Demographic Factors and Trends Associated with Mortality After AIDS Diagnosis in Puerto Rico.

ObjectivesData from the Centers for Disease Control and Prevention (CDC) show that firearm deaths are increasing in the USA. The aims of this study were to determine the magnitude of...

Introduction: Asian American subgroups (Asian Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display significant differences in mortality due to cardiovascular disease. It has previously been proposed that cancer is the leading cause of death for all Asian Americans. However, recent analysis of each individual subgroup reveals that heart disease is actually the leading cause of death for Asian Indian, Filipino and Japanese populations. Additionally, certain Asian American subgroups have an increased burden of risk factors and disease mortality at younger ages when compared to Non-Hispanic Whites. Years of potential life lost (YPLL) provides a measure of premature mortality due to cardiovascular disease by taking into account race-specific life expectancy and the younger age at death that is specific to Asian American populations. Hypothesis: We assessed the hypothesis that certain subgroups, such as Asian Indian and Filipino populations, lost more years of life due to cardiovascular disease when compared to other Asian American subgroups and Non-Hispanic Whites. Methods: We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003-2012. Sample size for Asian Americans was 354,256 and for Non-Hispanic Whites was 19,722,445. We calculated life expectancy, mean YPLL, and YPLL per 100,000 population for each Asian subgroup. We further characterized race-specific life expectancy using linear interpolation, and YPLL per 100,000 was standardized and age-adjusted using age categories. Results: Asian American subgroups display heterogeneity in cardiovascular disease burden. Asian Indians had a high burden of ischemic heart disease (IHD); Asian Indian men lost a mean of 17 years of life to IHD while Japanese and Non-Hispanic White men lost 14 years of life. Regarding cerebrovascular disease, Vietnamese populations lost a mean of 17 years of life, and Filipino populations lost a mean of 16 years. All Asian subgroups had higher years of life lost to cerebrovascular disease compared to Non-Hispanic Whites. Conclusion: Cardiovascular disease burden varies among Asian subgroups, and contributes to significant premature mortality in certain populations. Asian Indian and Filipino populations have the highest years of life lost due to ischemic heart disease. Filipino and Vietnamese have the highest years of life lost due to cerebrovascular disease. Mean YPLL due to cardiovascular disease was higher for Asian Indians, Korean, Vietnamese, and Filipino subgroups than mean YPLL for Non-Hispanic Whites. To address these health disparities, an analysis of risk factors is required and subgroup-specific interventions must be developed.

CALCULATING CARDIOMETABOLIC RISK: A DISEASE SIMULATION MODEL TO ESTIMATE THE LIFETIME RISK OF COMPLICATIONS OF CARDIOVASCULAR DISEASE AND DIABETES

Incidence and survival rates are commonly reported statistics, but these may fail to capture the full impact of childhood cancers. We describe the years of potential life lost (YPLL) and years of life lived with disease (YLLD) in children and adolescents who died of cancer in the United States to estimate the impact of childhood cancer in the United States in 2009. We examined mortality data in 2009 among children and adolescents <20 years old in both the National Vital Statistics System (NVSS) and the Surveillance, Epidemiology, and End Results (SEER) datasets. YPLL and YLLD were calculated for all deaths due to cancer. Histology-specific YPLL and YLLD of central nervous system (CNS) tumors, leukemia, and lymphoma were estimated using SEER. There were 2233 deaths and 153,390.4 YPLL due to neoplasm in 2009. CNS tumors were the largest cause of YPLL (31%) among deaths due to cancer and were the cause of 1.4% of YPLL due to all causes. For specific histologies, the greatest mean YPLL per death was due to atypical teratoid/rhabdoid tumor (78.0 years lost). The histology with the highest mean YLLD per death in children and adolescents who died of cancer was primitive neuroectodermal tumor (4.6 years lived). CNS tumors are the most common solid malignancy in individuals <20 years old and have the highest YPLL cost of all cancers. This offers the first histology-specific description of YPLL in children and adolescents and proposes a new measure of cancer impact, YLLD, in individuals who die of their disease. YPLL and YLLD complement traditional indicators of mortality and help place CNS tumors in the context of other childhood malignancies.

350 Background: We aim to illustrate the potential years of life lost (PYLL) and the average years of life lost (AYLL); secondary to genitourinary cancer in US during the period from 1972-2006 utilizing the Surveillance, Epidemiology and End Results (SEER) database, and illustrate the trends in the PYLL over this time period. Methods: PYLL were calculated to assess premature mortality trends in US for ureter, urinary bladder, kidney and renal pelvis, penis, testis, and prostate cancers. AYLL is the average of the differences between the actual ages at death and the expected remaining years of life for each person who died of cancer. Calculations were made based on the SEER cancer mortality data. Results: There were a total of 7,733,235 PYLL in both men and women secondary to urogenital cancer in US in the period from 1972-2006. In both males and females, the greatest PYLL were for kidney and renal pelvis cancer related mortality. In both sexes no improvement in PYLL secondary to ureteral and bladder cancer related mortality was observed. In males the greatest reduction in PYLL was in testicular cancer followed by prostate cancer. Conclusions: PYLL and AYLL are two powerful tools that reflect the impact of cancer related mortality on society. There has been an increasing trend in PYLL related to urogenital cancers over the last 35 years for both males and females. Kidney cancer had the highest increase in PYLL among both genders and more efforts are needed to address its progression. No significant financial relationships to disclose.

BackgroundSince the availability of antiretroviral therapy, mortality rates among people with HIV (PWH) have decreased; however, this trend may fail to quantify premature deaths among PWH. We assessed trends and disparities in all-cause and premature mortality by sex, HIV risk factor, and race, among PWH receiving care at the Vanderbilt Comprehensive Care Clinic from January 1998 – December 2018.MethodsWe examined mortality trends across calendar eras using person-time from clinic entry to date of death or December 31, 2018. We compared mortality rates by demographic and clinical factors and calculated adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) using multivariable Poisson regression. For individuals who died, years of potential life lost (YPLL) were obtained from the expected years of life remaining by referencing US sex-specific period life tables at age and year of death; age-adjusted YPLL (aYPLL) rates were also calculated. We examined patient factors associated with YPLL using multivariable linear regression. ResultsAmong the 6,531 individuals (51% non-Hispanic [NH] White race, 40% NH Black race, 21% female) included, 956 (14.6%) died. Mortality rates dramatically decreased during the study period (Figure). After adjusting for calendar era, age, injection drug use, hepatitis C virus (HCV), year of HIV diagnosis, history of AIDS-defining illness, CD4 cell count, and HIV RNA at clinic entry, only female sex (aIRR=1.32, 95% CI: 1.13–1.55 vs. males) but not NH Black race (aIRR=1.02, 95% CI: 0.88–1.17 vs. NH White race) was associated with increased mortality. In contrast, aYPLL per 1,000-person years was significantly higher for both female and NH Black PWH (Table 1). In adjusted models including CD4 cell count, HIV RNA, HCV, and year of clinic entry, higher YPLL remained associated with NH Black race, female sex regardless of HIV risk factor, and younger age at HIV diagnosis (Table 2). ConclusionDespite marked improvement over time, sex disparities in mortality as well as sex and race disparities in YPLL remained among PWH in care in this cohort. YPLL is a useful measure for examining persistent gaps in longevity and premature mortality among PWH.Disclosures Peter F. Rebeiro, PhD, MHS, Gilead (Other Financial or Material Support, Single Honorarium for an Expert Panel)

Years of potential life lost and productivity costs due to COVID-19 in Turkey: one yearly evaluation

Burden of cancer mortality is often measured by death counts or mortality rates, but potential years of life lost (PYLL) and PYLL per death may be more useful to estimate the impact of cancer-related deaths occurring at younger ages. We used U.S. national death certificate data. A total of 45 categories of common cancers were grouped for cancer-specific calculations of PYLL and PYLL per death. PYLL was defined as the sum of the total years of life lost prior to age 75 years. The largest number of PYLL in 2017 was due to deaths from cancers of the lung/bronchus (891,313; 20.8%), colon/rectum (409,538; 9.6%), and breast (400,643; 9.4%). Cancers with the highest PYLLs generally also caused the largest number of deaths and had the highest mortality rates, with the exception of prostate cancer (5.1% of deaths, 2.0% of PYLL). In contrast, PYLLs per death were greatest for deaths due to cancers of testis (mean = 34.0 years), bones/joints (26.4), and other endocrine sites including thymus (25.2). Although PYLLs generally reflect mortality rates, they more heavily weigh cancers that occur at younger ages. In contrast, PYLL per death, which is an average quantification of life years lost for individual patients with cancer, shows a different pattern. Mortality rates, PYLL, and PYLL per death are complementary measures of the burden of deaths due to cancer that should be considered in tandem to prioritize public health interventions focused on preventing premature mortality.

Cancer is the second most common cause of death in Poland, responsible for 26.7% of deaths in 2023. Our aim was to estimate total direct and indirect costs of cancer in Poland. We acquired epidemiological data from the System Analysis and Implementation Database provided Polish Ministry of Health. For estimating the direct costs of medical procedures and chemotherapy, we used statistics of homogeneous groups of patients provided by the Polish National Health Fund. For analyzing the indirect costs in the field of absenteeism we acquired data from Statistical Portal of Polish Social Insurance Institution. The total direct costs of treatment for cancer in the adult population in the period 2021-2023 to be equal to USD 192,935,858, taking purchasing power parity of Polish currency into account. This was equal to 0.00394% of General Domestic Product. The costs associated with absenteeism were equal to USD 3,103,526,321, which was equal to 0.063% of GDP. The sum of Years of Potential Life Lost was equal to 930,962 and the sum of Years of Potential Productive Life Lost was equal to 363,511. Cancer morbidity and incidence in the period 2021-2023 increased by 1.3%. Mortality increased by 2.1%. The total cost of medical services relative to GDP in 2022 was lower than in 2021; in 2023, however, it was higher than both in 2021 and 2022. The cost of chemotherapy, both in absolute numbers and relative to GDP, was significantly lower in 2022 than in 2021. In 2023, the cost was higher than in 2021 and in 2022. The costs of absenteeism in three consecutive years increased. Years of Potential Life Lost and Years of Potential Productive Life Lost due to cancer increased substantially in the period 2021-2023, both for males and for females, in all three age groups.

This article examines the impact of the COVID-19 pandemic on potential years of life lost (PYLL) in Romania's counties in 2020 and 2021. PYLL highlights the burden of premature deaths in a community and is a useful tool for prioritizing community health issues. The study compares the PYLL variation between different counties, identifying disparities in premature mortality rates and highlighting areas that require specific public health interventions. The results indicate that COVID-19 has had a significant impact on potential years of life lost across the country. For the year 2020, the total number of deaths from confirmed COVID-19 cases was 19,455, of which 14,152 premature deaths caused 193,489 PYLL, with a crude rate of 1053.28 PYLL per 100,000 inhabitants. In 2021, there were 39,966 deaths from confirmed COVID-19 cases, with 28,777 premature deaths, 386,061 PYLL, and a crude rate of 2116.63 PYLL per 100,000 population. This study reveals significant variations only in some counties, based on BYLL rates, and in the two years analyzed. The proportion of premature deaths (<80 years) varied by county and gender. PYLL's analysis by gender shows that men experienced a higher number of premature deaths than women in most counties, and this trend persisted in both years. The results are presented in the form of thematic maps, highlighting standardized PYLL rates for both genders in each county, facilitating a visual understanding of regional disparities. The identified variations can serve as a basis for developing and implementing more effective public health policies, based on the specifics of each county.

According to the Global Burden of Disease, in Russia in 2019, the standardised rate of years of life lost from premature mortality reached its lowest value since the early 1990s. Still, it was 1.5 and 1.3 times higher than the similar rates for men and women in the WHO European Region. The authors sought to trace the evolution of the structural characteristics of years of life lost in Russia from 1990 to 2021 and identify the factors that led to such a significant gap in the level of losses from premature mortality. Estimates of the absolute number of years of life lost (YLL), age-specific (AYLL) and age-standardised rates (ES1976) of years of life lost (SYLL) for each sex were made based on Rosstat data for 1990-2021 on the distribution of deaths by sex, by five-year age groups (0, 1-4, 5-9...85+), and causes of death (statistical form C-51). A table for life expectancy at birth at 92.6 years was used as a standard life table. Redistribution of garbage codes of causes of death and correction for polymorbidity were not performed. Estimates of years of life lost are comparable to WHO estimates for Russia in absolute values by sex and age, while only partially so by causes of death. From 1990-2019, SYLL declined in both sexes, by a quarter. In 2019, SYLL for men was 374 per 1,000, 2.3 higher than that for women. Increased losses during the COVID-19 pandemic levelled up these gains. The maximum inequality in years of life lost for both sexes was characteristic of external causes of death (ECD) and respiratory diseases (RD), while the minimum, of neoplasms (NP). From 1990 to 2021, SYLL declined in both sexes from CD, NP, ECD, and RD. In the pre-pandemic period, there was an increase in losses from digestive diseases (DD), infectious diseases (ID) and a group of all other classes of causes of death. The approach we used enabled us to focus more on causes of death with a low standardised death rate (SDR), such as HIV, liver disease, and pancreatic conditions. While these causes contribute less to the SDR, deaths from them typically occur at a younger age, thus raising the total number of years of life lost. The analysis allowed us to reevaluate the impact of COVID-19, accountable for 1/7 and 1/5 of all years of life lost for men and women in 2021, respectively. Therefore, if women’s life expectancy decline was more significant than men’s, the SYLL for men during both years of the pandemic was higher than that for women.

Aim. To analyze the changes in years of potential life lost (YPLL) from cardiovascular diseases (CVDs) of the economically active Russian population in 2013-2019.Material and methods. YPLL was estimated according to the Global Burden of Disease reports at the age of 15-72 years for 2013-2019. The required data were obtained from the annual reports of Federal State Statistics Service. Nonstandardized YPLL was estimated using the following equation: YPLL= ƩDi x ai, where Di is the absolute number of deaths at age I, ai — years not lived. The calculation was carried out for all-cause mortality and separately for CVDs (coronary artery disease (CAD), myocardial infarction (MI), cerebrovascular diseases, bleeding and strokes, and other CVDs).Results. In 2013-2019, there is a decrease in YPLL from all causes, including CVDs. In 2013, YPLL amounted to 14,918,7 years per 100000 economically active population, while in 2019 — 12199,9 years; from CVDs — 4471,6 and 3748,1 years, respectively. YPLL from CAD decreased by 21,5%, from MI — by 23,9%, from bleeding and strokes — by 17%. The rate of YPLL decline in 2014 compared to 2013 was 0,9%. Further, the rate of decline increased, reaching a maximum of 7,6% in 2017 compared to 2016. The differences in YPLL from all causes and CVDs between men and women are almost threefold, as well as from MI and CAD — 4,4 and 3,8 times, respectively. The contribution of CVDs to YPLL from all causes amounted to a maximum of 30,8% in 2018. The contribution of CAD to YPLL from CVDs decreased from 48,0% in 2013 to 44,9% in 2019. The contribution of MI to YPLL from CVDs in men (in 2019, 8%) is less than the contribution of alcoholic and unspecified cardiomyopathy (13,6%), while in women — 5,6% and 11,4%, respectively. There are no data on deaths from heart defects.Conclusion. The change in the YPLL from specific CVD causes occurs unevenly (by year and sex). MI, deaths from which is one of the key parameters of targeted mortality reduction programs, has a smaller effect on the YPLL level than cardiomyopathy, including alcoholic. To reduce mortality and YPLL at the economically active age, it is necessary to correct target programs.

All causes of death related to the two risk factors, smoking and hazardous drinking, have been reviewed followed by a selection of those causes of death for which the causal role of the risk factor appears to be quasi-certain. For each cause, existing epidemiologic data were reviewed and used to determine the fraction of premature mortality which could be attributed to each factor (called the attributable fraction). This fraction was then multiplied by the corresponding Canadian premature mortality measured in terms of deaths between ages one and 70 and potential years of life lost (PYLL) between ages one and 70, which gives a higher weight to younger deaths. Of the 73,440 deaths between ages one and 70 in Canada in 1974, 12% (or 8718 deaths) were found to be attributable to current smoking and 6% (4716) to hazardous drinking. In terms of PYLL between ages one and 70, hazardous drinking ranks ahead of current smoking with 10% (or 132,044 PYLL) of the total PYLL, whereas current smoking represents 8% (105,085 PYLL) of the total . Regardless of whether premature mortality is expressed in terms of deaths or PYLL, about 18% of Canadian premature mortality is attributable to current smoking and/or drinking (with the range of possible values being 14-22%).

e17107 Background: Genitourinary (GU) cancers significantly impact United States (US) public health, not just in mortality but also in premature deaths. We evaluated the potential years of life lost (PYLL) due to these cancers (prostate, kidney, bladder, testicular, penile, and others) from 1975 to 2017 using the SEER database and stratified it across racial groups. Methods: From 1975 to 2017, GU cancers were identified using SEER*Stat 8.4.2 using ICD-10 CM codes. We analyzed premature deaths and calculated PYLL as [Life expectancy minus (age at diagnosis + survival time)]. Due to non-homogeneity, the Kruskal-Wallis test (α = 5%) was employed for subgroup PYLL analysis. Spearman correlation coefficient (ρ) assessed the relationship between the year of diagnosis and PYLL. Analyses were conducted using SAS OnDemand. Results: Of the 1,715,763 GU cancer cases (1975-2017), 235,279 had premature deaths, totaling 2,406,551.20 PYLL. Testicular cancer showed the highest median PYLL (33.3 years) compared to other sites, followed by penile cancer with a median PYLL of 12.2 years. Non-Hispanic (NH) Blacks had higher PYLL for prostate, kidney, ureteral, and bladder cancers (p&lt;0.05), while Hispanics had higher PYLL for penile and testicular cancers (p&lt;0.0001). ρ value for PYLL and year of diagnosis was 0.23. Conclusions: Our study reveals a substantial impact of GU cancers on premature mortality and PYLL in the US. Despite the lower prevalence, testicular and penile cancers contribute significantly to PYLL, likely related to younger age at diagnosis. Racial disparities were evident, with NH-Blacks and Hispanics experiencing higher PYLL for specific GU cancers compared to other racial groups. These findings underscore the pressing need for targeted interventions to address disparities and enhance GU cancer management and prevention outcomes. [Table: see text]

Social class gradients in years of potential life lost in Switzerland