Life Expectancy Of Individuals Research Articles

Prediction of individual lifetime cardiovascular risk and potential treatment benefit: development and recalibration of the LIFE-CVD2 model to four European risk regions.

The 2021 European Society of Cardiology prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding initiation of prevention. We aimed to update and systematically recalibrate the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model to four European risk regions for the estimation of lifetime CVD risk for apparently healthy individuals. The updated LIFE-CVD (i.e., LIFE-CVD2) models were derived using individual-participant data from 44 cohorts in 13 countries (687,135 individuals without established CVD, 30,939 CVD events in median 10.7 years of follow-up). LIFE-CVD2 uses sex-specific functions to estimate the lifetime risk of fatal and non-fatal CVD events with adjustment for the competing risk of non-CVD death, and is systematically recalibrated to four distinct European risk regions. The updated models showed good discrimination in external validation among 1,657,707 individuals (61,311 CVD events) from eight additional European cohorts in seven countries, with a pooled C-index of 0.795 (95%CI 0.767-0.822). Predicted and observed CVD event risks were well calibrated in population-wide electronic health records data in the UK (CPRD) and Netherlands (ELAN). When using LIFE-CVD2 to estimate potential gain in CVD-free life expectancy from preventive therapy, projections varied by risk region reflecting important regional differences in absolute lifetime risk. For example a 50-year-old smoking woman with a SBP of 140 mm Hg was estimated to gain 0.9 years in the low risk region versus 1.6 years in the very high risk region from lifelong 10 mm Hg SBP reduction. The benefit of smoking cessation for this individual ranged from 3.6 years in the low risk region to 4.8 years in the very high risk region. By taking into account geographical differences in CVD incidence using contemporary representative data sources, the recalibrated LIFE-CVD2 model provides a more accurate tool for the prediction of lifetime risk and CVD-free life expectancy for individuals without previous CVD, facilitating shared decision-making for cardiovascular prevention as recommended by 2021 European guidelines.

Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review

BackgroundThis scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available.MethodsAll original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners).The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken.ResultsA total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making.ConclusionThe results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.

One generation apart: Individual income and life expectancy in two Swedish cohorts born before and after the expansion of the welfare state

One generation apart: Individual income and life expectancy in two Swedish cohorts born before and after the expansion of the welfare state

Association of hospital-treated infectious diseases and infection burden with cardiovascular diseases and life expectancy.

The association of a broad spectrum of infectious diseases with cardiovascular outcomes remains unclear. We aim to provide the cardiovascular risk profiles associated with a wide range of infectious diseases and explore the extent to which infections reduce life expectancy. We ascertained exposure to 900+ infectious diseases before cardiovascular disease (CVD) onset in 453,102 participants from the UK Biobank study. Time-varying Cox proportional hazard models were used. Life table was used to estimate the life expectancy of individuals aged ≥50 with different levels of infection burden (defined as the number of infection episodes over time and the number of co-occurring infections). Infectious diseases were associated with a greater risk of CVD events (adjusted HR [aHR] 1.79 [95% confidence interval {CI} 1.74-1.83]). For type-specific analysis, bacterial infection with sepsis had the strongest risk of CVD events [aHR 4.76 (4.35-5.20)]. For site-specific analysis, heart and circulation infections posed the greatest risk of CVD events [aHR 4.95 (95% CI 3.77-6.50)], whereas noncardiac infections also showed excess risk [1.77 (1.72-1.81)]. Synergistic interactions were observed between infections and genetic risk score. A dose-response relationship was found between infection burden and CVD risks (p-trend <0.001). Infection burden >1 led to a CVD-related life loss at age 50 by 9.3 years [95% CI 8.6-10.3]) for men and 6.6 years [5.5-7.8] for women. The magnitude of the infection-CVD association showed specificity in sex, pathogen type, infection burden, and infection site. High genetic risk and infection synergistically increased the CVD risk.

Health status, life expectancy and early claiming of pension

Prior to 2011, individual life expectancy played no role in the Norwegian old-age pension system. However, after the 2011 reform, life expectancy became a central factor for early pension take-up. Asymmetric information is crucial in most insurance markets, including the new pension system, where employees can flexible claim a public pension from the age of 62. Individuals who expect to live longer than the average for their birth cohort can maximize their pension wealth by deferring pension claiming, while those with a shorter life expectancy should draw their pension as early as possible. This raises concerns that adverse selection may pose a risk to the sustainability of the new pension system. To investigate this issue, we use chronic disease as a proxy for life expectancy and examine its relationship with employment and pension decisions. Our findings show that individuals with a chronic health condition are more likely to draw a pension and continue working when they reach 62 years of age compared to those without a chronic health condition. This suggests potential adverse selection issues in the pension system, although our results suggest small effects after adjusting for unobservables.

Lifetime and 10-year cardiovascular risk prediction in individuals with type 1 diabetes: The LIFE-T1D model.

To develop and externally validate the LIFE-T1D model for the estimation of lifetime and 10-year risk of cardiovascular disease (CVD) in individuals with type 1 diabetes. A sex-specific competing risk-adjusted Cox proportional hazards model was derived in individuals with type 1 diabetes without prior CVD from the Swedish National Diabetes Register (NDR), using age as the time axis. Predictors included age at diabetes onset, smoking status, body mass index, systolic blood pressure, glycated haemoglobin level, estimated glomerular filtration rate, non-high-density lipoprotein cholesterol, albuminuria and retinopathy. The model was externally validated in the Danish Funen Diabetes Database (FDDB) and the UK Biobank. During a median follow-up of 11.8 years (interquartile interval 6.1-17.1 years), 4608 CVD events and 1316 non-CVD deaths were observed in the NDR (n = 39 756). The internal validation c-statistic was 0.85 (95% confidence interval [CI] 0.84-0.85) and the external validation c-statistics were 0.77 (95% CI 0.74-0.81) for the FDDB (n = 2709) and 0.73 (95% CI 0.70-0.77) for the UK Biobank (n = 1022). Predicted risks were consistent with the observed incidence in the derivation and both validation cohorts. The LIFE-T1D model can estimate lifetime risk of CVD and CVD-free life expectancy in individuals with type 1 diabetes without previous CVD. This model can facilitate individualized CVD prevention among individuals with type 1 diabetes. Validation in additional cohorts will improve future clinical implementation.

Survival trends among people living with human immunodeficiency virus on antiretroviral treatment in two rural districts in Ghana.

The human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs. A retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. "Stptime" per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk. The cumulative survival probability was 0.8847 (95% CI: 0.8334-0.9209). The overall mortality rate was 51.89 (95% CI: 36.89-72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6-9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78-14.13) p = 0.002] were associated with mortality. Survival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities.

A systematic review and meta-analysis of serum lipid concentrations in people with Down syndrome.

Down syndrome (DS) is the most prevalent chromosomal disorder, being the leading cause of intellectual disability. The increased life expectancy of individuals with DS has led to a shift in the incidence of non-communicable chronic diseases, resulting in new concerns, particularly cardiovascular disease (CVD) and Alzheimer's disease. This study aimed to analyse the blood lipid profile of a large DS cohort to establish a baseline for evaluating health risk parameters. A comprehensive literature search was conducted on PubMed and Virtual Health Library databases to identify original articles published before July 2022. Selected studies were included in the meta-analysis. Fifteen studies reporting serum lipid levels in individuals with DS were incorporated into the analysis. The meta-analysis used the means and standard deviations extracted from the selected studies. The analysis encompassed 671 participants in the DS group and 898 euploid controls. The results indicated significant differences in total cholesterol [C] (mean difference [MD]: -3.34; CI: 95%: -4.94 to -1.73; P<0.0001), HDL-C (MD: -3.39; CI: 95%: -6.72 to -0.06; P=0.05) and triglycerides (MD: 21.48; CI: 95%: 9.32 to 33.65; P=0.0005) levels between individuals with DS and their control counterparts. Individuals with DS have less favourable blood lipid concentrations than their controls, particularly HDL-C, triglycerides, and total-C, even when grouped by age. These findings underscore the importance of closer monitoring of lipid profiles in people with DS and the necessity for specific cut-offs for this population, considering the risk for ischemic heart and Alzheimer's diseases.

Counting the lifetime cost of obesity: Analysis based on national England data.

Obesity has a significant impact on all-cause mortality rate and overall health care resource use (HCRU). These outcomes are also strongly linked to age, sex and local deprivation of the population. We aimed to establish the lifetime costs of obesity by demographic group/geographic area using published mortality rates and HCRU use for integrated care boards (ICB) in England in the context of costs of therapeutic intervention. Population and expected mortality rates by age, sex and deprivation were obtained from national data. Obesity class prevalence was taken from the health of the nation study. The published impact of obesity by age, group, sex and deprivation on mortality and HCRU were applied to estimate life years lost and lifetime HCRU [by sex, age band and body mass index (BMI) class for each ICB]. The year 2019 was chosen as the study basis data to avoid influences of COVID-19 pandemic on obesity rates with application of 2022/23 HCRU values. Outcomes including prevalence, deaths, life years lost, HCRU and lifetime HCRU were compared by age and sex groups across four BMI classes normal/underweight (BMI <25 kg/m2 ), overweight (25-29.9 kg/m2 ), obese class I and II (30-39.9 kg/m2 ), and obese class III (≥40), with benchmarking being set against all population being BMI <25 kg/m2 overall and by each of the 42 ICBs. We also associated future life with deaths to provide an estimate of 'future life years lost' occurring each year. Total population aged >16 years was 45.4 million (51% female). 13.7 million (28% of the total adult population) had a BMI ≥30 mg/m2 and BMI ≥40 kg/m2 were 1.50 million (12%) of these 1.0 million (68%) were female and of these 0.6 million 40% were women aged 16-49 years. In addition, 35% of those with a BMI ≥40 kg/m2 were in the top deprivation quintile (i.e. overall 20%). Mortality was based on expected deaths of 518K/year, and modelling suggested that if a BMI <25 kg/m2 was achieved in all individuals, the death rate would fall by 63K to 455K/year for the English population (12% reduction). For those with a BMI ≥40 kg/m2 the predicted reduction was 12K deaths (54% lower); while in those aged 16-49 years with a BMI ≥40 kg/m2 72% of deaths were linked to obesity. For future life years lost, we estimated 2.5 years were lost in people with BMI 30-39.9 kg/m2 6.7 years when BMI ≥40 kg/m2 . However, for those aged 16-49 years with a BMI ≥40 kg/m2 , 8.3 years were lost. HCRU, for weight reduction, the annual HCRU decrease from BMI ≥40 kg/m2 to BMI 30-39.9 kg/m2 was £342 per person and from BMI 30-39.9 to 25-29.9 kg/m2 the reduction was £316/person. However, lifetime costs were similar because of reduced life expectancy for obese individuals. In quality adjusted life years (QALY), overall, 791 689 future life years were lost (13.1% of all) in people with BMI ≥25 kg/m2 and were related to excess weight. When the NICE £30 000 per QALY value was applied to the estimated total 791 689 future life years lost then the potential QALY value reduction lost was equivalent to £24 billion/year or £522/person in the obese population. For morbidly obese men and women the potential QALY value lost was £2864/person/year. Regarding geography, across the 42 ICBs, we observed significant variation in the prevalence of BMI ≥40 (1.8%-4.3%), excess mortality (11.6%-15.4%) and HCRU linked to higher BMI (7.2%-8.8%). The areas with the greatest impact on HCRU were in the north-west, north-east and Midlands of England, while the south shows less impact. The expected increases in annual HCRU because of obesity, when considered over a lifetime, are being mitigated by the increased mortality of obese individuals. Our data suggest that simple short-term HCRU reduction brought about through BMI reduction will be insufficient to fund additional specialist weight reduction interventions. The HRCUs associated with BMI are not in most cases related to short-term health conditions. They are a cumulative result over a number of years, so for age 16-49 years reducing BMI from ≥40 to 30-39.9 kg/m2 might show an annual decrease in HCRU/person by £325/year for women and £80/year for men but this might not have immediately occurred within that year. For those aged >70 years reducing BMI from ≥40 to 30-39.9 kg/m2 might show an annual decrease in HCRU/person by £777/year for women and £796/year for men but also may not be manifest within that year. However, for the morbidly obese men and women, the potential QALY value lost was £2864 per person per year with the potential for these funds to be applied to intensive weight management programmes, including pharmacotherapy.

Research on the healthy life expectancy of older adult individuals in China based on intrinsic capacity health standards and social stratification analysis.

Based on the health standard of intrinsic capacity, this paper conducts an empirical study on the healthy life expectancy of older adult individuals aged 60 and older in China and analyzes the health inequities associated with different social characteristics to provide a reference for improving care for the older adult in China. Data from the China Health and Retirement Longitudinal Study from 2011 to 2015 were used to evaluate the intrinsic capacity level of older adult individuals, and the multistate life table method was used to measure the healthy life expectancy of older adult individuals in China with the help of IMaCH software. Based on the theory of social stratification, the health inequality between older adult individuals in different social classes was analyzed in three dimensions: residence, income and education level. The calculation results show that the average life expectancy of the older adult in China at age 60 is 21.07 years, the healthy life expectancy is 16.89 years, and the healthy life expectancy accounts for 80.2% of the average life expectancy. The healthy life expectancy of older adult individuals with different social characteristics in China shows significant differences, and the healthy life expectancy of older adult individuals who are male, live in urban environments, have high levels of education and have middle- to high-income levels is significantly better than that of older adult individuals who are female, live in rural areas, have low levels of education and income. Healthy life expectancy measured by intrinsic capacity as the health standard has a certain reference value, which reflects the overall health level of older adult individuals in China and expands the transformation and multidimensional understanding of the healthy thinking of older adult individuals in China. The analysis by social stratification reflects the large health inequities that exist in the older adult population in China.

Craniological features of the American mink in south-eastern Belarus

A series of skulls (n = 27) of the American mink (Neogale vison) from the south-east of Belarus (Gomel region, floodplain of the Sozh River) was studied. The animals were caught by different hunters in 2000–2004. The sex of individuals was not determined. When examining the skull, only the most pronounced morpho-anatomical changes that can be diagnosed confidently as deviations from the norm were taken into account. In all cases, lamellar deposition of calcium salts in the area of tentorium cerebelli osseum inside the cranial vault was detected. The growing plate length reached half of the arch height in some individuals. These traits (considerable area of bone plates; presence of a sharp spine growing in different plains) allow suggesting that the analysed growths are of pathological origin. This pathology can considerably affect the viability and physiological status of individuals as it disrupts the functioning of the central nervous system. It is difficult to identify the cause of intracranial calcifications due to the possible effect of factors of various nature. Some degree of calcification of the opisthion region of foramen magnum was found. The changes occurred in the foramen shape cannot be considered phenetic variability. In most individuals, the thinning of maxillary bone in the teeth roots area is observed. However, we believe that the identified degree of bone tissue thinning is not critical and therefore does not affect the life expectancy of individuals. Two adult individuals have swelling of the maxillary bone. In one case, an extensive bone tissue excavation was identified on the left lower jaw, which led to the loss of the canine tooth. The analysed pathomorphological change is not of traumatic nature because in case of post-traumatic osteomyelitis sequesters (separating fragments) are formed. It is necessary to further analyse the American mink skulls available at scientific collections of Belarus and to identify the degree of calcium salt deposits and their impact on the foramen magnum phenotypes. We consider it necessary to create an annotated catalogue of pathologies and anomalies of the skull of the American mink in the south-east of Belarus and adjacent territories of Ukraine, since the morphological method is essential in the diagnosis of bone tissue diseases.

UNDERSTANDING AGE-RELATED DISPARITIES AND ENVIRONMENTAL BARRIERS IN OLDER ADULTS WITH MULTIPLE SCLEROSIS

Abstract Given the increasing life expectancy of individuals with multiple sclerosis (MS), the challenges faced by older adults with MS in terms of health changes and decreased physical function contribute to a potentially diminished quality of life. Despite this, our understanding of how this condition manifests in the context of aging remains limited. This study aims to examine age-related variations in fatigue, anxiety, depression, community engagement, and environmental barriers in older adults with MS, as well as to explore health disparities among older adults with MS. This secondary analysis involved 288 individuals with MS, divided into two age groups: below 60 years and 60 years and above. Aim 1 used T-tests and Aim 2 employed ANCOVA with disability adjustment. The results show that older adults with MS had higher levels of community engagement, disability, and behavioral-cognitive fatigue, reporting lower levels of anxiety, cognitive-motor fatigue, fatigue severity, and participation barriers than younger adults with MS. Noteworthy health disparities emerge, characterized by reduced community integration/participation (F=10.622, p=.001) and heightened environmental barriers (F=4.323, p=.039), even when adjusting for disability levels. The study highlights environmental barriers impeding social participation among older adults with MS, emphasizing the need to address these obstacles to enhance their quality of life. This underscores the imperative for customized interventions targeting reduced community disengagement and heightened environmental barriers faced by older adults with MS.

POLICY SERIES: DOCTORAL PROGRAMS IN GERONTOLOGY: PROVIDING LEADERSHIP IN POLICY AND AGING

Abstract Advancements in education, medicine, wealth, technology, and population health have increased individual life expectancies. Healthy aging is not just a function of healthy genes, however; aging is modified by the broader context, which, in turn, creates opportunities and challenges that must be addressed by society. Lack of organized responses to population aging exacerbate social inequities based on workplace discrimination, displacement, and impoverishment, and contribute to public health inequalities pertaining to disease and disability, isolation, and vulnerability among older adults. Public policy offers one of the most effective ways to address inequities and inequalities such as these. This symposium spotlights four doctoral programs that prepare gerontologists who possess subject matter expertise in aging policy, conduct reliable policy surveillance and sourcing, execute empirical evaluations of policy formation and implementation, and offer well-informed contributions to policy makers who are most involved with supporting and protecting older adults. These well-established academic programs at the University of Massachusetts Boston (Edward Alan Miller, PhD), University of South Florida (Lyndsay Peterson, PhD), University of Southern California (Kathleen Wilbur, PhD), and Miami University (Jennifer M. Kinney, PhD) offer classroom education, research, and service-learning opportunities for students to acquire expertise in aging and public policy. Together, these programs provide models for training a generation of leaders in gerontology who can contribute productively to policy development and debates, illuminate structures and processes of policy making and implementation, and deploy analytic skills needed to evaluate policies relative to multiple and often competing interests.

Short-term exposure to ambient air pollution and injuries due to external causes according to intentions and mechanisms

Although injuries are a leading cause of death and affect the life expectancy of individuals who live with disabilities globally, the potential role of air pollution exposure on injuries due to external causes has received little scientific attention, especially compared with that given to the association of air pollution and non-external causes of morbidity and mortality. We investigated the association between emergency department visits for externally caused injuries and short-term exposure to major ambient air pollutants, with focus on the intentions and mechanisms of injuries. We identified 2,049,855 injured patients in Seoul, South Korea between 2008 and 2016 using the National Emergency Database. Daily short-term exposure to air pollution including particles <10 μm (PM10) and <2.5 μm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) was estimated based on hourly concentrations. We employed a time-stratified case-crossover study design using a conditional Poisson regression model adjusted for meteorological variables, influenza epidemics, and holidays. Immediate exposure (lag 0) to most pollutants significantly increased the risk of total injuries (PM2.5, 0.42 %; NO2, 0.68 %; SO2, 1.05 %; CO, 0.57 %; O3, 1.86 % per interquartile range increment), and the associations differed according to the intention and mechanism of injury. Unintentional and assault injuries were significantly associated with air pollution exposure, whereas self-harm injuries showed no association. In mechanism-specific analyses, injuries caused by falls, blunt objects, penetration, traffic accidents, machinery, and slips were associated with specific air pollutants, even in the co-pollutant models. The associations were stronger in injured patients aged <15 years, and in males than in their counterparts. Our results suggest that short-term air pollution exposure might play a role in the risk of externally caused injuries and the association may differ depending on the intention and mechanism of injury, which provide important evidence for injury prevention and air quality strategies.

Using Patient-Reported Outcome Measures to Identify Factors Associated with Impaired Physical Function in Younger and Older Adults Living with Sickle Cell Disease

Background Improvements in disease management techniques have led to increases in the life expectancy of individuals with sickle cell disease (SCD). Despite the increasing number of older adults with SCD (defined as age ≥ 40 years), there is limited data on how symptoms experienced by this population such as pain, sleep, depression, and fatigue impact how they function day-to-day. In this study, we sought to determine which modifiable patient-reported factors most strongly correlate with patient reported physical function in adults with SCD. Understanding factors associated with impaired physical function will provide targets for future interventional studies to improve function. Methods We conducted a cross-sectional study at a single academic sickle cell center. Participants completed the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) Stiffness Impact and Sleep Impact surveys and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Pain Intensity, Pain Interference, Fatigue, Cognitive Function, and Emotional Distress measures. For ASCQ-Me, higher scores imply better self-reported health. For PROMIS, higher scores mean higher levels of the concept being measured. Relationships between the variables thought to influence SCD experience were explored using analytical networks and centrality measures (INSIGHTS, Nanbar Health's data analysis and 3D visualization tool) that built upon calculated pairwise Spearman correlations of the non-normal variable set. Results Surveys were administered to 92 participants with 97% of participants completing all surveys. The mean score for each item was obtained across all participants. Scores were then stratified by age group and t-tests were performed to compare scores on results between groups for each ASCQ-Me and PROMIS measure. Across those who completed both surveys, the mean age was 43 (SD 13.7). The mean age for older adults was 54 (SD 8.6) and the mean age for younger adults was 30 (SD 5.5). More participants were female (58%) than male (42%). Genotypes included HbSS (58%), HbSβ 0-thalassemia (5%), HbSC, (24%), and HbSβ +-thalassemia (13%). The mean score on PROMIS Physical Function for all participants was 48.7 with 18% of responders reporting impaired physical function (score ≤ 40). Older adults had lower mean scores on PROMIS Physical Function (46.4) vs. for younger adults (51.6, p &amp;lt;0.05). The strongest correlations were between PROMIS Physical Function and ASQME Stiffness Impact (r s= 0.66; p&amp;lt;0.001), PROMIS Pain Intensity (r s= -0.61; p&amp;lt;0.001), PROMIS Pain Interference, (r s= -0.61; p&amp;lt;0.001), and ASCQ-Me Fatigue (r s = -0.55; p&amp;lt;0.001). There was a moderate positive correlation between PROMIS Physical Function and ASCQ-Me Sleep Impact (r s= 0.40; p&amp;lt;0.001) and PROMIS Cognitive Function (r s=0.36 p &amp;lt; 0.001) implying better sleep and better cognitive function were associated with better patient reported physical function. Lastly, better physical function had a low-moderate association with PROMIS Emotional Distress (r s= - 0.24; p &amp;lt; 0.05). We assessed relationships between all of the patient-reported outcome measures and found that the strongest relationships were between Pain Intensity and Pain Interference (r s= 0.69), Pain Intensity and Stiffness (r s= -0.67), and Fatigue and Cognitive Function (r s= -0.69). There was no central node identified (Figure). Conclusion Each factor evaluated in this study showed a statistically significant and clinically meaningful relationship to patient reported physical function. One of our major findings was that when mapped against each other, there was no central node explaining the identified correlations between the variables assessed. These results suggest that physical functioning is multifactorial and that there exist multiple modifiable factors that may influence function in people with SCD. Factors associated with physical function will serve as targets for future interventional studies to maintain and improve function in adults with SCD.

Chronic Myeloid Leukemia Reduces Survival in Elderly Patients (age ≥ 75 years old): An International Multicenter Retrospective Study

Background Tyrosine kinase inhibitors (TKIs) have significantly improved the life expectancy of individuals with chronic myeloid leukemia (CML), bringing it closer to that of the age-matched general population 1. However, clinical trial data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program indicates that only 3.8% of CML patients aged 75 or above participate in trials, despite this age group representing about 30% of CML patients 2. This study aims to assess the outcomes of elderly patients aged 75 years or older diagnosed with CML. Methods We conducted a retrospective study, using electronic medical records of consecutive CML patients aged ≥ 75 years, diagnosed between January 2002 and December 2021 at four hematological centers in Israel and Moffitt Cancer Center in Florida, United States (MCC). One-year and five-year overall survival (OS) rates were calculated for the whole cohort and for octogenarians (above 80 years). In addition, to assess if CML diagnosis affected life expectancy, we estimated the expected OS of the Israeli cohort based on life expectancy data from the central bureau of statistics (CBS). Kaplan-Meier curves were used to compare expected and observed median OS with the Log-rank analysis. Local Institutional Review Boards approved the study. Results A total of 123 patients (78 treated in MCC and 45 in Israel) aged ≥ 75 years were diagnosed with CML, with a median age of 79 (range: 75 - 100) years, and 55 patients (45%) were octogenarians. At the time of CML diagnosis 84% of had comorbidities, including cardiovascular risk factors in 90 patients (73%), while 50 patients (41%) had cardiovascular/cerebrovascular diseases. Most patients (93%) were diagnosed in chronic phase CML and high/intermediate EUTOS-LTS risk score (96%) treated with imatinib in the 1 st line treatment (69%). After a median duration of 15 (range:1-153) months on 1 st line treatment, 71 patients (58%) discontinued therapy primarily due to intolerance (n=51) while other causes included resistance (n=15), noncompliance/insurance issues (n=4) or progression to blast crisis (n=1). The 2 nd -line treatment included mainly 2 nd generation TKIs (n=53, 74%) (dasatinib-26, nilotinib -19 and bosutinib-8), while 9 patients received imatinib, 1 patient received nilotinib and imatinib, 5 patients received hydroxyurea and 3 patients were lost to follow-up. 35 patients (28%) reached 3 rd line of treatment (imatinib- 5, dasatinib- 3, bosutinib-12, nilotinib-5, ponatinib-2, asciminib-1, hydroxyurea -1, loss to follow up- 6) chiefly (28 patients) due to intolerance and others (7 patients) due to resistance. The best response assessed by RQ-PCR showed deep molecular response (DMR) in 50%, major molecular response (MMR) in 16%, and complete cytogenetic response (CCyR) in 11% of patients with a median time to maximal response of 19 (range: 0.5-111) months. Nevertheless, treatment-free remission (TFR) was rare (n=1). During a median follow-up of 45 (0.4-198) months, 55 (45%) patients died, with cardiovascular complications (n=9), disease progression (n=8), infection (n=7), and secondary malignancy (n=4) being the main known causes. The median OS for the whole cohort was 72.4 (53.1-91.7) months. Improved OS was documented in patients with an age adjusted charlson comorbidity index&amp;lt; 5 (vs. ≥5, p=0.007), those who achieved DMR (vs. no DMR, p=0.001) and median time to best response of 0-18 months (vs. ≥18, p=0.004). Moreover, OS was improved in patients who received 2 nd generation TKIs in 1 st line treatment, 91.1 (81.5-131) vs. 57.7 (35.4-79.9) months in those who received imatinib, (p=0.023). Older age did not affect OS; 1 and 5-year OS for the whole cohort was 86% and 29%, respectively, and 84.3% and 19.6% for the octogenarians, respectively (p=0.076). In the Israeli cohort, while the median expected OS was 103.7 (24-164.7) months, the median observed OS was only 54.77 (2.1-195) months (p=0.03). Conclusions Elderly CML patients were often diagnosed in chronic phase with high/intermediate risk scores. The majority received imatinib as 1 st line treatment and achieved CCyR and MMR, with half of patients achieving also DMR. Surprisingly, patients treated with imatinib had worse OS compared to those receiving 2nd generation TKIs as 1st line treatment. Furthermore, the Israeli cohort analysis supports reduced life expectancy in the very elderly patients with CML.

Changing Trends in Sickle Cell Disease-Related Mortality in the United States over Four Decades

Introduction: Sickle cell disease (SCD) causes significant morbidity and early mortality. The Cooperative Study of Sickle Cell Disease estimated median life expectancy for individuals with SCD at 42 years for males and 48 years for females in the early 1990s. However, this calculation was made prior to now standards-of-care in SCD, including routine transcranial doppler screening, pneumococcal prophylaxis, and the introduction of the primary disease-modifying therapy hydroxyurea and the widespread use of chronic blood transfusion. Over the last thirty years, with expanded access to disease modifying therapies, increased evidence exists for the preservation of organ function and less frequent acute vaso-occlusive pain. It remains unclear whether the introduction of these therapies has affected overall SCD-related mortality or the specific causes of death of those with SCD in the United States, particularly in the last decade when the use of hydroxyurea has expanded most significantly. Methods: We used the US mortality statistics for 1979-2020 available publicly through the CDC WONDER database (http://wonder.cdc.gov), which is a compilation of county, state, and national-level mortality statistics derived from death certificates, including age category at death, sex, race, ethnicity, year of death, underlying cause of death, and additional contributing causes using ICD-9 codes for 1979-1998 (282.6 sickle cell anemia- all SCD genotypes were included under one code in ICD-9) and ICD-10 codes for 1999-2020 (D57.0 sickle cell anemia with crisis; D57.1 sickle cell anemia without crisis; D57.2 double heterozygous sickling disorders; D57.8 other sickle cell disorders). We searched the SCD ICD-10 codes listed as underlying cause of death by five-year age groups for Black individuals and all ethnicities, (from Hamideh and Alvarez, Pediatric Blood and Cancer 2013) and compared the crude death rates overall and for each age group to those of 1999-2009. We also searched using the SCD ICD-10 codes included in “the multiple causes of death” to determine the 15 most common ICD categories of death in each 10-year period. Results: For the period 2010-2020, 5272 Black (Hispanic &amp; non-Hispanic) individuals died in the United States with the underlying cause of death listed as one of the ICD-10 SCD codes (see Figure 1A for a map of the crude mortality rate distribution). The crude mortality rate was 1.1 per 100,000 Black individuals, which was significantly lower than the period 1999-2009 (crude rate 1.2 per 100,000, p &amp;lt; 0.0001) (Figure 1B). Of note, similar to prior trends, there is a significant increase in mortality rate in the 15-19 year age group versus 20-24 years (0.9 per 100,000 to 1.4 per 100,000, p &amp;lt; 0.0001) corresponding with the age of transition to adult centers. The mean age at death for all genotypes for 2010-2020 was 43 years (females: 44 years, males: 41 years) versus 39 years for 1999-2009 (females: 40 years, males: 38 years). For the period 2010-2020, 61% of cases listed SCD as the primary cause of death without specificity or proximal cause; for the other 39% of cases when an underlying cause of death was noted, cardiovascular disease was the most common (28%), followed by accidents (7%), cerebrovascular disease (7%), malignancy (6%), septicemia (4.8%), and renal disease (3.8%). The fifteen most common causes of death accounted for 90% of underlying causes of death listed in the SCD population. Conclusion: The sickle cell disease-related mortality rate has significantly declined over the last 40 years, including in the period 1999-2020, corresponding with the introduction of disease modifying therapies, improved SCD care, and decreased infant mortality. This overall improvement, however, provides contrast to the enduring sharp increase in mortality in the young adult years. This demonstrates the critical need to improve the transition process from pediatric to adult care and to emphasize the need for additional support for young adults after they transition to adult SCD care.

Cost-Effectiveness Analysis of Vaccines for COVID-19 According to Sex, Comorbidity and Socioeconomic Status: A Population Study.

Coronavirus disease 2019 (COVID-19) vaccines are extremely effective in preventing severe disease, but their real-world cost effectiveness is still an open question. We present an analysis of the cost-effectiveness and economic impact of the initial phase of the COVID-19 vaccination rollout in the Basque Country, Spain. To calculate costs and quality-adjusted life years for the entire population of the Basque Country, dynamic modelling and a real-world data analysis were combined. Data on COVID-19 infection outcomes (cases, hospitalisations, intensive care unit admissions and deaths) and population characteristics (age, sex, socioeconomic status and comorbidity) during the initial phase of the vaccination rollout, from January to June of 2021, were retrieved from the Basque Health Service database. The outcomes in the alternative scenario (without vaccination) were estimated with the dynamic model used to guide public health authority policies, from February to December 2020. Individual comorbidity-adjusted life expectancy and costs were estimated. By averting severe disease-related outcomes, COVID-19 vaccination resulted in monetary savings of €26.44 million for the first semester of 2021. The incremental cost-effectiveness ratio was €707/quality-adjusted life year considering official vaccine prices and dominant real prices. While the analysis by comorbidity showed that vaccines were considerably more cost effective in individuals with pre-existing health conditions, this benefit was lower in the low socioeconomic status group. The incremental cost-effectiveness ratio of the vaccination programme justified the policy of prioritising high-comorbidity patients. The initial phase of COVID-19 vaccination was dominant from the perspective of the healthcare payer.

Colorectal Cancer Screening Receipt Does Not Differ by 10-Year Mortality Risk Among Older Adults.

Health status and life expectancy are important considerations for assessing potential benefits and harms of colorectal cancer (CRC) screening programs, particularly among older adults. We examined receipt of past-year CRC screening according to predicted 10-year mortality risk among 25,888 community-dwelling adults aged 65-84 years who were not up-to-date with screening in the nationwide National Health Interview Survey. Ten-year mortality risk was estimated using a validated index; from the lowest to highest quintiles of the index, risk was 12%, 24%, 39%, 58%, and 79%, respectively. We also examined the proportion of screening performed among adults with life expectancy <10 years. The prevalence of past-year CRC screening was 39.5%, 40.6%, 38.7%, 36.4%, and 35.4%, from the lowest to highest quintile of 10-year mortality risk. Odds of CRC screening did not differ between adults in the lowest vs highest quintile (adjusted odds ratio 1.05, 95% confidence interval: 0.93-1.20). One-quarter (27.9%) of past-year CRC screening occurred in adults with life expectancy <10 years, and more than half (50.7%) of adults aged 75-84 years had 10-year mortality risk ≥50% at the time of screening. In an exploratory analysis, invasive but not noninvasive screening increased as 10-year mortality risk increased ( P < 0.05) among adults aged 70-79 years. Past-year CRC screening does not differ by predicted 10-year mortality risk. An age-based approach to CRC screening results in underscreening of older, healthier adults and overscreening of younger adults with chronic conditions. Personalized screening with incorporation of individual life expectancy may increase the value of CRC screening programs.

Modelling the effect of demographic change and healthcare infrastructure on the patient structure in German hospitals – a longitudinal national study based on official hospital statistics

BackgroundEffects of demographic change, such as declining birth rates and increasing individual life expectancy, require health system adjustments offering age- and needs-based care. In addition, healthcare factors can also influence health services demand.MethodsThe official German hospital statistics database with odd-numbered years between 1995 and 2011 was analysed. This is a national comprehensive database of all general hospital inpatient services delivered. Official data from hospital statistics were linked at the district level with demographic and socio-economic data as well as population figures from the official regional statistics. Panel data regression, modelling case numbers per hospital, was performed for 13 diagnosis groups that characterised the patient structure. Socio-demographic variables included age, sex, household income, and healthcare factors included bed capacity, personnel and hospital characteristics.ResultsThe median number of annual treatments per hospital increased from 6 015 (5th and 95th percentile [670; 24 812]) in 1995 to 7 817 in 2011 (5th and 95th percentile [301; 33 651]). We developed models characterising the patient structure of health care in Germany, considering both socio-demographic and hospital factors. Demographic factors influenced case numbers across all major diagnosis groups. For example, the age groups 65–74 and 75 + influenced cerebrovascular disease case numbers (p < 0.001). Other important factors included human and material resources of hospitals or the household income of patients. Distinct differences between the models for the individual diagnosis groups were observed.ConclusionsHospital planning should not only consider demographic change but also hospital infrastructure and socio-economic factors.