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Jiang Y, Li L. Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation. Glob Health Res Policy 2024; 9:15. [PMID: 38679749 PMCID: PMC11057077 DOI: 10.1186/s41256-024-00357-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/23/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND The population of China is aging rapidly. However, the long-term trajectories of functionally dependent late middle-aged and older Chinese people are currently absent. The present study aimed to estimate the population size and proportion of late middle-aged and older adults with difficulties and dependence on activities of daily living (ADL) and instrumental activities of daily living (IADL) in China from 2018 to 2048. METHODS We constructed a dynamic microsimulation model to project the population size and proportions of late middle-aged and older Chinese people who have difficulty and dependence in ADL and IADL from 2018-2048. The model was populated with a representative sample of the target population and allowed individual-level interaction between risk factors, diseases, and health outcomes. Analyses by socioeconomic subgroups were also conducted. RESULTS Almost 25% and 38% of late middle-aged and older people in China will become ADL- and IADL-dependent by 2048, respectively. Also, 17% of the target population will be severely ADL-disabled by 2048. The inequity in functional status across subgroups by sex, educational level, and urban/rural residency will become substantial. CONCLUSIONS The numbers and percentages of China's functionally difficult and dependent late middle-aged and older population will increase by magnitudes as of the mid-21st century, the pressure of which is compounded by its disproportionate distribution across subgroups. To alleviate the overwhelming challenge, efforts to improve the functional status of the underserved subpopulation should also be iterated.
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Affiliation(s)
- Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Room 533, #1 West Wing of Medical Complex, 66 Gongchang Road, Guangming District, Shenzhen, Guangdong, China.
| | - Limin Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Room 533, #1 West Wing of Medical Complex, 66 Gongchang Road, Guangming District, Shenzhen, Guangdong, China
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Budhu JA, Chukwueke UN, Jackson S, Lee EQ, McFaline-Figueroa JR, Willmarth N, Dalmage M, Kawachi I, Arons D, Chang SM, Galanis E, Hervey-Jumper SL, Wen PY, Porter AB. Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort. Neuro Oncol 2024; 26:596-608. [PMID: 38071654 PMCID: PMC10995510 DOI: 10.1093/neuonc/noad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies, contradicting the principle of distributive justice, as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment-induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care, expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will also improve patient care.
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Affiliation(s)
- Joshua A Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Weill Cornell Medicine, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Ugonma N Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sadhana Jackson
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Ricardo McFaline-Figueroa
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahalia Dalmage
- Division of Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Patrick Y Wen
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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Chapel JM, Tysinger B, Goldman DP, Rowe JW, The Research Network On An Aging Society. The Forgotten Middle: Worsening Health And Economic Trends Extend To Americans With Modest Resources Nearing Retirement. Health Aff (Millwood) 2023; 42:1230-1240. [PMID: 37611204 DOI: 10.1377/hlthaff.2023.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
In an aging US society, anticipating the challenges that future seniors will face is essential. This study analyzed the health and economic well-being of five cohorts of Americans in their mid-fifties between 1994 and 2018 using the Future Elderly Model, a dynamic microsimulation based on the Health and Retirement Study. We projected mortality, quality-adjusted life years, health expenditures, and income and benefits. We classified individuals by economic status and focused on the lower middle and upper middle of the economic distribution. Outcome disparities between people in these two groups widened substantially between the 1994 and 2018 cohorts. Quality-adjusted life expectancy increased (5 percent) for the upper-middle economic status group but stagnated for their lower-middle peers. We found that the combined value of the current stock (financial and housing wealth) and the present value of the expected flow of resources (income, health expenditures, and quality-adjusted life-years) after age sixty grew 13 percent for the upper-middle group between cohorts, whereas people in the lower-middle group in 2018 were left scarcely better off (3 percent growth) than their peers two decades earlier. The relatively neglected "forgotten middle" group of near-retirees in the lower-middle group may require stronger supports than are currently available to them.
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Affiliation(s)
- Jack M Chapel
- Jack M. Chapel , University of Southern California, Los Angeles, California
| | | | | | - John W Rowe
- John W. Rowe, Columbia University, New York, New York
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Hlávka JP, Yu JC, Lakdawalla DN. Crosswalk between the Mini-Mental State Examination and the Telephone Interview for Cognitive Status (TICS-27/30/40). Alzheimers Dement 2022; 18:2036-2041. [PMID: 35103408 PMCID: PMC10373741 DOI: 10.1002/alz.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/08/2021] [Accepted: 12/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND We develop a crosswalk between the Mini-Mental State Examination (MMSE) and Telephone Interview for Cognitive Status (TICS)-27, TICS-30, and TICS-40 for adults 65 years and older. METHODS We examined the scores of 1809 participants, with and without cognitive impairment, who completed the MMSE and the TICS assessment in the 2016 Health and Retirement Study and the 2016 Harmonized Cognitive Assessment Protocol study. Crosswalks between MMSE and TICS-27/30/40 were developed via equipercentile equating. RESULTS We present crosswalks for MMSE and TICS-27/30/40 for the 65+ population representative of the US elderly. While monotonic, the pattern of the TICS-30 to MMSE crosswalk differs from the other two crosswalks (MMSE to TICS-27/40). CONCLUSION Our analysis offers an empirical crosswalk between two commonly used cognitive measures-the MMSE and TICS. Our findings suggest the need for validated and robust measures that allow for the comparison of scores on different cognitive scales.
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Affiliation(s)
- Jakub P Hlávka
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Jeffrey C Yu
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA.,School of Pharmacy, University of Southern California, Los Angeles, California, USA
| | - Darius N Lakdawalla
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA.,School of Pharmacy, University of Southern California, Los Angeles, California, USA
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Scarborough P, Kaur A, Cobiac LJ. Forecast of myocardial infarction incidence, events and prevalence in England to 2035 using a microsimulation model with endogenous disease outcomes. PLoS One 2022; 17:e0270189. [PMID: 35771859 PMCID: PMC9246106 DOI: 10.1371/journal.pone.0270189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Models that forecast non-communicable disease rates are poorly designed to predict future changes in trend because they are based on exogenous measures of disease rates. We introduce microPRIME, which forecasts myocardial infarction (MI) incidence, events and prevalence in England to 2035. microPRIME can forecast changes in trend as all MI rates emerge from competing trends in risk factors and treatment. Materials and methods microPRIME is a microsimulation of MI events within a sample of 114,000 agents representative of England. We simulate 37 annual time points from 1998 to 2035, where agents can have an MI event, die from an MI, or die from an unrelated cause. The probability of each event is a function of age, sex, BMI, blood pressure, cholesterol, smoking, diabetes and previous MI. This function does not change over time. Instead population-level changes in MI rates are due to competing trends in risk factors and treatment. Uncertainty estimates are based on 450 model runs that use parameters calibrated against external measures of MI rates between 1999 and 2011. Findings Forecasted MI incidence rates fall for men and women of different age groups before plateauing in the mid 2020s. Age-standardised event rates show a similar pattern, with a non-significant upturn by 2035, larger for men than women. Prevalence in men decreases for the oldest age groups, with peaks of prevalence rates in 2019 for 85 and older at 25.8% (23.3–28.3). For women, prevalence rates are more stable. Prevalence in over 85s is estimated as 14.5% (12.6–16.5) in 2019, and then plateaus thereafter. Conclusion We may see an increase in event rates from MI in England for men before 2035 but increases for women are unlikely. Prevalence rates may fall in older men, and are likely to remain stable in women over the next decade and a half.
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Affiliation(s)
- Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- National Institute of Health and Care Research Biomedical Research Centre at Oxford, Oxford, United Kingdom
- * E-mail:
| | - Asha Kaur
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Linda J. Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Griffith University, Queensland, Australia
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Reif J, Heun-Johnson H, Tysinger B, Lakdawalla D. Measuring the COVID-19 Mortality Burden in the United States : A Microsimulation Study. Ann Intern Med 2021; 174:1700-1709. [PMID: 34543588 PMCID: PMC8462514 DOI: 10.7326/m21-2239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Fully assessing the mortality burden of the COVID-19 pandemic requires measuring years of life lost (YLLs) and accounting for quality-of-life differences. OBJECTIVE To measure YLLs and quality-adjusted life-years (QALYs) lost from the COVID-19 pandemic, by age, sex, race/ethnicity, and comorbidity. DESIGN State-transition microsimulation model. DATA SOURCES Health and Retirement Study, Panel Study of Income Dynamics, data on excess deaths from the Centers for Disease Control and Prevention, and nursing home death counts from the Centers for Medicare & Medicaid Services. TARGET POPULATION U.S. population aged 25 years and older. TIME HORIZON Lifetime. PERSPECTIVE Individual. INTERVENTION COVID-19 pandemic through 13 March 2021. OUTCOME MEASURES YLLs and QALYs lost per 10 000 persons in the population. The estimates account for the age, sex, and race/ethnicity of decedents, along with obesity, smoking behavior, lung disease, heart disease, diabetes, cancer, stroke, hypertension, dementia, and nursing home residence. RESULTS OF BASE-CASE ANALYSIS The COVID-19 pandemic resulted in 6.62 million QALYs lost (9.08 million YLLs) through 13 March 2021, with 3.6 million (54%) lost by those aged 25 to 64 years. The greatest toll was on Black and Hispanic communities, especially among men aged 65 years or older, who lost 1138 and 1371 QALYs, respectively, per 10 000 persons. Absent the pandemic, 38% of decedents would have had average or above-average life expectancies for their subgroup defined by age, sex, and race/ethnicity. RESULTS OF SENSITIVITY ANALYSIS Accounting for uncertainty in risk factors for death from COVID-19 yielded similar results. LIMITATION Estimates may vary depending on assumptions about mortality and quality-of-life projections. CONCLUSION Beyond excess deaths alone, the COVID-19 pandemic imposed a greater life expectancy burden on persons aged 25 to 64 years, including those with average or above-average life expectancies, and a disproportionate burden on Black and Hispanic communities. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Julian Reif
- University of Illinois, Champaign, Illinois, and National Bureau of Economic Research, Cambridge, Massachusetts (J.R.)
| | | | - Bryan Tysinger
- University of Southern California, Los Angeles, California (H.H., B.T.)
| | - Darius Lakdawalla
- University of Southern California, Los Angeles, California, and National Bureau of Economic Research, Cambridge, Massachusetts (D.L.)
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