Life Expectancy Of General Population Research Articles

Loss in Overall and Quality-Adjusted Life Expectancy for Patients With Chronic-Phase Chronic Myeloid Leukemia.

The introduction of tyrosine kinase inhibitors has considerably improved the life expectancy (LE) for patients with chronic myeloid leukemia (CML). Evaluating health-related quality of life within the treatment pathway remains crucial. Using the Swedish CML register, we included 991 adult patients with chronic-phase (CP) CML diagnosed 2007 to 2017, with follow-up until 2018. We developed a multistate model to estimate the loss in LE (LLE) and loss in quality-adjusted life expectancy (LQALE) for the patient population compared to the general population, along with the respective proportions of losses relative to the general population. All patients with CP-CML had a relatively low reduced LE but with larger LQALE. The maximum LLE within age/sex subgroups was 5.7 years (general population LE: 43.2 years vs. CP-CML LE: 37.5 years) for females diagnosed at age 45 years, with LQALE of 12.0 quality-adjusted life years (QALYs) (general population QALE: 38.2 QALYs vs. CP-CML QALE: 26.3 QALYs). Across all ages, the proportions of LLE ranged from 9% to 15%, and the proportions of LQALE were 29% to 33%. Despite a low LLE, our findings reveal a greater LQALE for patients with CP-CML. Further improvements in management of CP-CML are thus warranted to successfully address the prevailing medical needs.

Increase in the Life Expectancy of Patients with Cancer in the United States.

Cancer is becoming more of a chronic disease due to improvements in treatment and early detection for multiple cancer sites. To gain insight on increased life expectancy due to these improvements, we quantified trends in the loss in expectation of life (LEL) due to a cancer diagnosis for six cancer sites from 1975 through 2018. We focused on patients diagnosed with female breast cancer, chronic myeloid leukemia (CML), colon and rectum cancer, diffuse large B-cell lymphoma (DLBCL), lung cancer, or melanoma between 1975 and 2018 from nine Surveillance, Epidemiology, and End Results cancer registries. Life expectancies for patients with cancer ages 50+ were modeled using flexible parametric survival models. LEL was calculated as the difference between general population life expectancy and life expectancy for patients with cancer. Over 2 million patients were diagnosed with one of the six cancers between 1975 and 2018. Large increases in life expectancy were observed between 1990 and 2010 for female breast, DLBCL, and CML. Patients with colon and rectum cancer and melanoma had more gradual improvements in life expectancy. Lung cancer LEL only began decreasing after 2005. Increases in life expectancy corresponded with decreases in LEL for patients with cancer. The reported gains in life expectancy largely correspond to progress in the screening, management, and treatment of these six cancers since 1975. LEL provides an important public health perspective on how improvements in treatment and early detection and their impacts on survival translate into changes in cancer patients' life expectancy.

MORTALITY AND MORBIDITY DIFFERENCE IN GERIATRICS PATIENTS HOSPITALIZED FOR INFLAMMATORY BOWEL DISEASE: POPULATION-BASED AGE-STRATIFIED RETROSPECTIVE STUDY

Given the increase in prevalence of Inflammatory Bowel Disease (IBD) worldwide and the increase in general population life expectancy, it is expected to for IBD to be more prevalent disorder among elderly patients. However, the mortality and outcomes of geriatric patients hospitalized for management of IBD remain understudied.

MORTALITY AND MORBIDITY DIFFERENCE IN GERIATRICS PATIENTS HOSPITALIZED FOR INFLAMMATORY BOWEL DISEASE: POPULATION-BASED AGE-STRATIFIED RETROSPECTIVE STUDY

Abstract BACKGROUND Given the increase in prevalence of Inflammatory Bowel Disease (IBD) worldwide and the increase in general population life expectancy, it is expected to for IBD to be more prevalent disorder among elderly patients. However, the mortality and outcomes of geriatric patients hospitalized for management of IBD remain understudied. METHODS Using ICD-10 codes, the National Inpatient Sample database of the years 2016 to 2019 was screened for to geriatric (≥ 65 years old) and non-geriatric adult (18-65 years old) population who were hospitalized with a primary diagnosis of IBD (Crohn’s Disease and Ulcerative Colitis). Multivariate logistic regression analysis was performed to compare the mortality and hospital complications risks of elderly patients (Study group) hospitalized for IBD to that of younger group (Controls). Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant if p-value was <0.05. RESULTS Among 953,094 adults’ patients who were hospitalized in US with a primary diagnosis of IBD from 2016 - 2019, 370,424 (38.9%) were ≥ 65 years old. Age-stratified patients baseline characteristics are listed in Table 1. In term of mortality, Geriatric patients were found to have a 2.50-fold increase in risk of mortality (OR 2.50, 95% CI 2.29– 2.72, p<0.001) when compared to younger adults. In term of in-hospital outcomes (Figure 1), Geriatrics patients had a higher risk of sepsis (OR 1.21, 95% CI 1.16– 1.26, p< 0.001), septic shock (OR 1.44, 95% CI 1.34– 1.54, p< 0.001), acute kidney injury (OR 1.43, 95% CI 1.38– 1.48, p< 0.001), acute coronary syndrome (OR 1.52, 95% CI 1.36 – 1.70, p<0.001), in-hospital cardiac arrest (OR 1.29, 95% CI 1.09 – 1.53, p= 0.003), UTIs (OR 1.93, 95% CI 1.86 – 2.01, p< 0.001), pneumonia (OR 1.36, 95% CI 1.30 – 1.43, p< 0.001), acute respiratory failure (OR 1.41, 95% CI 1.34 – 1.48, p<0.001) and mechanical ventilation (OR 1.13, 95% CI 1.05 – 1.23, p=0.001) when comparted to non-Geriatrics patients. Interestingly, Geriatrics/IBD patients had no significant difference in length of stay (Coefficient 0.09 days, 95% CI -0.009 –0.172, p<0.028) and cost of care (Coefficient 403$, 95% CI -937 – 1745, p=0.55) when compared to younger subjects. CONCLUSION Elderly patients hospitalized for management of IBD have higher rates of mortality, sepsis, septic shock, acute kidney injury, acute coronary syndrome, in-hospital cardiac arrest, UTIs, pneumonia, acute respiratory failure and mechanical ventilation, with no significant difference in healthcare resources utilization compared to younger subjects. These results are likely related to the higher comorbidities and the benefits/risk balance of undergoing invasive therapeutic measures in this friable age group.

The evolution of the loss of life expectancy in patients with chronic myeloid leukaemia: a population-based study in the Netherlands, 1989-2018.

SummaryStudies on the conditional life expectancy of patients with chronic myeloid leukaemia (CML) are lacking. Using data from the Netherlands Cancer Registry, we examined the life expectancy of patients with CML in the Netherlands diagnosed during 1989–2018. As of the early 2010s, the life expectancy of patients with CML who survived several years after diagnosis came narrowly close to the general population’s life expectancy, regardless of age. This finding can essentially be ascribed to the introduction and broader application of tyrosine kinase inhibitors (TKIs) and provide optimism to patients with CML who can look forward to a near‐normal life expectancy in a modern TKI era.

Life expectancy, mortality risks and cause of death in patients with serious mental illness in South East London: a comparison between 2008-2012 and 2013-2017.

People with serious mental illness (SMI) have a significantly shorter life expectancy than the general population. This study investigates whether the mortality rate in this group has changed over the last decade. Using Clinical Record Interactive Search software, we extracted data from a large electronic database of patients in South East London. All patients with schizophrenia, schizoaffective disorder or bipolar disorder from 2008 to 2012 and/or 2013 to 2017 were included. Estimates of life expectancy at birth, standardised mortality ratios and causes of death were obtained for each cohort according to diagnosis and gender. Comparisons were made between cohorts and with the general population using data obtained from the UK Office of National Statistics. In total, 26 005 patients were included. In men, life expectancy was greater in 2013-2017 (64.9 years; 95% CI 63.6-66.3) than in 2008-2012 (63.2 years; 95% CI 61.5-64.9). Similarly, in women, life expectancy was greater in 2013-2017 (69.1 years; 95% CI 67.5-70.7) than in 2008-2012 (68.1 years; 95% CI 66.2-69.9). The difference with general population life expectancy fell by 0.9 years between cohorts in men, and 0.5 years in women. In the 2013-2017 cohorts, cancer accounted for a similar proportion of deaths as cardiovascular disease. Relative to the general population, life expectancy for people with SMI is still much worse, though it appears to be improving. The increased cancer-related mortality suggests that physical health monitoring should consider including cancer as well.

Life Expectancy, Mortality Risks and Cause of Death in Patients with Serious Mental Illness: A Comparison between 2008-2012 and 2013-2017

Background: People with serious mental illness have a significantly shorter life expectancy than the general population. This study investigates whether the mortality rate in this group has changed over the last decade. Method: Using Clinical Record Interactive Search (CRIS) software, we extracted data from a large electronic database of patients in South East London. All patients who had received a diagnosis of schizophrenia, schizoaffective disorder or bipolar affective disorder from 2008-2012 and/or 2013-2017 were included. Estimates of life expectancy at birth, standardized mortality ratios and causes of death were obtained for each cohort according to diagnosis and gender. Comparisons were made between cohorts and with the general population using data obtained from UK Office of National Statistics. Findings: 26,005 patients with serious mental illness were included. In men, life expectancy was greater in 2013-2017 (64.9 years; 95% CI: 63.6-66.3) than in 2008-2012 (63.2 years; 95% CI: 61.5-64.9). Similarly, in women, life expectancy was greater in 2013-2017 (69.1 years; 95% CI: 67.5-70.7) than in 2008-2012 (68.1 years; 95% CI: 66.2-69.9). The difference with general population life expectancy fell by 0.9 years between cohorts in men, and by 0.5 years in women. In women with SMI, cancer was the leading cause of death in 2013-2017, whereas the leading cause in 2008-2012 was cardiovascular diseases. In men with SMI there were more deaths due to cancer in 2013-2017 than in 2008-2012. Cancer overtook cardiovascular disease as the leading cause of death in women. Interpretations: Relative to the general population, life expectancy for people with serious mental illness it is still much worse though appears to be improving. The increased cancer-related mortality in these patients suggests that physical health monitoring should consider including cancer as well as cardiovascular and metabolic disease. Funding Statement: EC is funded by a National Institute for Health Research Doctoral Research Fellowship (NIHR300273). CK was funded by Taipei City Government. RP is funded by National Institute for Health Research. Academy of Medical Sciences, The Wellcome Trust, MRC, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form and declared no interest of conflicts. Ethics Approval Statement: The SLaM BRC Case Register and CRIS have received ethical approval as an anonymised data set for secondary analyses from the Oxfordshire Research Ethics Committee C (18/SC/0372). The Clinical Data Linkage Service was used for data protection, linkage and extraction.

Life expectancy and years of life lost in HIV patients under the care of BandarAbbas Behavioral Disorders Counseling Center.

Background:HIV epidemic is mostly targeted adults and has numerous negative health, social, economic, cultural and political consequences. In this study Life Expectancy (LE) and Average Years of Life Lost (AYLL) in HIV/AIDS patients are estimated.Materials and Methods:In this descriptive study all the patients at the age of 18 and more under the care of BandarAbbas Behavioral Disorders Counseling Center (BBDCC) during 2005-2015 are included. The town of BandarAbbas is center of Hormozgan Province in southern Iran. LE and AYLL have been estimated based on Life Table.Results:One hundred thirty four of the 426 eligible patients died during the study period. Compared to the general population LE for HIV/AIDS patients at age 20 is 46 years less in comparison with the general population of BandarAbbas. Moreover, a total of 8839 years of life lost during 2005-2015.Conclusion:LE in HIV/AIDS patients is less than LE among BandarAbbas general population and AYLL among them is more than general population. Most of the years of life lost are preventable if the health care system seriously will implement programs to control HIV/AIDS.

Aims and expectations of a prospective multicenter study on aortic valve surgery: (E-AVR registry)

Background: Treatment of severe aortic valve stenosis (SAVS) is a hot topic due to improved life expectancy of general population, improvement of diagnostic tools, and consequent increased number of patients requiring aortic valve surgery. Traditional aortic valve replacement and recent transcatheter aortic prosthesis implantation have reported comparable or non-inferior mortality in randomised controlled trials (RCTs). However, RCTs have the limitation of the predefined inclusion/exclusion criteria, and cannot completely reflect the ‘real clinical world’. Recently sutureless prostheses, often implanted via minimally invasive approaches, have been reported as an alternative strategy. However, their definitive impact on clinical results is not yet completely evaluated because of the limited sample size of patients population of most of published studies, based on monocentric patients series. Methods: The aim of this prospective multicentre registry including all patients referred for aortic valve surgery and treated with all available techniques is to obtain a ‘real-world’ scenario of the clinical results arising from current surgical options. Results: The research protocol enrollment phase is ongoing. Therefore we have not yet results to publish. When available, the research findings deriving from E-AVR registry will be presented in the scientific community in international congresses and published in peer review international journals in the fields of cardiac surgery and cardiology. Conclusions: This multicenter, prospective, European registry has been designed with the aim to cast light on a lot of controversial issues, particularly those regarding the impact of patient baseline risk factors as well as treatment methods for SAVR, with or without coronary artery bypass grafting (CABG), on the prognosis after treatment. We believe that the information derived from this registry can provide deep knowledge on the causes that lead to adverse outcomes after SAVR, to avoid them, and finally to identify the best treatment option for SAVS for each patient.

Quality of life of women who practice dance: a systematic review protocol

BackgroundAs general population life expectancy has increased, the need to investigate the quality of life has arisen, especially because it is important that people have a healthy long life and with good quality. Studies are done with specific populations, and in the case of this investigation, the target studies are the ones done with women. Female population is growing demographically and professionally. Women have shown increased levels of stress and higher number of illness. It is known that many practices can be used to improve the level of quality of life and that one of them is the dance. Dance is an activity which combines physical and psychosocial aspects. Moreover, it promotes self-expression, self-esteem, and self-confidence. It relieves women of stress. And it also helps in a variety of aspects such as group interaction, motivation, and positive emotions. In this systematic review, the main objective is to assess the effect of dance on quality of life of adult women.MethodsOnly quantitative studies will be included. Studies will be accepted with any amount of dance practice time. They will have been published in the following bibliographic databases: Scientific Electronic Library Online (SciELO), Biblioteca Virtual em Saúde (BVS), Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), MEDLINE, Embase, and Cochrane from inception until June 30, 2018. There will be no restrictions for geographical location. It will be included studies published in Portuguese, English, and Spanish. Only published ones will be included in the review.DiscussionThere is a variety of systematic review studies with men and women on quality of life and dance, but this is the first one focused exclusively on adult female audience. It is expected that this review will be useful to promote the discussion about quality of life of adult women and the interest of this population for dance practice. In order to summarize and to explain the characteristics and findings of those studies, tables and information from texts will be used in a systematic narrative synthesis.Systematic review registrationPROSPERO CRD42016039961

JS1-4 - Drug Therapy of Heart Failure in Japan

Heart failure syndrome (HF) is one of the major public health concerns, since the number of aged people who are susceptible for HF are increasing and donor supply for cardiac transplantation is limited in Japan. Several clinical trials have established that beta-adrenergic receptor blockers are most useful in prolonging life expectancy in general population of HF in addition to renin-angiotensin system blockade. However, several problems remain to be solved. HF is accompanied by multiple comorbidities, especially in elderly patients. Use of evidence-based medicines is limited in such patients. Epidemiological survey has shown that there are considerable differences in general practices by the countries. In addition, couples of novel pharmacologic therapies such as ivabradine and angiotensin-neprilysin inhibitor remain to be approved in our country. Finally, therapeutic strategy for HF with predominantly diastolic dysfunction is another concern. HF with preserved ejection fraction is the most important issue as a new economic burden of coming era. Renin-angiotensin system blockade appears to be promising in patients with HF due to predominantly diastolic dysfunction, which is a common setting in elderly people.

Using Survival Analysis to Improve Estimates of Life Year Gains in Policy Evaluations

Policy evaluations taking a lifetime horizon have converted estimated changes in short-term mortality to expected life year gains using general population life expectancy. However, the life expectancy of the affected patients may differ from the general population. In trials, survival models are commonly used to extrapolate life year gains. The objective was to demonstrate the feasibility and materiality of using parametric survival models to extrapolate future survival in health care policy evaluations. We used our previous cost-effectiveness analysis of a pay-for-performance program as a motivating example. We first used the cohort of patients admitted prior to the program to compare 3 methods for estimating remaining life expectancy. We then used a difference-in-differences framework to estimate the life year gains associated with the program using general population life expectancy and survival models. Patient-level data from Hospital Episode Statistics was utilized for patients admitted to hospitals in England for pneumonia between 1 April 2007 and 31 March 2008 and between 1 April 2009 and 31 March 2010, and linked to death records for the period from 1 April 2007 to 31 March 2011. In our cohort of patients, using parametric survival models rather than general population life expectancy figures reduced the estimated mean life years remaining by 30% (9.19 v. 13.15 years, respectively). However, the estimated mean life year gains associated with the program are larger using survival models (0.380 years) compared to using general population life expectancy (0.154 years). Using general population life expectancy to estimate the impact of health care policies can overestimate life expectancy but underestimate the impact of policies on life year gains. Using a longer follow-up period improved the accuracy of estimated survival and program impact considerably.

Secular Changes in Postfracture Outcomes Over 2 Decades in Australia: A Time-Trend Comparison of Excess Postfracture Mortality in Two Birth Controls Over Two Decades.

Hip fracture incidence has been declining and life expectancy improving. However, trends of postfracture outcomes are unknown. The objective of the study was to compare the refracture risk and excess mortality after osteoporotic fracture between two birth cohorts, over 2 decades. Prospective birth cohorts were followed up over 2 decades (1989-2004 and 2000-2014). The study was conducted in community-dwelling participants in Dubbo, Australia. Women and men aged 60-80 years, participating in Dubbo Osteoporosis Epidemiology Study 1 (DOES 1; born before 1930) and Dubbo Osteoporosis Epidemiology Study 2 (DOES 2; born after 1930) participated in the study. Age-standardized fracture and mortality over two time intervals: (1989-2004 [DOES 1] and 2000-2014 [DOES 2]) were measured. The DOES 2 cohort had higher body mass index and bone mineral density and lower initial fracture rate than DOES 1, but similar refracture rates [age-standardized refracture rates per 1000 person-years: women: 53 (95% confidence interval [CI] 42-63) and 51 (95% CI 41-60) and men: 53 (95% CI 38-69) and 55 (95% CI 40-71) for DOES 2 and DOES 1, respectively). Absolute postfracture mortality rates declined in DOES 2 compared with DOES 1, mirroring the improvement in general-population life expectancy. However, when compared with period-specific general-population mortality, there was a similar 2.1- to 2.6-fold increased mortality risk after a fracture in both cohorts (age-adjusted standardized mortality ratio, women: 2.05 [95% CI 1.43-2.83] and 2.43 [95% CI 1.95-2.99] and men: 2.56 [95% CI 1.78-3.58] and 2.48 [95% CI 1.87-3.22] for DOES 2 and DOES 1, respectively). Over the 2 decades, despite the decline in the prevalence of fracture risk factors, general-population mortality, and initial fracture incidence, there was no improvement in postfracture outcomes. Refracture rates were similar and fracture-associated mortality was 2-fold higher than expected. These data indicate that the low postfracture treatment rates are still a major problem.

Demographic Transition and Population Ageing

This article discusses the findings of a literature review on older persons globally. In recent years the number of older persons aged 60 years and older is growing worldwide. Declining in birth and mortality rates are said to be the main contributors to this new phenomenon. Life expectancy of general population has also increased, and thus the number of older population in society increased. Although all nations in the world are experiencing the growth of older population, developed countries has a relatively large portion of this population in their population structure. The purpose of this article is analyzing the process of demographic transistion that produces the growth of older person world wide. In particular, it describes the growth of older population globally with particular emphasis on the proportion of older population over the years, distribution of older population, and rate of growth of this older population. By using a secondary analysis, various sources related to older persons at international level are reviewed. This paper highlights that the proportion of older population has increased, it has distributed unevently, and the growth rate of older population is higher as compared to the growth of the total population globally. DOI: 10.5901/mjss.2015.v6n3s2p213

The Use of Statin Enhances Chance of Achieving MR4.5 in Chronic Myeloid Leukemia Patients in Chronic Phase Following Imatinib Therapy

Abstract BACKGROUND: HMG-CoA reducatase inhibitors, or statins, are commonly prescribed medications which improve life expectancy in general population. They are known to improve hypercholesterolemia and decrease the incidence of cardiovascular events including myocardial infarction or stroke, but also suggested for cancer prevention even though the mechanism is not fully elucidated. Recent studies emphasized the potential role of statins in the cancer treatment to increase response rate to chemotherapy and to improve survival of cancer patients. Statin family of drugs is known to trigger tumor specific apoptosis and to result in growth arrest in leukemias (Penn, Leukemia 2002). The promising result of STIM (STop Imatinb) trial suggested that successful discontinuation of tyrosine kinase inhibitor (TKI) in patients with chronic myeloid leukemia (CML) is possible when patients attain deeper molecular response (defined as 4.5 log reduction or deeper) for 2 years or longer. However, with our current knowledge, there is no known additive intervention facilitates the achievement of MR4.5. We hypothesized that the use of statin improves response rate to tyrosine kinase inhibitor (TKI) therapy in patients with chronic myeloid leukemia (CML), thus increasing MR4.5 achievement and increasing the chance of being attempted TKI discontinuation. METHODS: A total of 503 patients treated with TKI for CML treatment were initially evaluated for the response to TKI therapy with respect to complete cytogenetic response (CCyR), major molecular response (MMR) and molecular response at 4.5 (MR4.5) and statin use. The inclusion criteria confined the patients with chronic phase (CP) treated with imatinib at the dose of 400mg daily, thus excluding 95 patients. Finally, 408 patients were entered into the final analysis. The statin group was defined as those on statin for cholesterol control at the time of imatinib commencement and remaining on statin while on at least 3 years or longer. Cumulative incidence method considering competing risk was adopted to calculate the incidences of MCyR, CCyR, MMR and MR4.5. Discontinuation of imatinib was accounted as competing risk in the analysis. Treatment failure, progression free- and overall survival was also evaluated. RESULTS: With a median follow-up duration of 6 years (range 3 months to 14 years), 88 patients (21.3%) were defined as “statin” group. Types of statin includes atorvastatin (n=44, 50%), rosuvastatin (n=26, 30%), simvastatin (n=10, 11%), pravastatin (n=6, 7%) and fluvastatin (n=2, 2%). The MCyR and CCyR achievement was not significantly different between the 2 groups (p=0.769 for MCyR and p=0.091 for CCyR). No difference of CCyR at 12 months was noted: 70.1% in statin vs 62.8% in non-statin group. The statin group showed a higher response rate than non-statin group for MMR (p=0.005) and MR4.5 (p=0.001): 67.3% vs 49.2% for MMR at 18 months; 55.8% vs 41.0% for MR4.5 at 5 years (Figure). Multivariate analysis was successful to confirm the use of statin as an independent clinical factor for improving MR4.5 (HR 1.785, 95% CI [1.260-2.530], p=0.001), but other clinical factors were not identified such as Sokal risk, age, gender or additional cytogenetic abnormalities (ACAs) at presentation. For MMR, the use of statin was also confirmed as independent factor for MMR (HR 1.541 95% [1.015-2.341], p=0.043) in addition to ACAs (HR 0.381, p=0.0038) and high sokal risk (HR 0.687, p=0.042). The use of statin was not found to be associated with improvement in treatment failure (p=0.580), progression free survival (p=0.731) or overall survival (p=0.542) in the present study. CONCLUSION: The use of statin suggested to improve deeper molecular response following imatinib therapy in CML-CP patients, therefore is promising to increase chance of attempt to TKI discontinuation. Statin appears to improve the chance of MR4.5 achievement by 78.5%. Careful interpretation is required and replication study in an independent cohort is strongly warranted to reach a clear conclusion on this promising effect of statin. The use of statin to deepen the molecular response of TKI therapy should be evaluated in the context of clinical trial. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Epidemiology of traumatic spinal cord injury: trends and future implications

Review supplemented by inception cohort. To review trends in the incidence, prevalence, demographic characteristics, etiology, injury severity and selected treatment outcomes of traumatic spinal cord injury (SCI). International review and US model systems cohort. An extensive literature review was conducted to identify all relevant studies of descriptive epidemiology of traumatic SCI. This review was supplemented by analyses of trends in US SCI epidemiology that are reflected in the National Spinal Cord Injury Statistical Center and Shriners Hospital Spinal Cord Injury databases. Incidence and prevalence of traumatic SCI in the United States are higher than in the rest of the world. Average age at injury is increasing in accordance with an aging general population at risk. The proportion of cervical injuries is increasing, whereas the proportion of neurologically complete injuries is decreasing. Injuries due to falls are increasing. Recent gains in general population life expectancy are not reflected in the SCI population. Treatment outcomes are changing as a result of increasing age and changes in US health care delivery. Within the prevalent population, the percentage of elderly persons will not increase meaningfully until the high mortality rates observed among older persons significantly improve. Those who reach older ages will typically have incomplete and/or lower level injuries, and will have relatively high degrees of independence and overall good health.

The EVEREST study: an international collaboration.

Rates of initiation of renal replacement therapy (RRT), use of home modalities of treatment and patient outcomes vary considerably between countries. This paper reports the methods and baseline characteristics of countries participating in the EVEREST study (n = 46), a global collaboration examining the association between medical and non-medical factors and RRT incidence, modality mix and survival. Numbers of incident and prevalent patients were collected for current (2003–05) and historic (1983–85, 1988–90, 1993–95 and 1998–2000) periods stratified, where available, by age, gender, treatment modality and cause of end stage renal disease (diabetic versus non-diabetic). General population age and health indicators and national-level macroeconomic data were collected from secondary data sources. National experts provided primary data on renal service funding, resources and organization. The median (inter quartile range) RRT incidence per million of the population (pmp) was 130 pmp (102–167 pmp). The general population life expectancy at 60 was 22.1 years (19.7–23.1 years) and 6.9% had diabetes mellitus (5.4–9.0%). Healthcare spending as a percentage of gross domestic product was 8.1% (5.6–9.3%). Countries averaged nine dialysis facilities pmp (4–12 pmp), with 69.0% (43.9–99.0%) owned by the public or private not-for-profit sector. The number of nephrologists ranged from 0.5 to 48 pmp (median 12 pmp). The heterogeneity of EVEREST countries will enable modelling to examine the independent association between medical and non-medical factors on RRT epidemiology.