Age Of Entry Research Articles

Social isolation and likelihood of becoming centenarians: evidence from the Chinese longitudinal healthy longevity survey

BackgroundSocial isolation, defined as an individual’s lack of social connections, is particularly prevalent among older adults. However, its association with health outcomes among the oldest-old population (aged 80 and above) was understudied.AimsTo examine the association between social isolation and the likelihood of becoming a centenarian among the oldest-old people in China, aiming to provide novel insights into promoting healthy aging and longevity.MethodsUsing data from The Chinese Longitudinal Healthy Longevity Survey, conducted in 22 provinces in mainland China since 1998, we performed a community-based, prospective nested case-control study. The primary outcome was survival to the age of 100 by 2018 (the end of follow-up). Information on social isolation and other covariates was collected via a questionnaire at baseline. The degree of social isolation was categorized as low, moderate, and high. Included (n = 5,716) were 1,584 identified centenarians and 4,132 controls (deceased before reaching 100 years), matched by age, sex, and year of entry. A conditional logistic regression model was used to evaluate the association between social isolation and the likelihood of becoming a centenarian, adjusting for demographic factors, lifestyle factors, chronic disease, potential disability, optimistic attitude, and perceived loneliness.ResultsIndividuals with the highest social isolation score had lower odds of becoming centenarians (adjusted OR:0.82; 95% CI: 0.68, 0.98), relative to those with the least social isolation (P-value < 0.05), and this association persisted in sensitivity analyses. The association was more pronounced among ever smokers, compared to never smokers (P-value = 0.001). We did not observe significant interactions between social isolation and other covariates (P-value > 0.05 for all).ConclusionsThis study highlights the inverse association between social isolation and the likelihood of becoming a centenarian, emphasizing the need for public health initiatives to combat isolation in the older population.

5-year vaccine protection following a single dose of Vi-tetanus toxoid conjugate vaccine in Bangladeshi children (TyVOID): a cluster randomised trial

WHO currently recommends a single dose of typhoid conjugate vaccine (TCV) in high-burden countries based on 2-year vaccine efficacy data from large randomised controlled trials. Given the decay of immunogenicity, the protection beyond 2 years is unknown. We therefore extended the follow-up of the TyVAC trial in Bangladesh to assess waning of vaccine protection to 5 years after vaccination. We conducted a cluster randomised controlled trial (TyVAC; ISRCTN11643110) in Dhaka, Bangladesh, between 2018 and 2021. Children aged 9 months to 15 years were invited to receive a single dose of TCV or Japanese encephalitis vaccine between April 15, 2018, and November 16, 2019, based on the randomisation of their clusters of residence. Children who received the Japanese encephalitis vaccine were invited to receive TCV at the final visit between Jan 6, and Aug 31, 2021, according to the protocol. This follow-on study extended the follow-up of the original trial until Aug 14, 2023. The primary endpoint of this study was to compare the incidence of blood culture-confirmed typhoid between children who received TCV in 2018-19 (the previous-TCV group) and those who received the vaccine in 2021 (the recent-TCV group), to evaluate the relative decline in vaccine protection. We also did a nested study using the test-negative design comparing the recent-TCV and previous-TCV groups with unvaccinated individuals, as well as an immunogenicity study in a subset of 1500 children. Compared with the recent-TCV group, the previous-TCV group had an increased risk of typhoid fever between 2021-23, with an adjusted incidence rate ratio of 3·10 (95% CI 1·53 to 6·29; p<0·0001), indicating a decline in the protection of a single-dose of TCV 3-5 years after vaccination. The extrapolated vaccine effectiveness in years 3-5 was 50% (95% CI -13 to 78), and was validated using the test-negative design analysis, with a vaccine effectiveness of 84% (74 to 90) in the recent-TCV group and 55% (36 to 68) in the previous-TCV group, compared with unvaccinated individuals. Anti-Vi-IgG responses declined over the study period. The highest rate of decay was seen in children vaccinated at younger than 2 years in the original trial. The inverse correlation between age and the decay of antibodies was also seen in the subgroup analysis of vaccine effectiveness, where the youngest age group (<7 years at fever visits) exhibited the fastest waning, with vaccine effectiveness dropping to 24% (95% CI -29 to 55) at 3-5 years after vaccination. A decline in the protection conferred by a single-dose TCV was observed 3-5 years after vaccination, with the greatest decline in protection and immune responses observed in children vaccinated at younger ages. A booster dose of TCV around school entry age might be needed for children vaccinated while younger than 2 years to sustain protection against typhoid fever during the school years when the risk is the highest. The Bill & Melinda Gates Foundation.

Components of changes in nuptiality patterns among Ethiopian women: A decomposition analysis of demographic and health surveys

Analyzing shifts in nuptiality patterns plays a significant role in understanding how demographic variables respond to socioeconomic changes. However, there has been a lack of comprehensive research on the sources of changes in nuptiality patterns. This study examines how nuptiality patterns change and investigates the factors linked to changes in two birth cohorts. Data from the Ethiopian Demographic and Health Surveys conducted in 2000 and 2016 were used. Marriage was observed to be early and nearly universal in both birth cohorts. A large proportion of the difference in the cumulative incidence of first marriage between the cohorts was observed at age 15 and decreased after age 35. However, the age of entry into the first marriage was slightly delayed, with a 46% reduction in the rate of marital dissolution. In addition, the compositional and structural impacts of a covariate were responsible for initiating the cumulative incidence of transition to first marriage. Furthermore, women&amp;rsquo;s education, occupation, and regional variation were identified as the main contributors to the reduction in the cumulative incidence of first marriage. Results show that the changes in nuptiality patterns were explained by a reduction in cumulative incidence of marriage, a shift in the timing of entry into the first marriage, and marital dissolution across the two birth cohorts. Moreover, socioeconomic factors, spatial drivers, and discriminatory effects between the two cohorts were the sources of changes in nuptiality patterns in Ethiopia.

Application of Projected Unit Credit Method and Entry Age Normal in Pension Fund Insurance of PT Pos Indonesia, South Aceh Regency

This study aims to analyze the application of the Projected Unit Credit (PUC) Method and the Entry Age Normal (EAN) Method in the context of pension fund insurance. The Projected Unit Credit Method and the Entry Age Normal Method are two actuarial approaches used to calculate liabilities and determine the required contributions in pension plans. The Projected Unit Credit Method calculates based on projected future salaries and benefits accumulated over the employee's working life, while the Entry Age Normal Method distributes the cost of retirement benefits evenly over the employee's working life. Data was collected from various pension plans that use both methods. Analysis was conducted to compare the accuracy of liability estimation, contribution stability, and the impact of each method on pension fund sustainability. The results show that the Projected Unit Credit Method provides a more realistic liability estimate by considering salary increases, while the Entry Age Normal Method offers better contribution stability from year to year. The selection of the appropriate actuarial method is highly dependent on the objectives and specific conditions of the pension program being managed. These findings are expected to help pension fund managers make more informed decisions to ensure the welfare of pension plan participants.

Longitudinal decline in peak V̇o2 with aging in a healthy population is associated with a reduction in peripheral oxygen utilization but not in cardiac output.

Aging is associated with a significant decline in aerobic capacity assessed by maximal exercise oxygen consumption (V̇o2max). The relative contributions of the specific V̇o2 components driving this decline, namely cardiac output (CO) and arteriovenous oxygen difference (A - V)O2, remain unclear. We examined this issue by analyzing data from 99 community-dwelling participants (baseline age: 21-96 yr old; average follow-up: 12.6 yr old) from the Baltimore Longitudinal Study of Aging, free of clinical cardiovascular disease. V̇o2peak, a surrogate of V̇o2max, was used to assess aerobic capacity during upright cycle ergometry. Peak exercise left ventricular volumes, heart rate, and CO were estimated using repeated gated cardiac blood pool scans. The Fick equation was used to calculate (A - V)O2diff,peak from COpeak and V̇o2peak. In unadjusted models, V̇o2peak, (A - V)O2diff,peak, and COpeak declined longitudinally over time at steady rates with advancing age. In multiple linear regression models adjusting for baseline values and peak workload, however, steeper declines in V̇o2peak and (A - V)O2diff,peak were observed with advanced entry age but not in COpeak. The association between the declines in V̇o2peak and (A - V)O2diff,peak was stronger among those ≥50 yr old compared with their younger counterparts, but the difference between the two age groups did not reach statistical significance. These findings suggest that age-associated impairment of peripheral oxygen utilization during maximal exercise poses a stronger limitation on peak V̇o2 than that of CO. Future studies examining interventions targeting the structure and function of peripheral muscles and their vasculature to mitigate age-associated declines in (A - V)O2diff are warranted.NEW & NOTEWORTHY The age-associated decline in aerobic exercise performance over an average of 13 yr in community-dwelling healthy individuals is more closely associated with decreased peripheral oxygen utilization rather than decreased cardiac output. This association was more evident in older than younger individuals. These findings suggest that future studies with larger samples examine whether these associations vary across the age range and whether the decline in cardiac output plays a greater role earlier in life. In addition, studies focused on determinants of peripheral oxygen uptake by exercising muscle may guide the selection of preventive strategies designed to maintain physical fitness with advancing age.

Association of Statin Use with Dementia Risk Among Older Adults in Japan: A Nested Case-Control Study Using the LIFE Study.

Previous studies have shown a possible association between statin use and a decreased risk of dementia, but the association has not been sufficiently established, especially in the super-aging society of Japan. This study aimed to determine the association between statin use and the risk of dementia among Japanese participants aged> =65 years old. Data from the Longevity Improvement and Fair Evidence (LIFE) Study were utilized, including medical and long-term care (LTC) claim data from 17 municipalities between April 2014 and December 2020. A nested case-control study was conducted with one case matched to five controls based on age, sex, municipality, and year of cohort entry. We used a conditional logistic regression model to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs). This study included 57,302 cases and 283,525 controls, with 59.7% of the participants being woman. After adjusting for potential confounders, statin use was associated with a lower risk of dementia (OR, 0.70; 95% CI: 0.68-0.73) and Alzheimer's disease (OR: 0.66; 95% CI: 0.63-0.69). Compared with non-users, the ORs of dementia were as follows: 1.42 (1.34-1.50) for 1-30 total standardized daily dose (TSDD), 0.91 (0.85-0.98) for 31-90 TSDD, 0.63 (0.58-0.69) for 91-180 TSDD, and 0.33 (0.31-0.36) for >180 TSDD in dose-analysis. Statin use is associated with a reduced risk of dementia and Alzheimer's disease among older Japanese adults. A low cumulative statin dose is associated with an increased risk of dementia, whereas a high cumulative statin dose is a protective factor against dementia.

Does entering early childhood education as a toddler benefit language and social development until age seven? A propensity score analysis

Is entering into early childhood education (ECE) at a young age a resource or risk for language and social development? For the German National Education Panel Study – Newborn Cohort (analytical n = 2296), we balanced 23 covariates taken in infancy with inverse probability of treatment weighting (IPTW) and modeled relations between ECE entry age (very early entry <24, early entry 24-35, later entry >35 months) and societal language and social development age three to seven. Very early entry predicted larger vocabulary for dual language learners (DLLs) and children of less educated parents until first grade, implying “buffering effects.” Early entry also predicted vocabulary advantages in first grade. Very early and early entry predicted fewer peer problems until first grade. Very early entry predicted more prosocial behavior for monolinguals, but less for DLLs in first grade. Robustness checks suggested several of these advantages emerge only in diverse populations and revealed disadvantages implying “lost resources.”

What else? Immigrant–native cohorts entering the labour market under a context of adverse shocks: the great recession and COVID-19

Purpose This paper aims to analyse the short- and long-term effects of entering the Spanish labour market under tough economic conditions on young immigrant–native earnings and employment outcomes. Design/methodology/approach The authors use cohorts, where the entry cohort into the labour market is the unit of observation. As a database, the authors use the continuous sample of working histories covering the period 2007–2021. Then, the authors estimate the model using weighted least squares. Findings The results show that the great recession and COVID-19 led to a blockage at the entrance of the labour market, reducing the number of workers. Additionally, the authors observe an adverse impact in terms of employment and earnings on those entering the labour market. Besides, this effect varies in intensity and persistence for natives and immigrants, as well as by country of birth, age of entry, gender and educational level. Originality/value A contribution to the literature is the analysis of the earnings and employment trajectories of young people entering the Spanish labour market for the first time during an adverse shock, such as the 2008 economic crisis or the COVID-19 crisis, and the possible differences that exist between native and immigrant workers. So, the authors analyse the labour market trajectories of workers covering the most recent years. Likewise, the authors carry out an extensive heterogeneity analysis in which they distinguish workers by educational level, gender, age of entry into the labour market and immigrants by their country of birth. This represents an additional contribution. The use of a cohort approach also contributes to the existing literature.

Analysing the dropout patterns of individual children in Nepal: relationship between school dropout and grade repetition/entrance age

PurposeUsing longitudinal data of children in Nepal, this study examines the relationships between dropouts, grade repetition and the causes of dropout, such as entrance age, to derive concrete recommendations to improve the basic education completion rates in Nepal, one of the targets of Sustainable Development Goal 4 (SDG4).Design/methodology/approachThe data for this study were drawn from school records kept in the target schools, home visit surveys and interviews with principals and teachers. After comparing the repetition experience and the frequency of repetitions between graduates and dropouts, the study analysed the dropout patterns of individual children. The study then examined the effects of repetition and entrance age on children’s schooling.FindingsThe results identified a large group of children who dropped out of school without any repetition, with only 15.9% of the children repeating a grade immediately before dropping out. The findings indicated that harsh family environments, being overage and low educational expectations were factors in sudden dropout.Originality/valueCollecting longitudinal data is difficult in developing countries, and few studies use such data. The question of access to education has been re-ignited by the COVID-19 pandemic; this study used longitudinal data to thoroughly analyse children’s dropout patterns and provide specific recommendations that will contribute to the achievement of SDG4.

The life care annuity: enhancing product features and refining pricing methods

AbstractThe state-of-the-art proposes life care annuities, that have been recently designed as variable annuity contracts with Long-Term Care payouts and Guaranteed Lifelong Withdrawal Benefits. In this paper, we propose more general features for these insurance products and refine their pricing methods. We name our proposed product “GLWB-LTC”. In particular, as to the product features, we allow dynamic withdrawal strategies, including the surrender option. Furthermore, we consider stochastic interest rates, described by a Cox–Ingersoll–Ross process. As to the numerical methods, we solve the stochastic control problem involved by the selection of the optimal withdrawal strategy through a robust tree method, which outperforms the Monte Carlo approach. We name this method “Tree-LTC”, and we use it to estimate the fair price of the product, as some relevant parameters vary, such as, for instance, the entry age of the policyholder. Furthermore, our numerical results show how the optimal withdrawal strategy varies over time with the health status of the policyholder. Our findings stress the important advantage of flexible withdrawal strategies in relation to insurance policies offering protection from health risks. Indeed, the policyholder is given more choice about how much to save for protection from the possible disability states at future times.

P-776 School-age outcomes among IVF and ICSI -conceived children: a causal inference analysis using linked population-wide data

Abstract Study question What is the causal effect of method of oocyte insemination; standard in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), on childhood development at school entry? Summary answer The developmental outcomes at school entry for children conceived by ICSI, without severe male factor infertility, are equivalent to those conceived via standard IVF. What is known already Over 12 million children have been conceived globally with the assistance of assisted reproductive technology (ART). Within ART, ICSI continues to increase as the most common mode of oocyte insemination, even when not clearly indicated (i.e. without male factor infertility). Large cohort studies have suggested that ART, and ICSI in particular, may be associated with an increase in congenital abnormalities, autism spectrum disorder, developmental delay and intellectual disability. However, the studies are heterogenous and the evidence conflicting. The association between the ICSI technique itself and long-term childhood development remains unclear. Study design, size, duration Causal inference methods were used to analyse observational data in a way that emulates a target randomised clinical trial. For example, patients where standard IVF was not an option, (e.g., due to severe male factor infertility), were excluded. The state-wide cohort included linked maternal and childhood administrative data from Victoria, Australia. To eliminate potential confounding associated with IVF, comparison was made with children conceived via standard IVF (rather than conception without assistance). Participants/materials, setting, methods The study included singleton infants conceived via ART and born between 2005-2013. The primary exposure was conception via ICSI, with those born following conventional IVF insemination as controls. The outcome examined was the Australian Early Development Census (AEDC), a broad assessment of development and well-being performed in Australian schools, every triennium, at school entry (age 4-6). We combined multiple imputation and inverse probability weighting with regression adjustment to estimate population average causal effects. Main results and the role of chance The final cohort included 4,035 IVF and ICSI conceived children across the two outcome cohorts. Linked records were available for 2,468 ICSI children and 1,567 IVF-conceived controls. Maternal characteristics between the two treatment cohorts were similar for age, parity, education, language background, and number of eggs collected during treatment cycle. The ICSI conceived children were generally from residential areas of lower socio-economic status and conception was more likely to involve donated gametes. The unadjusted rate of the primary outcome; AEDC-defined “developmental vulnerability”, was 10.83% among the IVF group and 10.14% among the ICSI group. Given the use of observational data, there were missing data and inherent differences in the covariate profile between exposure cohorts. Multiple imputation, bootstrapping and doubly robust inverse probability weighted regression adjustment modelling was utilised to allow a causal interpretation of results. There was no evidence of a causal effect of ICSI-conception on the risk of AEDC-defined developmental vulnerability at school entry compared with spontaneously conceived children; adjusted risk difference -0.8% (95% CI -2.7% to 1.1%) and adjusted risk ratio 0.92 (95% CI 0.76 to 1.12). The adjustment variable set was determined a priori via a modified Delphi procedure. Limitations, reasons for caution Children who did not attend school due to severe disability were excluded, leading to potential selection bias. Within our study cohort of 2,468 ICSI children, no increased risk of developmental vulnerability was identified. It is possible that unmeasured confounders could have led to bias in estimating the treatment effects. Wider implications of the findings This study, in contrast to previous evidence, suggests that empiric use of ICSI compared with conventional IVF insemination does not affect early childhood developmental outcomes. These findings provide important reassurance for current and prospective parents, and clinicians alike. Trial registration number not applicable

Unfavorable food consumption in children up to school entry age: results from the nationwide German KiESEL study.

Evidence points toward the early life being crucial for preventing nutrition-related diseases. As promotion of healthier food preferences in toddlerhood and preschool age might still modulate the trajectories of disease risk, understanding diet in these age groups is necessary. The objective was to analyze food consumption and diet quality of 1-5-year-old children living in Germany in relation to age and sex. Data from 890 children, a subsample of the representative, cross-sectional Children's Nutrition Survey to Record Food Consumption (KiESEL) conducted by the German Federal Institute for Risk Assessment in 2014-2017, were analyzed. Dietary data were collected using food records (3 consecutive plus 1 independent day). Diet quality was evaluated against the German food-based dietary guidelines (FBDG). Consumption of unfavorable foods (e.g., sweets, soft drinks) exceeded the recommended maximum of 10% of energy intake (E%) by a multiple in all age and sex groups (medians: 24.8-35.8 E%). Preschoolers consumed more unfavorable foods than toddlers and boys more than girls. More than half of the children exceeded the recommendation for meat intake (medians: 2.3-3.2% of the total food consumption (%TFC) vs. 2 %TFC), especially preschoolers. In nearly all children, vegetable consumption was too low (medians: 4.2-4.5 %TFC vs. 12 %TFC). Also, milk/milk product consumption was below recommendations, more so in preschoolers (median: 12.0 %TFC ♂, 11.9 %TFC ♀ vs. 18 %TFC) than in toddlers (median: 16.1 %TFC ♂, 19.6 %TFC ♀). In toddlers and preschoolers with overweight or obesity, adherence to dietary recommendations of these food groups was largely similar to that of the total sample. Overall, 5-year-olds showed an unhealthier dietary pattern than 1-year-olds, which already emerged at age 2 years and became more evident at age 3 years. An adverse dietary pattern arises and even deteriorates at a very young age, showing sex-specific aspects. High attention from public health and research needs to be given to toddlerhood and even earlier life phases, e.g., to develop more age-specific FBDGs, aiming at reducing unhealthy food consumption.

Prescribed Drug Use and Aneurysmal Subarachnoid Hemorrhage Incidence: A Drug-Wide Association Study.

Current benefits of invasive intracranial aneurysm treatment to prevent aneurysmal subarachnoid hemorrhage (aSAH) rarely outweigh treatment risks. Most intracranial aneurysms thus remain untreated. Commonly prescribed drugs reducing aSAH incidence may provide leads for drug repurposing. We performed a drug-wide association study (DWAS) to systematically investigate the association between commonly prescribed drugs and aSAH incidence. We defined all aSAH cases between 2000 and 2020 using International Classification of Diseases codes from the Secure Anonymised Information Linkage databank. Each case was matched with 9 controls based on age, sex, and year of database entry. We investigated commonly prescribed drugs (>2% in study population) and defined 3 exposure windows relative to the most recent prescription before index date (i.e., occurrence of aSAH): current (within 3 months), recent (3-12 months), and past (>12 months). A logistic regression model was fitted to compare drug use across these exposure windows vs never use, controlling for age, sex, known aSAH risk factors, and health care utilization. The family-wise error rate was kept at p < 0.05 through Bonferroni correction. We investigated exposure to 205 commonly prescribed drugs between 4,879 aSAH cases (mean age 61.4, 61.2% women) and 43,911 matched controls. We found similar trends for lisinopril and amlodipine, with a decreased aSAH risk for current use (lisinopril odds ratio [OR] 0.63, 95% CI 0.44-0.90, amlodipine OR 0.82, 95% CI 0.65-1.04) and an increased aSAH risk for recent use (lisinopril OR 1.30, 95% CI 0.61-2.78, amlodipine OR 1.61, 95% CI 1.04-2.48). A decreased aSAH risk in current use was also found for simvastatin (OR 0.78, 95% CI 0.64-0.96), metformin (OR 0.58, 95% CI 0.43-0.78), and tamsulosin (OR 0.55, 95% CI 0.32-0.93). By contrast, an increased aSAH risk was found for current use of warfarin (OR 1.35, 95% CI 1.02-1.79), venlafaxine (OR 1.67, 95% CI 1.01-2.75), prochlorperazine (OR 2.15, 95% CI 1.45-3.18), and co-codamol (OR 1.31, 95% CI 1.10-1.56). We identified several drugs associated with aSAH, of which 5 drugs (lisinopril and possibly amlodipine, simvastatin, metformin, and tamsulosin) showed a decreased aSAH risk. Future research should build on these signals to further assess the effectiveness of these drugs in reducing aSAH incidence. This study provides Class III evidence that some commonly prescribed drugs are associated with subsequent development of aSAH.

Patient-perceived barriers to early initiation of prenatal care at a large, urban federally qualified health center: a mixed-methods study

BackgroundEarly initiation of prenatal care is widely accepted to improve the health outcomes of pregnancy for both mothers and their infants. Identification of the various barriers to entry into care that patients experience may inform and improve health care provision and, in turn, improve the patient’s ability to receive necessary care.AimThis study implements a mixed-methods approach to establish methods and procedures for identifying barriers to early entry to prenatal care in a medically-vulnerable patient population and areas for future quality improvement initiatives.MethodsAn initial chart review was conducted on obstetrics patients that initiated prenatal care after their first trimester at a large federally qualified health center in Brooklyn, NY, to determine patient-specified reasons for delay. A thematic analysis of these data was implemented in combination with both parametric and non-parametric analyses to characterize the population of interest, and to identify the primary determinants of delayed entry.ResultsThe age of patients in the population of interest (n = 169) was bimodal, with a range of 15 – 43 years and a mean of 28 years. The mean gestational age of entry into prenatal care was 19 weeks. The chart review revealed that 8% recently moved to Brooklyn from outside of NYC or the USA. Nine percent had difficulty scheduling an initial prenatal visit within their first trimester. Teenage pregnancy accounted for 7%. Provider challenges with documentation (21%) were noted. The most common themes identified (n = 155) were the patient being in transition (21%), the pregnancy being unplanned (17%), and issues with linkage to care (15%), including no shows or patient cancellations. Patients who were late to prenatal care also differed from their peers dramatically, as they were more likely to be Spanish-speaking, to be young, and to experience a relatively long delay between pregnancy confirmation and entry into care. Moreover, the greatest determinant of delayed entry into care was patient age.ConclusionOur study provides a process for other like clinics to identify patients who are at risk for delayed entry to prenatal care and highlight common barriers to entry. Future initiatives include the introduction of a smart data element to document reasons for delay and use of community health workers for dedicated outreach after no show appointments or patient cancellations.

Late mortality and chronic health conditions in long-term survivors of nasopharyngeal cancers: The 20-year follow-up of territory-wide Hong Kong Nasopharyngeal Cancer Survivor Study (HKNPCSS).

12045 Background: The survival rate of patients with nasopharyngeal cancer (NPC) has significantly improved in the last decade. However, there are only a few studies that have quantified the long-term morbidity and mortality that follow NPC treatment. This study aims to analyze the chronic health conditions, all-cause mortality, and cause-specific mortality among NPC survivors. Methods: The Hong Kong NPC Survivor Study (HKNPCSS) is a retrospective cohort study conducted across all six oncology centers in Hong Kong. It included longitudinal follow-up of 5-year survivors diagnosed with NPC between 1997 to 2015. We compared the standardized mortality ratio (SMRs) of 7893 survivors to a matched population in terms of age, sex, and calendar year. We also calculated the frequencies of chronic conditions of 7893 survivors and 23679 healthy individuals with matched age, sex, and date of cohort entry. Chronic health conditions were classified using the Common Terminology Criteria for Adverse Events. Cox proportional hazard models were used to estimate hazard ratios (HRs) for chronic health conditions. Results: The mean age of NPC survivors was 49.1 years, while healthy individuals had a mean age of 50.5 years. Among the 7893 NPC survivors, the 20-year cumulative all-cause mortality was 34.0% (95% CI, 29.1%-38.9%), with 1668 (59.9%) of 2785 deaths attributed to health-related causes. The SMR for NPC survivors compared to the general population was 3.81 (95% CI, 3.67-3.95), with the highest SMRs observed for pulmonary (SMR: 6.18, 95% CI, 5.73-6.64) and cardiovascular (SMR: 2.12, 95% CI, 1.90-2.36) causes. Among the survivors, 59.2% (n=4674) had severe, life-threatening, or fatal (grade 3-5) health conditions, with a 20-year cumulative incidence of 59.0% (95% CI, 56.4%-61.5%). The adjusted hazard ratio (HR) of grade 3-5 chronic condition in NPC survivors, compared to healthy cohorts, was 7.02 (95% CI, 6.64-7.42). Gastrointestinal (HR: 20.7), hearing, visual, and nasal (HR: 15.4), and neurological (HR: 8.39) conditions had the highest risks. Intensity modulated radiotherapy (IMRT), compared to non-IMRT, was associated with reduced risks of all-cause mortality (HR: 0.83, 95% CI, 0.74-0.91) and a trend towards reduced grade 3-5 chronic health conditions (HR: 0.89, 95% CI, 0.75-1.05). Conclusions: Even 20 years after diagnosis, NPC survivors still face increased risks of late mortality and morbidity. The findings emphasize the need for a comprehensive survivorship program to improve outcomes for NPC survivors.

Abstract PS07-03: Randomized trials of oestrogen-alone and breast cancer incidence: a meta-analysis

Abstract Background Findings from cohort studies compared with those from the Women's Health initiative (WHI) randomized, placebo-controlled clinical trial regarding estrogen-alone and breast cancer risk are discordant. The WHI randomized trial enrolled 10,729 postmenopausal women with prior hysterectomy, mean age 64 years (33.2% 50-59), no prior breast cancer and a non-suspicious baseline mammogram. After 7.2 years intervention and 16.2 years cumulative follow-up, conjugated equine estrogen (CEE)-alone (vs placebo) significantly reduced breast cancer incidence by 22% (P = 0.005) and significantly reduced breast cancer mortality by 40% (P = 0.04) (Chlebowski JAMA 2020). In contrast, cohort studies had opposite findings, estrogen-alone use was associated with significantly higher breast cancer incidence and significantly higher breast cancer mortality. Therefore, we identified all available estrogen-alone randomized clinical trials where breast cancer findings were reported to conduct a meta-analysis examining the totality of the randomized clinical trial evidence regarding estrogen-alone influence on breast cancer incidence. Methods We conducted PubMed and Google Scholar searches on randomized trials and: estrogen, hormone therapy, and breast cancer, and searches from a prior meta-analyses and reviews. In the current meta-analysis, for trials with published relative risks (RR) and 95% confidence intervals (CI), each log-RR was multiplied by weight = 1/V, where V = variance of the log-RR, and V was derived from the corresponding 95% CI. For smaller trials with only breast cancer numbers, a different method was used, the corresponding log-RR = (O – E)/weight, where O is the observed case number in the oestrogen-alone group and E the corresponding expected case number, E = nP. Findings Ten randomized trials, incorporating WHI findings, and findings from nine smaller trials included 14,272 randomized participants and 591 incident breast cancers. Of 9 smaller trials, 6 required negative baseline screening mammograms; mean entry age: 50 to 56 years in 5 trials and 62 to 71 years in 4 trials. In the nine smaller trials, 1.2% (24 of 2029) vs 2.2% (33 of 1514) randomized to estrogen-alone vs placebo (open label, one trial) were diagnosed with breast cancer, respectively (RR 0.65 95% CI 0.38-1.11, P = 0.12). For 5 trials evaluating estradiol formulations, RR = 0.63 95% CI 0.34-1.16, P = 0.15. In the WHI trial, 4.5% (238 of 5310) vs 5.5% (296 of 5429) randomized to estrogen-alone were diagnosed with breast cancer, respectively (RR 0.78 95% CI 0.65-0.93, P = 0.005)). Combining smaller trials and WHI results, 3.6% (262 of 7339) vs 4.7% (329 of 6943) randomized to estrogen-alone vs placebo were diagnosed with breast cancer, respectively (overall RR 0.77 95% CI 0.65-0.91, P = 0.002). Results from a sensitivity analysis for the smaller trials using exact conditional logistic regression were essentially unchanged (RR 0.64 95% CI 0.35-1.13). Interpretation The totality of randomized clinical trial evidence supports a conclusion that estrogen-alone use, among postmenopausal women with prior hysterectomy, significantly reduces breast cancer incidence. This consistent pattern seen in these randomized trials suggests the WHI CEE-alone findings are not “stand alone” outcomes or due to chance. Citation Format: Rowan Chlebowski, Aaron Aragaki, Kathay Pan, Joanne Mortimer, Karen Johnson, Jean Wactawski-Wende, Meryl LeBoff, Sayeh Lavasani, Dorothy Lane, Rebecca Nelson, JoAnn Manson. Randomized trials of oestrogen-alone and breast cancer incidence: a meta-analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS07-03.

Criminal justice transitions among adolescents in Australia: A multi-state model

PurposeThis study aimed to identify key transitional pathways in the criminal justice system from adolescence to adulthood and the risk factors associated with the escalation of criminal justice involvement over time. MethodWe retrospectively linked offending records from 1994 to 2022 and mental health records from 2001 to 2022 for a cohort of 1556 adolescents identified through four health surveys in New South Wales, Australia. Transition probabilities were calculated using the Aalen-Johansen method, and the hazards of transition-specific covariates were estimated. ResultsThe median age of adolescent entry was 15 years. The cohort was predominantly male (87.5%) and non-Indigenous (65.6%). Among incarcerated adolescents, 76.8% transitioned to adult incarceration. Transition probabilities were the highest among those aged 10–13 years. Among those with mental disorders, psychosis was associated with transitions to adolescent and adult incarceration. Other risk factors for future incarceration include being male, Indigenous, socio-economically disadvantaged, having a history of adolescent incarceration, and being diagnosed with substance use and behavioural disorders. ConclusionYounger adolescents have higher transition probabilities to more intense criminal justice involvement. Legislative and policy reforms are needed to delay the onset of adolescent criminal justice involvement and ensure age-appropriate rehabilitative strategies to reduce recidivism.

The early bird gets the worm: age of entry to STEM-related academic education – gender and SES differences

ABSTRACT Background The transition to adulthood in contemporary industrialized society, which once followed a fairly standard pattern, has undergone many changes in terms of timing and order of events. Today’s emerging adults are as likely as not to postpone their entry to college after high school, withdraw temporarily from studies after enrolling, and switch study tracks as well as colleges or universities. While there may be a risk of inappropriate educational choice for those of younger age due to low career maturity, a substantial ‘price’ may also be paid for delayed entry in terms of several labor market indicators. Purpose The study examines gender and SES differences in the age of entering an academic education in STEM (Science, Technology, Engineering and Mathematics) field in Israel. Sample and methods This research was conducted through an online survey of a representative sample of 313 STEM students. Results The findings show the non-significant effect of SES on the age of entering academic education among young women. In contrast, young men with higher SES were likely to start STEM education earlier compared to their lower SES counterparts. Conclusions In the competitive STEM-oriented labor market with its pronounced preference for younger graduates from academic institutions, low SES men who postponed their entry to academic institutions may thus be ‘punished’ for their relatively older age. Therefore, the timing of entering academic education should not be overlooked in social stratification models and theories. Identifying ‘risk groups’ in relation to postponing vs speeding up factors may provide insights for STEM policy makers and practitioners.

School Entry-Age Effect on Student’s Affective–Motivational Attitudes in German Elementary Schools

AbstractThe effect of school entry age on children’s later performance is a long-debated topic without any convergence. Besides, existing studies have mostly limited themselves to examining the impact of entry age on children’s cognitive achievements. In Germany, where different entry-age regulations exist across federal states and academic tracking takes place very early, it is crucial to investigate whether these differential school entry ages affect children’s outcomes. This study, based on the longitudinal data available from the National Educational Panel Study, investigates the possible entry-age effect on children’s willingness to make an effort and their school enjoyment in the German elementary school context. The study found a positive entry-age effect only for willingness to make an effort but not for school enjoyment, and the existing entry-age effect decreases over time. Therefore, empirical evidence confirms that, in Germany, the entry-age effect persists in the short run and some child outcomes seem more sensitive to entry age than others. These are important findings in the German context where students’ academic tracking starts from lower secondary schooling and entry-age effects may significantly influence it.

Age of entry into early childhood education and care, literacy and reduction of educational inequality in Nordic countries

ABSTRACT An early start to good-quality early childhood education and care (ECEC) is considered beneficial, especially for disadvantaged children's development and educational outcomes. This assumption was tested using the latest two waves (2015 and 2018) of data from the Programme for International Student Assessment (PISA) in five countries using the Nordic model of early education and care: Denmark, Finland, Iceland, Norway, and Sweden. The article finds evidence of the overall positive association between the age of entry in ECEC and literacy at age 15 in all Nordic countries. However, the relationship is non-linear, and the highest benefits seem to occur following entry into ECEC from ages two to three. The link between family background and ECEC enrollment largely explains this association. We did not find that ECEC would generally compensate for low socioeconomic status (SES) in children’s achievement. However, the Matthew effect was observed in Norway, where an early ECEC start is more strongly associated with literacy scores for affluent children than disadvantaged children. These findings have limitations due to their correlational nature. Still, this article indicates that even in high-quality universal ECEC systems, early preschool education is not a panacea for lowering achievement gaps due to parental background.