Estimated Lifetime Risk Research Articles

Estimating lifetime and 10-year risk of lung cancer

Lung cancer is the commonest cancer worldwide. Mortality and incidence rates are traditionally used to assess cancer burden and as public health indicators. However, these metrics are difficult to interpret at an individual level. Providing the lifetime and 10-year risks of cancer could improve risk communication. Our aim was to estimate current lifetime and 10-year risks of lung cancer by smoking status and changes in these risks between 1995 and 2013 in a Swiss population. We used all lung cancer cases recorded between 1995 and 2013 by two population-based cancer registries in the contiguous cantons of Vaud and Valais, in Western Switzerland. We estimated sex-specific lifetime risk and 10-year risk of lung cancer using the current probability method, accounting for competing risk of death. Estimates were also provided by smoking status. Between 1995 and 2013, 9623 cases of lung cancer were recorded. During this period, the lifetime risk decreased in men from 7.1% to 6.7% and increased in women from 2.5% to 4.1%. In both sexes, the 10-year risk of lung cancer increased with age until the age of 60–70 and decreased thereafter. Difference in the cumulative risk between current, former, and never smokers were very large and reported in user-friendly charts to ease risk communication. These lifetime and 10-year risk estimates could be used systematically as public health indicators. Regularly updating risk estimations are necessary for conditions like lung cancer whose incidence has changed substantially.

Providing sodium information on a restaurant menu: a case study from the restaurant at Kellogg Ranch part II

ABSTRACTExcess sodium intake is a major risk factor for hypertension, and subsequently, heart disease and stroke, the first and fifth leading causes of death in the United States. For many people, blood pressure rises progressively as salt (sodium chloride) intake increases. Nearly one in three Americans or 67 million adults have hypertension, half of whom have uncontrolled hypertension. Furthermore, the estimated lifetime risk of developing hypertension in the United States is 90%. In 2009, high blood pressure was reported as a primary or contributing cause of approximately 348,000 US deaths. That’s almost 1,000 deaths each day. The costs of prehypertension and hypertension are staggering. Estimates place the direct and indirect costs of hypertension at $73.4 billion in 2009. The purpose of this study was to determine if providing sodium information to restaurant guests would influence their menu choices. The sodium study was conducted in a hospitality management college’s student-operated restaurant. The restaurant was open to the public for lunch and dinner. Once guests were seated, they were given a menu. Guests were given menus for 3 weeks during lunch and dinner without sodium information printed on the menus and for 3 weeks during lunch and dinner with sodium information printed on the menus. The number of orders for each item on both the lunch and dinner menus was recorded during the 3 weeks for lunch and dinner when no sodium information was printed on the menus and during the 3 weeks for lunch and dinner when sodium information was printed on the menus. Each item on the menu was rated as either high in sodium or low in sodium. Statistical analysis was performed on the data collected. The analysis was conducted between lunch and dinner menus with sodium listed and without sodium listed and between menu items high in sodium and low in sodium. A two-way chi squares test was applied on the data. The results showed that whether sodium was listed or not listed on the lunch menu, guests ordered high-sodium menu items. Likewise, results showed that whether sodium was listed or not listed on the dinner menu, guests ordered low-sodium menu items.

The effects of increasing longevity and changing incidence on lifetime risk differentials: A decomposition approach.

Increasing longevity can distort time trends in summary measures of health and mortality, such as the lifetime risk of getting diseased. If not observing a cohort, this lifetime risk is calculated with cross-sectional data on age-specific incidence and survival. In those instances, incidence and survival may work in opposite directions resulting in lifetime risk estimates where, reductions in incidence might be offset by a simultaneous longevity increase. The proposed method decomposes the difference between two lifetime risks into contributions of changing incidence and changing survival. The approach can be extended to measure the contributions of changes in disease related mortality and even case fatality. We illustrate the method with hypothetical examples as well as remaining lifetime risk at age 60 of experiencing a myocardial infarction, colorectal cancer and hip fractures for Swedish males. The empirical examples show that the influence of increasing longevity on the development of lifetime risk depends on the respective age profile of occurrence. In the cases of myocardial infarction and hip fracture, longevity increases of the general population counterbalanced or even exceeded the substantial gains in disease incidence, while for colorectal cancer, the lifetime risk was almost unaffected by the longevity improvement. This was because colorectal cancer has an on average earlier onset than myocardial infarction and hip fracture.

Variations of PM2.5, PM10 mass concentration and health assessment in Islamabad, Pakistan

Sparse information appears in lack of awareness among the people regarding the linkage between particulate matter (PM) and mortality in Pakistan. The current study is aimed to investigate the seasonal mass concentration level of PM2.5 and PM10 in ambient air of Islamabad to assess the health risk of PM pollution. The sampling was carried out with two parallel medium volume air samplers on Whatman 47 mm quartz filter at a flow rate of 100L/min. Mass concentration was obtained by gravimetric analysis. A noticeable seasonal change in PM10 and PM2.5 mass concentration was observed. In case of PM2.5, the winter was a most polluted and spring was the cleanest season of 2017 in Islamabad with 69.97 and 40.44 μgm−3 mean concentration. Contrary, highest (152.42 μgm−3) and lowest (74.90 μgm−3) PM10 mass concentration was observed in autumn and summer respectively. Air Quality index level for PM2.5 and PM10 was remained moderated to unhealthy and good to sensitive respectively. Regarding health risk assessment, using national data for mortality rates, the excess mortality due to PM2.5 and PM10 exposure has been calculated and amounts to over 198 and 98 deaths annually for Islamabad. Comparatively estimated lifetime risk for PM2.5 (1.16×10-6) was observed higher than PM10 (7.32×10-8).

Abstract P065: Lifetime Risk of Developing Type 2 Diabetes by Levels of Adiposity in the US Population

Introduction: Prior estimates of lifetime risk (LTR) for developing type 2 diabetes (diabetes) among US adults have been derived using Markov modeling, thus were not based on longitudinal data. We use pooled data from several US community-based cohorts to estimate the LTR of diabetes according to age, sex and body mass index (BMI). Hypothesis: Higher BMI is associated with higher LTR of diabetes irrespective of the index age; and men have a higher LTR of diabetes compared to women. Methods: We pooled individual-level data from 7 US-based cohorts: Framingham Heart Study; Framingham Offspring Heart Study; Coronary Artery Risk Development in Young Adults (CARDIA); Atherosclerosis Risk in Communities (ARIC); Cardiovascular Health Study (CHS); Multi-Ethnic Study of Atherosclerosis (MESA); and Jackson Heart Study (JHS). Participants were free of diabetes (fasting blood glucose ≥126 mg/dl or use of medications) at index age, and were categorized by BMI (normal weight [<25 kg/m 2 ], overweight [25-29 kg/m 2 ] and obese (BMI≥30 kg/m 2 )]. The LTR of diabetes, at index age 55, was derived modified Kaplan-Meier estimator adjusting for competing risk of death free from diabetes. Results: Our sample consisted of 14139 Black and White participants (56% female). At index age 55 years, the 25-year adjusted risk for diabetes was 5.3% (95% confidence interval: 4.1-6.6%) in men and 2.8% (2.2-3.5%) in women with normal weight (Figure). The corresponding risks for diabetes among overweight participants were 11.0% (9.7-12.3%) in men and 8.5% (7.3-9.7%) in women. In obese individuals, the 25-year risk for diabetes was 24.3% (21.9- 26.6%) in men, and 20.4% (18.6-22.2%) in women. Conclusions: In this sample of middle-aged US adults , long-term risk for diabetes was substantially higher in overweight and obese participants. These data strongly suggest that lowering the population burden of obesity is critical for lowering the population burden of diabetes.

Abstract P023: Lifetime Risk of Atrial Fibrillation by Race and Socioeconomic Status: The Atherosclerosis Risk in Communities (ARIC) Study

Background: The lifetime risk of atrial fibrillation (AF) has been previously reported in whites, but not in African Americans. Moreover, we lack current estimates of lifetime risk of AF that take into account recent trends in the incidence of this arrhythmia. Lifetime risk of AF by socioeconomic status has not been investigated before. Methods: We studied 15,343 whites and African Americans in the Atherosclerosis Risk in Communities study who were followed for an average of 21 years (maximum 27 years). Total family income was categorized as <$25,000, $25,000-$49,999, and ≥$50,000, and education as < high school graduate, high school graduate, and at least some college. Incident AF was ascertained from study electrocardiograms, hospital discharge records, and death certificates. Lifetime risk of AF was estimated by a modified Kaplan-Meier method that accounted for the competing risk of death. Results: We identified 2760 AF cases during follow-up. Lifetime risk of AF was 36% (95% CI: 32-38%) in white men, 30% (26-32%) in white women, 21% (13-24%) in African American men, and 22% (16-25%) in African American women (Figure). Regardless of race and sex, incidence rates of AF decreased from the lowest to highest categories of income and education. In contrast, lifetime risk of AF increased in individuals with higher income and education in most sex-race groups. Cumulative incidence of AF was lower in those with higher income and education compared to their low socioeconomic status counterparts through earlier life, but was reversed after age 80. Conclusion: Lifetime risk of AF in a contemporary cohort in the United States was approximately 1 in 3 among whites and 1 in 5 among African Americans. Socioeconomic status was inversely associated with cumulative incidence of AF before the last decades of life.

Vitamin D, Hypercalciuria and Kidney Stones.

The estimated lifetime risk of nephrolithiasis is growing nowadays, and the formation of kidney stones is frequently promoted by hypercalciuria. Vitamin D, and especially its active metabolite calcitriol, increase digestive calcium absorption—as urinary calcium excretion is directly correlated with digestive calcium absorption, vitamin D metabolites could theoretically increase calciuria and promote urinary stone formation. Nevertheless, there was, until recently, low evidence that 25-hydroxyvitamin D serum levels would be correlated with kidney stone formation, even if high calcitriol concentrations are frequently observed in hypercalciuric stone formers. Low 25-hydroxyvitamin D serum levels have been associated with a broad spectrum of diseases, leading to a huge increase in vitamin D prescription in the general population. In parallel, an increased frequency of kidney stone episodes has been observed in prospective studies evaluating vitamin D alone or in association with calcium supplements, and epidemiological studies have identified an association between high 25-hydroxyvitamin D serum levels and kidney stone formation in some groups of patients. Moreover, urinary calcium excretion has been shown to increase in response to vitamin D supplements, at least in some groups of kidney stone formers. It seems likely that predisposed individuals may develop hypercalciuria and kidney stones in response to vitamin D supplements.

Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity

Prior studies have demonstrated lower all-cause mortality in individuals who are overweight compared with those with normal body mass index (BMI), but whether this may come at the cost of greater burden of cardiovascular disease (CVD) is unknown. To calculate lifetime risk estimates of incident CVD and subtypes of CVD and to estimate years lived with and without CVD by weight status. In this population-based study, we used pooled individual-level data from adults (baseline age, 20-39, 40-59, and 60-79 years) across 10 large US prospective cohorts, with 3.2 million person-years of follow-up from 1964 to 2015. All participants were free of clinical CVD at baseline with available BMI index and CVD outcomes data. Data were analyzed from October 2016 to July 2017. World Health Organization-standardized BMI categories. Total CVD and CVD subtype, including fatal and nonfatal coronary heart disease, stroke, congestive heart failure, and other CVD deaths. Heights and weights were measured directly by investigators in each study, and BMI was calculated as weight in kilograms divided by height in meters squared. We performed (1) modified Kaplan-Meier analysis to estimate lifetime risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CVD or noncardiovascular death, and (3) the Irwin restricted mean to estimate years lived free of and with CVD. Of the 190 672 in-person examinations included in this study, the mean (SD) age was 46.0 (15.0) years for men and 58.7 (12.9) years for women, and 140 835 patients (73.9%) were female. Compared with individuals with a normal BMI (defined as a BMI of 18.5 to 24.9), lifetime risks for incident CVD were higher in middle-aged adults in the overweight and obese groups. Compared with normal weight, among middle-aged men and women, competing hazard ratios for incident CVD were 1.21 (95% CI, 1.14-1.28) and 1.32 (95% CI, 1.24-1.40), respectively, for overweight (BMI, 25.0-29.9), 1.67 (95% CI, 1.55-1.79) and 1.85 (95% CI, 1.72-1.99) for obesity (BMI, 30.0-39.9), and 3.14 (95% CI, 2.48-3.97) and 2.53 (95% CI, 2.20-2.91) for morbid obesity (BMI, ≥40.0). Higher BMI had the strongest association with incident heart failure among CVD subtypes. Average years lived with CVD were longer for middle-aged adults in the overweight and obese groups compared with adults in the normal BMI group. Similar patterns were observed in younger and older adults. In this study, obesity was associated with shorter longevity and significantly increased risk of cardiovascular morbidity and mortality compared with normal BMI. Despite similar longevity compared with normal BMI, overweight was associated with significantly increased risk of developing CVD at an earlier age, resulting in a greater proportion of life lived with CVD morbidity.

Risk assessment of occupational exposure to benzene using numerical simulation in a complex geometry of a reforming unit of petroleum refinery.

There has been an increasing concern about the continuous and the sudden release of volatile organic pollutants from petroleum refineries and occupational and environmental exposures. Benzene is one of the most prevalent volatile compounds, and it has been addressed by many authors for its potential toxicity in occupational and environmental settings. Due to the complexities of sampling and analysis of benzene in routine and accidental situations, a reliable estimation of the benzene concentration in the outdoor setting of refinery using a computational fluid dynamics (CFD) could be instrumental for risk assessment of occupational exposure. In the present work, a computational fluid dynamic model was applied for exposure risk assessment with consideration of benzene being released continuously from a reforming unit of a refinery. For simulation of benzene dispersion, GAMBIT, FLUENT, and CFD post software are used as preprocessing, processing, and post-processing, respectively. Computational fluid dynamic validation was carried out by comparing the computed data with the experimental measurements. Eventually, chronic daily intake and lifetime cancer risk for routine operations through the two seasons of a year are estimated through the simulation model. Root mean square errors are 0.19 and 0.17 for wind speed and concentration, respectively. Lifetime risk assessments of workers are 0.4-3.8 and 0.0096-0.25 per 1000 workers in stable and unstable atmospheric conditions, respectively. Exposure risk is unacceptable for the head of shift work, chief engineer, and general workers in 141days (38.77%) in a year. The results of this study show that computational fluid dynamics is a useful tool for modeling of benzene exposure in a complex geometry and can be used to estimate lifetime risks of occupation groups in a refinery setting.

Patient-Centered Care in Breast Cancer Genetic Clinics.

With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting.

The Risk of Cancer Might be Lower Than We Think. Alternatives to Lifetime Risk Estimates.

BackgroundEstimates of lifetime cancer risk are commonly used in the clinical setting and in health-care evaluations. These measures are based on lifetime cancer risk estimates and may create an unrealistically frightening perception of cancer risk for an individual. We suggest using two new measures of cancer risk to complement the cancer lifetime risk measure, namely estimates of cancer risk from birth to a specific age or from a specific age to life expectancy.MethodsWe calculated risks using incidence density data from the Israel National Cancer Registry of 2013, applying a well-known formula for calculating risk, for a follow-up time. The joint disease-free survival probability is calculated for several age intervals, and hence the risk (i.e. 1–survival) for the intervals.ResultsThe risk of cancer to age 80 in Jewish men and women, respectively, ranged from about 0.336 and 0.329 at age 0, to 0.279 and 0.237 at age 60. The risk of cancer from birth up to an age in Jewish men and women, respectively, ranged from 0 and 0 at birth to 0.088 and 0.129 at age 60. The risk of cancer to age 80 in Arab men and women, respectively, ranged from 0.298 and 0.235 at age 0 to 0.249 and 0.161 at age 60. The risk of cancer from birth up to an age in Arab men and women, respectively, ranged from 0 and 0 at age 0 to 0.074 and 0.095 at age 60. In Jewish and Arab women, breast cancer risk to age 80 decreased from about 0.127 in Jewish women at age 40 to 0.079 at age 60 and from 0.080 to 0.043 in Arab women; the risk from birth up to a specific age ranged between 0 and 0.056, and 0 and 0.040, respectively.ConclusionThe two proposed new estimates convey important additional information to patients and physicians. These estimates are considerably lower than the frequently quoted 33% lifetime cancer risk and are more relevant to patients and physicians. Similarly, breast cancer risk estimates up to or from a specific age differ considerably from the frequently quoted lifetime risk estimates of 1 in 8 women.

Evaluation of Kidney Donors: Core Curriculum 2018

Nearly 100,000 patients are waiting for a kidney transplant, yet each year only 11,000 undergo transplantation with a deceased donor kidney. Annual death rates among waitlist registrants range from 5% to 15%; many die before receiving a transplant. Not surprisingly, registrants turn to family and friends to become living kidney donors on their behalf. Living kidney donor selection practices aim to quantify lifetime risk for kidney failure based on a candidate's predonation demographic and health characteristics. It has been established that estimated lifetime risk for kidney failure varies considerably based on predonation comorbid conditions, and as such, it is of paramount importance that potential living donor candidates undergo proper medical, surgical, and psychosocial screening before donation. This installment of AJKD's Core Curriculum in Nephrology provides readers with the tools necessary for proper evaluation of living kidney donor candidates.

The impact of patient age on breast cancer risk prediction models.

The impact of age on breast cancer risk model calculations at the population level has not been well documented. Retrospective analysis of formal breast cancer risk assessment in 36542 females ages 40-84 at a single institution from 02/2007 to 12/2009. Five-year and lifetime breast cancer risks were calculated using Gail, Tyrer-Cuzick version 6 (TC6), Tyrer-Cuzick version 7 (TC7), BRCAPRO, and Claus models. Risk of BRCA mutation was calculated using BRCAPRO, TC6, TC7, and Myriad. Eligibility for BRCA testing was assessed using NCCN guidelines. Descriptive analyses were performed and trends in risk were assessed by age. The lifetime risk of breast cancer trended down with increasing age in all risk models. TC7 calculated the highest estimates for lifetime risk for all age ranges and had the highest proportion of patients with a calculated lifetime risk >20%. Five-year risk increased with age in all models. By age 60-64, every risk model predicted a mean 5-year risk ≥1.7%. Myriad estimated >5% risk of BRCA mutation more often than other models for all ages. Risk of BRCA mutation stayed constant with age with Myriad, but trended down with increasing age with TC6, TC7, and BRCAPRO. More patients have an estimated lifetime risk of breast cancer >20% and qualify for MRI screening with the Tyrer-Cuzick model. All models predict an increased 5-year risk with age, which could impact chemoprevention recommendations. To maximize access to genetic testing, the Myriad model and NCCN guidelines should be used.

Sports Participation in High School and College Leads to High Bone Density and Greater Rates of Bone Loss in Young Men: Results from a Population-Based Study.

Estimated lifetime risk of an osteoporotic fracture in men over the age of 50years is substantial and lifestyle factors such as physical activity may explain variation in bone mass and bone loss associated with aging. Men (n = 253) aged 20-66years were followed for 7.5years and factors that influence changes in means and rates of change in bone mass, density, and size using dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) were investigated; in particular, seasons of sports participation during high school and college. Men with greater sports participation had higher total hip bone mineral content (BMC) (48.4 ± 0.9 and 48.6 ± 0.9g for 7-12 and 13+ seasons vs. 45.6 ± 0.8 and 45.4 ± 0.7g for 0 and 1-6 seasons, respectively p < 0.05) and areal bone mineral density (aBMD) (1.082 ± 0.015 and 1.087 ± 0.015g/cm2 for 7-12 and 13+ seasons vs. 1.011 ± 0.015 and 1.029 ± 0.013g/cm2 for 0 and 1-6 seasons, respectively p < 0.05) than men who participated in less sport-seasons. However, men with higher sports participation also had greater rates of bone loss in their mid-twenties at the hip (BMC - 0.8 and - 1.2% and aBMD - 0.8 and - 0.9% for 7-12 and 13+ seasons of sport participation, respectively) compared to those with 0 seasons of sport participation (BMC - 0.6% and aBMD - 0.6%) (all p < 0.05). Similar results were observed for femoral neck aBMD. Men with 7+ seasons of sport participation had higher cross-sectional area at the 20% distal radius site than those with no sports participation (all p < 0.05). These findings support significant effects of high school and/or college sports participation on bone mass and geometry in men throughout adulthood.

Corrigendum.

Developmental Medicine & Child NeurologyVolume 59, Issue 12 p. 1315-1315 CorrigendumFree Access Corrigendum This article corrects the following: Leukodystrophies and genetic leukoencephalopathies in childhood: a national epidemiological study Lesley A Stellitano, Anne Marie Winstone, Marjo S Knaap, Christopher M Verity, Volume 58Issue 7Developmental Medicine & Child Neurology pages: 680-689 First Published online: February 11, 2016 First published: 14 November 2017 https://doi.org/10.1111/dmcn.13573AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Leukodystrophies and genetic leukoencephalopathies in childhood: a national epidemiological study In the article by Stellitano et al.,1 the calculations of the lifetime risk of leukodystrophies in children in the United Kingdom were erroneous. To find the number of live births during the period May 1997 to November 2014 inclusive, the authors used the Office of National Statistics (ONS) data set for England and Wales, which was 11 252 927, rather than the data set for the United Kingdom, which was 13 076 173.2 The paper's abstract on page 680 reports that for the leukodystrophies there was an estimated lifetime risk of 31 per million live births; this should be corrected to 26.7 per million. The relevant results on page 681 (in the results section, paragraph 2) should have read as follows: ‘The estimated lifetime risk per million UK live births for the whole leukodystrophy group was 26.7. For the nine most common leukodystrophies it was: metachromatic leukodystrophy 5.8, X-linked adrenoleukodystrophy (including asymptomatic X-ALD) 5.7, Krabbe disease 4.2, Aicardi-Goutières disease 1.9, Alexander disease 1.5, Canavan disease 1.4, vanishing white matter disease 1.3, Pelizaeus-Merzbacher disease 1.2, and megalencephalic leukoencephalopathy with subcortical cysts 0.8.’ On page 685, the result for Krabbe disease (4.9/million) should be corrected to 4.2 per million, and the lifetime adrenoleukodystrophy risk (6.6/million) should be corrected to 5.7 per million. The authors apologize for these errors. References 1Stellitano LA, Winstone AM, van der Knaap MS, Verity CM. Leukodystrophies and genetic leukoencephalopathies in childhood: a national epidemiological study. Dev Med Child Neurol 2016; 58: 680– 9. 2 Office for National Statistics. Vital Statistics: Population and Health Reference Tables. 28 November 2016. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/vitalstatisticspopulationandhealthreferencetables (accessed 18 April 2017). Volume59, Issue12December 2017Pages 1315-1315 ReferencesRelatedInformation

Life Time Risk of Maternal Death in districts of Maharashtra State, India: Mathematical Estimation Using Proxy Indicators

Background: Maternal Mortality Ratio, Maternal Mortality Rate, Life Time Risk of Maternal Death are used to describe maternal mortality. First is most commonly quoted indicator. The Life Time Risk is most comprehensive. Three simple methods of calculations of Life Time Risk are documented. The calculations require Maternal Mortality Ratio and Total Fertility Rate; Maternal Mortality Rate and Reproductive Age Group Span. Reliable district wise data of these indicators is unavailable. Aim &amp; Objectives: To calculate district wise life time risk of maternal deaths. Material &amp; Methods: The proportion of non-institutional deliveries was used as proxy for Maternal Mortality Ratio and the proportion of couples not using any family planning method was used as proxy for the Total Fertility Rate. The correlation and regression equation between estimated Life Time Risk using standard method and using proxies was calculated. District wise Life Time Risk for Maharashtra state was calculated using the regression equation. Results: Good correlation was observed using proxies (r=0.97) and regression equation was: y=0.09+1.71x. For Maharashtra state the estimated of Life Time Risk was found to be 0.14% which exactly matched the estimate using conventional method. Conclusion: Using proxies reliable estimates of Life Time Risk for districts can be calculated.

Physical Activity and Lifetime Risk of Cardiovascular Disease and Cancer.

Although the World Health Organization has recommended moderate- to vigorous-intensity physical activity (MVPA) to prevent cardiovascular disease (CVD) and some cancers, there are no estimates of lifetime risk of these noncommunicable diseases according to PA levels. We aimed to estimate the lifetime risk of CVD and cancers according to PA levels. We followed 5807 men and 7252 women in the United States, 45-64 yr old, initially free of CVD and cancer from 1987 through 2012, and used a life table approach to estimate lifetime risks of CVD (coronary heart disease, heart failure, and stroke) and total cancer according to PA levels: poor (0 min·wk of MVPA), intermediate (1-74 min·wk of VPA or 1-149 min·wk of MVPA), or recommended (≥75 min·wk of VPA or ≥150 min·wk of MVPA). During the 246,886 person-years of follow-up, we documented 4065 CVD and 3509 cancer events and 2062 non-CVD and 2326 noncancer deaths. In men, the lifetime risks of CVD from 45 through 85 yr were 52.7% (95% confidence interval = 49.4-55.5) for poor PA and 45.7% (42.7-48.3) for recommended PA. In women, the respective lifetime risks of CVD were 42.4% (39.5-44.9) and 30.5% (27.5-33.1). Lifetime risks of total cancer were 40.1% (36.9-42.7) for poor PA and 42.6% (39.7-45.2) for recommended activity in men and 31.4% (28.7-33.8) and 30.4% (27.7-32.9), respectively, in women. Compared with a poor PA level, the PA recommended by the World Health Organization was associated with lower lifetime risk of CVD, but not total cancer, in both men and women.

Association of Educational Attainment With Lifetime Risk of Cardiovascular Disease

Estimates of lifetime risk may help raise awareness of the extent to which educational inequalities are associated with risk of cardiovascular disease (CVD). To estimate lifetime risks of CVD according to categories of educational attainment. Participants were followed from 1987 through December 31, 2013. All CVD events (coronary heart disease, heart failure, and stroke) were confirmed by physician review and International Classification of Diseases codes. A total of 13 948 whites and African Americans who were 45 to 64 years old and free of CVD at baseline were included from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis, Minnesota). The data analysis was performed from June 7 to August 31, 2016. Educational attainment. We used a life table approach to estimate lifetime risks of CVD from age 45 through 85 years according to educational attainment. We adjusted for competing risks of death from underlying causes other than CVD. The sample of 13 948 participants was 56% female and 27% African American. During 269 210 person-years of follow-up, we documented 4512 CVD events and 2401 non-CVD deaths. Educational attainment displayed an inverse dose-response relation with cumulative risk of CVD, which became evident in middle age, with the most striking gap between those not completing vs completing high school. In men, lifetime risks of CVD were 59.0% (95% CI, 54.0%-64.1%) for grade school, 52.5% (95% CI, 47.7%-56.8%) for high school education without graduation, 50.9% (95% CI, 47.3%-53.9%) for high school graduation, 47.2% (95% CI, 41.5%-52.5%) for vocational school, 46.4% (95% CI, 42.8%-49.6%) for college with or without graduation, and 42.2% (95% CI, 36.6%-47.0%) for graduate/professional school; in women, 50.8% (95% CI, 45.7%-55.8%), 49.3% (95% CI, 45.1%-53.1%), 36.3% (95% CI, 33.4%-39.1%), 32.2% (95% CI, 26.0%-37.3%), 32.8% (95% CI, 29.1%-35.9%), and 28.0% (95% CI, 21.9%-33.3%), respectively. Educational attainment was inversely associated with CVD even within categories of family income, income change, occupation, or parental educational level. More than 1 in 2 individuals with less than high school education had a lifetime CVD event. Educational attainment was inversely associated with the lifetime risk of CVD, regardless of other important socioeconomic characteristics. Our findings emphasize the need for further efforts to reduce CVD inequalities related to educational disparities.

Second cancer risk assessments after involved-site radiotherapy for mediastinal Hodgkin lymphoma.

This study was conducted to provide second cancer risk assessments attributable to involved-site radiotherapy (ISRT) of mediastinal Hodgkin lymphoma (HL) and to compare these risks with those from the conventional involved-field radiation therapy (IFRT). Both ISRT and IFRT plans were made for 11 patients (six females, five males) with HL in the region of mediastinum. All three-dimensional plans involved 6 MV photon beams and delivered 30 Gy to the target site. Differential dose-volume histograms were defined for the lung, female breast, and esophagus which were partly included within the planned treatment fields. The patient-specific organ equivalent dose (OED) and the relevant lifetime attributable risk (LAR) of developing malignancies in each of the above critical organs were determined with the aid of a mechanistic, plateau and bell-shaped models. The LAR estimates were compared with the baseline risks for unexposed people. The OED range of lung, breast, and esophagus calculated by the ISRT plans was 176.1-360.2, 19.5-124.1, and 42.6-157.7 cGy, respectively. The resultant LARs of developing lung and breast cancer as estimated by the three different models were at least 1.8 and 5.3 times lower than the baseline risks, respectively. The probability for the appearance of radiation-induced esophageal malignancies from ISRT in males was also up to 3.8 times smaller than the nominal incidence cancer rates. The corresponding probability in irradiated females exceeded the baseline risks. The estimated lifetime risks for lung and breast cancer induction due to ISRT were systematically and significantly lower than those from the IFRT irrespective of the model used for analysis (P < 0.05). No significant difference was found between the LARs for esophageal cancer development estimated by the ISRT and IFRT plans (P = 0.63). The presented second cancer risk data may be of value in the selection of the optimal radiotherapy technique for the management of mediastinal HL and in the subsequent follow-up of irradiated patients.

Prediction of cardiovascular risk in patients with familial hypercholesterolaemia.

Patients with familial hypercholesterolaemia (FH) have an elevated cardiovascular (CV) risk. The objective of this analysis was to adjust CV risk equations derived in non-FH populations with hyperlipidaemia to predict CV risk in FH patients, and then to use these adjusted CV risk equations in a decision analytic model in order to predict lifetime CV risk in FH patients. A literature search of publications reporting CV risk in FH patients identified the publication with the most credible estimate of CV risk increase. A CV event rate ratio (RR) (FH vs. non-FH) was derived from reported odds ratios by pooling treated and untreated patients. Predicted CV event risks based on non-FH risk equations were adjusted with the RR to reflect CV risk in FH patients. A decision analytic model incorporating these adjusted risk equations was used to predict 10-year and lifetime CV risk in FH patients. Combining the derived RR of 7.1 (95% CI: 5.7-8.7) with the predicted CV risks in a decision analytic model yielded 10-year and lifetime risk estimates of 45% and 88% in FH patients based on the RUTHERFORD-2 trial population. Based on the initial (cross-sectional) RR of 7.1, FH patients were predicted to have 3.9 times more events over their lifetime than non-FH patients with a similar risk profile. The CV risk in FH is high and represents an unmet medical need for patients. Increased efforts for better diagnosis and management of FH should be employed to improve patient outcomes.