Recent Cohorts Research Articles

Update to Gabapentinoid Use in the United States, 2002-2021.

Gabapentinoids are commonly used medications for numerous off-label conditions. The 2002-2021 Medical Expenditure Panel Survey (MEPS) was used to investigate the proportion of the adult population who were gabapentinoid users, the ages of these users, medications and diagnoses associated with users, and the likelihood of starting, stopping, or continuing gabapentinoids. Gabapentinoid users continued to increase since our last publication from 4.0% in 2015 to 4.7% in 2021. Gabapentinoid use was much more likely among individuals who used other medications used in chronic pain. Between 2017-2021, numerous chronic pain conditions were associated with gabapentinoid use. New gabapentinoid users clearly outnumbered gabapentinoid stoppers between 2011-2012 and 2017-2018, but this difference decreased in the most recent cohorts.

An Alternative and Up-To-Date Recommendation for a Proper Site for Parathyroid Transplantation: The Omentum.

Various sites have been used for parathyroid allotransplant, such as injection into the forearm, sternocleidomastoid, or deltoid muscles. However, transplant efficiency in these regions varies according to the results reported in the literature and also obtained from our previous studies. Using the omentum "as a natural incubator" for composite tissue-derived cell transplants to increase transplant success is possible. To examine the efficiency of transplant sites for parathyroid allotransplant, we compared clinical cases from the literature and our experience with 23 cases. The omental transplant process is performed under general anesthesia by laparoscopic intervention. The abdominal cavity is visualized with an endocamera from a 5-mm trocar. With the help of a flexible catheter from another 5-mm trocar, microencapsulated or naked parathyroid cells are deposited on the omentum in approximately 30 mL of isotonic saline. The trocar sites are then sutured, and the surgery is terminated. Recipients were followed for 6 months with examination of biochemical parameters (parathormone, calcium, and phosphorus levels), medication use, and clinical scoring. In the 23 patients who received parathyroid allotransplants over the omentum, 7 recipients did not exhibit any changes according to the scoring system criteria. However, on average, serum calcium and phosphorus levels remained within the healthy reference range. In addition, use of oral medications among patients decreased, indicating successful transplant survival. These results were consistent with a significant decrease in hypocalcemia symptoms among patients. In the 23 patients, the success rate was 69.5% for the first 6-month period after transplant. Recent developments and large cohorts are needed to demonstrate the higher efficacy of parathyroid allotransplant over the omentum.

Exploring Disparities for Obesity in Korea Using Hierarchical Age-Period-Cohort Analysis With Cross-Classified Random Effect Models.

This research article investigates the age, period, and birth cohort effects on prevalence of obesity in the Korean population, with the goal of identifying key factors to inform effective public health strategies. We analyzed data from the Korea National Health and Nutrition Examination Survey, spanning 2007-2021, including 35,736 men and 46,756 women. Using the hierarchical age-period-cohort (APC) analysis with cross-classified random effects modeling, we applied multivariable mixed logistic regression to estimate the marginal prevalence of obesity across age, period, and birth cohort, while assessing the interaction between APC and lifestyle and socioeconomic factors. Our findings reveal an inverted U-shaped age effect on obesity, influenced by smoking history (P for interaction = 0.020) and physical activity (I for interaction < 0.001). The period effect was positive in 2020 and 2021, while negative in 2014 (P for period effect < 0.001). A declining trend in obesity prevalence was observed in birth cohorts from 1980s onward. Notably, disparities in obesity rates among recent birth cohorts have increased in relation to smoking history (P for interaction = 0.020), physical activity (P for interaction < 0.001), and residence (P for interaction = 0.005). Particularly, those born after 1960 were more likely to be obese if they were ex-smokers, physical inactive, or lived in rural areas. These findings highlight growing disparities in obesity within birth cohorts, underscoring the need for targeted health policies that promote smoking cessation and physical activity, especially in rural areas.

AGE AND COHORT TRENDS OF RACIAL/ETHNIC DIFFERENCE IN RELIGIOUS PARTICIPATION AMONG MIDDLE-AGED AND OLDER AMERICANS

Abstract Religious involvement is an important way of maintaining social connectedness for older Americans. While large quantities of studies have explored age and cohort effects of religious participation separately, less is known about racial/ethnic disparities. Applying growth curve modeling to the 2004-2020 waves of the Health and Retirement Study (N=134,734 person-years), the current study examines how religious attendance changes across the life course and among recent birth cohorts, as well as how exposure to immigration policy regimes (IPR) shapes Hispanic immigrants’ religious participation behaviors. Results suggest an overall reversed U-shape age trajectory with lower average levels and faster declines among more recent cohorts. Compared to White older adults, Black and Hispanic populations attend religious activities more frequently, but their attendance declines at faster rates in later life, leading to minimal White-Nonwhite differences in the oldest ages. However, Hispanic immigrants display significantly less decline in religious participation among more recent cohorts relative to Whites, although no similar trend is found between White and Black/native Hispanic older adults. Further analyses of Mexican Hispanic immigrants suggest that longer exposure to restricted IPR (since the Immigration Reform and Control Act of 1986, IRCA) is associated with increased religious attendance, but less restricted IPR (between 1964 and 1985) is associated with decreased religious participation net of age and cohort effects. These findings emphasize the importance of understanding the civic engagement experiences of Hispanic immigrants against the context of immigration policy regimes.

COHORT CHANGE AND LIFE COURSE SOCIOECONOMIC DIFFERENCES IN COGNITIVE HEALTH TRAJECTORIES

Abstract The combination of socioeconomic gains and losses during a lifetime contributes to a large inequality in cognitive capacity in later life. Although studies have examined the connection between an individual’s socioeconomic status over the life course and cognitive health trajectories, it is unclear how historical contexts may have influenced these associations. In light of the dynamic macro-social environment in Korea, this study utilizes data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2018. I explore the variation in the socioeconomic patterning of cognitive health trajectories based on the benchmarking of socioeconomic status across the life course. The study reveals three main findings. First, I find cohort-specific cognitive health trajectories based on socioeconomic status across the life course. Notably, childhood socioeconomic status leaves an indelible mark on levels of cognition only among earlier cohorts born during the Japanese Occupation period. Additionally, socioeconomic disparities in the rate of cognitive health decline widen among earlier cohorts, while this trend is not observed among more recent cohorts. Second, compared to childhood and later-life socioeconomic status, education consistently shows a positive association with higher levels of cognition rather than slower cognitive decline, regardless of whether the cohorts are earlier or more recent. Third, there is a notable gender difference in socioeconomic disparities in cognitive decline, with women experiencing more pronounced disparities compared to men, especially among earlier cohorts. These findings underscore the significance of historical and contextual factors when examining the association between socioeconomic status and cognitive health across the life course.

DOES LIVING WITH A FAMILY AFFECT SOCIAL CONTACT/PARTICIPATION? VARIATIONS ACROSS BIRTH COHORTS AND GENDER IN JAPAN

Abstract Changing family structures and values might have affected social relationships outside the household in a different way for men and women. This study clarified birth cohort and gender differences among older Japanese in terms of (a) trajectories of social contact and participation and (b) effects of living with a family on them. Data were obtained from ten waves of the National Survey of the Japanese Elderly (1987-2021) for 5,855 individuals who commenced participation by 2012. Quadratic growth models were examined as a function of age at time t (≥63 years) for the frequency of contact with children living apart, with friends and neighbors, and participation in community groups, whose intercept and slope were predicted by gender and birth cohorts (C1:1902-13, C2:1914-25, C3:1926-37, C4:1938-49). Whether effects of being married and co-residing with a child would differ by gender and cohorts was also examined, controlling for socioeconomic and health status. The results showed that the level of contact/participation at age 75 increased in women in recent cohorts. The frequency for friends and groups declined with age after the mid-70s across cohorts. C4 showed a steeper decline in the child/friend contact, indicating the COVID-19 influence. Living with a family generally impeded social contact, except that married men contacted non-coresident children more frequently than their unmarried counterparts. The negative effect of living with a child was greater in women and the earliest birth cohort. Thus, social isolation could matter not only for older adults living alone, but also for those living with a family.

Extremely Early Appearance of Islet Autoantibodies in Genetically Susceptible Children

Objective. We studied the characteristics of children who developed islet autoantibodies by the age of 0.50 years and hypothesized that the appearance of extremely early islet autoimmunity differs between four birth cohorts within 1994–2019 according to the change in the incidence of Type 1 diabetes (T1D) in Finland. Methods. Data from Finnish children participating in the Type 1 Diabetes Prediction and Prevention (DIPP) study, or the Environmental Determinants of Diabetes in the Young (TEDDY) study were analyzed. These studies follow children with increased HLA-conferred risk for T1D with regular measurements of islet autoantibodies. Maternally transferred antibodies were excluded by comparing islet autoantibodies in cord serum, child’s first follow-up serum and the maternal serum. Results. Among 20,979 Finnish children at increased risk to T1D, 53 (0.25%) developed at least one islet autoantibody at the age of ≤0.50 years. During a mean follow-up of 8.1 years, 15.1% progressed to T1D (median age at diagnosis 2.0 years), 43.4% developed confirmed islet autoimmunity but no T1D, and 41.5% had only transient islet autoantibodies. IAA was the most common first-appearing autoantibody. Among progressors, age at diagnosis was 1.0–2.4 years in children with IAA-initiated autoimmunity and 4.5–16.1 years in ZnT8A-initiated autoimmunity. When comparing children developing autoantibodies either at the age of ≤0.50 years or 0.51–0.75 years, confirmed positivity during follow-up was more common in the older group (81.7% vs. 58.5%; p = 0.002 ). In four birth cohorts within 1994–2019 appearance of islet autoantibodies at the age of ≤0.50 years decreased towards the most recent birth cohorts ( p = 0.016 ). Conclusion. Islet autoimmunity by the age of 0.50 years was rare in genetically susceptible children and was typically initiated with IAA. Confirmed positivity was less common in children with autoantibodies at age ≤0.50 than at slightly older age. The secular decrease of islet autoimmunity before age 0.50 years was observed. This trial is registered with NCT03269084 and NCT00279318.

Trends in the mortality of diabetes in Mexico from 1998 to 2022: a joinpoint regression and age-period-cohort effect analysis

ObjectiveThe purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. Study designJoinpoint regression and age-period-cohort effect analysis. MethodsBased on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. ResultsFrom 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). ConclusionThe DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.

Economic Assimilation of Asian American Immigrants by Nationality: Aging and Cohort Effects, and the Model Minority Myth

This paper examines the income profiles of Asian American immigrants from six major Asian countries of origin, disaggregated, relative to U.S. natives between 1970 and 2020. We observe more recent cohorts to experience either higher or similar levels of relative entry wages compared to older cohorts for all six Asian countries. Further, while the “model minority” stereotype often suggests that Asians collectively work tirelessly to achieve success, leading to smoother economic assimilation into American society compared to immigrants from other backgrounds, our findings challenge this notion. We discover that economic assimilation among immigrants from these six Asian countries of origin follows distinct patterns, and there is no overarching narrative that supports the idea of a collective “model minority” among them.

Cohort profile: Genetic data in the German Socio-Economic Panel Innovation Sample (SOEP-G).

The German Socio-Economic Panel (SOEP) serves a global research community by providing representative annual longitudinal data of respondents living in private households in Germany. The dataset offers a valuable life course panorama, encompassing living conditions, socioeconomic status, familial connections, personality traits, values, preferences, health, and well-being. To amplify research opportunities further, we have extended the SOEP Innovation Sample (SOEP-IS) by collecting genetic data from 2,598 participants, yielding the first genotyped dataset for Germany based on a representative population sample (SOEP-G). The sample includes 107 full-sibling pairs, 501 parent-offspring pairs, and 152 triads, which overlap with the parent-offspring pairs. Leveraging the results from well-powered genome-wide association studies, we created a repository comprising 66 polygenic indices (PGIs) in the SOEP-G sample. We show that the PGIs for height, BMI, and educational attainment capture 22∼24%, 12∼13%, and 9% of the variance in the respective phenotypes. Using the PGIs for height and BMI, we demonstrate that the considerable increase in average height and the decrease in average BMI in more recent birth cohorts cannot be attributed to genetic shifts within the German population or to age effects alone. These findings suggest an important role of improved environmental conditions in driving these changes. Furthermore, we show that higher values in the PGIs for educational attainment and the highest math class are associated with better self-rated health, illustrating complex relationships between genetics, cognition, behavior, socio-economic status, and health. In summary, the SOEP-G data and the PGI repository we created provide a valuable resource for studying individual differences, inequalities, life-course development, health, and interactions between genetic predispositions and the environment.

Alcohol initiation before age 15 predicts earlier hazardous drinking: A survival analysis of a 7-year prospective longitudinal cohort of Australian adolescents.

Early alcohol use may predict later alcohol problems, but the magnitude of this effect and impact of delayed onset remain uncertain. This study measured age-based differences in progression from first full alcoholic drink to hazardous drinking in one of the largest and most recent prospective cohorts of Australian adolescents. A 7-year (2012-19) prospective longitudinal cohort of 2082 Australian adolescents was established from the Climate and Preventure (cohort 1) and Climate Schools Combined (cohort 2) studies. Participants completed surveys annually from ages 13 to 20 years. Interval censored survival analyses were conducted with first episode of hazardous drinking [three or more on proxy Alcohol Use Disorders Identification Test (AUDIT-C)] as the survival end-point, controlling for age, sex and mental health symptomatology. Onset of hazardous drinking was expressed as hazard ratios (HRs), and median survival time (years) was used to model first onset of hazardous alcohol use in survival curves. Compared with those aged 15 or older, those who had their first full drink at 12 or younger had significantly elevated risk of hazardous drinking onset during the study period [log (HR): 9.3; 95% confidence interval (CI) = 7.0-12.0, P < 0.001]. Compared with those who had their first full drink at ages 13-14, those who delayed until 15 or older had significantly later onset of hazardous drinking; 1.63 years for males (95% CI = 1.31-1.92, P < 0.001) and 1.50 for females (95% CI = 1.15-1.81, P < 0.001), resulting in a median age of onset of hazardous drinking of > 19 for both sexes (male: 19.05 years, 95% CI = 18.74-19.38; female: 19.47 years, 95% CI = 19.19-19.75). First drink at ages 13-14 was associated with the earliest onset of hazardous drinking (males: 17.43 years; females: 17.98 years). In Australia, alcohol initiation prior to age 15 appears to be associated with an earlier onset of hazardous drinking than initiation after age 15.

Temporal trends in the incidence and mortality of road injuries in China: Current trends and future predictions

BackgroundChina has the highest number of road injury deaths in the world. The aim of this study was to determine the long-term incidence and mortality trends of road injuries in China between 1990 and 2019 and to make projections up to 2030. MethodsIncident and death data were extracted from the Global Burden of Disease (GBD) 2019 study and population data were extracted from the GBD 2019 and World Population Prospects 2019 studies. An age-period-cohort framework was used for the analysis. ResultsIn 2019, 16.1 million road injuries (age-standardized incidence rate [ASIR]: 991.3/100,000) occurred in China. Between 1990 and 2019, the ASIR of road injuries in China increased by 87.4 %. In 2019, there are 250.0 thousand road deaths (age-standardized mortality rate [ASMR]: 14.79/100,000), and the ASMR decreased by 27.0 % between 1990 and 2019. Period and cohort risks for the incidence of road injuries were increased for both sexes. Period and cohort risks for road injury mortality appeared to increase in recent period and birth cohorts. The ASIR of road injuries was projected to increase in the future, and the ASMR was projected to decrease; however, the ASIR of cyclist road injuries in females was projected to increase in the future. Among road injuries, elderly individuals were projected to have an increasing proportion of occurrence and death. Although the proportion is decreasing, pedestrian road injuries were projected to still account for more than half of road injury deaths in China up to 2030. ConclusionsThe incidence of road injuries in China has increased overall, while the overall mortality rate has decreased over the past 30 years, and this trend is expected to continue in the future. Effective effort is needed to improve road safety, especially for elderly individuals and female cyclists. In addition, pedestrian road safety also needs to be improved.

Generational change in party support in Germany: The decline of the Volksparteien, the rise of the Greens, and the transformation of the education divide

Motivated by the eroding support for the old “Volksparteien” CDU/CSU and SPD, especially among younger voters, this study conducts an age-period-cohort analysis of vote choices in all 20 German federal elections, from 1949 to 2021. I study both generational differences in levels of party support and the changing effect of education on voting. The results, first, point to the importance of generational replacement in understanding party's shifting fortunes, with the CDU/CSU and the SPD being weaker in more recent cohorts and the Greens stronger. Second, while high education divides voters of the old right (CDU/CSU and especially FDP) and left (SPD) in earlier cohorts, it divides voters of the new-left Greens and the radical-right AfD in more recent cohorts. This study enhances our understanding of the changing patterns of party support in the German electorate and, as a broader lesson, shows how electoral realignment is driven by generational replacement.

The Influence of Education and Occupation Type on Birth Cohort Differences in Cognitive Function of Mexican Older Adults.

Mexico's population aging is occurring in the context of social changes such as increased educational attainment and occupational shifts from agriculture to service and industry. The current study compares cognitive function between two birth cohorts of Mexican adults aged 60-76 to determine if population-level changes in education and occupation type contribute to cohort differences in cognitive function. We used the Mexican Health and Aging Study to examine adults aged 60-76 in 2001 (men: 2,309; women: 2,761) and 2018 (men: 2,842; women: 3,825). Global cognition was calculated from five measures. Five main lifetime occupation types were created: no main job; agriculture; service; professional; and industrial. Ordinary least squares regression and structural equation models (SEM) were used to examine cohort differences in cognitive functioning. Ordinary least squares models that adjusted for age, community size, and marital status indicated that men and women had higher global cognition in 2018 than 2001 (men: b = 0.44, p < .01; women: b = 0.54, p < .01). These differences were reduced after adjusting for education and occupation type (men: b = 0.27, p < .01; women: b = 0.37, p < .01). Results from SEM indicated that the indirect effects of education on cognitive functioning were larger than occupation type for men (education: b = 0.18, p < .05; occupation: b = 0.001, p = .91) and women (education: b = 0.18, p < .05; occupation: b = 0.002, p = .22). Cognitive functioning is higher among more recent birth cohorts of older adults in Mexico. These cohort differences are partially mediated by education but not main lifetime occupation. Additional factors may contribute to cohort differences in cognitive function for older adults in Mexico.

Understanding the health decline of Americans in boomers to millennials

Morbidity and mortality are on the rise among Americans from Boomers to Millennials. We investigate early-life diseases and the socioeconomic, psychosocial, and bio-behavioral factors behind this worsening health trend. Using data from the Panel Study of Income Dynamics Family and Individual Files 1968–2013, we find that the chronic disease index and poor subjective health have continuously increased for Baby Boomers and later cohorts. Early-life diseases, obesity, and shortening job tenure account for about half the health decline across cohorts. Weakening union protection, decreasing marriage, and declining religion only make minor contributions. All other factors, including early life nutrition and family background, adulthood socioeconomic status, physical activity, and smoking behaviors, make negative or non-significant contributions. These findings highlight that even though recent cohorts have better childhood nutrition, family socioeconomic environment,and higher levels of education and income, these advantages have been offset by elevated early-life disease exposure, obesity, and a precarious labor market. We discuss the findings in the context of Case and Deaton's “cumulative deprivation” thesis.

Gender homophily: In-group citation preferences and the gender disadvantage

Based on an extensive sample of articles in the life sciences, we find that gender homophily in forward citations is substantial: compared to men-led articles (i.e., those with men as either the first or last author), women-led articles receive fewer forward citations from subsequent men-led articles and more forward citations from subsequent women-led articles. This occurs across life science fields with varying gender ratios. Forward citations flow differentially to papers led by women versus men for a variety of reasons, including the detailed field and scientific concepts covered in the articles, the journals in which they are published, article length, authors' research experience, and the size of the author team. After accounting for this extensive set of factors, we find some forward citations appear to be driven by gender citation homophily – that is, gender alignment between citing and cited authors. This pattern greatly disadvantages women in fields where they are underrepresented, leading to a gender citation gap, compared to more gender-balanced fields, where the gap is shrinking. We also find that articles written by more recent cohorts of scientists are subject to less gender citation homophily than earlier cohorts. Investigation into potential pathways by which gender citation homophily operates suggests it stems from gendered specialization in research niches and, to a lesser extent, from gender homophily in professional connections among scientists, as opposed to from direct discrimination against unknown authors based on gender inferred from their names. Since gender homophily in citations impedes gender-indifferent knowledge flow in most fields, its adverse impact on science likely includes not only slowing women's careers but also creating a less efficient diffusion of knowledge and recombination of work from earlier papers into newer work.

Does the decline in Swedish adolescent drinking persist into early adulthood?

Sweden has experienced a substantial decrease in adolescent drinking over the past decades. Whether the reduction persists into early adulthood remains unclear. Using survey data, the present study aimed to determine whether reductions in indicators of alcohol use observed among adolescents remain in early adulthood and whether changes in alcohol intake are consistent among light/moderate and heavy drinkers. Data from the Swedish monthly Alcohol Monitoring Survey (2001-20) were used to construct five 5-year birth cohorts (1978-82, 1983-87, 1988-92, 1993-97 and 1998-2002). Sweden. A total of n = 52 847 respondents (48% females) aged 16 and 30 years were included in this study. For both males and females, temporal changes in the prevalence of any drinking, the prevalence of heavy episodic drinking (HED) and total alcohol intake in the past 30 days in centilitres were analysed. The prevalence of any drinking in more recent cohorts remained low until young people came into their early (females) and mid- (males) 20s. Male cohorts differed in the prevalence of HED across age, with the later cohorts showing lower odds than earlier cohorts (odds ratios between 0.54 and 0.66). Among females, no systematic differences between cohorts across age could be observed. Later male birth cohorts in light/moderate drinkers had lower alcohol intake than earlier cohorts (correlation coefficients between -0.09 and -0.54). No statistically significant cohort effects were found for male heavy drinkers. Although differences in alcohol intake among females diminished as age increased, the cohorts did not differ systematically in their level of alcohol intake. In Sweden, the reduced uptake of drinking in adolescents appears to fade as people move into adulthood. Observed reductions in alcohol intake among light and moderate drinkers appear to persist into adulthood. More recent male cohorts show a lower prevalence rate of heavy episodic drinking.

Time trend of pancreatic cancer mortality in the Western Pacific Region: age-period-cohort analysis from 1990 to 2019 and forecasting for 2044

BackgroundPancreatic cancer poses a serious medical problem worldwide. Countries in the Western Pacific Region are facing public health challenges from cancer. This study assesses the time trends of pancreatic cancer mortality in the Western Pacific Region from 1990 to 2019 and predicts its trend to 2044.MethodsMortality data were obtained from the Global Health Data Exchange. We used an age-period-cohort model to estimate age, period and birth cohort effects on pancreatic cancer mortality from 1990 to 2019 by calculating net drift, local drift, age-specific rate, period rate ratio, and cohort rate ratio. We also predict pancreatic cancer mortality to 2044 in Western Pacific countries.ResultsOverall, there were 178,276 (95% uncertain interval: 157,771 to 198,636) pancreatic cancer deaths in the Western Pacific Region in 2019, accounting for 33.6% of all deaths due to pancreatic cancer worldwide. There were significant increases in pancreatic cancer disability-adjusted life years between 1990 and 2019 in the Western Pacific Region, mainly due to population growth and aging. Pancreatic cancer mortality increased with age. The period effect showed an increasing trend of mortality for both sexes over the study period. Compared to the reference period (2000 to 2004), the rate ratio was elevated in both males and females in the period of 2015 to 2019. There was an overall increasing rate ratio from early birth cohorts to recent cohorts. Deaths may continue to increase in the next 25 years in the ten countries, while most countries have seen their age-standardized rate forecasts fall.ConclusionThe mortality of pancreatic cancer is still high in the Western Pacific Region. Countries/territories should focus on pancreatic cancer prevention and early cancer screening in high-risk populations. Specific public health methods and policies aimed at reducing risk factors for pancreatic cancer are also needed.

Worldwide trends in mortality for hypertensive heart disease from 1990 to 2019 with projection to 2034: data from the Global Burden of Disease 2019 study.

This study aims to analyse the worldwide trends in hypertensive heart disease (HHD) mortality and associations with age, period, and birth cohort and predict the future burden of HHD deaths. Mortality estimates were obtained from Global Burden of Disease 2019 study. We used age-period-cohort (APC) model to examine the age, period, and cohort effects on HHD mortality between 1990 and 2019. Bayesian APC model was utilized to predict HHD deaths to 2034. The global HHD deaths were 1.16 million in 2019 and were projected to increase to 1.57 million in 2034, with the largest increment in low- and middle-income countries (LMICs). Between 1990 and 2019, middle/high-middle socio-demographic index (SDI) countries had the largest mortality reductions (annual percentage change = -2.06%), whereas low SDI countries saw a lagging performance (annual percentage change = -1.09%). There was a prominent transition in the age distribution of deaths towards old-age population in middle/high-middle SDI countries, while the proportion of premature deaths (aged under 60 years) remained at 24% in low SDI countries in 2019. Amongst LMICs, Brazil, China, and Ethiopia showed typically improving trends both over time and in recent birth cohorts, whereas 63 countries including Indonesia, the Philippines, and Pakistan had unfavourable or worsening risks for recent periods and birth cohorts. The HHD death burden in 2019 is vast and is expected to increase rapidly in the next decade, particularly for LMICs. Limited progress in HHD management together with high premature mortality would exact huge human and medical costs in low SDI countries. The examples from Brazil, China, and Ethiopia suggest that efficient health systems with action on improving hypertension care can reduce HHD mortality effectively in LMICs.

Exploring the relationship between COVID‐19 and immediate 2‐year college enrollment and persistence among Kalamazoo Promise scholars

AbstractThere are hundreds of recognized tuition‐free college “promise” programs, but few are as generous or flexible as the Kalamazoo Promise (KPromise). Pre‐COVID studies on KPromise have demonstrated effects on increased college attendance, credit completion, and persistence. Extending these findings to the COVID‐19 pandemic context can help establish a baseline understanding of the ability and limits of tuition‐free college to mitigate a shock to college enrollment and speed the recovery in the aftermath. This chapter explores incoming student college enrollment and first‐year persistence among recent KPromise cohorts at the primary community college that scholars attend: Kalamazoo Valley Community College (KVCC). We found that enrollment decreased for two consecutive cohorts, notably among students with lower high school academic performance. We found that first‐year stop out overall increased, and these two changes together resulted in demographic changes in the KPromise student population at KVCC. Our findings have important implications for tuition‐free programs and the 2‐year institutions that receive Promise students.