Years Of Life Expectancy Research Articles

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

Trends in Healthy Life Years Between 2005 and 2019 in 31 European Countries: The Compression or Expansion of Morbidity?

Our objective was to assess morbidity trends in Europe and to classify European countries based on population ageing theories: the compression, expansion and dynamic equilibrium of morbidity. The proportions of healthy life years were calculated for 31 European countries for the period 2005-2019 based on life expectancy values and healthy life years at age 65years adopted from the Eurostat database. European countries were classified according to morbidity patterns applying the standard deviation distance from the average of relative change method between the selected years. A large degree of variation in terms of life expectancy and healthy life years at age 65years was determined between 2005 and 2019. While the life expectancy differences between men and women were consistent across all the European countries, the gender gap concerning healthy life years was more diverse. Approximately one-third of the countries fell into the expansion, compression and dynamic equilibrium categories, respectively. Significant variations were identified in healthy life year trends across European countries, which underscores the need for preventive strategies.

Impact of colorectal cancer screening programme on survival and employment in Taiwan: A nationwide analysis of real-world data.

Colorectal cancer (CRC) leads to life loss and a significant economic burden, which could be reduced by CRC screening. We assessed the potential savings of lives and employment to evaluate the effectiveness of the Taiwan CRC Screening Programme. Through interlinkages among Taiwan Cancer Registry, National Mortality Registry, Taiwan CRC Screening Database, and National Health Insurance claim data, we enroled patients with colorectal adenocarcinoma, aged 50-74years and diagnosed during 2004-2017, and followed them up to 2018. Life expectancy (LE), lifetime employment duration (LED), loss-of-LE and loss-of-LED were calculated, compared with age-, sex- and calendar year-matched cohorts. Assuming no difference within a specific stage for screen-detected versus non-screen detected CRC and weighting them by different stage distributions, we compared the total loss-of-LE and loss-of-LED. The cohort enroled 77,169 patients with colorectal adenocarcinoma, which included 31,728 women (mean [SD] age, 62.5 [7.1] years) and 45,441 men (mean [SD] age, 62.8 [6.8] years). The mean loss-of-LE and loss-of-LED in women were 6.0 (95% confidence interval [CI] 5.7-6.3) and 1.0 (95% CI 0.8-1.1) year(s), whereas those in men were 5.1 (95% CI 4.9-5.4) and 1.1 (95% CI 1.0-1.2) years, respectively. Among the cohort, 53,678 cases had the screening information. On average, screening potentially saved 2.9 (95% CI 2.6-3.2) years of life expectancy plus 0.5 (95% CI 0.4-0.6) years of employment per case in women and 2.7 (95% CI 2.5-3.0) years plus 0.6 (95% CI 0.5-0.7) years in men, respectively. The Taiwan CRC Screening Programme is associated with the savings of lives and employment duration. Future studies are warranted to evaluate the cost-effectiveness of beginning screening at a younger age after accounting for saving employment loss and possibly adjusting lead time bias.

Long-Term Health Outcomes of Huntington Disease and the Impact of Future Disease-Modifying Treatments: A Decision-Modeling Analysis.

Disease-modifying treatments (DMTs) such as gene therapy are currently under investigation as a potential treatment for Huntington disease (HD). Our objective was to estimate the long-term natural history of HD progression and explore the potential efficacy impacts and value of a hypothetical DMT using a decision-analytic modeling framework. We developed a health state transition model that separately analyzed 40-year-old individuals with prefunctional decline (PFD, HD Integrated Staging System [HD-ISS] stage <3, total functional score [TFC] 13), active functional decline Shoulson and Fahn category 1 (SF1, HD-ISS stage 3, TFC 13-11), and SF2 (HD-ISS stage 3, TFC 10-7). Three-year outcomes from the TRACK-HD longitudinal study were linearly extrapolated to estimate the long-term health outcomes and costs of each population. For PFD individuals, we used the HD-ISS to predict the onset of functional decline. HD costs and quality-adjusted life years (QALYs) were estimated over a lifetime horizon by applying health state-specific costs and utilities derived from a related HD burden-of-illness study. We then estimated the long-term health impacts of hypothetical DMTs that slowed or delayed onset of functional decline. We conducted sensitivity analyses to assess model uncertainties. The expected life years for 40-year-old PFD, SF1, and SF2 populations were 20.46 (95% credible range [CR]: 19.05-22.30), 13.93 (10.82-19.08), and 10.99 (8.28-22.07), respectively. The expected QALYs for PFD, SF1, and SF2 populations were 15.93 (14.91-17.44), 8.29 (6.36-11.79), and 5.79 (4.14-12.91), respectively. The lifetime costs of HD were $508,200 ($310,300 to $803,700) for the PFD population, $1.15 million ($684,500 to $1.89 million) for SF1 individuals, and $1.07 million ($571,700 to $2.26 million) for SF2 individuals. Although hypothetical DMTs led to cost savings in the PFD population by delaying the cost burdens of functional decline, they increased costs in SF1 and SF2 populations by prolonging time spent in expensive progressive HD states. Our novel HD-modeling framework estimates HD progression over a lifetime and the associated costs and QALYs. Our approach can be used for future cost-effectiveness models as positive DMT clinical trial evidence becomes available.

Abstract A135: Social disparities in breast cancer screening: Up-to-date screening versus overscreening

Abstract Objective: The United States Preventative Services Task Force breast cancer (BC) screening guidelines in 2022 recommended biennial mammography for women aged 50-74 and cited insufficient evidence to assess mammography’s benefits vs. harms in women aged ≥75. Other guidelines recommend screening cessation for women with &amp;lt;10 years of life expectancy. We examined how racial/ethnic, socioeconomic and geographic patterns observed in up-to-date screening (UTDS) for age-eligible women differ from women aged out of these guidelines or those with limited life expectancy (i.e. overscreening). Methods: We used nationally representative data from the 2022 Behavioral Risk Factor Surveillance System for women aged 50+. Women screened in the past 1-2 years were considered UTDS in age group 50-74 and ‘overscreened’ if 75+ or with a high mortality risk of any age (≥8 score using modified Lee mortality index). We used multivariable logistic regressions to examine UTDS and overscreening in relation to self-identified race/ethnicity, metropolitan status, having a personal health care provider, highest education level, and marital status, stratified by age group and mortality risk. Results: 19.2% of 99601 women aged 50-74 did not have UTDS, while 73.7% of 34545 women 75+ and 60.2% of 22225 women with limited life expectancy continued to receive screening (overscreened). Among those aged 50-74, compared to non-Hispanic (NH) White, NH American Indian/Alaskan Native women (OR=0.60, 95% CI=0.45–0.82) and NH women of unknown race (OR=0.61, 95% CI=0.45–0.82) were less likely to have UTDS while NH Black (OR=1.81, 95% CI=1.60–2.03) and Hispanic (OR=1.24, 95% CI=1.05–1.46) women were more likely to have UTDS. Lower socioeconomic resources were consistently associated with lower likelihood of UTDS (e.g. not having vs. having a personal health care provider (OR=0.22, 95% CI=0.19–0.26) or high school or less education vs. higher than high school (OR=0.73, 95% CI=0.67–0.79)). In ages 75+, compared to NH White, NH Black women were more likely to be overscreened (OR=1.32, 95% CI=1.06–1.65), and NH women of unknown race were less likely to be overscreened (OR=0.49, 95% CI=0.29–0.83). Low socioeconomic indicators were also associated with lower likelihood of overscreening (e.g. not having vs. having a personal health care provider (OR=0.48, 95% CI=0.36–0.63) or high school or less education vs. higher than high school (OR=0.76, 95% CI=0.67–0.86)). Among women with a higher mortality risk, NH Black women (OR=2.05, 95% CI=1.64–2.56) and Hispanic women (OR=1.61, 95% CI=1.09– 2.38) were more likely to be overscreened than NH White women. Conclusion: The findings reveal racial/ethnic, socioeconomic and geographic disparities in UTDS. NH Black and Hispanic women, who are more likely to have UTDS, may be at risk of overscreening as they age or if they have limited life expectancy. These patterns in UTDS and overscreening are critical considerations for implementing equitable BC screening guidelines and optimizing the benefits while minimizing the harms of screening in diverse populations. Citation Format: Michelle L. Lui, Erica Lee Argov, Anita G. Karr, Rebecca D. Kehm, Parisa Tehranifar. Social disparities in breast cancer screening: Up-to-date screening versus overscreening [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A135.

Cross-Sectional Association Between Life Expectancy and Unhealthy Life Years: Proof of Concept Tests of the CroHaM Hypothesis

The recently presented CroHaM hypothesis says (1) that longitudinal health domain-specific expansion and compression effects depend primarily on the health domains’ mortality risk and (2) that these effects exist equivalently in the cross-sectional context, affecting differences in healthy life years (HLY) between populations and subpopulations with different levels of life expectancy (LE). We test this hypothesis by analysing the association between LE and unhealthy life years (ULY) at age 50 for a large number of subpopulations. The analyses are carried out for three health domains which are differently related to mortality: poor self-perceived health and strong activity limitation with comparatively high mortality, and chronic morbidity with comparatively low risk of dying. Data on gender- and subpopulation-specific prevalence of these health conditions are taken from the Actual German Health Study 2012 (GEDA). LEs are estimated with the “Longitudinal Survival Method”, using data of the German Life Expectancy Survey. ULY are estimated with the “Sullivan Method”. Differences in ULY between each subpopulation and the total population and between women and men for each subpopulation are decomposed into the effects caused by differences in health (“health effect”) and mortality (“mortality effect”) with the “Nusselder/Looman Method”. The results confirm the CroHaM hypothesis: we find a positive relationship between LE and ULY only for chronic morbidity, whereas this relationship is negative for poor self-perceived health and strong activity limitation. However, when the mortality effect is controlled for, we find a negative relationship between LE and ULY for all three health domains. The practical relevance of these findings is discussed using the example of the so-called “gender paradox” in health and mortality. We conclude that the CroHaM hypothesis may describe an important determinant of life years spent with and without health impairment, and it may help to better understand and interpret trends and differentials in HLY or ULY based on cross-sectional data. * This article belongs to a special issue on “Levels and Trends of Health Expectancy: Understanding its Measurement and Estimation Sensitivity”.

The Immigrant Mortality Advantage Among Over-65 Middle Eastern and North African Immigrants to the United States.

Immigrants to the United States often have longer life expectancies than their U.S.-born counterparts, however it is unclear whether a similar "immigrant advantage" exists for immigrants from the Middle East and North Africa (MENA). This study uses a novel machine-learning name classifier to offer one of the first national-level examinations of MENA mortality patterns by nativity in the United States. A recurrent neural network model was developed to identify MENA individuals based on given name and surname characteristics. The model was trained on more than 2.5 million mortality-linked social security records in the Berkeley Unified Numident Mortality Database (BUNMD). Mortality rates and life expectancy were estimated using a Gompertz distribution and maximum likelihood estimation, focusing on high-coverage years between 1988 and 2005 and deaths over age 65. Foreign-born MENA men over 65 showed a significant immigrant mortality advantage with a hazard ratio (HR) of 0.64 and an estimated 3.13 additional years of life expectancy at age 65 compared to U.S.-born counterparts. Foreign-born MENA women also exhibited an advantage, with a HR of 0.71 and an additional 2.24years of life expectancy at age 65. This study is one of the first national-level analyses of mortality outcomes among the over-65 MENA population in the United States, finding a MENA immigrant mortality advantage. The results suggest further research is needed to identify and disaggregate the MENA population in health research.

Decision analysis for transplant candidates with primary myelofibrosis in the ruxolitinib era.

The recent progress with ruxolitinib treatment might improve quality-of-life as well as overall survival in patients with primary myelofibrosis (PMF). Therefore, the optimal timing of allogeneic hematopoietic cell transplantation (HCT) remains to be elucidated in the ruxolitinib era. We constructed a Markov model to simulate the 5-year clinical course of transplant candidates with PMF, and compared outcomes between immediate HCT and delayed HCT after ruxolitinib failure. Since older age was associated with an increased risk of mortality, we analyzed patients aged < 60 and ≥ 60 separately in subgroup analyses. The expected life years was consistently longer in delayed HCT after ruxolitinib failure regardless of patient age. Regarding quality-adjusted life years (QALYs), a baseline analysis showed that immediate HCT was inferior to delayed HCT after ruxolitinib failure (2.19 versus 2.26). In patients aged < 60, immediate HCT was equivalent to delayed HCT after ruxolitinib failure (2.31 versus 2.31). On the other hand, in patients aged ≥ 60, immediate HCT was inferior to delayed HCT after ruxolitinib failure (1.98 versus 2.21). A one-way sensitivity analysis showed that the utility of being alive without chronic graft-versus-host disease after immediate HCT was the most influential parameter for QALYs, and that a value higher than 0.836 could reverse the superiority of delayed HCT after ruxolitinib failure. As a result, delayed HCT after ruxolitinib failure is expected to be superior to immediate HCT, especially in patients aged ≥ 60, and is also a promising strategy even in those aged < 60.

The effect of the COVID-19 health disruptions on breast cancer mortality for older women: a semi-Markov modelling approach

ABSTRACT Public health measures necessitated by the COVID-19 pandemic have affected cancer pathways by halting screening, delaying diagnostic tests and reducing the numbers starting treatment. Specifically, this moves individuals from observed and treated pathways to unobserved and untreated pathways. We introduce a semi-Markov model that includes both, extending an industry-based multiple state model used for life and critical illness insurance. Our model includes events related to cancer diagnosis and progression based on publicly available population data for women aged 65–89 in England and on relevant medical literature. We quantify age-specific excess deaths, for a period up to 5 years, along with years of life expectancy lost and changes in cancer mortality by cancer stage. Our analysis suggests a 3–6% increase in breast cancer deaths, and a 4–6% increase in registrations of advanced breast cancer, robust under sensitivity analysis. This should be applicable to actuarial work in areas where longevity and advanced age morbidity affect healthcare, retirement and insurance.

Assessing life expectancy disparities in Chicago with a deep dive into green space

BackgroundFew studies have examined the association between green space and life expectancy, and only one study has looked at that data for small areas in the United States. These studies have found a positive association between green space and life expectancy. This study investigates the association between green space and small-area life expectancy in Chicago, a city in the United States with distinct environmental and socioeconomic characteristics and the largest U.S. life expectancy gap between neighborhoods. MethodsWe conducted a spatial analysis using the green space metrics of normalized difference vegetation index (NDVI), park access, and tree canopy. Additionally, we included 18 lifestyle, environmental, and social covariates. Diagnostic analytics included multiple linear regression, Moran I test for spatial dependence, and principal component analysis with CAR Gaussian model. We performed a simulation to predict life expectancy gain if NDVI was brought to median levels. ResultsOur study revealed that after adjusting for covariates and spatial dependence (Moran I test p = 0.012) with a CAR Gaussian model, NDVI (credible interval = 0.292-0.894) demonstrated significance at a 5 % level, while tree canopy (credible interval = -0.404-0.109) and park access (credible interval = -0.258-0.161) did not. Excluding non-significant variables (tree canopy and park access) from the CAR Gaussian model, the median effect of NDVI on life expectancy was 0.491 (95 % credible interval: 0.24–0.718). Projecting this effect to tracts below the median NDVI predicted a gain of 476,000 years of life expectancy for Chicago residents. ConclusionThis study provides evidence that green space and LE are positively correlated, suggesting the potential to increase green space to address current LE gaps. Future research should investigate the mechanisms by which green space correlates to lifespan.

Old but gold: The use of multiregional life tables and the place-of-birth-dependent approach for studying recent internal migration in Italy

There has been a significant shift in migratory behavior within Italy over time. The origins and destinations of the migration flows, which were previously characterized by a clear prevalence of moving from the south to the center-north, are now much more heterogeneous and complex. Despite the important progress achieved in the past 20 years, the measurement of internal migration remains a contentious topic in international research. Using data provided by the Italian National Institute of Statistics, we applied Rogers&amp;rsquo; multiregional model place-of-birth-dependent approach to assess the internal migration flows that occurred in Italy in the period 2002 &amp;ndash; 2013. This approach provides accurate measurements of internal migration, noting in particular the years of life expectancy for each birth cohort living in each geographical Italian macroregion (northeast, northwest, center, and south). The results indicate that the northwest is the main area of destination for internal migration. The birth cohort in the south is the one that has the greatest number of years of life expectancy in other macroregions. Interestingly, this cohort is the only one characterized by a predominantly male migratory model.

Predictors of Survival, Treatment Modalities, and Clinical Outcomes of Diffuse Large B-Cell Lymphoma in Patients Older Than 70 Years Still an Unmet Medical Need in 2024 Based on Real-World Evidence.

Diffuse large B-cell lymphoma (DLBCL) especially affects the older population. Old (≥60 years) and very old age (≥80 years) DLBCL patients often present high-risk molecular alterations, lower tolerability to conventional immunochemotherapy, and poor clinical outcomes. In this scenario, attenuated therapeutic strategies, such as the R-MiniCHOP and R-MiniCHOP of the elderly regimens, have emerged for this particularly fragile population. However, the responses, clinical outcomes, and toxicities of these regimens currently remain poorly understood, mainly because these individuals are not usually included in controlled clinical trials. This retrospective, observational, and single-center real-world study included 185 DLBCL, NOS patients older than 70 years treated at the largest oncology center in Latin America from 2009 to 2020. We aimed to assess the outcomes, determine survival predictors, and compare responses and toxicities between three different primary therapeutic strategies, including the conventional R-CHOP regimen and the attenuated R-MiniCHOP and R-MiniCHOP of the elderly protocols. The median age at diagnosis was 75 years (70-97 years), and 58.9% were female. Comorbidities were prevalent, including 19.5% with immobility, 28.1% with malnutrition, and 24.8% with polypharmacy. Advanced clinical stage was observed in 72.4%, 48.6% had bulky disease ≥7 cm, 63.2% had B-symptoms, and 67.0% presented intermediate-high/high-risk IPI. With a median follow-up of 6.3 years, the estimated 5-year OS and PFS were 50.2% and 44.6%, respectively. The R-MiniCHOP of the elderly regimen had a lower ORR (p = 0.040); however, patients in this group had higher rates of unfavorable clinical and laboratory findings, including hypoalbuminemia (p = 0.001), IPI ≥ 3 (p = 0.013), and NCCN-IPI ≥ 3 (p = 0.002). Although associated with higher rates of severe neutropenia (p = 0.003), the R-CHOP regimen promoted increased OS (p = 0.003) and PFS (p = 0.005) in comparison to the attenuated protocols. Additionally, age ≥ 75 years, high levels of LDH, B-symptoms, advanced clinical stage (III/IV), neutrophilia, and low lymphocyte/monocyte ratio were identified as poor prognostic factors in this cohort. In this large and real-life Latin American cohort, we demonstrated that patients with DLBCL, NOS older than 70 years still do not have satisfactory clinical outcomes in 2024, with half of cases not reaching 5 years of life expectancy after diagnosis. Although the conventional R-CHOP offers response and survival advantages over attenuated regimens, its myelotoxicity is not negligible. Therefore, the outcomes reported and the prognostic factors here identified may assist clinicians in the appropriate selection of therapeutic strategies adapted to the risk for old and very old DLBCL patients.

Assessing the impact of type 2 diabetes on mortality and life expectancy according to the number of risk factor targets achieved: an observational study

BackgroundType 2 diabetes (T2D) is associated with an increased risk of premature death. Whether multifactorial risk factor modification could attenuate T2D-related excess risk of death is unclear. We aimed to examine the association of risk factor target achievement with mortality and life expectancy among patients with T2D, compared with individuals without diabetes.MethodsIn this longitudinal cohort study, we included 316 995 participants (14 162 with T2D and 302 833 without T2D) free from cardiovascular disease (CVD) or cancer at baseline between 2006 and 2010 from the UK Biobank. Participants with T2D were categorised according to the number of risk factors within target range (non-smoking, being physically active, healthy diet, guideline-recommended levels of glycated haemoglobin, body mass index, blood pressure, and total cholesterol). Survival models were applied to calculate hazard ratios (HRs) for mortality and predict life expectancy differences.ResultsOver a median follow-up of 13.8 (IQR 13.1–14.4) years, deaths occurred among 2105 (14.9%) participants with T2D and 18 505 (6.1%) participants without T2D. Compared with participants without T2D (death rate per 1000 person-years 4.51 [95% CI 4.44 to 4.57]), the risk of all-cause mortality among those with T2D decreased stepwise with an increasing number of risk factors within target range (0–1 risk factor target achieved: absolute rate difference per 1000 person-years 7.34 [4.91 to 9.78], HR 2.70 [2.25 to 3.25]; 6–7 risk factors target achieved: absolute rate difference per 1000 person-years 0.68 [-0.62 to 1.99], HR 1.16 [0.93 to 1.43]). A similar pattern was observed for CVD and cancer mortality. The association between risk factors target achievement and all-cause mortality was more prominent among participants younger than 60 years than those 60 years or older (P for interaction = 0.012). At age 50 years, participants with T2D who had 0–1 and 6–7 risk factors within target range had an average 7.67 (95% CI 6.15 to 9.19) and 0.99 (-0.59 to 2.56) reduced years of life expectancy, respectively, compared with those without T2D.ConclusionsIndividuals with T2D who achieved multiple risk factor targets had no significant excess mortality risk or reduction in life expectancy than those without diabetes. Early interventions aiming to promote risk factor modification could translate into improved long-term survival for patients with T2D.

Is Agri-residue Burning a Menace for Air Quality &amp; Public Health in Delhi, India?

Skies over Delhi become blurred and visibility is significantly reduced and the air is hefty and causes a burning sensation in the eyes. As every year in November, a thick blanket of smog veils Delhi and its surrounding National Capital Region-NCR of India, which constitute the world’s most polluted megacity. According to a senior pulmonologist and member of the WHO commission on global air pollution and health, patients experiencing breathing problems increase by 30-40 percent every year during October-November. But Delhi’s smog wasn’t always this bad in early winter; it started only about 10-15 years ago. Satellite images show high Aerosol Optical Depth (AOD), as soon as farmers start burning paddy straw and stubble (agri-residue) in agricultural fields, and air quality severely deteriorates. The agri-residue smoke from agricultural areas surrounding Delhi, combined with urban pollution from vehicles, industry, and fireworks from the Diwali festival, increase pollutants to the severe category. Smoke from farm fires after harvest contributed about ⁓ 26-50% of the PM2.5 (tiny particles that damage lungs and can worsen cardiac ailments) to Delhi’s air in November 2023. The average resident of this megacity is on track to lose ⁓ 8 years of life expectancy if high pollution levels persist (EPIC, 2023). Authorities in this smog-ridden capital, even imposed emergency school closures of 7 to 15 days in 2016, 2017 and 2023 to mitigate health issues in the population, who flooded emergency wards at hospitals.

Forensic Analysis of Lung Cancer from Secondhand Smoke Exposure of a Motel Worker

Background: In July 2018, Ms. PJM, a 50-year-old lifelong nonsmoker, was diagnosed with primary Stage IV lung adenocarcinoma with secondary metastasis to the brain, after being hospitalized for a fall in the motel where she worked, in Los Angeles, California. She had been employed as a maid cleaning rooms in this motel for 20 years, where she was exposed to secondhand and thirdhand tobacco smoke daily. Her death certificate, dated June 2021, declared metastatic lung cancer to be the cause of her death at age 53. Occupational disability and death claims filed by her attorney were contested by her employer. Aims: To conduct a forensic analysis using mathematical modeling to quantify Ms. PJM’s toxic secondhand and thirdhand smoke exposures, in order to estimate her risk of lung cancer from exposure to tobacco combustion products and other potential carcinogenic agents to which she might have been exposed. Methods: A quantitative analysis employing assessment of Hazard, Exposure, Dose, Dose-Response, and Risk plus a Discussion of Uncertainty. It is routinely used by U.S. federal regulatory agencies, including the Occupational Safety and Health Administration (OSHA), and the Environmental Protection Agency (EPA). Results: Ms. PJM’s modeled exposure to fine particulate matter from secondhand smoke ranged from the Hazardous to Significant Harm Levels of the EPA Air Quality Index for fine particles (PM2.5). Her modeled dose of serum cotinine ranged from the 90th to beyond the 95th percentile of nonsmokers’ dose, measured in a statistical sample of the U.S. nonsmoking population. Her estimated risk exceeds OSHA’s Significant Risk of Material Impairment of Health Level by a factor of three. She is estimated to have been exposed to the thirdhand smoke of at least 1.4 million cigarettes outgassing from room surfaces during her 20 years of labor. As for potential confounders, there were no known carcinogens in any of the cleaning agents she used; there is no evidence that she was exposed to asbestos, and she resided in a low-radon area of Los Angeles. Conclusions: As a result of her occupational exposure to secondhand and thirdhand smoke, Ms. PJM lost an estimated 33 years of life expectancy. The State of California has been remiss in failing to extend its workplace smoking ban to hotels and motels, leaving their workstaff at grave risk of the manifold diseases of passive smoking.

Examining the Effect of Partial and Complete Elimination of a Specific Disease on the Gain in Life Expectancy at Birth in India and Selected States

Background: Life expectancy, especially life expectancy at birth, is a good indicator of current health condition of the population and is estimated through life tables. The present study aims to examine the effect of partial and complete elimination of a specific disease on the gain in life expectancy at birth by sex in India and selected states using Medical Certification of Cause of Death (MCCD) secondary data for 2017.&#x0D; Methods: Life tables were constructed for all cause-specific deaths using Greville method for both males and females separately for India and selected states. Cause-deleted life tables were also constructed for partial (25%, 50%, 75%) and complete (100%) elimination of ten leading cause of death groups. Gain in life expectancy was estimated as the difference between values of cause-deleted life table and cause-specific life table.&#x0D; Results: Complete elimination of diseases of the circulatory system yielded maximum gain in life expectancy at birth in males (14.64 years) and in females (15.49 years) both in Haryana. It was followed by diseases of the respiratory system in males (6.45 years) in Jharkhand and in females (6.17 years) in Uttar Pradesh; certain infectious and parasitic diseases in males (3.82 years) in Uttar Pradesh and in females (3.58 years) in Delhi; neoplasms in males (2.71 years) and in females (2.11 years) both in Kerala. Similar results were obtained in case of remaining diseases.&#x0D; Conclusions: Maximum gained years in life expectancy at birth would be obtained after reducing or eliminating mortality from diseases of the circulatory system. These findings may help in setting up health goals, allocating resources, and launching tailor-made health care programmers.

IMPACT OF HEALTHY LIFESTYLE FACTORS ON LIFE EXPECTANCY AND LIFETIME HEALTHCARE COST: A NATIONWIDE COHORT STUDY

Abstract In an aging society with increasing life expectancy, the significance of healthy behaviors has garnered considerable attention. Research indicates that adopting healthy behaviors not only contributes to a longer life expectancy but also leads to reduced healthcare expenditure. Our study aims to investigate the impact of individual and combined healthy lifestyle factors on life expectancy and lifetime healthcare expenditure in Taiwan. Analyzing data from the National Health Interview Survey cohort, we examined five healthy lifestyle behaviors: nonsmoking, avoiding excessive alcohol consumption, regular physical activity, sufficient fruit and vegetable intake, and maintaining a normal weight. By employing a rolling extrapolation algorithm, we estimated the lifetime survival function of the study cohorts and calculated the life expectancy and lifetime healthcare expenditure of populations with and without healthy lifestyle factors. Our analysis of 19,893 participants aged 30 and above revealed that adopting a healthy lifestyle is associated with longer life expectancy and reduced healthcare expenditure in Taiwanese adults. Participants adhering to all five behaviors gained 11.93 years in life expectancy compared to those with none, with an annual average healthcare expenditure reduction of $7,308. Smoking and diet were the most significant risk factors for shorter life expectancy, with current and former smokers experiencing a 4.02-year reduction and individuals with sufficient fruit and vegetable intake gaining 3.69 years compared to those with insufficient intake. These findings offer a comprehensive understanding of the impact of healthy lifestyle factors on overall health and economic burden, providing evidence-based guidance for policymakers and stakeholders in promoting healthy aging.

Remnant cholesterol and risk of premature mortality: an analysis from a nationwide prospective cohort study.

To explore the relationship between remnant cholesterol (RC) and the risk of premature mortality as well as life expectancy in the general population. We included a total of 428 804 participants from the UK Biobank for analyses. Equivalent population percentiles approach based on the low-density lipoprotein cholesterol cut-off points was performed to categorize participants into three RC groups: low (with a mean RC of 0.34mmol/L), moderate (0.53mmol/L), and high (1.02mmol/L). We used multivariable Cox proportional hazards models to evaluate the relationship between RC groups and the risk of premature mortality (defined as death before age 75 years). Life table methods were used to estimate life expectancy by RC groups. During a median follow-up of 12.1 years (Q1-Q3 11.0-13.0), there were 23 693 all-cause premature deaths documented, with an incidence of 4.83 events per 1000 person-years [95% confidence interval (CI): 4.77-4.89]. Compared with the low RC group, the moderate RC group was associated with a 9% increased risk of all-cause premature mortality [hazard ratio (HR) = 1.09, 95% CI: 1.05-1.14], while the high RC group had an 11% higher risk (HR=1.11, 95% CI: 1.07-1.16). At the age of 50 years, high RC group was associated with an average 2.2 lower years of life expectancy for females, and an average 0.1 lower years of life expectancy for males when compared with their counterparts in the low RC group. Elevated RC was significantly related to an increased risk of premature mortality and a reduced life expectancy. Premature death in the general population would benefit from measurement to aid risk stratification and proactive management of RC to improve cardiovascular risk prevention efforts.

Changing impact of COVID-19 on life expectancy 2019–2023 and its decomposition: Findings from 27 countries

BackgroundThe World Health Organization declared COVID-19 no longer a global health emergency on 5th May 2023; however, the impact of COVID-19 on life expectancy throughout the pandemic period is not clear. This study aimed to quantify and decompose the changes in life expectancy during 2019–2023 and corresponding age and gender disparities in 27 countries. MethodsData were sourced from the Human Mortality Database, the World Population Prospects 2022 and the United Kingdom's Office for National Statistics. Life expectancy was estimated using the abridged life table method, while differentials of life expectancies were decomposed using the age-decomposition algorithm. ResultsThere was an overall reduction in life expectancy at age 5 among the 27 countries in 2020. Life expectancy rebounded in Western, Northern and Southern Europe in 2021 but further decreased in the United States, Chile and Eastern Europe in the same year. In 2022 and after, lost life expectancy years in the United States, Chile and Eastern Europe were slowly regained; however, as of 7th May 2023, life expectancy in 22 of the 27 countries had not fully recovered to its pre-pandemic level. The reduced life expectancy in 2020 was mainly driven by reduced life expectancy at age 65+, while that in subsequent years was mainly driven by reduced life expectancy at age 45–74. Women experienced a lower reduction in life expectancy at most ages but a greater reduction at age 85+. ConclusionsThe pandemic has caused substantial short-term mortality variations during 2019–2023 in the 27 countries studied. Although most of the 27 countries experienced increased life expectancy after 2022, life expectancy in 22 countries still has not entirely regained its pre-pandemic level by May 2023. Threats of COVID-19 are more prominent for older adults and men, but special attention is needed for women aged 85+ years.

Mortality from Breast Cancer in Women under 50 Years of Age in Colombia.

To calculate and analyze the mortality rates from breast cancer in women under 50 years of age in Colombia and to compare them with those of other countries in the region. Based on data from the registry of deaths in 2018 and the results of the National Population and Housing Census of Colombia for the same year, specific mortality rates in women with breast cancer, specific mortality according to age group, standardized by age, proportional mortality, potential years of life lost, and years of life expectancy lost in women under 50 years of age who died from breast cancer were calculated. The mortality rate of regional countries was consulted on the Global Cancer Observatory webpage. In the group from 20 to 49 years, the specific mortality rate was higher in the age range from 45 to 49 years, with a rate of 23.42 × 100,000, a value that was above the specific mortality rate due to breast cancer in women in Colombia, 15.17 × 100.000. In the age range of 45 to 49 years, the potential years of life lost were 42.16. Of the 0.275 years of life expectancy lost by the population due to this neoplasia, women under 50 years of age represented 0.091 (33%). Colombia is the fifth in the rank of mortality in Latin American countries in this age group. Breast cancer in patients from 30 to 59 years is the number one cause for the decrease in life expectancy of women in Colombia. Women under 50 years of age represent one third of this decrease. This neoplasm is also the leading cause of mortality in women younger than 50 years in South America.