Cohort Life Expectancy Research Articles

Long-term exposure to urban air pollution and the relationship with life expectancy in cohort of 3.5 million people in Silesia.

Air pollution is considered to be one of the most important environmental health determinants. The studies constitute an attempt to explain the role of air pollutants in the impact on the length of life of the 3.5 million people living in the cities of the Silesia province in Poland. The association between the long-term inhalation exposure to PM10, benzo(a)pyrene, cadmium and lead in the period from 1989 to 2008 and length of life in the year 2014 of the inhabitants of 19 cities of the Silesia province has been estimated. The Pearson linear regression method was applied to calculate the relation between exposure to specific pollutants and length of life. In order to determine the influence of the mixture of the pollutants the multiple regression analysis was carried out. The studies have confirmed the significant correlations between the chronic exposure of Silesia province residents to PM10 and benzo(a)pyrene and their length of life. The stronger correlation was demonstrated in case of the long-term exposure to the mixture of examined air pollutants. Differentiated exposure of the inhabitants of the Silesia province to air pollutants results in existing inequalities in the life expectancy of men and women among the cities.

Ukrainian

Ukrainian

Surgical and nonsurgical management of patent ductus arteriosus in cats: 28 cases (1991-2012).

To characterize the clinical features and outcome of cats treated for patent ductus arteriosus (PDA) with attenuation (extravascular or intravascular) versus medical treatment only. Retrospective case series. 28 client-owned cats with congenital PDA. Medical records for cats with PDA diagnosed by means of echocardiography were reviewed. Data retrieved included signalment; history; clinical signs; results of physical examination, ECG, echocardiography, and thoracic radiography; response to medical management if attempted; type of attenuation procedure if attempted (surgical or intravascular); procedural details; intraoperative and postoperative (≤ 2 weeks) complications; and long-term (> 2 weeks) complications. Follow-up was obtained from medical records and via telephone interviews. All 28 cats were referred for evaluation of a cardiac murmur, but 17 of 26 (65%) for which initial clinical signs were available did not have overt signs at initial evaluation. Multiple congenital cardiac defects were identified in 6 of 23 (26%) cats. Seventeen of 26 (65%) cats were documented as treated with 1 or more vascular attenuation procedures; vascular attenuation was not attempted in 11 cats receiving an angiotensin-converting enzyme inhibitor or loop diuretic (n = 2) or no medical treatment (9). Surgical ligation was successful in 11 of 15 cats, and coil embolization was successful in 2 cats. Procedural or postoperative complications included death (n = 2), left-sided laryngeal paralysis (2), voice change (1), fever (1), hemorrhage (4), and chylothorax (1). Long-term follow-up was available for 16 of 28 (57%) cats. Three of 4 cats that did not undergo surgical attenuation died of cardiac-related disease. Results suggested that PDA occurs rarely in cats, and clinical signs and diagnostic findings were consistent with those previously reported for dogs. Surgical versus nonsurgical treatment did not result in a significant difference in life expectancy in this small cohort. Evaluation of laryngeal function after surgical ligation is recommended. Further study of the outcome associated with various treatment options in a larger population of patients is recommended.

Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010.

Type 1 diabetes has historically been associated with a significant reduction in life expectancy. Major advances in treatment of type 1 diabetes have occurred in the past 3 decades. Contemporary estimates of the effect of type 1 diabetes on life expectancy are needed. To examine current life expectancy in people with and without type 1 diabetes in Scotland. We also examined whether any loss of life expectancy in patients with type 1 diabetes is confined to those who develop kidney disease. Prospective cohort of all individuals alive in Scotland with type 1 diabetes who were aged 20 years or older from 2008 through 2010 and were in a nationwide register (n=24,691 contributing 67,712 person-years and 1043 deaths). Differences in life expectancy between those with and those without type 1 diabetes and the percentage of the difference due to various causes. Life expectancy at an attained age of 20 years was an additional 46.2 years among men with type 1 diabetes and 57.3 years among men without it, an estimated loss in life expectancy with diabetes of 11.1 years (95% CI, 10.1-12.1). Life expectancy from age 20 years was an additional 48.1 years among women with type 1 diabetes and 61.0 years among women without it, an estimated loss with diabetes of 12.9 years (95% CI, 11.7-14.1). Even among those with type 1 diabetes with an estimated glomerular filtration rate of 90 mL/min/1.73 m2 or higher, life expectancy was reduced (49.0 years in men, 53.1 years in women) giving an estimated loss from age 20 years of 8.3 years (95% CI, 6.5-10.1) for men and 7.9 years (95% CI, 5.5-10.3) for women. Overall, the largest percentage of the estimated loss in life expectancy was related to ischemic heart disease (36% in men, 31% in women) but death from diabetic coma or ketoacidosis was associated with the largest percentage of the estimated loss occurring before age 50 years (29.4% in men, 21.7% in women). Estimated life expectancy for patients with type 1 diabetes in Scotland based on data from 2008 through 2010 indicated an estimated loss of life expectancy at age 20 years of approximately 11 years for men and 13 years for women compared with the general population without type 1 diabetes.

Variation in treatment associated with life expectancy in a population-based cohort of men with early-stage prostate cancer.

Men with major comorbidities are at risk for overtreatment of prostate cancer due to uncertainty regarding their life expectancy. We sought to characterize life expectancy and treatment in a population-based cohort of men with differing ages and comorbidity burdens at diagnosis. We sampled 96,032 men aged ≥66 years with early-stage prostate cancer who had Gleason scores ≤7 and were diagnosed during 1991 to 2007 from the Surveillance, Epidemiology, and End Results-Medicare database. We calculated cumulative incidence of other-cause mortality and determined treatment patterns among subgroups defined by age and Charlson comorbidity index scores. Overall, life expectancy was <10 years (10-year other-cause mortality rate, >50%) for 50,049 of 96,032 men (52%). Life expectancy differed by age and comorbidity score and was <10 years for men ages 66 to 69 years with Charlson scores ≥2, for men ages 70 to 74 years with Charlson scores ≥1, and for all men ages 75 to 79 years and ≥80 years. Among those who had a life expectancy <10 years, treatment was aggressive (surgery, radiation, or brachytherapy) for 68% of men aged 66 to 69 years, 69% of men aged 70 to 74 years, 57% of men aged 75 to 79 years, and 24% of men aged ≥80 years. Among these men, aggressive treatment was predominantly radiation therapy (50%, 53%, 63%, and 69%, respectively) and less frequently was surgery (30%, 25%, 13%, and 9%, respectively). Multivariate models revealed little variation in the probability of aggressive treatment by comorbidity status within age subgroups despite substantial differences in mortality. Men aged <80 years at diagnosis who have life expectancies <10 years often receive aggressive treatment for low-risk and intermediate-risk prostate cancer, mostly with radiation therapy.

European Cystic Fibrosis Society Standards of Care: Framework for the Cystic Fibrosis Centre.

A significant increase in life expectancy in successive birth cohorts of people with cystic fibrosis (CF) is a result of more effective treatment for the disease. It is also now widely recognized that outcomes for patients cared for in specialist CF Centres are better than for those who are not. Key to the effectiveness of the specialist CF Centre is the multidisciplinary team (MDT), which should include consultants, clinical nurse specialist, microbiologist, physiotherapist, dietitian, pharmacist, clinical psychologist, social worker, clinical geneticist and allied healthcare professionals, all of whom should be experienced in CF care. Members of the MDT are also expected to keep up to date with developments in CF through continued professional development, attendance at conferences, auditing and involvement in research. Specialists CF Centres should also network with other Centres both nationally and internationally, and feed Centre data to registries in order to further the understanding of the disease. This paper provides a framework for the specialist CF Centre, including the organisation of the Centre and the individual roles of MDT members, as well as highlighting the value of CF organisations and disease registries.

Hepatology highlights

Hepatology highlights

The Longevity Prospects of Australian Seniors: An Evaluation of Forecast Method and Outcome

AbstractContinuing rapid changes in the level and pattern of mortality require that forecasts are available that are timely, relevant and reliable. This paper evaluates a previous forecast of the mortality and longevity of Australian seniors, both in terms of the validity of the chosen method – the Booth–Maindonald–Smith (BMS) variant of Lee–Carter – and the accuracy and reliability of the forecast itself. The validity of the method is assessed by a comprehensive review and evaluation of available methods, confirming BMS as the method of choice. The accuracy and reliability of the forecast is assessed by comparing it with actual experience and with a new forecast of period and cohort survival probabilities and life expectancies. The evaluation and the current forecast itself will inform the actuarial profession and wider industry in the areas of mortality and longevity risk as well as public debate and policy in population health and ageing.

Adolescent experience predicts longevity: evidence from historical epidemiology.

Human development reportedly includes critical and sensitive periods during which environmental stressors can affect traits that persist throughout life. Controversy remains over which of these periods provides an opportunity for such stressors to affect health and longevity. The elaboration of reproductive biology and its behavioral sequelae during adolescence suggests such a sensitive period, particularly among males. We test the hypothesis that life expectancy at age 20 among males exposed to life-threatening stressors during early adolescence will fall below that among other males. We apply time-series methods to cohort mortality data in France between 1816 and 1919, England and Wales between 1841 and 1919, and Sweden between 1861 and 1919. Our results indicate an inverse association between cohort death rates at ages 10-14 and cohort life expectancy at age 20. Our findings imply that better-informed and more strategic management of the stressors encountered by early adolescents may improve population health.

The male–female health-survival paradox and sex differences in cohort life expectancy in Utah, Denmark, and Sweden 1850–1910

PurposeIn Utah, the prevalence of unhealthy male risk behaviors are lower than in most other male populations, whereas women experience higher mortality risk because of higher fertility rates. Therefore, we hypothesize that the Utah sex differential in mortality would be small and less than in Sweden and Denmark. MethodsLife tables from Utah, Denmark, and Sweden were used to calculate cohort life expectancies for men and women born in 1850–1910. ResultsThe sex difference in cohort life expectancy was similar or larger in Utah when compared with Denmark and Sweden. The change over time in the sex differences in cohort life expectancy was approximately 2 years smaller for active Mormons in Utah than for other groups suggesting lifestyle as an important component for the overall change seen in cohort life expectancy. Sex differences in cohort life expectancy at the age of 50 years were similar for individuals actively affiliated with the Church of Jesus Christ of Latter-day Saints and for Denmark and Sweden. ConclusionsThe hypothesis that a smaller sex difference in cohort life expectancies in Utah would be detected in relation to Denmark and Sweden was not supported. In Utah, the male–female differences in life expectancy remain substantial pointing toward biological mechanisms or other unmeasured risk factors.

Esperança de vida e sua relação com indicadores de longevidade: um estudo demográfico para o Brasil, 1980-2050

Quando a mortalidade encontra-se em constante mudança, a tabela de sobrevivência de período não descreve a verdadeira experiência de vida das coortes presentes na população. Nesse sentido, o emprego das taxas correntes de mortalidade na estimativa do tempo médio de vida distorce o conceito original de esperança de vida. Como uma medida de coorte, a longevidade deveria ser estimada para um grupo real de pessoas, mas usualmente refere-se a uma coorte hipotética. Dadas as quedas passadas da mortalidade e as prováveis reduções futuras, a esperança de vida de coorte se torna maior do que a de período. Apesar disso, esta última pode ser vista como um indicador defasado do tempo médio de vida de alguma coorte passada (coorte equivalente). Este artigo explora o tempo requerido para encontrar essa coorte passada (defasagem) e as diferenças entre as esperanças de vida em um dado ano (diferencial) a fim de determinar a translação da medida de período, na perspectiva de coorte. Com a tendência de ganhos da longevidade cada vez menores no Brasil, os resultados indicam que, tanto para homens quanto para mulheres, o diferencial se reduz com o tempo, ao passo que a defasagem torna-se crescente. Isto é, com o passar dos anos, as estimativas correntes de período e coorte tendem a se aproximar, enquanto as coortes equivalentes se tornam mais remotas.

PRM44 Increasing Life Expectancy: Implications for Cost-Effectiveness Analysis

In developed countries mortality in the general population has been declining for several decades and is anticipated to decrease further, especially among the elderly. Life tables based on national statistics reflect mortality conditions of a particular year and therefore do not take into account that survival increases in the general population. As a consequence, life tables seem to systematically underestimate overall survival of the general population. Health economic models use life tables to predict survival of the general population and may therefore also underestimate survival. Our study compares survival prediction methods and discuss implications for health economic models. Period life expectancy at age 50 calculated from Dutch mortality rates published for 2009 was compared with life expectancy of a cohort aged 50 in 2009 calculated from projected mortality rates forecasted by the standard Lee-Carter approach. The Lee-Carter model forecasts the level and age pattern of mortality based on the combination of singular value decomposition of mortality rates and statistical time series methods. Mortality rates were taken from the Human Mortality Database. Projections were based on historical data between 1970 and 2009. Based on projected mortality, cohort life expectancy was 34.97 years whereas period life expectancy was only 32.37 years (−2.60 years). When life years were discounted at a 1.5% rate, the corresponding values were 25.31 and 26.40 years (−1.09 years). The analyses shows that taking into account the decrease in survival over time results in a difference of 7% in undiscounted and 4% in discounted life expectancy in the Netherlands. This difference can have a substantial impact on cost-effectiveness results, especially of curative interventions for diseases that are life threatening or of prevention programmes over a long time horizon. In these cases, sensitivity analysis should be carried out to investigate the impact of decreasing mortality.

Steep Increase in Best‐Practice Cohort Life Expectancy

We analyze trends in best-practice life expectancy among female cohorts born from 1870 to 1950. Cohorts experience declining rather than constant death rates, and cohort life expectancy usually exceeds period life expectancy. Unobserved mortality rates in non-extinct cohorts are estimated using the Lee-Carter model for mortality in 1960–2008. Best-practice cohort and period life expectancies increased nearly linearly. Across cohorts born from 1870 to 1920 the annual increase in cohort length of life was 0.43 years. Across calendar years from 1870 to 2008, the annual increase was 0.28 years. Cohort life expectancy increased from 53.7 years in the 1870 cohort to 83.8 years in the 1950 cohort. The corresponding cohort/period longevity gap increased from 1.2 to 10.3 years. Among younger cohorts, survival to advanced ages is substantially higher than could have been anticipated by period mortality regimes when these cohorts were young or middle-aged. A large proportion of the additional expected years of life are being lived at ages 65 and older. This substantially changes the balance between the stages of the life cycle.

Molecular Targets in Metastatic Lymph Nodes in Oesophageal Cancer Predict Patient Survival

adenocarcinoma would be between 1:7 and 1:8. The average number of surveillance OGDs during a patient's lifetime using the above surveillance protocol is 9.8 per patient. Conclusion: These data predict a significant lifetime risk of development of high-grade dysplasia or adenocarcinoma in patients diagnosed with Barrett's esophagus. The total burden of surveillance endoscopies excluding those for therapeutic interventions to the metaplastic segment or for follow-up of high-grade dysplasia, cancer or endoluminal treatment is 9.8 per patient.

On the correspondence between CAL and lagged cohort life expectancy

It has been established that under certain mortality assumptions, the current value of the Cross-sectional Average length of Life (CAL) is equal to the life expectancy for the cohort currently reaching its life expectancy. This correspondence is important, because the life expectancy for the cohort currently reaching its life expectancy, or lagged cohort life expectancy (LCLE), has been discussed in the tempo literature as a summary mortality measure of substantive interest. In this paper, we build on previous work by evaluating the extent to which the correspondence holds in actual populations. We also discuss the implications of the CAL-LCLE correspondence (or lack thereof) for using CAL as a measure of cohort life expectancy, and for understanding the connection between CAL, LCLE, and underlying period mortality conditions.

Linking period and cohort life-expectancy linear increases in Gompertz proportional hazards models

In a Gompertz mortality model with constant yearly improvements at all ages, linear increases in period life expectancy correspond to linear increases in the respective cohort life expectancy. The link between the two measures can be given by a simple

The Demography of an Early Mortality Transition: Life Expectancy, Survival and Mortality Rates for Britain’s Royals, 1500‐1799

This paper details the statistical sources, methods and findings that underpin the demographic evidence offered by Johansson (2010) in support of her thesis regarding “Europe’s first knowledge‐driven mortality transition,” namely the pronounced and sustained rise in the expectations of life that took place among the 17th and early 18th century birth cohorts of members of Britain’s royal families. The consequent interest in exposing the existence of systematic demographic effects of changes in the medical treatments and healthcare regimes received by this elite makes it germane to establish the statistical significance of a particular pattern of inter‐cohort changes in the royals’ mortality experience – namely, one whose timing and age‐and sex‐specificity make it plausibly attributable to the historical improvements in the medical knowledge and practice of their doctors, as has been documented by Johansson (1999, 2010). Complete genealogical data for the members of Britain’s royal families born c.1500-c.1800, due to Weir (1996), permits construction of cohort life expectancy at birth and at age 25 for royal males, royal females, as well for the small number of male monarchs, their female consorts and the queens. Inter‐cohort comparisons of life table mortality schedules are obtained by using the 5‐year average survival rates distributions for successive birth cohorts to estimate for each cohort the parameters of Anson’s (1991) general model of age‐specific mortality hazards rates – the empirical probability of dying within 5 years of age x, conditional having survived to that age. A variety of tests show the gross changes of interest to be statistically significant. The discussion contrasts the mortality transition among the royal families’ members with the contemporaneous demographic experience of rural and urban segments of the English population at large over the period 1500‐1800.

The estimated life expectancy in a community cohort of Parkinson's disease patients with and without dementia, compared with the UK population

ObjectiveTo compare survival, life expectancies (LE), and the anticipated age at the time of death (AAD), in a community-based cohort of Parkinson's disease (PD) patients with and without significant cognitive...

Comonotonic Approximations to Quantiles of Life Annuity Conditional Expected Present Values: Extensions to General Arima Models and Comparison with the Bootstrap

AbstractThis paper aims to provide accurate approximations for the quantiles of the conditional expected present value of the payments made by the annuity provider, given the future path of the Lee-Carter time index. Conditional cohort and period life expectancies are also considered. The paper also addresses some associated simulation issues, which, hitherto, have been unresolved.

Remaining life expectancy among older people in a rural area of Vietnam: trends and socioeconomic inequalities during a period of multiple transitions

BackgroundBetter understanding of the trends and disparities in health at old age in terms of life expectancy will help to provide appropriate responses to the growing needs of health and social care for the older population in the context of limited resources. As a result of rapid economic, demographic and epidemiological changes, the number of people aged 60 and over in Vietnam is increasing rapidly, from 6.7% in 1979 to 9.2% in 2006. Life expectancy at birth has increased but not much are known about changes in old ages. This study assesses the trends and socioeconomic inequalities in RLE at age 60 in a rural area in an effort to highlight this vulnerable group and to anticipate their future health and social needs.MethodsAn abridged life table adjusted for small area data was used to estimate cohort life expectancies at old age and the corresponding 95% confidence intervals from longitudinal data collected by FilaBavi DSS during 1999-2006, which covered 7,668 people at age 60+ with 43,272 person-years, out of a total of 64,053 people with 388,278 person-years. Differences in life expectancy were examined according to socioeconomic factors, including socio-demographic characteristics, wealth, poverty and living arrangements.ResultsLife expectancies at age 60 have increased by approximately one year from the period 1999-2002 to 2003-2006. The increases are observed in both sexes, but are significant among females and relate to improvements among those who belong to the middle and upper household wealth quintiles. However, life expectancy tends to decrease in the most vulnerable groups. There is a wide gap in life expectancy according to poverty status and living arrangements, and the gap by poverty status has widened over the study period. The gender gap in life expectancy is consistent across all socioeconomic groups and tends to be wider amongst the more disadvantaged population.ConclusionsThere is a trend of increasing life expectancy among older people in rural areas of Vietnam. Inequalities in life expectancy exist between socioeconomic groups, especially between different poverty levels and also patterns of living arrangements. These inequalities should be addressed by appropriate social and health policies with stronger targeting of the poorest and most disadvantaged groups.