Years Of Potential Life Research Articles

The burden of opioid-related mortality in Texas, 1999 to 2019

To examine and quantify the burden of opioid-related mortality utilizing a serial cross-sectional design of individuals 15 to 64 years of age whose death was related to opioid use from January 1, 1999, to January 31, 2019. Data was obtained from the CDC WONDER Multiple Cause of Death Online Database, which captures mortality and population estimates across the United States stratified by geography, age, sex, race, and ethnicity. The burden of opioid-related deaths in Texas was evaluated as the proportion of all deaths attributable to this underlying cause of death over the study period and years of potential life lost (YPLL). Results revealed that between 1999 and 2019, 19,039 opioid-related deaths occurred among persons age 15 to 64, resulting in an increase of 402% over the study period (from 3.8 per 100,000 in 1999 to 8.2 per 100,000 in 2019). In 2019, the number of opioid-related deaths was highest among males (67.1%), non-Hispanic whites (76.0%), and adults aged 25-54 (74.1%). Overall, in Texas in 2019, opioid-related deaths resulted in 51,743 years of potential life lost (3.2 YPLL per 1000) most of which were among males (36,318 YPLL). Additionally, premature mortality due to opioids was highest among adults aged 25 to 34 years (5.1 YPLL per 1000) , and those aged 35 to 44 years (3.8 YPLL per 1000). We identified a steady yet significant rise in opioid-related mortality in Texas since 1999 and in particular among demographic groups considered at relatively high risk for midlife mortality. This study is also considered the first of its kind to quantify the burden of premature mortality related to opioid overdoses in Texas.

Epidemiology of cardiovascular disease in Europe.

This Review presents data describing the health burden of cardiovascular disease (CVD) within and across the WHO European Region. CVD remains the most common cause of death in the region. Deaths from CVD in those aged <70years, commonly referred to as premature, are a particular concern, with >60 million potential years of life lost to CVD in Europe annually. Although more women than men die from CVD, age-standardized rates of both morbidity and death are higher in men, and these differences in rates are greatest in individuals aged <70 years. Large inequalities in all measures of morbidity, treatment and mortality can be found between countries across the continent and must be a focus for improving health. Large differences also exist in the data available between countries. The development and implementation of evidence-based preventive and treatment approaches must be supported in all countries by consistent surveillance and monitoring, such that we can quantify the health burden of CVD as well as target interventions and provide impetus for action across Europe.

Male-Female Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: A State-by-State Analysis

Males are at higher risk relative to females of severe outcomes following COVID-19 infection. Focusing on COVID-19-attributable mortality in the United States (U.S.), we quantified and contrasted years of potential life lost (YPLL) attributable to COVID-19 by sex based on data from the U.S. National Center for Health Statistics as of 31 March 2021, specifically by contrasting male and female percentages of total YPLL with their respective percent population shares and calculating age-adjusted male-to-female YPLL rate ratios, both nationally and for each of the 50 states and the District of Columbia. Using YPLL before age 75 to anchor comparisons between males and females and a novel Monte Carlo simulation procedure to perform estimation and uncertainty quantification, our results reveal a near-universal pattern across states of higher COVID-19-attributable YPLL among males compared to females. Furthermore, the disproportionately high COVID-19 mortality burden among males is generally more pronounced when measuring mortality burden in terms of YPLL compared to death counts, reflecting dual phenomena of males dying from COVID-19 at higher rates and at systematically younger ages relative to females. The U.S. COVID-19 epidemic also offers lessons underscoring the importance of cultivating a public health environment that recognizes sex-specific needs as well as different patterns in risk factors, health behaviors, and responses to interventions between men and women. Public health strategies incorporating focused efforts to increase COVID-19 vaccinations among men are particularly urged.

Impact of racial disparities on potential years of life lost due to gynecologic cancer in the United States: trends from 1975 to 2017 based on SEER database

<h3>Objectives:</h3> Gynecologic cancer is a major health problem in the United States. We assessed potential years of life lost (PYLL) in women secondary to gynecologic cancer in the United States from 1975 to 2017 using the SEER (Surveillance, Epidemiology and End Results) database. We also report race-adjusted trends in PYLL to highlight racial disparities impacting mortality in gynecologic malignancies. <h3>Methods:</h3> We extracted data from the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 2019 dataset using ICD-O codes for cervix, corpus and uterus, ovary, vulvar, vaginal and other gynecologic cancers. Patients who were diagnosed between 1975-2017 were included. Survival time was estimated by using recorded age of diagnosis and survival data from SEER. Potential years of life lost up to and including age 75 years were calculated after stratifying for tumor site. Statistical analysis was done using One-Way ANOVA test. <h3>Results:</h3> A total of 342159 patients were included in the analysis. Total 1825109 potential years of life were lost due to gynecologic cancers from 1975 to 2017. Uterine followed by ovarian were the two most common gynecologic malignancies with highest number of recorded cases (46.4% and 24.8% respectively). Median PYLL for cervical cancer (12.7 years) was higher than other gynecologic malignancies likely due to early median age of diagnosis (49 years). Across the board, for every subtype of gynecologic malignancy reported, median PYLL for Non-Hispanic White (NHW) population was lower as compared to women from all other racial and ethnic groups. p-value was significiant for every tumor type (Table 1). For NHW females with uterine cancer median PYLL was -0.8 years suggesting likelihood of survival past age of 75 years. <h3>Conclusions:</h3> Analysis of real-world data represents a clear trend pointing towards racial and ethnic disparities in PYLL due to gynecologic malignancies in the United States. Health care policies and efforts need to be focused on improving access to treatment and affordability of medical care for population groups at higher risk of losing quality life years.

The Great Unequalizer: Initial Health Effects of COVID-19 in the United States

We measure inequities from the COVID-19 pandemic on mortality and hospitalizations in the United States during the early months of the outbreak. We discuss challenges in measuring health outcomes and health inequality, some of which are specific to COVID-19 and others that complicate attribution during most large health shocks. As in past epidemics, preexisting biological and social vulnerabilities profoundly influenced the distribution of disease. In addition to the elderly, Hispanic, Black and Native American communities were disproportionately affected by the virus, particularly when assessed using the years of potential life lost metric. We provide a conceptual framework and initial empirical analysis that seek to shed light on contributors to pandemic-related health inequality, and we suggest areas for future research.

Mortality associated with non-melanoma skin cancer in Spain from 1979 to 2018: trends and age-adjusted rates.

Non-melanoma skin cancers (NMSCs) are the most frequent group of malignant tumours worldwide. Objectives: The aim of the present research was to analyse mortality associated with NMSC in Spain between 1979 and 2018 and highlight changes regarding trend in mortality and differences according to age groups and gender. Death records and mid-year population data were collected from the National Statistics Institute. Age-standardized mortality rates were calculated. Significant changes in mortality trends were identified using Joinpoint regression. The independent effects of age, period and cohort and potential years of life lost due to NMSC were also analysed. Mortality rates associated with NMSC in Spain were reported as 2.49 per 100,000 inhabitants in 1979 (95%CI: 2.24-2.77) and 1.27 per 100,000 inhabitants in 2018 (95%CI; 1.16-1.39) for the overall population. Women who were born after the 70 s showed a significant increase in relative risk of death due to NMSC. Mortality associated with NMSC in Spain shows a decreasing overall trend that appears to have stabilized since 2005, with the exception of women between 35 and 64 years old.

Estimation of the economic burden of COVID-19 using disability-adjusted life years (DALYs) and productivity losses in Kerala, India: a model-based analysis

ObjectivesFrom the beginning of the COVID-19 pandemic, clinical practice and research globally have centred on the prevention of transmission and treatment of the disease. The pandemic has had a huge...

Long-term Survival of Treated Tuberculosis Patients in Comparison to a General Population In South India: A Matched Cohort Study

ObjectivesThis study aimed to measure the mortality rate, potential years of life lost, and excess general mortality among individuals treated for pulmonary tuberculosis (TB) in a TB endemic country. MethodsA retrospective analysis was conducted on a population-based cohort study of 4022 TB patients and 12,243 gender-matched and age-matched controls from prevalence surveys conducted between 2000 and 2004 in the Thiruvallur district of Tamil Nadu, South India. ResultsThe mortality rate among TB patients was 59/1000 person-years. The excess standardized mortality ratio was 2.3 (95% CI: 1.7–3.1). The rate of potential years of life lost was 6.15/1000 (95% CI: 5.97–6.33) in the TB cohort compared to the general population of 1.52/1000 (95% CI: 1.46–1.60). Individuals aged >50 years, those underweight (<40 kg), with treatment failures, or lost to follow-up had higher mortality rates when compared with the rest of the TB cohort. The risk of death was significantly higher in the TB cohort until the end of the fourth year when compared with later years. ConclusionMortality in the TB cohort was 2.3 times higher than in the age-matched general population. Most deaths occurred in the first year after completing treatment. Post-treatment follow-ups and interventions for reducing comorbid conditions are necessary to prevent deaths.

Mortality and Years of Potential Life Lost Due to COVID-19 in Brazil

In November 2020, Brazil ranked third in the number of cases of coronavirus disease 2019 (COVID-19) and second in the number of deaths due to the disease. We carried out a descriptive study of deaths, mortality rate, years of potential life lost (YPLL) and excess mortality due to COVID-19, based on SARS-CoV-2 records in SIVEP-Gripe (Ministry of Health of Brazil) from 16 February 2020, to 1 January 2021. In this period, there were 98,025 deaths from COVID-19 in Brazil. Men accounted for 60.5% of the estimated 1.2 million YPLLs. High YPLL averages showed prematurity of deaths. The population aged 45–64 years (both sexes) represented more than 50% of all YPLLs. Risk factors were present in 69.5% of deaths, with heart disease, diabetes and obesity representing the most prevalent comorbidities in both sexes. Indigenous people had the lowest number of deaths and the highest average YPLL. However, in indigenous people, pregnant women and mothers had an average YPLL of over 35 years. The excess mortality for Brazil was estimated at 122,914 deaths (9.2%). The results show that the social impacts of YPLL due to COVID-19 are different depending on gender, race and risk factors. YPLL and excess mortality can be used to guide the prioritization of health interventions, such as prioritization of vaccination, lockdowns, or distribution of facial masks for the most vulnerable populations.

Nosological and Age and Gender Profile of the Vologda Oblast Population Mortality and the Associated Demographic Losses

The continuation and deepening of regional studies of the nosological and age and gender structure of mortality and its temporal dynamics is due both to the need for scientific monitoring of the implementation of regional programs and projects of the Vologda Oblast dedicated to the protection and promotion of public health, and the need to update the trends in mortality of the region residents in the context of modern socio-demographic challenges (population aging, depopulation, a complex epidemiological situation against the background of the spread of coronavirus infection).The purpose of the study was the analysis of the nosological and age and gender profile of mortality in the Vologda Oblast and the resulting demographic losses, including their transformation over the period from 2015 to 2019. The choice of the analyzed period is not accidental: if in 2015 the region was characterized by the most positive indicators of natural population movement (the total coefficient of natural loss since the beginning of the 2000s reached a minimum of -1.1 per mille), then by 2019 the situation changed dramatically — the indicator of natural loss increased and amounted to - 4.5 per mille.Materials and methods. The study was based on both general scientific and special statistical and demographic methods of research — structural and dynamic analysis of mortality indicators of the Vologda oblast population; assessment of demographic losses due to premature mortality by calculating lost years of potential life; calculation of mortality rates. The information base was the data of the territorial body of the Federal state statistics service for the Vologda Oblast, in particular, the annual data on the distribution of the deceased by sex, age groups and causes of death for 2015-2019.Results. The conducted study allowed us to establish that, in general, the structure of mortality in the region shows signs of its gradual modernization: the level of mortality from diseases of the circulatory system, external causes of death and their share in the total number of deaths are reduced, while increasing the proportion of neoplasms, symptoms, signs, deviations from the norm detected in clinical and laboratory tests, which is quite natural due to the shift in mortality to older age groups. At the same time, its features “slow down” the evolution of the mortality structure, such as a high proportion of young age groups (under 45 years old), especially categories 30-44 years old, in mortality from external causes, infectious and parasitic diseases, endocrine diseases, nutritional disorders, metabolic disorders and, as a result, the large scale of premature mortality of the region's population; male premature super-mortality, as well as the high contribution of the child population (0-14 years old) to premature mortality from diseases of the nervous system and sensory organs.Conclusion. Against the background of the coronavirus pandemic, the fact of a high contribution of young age groups (up to 45 years) to mortality from infectious and parasitic diseases is of great concern due to the likelihood of a sharp increase in the scale of human losses as a result of the layering of new premature deaths due to the consequences of COVID-19. It is considered necessary to include additional indicators of mortality reflecting its gender, age and nosological profile in the regional comprehensive program “Public health — in the center of attention”.

Epidemiology and risk factors for stroke in young individuals: implications for prevention.

Summarize and examine the epidemiology, etiologies, risk factors, and treatment of stroke among young adults and highlight the importance of early recognition, treatment, and primordial prevention of risk factors that lead to stroke. Incidence of stroke, predominantly ischemic, among young adults has increased over the past two decades. This parallels an increase in traditional risk factors such as hypertension, diabetes, and use of tobacco, and use of illicit substances among young stroke patients. Compared to older patients, there is a much higher proportion of intracerebral and subarachnoid hemorrhage in young adults. The cause of ischemic stroke in young adults is also more diverse compared to older adults with 1/3rd classified as stroke of undetermined etiology due to inadequate effort or time spent on investigating these diverse and rare etiologies. Young premature Atherosclerotic Cardiovascular Disease patients have suboptimal secondary prevention care compared to older patients with lower use of antiplatelets and statin therapy and lower adherence to statins. Among young patients, time-critical diagnosis and management remain challenging, due to atypical stroke presentations, vast etiologies, statin hesitancy, and provider clinical inertia. Early recognition and aggressive risk profile modification along with primary and secondary prevention therapy optimization are imperative to reduce the burden of stroke among young adults and save potential disability-adjusted life years.

Years of potential life lost from cardiovascular diseases of the economically active Russian population in 2013-2019

Aim. To analyze the changes in years of potential life lost (YPLL) from cardiovascular diseases (CVDs) of the economically active Russian population in 2013-2019.Material and methods. YPLL was estimated according to the Global Burden of Disease reports at the age of 15-72 years for 2013-2019. The required data were obtained from the annual reports of Federal State Statistics Service. Nonstandardized YPLL was estimated using the following equation: YPLL= ƩDi x ai, where Di is the absolute number of deaths at age I, ai — years not lived. The calculation was carried out for all-cause mortality and separately for CVDs (coronary artery disease (CAD), myocardial infarction (MI), cerebrovascular diseases, bleeding and strokes, and other CVDs).Results. In 2013-2019, there is a decrease in YPLL from all causes, including CVDs. In 2013, YPLL amounted to 14,918,7 years per 100000 economically active population, while in 2019 — 12199,9 years; from CVDs — 4471,6 and 3748,1 years, respectively. YPLL from CAD decreased by 21,5%, from MI — by 23,9%, from bleeding and strokes — by 17%. The rate of YPLL decline in 2014 compared to 2013 was 0,9%. Further, the rate of decline increased, reaching a maximum of 7,6% in 2017 compared to 2016. The differences in YPLL from all causes and CVDs between men and women are almost threefold, as well as from MI and CAD — 4,4 and 3,8 times, respectively. The contribution of CVDs to YPLL from all causes amounted to a maximum of 30,8% in 2018. The contribution of CAD to YPLL from CVDs decreased from 48,0% in 2013 to 44,9% in 2019. The contribution of MI to YPLL from CVDs in men (in 2019, 8%) is less than the contribution of alcoholic and unspecified cardiomyopathy (13,6%), while in women — 5,6% and 11,4%, respectively. There are no data on deaths from heart defects.Conclusion. The change in the YPLL from specific CVD causes occurs unevenly (by year and sex). MI, deaths from which is one of the key parameters of targeted mortality reduction programs, has a smaller effect on the YPLL level than cardiomyopathy, including alcoholic. To reduce mortality and YPLL at the economically active age, it is necessary to correct target programs.

The trend and burden of cardiovascular death in Anhui Province from 2013 to 2018

Objective To understand the characteristics and life loss of cardiovascular diseases (CVDs) among residents in Anhui Province. Methods The data of 24 surveillance points in Anhui Province from 2013 to 2018 in the national death information registration management system was collected. The mortality of CVDs was analyzed, and the change trend of CVDs mortality was tested by annual percent change (APC). Potential years of life lost (PYLL), potential years of life lost rate (PYLLR) and average years of life lost (AYLL) were used for disease burden assessment. Results From 2013 to 2018, the standardized mortality rate of CVDs in Anhui Province was 260.36/100 000, showing a decreasing trend year by year (APC%=-2.53%). The CVDs mortality rate was higher in men than in women, and higher in rural areas than in urban. And it is the highest in Northern Anhui, followed by central Anhui, and the lowest in southern Anhui. CVDs were the first cause of in the whole population (48.58%), with PYLLR of 12.86‰ and AYLL of 11.13 years. PYLLR was the highest in cerebral hemorrhage (4.69 ‰) and ischemic heart disease (4.28 ‰). AYLL ranked the top three in chronic rheumatic heart disease, cerebral hemorrhage and ischemic heart disease. Conclusion The prevention and control of CVDs in Anhui Province has received some achievement, but the burden of disease is still heavy, the prevention and control of high-risk groups should be strengthened.

Economic burden of lives lost due to COVID-19 in New York State.

Aim: To examine the economic impact of lives lost due to the COVID-19 pandemic across New York State. Materials & methods: Death counts by age range and period life expectancy were extracted from the NYS Department of Health, NYC Department of Health and Mental Hygiene, and Social Security Administration website. Years of potential life lost and value of statistical life (VSL) were calculated. Results: The average years of potential life lost per person was 12.72 and 15.13, and the VSL was US$119.62 and 90.45 billion, in NYS and NYC, respectively. VSL was greatest in Queens and Brooklyn, followed by the Bronx, Manhattan and Staten Island. Conclusion: New York City, specifically Queens and Brooklyn, bore the greatest economic burden of lives lost across the state.

The duality of risk from threats: Are homicidal threats a novel determinant for suicide risk?

Suicide and homicide have long been considered to sit at opposing ends of a continuum of deliberate harm, initially emerging as separate fields of practice. While it is now accepted that suicide and homicide are associated, the evidence base for how they are associated is far from complete. Surfacing from this body of knowledge are questions of clinical and ethical responsibilities, such as assessors of risk to moving to a default position of evaluating risk to self and others, regardless of which is the presenting problem. The current study examined longitudinal suicide risk among those known to have uttered homicidal threats. 757 threateners, known to the health and/or criminal justice systems for threatening to kill a person other than themselves, were examined via case matching methodology to reveal deaths recorded in a national coronial database. Over the follow up period, 11% of the threateners died, and over half of them (57.5%) perished from suicide. Threateners who died lost on average 47years of potential life. That is, they lost more than half their life when compared to the average life expectancy of Australians. Further offending was also associated with higher mortality as was having a history of mental health treatment. This study provides support for the duality of risk from uttered threats as threatening homicide was found to be a novel predictor of suicide risk.

Receptor-Interacting Protein 140 Enhanced Temozolomide-Induced Cellular Apoptosis Through Regulation of E2F1 in Human Glioma Cell Lines.

Glioblastoma (GBM), a grade IV glioma, is responsible for the highest years of potential life lost among cancers. The poor prognosis is attributable to its high recurrence rate, caused in part by the development of resistance to chemotherapy. Receptor-interacting protein 140 (RIP140) is a very versatile coregulator of nuclear receptors and transcription factors. Although many of the pathways regulated by RIP140 contribute significantly to cancer progression, the function of RIP140 in GBM remains to be determined. In this study, we found that higher RIP140 expression was associated with prolonged survival in patients with newly diagnosed GBM. Intracellular RIP140 levels were increased after E2F1 activation following temozolomide (TMZ) treatment, which in turn modulated the expression of E2F1-targeted apoptosis-related genes. Overexpression of RIP140 reduced glioma cell proliferation and migration, induced cellular apoptosis, and sensitized GBM cells to TMZ. Conversely, knockdown of RIP140 increased TMZ resistance. Taken together, our results suggest that RIP140 prolongs the survival of patients with GBM both by inhibiting tumor cell proliferation and migration and by increasing cellular sensitivity to chemotherapy. This study helps improve our understanding of glioma recurrence and may facilitate the development of more effective treatments.

Estimating multiple greenspace exposure types and their associations with neighbourhood premature mortality: A socioecological study

BackgroundGreenspace exposures are often measured using single exposure metrics, which can lead to conflicting results. Existing methodologies are limited in their ability to estimate greenspace exposure comprehensively. We demonstrate new methods for estimating single and combined greenspace exposure metrics, representing multiple exposure types that combine impacts at various scales. We also investigate the association between those greenspace exposure types and premature mortality. MethodsWe used geospatial data and spatial analytics to model and map greenspace availability, accessibility and eye-level visibility exposure metrics. These were harmonised and standardised to create a novel composite greenspace exposure index (CGEI). Using these metrics, we investigated associations between greenspace exposures and years of potential life lost (YPLL) for 1673 neighbourhoods applying spatial autoregressive models. We also investigated the variations in these associations in conjunction with levels of socioeconomic deprivation based on the index of multiple deprivations. ResultsOur new CGEI metric provides the opportunity to estimate spatially explicit total greenspace exposure. We found that a 1-unit increase in neighbourhood CGEI was associated with approximately a 10-year reduction in YPLL. Meaning a 0.1 increment or 10% increase in the CGEI is associated with an approximately one year lower premature mortality value. A single 1-unit increase in greenspace availability was associated with a YPLL reduction of 9.8 years, whereas greenness visibility related to a reduction of 6.14 years. We found no significant association between greenspace accessibility and YPLL. Our results further identified divergent trends in the relations between greenspace exposure types (e.g. availability vs. accessibility) and levels of socioeconomic deprivation (e.g. least vs. most). ConclusionOur methods and metrics provide a novel approach to the assessment of multiple greenspace exposure types, and can be linked to the broader exposome framework. Our results showed that a higher composite greenspace exposure is associated with lower premature mortality.

Production losses attributable to suicide deaths in European Union

BackgroundSuicide is an important public health problem with multidimensional consequences for societies. One of the under-researched areas of suicide consequences are cross-country analyses of production losses associated with these deaths. The aim of this study was to estimate the production losses (indirect cost) of suicide deaths in 28 European Union states (EU-28) in 2015.MethodsThe study used societal perspective and human capital approach to investigate production losses due to suicide mortality at working age. Eurostat’s data on the number of deaths was used to identify suicide mortality burden in terms of years of potential productive life lost. Labour and economic indicators were applied to proxy the discounted value of potential economic output lost. A one-way deterministic sensitivity analysis was conducted to test the robustness of the estimates.ResultsThe production losses attributable to suicide deaths in EU-28 in 2015 were €9.07 billion. The per suicide indirect cost of these deaths was €231,088 for the whole EU-28 population; Luxembourg experienced the highest per suicide burden of €649,148. The per capita production losses of suicides in EU-28 was €17.80 and Ireland experienced the highest per capita burden of €48.57. The losses constituted an economic burden of 0.061% of EU-28’s GDP and this share ranged from 0.018% in Cyprus to 0.161% in Latvia. Most of the losses (71–91%) were due to men’s deaths. The results of the sensitivity analysis exhibit a large variation of losses; the highest (lowest) cost was identified with no adjustment for lower employment rates among those dying by suicide (adjustment for minimum productivity) and was 92.3% higher (59.7% lower) on average than in the base scenario.ConclusionPublic health actions aimed at prevention of suicides might reduce their health burden but also contribute to the economic welfare of European societies.

Mapping diabetes burden by school-district for school-based diabetes prevention interventions in selected cities in Michigan, USA.

To decrease diabetes morbidity and mortality rates, early interventions are needed to change lifestyles that are often cemented early, making school-based interventions important. However, with limited resources and lack of within-county diabetes data, it is difficult to determine which local areas require intervention. To identify at-risk school districts, this study mapped diabetes prevalence and related deaths by school district using geographic information systems (GIS). The 2010-2014 records of diabetes-related deaths were identified for 13 cities in Michigan, USA. Diabetes prevalence was estimated using the weighted average of population by school district from the '500 Cities Project' of the Centres of Disease Control and prevention (CDC). Prevalence and mortality rates were mapped by school district and the correlation between diabetes prevalence and mortality rate analysed using the Spearman's rank correlation. Years of potential life lost (YPLL) were calculated using a 75-year endpoint. The result indicated there were geographic variations in diabetes prevalence, mortality and YPLL across Michigan. Most census tracts in the cities of Detroit, Flint and downtown Grand Rapids had higher diabetes prevalence and mortality rate with rs (628)=0.52, P<0.005. School districts with high mortality rates also had high prevalence with rs (13)=0.72, P=0.002. Flint City School District showed a higher rate of diabetes prevalence, death and YPLL than others and should thus be considered a priority for diabetes prevention interventions. Using school districts as the geographic spatial unit of analysis, we identified local variation in diabetes burden for targeting school-based diabetes prevention interventions.

Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants

Metabolic-bariatric surgery delivers substantial weight loss and can induce remission or improvement of obesity-related risks and complications. However, more robust estimates of its effect on long-term mortality and life expectancy-especially stratified by pre-existing diabetes status-are needed to guide policy and facilitate patient counselling. We compared long-term survival outcomes of severely obese patients who received metabolic-bariatric surgery versus usual care. We did a prespecified one-stage meta-analysis using patient-level survival data reconstructed from prospective controlled trials and high-quality matched cohort studies. We searched PubMed, Scopus, and MEDLINE (via Ovid) for randomised trials, prospective controlled studies, and matched cohort studies comparing all-cause mortality after metabolic-bariatric surgery versus non-surgical management of obesity published between inception and Feb 3, 2021. We also searched grey literature by reviewing bibliographies of included studies as well as review articles. Shared-frailty (ie, random-effects) and stratified Cox models were fitted to compare all-cause mortality of adults with obesity who underwent metabolic-bariatric surgery compared with matched controls who received usual care, taking into account clustering of participants at the study level. We also computed numbers needed to treat, and extrapolated life expectancy using Gompertz proportional-hazards modelling. The study protocol is prospectively registered on PROSPERO, number CRD42020218472. Among 1470 articles identified, 16 matched cohort studies and one prospective controlled trial were included in the analysis. 7712 deaths occurred during 1·2 million patient-years. In the overall population consisting 174 772 participants, metabolic-bariatric surgery was associated with a reduction in hazard rate of death of 49·2% (95% CI 46·3-51·9, p<0·0001) and median life expectancy was 6·1 years (95% CI 5·2-6·9) longer than usual care. In subgroup analyses, both individuals with (hazard ratio 0·409, 95% CI 0·370-0·453, p<0·0001) or without (0·704, 0·588-0·843, p<0·0001) baseline diabetes who underwent metabolic-bariatric surgery had lower rates of all-cause mortality, but the treatment effect was considerably greater for those with diabetes (between-subgroup I2 95·7%, p<0·0001). Median life expectancy was 9·3 years (95% CI 7·1-11·8) longer for patients with diabetes in the surgery group than the non-surgical group, whereas the life expectancy gain was 5·1 years (2·0-9·3) for patients without diabetes. The numbers needed to treat to prevent one additional death over a 10-year time frame were 8·4 (95% CI 7·8-9·1) for adults with diabetes and 29·8 (21·2-56·8) for those without diabetes. Treatment effects did not appear to differ between gastric bypass, banding, and sleeve gastrectomy (I2 3·4%, p=0·36). By leveraging the results of this meta-analysis and other published data, we estimated that every 1·0% increase in metabolic-bariatric surgery utilisation rates among the global pool of metabolic-bariatric candidates with and without diabetes could yield 5·1 million and 6·6 million potential life-years, respectively. Among adults with obesity, metabolic-bariatric surgery is associated with substantially lower all-cause mortality rates and longer life expectancy than usual obesity management. Survival benefits are much more pronounced for people with pre-existing diabetes than those without. None.