Estimated Life Expectancy Research Articles

Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration

BackgroundThe historical size threshold for abdominal aortic aneurysm (AAA) repair is widely accepted to be 5.5 cm for men and 5.0 cm for women. However, contemporary AAA rupture risks may be lower than historical benchmarks, which has implications for when AAAs should be repaired. Our objective was to use contemporary AAA rupture rates to inform optimal size thresholds for AAA repair. MethodsWe used a Markov chain analysis to estimate life expectancy for patients with AAA. The primary outcome was AAA-related mortality. We estimated survival using Social Security Administration life tables and published contemporary AAA rupture estimates. For those undergoing repair, we modified survival estimates using data from the Vascular Quality Initiative and Medicare on complications, late rupture, and open conversion. We used this model to estimate the AAA repair size threshold that minimizes AAA-related mortality for 60-year-old average-health men and women. We performed a sensitivity analysis of poor-health patients and 70- and 80-year-old base cases. ResultsThe annual risk of all-cause mortality under surveillance for a 60-year-old woman presenting with a 5.0 cm AAA using repair thresholds of 5.5 cm, 6.0 cm, 6.5 cm, and 7.0 cm was 1.7%, 2.3%, 2.7%, and 2.8%, respectively. The corresponding risk for a man was 2.3%, 2.9%, 3.3%, and 3.4% for the same repair thresholds, respectively. For a 60-year-old average-health woman, an AAA repair size of 6.1 cm was the optimal threshold to minimize AAA-related mortality. Life expectancy varied by <2 months for repair at sizes from 5.7 cm to 7.1 cm. For a 60-year-old average-health man, an AAA repair size of 6.9 cm was the optimal threshold to minimize AAA-related mortality. Life expectancy varied by <2 months for repair at sizes from 6.0 cm to 7.4 cm. Women in poor health, at various age strata, had optimal AAA repair size thresholds that were >6.5 cm, whereas men in poor health, at all ages, had optimal repair size thresholds that were >8.0 cm. ConclusionsThe optimal threshold for AAA repair is more nuanced than a discrete size. Specifically, there appears to be a range of AAA sizes for which repair is reasonable to minmized AAA-related mortality. Notably, they all are greater than current guideline recommendations. These findings would suggest that contemporary AAA size thresholds for repair should be reconsidered.

Loss in life expectancy in patients with stage II-III cutaneous melanoma in Sweden: A population-based cohort study

BackgroundSurvival in cutaneous melanoma (CM) is heterogeneous. Loss in life expectancy (LLE) measures impact of CM on remaining lifespan compared to general population. ObjectivesInvestigating LLE in operated stage II-III CM patients. MethodsData from 8,061 patients (aged 40-80 years) with stage II–III CM in Sweden, diagnosed between 2005-2018 were analyzed (Swedish Melanoma Registry). A flexible parametric survival model estimated life expectancy and LLE. ResultsBased on 2018 diagnoses, stage II and III CM patients lost 2209 and 1902 life years, respectively. LLE was higher in stage III: 5.2 vs 10.9 years (stage II vs III 60-year-old females). Younger patients had higher LLE: 10.7 vs 3.9 years (stage II CM in 40 vs 70-year-old males). In stage II, females had lower LLE than males; 50-year-old females and males stage II CM had LLE equal to 7.3 and 8.3 years, respectively. LLE increased with higher substages, stage IIB resembling IIIB and IIC resembling IIIC-D. LimitationsExtrapolation was used to estimate LLE. Varying stage group sizes require caution. ConclusionsOur results are both clinically relevant and easy-to-interpret measures of the impact of CM on survival, but the results also summarize the prognosis over the lifetime of a CM patient.

PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life

Background: Effects on anticancer therapy following the integration of palliative care and oncology are rarely investigated. Thus, its potential effect is unknown. Aim: To investigate the effects of the complex intervention PALLiON versus usual care on end-of-life anticancer therapy. Design: Cluster-randomised controlled trial (RCT), registered at ClinicalTrials.gov (No. NCT01362816). The complex intervention consisted of a physician education program enhancing theoretical, clinical and communication skills, a patient-centred care pathway and patient symptom reporting prior to all consultations. Primary outcome was overall use, start and cessation of anticancer therapy in the last 3 months before death. Secondary outcomes were patient-reported outcomes. Mixed effects logistic regression models and Cox proportional hazard were used. Setting: A total of 12 Norwegian hospitals (03/2017–02/2021). Participants: Patients ⩾18 years, advanced stage solid tumour, starting last line of anticancer therapy, estimated life expectancy ⩽12 months. Results: A total of 616 (93%) patients were included (intervention: 309/control:307); 63% males, median age 69, 77% had gastrointestinal cancers. Median survival time from inclusion was 8 (IQR 3–14) and 7 months (IQR 3–12), and days between anticancer therapy start and death were 204 (90–378) and 168 (69–351) (intervention/control). Overall, 78 patients (13%) received anticancer therapy in the last month (intervention: 33 [11%]/control: 45 [15%]). No differences were found in patient-reported outcomes. Conclusion: We found no significant differences in the probability of receiving end-of-life anticancer therapy. The intervention did not have the desired effect. It was probably too general and too focussed on communication skills to exert a substantial influence on conventional clinical practice.

Risk factors for death from other diseases after curative gastrectomy and lymph node dissection for gastric cancer

BackgroundRecent advances in treatment are expected to bring a cure to more patients with gastric cancer (GC). Focusing on the risk of death from other diseases (DOD) has become a crucial issue in patients cured of GC. The aim of this study was to elucidate the risk factors for DOD in patients who underwent curative gastrectomy with lymph node dissection for GC.MethodsWe enrolled 810 patients who underwent curative gastrectomy with lymph node dissection for GC from January 1990 to December 2014 and had no recurrence or death of GC until December 2019. We investigated the risk factors for DOD defined as death excluding death from a malignant neoplasm, accident, or suicide after gastrectomy, focusing on the perioperative characteristics at gastrectomy.ResultsAmong 315 deaths from any cause, 210 died from diseases other than malignancy, accidents and suicide. The leading cause of DOD was pneumonia in 54 patients (25.7%). The actual survival period in 167 patients (79.5%) with DOD was shorter than their estimated life expectancy at gastrectomy. Multivariate analysis revealed that a high Charlson Comorbidity Index score (score 1–2: hazard ratio [HR] 2.192, 95% confidence interval [CI] 1.713–2.804, P < 0.001 and score ≥ 3: HR 4.813, 95% CI 3.022–7.668, P < 0.001), total gastrectomy (HR 1.620, 95% CI 1.195–2.197, P = 0.002) and the presence of postoperative complications (HR 1.402, 95% CI 1.024–1.919, P = 0.035) were significant independent risk factors for DOD after gastrectomy for GC, in addition to age of 70 years or higher, performance status of one or higher and body mass index less than 22.0 at gastrectomy.ConclusionsPneumonia is a leading cause of DOD after curative gastrectomy and lymph node dissection for GC. Paying attention to comorbidities, minimizing the choice of total gastrectomy and avoiding postoperative complications are essential to maintain the long-term prognosis after gastrectomy.

Standardized multi-institutional data analysis of fixed and removable prosthesis: estimation of life expectancy with regards to variable risk factors.

This study aims to assess and predict lifespan of dental prostheses using newly developed Korean Association of Prosthodontics (KAP) criteria through a large-scale, multi-institutional survey. Survey was conducted including 16 institutions. Cox proportional hazards model and principal component analysis (PCA) were used to find out relevant factors and predict life expectancy. 1,703 fixed and 815 removable prostheses data were collected and evaluated. Statistically significant factors in fixed prosthesis failure were plaque index and material type, with a median survival of 10 to 18 years and 14 to 20 years each. In removable prosthesis, factors were national health insurance coverage, antagonist type, and prosthesis type (complete or partial denture), with median survival of 10 to 13 years, 11 to 14 years, and 10 to 15 years each. For still-usable prostheses, PCA analysis predicted an additional 3 years in fixed and 4.8 years in removable prosthesis. Life expectancy of a prosthesis differed significantly by factors mostly controllable either by dentist or a patient. Overall life expectancy was shown to be longer than previous research.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ПОДХОДОВ К ОЦЕНКЕ ОЖИДАЕМОЙ ПРОДОЛЖИТЕЛЬНОСТИ ЗДОРОВОЙ ЖИЗНИ

Significance. Healthy life expectancy is a group of indicators that allows to estimate how long a person will live with “good” health given the current level of mortality and health of the population. The relevance of the calculation and assessment of healthy life expectancy is conditioned, among other things, by the Decree of the President of the Russian Federation dated 07.05.2024 N 309 “On the national development goals of the Russian Federation for the period until 2030 and prospects until 2036” - by 2030, it is planned to achieve “outpacing growth of healthy life expectancy indicators”, i.e. to reduce the difference between healthy life expectancy and life expectancy. The purpose of the study is to review the methods of calculating healthy life expectancy, sources of data on healthy life expectancy in Russia and the world, and a brief analysis of the dynamics in healthy life expectancy in Russia. Material and Methods. Literature sources and databases were studied to analyze the calculation methods and existing estimates of healthy life expectancy. Literature sources were searched in PubMed and eLibrary databases, and data - on the websites of the World Health Organization, Global Burden of Disease, Eurostat, “Unified Interdepartmental Information and Statistical System”. Results. One of the two main methods is usually chosen to estimate healthy life expectancy: the widely used Sullivan formula (cross-sectional analysis) and the less frequently used multistatus table method (longitudinal analysis). There are also various methods of defining “good” health: self-rated health or presence or absence of limitations or diseases. From 1990 to 2019, healthy life expectancy increased globally and in Russia; in Russia, there was a decline in healthy life expectancy during the Covid-19 pandemic, followed by a steady recovery afterwards. Conclusion. Healthy life expectancy in research and in public administration has not been as widely used as life expectancy, which is probably a consequence of the peculiarities of the methodology for calculating the indicator and its sensitivity not only to the objective parameter of mortality. However, being an integral indicator, healthy life expectancy can provide information on the “quality” of life expectancy growth.

Mortality in patients with major depressive disorder: A nationwide population-based cohort study with 11-year follow-up.

Major depressive disorder (MDD) is a leading cause of disability and premature mortality. This study compared the overall survival (OS) between patients with MDD and non-MDD controls stratified by gender, age, and comorbidities. This nationwide population-based cohort study utilized longitudinal patient data (01/01/2010 - 12/31/2020) from the Hungarian National Health Insurance Fund database, which contains healthcare service data for the Hungarian population. Patients with MDD were selected and matched 1:1 to those without MDD using exact matching. The rates of conversion from MDD to bipolar disorder (BD) or schizophrenia were also investigated. Overall, 471,773 patients were included in each of the matched MDD and non-MDD groups. Patients with MDD had significantly worse OS than non-MDD controls (hazard ratio [HR]=1.50; 95% CI: 1.48-1.51; males HR=1.69, 95% CI: 1.66-1.72; females HR=1.40, 95% CI: 1.38-1.42). The estimated life expectancy of patients with MDD was 7.8 and 6.0years less than that of controls aged 20 and 45years, respectively. Adjusted analyses based on the presence of baseline comorbidities also showed that patients with MDD had worse survival than non-MDD controls (adjusted HR=1.29, 95% CI: 1.28-1.31). After 11 years of follow-up, the cumulative conversions from MDD to BD and schizophrenia were 6.8 and 3.4%, respectively. Converted patients had significantly worse OS than non-converted patients. Compared with the non-MDD controls, a higher mortality rate in patients with MDD, especially in those with comorbidities and/or who have converted to BD or schizophrenia, suggests that early detection and personalized treatment of MDD may reduce the mortality in patients diagnosed with MDD.

Life expectancy among Native Americans during the COVID-19 pandemic: estimates, uncertainty, and obstacles.

Few reliable estimates have been available for assessing the impact of the COVID-19 pandemic on mortality among Native Americans. Using deidentified publicly available data on deaths and populations by age, we estimated life expectancy for the years 2019-2022 for single-race non-Hispanic Native Americans. Life expectancy in 2022 was 67.8years, 2.3years higher than in 2021 but a huge 4-year loss from 2019. Although our life expectancy estimates for 2022 varied under different assumptions about racial/ethnic classification and age misreporting errors, all estimates were lower than the average for middle-income countries. Estimates of losses and gains in life expectancy were consistent across assumptions. Large reductions in COVID-19 death rates between 2021 and 2022 were largely offset by increases in rates of death from unintentional injuries (particularly drug overdoses), chronic liver disease, diabetes, and heart disease, underscoring the difficulties facing Native Americans in achieving reductions in mortality, letalone returning to levels of mortality prior to the pandemic. Serious data problems have persisted for many years, but the scarcity and inadequacy of estimates during the pandemic have underscored the urgent need for timely and accurate demographic data on the Native American population.

SELF-REPORTED VERSUS DIAGNOSIS-BASED DISEASED LIFE EXPECTANCY AMONG OLDER COLOMBIANS

Abstract The number of older adults in Colombia will soon double and it is essential to understand the disease burden in this population. Disease prevalence is often estimated from medical diagnoses, which can underestimate disease in populations with less health care access and low health literacy. We compare differences in diseased life expectancy (DLE) using self-reported vs. measured markers for diabetes and hypertension using data from the 2015 health and wellbeing survey of older adults in Colombia (SABE-Col), a nationally representative survey of Colombians ages 60+. Respondents reported whether they had ever been told by a doctor that they had either diabetes or hypertension. Using direct measures of glucose and blood pressure and clinical cut-points, we determined which respondents were considered to have diabetes or hypertension. We used the Sullivan method to estimate life expectancy with and without disease. Data from self-reports alone generally suggest lower DLE than from both self-reported and measured disease statuses. At age 60, women have a total life expectancy of 20.56 years. We find a lower DLE for hypertension using self-reported data (12.66 years) than measured (13.24 years). Conversely, reported diabetes is similar (4.18 years) to the measured (4.28 years) DLE. Men, at age 60, have a total life expectancy of 18.04 years. DLE for hypertension using self-reports is lower (8.78 years) than measured (9.61 years). Similarly, DLE for diabetes is lower for self-report (2.98 years) than measured (3.04). Our findings show the burden of disease in this rapidly aging population.

WHO WORKS LONGER IN LATER LIFE? KEY VARIATIONS IN WORKING LIFE EXPECTANCY IN INTERNATIONAL PERSPECTIVE

Abstract In the context of population aging, policymakers are eager to encourage and enable longer working lives, assuming this will lead to increased tax revenue and reduced demand on social security and health care systems. Simultaneously, individuals who work longer will gain additional income and may experience the psychosocial benefits that come from workplace engagement. However, many factors drive early labor market exit, and blanket policy strategies to extend working lives often ignore the nuances that shape the length of real working lives. Such policies have emerged partly from increased life expectancies, although these measures fail to capture subgroup differences in the capacity to continue working. They also do not account for often discontinuous labor market trajectories, particularly around retirement. As such, scholars have turned to more refined methodologies and concepts like working life expectancy (WLE) to better inform policies that actively aim to increase retirement ages. This symposium highlights an ongoing program of work by the IDEAR network, which examines WLE using longitudinal studies of aging in Europe. The symposium features results from Sweden and England, estimating WLE using multi-state models. Unlike other approaches to estimate life expectancy employing the Sullivan method, this approach allows for reversible transitions between work and non-work, reflecting the dynamic and complex nature of modern labor market transitions and exits. The symposium further presents how WLE varies according to key determinants, including socioeconomic status, healthy lifestyles, and unpaid caregiving, highlighting the policy implications that emerge from recognizing inequalities and variations in WLE across vulnerable subgroups.

Relationship of life expectancy with quality of life and health-related hope among Japanese patients receiving home medical care: The Zaitaku Evaluative Initiatives and Outcome Study

Spiritual care for patients’ quality of life (QOL) and hope should be included in home medical care for patients with limited life expectancy. This study aimed to analyze the associations between estimated life expectancy, QOL, and hope among patients receiving home medical care in Japan. This multicenter cross-sectional study involved 29 home medical care facilities in Japan. Patients were categorized by estimated life expectancy, as assessed by home medical care physicians. The outcomes were QOL measured via the Quality-of-Life Scale for Elderly Patients Receiving Professional Home Care (QOL-HC: higher score indicates better QOL), the domain scores of health-related hope (“health,” “role and connectedness,” and “something to live for”; higher scores indicate higher levels of hope), and life functioning measured using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0; higher score indicates worse functioning and disability). QOL-HC scores were significantly higher in patients with shorter life expectancy (&lt; 6 m vs. ≥ 1 y, adjusted mean differences: 0.7 points [95%CI 0.1 to 1.3]). Regarding health-related hope, “something to live for” scores were associated with shorter life expectancy (&lt; 6 m vs. ≥ 1 y, -17.7 points [-34.2 to -1.2]), whereas “role and connectedness” scores did not change remarkably with shorter life expectancy (&lt; 6 m vs. ≥ 1 y, -3.3 points [-16.4 to 9.8]). Furthermore, shorter life expectancy was associated with higher WHODAS 2.0 scores (&lt; 6 m vs. ≥ 1 y, 19.6 points [4.3 to 34.8]). Home medical care physicians who engage in spiritual care should facilitate thoughtful dialogue with their patients by recognizing declines in life functions and hope for fulfilment, which are associated with short life expectancy.

Remnant cholesterol and risk of premature mortality: an analysis from a nationwide prospective cohort study.

To explore the relationship between remnant cholesterol (RC) and the risk of premature mortality as well as life expectancy in the general population. We included a total of 428 804 participants from the UK Biobank for analyses. Equivalent population percentiles approach based on the low-density lipoprotein cholesterol cut-off points was performed to categorize participants into three RC groups: low (with a mean RC of 0.34mmol/L), moderate (0.53mmol/L), and high (1.02mmol/L). We used multivariable Cox proportional hazards models to evaluate the relationship between RC groups and the risk of premature mortality (defined as death before age 75 years). Life table methods were used to estimate life expectancy by RC groups. During a median follow-up of 12.1 years (Q1-Q3 11.0-13.0), there were 23 693 all-cause premature deaths documented, with an incidence of 4.83 events per 1000 person-years [95% confidence interval (CI): 4.77-4.89]. Compared with the low RC group, the moderate RC group was associated with a 9% increased risk of all-cause premature mortality [hazard ratio (HR) = 1.09, 95% CI: 1.05-1.14], while the high RC group had an 11% higher risk (HR=1.11, 95% CI: 1.07-1.16). At the age of 50 years, high RC group was associated with an average 2.2 lower years of life expectancy for females, and an average 0.1 lower years of life expectancy for males when compared with their counterparts in the low RC group. Elevated RC was significantly related to an increased risk of premature mortality and a reduced life expectancy. Premature death in the general population would benefit from measurement to aid risk stratification and proactive management of RC to improve cardiovascular risk prevention efforts.

Impact of 8 lifestyle factors on mortality and life expectancy among United States veterans: The Million Veteran Program

BackgroundLifestyle medicine has been proposed as a way to address the root causes of chronic disease and their associated health care costs. ObjectiveThis study aimed to estimate mortality risk and longevity associated with individual lifestyle factors and comprehensive lifestyle therapy. MethodsAge- and sex-specific mortality rates were calculated on the basis of 719,147 veterans aged 40–99 y enrolled in the Veteran Affairs Million Veteran Program (2011–2019). Hazard ratios and estimated increase in life expectancy were examined among a subgroup of 276,132 veterans with complete data on 8 lifestyle factors at baseline. The 8 lifestyle factors included never smoking, physical activity, no excessive alcohol consumption, restorative sleep, nutrition, stress management, social connections, and no opioid use disorder. ResultsOn the basis of 1.12 million person-years of follow-up, 34,247 deaths were recorded. Among veterans who adopted 1, 2, 3, 4, 5, 6, 7, and 8 lifestyle factors, the adjusted hazard ratios for mortality were 0.74 (0.60–0.90), 0.60 (95% CI: 0.49, 0.73), 0.50 (95% CI: 0.41, 0.61), 0.43 (95% CI: 0.35, 0.52), 0.35 (95% CI: 0.29, 0.43), 0.27 (95% CI: 0.22, 0.33), 0.21 (95% CI: 0.17, 0.26), and 0.13 (95% CI: 0.10, 0.16), respectively, as compared with veterans with no adopted lifestyle factors. The estimated life expectancy at age 40 y was 23.0, 26.5, 28.8, 30.8, 32.7, 35.1, 38.3, 41.3, and 47.0 y among males and 27.0, 28.8, 33.1, 38.0, 39.2, 41.4, 43.8, 46.3, and 47.5 y for females who adopted 0, 1, 2, 3, 4, 5, 6, 7, and 8 lifestyle factors, respectively. The difference in life expectancy at age 40 y was 24.0 y for male veterans and 20.5 y for female veterans when comparing adoption of 8–9 lifestyle factors. ConclusionsA combination of 8 lifestyle factors is associated with a significantly lower risk of premature mortality and an estimated prolonged life expectancy.

Multi-Population O’Hare with ARIMA, ARIMA-GARCH and ANN in Forecasting Mortality Rate

Multi-population mortality model has gained attention from prominent researchers of mortality due to its ability to provide biologically reasonable forecast. Previously, many researchers have proposed several multi-population stochastic mortality models that they considered adequate to produce accurate life expectancy. However, little have been addressed of the variability in full ages and time, which can contribute to an erroneous estimation of life expectancy. Therefore, this study proposed a new multi-population O’Hare with ARIMA, ARIMA-GARCH and ANN in forecasting the mortality rate for male and female in Malaysia, Taiwan, Japan, Hong Kong, Australia, USA, UK, Canada, and Switzerland. Multi-population O’Hare was used as a reference model, whilst ARIMA, ARIMA-GARCH and ANN were incorporated to the reference model to forecast the mortality rates. The adequacy of the proposed model was assessed by using measurement errors which were Mean Absolute Percentage Error (MAPE) and Root Mean Square Error (RMSE). The results showed by multi-population O’Hare with ARIMA-GARCH gave the best forecasting performance for Taiwan, Japan, Australia, USA, UK, Canada, and Switzerland. On the other hand, multi-population O’Hare with ARIMA gave the best forecasting performance for Malaysia, whereas multi-population O’Hare with ANN gave the best forecasting performance for Hong Kong.

Sense of Purpose in Life Predicts Reduced Risk for and Delayed Onset of Mild Cognitive Impairment: A Multistate Survival Model

AbstractBackgroundWith no known cure for Alzheimer’s disease and related dementias, delaying the onset of cognitive decline represents a key target for future dementia research. Sense of purpose has been shown to be associated with high cognitive functioning, more supportive social ties, and greater intellectual activity, and may be valuable for mitigating cognitive impairment both before and following its onset.MethodLongitudinal data from the Health and Retirement Study (HRS, n = 10,542) and the Rush Memory and Aging Project (MAP, n = 10.48) were used to examine associations between sense of purpose and prospective transitions across normal cognition, mild cognitive impairment (MCI), dementia, and death over up to 12 and 19 years, respectively. Multistate survival modeling examined the impact of sense of purpose on risk for each transition, adjusting for age, sex, education, apolipoprotein‐E allele, and depressive symptoms. Multinomial regression was used to estimate life expectancy in each cognitive state.ResultMore purposeful older adults were found to have lower prospective risk of developing MCI in the HRS (HR = 0.93, 95% CI: 0.90, 0.97) and MAP (HR = 0.82, 95% CI: 0.69, 0.98) and had increased likelihood of improvement in cognitive functioning following MCI classification. In both samples, those higher in sense of purpose were found to have significantly longer overall life expectancy and life expectancy free of cognitive impairment (without MCI or dementia).ConclusionOlder adults higher in sense of purpose appear to live longer lives, with these differences in life expectancy attributable to increases in years lived without cognitive impairment. Replication of findings across longitudinal studies with disparate samples and measurement procedures provides robust support that having a strong sense of purpose in life contributes to cognitive reserve and resilience. Interventions aiming to promote older adult sense of purpose could extend the cognitive healthspan—the period in which individuals live in a cognitively healthy state free of impairment.

Estimates of Survival and Life Expectancy with Tafasitamab Plus Lenalidomide in the L-Mind Study Compared with Real-World Standard-of-Care for Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma

Background The presence of stable plateaus in Kaplan-Meier (KM) survival analyses of clinical trials with ≥5 years of median follow-up raises the issue of the curative potential of immunotherapies for patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Mixture cure models (MCM), unlike standard survival analyses, stratify study populations into long-term survivors (LTS) and non-LTS based on statistical modeling approaches. LTS are assumed to not experience a disease-related event (termed “cured” in only a statistical sense) and are assumed to have an all-cause mortality of the age- and gender-matched general populace. Non-LTS experience events based on the outcomes of the underlying study. Based on these analyses, life expectancies for the combined (LTS and non-LTS) study population are estimable (Felizzi F et al. 2021). The final 5-year results of the Phase II L-MIND study (NCT02399085; Duell J et al. 2023) of tafasitamab + lenalidomide (LEN) in patients with R/R DLBCL identified an LTS population, making the study data suitable for MCM analysis. For contextualization, patients from the retrospective, observational RE-MIND2 study (NCT04697160; Nowakowski G et al. 2022; Nowakowski G et al. 2023) who were treated with a wide variety of systemic therapies including polatuzumab vedotin / bendamustine / rituximab (pola-BR) were matched to the L-MIND population. We used various MCM analyses to estimate the proportion of LTS and overall life expectancy in patients from L-MIND compared with matched RE-MIND2 cohorts. Methods Patients from the full analysis set (FAS) from L-MIND (n=80) were 1:1 matched without replacement with a RE-MIND2 comparator cohort, based on 9 covariates originally defined in the RE-MIND2 study, generating 76 matched pairs (M_popn). Two subsets of patients from L-MIND were also defined: those with only one prior line of therapy (pLoT; 1:1 matched to a corresponding RE-MIND2 cohort) generating 39 matched pairs; and those experiencing a response to therapy (non-matched subsets from the 1:1 matched populations). KM curves for the comparisons are displayed, and a semi-parametric MCM was used to estimate the proportion of LTS and combined life expectancy (accounting for LTS and non-LTS) within each population (Cai C et al. 2021; Gressani O et al. 2022). The life expectancy of the general population was estimated using data from the US National Vital Statistics System. Additional MCMs were generated for sensitivity analyses. Results KM curves show improved survival outcomes in the L-MIND M_popn treated with tafasitamab + LEN with up to 5 years of follow-up compared with RE-MIND2 M_popn receiving standard-of-care systemic therapies in an observational setting( Figure 1). The LTS proportion of the L-MIND M_popn was estimated as 40%, and the combined life expectancy was 7.27 years (95% confidence interval [CI]: 5.56-8.93 years). By comparison, the RE-MIND2 M_popn had a LTS proportion and a combined life expectancy of 13% and 2.93 years (CI: 1.68-4.86 years), respectively. The probability of survival among patients with response to therapy in L-MIND or in the observational RE-MIND2 setting is shown in Figure 2. In patients with an objective response in L-MIND M_popn, the LTS proportion was estimated as 59%, with a combined life expectancy of 9.97 years (CI: 7.69-11.79 years). For the subset of patients with response in RE-MIND2 M_popn, the LTS proportion and combined life expectancy were 18% and 3.73 years (CI: 1.99-6.51 years), respectively. Half of the patients in L-MIND received tafasitamab + LEN as second-line therapy; the LTS proportion in this subset was 51%, with a combined life expectancy of 8.24 years (CI: 5.96-10.21 years). Additional subgroup and sensitivity analyses will be presented later. Conclusions The MCM analysis of 5-year data from the L-MIND study suggests that treatment with tafasitamab + LEN tripled the proportion of LTS (40%) when compared with matched real-world patient cohorts receiving systemic therapies (13% LTS). Among patients responding to treatment, the proportion of LTS increased to 59% for those receiving tafasitamab + LEN, compared with 18% for other systemic treatment. The increases in LTS proportion resulted in substantial increases in estimates of life expectancy; these exploratory data warrant further examination in larger patient cohorts.

An Update on the Interdisciplinary Dental Care Approach for Geriatric Diabetic Patients.

Diabetes mellitus is a prevalent health issue escalating worldwide that gives rise to numerous problems. Periodontal disorders are recognized as the sixth consequence associated with diabetes mellitus. Research shows that dental health affects overall health, and this knowledge is changing the dental field. The correct choice of glucose goal levels and the optimal selection of glucose-lowering medications are determined by a comprehensive geriatric assessment, an estimate of life expectancy, and a rationale for therapy at regular intervals in elderly diabetics. This article provides an overview of the correlation between diabetes and oral health, with a specific emphasis on xerostomia, periodontal disease, and dental caries. Thus, dentists play a significant role within the allied health profession by contributing to the provision of oral care for those diagnosed with diabetes, with a special focus on geriatric patients.

Estimating life expectancy and years of life lost for autistic people in the UK: a matched cohort study

Previous research has shown that people who have been diagnosed autistic are more likely to die prematurely than the general population. However, statistics on premature mortality in autistic people have often been misinterpreted. In this study we aimed to estimate the life expectancy and years of life lost experienced by autistic people living in the UK. We studied people in the IQVIA Medical Research Database with an autism diagnosis between January 1, 1989 and January 16, 2019. For each participant diagnosed autistic, we included ten comparison participants without an autism diagnosis, matched by age, sex, and primary care practice. We calculated age- and sex-standardised mortality ratios comparing people diagnosed autistic to the reference group. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy at age 18 and years of life lost. We analysed the data separately by sex, and for people with and without a record of intellectual disability. We discuss the findings in the light of the prevalence of recorded diagnosis of autism in primary care compared to community estimates. From a cohort of nearly 10 million people, we identified 17,130 participants diagnosed autistic without an intellectual disability (matched with 171,300 comparison participants), and 6450 participants diagnosed autistic with an intellectual disability (matched with 64,500 comparison participants). The apparent estimates indicated that people diagnosed with autism but not intellectual disability had 1.71 (95% CI: 1.39-2.11) times the mortality rate of people without these diagnoses. People diagnosed with autism and intellectual disability had 2.83 (95% CI: 2.33-3.43) times the mortality rate of people without these diagnoses. Likewise, the apparent reduction in life expectancy for people diagnosed with autism but not intellectual disability was 6.14 years (95% CI: 2.84-9.07) for men and 6.45 years (95% CI: 1.37-11.58 years) for women. The apparent reduction in life expectancy for people diagnosed with autism and intellectual disability was 7.28 years (95% CI: 3.78-10.27) for men and 14.59 years (95% CI: 9.45-19.02 years) for women. However, these findings are likely to be subject to exposure misclassification biases: very few autistic adults and older-adults have been diagnosed, meaning that we could only study a fraction of the total autistic population. Those who have been diagnosed may well be those with greater support needs and more co-occurring health conditions than autistic people on average. The findings indicate that there is a group of autistic people who experience premature mortality, which is of significant concern. There is an urgent need for investigation into the reasons behind this. However, our estimates suggest that the widely reported statistic that autistic people live 16-years less on average is likely incorrect. Nine out of 10 autistic people may have been undiagnosed across the time-period studied. Hence, the results of our study do not generalise to all autistic people. Diagnosed autistic adults, and particularly older adults, are likely those with greater-than-average support needs. Therefore, we may have over-estimated the reduction in life expectancy experienced by autistic people on average. The larger reduction in life expectancy for women diagnosed with autism and intellectual disability vs. men may in part reflect disproportionate underdiagnosis of autism and/or intellectual disability in women. Dunhill Medical Trust, Medical Research Council, National Institute for Health and Care Research, and the Royal College of Psychiatrists.

Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study

BackgroundRacial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover.MethodsUsing National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019).ResultsIn 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities.ConclusionUrban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.

An Analysis of Clinical and Systemic Factors Associated with Palliative Radiotherapy Delivery and Completion at the End of Life in Alberta, Canada.

Radiotherapy (RT) is often utilized for symptom control at the end of life. Palliative RT (pRT) may not be taken to completion by patients, thus decreasing clinical benefits and adversely impacting resource allocation. We determined rates of incomplete pRT and examined predictors of non-completion using an electronic questionnaire. Methods: A questionnaire was embedded within the RT electronic prescribing system for all five cancer centers of Alberta, Canada, between 2017 and 2020. Prescribing radiation oncologists (ROs) were tasked with completing the questionnaire. Treatment variables were collected for 2040 patients prescribed pRT. Details on pRT courses delivered and completed were used to determine rates of incomplete RT. Electronic medical records of a subset of 367 patients randomly selected from the 2040 patients were then analyzed to examine for association of non-completion of RT with patient, disease, and therapy-related factors. Results: Overall, 10% of patients did not complete pRT. The rate of single fractions prescribed as a proportion of all RT fractions increased from 18% (pre-2017: pre-study era) to 29% (2017-2020: study era) (p < 0.0001). After conducting multivariate analysis on the overall group, multiple lifetime malignancies (OR:0.64) or increasing the number of pRT fractions (OR:0.08-0.17) were associated with non-completion. Being selected for stereotactic RT (OR:3.75) or survival > 30 days post-RT prescription (OR:2.20-5.02) were associated with greater rates of RT completion. The ROs' estimates of life expectancy at the time of RT prescription were not predictive of RT completion. In the multivariate analysis of the 367-patient subset, the presence of hepatic metastases (OR 2.59), survival 30-59 days (OR 6.61) and survival 90+ days (OR 8.18) post-RT prescription were associated with pRT completion. Only increasing pRT fractionation (OR:0.05-0.2) was associated with non-completion. Conclusion: One in ten patients prescribed pRT did not complete their treatment course. Decreasing pRT fractionation and improving prognostication in patients near the end of life may decrease rates of incomplete RT courses.