Semi-Markov modeling for disease incidence risk and duration

BackgroundUpdated data on hormone-related cancers (HRCs) are crucial for their prevention, management, and treatment, aligning with the UN's Sustainable Development Goals. This study focuses on HRCs: breast, thyroid, uterine, ovarian, prostate, and testicular cancers. Despite their significance, comparative studies on these cancers are limited.MethodsData for incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) related to HRCs were obtained from the Global Burden of Disease Study 2021. Statistical analyses were performed using R and Joinpoint Software. Age-standardized rates (ASR), percentage changes (1990–2021), annual percent change (APC) and average annual percent change (AAPC) are used to examine trends and risk factors associated with HRCs across various years, genders, and age groups, both in China and globally.FindingsIn 2021, China reported 659450 incidence cases of six HRCs, including 527009 cases (95% UI: 398030, 684814) in females and 132442 cases (89701, 181113) in males, reflecting a 29.97% increase since 1990. Deaths attributed to HRCs totaled 176526, with 130281 cases (99207, 166654) among females and 46245 cases (33049, 62510) among males, marking an 11.07% increase during the same period. The age-standardized incidence rates (ASIR) for HRCs in China were 10.70 (38.19, 65.86) per 100,000 for females and 13.87(9.50, 18.71) for males, in contrast to global rates of 17.07(62.11, 72.57) for females and 39.21(35.75, 41.69) for males. Age-standardized death rates (ASDR) were 3.54(9.22, 15.50) for females and 5.86(4.16, 7.83) for males, compared to higher global ASDRs of 6.17(19.49, 22.98) and 13.73(12.06, 14.78),respectively.From 1990 to 2021, China and the global population saw significant increases in ASIR for most cancers, except global ovarian cancer (AAPC = -0.229). Female HRCs mortality, YLLs, and DALYs declined significantly, particularly for uterine cancer. Conversely, Chinese males experienced increased mortality, YLLs, and DALYs for breast and thyroid cancers. Testicular cancer prevalence increased among Chinese males (AAPC = 7.329). Specifically, female breast cancer mortality in China decreased from 2011 to 2014 (APC = -2.82). Uterine cancer mortality dropped sharply from 2011 to 2015 (APC = -7.91). Thyroid cancer mortality declined from 2000 to 2007 (APC = -3.54), while ovarian cancer mortality decreased from 2000 to 2004 (APC = -3.33). Male breast cancer incidence peaked around 2010, and testicular cancer incidence rose significantly from 2011 to 2015 (APC = 7.77). All above changes were statistically significant (P < 0.05).Regarding age distribution characteristics, female HRCs consistently peak in the 60–74 age group globally and in China, whereas male HRCs show greater variability. In this age bracket, female breast cancer incidence reaches 348.90 (270.60, 440.16) in China versus 483.55 (449.97, 516.08) globally, while uterine cancer rates are 71.74 (52.18, 99.03) in China compared to 151.71 (138.55, 163.03) worldwide. Similarly, ovarian cancer peaks at 39.29 (28.29, 51.02) in China and 69.95 (63.59, 75.55) globally. Prostate cancer incidence also peaks in this group, with rates of 121.87 (84.48, 168.23) in China contrasting sharply with 534.72 (491.27, 568.09) globally. Conversely, testicular cancer shows a distinct pattern, peaking in the younger age group of 25–44 years, with incidences of 5.95 (4.44, 7.85) in China and 19.21 (18.04, 20.56) globally. The 25–44 age group also remains significant for thyroid cancer, with incidences of 23.31 (17.01, 32.52) in China and 31.57 (27.61, 36.30) globally.In terms of risk factors, smoking contributed to an ASR of 0.22 (0.16, 0.27) deaths globally, while alcohol accounted for 0.39 (0.27, 0.54) deaths. In China, low physical activity resulted in an ASR of 0.18 (0.03, 0.33) deaths, where high BMI notably increased risks for female HRCs. Environmental factors significantly impacted global ovarian cancer, contributing 0.12 (0.06, 0.19) deaths, while smoking influenced prostate cancer mortality, with an ASR of 0.36 (0.16, 0.60) deaths.InterpretationOur study reveals that rising incidence rates and age-specific patterns of female HRCs in China and globally are largely associated with shifts in lifestyle and dietary habits. To address this issue, it is essential to implement tailored prevention strategies for different cancer types and age groups and enhance management of risk factors, especially considering the growing burden of diseases affecting the elderly due to population aging.

This study aimed to evaluate the impact of cancer-related mortality on life expectancy in Feicheng City.We extracted the death records and population data of Feicheng City from 2013 to 2018 through the Feicheng Center for Disease Control and Prevention. The mortality, premature mortality, cause-eliminated life expectancy, potential years of life lost (PYLL), average potential years of life lost (APYLL), annual change percentage (APC), and other indicators of cancer were calculated. The age-standardized rates were calculated using the sixth national census (2010).From 2013 to 2018, the mortality rate of cancer in Feicheng City was 221.55/100,000, and the standardized mortality rate was 166.37/100,000. The standardized mortality rate increased from 2013 to 2014 and then decreased annually. The premature mortality of cancer was 8.98% and showed a downward trend (APC = −2.47%, t = −3.10, P = .04). From 2013 to 2018, the average life expectancy of residents in Feicheng City was 78.63 years. Eliminating the impact of cancer, life expectancy could increase by 3.72 years. The rate of life loss caused by cancer in men was higher than that in women. The total life loss caused by cancer deaths was 126,870.50 person-years, the potential life loss rate was 22.51‰, and the average potential life loss was 13.30 years. The standardized potential years of life lost rate showed a downward trend (APC = −2.96%, t = −3.72, P = .02), and APYLL decreased by 1.98% annually (t = −5.44, P = .01). The top 5 malignant tumors in APYLL were leukemia, breast cancer, brain tumor, liver cancer, and ovarian cancer.Lung cancer, esophageal cancer, female breast cancer, and childhood leukemia have a great impact on the life expectancy of residents in Feicheng City. Effective measures need to be taken to reduce the disease burden of malignant tumors.

20016 Background: Rankings of different cancer types by annual numbers of deaths provide important, albeit incomplete, data on overall impact of mortality. Because some cancers primarily affect younger people and have short survival, their impact on years of life lost (YLL) and lifetime earnings lost (LEL) is greater than that suggested by raw numbers of attributable deaths. To illustrate, we compared YLL and LEL for advanced stage malignant melanoma to seven tumor types also affecting both sexes. Methods: All fatal cases of advanced-stage cancer were identified in the most recent U.S. Surveillance Epidemiology and End Results (SEER) cancer registry (1995–2004). YLL due to melanoma was compared with other advanced-stage cancers that affect both sexes, including tumors of the colon/rectum, oral cavity/pharynx, brain/other nervous system (ONS), lung/bronchus, liver/intrahepatic bile duct, pancreas, and kidney/renal pelvis. Median survival was assessed using SEER*Stat software. YLL was calculated by subtracting the median survival since diagnosis from the individual’s life expectancy without cancer at the time of diagnosis, based on the 2003 U.S. Life Tables. Total YLL was calculated by summing the products of YLL and deaths in each age group; average YLL (AYLL) by dividing total YLL by total deaths; total LEL by multiplying LEL by deaths for each tumor type; and average LEL by dividing total LEL by total deaths. LEL were based on 2005 U.S. Census Bureau Historical Income Tables. Results: Malignant melanoma had both the highest estimated AYLL (22.1 years) and average LEL ($831,000) versus other cancers (Table). Conclusions: The impact of malignant melanoma on average years of life lost and lifetime earnings lost is greater than that of the other cancers assessed. Because melanoma often strikes younger people, and because current therapies do not significantly extend survival, the humanistic and societal burden is greater than that of the other tumor types. Average years of life lost (AYLL) and average lifetime earnings lost (LEL) Cancer Site AYLL Average LEL Melanoma of the skin 22.1 $831,000 Liver and intrahepatic bile duct 21.7 $769,000 Oral Cavity & Pharynx 20.3 $784,000 Brain and Other Nervous Systems 19.7 $757,000 Kidney and Renal Pelvis 19.2 $699,000 Lung and Bronchus 18.2 $652,000 Pancreas 17.5 $612,000 Colon and Rectum 17.1 $622,000 Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Pfizer, Inc Pfizer, Inc Pfizer, Inc Pfizer, Inc

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.

Background:Breast cancer is ranked among the most prevalent malignancies in the Chinese female population. However, comprehensive reports detailing the latest epidemiological data and attributable disease burden have not been extensively documented.Methods:In 2018, high-quality cancer surveillance data were recorded in 700 population-based cancer registries in China. We extracted data on female breast cancers (International Classification of Diseases, Tenth Revision [ICD-10]: C50) and estimated the incidence and mortality in 2022 according to the baseline data and corresponding trends from 2010 to 2018. Pathological types were classified according to the ICD for Oncology, 3rd Edition codes. Disability-adjusted life years (DALYs) were calculated as the sum of the years of life lost (YLLs) and years lived with disability (YLDs).Results:In 2022, approximately 357,200 new female breast cancer cases and 75,000 deaths occurred in China, accounting for 15.59% and 7.94% of total new cancer cases and deaths, respectively. The age-standardized incidence rate (ASIR) was 33.04 per 100,000. When analyzed by pathological type, the ASIRs for papillary neoplasms, invasive breast carcinoma, rare and salivary gland-type tumors, and other types were 1.13, 29.79, 0.24, and 1.88 per 100,000, respectively. The age-standardized mortality rate (ASMR) was 6.10 per 100,000. A total of 2,628,000 DALYs were found to be attributable to female breast cancer in China, comprising 2,278,300 YLLs and 349,700 YLDs. The ASIR, ASMR, and age-standardized rate (ASR) for DALYs in urban areas were consistently higher than those in rural areas. We observed a four-fold increase in the ASIR and ASR for DALYs and an eight-fold increase in the ASMR among females over 55 years compared with those aged under 55 years.Conclusion:These data provide invaluable insights into the latest epidemiology of female breast cancer in China and highlight the urgency for disease prevention and control strategy formulation.

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

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.

Measuring the impact of competing risks of death on society is important for setting public health policy and allocating resources. However, various indicators may result in inconsistent conclusions. The potential gains in life expectancy (PGLE) by elimination of deaths from HIV/AIDS, diseases of the heart and malignant neoplasms were compared to the years of potential life lost (YPLL) due to these causes in measuring the impact of premature death for the US population of working age (15-64 years). The PGLE and the YPLL were computed from mortality reports (1987-1992) by race and gender group for deaths from HIV/AIDS, diseases of the heart and malignant neoplasms for the US population of working age. The YPLL overestimated the importance of premature deaths from HIV/AIDS compared to the PGLE. For the total US population and total US white population of working age, the YPLL were about 20-30% higher than the PGLE. However, the YPLL were about 20-30% lower than the PGLE for the US black population of working age. Furthermore the relative importance of the impact of death from various diseases may be interchanged by these two indicators. For example, for US black males of working age, the impact of deaths from HIV/AIDS by PGLE in 1992 was higher than that from malignant neoplasms and lower than that from diseases of the heart, but by using YPLL, the impact of premature deaths from HIV/AIDS was higher than that from both diseases of the heart and malignant neoplasms. The PGLE by elimination of deaths from diseases takes into account the competing risks on the population and it can be compared easily across populations. The YPLL is an index that does not take into account competing risks and it is also heavily influenced by the age structure and total population size. Although there are several standardization techniques proposed to improve the comparability of the YPLL across different populations, the YPLL fails to address the central issue of competing risks operating on the population. For this reason, we prefer the PGLE to the YPLL in measuring the impact of premature deaths on a population.

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.

Changes in life expectancy for cancer patients over time since diagnosis

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...

There is a well-established relationship between temperature and mortality, with older individuals being most at risk in high-income settings. This raises the question of the degree to which lives are being shortened by exposure to heat or cold. Years of life lost (YLL) take into account population life expectancy and age at which mortality occurs. However, YLL are rarely used as an outcome-metric in studies of temperature-related mortality. This represents an important gap in knowledge; to better comprehend potential impacts of temperature in the context of climate change and an ageing population, it is important to understand the relationship between temperature and YLL, and also whether the risks of temperature related mortality and YLL have changed over recent years.Gridded temperature data derived from observations, and mortality data were provided by the UK Met Office and the Office for National Statistics (ONS), respectively. We derived YLL for each death using sex-specific yearly life expectancy from ONS English-national lifetables. We undertook an ecological time-series regression analysis, using a distributed-lag double-threshold model, to estimate the relationship between daily mean temperature and daily YLL and mortality between 1996 and 2013 in Greater London, the West Midlands including Birmingham, and Greater Manchester. Temperature-thresholds, as determined by model best fit, were set at the 91st (for heat-effects) and 35th (for cold-effects) percentiles of the mean temperature distribution. Secondly, we analysed whether there had been any changes in heat and cold related risk of YLL and mortality over time.Heat-effects (lag 0–2 days) were greatest in London, where for each 1 °C above the heat-threshold the risk of mortality increased by 3.9% (CI 3.5%, 4.3%) and YLL increased by 3.0% (2.5%, 3.5%). Between 1996 and 2013, the proportion of total deaths and YLL attributable to heat in London were 0.50% and 0.40% respectively. Cold-effects (lag 0–27 days) were greatest in the West Midlands, where for each 1 °C below the cold-threshold, risk of mortality increased by 3.1% (2.4%, 3.7%) and YLL also increased by 3.1% (2.2%, 3.9%). The proportion of deaths and YLL attributable to cold in the West Midlands were 3.3% and 3.2% respectively. We found no evidence of decreasing susceptibility to heat and cold over time.The addition of life expectancy information into calculations of temperature-related risk and mortality burdens for English cities is novel. We demonstrate that although older individuals are at greatest risk of temperature-related mortality, heat and cold still make a significant contribution to the YLL due to premature death.

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.

The United States' opioid crisis is worsening, with the number of deaths reaching 81,806 in 2022 after more than tripling over the past decade. This study aimed to comprehensively characterize changes in burden of opioid overdose mortality in terms of life expectancy reduction and years of life lost between 2019 and 2022, including differential burden across demographic groups and the contribution of polysubstance use. Using life tables and counts for all-cause and opioid overdose deaths from the National Center for Health Statistics, we constructed cause-eliminated life tables to estimate mortality by age in the absence of opioid-related deaths. We calculated the loss in life expectancy at birth (LLE) and total years of life lost (YLL) due to opioid overdose deaths by state of residency, sex, racial/ethnic group, and co-involvement of cocaine and psychostimulants. Opioid-related deaths in the US led to an estimated 3.1 million years of life lost in 2022 (38 years per death), compared to 2.0 million years lost in 2019. Relative to a scenario with no opioid mortality, we estimate that opioid-related deaths reduced life expectancy nationally by 0.67 years in 2022 vs 0.52 years in 2019. This LLE worsened in all racial/ethnic groups during the study period: 0.76y-0.96y for white men, 0.36y-0.55y for white women, 0.59y-1.1y for Black men, 0.27y-0.53y for Black women, 0.31y-0.82y for Hispanic men, 0.19y-0.31y for Hispanic women, 0.62y-1.5y for American Indian/Alaska Native (AI/AN) men, 0.43y-1y for AI/AN women, 0.09y-0.2y for Asian men, and 0.08y-0.13y for Asian women. Nearly all states experienced an increase in years of life lost (YLL) per capita from 2019 to 2022, with YLL more than doubling in 16 states. Cocaine or psychostimulants with abuse potential (incl. methamphetamines) were involved in half of all deaths and years of life lost in 2022, with substantial variation in the predominant drug class by state and racial/ethnic group. The burden of opioid-related mortality increased dramatically in the US between 2019 and 2022, coinciding with the period of the COVID-19 pandemic and the associated disruptions to social, economic, and health systems. Opioid overdose deaths are an important contributor to decreasing US life expectancy, and Black, Hispanic, and Native Americans now experience mortality burdens approaching or exceeding white Americans. None.

Fatal injury surveillance data coupled with life expectancy data may be used to assess the impact of occupational fatal injuries on years of potential life lost (YPLL).We compare three definitions of YPLL and trends over time in YPLL. Two definitions determine YPLL as expected life lost to fixed life expectancies of 65 or 85 years. The third definition uses actuarial adjustments of life expectancy given survival to a given age stratified by gender and race. Fatalities from the National Traumatic Occupational Fatality (NTOF) database are used to illustrate the three definitions of YPLL.The three YPLL measures were similar in magnitude and direction of the trend in YPLL over 1980-1992. Proper interpretation of these trends can only be made in conjunction with other measures (e.g., rates). Almost all YPLL trends are declining, implying that over time fatal injuries are shifting to older workers. The exception is the increasing trend in YPLL for the retail trade industry, injury rates have also been increasing over time for this industry. Mining and construction have the highest YPLL among all industries. This analysis suggests efforts to prevent the occupational fatalities of younger workers should focus on the retail trade, mining, and construction industries.