Loss Of Life Expectancy Research Articles

Assessing the impact of including variation in general population mortality on standard errors of relative survival and loss in life expectancy

BackgroundA relative survival approach is often used in population-based cancer studies, where other cause (or expected) mortality is assumed to be the same as the mortality in the general population, given a specific covariate pattern. The population mortality is assumed to be known (fixed), i.e. measured without uncertainty. This could have implications for the estimated standard errors (SE) of any measures obtained within a relative survival framework, such as relative survival (RS) ratios and the loss in life expectancy (LLE). We evaluated the existing approach to estimate SE of RS and the LLE in comparison to if uncertainty in the population mortality was taken into account.MethodsThe uncertainty from the population mortality was incorporated using parametric bootstrap approach. The analysis was performed with different levels of stratification and sizes of the general population used for creating expected mortality rates. Using these expected mortality rates, SEs of 5-year RS and the LLE for colon cancer patients in Sweden were estimated.ResultsIgnoring uncertainty in the general population mortality rates had negligible (less than 1%) impact on the SEs of 5-year RS and LLE, when the expected mortality rates were based on the whole general population, i.e. all people living in a country or region. However, the smaller population used for creating the expected mortality rates, the larger impact. For a general population reduced to 0.05% of the original size and stratified by age, sex, year and region, the relative precision for 5-year RS was 41% for males diagnosed at age 85. For the LLE the impact was more substantial with a relative precision of 1286%. The relative precision for marginal estimates of 5-year RS was 3% and 30% and for the LLE 22% and 313% when the general population was reduced to 0.5% and 0.05% of the original size, respectively.ConclusionsWhen the general population mortality rates are based on the whole population, the uncertainty in the estimates of the expected measures can be ignored. However, when based on a smaller population, this uncertainty should be taken into account, otherwise SEs may be too small, particularly for marginal values, and, therefore, confidence intervals too narrow.

Determination of Air Quality Life Index (Aqli) in Medinipur City of West Bengal(India) During 2019 To 2020 : A contextual Study

The Air Quality Index (AQI) utilized in various nations doesn't plainly show how much air pollution influences the average life expectancy (LE). This study explicitly shows how much air pollutants (especially atmospheric particulate matter) reduce the average LE of an individual in a given year in a specific city. This study has determined the Air Quality Life Index (AQLI) and has shown a reduction in the average LE of each resident of Medinipur city in 2019 and 2020. The reduction in human LE due to particulate matter pollution is actually based on a pair of semi-experimental variation studies, especially in the Chinese setting, derived from the impact of coarse particles (PM10: particle size ranges between 2.5 micrometers and 10 micrometers) on the northern and southern border populace of the China Huai River. The results showed that “an additional 10 micrograms per cubic meter of PM10 exposure reduces LE by 0.64 yrs’’.1 The methodology used in this study is based on the University of Chicago Energy Policy Institute's (EPIC) epidemiological estimates that provide the most acceptable and modified equation for determining global AQLI, which uses PM2.5 to PM10 ratios due to global PM10 data unavailability and recommends that ‘additional sustainable exposure to fine particles or PM2.5 (particle size less than or equal to 2.5 micrometers) reduces LE by 0.98 years per 10 micrograms per cubic meter’ which was followed by a pair of experimental results by Chen et al. (2013) and Ebenstein et al. (2017) on the impacts of long-term PM pollution on permanent residents of both the north and south sides of the China Huai River.2 Regional or global previous fine particle (PM2.5) densities are measured at a specific resolution using an integrated geophysical-statistical method that provides the global fine particulate or PM2.5 data3 used to determine the AQLI of a country or city, although PM2.5 concentrations are considered for world atmospheric pollution because atmospheric particulate matter (PM2.5) invades the deeper structures of the respiratory tract and has a more harmful or toxic impact on humans than coarse particles (PM10).4,5 Therefore, the current annual PM2.5 data is used by the ground-based monitor of PM2.5 concentration to determine the AQLI of the respective city in this study. The results of the study have shown that the current annual concentration of PM2.5 obtained from BreezoMeter and PMS3003 at four selected stations (S1 to S4) in Medinipur city ranged from 23 to 29 µg/m³ per year and the average LE loss in Medinipur varied from 1.3 years to 1.87 years per person, which may be caused by cardiopulmonary disease and lung cancer.

Excess mortality associated with elevated body weight in the USA by state and demographic subgroup: A modelling study

SummaryBackgroundThe obesity epidemic in the USA continues to grow nationwide. Although excess weight-related mortality has been studied in general, less is known about how it varies by demographic subgroup within the USA. In this study we estimated excess mortality associated with elevated body weight nationally and by state and subgroup.MethodsWe developed a nationally-representative microsimulation (individual-level) model of US adults between 1999 and 2016, based on risk factor data from 6,002,012 Behavioral Risk Factor Surveillance System respondents. Prior probability distributions for hazard ratios relating body-mass index (BMI) to mortality were informed by a global pooling dataset. Individual-level mortality risks were modelled accounting for demographics, smoking history, and BMI adjusted for self-report bias. We calibrated the model to empirical all-cause mortality rates from CDC WONDER by state and subgroup, and assessed the predictive accuracy of the model using a random sample of data withheld from model fitting. We simulated counterfactual scenarios to estimate excess mortality attributable to different levels of excess weight and smoking history.FindingsWe estimated that excess weight was responsible for more than 1300 excess deaths per day (nearly 500,000 per year) and a loss in life expectancy of nearly 2·4 years in 2016, contributing to higher excess mortality than smoking. Relative excess mortality rates were nearly twice as high for women compared to men in 2016 (21·9% vs 13·9%), and were higher for Black non-Hispanic adults. By state, overall excess weight-related life expectancy loss ranged from 1·75 years (95% UI 1·57–1·94) in Colorado to 3·18 years (95% UI 2·86-3·51) in Mississippi.InterpretationExcess weight has substantial impacts on mortality in the USA, with large disparities by state and subgroup. Premature mortality will likely increase as obesity continues to rise.FundingThe JPB Foundation, NIH, CDC

Risks and benefits of evacuation in TEPCO's Fukushima Daiichi nuclear power station accident

One month after the TEPCO accident, the number of the disaster-related deaths in Fukushima Prefecture exceeded that in Miyagi and Iwate which were not affected by the radiation, due to increase in disuse syndrome during the prolonged evacuation by the accident. About 90% of the deaths were the elderly. The risk and benefit of the evacuation of 11 municipalities in Fukushima are analyzed using data published by the Japanese government. The total loss of life expectancy (LLE) of the disaster-related deaths is 5,100,000 person-days. The LLE avoided by the evacuation is estimated from the cumulative doses of 172 locations. The average cumulative dose avoided is 205 mSv in 10 years. Total LLE avoided for 100,000 evacuees is 1,850,000 person-days. It is 2.8 times less than that accompanies evacuation. The delay in lifting the evacuation orders caused many disaster-related deaths among the elderly. The long-term evacuation of the TEPCO accident followed the dose rate recommended by ICRP, but is not justified.Discussions are provided for future improvements: (1) Lifetime fatal cancer probability from radiation exposure in the elderly is one-fifth of the average. Current guidelines do not take that into account. The difference needs to be incorporated into the nuclear emergency guidelines. (2) Radiation protection measures cannot describe other health risks, but the present guides are developed from the perspective of radiation protection. (3) Need to revise emergency guides to consider other health risks such as disuse syndrome of Fukushima, unnecessary abortions of Chernobyl and mental and psychological problems. (4) Risk communication with the general public does not work in a nuclear accident. (5) Exempt the ALARA principle from the public in low-dose area in the event of a nuclear accident. (6) Allow evacuees to participate in decontamination and restoration work. The lesson is important for countries where nuclear power plants are located in agricultural areas and are aging.

Risk of cardiovascular disease and loss in life expectancy in NAFLD.

Conflicting evidence exists on cardiovascular disease (CVD) risk in patients with NAFLD, and data are lacking on whether NAFLD increases mortality after a CVD event. Moreover, life expectancy in NAFLD has not been studied. We therefore examined CVD risk and life expectancy in patients with NAFLD compared with the general population. In this nationwide population-based cohort, all patients with NAFLD diagnosis and without baseline CVD (ascertaining from the Swedish National Patient Register from 1987 to 2016, n=10,023) were matched 10:1 on age, sex, and municipality to individuals from the general population (controls, n=96,313). CVD diagnosis and mortality were derived from national registers. Multistate models and flexible parametric survival models were used to estimate adjusted hazard ratios (aHRs) for CVD risk and loss in life expectancy due to NAFLD. We identified 1037 (10.3%) CVD events in patients with NAFLD and 4041 (4.2%) in controls. CVD risk was 2.6-fold higher in NAFLD compared with controls (aHR = 2.61, 95% CI = 2.36-2.88) and was strongest for nonfatal CVD (aHR = 3.71, 95% CI = 3.29-4.17). After a nonfatal CVD event, the risk for all-cause mortality was similar between patients with NAFLD and controls (aHR = 0.89, 95% CI = 0.64-1.25). Life expectancy in patients with NAFLD was, on average, 2.8 years lower than controls, with the highest loss of life-years when NAFLD was diagnosed in middle age (40-60 years). NAFLD was associated with a higher risk of nonfatal CVD but did not affect post-CVD mortality risk. Patients diagnosed with NAFLD have a lower life expectancy than the general population.

Long-Term Survival, Stroke Recurrence, and Life Expectancy After an Acute Stroke in Australia and New Zealand From 2008–2017: A Population-Wide Cohort Study

Data on long-term outcomes following an acute stroke are sparse. We assessed survival, risk of recurrent stroke and loss in life expectancy following an acute stroke using population-wide data from Australia and New Zealand. We included all adults with the first stroke hospitalization during 2008 and 2017 at all public and most private hospitals. Patients were followed up to 10 years after the stroke by linkage to each region's Registry of Deaths and subsequent hospitalizations. Flexible parametric survival modeling was used to estimate all-cause mortality, stroke recurrence, and loss in life expectancy. Competing risk model was used when estimating the risk of stroke recurrence. Three hundred thirteen thousand one hundred sixty-two patients were included (mean age 73.0±14.6 y, 52.0% males) with ischemic stroke (175 547, 56.1%) being the most common, followed by hemorrhagic stroke (77 940, 24.9%) and unspecified stroke (59 675, 19.1%). The overall survival probability was 79.4% at 3 months, 73.0% at 1 year, 52.8% at 5 years, and 36.4% at 10 years. Cumulative incidence of stroke recurrence was 7.8% at 3 months, 11.0% at 1 year, 19.8% at 5 years, and 26.8% at 10 years. Hemorrhagic stroke was associated with greater mortality (hazard ratio, 2.02 [95% CI, 1.99-2.04]) and recurrent stroke (hazard ratio, 1.63 [95% CI, 1.59-1.67]) compared with ischemic stroke. Female sex (hazard ratio, 1.10 [95% CI, 1.09-1.11]) and increasing age (≥85 years versus 18-54 years: hazard ratio, 7.36 [95% CI, 7.15-7.57]) were also associated with increased mortality. Several risk factors including atherosclerotic coronary and noncoronary vascular disease, cardiac arrhythmia, and diabetes were associated with increased risk of mortality and recurrent stroke. Compared with the general population, an acute stroke was associated with a loss of 5.5 years of life expectancy, or 32.7% of the predicted life expectancy, and was pronounced in patients with a hemorrhagic stroke (7.4 years and 38.5% of predicted life expectancy lost). In this population-wide study, death and recurrence of stroke were common after an acute stroke and an acute stroke was associated with considerable loss in life expectancy. Further improvements in treatment and secondary prevention of stroke are needed to reduce these risks.

Healthcare Performance Evaluation using preventable mortality criteria

Introduction. There is an urgent need to develop independent objective criteria for evaluating the Moscow healthcare system in accordance with the priorities of increasing life expectancy. Objectives. The study is aimed at assessing the methodology of preventable mortality by Moscow healthcare specialists, identifying the scale and dynamics of preventable mortality in Moscow on the basis of this methodology and assessing the impact of healthcare on life expectancy of Moscow population according to the set of criteria. Methods and materials. In 2019, an electronic survey was conducted among the experts from 14 medical specialties (937 respondents) working in inpatient and/or outpatient organizations. Upon the received results, trends and causes of preventable mortality in Moscow are presented. Results. There are three criteria that indicate the effectiveness of Moscow healthcare system over the past two decades (2000-2018): rapid-decreasing mortality from preventable causes against the background of the dynamics of total mortality in patients up to 75 years; higher rates of mortality reduction from causes dependent on behavioral risk factors; reduction in preventable mortality share in the life expectancy loss. At the same time, the rates of preventable mortality in Moscow remain quite significant, indicating that there is more potential for reducing premature mortality in Moscow. Of the 6.8 years for males and 3.7 years for females reduced by the maximum possible life expectancy before the age of 75 due to premature mortality, preventable deaths account for 5.0 and 2.3 years, respectively. By reducing mortality from preventable causes classified in group 1 and depending on the quality of medical care, life expectancy at the age of 75 years can be increased according to 2018 data by 2.3 years for men and 1.4 years for women. Due to causes classified in group 2 and dependent on effective primary prevention and public health efforts, the increase could be 2.8 and 0.8 years, respectively. The results of our study reveal potential for reducing mortality from nosological and age perspectives, and can be used to update health policy measures.

Work stress and loss of years lived without chronic disease: an 18-year follow-up of 1.5 million employees in Denmark

We aimed to examine the association between exposure to work stress and chronic disease incidence and loss of chronic disease-free life years in the Danish workforce. The study population included 1,592,491 employees, aged 30–59 in 2000 and without prevalent chronic diseases. We assessed work stress as the combination of job strain and effort-reward imbalance using job exposure matrices. We used Cox regressions to estimate risk of incident hospital-diagnoses or death of chronic diseases (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and calculated corresponding chronic disease-free life expectancy from age 30 to age 75. Individuals working in occupations with high prevalence of work stress had a higher risk of incident chronic disease compared to those in occupations with low prevalence of work stress (women: HR 1.04 (95% CI 1.02–1.05), men: HR 1.12 (95% CI 1.11–1.14)). The corresponding loss in chronic disease-free life expectancy was 0.25 (95% CI − 0.10 to 0.60) and 0.84 (95% CI 0.56–1.11) years in women and men, respectively. Additional adjustment for health behaviours attenuated these associations among men. We conclude that men working in high-stress occupations have a small loss of years lived without chronic disease compared to men working in low-stress occupations. This finding appeared to be partially attributable to harmful health behaviours. In women, high work stress indicated a very small and statistically non-significant loss of years lived without chronic disease.

Prevalence and Health-Adjusted Life Expectancy Among Older Adults With Hypertension in Chinese Rural Areas

BackgroundThe objectives of the present study were to explore the epidemiological characteristics of hypertension among rural older adults in resource-limited regions, and then evaluate the loss of health-adjusted life expectancy due to hypertension.MethodsParticipants aged between 60 and 79 years were enrolled from Henan rural cohort study. The prevalence, awareness, treatment, and control of hypertension were detailed across subgroups. Variances within subgroups were identified via Student's t tests or one-way ANOVA for continuous variables and chi-squared tests for categorical ones, and logistic regression model was employed to detect the potential influencing factors. The health-adjusted life expectancy was calculated by the Sullivan method with EuroqOL-5D data.ResultsAmong 16,785 participants, 7,472 (44.52%) were attacked by hypertension, 4,858 (65.02%) had been already aware of their condition, 4,009 (53.65%) were taking antihypertensive medication for treatment, while only 1,478 (19.78%) had their hypertension controlled. The prevalence of hypertension was significantly higher among women than men and it increased with age for both genders. For the older ones aged 60 years, the life expectancy was 22.0872 years and the health-adjusted life expectancy was 15.5578 and 15.9418 for those with or without hypertension, respectively. Namely, in this particular age group, subjects without hypertension could gain 0.3840 years of health-adjusted life expectancy.ConclusionThe prevalence of hypertension was relatively high while the awareness, treatment, and control were fairly low. The health-adjusted life expectancy of older adults in resource-limited areas could increase from the reduction of hypertension. There is an urgent need for strategies pertaining to the prevention and treatment of hypertension.Clinical Trial RegistrationThe Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375.

Assessing lead time bias due to mammography screening on estimates of loss in life expectancy

BackgroundAn increasingly popular measure for summarising cancer prognosis is the loss in life expectancy (LLE), i.e. the reduction in life expectancy following a cancer diagnosis. The proportion of life lost (PLL) can also be derived, improving comparability across age groups as LLE is highly age-dependent. LLE and PLL are often used to assess the impact of cancer over the remaining lifespan and across groups (e.g. socioeconomic groups). However, in the presence of screening, it is unclear whether part of the differences across population groups could be attributed to lead time bias. Lead time is the extra time added due to early diagnosis, that is, the time from tumour detection through screening to the time that cancer would have been diagnosed symptomatically. It leads to artificially inflated survival estimates even when there are no real survival improvements.MethodsIn this paper, we used a simulation-based approach to assess the impact of lead time due to mammography screening on the estimation of LLE and PLL in breast cancer patients. A natural history model developed in a Swedish setting was used to simulate the growth of breast cancer tumours and age at symptomatic detection. Then, a screening programme similar to current guidelines in Sweden was imposed, with individuals aged 40–74 invited to participate every second year; different scenarios were considered for screening sensitivity and attendance. To isolate the lead time bias of screening, we assumed that screening does not affect the actual time of death. Finally, estimates of LLE and PLL were obtained in the absence and presence of screening, and their difference was used to derive the lead time bias.ResultsThe largest absolute bias for LLE was 0.61 years for a high screening sensitivity scenario and assuming perfect screening attendance. The absolute bias was reduced to 0.46 years when the perfect attendance assumption was relaxed to allow for imperfect attendance across screening visits. Bias was also present for the PLL estimates.ConclusionsThe results of the analysis suggested that lead time bias influences LLE and PLL metrics, thus requiring special consideration when interpreting comparisons across calendar time or population groups.

Loss of life expectancy due to respiratory infectious diseases: findings from the global burden of disease study in 195 countries and territories 1990-2017.

Understanding of the patterns of and changes in mortality from respiratory infectious diseases (RID) and its contribution to loss of life expectancy (LE) is inadequate in the existing literature. With rapid sociodemographic changes globally, and the current COVID-19 pandemic, it is timely to revisit the disease burden of RID. Using the approaches of life table and cause-eliminated life table based on data from the Global Burden of Disease Study (GBD), the study analyses loss of LE due to RID in 195 countries/territories and its changes during the period 1990–2017. Results indicate that loss of LE due to RID stood at 1.29 years globally in 2017 globally and varied widely by age, gender, and geographic location, with men, elderly people, and populations in middle/low income countries/territories suffering a disproportionately high loss of LE due to RID. Additionally, loss of LE due to RID decreased remarkably by 0.97 years globally during the period 1990–2017 but increased slightly among populations older than 70 years and in many high income countries/territories. Results suggest that RID still pose a severe threat for population and public health, and that amid dramatic sociodemographic changes globally, the disease burden of RID may resurge. The study presents the first examination of the life-shortening effect of RID at the global and country/territory levels, providing new understanding of the changing disease burden of RID and shedding light on the potential consequences of the current COVID-19 pandemic.

Evaluation of distribution characteristics and health risk of polycyclic aromatic hydrocarbons in sediments: From the perspective of land–ocean coordination

Land-ocean coordinated management is an important wisdom for environmental protection and pollution prevention of marine and river systems. Taking Liao River and Estuarine as an example, the pollution characteristics, temporal and spatial distribution and change features of Polycyclic Aromatic Hydrocarbons (PAHs) in sediments in recent 20 years were studied from two different analysis perspectives of land and ocean. The research showed that the pollution of PAHs in the sediments of Liao River and Estuarine was not optimistic. The concentration of Σ16PAHs was 48–28,000 ng/g. The carcinogenic risk to humans shouldn't be ignored, which could cause the loss of life expectancy 0.03–4.2 years. The traceability analysis showed that the use and combustion of fossil fuels were the main sources of PAHs. In addition, the leakage of oil during the intensive transportation of ships in coastal waters might also contribute to PAHs. The concentrations of PAHs had obvious temporal and spatial distribution characteristics. Spatially, estuaries < tributaries < main streams; temporally, wet season < normal season < dry season in Liao River. Whereas, the variation of PAHs in estuarine sediments was slight. In the past 20 years, the concentration of PAHs in Liao River had increased first and then decreased, reaching maximum in 2010; However, the concentration of PAHs seldom decreased in estuarine sediments, in which showed a more serious situation of PAHs pollution control.

Women with bladder cancer: an underserved population due to a faulty health care system or in a biological disadvantage?

Abstract&#x0D; Although men are four times more frequently diagnosed than women with urothelial bladder cancer, clinical outcomes greatly differ between both genders, as women present a higher lethality rate, as well as a greater loss of life expectancy. At diagnosis, women present more advanced clinical stages, situation which has led to many efforts to elucidate the social determinants of health and the biological factors implied. Women face different challenges associated with a delay in both, diagnosis and treatment, a more limited access to systemic treatment, and lower response rates associated with immunotherapy. Women are underrepresented in the main chemotherapy, immunotherapy, and other systemic treatment trials, as they comprise only 15 to 25% of the overall population, limiting the possibility of drawing any definitive conclusions. Furthermore, through gene expression analysis, women have been linked to a more aggressive biological subtype of bladder cancer (basal), a higher rate of FGFR 1-4 mutated tumors, lower rate of NECTIN-4 expression, and a higher prevalence of germline mutations. Despite the worse prognosis, sex-based recommendations have not been developed. Cancer care teams must not hinder access to treatment options based on sex and should strive for an equitable cancer care.

Attributing hypertensive life expectancy loss to ambient heat exposure: A multicenter study in eastern China

Ambient high temperature is a worldwide trigger for hypertension events. However, the effects of heat exposure on hypertension and years of life lost (YLL) due to heat remain largely unknown. We conducted a multicenter study in 13 cities in Jiangsu Province, China, to investigate 9727 individuals who died from hypertension during the summer months (May to September) between 2016 and 2017. Meteorological observation data (temperature and rainfall) and air pollutants (fine particulate matter and ozone) were obtained for each decedent by geocoding the residential addresses. A time-stratified case-crossover design was used to quantify the association between heat and different types of hypertension and further explore the modification effect of individual and hospital characteristics. Meanwhile, the YLL associated with heat exposure was estimated. Our results show that summer heat exposure shortens the YLL of hypertensive patients by a total of 14,74 years per month. Of these, 77.9% of YLL was mainly due to hypertensive heart disease. YLL due to heat was pronounced for essential hypertension (5.1 years (95% empirical confidence intervals (eCI): 4.1–5.8)), hypertensive heart and renal disease with heart failure (4.4 years (95% eCI: 0.9–5.9)), and hypertensive heart and renal disease (unspecified, 3.5 years (95% eCI: 1.8–4.5)). Moderate heat was associated with a larger YLL than extreme heat. The distance between hospitals and patients and the number of local first-class hospitals can significantly mitigate the adverse effect of heat exposure on longevity. Besides, unmarried people and those under 65 years of age were potentially susceptible groups, with average reduced YLL of 3.5 and 3.9 years, respectively. Our study reveals that heat exposure increases the mortality risk from many types of hypertension and YLL. In the context of climate change, if effective measures are not taken, hot weather may bring a greater burden of disease to hypertension due to premature death.

Comparing the loss of life expectancy at birth during the 2020 and 1918 pandemics in six European countries

The COVID-19 pandemic that reached Europe in 2020 has often been compared to the Spanish flu pandemic of 1918. In this article, we compare the two pandemics in terms of their respective impacts on the loss of life expectancy at birth in six European countries (France, Italy, the Netherlands, Spain, Sweden, Switzerland) by estimating life expectancy in 2020 using Eurostat data. We found that the loss of life expectancy at birth was up to 20 times larger between 1917 and 1918 than between 2019 and 2020. A decomposition of these losses clearly shows that in all six countries, the main contributors were older age groups in 2020 and younger age groups in 1918. These observations are consistent with evidence indicating that most COVID-19 fatalities were among the elderly, while a majority of Spanish flu fatalities were among the young.

Life expectancy and cancer survival in Oncosalud: outcomes over a 15-year period in a Peruvian private institution.

BackgroundThere is a large gap in the data on cancer outcomes in Latin America, making it difficult to establish adequate cancer control policies in the region. The aim of our study was to describe the survival, life expectancy estimates and life expectancy changes over time for a large cohort of Peruvian patients insured with Oncosalud, a private healthcare system.Patients and methodsWe evaluated a retrospective cohort of patients diagnosed between 2000 and 2015 in Oncosalud (Lima-Peru). Cases included colon, rectum, stomach, bladder, breast, prostate and non-melanoma skin cancers. Survival was evaluated with the Kaplan–Meier methodology. The standard period life table was used to estimate the excess mortality risks of patients in our cohort compared to the population covered by the Peruvian Superintendence of Banks, Insurance Companies and Pension Funds (SBS). The years of life lost was estimated based on SBS population, matching patients by age and sex.ResultsA large cohort of 7,687 Peruvian cancer patients managed in a 15-year period was eligible. If patients survive 5 years after a cancer diagnosis, life expectancy tends to be close to that of a population without cancer. The number of years of life lost at diagnosis was higher at the youngest ages, steadily decreasing thereafter. During the first years after cancer diagnosis, young patients face a much higher loss in life expectancy than older ones. Patients suffering from colon, rectum, stomach and bladder cancer are the most affected by the years of life lost.ConclusionIn cancer patients surviving ≥ 5 years, life expectancy becomes similar to that observed in a population with similar socioeconomic characteristics. The estimated survival rate in our cohort is higher than that reported by public cancer registries in Peru. This could be explained by the different socio-economic background and access to specialised cancer care.

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-shortening effects of radiological weapons in military operations

Military operations can present risks whose origins may be unconventional. As an example, we can mention those within the spectrum of chemical, biological, radiological, and nuclear (CBRN) defense. This study evaluates, through a computer simulation, an operation in which soldiers face radiological contamination after the triggering of a radiological dispersion device (RDD) in an inhabited urban area. The simulation of the Gaussian scattering (analytical) of the Cs-137 radionuclide is performed using the HotSpot Health Physics codes software. The results of the simulation are evaluated according to two radiological risk domains, referring to high (above 100 mSv) and low integrated radiation doses over 4 continuous days of operation. The radiological risk for developing solid cancer according to specific epidemiological models was estimated. This information served as a basis for estimating the future detriment, that is, the loss of life expectancy (LLE). In addition, the methodology may serve as an instructional resource for tabletop exercises contributing to develop leadership and preparation for decision-making in asymmetric environments.

Optimising health and economic impacts of COVID-19 vaccine prioritisation strategies in the WHO European Region: a mathematical modelling study.

SummaryBackgroundCountries in the World Health Organization (WHO) European Region differ in terms of the COVID-19 vaccine supply conditions. We evaluated the health and economic impact of different age-based vaccine prioritisation strategies across this demographically and socio-economically diverse region.MethodsWe fitted age-specific compartmental models to the reported daily COVID-19 mortality in 2020 to inform the immunity level before vaccine roll-out. Models capture country-specific differences in population structures, contact patterns, epidemic history, life expectancy, and GDP per capita.We examined four strategies that prioritise: all adults (V+), younger (20-59 year-olds) followed by older adults (60+) (V20), older followed by younger adults (V60), and the oldest adults (75+) (V75) followed by incrementally younger age groups. We explored four roll-out scenarios (R1-4) — the slowest scenario (R1) reached 30% coverage by December 2022 and the fastest (R4) 80% by December 2021. Five decision-making metrics were summarised over 2021-22: mortality, morbidity, and losses in comorbidity-adjusted life expectancy, comorbidity- and quality-adjusted life years, and human capital. Six vaccine profiles were tested — the highest performing vaccine has 95% efficacy against both infection and disease, and the lowest 50% against diseases and 0% against infection.FindingsOf the 20 decision-making metrics and roll-out scenario combinations, the same optimal strategy applied to all countries in only one combination; V60 was more or similarly desirable than V75 in 19 combinations. Of the 38 countries with fitted models, 11-37 countries had variable optimal strategies by decision-making metrics or roll-out scenarios. There are greater benefits in prioritising older adults when roll-out is slow and when vaccine profiles are less favourable.InterpretationThe optimal age-based vaccine prioritisation strategies were sensitive to country characteristics, decision-making metrics, and roll-out speeds. A prioritisation strategy involving more age-based stages (V75) does not necessarily lead to better health and economic outcomes than targeting broad age groups (V60). Countries expecting a slow vaccine roll-out may particularly benefit from prioritising older adults.FundingWorld Health Organization, Bill and Melinda Gates Foundation, the Medical Research Council (United Kingdom), the National Institute of Health Research (United Kingdom), the European Commission, the Foreign, Commonwealth and Development Office (United Kingdom), Wellcome Trust

Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years

BackgroundThe objectives of this research were to determine the savings of loss-of-life expectancy (LE) and lifetime medical costs (LMC) from prevention of spinal cord injuries (SCI) in Taiwan.MethodsFrom the claims...