Age Cohorts Research Articles

Sociodemographic Inequalities in Oral Health-Related Quality of Life in Older Adults: 15 Years Follow-Up of the 1932 and 1942 Birth Cohorts in Sweden.

Focusing on two birth cohorts of older adults, this study aimed to (1) describe the development of oral health-related quality of life (OHRQoL) across time from 2007 to 2022 and (2) assess sociodemographic inequalities in OHRQoL and whether these inequalities remain stable, widen or narrow during the follow-up period. In 1992 and 2007 the 1942 and 1932 birth cohorts living in the Swedish counties of Örebro and Östergotland participated with 6346 (response 71.4%) and 3735 individuals (response 71.9%), respectively. Of the 6346 1942 birth cohort participants, 2479 (38.5% of baseline) completed postal follow-ups in 1997, 2002, 2007, 2012, 2017 and 2022. Of the 3735 1932 birth cohort participants, 751 (20% of baseline) participated also in 2012, 2017 and 2022. Oral impacts of daily performance (OIDP) and socio-demographic characteristics were assessed at each survey year. A cohort table depicted the prevalence rates of OIDP (OIDP > 0) across time, disentangling age, period and cohort effects. Logistic mixed models with interaction terms of each socio-demographic covariate and time were used to test differences in socio-demographic inequalities of oral impacts over time. Between 2007 and 2022, OIDP > 0 varied from 22.7% to 28.7% in the 1932 birth cohort (age 75-90) and from 25.3% to 26.6% in the 1942 cohort (age 65-80). Mixed models revealed that cluster specific odds ratios (ORs) for OIDP > 0 varied from 0.2 to 2.5 with respect to avoidance of dental care due to cost and health perceptions in the 1942 cohort. Corresponding OR estimates in the 1932 cohort were 0.2 and 2.1. In both cohorts, inequality estimates according to country of birth and education were smaller in 2022 than in 2007. In the 1932 cohort, inequality according to sex was larger in 2022 than in 2007. Higher prevalence of oral impacts with increasing age and overtime were observed for both cohorts. Narrowing and widening of oral health socio-demographic disparities occurred. Further examination of the interaction of socio-demographic factors with age or time may allow for targeted policy strategies aimed to alleviate oral health disparities in older ages.

Economic Elites and Global Shocks: A Conceptual Mapping

How do economic elites react to global shocks? Here, global shocks refer to events that disrupt both the economy and society, such as economic crises, political regime collapses, natural and climate disasters, and collective health emergencies, including pandemics. These events have varied impacts across different geographical regions and population groups, including social classes and age cohorts. We argue that examining the relationship between global shocks and economic elites provides a unique perspective on significant trends among these elites. Against this backdrop, we will address two key aspects regarding the current characteristics and internal differentiations of economic elites: (a) their stance on socioeconomic inequalities, legitimization, and the construction of social acceptance; (b) new lifestyles and spatial relationships, including practices like land and space grabbing.

Evaluation of intrarenal vein flow patterns during routine echocardiography.

Intrarenal vein flow (IRVF) abnormalities can predict cardiovascular events including heart failure. This study aimed to evaluate the utility of short IRVF scans during routine comprehensive transthoracic echocardiography (TTE) examinations in a standard TTE laboratory. We screened consecutive patients who underwent elective TTE at our Ultrasound Imaging Laboratory between March 2018 and July 2019 and prospectively enrolled those who completed a 5min IRVF scan during the 30min TTE procedure. Among the 2101 screened patients, 1326 were included in the study cohort (age: 73 ± 13years, 756 men). IRVF abnormalities were detected in 13 (1.0%) patients. Twenty-one cardiac events were observed (1.6%, 21/1326): one myocardial infarction and 20 heart failures. Cumulative survival probability plots were generated using the Kaplan-Meier method within 6months after the TTE index day and assessed using the log-rank test. The plots revealed significantly worse prognoses in patients with elevated right arterial pressure (RAP) and abnormal IRVF, when compared to normal RAP or normal IEVF (p < 0.0001 and p < 0.0001, respectively). In a receiver operating curve analysis to predict the occurrence of cardiovascular events, E/e' had moderate predictive potential (area under the curve: 0.795, p < 0.0001), and the combination of E/e' and IRVF abnormality had better predictive potential than did E/e' alone (p = 0.043). Although rarely observed on TTE, IRVF abnormalities improve the ability of E/e' to detect cardiac events, especially heart failure. Further large-scale prospective studies are required to confirm our findings.

METABOLIC DYSFUNCTION-ASSOCIATED FATTY LIVER DISEASE IN THE ELDERLY PEOPLE

Background. As the global population ages, metabolic disorders are becoming increasingly prevalent, leading to a significant rise in fatty liver disease among the elderly. Metabolic-associated fatty liver disease, formerly known as non-alcoholic fatty liver disease, is now the most common liver disease. Closely linked to metabolic disorders like obesity, type 2 diabetes, and dyslipidemia, Metabolic-associated fatty liver disease currently affects 24% of the adult population, equating to one billion individuals worldwide. Purpose of study. To analyze the incidence structure of metabolically associated fatty liver disease in the elderly population and to determine the mechanisms of liver aging that affect the prevalence and mortality from this disease in an elderly cohort of individuals. Material and methods of study. For this literature review, we analyzed 32 scientific publications, including reviews, original articles, and meta-analyses, published between 2012 and 2024. We conducted a literature search using databases such as Google Scholar, Web of Science, PubMed, Scopus, and Abridged Index Medicus. Results. Reviewing the available literature sources has revealed the prevalence of fatty liver disease peaking at the age of 40– 50 in men and 60–69 in women but decreasing in the older cohorts (&gt;75 years). The mechanisms of liver cell aging influence the course of this disease in old patients have been identified as well. However, there are no data indicated concerning the direct impact on prevalence and association with fibrosis in the elderly population. Conclusion. Conflicting data on the prevalence of metabolic-associated fatty liver disease among the diagnosed elderly patients highlight the need for further research to realise the mechanisms underlying the age-related changes in the liver. The study of this disease in elderly persons is rather important to improve the quality of life and optimising medical care and developing prevention and treatment strategies.

40-years of relative age effects: life is not fair!

This paper explores the Relative Age Effect (RAE) after nearly 40 years since its initial examination in sports. Two original studies identified significant participation differences between relatively older and younger players in age-grouped elite hockey and soccer. In the current study, we replicate the original analyses using 2023 data. By comparing data from the original studies and 2023, focusing on Major Junior A hockey in North America and the Under-17 and Under-20 World Soccer Tournaments, we observe remarkably similar RAE patterns. For instance, both the original and the 2023 studies indicate that about 40% of elite young adult players were born in the first quarter of the age cohort, compared to just 10% in the last quarter. This paper underscores the ongoing advantages and disadvantages created by RAE and calls for greater focus on strategies to mitigate its unfair effects in sports and education.

Mapping and modeling age-related changes in intrinsic neural timescales

Intrinsic timescales of brain regions exhibit heterogeneity, escalating with hierarchical levels, and are crucial for the temporal integration of external stimuli. Aging, often associated with cognitive decline, involves progressive neuronal and synaptic loss, reshaping brain structure and dynamics. However, the impact of these structural changes on temporal coding in the aging brain remains unclear. We mapped intrinsic timescales and gray matter volume (GMV) using magnetic resonance imaging (MRI) in young and elderly adults. We found shorter intrinsic timescales across multiple large-scale functional networks in the elderly cohort, and a significant positive association between intrinsic timescales and GMV. Additionally, age-related decline in performance on visual discrimination tasks was linked to a reduction in intrinsic timescales in the cuneus. To explain these age-related shifts, we developed an age-dependent spiking neuron network model. In younger subjects, brain regions were near a critical branching regime, while regions in elderly subjects had fewer neurons and synapses, pushing the dynamics toward a subcritical regime. The model accurately reproduced the empirical results, showing longer intrinsic timescales in young adults due to critical slowing down. Our findings reveal how age-related structural brain changes may drive alterations in brain dynamics, offering testable predictions and informing possible interventions targeting cognitive decline.

Systematic identification and quantification of factors and their interactions with age, sex, and panel wave influencing cognitive function in Korean older adults

BackgroundCognitive decline in older adults is influenced by diverse factors, and degrees of influence of these factors may vary depending on sex, age cohorts, and passage of time. Moreover, these factors differ in their responsiveness to general interventions. Thus, identifying these factors including their interactions with age, sex, and panel wave and conducting a systematic quantification of their influences on cognitive function are both necessary for developing efficient intervention strategies.MethodsTo identify the influencing factors and their interactions, we applied a systematic stepwise variable selection using 2,535 community-dwelling older adults who participated in the Korean Longitudinal Study of Aging from Wave 5 (2014) to Wave 8 (2020). These factors were subsequently grouped based on their modifiability to investigate group-wise influences on cognitive function. For handling the longitudinal data, a generalized least squares method was used, and the degrees of influence of these factors were measured using the delta R2.ResultsTwelve variables had significant main effects on cognitive function in older adults. Among these variables, age interacted with sex, regular exercise, and marital status. Sex interacted with regular exercise, education level, and depressive symptoms. Wave number interacted with depressive symptoms and social activity. In addition, the group-wise delta R2 values were found to be 10.9, 6.3, and 5.9% in the difficult-to-modify, modifiable, and non-modifiable factor groups, respectively. Afterwards, we provided the delta R2 for each sub-population divided by the levels of age, sex, and wave number to examine how these factors changed the influences.ConclusionBased on the interaction and quantification results, we elucidated the characteristics of the influencing factors and their degrees of influence, and we suggest grouping factors based on their modifiability to systematically prevent cognitive decline in older adults.

Predictors of mortality in a large cohort of elders with essential tremor.

Prospective data show an increased risk of mortality in essential tremor (ET). Understanding the contributors to this increased mortality is of value. 347 cases enrolled in a prospective study of cognition in elders with ET (M baseline age = 79.6 years, M follow-up length = 2.7 years). At each visit, cases completed clinical assessments, a cognitive test battery and were assigned a Clinical Dementia Rating (CDR). Cox proportional hazards regression equations identified predictors of cases' relative risk of mortality. 41 (11.8%) of 347 cases died during follow-up. Deceased cases were older at baseline, had fewer years of education, used more medication, had more severe tremor, had more gait impairment, and reported more falls, less physical activity, and more depressive symptoms than did living cases. In univariate analyses, a CDR score of 1 or 2 (dementia) was associated with a six-fold increased the risk of mortality (Hazards ratio, HR = 6.33). Moderate rather than milder levels of dementia (CDR 2 rather than 1) were driving this effect, with multivariate models demonstrating HRs in excess of 7.5 (p <0.001). Gait impairment and falls were also associated with significant increased risk of mortality in multivariate models. We identified several factors that may be used to risk-stratify ET patients with respect to mortality. The information from these analyses can be of value in identifying subgroups of ET patients who demonstrate risk for early death; such subgroups can then be targeted for interventions as well as preventive measures.

Normative trajectories of R1, R2*, and magnetic susceptibility in basal ganglia on healthy ageing

Abstract Quantitative MRI (qMRI) techniques, including R1, R2*, and magnetic susceptibility mapping, have emerged as promising tools for generating surrogate imaging markers of brain tissue microstructure, enabling non-invasive in vivo measurements associated with myelination and iron deposition. Gaining insights into how these quantitative measurements evolve throughout a normal lifespan can enhance our understanding of brain maturation processes and facilitate studies of disease-related microstructural changes by distinguishing pathological alterations from normal brain development. In this study, we established the normative trajectories of R1, R2*, and magnetic susceptibility in the basal ganglia at 3T. We used a healthy ageing cohort comprising 260 subjects with an evenly distributed age range (from 18 to 80 years) and sex ratio throughout adulthood. Utilising the non-parametric Gaussian Process Regression model to derive the normative trajectories, we found that R1 in these structures predominantly exhibits a quadratic shape over age, while R2* and magnetic susceptibility are primarily linear. We validated the normative trajectories of R2* and magnetic susceptibility using an independent cohort. This result reinforces existing findings on the association between age and qMRI. Additionally, we demonstrated that the spatial distributions of the qMRI parameters also change with age in the putamen and caudate nucleus. Finally, the utility of normative modelling of qMRI in the basal ganglia is validated using an independent cohort comprising both healthy participants and individuals with Parkinson’s disease, with comparable data acquisition protocols.

The Self-Reported Human Health Impacts of Disaster on People in India: A Cross-Sectional Analysis of the Longitudinal Aging Study India.

The human health impacts of disaster are predicted to increase in frequency and severity due to the effects of climate change. This has impacts on all nations, but understanding disaster-related health impacts in highly populous nations, such as India, will help to inform risk preparedness and reduction measures for large proportions of the global population. Disaster-related human health impacts in India were examined via the use of survey data to inform risk reduction. A cross-sectional analysis of Wave 1 (2017-2018) data from the Longitudinal Aging Study India (LASI) was conducted to explore the impact of both natural and human-induced disasters on the self-reported health of people 45 years and above, as well as their partners (irrespective of age). Descriptive statistics, chi square tests of association, odds ratio, and logistic regression were used to analyze the data by socio-demographics, geographic location, and health concern type. Out of a total 72,250 respondents, 2,301 (3.5%) reported disaster-related health impacts, of which 90.1% were significant. Rural residents and those with no education were more likely to be affected. Droughts were most commonly responsible for affecting human health (41.7%), followed by floods (24.0%). Two-thirds of the sample reported psychological trauma and one-in-five experienced chronic illness. The LASI study presents an important first understanding of the self-reported human health impacts of disasters, both natural and human-induced in India. Findings indicate social determinants such as education level and rurality impact risk of disaster-related health impacts, while mental health concerns represent the biggest disaster-related health concern. Future waves of LASI should be examined to determine if human health impacts are increasing due to the effects of climate change, as well as the vulnerability of an aging cohort.

Non-metastatic gastric cancer (GC) in patients aged 80 years or older: Immediate and long-term outcomes of combined treatment.

453 Background: Comorbidities and increased risk of chemotherapy-induced toxicity in elderly patients presents significant challenges in management of GC. Here we presents a single-center experience in treatment patients aged 80 years or older with non-metastatic GS, reporting both immediate and long-term outcomes of surgical treatment (ST). Methods: This retrospective analysis includes 61 patients (pts) diagnosed with non-metastatic GC or cardio-esophageal junction (CEJ) cancer. The primary endpoint was relapse-free survival (RFS); secondary endpoints included overall survival (OS) and the incidence of surgical complications (SC). Results: Among the 61 pts (median age 82.7 years, range 80.0-89.2) 39.3% were men. ECOG PS was 0-1 in 49 pts (80.6%) and 2 – in 12 pts (19.4%). The primary tumor site was the stomach in 57 pts (93.4%) and the CEJ in 4 pts (6.6%). Tumor stage had been defined as cT 1-2 in 33.3% pts, cT 3-4 in 57.1%; cN 0 – in 36.1%, stage remained unknown in 6.3%. Radical surgery was performed in pts 78.7% (n=48), 29 pts (47.5%) of them underwent ST only without perioperative chemotherapy (CT). Neoadjuvant CT (NACT) received 23 pts (37.7%): platinum-based doublet regimen – 82.6% (n=19), while 17.4% (n=4) received capecitabine only. ST was performed in 47.8% (n=11) pts received NACT, other 12 pts didn’t undergo ST due to progression of disease (8.3%), comorbidities (33.3%), or patient preference (16.7%) in 1, 4 and 2 cases, respectively. Adjuvant CT was administered to 9 pts (14.3%). Surgical interventions included gastrectomy in 16.6% pts (n=9), proximal or distal resection – in 8.3% (n=4) and 74.1% (n=35), respectively. R0-resection was achieved in 42 pts (88.6%). SC has 20.8% (n=10) pts: classified as Clavien-Dindo grade (G) II – 4.4%, G IIIa – 8.9%, G IIIb - 8.9%; these included anastomotic leakage (6.7%), abscess formation (2.2%), cardiac events and thrombosis (4.4%), and eventration (2.2%). SC G IV or V not reported. The median duration of postoperative hospitalization was 8 days. In the overall cohort, the 3-y RFS was 53% (95%CI 28.9-53.9), 3-y OS – 67% (95%CI 27.9-75.2). Among the pts with stage IA (n=15), the 3-y RFS was 72% (95%CI 49.1-85.1), with a maximum follow-up period of 80 months and no cancer-related deaths. In patients with cT 2-4 N any 3-y RFS was 70% in the overall cohort and 74% in the surgery-only group (HR 1.09; 95%CI 0.45-2.65, p=1). Conclusions: Our findings demonstrate that over 65% of patients aged 80 years or older survive for at least 3 years following surgery for GC, with 53% living without evidence of metastases. Additionally, the rate of SC in this elderly cohort is comparable to that observed in younger populations. The role of perioperative or neoadjuvant CT in this age group remains a topic of ongoing research and discussion. It is critical to manage such population at referral oncological centers with expertise in treating elderly cancer pts.

Abstract TMP105: Frequency with which Patent Foramen Ovale are Causative vs Incidental in Elderly Patients with Cryptogenic Stroke

Background: Paradoxical embolism through a PFO is a common etiologic mechanism in the 18-60 yo patients with otherwise cryptogenic stroke (CS). However, its importance as a cause of stroke in the elderly is less clear. Older individuals have more competing causes of stroke, potentially reducing the relevance of PFO-associated stroke; but they have more venous thromboembolism and greater right-to-left shunting, potentially enhancing PFO-associated stroke frequency. Clinical management would be aided by estimates of how often a PFO in an older patient with CS is causal vs. incidental. Methods: Through systematic search, we identified all case–control studies of the comparative frequency of PFO in patients with CS vs known stroke cause (KS). We performed a random-effects meta-analysis across these studies to determine the best estimate of the differential frequency of PFO in CS and KS among three age cohorts: 1) age 60 and older 2) age 50/55 and older; and age 70/75 and older. We then applied Bayes’ theorem to determine the probability that detected PFO is causal or incidental in these groups. Results: The systematic search identified: for age 60+, 1 study enrolling 397 patients (190 CS, 207 KS); for age 50/55+, 5 studies enrolling 1203 patients (534 CS, 669 KS); and for age 70/75+, 3 studies enrolling 431 patients (171 CS, 260 KS). Methods of PFO detection were TCD in 47% of patients, TTE in 5%, and TEE in 48%. Crude cumulative rates of PFO detection were: age 60+, CS 68/190 (35.8%) vs. KS 44/207 (21.3%); age 50/55+, CS 198/554 (35.7%) vs. KS 81/669 (12.1%); and age 70/75+, CS 58/171 (33.9%) vs. KS 43/260 (16.5%). In the formal meta-analyses, summary odds ratios for PFO in CS vs. KS patients were: age 60+, 2.06 (95% CI, 1.32-3.23), p = 0.001; age 50/55+, 4.23 (95% CI, 2.44-7.32), p = 0.00001;.and age 70/75+ 3.77 (95% CI, 1.27-11.24), p = 0.02. With the application of Bayes’ theorem, the corresponding probabilities indicated that, when present, PFO in patients with CS is causal in: age 60+, 51.5% (95% CI, 24.2-69.0%); age 50/55, 78.2% (95% CI, 60.4-83.9%); and age 70/75+,61.5% (95%CI, 21.0-91.1%). Conclusion: Although confidence intervals are wide reflecting moderate study sizes, current evidence indicates that in older patients with cryptogenic stroke and PFO, the PFO is causal in at least one half of patients. These findings support the performance of randomized trials of PFO closure in older patients with otherwise cryptogenic stroke.

Cognitive Impairment is common and unrecognized in vascular surgery patients

ObjectivesPatients’ capacities to understand and act upon healthcare information is crucial to decision-making and high-quality care. Cognitive impairment (CI) has been associated with adverse outcomes across a range of diseases and surgeries. Despite the importance of CI, there is little to no information on its prevalence and severity in vascular surgery patients in the United States. We therefore conducted a prospective observational study to better characterize the prevalence and severity of CI in a contemporary vascular surgery practice. MethodsWe enrolled 111 outpatients attending a vascular surgery clinic using pragmatic consecutive sampling. Patients were excluded if they had a previous diagnosis of blindness, deafness, or dementia. Subjects completed a demographic survey and the Montreal Cognitive Assessment (MoCA), which was administered by a trained proctor. Chart review was used to assess comorbidities. The MoCA is a validated tool consisting of tasks such as clock drawing for assessing CI. It has a lower educational bias and higher sensitivity for detecting mild impairment compared to other exams. The MoCA is scored from 0-30 based on an objective grading system. Scores between 0-9, 10-17, 18-25, and 26-30 indicate severe, moderate, mild, and no CI respectively. Statistical analysis, including multivariable modeling was performed using SAS. ResultsOf 163 patients, our analysis included 111 consecutive vascular patients who completed the MoCA. The average age of the entire cohort was 64.1 years, and 58.6% were male. The majority of the patients in the study were white (80.1%). The mean MoCA score of the entire cohort was 22.6 (mild CI). Of all subjects, 77% had CI: 68% with mild and 9% with moderate CI. Hypertension (p=.024), congestive heart failure (CHF) (p=.028), fewer years of education (p=.032), and Medicaid enrollment (p=.046) all had significant univariate associations with CI. There was no statistically significant difference between age (p=.11) or the primary vascular diagnosis disease for which the patient sought treatment and CI (p=.49). Multivariable models demonstrated that only CHF (OR 3.8, p=.046) was statistically significantly associated with risk of CI. ConclusionIn this first-time prospective study of the entire spectrum of vascular patients in the U.S., we found that nearly 4 out of every 5 vascular surgery patients have undiagnosed cognitive impairment. Furthermore, we found that having CHF was associated with a higher likelihood of CI. Given the implications on consent, decision-making, and postoperative care, future work should focus on enrollment of a larger cohort along with an examination of the impact of CI on mortality, length of stay, and other outcomes.

Chemotherapy selection for advanced or metastatic pancreatic cancer using machine learning models trained with multi-center datasets.

738 Background: Several factors must be considered when selecting the chemotherapeutic regimen for advanced or metastatic pancreatic cancer. The decision between FOLFIRINOX and Gemcitabine/Nab-paclitaxel (GnP) as the first-line therapy is challenging, as survival is influenced by the efficacy and toxicity profiles of these treatments, along with individual patient characteristics and therapeutic vulnerabilities. This study aims to facilitate the selection of an appropriate first-line regimen for advanced or metastatic pancreatic cancer by employing machine learning (ML) methods trained on multi-center datasets. Methods: Our study is based on a cohort of 191 patients who underwent systemic chemotherapy for advanced or metastatic pancreatic cancer at the Gangneung Asan Hospital and Asan Medical Center in South Korea between 2014 and 2023. The dataset consisted of 17 types of demographic and clinical characteristics, as well as time-course of response and survival outcomes. We divided the cohort into training and test groups (4:1) in a stratified manner. ML models predicting overall survival (OS) were trained on the former group using the CatBoost method. The models utilizing a minimal subset of variables were selected with respect to ROC-AUC during 5-fold cross validation. A patient was classified as having high risk to a therapy when the predicted probability of death following treatment initiation was above the threshold value as determined during training of the respective model. Results: The median age of the entire cohort was 62 years, with 64% being male. The ML models achieved ROC-AUCs of 0.81 and 0.82 when predicting early death within 12 months following the initial administration of FOLFIRINOX or GnP, respectively. The predictive accuracies of the models were 0.77 and 0.80 for the unseen datasets from the two treatment groups, respectively. The median OS of the high- versus low-risk groups of FOLFIRINOX predicted by the ML models were significantly different (9 vs 15 months, P &lt;0.0001), with a hazard ratio (HR) of 2.8. Similarly, the median OS of the high- and low-risk groups of GnP were significantly different (9 vs 18 months, P &lt;0.01, HR of 2.5). We observed that 27% of the patients predicted as high risk to FOLFIRINOX therapy were predicted as low risk to GnP and vice versa for 32% of the patients predicted as high risk to GnP therapy. Conclusions: We developed ML models to compute the probability of early death following FOLFIRINOX or GnP therapy from routinely collected data of the patients with advanced or metastatic pancreatic cancer. After confirming robust predictive performance with multi-center datasets, we believe that these models may assist clinicians in selecting a first-line regimens, potentially enhancing personalized treatment strategies for this challenging disease.

Overall survival (OS) of patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) treated with first-line (1L) FOLFIRINOX (FFX): Bridging the gap between the NAPOLI 3 trial and real-world practice.

690 Background: NALIRIFOX (liposomal irinotecan + 5-fluorouracil/leucovorin + oxaliplatin) demonstrated significantly improved OS compared to 1L gemcitabine + nab-paclitaxel in the phase 3 NAPOLI 3 trial (NCT04083235). The median OS (95% CI) in the NALIRIFOX intention-to-treat population (N= 383) was 11.1 (10.0, 12.1) months. However, the relative efficacy of NALIRIFOX versus FFX (irinotecan + 5-fluorouracil/leucovorin + oxaliplatin), another standard of care for 1L treatment of mPDAC, has not been studied. To further contextualize findings from NAPOLI 3 trial, the current study described OS among patients treated with 1L FFX in the real-world setting. Methods: Three cohorts of patients with mPDAC treated with 1L FFX were identified from the Flatiron Health database. The all-comer cohort included all adult patients with mPDAC treated with 1L FFX since January 2014. Among them, the trial-aligned cohort included patients with mPDAC treated with 1L FFX between January 1, 2020 and July 31, 2022 (to align with the time period of NAPOLI 3 trial) who met the eligibility criteria of NAPOLI 3. Finally, a subgroup of patients in the trial-aligned cohort who received modified FFX (mFFX) regimen composed the trial-aligned mFFX cohort. OS was assessed using Kaplan-Meier analysis. Results: The all-comer cohort consisted of 3,271 patients. The trial-aligned cohort included 219 patients, of whom 154 (70%) were treated with mFFX. The distribution of baseline characteristics was similar across three cohorts (Table). The median age of the trial-aligned cohort was 65 years old, with 46% of patients being female, 67% being White, and 47% having ECOG score of 1. The median OS (95% CI) in the all-comer cohort and trial-aligned cohort was 9.0 (8.5, 9.3) months and 9.1 (7.8, 10.9) months, respectively; the median OS (95% CI) was 8.6 (7.3, 10.5) months in the trial-aligned mFFX cohort. Conclusions: NALIRIFOX regimen in the NAPOLI 3 trial showed numerically improved OS compared to FFX, including mFFX, in the real-world setting. Analysis adjusting for baseline characteristics are warranted and will provide further insights for the comparative efficacy of the two regimens. Characteristics of real-world FOLFIRINOX cohorts. All-comer cohort(N=3,271) Trial-aligned cohort(N=219) Trial-aligned mFFX cohort (N=154) Baseline characteristics Age, years, mean (SD) 63.5 (9.0) 64.6 (8.2) 65.1 (8.5) Female, n (%) 1,377 (42.1) 100 (45.7) 68 (44.2) White, n (%) 2,118 (64.8) 146 (66.7) 100 (64.9) ECOG score = 1, n (%) 1,327 (48.9)* 103 (47.0) 77 (50.0) Endpoint Median OS, months (95% CI) 9.0 (8.5, 9.3) 9.1 (7.8, 10.9) 8.6 (7.3, 10.5) Abbreviations: CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; OS, overall survival; SD, standard deviation. *Proportion calculated based on 2,711 patients with ECOG available at baseline.

Association between sarcopenia components and depressed mood varies by sex among community-dwelling older adults from the Korean Frailty and Aging Cohort Study

This cross-sectional study investigated the association between sarcopenia components and depressed mood in community-dwelling adults aged 70–84 years from the Korean Frailty and Aging Cohort Study. Depressed mood was assessed using the Geriatric Depression Scale short form. Logistic regression was used to examine sex-specific associations between sarcopenia components and depressed mood. Among 1,913 participants (mean age: 75.9 years, 49.0% women), 12.2% and 23.6% had depressed mood and sarcopenia, respectively. Sarcopenia prevalence increased among individuals with depressed mood in both sexes (men: P < 0.001; women: P = 0.016). Severe sarcopenia (men: OR, 3.620; 95% CI, 1.634−8.022; women OR, 3.332; 95% CI, 1.689−6.574) and concurrent low muscle strength and physical performance (men: OR, 3.660; 95% CI, 1.541−8.691; women: OR, 2.333; 95% CI, 1.294−4.206) correlated with depressed mood across sexes. The co-occurrence of low muscle mass and muscle strength (OR, 2.451; 95% CI, 1.007−5.964) was associated with depressed mood in men, whereas low physical performance (OR, 2.007; 95% CI, 1.275−3.160) and the coexistence of low muscle mass and physical performance (OR, 1.804; 95% CI, 1.003–3.248) correlated with depressed mood in women. Sarcopenia and depressed mood were significantly associated among older adults, underscoring the need to account for sex-specific differences in sarcopenia components when evaluating mental health outcomes to tailor interventions targeting sarcopenia and improve the mental well-being of aging populations.

Well-being and suicidal ideation in U.S. Veterans: Age cohort effects during military-to-civilian transition

Well-being and suicidal ideation in U.S. Veterans: Age cohort effects during military-to-civilian transition

A Whole-Body Physiology Model to Investigate Respiratory Function During Exercise Across Different Age Cohorts

A Whole-Body Physiology Model to Investigate Respiratory Function During Exercise Across Different Age Cohorts

Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 disease.

During the COVID-19 pandemic, nursing home (NH) residents faced the highest risk of severe COVID-19 disease and mortality. Due to their frailty status, comorbidity burden can serve as a useful predictive indicator of vulnerability in this frail population. However, the prognostic value of these cumulative comorbidity scores like the Charlson comorbidity index (CCI) remained unclear in this population. We evaluated the incremental predictive value of the CCI for predicting 28-day mortality in NH residents with COVID-19, compared to prediction using age and sex only. We included older individuals of ≥ 70years of age in a large retrospective observational cohort across NHs in the Netherlands. Individuals with PCR-confirmed COVID-19 diagnosis from 1 March 2020 to 31 December 2021 were included. The CCI score was computed by searching for the comorbidities recorded in the electronic patient records. All-cause mortality within 28days was predicted using logistic regression based on age and sex only (base model) and by adding the CCI to the base model (CCI model). The predictive performance of the base model and the CCI model were compared visually by the distribution of predicted risks and area under the receiver operator characteristic curve (AUROC), scaled Brier score, and calibration slope. A total of 4318 older NH residents were included in this study with a median age of 88years [IQR: 83-93] and a median CCI score of 6 [IQR: 5-7]. 1357 (31%) residents died within 28days after COVID-19 diagnosis. The base model, with age and sex as predictors, had an AUROC of 0.61 (CI: 0.60 to 0.63), a scaled brier score of 0.03 (CI: 0.02 to 0.04), and a calibration slope of 0.97 (CI: 0.83 to 1.13). The addition of CCI did not improve these predictive performance measures. The addition of the CCI as a vulnerability indicator did not improve short-term mortality prediction in NH residents. Similar (high) age and number of comorbidities in the NH population could reduce the effectiveness of these predictors, emphasizing the need for other population-specific predictors that can be utilized in the frail NH residents.

The burden and temporal trend of early onset pancreatic cancer based on the GBD 2021

In the context of the global increase in early-onset tumours, investigating the global disease burden caused by early-onset pancreatic cancer (EOPC) is imperative. Data on the burden of EOPC were obtained from the Global Burden of Disease Study 2021. A joinpoint regression model was used to analyse the temporal trend of the EOPC burden, and an age‒period‒cohort (APC) model was used to analyse the influence of age, period, and birth cohort on burden trends. Globally, the number of EOPC cases increased from 24,480 to 42,254, and the number of deaths increased from 17,193 to 26,996 between 1990 and 2021. The results of the APC model showed that the burden of EOPC increases with increasing age, whereas the variations in period and cohort effects exhibited a complex pattern across different sociodemographic index regions. Consequently, the disease burden of EOPC is increasing worldwide, highlighting the need for effective interventions.