Significant Difference In Life Expectancy Research Articles

The effect of marital status on life expectancy: Is cohabitation as protective as marriage?

AbstractIt is well-known that marital status is an important predictor for life expectancy. However, non-married individuals are often misclassified as singles which ignores the heterogeneity within the group. This paper shows the importance of distinguishing between types of singles, and in particular whether they are cohabiting, when predicting life expectancies. We use unique and detailed longitudinal register data to track marital status throughout the individual's lifetime. We find that all types of singles consistently benefit from living with a spouse, i.e., after divorce, becoming widower or being never married. This result holds for both men and women. For certain types of cohabiting singles we reject significant differences in life expectancy compared to married individuals. Finally, we use a case study to show that, like married individuals, all types of singles that cohabit also serve as informal caregivers and have the potential to limit the end-of-life long-term care expenditure levels.

How can we overcome health inequalities in psychiatry?

Health inequalities in psychiatry are well established, with people living in poverty and those from minoritised groups receiving different care and experiencing worse health outcomes. Psychiatric patients experience significant differences in life expectancy compared with the general population. This article explores changes within psychiatric services and public health interventions that could address health inequalities and asks why this has not happened yet.

Subjective Well-Being and Active Life Expectancy in Japan: Evidence From a Longitudinal Study.

Existing research has suggested that older adults in Japan enjoy phenomenal physical health status, but they have poor subjective well-being (SWB). Limited empirical evidence exists, however, on how physical health and SWB intersect and are linked to the lives of older men and women in Japan. Using the concept of health expectancy, this study examines the role of SWB, as measured by life satisfaction, in the mortality and morbidity experiences of Japanese adults aged 65 years and older. We used the nationally representative Nihon University Japanese Longitudinal Study of Aging, 1999-2009. Our measurement of morbidity is disability, based on difficulty in activities in daily living (ADLs) and instrumental ADLs. We use the Interpolation of Markov Chains approach to compute life expectancy (LE), LE without disability (active LE), and LE with differing severity of disability for those who are satisfied with life and for those who are not. We documented significant differences in LE and active LE by the state of life satisfaction among older adults in Japan. Men and women who are satisfied with life are expected to live longer and spend more years without having disability compared to those who are not satisfied. We found no differences in the length of life with disability of differing severity by the state of life satisfaction. Our results highlight the important role of SWB at older ages in Japan, because it is directly related to the physical health of its aging population. Fully understanding the health of the older population requires research that focuses on both objective and subjective dimensions of well-being.

Clinical features, diagnosis, treatment and prognosis of otolaryngological extranodal sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease, RDD).

To investigate the clinical features, diagnosis, treatment and prognosis of otolaryngological extranodal RDD. A retrospective analysis was performed on 16 patients who were initially diagnosed and treated with otolaryngological extranodal RDD in our hospital from January 2013 to January 2019. There were 9 females and 7 males. The mean diagnostic age was 45.35. Nasal, laryngeal and otic RDD were, respectively, accounting for 56.25%, 31.25% and 12.5%. The median interval diagnostic time was individually 1, 0.5 and 0.2year for nasal, laryngeal and otic RDD. The most common symptoms were separately progressive nasal congestion, dyspnea, otorrhea in nasal, laryngeal and otic RDD. 13 had cervical lymph node swelling on MRI. Surgery or postoperative radiotherapy were conformed. In the end, 14 patients with RDD survived. The survival rate is as high as 87.5%. One of them died of RDD in the fifth year. One case was lost to follow-up 2years after treatment. Patients survive for at least 2 years and up to 9 years. There was no significant difference in life expectancy of extranodal RDD among different parts of ENT (P = 0.508 > 0.05). The average ages of laryngeal and nasal RDD were similar (P = 0.898 > 0.05). However, the age of both was significantly higher than ear RDD (P = 0.023 and 0.019 < 0.05). The average diagnostic age was more than 20years. Nasal RDD was the most common in this area. All laryngeal RDD had infiltrated subglottis. Functional surgery and postoperative radiotherapy can be used to achieve long-term remission and survival.

Сравнительный анализ стентирования и гастростомии у больных со злокачественной патологией пищевода и пищеводно-желудочного перехода

Objective — to analyze the results of esophageal stenting in comparison with gastrostomy in patients with malignant dysphagia. Material and methods. The first group consists of 100 men and 42 women with malignant dysphagia, who underwent stenting of the esophagus and cardia with self-expanding metal stents. The group consists of 142 people aged 43 to 90 years. Stenting of the esophagus in this group was performed with the aim of resolving malignant stenosis of the esophagus in 71 patients: malignant stenosis of the esophageal-gastric junction in 59 patients and extraorgan compression of the esophagus from the outside in 12 patients. The second group consisted of 164 people in the age group from 33 to 89 years — 140 men and 24 women who underwent gastrostomy by the laparotor method according to Topprover in order to resolve malignant dysphagia. Gastrostomy was imposed on 110 patients due to malignant stenosis of the esophagus: with malignant stenosis of the esophageal-gastric junction in 44 patients and as a result of external compression in 10 patients. Results. Complications in patients after stenting in the remote period occurred in 17 cases. In the group of patients who underwent gastrostomy, complications requiring gastrostomy replacement occurred in 23 patients. Death occurred in one patient as a result of specific complications after gastrostomy. Life expectancy as a percentage, regardless of the pathology of the disease, does not have a large spread in the comparison groups and is approximately the same. The results of studies on life expectancy depending on the type of treatment (stenting-gastrostomy) and the location of the tumor lesion did not reveal statistically significant differences. Conclusions. Comparison of the results of implantation of self-expanding metal esophageal stents and gastrostomy by the laparotomic method in malignant dysphagia of the esophagus and esophagogastric junction was performed for the first time. In the course of the study, it was revealed that in the studied groups of patients, life expectancy in percentage terms, regardless of the pathology of the disease, does not have a wide spread and is approximately the same. There are no statistically significant differences in life expectancy depending on the type of treatment (stenting-gastrostomy) and the location of the tumor lesion in the analysis of variance according to the criterion of the least significant difference. Esophageal stenting with self-expanding metal stents is the least traumatic and effective method of choosing the resolution of malignant dysphagia of the esophagus and gastroesophageal junction with low complication rates, which allows to restore adequate nutrition, thereby improving the quality of life in incurable patients.

10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease

BackgroundThe optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear. ObjectivesThe goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD). MethodsIn the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models. ResultsAmong 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; pinteraction = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; pinteraction = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: −0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients. ConclusionsElderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050) (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)

The presence of Superfund sites as a determinant of life expectancy in the United States

Superfund sites could affect life expectancy (LE) via increasing the likelihood of exposure to toxic chemicals. Here, we assess to what extent such presence could alter the LE independently and in the context of sociodemographic determinants. A nationwide geocoded statistical modeling at the census tract level was undertaken to estimate the magnitude of impact. Results showed a significant difference in LE among census tracts with at least one Superfund site and their neighboring tracts with no sites. The presence of a Superfund site could cause a decrease of −0.186 ± 0.027 years in LE. This adverse effect could be as high as −1.22 years in tracts with Superfund sites and high sociodemographic disadvantage. Specific characteristics of Superfund sites such as being prone to flooding and the absence of a cleanup strategy could amplify the adverse effect. Furthermore, the presence of Superfund sites amplifies the negative influence of sociodemographic factors at lower LEs.

A health equity focused National Prevention Plan 2020-2025 and related capacity building (CCM, 201)

Abstract In Italy there are significant differences in life expectancy, morbidity and disability between different social groups: the wealthiest and educated people are better off, get sick less and live longer. The poorer Italian Regions show less favourable health indicators. However, Italy aims to reduce health inequalities (HI) among the priorities of its agenda. The 2014-2018 National Prevention Plan (NPP) had already instructed the Regions to include the fight against HI in the guiding principles of the regional prevention plans (RPP). The new NPP 2020-2025 confirms the need to strengthen the fight against HI and the reduction of the main social and geographical inequalities that are observed in our country represents a priority to all the objectives of the NPP, which requires the disclosure of scientific data, validated methods and tools to guarantee equity in the action. In this scenario, there is a project coordinated by the Istituto Superiore di Sanità with the contribution of DORS, the Documentation Centre for Health Promotion of Piedmont Region. The main objective of this project is to support the Ministry of Health (MoH) and the Regions in order to consolidate the introduction of the equity lenses approach in the new NPP, in particular the project aims at: promoting a health equity-oriented approach in priority and target setting, choice of a strategy, and in the design of the monitoring and evaluation system;investing in a capacity building process for regional officers responsible of the elaboration and implementation of the RPP in each Italian region. 20 Italian Regions participate to this two-year project (2019-2020). Two face-to-face training modules and the sharing of a web community of practice have been planned. The project involves developing support tools that provide equity-oriented practices. The main expected result is the increase of the equity-oriented actions and their dissemination across the country.

Predictors of Life Expectancy After an Alzheimer’s Disease Diagnosis in a National Multi-Center Autopsy-Confirmed Sample

Abstract Objective Life expectancy varies between 3-12 years following the diagnosis of Alzheimer’s disease (AD) and is an important clinical question for patients and families. Current literature is limited by relatively small sample sizes and a reliance on clinical diagnoses. This study sought to evaluate predictors of AD life expectancy in a large autopsy-confirmed sample. Methods Baseline data from individuals 50 years and older clinically and neuropathologically diagnosed with AD (N=764) were obtained from the National Alzheimer’s Coordinating Center. Life expectancy was calculated in months from AD diagnosis to death. Nineteen variables (demographic, medical/health, disease severity, and psychiatric) obtained at dementia diagnosis were examined. Variables that showed significant differences in life expectancy using t-tests and Pearson correlations (14 of 19) were then entered into a forward multiple regression. Results Seven predictors in the model explained 27% of the variance in life expectancy (F= 40.7, R-squared= 0.267). Lower MMSE scores (β= 0.339, p &lt; .001), male sex (β= -0.144, p &lt; .001), older age (β= -0.130, p &lt; .001), non-Hispanic Caucasian race/ethnicity (β= 0.115, p &lt; .001), greater impairment on the Functional Activities Questionnaire (β= -0.091, p=.042), abnormal neurological/physical exam (β= -0.083, p=.011), and higher Neuropsychiatric Inventory Questionnaire total scores (β= -0.079, p=.016) predicted shorter life expectancy. Conclusions Global cognitive impairment, sex, age, race/ethnicity, functional impairment, abnormal neurological exam findings, and psychiatric symptoms explain a significant proportion of life expectancy following an AD diagnosis. Future studies should explore the relationship between life expectancy, specific neurological abnormalities, and psychiatric symptoms. These 7 predictors could potentially be used to predict life expectancy in individuals diagnosed with AD.

Gender, nutritional status and disability-free life expectancy among older people in Santiago, Chile.

BackgroundThis study was aimed to estimate life expectancy (LE), disability-free life expectancy (DFLE) and disabled life expectancy (DLE) among older adults from Santiago, Chile, and to determine the existence of differences by gender and by body mass index (BMI) categories in these indicators.MethodsA sample of 1216 people aged 60 or more, from the Chilean cohort of the Study of Health, Ageing and Well-Being was recruited in 2000; two follow-up assessments were carried out in a 10-year period. Functional limitation was assessed through self-report of difficulties in activities of daily living, instrumental activities of daily living and mobility. BMI was determined with measured weight and height. Multistate life tables were employed to estimate LE and healthy life expectancy (HLE).ResultsAt 60 years, women could expect to live on average an additional 20.4 years (95% CI 19.0–21.6), and men an additional 16.4 years (95% CI 14.9–17.7). Total LE was longer among women at all ages, but they had a higher proportion of disabled years to be lived compared to men, with a difference of 14% at 60 years, and 10% at 90 years. There were no significant differences in LE, DFLE and DLE between BMI categories.DiscussionDespite a longer LE, Chilean older women expect to live a higher proportion of years with disabilities, compared to men. Public health programs should address factors affecting LE of older men, and those associated with disability among older women.

A RETROSPECTIVE REVIEW OF WESTERN LOWLAND GORILLA (GORILLA GORILLA GORILLA) MORTALITY IN EUROPEAN ZOOLOGIC COLLECTIONS BETWEEN 2004 AND 2014.

An understanding of the main causes of mortality among captive gorillas is imperative to promoting their optimal care, health, and welfare. A retrospective observational review of mortality among the European zoo-housed western lowland gorilla ( Gorilla gorilla gorilla) population from 2004 to 2014 was carried out. This is the first published study of mortality in this population. Relevant postmortem data were requested from each collection reporting a death during the study period. Age at death enabled grouping into discrete age categories. Deaths were classified according to cause. The main causes of death overall and for each age category and sex were identified. In total, 151 gorillas from 50 European collections died during the study period. Postmortem data were available for 119 (79%) of the deaths, of which 102 (86%) were classified by cause. Diseases of the digestive system were responsible for most (23%) deaths overall. Also of significance (each accounting for 15% overall mortality) were deaths due to external causes (especially trauma) among young gorillas and cardiovascular disease among adult and aged animals. Being a male gorilla was associated with an 8.77- and 5.40-fold increase in risk of death due to cardiovascular and respiratory disease, respectively. Death due to external causes was 4.45 times more likely among females than males. There was no statistically significant difference in life expectancy between male and female gorillas. The authors conclude that further work is needed to understand risk factors involved in the main causes of death and suggest a need for standardization with regard the approach to postmortem examination and data collection, sample collection, and storage across European zoos.

COMPARATIVE ANALYSIS OF POSTOPERATIVE CHEMORADIOTHERAPY REGIMENS IN PATIENTS WITH MALIGNANT BRAIN GLIOMAS

The initial results of radiation therapy with different chemotherapy treatment regimen are provided in the article. Radiation therapy was carried out in all patients using by linear accelerators in the bremsstrahlung energy mode (6 MeV) once a day, 5 times a week. The single boost dose was 3 Gy, 51 Gy total. Upon reaching total boost dose in 18, 24, 30, 36, 42 and 48 Gy patients of the first and third groups received temozolomide (250 mg). Vincristine was administered intravenously to patients of the second and the fourth groups (1 mg) after reaching the total boost dose 18, 33 and 48 Gy. The next day these patients received nitrosourea derivatives (CCNU 80 mg orally or BCNU 50 mg intravenously). Postoperative chemoradiotherapy with temozolomide in patients with glioblastoma resulted in a significant increase of life expectancy. In GBM/temozolomide group median survival was 16,9 months vs 11,3 months in patients who received vincristine/nitrosourea derivatives (р=0,016). There was no significant difference in life expectancy in patients with AA (р=0,13): median survival was 29,9 (group 3) and 22,7 months (group 4).

Educational differences in life expectancy over five decades among the oldest old in Norway.

Socioeconomic inequalities in life expectancy have been shown among the middle aged and the youngest of the old individuals, but the situation in the oldest old is less clear. The aim of this study was to investigate trends in life expectancy at ages 85, 90 and 95 years by education in Norway in the period 1961-2009. This was a register-based population study including all residents in Norway aged 85 and over. Individual-level data were provided by the Central Population Register and the National Education Database. For each decade during 1961-2009, death rates by 1-year age groups were calculated separately for each sex and three educational categories. Annual life tables were used to calculate life expectancy at ages 85 (e85), 90 (e90) and 95 (e95). Educational differentials in life expectancy at each age were non-significant in the early decades, but became significant over time. For example, for the decade 2000-9, a man aged 90 years with primary education had a life expectancy of 3.4 years, while a man with tertiary education could expect to live for 3.8 years. Similar numbers in women were 4.1 and 4.5 years, respectively. Even among 95-year-old men, statistically significant differences in life expectancy were found by education in the two last decades. Education matters regarding remaining life expectancy also for the oldest old in Norway. Life expectancy at these ages is low, so a growth of 0.5 years in the life expectancy differential is sizeable.

Surgical and nonsurgical management of patent ductus arteriosus in cats: 28 cases (1991-2012).

To characterize the clinical features and outcome of cats treated for patent ductus arteriosus (PDA) with attenuation (extravascular or intravascular) versus medical treatment only. Retrospective case series. 28 client-owned cats with congenital PDA. Medical records for cats with PDA diagnosed by means of echocardiography were reviewed. Data retrieved included signalment; history; clinical signs; results of physical examination, ECG, echocardiography, and thoracic radiography; response to medical management if attempted; type of attenuation procedure if attempted (surgical or intravascular); procedural details; intraoperative and postoperative (≤ 2 weeks) complications; and long-term (> 2 weeks) complications. Follow-up was obtained from medical records and via telephone interviews. All 28 cats were referred for evaluation of a cardiac murmur, but 17 of 26 (65%) for which initial clinical signs were available did not have overt signs at initial evaluation. Multiple congenital cardiac defects were identified in 6 of 23 (26%) cats. Seventeen of 26 (65%) cats were documented as treated with 1 or more vascular attenuation procedures; vascular attenuation was not attempted in 11 cats receiving an angiotensin-converting enzyme inhibitor or loop diuretic (n = 2) or no medical treatment (9). Surgical ligation was successful in 11 of 15 cats, and coil embolization was successful in 2 cats. Procedural or postoperative complications included death (n = 2), left-sided laryngeal paralysis (2), voice change (1), fever (1), hemorrhage (4), and chylothorax (1). Long-term follow-up was available for 16 of 28 (57%) cats. Three of 4 cats that did not undergo surgical attenuation died of cardiac-related disease. Results suggested that PDA occurs rarely in cats, and clinical signs and diagnostic findings were consistent with those previously reported for dogs. Surgical versus nonsurgical treatment did not result in a significant difference in life expectancy in this small cohort. Evaluation of laryngeal function after surgical ligation is recommended. Further study of the outcome associated with various treatment options in a larger population of patients is recommended.

KEPEMILIKAN SUMBER DAYA ALAM TERHADAP KONDISI SOSIAL EKONOMI WILAYAH DI INDONESIA

This study aims to determine the difference in life expectancy, the average, the difference in GDP per capita, and differences in poverty rates between developed regions rich natural resources and developed regions poor in natural resources. This study uses Typology Klassen in sampling, The results showed that there are significant differences in life expectancy in developed regions are rich in natural resources and advanced regions poor in natural resources. There are significant differences in the average length of school in the forward region rich in natural resources and advanced regions poor in natural resources. There are significant differences in GDP per capita between developed regions rich natural resources and developed regions poor in natural resources. There were no significant differences in the levels of poverty in the developed regions rich in natural resources with advanced regions poor in natural resourcesKeyword : natural resource curse, life expetancy, length of school, GDP, poverty

Proposed score for survival of patients with myelodysplastic syndromes

Patient selection for various therapies in myelodysplastic syndromes (MDS) is based on prognostic factors, scoring systems and the individual life expectancy. However, most established risk scores include mainly disease-related parameters and thus focus on leukaemia-transformation rather than survival. To establish a risk score optimized for prediction of survival, we analysed international prognostic scoring system (IPSS)-related and IPSS-independent variables in 400 patients with primary MDS (median age: 71 years; range 18-91) of the Austrian MDS platform. Patients were randomly split into a learning sample (60%) and validation sample (40%). External validation was performed on 93 patients from the Heinrich Heine University (Duesseldorf/Germany). By multivariate analysis, IPSS, ferritin, age and comorbidities were found to be independent predictive variables concerning survival. Based on weighing these prognostic parameters against each other, we established a novel survival score employing IPSS, ferritin (< 900 ng/mL = 0; ≥ 900 ng/mL = 1), age (< 70 years = 0; 70-79 years = 1; ≥ 80 years = 1.5) and HCT-CI comorbidity (low/intermediate = 0; high = 0.5). Using this score, four prognostic risk groups could be discriminated in the validation sample, with highly significant differences in life expectancy [median survival: LowS (score 0), not reached; Int-1S (score 0.5-1.0), 3.84 years; Int-2S (score 1.5-2.0): 2.72 years; and HighS (score > 2.0): 0.80 years; P < 0.0001]. Our newly proposed score may be a useful tool for survival prediction in MDS and helpful in patient selection for various therapies in daily practice and clinical trials.

The role of occupation and working in healthy ageing

Work life can have a significant impact on ageing. Professor Harri Vainio, from the Finish Institute of Occupational Health, looks at what should be done to ensure that work promotes healthy ageing The importance of healthy ageing poses challenges to all European countries. By 2025 about one-third of Europe's population will be aged 60 years and over, and the number of people aged 80 years and over 1 will rise rapidly. This will have an enormous impact on European societies. While the demographic mechanisms driving this development - lower fertility rates and longer lifespans 2 - are well-known, knowledge regarding the impact of a person's work life and lifestyle on healthy ageing is still incomplete.3,4 Although the study of successful ageing requires that we take into account the entire life course, work life nonetheless has a significant influence on ageing, because careers today tend to be long. Healthy ageing can be promoted throughout work life by ensuring that work does not worsen illnesses or increase the probability of functional deficiency related to illnesses. Work must also support good cognitive and physical capacity, as well as an active attitude towards life in general.5 Investing in healthy ageing contributes to the labour supply, decreasing the likelihood of early retirement. Employers and employees need to take responsibility for the health of the older members of the workforce so that these can work until increasingly older ages. This can be achieved by, for example, improving mental, social and physical functional capacity and making age management everyday practice at workplaces. Investments in healthy ageing must be made throughout the entire work life,6 however the last few years of work may particularly affect a person's everyday life after retirement. Good work ability means good functional capacity and health, and leads to a better quality of life once retired. People are able to directly affect healthy, successful ageing to a greater extent than has been previously assumed. For example lifestyle factors, especially exercise, nutrition, and the ratio of rest to work all affect the health and functional capacity of older workers. The characteristics of the physical environment, work itself and working conditions, one's economic situation; services; social relationships; friends; society's attitudes; and social equity are also connected to healthy ageing.5, 9 Different combinations of work and lifestyle factors are becoming visible in the health and functional capacity of employees aged over 45 years. On the one hand, harmful exposure at work and a detrimental lifestyle will eventually cause ill health. On the other hand however, safe, rewarding work and a lifestyle that supports health ensures a healthy life course. Most of the workforce falls between these two extremes. The criteria for healthy ageing can be examined from the viewpoint of successful, regular, and pathological ageing. A study on the importance of age identification for healthy ageing showed that 'positive' people felt younger, and were happier with their chronological age than those classified as 'negative'. The younger the respondents felt, the higher they ranked their functional capacity.10 Employees' resources (health, functional capacity, competence, attitudes) change significantly during the life course. Working conditions cause many kinds of threats to health and functional capacity. There are significant differences in life expectancy, long-term illnesses, and exposure to accidents between different occupational groups. This may also be a result of lifestyle and heritage. Together these factors can even affect the differences in the mortality patterns of different occupational groups.11 Although perceived health problems generally increase with age both before and after retirement, they often decrease sharply between the year before and the year after retirement. …

The impact of advanced age on outcomes in squamous cell carcinoma of the head and neck.

5577 Background: Limited data are available regarding outcomes in elderly head and neck cancer patients. This retrospective study was designed to characterize head and neck cancer in geriatric patients in the UNC Tumor Registry. Methods: Of 1,598 patients identified from the registry, 1,291 patients were &lt;70 years old (young group, YG) and 307 patients were &gt; 70 (elderly group, EG) at diagnosis. Both overall survival (OS), calculated from diagnosis to death or the last follow up, and relapse free survival (RFS) were censored at 60 months. Log-rank test was used to compare survival difference. Cox proportional hazard model was used to estimate hazard ratio, adjusting for potential confounding factors. All tests were performed in R 2.13.1. Results: EG patients were more likely to present at an early stage with 25% presenting at stage I and 37% presenting at stage IV compared to 17% and 51% respectively in YG. EG had a median OS of 35 months (95% CI: 28-41 months) compared to approximately 60 months in YG (p &lt; 0.0001 log rank test). The median RFS for EG and YG are 25 (95% CI: 20-32 months) and 44 (95% CI: 38-52 months) months respectively (p &lt; 0.0001 log rank test). When controlling for possible confounders, EG patients were nearly twice as likely to die (HR 1.94, 95% CI 1.635-2.302, p&lt;0.0001) and 70% more likely to relapse in 5 years compared to YG (HR 1.704, 95% CI 1.449-2.004, p&lt;0.05). The median life expectancy for elderly patients in our study was nearly 5 years for stage I/II and &lt;2 years for stage III/IV. Conclusions: Poor OS and RFS in elderly patients compared to younger patients in this study indicate a need for further investigation considering comorbidities and aggressiveness of treatment. Significant differences in life expectancy in elderly patients with early versus late disease may help guide patients and clinicians in determining how aggressively to treat.

Life Expectancy and Old Age Savings

Rich people, women, and healthy people live much longer than their poor, male, and sick counterparts. Two extremes, taken from our analysis of single people in the Assets and Health Dynamics of the Oldest Old (AHEAD) dataset, illustrate this point: an unhealthy 70-year-old male at the twentieth percentile of the permanent income distribution expects to live only 6 more years, that is, to age 76. In contrast, a healthy 70-year-old woman at the eightieth percentile of the permanent income distribution expects to live 16 more years, thus making it to age 86.] Such significant differences in life expectancy could, all else equal, lead to significant differ ences in saving behavior. A related observation is that people with high permanent incomes keep large amounts of assets until very late in life. Table 1, also based on the

21-gene RT-PCR assay in lymph node negative (LN-), estrogen receptor positive (ER+) breast cancer: An economic analysis including prognostic and predictive information

6024 Background: The prognostic accuracy of a 21-gene RT-PCR assay has undergone validation in 668 evaluable LN-, ER+ early stage breast cancer patients receiving tamoxifen on NSABP B-14 (Paik, NEJM 2004) and its economic evaluation (Hornberger, Am J Man Care 2005). Assay predictive accuracy for response to chemotherapy or tamoxifen has also undergone recent validation in 651 patients on NSABP B-20 and 645 patients on NSABP B-14 (Paik, SABCS 2004). Methods: Based on the model recurrence score (RS), women with LN−, ER+ breast cancer with and without adjuvant chemotherapy (C) or tamoxifen (T) were classified as high (RS ≥31), intermediate (RS 18–30) or low (RS &lt;18) risk of distant recurrence at 10 years. Incremental costs ($), life-years (LYs), quality-adjusted LYs (QALYs) and cost-effectiveness (C/E; cost per LY gained) were estimated for: RS-guided treatment (RSGT) with T for low and intermediate risk patients and C+T for high-risk patients, compared to either T alone or C+T for all patients. Results: Under base case assumptions, no significant difference in life expectancy at 10 years is estimated between the RSGT and C+T strategies whereas RSGT is associated with a gain in individual life expectancy of 2.7 LYs compared to T alone. RSGT is estimated to yield a net cost savings of $4,502 compared to C+T with an incremental C/E of $1,059 per LY saved compared to T alone. At a utility of 90% associated with adjuvant chemotherapy, RSGT is associated with a gain in individual QALYs of 1.82 compared to T alone at a cost utility of $1,573/QALY and a gain in 3.21 QALYs compared to C+T. RSGT is associated with lower expected cost than C+T for total chemotherapy costs above $3,998. The gain in LYs with RSGT compared to T alone increases with healthy age-specific life expectancy (years) while the cost per LY gained decreases. Conclusions: Treatment based on the RSGT compared to T alone is associated with acceptable C/E ratios and substantially lower toxicity and cost compared to C+T. [Table: see text] [Table: see text]