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Issa J, Van Ourti T, van Baal P, O'Donnell O. Ranking Age-at-Death Distributions Using Dominance: Robust Evaluation of United States Mortality Trends, 2006-2021. Demography 2024; 61:1143-1159. [PMID: 39023437 DOI: 10.1215/00703370-11460856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Diverging mortality trends at different ages motivate the monitoring of lifespan inequality alongside life expectancy. Conclusions are ambiguous when life expectancy and lifespan inequality move in the same direction or when inequality measures display inconsistent trends. We propose using nonparametric dominance analysis to obtain a robust ranking of age-at-death distributions. Application to U.S. period life tables for 2006-2021 reveals that, until 2014, more recent years generally dominate earlier years, implying improvement if longer lifespans that are less unequally distributed are considered better. Improvements were more pronounced for non-Hispanic Black and Hispanic individuals than for non-Hispanic White individuals. Since 2014, for all subpopulations-particularly Hispanics-earlier years often dominate more recent years, indicating worsening age-at-death distributions if shorter and more unequal lifespans are considered worse. Dramatic deterioration of the distributions in 2020-2021 during the COVID-19 pandemic is most evident for Hispanic individuals.
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Affiliation(s)
- Jawa Issa
- Erasmus School of Health Policy and Management, EsCHER, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tom Van Ourti
- Erasmus School of Health Policy and Management, Erasmus School of Economics, EsCHER, Erasmus University Rotterdam, Tinbergen Institute, Rotterdam, the Netherlands
| | - Pieter van Baal
- Erasmus School of Health Policy and Management, EsCHER, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Owen O'Donnell
- Erasmus School of Economics, Erasmus School of Health Policy and Management, EsCHER, Erasmus University Rotterdam, Tinbergen Institute, Rotterdam, the Netherlands
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Springhetti P, Abdoun K, Clavel MA. Sex Differences in Aortic Stenosis: From the Pathophysiology to the Intervention, Current Challenges, and Future Perspectives. J Clin Med 2024; 13:4237. [PMID: 39064275 PMCID: PMC11278486 DOI: 10.3390/jcm13144237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Calcific aortic stenosis (AS) is a major cause of morbidity and mortality in high-income countries. AS presents sex-specific features impacting pathophysiology, outcomes, and management strategies. In women, AS often manifests with a high valvular fibrotic burden, small valvular annuli, concentric left ventricular (LV) remodeling/hypertrophy, and, frequently, supernormal LV ejection fraction coupled with diastolic dysfunction. Paradoxical low-flow low-gradient AS epitomizes these traits, posing significant challenges post-aortic valve replacement due to limited positive remodeling and significant risk of patient-prosthesis mismatch. Conversely, men present more commonly with LV dilatation and dysfunction, indicating the phenotype of classical low-flow low-gradient AS, i.e., with decreased LV ejection fraction. However, these distinctions have not been fully incorporated into guidelines for AS management. The only treatment for AS is aortic valve replacement; women are frequently referred late, leading to increased heart damage caused by AS. Therefore, it is important to reassess surgical planning and timing to minimize irreversible cardiac damage in women. The integrity and the consideration of sex differences in the management of AS is critical. Further research, including sufficient representation of women, is needed to investigate these differences and to develop individualized, sex-specific management strategies.
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Affiliation(s)
- Paolo Springhetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada; (P.S.); (K.A.)
- Department of Medicine, Division of Cardiology, University of Verona, 37129 Verona, Italy
| | - Kathia Abdoun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada; (P.S.); (K.A.)
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada; (P.S.); (K.A.)
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Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. Projections of costs and quality adjusted life years lost due to dementia from 2020 to 2050: A population-based microsimulation study. Alzheimers Dement 2023; 19:4532-4541. [PMID: 36916447 DOI: 10.1002/alz.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Efficient healthcare planning requires reliable projections of the future increase in costs and quality-adjusted life years (QALYs) lost due to dementia. METHODS We used the microsimulation model MISCAN-Dementia to simulate life histories and dementia occurrence using population-based Rotterdam Study data and nationwide birth cohort demographics. We estimated costs and QALYs lost in the Netherlands from 2020 to 2050, incorporating literature estimates of cost and utility for patients and caregivers by dementia severity and care setting. RESULTS Societal costs and QALYs lost due to dementia are estimated to double between 2020 and 2050. Costs are incurred predominantly through institutional (34%), formal home (31%), and informal home care (20%). Lost QALYs are mostly due to shortened life expectancy (67%) and, to a lesser extent, quality of life with severe dementia (14%). DISCUSSION To limit healthcare costs and quality of life losses due to dementia, interventions are needed that slow symptom progression and reduce care dependency.
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Affiliation(s)
- Chiara C Brück
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Center, Erasmus MC, Rotterdam, The Netherlands
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Alvarez JA, Vaupel JW. Mortality as a Function of Survival. Demography 2023; 60:327-342. [PMID: 36705545 DOI: 10.1215/00703370-10429097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Everyone has a chronological age. Because survivorship declines relentlessly in populations with age-specific death rates greater than zero, everyone also has a survivorship age ("s-age"), the age at which a proportion s of the population is still alive. S-ages can be estimated for both periods and cohorts. While trajectories of mortality over chronological ages differ (e.g., across populations, over time, by sex, or by any subpopulation), mortality trajectories over s-ages are similar, a sign that populations experience similar mortality dynamics at specific levels of survivorship. We show that this important demographic regularity holds for 23 sex-specific populations analyzed during a period comprising more than 100 years.
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Affiliation(s)
- Jesús-Adrián Alvarez
- Danish Labour Market Supplementary Pension Fund (ATP), Hillerød, Denmark.,Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - James W Vaupel
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
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Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. Projected prevalence and incidence of dementia accounting for secular trends and birth cohort effects: a population-based microsimulation study. Eur J Epidemiol 2022; 37:807-814. [PMID: 35731313 PMCID: PMC9215138 DOI: 10.1007/s10654-022-00878-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
There is need for accurate projections of the future dementia burden to prepare healthcare systems and policymakers. Existing projections only account for population ageing, not for observed declines in age-specific dementia incidence of 13% per decade. We developed a dementia microsimulation model that synthesizes population-based data from the Rotterdam Study with changes in demographics between birth cohorts from the early 1900s onwards. We determined dementia prevalence and incidence until 2050 for three different dementia incidence trend scenarios: (1) stable age-specific incidence, (2) linear decline by 13% per decade, (3) nonlinear declines averaging 13% per decade. Assuming a stable age-specific incidence resulted in a 130% increase in incidence and 118% in prevalence between 2020 and 2050. By contrast, the linearly declining trend resulted in substantially smaller increases of 58% in incidence (95%CI: 29–87%), and 43% in prevalence (95%CI: 13–66%), corresponding to 39% lower incidence and 36% lower prevalence by 2050 than in the stable-incidence scenario. Results for various non-linear declines fell between the stable and linear trend. The future burden of dementia is highly susceptible to achievable changes in age-specific incidence. Extension of previously established secular trends globally would reduce widely upheld projections of new dementia cases until 2050 by 39%.
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Affiliation(s)
- Chiara Celine Brück
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Takai A, Kumar A, Kim R, Subramanian SV. Life expectancies across congressional districts in the United States. Soc Sci Med 2022; 298:114855. [PMID: 35290786 DOI: 10.1016/j.socscimed.2022.114855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 01/02/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Abstract
Examining data on the congressional district level may better align with the interests of Members of Congress who have the power to implement federal health policies. Despite this importance, measurement of health indicators at the congressional district level remains widely understudied. In this study, we estimated overall life expectancy and variation within each congressional district by computing standard deviations of census tract-level age-specific life expectancies for 2010-2015. We found smaller standard deviations in congressional districts with higher overall life expectancy at younger ages, but the pattern was reversed at older ages.
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Affiliation(s)
- Aya Takai
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Akhil Kumar
- Turner Fenton Secondary School, Brampton, ON, Canada; Center for Geographic Analysis, Harvard University, Cambridge, MA, USA
| | - Rockli Kim
- Division of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.
| | - S V Subramanian
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.
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Chauvette V, Bouhout I, Tarabzoni M, Wong D, Bozinovski J, Chu MW, El-Hamamsy I, Lefebvre L, Poirier N, Cartier R, Demers P, Halim MA. The Ross procedure in patients older than 50: A sensible proposition? J Thorac Cardiovasc Surg 2020; 164:835-844.e5. [DOI: 10.1016/j.jtcvs.2020.09.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/18/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
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