Age-specific Rates Research Articles

A flexible approach to modelling stillbirths using the foetuses at risk approach.

Survival analysis methods are increasingly used to model the gestational age-specific risk of perinatal phenomena such as stillbirth. To compare two types of survival analysis models, and highlight differences by estimating the relationships between pre-pregnancy BMI and gestational age-specific rates of stillbirth. The study was based on singleton live births and stillbirths in the United States in 2016-2017, with data obtained from the natality and fetal death files of the National Center for Health Statistics. We compared Cox regression versus piecewise exponential additive mixed models (PAMMs) for modelling the relationship between BMI and stillbirth across gestational age. In a second analysis, we illustrated the performance of both models for assessing the relationship between the trimester-specific number of cigarettes smoked, a time-dependent covariate, and stillbirth. The study population included 7,567,316 births, of which 42,739 were stillbirths (5.6 per 1000 total births). Stillbirth rates increased with increasing pre-pregnancy BMI and increasing gestational age. In analyses with BMI as a categorical variable, the Cox model and PAMM models yielded similar results. Analyses of BMI as a continuous variable also showed similar results when BMI associations were assumed to be linear, and the changes in gestational age-specific rates were modelled parametrically. However, results differed slightly when PAMMs, modelled with data-driven approaches, were used to estimate changes in BMI effects across gestational age; PAMMs provided a more nuanced modelling of time-varying effects. PAMM models showed an approximately linear increase in the effect of smoking on stillbirth with increasing gestational age. For survival analyses using the foetuses-at-risk approach, PAMMs provide a valuable alternative to the traditional Cox model, with increased modelling flexibility when proportional hazards assumptions are violated.

Temporal trend and global burden of type 2 diabetes attributable to non-optimal temperature, 1990-2019: an analysis for the Global Burden of Disease Study 2019.

Exposure to hot or cold temperatures was reported to be associated with increased mortality and morbidity of type 2 diabetes, but few studies have estimated the temporal trend and global burden of type 2 diabetes attributable to non-optimal temperature. Based on the Global Burden of Disease Study 2019, we collected data on the numbers and rates of deaths and disability-adjusted life years (DALYs) of type 2 diabetes attributed to non-optimal temperature. The joinpoint regression analysis was used to estimate the temporal trends of the age-standardized rate of mortality and DALYs from 1990 to 2019 by average annual percentage change (AAPC). From 1990 to 2019, globally, the numbers of deaths and DALYs of type 2 diabetes attributable to non-optimal temperature increased by 136.13% (95% (uncertainty interval) UI: 87.04% to 277.76%) and 122.26% (95% UI: 68.77% to 275.59%), with the number from 0.05 (95% UI: 0.02 to 0.07) million and 0.96 (95% UI: 0.37 to 1.51) million in 1990 to 0. 11 (95% UI: 0.07 to 0.15) million and 2.14 (95% UI: 1.35 to 3.13) million in 2019. The age-standardized mortality rate (ASMR) and DALYs rate (ASDR) of type 2 diabetes attributable to non-optimal temperature showed an increasing trend in the high temperature effect and lower (low, low-middle and middle) socio-demographic index (SDI) region, with AAPCs of 3.17%, 1.24%, 1.61%, and 0.79% (all P < 0.05), respectively. The greatest increased ASMR and ASDR were observed in Central Asia, followed by Western Sub-Saharan Africa and South Asia. Meanwhile, the contribution of type 2 diabetes burden attributable to high temperature gradually increased globally and in five SDI regions. In addition, the global age-specific rate of mortality and DALYs of type 2 diabetes attributable to non-optimal temperature for both men and women almost increased with age in 2019. The global burden of type 2 diabetes attributable to non-optimal temperature increased from 1990 to 2019, particularly in high temperature, regions with lower SDI, and the older population. Appropriate temperature interventions are necessary to curb climate change and increasing diabetes.

Forecasting Total Fertility Rates For Urban And Rural Areas In Pakistan With A Coherent Functional Model.

To project total fertility rates for urban and rural areas in Pakistan up to 2027 with 80% prediction intervals. The secondary-data study was conducted from March 2020 to August 2020 at Data Bank in the Department of Statistics, University of Karachi, Pakistan, and comprised publicly available data of the Pakistan Demographic Survey from 1984 to 2007. Two statistical models, the functional time series model and the coherent functional model, were used to make the predictions about age-specific fertility rates. The forecasting performance of the models was compared through error measures. Data was analysed using R version 3.6.3. The predicted total fertility rate was 1.7 (80% prediction interval: 0.4-4.4) births per woman for urban areas and 2.2 (80% prediction interval: 0.6-5.3) births per woman for rural areas in 2027 using coherent functional model. The total fertility rate predicted by the functional time series model was 2.1 (80% prediction interval: 1.6- 2.6) births in urban areas and 2.7 (80% prediction interval: 1.7-4.1) births per woman in rural areas. The empirical comparison of forecast error measures obtained from the two models indicated that the coherent functional model performed better for forecasting total fertility rates for urban and rural areas in Pakistan. The projection of fertility rate obtained by the functional time series model and the coherent functional model described the future fertility behaviour of urban and rural populations.

Low birthweight is associated with a higher incidence of type 2 diabetes over two decades independent of adult BMI and genetic predisposition

Aims/hypothesisLow birthweight is a risk factor for type 2 diabetes. Most previous studies are based on cross-sectional prevalence data, not designed to study the timing of onset of type 2 diabetes in relation to birthweight. We aimed to examine associations of birthweight with age-specific incidence rate of type 2 diabetes in middle-aged to older adults over two decades.MethodsAdults aged 30–60 years enrolled in the Danish Inter99 cohort in 1999–2001 (baseline examination), with information on birthweight from original birth records from 1939–1971 and without diabetes at baseline, were eligible. Birth records were linked with individual-level data on age at diabetes diagnosis and key covariates. Incidence rates of type 2 diabetes as a function of age, sex and birthweight were modelled using Poisson regression, adjusting for prematurity status at birth, parity, polygenic scores for birthweight and type 2 diabetes, maternal and paternal diabetes history, socioeconomic status and adult BMI.ResultsIn 4590 participants there were 492 incident type 2 diabetes cases during a mean follow-up of 19 years. Type 2 diabetes incidence rate increased with age, was higher in male participants, and decreased with increasing birthweight (incidence rate ratio [95% CI per 1 kg increase in birthweight] 0.60 [0.48, 0.75]). The inverse association of birthweight with type 2 diabetes incidence was statistically significant across all models and in sensitivity analysis.Conclusions/interpretationA lower birthweight was associated with increased risk of developing type 2 diabetes independent of adult BMI and genetic risk of type 2 diabetes and birthweight.Graphical

Influence of filter age on Fe, Mn and NH4+ removal in dual media rapid sand filters used for drinking water production

Rapid sand filtration is a common method for removal of iron (Fe), manganese (Mn) and ammonium (NH4+) from anoxic groundwaters used for drinking water production. In this study, we combine geochemical and microbiological data to assess how filter age influences Fe, Mn and NH4+ removal in dual media filters, consisting of anthracite overlying quartz sand, that have been in operation for between ∼2 months and ∼11 years. We show that the depth where dissolved Fe and Mn removal occurs is reflected in the filter medium coatings, with ferrihydrite forming in the anthracite in the top of the filters (< 1 m), while birnessite-type Mn oxides are mostly formed in the sand (> 1 m). Removal of NH4+ occurs through nitrification in both the anthracite and sand and is the key driver of oxygen loss. Removal of Fe is independent of filter age and is always efficient (> 97% removal). In contrast, for Mn, the removal efficiency varies with filter age, ranging from 9 to 28% at ∼2–3 months after filter replacement to 100% after 8 months. After 11 years, removal reduces to 60–80%. The lack of Mn removal in the youngest filters (at 2–3 months) is likely the result of a relatively low abundance of mineral coatings that adsorb Mn2+ and provide surfaces for the establishment of a microbial community. 16S rRNA gene amplicon sequencing shows that Gallionella, which are known Fe2+ oxidizers, are present after 2 months, yet Fe2+ removal is mostly chemical. Efficient NH4+ removal (> 90%) establishes within 3 months of operation but leakage occurs upon high NH4+loading (> 160 µM). Two-step nitrification by Nitrosomonas and Candidatus Nitrotoga is likely the most important NH4+ removal mechanism in younger filters during ripening (2 months), after which complete ammonia oxidation by Nitrospira and canonical two-step nitrification occur simultaneously in older filters. Our results highlight the strong effect of filter age on especially Mn2+but also NH4+ removal. We show that ageing of filter medium leads to the development of thick coatings, which we hypothesize leads to preferential flow, and breakthrough of Mn2+. Use of age-specific flow rates may increase the contact time with the filter medium in older filters and improve Mn2+ and NH4+ removal.

Age-period-cohort analysis of pancreatitis epidemiological trends from 1990 to 2019 and forecasts for 2044: a systematic analysis from the Global Burden of Disease Study 2019.

Pancreatitis poses a serious medical problem worldwide. This study aims to explore the epidemiological trends of pancreatitis from 1990 to 2019, analyze the association between disease burden and age, period and birth cohort, and subsequently present a forecast of pancreatitis incidence and deaths. Epidemiologic data were gathered from the Global Health Data Exchange query tool. Joinpoint regression model was used to calculate the average annual percentage changes (AAPCs). Age-period-cohort analysis was utilized to estimate the independent effects of age, period and birth cohort. We also predicted the global epidemiological trends to 2044. Globally, the incident cases and deaths of pancreatitis increased 1.63-and 1.65-fold from 1990 to 2019, respectively. Joinpoint regression analysis showed that the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) decreased over the past three decades. The age effect indicates that older people have higher age-specific incidence and death rates. The period effect on incidence and deaths showed downward trends from 1990 to 2019. The cohort effect demonstrated that incidence and death risk peaked in the earlier birth cohort and were lower in the latest birth cohort. Incident cases and deaths of pancreatitis may significantly increase in the next 25 years. The ASIRs were predicted to slightly increase, while the ASDRs were predicted to decrease. Epidemiologic patterns and trends of pancreatitis across age, period and birth cohort may provide novel insight into public health. Limitations of alcohol use and prevention strategies for pancreatitis are necessary to reduce future burden.

Pattern and trends of the total and age-specific fertility rates during 1990–2018 in Pakistan

BackgroundPakistan has an inadequate vital event registration system, leading to fewer than half of all births being registered, and this issue is further exacerbated by systematic recall errors and omission of births. This study aims to evaluate direct and indirect methods of fertility estimation to analyze the trends and patterns of fertility rates in Pakistan from 1990 to 2018.Design/methodology/approachIndirect methods are utilized in this study to evaluate the direction and extent of changes in total and age-specific fertility rates, and these findings are compared to direct estimates. The study draws data on livebirths from four waves of the Pakistan Demographic and Health Survey that took place between 1990 and 2018. To ensure the quality of data, graphical methods and Whipple and Myers indices are employed. Additionally, the Brass Relational Gompertz model was used to analyze the data.ResultsThe Relational Gompertz model revealed that total fertility rates (TFRs) were higher than direct estimates by 0.4 children and age-specific fertility rates (ASFR) were higher for all age groups except the oldest. The difference was more significant among younger women aged 15–24, and less so for age groups 29 and above. The gap in estimated fertility between direct and indirect methods decreased with age.ConclusionThe indirect method is an invaluable tool in situations where direct measurement of fertility rates is challenging or impossible. By utilizing this method, policymakers can gain important insights into the fertility patterns and trends of a population, which is crucial for making informed decisions on fertility planning.

Incidence of Burkitt lymphoma in the United States during 2000 to 2019.

Burkitt lymphoma (BL) is an aggressive B-cell lymphoma that occurs worldwide. A study of BL in the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program during 1973 to 2005 (n = 3043) revealed three age-specific incidence peaks of BL and rates that were rising. We studied BL cases diagnosed in SEER 22 during 2000 to 2019 (n = 11 626) to investigate age-specific BL incidence rates and temporal trends. The age-standardized BL incidence rate was 3.96/million person-years, with a 2.85:1 male-to-female ratio. The BL rate among both Hispanic and White individuals was higher than in Black individuals (4.52, 4.12 vs 3.14). Age-specific BL rates showed peaks during pediatric, adult and elderly years in males and pediatric and elderly peaks in females. Based on 4524 BL cases with HIV status (SEER 13), only one peak in adult males (45 years) was observed. Overall age-standardized BL incidence rates rose 1.2%/year (not significant) up to 2009 then fell significantly by 2.4%/year thereafter. Temporal trends in BL rates during 2000 to 2019 varied with age group as pediatric BL rates rose 1.1%/year, while elderly BL rates fell 1.7%/year and adult BL rates rose 3.4%/year until 2007 before falling 3.1%/year thereafter. Overall survival from BL was 64% at 2 years, being highest in pediatric patients and lowest in Black and elderly individuals vs other subgroups. Survival improved by 20% between 2000 and 2019. Our data suggest that BL age-specific incidence rates are multimodal and that overall BL rates rose up to 2009 and then fell, suggesting changes in etiological factors or diagnosis.

The epidemiological patterns of non-Hodgkin lymphoma: global estimates of disease burden, risk factors, and temporal trends.

The incidence of non-Hodgkin's lymphoma (NHL) has increased steadily over the past few decades. Elucidating its global burden will facilitate more effective disease management and improve patient outcomes. We explored the disease burden, risk factors, and trends in incidence and mortality in NHL globally. The up-to-date data on age-standardized incidence and mortality rates of NHL were retrieved from the GLOBOCAN 2020, CI5 volumes I-XI, WHO mortality database, and Global Burden of Disease (GBD) 2019, focusing on geographic disparities worldwide. We reported incidence and mortality by sex and age, along with corresponding age-standardized rates (ASRs), the average annual percentage change (AAPC), and future burden estimates to 2040. In 2020, there were an estimated 545,000 new cases and 260,000 deaths of NHL globally. In addition, NHL resulted in 8,650,352 age-standardized DALYs in 2019 worldwide. The age-specific incidence rates varied drastically across world areas, at least 10-fold in both sexes, with the most pronounced increase trend found in Australia and New Zealand. By contrast, North African countries faced a more significant mortality burden (ASR, 3.7 per 100,000) than highly developed countries. In the past decades, the pace of increase in incidence and mortality accelerated, with the highest AAPC of 4.9 (95%CI: 3.6-6.2) and 6.8 (95%CI: 4.3-9.2) in the elderly population, respectively. Considering risk factors, obesity was positively correlated with age-standardized incidence rates (P< 0.001). And North America was the high-risk region for DALYs due to the high body mass index in 2019. Regarding demographic change, NHL incident cases are projected to rise to approximately 778,000 by 2040. In this pooled analysis, we provided evidence for the growing incidence trends in NHL, particularly among women, older adults, obese populations, and HIV-infected people. And the marked increase in the older population is still a public health issue that requires more attention. Future efforts should be directed at cultivating health awareness and formulating effective and locally tailored cancer prevention strategies, especially in most developing countries.

Lymphosarcoma Incidence in Kazakhstan: A Retrospective Survey (2010-2019).

The aim is to study the trends of lymphosarcoma incidence in the regional context in Kazakhstan. The retrospective study was done using descriptive method of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. 3,987 new cases of lymphosarcoma were registered in the country (50.7% in men, 49.3% in women). During the studied years the average age of patients was 54.2±0.8 years. The highest incidence rates per 100,000 in the entire population were found in the age groups 65-69 years (10.4±0.6), 70-74 years (10.7±0.8), and 75-79 years (10.3±0.8). The highest tendency to increase in age-related incidence rates was at the age over 85 (APC=+8.26) and to decrease at the age under 30 (APC=-6.17). The average annual standardized incidence rate was 2.3 per 100,000, and in dynamics tended to increase (APC=+1.43). It was found that the downward trend was observed in five regions (Akmola, Atyrau, Karaganda, North and South Kazakhstan), and the most pronounced decline was in the Karaganda (APC=-3.61) and South Kazakhstan (APC=-2.93) regions. When compiling thematic maps, incidence rates were determined based on standardized indicators: low - up to 1.97, average - from 1.97 to 2.60, high - above 2.60 per 100,000 for both sexes. Trends in the incidence of lymphosarcoma in Kazakhstan are growing and have geographical variability, and a high incidence is observed in the eastern and northern regions of the country. Sex differences have been established the incidence in men is higher than in female population, but the rate of increase in the incidence in women is more pronounced.

Mortality trend analysis of schistosomiasis in the Philippines from 1960-2019

Despite the different reviews and publications about schistosomiasis disease, it remains an economic and public health problem in the Philippines. Thereby, this study examined the trends of schistosomiasis mortality in the Philippines over 60 years concerning sex, age, and region-specific, using the data from the Philippine Health Statistics. Results show that national mortality rates have decreased from 1960-2019. The trend in schistosomiasis sex-specific mortality rates showed that men had a greater schistosomiasis- related death rate than women. For the age-specific mortality rate, children under the age of 1 have the lowest death rate compared with people over 70 having the highest death rate. For the region-specific mortality, Region VIII (Eastern Visayas) has the highest mortality rate with a value of 4, and Region XI (Davao) has the highest morbidity rate with a value of 53. To fully eradicate schistosomiasis in the succeeding years, an extensive transmission control measure and awareness education program must be implemented locally and nationally.

An epidemiology study for tuberculosis in the Philippines from 1960 to 2019

Tuberculosis has long been a public health threat in the Philippines, however, there is still no recent trend study for this country’s morbidity and deaths from the said infectious disease. With that, an age-, sex-, and region-specific morbidity and mortality trend study for tuberculosis in the Philippines was conducted for these types of studies significantly help in the surveillance and control of diseases. Data from the Philippine Health Statistics from 1960 to 2019 was mined to assess the morbidity and mortality rates from tuberculosis in terms of age, sex, and regions, which were then visualized through graphs. The results revealed that the mortality rate trend for tuberculosis in the Philippines from 1960 to 2019 declined over time. Also, as for the sex-specific mortality rate trend, it was observed that males consistently had a higher death rate in comparison to females through the years. As for the age-specific mortality rates, it increased with age, showing the direct proportionality of age to the rate of deaths. Lastly, for the region-specific morbidity and mortality rates, it was observed that Region V (Bicol Region) has the highest morbidity rate. On the other hand, Region VI (Western Visayas) has the highest mortality rate from tuberculosis.

Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure

BackgroundPrevious studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials...

Comparative demographics, population projections and egg maturation patterns of four eupelmid egg parasitoids on the factitious host Antherae pernyi.

The genera Anastatus and Mesocomys (both Hymenoptera: Eupelmidae) are important solitary egg endoparasitoids as biological control agents for lepidopterous and hemipterous pests worldwide. Here, we comparatively evaluated the demographic parameters of four important eupelmid egg parasitoids (Anastatus fulloi, A. japonicus, Mesocomys albitarsis and M. trabalae) reared on the factitious host eggs of the Chinese oak silkworm Antheraea pernyi, using age-stage two-sex life tables, their population projections as well as egg maturation patterns. Both the age-specific net reproductive rate (lx mx ) and reproductive value (vxj ) increased initially and then gradually decreased with increasing age in all four parasitoid species. Overall, the two Mesocomys species had higher survival rates at stable age-stage distribution, peak reproductive values, and intrinsic rates of increase than the two Anastatus species. Mesocomys albitarsis had the longest longevity while A. japonicus had the longest oviposition days and mean generation time. The two Mesocomys species are thus projected to have faster population increase than the two Anastatus species. Adult females of all four parasitoid species emerged with only a few mature eggs (< 6 eggs) and most of their eggs were matured post-emergence (i.e., strict synovigeny). The estimated 90% of lifetime complement of reproduction (offspring) and realized days were 374 and 32 for A. japonicus, 337 and 22 for M. trabalae, 330 and 19 for M. albitarsis and 147 and 28 for A. fulloi. Our results indicated that the two Mesocomys species have higher control capacity than the two Anastatus species. Provision of adult food for these strictly synovigenic parasitoids would be essential to prolong their lifespan and continuously produce eggs for parasitizing their hosts for mass rearing or augmentative biological control programs. This article is protected by copyright. All rights reserved.

Epidemiology and risk factors of atopic dermatitis among children in Basrah, Iraq

Atopic dermatitis is a major public health problem, especially among children and has an economic burden at family and community levels. The present research aimed to study the frequency, distribution and determinants of atopic dermatitis in Basrah city, Iraq. A cross-sectional study was carried out between December 2020 and March 2021 at the dermatology outpatient clinic of Alfayhaa Hospital in Basrah, Iraq. The overall prevalence of the disease among children was 21.3 %. The age-specific prevalence rate among infantile, childhood and adolescent groups were 40.7%, 21.7%, and 12.1%, respectively. One hundred Four children who attended the dermatology outpatient clinic were diagnosed with Atopic dermatitis. The mean age of the patients was 6.6±2.8 years. In 87.5% of the cases, the onset of disease was before two years of age. Using objective scoring atopic dermatitis (SCORAD), the disease was classified into mild, moderate and severe with a percentage of 10.6, 83.6, and 5.8, respectively. There was no significant association between the severity of atopic dermatitis with early-onset, positive family history of atopy, nor a high body mass index (BMI). We recommend further large-scale and community-based studies to estimate the real burden of the disease with emphasis on preventive measures.

An estimate of the burden of pancreatic cancer globally and its comparison with different WHO regions using Global Burden of Disease Database: A retrospective population-based analysis.

e16321 Background: Pancreatic cancer is a highly aggressive malignancy and is the fourth leading cause of cancer-related deaths in the United States and seventh globally. Most pancreatic cancers are adenocarcinomas that have poor prognoses. The highest incidence is reported between 65-69 in men and 75-79 in women. Worldwide, both incidence and mortality are increasing. We must evaluate the global and regional patterns to understand the impact of risk factors and develop early detection methods and treatments. Methods: We extracted pancreatic cancer mortality data from the Global Burden of Disease database based on the International Classification of Diseases versions 10 and 9. Age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), the age-specific death rate(ASDR), mortality-incidence ratio (MIR) and disability-adjusted life years (DALYs) were extracted for global as well as six WHO regions (Africa, Region of the Americas, South-East Asia, Europe, Eastern Mediterranean, Western Pacific) for both for the years 1990 and 2019. Joinpoint regression analysis was used to describe trends. Results: Between 1990 and 2019, pancreatic cancer ASIRs, ASMRs, and DALYs increased among the six regions in both males and females. Globally, ASIR, ASMR and DALY increased in males (+25.02%, +23.40%, +19.97%) and females (+26.35%, +24.30%, +22.08%). However, MIR decreased globally (males: -1.29%, females: -1.62%). The Eastern Mediterranean region showed the highest percentage change in ASIR, ASMR, and DALY in both males (+110.45%, +106.53%, +103.24%, respectively) and females (+140.20, +135.48%, +127.20% respectively), followed by the South-East Asia region (males: +71.38%, +70.03%, +63.80% respectively; females: +114.20%, +111.78%, +106.91% respectively). MIRs showed decreased trends among all six regions in both sexes. Europe region showed the highest decrease in males (-1.91%) and females (-3.09%). Conclusions: Overall, we reported the increasing disease burden of pancreatic cancer globally between 1990 and 2019. ASIRs, ASMRs and DALYs all increased throughout the six regions in both sexes, with the Eastern Mediterranean region being the highest. MIRs showed a global decreasing trend in both sexes, which may indicate an overall improvement in pancreatic cancer clinical care.

Visits to Alberta Emergency Departments for Child Mental Health Concerns During the COVID-19 Pandemic: An Examination of Visit Trends in Relation to School Closures and Reopenings.

We examined emergency department (ED) mental health visit trends by children in relation to periods of school closure and reopening during the COVID-19 pandemic in Alberta, Canada. Mental health visits by school-aged children (5 to <18 years) were extracted from the Emergency Department Information System, a province-wide database, from March 11, 2020, to November 30, 2021 (pandemic period; n = 18,997) and March 1, 2019, to March 10, 2020 (1-year, prepandemic comparator period; n = 11,540). We calculated age-specific visit rates and compared rate differences between periods of school closure (March 15-June 30, 2020; November 30, 2020-January 10, 2021; April 22-June 30, 2021) and reopening (September 4-November 29, 2020; January 11-April 21, 2021; September 3-November 30, 2021) to matched prepandemic periods. We used a ratio of relative risk to examine the risk of a visit during closures versus reopenings. The cohort included 11,540 prepandemic visits and 18,997 pandemic visits. Compared with prepandemic periods, ED visit rates increased across all ages during the first (+85.53%; 95% confidence interval [CI], 73.68% to 100.41%) and third (+19.92%; 95% CI, 13.28% to 26.95%) school closures, and decreased during the second closure (-15.37%; 95% CI, -22.22% to -7.92%). During school reopenings, visit rates decreased across all ages during the first reopening (-9.30%; 95% CI, -13.94% to -4.41%) and increased during the third reopening (+13.59%; 95% CI, 8.13% to 19.34%); rates did not change significantly during the second reopening (2.54%; 95% CI, -3.45% to 8.90%). The risk of a visit during school closure versus reopening was only higher for the first closure with 2.06 times the risk (95% CI, 1.88 to 2.25). Emergency department mental health visit rates were highest during the first school closure of the COVID-19 pandemic, and the risk of a visit during this closure period was twice compared with when schools first reopened.

Missing Americans: Early death in the United States-1933-2021.

We assessed how many US deaths would have been averted each year, 1933-2021, if US age-specific mortality rates had equaled the average of 21 other wealthy nations. We refer to these excess US deaths as "missing Americans." The United States had lower mortality rates than peer countries in the 1930s-1950s and similar mortality in the 1960s and 1970s. Beginning in the 1980s, however, the United States began experiencing a steady increase in the number of missing Americans, reaching 622,534 in 2019 alone. Excess US deaths surged during the COVID-19 pandemic, reaching 1,009,467 in 2020 and 1,090,103 in 2021. Excess US mortality was particularly pronounced for persons under 65 years. In 2020 and 2021, half of all US deaths under 65 years and 90% of the increase in under-65 mortality from 2019 to 2021 would have been avoided if the United States had the mortality rates of its peers. In 2021, there were 26.4 million years of life lost due to excess US mortality relative to peer nations, and 49% of all missing Americans died before age 65. Black and Native Americans made up a disproportionate share of excess US deaths, although the majority of missing Americans were White.

Associations of increasing breast cancer incidence with the current drinking habits and the past smoking habits among Japanese women

Background We have reported that age-specific incidence rates of breast cancer among Japanese women increased from 2005 to 2015 in a bimodal distribution pattern, with two peaks in the pre- and postmenopausal age groups. Objectives The present study aimed to assess the associations of the increasing age-specific breast cancer incidence or mortality with the prevalence of obesity and drinking and smoking habits, compared with those in uterine body, female and male colon and lung cancers. Methods Linear correlations of annual rates from 2005 to 2015 of the 10-year age-specific cancer incidence and mortality with the prevalence of obesity (body mass index, 25 and over) and drinking (alcohol, 20 g and over 3 times or more a week) and smoking habits were assessed by Pearson’s correlation coefficients during the same 10-year period (from 2005 to 2015) or the 10-year period 10 years before the cancer incidence and mortality were noted (from 1995 to 2005). Results Positive correlations (r&gt;0.640) were found between the increasing breast cancer incidence and the drinking habit during the same period or the smoking habit during the period 10 years before. Similar but weaker correlations were found for the breast cancer mortality rate increasing with age. Positive correlations were found between the decreasing male lung cancer mortality rate and the smoking habit rate during the period 10 years before. Conclusions The present ecological study indicated that the breast cancer incidence was associated with the current drinking habits and the past smoking habits among Japanese women.

(441) Quantifying Men with Erectile Dysfunction Potential Candidates for Penile Prosthesis Implantation in the US

Abstract Introduction While penile prosthesis implantation (PPI) is a recommended treatment option per the American Urological Association for men with erectile dysfunction (ED), there are a limited number of urologists performing PPI procedures in the US. Objective This study quantified the number of US men with ED and projected the number of potential candidates for PPI in 2022. Methods An excel-based disease-impact model was constructed using a top-down estimation approach based on two age groups for ED: 18-64 and ≥65 years old. The starting US male population was extracted from the 2022 US Census after the removal of age-specific mortality rates obtained from the National Vital Statistics Reports. Only men who subscribed to public or private health insurance were included in the model using insurance status data from the US Census. ED prevalence rates were obtained from administrative claims data analyses (IBM® MarketScan® Commercial Database [18-64 years] and 5% Medicare Standard Analytical Files [≥65 years]) using relevant International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes to calculate a base-case estimate of men with ED. To quantify the number of PPI candidates, the rate of men with ED but without ED treatment was obtained from the claims data and combined with the proportion of men with moderate-to-severe ED obtained from published research. The ED prevalence obtained from the administrative claims data analyses reflects a documented diagnosis of ED, which may underestimate the actual US prevalence of ED. Therefore, scenario analyses were conducted using patient-reported ED prevalence data obtained from a literature search of Medline. Results Using the ED prevalence obtained from the administrative claims data analyses, an estimated 8.3% of insured men (8,882,548 aged 18-64 and 1,419,992 aged ≥65) had a diagnosis of ED from 124,318,519 eligible US men aged ≥18 in 2022. The base-case estimate using claims data for the untreated ED rate and published literature for the proportion with moderate-to-severe ED showed 17.1% of men with an ED diagnosis claim could benefit from PPI (1,759,248 men aged ≥18). The literature review for the scenario analyses identified 11 publications from 2000 to 2020 with patient-reported ED prevalence. ED prevalence was assessed using different methods: International Index of Erectile Function (IIEF; 3 publications, 27.3%), Massachusetts Male Aging Study (MMAS)-derived questionnaire (3 publications, 27.3%), and other patient self-reported questionnaires (5 publications, 45.5%). Patient self-reported ED prevalence across all ages ranged from 5.1% to 70.2%. Applying the patient self-reported ED prevalence range to the scenario analyses, it was found that as many as 13,436,363 men in the US with ED could benefit from PPI. Conclusions From this disease-impact model, the estimated number of US men with ED is 124,318,519 as of 2022. Between 1.7 and 13.4 million of these men could potentially benefit from PPI. Ensuring sufficient penile prosthesis implanters could mitigate the potential physical, emotional, and social burden of untreated ED. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific Clarification Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific