Comparing comprehension and perception for alternative speed-of-ageing and standard hazard ratio formats

Mortality of type 2 diabetes in Germany: additional insights from Gompertz models

AIMS

The Gompertz law of mortality proclaims that human mortality rates in middle to old ages grow log-linearly with age and this law has been confirmed at multiple instances. We investigated if diabetes mortality in Germany also obeys to the Gompertz law and how this information helps to communicate diabetes mortality more intuitively.

METHODS

We analyzed all statutory health-insured persons in Germany in 2013 that were aged 30 years or older. Deaths in 2014 were recorded and given in 5-year age groups. We fitted weighted linear regression models (separately for females and males and for people with and without diabetes) and additionally computed the probability that a person with diabetes dies before a person of the same age and sex without diabetes, and the "diabetes age", that is, the additional years of mortality risk added to an individual's chronological age due to diabetes-related excess mortality.

RESULTS

We included N = 47,365,120 individuals, 6,541,181 of them with diabetes. In 2014, 763,228 deaths were recorded, among them 288,515 with diabetes. Diabetes mortality followed nearly perfectly Gompertz distributions. The probability that a person with diabetes dies before a person without diabetes was 61.9% for females and 63.3% for males.

CONCLUSIONS

Diabetes mortality for females and males aged 30 years or older in Germany in 2014 followed the Gompertz law of mortality. The survival information of the population with diabetes during a large part of the lifespan can thus be reduced to the two parameters of the Gompertz distribution.

Testing the somatic marker hypothesis in decisions-from-experience with non-stationary outcome probabilities

Introduction

The Somatic Marker Hypothesis (SMH) posits that in experience-based choice, people develop physiological reactions that mark options as either positive or negative. These somatic markers aid decision making because they differentiate between "good" and "bad" options during pre-choice deliberation.

Methods

We examined this proposed role for somatic states in two decision-from-experience tasks (each N = 36) in which participants selected repeatedly with full feedback (i.e., for obtained and forgone outcomes) between two unlabeled options that returned wins or losses, with half receiving an additional summary of past outcomes. The probabilities of good and bad outcomes changed at an unannounced point. Participants completed a 100-trial game with a switch in the optimal option after trial 40 (Study 1) or a 200-trial game with switch points after trial 40 and trial 120 (Study 2). Skin conductance (SC) was measured continuously as an index of emotional intensity, from which we extracted measures of anticipatory SC (pre-choice) and outcome SC (post-choice).

Results

Participants reliably selected the optimal option prior to any switches. They also altered their choices appropriately when the payoffs changed, though optimal play following payoff switches was reduced. Losses resulted in a greater outcome SC than wins, but only in Study 1, as did the finding that the outcome SC was greater when the forgone outcome was positive. Anticipatory SC did not reliably predict optimal play in either study.

Discussion

These results provide little support for the SMH. Our studies point to the importance of using diverse tasks and measures and very large sample sizes when testing the role of somatic states in decision making.

Examining Insensitivity to Probability in Evidence-Based Communication of Relative Risks: The Role of Affect and Communication Format

Affect can influence judgments of event riskiness and use of risk-related information. Two studies (Ns: 85 and 100) examined the insensitivity-to-probability effect-where people discount probability information when scenarios are affect-rich-applying it to evidence-informed risk communication. We additionally investigated whether this effect is moderated by format, based on predictions from the evaluability and pattern-recognition literatures, suggesting that graphical formats may attenuate insensitivity to probability. Participants completed a prior beliefs questionnaire (Study 1), and risk perception booklet (both studies) that presented identical statistical information about the relative risks associated with two scenarios-one with an affect-rich outcome, the other an affect-poorer outcome. In Study 1, this was presented graphically. In Study 2, information was presented in one of three formats: written, tabular, or graphical. Participants provided their perceptions of the risk for each scenario at a range of risk-levels. The affect-rich scenario was perceived as higher in risk, and, importantly, despite presenting identical relative risk information in both scenarios, was associated with a reduced sensitivity to probability information (both studies). These differences were predicted by participants' prior beliefs concerning the scenario events (Study 1) and were larger for the single-item written format than graphical format (Study 2). The findings illustrate that insensitivity to probability information can occur in evidence-informed risk communications and highlight how communication format can moderate this effect. This interplay between affect and format therefore reflects an important consideration for information designers and researchers.

An Intuitive Risk Communication Tool to Enhance Patient-Provider Partnership in Diabetes Consultation

INTRODUCTION

This technology report introduces an innovative risk communication tool developed to support providers in communicating diabetes-related risks more intuitively to people with type 2 diabetes mellitus (T2DM).

METHODS

The development process involved three main steps: (1) selecting the content and format of the risk message; (2) developing a digital interface; and (3) assessing the usability and usefulness of the tool with clinicians through validated questionnaires.

RESULTS

The tool calculates personalized risk information based on a validated simulation model (United Kingdom Prospective Diabetes Study Outcomes Model 2) and delivers it using more intuitive risk formats, such as "effective heart age" to convey cardiovascular risks. Clinicians reported high scores for the usability and usefulness of the tool, making its adoption in routine care promising.

CONCLUSIONS

Despite increased use of risk calculators in clinical care, this is the first time that such a tool has been developed in the diabetes area. Further studies are needed to confirm the benefits of using this tool on behavioral and health outcomes in T2DM populations.

Estimating everyday risk: Subjective judgments are related to objective risk, mapping of numerical magnitudes and previous experience

We aimed to investigate individual differences that associate with peoples' acute risk perception for activities such as walking and giving birth, including objective risk and the mapping of numerical magnitudes. The Amazon Mechanical Turk platform was used, with 284 participants recruited (40% female) ranging between 19 and 68 years. Participants had to indicate the positions of (1) the relative death risk of activities on a horizontal-line with 'very low risk of death' and 'very high risk of death' as left and right anchors respectively and (2), numerical magnitudes on a horizontal-line ranging 0-1000. The MicroMort framework was used to index acute risk of death (one/million chance of dying from an accident). Previous experience with the activities, handedness, along with risk propensity and unrealistic optimism were also measured. Linear mixed-effects modelling was used to investigate predictors of subjective MicroMort judgments. Individuals subjectively judged activities to be riskier if the activity was objectively riskier, if they over-estimated on the numerical task (more so for low-risk activities as compared to high-risk), or if they had not experienced the activity previously. The observed relationship between the number line task and everyday risk judgments is in keeping with the idea of a common magnitude representation system. In conclusion, individuals are able to discriminate between activities varying in risk in an absolute sense, however intuition for judging the relative differences in risk is poor. The relationship between the misjudging of both risks and numerical magnitudes warrants further investigation, as may inform the development of risk communication strategies.

Understanding the Effect of Information Presentation Order and Orientation on Information Search and Treatment Evaluation

BACKGROUND

Past research finds that treatment evaluations are more negative when risks are presented after benefits. This study investigates this order effect: manipulating tabular orientation and order of risk-benefit information, and examining information search order and gaze duration via eye-tracking.

DESIGN

108 (Study 1) and 44 (Study 2) participants viewed information about treatment risks and benefits, in either a horizontal (left-right) or vertical (above-below) orientation, with the benefits or risks presented first (left side or at top). For 4 scenarios, participants answered 6 treatment evaluation questions (1-7 scales) that were combined into overall evaluation scores. In addition, Study 2 collected eye-tracking data during the benefit-risk presentation.

RESULTS

Participants tended to read one set of information (i.e., all risks or all benefits) before transitioning to the other. Analysis of order of fixations showed this tendency was stronger in the vertical (standardized mean rank difference further from 0, M = ± .88) than horizontal orientation ( M = ± 0.71). Approximately 50% of the time was spent reading benefits when benefits were shown first, but this was reduced to ~40% when risks were presented first (regression coefficient: B = -4.52, p < .001). Eye-tracking measures did not strongly predict treatment evaluations, although time percentage reading benefits positively predicted evaluation when holding other variables constant ( B = 0.02, p = .023).

CONCLUSION

These results highlight the impact of seemingly arbitrary design choices on inspection order. For instance, presenting risks where they will be seen first leads to relatively less time spent considering treatment benefits. Other research suggests these changes to inspection order can influence multi-option and multi-attribute choices, and represent an area for future research.