Changes In Age Distribution Research Articles

How many people will live and die with serious illness in Ireland to 2040? Estimated needs and costs using microsimulation

As populations age, more people worldwide will live and die with serious illness like cancer, heart disease and dementia. Prior projections of serious illness prevalence and end-of-life care needs have typically used static population-level methods. We estimated future disease prevalence and healthcare costs by applying dynamic microsimulation models to high-quality individual-level panel data on older adults (aged 50 + ) in Ireland. We estimated that the number of people living and dying with serious illness will increase approximately 70 % over 20 years. Per-capita annual costs both at end of life and not at end of life increase substantially due to ageing populations and growing complexity. Total health system expenditures on care for people with serious illness are projected to double before accounting for rising cost of inputs in real terms. Decomposition of these estimates suggests that 39 % of additional costs are accounted for by rising absolute numbers of older people, 37 % by changing age distribution and growing life expectancy, and 23 % due to rising individual complexity including morbidity and functional limitations. Our results and methods will be of interest to other countries planning for the future population health needs, and formidable health system resources associated with these needs, in the coming years.

The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study.

A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. During prepandemic influenza seasons, overall RV detection was 92.7% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3%; coinfections: 456/1493, 30.5%) in children (<18 years) and 62.8% (2723/4339) (influenza: 1742/4339, 40.1%; coinfections: 264/4339, 6.1%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1%) to 90.3% (308/341) in 2021-22 (ORVs: 278/341, 82%; SARS-CoV-2: 30/341, 8.8%; coinfections: 110/341, 32.3%) and 88.9% (361/406) in 2022-23 (ORVs: 339/406, 84%; SARS-CoV-2: 22/406, 5.4%; coinfections: 128/406, 31.5%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7% (333/762) in 2020-21 (ORVs: 26/762, 3.4%; SARS-CoV-2: 307/762, 40.3%; coinfections: 7/762, 0.9%) to 57.8% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2%; SARS-CoV-2: 552/1265, 43.6%; coinfections: 42/1265, 3.3%) and 50.1% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5%; SARS-CoV-2: 337/1488, 22.6%; coinfections: 36/1488, 2.4%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations.

Changes in Age Distribution and Maternal Mortality in a Subset of the U.S., 2014–2021

This study aimed to determine the association between changes in age distribution and maternal mortality rates (MMR) in a subset of the United States between 2014 and 2021. A serial cross-sectional analysis of birthing individuals aged 15-44 years from 2014 to 2021 was performed. States that had not adopted the pregnancy checkbox as of 2014 were excluded from the primary analysis. A significant inflection point in MMR was identified in 2019 with the Joinpoint Regression Program, so all analyses were stratified: 2014-2019 and 2019-2021. The Kitagawa decomposition was applied to quantify the contribution from (1) changes in age distribution and (2) changes in age-specific MMR (ASMR) to total MMR. Data analysis occurred between 2022 and 2023. From 2014 to 2021, the mean (standard deviation) age of birthing individuals changed from 28.3 (5.8) to 29.4 (5.7) years. The MMR (95% CI) increased significantly from 16.5 (15.8-18.5) to 18.9 (17.4-20.5) per 100,000 live births from 2014 to 2019 with acceleration in MMR to 31.8 (30.0-33.8) by 2021. The change in maternal age distribution contributed to 36% of the total change in the MMR from 2014 to 2019 and 4% from 2019 to 2021. Age-specific MMR components increased significantly for those aged 25-29 years and 30-34 years from 2014 to 2019. All 5-year age strata except the 15-19 year old group saw increases in age-specific MMR from 2019 to 2021. MMR increased significantly from 2014 to 2021 with rapid increase after 2019. However, older age of birthing individuals explained only a minority of the increased MMR in both periods. The greatest contribution to MMR arose from increases in age-specific MMR.

Surgical Procedures for the Treatment of Stress Urinary Incontinence (SUI) in the Light of the Updated FDA-Warning and its Effects on Practice Patterns in Germany between 2010 and 2021.

Changes in surgical practice patterns to cure stress urinary incontinence (SUI) became evident after FDA warnings regarding vaginal mesh were issued. The primary aim was to describe nationwide numbers of suburethral alloplastic slings (SAS) inserted in 2010, 2015, 2018 and 2021 in Germany. Secondary, numbers were related to SUI specific non-alloplastic alternatives and bulking agents. Additionally, age distribution and overall inpatient surgeries in women were subject to analysis. Descriptive study utilizing data gathered from the German Federal Statistical Office ( www.destatis.de ). Included were the following procedures of inpatient surgery: A. SAS; B. non-allplastic slings; C. open/laparoscopic colposuspension; D. Bulking agents; overall changes and changes in age distribution (groups of 5-years intervals) are described. Overall, n=3599466 female inpatient procedures were analyzed. There was a considerable decrease of SAS surgeries of 28.49% between 2010 (n=23464) and 2015 (n=16778), and a decrease of 12.42% between 2015 and 2018 (n=14695) and an additional decrease of 40.66% between 2018 and 2021 (n=8720). Over time a 55.03% continuous decrease in non-alloplastic slings was observed (n=725 in 2010 to n=326 in 2021). Open and laparoscopic colposuspension numbers went down with a rate of 58.23% (n=4415 in 2010, n=1844 in 2021). Between 2010 and 2018, only bulking agent procedures increased with a rate of 5.89% from n=1425 to n=1509. There was a considerable decrease in inpatient surgical procedures using SAS. Alternatives not only failed to compensate, but experienced also a major decline.

SELF-EMPLOYMENT IN INDIA IN THE FACE OF GROWING POPULATION AND UNEMPLOYMENT: HIGHLIGHTING THE UNDERCURRENT DETERMINANTS AT PLAY

There has been a pressure on consecutive governments and policymakers to create enough jobs in India so that the workforce of India can be used improved and the population can be self-sustainable by becoming economically strong. The creation of jobs, in addition to safeguarding that the working population becomes economically productive, is also a vital avenue for fighting poverty and lack of proper use of intellectual, manual and skill-based potentials of the individuals. India has come to enjoy a distinct advantage in labour market compared to most developed and less developed countries due to the fast changing age distribution of population. India has experienced fairly consistent changes in the first indicator, especially after the 1991 reforms, but the trend in employment has not revealed any consistent or clear pattern. Though the Periodic Labour Force Survey (PLFS) shows increment in worker to population ratio and narrowing of the gender gap in employment in recent past, the unemployment scenario of India still remains disappointing. The present study aims to analyze the factors leading to unemployment and its impact on the Indian economy. The study focusses on how growing population leads to unemployment. The study makes use of secondary data sources and focusses on the present scenario of unemployment in India. The paper analyzes how an increase in population, poverty, illiteracy, inflation and lack of full employment can lead to a slowdown in the growth of the economy.

Study of liver cirrhosis over twenty consecutive years in adults in Southern China.

Liver cirrhosis (LC) is a prevalent and severe disease in China. The burden of LC is changing with widespread vaccination of hepatitis B virus (HBV) and antiviral therapy. However, the recent transition in etiologies and clinical features of LC cases requiring hospitalization is unclear. To identify the transition in etiologies and clinical characteristics of hospitalized LC patients in Southern China. In this retrospective, cross-sectional study we included LC inpatients admitted between January 2001 and December 2020. Medical data indicating etiological diagnosis and LC complications, and demographic, laboratory, and imaging data were collected from our hospital-based dataset. The etiologies of LC were mainly determined according to the discharge diagnosis, and upper gastrointestinal bleeding, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatocellular carcinoma (HCC), portal vein thrombosis, hepatorenal syndrome, and acute-on-chronic liver failure (ACLF) were considered LC-related complications in our study. Changing trends in the etiologies and clinical characteristics were investigated using logistic regression, and temporal trends in proportions of separated years were investigated using the Cochran-Armitage test. In-hospital prognosis and risk factors associated with in-hospital mortality were also investigated. A total of 33143 patients were included in the study [mean (SD) age, 51.7 (11.9) years], and 82.2% were males. The mean age of the study population increased from 51.0 years in 2001-2010 to 52.0 years in 2011-2020 (P < 0.001), and the proportion of female patients increased from 16.7% in 2001-2010 to 18.2% in 2011-2020 (P = 0.003). LC patients in the decompensated stage at diagnosis decreased from 68.1% in 2001-2010 to 64.6% in 2011-2020 (P < 0.001), and the median score of model for end-stage liver disease also decreased from 14.0 to 11.0 (P < 0.001). HBV remained the major etiology of LC (75.0%) and the dominant cause of viral hepatitis-LC (94.5%) during the study period. However, the proportion of HBV-LC decreased from 82.4% in 2001-2005 to 74.2% in 2016-2020, and the proportion of viral hepatitis-LC decreased from 85.2% in 2001-2005 to 78.1% in 2016-2020 (both P for trend < 0.001). Meanwhile, the proportions of LC caused by alcoholic liver disease, autoimmune hepatitis and mixed etiology increased by 2.5%, 0.8% and 4.5%, respectively (all P for trend < 0.001). In-hospital mortality was stable at 1.0% in 2011-2020, whereas HCC and ACLF manifested the highest increases in prevalence among all LC complications (35.8% to 41.0% and 5.7% to 12.4%, respectively) and were associated with 6-fold and 4-fold increased risks of mortality (odds ratios: 6.03 and 4.22, respectively). LC inpatients have experienced changes in age distribution and etiologies of cirrhosis over the last 20 years in Southern China. HCC and ACLF are associated with the highest risk of in-hospital mortality among LC complications.

Aging and the rise in bottom income inequality in Korea

Korea is one of the world’s fastest-aging societies, with poverty and low income prevalent among the elderly population. Unlike other advanced economies, where top income inequality has driven the rise in income inequality, fluctuations in income inequality in Korea in recent decades have been dominated by changes in the bottom half of the income distribution. Using data from the 1998–2016 Household Income and Expenditure Survey and the 2012–2019 Survey of Household Finances and Living Conditions, this study explores the extent to which population aging is associated with changes in the top (P90P50) and bottom (P50P10) income inequalities by applying recentered influence function decomposition technique. Our results indicate that population aging, or the compositional change in age distribution, is the largest contributor to the rise in bottom income inequality during the 21st century. Other factors, including the composition and rate effects of education, rate effect of age, and structural changes in labor markets, account for, at most, a small portion of the changes. The implications of these findings are discussed.

California's Public Safety Realignment Act and prisoner mortality.

In 2011, a historic Supreme Court decision mandated that the state of California substantially reduce its prison population to alleviate overcrowding, which was deemed so severe as to preclude the provision of adequate healthcare. To comply, California passed the Public Safety Realignment Act (Assembly Bill [AB] 109), representing the largest ever court-ordered reduction of a prison population in U.S. history. AB109 was successful in reducing the state prison population; however, although the policy was precipitated by inadequate healthcare in state prisons, no studies have examined its effects on prisoner health. As other states grapple with overcrowded prisons and look to California's experience with this landmark policy, understanding how it may have impacted prisoner health is critical. We sought to evaluate the effects of AB109 on prison mortality and assess the extent to which policy-induced changes in the age distribution of prisoners may have contributed to these effects. To do so, we used prison mortality data from the Bureau of Justice Statistics and the California Deaths in Custody reporting program and prison population data from the National Corrections Reporting Program to examine changes in overall prison mortality, the age distribution of prisoners, and age-adjusted prison mortality in California relative to other states before and after the implementation of AB109. Following AB109, California prisons experienced an increase in overall mortality relative to other states that attenuated within three years. Over the same period, California experienced a greater upward shift in the age distribution of its prisoners relative to other states, suggesting that the state's increase in overall mortality may have been driven by this change in age distribution. Indeed, when accounting for this differential change in age distribution, mortality among California prisoners exhibited a greater reduction relative to other states in the third year after implementation. As other states seek to reduce their prison populations to address overcrowding, assessments of California's experience with AB109 should consider this potential improvement in age-adjusted mortality.

Ageing in Saudi Arabia: new dimensions and intervention strategies

Ageing process of population passing through demographic dividend in many of the Arab countries, including Saudi Arabia, where the demographic transition process entered a progressive stage. This process has been accelerated with rapid reductions in fertility caused by various changes in the socio-economic and life style dimensions. Researches on population ageing in the country are rare and thus this analytic research aims at exploring population ageing trends at the backdrop of demographic transition to help build up demanded strategies and policies. This analysis explains a rapid native population ageing especially on absolute size: an increase in line with theoretical demographic transition process. Consequently, structural changes in age distribution accompanied a change in age pyramid from an expansive shape of the late 1990s to a constrictive shape in 2010 and further shrinking by 2016. Obviously, various age related indices—age dependency, index of ageing, and median age—exemplify this trend. Still, the old aged population remain static in terms of percentages or indices, exemplifying that the movement of age cohorts continue in the early ages shall reach old age, soon, in this decade: hence, characterizes retirement boom and multiple pathologies compressed to last years of life. Thus, this is an ideal time to prepare for challenges of ageing, learning from the experiences of nations confronted with similar demographic trends. Old aged population deserves care, concern and compassion to ‘add life to years’ with dignity and independence. Informal care mechanisms, especially families, play a vital role on this behalf, and so, deserve to be strengthened and empowered through welfare measures, rather than turning to improving formal care system.

Age distribution of dengue cases in southern Vietnam from 2000 to 2015.

Dengue is the most common vector-borne viral infection. In recent times, an increase in the age of cases with clinical dengue has been reported in the national surveillance system and published literature of Vietnam. This change not only alter the risk of transmission and disease burden in different populations but also will impact for prevention and control strategies. A retrospective study was conducted from 2000 to 2015 in 19 provinces of southern Vietnam to describe the changes in age distribution of dengue cases and circulating serotypes. The study is a time trend analysis of the data aggregated from the database of dengue surveillance system. The database consisted of clinically diagnosed and laboratory-confirmed cases of dengue in southern Vietnam from 2000 to 2015. In the study period, the mean age of dengue cases increased from 12.2 ± 8.8 years old (y/o) to 16.8 ± 13.3 y/o between 2000 and 2015. Majority of severe cases were observed in the age group of 5-9 y/o and 10-14 y/o. Overall, the mortality and case fatality rates (CFR) were lowest during 2010 to 2015, and all four serotypes of dengue were observed. With the exception of severe form, the age distribution of clinical cases of dengue appears to be shifting towards older age groups. An increase in the mean age of clinical cases of dengue has been observed in southern Vietnam over the past decade, and the highest incidence was observed in age group of 5-14 y/o. All serotypes of dengue were in circulation.

A Statistical Analysis of the Change in Age Distribution of Spawning Hatchery Salmon

Declines in salmon sizes have been reported primarily as a result of younger maturation rates. This change in age distribution poses serious threats to salmon-dependent peoples and ecological systems. We perform a statistical analysis to examine the change in age structure of spawning Alaskan chum salmon Oncorhynchus keta and Chinook salmon O. tshawytscha using 30 years of hatchery data. To highlight the impacts of this change, we investigate the average number of fry/smolt that each age of spawning chum/Chinook salmon produce. Our findings demonstrate an increase in younger hatchery salmon populations returning to spawn, and fewer amounts of fry produced by younger salmon compared to older salmon. These results suggest the potential risks associated with younger spawning salmon and aim to help better understand salmon behavior in order to sustain and protect healthy salmon populations.

Reappraising the public health benefits conferred by environmental policy: Considerations for an aging society.

Although addressing environmental pollution and unprecedented societal aging are concurrent public health challenges, rarely is the relationship between the two considered. Current approaches to valuing the public health benefits conferred by environmental policy may be ill-suited to aging populations. We describe the limitations of the age-invariant approach used by the United States Environmental Protection Agency to estimate the public health benefits corresponding to environmental regulation. These include the poor age-representativeness of the samples informing the valuation of mortality risk reduction, the exclusion of age-related outcomes from valuation, and the omission of age-related third-party expenditures. We offer an empirical framework that could address these limitations. Our recommendations could improve the calibration of environmental regulatory analysis to the changing age distribution of the United States population.

The impact of the demographic shift on limb amputation incidence in Saskatchewan, Canada, 2006-2019.

BackgroundChanging demographics in a population may have an inevitable influence on disease incidence including limb amputation. However, the extent to which these changes affect limb amputation (LA) is unknown. Understanding the impact of changing demographics on LA would provide the best opportunity to plan for the future. We assessed the impact of changes in age and sex on limb amputation in Saskatchewan between 2006 and 2019.MethodsRetrospective linked Saskatchewan’s LA cases, and demographic characteristics and residents population from 2006–2019 was used. The amputation rate was calculated by dividing the total number of LA cases recorded each year by the annual Saskatchewan resident population and the results expressed per 100,000 populations. Furthermore, decomposition analysis was used to assess the impact of changes in age and sex on LA in a decade (2008–2017) and the Generalized Additive Model (GAM) was employed to examine the linear and non-linear effect of age.ResultsWe found that in the ten years (2008–2017), the absolute LA rate difference was 9.0 per 100,000 population. Changes in age structure alone contributed 7.7% to the LA rate increase and 92.3% to changes in age-specific LA rates. The decade witnessed a marginal population difference between males and females, but the LA rate was 2.1–2.2 times higher in males than in females. The GAM revealed a non-linear relationship between LA and age, and further indicates that the risk of LA significantly increased as age increases.ConclusionsIn a decade, we found that changes in age distribution and age-specific rate substantially impacted the increase in the LA rate observed in the province. This highlights the urgent need for strategized programs to respond to these changes as both the population and diabetes, which is age-dependent and a leading cause of LA, are expected to increase in the province by 2030. As changes in population and demographic factors are inevitable, this study provides data for policy makers on the need for continuous incorporation of the shift in population in the design of future health services.

TB in the elderly: clinical features and outcomes.

BACKGROUND: TB in low-incidence countries is characterised by changes in age distribution towards larger numbers of cases among the elderly.OBJECTIVES: To investigate clinical features and outcomes of TB treatment in older patients and identify predictors of poor outcome.METHODS: Multicentre retrospective study of new TB cases from 53 hospitals included in the registry of the Integrated Tuberculosis Research Programme of the Spanish Society of Pulmonology and Thoracic Surgery (Sociedad Española de Neumología y Cirugía Torácica) between 2006 and 2020.RESULTS: We identified 731 patients aged ≥75 years from a cohort of 7,505 patients with TB. In the elderly, weight loss, disseminated disease and normal X-rays or infiltrates without cavitation were more common. All-cause mortality was 16% (5% of deaths due to TB). The elderly had higher rates of toxicity (6.7%) and hospital admissions (36%). In the multivariate analysis of predictors of TB mortality in ≥75-year-olds, only weight, age and treatment with non-standard regimens remained significant.CONCLUSIONS: TB in older patients needs more attention and remains a challenge because of a lack of specific clinical and radiological features. Standard treatment is effective, although mortality is higher than in young patients. Low weight, non-standard regimens and age are significant predictors of TB mortality.

Identifying the changing age distribution of opioid-related mortality with high-frequency data.

BackgroundOpioid-related mortality continues to rise across North America, and mortality rates have been further exacerbated by the COVID-19 pandemic. This study sought to provide an updated picture of trends of opioid-related mortality for Ontario, Canada between January 2003 and December 2020, in relation to age and sex.MethodsUsing mortality data from the Office of the Chief Coroner for Ontario, we applied Bayesian Poisson regression to model age/sex mortality per 100,000 person-years, including random walks to flexibly capture age and time effects. Models were also used to explore how trends might continue into 2022, considering both pre- and post-COVID-19 courses.ResultsFrom 2003 to 2020, there were 11,633 opioid-related deaths in Ontario. A shift in the age distribution of mortality was observed, with the greatest mortality rates now among younger individuals. In 2003, mortality rates reached maximums at 5.5 deaths per 100,000 person-years (95% credible interval: 4.0–7.6) for males around age 44 and 2.2 deaths per 100,000 person-years (95% CI: 1.5–3.2) for females around age 51. As of 2020, rates have reached maximums at 67.2 deaths per 100,000 person-years (95% CI: 55.3–81.5) for males around age 35 and 16.8 deaths per 100,000 person-years (95% CI: 12.8–22.0) for females around age 37. Our models estimate that opioid-related mortality among the younger population will continue to grow, and that current conditions could lead to male mortality rates that are more than quadruple those of pre-pandemic estimations.ConclusionsThis analysis may inform a refocusing of public health strategy for reducing rising rates of opioid-related mortality, including effectively reaching both older and younger males, as well as young females, with health and social supports such as treatment and harm reduction measures.

Trends of Total Knee Arthroplasty According to Age Structural Changes in Korea from 2011 to 2018.

Total Knee Arthroplasty (TKA) is one of the most commonly performed surgeries worldwide since it can improve pain, quality of life, and functional outcome. Due to the expansion of hospitals specialized in joint surgery, the topography of TKA implementation in Korea is changing. This study analyzed longitudinal trends of TKA based on changes in age distribution, sex, hospital, and region based on the Health Insurance Review and Assessment Service (HIRA) of Korea database. Data were collected from the National Health Insurance Service (NHIS), the Korean Statistical Information Service (KOSIS), and the Health Insurance Review and Assessment Service (HIRA) in Korea for the period 2011–2018. Results show the total number of surgeries increased and the number of patients by age decreased in those under the age of 70, while the number of patients over 70 years of age increased. A remarkable increase in women was found, and there was no significant difference between regions. TKA is spreading in a more universal and easily accessible form in Korea and has increased more in other relatively small medical institutions compared to tertiary referral medical centers. Due to the increase of orthopedics’ specialized hospitals and clinics, TKA is becoming more prominent in those hospitals.

Change in age distribution of COVID-19 deaths with the introduction of COVID-19 vaccination

ObjectivesMost countries initially deployed COVID-19 vaccines preferentially in elderly populations. We aimed to evaluate whether population-level vaccine effectiveness is heralded by an increase in the relative proportion of deaths among non-elderly populations that were less covered by vaccination programs. Eligible dataWe collected data from 40 countries on age-stratified COVID-19 deaths during the vaccination period (1/14/2021–5/31/2021) and two control periods (entire pre-vaccination period and excluding the first wave). Main outcome measuresWe meta-analyzed the proportion of deaths in different age groups in vaccination versus control periods in (1) countries with low vaccination rates; (2) countries with age-independent vaccination policies; and (3) countries with standard age-dependent vaccination policies. ResultsCountries that prioritized vaccination among older people saw an increasing share of deaths among 0–69 year old people in the vaccination versus the two control periods (summary proportion ratio 1.32 [95 CI% 1.24–1.41] and 1.35 [95 CI% 1.26–1.44)]. No such change was seen on average in countries with age-independent vaccination policies (1.05 [95 CI% 0.78–1.41 and 0.97 [95 CI% 0.95–1.00], respectively) and limited vaccination (0.93 [95 CI% 0.85–1.01] and 0.95 [95 CI% 0.87–1.03], respectively). Proportion ratios were associated with the difference of vaccination rates in elderly versus non-elderly people. No significant changes occurred in the share of deaths in age 0–49 among all 0–69 deaths in the vaccination versus pre-vaccination periods. ConclusionsThe substantial shift in the age distribution of COVID-19 deaths in countries that rapidly implemented vaccination predominantly among elderly provides evidence for the population level-effectiveness of COVID-19 vaccination and a favorable evolution of the pandemic towards endemicity with fewer elderly deaths.

Changing epidemiology of dengue in Sri Lanka-Challenges for the future.

BackgroundDengue infections are on the rise in Sri Lanka and are spreading to all areas in the country. Here, we discuss the changes in dengue epidemiology in Sri Lanka in relation to changes in age distribution, changes in seroprevalence rates over time, and possible reasons contributing to such changes.Methods and findingsAlthough the incidence of dengue increased 20-fold from the year 2000 to 2012 and a further 3-fold from 2012 to 2019, this increase is not reflected in a similar increase in the age-stratified seropositivity rates for dengue. For instance, the annual seroconversion rates were 0.76% in 2013 and 0.91% in 2017. The annual seroconversion rates in the 6 to 17 age group were 1.5% per year in 2003, 3.9% in 2013, and 4.1% in 2017. In addition, although a 13-fold increase in dengue was seen in those who were <19 years of age, a 52.4-fold increase was seen in the 40- to 59-year age group. The case fatality rates (CFRs) have similarly changed, with 61.8% of deaths occurring in those <19 years of age in the year 2000, while in 2012 to 2018, the highest CFR were seen in those who were aged 20 to 39 years. Although there has been a marked increase in the number of cases, the vector densities did not change during a 4-year period. The proportion of adult individuals experiencing a secondary dengue infection has also remained between 65% and 75% between the years 2004 and 2018.ConclusionsA change in the ratio of symptomatic to asymptomatic infections can give rise to changes in the reported incidence of dengue. In order to take an appropriate policy decision in dengue control activities, it would be important to study the changes in virus serotypes, vector dispersion, and densities. Further, the contribution of the rise in metabolic diseases to an increase in the symptomatic as well as more severe infections due to dengue is explored.

Tracking changes in age distribution of head and neck cancer in the United States from 1975 to2016.

Several independent studies report an alarming increase in patients younger than 40 being diagnosed with squamous cell carcinoma. There is currently a lack of available data clearly tracking changes in the age distribution of head and neck cancer (HNC) within the United States. This study attempts to elucidate any trends in oral cavity, oropharynx, larynx and hypopharynx cancer age distribution in the United States population from 1975 to 2016. Unlike previous studies, this paper does not track incidence but rather reports proportional changes of prevalence within age cohorts over time. This is a retrospective chart review centred on data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI). Each decade interval from 1975 to 2016 displays the proportion of HNC patients, classified by primary tumour subsite, within each age cohort. Mean age at diagnosis increased for all subsites except oropharynx. Oropharyngeal cancer was the only subsite to show a decrease in the mean age at diagnosis. In addition, oropharyngeal cancer was the only subsite to demonstrate an overall increase in proportional prevalence, largely due to increased incidence in middle-age (40-59years) patients. Cancers of the oral cavity were the only subset to show a true increase in the proportion of young (0-39years) patients, but its mean age at diagnosis still increased. When stratifying by gender, the proportion of young patients in female HNC cases is higher than the young male proportion. Overall, this study demonstrates an increased proportion of older HNC patients that is consistent with the ageing population. Oral cavity cancer demonstrated a true increase in the proportion of young patients, likely due to the increased incidence of young women diagnosed with this cancer. Oropharyngeal cancer was the only subsite to show a decrease in the mean age at diagnosis. The increased proportion of middle-age patients with oropharyngeal cancer likely reflects the increase in HPV-related cancers.

Estimating effective infection fatality rates during the course of the COVID-19 pandemic in Germany

BackgroundThe infection fatality rate (IFR) of the Coronavirus Disease 2019 (COVID-19) is one of the most discussed figures in the context of this pandemic. In contrast to the case fatality rate (CFR), the IFR depends on the total number of infected individuals – not just on the number of confirmed cases. In order to estimate the IFR, several seroprevalence studies have been or are currently conducted.MethodsUsing German COVID-19 surveillance data and age-group specific IFR estimates from multiple international studies, this work investigates time-dependent variations in effective IFR over the course of the pandemic. Three different methods for estimating (effective) IFRs are presented: (a) population-averaged IFRs based on the assumption that the infection risk is independent of age and time, (b) effective IFRs based on the assumption that the age distribution of confirmed cases approximately reflects the age distribution of infected individuals, and (c) effective IFRs accounting for age- and time-dependent dark figures of infections.ResultsEffective IFRs in Germany are estimated to vary over time, as the age distributions of confirmed cases and estimated infections are changing during the course of the pandemic. In particular during the first and second waves of infections in spring and autumn/winter 2020, there has been a pronounced shift in the age distribution of confirmed cases towards older age groups, resulting in larger effective IFR estimates. The temporary increase in effective IFR during the first wave is estimated to be smaller but still remains when adjusting for age- and time-dependent dark figures. A comparison of effective IFRs with observed CFRs indicates that a substantial fraction of the time-dependent variability in observed mortality can be explained by changes in the age distribution of infections. Furthermore, a vanishing gap between effective IFRs and observed CFRs is apparent after the first infection wave, while an increasing gap can be observed during the second wave.ConclusionsThe development of estimated effective IFR and observed CFR reflects the changing age distribution of infections over the course of the COVID-19 pandemic in Germany. Further research is warranted to obtain timely age-stratified IFR estimates, particularly in light of new variants of the virus.