Chang, Yu-Yin; Chen, Pau-Chung; Hsu, Chih-Cheng; Chang, Yu-Kang; Chang, Yu-Hung; Lee, Lukas Jyuhn-Hsiarn; Wu, Kwan-Dun; Tsai, Tun-Jun; Wang, Jung-Der

2013-01-01

This study compared the lifetime costs for peritoneal dialysis (PD) and hemodialysis (HD) patients in Taiwan. Using the National Health Insurance (NHI) database of all end-stage renal disease patients on maintenance dialysis registered from July 1997 to December 2005, we matched eligible PD patients with eligible HD patients on age, sex, and diabetes status. The matched patients were followed until 31 December 2006. Patients were excluded if they were less than 18 years of age, had been diagnosed with cancer before dialysis, or had been dialyzed at centers or clinics other than hospitals. Outcomes-including life expectancy, total lifetime costs, and costs per life-year paid by the NHI-were estimated and compared. The 3136 pairs of matched PD and HD patients had a mean age of 53.2 ± 15.4 years. The total lifetime cost for PD patients (US$139 360 ± US$8 336) was significantly lower than that for HD patients (US$185 235 ± US$9 623, p < 0.001). Except for patients with diabetes (who had a short life expectancy), the total lifetime cost was significantly lower for PD patients than for HD patients regardless of sex and age (p < 0.01). In Taiwan, the total lifetime costs paid by the NHI were lower for PD than for HD patients.

[Impact of homicide on male life expectancy in Mexico].

PubMed

González-Pérez, Guillermo Julián; Vega-López, María Guadalupe; Cabrera-Pivaral, Carlos Enrique

2012-11-01

To determine the impact of homicide on male life expectancy in Mexico and its 32 states during the three-year periods 1998-2000 and 2008-2010 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. Based on official death and population data, abridged tables for male mortality in Mexico as a whole and its states were created for the three-year periods studied. Health-adjusted life expectancy and YLEL for men aged 15 to 75 were calculated by selected causes (homicide, diabetes mellitus, and traffic accidents) and age groups in each three-year period. In the years between the 1998-2000 and 2008-2010 periods, YLEL due to homicide increased both nationally and in 19 states. In four states, the YLEL in 2008-2010 exceeded two, with the state of Chihuahua standing out at 5.2 years. In 14 of the 18 states where health-adjusted life expectancy among men declined between the two three-year periods, the YLEL due to homicide increased. From 2008 to 2010, homicides were the leading cause of YLEL among men aged 20-44. YLEL due to homicide among those aged 15-44 increased between the two three-year periods. The increase in the rate of homicidal violence, especially among young people, is impeding an increase in male life expectancy in Mexico. In several states, such as Chihuahua and Durango, this violence appears to be the main reason for the decline in life expectancy among men aged 15 to 75.

Inferring frail life expectancies in Chicago from daily fluctuations in elderly mortality.

PubMed

Murray, Christian J; Lipfert, Frederick W

2013-07-01

Susceptible sub-populations with existing disease have exhibited stronger relationships between air quality and mortality in time-series studies, but their associated life expectancies have largely been overlooked. Murray and Nelson developed a new time-series model that estimated a small unobserved (frail) sub-population and their resulting life expectancies in Philadelphia, including environment relationships. As a further example in a different geographic area, we used this model with 1987-2000 daily mortality data in Chicago and found a stable frail population at risk of ∼900 persons with a mean life expectancy of ∼11 days; fewer than two daily deaths were associated with air pollution. We considered daily concentrations of CO, NO₂, O₃, PM₁₀ and SO₂, and found PM₁₀ and O₃ to have stronger associations with frail mortality. Our estimates of life expectancy and air pollution and temperature relationships are similar to those found in other studies that used different methods. Temperature was more important than air pollution during the 1995 heat wave, when mortality risks increased dramatically after 2 d exposure and life expectancies decreased to 3-5 d. Modeling this event separately had substantial effects on lagged mortality--air pollution relationships and the population at risk. The premises of the Murray-Nelson model were supported by simultaneously considering an additional subgroup of non-frail individuals; they contributed only ∼1% of total elderly deaths. We conclude that frail life expectancies estimated by the Murray-Nelson model are robust, and that under these conditions non-frail persons have little risk of acute mortality, with or without contributions from air pollution.

Trends in Life Expectancy and Lifespan Variation by Educational Attainment: United States, 1990-2010.

PubMed

Sasson, Isaac

2016-04-01

The educational gradient in life expectancy is well documented in the United States and in other low-mortality countries. Highly educated Americans, on average, live longer than their low-educated counterparts, who have recently seen declines in adult life expectancy. However, limiting the discussion on lifespan inequality to mean differences alone overlooks other dimensions of inequality and particularly disparities in lifespan variation. The latter represents a unique form of inequality, with higher variation translating into greater uncertainty in the time of death from an individual standpoint, and higher group heterogeneity from a population perspective. Using data from the National Vital Statistics System from 1990 to 2010, this is the first study to document trends in both life expectancy and S25--the standard deviation of age at death above 25--by educational attainment. Among low-educated whites, adult life expectancy declined by 3.1 years for women and by 0.6 years for men. At the same time, S25 increased by about 1.5 years among high school-educated whites of both genders, becoming an increasingly important component of total lifespan inequality. By contrast, college-educated whites benefited from rising life expectancy and record low variation in age at death, consistent with the shifting mortality scenario. Among blacks, adult life expectancy increased, and S25 plateaued or declined in nearly all educational attainment groups, although blacks generally lagged behind whites of the same gender on both measures. Documenting trends in lifespan variation can therefore improve our understanding of lifespan inequality and point to diverging trajectories in adult mortality across socioeconomic strata.

Increased Risk Proneness or Social Withdrawal? The Effects of Shortened Life Expectancy on the Expression of Rescue Behavior in Workers of the ant Formica cinerea (Hymenoptera: Formicidae).

PubMed

Miler, Krzysztof; Symonowicz, Beata; Godzińska, Ewa J

2017-01-01

In social insects behavioral consequences of shortened life expectancy include, among others, increased risk proneness and social withdrawal. We investigated the impact of experimental shortening of life expectancy of foragers of the ant Formica cinerea achieved by their exposure to carbon dioxide on the expression of rescue behavior, risky pro-social behavior, tested by means of two bioassays during which a single worker (rescuer) was confronted with a nestmate (victim) attacked by a predator (antlion larva capture bioassay) or immobilized by an artificial snare (entrapment bioassay). Efficacy of carbon dioxide poisoning in shortening life expectancy was confirmed by the analysis of ant mortality. Rescue behavior observed during behavioral tests involved digging around the victim, transport of the sand covering the victim, pulling the limbs/antennae/mandibles of the victim, direct attack on the antlion (in antlion larva capture tests), and snare biting (in entrapment tests). The rate of occurrence of rescue behavior was lower in ants with shortened life expectancy, but that effect was significant only in the case of the entrapment bioassay. Similarly, only in the case of the entrapment bioassay ants with shortened life expectancy displayed rescue behavior after a longer latency and devoted less time to that behavior than ants from the control groups. Our results demonstrated that in ant workers shortened life expectancy may lead to reduced propensity for rescue behavior, most probably as an element of the social withdrawal syndrome that had already been described in several studies on behavior of moribund ants and honeybees.

Mating system, feeding type and ex situ conservation effort determine life expectancy in captive ruminants.

PubMed

Müller, Dennis W H; Lackey, Laurie Bingaman; Streich, W Jürgen; Fickel, Jörns; Hatt, Jean-Michel; Clauss, Marcus

2011-07-07

Zoo animal husbandry aims at constantly improving husbandry, reproductive success and ultimately animal welfare. Nevertheless, analyses to determine factors influencing husbandry of different species are rare. The relative life expectancy (rLE; life expectancy (LE) as proportion of longevity) describes husbandry success of captive populations. Correlating rLE with biological characteristics of different species, reasons for variation in rLE can be detected. We analysed data of 166 901 animals representing 78 ruminant species kept in 850 facilities. The rLE of females correlated with the percentage of grass in a species' natural diet, suggesting that needs of species adapted to grass can be more easily accommodated than the needs of those adapted to browse. Males of monogamous species demonstrate higher rLE than polygamous males, which matches observed differences of sexual bias in LE in free-living populations and thus supports the ecological theory that the mating system influences LE. The third interesting finding was that rLE was higher in species managed by international studbooks when compared with species not managed in this way. Our method facilitates the identification of biological characteristics of species that are relevant for their husbandry success, and they also support ecological theory. Translating these findings into feeding recommendations, our approach can help to improve animal husbandry.

Personalized risk communication for personalized risk assessment: Real world assessment of knowledge and motivation for six mortality risk measures from an online life expectancy calculator.

PubMed

Manuel, Douglas G; Abdulaziz, Kasim E; Perez, Richard; Beach, Sarah; Bennett, Carol

2018-01-01

In the clinical setting, previous studies have shown personalized risk assessment and communication improves risk perception and motivation. We evaluated an online health calculator that estimated and presented six different measures of life expectancy/mortality based on a person's sociodemographic and health behavior profile. Immediately after receiving calculator results, participants were invited to complete an online survey that asked how informative and motivating they found each risk measure, whether they would share their results and whether the calculator provided information they need to make lifestyle changes. Over 80% of the 317 survey respondents found at least one of six healthy living measures highly informative and motivating, but there was moderate heterogeneity regarding which measures respondents found most informative and motivating. Overall, health age was most informative and life expectancy most motivating. Approximately 40% of respondents would share the results with their clinician (44%) or social networks (38%), although the information they would share was often different from what they found informative or motivational. Online personalized risk assessment allows for a more personalized communication compared to historic paper-based risk assessment to maximize knowledge and motivation, and people should be provided a range of risk communication measures that reflect different risk perspectives.

Between 'Pioneers' of the Cardiovascular Revolution and Its 'Late Followers': Mortality Changes in the Czech Republic and Poland Since 1968.

PubMed

Fihel, Agnieszka; Pechholdová, Marketa

2017-01-01

After several decades of stagnation, mortality in most Central European countries started to decrease after 1989. The Czech Republic and Poland were the first former Communist countries in this region to experience a rapid and sustained increase in life expectancy. This study focuses on the trends in cause-of-death mortality that have contributed to the recent progress in these two countries. The analysis is based on the cause-of-death time series (1968-2013) reconstructed in accordance with the 10th ICD revision, which makes the data fully comparable over the full period under study. Actual trends in cause-specific mortality are presented, and age, sex and causes of death components of life expectancy changes are disentangled. In both countries, the reduction in cardiovascular mortality at adult and old ages was crucial for the increase in life expectancy after 1991. Results are discussed in the context of institutional changes that occurred after the fall of Communism, such as the reorientation of health policies and the emergence of non-governmental organizations. Changes in health-related attitudes and behaviours as well as structural changes in societies, notably the rising share of persons with tertiary education, are also discussed.

Are Global and Regional Improvements in Life Expectancy and in Child, Adult and Senior Survival Slowing?

PubMed Central

Hum, Ryan J.; Verguet, Stéphane; Cheng, Yu-Ling; McGahan, Anita M.; Jha, Prabhat

2015-01-01

Improvements in life expectancy have been considerable over the past hundred years. Forecasters have taken to applying historical trends under an assumption of continuing improvements in life expectancy in the future. A linear mixed effects model was used to estimate the trends in global and regional rates of improvements in life expectancy, child, adult, and senior survival, in 166 countries between 1950 and 2010. Global improvements in life expectancy, including both child and adult survival rates, decelerated significantly over the study period. Overall life expectancy gains were estimated to have declined from 5.9 to 4.0 months per year for a mean deceleration of -0.07 months/year2; annual child survival gains declined from 4.4 to 1.6 deaths averted per 1000 for a mean deceleration of -0.06 deaths/1000/year2; adult survival gains were estimated to decline from 4.8 to 3.7 deaths averted per 1000 per year for a mean deceleration of -0.08 deaths/1000/year2. Senior survival gains however increased from 2.4 to 4.2 deaths averted per 1000 per year for an acceleration of 0.03 deaths/1000/year2. Regional variation in the four measures was substantial. The rates of global improvements in life expectancy, child survival, and adult survival have declined since 1950 despite an increase in the rate of improvements among seniors. We postulate that low-cost innovation, related to the last half-century progress in health–primarily devoted to children and middle age, is reaping diminishing returns on its investments. Trends are uneven across regions and measures, which may be due in part to the state of epidemiological transition between countries and regions and disparities in the diffusion of innovation, accessible only in high-income countries where life expectancy is already highest. PMID:25992949

Evaluating the cost-effectiveness of afatinib after platinum-based therapy for the treatment of squamous non-small-cell lung cancer in France

PubMed Central

Pignata, Maud; Chouaid, Christos; Le Lay, Katell; Luciani, Laura; McConnachie, Ceilidh; Gordon, James; Roze, Stéphane

2017-01-01

Background and aims Lung cancer has the highest mortality rate of all cancers worldwide. Non-small-cell lung cancer (NSCLC) accounts for 85% of all lung cancers and has an extremely poor prognosis. Afatinib is an irreversible ErbB family blocker designed to suppress cellular signaling and inhibit cellular growth and is approved in Europe after platinum-based therapy for squamous NSCLC. The objective of the present analysis was to evaluate the cost-effectiveness of afatinib after platinum-based therapy for squamous NSCLC in France. Methods The study population was based on the LUX-Lung 8 trial that compared afatinib with erlotinib in patients with squamous NSCLC. The analysis was performed from the perspective of all health care funders and affected patients. A partitioned survival model was developed to evaluate cost-effectiveness based on progression-free survival and overall survival in the trial. Life expectancy, quality-adjusted life expectancy and direct costs were evaluated over a 10-year time horizon. Future costs and clinical benefits were discounted at 4% annually. Deterministic and probabilistic sensitivity analyses were performed. Results Model projections indicated that afatinib was associated with greater life expectancy (0.16 years) and quality-adjusted life expectancy (0.094 quality-adjusted life years [QALYs]) than that projected for erlotinib. The total cost of treatment over a 10-year time horizon was higher for afatinib than erlotinib, EUR12,364 versus EUR9,510, leading to an incremental cost-effectiveness ratio of EUR30,277 per QALY gained for afatinib versus erlotinib. Sensitivity analyses showed that the base case findings were stable under variation of a range of model inputs. Conclusion Based on data from the LUX-Lung 8 trial, afatinib was projected to improve clinical outcomes versus erlotinib, with a 97% probability of being cost-effective assuming a willingness to pay of EUR70,000 per QALY gained, after platinum-based therapy in patients with squamous NSCLC in France. PMID:29123418

Trifluridine/Tipiracil (TAS-102) in Refractory Metastatic Colorectal Cancer: A Multicenter Register in the Frame of the Italian Compassionate Use Program.

PubMed

Cremolini, Chiara; Rossini, Daniele; Martinelli, Erika; Pietrantonio, Filippo; Lonardi, Sara; Noventa, Silvia; Tamburini, Emiliano; Frassineti, Giovanni Luca; Mosconi, Stefania; Nichetti, Federico; Murgioni, Sabina; Troiani, Teresa; Borelli, Beatrice; Zucchelli, Gemma; Dal Maso, Alessandro; Sforza, Vincenzo; Masi, Gianluca; Antoniotti, Carlotta; Di Bartolomeo, Maria; Miceli, Rosalba; Ciardiello, Fortunato; Falcone, Alfredo

2018-05-08

TAS-102 is indicated for patients with metastatic colorectal cancer (mCRC) previously treated with, or not considered candidates for, available therapies. Given the complete inefficacy in half of patients, the lack of predictive factors, the palliative setting, and the financial and clinical toxicity, optimizing the cost-benefit ratio is crucial. The "ColonLife" nomogram allows an estimate of the 12-week life expectancy of patients with refractory mCRC. We collected data from patients treated at eight Italian centers in the compassionate use program. Baseline characteristics of patients who were or were not progression free at 6 months were compared. The discriminative ability of the ColonLife nomogram was assessed. Among patients who received both TAS-102 and regorafenib, clinical outcomes of the two sequences were compared. This study included 341 patients. Six (2%) and 93 (27%) patients achieved response and disease stabilization, respectively. The median progression-free survival (PFS) was 2.4 months with an estimated 6-month PFS rate of 19%; the median overall survival (OS) was 6.2 months. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 0, normal lactate dehydrogenase (LDH), and a time from the diagnosis of metastatic disease of >18 months were independently associated with higher chances of a patient being progression free at 6 months. The discriminative ability of ColonLife was confirmed. Among 121 patients who received both regorafenib and TAS-102, no differences in first or second PFS or OS were reported between the two sequences. One out of five patients achieves clinical benefit with TAS-102. ECOG PS, LDH, and time from diagnosis of metastatic disease may help to identify these patients. Excluding patients with very short life expectancy appears a reasonable approach. Improving the cost-efficacy ratio of TAS-102 in metastatic colorectal cancer is needed to spare useless toxicities in a definitely palliative setting. Eastern Cooperative Oncology Group performance status, lactate dehydrogenase levels, and time from the diagnosis of metastatic disease may help to identify patients more likely to achieve benefit. Properly designed prognostic tools (i.e., the "ColonLife" nomogram) may enable excluding from further treatments patients with very limited life expectancy. © AlphaMed Press 2018.

Future healthy life expectancy among older adults in the US: a forecast based on cohort smoking and obesity history.

PubMed

Cao, Bochen

2016-01-01

In the past three decades, the elderly population in the United States experienced increase in life expectancy (LE) and disability-free life expectancy (LE(ND)), but decrease in life expectancy with disability (LE(D)). Smoking and obesity are two major risk factors that had negative impacts on these trends. While smoking prevalence continues to decline in recent decades, obesity prevalence has been growing and is currently at a high level. This study aims to forecast the healthy life expectancy for older adults aged 55 to 85 in the US from 2011 to 2040, in relation to their smoking and obesity history. First, population-level mortality data from the Human Mortality Database (HMD) and individual-level disability data from the US National Health Interview Survey (NHIS) were used to estimate the transition rates between different health states from 1982 to 2010, using a multi-state life table (MSLT) model. Second, the estimated transition rates were fitted and projected up to 2040, using a modified Lee-Carter model that incorporates cohort smoking and obesity history from NHIS. Mortality and morbidity for both sexes will continue to decline in the next decades. Relative to 2010, men are expected to have 3.2 years gain in LE(ND) and 0.8 years loss in LE(D). For women, there will be 1.8 years gain in LE(ND) and 0.8 years loss in LE(D). By 2040, men and women are expected to spend respectively 80 % and 75 % of their remaining life expectancy between 55 and 85 disability-free. Smoking and obesity have independent negative impacts on both the survival and disability of the US older population in the coming decades, and are responsible for the present and future gender disparity in mortality and morbidity. Overall, the US older population is expected to enjoy sustained health improvements and compression of disability, largely due to decline in smoking.

Years of life lost due to infectious diseases in Poland

PubMed Central

Bryla, Marek; Dziankowska-Zaborszczyk, Elzbieta; Bryla, Pawel; Pikala, Malgorzata

2017-01-01

Purpose An evaluation of mortality due to infectious diseases in Poland in 1999–2012 and an analysis of standard expected years of life lost due to the above diseases. Methods The study material included a database created on the basis of 5,219,205 death certificates of Polish inhabitants, gathered between 1999 and 2012 and provided by the Central Statistical Office. Crude Death Rates (CDR), Standardized Death Rates (SDR) and Standard Expected Years of Life Lost (SEYLL) due to infectious and parasitic diseases were also evaluated in the study period as well as Standard Expected Years of Life Lost per living person (SEYLLp) and Standard Expected Years of Life Lost per dead person (SEYLLd). Time trends were evaluated with the application of joinpoint models and an annual percentage change in their values. Results Death certificates report that 38,261 people died due to infectious diseases in Poland in the period 1999–2012, which made up 0.73% of the total number of deaths. SDR caused by these diseases decreased, particularly in the male group: Annual Percentage Change (APC = -1.05; 95% CI:-2.0 to -0.2; p<0.05). The most positive trends were observed in mortality caused by tuberculosis (A15-A19) (APC = -5.40; 95% CI:-6.3 to -4.5; p<0.05) and also meningitis, encephalitis, myelitis and encephalomyelitis (G03-G04) (APC = -3.42; 95% CI:-4.7 to -2.1; p<0.05). The most negative mortality trends were observed for intestinal infectious diseases (A00-A09) Annual Average Percentage Change (AAPC = 7.3; 95% CI:3.1 to 11.7; p<0.05). SDR substantially decreased in the first half of the study period, but then significantly increased in the second half. Infectious and parasitic diseases contributed to a loss of around 37,000 standard expected years of life in 1999 and more than 28,000 in 2012. During the study period, the SEYLLp index decreased from 9.59 to 7.39 per 10,000 population and the SEYLLd index decreased from 14.26 to 10.34 years (AAPC = 2.3; 95% CI:-2,9 to -1.7; p<0.05). Conclusions Despite smaller numbers of deaths reported from infectious causes these diseases still represent a serious problem for Poland compared to countries in Western Europe. PMID:28333988

Analysis of dynamic capacity of low-contact-ratio spur gears using Lundberg-Palmgren theory

NASA Technical Reports Server (NTRS)

Coy, J. J.

1975-01-01

A concise mathematical model is developed for surface fatigue life of low-contact-ratio spur gears. The expected fatigue life of the pinion, gear, or gear sets may be calculated from the model. An equation for the dynamic capacity of the gear set was also derived in terms of the transmitted tangential tooth load which will give a 10-percent fatigue life of one million pinion revolutions. The theoretical life was compared with experimental data for a set of VAR AISI 9310 gears operating at a Hertz stress of 1.71X10 to the 9th power newtons per square meter (248,000 psi) and 10 000 revolutions per minute. Good agreement was obtained between the experimental and theoretical surface fatigue life of the gears.

Cost-Effectiveness of Transcatheter Aortic Valve Replacement With a Self-Expanding Prosthesis Versus Surgical Aortic Valve Replacement.

PubMed

Reynolds, Matthew R; Lei, Yang; Wang, Kaijun; Chinnakondepalli, Khaja; Vilain, Katherine A; Magnuson, Elizabeth A; Galper, Benjamin Z; Meduri, Christopher U; Arnold, Suzanne V; Baron, Suzanne J; Reardon, Michael J; Adams, David H; Popma, Jeffrey J; Cohen, David J

2016-01-05

Previous studies of the cost-effectiveness of transcatheter aortic valve replacement (TAVR) have been based primarily on a single balloon-expandable system. The goal of this study was to evaluate the cost-effectiveness of TAVR with a self-expanding prosthesis compared with surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis and high surgical risk. We performed a formal economic analysis on the basis of individual, patient-level data from the CoreValve U.S. High Risk Pivotal Trial. Empirical data regarding survival and quality of life over 2 years, and medical resource use and hospital costs through 12 months were used to project life expectancy, quality-adjusted life expectancy, and lifetime medical costs in order to estimate the incremental cost-effectiveness of TAVR versus SAVR from a U.S. Relative to SAVR, TAVR reduced initial length of stay an average of 4.4 days, decreased the need for rehabilitation services at discharge, and resulted in superior 1-month quality of life. Index admission and projected lifetime costs were higher with TAVR than with SAVR (differences $11,260 and $17,849 per patient, respectively), whereas TAVR was projected to provide a lifetime gain of 0.32 quality-adjusted life-years ([QALY]; 0.41 LY) with 3% discounting. Lifetime incremental cost-effectiveness ratios were $55,090 per QALY gained and $43,114 per LY gained. Sensitivity analyses indicated that a reduction in the initial cost of TAVR by ∼$1,650 would lead to an incremental cost-effectiveness ratio <$50,000/QALY gained. In a high-risk clinical trial population, TAVR with a self-expanding prosthesis provided meaningful clinical benefits compared with SAVR, with incremental costs considered acceptable by current U.S. With expected modest reductions in the cost of index TAVR admissions, the value of TAVR compared with SAVR in this patient population would become high. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement [Medtronic CoreValve U.S. Pivotal Trial]; NCT01240902). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Longevity of outstanding sporting achievers: Mind versus muscle

PubMed Central

Smerdon, David C.; Clarke, Philip M.

2018-01-01

Background While there is strong evidence showing the survival advantage of elite athletes, much less is known about those engaged in mind sports such as chess. This study aimed to examine the overall as well as regional survival of International Chess Grandmasters (GMs) with a reference to the general population, and compare relative survival (RS) of GMs with that of Olympic medallists (OMs). Methods Information on 1,208 GMs and 15,157 OMs, respectively, from 28 countries were extracted from the publicly available data sources. The Kaplan-Meier method was used to estimate the survival rates of the GMs. A Cox proportional hazards model was used to adjust the survival for region, year at risk, age at risk and sex, and to estimate the life expectancy of the GMs. The RS rate was computed by matching each GM or OM by year at risk, age at risk and sex to the life table of the country the individual represented. Results The survival rates of GMs at 30 and 60 years since GM title achievement were 87% and 15%, respectively. The life expectancy of GMs at the age of 30 years (which is near the average age when they attained a GM title) was 53.6 ([95% CI]: 47.7–58.5) years, which is significantly greater than the overall weighted mean life expectancy of 45.9 years for the general population. Compared to Eastern Europe, GMs in North America (HR [95% CI]: 0.51 [0.29–0.88]) and Western Europe (HR [95% CI]: 0.53 [0.34–0.83]) had a longer lifespan. The RS analysis showed that both GMs and OMs had a significant survival advantage over the general population, and there was no statistically significant difference in the RS of GMs (RS [95% CI]: 1.14 [1.08–1.20]) compared to OMs: (RS [95% CI]: 1.09 [1.07–1.11]) at 30 years. Conclusion Elite chess players live longer than the general population and have a similar survival advantage to elite competitors in physical sports. PMID:29723296

Do heads of government age more quickly? Observational study comparing mortality between elected leaders and runners-up in national elections of 17 countries

PubMed Central

Olenski, Andrew R; Abola, Matthew V

2015-01-01

Objectives To determine whether being elected to head of government is associated with accelerated mortality by studying survival differences between people elected to office and unelected runner-up candidates who never served. Design Observational study. Setting Historical survival data on elected and runner-up candidates in parliamentary or presidential elections in Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, New Zealand, Norway, Poland, Spain, Sweden, United Kingdom, and United States, from 1722 to 2015. Participants Elected and runner-up political candidates. Main outcome measure Observed number of years alive after each candidate’s last election, relative to what would be expected for an average person of the same age and sex as the candidate during the year of the election, based on historical French and British life tables. Observed post-election life years were compared between elected candidates and runners-up, adjusting for life expectancy at time of election. A Cox proportional hazards model (adjusted for candidate’s life expectancy at the time of election) considered years until death (or years until end of study period for those not yet deceased by 9 September 2015) for elected candidates versus runners-up. Results The sample included 540 candidates: 279 winners and 261 runners-up who never served. A total of 380 candidates were deceased by 9 September 2015. Candidates who served as a head of government lived 4.4 (95% confidence interval 2.1 to 6.6) fewer years after their last election than did candidates who never served (17.8 v 13.4 years after last election; adjusted difference 2.7 (0.6 to 4.8) years). In Cox proportional hazards analysis, which considered all candidates (alive or deceased), the mortality hazard for elected candidates relative to runners-up was 1.23 (1.00 to 1.52). Conclusions Election to head of government is associated with a substantial increase in mortality risk compared with candidates in national elections who never served. PMID:26666894

Do heads of government age more quickly? Observational study comparing mortality between elected leaders and runners-up in national elections of 17 countries.

PubMed

Olenski, Andrew R; Abola, Matthew V; Jena, Anupam B

2015-12-14

To determine whether being elected to head of government is associated with accelerated mortality by studying survival differences between people elected to office and unelected runner-up candidates who never served. Observational study. Historical survival data on elected and runner-up candidates in parliamentary or presidential elections in Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, New Zealand, Norway, Poland, Spain, Sweden, United Kingdom, and United States, from 1722 to 2015. Elected and runner-up political candidates. Observed number of years alive after each candidate's last election, relative to what would be expected for an average person of the same age and sex as the candidate during the year of the election, based on historical French and British life tables. Observed post-election life years were compared between elected candidates and runners-up, adjusting for life expectancy at time of election. A Cox proportional hazards model (adjusted for candidate's life expectancy at the time of election) considered years until death (or years until end of study period for those not yet deceased by 9 September 2015) for elected candidates versus runners-up. The sample included 540 candidates: 279 winners and 261 runners-up who never served. A total of 380 candidates were deceased by 9 September 2015. Candidates who served as a head of government lived 4.4 (95% confidence interval 2.1 to 6.6) fewer years after their last election than did candidates who never served (17.8 v 13.4 years after last election; adjusted difference 2.7 (0.6 to 4.8) years). In Cox proportional hazards analysis, which considered all candidates (alive or deceased), the mortality hazard for elected candidates relative to runners-up was 1.23 (1.00 to 1.52). Election to head of government is associated with a substantial increase in mortality risk compared with candidates in national elections who never served. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Negative relationship behavior is more important than positive: Correlates of outcomes during stressful life events.

PubMed

Rivers, Alannah Shelby; Sanford, Keith

2018-04-01

When people who are married or cohabiting face stressful life situations, their ability to cope may be associated with two separate dimensions of interpersonal behavior: positive and negative. These behaviors can be assessed with the Couple Resilience Inventory (CRI). It was expected that scales on this instrument would correlate with outcome variables regarding life well-being, stress, and relationship satisfaction. It was also expected that effects for negative behavior would be larger than effects for positive and that the effects might be curvilinear. Study 1 included 325 married or cohabiting people currently experiencing nonmedical major life stressors and Study 2 included 154 married or cohabiting people with current, serious medical conditions. All participants completed an online questionnaire including the CRI along with an alternate measure of couple behavior (to confirm scale validity), a measure of general coping style (to serve as a covariate), and measures of outcome variables regarding well-being, quality of life, perceived stress, and relationship satisfaction. The effects for negative behavior were larger than effects for positive in predicting most outcomes, and many effects were curvilinear. Notably, results remained significant after controlling for general coping style, and scales measuring positive and negative behavior demonstrated comparable levels of validity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Potential Gains in Life Expectancy from Reductions in Leading Causes of Death, Los Angeles County: a Quantitative Approach to Identify Candidate Diseases for Prevention and Burden Disparities Elimination.

PubMed

Ho, Alex; Hameed, Heena; Lee, Alice W; Shih, Margaret

2016-09-01

Despite overall gains in life expectancy at birth among Los Angeles County residents, significant disparities persist across population subgroups. The purpose of this study was to quantify the potential sex- and race/ethnicity-specific gains in life expectancy had we been able to fully or partially eliminate the leading causes of death in Los Angeles County. Complete annual life tables for local residents were generated by applying the same method used for the National Center of Health Statistics US life tables published in 1999. Based on 2010 Los Angeles County mortality records, sex- and race/ethnicity-specific potential gains in life expectancy were calculated using scenarios of 10, 20, 50, and 100 % elimination of 12 major causes of death. Coronary heart disease, the leading cause of death, was found to be most impactful on life expectancy. Its hypothetical full elimination would result in life expectancy gains ranging from 2.2 years among white females to 3.7 years among black males. Gains from complete elimination of lung cancer and stroke ranked second, with almost an additional year of life for each gender. However, marked disparities across racial/ethnic groups were noted from the elimination of several other causes of death, such as homicide, from which the gain among black males exceeded 13 times more than their white counterparts. By differentially targeting specific causes of death in disease prevention, not only can findings of this study aid in efficiently narrowing racial/ethnic disparities, they can also provide a quantitative means to identify and rank priorities in local health policymaking.

Economics in "Global Health 2035": a sensitivity analysis of the value of a life year estimates.

PubMed

Chang, Angela Y; Robinson, Lisa A; Hammitt, James K; Resch, Stephen C

2017-06-01

In "Global health 2035: a world converging within a generation," The Lancet Commission on Investing in Health (CIH) adds the value of increased life expectancy to the value of growth in gross domestic product (GDP) when assessing national well-being. To value changes in life expectancy, the CIH relies on several strong assumptions to bridge gaps in the empirical research. It finds that the value of a life year (VLY) averages 2.3 times GDP per capita for low- and middle-income countries (LMICs) assuming the changes in life expectancy they experienced from 2000 to 2011 are permanent. The CIH VLY estimate is based on a specific shift in population life expectancy and includes a 50 percent reduction for children ages 0 through 4. We investigate the sensitivity of this estimate to the underlying assumptions, including the effects of income, age, and life expectancy, and the sequencing of the calculations. We find that reasonable alternative assumptions regarding the effects of income, age, and life expectancy may reduce the VLY estimates to 0.2 to 2.1 times GDP per capita for LMICs. Removing the reduction for young children increases the VLY, while reversing the sequencing of the calculations reduces the VLY. Because the VLY is sensitive to the underlying assumptions, analysts interested in applying this approach elsewhere must tailor the estimates to the impacts of the intervention and the characteristics of the affected population. Analysts should test the sensitivity of their conclusions to reasonable alternative assumptions. More work is needed to investigate options for improving the approach.

Primary care providers’ perspectives on discontinuing prostate cancer screening

PubMed Central

Pollack, Craig E.; Platz, Elizabeth A.; Bhavsar, Nrupen A.; Noronha, Gary; Green, Gene E.; Chen, Sean; Carter, H. Ballentine

2012-01-01

Background Clinical guidelines recommend against routine prostate specific antigen (PSA) screening in older men and those with lower life expectancies. We examined providers’ decision-making regarding discontinuing PSA screening. Methods We administered a survey of primary providers from a large, university-affiliated primary care practice. Providers were asked about their current screening practices, factors that influence their decision to discontinue screening, and barriers to discontinuing screening. Bivariate and multivariable logistic regression analyses were used to examine whether taking age and/or life expectancy into account and barriers to discontinuing were associated with clinician characteristics and practice styles. Results 88.7% of providers participated in the survey (125 out of 141). Over half (59.3%) took both age and life expectancy into account whereas 12.2% did not consider either in their decisions to discontinue PSA screening. Providers varied with the age they typically stop screening and majority (66.4%) report difficulty in assessing life expectancy. Taking patient age and life expectancy into account was not associated with provider characteristics or practice styles. The most frequently cited barriers to discontinuing PSA screening were patient expectation (74.4%) and time constraints (66.4%). Black providers were significantly less likely than non-black providers to endorse barriers related to time constraints and clinical uncertainty, though these results are limited by the small sample size of black providers. Conclusion Though age and life expectancy often figure prominently in decisions to employ screening, providers face multiple barriers to discontinue PSA routine screening, PMID:22517310

Whale baleen trace element signatures: a predictor of environmental life history?

NASA Astrophysics Data System (ADS)

Wilcox Freeburg, E.; Brault, S.; Mayo, C.; Oktay, S.; Hannigan, R.

2009-12-01

The analysis of trace element composition of biogenic structures (e.g., otoliths, feathers) by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) provides unique insights into the environmental life history of individuals. We studied the trace element chemistry of right whale baleens in an attempt to reconstruct migration patterns. Though much is known about the feeding and breeding habitats of these whales, little is known about the location in which they spend most of their adult years. Baleens, made of keratin, grow continuously and are metabolically inactive. Previous work showed that the stable isotope chemistry along the length of a baleen records changes in diet, such as weaning. Baleen chemistry should, therefore, also record the environmental life history of the individual. Trace metal chemistry along a single baleen plate from a right whale were analyzed by LA-ICP-MS. Semi-quantitative elemental signatures were obtained using NIST 612 (glass standard) and MACS-3 (calcium carbonate standard). These concentrations were then compared for accuracy to acid digested baleen laterally adjacent to the laser ablation site via aqueous ICP-MS. Elemental chemistry was compared to known feeding/breeding locations of the individual (water chemistry). Using these comparisons as well as principal components analysis, life history of the individual was reconstructed. Development of an in-house keratin standard is in progress and is expected to strengthen the confidence in results. Future work is expected to bring a more complete knowledge of right whale wintering habits.

Survival rates among Seventh Day Adventists compared with the general population in Poland.

PubMed

Jedrychowski, W; Tobiasz-Adamczyk, B; Olma, A; Gradzikiewicz, P

1985-01-01

The purpose of the work was to test the hypothesis that the survival rate is higher among the Seventh Day Adventists (SDA) than in the general population of Poland, because of the strictly respected customs adhered to by members of this church community, such as abstinence from smoking and from alcohol. The data on life expectancy in the SDA community covered a total of 236 members of this denomination in Kraków (86 males and 150 females). The survival probability rates were estimated by the life table method, for both men and women separately, and were subsequently compared with the corresponding parameters of the Polish Life Tables. Over a period of 10 years, in which these data were studied, there were 11 deaths in males and 24 deaths in females. Mean age at death was 71.9 years among men and 75.1 among women. The survival curves traced over the age groups of both sexes of SDA members were fairly similar, but they were markedly higher than in the general population of Poland. In the general population the survival rates for people over 40 years old were higher in females than in males, whereas no corresponding sex differences in rates concerning SDA members were observed. The greater benefit in life expectancy is gained in the SDA group in comparison with men in the general population. This is attributable to their abstinence from very harmful habits, otherwise more widespread in this sex group.

The Promise of Prevention: The Effects of Four Preventable Risk Factors on National Life Expectancy and Life Expectancy Disparities by Race and County in the United States

PubMed Central

Danaei, Goodarz; Rimm, Eric B.; Oza, Shefali; Kulkarni, Sandeep C.; Murray, Christopher J. L.; Ezzati, Majid

2010-01-01

Background There has been substantial research on psychosocial and health care determinants of health disparities in the United States (US) but less on the role of modifiable risk factors. We estimated the effects of smoking, high blood pressure, elevated blood glucose, and adiposity on national life expectancy and on disparities in life expectancy and disease-specific mortality among eight subgroups of the US population (the “Eight Americas”) defined on the basis of race and the location and socioeconomic characteristics of county of residence, in 2005. Methods and Findings We combined data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to estimate unbiased risk factor levels for the Eight Americas. We used data from the National Center for Health Statistics to estimate age–sex–disease-specific number of deaths in 2005. We used systematic reviews and meta-analyses of epidemiologic studies to obtain risk factor effect sizes for disease-specific mortality. We used epidemiologic methods for multiple risk factors to estimate the effects of current exposure to these risk factors on death rates, and life table methods to estimate effects on life expectancy. Asians had the lowest mean body mass index, fasting plasma glucose, and smoking; whites had the lowest systolic blood pressure (SBP). SBP was highest in blacks, especially in the rural South—5–7 mmHg higher than whites. The other three risk factors were highest in Western Native Americans, Southern low-income rural blacks, and/or low-income whites in Appalachia and the Mississippi Valley. Nationally, these four risk factors reduced life expectancy at birth in 2005 by an estimated 4.9 y in men and 4.1 y in women. Life expectancy effects were smallest in Asians (M, 4.1 y; F, 3.6 y) and largest in Southern rural blacks (M, 6.7 y; F, 5.7 y). Standard deviation of life expectancies in the Eight Americas would decline by 0.50 y (18%) in men and 0.45 y (21%) in women if these risks had been reduced to optimal levels. Disparities in the probabilities of dying from cardiovascular diseases and diabetes at different ages would decline by 69%–80%; the corresponding reduction for probabilities of dying from cancers would be 29%–50%. Individually, smoking and high blood pressure had the largest effect on life expectancy disparities. Conclusions Disparities in smoking, blood pressure, blood glucose, and adiposity explain a significant proportion of disparities in mortality from cardiovascular diseases and cancers, and some of the life expectancy disparities in the US. Please see later in the article for the Editors' Summary PMID:20351772

Physical occupational exposures and health expectancies in a French occupational cohort

PubMed Central

Head, Jenny; Stenholm, Sari; Singh Chungkham, Holendro; Goldberg, Marcel; Zins, Marie

2017-01-01

Objectives To examine the relationships of strenuous and hazardous working conditions and rotating shifts that involve night working with life expectancy in good perceived health and life expectancy without chronic disease. Methods The sample contained male gas and electricity workers from the French GAZEL cohort (n=13 393). Six measures of physical working conditions were examined: Self-reports from 1989 and 1990 of ergonomic strain, physical danger, rotating shifts that involve night working and perceived physical strain; company records of workplace injuries and a job-exposure matrix of chemical exposures. Partial healthy life expectancies (age 50–75) relating to (1) self-rated health and (2) chronic health conditions, obtained from annual questionnaires (1989–2014) and company records, were estimated using multistate life tables. The analyses were adjusted for social class and occupational grade. Results Participants with physically strenuous jobs and who had experienced industrial injuries had shorter partial life expectancy. More physically demanding and dangerous work was associated with fewer years of life spent in good self-rated health and without chronic conditions, with the exception of shift work including nights, where the gradient was reversed. Conclusions Strenuous and hazardous work may contribute to lost years of good health in later life, which has implications for individuals' quality of life as well as healthcare use and labour market participation. PMID:27655775

Shared Relationship Efficacy of Dyad Can Increase Life Satisfaction in Close Relationships: Multilevel Study

PubMed Central

Ito, Kenichi; Yoshida, Toshikazu

2016-01-01

Characteristics of relationship itself play an important role in determining well-being of individuals who participate in the relationship. We used efficacy expectations mutually shared between close friends or romantic partners as a characteristic of relationship and investigated its impact on their life satisfaction. In Study 1, we conducted a cross-sectional study among 137 pairs of close same-sex friends to test whether the efficacy expectations shared between friends are associated with levels of life satisfaction. In Study 2, we conducted a longitudinal study among 114 heterosexual romantic couples to test predictive validity of the efficacy expectations shared between couples predict levels of life satisfaction 2 month later. In both studies we found a consistent result that as degrees of the efficacy expectations shared between individuals in a relationship increased, the degree of their life satisfaction also increased. Underlying mechanisms that explain how characteristics of relationship itself increase life satisfaction are discussed. PMID:27437946

Mood regulation and quality of life in social anxiety disorder: An examination of generalized expectancies for negative mood regulation

PubMed Central

Sung, Sharon C.; Porter, Eliora; Robinaugh, Donald J.; Marks, Elizabeth H.; Marques, Luana M.; Otto, Michael W.; Pollack, Mark H.; Simon, Naomi M.

2014-01-01

The present study examined negative mood regulation expectancies, anxiety symptom severity, and quality of life in a sample of 167 patients with social anxiety disorder (SAD) and 165 healthy controls with no DSM-IV Axis I disorders. Participants completed the Generalized Expectancies for Negative Mood Regulation Scale (NMR), the Beck Anxiety Inventory, and the Quality of Life Enjoyment and Satisfaction Questionnaire. SAD symptom severity was assessed using the Liebowitz Social Anxiety Scale. Individuals with SAD scored significantly lower than controls on the NMR. Among SAD participants, NMR scores were negatively correlated with anxiety symptoms and SAD severity, and positively correlated with quality of life. NMR expectancies positively predicted quality of life even after controlling for demographic variables, comorbid diagnoses, anxiety symptoms, and SAD severity. Individuals with SAD may be less likely to engage in emotion regulating strategies due to negative beliefs regarding their effectiveness, thereby contributing to poorer quality of life. PMID:22343166

Estimating life expectancies for US small areas: a regression framework

NASA Astrophysics Data System (ADS)

Congdon, Peter

2014-01-01

Analysis of area mortality variations and estimation of area life tables raise methodological questions relevant to assessing spatial clustering, and socioeconomic inequalities in mortality. Existing small area analyses of US life expectancy variation generally adopt ad hoc amalgamations of counties to alleviate potential instability of mortality rates involved in deriving life tables, and use conventional life table analysis which takes no account of correlated mortality for adjacent areas or ages. The alternative strategy here uses structured random effects methods that recognize correlations between adjacent ages and areas, and allows retention of the original county boundaries. This strategy generalizes to include effects of area category (e.g. poverty status, ethnic mix), allowing estimation of life tables according to area category, and providing additional stabilization of estimated life table functions. This approach is used here to estimate stabilized mortality rates, derive life expectancies in US counties, and assess trends in clustering and in inequality according to county poverty category.

Better way to measure ageing in East Asia that takes life expectancy into account.

PubMed

Scherbov, Sergei; Sanderson, Warren C; Gietel-Basten, Stuart

2016-06-01

The aim of the study was to improve the measurement of ageing taking into account characteristics of populations and in particular changes in life expectancy. Using projected life tables, we calculated prospective old age dependency ratios (POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy (RLE) for all countries of East Asia. POADRs grow less rapidly than old age dependency ratios (OADRs). For example, in the Republic of Korea, the OADR is forecast to increase from around 0.1 in 1980 to around 0.8 in 2060, while the POADR is forecast to increase from around 0.1 to 0.4 over the same period. Policy makers may wish to take into account the fact that the increases in measures of ageing will be slower when those measures are adjusted for changes in life expectancy. © 2016 AJA Inc.

Evaluating the Environmental Impacts of a Nano-Enhanced Field Emission Display Using Life Cycle Assessment: A Screening-Level Study

EPA Science Inventory

Carbon nanotube (CNT) field emission displays (FEDs) are currently in the product development stage and are expected to be commercialized in the near future because they offer image quality and viewing angles comparable to a cathode ray tube (CRT) while using a thinner structure,...

Migrant and Seasonal Farmworker Health Objectives for the Year 2000. Document in Progress.

ERIC Educational Resources Information Center

National Migrant Resource Program, Inc., Austin, TX.

Compared to the U.S. population, migrant farmworkers have a low life expectancy, high infant mortality rate, and high incidence of malnutrition and parasitic infection. Drawing on Public Health Service health objectives for the nation, this document proposes farmworker-specific objectives for a health promotion and disease prevention agenda. While…

A Profile of Public School Biology Teachers in the USA.

ERIC Educational Resources Information Center

Lindauer, Ivo E.; Queitzsch, Mary L.

1996-01-01

Uses data from the National Center for Educational Statistics' Schools and Staffing Survey (SASS) to present a profile of biology teachers. Discusses background of biology teachers, preparation in the physical and life sciences, who does the preparation, and expected future trends. Compares data with results reported for chemistry, earth science,…

Excluding Institutionalized Elderly from Surveys: Consequences for Income and Poverty Statistics

ERIC Educational Resources Information Center

Peeters, Hans; Debels, Annelies; Verpoorten, Rika

2013-01-01

Growing life expectancy and changes in financial, marriage and labour markets have placed the income position of the elderly at the center of scientific and political discourse. As a consequence, the last decades witnessed the publication of various influential reports that contained comparative statistics on old age income inequalities on the…

"Color Me Healthy." Risk Reduction for Indian Children through Good Nutrition.

ERIC Educational Resources Information Center

Bode, Frances

Life expectancy among certain American Indian tribes is only 50 years of age as compared with 74.6 years for the general population. Leading causes of death among Indian infants continue to be respiratory, digestive, infective, parasitic disease, and congenital malformations. Child obesity, dental caries, atherosclerosis, iron deficiency anemia,…

Controlling the Climate of Your Schools: Tips On Choosing an HVAC System.

ERIC Educational Resources Information Center

Phelan, John G.

1998-01-01

Provides tips on choosing a school heating/ventilation and air-conditioning system that meets a school's needs and budget. Discusses how to assess a school's needs and offers suggestions for making the final decision. Data tables are provided that compare various systems, including costs, maintenance, and life expectancy. (GR)

The Interest Issues of Gifted Children

ERIC Educational Resources Information Center

Bildiren, Ahmet

2018-01-01

Gifted and talented children show differences in many respects compared to normal developing children. It is expected that these differences may also arise in daily life of all these children. In this research, it is aimed to investigate that whether the responses of three wishes questions of the gifted and talented and normal developing children…

Educational inequalities in mortality by cause of death: first national data for the Netherlands.

PubMed

Kulhánová, Ivana; Hoffmann, Rasmus; Eikemo, Terje A; Menvielle, Gwenn; Mackenbach, Johan P

2014-10-01

Using new facilities for linking large databases, we aimed to evaluate for the first time the magnitude of relative and absolute educational inequalities in mortality by sex and cause of death in the Netherlands. We analyzed data from Dutch Labour Force Surveys (1998-2002) with mortality follow-up 1998-2007 among people aged 30-79 years. We calculated hazard ratios using Cox proportional hazards model, age-standardized mortality rates and partial life expectancy by education. We compared results for the Netherlands with those for other European countries. The relative risk of dying was about two times higher among primary educated men and women as compared to their tertiary educated counterparts, leading to a gap in partial life expectancy of 3.4 years (men) and 2.4 years (women). Inequalities in mortality are similar to those in other countries in North-Western Europe, but inequalities in lung cancer mortality are substantially larger in the Netherlands, particularly among men. The Netherlands has large inequalities in mortality, especially for smoking-related causes of death. These large inequalities require the urgent attention of policy makers.

Family Cultures in The Context of Migration and Ageing.

PubMed

Albert, Isabelle; Coimbra, Stephanie Barros

2017-06-01

Intergenerational family relations are embedded in family cultures which influence how families regulate their relations over the whole life span with regard to key issues, such as autonomy and relatedness, or support exchange and reciprocity, and which may vary inter- and intraculturally. Migrant families undoubtedly face a special situation as values and expectations from the culture of origin and from the host cultural context might differ. Not much is known yet about how migrant families adapt their family cultures to the host cultural context. The present article will focus on aspects of intergenerational family regulation by taking into account family cultures of migrant compared to non-migrant families in a life span perspective. We will illustrate our theoretical outline by presenting first results from the IRMA-study comparing Luxembourgish and Portuguese immigrant families living in Luxembourg. We focus on issues of family cohesion, enmeshment and normative expectations regarding adult children's support for their ageing parents, by drawing both on quantitative questionnaire as well as qualitative interview data. Implications for the experience of ambivalence and conflicts as well as well-being of family members from both generations will be discussed.

[The changing gaps of life expectancy on genders in urban cities of China, from 2005 to 2010].

PubMed

Shen, Jie; Jiang, Qing-wu

2013-07-01

To analyze the gender difference of life expectancy in urban people of China and to explore both age-specific and cause-specific contributions to the changing differences in life expectancy on genders. Data on life expectancy (male and female) and mortality were obtained from the"Annual Statistics of public health in China". Male-female gender difference was analyzed by decomposition methodologies, including age-specific decomposition and the cause-specific decomposition. Women had lived much longer than men in the Chinese urban citizens, with remarkable gains in life expectancy since 2005. Difference in gender reached a peak in 2007, with the gap of 5.3 years. Differences on mortality between men and women in the 60-79 age groups made the largest contribution (42%-47%) to the gap of 6 years on life expectancy in genders. With the widening of the gaps in gender on life expectancy between 2005 and 2007, faster declining of mortality among groups of women in age 0-1 age and over 75 years old groups made the largest contributions. Between 2007 and 2008, along with the reduction of gaps in gender, all the age groups except the 1-15 and 50-55 year-olds showed negative efforts. In 2009-2010, the widening gaps in gender on life expectancy were caused by the positive effect in the 60-70 age group. Among all the causes of death, cancer (1.638-2.019 years), circulatory diseases (1.271-1.606 years), respiratory diseases (0.551-0.800 years) made the largest contributions to the gender gap. 33%-38% of the gaps in gender were caused by cancer and among all the cancers, among which lung cancer contributed 0.6 years to the overall gap. Contribution of cancers to the gender gap was reducing, but when time went on it was mostly influenced by the narrowing effect caused by liver cancer on the gap in gender. Traffic accidents and suicidal issues were the external causes that influencing the gender gap and contributing 10.60%-15.78% to the overall differentials. Public health efforts in reducing the excess mortalities for cancer, circulatory and respiratory diseases, suicide, among men in particular, will further narrow the gender gap on life expectancy in the urban cities of China.

Shorter lives in stingier states: Social policy shortcomings help explain the US mortality disadvantage.

PubMed

Beckfield, Jason; Bambra, Clare

2016-12-01

The United States has a mortality disadvantage relative to its political and economic peer group of other rich democracies. Recently it has been suggested that there could be a role for social policy in explaining this disadvantage. In this paper, we test this "social policy hypothesis" by presenting a time-series cross-section analysis from 1970 to 2010 of the association between welfare state generosity (for unemployment insurance, sickness benefits, and pensions) and life expectancy, for the US and 17 other high-income countries. Fixed-effects estimation with autocorrelation-corrected standard errors (robust to unmeasured between-country differences and serial autocorrelation of repeated measures) found strong associations between welfare generosity and life expectancy. A unit increase in overall welfare generosity yields a 0.17 year increase in life expectancy at birth (p < 0.001), and a 0.07 year increase in life expectancy at age 65 (p < 0.001). The strongest effects of the welfare state are in the domain of pension benefits (b = 0.439 for life expectancy at birth, p < 0.001; b = 0.199 for life expectancy at age 65, p < 0.001). Models that lag the measures of social policy by ten years produce similar results, suggesting that the results are not driven by endogeneity bias. There is evidence that the US mortality disadvantage is, in part, a welfare-state disadvantage. We estimate that life expectancy in the US would be approximately 3.77 years longer, if it had just the average social policy generosity of the other 17 OECD nations. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Analysis of air pollution mortality in terms of life expectancy changes: relation between time series, intervention, and cohort studies.

PubMed

Rabl, Ari

2006-02-01

Information on life expectancy change is of great concern for policy makers, as evidenced by the discussions of the so-called "harvesting" issue (i.e. the question being, how large a loss each death corresponds to in the mortality results of time series studies). Whereas most epidemiological studies of air pollution mortality have been formulated in terms of mortality risk, this paper shows that a formulation in terms of life expectancy change is mathematically equivalent, but offers several advantages: it automatically takes into account the constraint that everybody dies exactly once, regardless of pollution; it provides a unified framework for time series, intervention studies and cohort studies; and in time series and intervention studies, it yields the life expectancy change directly as a time integral of the observed mortality rate. Results are presented for life expectancy change in time series studies. Determination of the corresponding total number of attributable deaths (as opposed to the number of observed deaths) is shown to be problematic. The time variation of mortality after a change in exposure is shown to depend on the processes by which the body can repair air pollution damage, in particular on their time constants. Hypothetical results are presented for repair models that are plausible in view of the available intervention studies of air pollution and of smoking cessation. If these repair models can also be assumed for acute effects, the results of cohort studies are compatible with those of time series. The proposed life expectancy framework provides information on the life expectancy change in time series studies, and it clarifies the relation between the results of time series, intervention, and cohort studies.

Income gaps in self-rated poor health and its association with life expectancy in 245 districts of Korea.

PubMed

Kim, Ikhan; Bahk, Jinwook; Yun, Sung-Cheol; Khang, Young-Ho

2017-01-01

To examine the income gaps associated with self-rated poor health at the district level in Korea and to identify the geographical correlations between self-rated poor health, life expectancy, and the associated income gaps. We analyzed data for 1,578,189 participants from the Community Health Survey of Korea collected between 2008 and 2014. The age-standardized prevalence of self-rated poor health and the associated income gaps were calculated. Previously released data on life expectancy and the associated income gaps were also used. We performed correlation and regression analyses for self-rated poor health, life expectancy, and associated income gaps. Across 245 districts, the median prevalence of self-rated poor health was 15.7% (95% confidence interval [CI], 14.6 to 16.8%), with interquartile range (IQR) of 3.1 percentage points (%p). The median interquintile gaps in the prevalence of self-rated poor health was 11.1%p (95% CI, 8.1 to 14.5%p), with IQR of 3.6%p. Pro-rich inequalities in self-rated health were observed across all 245 districts of Korea. The correlation coefficients for the association between self-rated poor health and the associated income gaps, self-rated poor health and life expectancy, and income gaps associated with self-rated poor health and life expectancy were 0.59, 0.78 and 0.55 respectively. Income gaps associated with self-rated poor health were evident across all districts in Korea. The magnitude of income gaps associated with self-rated poor health was larger in the districts with greater prevalence of self-rated poor health. A strong correlation between self-rated poor health and life expectancy was also observed.

Income gaps in self-rated poor health and its association with life expectancy in 245 districts of Korea

PubMed Central

2017-01-01

OBJECTIVES To examine the income gaps associated with self-rated poor health at the district level in Korea and to identify the geographical correlations between self-rated poor health, life expectancy, and the associated income gaps. METHODS We analyzed data for 1,578,189 participants from the Community Health Survey of Korea collected between 2008 and 2014. The age-standardized prevalence of self-rated poor health and the associated income gaps were calculated. Previously released data on life expectancy and the associated income gaps were also used. We performed correlation and regression analyses for self-rated poor health, life expectancy, and associated income gaps. RESULTS Across 245 districts, the median prevalence of self-rated poor health was 15.7% (95% confidence interval [CI], 14.6 to 16.8%), with interquartile range (IQR) of 3.1 percentage points (%p). The median interquintile gaps in the prevalence of self-rated poor health was 11.1%p (95% CI, 8.1 to 14.5%p), with IQR of 3.6%p. Pro-rich inequalities in self-rated health were observed across all 245 districts of Korea. The correlation coefficients for the association between self-rated poor health and the associated income gaps, self-rated poor health and life expectancy, and income gaps associated with self-rated poor health and life expectancy were 0.59, 0.78 and 0.55 respectively. CONCLUSIONS Income gaps associated with self-rated poor health were evident across all districts in Korea. The magnitude of income gaps associated with self-rated poor health was larger in the districts with greater prevalence of self-rated poor health. A strong correlation between self-rated poor health and life expectancy was also observed. PMID:28330335

Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden.

PubMed

Borg, Sixten; Nahi, Hareth; Hansson, Markus; Lee, Dawn; Elvidge, Jamie; Persson, Ulf

2016-05-01

Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. We developed a health-economic discrete event simulation model of a patient's course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (€19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (€81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (€62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental cost-effectiveness ratio is SEK 798 613 (€84 900) per QALY gained. In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.

A non-stationary cost-benefit analysis approach for extreme flood estimation to explore the nexus of 'Risk, Cost and Non-stationarity'

NASA Astrophysics Data System (ADS)

Qi, Wei

2017-11-01

Cost-benefit analysis is commonly used for engineering planning and design problems in practice. However, previous cost-benefit based design flood estimation is based on stationary assumption. This study develops a non-stationary cost-benefit based design flood estimation approach. This approach integrates a non-stationary probability distribution function into cost-benefit analysis, and influence of non-stationarity on expected total cost (including flood damage and construction costs) and design flood estimation can be quantified. To facilitate design flood selections, a 'Risk-Cost' analysis approach is developed, which reveals the nexus of extreme flood risk, expected total cost and design life periods. Two basins, with 54-year and 104-year flood data respectively, are utilized to illustrate the application. It is found that the developed approach can effectively reveal changes of expected total cost and extreme floods in different design life periods. In addition, trade-offs are found between extreme flood risk and expected total cost, which reflect increases in cost to mitigate risk. Comparing with stationary approaches which generate only one expected total cost curve and therefore only one design flood estimation, the proposed new approach generate design flood estimation intervals and the 'Risk-Cost' approach selects a design flood value from the intervals based on the trade-offs between extreme flood risk and expected total cost. This study provides a new approach towards a better understanding of the influence of non-stationarity on expected total cost and design floods, and could be beneficial to cost-benefit based non-stationary design flood estimation across the world.

What happened to life expectancy in Spain in the 1980s?

PubMed Central

Chenet, L; McKee, M; Otero, A; Ausin, I

1997-01-01

BACKGROUND: Life expectancy at birth in Spain improved between 1972 and 1982, by 2.5 years for males and 3.2 years for females. This slowed considerably in the following decade, with increases of only 0.5 and 1.7 years respectively. OBJECTIVE: To determine the causes of death that have been responsible for the failure by Spain to maintain in the 1980s and 1990s the rate of improvement in life expectancy seen during the 1970s. DESIGN: Data from WHO mortality tapes grouped in a series of clinically meaningful categories were used to calculate the contribution of each category, in five year age groups, to the changing life expectancy at birth in the two periods. SETTING: Spain. RESULTS: The trend in life expectancy at birth in Spain over this 20 year period can be considered to have two components, both with important consequences for public health policy. Underlying trends include a steady negative contribution from respiratory cancer in men and a reduction in cardiovascular disease. More recent trends include a considerable deterioration in deaths among young adults, most notably from accidents and, possibly, AIDS. CONCLUSION: The failure to maintain the rate of earlier gains in life expectancy in Spain can be attributed largely to a few conditions, although these may indicate less obvious underlying problems. These findings have important consequences for prioritising public health policies. PMID:9425460

Impact of income inequality on life expectancy in a highly unequal developing country: the case of Brazil.

PubMed

Rasella, Davide; Aquino, Rosana; Barreto, Mauricio Lima

2013-08-01

Few studies have analysed the effects of income inequality on health in developing countries, particularly during economic growth, reduction of social disparities and reinforcement of the welfare and healthcare system. We evaluated the association between income inequality and life expectancy in Brazil, including the effect of social and health interventions, in the period 2000-2009. A panel dataset was created for the 27 Brazilian states over the referred time period. Multivariable linear regressions were performed using fixed-effects estimation with heteroscedasticity and serial correlation robust SEs. Models were fitted for life expectancy as a dependent variable, using the Gini index or a percentile income dispersion ratio as the main independent variable, and for demographic, socioeconomic and healthcare-related determinants as covariates. The Gini index, as the other measure of income inequality, was negatively associated with life expectancy (p<0.05), even after adjustment for all the socioeconomic and health-related covariates. The Family Health Program, the main primary healthcare (PHC) programme of the country, was positively associated with life expectancy (p<0.05). In recent years, effective social policies have enabled Brazil to partially reduce absolute poverty and income inequality, contributing-together with PHC-to decreasing death rates in the population. Reducing income inequality may represent an important step towards improving health and increasing life expectancy, particularly in developing countries where inequalities are high.

The relationship between praying and life expectancy in cancerous patients.

PubMed

Hekmati Pour, N; Hojjati, H

2015-01-01

Introduction. Knowing that someone was entangled with cancer is a surprising experience for that person. Being aware of having cancer not only makes the person loose his hopes and ambitions, but also influences his body and mental. Meanwhile, religion can play the proper role of complementary treatment, increasing life expectancy in these patients. Objective. The study was conducted with the aim of determining the relationship between praying and life expectancy in cancerous patients. Method. This descriptive correlation study was performed on 96 malignant patients who were under chemotherapy in Golestan province in 1392. Paloma and Pendleton's Measure of Prayer Type questionnaires and Schneider questionnaire of life expectancy were used to collect this information. Analyses were performed by using SPSS 21.0. Data were analyzed by using the linear regression and the analytical significance was set at p < 0.05. Findings. The linear regression showed a significant relationship between life expectancy and praying (CI95:0.01-0.13), OR = 0.07, Beta = -0.24 P < 0.02) and in the light of previous experience it showed a significant relationship between praying and life expectancy. Conclusion. According to the obtained result of this study, cancerous patients can overcome their illness through praying, and they can also triumph cancer through self-confidence and control it, by getting more knowledge of their disease and become more hopeful about their future.

[A comparison of the causes of adult mortality and its effects on life-expectancy across the regions of Colombia].

PubMed

López, Elizabeth; Arce, Patricia

2008-09-01

When determining some populations state of health, an understanding of the causes of mortality is essential. Changes in mortality due to causes was established to determine their contribution to the life-expectancy by gender and region of the Colombian population aged 15 to 74, between 1985 and 1999, by gender and region. This was a descriptive, retrospective study; the sources of information were records of deaths from 1983 to 2001 and population projections according to Departamento Administrativo Nacional de Estadística. The age selected as a sample population was 15 to 74. Changes in mortality were measured by using Eduardo Arriagas methodology, which is based on calculating temporary life-expectancy, absolute and relative change indices, and how changes in mortality due to cause of death contribute to life-expectancy. The main cause of reduced temporary life-expectancy in both genders was the increase in deaths by suicide, homicide and other violent causes (the reduction was greater for men than women in all regions studied). The greatest positive contribution to longevity was by the reduction in circulatory system diseases and accidents. A minimal gain in temporary life-expectancy was achieved as the positive affect of reduced mortality due to natural causes. This gain was annulled by the negative contributions of increased mortality due to suicide, homicide and other violent avoidable acts.

Adaptation or recovery after health shocks? Evidence using subjective and objective health measures.

PubMed

Baji, Petra; Bíró, Anikó

2018-05-01

In this paper, we analyse the effect of an onset of a health shock on subjective survival probability and compare it with objective survival probability and self-reported health measures. In particular, we are interested in whether expectations of people respond to health shocks and whether these follow the evolution of objective life expectations and self-reported health measures over time. Using longitudinal data from the Health and Retirement Study, we estimate fixed effects models of adaptation for the objective and subjective survival probabilities and for some self-reported health measures. The results show that after cancer diagnosis, conditional on surviving, both the objective and subjective longevity and self-reported health measures drift back to the before diagnosis trajectories. For stroke and heart attack, in spite of their persistent negative effect on survival, subjective life expectations and self-reported health measures seem to indicate only a transient effect of the health shock. The differences between the objective and subjective measures are in line with the concept of adaptation. We discuss the policy implications of our results. Copyright © 2018 John Wiley & Sons, Ltd.

A country divided? Regional variation in mortality in Ukraine.

PubMed

Murphy, Adrianna; Levchuk, Nataliia; Stickley, Andrew; Roberts, Bayard; McKee, Martin

2013-12-01

We set out to identify the contribution of various causes of death to regional differences in life expectancy in Ukraine. Mortality data by oblast (province) were obtained from the State Statistical Committee of Ukraine. The contribution of various causes of death to differences in life expectancy between East, West and South Ukraine was estimated using decomposition. In 2008, life expectancy for men in South (61.8 years) and East Ukraine (61.2 years) was lower than for men in West Ukraine (64.0 years). A similar pattern was observed among women. This was mostly due to deaths from infectious disease and external causes among young adults, and cardio- and cerebro-vascular deaths among older adults. Deaths from TB among young adults contribute most to differences in life expectancy. Deaths due to infectious disease, especially TB, play an important role in the gap in life expectancy between regions in Ukraine. These deaths are entirely preventable--further research is needed to identify what has 'protected' individuals in Western Ukraine from the burden of deaths experienced by their Southern and Eastern counterparts.

Research Spotlight: The varying life expectancies of American reservoirs

NASA Astrophysics Data System (ADS)

Schultz, Colin

2011-04-01

Tasked with controlling floods, coping through droughts, generating electricity, maintaining the flow of drinking water, preserving species' habitats, and managing the local environment, the United States' large-scale freshwater management system is important. Unfortunately, as sediment is washed from river basins to reservoirs, the persistent addition of material eats away at a reservoir's capacity and, consequently, its useful life expectancy. Understanding the integrity of the reservoir system is particularly important, with climate projections anticipating warmer, drier conditions for some parts of the country. Using a database of sedimentation surveys conducted between 1775 and 1993, Graf et al. calculate the life expectancies of many of the nation's reservoirs. They find that although most of the country's large reservoirs were built between 1950 and 1960, they have a wide range of expiration dates. They find that most large reservoirs, those with capacities greater than 1.2 cubic kilometers (0.29 cubic mile), have useful life expectancies ranging from 200 to more than 1000 years, with the lowest average life expectancy in the interior West. (Water Resources Research, doi:10.1029/2009WR008836, 2010)

Clinical Impact and Cost-effectiveness of Diagnosing HIV Infection During Early Infancy in South Africa: Test Timing and Frequency.

PubMed

Francke, Jordan A; Penazzato, Martina; Hou, Taige; Abrams, Elaine J; MacLean, Rachel L; Myer, Landon; Walensky, Rochelle P; Leroy, Valériane; Weinstein, Milton C; Parker, Robert A; Freedberg, Kenneth A; Ciaranello, Andrea

2016-11-01

 Diagnosis of human immunodeficiency virus (HIV) infection during early infancy (commonly known as "early infant HIV diagnosis" [EID]) followed by prompt initiation of antiretroviral therapy dramatically reduces mortality. EID testing is recommended at 6 weeks of age, but many infant infections are missed.  We simulated 4 EID testing strategies for HIV-exposed infants in South Africa: no EID (diagnosis only after illness; hereafter, "no EID"), testing once (at birth alone or at 6 weeks of age alone; hereafter, "birth alone" and "6 weeks alone," respectively), and testing twice (at birth and 6 weeks of age; hereafter "birth and 6 weeks"). We calculated incremental cost-effectiveness ratios (ICERs), using discounted costs and life expectancies for all HIV-exposed (infected and uninfected) infants.  In the base case (guideline-concordant care), the no EID strategy produced a life expectancy of 21.1 years (in the HIV-infected group) and 61.1 years (in the HIV-exposed group); lifetime cost averaged $1430/HIV-exposed infant. The birth and 6 weeks strategy maximized life expectancy (26.5 years in the HIV-infected group and 61.4 years in the HIV-exposed group), costing $1840/infant tested. The ICER of the 6 weeks alone strategy versus the no EID strategy was $1250/year of life saved (19% of South Africa's per capita gross domestic product); the ICER for the birth and 6 weeks strategy versus the 6 weeks alone strategy was $2900/year of life saved (45% of South Africa's per capita gross domestic product). Increasing the proportion of caregivers who receive test results and the linkage of HIV-positive infants to antiretroviral therapy with the 6 weeks alone strategy improved survival more than adding a second test.  EID at birth and 6 weeks improves outcomes and is cost-effective, compared with EID at 6 weeks alone. If scale-up costs are comparable, programs should add birth testing after strengthening 6-week testing programs. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Economic evaluation of nivolumab for the treatment of second-line advanced squamous NSCLC in Canada: a comparison of modeling approaches to estimate and extrapolate survival outcomes.

PubMed

Goeree, Ron; Villeneuve, Julie; Goeree, Jeff; Penrod, John R; Orsini, Lucinda; Tahami Monfared, Amir Abbas

2016-06-01

Background Lung cancer is the most common type of cancer in the world and is associated with significant mortality. Nivolumab demonstrated statistically significant improvements in progression-free survival (PFS) and overall survival (OS) for patients with advanced squamous non-small cell lung cancer (NSCLC) who were previously treated. The cost-effectiveness of nivolumab has not been assessed in Canada. A contentious component of projecting long-term cost and outcomes in cancer relates to the modeling approach adopted, with the two most common approaches being partitioned survival (PS) and Markov models. The objectives of this analysis were to estimate the cost-utility of nivolumab and to compare the results using these alternative modeling approaches. Methods Both PS and Markov models were developed using docetaxel and erlotinib as comparators. A three-health state model was used consisting of progression-free, progressed disease, and death. Disease progression and time to progression were estimated by identifying best-fitting survival curves from the clinical trial data for PFS and OS. Expected costs and health outcomes were calculated by combining health-state occupancy with medical resource use and quality-of-life assigned to each of the three health states. The health outcomes included in the model were survival and quality-adjusted-life-years (QALYs). Results Nivolumab was found to have the highest expected per-patient cost, but also improved per-patient life years (LYs) and QALYs. Nivolumab cost an additional $151,560 and $140,601 per QALY gained compared to docetaxel and erlotinib, respectively, using a PS model approach. The cost-utility estimates using a Markov model were very similar ($152,229 and $141,838, respectively, per QALY gained). Conclusions Nivolumab was found to involve a trade-off between improved patient survival and QALYs, and increased cost. It was found that the use of a PS or Markov model produced very similar estimates of expected cost, outcomes, and incremental cost-utility.

Efficient estimation of Pareto model: Some modified percentile estimators.

PubMed

Bhatti, Sajjad Haider; Hussain, Shahzad; Ahmad, Tanvir; Aslam, Muhammad; Aftab, Muhammad; Raza, Muhammad Ali

2018-01-01

The article proposes three modified percentile estimators for parameter estimation of the Pareto distribution. These modifications are based on median, geometric mean and expectation of empirical cumulative distribution function of first-order statistic. The proposed modified estimators are compared with traditional percentile estimators through a Monte Carlo simulation for different parameter combinations with varying sample sizes. Performance of different estimators is assessed in terms of total mean square error and total relative deviation. It is determined that modified percentile estimator based on expectation of empirical cumulative distribution function of first-order statistic provides efficient and precise parameter estimates compared to other estimators considered. The simulation results were further confirmed using two real life examples where maximum likelihood and moment estimators were also considered.

Personaltiy correlates of the joy of life.

PubMed

Tolor, A

1978-07-01

Hypothesized that greater diversity of joy and more intense levels of joy would be associated with low hopelessness, high sensation seeking the perception of the world as just, and high sensitization as compared with high repression. It also was predicted that female Ss would score higher in sources of joy and in intensity as compared to males. One hundred and thirty-four college students were administered the Joy of Life Scale, Hopelessness Scale, Sensation Seeking Scale, Just World Scale, and Revised Repression-Sensitization Scale. The hypothesis was supported for sensation seeking in that High Sensation Seekers assigned significantly (p less than .05) higher mean intensity ratings to experiences that produced joy of life, than did Low Sensation Seekers. Contrary to expectation, there was a nonsignificant trend for sensitizers, when compared with repressors, to select fewer joy-related experiences and to evaluate these experiences as less joyful. The experiences that most often led to high levels of joy were those referrable to positive emotional events.

Subjective expectations in the context of HIV/AIDS in Malawi

PubMed Central

Delavande, Adeline; Kohler, Hans-Peter

2009-01-01

In this paper we present a newly developed interactive elicitation methodology for collecting probabilistic expectations in a developing country context with low levels of literacy and numeracy, and we evaluate the feasibility and success of this method for a wide range of outcomes in rural Malawi. We find that respondents’ answers about their subjective expectations take into account basic properties of probabilities, and vary meaningfully with observable characteristics and past experience. From a substantive point of view, the elicited expectations indicate that individuals are generally aware of differential risks. For example, individuals with lower incomes and less land rightly feel at greater risk of financial distress than people with higher socioeconomic status (SES), and people who are divorced or widowed rightly feel at greater risk of being infected with HIV than currently married individuals. Meanwhile many expectations—including the probability of being currently infected with HIV—are well-calibrated compared to actual probabilities, but mortality expectations are substantially overestimated compared to life table estimates. This overestimation may lead individuals to underestimate the benefits of adopting HIV risk-reduction strategies. The skewed distribution of expectations about condom use also suggests that a small group of innovators are the forerunners in the adoption of condoms within marriage for HIV prevention. PMID:19946378

Men, Women, and Life Annuities

ERIC Educational Resources Information Center

King, Francis P.

1976-01-01

A senior research officer of Teacher Insurance and Annuity Association (TIAA) and College Retirement Equities Fund (CREF) discusses the issue of different life annuity benefits to men and women concluding that age and sex are two objective and statistically reliable factors used in determining life expectancy and thus the expected duration of…

Willingness to Pay for Environmental Health Risk Reductions When There are Varying Degrees of Life Expectancy: A White Paper (2006)

EPA Pesticide Factsheets

The use of existing value of statistical life (VSL) estimates in benefit-cost analysis relates to relatively short changes in life expectancy. The authors' strategy for addressing this question is to briefly survey the existing economics literature.

End-of-life care content in 50 textbooks from multiple specialties.

PubMed

Rabow, M W; Hardie, G E; Fair, J M; McPhee, S J

2000-02-09

Prior reviews of small numbers of medical textbooks suggest that end-of-life care is not well covered in textbooks. No broad study of end-of-life care content analysis has been performed on textbooks across a wide range of medical, pediatric, psychiatric, and surgical specialties. To determine the quantity and rate the adequacy of information on end-of-life care in textbooks from multiple medical disciplines. DESIGN AND SOURCES: A 1998 review of 50 top-selling textbooks from multiple specialties (cardiology, emergency medicine, family and primary care medicine, geriatrics, infectious disease and acquired immunodeficiency syndrome [AIDS], internal medicine, neurology, oncology and hematology, pediatrics, psychiatry, pulmonary medicine, and surgery) for the presence and adequacy of content in 13 end-of-life care domains. Chapters on diseases commonly causing death and those devoted to end-of-life care were identified, read, rated, and compared by textbook specialty, chapter, and domain for the presence of helpful information in the 13 domains. Content for each domain was rated as absent, minimally present, or helpful. Textbook indexes were analyzed for the number of pages relevant to end-of-life care. Overall, helpful information was provided in 24.1% (range, 8.7%-44.2%) of the expected end-of-life content domains; in 19.1% (range, 6.2%-38.5%), expected content received minimal attention; and in 56.9% (range, 23.1 %-77.9%), expected content was absent. As a group, the textbooks with the highest percentages of absent content were in surgery (71.8%), infectious diseases and AIDS (70%), and oncology and hematology (61.9%). Textbooks with the highest percentage of helpful end-of-life care content were in family medicine (34.4%), geriatrics (34.4%), and psychiatry (29.6%). In internal medicine textbooks, the content domains with the greatest amount of helpful information were epidemiology and natural history. Content domains covered least well were social, spiritual, ethical, and family issues, as well as physician after-death responsibilities. On average, textbook indexes cited 2% of their total pages as pertinent to end-of-life care. Top-selling textbooks generally offered little helpful information on caring for patients at the end of life. Most disease-oriented chapters had no or minimal end-of-life care content. Specialty textbooks with information about particular diseases often did not contain helpful information on caring for patients dying from those diseases.

Economics in “Global Health 2035”: a sensitivity analysis of the value of a life year estimates

PubMed Central

Chang, Angela Y; Robinson, Lisa A; Hammitt, James K; Resch, Stephen C

2017-01-01

Background In “Global health 2035: a world converging within a generation,” The Lancet Commission on Investing in Health (CIH) adds the value of increased life expectancy to the value of growth in gross domestic product (GDP) when assessing national well–being. To value changes in life expectancy, the CIH relies on several strong assumptions to bridge gaps in the empirical research. It finds that the value of a life year (VLY) averages 2.3 times GDP per capita for low– and middle–income countries (LMICs) assuming the changes in life expectancy they experienced from 2000 to 2011 are permanent. Methods The CIH VLY estimate is based on a specific shift in population life expectancy and includes a 50 percent reduction for children ages 0 through 4. We investigate the sensitivity of this estimate to the underlying assumptions, including the effects of income, age, and life expectancy, and the sequencing of the calculations. Findings We find that reasonable alternative assumptions regarding the effects of income, age, and life expectancy may reduce the VLY estimates to 0.2 to 2.1 times GDP per capita for LMICs. Removing the reduction for young children increases the VLY, while reversing the sequencing of the calculations reduces the VLY. Conclusion Because the VLY is sensitive to the underlying assumptions, analysts interested in applying this approach elsewhere must tailor the estimates to the impacts of the intervention and the characteristics of the affected population. Analysts should test the sensitivity of their conclusions to reasonable alternative assumptions. More work is needed to investigate options for improving the approach. PMID:28400950

Quantifying the risks and benefits of efavirenz use in HIV-infected women of childbearing age in the United States

PubMed Central

Hsu, HE; Rydzak, CE; Cotich, KL; Wang, B; Sax, PE; Losina, E; Freedberg, KA; Goldie, SJ; Lu, Z; Walensky, RP

2010-01-01

Objectives We quantified the benefits (life expectancy gains) and harms (efavirenz-related teratogenicity) associated with using efavirenz in HIV-infected women of childbearing age in the United States. Methods We used data from the Women’s Interagency HIV Study in an HIV disease simulation model to estimate life expectancy in women who receive an efavirenz-based initial antiretroviral regimen compared with those who delay efavirenz use and receive a boosted protease inhibitor-based initial regimen. To estimate excess risk of teratogenic events with and without efavirenz exposure per 100,000 women, we incorporated literature-based rates of pregnancy, live births, and teratogenic events into a decision analytic model. We assumed a teratogenicity risk of 2.90 events/100 live births in women exposed to efavirenz during pregnancy and 2.68/100 live births in unexposed women. Results Survival for HIV-infected women who received an efavirenz-based initial antiretroviral therapy regimen was 0.89 years greater than for women receiving non-efavirenz-based initial therapy (28.91 vs. 28.02 years). The rate of teratogenic events was 77.26/100,000 exposed women, compared with 72.46/100,000 unexposed women. Survival estimates were sensitive to variations in treatment efficacy and AIDS-related mortality. Estimates of excess teratogenic events were most sensitive to pregnancy rates and number of teratogenic events/100 live births in efavirenz-exposed women. Conclusions Use of non-efavirenz-based initial antiretroviral therapy in HIV-infected women of childbearing age may reduce life expectancy gains from antiretroviral treatment, but may also prevent teratogenic events. Decision-making regarding efavirenz use presents a tradeoff between these two risks; this study can inform discussions between patients and health care providers. PMID:20561082

Quantifying the risks and benefits of efavirenz use in HIV-infected women of childbearing age in the USA.

PubMed

Hsu, H E; Rydzak, C E; Cotich, K L; Wang, B; Sax, P E; Losina, E; Freedberg, K A; Goldie, S J; Lu, Z; Walensky, R P

2011-02-01

The aim of the study was to quantify the benefits (life expectancy gains) and risks (efavirenz-related teratogenicity) associated with using efavirenz in HIV-infected women of childbearing age in the USA. We used data from the Women's Interagency HIV Study in an HIV disease simulation model to estimate life expectancy in women who receive an efavirenz-based initial antiretroviral regimen compared with those who delay efavirenz use and receive a boosted protease inhibitor-based initial regimen. To estimate excess risk of teratogenic events with and without efavirenz exposure per 100,000 women, we incorporated literature-based rates of pregnancy, live births, and teratogenic events into a decision analytic model. We assumed a teratogenicity risk of 2.90 events/100 live births in women exposed to efavirenz during pregnancy and 2.68/100 live births in unexposed women. Survival for HIV-infected women who received an efavirenz-based initial antiretroviral therapy (ART) regimen was 0.89 years greater than for women receiving non-efavirenz-based initial therapy (28.91 vs. 28.02 years). The rate of teratogenic events was 77.26/100,000 exposed women, compared with 72.46/100,000 unexposed women. Survival estimates were sensitive to variations in treatment efficacy and AIDS-related mortality. Estimates of excess teratogenic events were most sensitive to pregnancy rates and number of teratogenic events/100 live births in efavirenz-exposed women. Use of non-efavirenz-based initial ART in HIV-infected women of childbearing age may reduce life expectancy gains from antiretroviral treatment, but may also prevent teratogenic events. Decision-making regarding efavirenz use presents a trade-off between these two risks; this study can inform discussions between patients and health care providers.

Views of Japanese medical students on the work-life balance of female physicians

PubMed Central

Nin, Tomoni; Akano, Megumi; Hasuike, Yukiko; Iijima, Hiroko; Suzuki, Keiichirou

2017-01-01

Objectives To survey medical students on their ideas of future work-life balance and discuss topics for next-generation medical education. Methods First-year (n=372, 34.9% female) and sixth-year medical students (n=311, 44.1% female) responded to a questionnaire on future self, marriage and childcare, and gender differences at the workplace. Responses were compared between academic years and gender. Responses were evaluated by gender and academic year using the Mann-Whitney U test.  Significance was set at p<0.01. Results The first-year and sixth-year students, regardless of gender, had different views on gender-related favorable treatment at workplaces {U=13464, p=0.000 (first-year), U=10407, p=0.000 (sixth-year)}. A greater percentage of female students would choose career options based on the possibility of marriage and childbirth {U=10689, p=0.000 (first-year), U=10930, p=0.000 (sixth-year)}. Among first-year students, a greater percentage of female students expected to work part-time. Also among first-year students, greater percentages of female students expected to work part-time or leave their jobs temporarily while raising their children. Compared with first-year male students, first-year female students expected to undertake larger portions of the childcare and housework burden than their partners. However, gender differences in work-life balance and childcare leave vanished in the sixth-year students. Conclusions Female medical students accepted childcare and housework burdens as inevitable; the work environment they choose might affect their career development. While support from male partners and institutions must be increased, voluntary actions and change in mentality of female students need to be promoted through medical education to prevent them from waiting passively for the situation to change. PMID:28501830

Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort.

PubMed

Lindqvist, P G; Epstein, E; Nielsen, K; Landin-Olsson, M; Ingvar, C; Olsson, H

2016-10-01

Women with active sunlight exposure habits experience a lower mortality rate than women who avoid sun exposure; however, they are at an increased risk of skin cancer. We aimed to explore the differences in main causes of death according to sun exposure. We assessed the differences in sun exposure as a risk factor for all-cause mortality in a competing risk scenario for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 (aged 25-64 years at the start of the study). We obtained detailed information at baseline on sun exposure habits and potential confounders. The data were analysed using modern survival statistics. Women with active sun exposure habits were mainly at a lower risk of cardiovascular disease (CVD) and noncancer/non-CVD death as compared to those who avoided sun exposure. As a result of their increased survival, the relative contribution of cancer death increased in these women. Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. Compared to the highest sun exposure group, life expectancy of avoiders of sun exposure was reduced by 0.6-2.1 years. The longer life expectancy amongst women with active sun exposure habits was related to a decrease in CVD and noncancer/non-CVD mortality, causing the relative contribution of death due to cancer to increase. © 2016 The Association for the Publication of the Journal of Internal Medicine.

Views of Japanese medical students on the work-life balance of female physicians.

PubMed

Takahashi, Keiko; Nin, Tomoni; Akano, Megumi; Hasuike, Yukiko; Iijima, Hiroko; Suzuki, Keiichirou

2017-05-11

To survey medical students on their ideas of future work-life balance and discuss topics for next-generation medical education. First-year (n=372, 34.9% female) and sixth-year medical students (n=311, 44.1% female) responded to a questionnaire on future self, marriage and childcare, and gender differences at the workplace. Responses were compared between academic years and gender. Responses were evaluated by gender and academic year using the Mann-Whitney U test.  Significance was set at p<0.01. The first-year and sixth-year students, regardless of gender, had different views on gender-related favorable treatment at workplaces {U=13464, p=0.000 (first-year), U=10407, p=0.000 (sixth-year)}. A greater percentage of female students would choose career options based on the possibility of marriage and childbirth {U=10689, p=0.000 (first-year), U=10930, p=0.000 (sixth-year)}. Among first-year students, a greater percentage of female students expected to work part-time. Also among first-year students, greater percentages of female students expected to work part-time or leave their jobs temporarily while raising their children. Compared with first-year male students, first-year female students expected to undertake larger portions of the childcare and housework burden than their partners. However, gender differences in work-life balance and childcare leave vanished in the sixth-year students. Female medical students accepted childcare and housework burdens as inevitable; the work environment they choose might affect their career development. While support from male partners and institutions must be increased, voluntary actions and change in mentality of female students need to be promoted through medical education to prevent them from waiting passively for the situation to change.

Fractional carbon dioxide laser resurfacing of rhytides and photoaged skin--a prospective clinical study on patient expectation and satisfaction.

PubMed

Kohl, Elisabeth; Meierhöfer, Julia; Koller, Michael; Zeman, Florian; Groesser, Leopold; Karrer, Sigrid; Hohenleutner, Ulrich; Landthaler, Michael; Hohenleutner, Silvia

2015-02-01

Fractional CO2 -laser resurfacing is increasingly used for treating rhytides and photoaged skin because of its favorable benefit-risk ratio. A key outcome measure and treatment goal in aesthetic laser therapy is patient satisfaction. However, few data are available on patient-reported outcomes after fractional ablative skin-resurfacing. To compare patient expectations before and patient satisfaction after three fractional CO2 -laser treatments and to correlate objectively measured wrinkle reduction with patient satisfaction after treatment. We investigated patient expectation and satisfaction using a 14-item questionnaire in 24 female patients. We assessed the skin-related quality of life and patient satisfaction with skin appearance. We profilometrically measured wrinkle size in four facial areas before and three months after treatment and investigated correlations between wrinkle reduction and patient satisfaction. The high patient expectations before treatment (ceiling effect) were actually slightly exceeded. The average score of 14 items delineating patient satisfaction with laser treatment was higher (4.64 ± 0.82; n = 24) than the respective expectations before treatment (4.43 ± 0.88; n = 24). Skin-related quality of life and patient satisfaction with skin appearance had significantly improved after the last treatment. Patients dissatisfied with their skin appearance before treatment (mean 2.1 ± 1.5; evaluated on a scale ranging from 0-6) were satisfied (mean 5.1 ± 1.2) (P < 0.001) with skin appearance at the follow-up. Patient satisfaction with skin appearance was not correlated to the profilometrically measured reduction of wrinkle size of any facial area. Our results show high patient satisfaction with ablative fractional skin resurfacing, also regarding improved self-esteem and self-satisfaction despite high pre-treatment expectations. Skin-specific quality of life had significantly improved. Thus, this treatment modality can be recommended for patients with photoaged skin wishing to improve skin appearance. © 2015 Wiley Periodicals, Inc.

Early-life mortality risks in opposite-sex and same-sex twins: a Danish cohort study of the twin testosterone transfer hypothesis.

PubMed

Ahrenfeldt, Linda Juel; Larsen, Lisbeth Aagaard; Lindahl-Jacobsen, Rune; Skytthe, Axel; Hjelmborg, Jacob V B; Möller, Sören; Christensen, Kaare

2017-02-01

To investigate the twin testosterone transfer (TTT) hypothesis by comparing early-life mortality risks of opposite-sex (OS) and same-sex (SS) twins during the first 15 years of life. We performed a population-based cohort study to compare mortality in OS and SS twins. We included 68,629 live-born Danish twins from 1973 to 2009 identified through the Danish Twin Registry and performed piecewise stratified Cox regression and log-binomial regression. Among 1933 deaths, we found significantly higher mortality for twin boys than for twin girls. For both sexes, OS twins had lower mortality than SS twins; the difference persisted for the first year of life for boys and for the first week of life for girls. Although the mortality risk for OS boys was in the expected direction according to the TTT hypothesis, the results for OS girls pointed in the opposite direction, providing no clear evidence for the TTT hypothesis. Copyright © 2016 Elsevier Inc. All rights reserved.

Volvo Penta 4.3 GL E15 Emissions and Durability Test

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zoubul, G.; Cahoon, M.; Kolb, R.

2011-10-01

A new Volvo Penta carbureted 4.3 GL engine underwent emissions and dynamometer durability testing from break-in to expected end of life using an accelerated ICOMIA marine emissions cycle and E15 fuel. Only ethanol content was controlled. All aging used splash-blended E15 fuel. Exhaust emissions, exhaust gas temperature, torque, power, barometric pressure, air temperature, and fuel flow were measured at five intervals using site-blended E15 aging fuel and certification fuel (E0). The durability test cycle showed no noticeable impact on mechanical durability or engine power. Emissions performance degraded beyond the certification limit for this engine family, mostly occurring by 28% ofmore » expected life. Such degradation is inconsistent with prior experience. Comparisons showed that E15 resulted in lower CO and HC, but increased NOX, as expected for non-feedback-controlled carbureted engines with increased oxygen in the fuel. Fuel consumption also increased with E15 compared with E0. Throughout testing, poor starting characteristics were exhibited on E15 fuel for hot re-start and cold-start. Cranking time to start and smooth idle was roughly doubled compared with typical E0 operation. The carburetor was factory-set for lean operation to ensure emissions compliance. Test protocols did not include carburetor adjustment to account for increased oxygen in the E15 fuel.« less

Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero, One and Five in India: A Decomposition Analysis

PubMed Central

Dubey, Manisha

2015-01-01

Objectives Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover. Methods We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981–2009 for 16 Indian states by sex (comprising of India’s 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover. Findings India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women). Conclusions For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1–59 months in high child mortality areas can help India to attain this crossover early. PMID:26683617

Final Report for Office of Naval Research Contract N00014-76-C-0782. Volume I,

DTIC Science & Technology

1979-07-01

American life . As the baby boom generation entered the labor market, however, they found the con- ditions very different than those that they had...present discounted value (PDV) of the enlistee’s expected earning with those of civilian earnings for his life - cycle. Suppose that n represents an...individual’s expected life -time working period. Then the PDV of the expected earnings for the potential enlistee and for the non-enlistee can be expressed

Physical occupational exposures and health expectancies in a French occupational cohort.

PubMed

Platts, Loretta G; Head, Jenny; Stenholm, Sari; Singh Chungkham, Holendro; Goldberg, Marcel; Zins, Marie

2017-03-01

To examine the relationships of strenuous and hazardous working conditions and rotating shifts that involve night working with life expectancy in good perceived health and life expectancy without chronic disease. The sample contained male gas and electricity workers from the French GAZEL cohort (n=13 393). Six measures of physical working conditions were examined: Self-reports from 1989 and 1990 of ergonomic strain, physical danger, rotating shifts that involve night working and perceived physical strain; company records of workplace injuries and a job-exposure matrix of chemical exposures. Partial healthy life expectancies (age 50-75) relating to (1) self-rated health and (2) chronic health conditions, obtained from annual questionnaires (1989-2014) and company records, were estimated using multistate life tables. The analyses were adjusted for social class and occupational grade. Participants with physically strenuous jobs and who had experienced industrial injuries had shorter partial life expectancy. More physically demanding and dangerous work was associated with fewer years of life spent in good self-rated health and without chronic conditions, with the exception of shift work including nights, where the gradient was reversed. Strenuous and hazardous work may contribute to lost years of good health in later life, which has implications for individuals' quality of life as well as healthcare use and labour market participation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Opinions of the Dutch public on palliative sedation: a mixed-methods approach

PubMed Central

van der Kallen, Hilde TH; Raijmakers, Natasja JH; Rietjens, Judith AC; van der Male, Alex A; Bueving, Herman J; van Delden, Johannes JM; van der Heide, Agnes

2013-01-01

Background Palliative sedation is defined as deliberately lowering a patient’s consciousness, to relieve intolerable suffering from refractory symptoms at the end of life. Palliative sedation is considered a last resort intervention in end-of-life care that should not be confused with euthanasia. Aim To inform healthcare professionals about attitudes of the general public regarding palliative sedation. Design and setting A cross-sectional survey among members of the Dutch general public followed by qualitative interviews. Method One thousand nine hundred and sixty members of the general public completed the questionnaire, which included a vignette describing palliative sedation (response rate 78%); 16 participants were interviewed. Results In total, 22% of the responders indicated knowing the term ‘palliative sedation’. Qualitative data showed a variety of interpretations of the term. Eighty-one per cent of the responders agreed with the provision of sedatives as described in a vignette of a patient with untreatable pain and a life expectancy of <1 week who received sedatives to alleviate his suffering. This percentage was somewhat lower for a patient with a life expectancy of <1 month (74%, P = 0.007) and comparable in the case where the physician gave sedatives with the aim of ending the patient’s life (79%, P = 0.54). Conclusion Most of the general public accept the use of palliative sedation at the end of life, regardless of a potential life-shortening effect. However, confusion exists about what palliative sedation represents. This should be taken into account by healthcare professionals when communicating with patients and their relatives on end-of-life care options. PMID:24152482

Opinions of the Dutch public on palliative sedation: a mixed-methods approach.

PubMed

van der Kallen, Hilde T H; Raijmakers, Natasja J H; Rietjens, Judith A C; van der Male, Alex A; Bueving, Herman J; van Delden, Johannes J M; van der Heide, Agnes

2013-10-01

Palliative sedation is defined as deliberately lowering a patient's consciousness, to relieve intolerable suffering from refractory symptoms at the end of life. Palliative sedation is considered a last resort intervention in end-of-life care that should not be confused with euthanasia. To inform healthcare professionals about attitudes of the general public regarding palliative sedation. design and setting: A cross-sectional survey among members of the Dutch general public followed by qualitative interviews. One thousand nine hundred and sixty members of the general public completed the questionnaire, which included a vignette describing palliative sedation (response rate 78%); 16 participants were interviewed. In total, 22% of the responders indicated knowing the term 'palliative sedation'. Qualitative data showed a variety of interpretations of the term. Eighty-one per cent of the responders agreed with the provision of sedatives as described in a vignette of a patient with untreatable pain and a life expectancy of <1 week who received sedatives to alleviate his suffering. This percentage was somewhat lower for a patient with a life expectancy of <1 month (74%, P = 0.007) and comparable in the case where the physician gave sedatives with the aim of ending the patient's life (79%, P = 0.54). Most of the general public accept the use of palliative sedation at the end of life, regardless of a potential life-shortening effect. However, confusion exists about what palliative sedation represents. This should be taken into account by healthcare professionals when communicating with patients and their relatives on end-of-life care options.

The Contribution of Drug Overdose to Educational Gradients in Life Expectancy in the United States, 1992-2011.

PubMed

Ho, Jessica Y

2017-06-01

Since the mid-1990s, the United States has witnessed a dramatic rise in drug overdose mortality. Educational gradients in life expectancy widened over the same period, and drug overdose likely plays a role in this widening, particularly for non-Hispanic whites. The contemporary drug epidemic is distinctive in terms of its scope, the nature of the substances involved, and its geographic patterning, which influence how it impacts different education groups. I use vital statistics and National Health Interview Survey data to examine the contribution of drug overdose to educational gradients in life expectancy from 1992-2011. I find that over this period, years of life lost due to drug overdose increased for all education groups and for both males and females. The contribution of drug overdose to educational gradients in life expectancy has increased over time and is greater for non-Hispanic whites than for the population as a whole. Drug overdose accounts for a sizable proportion of the increases in educational gradients in life expectancy, particularly at the prime adult ages (ages 30-60), where it accounts for 25 % to 100 % of the widening in educational gradients between 1992 and 2011. Drug overdose mortality has increased more rapidly for females than for males, leading to a gender convergence. These findings shed light on the processes driving recent changes in educational gradients in life expectancy and suggest that effective measures to address the drug overdose epidemic should take into account its differential burden across education groups.

The stagnation of the Mexican male life expectancy in the first decade of the 21st century: the impact of homicides and diabetes mellitus.

PubMed

Canudas-Romo, Vladimir; García-Guerrero, Víctor Manuel; Echarri-Cánovas, Carlos Javier

2015-01-01

In the first decade of the 21st century, the Mexican life expectancy changed from a long trend of increase to stagnation. These changes concur with an increase in deaths by homicides that the country experienced in that decade, and an obesity epidemic that had developed over the last decades of the 20th century. We quantify the impact of causes of death on life expectancy from 2000 to 2010. Two approaches to analyse causes of death are used: the number of life years lost due to each of the causes of death in a given year, and cause-decomposition techniques for comparisons of life expectancy from 2000 to 2010. The apparent stagnation in life expectancy is the result of an increase in deaths by homicides and diabetes mellitus on the one hand, and the positive improvements observed in other causes of death on the other. The negative impact of homicides is particularly observed for ages 15 and 50, and for that of diabetes mellitus at ages above 45 years. There is little basis for optimism regarding the future scenarios of the health of the Mexican population based on the first decade of the 21st century. Male life expectancy would have increased by 2 years if deaths by homicides and diabetes mellitus had been avoided. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Contribution of Drug Overdose to Educational Gradients in Life Expectancy in the United States, 1992–2011

PubMed Central

Ho, Jessica Y.

2017-01-01

Over the past two decades, the United States has witnessed a dramatic rise in drug overdose mortality. Educational gradients in life expectancy widened over the same period, and it is likely that drug overdose plays a role in this widening, particularly for non-Hispanic whites. The contemporary drug epidemic is distinctive in terms of its scope, the nature of the substances involved, and its geographic patterning, which influence how it impacts different education groups. I use data from vital statistics and from the National Health Interview Survey to examine the contribution of drug overdose to educational gradients in life expectancy from 1992–2011. I find that over this period, years of life lost due to drug overdose increased for all education groups and for both males and females. The contribution of drug overdose to educational gradients in life expectancy has increased over time and is greater for non-Hispanic whites than for the population as a whole. Drug overdose accounts for a sizeable proportion of the increases in educational gradients in life expectancy, particularly at the prime adult ages (ages 30–60) where it accounts for 25–100% of the widening in educational gradients between 1992–2011. Over time, drug overdose mortality has increased more rapidly for females than for males, leading to a gender convergence. These findings shed light on the processes driving recent changes in educational gradients in life expectancy and suggest that effective measures to address the drug overdose epidemic should take into account its differential burden across education groups. PMID:28324483

Are we selecting the right patients for treatment of localized prostate cancer? Results of an actuarial analysis.

PubMed

Koch, M O; Miller, D A; Butler, R; Lebos, L; Collings, D; Smith, J A

1998-02-01

To determine our accuracy in selecting patients with at least a 10-year life expectancy for aggressive treatment of localized prostate cancer. The medical records of 261 consecutive patients who underwent radical retropubic prostatectomy were submitted to the actuarial division of American General Life and Accident Insurance Company (AGLA) for estimation of life expectancy, excluding the diagnosis of prostate cancer. Survival curves were generated from predicted individual survivals. In patients with less than a 10-year life expectancy, AGLA provided us with the basis for assigning suboptimal survival rates. The mean life expectancy for the group was 15.2 years. Two hundred ten men (80%) were projected to have a life expectancy of more than 10 years, including 27 of 55 (49%) and 4 of 8 (50%) men who were older than or equal to 70 and 75 years of age, respectively. Coronary artery disease and diabetes mellitus were the most common coexisting medical conditions that adversely affected risk as single disease entities. Although clinicians do not estimate life expectancy with the scientific exactitude of an actuary, the ability to assess the patient in person and assimilate pertinent medical information in a less rigid format yields similar results. Selection of men for definitive treatment of localized prostate cancer should be based on the inherent aggressiveness of the disease and the health of the individual and should not be limited by specific age cutoffs. Populations of men undergoing radical prostatectomy are younger and healthier than those in reported series of watchful waiting for prostate cancer.

Investigation on the performance of a viscoelastic dielectric elastomer membrane generator.

PubMed

Zhou, Jianyou; Jiang, Liying; Khayat, Roger E

2015-04-21

Dielectric elastomer generators (DEGs), as a recent transduction technology, harvest electrical energy by scavenging mechanical energy from diverse sources. Their performance is affected by various material properties and failure modes of the dielectric elastomers. This work presents a theoretical analysis on the performance of a dielectric elastomer membrane generator under equi-biaxial loading conditions. By comparing our simulation results with the experimental observations existing in the literature, this work considers the fatigue life of DE-based devices under cyclic loading for the first time. From the simulation results, it is concluded that the efficiency of the DEG can be improved by raising the deforming rate and the prescribed maximum stretch ratio, and applying an appropriate bias voltage. However, the fatigue life expectancy compromises the efficiency improvement of the DEG. With the consideration of the fatigue life, applying an appropriate bias voltage appears to be a more desirable way to improve the DEG performance. The general framework developed in this work is expected to provide an increased understanding on the energy harvesting mechanisms of the DEGs and benefit their optimal design.

Long-term morbidity, mortality, and economics of rheumatoid arthritis.

PubMed

Wong, J B; Ramey, D R; Singh, G

2001-12-01

To estimate the morbidity, mortality, and lifetime costs of care for rheumatoid arthritis (RA). We developed a Markov model based on the Arthritis, Rheumatism, and Aging Medical Information System Post-Marketing Surveillance Program cohort, involving 4,258 consecutively enrolled RA patients who were followed up for 17,085 patient-years. Markov states of health were based on drug treatment and Health Assessment Questionnaire scores. Costs were based on resource utilization, and utilities were based on visual analog scale-based general health scores. The cohort had a mean age of 57 years, 76.4% were women, and the mean duration of disease was 11.8 years. Compared with a life expectancy of 22.0 years for the general population, this cohort had a life expectancy of 18.6 years and 11.3 quality-adjusted life years. Lifetime direct medical care costs were estimated to be $93,296. Higher costs were associated with higher disability scores. A Markov model can be used to estimate lifelong morbidity, mortality, and costs associated with RA, providing a context in which to consider the potential value of new therapies for the disease.

Do NHS clinicians and members of the public share the same views about reducing inequalities in health?

PubMed

Tsuchiya, Aki; Dolan, Paul

2007-06-01

Decisions about how to allocate resources in health care are as much about social value judgements as they are about getting the medical facts right. In this context, it is important to compare the social preferences of members of the general public with those of National Health Service (NHS) staff involved in service delivery. A questionnaire eliciting peoples' preferences over maximising life expectancy and reducing inequalities in life expectancy between the highest and lowest social classes was completed by 271 members of the UK public and 220 NHS clinicians. The two samples have different preferences with the general public showing a greater willingness than clinicians to sacrifice total health for a more equal distribution of health. These differences may highlight tensions between what the public wants and what clinicians want, and should be subject to further investigation.

The cost-effectiveness of insulin glargine vs. neutral protamine Hagedorn insulin in type 2 diabetes: a focus on health economics.

PubMed

Levin, P

2008-07-01

Diabetes mellitus is a major public health problem, in particular because of long-term complications affecting essential organs, such as the eyes and kidneys, which can lead to a reduction in life expectancy and high healthcare costs. The number of individuals with diabetes mellitus is projected to rise worldwide from 171 million people in 2000 to 366 million people in 2030. With the number of patients with diabetes continually growing, the burden of pressure on worldwide health systems is huge. Accordingly, regulatory and marketing approvals of new medicines are beginning to incorporate economic evaluation techniques to determine their cost-effectiveness. Overall, the studies included in this review show that the initiation of insulin glargine is cost-effective and is expected to lead to substantial improvements in both life years (LYs) and quality-adjusted LYs compared with neutral protamine Hagedorn insulin.

The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors

PubMed Central

2017-01-01

Importance Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. Objectives To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. Design We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. Results US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. Conclusions and Relevance From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. PMID:23842577

The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.

PubMed

Murray, Christopher J L; Atkinson, Charles; Bhalla, Kavi; Birbeck, Gretchen; Burstein, Roy; Chou, David; Dellavalle, Robert; Danaei, Goodarz; Ezzati, Majid; Fahimi, A; Flaxman, D; Foreman; Gabriel, Sherine; Gakidou, Emmanuela; Kassebaum, Nicholas; Khatibzadeh, Shahab; Lim, Stephen; Lipshultz, Steven E; London, Stephanie; Lopez; MacIntyre, Michael F; Mokdad, A H; Moran, A; Moran, Andrew E; Mozaffarian, Dariush; Murphy, Tasha; Naghavi, Moshen; Pope, C; Roberts, Thomas; Salomon, Joshua; Schwebel, David C; Shahraz, Saeid; Sleet, David A; Murray; Abraham, Jerry; Ali, Mohammed K; Atkinson, Charles; Bartels, David H; Bhalla, Kavi; Birbeck, Gretchen; Burstein, Roy; Chen, Honglei; Criqui, Michael H; Dahodwala; Jarlais; Ding, Eric L; Dorsey, E Ray; Ebel, Beth E; Ezzati, Majid; Fahami; Flaxman, S; Flaxman, A D; Gonzalez-Medina, Diego; Grant, Bridget; Hagan, Holly; Hoffman, Howard; Kassebaum, Nicholas; Khatibzadeh, Shahab; Leasher, Janet L; Lin, John; Lipshultz, Steven E; Lozano, Rafael; Lu, Yuan; Mallinger, Leslie; McDermott, Mary M; Micha, Renata; Miller, Ted R; Mokdad, A A; Mokdad, A H; Mozaffarian, Dariush; Naghavi, Mohsen; Narayan, K M Venkat; Omer, Saad B; Pelizzari, Pamela M; Phillips, David; Ranganathan, Dharani; Rivara, Frederick P; Roberts, Thomas; Sampson, Uchechukwu; Sanman, Ella; Sapkota, Amir; Schwebel, David C; Sharaz, Saeid; Shivakoti, Rupak; Singh, Gitanjali M; Singh, David; Tavakkoli, Mohammad; Towbin, Jeffrey A; Wilkinson, James D; Zabetian, Azadeh; Murray; Abraham, Jerry; Ali, Mohammad K; Alvardo, Miriam; Atkinson, Charles; Baddour, Larry M; Benjamin, Emelia J; Bhalla, Kavi; Birbeck, Gretchen; Bolliger, Ian; Burstein, Roy; Carnahan, Emily; Chou, David; Chugh, Sumeet S; Cohen, Aaron; Colson, K Ellicott; Cooper, Leslie T; Couser, William; Criqui, Michael H; Dabhadkar, Kaustubh C; Dellavalle, Robert P; Jarlais; Dicker, Daniel; Dorsey, E Ray; Duber, Herbert; Ebel, Beth E; Engell, Rebecca E; Ezzati, Majid; Felson, David T; Finucane, Mariel M; Flaxman, Seth; Flaxman, A D; Fleming, Thomas; Foreman; Forouzanfar, Mohammad H; Freedman, Greg; Freeman, Michael K; Gakidou, Emmanuela; Gillum, Richard F; Gonzalez-Medina, Diego; Gosselin, Richard; Gutierrez, Hialy R; Hagan, Holly; Havmoeller, Rasmus; Hoffman, Howard; Jacobsen, Kathryn H; James, Spencer L; Jasrasaria, Rashmi; Jayarman, Sudha; Johns, Nicole; Kassebaum, Nicholas; Khatibzadeh, Shahab; Lan, Qing; Leasher, Janet L; Lim, Stephen; Lipshultz, Steven E; London, Stephanie; Lopez; Lozano, Rafael; Lu, Yuan; Mallinger, Leslie; Meltzer, Michele; Mensah, George A; Michaud, Catherine; Miller, Ted R; Mock, Charles; Moffitt, Terrie E; Mokdad, A A; Mokdad, A H; Moran, A; Naghavi, Mohsen; Narayan, K M Venkat; Nelson, Robert G; Olives, Casey; Omer, Saad B; Ortblad, Katrina; Ostro, Bart; Pelizzari, Pamela M; Phillips, David; Raju, Murugesan; Razavi, Homie; Ritz, Beate; Roberts, Thomas; Sacco, Ralph L; Salomon, Joshua; Sampson, Uchechukwu; Schwebel, David C; Shahraz, Saeid; Shibuya, Kenji; Silberberg, Donald; Singh, Jasvinder A; Steenland, Kyle; Taylor, Jennifer A; Thurston, George D; Vavilala, Monica S; Vos, Theo; Wagner, Gregory R; Weinstock, Martin A; Weisskopf, Marc G; Wulf, Sarah; Murray

2013-08-14

Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.

Teaching End-of-Life Care Using Interprofessional Simulation.

PubMed

Gannon, Jane; Motycka, Carol; Egelund, Eric; Kraemer, Dale F; Smith, W Thomas; Solomon, Kathleen

2017-04-01

Competency in end-of-life (EOL) care is a growing expectation for health professions students. This study assessed the impact of four EOL care scenarios, using high-fidelity simulation, on the perceived learning needs and attitudes of pharmacy and nursing students. On three campuses, pharmacy students (N = 158) were exposed to standard paper EOL case scenarios, while a fourth campus exposed eight graduate nursing and 37 graduate pharmacy students to simulated versions of the same cases. The paper-based groups produced similar pre-post changes on the End of Life Professional Caregiver Survey. Results were pooled and compared with the simulation-only group, revealing significantly higher changes in pre-post scores for the simulation group. Students participating in the simulation group showed some significant differences in attitudes toward EOL care, compared with students in the classroom setting. [J Nurs Educ. 2017;56(4):205-210.]. Copyright 2017, SLACK Incorporated.

Children of Misfortune: Early Adversity and Cumulative Inequality in Perceived Life Trajectories1

PubMed Central

Schafer, Markus H.; Ferraro, Kenneth F.; Mustillo, Sarah A.

2011-01-01

Adversity early in life may alter pathways of aging, but what interpretive processes can soften the blow of early insults? Drawing from cumulative inequality theory, the authors analyze trajectories of life evaluations and then consider whether early adversity offsets favorable expectations for the future. Results reveal that early adversity contributes to more negative views of the past but rising expectations for the future. Early adversity also has enduring effects on life evaluations, offsetting the influence of buoyant expectations. The findings draw attention to the limits of human agency under the constraints of early adversity—a process described as biographical structuration. PMID:21648247

Education, Life Expectancy and Family Bargaining: The Ben-Porath Effect Revisited

ERIC Educational Resources Information Center

Leker, Laura; Ponthiere, Gregory

2015-01-01

Following Ben-Porath [1967. "The Production of Human Capital and the Life-Cycle of Earnings." "Journal of Political Economy" 75 (3): 352-365], the influence of life expectancy on education and on human capital has attracted much attention among growth theorists. Whereas existing growth models rely on an education decision made…

Life table analysis of the United States' Year 2000 mortality objectives.

PubMed

Rockett, I R; Pollard, J H

1995-06-01

The US Year 2000 mortality objectives are model standards cast as targeted changes in age-adjusted cause-specific death rates. This research centred on the projected impact of such changes on life expectancy and the mortality toll for each sex. A computer simulation was conducted using single decrement, multiple decrement and cause-elimination life table techniques, together with a decomposition procedure. Male and female life expectancy at birth was projected to increase by 1.71 and 1.51 years, respectively, between the designated 1987 baseline and 2000. The leading beneficiaries would be those aged 65 and older, followed by those aged 45-64, and infants. Declines in coronary heart disease, stroke and injury death rates would most influence the projected life expectancy changes, irrespective of sex. Approximately 782,000 male deaths and 730,000 female deaths would be averted under Year 2000 assumptions. Life expectancy would be a useful summary measure to incorporate into official evaluations of the Year 2000 mortality objectives. Targeting of excess male mortality in the US and other highly industrialized nations is recommended.

Greater Equality: The Hidden Key to Better Health and Higher Scores

ERIC Educational Resources Information Center

Wilkinson, Richard; Pickett, Kate

2011-01-01

There are now many studies of income inequality and health that compare countries, American states, or other large regions, and the majority of these studies show that more egalitarian societies tend to be healthier. Inequality is associated with lower life expectancy, higher rates of infant mortality, shorter height, poor self-reported health,…

Magnetic Tape Storage and Handling: A Guide for Libraries and Archives.

ERIC Educational Resources Information Center

Van Bogart, John W. C.

This document provides a guide on how to properly store and care for magnetic media to maximize their life expectancies. An introduction compares magnetic media to paper and film and outlines the scope of the report. The second section discusses things that can go wrong with magnetic media. Binder degradation, magnetic particle instabilities,…

Physical activity extends life expectancy

Cancer.gov

Leisure-time physical activity is associated with longer life expectancy, even at relatively low levels of activity and regardless of body weight, according to a study by a team of researchers led by the NCI.

Rapid increase in Japanese life expectancy after World War II.

PubMed

Sugiura, Yasuo; Ju, Young-Su; Yasuoka, Junko; Jimba, Masamine

2010-02-01

Japanese life expectancy increased by about 13.7 years during the first decade after World War II, despite the country's post-war poverty. Although it is known that medical progress explains part of this increase, roles of non-medical factors have not been systematically studied. This study hypothesizes that non-medical factors, in addition to medical factors, are associated with the rapid increase in life expectancy in Japan. We analyzed the time trends of potential explanatory factors and used regression analysis with historical data from the Ministry of Internal Affairs and Communications' Historical Statistics of Japan during the period between 1946 and 1983. Time trends analysis revealed that the rapid increase in life expectancy preceded the dramatic growth of per capita Gross Domestic Product (GDP) by 10 years. In education, the nearly universal enrollment in elementary schools and increased advancement to upper secondary schools for both sexes were associated with better health. Regarding legislation, 32 health laws were passed in the first decade after the war and these laws were associated with improved health. Using regression analysis, we found that the enrollment rate in elementary schools, the number of health laws, and expansion of community-based activity staff were significantly associated with the increased life expectancy during the first decade after World War II. To conclude, in addition to medical factors, non-medical factors applied across the country, particularly education, community-based activities and legislation were associated with the rapid increase in Japanese life expectancy after World War II.

Mexico's epidemic of violence and its public health significance on average length of life

PubMed Central

Canudas-Romo, Vladimir; Aburto, José Manuel; García-Guerrero, Victor Manuel; Beltrán-Sánchez, Hiram

2017-01-01

Objectives A disproportionate number of homicides have caused Mexican life expectancy to stagnate during the new millennium. No efforts currently exist to quantify the harm of violent acts on the lives of the general population. We quantified the impact of perceived vulnerability on life expectancy. Methods Three Mexican national surveys on perceptions of public safety, life tables, and crime and vital statistics (2000–2014) were used. Prevalence rates of vulnerability/safety by age and sex were obtained from surveys at 2 different levels: federal state and home. The Sullivan method was used to estimate life expectancy lived with and without vulnerability for Mexican women and men. Results Overall life expectancy at age 20 stagnated between 2005 and 2014 for females and males; yet, there was an increase of 40% and 70% in average number of years lived with vulnerability at the state and home levels, respectively. In 2014, female life expectancy at age 20 was 59.5 years (95% CI 59.0 to 60.1); 71% of these years (42.3 years, 41.6 to 43.0) were spent with perceived vulnerability of violence taking place in the state and 26% at the home (15.3 years, 15 to 15.8). For males, life expectancy at age 20 was 54.5 years (53.7 to 55.1); 64% of these years (34.6 years, 34.0 to 35.4) were lived with perceived vulnerability of violence at the state and 20% at the home (11.1 years, 10.8 to 11.5). Conclusions The number of years lived with perceived vulnerability among Mexicans has increased by 30.5 million person-years over the last 10 years. If perceived vulnerability remains at its 2014 level, the average Mexican adults would be expected to live a large fraction of his/her life with perceived vulnerability of violence. Acts of violence continue to rise in the country and they should be addressed as a major public health issue before they become endemic. PMID:27451436

For better and for worse: the relationship between future expectations and functioning in the second half of life.

PubMed

Shrira, Amit; Palgi, Yuval; Ben-Ezra, Menachem; Spalter, Tal; Kavé, Gitit; Shmotkin, Dov

2011-03-01

To examine age group differences in the relationship between future expectations about standards of living and physical, mental, and cognitive functioning in the second half of life. Data from the Survey of Health, Ageing, and Retirement in Europe (N=27,687, mean age=64.44). First, with increasing age, the expectation to improve (ETI) and the expectation to worsen (ETW) in standards of living became more independent of each other. Second, with increasing age, ETI was less strongly correlated with functioning whereas ETW was more strongly correlated with it. Third, with increasing age, the relationship between ETI and functioning was more strongly moderated by ETW, so that adaptive functioning was associated with expectations that no major change is to occur and with expectations for both growth and decline. Late-life positive and negative expectancies are less interdependent than they are in younger age, probably due to their stronger interaction when associating with functioning. Expectancies interact either to reflect an attempt to preserve the functional status quo (low expectancy to improve and to decline) or may signal a highly complex mental organization (high expectancy to improve and to decline).

For Better and for Worse: The Relationship between Future Expectations and Functioning in the Second Half of Life

PubMed Central

Palgi, Yuval; Ben-Ezra, Menachem; Spalter, Tal; Kavé, Gitit; Shmotkin, Dov

2011-01-01

Objectives. To examine age group differences in the relationship between future expectations about standards of living and physical, mental, and cognitive functioning in the second half of life. Method. Data from the Survey of Health, Ageing, and Retirement in Europe (N = 27,687, mean age = 64.44). Results. First, with increasing age, the expectation to improve (ETI) and the expectation to worsen (ETW) in standards of living became more independent of each other. Second, with increasing age, ETI was less strongly correlated with functioning whereas ETW was more strongly correlated with it. Third, with increasing age, the relationship between ETI and functioning was more strongly moderated by ETW, so that adaptive functioning was associated with expectations that no major change is to occur and with expectations for both growth and decline. Discussion. Late-life positive and negative expectancies are less interdependent than they are in younger age, probably due to their stronger interaction when associating with functioning. Expectancies interact either to reflect an attempt to preserve the functional status quo (low expectancy to improve and to decline) or may signal a highly complex mental organization (high expectancy to improve and to decline). PMID:21296870

The impact of smoking on expected lifetime with and without chronic disease among Palestinian men in the West Bank.

PubMed

Brønnum-Hansen, Henrik; Jonassen, Marie; Shaheen, Amira; Duraidi, Mohammed; Qalalwa, Khaled; Jeune, Bernard

2018-06-01

The purpose of the study was to estimate life expectancy and the average lifetime with and without chronic disease among male never smokers, ex-smokers and smokers living in the West Bank of the occupied Palestinian territory. The study used a life table for the West Bank male population and Danish relative risk estimates for death for smokers and ex-smokers vs. never smokers and utilized data from the Palestinian Family Survey 2010. Expected lifetime with and without chronic disease was estimated and the contributions from the mortality and the morbidity effect to smoking related difference in average lifetime with and without chronic disease were assessed by decomposition. In the West bank 40% of the male population are smokers. Life expectancy of 15-year-old Palestinian men who would never start smoking was 59.5 years, 41.1 of which were expected to be without chronic disease. Ex-smokers could expect 57.9 years of remaining lifetime, 37.7 years of which without disease. For lifelong heavy smokers (> 20 cigarettes per day), the expected lifetime was reduced to 52.6 years, of which 38.5 years were without chronic disease. Of the total loss of 6.9 years of life expectancy among heavy smokers, the mortality effect accounted for 2.5 years without and 4.4 years with disease, whereas the morbidity effect was negligible. The high prevalence of smoking causes a considerable loss of life years and lifetime without chronic disease. We recommend the Palestinian health authorities to enforce the anti-smoking law.

Cost-effectiveness of diabetes case management for low-income populations.

PubMed

Gilmer, Todd P; Roze, Stéphane; Valentine, William J; Emy-Albrecht, Katrina; Ray, Joshua A; Cobden, David; Nicklasson, Lars; Philis-Tsimikas, Athena; Palmer, Andrew J

2007-10-01

To evaluate the cost-effectiveness of Project Dulce, a culturally specific diabetes case management and self-management training program, in four cohorts defined by insurance status. Clinical and cost data on 3,893 persons with diabetes participating in Project Dulce were used as inputs into a diabetes simulation model. The Center for Outcomes Research Diabetes Model, a published, peer-reviewed and validated simulation model of diabetes, was used to evaluate life expectancy, quality-adjusted life expectancy (QALY), cumulative incidence of complications and direct medical costs over patient lifetimes (40-year time horizon) from a third-party payer perspective. Cohort characteristics, treatment effects, and case management costs were derived using a difference in difference design comparing data from the Project Dulce program to a cohort of historical controls. Long-term costs were derived from published U.S. sources. Costs and clinical benefits were discounted at 3.0 percent per annum. Sensitivity analyses were performed. Incremental cost-effectiveness ratios of $10,141, $24,584, $44,941, and $69,587 per QALY gained were estimated for Project Dulce participants versus control in the uninsured, County Medical Services, Medi-Cal, and commercial insurance cohorts, respectively. The Project Dulce diabetes case management program was associated with cost-effective improvements in quality-adjusted life expectancy and decreased incidence of diabetes-related complications over patient lifetimes. Diabetes case management may be particularly cost effective for low-income populations.

The metabolic pace-of-life model: incorporating ectothermic organisms into the theory of vertebrate ecoimmunology.

PubMed

Sandmeier, Franziska C; Tracy, Richard C

2014-09-01

We propose a new heuristic model that incorporates metabolic rate and pace of life to predict a vertebrate species' investment in adaptive immune function. Using reptiles as an example, we hypothesize that animals with low metabolic rates will invest more in innate immunity compared with adaptive immunity. High metabolic rates and body temperatures should logically optimize the efficacy of the adaptive immune system--through rapid replication of T and B cells, prolific production of induced antibodies, and kinetics of antibody--antigen interactions. In current theory, the precise mechanisms of vertebrate immune function oft are inadequately considered as diverse selective pressures on the evolution of pathogens. We propose that the strength of adaptive immune function and pace of life together determine many of the important dynamics of host-pathogen evolution, namely, that hosts with a short lifespan and innate immunity or with a long lifespan and strong adaptive immunity are expected to drive the rapid evolution of their populations of pathogens. Long-lived hosts that rely primarily on innate immune functions are more likely to use defense mechanisms of tolerance (instead of resistance), which are not expected to act as a selection pressure for the rapid evolution of pathogens' virulence. © The Author 2014. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.

Neoadjuvant therapy versus upfront surgical strategies in resectable pancreatic cancer: A Markov decision analysis.

PubMed

de Geus, S W L; Evans, D B; Bliss, L A; Eskander, M F; Smith, J K; Wolff, R A; Miksad, R A; Weinstein, M C; Tseng, J F

2016-10-01

Neoadjuvant therapy is gaining acceptance as a valid treatment option for borderline resectable pancreatic cancer; however, its value for clearly resectable pancreatic cancer remains controversial. The aim of this study was to use a Markov decision analysis model, in the absence of adequately powered randomized trials, to compare the life expectancy (LE) and quality-adjusted life expectancy (QALE) of neoadjuvant therapy to conventional upfront surgical strategies in resectable pancreatic cancer patients. A Markov decision model was created to compare two strategies: attempted pancreatic resection followed by adjuvant chemoradiotherapy and neoadjuvant chemoradiotherapy followed by restaging with, if appropriate, attempted pancreatic resection. Data obtained through a comprehensive systematic search in PUBMED of the literature from 2000 to 2015 were used to estimate the probabilities used in the model. Deterministic and probabilistic sensitivity analyses were performed. Of the 786 potentially eligible studies identified, 22 studies met the inclusion criteria and were used to extract the probabilities used in the model. Base case analyses of the model showed a higher LE (32.2 vs. 26.7 months) and QALE (25.5 vs. 20.8 quality-adjusted life months) for patients in the neoadjuvant therapy arm compared to upfront surgery. Probabilistic sensitivity analyses for LE and QALE revealed that neoadjuvant therapy is favorable in 59% and 60% of the cases respectively. Although conceptual, these data suggest that neoadjuvant therapy offers substantial benefit in LE and QALE for resectable pancreatic cancer patients. These findings highlight the value of further prospective randomized trials comparing neoadjuvant therapy to conventional upfront surgical strategies. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer.

PubMed

Zemplényi, A T; Kaló, Z; Kovács, G; Farkas, R; Beöthe, T; Bányai, D; Sebestyén, Z; Endrei, D; Boncz, I; Mangel, L

2018-01-01

The aim of our analysis was to compare the cost-effectiveness of high-dose intensity-modulated radiation therapy (IMRT) and hypofractionated intensity-modulated radiation therapy (HF-IMRT) versus conventional dose three-dimensional radiation therapy (3DCRT) for the treatment of localised prostate cancer. A Markov model was constructed to calculate the incremental quality-adjusted life years and costs. Transition probabilities, adverse events and utilities were derived from relevant systematic reviews. Microcosting in a large university hospital was applied to calculate cost vectors. The expected mean lifetime cost of patients undergoing 3DCRT, IMRT and HF-IMRT were 7,160 euros, 6,831 euros and 6,019 euros respectively. The expected quality-adjusted life years (QALYs) were 5.753 for 3DCRT, 5.956 for IMRT and 5.957 for HF-IMRT. Compared to 3DCRT, both IMRT and HF-IMRT resulted in more health gains at a lower cost. It can be concluded that high-dose IMRT is not only cost-effective compared to the conventional dose 3DCRT but, when used with a hypofractionation scheme, it has great cost-saving potential for the public payer and may improve access to radiation therapy for patients. © 2016 John Wiley & Sons Ltd.

Quality of Life in Elderly Cancer Patients Undergoing Chemotherapy.

PubMed

Lavdaniti, Maria; Zyga, Sofia; Vlachou, Eugenia; Sapountzi-Krepia, Despina

2017-01-01

As life expectancy increases, it is expected that 60% of all cases of cancer will be detected in elderly patients in the next two decades. Cancer treatment for older persons is complicated by a number of factors, thus negatively affecting patients' quality of life. The purpose of this study is to investigate quality of life in elderly cancer patients undergoing chemotherapy. This study was descriptive and non-experimental. It was conducted in one large hospital in a major city of Northern Greece. The sample was convenience comprising 53 elderly cancer patients undergoing cycle 3 chemotherapy. The data was collected using the Functional Assessment of Cancer Therapy scale and included questions related to demographic and clinical characteristics. The majority of participants were men (n = 27, 50.9%) who were married (n = 32, 79.5%). Their mean age was 70.07 ± 3.60. Almost half of the sample (n = 30, 56.6%) had colon cancer. There was a statistical significant difference between men and women pertaining to physical wellbeing (p = 0.004) and overall quality of life (p < 0.001). When comparing each subscale with the patients' marital status it was found that there was a statistical difference with respect to social/family wellbeing (p = 0.029), functional wellbeing (p = 0.09) and overall quality of life (p < 0.001). Moreover, the type of cancer affected overall quality of life (p < 0.001) and social/family wellbeing (p = 0.029). These findings call attention to quality of life and its related factors in elderly cancer patients. It is highly recommended to envisage measures for improving quality of life in this group of cancer patients.

Analysis of underlying and multiple-cause mortality data: the life table methods.

PubMed

Moussa, M A

1987-02-01

The stochastic compartment model concepts are employed to analyse and construct complete and abbreviated total mortality life tables, multiple-decrement life tables for a disease, under the underlying and pattern-of-failure definitions of mortality risk, cause-elimination life tables, cause-elimination effects on saved population through the gain in life expectancy as a consequence of eliminating the mortality risk, cause-delay life tables designed to translate the clinically observed increase in survival time as the population gain in life expectancy that would occur if a treatment protocol was made available to the general population and life tables for disease dependency in multiple-cause data.

The impact of health care resources, socioeconomic status, and demographics on life expectancy: a cross-country study in three Southeast Asian countries.

PubMed

Chan, Moon Fai

2015-03-01

This study aimed to examine the impact of health care resources, socioeconomic status, and demographic changes on life expectancy in Indonesia, Philippines, and Vietnam. This was a cross-country study to collect annual data (1980-2008) from each target country. Life expectancy was the dependent variable and health care resources, socioeconomic status, and demographics were the 3 main determinants. Structural equation modeling was employed, and the results indicate that the availability of more health care resources (Indonesia: coefficient = .47, P = .008; Philippines: coefficient = .48, P = .017; Vietnam: coefficient = .48, P = .004) and higher levels of socioeconomic advantages (Indonesia: coefficient = .41, P = .014; Vietnam: coefficient = .34, P = .026) are more likely to increase life expectancy. In contrast, demographic changes are more likely to increase life expectancy because of the wide range of health care resources. These findings suggest that more effort, particularly during economic downturns, should be put into removing the barriers that impede access to health care services and increasing preventive care for the population that currently has less access to health care in communities where there is a shortage of medical resources. © 2013 APJPH.

Cost-Effectiveness of Radiofrequency Catheter Ablation Compared with Antiarrhythmic Drug Therapy for Paroxysmal Atrial Fibrillation

PubMed Central

Reynolds, Matthew R.; Zimetbaum, Peter; Josephson, Mark E.; Ellis, Ethan; Danilov, Tatyana; Cohen, David J.

2009-01-01

Background Radiofrequency catheter ablation (RFA) has emerged as an important treatment strategy for AF. The potential cost-effectiveness of RFA for AF, relative to antiarrhythmic drug (AAD) therapy, has not been fully explored from a U.S. perspective. Methods and Results We constructed a Markov disease simulation model for a hypothetical cohort of drug- refractory paroxysmal AF patients managed either with RFA ± AAD or AAD alone. Costs and quality-adjusted life years (QALYs) were projected over 5 years. Model inputs were drawn from published clinical trial and registry data, from new registry and trial data analysis, and from data prospectively collected from AF patients managed with RFA at our institution. We assumed no benefit form ablation on stroke, heart failure or death, but did estimate changes in quality-adjusted life expectancy using data from several AF cohorts. In the base case scenario, cumulative costs with the RFA and AAD strategies were $26,584 and $19,898, respectively. Over 5 years, quality adjusted life expectancy was 3.51 QALYs with RFA, versus 3.38 for the AAD group. The incremental cost-effectiveness ratio for RFA vs. AAD was thus $51,431/QALY. Model results were most sensitive to time horizon, the relative utility weights of successful ablation vs. unsuccessful drug therapy, and to the cost of an ablation procedure. Conclusions RFA ± AAD for symptomatic, drug-refractory paroxysmal AF appears to be reasonably cost-effective compared with AAD therapy alone from the perspective of the US health care system, based on improved quality of life and avoidance of future health care costs. PMID:19808491

Impact of Fast Charging on Life of EV Batteries; NREL (National Renewable Energy Laboratory)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Neubauer, Jeremy; Wood, Eric; Burton, Evan

Installation of fast charging infrastructure is considered by many as one of potential solutions to increase the utility and range of electric vehicles (EVs). This is expected to reduce the range anxiety of drivers of EVs and thus increase their market penetration. Level 1 and 2 charging in homes and workplaces is expected to contribute to the majority of miles driven by EVs. However, a small percentage of urban driving and most of inter-city driving could be only achieved by a fast-charging network. DC fast charging at 50 kW, 100 kW, 120 kW compared to level 1 (3.3 kW) andmore » level 2 (6.6 kW) results in high-current charging that can adversely impact the life of the battery. In the last couple of years, we have investigated the impact of higher current rates in batteries and potential of higher temperatures and thus lower service life. Using mathematical models, we investigated the temperature increase of batteries due to higher heat generation during fast charge and have found that this could lead to higher temperatures. We compared our models with data from other national laboratories both for fine-tuning and calibration. We found that the incremental temperature rise of batteries during 1C to 3C fast charging may reduce the practical life of the batteries by less than 10% over 10 to 15 years of vehicle ownership. We also found that thermal management of batteries is needed for fast charging to prevent high temperature excursions leading to unsafe conditions.« less

Mortality trends in Australian Aboriginal peoples and New Zealand Māori.

PubMed

Phillips, Bronwen; Daniels, John; Woodward, Alistair; Blakely, Tony; Taylor, Richard; Morrell, Stephen

2017-01-01

The health status of Indigenous populations of Australia and New Zealand (NZ) Māori manifests as life expectancies substantially lower than the total population. Accurate assessment of time trends in mortality and life expectancy allows evaluation of progress in reduction of health inequalities compared to the national or non-Indigenous population. Age-specific mortality and life expectancy (at birth) (LE) for Indigenous populations (Australia from 1990 and NZ from 1950); and all Australia and non-Māori NZ (from 1890), males (M) and females (F), were obtained from published sources and national statistical agency reports. Period trends were assessed for credible estimates of Indigenous LE, and the LE gap compared to the total population for Australia, and non-Māori for NZ. Period trends in premature adult mortality, as cumulative probability of dying over 15-59 years, were assessed similarly. The relative contribution of differences in age-specific mortality to the LE gap between Indigenous and the all-Australia population, and the non-Māori NZ, was estimated for each country by sex for the most recent period: 2010-2012 for Australia, 2012-2014 for NZ. LE increased for all populations, although LE gaps between Indigenous and all Australia showed little change over time. LE gaps between NZ Māori and non-Māori increased significantly from the early 1980s to the mid-1990s, and since then have fallen again. Recent LE gaps in Australia (M 12.5; F 12.0 years in 2010-2012) were larger than in NZ (M 7.3; F 6.8 years in 2012-2014). Premature adult mortality (15-59 years) improved for all populations, but mortality ratios show little change since 2000, with Indigenous at 3½-4 times that of all Australians, and Māori 2-3 times that of non-Māori. Using decomposition analysis, the age interval contributing most strongly to differences in LE between Indigenous and all Australia was 35-59 years, but between Māori and non-Māori it was 60-74 years. In Australia and NZ, Indigenous LE and adult mortality are improving in absolute terms, but not relative to the entire or non-Indigenous populations, causing gaps in life expectancy to persist.

Long-term survival following open repair of ruptured abdominal aortic aneurysm.

PubMed

Englund, Raymond; Katib, Nedal

2017-05-01

Long-term results for patients being managed for ruptured compared to elective abdominal aortic aneurysms (AAA) are unclear. We hypothesize that patients who survive 30 days or more following repair of ruptured AAA (RAAA) performed by open technique have a life expectancy no different to those patients surviving 30 days or more following elective AAA repair, or compared to a general age-matched population. Between 1987 and December 2014, 620 consecutive patients were treated by the principal author for aortic aneurysmal disease. Two subgroups were selected from this population, elective open abdominal repair (215) and RAAA open repair (105). Comparable age-matched life curves with the general population were used from the Australian Bureau of Statistics for each patient according to gender, age and date of presentation. Statistical comparison was by Kaplan-Meier survival analysis. Both the open and RAAA groups were well matched for age and sex. There was no statistical difference between RAAA survival and an age-matched population P = 0.23, or was there any difference between open repair and an age-matched population, P = 0.1. Survival curves for RAAA and open repair were similar, P = 0.98. For elective open repair 1-, 5-, 10-, 15- and 20-year survival was 93.6, 71.2, 40, 17 and 2% respectively. Corresponding results for RAAA were 92.5, 74, 36.7, 13.5 and 5% respectively. Open AAA repair for RAAA or elective aneurysm treatment restores predicted life expectancy for those patients surviving 30 days or more and is therefore a durable method of treatment for this condition. © 2016 Royal Australasian College of Surgeons.

Forecasting continuously increasing life expectancy: what implications?

PubMed

Le Bourg, Eric

2012-04-01

It has been proposed that life expectancy could linearly increase in the next decades and that median longevity of the youngest birth cohorts could reach 105 years or more. These forecasts have been criticized but it seems that their implications for future maximal lifespan (i.e. the lifespan of the last survivors) have not been considered. These implications make these forecasts untenable and it is less risky to hypothesize that life expectancy and maximal lifespan will reach an asymptotic limit in some decades from now. Copyright © 2012 Elsevier B.V. All rights reserved.

Rough Set Theory based prognostication of life expectancy for terminally ill patients.

PubMed

Gil-Herrera, Eleazar; Yalcin, Ali; Tsalatsanis, Athanasios; Barnes, Laura E; Djulbegovic, Benjamin

2011-01-01

We present a novel knowledge discovery methodology that relies on Rough Set Theory to predict the life expectancy of terminally ill patients in an effort to improve the hospice referral process. Life expectancy prognostication is particularly valuable for terminally ill patients since it enables them and their families to initiate end-of-life discussions and choose the most desired management strategy for the remainder of their lives. We utilize retrospective data from 9105 patients to demonstrate the design and implementation details of a series of classifiers developed to identify potential hospice candidates. Preliminary results confirm the efficacy of the proposed methodology. We envision our work as a part of a comprehensive decision support system designed to assist terminally ill patients in making end-of-life care decisions.

Calibrating and adjusting expectations in life: A grounded theory on how elderly persons with somatic health problems maintain control and balance in life and optimize well-being

PubMed Central

Helvik, Anne-Sofie; Iversen, Valentina Cabral; Steiring, Randi; Hallberg, Lillemor R-M

2011-01-01

Aim This study aims at exploring the main concern for elderly individuals with somatic health problems and what they do to manage this. Method In total, 14 individuals (mean=74.2 years; range=68–86 years) of both gender including hospitalized and outpatient persons participated in the study. Open interviews were conducted and analyzed according to grounded theory, an inductive theory-generating method. Results The main concern for the elderly individuals with somatic health problems was identified as their striving to maintain control and balance in life. The analysis ended up in a substantive theory explaining how elderly individuals with somatic disease were calibrating and adjusting their expectations in life in order to adapt to their reduced energy level, health problems, and aging. By adjusting the expectations to their actual abilities, the elderly can maintain a sense of that they still have the control over their lives and create stability. The ongoing adjustment process is facilitated by different strategies and result despite lower expectations in subjective well-being. The facilitating strategies are utilizing the network of important others, enjoying cultural heritage, being occupied with interests, having a mission to fulfill, improving the situation by limiting boundaries and, finally, creating meaning in everyday life. Conclusion The main concern of the elderly with somatic health problems was to maintain control and balance in life. The emerging theory explains how elderly people with somatic health problems calibrate their expectations of life in order to adjust to reduced energy, health problems, and aging. This process is facilitated by different strategies and result despite lower expectation in subjective well-being. PMID:21468299

Estimating benefits of past, current, and future reductions in smoking rates using a comprehensive model with competing causes of death.

PubMed

van Meijgaard, Jeroen; Fielding, Jonathan E

2012-01-01

Despite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. The objective of this study was to use a life course model with multiple competing causes of death to elucidate the ongoing benefits of tobacco-use control efforts on US death rates. We used a continuous-time life course simulation model for the US population. We modeled smoking initiation and cessation and 20 leading causes of death as competing risks over the life span, with the risk of death for each cause dependent on past and current smoking status. Risk parameters were estimated using data from the National Health Interview Survey that were linked to follow-up mortality data. Up to 14% (9% for men, 14% for women) of the total gain in life expectancy since 1960 was due to tobacco-use control efforts. Past efforts are expected to further increase life expectancy by 0.9 years for women and 1.3 years for men. Additional reduction in smoking prevalence may eventually yield an average 3.4-year increase in life expectancy in the United States. Coronary heart disease is expected to increase as a share of total deaths. A dynamic individual-level model with multiple causes of death supports assessment of the delayed benefits of improved tobacco-use control efforts. We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years. Smoking will remain a major contributor to preventable illness and death, worthy of continued interventions.

The value of point-of-care CD4+ and laboratory viral load in tailoring antiretroviral therapy monitoring strategies to resource limitations.

PubMed

Hyle, Emily P; Jani, Ilesh V; Rosettie, Katherine L; Wood, Robin; Osher, Benjamin; Resch, Stephen; Pei, Pamela P; Maggiore, Paolo; Freedberg, Kenneth A; Peter, Trevor; Parker, Robert A; Walensky, Rochelle P

2017-09-24

To examine the clinical and economic value of point-of-care CD4 (POC-CD4) or viral load monitoring compared with current practices in Mozambique, a country representative of the diverse resource limitations encountered by HIV treatment programs in sub-Saharan Africa. We use the Cost-Effectiveness of Preventing AIDS Complications-International model to examine the clinical impact, cost (2014 US$), and incremental cost-effectiveness ratio [$/year of life saved (YLS)] of ART monitoring strategies in Mozambique. We compare: monitoring for clinical disease progression [clinical ART monitoring strategy (CLIN)] vs. annual POC-CD4 in rural settings without laboratory services and biannual laboratory CD4 (LAB-CD4), biannual POC-CD4, and annual viral load in urban settings with laboratory services. We examine the impact of a range of values in sensitivity analyses, using Mozambique's 2014 per capita gross domestic product ($620) as a benchmark cost-effectiveness threshold. In rural settings, annual POC-CD4 compared to CLIN improves life expectancy by 2.8 years, reduces time on failed ART by 0.6 years, and yields an incremental cost-effectiveness ratio of $480/YLS. In urban settings, biannual POC-CD4 is more expensive and less effective than viral load. Compared to biannual LAB-CD4, viral load improves life expectancy by 0.6 years, reduces time on failed ART by 1.0 year, and is cost-effective ($440/YLS). In rural settings, annual POC-CD4 improves clinical outcomes and is cost-effective compared to CLIN. In urban settings, viral load has the greatest clinical benefit and is cost-effective compared to biannual POC-CD4 or LAB-CD4. Tailoring ART monitoring strategies to specific settings with different available resources can improve clinical outcomes while remaining economically efficient.

Life expectancy in elderly patients following burns injury.

PubMed

Sepehripour, Sarvnaz; Duggineni, Sirisha; Shahsavari, Somaya; Dheansa, Baljit

2018-05-18

Burn injuries commonly occur in vulnerable age and social groups. Previous research has shown that frailty may represent a more important marker of adverse outcome in healthcare rather than chronological age (Roberts et al., 2012). In this paper we determined the relationship between burn injury, frailty, co-morbidities and long-term survival. Retrospective data collection from patients aged 75 with burns injuries, treated and discharged at Queen Victoria Hospital. The Clinical Frailty Scale (Rockwood et al., 2005) was used to calculate frailty at the time of admission. The expected mortality age (life expectancy) of deceased patients was obtained from two survival predictors. The data shows a statistically significant correlation between frailty score and complications and a statistically significant correlation between total body surface area percentage and complications. No significant difference was found between expected and observed age of death or life expectancy amongst the deceased (p value of 0.109). Based on the data from our unit, sustaining a burn as an elderly person does not reduce life expectancy. Medical and surgical complications, immediate, early and late, although higher with greater frailty and TBSA of burn, but do not adversely affect survival in this population. Copyright © 2018 Elsevier Ltd. All rights reserved.

Life Expectancy Can Explain the Precocity-Longevity Hypothesis Association of Early Career Success and Early Death.

PubMed

McCann, Stewart J H

2015-01-01

The precocity-longevity hypothesis that those who reach career milestones earlier in life have shorter life spans was tested with the 430 men elected to serve in the House of Representatives for the 71st U.S. Congress in 1929-1930 who were alive throughout 1930. There was no tendency for those first serving at an earlier age to die sooner or those serving first at a later age to die later than expected based on individual life expectancy in 1930. Although age at first serving was correlated with death age, the correlation was not significant when expected death age was controlled. The results cast serious doubt on the contention of the precocity-longevity hypothesis that the developmental aspects of the prerequisites, concomitants, and consequences of early career achievement peaks actively enhance the conditions for an earlier death.

Healthy life expectancy in Hong Kong Special Administrative Region of China.

PubMed Central

Law, C. K.; Yip, P. S. F.

2003-01-01

Sullivan's method and a regression model were used to calculate healthy life expectancy (HALE) for men and women in Hong Kong Special Administrative Region (Hong Kong SAR) of China. These methods need estimates of the prevalence and information on disability distributions of 109 diseases and HALE for 191 countries by age, sex and region of the world from the WHO's health assessment of 2000. The population of Hong Kong SAR has one of the highest healthy life expectancies in the world. Sullivan's method gives higher estimates than the classic linear regression method. Although Sullivan's method accurately calculates the influence of disease prevalence within small areas and regions, the regression method can approximate HALE for all economies for which information on life expectancy is available. This paper identifies some problems of the two methods and discusses the accuracy of estimates of HALE that rely on data from the WHO assessment. PMID:12640475

The cost effectiveness of rapid-acting insulin aspart compared with human insulin in type 2 diabetes patients: an analysis from the Japanese third-party payer perspective.

PubMed

Pollock, R F; Valentine, W J; Pilgaard, T; Nishimura, H

2011-01-01

The Nippon Ultra-Rapid Insulin and Diabetic Complication Evaluation Study (NICE Study) (NCT00575172) was a 5-year, open-label, randomised controlled trial which compared cardiovascular outcomes in Japanese type 2 diabetes patients intensively treated with regular human insulin or insulin aspart (NovoRapid; Novo Nordisk A/S, Bagsvaerd, Denmark), a rapid-acting insulin analogue. The aim of the present analysis was to evaluate the cost effectiveness of insulin aspart versus regular human insulin from the perspective of a Japanese third-party healthcare payer. A discrete event-simulation model was developed in Microsoft Excel to assess the within-trial cost effectiveness and make longer-term clinical projections in patients treated with regular human insulin or insulin aspart. In addition to severe hypoglycaemia, the model captured myocardial and cerebral infarction events and percutaneous coronary intervention and coronary artery bypass graft procedures. Within-trial mortality, incidence of severe hypoglycaemia and cardiovascular event probabilities were derived from the annual rates observed during the trial period, while post-trial outcomes were calculated using the event rates from the trial, adjusted for increasing patient age. Event costs were accounted from the healthcare payer perspective and expressed in 2008 Japanese yen (JPY), while health-related quality of life (HRQoL) was captured using event and state utilities. Future costs and clinical benefits were discounted at 3% annually. Life expectancy, quality-adjusted life expectancy, cardiovascular event rates and costs were evaluated over 5- and 10-year time horizons and sensitivity analyses were performed to assess variability in model outcomes. Over 5 years of treatment, insulin aspart dominated human insulin both in incremental life expectancy and in incremental quality-adjusted life-years (QALYS). Insulin aspart was associated with a small improvement in discounted life expectancy of 0.005 years (4.688 vs. 4.684 years) and an increase of 0.023 quality-adjusted life-years (QALYs) (3.800 vs. 3.776 QALYs) when compared with regular human insulin. Insulin aspart also incurred lower costs (JPY 481,586 vs. 594,717, difference -113,131) which resulted from the decreased incidence of cardiovascular events with insulin aspart (0.013 events per patient year vs. 0.030 on regular human insulin). Breakdown of costs indicated that pharmacy costs were higher with insulin aspart (JPY 346,608 vs. 278,468), but these costs were more than offset by the reduced costs associated with cardiovascular complications and hypoglycaemia over 5 years of treatment (JPY 134,978 vs. 316,249). Sensitivity analysis showed that insulin aspart was still cost-effective in the case where only 18% of the within-trial cardiovascular and mortality benefit over regular human insulin was captured in the model (assuming a willingness-to-pay threshold of JPY 5,000,000). The NICE study cohort was relatively small (n = 325), meaning that caution should be exercised when calculating and interpreting the incremental cost-effectiveness ratio. Also, despite the differences in cardiovascular risk profile between the Japanese and UK populations, UKPDS-derived risk equations were used to project MI outcomes and PCI and CABG procedures and UKPDS HRQoL scores were applied to all health states. While these risk formulas and HRQoL utilities may not be directly applicable to the Japanese population, no equivalent Japanese-specific data are currently available. In a Japanese type 2 diabetes population, prescribing rapid-acting insulin aspart significantly reduced cardiovascular complications over 5- and 10-year time horizons, resulting in increased quality of life and decreased costs when compared with human insulin.

Discussions of Life Expectancy and Changes in Illness Understanding in Patients With Advanced Cancer.

PubMed

Epstein, Andrew S; Prigerson, Holly G; O'Reilly, Eileen M; Maciejewski, Paul K

2016-07-10

Accurate illness understanding enables patients to make informed decisions. Evidence of the influence of prognostic discussions on the accuracy of illness understanding by patients would demonstrate the value of discussions. Recent and past oncology provider-patient discussions about prognosis/life expectancy were examined for their association with changes in illness understanding by patients. Patients (N = 178) with advanced cancers refractory to prior chemotherapy whom oncologists expected to die within 6 months were interviewed before and after a visit in which cancer restaging scan results were discussed. Illness understanding scores were the sum of four indicator variables: patient terminal illness acknowledgment, recognition of incurable disease status, knowledge of the advanced stage of the disease, and expectation to live months as opposed to years. Before the restaging scan visit, nine (5%) of 178 patients had completely accurate illness understanding (ie, correctly answered each of the four illness understanding questions). Eighteen patients (10%) reported only recent discussions of prognosis/life expectancy with their oncologists; 68 (38%) reported only past discussions; 24 (13%) reported both recent and past discussions; and 68 (38%) reported that they never had discussions of prognosis/life expectancy with their oncologists. After adjustment for potential confounders (ie, education and race/ethnicity), analysis identified significant, positive changes in illness understanding scores for patients in groups that reported recent only (least-squares mean change score, 0.62; 95% CI, 0.23 to 1.01; P = .002) and both recent and past (least-squares mean change score, 0.37; 95% CI, 0.04 to 0.70; P = 0.028) discussions of prognosis/life expectancy with their oncologists. Patients with advanced cancer who report recent discussions of prognosis/life expectancy with their oncologists come to have a better understanding of the terminal nature of their illnesses. © 2016 by American Society of Clinical Oncology.

Discussions of Life Expectancy and Changes in Illness Understanding in Patients With Advanced Cancer

PubMed Central

Epstein, Andrew S.; O’Reilly, Eileen M.; Maciejewski, Paul K.

2016-01-01

Purpose Accurate illness understanding enables patients to make informed decisions. Evidence of the influence of prognostic discussions on the accuracy of illness understanding by patients would demonstrate the value of discussions. Methods Recent and past oncology provider-patient discussions about prognosis/life expectancy were examined for their association with changes in illness understanding by patients. Patients (N = 178) with advanced cancers refractory to prior chemotherapy whom oncologists expected to die within 6 months were interviewed before and after a visit in which cancer restaging scan results were discussed. Illness understanding scores were the sum of four indicator variables: patient terminal illness acknowledgment, recognition of incurable disease status, knowledge of the advanced stage of the disease, and expectation to live months as opposed to years. Results Before the restaging scan visit, nine (5%) of 178 patients had completely accurate illness understanding (ie, correctly answered each of the four illness understanding questions). Eighteen patients (10%) reported only recent discussions of prognosis/life expectancy with their oncologists; 68 (38%) reported only past discussions; 24 (13%) reported both recent and past discussions; and 68 (38%) reported that they never had discussions of prognosis/life expectancy with their oncologists. After adjustment for potential confounders (ie, education and race/ethnicity), analysis identified significant, positive changes in illness understanding scores for patients in groups that reported recent only (least-squares mean change score, 0.62; 95% CI, 0.23 to 1.01; P = .002) and both recent and past (least-squares mean change score, 0.37; 95% CI, 0.04 to 0.70; P = 0.028) discussions of prognosis/life expectancy with their oncologists. Conclusion Patients with advanced cancer who report recent discussions of prognosis/life expectancy with their oncologists come to have a better understanding of the terminal nature of their illnesses. PMID:27217454

Social cognitive predictors of Mexican American college students' academic and life satisfaction.

PubMed

Ojeda, Lizette; Flores, Lisa Y; Navarro, Rachel L

2011-01-01

In this study, we used Lent's (2004) social cognitive model of well being to examine the academic and life satisfaction of 457 Mexican American college students attending a Hispanic-Serving Institution. Using structural equation modeling, results indicated that the model provided a good fit to the data. Specifically, we found positive relations from positive affect to enculturation, acculturation, college self-efficacy, academic satisfaction, and life satisfaction; from enculturation to college self-efficacy; from acculturation to college self-efficacy and college outcome expectations; from college self-efficacy to college outcome expectations, academic goal progress, academic satisfaction, and life satisfaction; from college outcome expectations to academic satisfaction; from academic goal progress to academic and life satisfaction; and from academic satisfaction to life satisfaction. Findings indicated the model was invariant across gender groups, and overall, 38% and 14% of the variance in academic satisfaction and life satisfaction, respectively, were explained by the predictor variables. Implications for research and practice are discussed.

Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions?

PubMed

Witjes, Suzanne; van Geenen, Rutger C I; Koenraadt, Koen L M; van der Hart, Cor P; Blankevoort, Leendert; Kerkhoffs, Gino M M J; Kuijer, P Paul F M

2017-02-01

Indications for total and unicondylar knee arthroplasty (KA) have expanded to younger patients, in which Patient-Reported Outcome Measures (PROMs) often show ceiling effects. This might be due to higher expectations. Our aims were to explore expectations of younger patients concerning activities in daily life, work and leisure time after KA and to assess to what extent PROMs meet and evaluate these activities of importance. Focus groups were performed among osteoarthritis (OA) patients <65 years awaiting KA, in which they indicated what activities they expected to perform better in daily life, work and leisure time after KA. Additionally, 28 activities of daily life, 17 of work and 27 of leisure time were depicted from seven PROMS, which were rated on importance, frequency and bother. A total score, representing motivation for surgery, was also calculated. Data saturation was reached after six focus groups including 37 patients. Younger OA patients expect to perform better on 16 activities after KA, including high-impact leisure time activities. From the PROMs, daily life and work activities were rated high in both importance and motivation for surgery, but for leisure time activities importance varied highly between patients. All seven PROMs score activities of importance, but no single PROM incorporates all activities rated important. Younger patients expect to perform better on many activities of daily life, work and leisure time after KA, and often at demanding levels. To measure outcomes of younger patients, we suggest using PROMs that include work and leisure time activities besides daily life activities, in which preferably scored activities can be individualized.

Health care expenditure and life expectancy in Australia: how well do we perform?

PubMed

Taylor, R; Salkeld, G

1996-06-01

The Australian health care system consists of mixed public and private financing underpinned by Medicare, a universal government-run insurance scheme paid through taxation (and levy) on income. Australia has improved its ranking for life expectancy (at birth) since 1960, and in 1990 ranked ninth and seventh of 24 countries for females and males respectively; this is ahead of the United States and United Kingdom, and approximately equal to Canada. Australian hospital bed supply and utilisation are average, after deletion of day-only cases. The proportion of gross domestic product (GDP) spent on health, in relation to GDP per capita (adjusted for purchasing power), in Australia in 1990 was average, and the prices for health care from 1975 to 1990 did not increase when adjusted for inflation. Although 68 per cent of health expenditure emanates from public sources in Australia, this is lower than in the majority of European countries and Canada. Some countries are doing poorly (such as the United States, with lower than average life expectancy and higher than predicted health expenditure) and some countries are doing well (with higher than average life expectancy and lower than predicted health expenditure; for example, Japan). Australia has higher than average life expectancy and only slightly higher than predicted health expenditure per capita. Although the Australian system could be improved, there are no indications that radical changes are required. The relatively high life expectancy in Australia can be attributed to favourable social and economic conditions, successful public health programs, and the availability of universal quality health care.

Geographic health inequalities in Norway: a Gini analysis of cross-county differences in mortality from 1980 to 2014.

PubMed

Skaftun, Eirin K; Verguet, Stéphane; Norheim, Ole F; Johansson, Kjell A

2018-05-24

This study aims at quantifying the level and changes over time of inequality in age-specific mortality and life expectancy between the 19 Norwegian counties from 1980 to 2014. Data on population and mortality by county was obtained from Statistics Norway for 1980-2014. Life expectancy and age-specific mortality rates (0-4, 5-49 and 50-69 age groups) were estimated by year and county. Geographic inequality was described by the absolute Gini index annually. Life expectancy in Norway has increased from 75.6 to 82.0 years, and the risk of death before the age of 70 has decreased from 26 to 14% from 1980 to 2014. The absolute Gini index decreased over the period 1980 to 2014 from 0.43 to 0.32 for life expectancy, from 0.012 to 0.0057 for the age group 50-69 years, from 0.0038 to 0.0022 for the age group 5-49 years, and from 0.0009 to 0.0006 for the age group 0-4 years. It will take between 2 and 32 years (national average 7 years) until the counties catch up with the life expectancy in the best performing county if their annual rates of increase remain unchanged. Using the absolute Gini index as a metric for monitoring changes in geographic inequality over time may be a valuable tool for informing public health policies. The absolute inequality in mortality and life expectancy between Norwegian counties has decreased from 1980 to 2014.

Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders.

PubMed

Wahlbeck, Kristian; Westman, Jeanette; Nordentoft, Merete; Gissler, Mika; Laursen, Thomas Munk

2011-12-01

People with mental disorders evince excess mortality due to natural and unnatural deaths. The relative life expectancy of people with mental disorders is a proxy measure of effectiveness of social policy and health service provision. To evaluate trends in health outcomes of people with serious mental disorders. We examined nationwide 5-year consecutive cohorts of people admitted to hospital for mental disorders in Denmark, Finland and Sweden in 1987-2006. In each country the risk population was identified from hospital discharge registers and mortality data were retrieved from cause-of-death registers. The main outcome measure was life expectancy at age 15 years. People admitted to hospital for a mental disorder had a two- to threefold higher mortality than the general population in all three countries studied. This gap in life expectancy was more pronounced for men than for women. The gap decreased between 1987 and 2006 in these countries, especially for women. The notable exception was Swedish men with mental disorders. In spite of the positive general trend, men with mental disorders still live 20 years less, and women 15 years less, than the general population. During the era of deinstitutionalisation the life expectancy gap for people with mental disorders has somewhat diminished in the three Nordic countries. Our results support further development of the Nordic welfare state model, i.e. tax-funded community-based public services and social protection. Health promotion actions, improved access to healthcare and prevention of suicides and violence are needed to further reduce the life expectancy gap.

Impact of ankylosing spondylitis on work and family life: comparisons with the US population.

PubMed

Ward, Michael M; Reveille, John D; Learch, Thomas J; Davis, John C; Weisman, Michael H

2008-04-15

To examine the impact of ankylosing spondylitis (AS) on work disability, nonparticipation in the labor force, marriage, divorce, and childbearing. In this cross-sectional survey, we asked AS patients (n = 591, 72.8% men, mean age 48.9 years) from the Los Angeles, Houston, San Francisco, and Washington, DC metropolitan areas about work and family life. The proportion of patients who were work disabled, did not participate in the labor force, had never been married, were divorced, or had a biological child were compared with the proportions expected for each outcome based on data from population surveys. Patients with AS were more likely to be work disabled (13.3% versus 5.7%; P < 0.0001) and somewhat more likely to not participate in the labor force compared with the proportion expected (25.1% versus 21.8%; P = 0.07). These associations were stronger among patients age > or =45 years and those with AS for > or =20 years. AS patients were more likely than expected to have never been married (22.8% versus 15.4%; P < 0.0001) or to be divorced (13.2% versus 10.0%; P = 0.02). Women with AS were less likely than expected to have had children (54.7% versus 64.9%; P = 0.02), but the proportion of men with AS who had children was not different from that of the general population. Patients with AS in this study were more likely to have never been married, more likely to be divorced, and more than twice as likely to be work disabled than members of the general population. Women with AS were also less likely to have had children than women in the general population.

Cost Effectiveness Analysis of Different Management Strategies between Best Supportive Care and Second-line Chemotherapy for Platinum-resistant or Refractory Ovarian Cancer.

PubMed

Luealon, Phanida; Khempech, Nipon; Vasuratna, Apichai; Hanvoravongchai, Piya; Havanond, Piyalamporn

2016-01-01

There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. All of the second-line chemotherapy strategies showed certain benefits due to an increased life- year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

The association of air pollution and greenness with mortality and life expectancy in Spain: A small-area study.

PubMed

de Keijzer, Carmen; Agis, David; Ambrós, Albert; Arévalo, Gustavo; Baldasano, Jose M; Bande, Stefano; Barrera-Gómez, Jose; Benach, Joan; Cirach, Marta; Dadvand, Payam; Ghigo, Stefania; Martinez-Solanas, Èrica; Nieuwenhuijsen, Mark; Cadum, Ennio; Basagaña, Xavier

2017-02-01

Air pollution exposure has been associated with an increase in mortality rates, but few studies have focused on life expectancy, and most studies had restricted spatial coverage. A limited body of evidence is also suggestive for a beneficial association between residential exposure to greenness and mortality, but the evidence for such an association with life expectancy is still very scarce. To investigate the association of exposure to air pollution and greenness with mortality and life expectancy in Spain. Mortality data from 2148 small areas (average population of 20,750 inhabitants, and median population of 7672 inhabitants) covering Spain for years 2009-2013 were obtained. Average annual levels of PM 10 , PM 2.5 , NO 2 and O 3 were derived from an air quality forecasting system at 4×4km resolution. The normalized difference vegetation index (NDVI) was used to assess greenness in each small area. Air pollution and greenness were linked to standardized mortality rates (SMRs) using Poisson regression and to life expectancy using linear regression. The models were adjusted for socioeconomic status and lung cancer mortality rates (as a proxy for smoking), and accounted for spatial autocorrelation. The increase of 5μg/m 3 in PM 10 , NO 2 and O 3 or of 2μg/m 3 in PM 2.5 concentration resulted in a loss of life in years of 0.90 (95% credibility interval CI: 0.83, 0.98), 0.13 (95% CI: 0.09, 0.17), 0.20years (95% CI: 0.16, 0.24) and 0.64 (0.59, 0.70), respectively. Similar associations were found in the SMR analysis, with stronger associations for PM 2.5 and PM 10 , which were associated with an increased mortality risk of 3.7% (95% CI: 3.5%, 4.0%) and 5.7% (95% CI: 5.4%, 6.1%). For greenness, a protective effect on mortality and longer life expectancy was only found in areas with lower socioeconomic status. Air pollution concentrations were associated to important reductions in life expectancy. The reduction of air pollution should be a priority for public health. Copyright © 2016 Elsevier Ltd. All rights reserved.

Children Rights in Social Studies Curricula in Elementary Education: A Comparative Study

ERIC Educational Resources Information Center

Merey, Zihni

2012-01-01

Social studies classes educate students as citizens who are expected to adopt democratic values and apply their information and richness to their life. Social studies classes are the ones that include human rights education in the first place. The purpose of this study is to make a comparison of inclusion levels of children's rights issues in…

Self-Stigma and Coming Out about One's Mental Illness

ERIC Educational Resources Information Center

Corrigan, Patrick W.; Morris, Scott; Larson, Jon; Rafacz, Jennifer; Wassel, Abigail; Michaels, Patrick; Wilkniss, Sandra; Batia, Karen; Rusch, Nicolas

2010-01-01

Self-stigma can undermine self-esteem and self-efficacy of people with serious mental illness. Coming out may be one way of handling self-stigma and it was expected that coming out would mediate the effects of self-stigma on quality of life. This study compares coming out to other approaches of controlling self-stigma. Eighty-five people with…

Development assistance for health in central and eastern European Region.

PubMed

Suhrcke, Marc; Rechel, Bernd; Michaud, Catherine

2005-12-01

We aimed to quantify development assistance for health to countries of central and eastern Europe and the Commonwealth of Independent States (CEE-CIS). We used the International Development Statistics database of the Organisation for Economic Co-operation and Development and the database on development assistance for health compiled for the Commission on Macroeconomics and Health to quantify health development assistance to the region, compared to global and overall development assistance. We based our analysis on standard health indicators, including child mortality, life expectancy at birth and health expenditures. Although total development assistance per capita to CEE-CIS was higher than that for most other regions of the world, development assistance for health was very low compared to other countries with similar levels of child mortality, life expectancy at birth and national expenditures on health. The allocation of development assistance for health on a global scale seems to be related far more to child mortality rather than adult mortality. Countries of CEE-CIS have a high burden of adult morbidity and mortality from non-communicable diseases, which does not appear to attract proportionate development assistance. Levels of development assistance for health should be determined in consideration of the region's particular burden of disease.

Design of the Space Station Freedom power system

NASA Technical Reports Server (NTRS)

Thomas, Ronald L.; Hallinan, George J.

1989-01-01

The design of Space Station Freedom's electric power system (EPS) is reviewed, highlighting the key design goals of performance, low cost, reliability and safety. Tradeoff study results that illustrate the competing factors responsible for many of the more important design decisions are discussed. When Freedom's EPS is compared with previous space power designs, two major differences stand out. The first is the size of the EPS, which is larger than any prior system. The second major difference between the EPS and other space power designs is the indefinite expected life of Freedom; 30 years has been used for life-cycle-cost calculations.

Adolescent Agentic Orientations: Contemporaneous Family Influence, Parental Biography and Intergenerational Development.

PubMed

Johnson, Monica Kirkpatrick; Hitlin, Steven

2017-10-01

Agentic orientations developed in adolescence have been linked to better health, well-being, and achievements in the years following. This study examines longitudinal parental influences on the development of adolescent children's agentic orientations, captured by the core constructs of mastery beliefs and generalized life expectations. Drawing on multigenerational panel data from the United States (1991-2011), the study examines contemporaneous family factors, but also how parental biographies (their own transition to adulthood) and parents' own adolescent agentic orientations influence their adolescent children. Study adolescents were 46% male, 52% white, and 15.6 years old on average. The findings indicate that parents' early orientations and experiences in the transition to adulthood have little effect on their children's mastery beliefs, but that parents' generalized life expectations (in adolescence) and having married before having the child were associated with their children's more optimistic life expectations. Contemporaneous family income and optimistic expectations among parents-as-adolescents were somewhat substitutable as positive influences on adolescents' optimistic life expectations. The findings contribute to our understanding of intergenerational and over-time influences on these key adolescent orientations.

Air pollution shortens life expectancy and health expectancy for older adults: the case of China.

PubMed

Wen, Ming; Gu, Danan

2012-11-01

Outdoor air pollution is one of the most worrying environmental threats China faces today. Comprehensive and quantitative analyses of the health consequences of air pollution in China are lacking. This study reports age- and sex-specific life expectancy and health expectancies (HEs) corresponding to different levels of air pollution based on associations between air pollution and individual risks for a host of health conditions and mortality net of individual- and community-level confounders. This is a multilevel prospective cohort study based a nationally representative sample of Chinese elders. The main outcome measures in this study include life expectancy estimated from mortality and HEs based on five health conditions including activity of daily living, instrumental activity of daily living, cognitive status, self-rated health, and chronic conditions. Net of the controls, exposure to outdoor air pollution corresponded to subsequent reductions of life expectancy and HEs for all five health conditions. These detrimental pollution effects were stronger for women. The gap in life expectancy between areas with good air quality and moderately heavily polluted areas was 3.78 years for women of age 65 and 0.93 years for men. The differences in HEs at age 65 were also large, ranging from 1.47 years for HE for good self-rated health in men to 5.20 years for activity of daily living disability-free HE in women. Air pollution has devastating health impacts on Chinese elders reducing longevity and shortening HEs. Women are more vulnerable than men. More strict air policy should be implemented to pursue sustainable development in China.

Analysis using life tables of the major causes of death and the differences between country of birth groups in New South Wales, Australia.

PubMed

Weerasinghe, D P; Parr, N J; Yusuf, F

2009-05-01

This study used life table methods to evaluate the potential effects of reduction in major disease mortality on life expectancy in New South Wales (NSW), and the differences in cause-specific mortality between country of birth groups. The total and partial elimination of major causes of death were examined to identify the high-risk groups for community-level health planning. Life tables were used to combine the mortality rates of the NSW population at different ages into a single statistical model. Using abridged, multiple decrement and cause-elimination life tables with the mortality data for NSW in 2000-2002, broader disease groups were examined. Multiple decrement tables were generated by country of birth. The effect of the partial elimination of ischaemic heart disease (IHD) was also studied. This study found that Pacific-born men and women who reach their 30th birthday and eventually die from IHD are expected to live, on average, 10.8 and 5.8 years less, respectively, than average men and women in NSW. If IHD is eliminated as a cause of death, 7.5 years for males and 6.7 years for females would be added to life expectancy at birth. Life expectancy at birth is likely to be further increased by reducing deaths caused by diseases of the cardiovascular system, particularly among people aged over 65 years, by reducing malignant neoplasm deaths among those aged below 65 years, and by reducing deaths due to accidents, injury and poisoning, mainly among men aged 15-29 years. Further gains in life expectancy could be achieved with community-level educational programmes on lifestyle management and disease prevention.

Why Nations Become Wealthy: The Effects of Adult Longevity on Saving

PubMed Central

Kinugasa, Tomoko; Mason, Andrew

2007-01-01

We analyze steady state and out-of-steady-state effects of the transition in adult longevity on the national saving rate using historical data and international panel data. The rise in adult life expectancy has a large and statistically significant effect on aggregate saving. The effects have been especially pronounced in East Asia because its mortality transition was very rapid. Gains in life expectancy are much more important than declines in child dependency. Population aging may not lead to lower saving rates in the future if life expectancy and the duration of retirement continue to increase. PMID:18167514

[The changing sex differences in life expectancy in Spain (1980-2012): decomposition by age and cause].

PubMed

García González, Juan Manuel; Grande, Rafael

To calculate and analyse the contributions of changes in mortality by age groups and selected causes of death to sex differences in life expectancy at birth in Spain from 1980 to 2012. Cross-sectional study with three time points (1980, 1995, and 2012). We used data from Human Cause-of-Death Database and Human Mortality Database. We use a decomposition method of the differences in life expectancy and gender differences in life expectancy from changes in mortality by 5-year age groups and causes of death between women and men. From 1980 to 1995, the lower mortality of women from 25 years old, and the differences in mortality by HIV/AIDS, lung cancer, and chronic obstructive pulmonary diseases contributed to the gap increase. From 1995 to 2012, greatest improvement in mortality of males under 74 years of age, and in improving male mortality from HIV/AIDS, acute myocardial infarction and traffic accidents contributed to the narrowing. The difference in life expectancy at birth between men and women has decreased since 1995 due to a greater improvement in mortality from causes of death associated with risky behaviours and habits of the working age male population. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Chemical Composition of Fine Particulate Matter and Life Expectancy

PubMed Central

Dominici, Francesca; Wang, Yun; Correia, Andrew W.; Ezzati, Majid; Pope, C. Arden; Dockery, Douglas W.

2016-01-01

Background In a previous study, we provided evidence that a decline in fine particulate matter (PM2.5) air pollution during the period between 2000 and 2007 was associated with increased life expectancy in 545 counties in the United States. In this article, we investigated which chemical constituents of PM2.5 were the main drivers of the observed association. Methods We estimated associations between temporal changes in seven major components of PM2.5 (ammonium, sulfate, nitrate, elemental carbon matter, organic carbon matter, sodium, and silicon) and temporal changes in life expectancy in 95 counties between 2002 and 2007. We included US counties that had adequate chemical components of PM2.5 mass data across all seasons. We fitted single pollutant and multiple pollutant linear models, controlling for available socioeconomic, demographic, and smoking variables and stratifying by urban and nonurban counties. Results In multiple pollutant models, we found that: (1) a reduction in sulfate was associated with an increase in life expectancy; and (2) reductions in ammonium and sodium ion were associated with increases in life expectancy in nonurban counties only. Conclusions Our findings suggest that recent reductions in long-term exposure to sulfate, ammonium, and sodium ion between 2002 and 2007 are associated with improved public health. PMID:25906366

Chemical Composition of Fine Particulate Matter and Life Expectancy: In 95 US Counties Between 2002 and 2007.

PubMed

Dominici, Francesca; Wang, Yun; Correia, Andrew W; Ezzati, Majid; Pope, C Arden; Dockery, Douglas W

2015-07-01

In a previous study, we provided evidence that a decline in fine particulate matter (PM2.5) air pollution during the period between 2000 and 2007 was associated with increased life expectancy in 545 counties in the United States. In this article, we investigated which chemical constituents of PM2.5 were the main drivers of the observed association. We estimated associations between temporal changes in seven major components of PM2.5 (ammonium, sulfate, nitrate, elemental carbon matter, organic carbon matter, sodium, and silicon) and temporal changes in life expectancy in 95 counties between 2002 and 2007. We included US counties that had adequate chemical components of PM2.5 mass data across all seasons. We fitted single pollutant and multiple pollutant linear models, controlling for available socioeconomic, demographic, and smoking variables and stratifying by urban and nonurban counties. In multiple pollutant models, we found that: (1) a reduction in sulfate was associated with an increase in life expectancy; and (2) reductions in ammonium and sodium ion were associated with increases in life expectancy in nonurban counties only. Our findings suggest that recent reductions in long-term exposure to sulfate, ammonium, and sodium ion between 2002 and 2007 are associated with improved public health.

How long do I have? Observational study on communication about life expectancy with advanced cancer patients.

PubMed

Henselmans, I; Smets, E M A; Han, P K J; de Haes, H C J C; Laarhoven, H W M van

2017-10-01

To examine how communication about life expectancy is initiated in consultations about palliative chemotherapy, and what prognostic information is presented. Patients with advanced cancer (n=41) with a median life expectancy <1year and oncologists (n=6) and oncologists-in-training (n=7) meeting with them in consultations (n=62) to discuss palliative chemotherapy were included. Verbatim transcripts of audio-recorded consultations were analyzed using MAXqda10. Life expectancy was addressed in 19 of 62 of the consultations. In all cases, patients took the initiative, most often through direct questions. Estimates were provided in 12 consultations in various formats: the likelihood of experiencing a significant event, point estimates or general time scales of "months to years", often with an emphasis on the "years". The indeterminacy of estimates was consistently stressed. Also their potential inadequacy was regularly addressed, often by describing beneficial prognostic predictors for the specific patient. Oncologists did not address the reliability or precision of estimates. Oncologists did not initiate talk about life expectancy, they used different formats, emphasized the positive and stressed unpredictability, yet not ambiguity of estimates. Prognostic communication should be part of the medical curriculum. Further research should address the effect of different formats of information provision. Copyright © 2017 Elsevier B.V. All rights reserved.

Beyond the income inequality hypothesis and human health: a worldwide exploration.

PubMed

Idrovo, Alvaro J; Ruiz-Rodríguez, Myriam; Manzano-Patiño, Abigail P

2010-08-01

To analyze whether the relationship between income inequality and human health is mediated through social capital, and whether political regime determines differences in income inequality and social capital among countries. Path analysis of cross sectional ecological data from 110 countries. Life expectancy at birth was the outcome variable, and income inequality (measured by the Gini coefficient), social capital (measured by the Corruption Perceptions Index or generalized trust), and political regime (measured by the Index of Freedom) were the predictor variables. Corruption Perceptions Index (an indirect indicator of social capital) was used to include more developing countries in the analysis. The correlation between Gini coefficient and predictor variables was calculated using Spearman's coefficients. The path analysis was designed to assess the effect of income inequality, social capital proxies and political regime on life expectancy. The path coefficients suggest that income inequality has a greater direct effect on life expectancy at birth than through social capital. Political regime acts on life expectancy at birth through income inequality. Income inequality and social capital have direct effects on life expectancy at birth. The "class/welfare regime model" can be useful for understanding social and health inequalities between countries, whereas the "income inequality hypothesis" which is only a partial approach is especially useful for analyzing differences within countries.

Mexico's epidemic of violence and its public health significance on average length of life.

PubMed

Canudas-Romo, Vladimir; Aburto, José Manuel; García-Guerrero, Victor Manuel; Beltrán-Sánchez, Hiram

2017-02-01

A disproportionate number of homicides have caused Mexican life expectancy to stagnate during the new millennium. No efforts currently exist to quantify the harm of violent acts on the lives of the general population. We quantified the impact of perceived vulnerability on life expectancy. Three Mexican national surveys on perceptions of public safety, life tables, and crime and vital statistics (2000-2014) were used. Prevalence rates of vulnerability/safety by age and sex were obtained from surveys at 2 different levels: federal state and home. The Sullivan method was used to estimate life expectancy lived with and without vulnerability for Mexican women and men. Overall life expectancy at age 20 stagnated between 2005 and 2014 for females and males; yet, there was an increase of 40% and 70% in average number of years lived with vulnerability at the state and home levels, respectively. In 2014, female life expectancy at age 20 was 59.5 years (95% CI 59.0 to 60.1); 71% of these years (42.3 years, 41.6 to 43.0) were spent with perceived vulnerability of violence taking place in the state and 26% at the home (15.3 years, 15 to 15.8). For males, life expectancy at age 20 was 54.5 years (53.7 to 55.1); 64% of these years (34.6 years, 34.0 to 35.4) were lived with perceived vulnerability of violence at the state and 20% at the home (11.1 years, 10.8 to 11.5). The number of years lived with perceived vulnerability among Mexicans has increased by 30.5 million person-years over the last 10 years. If perceived vulnerability remains at its 2014 level, the average Mexican adults would be expected to live a large fraction of his/her life with perceived vulnerability of violence. Acts of violence continue to rise in the country and they should be addressed as a major public health issue before they become endemic. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The management of patients with T1 adenocarcinoma of the low rectum: a decision analysis.

PubMed

Johnston, Calvin F; Tomlinson, George; Temple, Larissa K; Baxter, Nancy N

2013-04-01

Decision making for patients with T1 adenocarcinoma of the low rectum, when treatment options are limited to a transanal local excision or abdominoperineal resection, is challenging. The aim of this study was to develop a contemporary decision analysis to assist patients and clinicians in balancing the goals of maximizing life expectancy and quality of life in this situation. We constructed a Markov-type microsimulation in open-source software. Recurrence rates and quality-of-life parameters were elicited by systematic literature reviews. Sensitivity analyses were performed on key model parameters. Our base case for analysis was a 65-year-old man with low-lying T1N0 rectal cancer. We determined the sensitivity of our model for sex, age up to 80, and T stage. The main outcome measured was quality-adjusted life-years. In the base case, selecting transanal local excision over abdominoperineal resection resulted in a loss of 0.53 years of life expectancy but a gain of 0.97 quality-adjusted life-years. One-way sensitivity analysis demonstrated a health state utility value threshold for permanent colostomy of 0.93. This value ranged from 0.88 to 1.0 based on tumor recurrence risk. There were no other model sensitivities. Some model parameter estimates were based on weak data. In our model, transanal local excision was found to be the preferable approach for most patients. An abdominoperineal resection has a 3.5% longer life expectancy, but this advantage is lost when the quality-of-life reduction reported by stoma patients is weighed in. The minority group in whom abdominoperineal resection is preferred are those who are unwilling to sacrifice 7% of their life expectancy to avoid a permanent stoma. This is estimated to be approximately 25% of all patients. The threshold increases to 12% of life expectancy in high-risk tumors. No other factors are found to be relevant to the decision.

Age-Stage, Two-Sex Life Table Characteristics of Aedes albopictus and Aedes Aegypti in Penang Island, Malaysia.

PubMed

Maimusa, Hamisu A; Ahmad, Abu Hassan; Kassim, Nur Faeza A; Rahim, Junaid

2016-03-01

The life table developmental attributes of laboratory colonies of wild strains of Aedes albopictus and Aedes aegypti were analyzed and compared based on the age-stage, two-sex life table. Findings inclusive in this study are: adult preoviposition periods, total preoviposition period, mean intrinsic rate of increase (r), mean finite rate of increase (λ), net reproductive rates (R0), and mean generation time (T). The total preadult development time was 9.47 days for Ae. albopictus and 8.76 days for Ae. aegypti. The life expectancy was 19.01 days for Ae. albopictus and 19.94 days for Ae. aegypti. Mortality occurred mostly during the adult stage. The mean development time for each stage insignificantly correlated with temperature for Ae. albopictus (r  =  -0.208, P > 0.05) and (r  =  -0.312, P > 0.05) for Ae. aegypti. The population parameters suggest that Ae. albopictus and Ae. aegypti populations are r-strategists characterized by a high r, a large R0, and short T. This present study provides the first report to compare the life parameters of Ae. albopictus and Ae. aegypti strains from Penang island, Malaysia.

Cost-effectiveness analysis of implants versus autologous perforator flaps using the BREAST-Q.

PubMed

Matros, Evan; Albornoz, Claudia R; Razdan, Shantanu N; Mehrara, Babak J; Macadam, Sheina A; Ro, Teresa; McCarthy, Colleen M; Disa, Joseph J; Cordeiro, Peter G; Pusic, Andrea L

2015-04-01

Reimbursement has been recognized as a physician barrier to autologous reconstruction. Autologous reconstructions are more expensive than prosthetic reconstructions, but provide greater health-related quality of life. The authors' hypothesis is that autologous tissue reconstructions are cost-effective compared with prosthetic techniques when considering health-related quality of life and patient satisfaction. A cost-effectiveness analysis from the payer perspective, including patient input, was performed for unilateral and bilateral reconstructions with deep inferior epigastric perforator (DIEP) flaps and implants. The effectiveness measure was derived using the BREAST-Q and interpreted as the cost for obtaining 1 year of perfect breast health-related quality-adjusted life-year. Costs were obtained from the 2010 Nationwide Inpatient Sample. The incremental cost-effectiveness ratio was generated. A sensitivity analysis for age and stage at diagnosis was performed. BREAST-Q scores from 309 patients with implants and 217 DIEP flap reconstructions were included. The additional cost for obtaining 1 year of perfect breast-related health for a unilateral DIEP flap compared with implant reconstruction was $11,941. For bilateral DIEP flaps compared with implant reconstructions, the cost for an additional breast health-related quality-adjusted life-year was $28,017. The sensitivity analysis demonstrated that the cost for an additional breast health-related quality-adjusted life-year for DIEP flaps compared with implants was less for younger patients and earlier stage breast cancer. DIEP flaps are cost-effective compared with implants, especially for unilateral reconstructions. Cost-effectiveness of autologous techniques is maximized in women with longer life expectancy. Patient-reported outcomes findings can be incorporated into cost-effectiveness analyses to demonstrate the relative value of reconstructive procedures.

Application of Bayesian Approach to Cost-Effectiveness Analysis of Antiviral Treatments in Chronic Hepatitis B.

PubMed

Zhang, Hua; Huo, Mingdong; Chao, Jianqian; Liu, Pei

2016-01-01

Hepatitis B virus (HBV) infection is a major problem for public health; timely antiviral treatment can significantly prevent the progression of liver damage from HBV by slowing down or stopping the virus from reproducing. In the study we applied Bayesian approach to cost-effectiveness analysis, using Markov Chain Monte Carlo (MCMC) simulation methods for the relevant evidence input into the model to evaluate cost-effectiveness of entecavir (ETV) and lamivudine (LVD) therapy for chronic hepatitis B (CHB) in Jiangsu, China, thus providing information to the public health system in the CHB therapy. Eight-stage Markov model was developed, a hypothetical cohort of 35-year-old HBeAg-positive patients with CHB was entered into the model. Treatment regimens were LVD100mg daily and ETV 0.5 mg daily. The transition parameters were derived either from systematic reviews of the literature or from previous economic studies. The outcome measures were life-years, quality-adjusted lifeyears (QALYs), and expected costs associated with the treatments and disease progression. For the Bayesian models all the analysis was implemented by using WinBUGS version 1.4. Expected cost, life expectancy, QALYs decreased with age. Cost-effectiveness increased with age. Expected cost of ETV was less than LVD, while life expectancy and QALYs were higher than that of LVD, ETV strategy was more cost-effective. Costs and benefits of the Monte Carlo simulation were very close to the results of exact form among the group, but standard deviation of each group indicated there was a big difference between individual patients. Compared with lamivudine, entecavir is the more cost-effective option. CHB patients should accept antiviral treatment as soon as possible as the lower age the more cost-effective. Monte Carlo simulation obtained costs and effectiveness distribution, indicate our Markov model is of good robustness.

National Health Objectives for the Year 2000: The Demographic Impact of Health Promotion and Disease Prevention.

ERIC Educational Resources Information Center

Stoto, Michael A.; Durch, Jane S.

1991-01-01

Demographic impacts of meeting the National Health Objectives for 2000 were studied using life-table methods. Meeting the targets would increase life expectancy at birth by 1.5-2.1 years to 76.6-77.2 years. Modifying the coronary heart disease and unintentional injury targets to be more optimistic would further increase life expectancy. (SLD)

Trends in Education-Specific Life Expectancy, Data Quality, and Shifting Education Distributions: A Note on Recent Research.

PubMed

Hendi, Arun S

2017-06-01

Several recent articles have reported conflicting conclusions about educational differences in life expectancy, and this is partly due to the use of unreliable data subject to a numerator-denominator bias previously reported as ranging from 20 % to 40 %. This article presents estimates of life expectancy and lifespan variation by education in the United States using more reliable data from the National Health Interview Survey. Contrary to prior conclusions in the literature, I find that life expectancy increased or stagnated since 1990 among all education-race-sex groups except for non-Hispanic white women with less than a high school education; there has been a robust increase in life expectancy among white high school graduates and a smaller increase among black female high school graduates; lifespan variation did not increase appreciably among high school graduates; and lifespan variation plays a very limited role in explaining educational gradients in mortality. I also discuss the key role that educational expansion may play in driving future changes in mortality gradients. Because of shifting education distributions, within an education-specific synthetic cohort, older age groups are less negatively selected than younger age groups. We could thus expect a greater concentration of mortality at younger ages among people with a high school education or less, which would be reflected in increasing lifespan variability for this group. Future studies of educational gradients in mortality should use more reliable data and should be mindful of the effects of shifting education distributions.

Rolling-element fatigue life of silicon nitride balls. [as compared to that of steel, ceramic, and cermet materials

NASA Technical Reports Server (NTRS)

Parker, R. J.; Zaretsky, E. V.

1974-01-01

The five-ball fatigue tester was used to evaluate silicon nitride as a rolling-element bearing material. Results indicate that hot-pressed silicon nitride running against steel may be expected to yield fatigue lives comparable to or greater than those of bearing quality steel running against steel at stress levels typical rolling-element bearing application. The fatigue life of hot-pressed silicon nitride is considerably greater than that of any ceramic or cermet tested. Computer analysis indicates that there is no improvement in the lives of 120-mm-bore angular--contact ball bearings of the same geometry operating at DN values from 2 to 4 million where hot-pressed silicon nitride balls are used in place of steel balls.

Gender gaps--Life expectancy and proportion of life in poor health.

PubMed

Luy, Marc; Minagawa, Yuka

2014-12-01

The literature suggests that women report worse health but live longer than men--a phenomenon known as the gender paradox in health and mortality. Although studies examining the paradox abound, relatively little is known about mechanisms underlying the gap. With data on healthy life expectancy from the Global Burden of Disease Study 2010, this article analyses the relationship between length of life and health among men and women in 45 more-developed countries. The proportion of life spent in poor health is used as an indicator of health. This approach accounts for gender differences in longevity and illustrates the female health disadvantage pattern more clearly. Life expectancy at birth and the proportion of life in poor health are closely related for both genders. Furthermore, the larger the female excess in longevity, the larger the female excess in the proportion of life in poor health. By focusing on the proportion of life in poor health, this analysis suggests that women's longevity advantage translates into a health disadvantages relative to men. The results indicate that women suffer from poor health not in spite of living longer, but because they live longer.

Cost-Effectiveness of Solitaire Stent Retriever Thrombectomy for Acute Ischemic Stroke

PubMed Central

Shireman, Theresa I.; Wang, Kaijun; Saver, Jeffrey L.; Goyal, Mayank; Bonafé, Alain; Diener, Hans-Christoph; Levy, Elad I.; Pereira, Vitor M.; Albers, Gregory W.; Cognard, Christophe; Hacke, Werner; Jansen, Olav; Jovin, Tudor G.; Mattle, Heinrich P.; Nogueira, Raul G.; Siddiqui, Adnan H.; Yavagal, Dileep R.; Devlin, Thomas G.; Lopes, Demetrius K.; Reddy, Vivek K.; de Rochemont, Richard du Mesnil; Jahan, Reza; Vilain, Katherine A.; House, John; Lee, Jin-Moo; Cohen, David J.

2017-01-01

Background and Purpose Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions. Methods In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data. Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension questionnaire. Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors. Results Index hospitalization costs were $17 183 per patient higher for SST+tPA than for tPA ($45 761 versus $28 578; P<0.001), driven by initial procedure costs. Between discharge and 90 days, costs were $4904 per patient lower for SST+tPA than for tPA ($11 270 versus $16 174; P=0.014); total 90-day costs remained higher with SST+tPA ($57 031 versus $44 752; P<0.001). Higher utility values for SST+tPA led to higher in-trial quality-adjusted life years (0.131 versus 0.105; P=0.005). In lifetime projections, SST+tPA was associated with substantial gains in quality-adjusted life years (6.79 versus 5.05), cost savings of $23 203 per patient and was economically dominant when compared with tPA in 90% of bootstrap replicates. Conclusions Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial, SST increased initial treatment costs, but was projected to improve quality-adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA. PMID:28028150

The influence of smoking, sedentary lifestyle and obesity on cognitive impairment-free life expectancy.

PubMed

Anstey, Kaarin Jane; Kingston, Andrew; Kiely, Kim Matthew; Luszcz, Mary Alice; Mitchell, Paul; Jagger, Carol

2014-12-01

Smoking, sedentary lifestyle and obesity are risk factors for mortality and dementia. However, their impact on cognitive impairment-free life expectancy (CIFLE)has not previously been estimated. Data were drawn from the DYNOPTA dataset which was derived by harmonizing and pooling common measures from five longitudinal ageing studies. Participants for whom the Mini-Mental State Examination was available were included (N¼8111,48.6% men). Data on education, sex, body mass index, smoking and sedentary lifestyle were collected and mortality data were obtained from Government Records via data linkage.Total life expectancy (LE), CIFLE and years spent with cognitive impairment (CILE)were estimated for each risk factor and total burden of risk factors. CILE was approximately 2 years for men and 3 years for women, regardless of age. For men and women respectively, reduced LE associated with smoking was 3.82and 5.88 years, associated with obesity was 0.62 and 1.72 years and associated with being sedentary was 2.50 and 2.89 years. Absence of each risk factor was associated with longer LE and CIFLE, but also longer CILE for smoking in women and being sedentary in both sexes. Compared with participants with no risk factors, those with 2þ had shorter CIFLE of up to 3.5 years depending on gender and education level. Population level reductions in smoking, sedentary lifestyle and obesity increase longevity and number of years lived without cognitive impairment. Years lived with cognitive impairment may also increase.

Hunger influenced life expectancy in war-torn Sub-Saharan African countries.

PubMed

Uchendu, Florence N

2018-04-27

Malnutrition is a global public health problem especially in developing countries experiencing war/conflicts. War might be one of the socio-political factors influencing malnutrition in Sub-Saharan African (SSA) countries. This study aims at determining the influence of war on corruption, population (POP), number of population malnourished (NPU), food security and life expectancy (LE) in war-torn SSA countries (WTSSA) by comparing their malnutrition indicators. Fourteen countries in WTSSA were stratified into zones according to war incidences. Countries' secondary data on population (POP), NPU, Food Security Index (FSI), corruption perceptions index (CPI), Global Hunger Index (GHI) and LE were obtained from global published data. T test, multivariate and Pearson correlation analyses were performed to determine the relationship between CPI, POP, GHI, FSI, NPU, male LE (MLE) and female LE (FLE) in WTSSA at p < .05. Data were presented in tables, means, standard deviation and percentages. Mean NPU, CPI, GHI, POP, FSI, MLE and FLE in WTSSA were 5.0 million, 28.3%, 18.2%, 33.8 million, 30.8%, 54.7 years and 57.1 years, respectively. GHI significantly influenced LE in both male and female POP in WTSSA. NPU, CPI, FSI, GHI and FLE were not significantly different according to zones except in MLE. Malnutrition indicators were similarly affected in WTSSA. Hunger influenced life expectancy. Policies promoting good governance, equity, peaceful co-existence, respect for human right and adequate food supply will aid malnutrition eradication and prevent war occurrences in Sub-Saharan African countries.

[Change in our approach in the surgical management of congenital heart defects in patients with Down syndrome, 1974-2016].

PubMed

Hartyánszky, István; Bogáts, Gábor

2016-10-01

Congenital heart defects are frequently present in patients with Down syndrome. The authors analyzed the impact of changing approach in surgical management of congenital heart defect on the life expectancy of patients with Down syndrome. Between 1974 and 1997 the data of 359 children with Down syndrome were collected. Among them 255 patients had no surgery and the mortality in this group was 25.9%, whereas the mortality in the group of 104 patients who underwent palliative surgery was 8.6%. Surgical management of congenital heart defects provides the same life expectancy for these patients as compared to Down patients without cardiac defects. Primary reconstruction is the preferable surgical procedure in infancy that provides good results. Nowadays the number of the operated grown-up congenital heart disease patients with Down syndrome is increasing. During the last three years 82 grown-up congenital heart disease patients, including 4 patients with Down syndrome (aged between 24 and 60 years) were reconstructed successfully. Due to the successful surgery in infancy the population of grown-up congenital heart disease patients with Down syndrome is increasing. The cardiac surgeons are ready to do everything for the optimal life expectancy of these patients. However, management of special problems (indication and necessity of reoperation, optimal age) in patients with Down syndrome poses a great challenge for cardiologists and cardiac surgeons. Orv. Hetil., 2016, 157(40), 1601-1603.

Universal health coverage and the health Sustainable Development Goal: achievements and challenges for Sri Lanka.

PubMed

de Silva, Amala; Ranasinghe, Thushara; Abeykoon, Palitha

2016-09-01

With state-funded health care that is free at the point of delivery, a sound primary health-care policy and widespread health-care services, Sri Lanka seems a good example of universal health coverage. Yet, health transition and disparities in provision and financing threaten this situation. Sri Lanka did well on the Millennium Development Goal health indicators, but the Sustainable Development Goal (SDG) for health has a wider purview, which is to "ensure healthy lives and promote well-being for all at all ages". The gender gap in life expectancy and the gap between life expectancy and healthy life expectancy make achievement of the health SDG more challenging. Although women and children do well overall, the comparative health disadvantage for men in Sri Lanka is a cause for concern. From a financing perspective, high out-of-pocket expenditure and high utilization of the private sector, even by those in the lowest income quintile, are concerns, as is the emerging "third tier", where some individuals accessing state health care that is free at the point of delivery actually bear some of the costs of drugs, investigations and surgery. This cost sharing is resulting in catastrophic health expenditure for individuals, and delays in and non-compliance with treatment. These concerns about provision and financing must be addressed, as health transition will intensify the morbidity burden and loss of well-being, and could derail plans to achieve the health SDG.

comment="please make the changes marked up in the attached pdf"Sex-Dependent Effects of Caloric Restriction on the Ageing of an Ambush Feeding Copepod.

PubMed

Saiz, Enric; Calbet, Albert; Griffell, Kaiene

2017-10-04

Planktonic copepods are a very successful group in marine pelagic environments, with a key role in biogeochemical cycles. Among them, the genus Oithona is one of the more abundant and ubiquitous. We report here on the effects of caloric (food) restriction on the ageing patterns of the copepod Oithona davisae. The response of O. davisae to caloric restriction was sex dependent: under food limitation, females have lower age-specific mortality rates and longer lifespans and reproductive periods; male mortality rates and life expectancy were not affected. Males are more active swimmers than females, and given their higher energetic demands presumably generate reactive oxygen species at higher rates. That was confirmed by starvation experiments, which showed that O. davisae males burn through body reserves much faster, resulting in shorter life expectancy. Compared with common, coastal calanoid copepods, the effects of caloric restriction on O. davisae appeared less prominent. We think this difference in the magnitude of the responses is a consequence of the distinct life-history traits associated with the genus Oithona (ambush feeder, egg-carrier), with much lower overall levels of metabolism and reproductive effort.

Death Anxiety in Hospitalized End-of-Life Patients as Captured from a Structured Electronic Health Record

PubMed Central

Lodhi, Muhammad Kamran; Cheema, Umer Iftikhar; Stifter, Janet; Wilkie, Diana J.; Keenan, Gail M.; Yao, Yingwei; Ansari, Rashid; Khokhar, Ashfaq A.

2015-01-01

The nursing outcomes of hospitalized patients whose plans of care include death anxiety, which is a diagnosis among patients at the end-of-life, are obscure. The authors of the current article applied data mining techniques to nursing plan-of-care data for patients diagnosed with death anxiety, as defined by North American Nursing Diagnosis Association International, from four different hospitals to examine nursing care outcomes and associated factors. Results indicate that <50% of patients met the expected outcome of comfortable death. Gerontology unit patients were more likely to meet the expected outcome than patients from other unit types, although results were not statistically significant. Younger patients (i.e., age <65) had a lower chance of meeting the outcome compared with older patients (i.e., age ≥65) (χ2(1) = 9.266, p < 0.004). Longer stays improved the chances of meeting the outcome (χ2(2) = 6.47, p < 0.04). Results indicate that death anxiety outcomes are suboptimal and suggest the need to better educate clinicians about diagnosing and treating death anxiety among patients who face the end-of-life transition. PMID:25157534

Disability-Adjusted Life-Years (DALYs) for 315 Diseases and Injuries and Healthy Life Expectancy (HALE) in Iran and its Neighboring Countries, 1990-2015: Findings from Global Burden of Disease Study 2015.

PubMed

Sepanlou, Sadaf G; Parsaeian, Mahboubeh; Krohn, Kristopher J; Afshin, Ashkan; Farzadfar, Farshad; Roshandel, Gholamreza; Karimkhani, Chante; Bazargan-Hejazi, Sharzad; Kiadaliri, Aliasghar Ahmad; Ahmadieh, Hamid; Djalalinia, Shirin; Ebrahimi, Hedyeh; Eshrati, Babak; Esteghamati, Ali Reza; Farvid, Maryam S; Fereshtehnejad, Seyed-Mohammad; Hafezi-Nejad, Nima; Hassanvand, Mohammad Sadegh; Heydarpour, Pouria; Islami, Farhad; Karimi, Seyed M; Katibeh, Marzieh; Khosravi, Ardeshir; Khubchandani, Jagdish; Mahdavi, Mahdi; Pishgar, Farhad; Qorbani, Mostafa; Rahimi-Movaghar, Vafa; Safi, Sare; Sahraian, Mohammad Ali; Shahraz, Saeid; Sheikhbahaei, Sara; Mohammadi, Alireza; Mokdad, Ali H; Vos, Theo; Murray, Christopher J L; Moradi-Lakeh, Maziar; Naghavi, Mohsen; Malekzadeh, Reza

2017-07-01

Summary measures of health are essential in making estimates of health status that are comparable across time and place. They can be used for assessing the performance of health systems, informing effective policy making, and monitoring the progress of nations toward achievement of sustainable development goals. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) as main summary measures of health. We assessed the trends of health status in Iran and 15 neighboring countries using these summary measures. We used the results of GBD 2015 to present the levels and trends of DALYs, life expectancy (LE), and HALE in Iran and its 15 neighboring countries from 1990 to 2015. For each country, we assessed the ratio of observed levels of DALYs and HALE to those expected based on socio-demographic index (SDI), an indicator composed of measures of total fertility rate, income per capita, and average years of schooling. All-age numbers of DALYs reached over 19 million years in Iran in 2015. The all-age number of DALYs has remained stable during the past two decades in Iran, despite the decreasing trends in all-age and age-standardized rates. The all-cause DALY rates decreased from 47,200 in 1990 to 28,400 per 100,000 in 2015. The share of non-communicable diseases in DALYs increased in Iran (from 42% to 74%) and all of its neighbors between 1990 and 2015; the pattern of change is similar in almost all 16 countries. The DALY rates for NCDs and injuries in Iran were higher than global rates and the average rate in High Middle SDI countries, while those for communicable, maternal, neonatal, and nutritional disorders were much lower in Iran. Among men, cardiovascular diseases ranked first in all countries of the region except for Bahrain. Among women, they ranked first in 13 countries. Life expectancy and HALE show a consistent increase in all countries. Still, there are dissimilarities indicating a generally low LE and HALE in Afghanistan and Pakistan and high expectancy in Qatar, Kuwait, and Saudi Arabia. Iran ranked 11th in terms of LE at birth and 12th in terms of HALE at birth in 1990 which improved to 9th for both metrics in 2015. Turkey and Iran had the highest increase in LE and HALE from 1990 to 2015 while the lowest increase was observed in Armenia, Pakistan, Kuwait, Kazakhstan, Russia, and Iraq. The levels and trends in causes of DALYs, life expectancy, and HALE generally show similarities between the 16 countries, although differences exist. The differences observed between countries can be attributed to a myriad of determinants, including social, cultural, ethnic, religious, political, economic, and environmental factors as well as the performance of the health system. Investigating the differences between countries can inform more effective health policy and resource allocation. Concerted efforts at national and regional levels are required to tackle the emerging burden of non-communicable diseases and injuries in Iran and its neighbors.

Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico

PubMed Central

Profit, Jochen; Lee, Diana; Zupancic, John A.; Papile, LuAnn; Gutierrez, Cristina; Goldie, Sue J.; Gonzalez-Pier, Eduardo; Salomon, Joshua A.

2010-01-01

Background Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. Methods and Findings A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24–26, 27–29, and 30–33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24–26, 27–29, and 30–33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses. Conclusions Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis of conventional benchmarks for cost-effectiveness analysis. Please see later in the article for the Editors' Summary PMID:21179496

Increasing disability-free life expectancy among older adults in Palestine from 2006 to 2010.

PubMed

Brønnum-Hansen, Henrik; Duraidi, Mohammed; Qalalwa, Khaled; Jeune, Bernard

2015-04-01

The population of Palestine comprises almost 200 000 Palestinians aged 60 or older. The purpose of the study was to estimate disability-free life expectancy for Palestinians living in the West Bank and Gaza Strip and to evaluate changes from 2006 to 2010. The study combined mortality data and prevalence of activity limitation derived from the Palestinian Family Health Surveys carried out in 2006 and 2010. Based on questions about the ability to perform five basic daily activities, disability-free life expectancy was estimated. Changes between 2006 and 2010 were decomposed into contributions from changes in mortality and disability. Life expectancy at age 60 increased from 17.1 years in 2006 to 17.3 years in 2010 for men and from 18.7 years to 19.0 years for women. Disability-free life expectancy increased significantly, by 1.3 years for 60-year-old men (from 12.8 years to 14.1 years) and 1.8 years for 60-year-old women (from 12.6 years to 14.4 years). This increase was seen in the Gaza Strip as well as in the West Bank. While the modest contribution of the mortality effect did not differ between gender and regions, the strong contributions from the disability effects varied, being greatest for women in the Gaza Strip. The significant increase in disability-free life expectancy for both genders is remarkable and, to our knowledge, not seen in other low-income countries. This change may be due to decreasing incidence of disability and greater recovery from disability as a result of better prevention, care and rehabilitation of chronic diseases. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Gains in Life Expectancy Associated with Higher Education in Men

PubMed Central

Bijwaard, Govert E.; van Poppel, Frans; Ekamper, Peter; Lumey, L. H.

2015-01-01

Background Many studies show large differences in life expectancy across the range of education, intelligence, and socio-economic status. As educational attainment, intelligence, and socio-economic status are highly interrelated, appropriate methods are required to disentangle their separate effects. The aim of this paper is to present a novel method to estimate gains in life expectancy specifically associated with increased education. Our analysis is based on a structural model in which education level, IQ at age 18 and mortality all depend on (latent) intelligence. The model allows for (selective) educational choices based on observed factors and on an unobserved factor capturing intelligence. Our estimates are based on information from health examinations of military conscripts born in 1944–1947 in The Netherlands and their vital status through age 66 (n = 39,798). Results Our empirical results show that men with higher education have lower mortality. Using structural models to account for education choice, the estimated gain in life expectancy for men moving up one educational level ranges from 0.3 to 2 years. The estimated gain in months alive over the observational period ranges from -1.2 to 5.7 months. The selection effect is positive and amounts to a gain of one to two months. Decomposition of the selection effect shows that the gain from selection on (latent) intelligence is larger than the gain from selection on observed factors and amounts to 1.0 to 1.7 additional months alive. Conclusion Our findings confirm the strong selection into education based on socio-economic status and intelligence. They also show significant higher life expectancy among individuals with higher education after the selectivity of education choice has been taken into account. Based on these estimates, it is plausible therefore that increases in education could lead to increases in life expectancy. PMID:26496647

The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation

PubMed Central

Doran, Tim; Cookson, Richard

2016-01-01

Background There are substantial socioeconomic inequalities in both life expectancy and healthcare use in England. In this study, we describe how these two sets of inequalities interact by estimating the social gradient in hospital costs across the life course. Methods Hospital episode statistics, population and index of multiple deprivation data were combined at lower-layer super output area level to estimate inpatient hospital costs for 2011/2012 by age, sex and deprivation quintile. Survival curves were estimated for each of the deprivation groups and used to estimate expected annual costs and cumulative lifetime costs. Results A steep social gradient was observed in overall inpatient hospital admissions, with rates ranging from 31 298/100 000 population in the most affluent fifth of areas to 43 385 in the most deprived fifth. This gradient was steeper for emergency than for elective admissions. The total cost associated with this inequality in 2011/2012 was £4.8 billion. A social gradient was also observed in the modelled lifetime costs where the lower life expectancy was not sufficient to outweigh the higher average costs in the more deprived populations. Lifetime costs for women were 14% greater than for men, due to higher costs in the reproductive years and greater life expectancy. Conclusions Socioeconomic inequalities result in increased morbidity and decreased life expectancy. Interventions to reduce inequality and improve health in more deprived neighbourhoods have the potential to save money for health systems not only within years but across peoples’ entire lifetimes, despite increased costs due to longer life expectancies. PMID:27189975

Gains in Life Expectancy Associated with Higher Education in Men.

PubMed

Bijwaard, Govert E; van Poppel, Frans; Ekamper, Peter; Lumey, L H

2015-01-01

Many studies show large differences in life expectancy across the range of education, intelligence, and socio-economic status. As educational attainment, intelligence, and socio-economic status are highly interrelated, appropriate methods are required to disentangle their separate effects. The aim of this paper is to present a novel method to estimate gains in life expectancy specifically associated with increased education. Our analysis is based on a structural model in which education level, IQ at age 18 and mortality all depend on (latent) intelligence. The model allows for (selective) educational choices based on observed factors and on an unobserved factor capturing intelligence. Our estimates are based on information from health examinations of military conscripts born in 1944-1947 in The Netherlands and their vital status through age 66 (n = 39,798). Our empirical results show that men with higher education have lower mortality. Using structural models to account for education choice, the estimated gain in life expectancy for men moving up one educational level ranges from 0.3 to 2 years. The estimated gain in months alive over the observational period ranges from -1.2 to 5.7 months. The selection effect is positive and amounts to a gain of one to two months. Decomposition of the selection effect shows that the gain from selection on (latent) intelligence is larger than the gain from selection on observed factors and amounts to 1.0 to 1.7 additional months alive. Our findings confirm the strong selection into education based on socio-economic status and intelligence. They also show significant higher life expectancy among individuals with higher education after the selectivity of education choice has been taken into account. Based on these estimates, it is plausible therefore that increases in education could lead to increases in life expectancy.

The association between income and life expectancy revisited: deindustrialization, incarceration and the widening health gap.

PubMed

Nosrati, Elias; Ash, Michael; Marmot, Michael; McKee, Martin; King, Lawrence P

2017-11-22

The health gap between the top and the bottom of the income distribution is widening rapidly in the USA, but the lifespan of America's poor depends substantially on where they live. We ask whether two major developments in American society, deindustrialization and incarceration, can explain variation among states in life expectancy of those in the lowest income quartile. Life expectancy estimates at age 40 of those in the bottom income quartile were used to fit panel data models examining the relationship with deindustrialization and incarceration between 2001 and 2014 for all US states. A one standard deviation (s.d.) increase in deindustrialization (mean = 11.2, s.d. = 3.5) reduces life expectancy for the poor by 0.255 years [95% confidence interval (CI): 0.090-0.419] and each additional prisoner per 1000 residents (mean = 4.0, s.d. = 1.5) is associated with a loss of 0.468 years (95% CI: 0.213-0.723). Our predictors explain over 20% of the state-level variation in life expectancy among the poor and virtually the entire increase in the life expectancy gap between the top and the bottom income quartiles since the turn of the century. In the USA between 2001 and 2014, deindustrialization and incarceration subtracted roughly 2.5 years from the lifespan of the poor, pointing to their role as major health determinants. Future research must remain conscious of the upstream determinants and the political economy of public health. If public policy responses to growing health inequalities are to be effective, they must consider strengthening industrial policy and ending hyper-incarceration. © The Author 2017; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

The Social Distribution of Health: Estimating Quality-Adjusted Life Expectancy in England.

PubMed

Love-Koh, James; Asaria, Miqdad; Cookson, Richard; Griffin, Susan

2015-07-01

To model the social distribution of quality-adjusted life expectancy (QALE) in England by combining survey data on health-related quality of life with administrative data on mortality. Health Survey for England data sets for 2010, 2011, and 2012 were pooled (n = 35,062) and used to model health-related quality of life as a function of sex, age, and socioeconomic status (SES). Office for National Statistics mortality rates were used to construct life tables for age-sex-SES groups. These quality-of-life and length-of-life estimates were then combined to predict QALE as a function of these characteristics. Missing data were imputed, and Monte-Carlo simulation was used to estimate standard errors. Sensitivity analysis was conducted to explore alternative regression models and measures of SES. Socioeconomic inequality in QALE at birth was estimated at 11.87 quality-adjusted life-years (QALYs), with a sex difference of 1 QALY. When the socioeconomic-sex subgroups are ranked by QALE, a differential of 10.97 QALYs is found between the most and least healthy quintile groups. This differential can be broken down into a life expectancy difference of 7.28 years and a quality-of-life adjustment of 3.69 years. The methods proposed in this article refine simple binary quality-adjustment measures such as the widely used disability-free life expectancy, providing a more accurate picture of overall health inequality in society than has hitherto been available. The predictions also lend themselves well to the task of evaluating the health inequality impact of interventions in the context of cost-effectiveness analysis. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Aging in America in the Twenty-first Century: Demographic Forecasts from the MacArthur Foundation Research Network on an Aging Society

PubMed Central

Olshansky, S Jay; Goldman, Dana P; Zheng, Yuhui; Rowe, John W

2009-01-01

Context: The aging of the baby boom generation, the extension of life, and progressive increases in disability-free life expectancy have generated a dramatic demographic transition in the United States. Official government forecasts may, however, have inadvertently underestimated life expectancy, which would have major policy implications, since small differences in forecasts of life expectancy produce very large differences in the number of people surviving to an older age. This article presents a new set of population and life expectancy forecasts for the United States, focusing on transitions that will take place by midcentury. Methods: Forecasts were made with a cohort-components methodology, based on the premise that the risk of death will be influenced in the coming decades by accelerated advances in biomedical technology that either delay the onset and age progression of major fatal diseases or that slow the aging process itself. Findings: Results indicate that the current forecasts of the U.S. Social Security Administration and U.S. Census Bureau may underestimate the rise in life expectancy at birth for men and women combined, by 2050, from 3.1 to 7.9 years. Conclusions: The cumulative outlays for Medicare and Social Security could be higher by $3.2 to $8.3 trillion relative to current government forecasts. This article discusses the implications of these results regarding the benefits and costs of an aging society and the prospect that health disparities could attenuate some of these changes. PMID:20021588

Evaluation of the long-term cost-effectiveness of liraglutide therapy for patients with type 2 diabetes in France.

PubMed

Roussel, Ronan; Martinez, Luc; Vandebrouck, Tom; Douik, Habiba; Emiel, Patrick; Guery, Matthieu; Hunt, Barnaby; Valentine, William J

2016-01-01

The present study aimed to compare the projected long-term clinical and cost implications associated with liraglutide, sitagliptin and glimepiride in patients with type 2 diabetes mellitus failing to achieve glycemic control on metformin monotherapy in France. Clinical input data for the modeling analysis were taken from two randomized, controlled trials (LIRA-DPP4 and LEAD-2). Long-term (patient lifetime) projections of clinical outcomes and direct costs (2013 Euros; €) were made using a validated computer simulation model of type 2 diabetes. Costs were taken from published France-specific sources. Future costs and clinical benefits were discounted at 3% annually. Sensitivity analyses were performed. Liraglutide was associated with an increase in quality-adjusted life expectancy of 0.25 quality-adjusted life years (QALYs) and an increase in mean direct healthcare costs of €2558 per patient compared with sitagliptin. In the comparison with glimepiride, liraglutide was associated with an increase in quality-adjusted life expectancy of 0.23 QALYs and an increase in direct costs of €4695. Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio (ICER) of €10,275 per QALY gained vs sitagliptin and €20,709 per QALY gained vs glimepiride in France. Calculated ICERs for both comparisons fell below the commonly quoted willingness-to-pay threshold of €30,000 per QALY gained. Therefore, liraglutide is likely to be cost-effective vs sitagliptin and glimepiride from a healthcare payer perspective in France.

Life course analysis of the impact of mammary cancer and pyometra on age-anchored life expectancy in female Rottweilers: Implications for envisioning ovary conservation as a strategy to promote healthy longevity in pet dogs.

PubMed

Waters, D J; Kengeri, S S; Maras, A H; Suckow, C L; Chiang, E C

2017-06-01

Mammary cancer and pyometra are important health hazards associated with ovary conservation in pet dogs. Early ovariohysterectomy may reduce the incidence of these two diseases, but an estimate of the extent to which the development of mammary cancer or pyometra adversely influences overall longevity is missing. As a first step toward addressing this knowledge gap, the results of a historical cohort study of Rottweilers that lived in North America are reported. Questionnaires completed by owners and veterinarians were used to obtain lifetime health and medical information on 242 female Rottweilers, including years of lifetime ovary exposure, age at death, and cause of death. To determine the extent to which longevity was shortened in females that developed these ovary-associated diseases, age-anchored life expectancy-defined as the median number of remaining years until death for females alive at specified ages during the life course-and years of life lost, a measure of premature mortality, were estimated. Mammary carcinoma was diagnosed in 19 (7.9%) females; median age at diagnosis was 8.5 years; case fatality was 37%. Pyometra was diagnosed in 16 (6.6%) females; median age at diagnosis was 5.4 years; case fatality was 7%. Median lifetime ovary exposure for the study population was 4.3 years. Although risk for developing both diseases increased with longer ovary exposure, longer ovary exposure (≥4.3 years) was also associated with an overall longevity advantage-a 33% decrease in mortality, living 17 months longer than females with shorter ovary exposure (P=0.002). Analysis of age-anchored life expectancy showed that at no time points during the life course was the current or future diagnosis of mammary carcinoma or pyometra associated with shortened survival compared to females who never developed these conditions. This lack of longevity disadvantage is an expected result for diseases with late-onset, moderate (<50%) case fatality (mammary carcinoma) or low (<10%) case fatality (pyometra). These findings fail to support the notion that a strategy, such as elective ovariohysterectomy, implemented to reduce the incidence of mammary carcinoma and pyometra will beneficially impact overall longevity. It follows that future efforts to find and implement effective longevity-promoting interventions should look beyond reducing the incidence of a particular disease to considering trade-offs. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Cost-Effectiveness of Oral Nutrition Supplementation for Malnourished Older Hospital Patients.

PubMed

Zhong, Yue; Cohen, Joshua T; Goates, Scott; Luo, Menghua; Nelson, Jeffrey; Neumann, Peter J

2017-02-01

Malnutrition, which is associated with increased medical complications in older hospitalized patients, can be attenuated by providing nutritional supplements. This study evaluates the cost effectiveness of a specialized oral nutritional supplement (ONS) in malnourished older hospitalized patients. We conducted an economic evaluation alongside a multicenter, randomized, controlled clinical trial (NOURISH Study). The target population was malnourished older hospitalized patients in the USA. We used 90-day (base case) and lifetime (sensitivity analysis) time horizons. The study compared a nutrient-dense ONS, containing high protein and β-hydroxy-β-methylbutyrate to placebo. Outcomes included health-care costs, measured as the product of resource use and per unit cost; quality-adjusted life-years (QALYs) (90-day time horizon); life-years (LYs) saved (lifetime time horizon); and the incremental cost-effectiveness ratio (ICER). All costs were inflated to 2015 US dollars. In the base-case analysis, 90-day treatment group costs averaged US$22,506 per person, compared to US$22,133 for the control group. Treatment group patients gained 0.011 more QALYs than control group subjects, reflecting the treatment group's significantly greater probability of survival through 90 days' follow-up, as reported by the clinical trial. Hence, the 90-day follow-up period ICER was US$33,818/QALY. Assuming a lifetime time horizon, estimated treatment group life expectancy exceeded control group life expectancy by 0.71 years. Hence, the lifetime ICER was US$524/LY. The follow-up period for the trial was relatively short. Some of the patients were lost to follow-up, thus reducing collection of health-care utilization data during the clinical trial. Our findings suggest that the investigative ONS cost-effectively extends the lives of malnourished hospitalized patients.

Adult sibling experience, roles, relationships and future concerns - a review of the literature in learning disabilities.

PubMed

Davys, Deborah; Mitchell, Duncan; Haigh, Carol

2011-10-01

This paper provides a review of the literature related to adult siblings of learning-disabled people. Siblings of learning-disabled people are often looked upon as next of kin when older parents die; however, there is little research regarding sibling views and wishes. A literature review of published peer-reviewed empirical research was undertaken. Electronic databases and citation tracking were used to collate data using key terms such as adult siblings and learning disability. Relevant articles were analysed, compared and contrasted. Six key themes emerged suggesting a varied impact of learning disability upon sibling lives in areas that include life choices, relationships, identity and future plans. Some siblings report a positive impact upon life, others state their lives are comparable with other adults who do not have a learning-disabled sibling and others still report a negative impact. Sibling roles and relationships are varied. Evidence suggests that sibling roles, relationships and experience are affected by life stage. Parents often have a primary care role for the disabled person, whilst siblings perform a more distant role; however, sibling involvement often rises when parents are no longer able to provide previous levels of support. Many factors appear to affect the sibling experience and uptake of roles including gender, life stage and circumstances, level of disability, health status and relationships between family members. Siblings are concerned about the future, particularly when parents are no longer able to provide support, and many appear to have expectations of future responsibilities regarding their disabled sibling. As siblings of people who have a learning disability are often expected by society to provide support, it is important that health and social care practitioners are aware of issues that may impact on this relationship. © 2011 Blackwell Publishing Ltd.

Brief Multidimensional Students' Life Satisfaction Scale-PTPB Version (BMSLSS-PTPB): psychometric properties and relationship with mental health symptom severity over time.

PubMed

Athay, M Michele; Kelley, Susan Douglas; Dew-Reeves, Sarah E

2012-03-01

Youth life satisfaction is a component of subjective well-being, an important part of a strengths-based approach to treatment. This study establishes the psychometric properties of the Brief Multidimensional Students' Life Satisfaction Scale-PTPB Version (BMSLSS-PTPB). The BMSLSS-PTPB showed evidence of construct validity with significant correlations as expected to measures of youth hope and youth symptom severity, and no relationship as expected to youth treatment outcome expectations. A longitudinal analysis was conducted examining the relationship between youth-reported life satisfaction and mental health symptom severity (youth-, caregiver-, and clinician-report) for 334 youth (aged 11-18 years) receiving in-home treatment. Results indicated that life satisfaction consistently increased over the course of treatment but increased faster in youth whose symptom severity, as rated by all reporters, decreased over the course of treatment. Implications, future directions, and limitations of the study are discussed.

Brief Multidimensional Students’ Life Satisfaction Scale – PTPB Version (BMSLSS-PTPB): Psychometric Properties and Relationship with Mental Health Symptom Severity Over Time

PubMed Central

Athay, M. Michele; Kelley, Susan Douglas; Dew-Reeves, Sarah E.

2012-01-01

Youth life satisfaction is a component of subjective well-being, an important part of a strengths-based approach to treatment. This study establishes the psychometric properties of the Brief Multidimensional Students’ Life Satisfaction Scale – PTPB version (BMSLSS-PTPB). The BMSLSS-PTPB shows evidence of construct validity with significant correlations as expected to measures of youth hope and youth symptom severity, and no relationship as expected to youth treatment outcome expectations. A longitudinal analysis was conducted examining the relationship between youth-reported life satisfaction and mental health symptom severity (youth, caregiver-, and clinician-report) for 334 youth (aged 11–18 years) receiving in-home treatment. Results indicate that life satisfaction consistently increases over the course of treatment but increases faster in youth whose symptom severity, as rated by all reporters, decreases. Implications, future directions, and limitations of the study are discussed. PMID:22407553

Psychological distress and psychiatric disorders in primary health care patients in East and West Germany 1 year after the fall of the Berlin Wall.

PubMed

Achberger, M; Linden, M; Benkert, O

1999-04-01

The reunification of Germany confronted citizens in East and West Germany with many changes in their lives. These changes may be considered as critical life events. Especially for those in East Germany, life circumstances drastically changed, and individuals were increasingly required to adopt and develop coping capabilities. In addition to new opportunities and freedom, there was threatening uncertainty about the future. Theories of life events and stress postulate that threat events have an impact on human well-being. It was expected that there would be an increased rate of psychiatric morbidity after unification, especially in the eastern part of Germany. An international study by the WHO on psychiatric disorders in general health care was carried out in 1990, 1 year after the opening of the Berlin Wall, in both parts of Berlin and in Mainz, West Germany. This allowed for a comparison of the prevalence rates of psychiatric disorders among general health care patients in the East and West, after the euphoria immediately following unification had subsided. The prevalence rates of current ICD-10 diagnoses and of subthreshold disorders in East Berlin were similar to the rates in West Berlin and Mainz. The recognition rate of psychiatric disorders by physicians did not differ in East Berlin as compared to West Berlin and Mainz. Contrary to the prediction expected from the literature on individual negative life events, major changes in life circumstances and stressful life events on a societal level within 1 year did not have a major impact on psychological function.

Children's confession- and lying-related emotion expectancies: Developmental differences and connections to parent-reported confession behavior.

PubMed

Smith, Craig E; Rizzo, Michael T

2017-04-01

Young children understand that lying is wrong, yet little is known about the emotions children connect to the acts of lying and confessing and how children's emotion expectancies relate to real-world behavior. In the current study, 4- to 9-year-old children (N=48) heard stories about protagonists (a) committing transgressions, (b) failing to disclose their misdeeds, and (c) subsequently lying or confessing. Younger children (4-5years) expected relatively positive feelings to follow self-serving transgressions, failure to disclose, and lying, and they often used gains-oriented and punishment-avoidance reasoning when justifying their responses. Older children (7-9years) had the opposite pattern of emotional responses (better feelings linked to confession compared with lying). Older children expected a more positive parental response to a confession than younger children. Furthermore, children who expected more positive parental responses to confession were reported by parents to confess more in real life than children who expected more negative parental responses to confession. Thus, the current research demonstrates a link between children's emotion expectancies and actual confession behavior. Copyright © 2016 Elsevier Inc. All rights reserved.

Children’s Confession- and Lying-Related Emotion Expectancies: Developmental Differences and Connections to Parent-Reported Confession Behavior

PubMed Central

Rizzo, Michael T.

2016-01-01

Young children understand that lying is wrong, yet little is known about the emotions children connect to the acts of lying and confessing, and how children’s emotion expectancies relate to real-world behavior. In the present study, 4-to-9-year-old children (N = 48) heard stories about protagonists 1) committing transgressions, 2) failing to disclose their misdeeds, and 3) subsequently lying or confessing. Younger children (4-to-5 years) expected relatively positive feelings to follow self-serving transgressions, failure to disclose, and lying, and they often used gains-oriented- and punishment-avoidance-reasoning when justifying their responses. Older children (7-to-9 years) had the opposite pattern of emotional responses (better feelings linked to confession, compared to lying). Older children expected a more positive parental response to a confession than did younger children. Further, children who expected more positive parental responses to confession were reported by parents to confess more in real life than children who expected more negative parental responses to a confession. Thus, the present research demonstrates a link between children’s emotion expectancies and actual confession behavior. PMID:28063404

Unequal care for dying patients in Sweden: a comparative registry study of deaths from heart disease and cancer.

PubMed

Brännström, Margareta; Hägglund, Lena; Fürst, Carl Johan; Boman, Kurt

2012-12-01

The Swedish Palliative Registry is a nationwide quality registry aimed at facilitating improvement in end-of-life care. The goal is for the registry to list and report quality indicators related to care during the last week of life in all cases expected death in Sweden. To examine the quality of care during the last week of life as reported to the registry for patients with heart disease compared to those with cancer. A retrospective registry study. Patients dying of heart disease compared to those dying from cancer had more shortness of breath, fewer drugs prescribed as needed against the usual symptoms and often died alone. Furthermore, they and their close relatives received less information about the imminence of death and bereavement follow-up was less common. The healthcare personnel were less aware of the heart disease patients' symptoms and less often knew about where they wished to die. Great differences were found in registered end-of-life care suggesting that the care given to patients with heart disease and cancer was unequal even after adjustment for age, sex and setting at the time of death. If our observational findings are confirmed in future studies there is obviously a need for new models for end-of-life management in order to facilitate the provision of equal care to dying patients regardless of diagnosis.

A Review of Commercial and Medical-Grade Physiological Monitoring Devices for Biofeedback-Assisted Quality of Life Improvement Studies.

PubMed

Nogueira, Pedro; Urbano, Joana; Reis, Luís Paulo; Cardoso, Henrique Lopes; Silva, Daniel Castro; Rocha, Ana Paula; Gonçalves, Joaquim; Faria, Brígida Mónica

2018-04-17

With the rise in wearable technology and "health culture", we are seeing an increasing interest and affordances in studying how to not only prolong life expectancy but also in how to improve individuals' quality of life. On the one hand, this attempts to give meaning to the increasing life expectancy, as living above a certain threshold of pain and lack of autonomy or mobility is both degrading and unfair. On the other hand, it lowers the cost of continuous care, as individuals with high quality of life indexes tend to have lower hospital readmissions or secondary complications, not to mention higher physical and mental health. In this paper, we evaluate the current state of the art in physiological therapy (biofeedback) along with the existing medical grade and consumer grade hardware for physiological research. We provide a quick primer on the most commonly monitored physiologic metrics, as well as a brief discussion on the current state of the art in biofeedback-assisted medical applications. We then go on to present a comparative analysis between medical and consumer grade biofeedback devices and discuss the hardware specifications and potential practical applications of each consumer grade device in terms of functionality and adaptability for controlled (laboratory) and uncontrolled (field) studies. We end this article with some empirical observations based on our study so that readers might use take them into consideration when arranging a laboratory or real-world experience, thus avoiding costly time delays and material expenditures.

NCCLC: NETWORK FOR RAPID ASSESSMENT OF CHEMICAL LIFE CYCLE IMPACT

EPA Science Inventory

The project is expected to provide a platform for chemical and material life-cycle information exchange. A wide use of CLB will enable organically growing LCA database for chemicals and materials. The project is expected to help chemical producers understand potential envir...

Widening Life Expectancy Advantage of Hispanics in the United States: 1990-2010.

PubMed

Fenelon, Andrew; Blue, Laura

2015-08-01

We examine trends in the Hispanic longevity advantage between 1990 and 2010, focusing on the contribution of cigarette smoking. We calculate life expectancy at age 50 for Hispanics and non-Hispanic whites between 1990 and 2010. We use an indirect method to calculate the contribution of smoking to changes over time in life expectancy. Among women, the Hispanic advantage in life expectancy grows from 2.14 years in 1990 (95 % CI 1.99-2.30 years) to 3.53 years in 2010 (3.42-3.64 years). More than 40 % of this increase reflects widening differences in smoking-attributable mortality. The advantage for Hispanic men increases from 2.27 years (2.14-2.41 years) to 2.91 years (2.81-3.01 years), although smoking makes only a small contribution. Despite persistent disadvantage, US Hispanics have increased their longevity advantage over non-Hispanic whites since 1990, much of which reflects the continuing importance of cigarette smoking to the Hispanic advantage.