Life Expectancy Data Research Articles

Interactions between life expectancy and the incidence and mortality rates of cancer in China: a population-based cluster analysis

BackgroundThe relationship between cancer and life expectancy is well established in both developed and developing countries. China is a vast country with significant geographical differences in population structure and healthcare, and thus provides a unique opportunity to analyze the complex relationship between life expectancy and cancer incidence and mortality rates.MethodsCancer data were extracted for a total of 255 units (cities or counties) from the 2013 National Central Cancer Registry. Life expectancy data at the unit level were obtained from the National Centers for Disease Control and Prevention. Linear regression analysis was used to analyze the relationship between life expectancy and crude incidence and mortality rates of cancer. In a separate analysis, life expectancy was rated as low (< 76.0 years), middle (76–80 years), or high (> 80 years).ResultsOverall, the cancer incidence and mortality rates positively correlated with life expectancy in both sexes (R at 0.37 and 0.50, P < 0.001). The correlation was significant for the following cancers: lung, colorectal, prostate, bladder and pancreas, as well as for lymphoma in men (R 0.36–0.58, P < 0.001), lung, breast, colorectal, thyroid, uterus, and ovary in women (R 0.18–0.51, P < 0.001). We failed to observe an association between upper gastrointestinal cancer and life expectancy. The number of cities/counties with low, middle and high life expectancy levels were 110, 101 and 44, respectively. The highest age-standardized cancer incidence rate was observed in areas with a high life expectancy level (192.83/100,000). The highest age-standardized mortality rate was in areas with the lowest life expectancy (118.44/100,000). Cancers of the stomach, liver and esophagus are major cancer types in areas with low and middle life expectancy. In contrast, areas with high life expectancy had high incidence and mortality rates of colorectal cancer, breast cancer in women and prostate cancer in men.ConclusionsLonger life expectancy is associated with higher overall cancer incidence and mortality in China. The cancer pattern also varies substantially across areas with different life expectancy levels. Life expectancy levels must be considered when developing strategies to prevent and treat cancers.

Analisis Pengaruh Belanja Sektor Kesehatan Terhadap Angka Harapan Hidup Di Sumatera Utara

In increasing economic growth in an area, a dominant role is needed by the government in the area, where the government is spending in the hope that the greater the amount of government spending, the greater the economic growth of the region. The Human Development Index (HDI) in which there is a component of life expectancy is one of the measuring tools in looking at economic growth in an area. If the life expectancy in an area is higher then the level of productivity of the people in the area is also higher followed by an increase in income per capita which increases the purchasing power thus spurring the economic growth of the region. The purpose of this study was to examine the effect of government health spending in the health sector on life expectancy in the province of North Sumatra. The data used are North Sumatra government expenditure data in the field of health and life expectancy data in North Sumatra with the 2006-2014 base year obtained from the North Sumatra BPS and the Ministry of Health. The results of the Klassen Typology show that the relationship between health sector spending and life expectancy in the North Sumatra provincial district / city that which area is included in the high per capita expenditure category and where the area of life expectancy is low.

Socioeconomic inequalities in the non-fatal and fatal burden of disease: findings from Scottish Burden of Disease (SBoD) 2016 Scottish Burden of Disease Project Team

BackgroundSBOD2015 was the first endeavour to produce burden of disease estimates in Scotland using linkage of routine health records. In 2017, the study highlighted disparities in burden due to morbidity and mortality with respect to age and gender for 132 conditions, diseases and injuries.&#x0D; ObjectivesThe aim of SBOD2016 is to report on socioeconomic inequalities to provide further evidence to support preventable public health.&#x0D; MethodsMorbidity estimates were estimated using an extensive range of administrative datasets to provide a transparent and systematic approach to describe non-fatal population health loss. Combining these estimates with the Global Burden of Disease 2016 study’s relative assessment of severity and disability for each condition, we were able to calculate the Years Lived with Disability (YLD). Death registrations were used alongside life expectancy data to calculate the Years of Life Lost to premature mortality (YLL) as a measure of fatal burden.&#x0D; FindingsPreliminary findings show a three-fold increase in the burden of disease between individuals living in the most deprived areas compared to the least deprived areas. The profile of diseases contributing the largest burden also varies between the most and least deprived areas.&#x0D; ConclusionsBy combining information on fatal burden with the burden of living in less than ideal health (non-fatal burden), planners and policymakers have a better idea of the contribution that different diseases, conditions and injuries make to the total burden of disease and how this varies by levels of deprivation. This in turn provides information to support decisions about where prevention and service activity should be focused. It also provides a way of looking at the proportion of the burden that can be explained by a range of exposures in the population such as poverty or smoking.

New Insights into PM2.5 and Life-Expectancy Association using Predicted County-Average PM2.5 Concentrations

Background/Aim: Much of the current evidence of associations between long-term average PM2.5 exposures and health outcomes relies on exposures derived directly from regulatory monitoring data, using all available monitors in an area. These studies could be affected by limited data, particularly for time periods before 1999 when spatially extensive monitoring began. For instance, Pope et al. (2009) showed that between 1980 and 2000 a 10 µg/m3 reduction in PM2.5 was associated with 0.61±0.20 year longer life expectancy. That analysis used 1979-1983 averages of PM2.5 across 51 U.S. metropolitan statistical areas estimated from about 100 monitoring sites in the Inhalable Particulate Network. Our reanalysis re-examines this association using population-representative county-level predicted concentrations of PM2.5. Methods: We used the same life expectancy data in 211 continental U.S. counties as Pope et al. (2009). We predicted annual average PM2.5 concentrations at 70,000 census tract centroids for 1979-2004, using a previously developed point prediction model. We averaged these to the county level for the same years (1979-1983 and 1999-2000) and estimated regression coefficients for a PM2.5 reduction on life expectancy improvement over the 1980 and 2000 time periods, adjusting for area-level confounders. Results: We found a 10 µg/m3 decrease in predicted county average PM2.5 was associated with an average 0.69±0.31 year increase in life expectancy, slightly higher than the estimate reported by Pope et al. (2009). The PM2.5 effect estimates varied by pollutant averaging period and were larger when more recent years were included. However, all effect estimates had overlapping confidence intervals. Conclusions: Our approach to estimating population-representative PM2.5 concentrations lends additional support to the evidence that reduced in fine particulate matter contributes to improved life expectancy. Our estimates had wider confidence intervals because our county-averaged concentrations are less variable than those estimated directly from limited monitoring data.

Tolerable rates of visual field progression in a population-based sample of patients with glaucoma

AimsTo provide population-based data on the maximum tolerable rate of progression to avoid visual impairment (maxTRoP_VI) and blindness (maxTRoP_BL) from open-angle glaucoma (OAG).MethodsParticipants with OAG in the Thessaloniki Eye Study...

Happier countries, longer lives: an ecological study on the relationship between subjective sense of well-being and life expectancy.

The relationship between sense of well-being and longevity is not well-established across populations of varying levels of socioeconomic status. We sought to examine the relationship between happiness, or subjective sense of well-being and life expectancy using data from 151 countries. This analysis is based on the 2012 Happy Planet Index project conducted by the Center of Well-Being of the New Economics Foundation, based in the United Kingdom. Well-being data for each country were taken from responses to the 'Ladder of Life' question in the 2012 Gallup World Poll in which participants were asked to rate their quality of life on a scale from 1 (worst possible life) to 10 (best possible life). Life expectancy and gross domestic product data were taken from the 2011 United Nations records. Ecological footprint data were taken from Global Footprint Network records. Subjective sense of well-being was highly correlated with life expectancy (Pearson correlation r = 0.71, p < 0.0001). In a multivariable linear regression model adjusted for gross domestic product, ecological footprint, and population, each 1 unit of the well-being scale was associated with an increase in life expectancy of 4.0 years (95% confidence interval = 2.7-5.3). In conclusion, better sense of well-being has a strong relationship with life expectancy regardless of economic status or population size, suggesting that governments should foster happiness in order to support long-living populations.

Estimating utility weights and quality-adjusted life year loss for colorectal cancer-related health states in Korea

We aimed to assess utility weight of health states associated with colorectal cancer (CRC) that reflect the societal preference of the Korean population and to estimate the quality-adjusted life year (QALY) loss with CRC. We recruited 607 individuals from the Korean population; they were surveyed via face-to-face computer-assisted interviews. The participants evaluated each CRC-associated health state using standard gamble. Utility weight for each health state was calculated as the possibility of full health restoration. Moreover, we estimated total QALY loss due to CRC in Korean individuals aged ≥30 years in 2013. To calculate QALY due to morbidity, we yielded utility weights and used epidemiologic data of CRC on severity from the National Cancer Control Institute. QALY loss due to mortality was calculated using mortality of CRC and life expectancy data from the Korean Statistical Information Service. The highest and lowest utility weights were assigned to “adenomatous polyps” and “metastatic colon cancer”, respectively. Total QALY loss due to CRC in Korea was 173,662; these patients were more likely to be men or be included in the 70–74-year age group. These utility weights may be useful for conducting cost-utility studies of cancer screening for CRC and for measuring disease burden with QALY.

Towards quality, comprehensiveness and excellence. The accreditation project of the Organisation of European Cancer Institutes (OECI).

There are important gaps in the health status of citizens across Europe, as measured by life expectancy, mortality or morbidity data (Report for the European Commission on the health status of the European Union, 2003). Among the main determinants of the major causes of mortality and morbidity, stated in this report, stands recurrently access to quality healthcare. There is a fundamental need to define quality indicators and set minimal levels of performance quality criteria for healthcare. There is a need to integrate research into healthcare and to provide patients with equity of access to such high quality care. Oncology is a specialty particularly suited to experimenting a first application of accreditation at European level. The Organisation of European Cancer Institutes is a growing network of cancer Centres in Europe. The focus of the OECI is to work with professionals and organisations with regard to prevention, care, research, development, patient's role and education. In order to fulfil its mission, the OECI initiated in 2002 an accreditation project with three objectives: * to develop a comprehensive accreditation system for oncology care, taking into account prevention, care, research, education and networking. * to set an updated database of cancer centres in Europe, with exhaustive information on their resources and activities (in care, research, education and management) * to develop a global labelling tool dedicated to comprehensive cancer centres in Europe, designating the various types of cancer structures, and the comprehensive cancer centres of reference and Excellence. An accreditation tool has been established, defining standards and criteria for prevention, care, research, education and follow-up activities. A quantitative database of cancer centres is integrated in the tool, with a questionnaire, that provides an overall view of the oncological landscape in OECI cancer centres in Europe. Data on infrastructures, resources and activities have been collected. This OECI accreditation tool will be launched in autumn 2008 for all cancer centres in Europe. It serves as a basis for the development of the labelling tool for cancer structures in Europe, with a focus on Comprehensiveness and Excellence labels. Quality assessment and improvement is a critical need in Europe and is addressed by the OECI for cancer care in Europe. Accreditation is a well accepted process and is feasible. Standards and criteria as well as an accreditation tool have been developed. The OECI questionnaire gives an accurate vision of cancer institutions throughout Europe, helping assessing the needs and providing standards. The accreditation project is a long-term complete and voluntary process with external and internal added value, an active process of sharing information and experience that should help the whole cancer community reach comprehensiveness and excellence.

Long-term mortality after IPD and bacteremic versus non-bacteremic pneumococcal pneumonia

BackgroundShort-term mortality after invasive pneumococcal disease (IPD) and pneumococcal pneumonia is high but data on long-term mortality (including the comparison between bacteremic and non-invasive/non-bacteremic pneumococcal pneumonia) within the first years after diagnosis are scarce. MethodsAdult patients with ‘non-pneumonia’ IPD and ‘invasive pneumonia’ (from 2004 to 2012) and with ‘bacteremic’ vs ‘non-invasive/non-bacteremic (NI/NB)’ pneumococcal pneumonia (from 2008 to 2012) diagnosed by negative blood culture but a positive urinary antigen test (UAT) were identified in a Dutch hospital. Mortality of patients up to 10years after diagnosis was compared with age- and sex-matched life-expectancy data of the general population. Multivariable Cox regression analysis was used to study predictors for mortality in invasive pneumonia patients and to adjust for confounders comparing mortality between bacteremic and NI/NB/UAT-positive pneumonia patients. ResultsOf 228 invasive pneumonia patients 17% died within 30days and in 30-day survivors cumulative long-term mortality at 1 and 5years were 16% and 39% as compared with 3% and 15% in age- and sex-matched persons. High mortality was largely dependent on pre-existent comorbidities. In invasive pneumonia patients who survived the first 30days, age, male gender, chronic cardiovascular disease, malignancy and PCV7 serotype disease were independent predictors for higher long-term mortality. For bacteremic pneumonia patients (n=128) 30-day mortality was 16% and almost similar to 14% in NI/NB/UAT-positive pneumococcal pneumonia patients (n=170). In 30-day survivors of bacteremic pneumonia (n=108, median age 66years), cumulative mortality at 1 and 3years were 13% and 29% as compared with 18% and 40% in NI/NB/UAT-positive pneumococcal pneumonia patients (n=146, median age 67years) without a significant difference in mortality. ConclusionsApproximately 40% of all patients, who survived the first 30days after presentation with non-pneumonia IPD and pneumococcal pneumonia died within the following 5years. High long-term mortality was largely dependent on pre-existent comorbidity.

Predictions Burden of Diabetes and Economics Cost: Contributing Risk Factors of Changing Disease Prevalence and its Pandemic Impact to Qatar.

Background: The Middle East region is predicted to have one of the highest prevalence of diabetes mellitus (DM) in the world. The risk of diabetes continues to increase worldwide and its public health burden is unevenly distributed across socioeconomic strata. This burden is not only related to health care costs, but also to indirect costs caused by loss of productivity from disability and premature mortality. Aim: This study aims to estimate the economics cost of type 2 Diabetes Mellitus [T2DM] among adults in Qatar using national data, and to quantify the potential effect of a suggested preventive intervention program. Design: It is an observational cohort study. Setting: The survey was based on registry at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar. Subject: This study consisted of patients above 25 years of age with diagnosed diabetes mellitus registered at Hamad General Hospital and Primary Health Care (PHC) centers during January 2004 to July 2014. Methods: We developed a dynamic model in which actual incidence, prevalence, and life expectancy data are used and alternative assumptions about future trends in these parameters can be incorporated. Linear regression model has been performed to forecast the burden of diabetes in oil-rich country. Results: According to the dynamic model, a 10% increased in the number of diabetic patients in the State of Qatar from 33 610 in 2005 to 122 000 in 2012 (about 1% annually). The annual diabetes incidence rate was higher in women than in men during a period between 2005 to 2015 years. The static model forecasted as 10% increase over 10 years. The relative increase in prevalence of diabetes and number of diabetic people are higher in women than in men (16.6%; 17.5% and 18.4% in men vs. 22.6%; 23.8% and 25.1% in women). Most of the increase in prevalence of diabetes is projected to occur in younger age groups where it is estimated to increase among age groups of 50-59 years and above 60 years, respectively. Conclusion: The burden of diabetes in Qatar is markedly larger than proposed by IDF estimations - suggesting that Qatar would be one of the top 10 countries worldwide in diabetes prevalence. Family history of diabetes, consanguinity marriages', hereditary gene-environment interactions, poor nutrition in utero and in early life plus over nutrition in later life may also contribute to the current diabetes epidemic in Qatari's Arab populations. Finally, continuous training of primary health care professionals on diabetes care and prevention is an essential tool of improving diabetes in Qatar.

Comparing overall survival (OS) outcomes in patients with newly diagnosed chronic lymphocytic leukemia (CLL) with normal life expectancy.

7 Background: CLL is an orphan hematologic malignancy but also accounts for the most common adult leukemia in the Western Hemisphere, with a median age at diagnosis of 72 years. Median OS for symptomatic, treatment-naïve, elderly patients with CLL is approximately 5.3 years (CLL5; Eichhorst, et al. Blood 2009), whereas the life expectancy of a 72 year old (yo) is around 12 years (US Life Tables, 2006). Ibrutinib, an oral, first-in-class, covalent Bruton’s tyrosine kinase inhibitor, significantly improves OS. Early results from a phase 1/2 study in treatment-naïve elderly patients with CLL (PCYC-1102; median age, 71 years) suggest that single-agent ibrutinib extends OS, with survival at 3 years of approximately 97% (Byrd, et al. Blood 2015). Here we compare the OS in newly diagnosed patients with CLL treated with single-agent ibrutinib or chlorambucil with the normal life expectancy of a 72 yo adult. Methods: OS outcomes for patients treated with chlorambucil from the CLL5 study conducted in Germany (Eichhorst, et al. Blood 2009) were compared with long-term OS results from PCYC-1102 (Byrd, et al. Blood 2015). Life expectancy data were obtained from US Life Tables. Results: Results from CLL5 suggest that single-agent chlorambucil has a median OS of 5.3 years (median age, 71 years), with approximately 75% of patients alive at 3 years. The median OS for ibrutinib has not been reached (median follow-up, 3 years), with an estimated progression-free survival of 96% and OS of 97% at 3 years. Life expectancy for a 72 yo healthy person at 3 years is approximately 95%. Naïve comparisons suggest that single-agent ibrutinib may be altering the natural history of CLL, providing a longer OS versus chlorambucil and a similar OS as expected in a 72 yo in the general population. Conclusions: Treatment outcomes in CLL are fundamentally changing with the advent of new targeted therapies. This indirect naïve comparison between ibrutinib-treated patients and a general population suggests we may be moving from palliative care for elderly patients with CLL to chronic care management. Implications for chronic care management of patients with CLL will be discussed.

Centenarian Rates and Life Expectancy Related to the Death Rates of Multiple Sclerosis, Asthma, and Rheumatoid Arthritis and the Incidence of Type 1 Diabetes in Children.

The autoimmune diseases are among the 10 leading causes of death for women and the number two cause of chronic illness in America as well as a predisposing factor for cardiovascular diseases and cancer. Patients of some autoimmune diseases have shown a shorter life span and are a model of accelerated immunosenescence. Conversely, centenarians are used as a model of successful aging and have shown several immune parameters that are better preserved and lower levels of autoantibodies. The study reported here focused on clarifying the connection between longevity and some autoimmune and allergic diseases in 29 developed Organisation for Economic Co-operation and Development (OECD) countries, because multidisciplinary analyses of the accelerated or delayed aging data could show a distinct relationship pattern, help to identify common factors, and determine new important factors that contribute to longevity and healthy aging. The relationships between the mortality rates data of multiple sclerosis (MS), rheumatoid arthritis (RA), asthma, the incidence of type 1 diabetes (T1D) from one side and centenarian rates (two sets) as well as life expectancy data from the other side were assessed using regression models and Pearson correlation coefficients. The data obtained correspond to an inverse linear correlation with different degrees of linearity. This is the first observation of a clear tendency of diminishing centenarian rates or life expectancy in countries having higher death rates of asthma, MS, and RA and a higher incidence of T1D in children. The conclusion is that most probably there are common mechanistic pathways and factors affecting the above diseases and at the same time but in the opposite direction the processes of longevity. Further study, comparing genetic data, mechanistic pathways, and other factors connected to autoimmune diseases with those of longevity could clarify the processes involved, so as to promote longevity and limit the expansion of those diseases in the younger and older population.

Abstract 17368: Years of Life Lost Due to Heart Failure in the United States (US)

Background: Heart failure (HF) is a complicated syndrome where ~50% of patients die within 5 years of diagnosis. Years of life lost (YLL) is a population-based mortality indicator that takes into account age at death, giving greater weight to deaths occurring at a younger age and thereby providing information on mortality that is relevant to the entire population without the bias of elderly death. A YLL analysis was applied to patients with HF to illustrate the relationship between HF and premature mortality. Further YLL for HF was compared to other common elderly diseases. Methods: Data between 1999 and 2012 on the number of deaths attributed to HF and other conditions common in the elderly were from the Centers for Disease Control and Prevention and the National Center for Health Statistics online database; standard life-expectancy data for the US were from the World Health Organization global health observatory data repository. YLL was calculated from the number of deaths multiplied by years of life remaining based on a standard life expectancy at the age at which death occurs. Total YLL over all age groups was then divided by the total number of deaths for the mean YLL per HF patient. The same calculation was made for several other conditions for comparison. Results: A total of 804,095 US deaths were attributed to HF. The mean HF YLL was 9.64 years, which was higher than YLL calculated for osteoporosis and Alzheimer’s/other dementias (7.12 and 7.67 years, respectively; Figure) and similar to Parkinson’s disease (9.73 years). Conclusions: Analysis of premature mortality by YLL suggests that patients with HF would live on average 9.64 years longer had they not developed HF.

Prior rates of visual field loss and lifetime risk of blindness in glaucomatous patients undergoing trabeculectomy.

Trend-based analyses examining rates of visual field (VF) loss in glaucoma are useful for predicting risk of vision-related morbidity. Although patients with faster losses are likely to require treatment escalation, little is known about rates that might trigger a decision to intervene surgically. The aims of this study were to investigate prior rates of VF loss in patients attending for trabeculectomy and to estimate, in the absence of surgical intervention, lifetime risk of visual impairment, and blindness. A retrospective analysis of 117 eyes of 86 consecutive patients with glaucoma attending for trabeculectomy, including 53 patients referred from general ophthalmology clinics and 33 patients from specialist glaucoma clinics. Rates of change in standard automated perimetry mean deviation were examined using linear regression and random coefficient models. Risk of lifetime visual impairment and blindness was calculated using life expectancy data. Mean age at surgery was 71.0±9.7 years. Patients were followed for 10.7±7.5 years prior to surgery with an average of seven useable fields per eye. On average patients referred from general clinics lost 1.04 dB/year compared with 0.77 dB/year in those referred from glaucoma clinics (P=0.070). Patients referred from general clinics had more medication changes prior to surgery (3.4 and 2.6 changes, respectively; P=0.004). Given Scottish life expectancy data, untreated, 61 eyes (52%) would have passed the threshold for visual impairment, whereas 40 (34%) would have passed the threshold demarcating blindness. Patients attending for trabeculectomy had faster average rates of field loss prior to surgery than published values for the general glaucoma population with over one-third of eyes studied predicted to have become blind without intervention. Those managed by glaucoma specialists had fewer changes in medication and tended to slower rates of VF loss, although the latter did not reach statistical significance.

Cost-effectiveness of revascularization strategies: the ASCERT study.

ASCERT (American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies) was a large observational study designed to compare the long-term effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) to treat coronary artery disease (CAD) over 4 to 5 years. This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease. The Society of Thoracic Surgeons and American College of Cardiology Foundation databases were linked to the Centers for Medicare and Medicaid Services claims data. Costs for the index and observation period (2004 to 2008) hospitalizations were assessed by diagnosis-related group Medicare reimbursement rates; costs beyond the observation period were estimated from average Medicare participant per capita expenditure. Effectiveness was measured via mortality and life-expectancy data. Cost and effectiveness comparisons were adjusted using propensity score matching with the incremental cost-effectiveness ratio expressed as cost per quality-adjusted life-year gained. CABG patients (n = 86,244) and PCI patients (n = 103,549) were at least 65 years old with 2- or 3-vessel coronary artery disease. Adjusted costs were higher for CABG for the index hospitalization, study period, and lifetime by $10,670, $8,145, and $11,575, respectively. Patients undergoing CABG gained an adjusted average of 0.2525 and 0.3801 life-years relative to PCI over the observation period and lifetime, respectively. The life-time incremental cost-effectiveness ratio of CABG compared to PCI was $30,454/QALY gained. Over a period of 4 years or longer, patients undergoing CABG had better outcomes but at higher costs than those undergoing PCI.

Burden of disease caused by keratinocyte cancer has increased in The Netherlands since 1989

Keratinocyte cancer is the most common cancer among Caucasians. We sought to study time trends of the burden of disease attributable to keratinocyte cancer in The Netherlands. Data of all patients with newly diagnosed keratinocyte cancer (ie, squamous cell carcinoma and basal cell carcinoma) were obtained from the population-based Netherlands Cancer Registry and the Eindhoven Cancer Registry (1989-2008). Population structure, mortality data, and life expectancy data were extracted from Statistics Netherlands. The disability-adjusted life-years (DALY) was the sum of the years of life lived with disability and the years of life lost. The world standardized rate of keratinocyte cancer has doubled and was 103 and 94 per 100,000 person-years for males and females in 2004 to 2008, respectively. DALYs as a result of basal cell carcinoma increased by 124% and DALYs as a result of squamous cell carcinoma increased by 66% from 1989 to 1993. Keratinocyte cancer accounted for a total loss of 19,913 DALYs (15,369 years of life lived with disability and 4544 years of life lost) between 2004 and 2008. Only the first keratinocyte cancer was included in this study. Keratinocyte cancer is a large burden to the Dutch society. Because incidence rates of keratinocyte cancer continue to increase, the management becomes even more challenging.

Inbred mouse strains reveal biomarkers that are pro-longevity, antilongevity or role switching.

Traditionally, biomarkers of aging are classified as either pro-longevity or antilongevity. Using longitudinal data sets from the large-scale inbred mouse strain study at the Jackson Laboratory Nathan Shock Center, we describe a protocol to identify two kinds of biomarkers: those with prognostic implication for lifespan and those with longitudinal evidence. Our protocol also identifies biomarkers for which, at first sight, there is conflicting evidence. Conflict resolution is possible by postulating a role switch. In these cases, high biomarker values are, for example, antilongevity in early life and pro-longevity in later life. Role-switching biomarkers correspond to features that must, for example, be minimized early, but maximized later, for optimal longevity. The clear-cut pro-longevity biomarkers we found reflect anti-inflammatory, anti-immunosenescent or anti-anaemic mechanisms, whereas clear-cut antilongevity biomarkers reflect inflammatory mechanisms. Many highly significant blood biomarkers relate to immune system features, indicating a shift from adaptive to innate processes, whereas most role-switching biomarkers relate to blood serum features and whole-body phenotypes. Our biomarker classification approach is applicable to any combination of longitudinal studies with life expectancy data, and it provides insights beyond a simplified scheme of biomarkers for long or short lifespan.

Epigenetics: Where Environment, Society and Genetics Meet

Understanding how environment, social factors and genetics combine to affect patterns of health is an urgent priority. Social factors that affect health patterns include race and socioeconomic status (SES), while biological factors include sex, genetics and epigenetics. The consequence of biology and environment can be observed in life expectancy data. At 25 years old, life expectancy for white men is 4.4 years greater than for African–American men. Females follow a similar pattern. Income also affects life expectancy with high income earners outliving their low income counterparts, and white males and females outliving African–American males and females by 2–4 years at every income level [1]. Environment also affects perinatal mortality. US-born African–American women experience greater rates of perinatal mortality than their foreign-born counterparts [2]. Similar patterns can be observed with multiple health conditions, including cancer, depression, diabetes and heart disease highlighting the importance of this issue [1]. What is less clear is the mechanism by which these disparities are caused. One way in which biology and environment can both leave their fingerprint is through epigenetic changes. Epigenetics refers to the regulation of gene expression through modifications to DNA or DNA-associated proteins. Epigenetic regulation includes histone modifications, DNA methylation and nonprotein coding RNA. DNA methylation has been a particular focus of environment-mediated changes in health. Methylation changes have been associated with environmental chemical exposure [3], race, gender [4] and income level [5]. However, epigenetic gene regulation is bigger than methylation alone. Human and animal studies have begun to investigate environmental effects on epigenetics. While these publications are increasing, some factors need to be considered, these include tissue specificity, epigenetic specificity and transgenerational studies.

Natural History of Untreated Prostate Specific Antigen Radiorecurrent Prostate Cancer in Men with Favorable Prognostic Indicators

Background and Purpose. Life expectancy data could identify men with favorable post-radiation prostate-specific antigen (PSA) failure kinetics unlikely to require androgen deprivation therapy (ADT). Materials and Methods. Of 206 men with unfavorable-risk prostate cancer in a randomized trial of radiation versus radiation and ADT, 53 experienced a PSA failure and were followed without salvage ADT. Comorbidity, age and established prognostic factors were assessed for relationship to death using Cox regression analyses. Results. The median age at failure, interval to PSA failure, and PSA doubling time were 76.6 years (interquartile range [IQR]: 71.8–79.3), 49.1 months (IQR: 37.7–87.4), and 25 months (IQR: 13.1–42.8), respectively. After a median follow up of 4.0 years following PSA failure, 45% of men had died, none from prostate cancer and no one had developed metastases. Both increasing age at PSA failure (HR: 1.14; 95% CI: 1.03–1.25; P = 0.008) and the presence of moderate to severe comorbidity (HR: 12.5; 95% CI: 3.81–41.0; P < 0.001) were significantly associated with an increased risk of death. Conclusions. Men over the age of 76 with significant comorbidity and a PSA doubling time >2 years following post-radiation PSA failure appear to be good candidates for observation without ADT intervention.

Projection of Diabetes Burden through 2025 and Contributing Risk Factors of Changing Disease Prevalence: An Emerging Public Health Problem

Background: The Middle East region is predicted to have one of the highest prevalence of diabetes mellitus (DM) in the world. This is the first study in the region to forecast the burden of diabetes. Aim: This study aims to estimate the projected prevalence of type 2 diabetes mellitus [T2DM] among adults in Qatar over the period 2012 to 2025 using national data, and to quantify the potential effect of a suggested preventive intervention program. Design: It is an observational cohort study. Setting: The survey was based on registry at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar. Subjects: This study consisted of patients above 25 years of age with diagnosed diabetes mellitus registered at Hamad General Hospital and Primary Health Care (PHC) centers during January 2006 to December 2012. Methods: We developed a dynamic model in which actual incidence, prevalence, and life expectancy data are used and alternative assumptions about future trends in these parameters can be incorporated. Linear regression model has been performed to forecast the burden of diabetes in oil - rich country. Result: According to the dynamic model, a 10% increased in the number of diabetic patients in the State of Qatar from 37000 in 2006 to 122,000 in 2012 (about 1% annually). The annual diabetes incidence rate was higher in women than in men during a period between 2006 to 2012 years. The static model forecasted as 10% increase over 10 years. The relative increase in prevalence of diabetes and number of diabetic people is higher in women than in men (16.6%; 17.5% and 18.4% in men vs. 22.6%; 23.8% and 25.1% in women). Most of the increase in prevalence of diabetes is projected to occur in younger age groups where it is estimated to increase among age groups of 50-59 years and above 60 years, respectively. Conclusion: The burden of diabetes in Qatar is markedly larger than proposed by IDF estimations- suggesting that Qatar would be one of the top ten countries worldwide in diabetes prevalence. Family history of diabetes, consanguinity marriages’, hereditary gene-environment interactions, poor nutrition in utero and in early life plus over nutrition in later life may also contribute to the current diabetes epidemic in Qatari’s Arab populations. In planning future health care, monitoring of trends in incidence, prevalence, remission, and mortality or life expectancy is a necessary prerequisite.