Recent trends in life expectancy across high income countries: retrospective observational study

Trends in all-cause and cause-specific mortality by BMI levels in England, 2004-2019: a population-based primary care records study

Background

In the UK, obesity rates are rising concurrently with declining mortality rates. Yet, there is limited research on the shifts of mortality trends and the impact of obesity-related mortality. In this study, we examine mortality trends and the cause-specific proportional composition of deaths by body mass index.

Methods

We used primary healthcare records from the Clinical Practice Research Datalink between 2004 and 2019, linked to national death registration data. There were 880,683 individuals with at least one BMI measurement and a 5-year survival period. We used discrete Poisson regression and joinpoint analysis to estimate the all-cause and cause-specific mortality rate and significance of the trends.

Findings

Between January 1, 2004, and December 31, 2019, all-cause mortality rates declined in the obese category by 3% on average per year (from 23.3 to 14.6 deaths per 1000 person years) in males and 2% on average per year (from 12.5 to 9.4 deaths per 1000 person years) in females. Cardiovascular disease mortality declined 7% on average per year (from 12.4 to 4.4 deaths per 1000 person years) in males and 4% on average per year (from 5.5 to 3.0 deaths per 1000 person years) in females in the obese category. Increases in mortality rates from neurological conditions occurred in all BMI categories in males and females. By the end of the study, cancers became the primary contributor of death in males in all BMI categories and females in the overweight category.

Interpretation

There have been significant declines in all-cause and cardiovascular disease mortality in males and females, leading to a diversification of mortality, with cancers contributing to the highest proportion of deaths and increases in causes such as neurological and respiratory conditions. Further screening, prevention, and treatment implementation for a broader set of diseases is necessary for continued mortality improvements.

Funding

Imperial College London, Science Foundation Ireland.

Life expectancy and geographic variation in mortality: an observational comparison study of six high-income Anglophone countries

OBJECTIVE

To compare life expectancy levels and within-country geographic variation in life expectancy across six high-income Anglophone countries between 1990 and 2018.

DESIGN

Demographic analysis using aggregated mortality data.

SETTING

Six high-income Anglophone countries (USA, UK, Canada, Australia, Ireland and New Zealand), by sex, including an analysis of subnational geographic inequality in mortality within each country.

POPULATION

Data come from the Human Mortality Database, the WHO Mortality Database and the vital statistics agencies of six high-income Anglophone countries.

MAIN OUTCOME MEASURES

Life expectancy at birth and age 65; age and cause of death contributions to life expectancy differences between countries; index of dissimilarity for within-country geographic variation in mortality.

RESULTS

Among six high-income Anglophone countries, Australia is the clear best performer in life expectancy at birth, leading its peer countries by 1.26-3.95 years for women and by 0.97-4.88 years for men in 2018. While Australians experience lower mortality across the age range, most of their life expectancy advantage accrues between ages 45 and 84. Australia performs particularly well in terms of mortality from external causes (including drug- and alcohol-related deaths), screenable/treatable cancers, cardiovascular disease and influenza/pneumonia and other respiratory diseases compared with other countries. Considering life expectancy differences across geographic regions within each country, Australia tends to experience the lowest levels of inequality, while Ireland, New Zealand and the USA tend to experience the highest levels.

CONCLUSIONS

Australia has achieved the highest life expectancy among Anglophone countries and tends to rank well in international comparisons of life expectancy overall. It serves as a potential model for lower-performing countries to follow to reduce premature mortality and inequalities in life expectancy.

Neighborhood Socioeconomic Disadvantage Across the Life Course and Premature Mortality

Importance

There are consistent data demonstrating that socioeconomic disadvantage is associated with risk of premature mortality, but research on the relationship between neighborhood socioeconomic factors and premature mortality is limited. Most studies evaluating the association between neighborhood socioeconomic status (SES) and mortality have used a single assessment of SES during middle to older adulthood, thereby not considering the contribution of early life neighborhood SES.

Objective

To investigate the association of life course neighborhood SES and premature mortality.

Design, Setting, and Participants

This cohort study included Black and White participants of the multicenter Atherosclerosis Risk in Communities Study, a multicenter study conducted in 4 US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the northwestern suburbs of Minneapolis, Minnesota. Participants were followed up for a mean (SD) of 18.8 (5.7) years (1996-2020). Statistical analysis was performed from March 2023 through May 2024.

Exposure

Participants' residential addresses during childhood, young adulthood, and middle adulthood were linked with US Census-based socioeconomic indicators to create summary neighborhood SES scores for each of these life epochs. Neighborhood SES scores were categorized into distribution-based tertiles.

Main Outcomes and Measures

Premature death was defined as all-cause mortality occurring before age 75 years. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs.

Results

Among 12 610 study participants, the mean (SD) age at baseline was 62.6 (5.6) years; 3181 (25.2%) were Black and 9429 (74.8%) were White; and 7222 (57.3%) were women. The lowest, compared with the highest tertile, of neighborhood SES score in middle adulthood was associated with higher risk of premature mortality (HR, 1.28; 95% CI, 1.07-1.54). Similar associations were observed for neighborhood SES in young adulthood among women (HR, 1.25; 95% CI, 1.00-1.56) and neighborhood SES in childhood among White participants (HR, 1.25; 95% CI, 1.01-1.56). Participants whose neighborhood SES remained low from young to middle adulthood had an increased premature mortality risk compared with those whose neighborhood SES remained high (HR, 1.25; 95% CI, 1.05-1.49).

Conclusions and Relevance

In this study, low neighborhood SES was associated with premature mortality. The risk of premature mortality was greatest among individuals experiencing persistently low neighborhood SES from young to middle adulthood. Place-based interventions that target neighborhood social determinants of health should be designed from a life course perspective that accounts for early-life socioeconomic inequality.

Cross-sectional Average Length of Life Entropy ( H CAL ): International Comparisons and Decompositions

Keyfitz and Leser's life table entropy was proposed to serve as a relative inequality in mortality measure. Entropy considers the variation around the age at death relative to the length of lifespan in a population, allowing comparisons across time and populations. It is used widely in period and cohort applications. Here, we propose extending this measure and present an index that incorporates the history of survival of all cohorts present at a given time, namely the cross-sectional average length of life entropy, or CAL-entropy ( H CAL ). We decompose cross-population differences of CAL-entropy into the contribution of longevity and lifespan variation, and the change of those differences across time. Our illustrations show that populations are converging regarding lifespan inequality. Lifespan variation holds a noticeable share in the CAL-entropy gap among selected European populations. Longevity held once a pronounced share in CAL-entropy differences and their change, but its influence has receded over the years. The US demonstrates a unique trend where it performs worse across time compared to the selected European populations, and lifespan variation has played a major role in this process. This study signals the importance of lifespan variation in reducing inequality in mortality among developed and longevous populations.

A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001-20

This study examines two decades of change in social inequalities in life and health expectancy among older adults in Australia, one of the few countries that escaped an economic recession during the global financial crisis. We compare adults aged 45+ across three measures of individual socio-economic position-education, occupation, and household wealth-and use multistate life tables to estimate total life expectancy (TLE) and life expectancy free of limiting long-term illness (LLTI-free LE) based on 20 waves of the Household, Income and Labour Dynamics in Australia Survey (2001-20). Our findings highlight substantial social disparities in both TLE and LLTI-free LE in Australia. Grouping individuals by household wealth shows striking differentials in LLTI-free LE. We observe widening social disparities in healthy longevity over time by all three measures of socio-economic position. This diverging trend in healthy longevity is troubling against the backdrop of widening income and wealth inequalities in Australia.

Social and Economic Determinants of Life Expectancy at Birth in Eastern Europe

Life expectancy at birth is considered a parameter of the social development, health system, or economic development of a country. We aimed to investigate the effects of GDP per capita (as the economic factor), health care expenditure, the number of medical doctors (as social factors), and CO2 emissions (as the environmental factor) on life expectancy. We used panel data analysis for 13 Eastern European countries over the 2000-2020 period. After performing the analysis, we used a cross-country fixed-effects panel (GLS with SUR weights). According to our model, a one percent increase in health expenditure (as % of GDP) increases life expectancy at birth by 0.376 years, whereas each additional medical doctor per 10,000 inhabitants increases life expectancy at birth by 0.088 years on average. At the same time, each additional 10,000 USD per capita each year would increase life expectancy at birth by 1.8 years on average. If CO2 emissions increase by 1 metric ton per capita, life expectancy at birth would decrease by 0.24 years, suggesting that higher carbon emissions are capable of reducing longevity. Every European country has to make special efforts to increase the life expectancy of its inhabitants by applying economic and health policies focused on the well-being of the population.

[Mortality trends in Germany in an international context]

BACKGROUND AND AIM

Due to its strong economy and a well-developed healthcare system, Germany is well positioned to achieve above-average reductions in mortality. Nevertheless, in terms of life expectancy, Germany is increasingly falling behind Western Europe. We compare mortality trends in Germany with other Western European countries, covering the period from 1960 to 2019. The focus is on long-term trends in Germany's ranking in international mortality trends. In addition, we conduct a detailed mortality analysis by age.

METHODS

Our analysis is mostly based on mortality data from the Human Mortality Database (HMD). Cause-specific mortality data originate from the database of the World Health Organization (WHO). For the international comparison of mortality trends, we use conventional mortality indicators (age-standardized mortality rate, period life expectancy).

RESULTS

Compared to other Western European countries, Germany has higher mortality in the middle and older age groups. Germany's life expectancy gap compared to Western Europe has grown during the past 20 years. In 2000, Germany was 0.73 years behind for men and 0.74 years behind for women. By 2019, these figures had risen to 1.43 and 1.34 years, respectively. This is mainly due to mortality from non-communicable diseases.

CONCLUSION

For Germany to catch up with other Western European countries, a stronger focus on further reducing mortality at ages 50+ is crucial. This also requires further research to understand the factors behind Germany's disadvantageous position.

Fermented Protaetia brevitarsis Larvae Ameliorates Chronic Ethanol-Induced Hepatotoxicity in Mice via AMPK and TLR-4/TGF-β1 Pathways

This study evaluated the hepatoprotective effect of fermented Protaetia brevitarsis larvae (FPB) in ethanol-induced liver injury mice. As a result of amino acids in FPB, 18 types of amino acids including essential amino acids were identified. In the results of in vitro tests, FPB increased alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) activities. In addition, FPB treatment increased cell viability on ethanol- and H2O2-induced HepG2 cells. FPB ameliorated serum biomarkers related to hepatoxicity including glutamic oxaloacetic transaminase, glutamine pyruvic transaminase, total bilirubin, and lactate dehydrogenase and lipid metabolism including triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Also, FPB controlled ethanol metabolism enzymes by regulating the protein expression levels of ADH, ALDH, and cytochrome P450 2E1 in liver tissue. FPB protected hepatic oxidative stress by improving malondialdehyde content, reduced glutathione, and superoxide dismutase levels. In addition, FPB reversed mitochondrial dysfunction by regulating reactive oxygen species production, mitochondrial membrane potential, and ATP levels. FPB protected ethanol-induced apoptosis, fatty liver, and hepatic inflammation through p-AMP-activated protein kinase and TLR-4/NF-κB signaling pathways. Furthermore, FPB prevented hepatic fibrosis by decreasing TGF-β1/Smad pathway. In summary, these results suggest that FPB might be a potential prophylactic agent for the treatment of alcoholic liver disease via preventing liver injury such as fatty liver, hepatic inflammation due to chronic ethanol-induced oxidative stress.

Influenza: cause or excuse? An analysis of flu's influence on worsening mortality trends in England and Wales, 2010-19

BACKGROUND

England and Wales experienced a stagnation of previously improving life expectancy during the 2010s. Public bodies cited influenza as an important cause.

SOURCES OF DATA

We used data from the Office for National Statistics to examine mortality attributed directly to influenza and to all influenza-like diseases for the total population of England and Wales 2010-19. Several combinations of ICD-10 codes were used to address the possibility of under-counting influenza deaths.

AREAS OF AGREEMENT

Deaths from influenza and influenza-like diseases declined between 2010 and 2019, while earlier improvements in mortality from all causes of death were stalling and, with some causes, worsening. Our findings support existing research showing that influenza is not an important cause of the stalling of mortality rates 2010-19.

AREAS OF CONTROVERSY

Influenza was accepted by many as an important cause of stalling life expectancy for much of the 2010s, while few in public office have accepted austerity as a key factor in the changes seen during that time.

GROWING POINTS

This adds to the mounting evidence that austerity damaged health prior to COVID-19 and left the population more vulnerable when it arrived.

AREAS FOR DEVELOPING TIMELY RESEARCH

Future research should explore why so many in public office were quick to attribute the change in trends in overall mortality in the UK in this period to influenza, and why many continue to do so through to 2023 and to deny the key role of austerity in harming population health.

The effect of traumatic head injuries on the outcome of middle-aged and geriatric orthopedic trauma patients

BACKGROUND

The purpose of this study is to characterize the effects of head injuries amongst the middle-aged and geriatric populations on hospital quality measures, costs, and outcomes in an orthopedic trauma setting.

METHODS

Patients with head and orthopedic injuries aged >55 treated at an academic medical center from October 2014-April 2021 were reviewed for their Abbreviated Injury Score for Head and Neck (AIS-H), baseline demographics, injury characteristics, hospital quality measures and outcomes. Univariate comparative analyses were conducted across AIS-H groups with additional regression analyses controlling for confounding variables. All statistical analyses were conducted with a Bonferroni adjusted alpha.

RESULTS

A total of 1,051 patients were included. The mean age was 74 years, and median AIS-H score was 2 (range 1-6). While outcomes worsened and costs increased as AIS-H scores increased, the most drastic (and clinically relevant) rise occurs between scores 2-3. Patients who sustained a head injury warranting an AIS-H score of 3 experienced a significantly higher rate of major complications, need for ICU admission, inpatient and 1-year mortality with longer lengths of stay and higher total costs despite no differences in demographics or injury characteristics. Regression analysis found a higher AIS-H score was independently associated with greater mortality risk.

CONCLUSION

AIS-H scores >2 correlate with significantly worse outcomes and higher hospital costs. Concomitant head injuries impact both outcomes and direct variable costs for middle-aged and geriatric orthopedic trauma patients. Clinicians, hospitals, and payers should consider the significant effect of head injuries on the hospitalization of these patients.

Food Insecurity and Premature Mortality and Life Expectancy in the US

Importance

Food insecurity has been linked to multiple causes of disease and premature mortality; however, its association with mortality by sex and across racial and ethnic groups remains unknown in the US.

Objective

To investigate the associations of the entire range of food security with all-cause premature mortality and life expectancy across racial and ethnic and sex groups in US adults.

Design, Setting, and Participants

This cohort study included adults (aged ≥18 years) who participated in the National Health and Nutrition Examination Survey from 1999 to 2018, with linkage to the National Death Index through December 31, 2019. Data analysis was performed from August to November 2023.

Exposures

Levels of food security were assessed with the US Department of Agriculture Adult Food Security Survey Module (full, marginal, low, and very low).

Main Outcomes and Measures

All-cause premature mortality (death that occurs before age 80 years) and life expectancy.

Results

The study included 57 404 adults (weighted mean [SE] age, 46.0 [0.19] years; 51.8% female; 12 281 Black individuals [21.4%]; 10 421 Mexican individuals [18.2%]; 4627 Other Hispanic individuals [8.1%]; 24 817 White individuals [43.2%]; and 5258 individuals of other races, including multiracial [9.2%]). During a median (IQR) of 9.3 (5.0-14.3) years of follow-up, 4263 premature deaths were documented. Compared with the full food security group, the adjusted hazard ratios were 1.50 (95% CI, 1.31-1.71), 1.44 (95% CI, 1.24-1.68), and 1.81 (95% CI, 1.56-2.10) across marginal, low, and very low food security groups, respectively (P < .001 for trend). The corresponding life expectancy at age 50 years in each group was 32.5 (95% CI, 32.4-32.6), 29.9 (95% CI, 28.9-30.9), 30.0 (95% CI, 28.9-31.0), and 28.0 (95% CI, 26.8-29.2) years. Equivalently, adults with marginal, low, or very low food security lived on average 2.6 (95% CI, 1.5-3.7), 2.5 (95% CI, 1.4-3.7), or 4.5 (95% CI, 3.2-5.8) fewer years at age 50 years, respectively, compared with those with full food security. The associations appeared to be stronger in women than in men (hazard ratios comparing very low food security with full food security, 2.29 [95% CI, 1.83-2.86] in women and 1.46 [95% CI, 1.19-1.78] in men; P = .009 for interaction) and stronger in White adults than in Black adults (hazard ratios comparing very low food security with full food security, 2.07 [95% CI, 1.70-2.53] in White adults and 1.33 [95% CI, 1.01-1.75] in Black adults; P < .001 for interaction) or in Hispanic adults (hazard ratios comparing very low food security with full food security, 1.06 [95% CI, 0.71-1.58]; P < .001 for interaction).

Conclusions and Relevance

In this cohort study, although the association of food security and life expectancy varied across sex and racial and ethnic groups, overall, lower levels of food security were associated with a higher risk of premature mortality and a shorter life expectancy. The findings of this study highlight the potential importance of improving food security in promoting population health and health equity.

The Global Road Traffic Death Rate and Human Development Index from 2000 to 2019: A Trend Analysis

BACKGROUND

Numerous studies on the association between the human development index (HDI) and road traffic death rate (RTDR) merely focus on developed countries, not reflecting the relationship between the HDI components and RTDR in a time-trend analysis. Accordingly, this study analyzes the trends of RTDR and their association with the HDI and its components from 2000 to 2019.

METHODS

The RTDR data of 154 countries were imported into the unconditional latent growth model (LGM) to assess the RTDR trends. The impact of the HDI and its components (viz., education, income, and life expectancy [LE viz]) on the trajectory of RTDR was also evaluated using the conditional LGM.

RESULTS

The results of the unconditional LGM indicated an overall decreasing trend in RTDR. The conditional LGM results revealed the negative effect of the HDI and its components on the model parameters. The findings of random forests indicated that education and LE were the most crucial variables.

CONCLUSION

Overall, this study emphasizes the significance of HDI and its components, particularly education and LE, in lowering the number of traffic fatalities. In this sense, improving formal education and LE could be one of the main policies that policymakers could consider to reduce RTDR.

US exceptionalism? International trends in midlife mortality

BACKGROUND

Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64 years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries.

METHODS

We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64 years) age-standardized death rates across 15 major cause-of-death categories.

RESULTS

US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54 year and in Canada, Poland and Sweden among for those aged 25-44 years.

CONCLUSIONS

The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.

Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews

BACKGROUND

A fairer economy is increasingly recognised as crucial for tackling widening social, economic and health inequalities within society. However, which actions have been evaluated for their impact on inclusive economy outcomes is yet unknown.

OBJECTIVE

Identify the effects of political, economic and social exposures, interventions and policies on inclusive economy (IE) outcomes in high-income countries, by systematically reviewing the review-level evidence.

METHODS

We conducted a review of reviews; searching databases (May 2020) EconLit, Web of Science, Sociological Abstracts, ASSIA, International Bibliography of the Social Sciences, Public Health Database, Embase and MEDLINE; and registries PROSPERO, Campbell Collaboration and EPPI Centre (February 2021) and grey literature (August/September 2020). We aimed to identify reviews which examined social, political and/or economic exposures, interventions and policies in relation to two IE outcome domains: (i) equitable distribution of the benefits of the economy and (ii) equitable access to the resources needed to participate in the economy. Reviews had to include primary studies which compared IE outcomes within or between groups. Quality was assessed using a modified version of AMSTAR-2 and data synthesised informed by SWiM principles.

RESULTS

We identified 19 reviews for inclusion, most of which were low quality, as was the underlying primary evidence. Most reviews (n = 14) had outcomes relating to the benefits of the economy (rather than access to resources) and examined a limited set of interventions, primarily active labour market programmes and social security. There was limited high-quality review evidence to draw upon to identify effects on IE outcomes. Most reviews focused on disadvantaged groups and did not consider equity impacts.

CONCLUSIONS

Review-level evidence is sparse and focuses on 'corrective' approaches. Future reviews should examine a diverse set of 'upstream' actions intended to be inclusive 'by design' and consider a wider range of outcomes, with particular attention to socioeconomic inequalities.

Social Vulnerability and the Prevalence of Opioid Use Disorder Among Older Medicare Beneficiaries in U.S. Counties

OBJECTIVES

Recent research has investigated the factors associated with the prevalence of opioid use disorder (OUD) among older adults (65+), which has rapidly increased in the past decade. However, little is known about the relationship between social vulnerability and the prevalence of OUD, and even less is about whether the correlates of the prevalence of OUD vary across the social vulnerability spectrum. This study aims to fill these gaps.

METHODS

We assemble a county-level data set in the contiguous United States (U.S.) by merging 2021 Medicare claims with the CDC's social vulnerability index and other covariates. Using the total number of older beneficiaries with OUD as the dependent variable and the total number of older beneficiaries as the offset, we implement a series of nested negative binomial regression models and then analyze by social vulnerability quartiles.

RESULTS

Higher social vulnerability is associated with higher prevalence of OUD in U.S. counties. This association cannot be fully explained by the differences in the characteristics of older Medicare beneficiaries (e.g., average age) and/or other social conditions (e.g., social capital) across counties. Moreover, the group comparison tests indicate correlates of the prevalence of OUD vary across social vulnerability quartiles in that the average number of mental disorders is positively related to OUD prevalence in the least and the most vulnerable counties and social capital benefits the less vulnerable counties.

DISCUSSION

A perspective drawing upon contextual factors, especially social vulnerability, may be more effective in reducing OUD among older adults in U.S. counties than a one-size-fits-all approach.

Disparities in Mortality Between Appalachian and non-Appalachian Regions of Kentucky

Introduction

In the opioid epidemic, the U.S. faces a significant public health crisis, with some areas of the country, such as rural and Appalachian regions, suffering more than others. The differential regional impact of the crisis in Kentucky-a state with both non-metropolitan/metropolitan and Appalachian/Non-Appalachian statuses-has not yet been documented despite such knowledge being essential to the success of overdose prevention efforts.

Purpose

This study compares all-cause, drug- and opioid-related mortality between counties in different regions of Kentucky: Appalachian non-metropolitan, Appalachian metropolitan, non-Appalachian non-metropolitan, and non-Appalachian metropolitan.

Methods

Age-adjusted mortality data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER, 2000-2019) were used. County-level demographic and socioeconomic data were obtained from the U.S. Census Bureau, 2010 American Community Survey. Statistical analyses were performed with negative binomial regression models with a log link.

Results

The Appalachian non-metropolitan region of Kentucky had a significantly higher (p < .05) all-cause mortality (1,076/100,000) compared to the state's non-Appalachian metropolitan (904/100,000), non-Appalachian non-metropolitan (959/100,000), and Appalachian metropolitan (938/100,000) regions. Within non-Appalachian regions, non-metropolitan rates were higher than metropolitan (p = .0006). For drug- and opioid-related mortality, non-metropolitan and metropolitan regions had comparable rates within non-Appalachia, as well as within Appalachia. Appalachian regions had twice the mortality rates of non-Appalachian regions of the state (p < .05). Among the Appalachian counties, non-metropolitan counties had higher all-cause mortality than metropolitan counties.

Implications

The findings from this study can help healthcare practitioners and public health officials develop interventions addressing drug-related and opioid-related mortality in Kentucky targeted to the regions where rates are significantly higher. Also, the information on geographic, demographic, and socioeconomic factors related to these types of mortality can be used to design interventions specific to the target population's socio-demographics.

Lifestyle effects on aging and CVD: A spotlight on the nutrient-sensing network

Aging is widespread worldwide and a significant risk factor for cardiovascular disease (CVD). Mechanisms underlying aging have attracted considerable attention in recent years. Remarkably, aging and CVD overlap in numerous ways, with deregulated nutrient sensing as a common mechanism and lifestyle as a communal modifier. Interestingly, lifestyle triggers or suppresses multiple nutrient-related signaling pathways. In this review, we first present the composition of the nutrient-sensing network (NSN) and its metabolic impact on aging and CVD. Secondly, we review how risk factors closely associated with CVD, including adverse life states such as sedentary behavior, sleep disorders, high-fat diet, and psychosocial stress, contribute to aging and CVD, with a focus on the bridging role of the NSN. Finally, we focus on the positive effects of beneficial dietary interventions, specifically dietary restriction and the Mediterranean diet, on the regulation of nutrient metabolism and the delayed effects of aging and CVD that depend on the balance of the NSN. In summary, we expound on the interaction between lifestyle, NSN, aging, and CVD.

Trends in cause-specific mortality: deaths of despair in Spain, 1980-2019

BACKGROUND

Research from various countries has shown increases in alcohol- and drug-related deaths and suicide, known as 'deaths of despair' over recent decades, particularly among low-educated middle-aged individuals. However, little is known about trends in death-of-despair causes in Spain. Therefore, we aim to descriptively examine this among 25-64-year-olds from 1980 to 2019 and by educational attainment for the years 2017-19.

METHODS

We obtained mortality and population data from the National Institute of Statistics to estimate age-standardized mortality rates and assess educational inequalities using the relative index of inequality (RII).

RESULTS

Deaths of despair as a share of total mortality slightly increased from 2000 onwards, particularly among 25-64-year-old men (from 9 to 10%). Only alcohol-related mortality declined relatively more since 1980 compared with all-cause mortality. Regarding educational differences, low-educated men presented higher mortality rates in all death-of-despair causes (alcohol-related: RII 3.54 (95% CI: 2.21-5.66); drug-related: RII 3.49 (95% CI: 1.80-6.77); suicide: RII 1.97 (95% CI: 1.49-2.61)). Women noteworthy differences were only observed for alcohol-related (RII 3.50 (95% CI: 2.13-5.75)).

CONCLUSIONS

Findings suggest an increasing proportion of deaths of despair among 25-64-year-olds since 2000, particularly among men. Public health policies are needed to reduce and prevent these premature and preventable causes of mortality.

Actuarial Aging Rates in Human Cohorts

Aging rate is an important characteristic of human aging. Attempts to measure aging rates through the Gompertz slope parameter lead to a conclusion that actuarial aging rates were stable during the most of the 20th century, but recently demonstrate an increase over time in the majority of studied populations. These findings were made using cross-sectional mortality data rather than by the analysis of mortality of real birth cohorts. In this study we analyzed historical changes of actuarial aging rates in human cohorts. The Gompertz parameters were estimated in the age interval 50-80 years using data on one-year cohort age-specific death rates from the Human Mortality Database (HMD). Totally, data for 2,294 cohorts of men and women from 76 populations were analyzed. Changes of the Gompertz slope parameter in the studied cohorts revealed two distinct patterns for actuarial aging rate. In higher mortality Eastern European countries actuarial aging rates showed continuous decline from the 1910 to 1940 birth cohort. In lower mortality Western European countries, Australia, Canada, Japan, New Zealand, and USA actuarial aging rates declined from the 1910th to approximately 1930th cohort and then increased. Overall, in 50 out of 76 populations (68%) actuarial aging rate demonstrated decreasing pattern of change over time. Compensation effect of mortality (CEM) was tested for the first time in human cohorts and the cohort species-specific lifespan was estimated. CEM was confirmed using cohort data and human cohort species-specific lifespan estimates were similar to the estimates obtained for the cross-sectional data published earlier.

Frequency of Systemic Diseases and Oral Lesions Among the Institutionalized Elderly Subjects in the Northeast of Iran

Background

With ageing, the number of systemic diseases and the consumption of drugs increase. Moreover, some oral lesions, especially denture-related lesions, are commonly observed.

Aim and Objective

The purpose of this study was to determine the frequency of systemic diseases and oral lesions in the elderly in the Mashhad Geriatric Institutes.

Methods

Institutionalized elderly people, who could cooperate for oral examination, enrolled in this descriptive cross-sectional study. The frequency of oral lesions and their systemic diseases were recorded in the self-made checklist. For statistical analysis, Student's t-test and Chi-square test were utilized. The significance level was considered to be 0.05.

Results

During the study, 224 elderly subjects with a mean age of 75.63 ± 11.22 years were evaluated. The mean duration of residency in the elderly nursing centres was 1.87 ± 1.37 years. Hypertension, Alzheimer's disease and diabetes were the most common systemic diseases, and about 47% of the patients had two or multiple concurrent diseases. Among participants, 97.1% had at least one oral lesion. The most common oral lesions were fissured tongue (75%), sublingual varicosity (68.3%) and hairy or coated tongue (38.4%), respectively, which are classified as normal variations of oral mucosa. The most common pathological lesions were denture stomatitis, frictional keratosis and lichenoid reactions.

Conclusion

Regarding to the high frequency of oral lesions among ageing people, regular examination of the oral mucosa for early detection of oral lesions and appropriate treatments is recommended.

Intervention targets for reducing mortality between mid-adolescence and mid-adulthood: a protocol for a machine-learning facilitated systematic umbrella review

INTRODUCTION

A rise in premature mortality-defined here as death during the most productive years of life, between adolescence and middle adulthood (15-60 years)-is contributing to stalling life expectancy in high-income countries. Causes of mortality vary, but often include substance misuse, suicide, unintentional injury and non-communicable disease. The development of evidence-informed policy frameworks to guide new approaches to prevention require knowledge of early targets for intervention, and interactions between higher level drivers. Here, we aim to: (1) identify systematic reviews with or without meta-analyses focused on intervention targets for premature mortality (in which intervention targets are causes of mortality that can, at least hypothetically, be modified to reduce risk); (2) evaluate the review quality and risk of bias; (3) compare and evaluate each review's, and their relevant primary studies, findings to identify existing evidence gaps.

METHODS AND ANALYSIS

In May 2023, we searched electronic databases (MEDLINE, PubMed, Embase, Cochrane Library) for peer-reviewed papers published in the English language in the 12 years from 2012 to 2023 that examined intervention targets for mortality. Screening will narrow these papers to focus on systematic reviews with or without meta-analyses, and their primary papers. Our outcome is death between ages 15 and 60 years; with potential intervention targets measured prior to death. A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) will be used to assess quality and risk of bias within included systematic reviews. Results will be synthesised narratively due to anticipated heterogeneity between reviews and between primary studies contained within included reviews.

ETHICS AND DISSEMINATION

This review will synthesise findings from published systematic reviews and meta-analyses, and their primary reviewed studies, meaning ethics committee approval is not required. Our findings will inform cross-cohort consortium development, be published in a peer-reviewed journal, and be presented at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42022355861.

Widening area-based socioeconomic inequalities in cancer mortality in Germany between 2003 and 2019

Cancer mortality has declined in recent decades, but-due to a lack of national individual-level data-it remains unclear whether this applies equally to all socioeconomic groups in Germany. Using an area-based approach, this study investigated socioeconomic inequalities in cancer mortality and their secular trends on a German nationwide scale for the first time. Official cause-of-death data from 2003 to 2019 were linked to the district-level German Index of Socioeconomic Deprivation. Age-standardised mortality rates for all cancers combined and the most common site-specific cancers were calculated according to the level of regional socioeconomic deprivation. To quantify the extent of area-based socioeconomic inequalities in cancer mortality, absolute (SII) and relative (RII) indices of inequality were estimated using multilevel Poisson models. On average, cancer mortality was 50% (women) and 80% (men) higher in Germany's most deprived than least deprived districts (absolute difference: 84 deaths per 100,000 in women and 185 deaths per 100,000 in men). As declines in cancer mortality were larger in less deprived districts, the socioeconomic gap in cancer mortality widened over time. This trend was observed for various common cancers. Exceptions were cancers of the lung in women and of the pancreas in both sexes, for which mortality rates increased over time, especially in highly deprived districts. Our study provides first evidence on increasing socioeconomic inequalities in cancer mortality on a nationwide scale for Germany. Area-based linkage allows to examine socioeconomic inequalities in cancer mortality across Germany and identify regions with high needs for cancer prevention and control.

Life Course Patterns of Prescription Drug Use in the United States

Prescription drug use has reached historic highs in the United States-a trend linked to increases in medicalization, institutional factors relating to the health care and pharmaceutical industries, and population aging and growing burdens of chronic disease. Despite the high and rising prevalence of use, no estimates exist of the total number of years Americans can expect to spend taking prescription drugs over their lifetimes. This study provides the first estimates of life course patterns of prescription drug use using data from the 1996-2019 Medical Expenditure Panel Surveys, the Human Mortality Database, and the National Center for Health Statistics. Newborns in 2019 could be expected to take prescription drugs for roughly half their lives: 47.54 years for women and 36.84 years for men. The number of years individuals can expect to take five or more drugs increased substantially. Americans also experienced particularly dramatic increases in years spent taking statins, antihypertensives, and antidepressants. There are also important differences in prescription drug use by race and ethnicity: non-Hispanic Whites take the most, Hispanics take the least, and non-Hispanic Blacks fall in between these extremes. Americans are taking drugs over a wide and expanding swathe of the life course, a testament to the centrality of prescription drugs in Americans' lives today.

Genotype-by-socioeconomic status interaction influences heart disease risk scores and carotid artery thickness in Mexican Americans: the predominant role of education in comparison to household income and socioeconomic index

Background: Socioeconomic status (SES) is a potent environmental determinant of health. To our knowledge, no assessment of genotype-environment interaction has been conducted to consider the joint effects of socioeconomic status and genetics on risk for cardiovascular disease (CVD). We analyzed Mexican American Family Studies (MAFS) data to evaluate the hypothesis that genotype-by-environment interaction (GxE) is an important determinant of variation in CVD risk factors. Methods: We employed a linear mixed model to investigate GxE in Mexican American extended families. We studied two proxies for CVD [Pooled Cohort Equation Risk Scores/Framingham Risk Scores (FRS/PCRS) and carotid artery intima-media thickness (CA-IMT)] in relation to socioeconomic status as determined by Duncan's Socioeconomic Index (SEI), years of education, and household income. Results: We calculated heritability for FRS/PCRS and carotid artery intima-media thickness. There was evidence of GxE due to additive genetic variance heterogeneity and genetic correlation for FRS, PCRS, and CA-IMT measures for education (environment) but not for household income or SEI. Conclusion: The genetic effects underlying CVD are dynamically modulated at the lower end of the SES spectrum. There is a significant change in the genetic architecture underlying the major components of CVD in response to changes in education.

A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic

BACKGROUND

Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition.

METHODS

Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001-2003 and 2016-2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method.

RESULTS

The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences.

CONCLUSION

Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.

Impact of COVID-19 on subnational variations in life expectancy and life disparity at birth in India: evidence from NFHS and SRS data

BACKGROUND

Measuring life expectancy and life disparity can assist in comprehending how the COVID-19 pandemic has affected the mortality estimates in the Indian population. The present study aims to study the life expectancy and life disparity at birth at the national and subnational levels before and during the COVID-19 pandemic using the NFHS and SRS data.

METHODS

The measures Life expectancy at birth ([Formula: see text]) and Life disparity at birth ([Formula: see text]) were computed for the non-pandemic and pandemic years from NFHS (2015-16), SRS (2015) and NFHS (2019-21), SRS (2020) respectively at the national and Subnational level in India. Using NFHS data for the 36 states and SRS data for the 22 states, the study calculates [Formula: see text] and [Formula: see text] by total, male and female population.

RESULTS

The [Formula: see text] for male and female decline from 64.3 years and 69.2 years in 2015-16 to 62.9 years and 68.9 years in 2019-21. The [Formula: see text] shows a drop of approximately 1.4 years for males and 0.3 years for females in the pandemic year 2019-21 when compared to the non-pandemic year 2015-16. At the subnational level [Formula: see text] shows a decline for 22 states in person, 23 states in males and 21 states in females in the pandemic year 2019-21 as compared to the non-pandemic years 2015-16. The [Formula: see text] shows a increase for 21 states in person, 24 states in females and 17 states in males in the pandemic year than non-pandemic year. The findings shows a significant losses in [Formula: see text] and gains in [Formula: see text] for males than females in the pandemic year as compared to the non-pandemic year at the subnational level in India.

CONCLUSIONS

COVID-19 pandemic has decreased [Formula: see text] and increased [Formula: see text] in the pandemic year 2019-21 at the national and subnational level in India. COVID-19 had a significant impact on the age pattern of mortality for many states and male, female population and delayed the mortality transition in India.

Residence in urban or rural counties in relation to opioid overdose mortality among Kentucky hospitalizations before and during the COVID-19 pandemic

BACKGROUND

At the beginning of the opioid overdose epidemic, overdose mortality rates were higher in urban than in rural areas. We examined the association between residence in an urban or rural county and subsequent opioid overdose mortality in Kentucky, a state highly impacted by the opioid epidemic, and whether this was modified by the COVID-19 pandemic.

METHODS

We captured hospitalizations in Kentucky from 2016 to 2020, involving an opioid using ICD-10-CM codes T40.0-T40.4 and T40.6. Patient's county was classified as urban or rural based on the NCHS Urban-Rural Classification Scheme. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of opioid overdose mortality, adjusted for demographics, hospitalization severity, and zip code SES. We assessed effect modification by the COVID-19 pandemic.

RESULTS

Overall, patients living in urban counties had 46% higher odds of opioid overdose death than patients residing in rural counties (adjusted OR=1.46; 95% CI=1.22, 1.74). Before the pandemic, patients in urban counties had 63% increased odds of opioid overdose death (adjusted OR=1.63; 95% CI=1.34, 1.97); however, during the COVID-19 pandemic, patients in urban and rural counties became more similar in regard to opioid overdose mortality (adjusted OR=0.72; 95% CI=0.45, 1.16; p-value for interaction =0.02).

CONCLUSION

Before the pandemic, living in urban counties was associated with higher opioid overdose mortality among Kentucky hospitalizations; however, during the COVID-19 pandemic, opioid overdose mortality in rural areas increased, approaching rates in urban areas. COVID-19 posed social, economic, and healthcare challenges that may be contributing to worsening mortality trends affecting both urban and rural patients.

Development and Validation of a Simulation Model for Treatment to Maintain Remission in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

OBJECTIVE

Fixed and tailored rituximab retreatment strategies to maintain remission in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are associated with tradeoffs. The current study was undertaken to develop a simulation model (AAV-Sim) to project clinical outcomes with these strategies.

METHODS

We developed the AAV-Sim, a microsimulation model of clinical events among individuals with AAV initiating treatment to maintain remission. Individuals transition between health states of remission or relapse and are at risk for severe infection, end-stage renal disease, or death. We estimated transition rates from published literature, stratified by individual-level characteristics. We performed validation using the mean average percent error (MAPE) and the coefficient of variation of root mean square error (CV-RMSE). In internal validation, we compared model-projected outcomes over 28 months with outcomes observed in the Rituximab versus Azathioprine in ANCA-Associated Vasculitis 2 (MAINRITSAN2) trial, which compared fixed versus tailored retreatment. In external validation, we compared outcomes with fixed rituximab retreatment from the AAV-Sim to outcomes from the MAINRITSAN1 trial and an observational study.

RESULTS

The AAV-Sim projected outcomes similar to those in the MAINRITSAN2 trial, including minor (AAV-Sim 6.0% fixed versus 7.3% tailored; MAINRITSAN2 6.2% versus 8.6%; MAPE 3% and 15%) and major relapse (AAV-Sim 3.5% versus 5.5%; MAINRITSAN2 3.7% versus 7.4%; MAPE 5% and 26%), severe infection (AAV-Sim 19.4% versus 11.1%; MAINRITSAN2 19.8% versus 10.2%; MAPE 2% and 9%), and relapse-free survival (AAV-Sim 84.8% versus 82.3%; MAINRITSAN2 86% versus 84%; CV-RMSE 2.3% and 2.5%). Similar performance was observed in external validation.

CONCLUSION

The AAV-Sim projected a range of clinical outcomes for different treatment approaches that were validated against published data. The AAV-Sim has the potential to inform management guidelines and research priorities.

Falling Behind: The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933-2021

Objectives. To document the evolution of the US life expectancy disadvantage and regional variation across the US states. Methods. I obtained life expectancy estimates in 2022 from the United Nations, the Human Mortality Database, and the US Mortality Database, and calculated changes in growth rates, US global position (rank), and state-level trends. Results. Increases in US life expectancy slowed from 1950 to 1954 (0.21 years/annum) and 1955 to 1973 (0.10 years/annum), accelerated from 1974 to 1982 (0.34 years/annum), and progressively deteriorated from 1983 to 2009 (0.15 years/annum), 2010 to 2019 (0.06 years/annum), and 2020 to 2021 (-0.97 years/annum). Other countries experienced faster growth in each phase except 1974 to 1982. During 1933 to 2021, 56 countries on 6 continents surpassed US life expectancy. Growth in US life expectancy was slowest in Midwest and South Central states. Conclusions. The US life expectancy disadvantage began in the 1950s and has steadily worsened over the past 4 decades. Dozens of globally diverse countries have outperformed the United States. Causal factors appear to have been concentrated in the Midwest and South. Public Health Implications. Policies that differentiate the United States from other countries and circumstances associated with the Midwest and South may have contributed. (Am J Public Health. 2023;113(9):970-980. https://doi.org/10.2105/AJPH.2023.307310).

Distribution of the compression and expansion of morbidity in 194 countries and territories, 1990-2016: The role of income inequality

Studies on detailed types of health changes and the associations between the types and income inequality are inadequate. This study analyses the global distribution of the compression and expansion of morbidity in 194 countries and territories between 1990 and 2016, and investigates the role of income inequality in the distribution. This study shows that all seven types of health changes coexist, despite being distributed unevenly. The relative expansion of morbidity with increased or constant life expectancy (Type 6, 54.48%) is the most popular type, followed by the relative compression of morbidity with increased or constant life expectancy (Type 3, 30.71%). Income distribution within a society matters for health changes. Societies with greater income inequality tend to have Type 6, a worse scenario of health changes. Measures to reduce income inequality or mitigate its adverse effects will contribute to the relative compression of morbidity with increased or constant life expectancy.

Changes in longevity inequality by education among OECD countries before the COVID-19 pandemic

BACKGROUND

Disparities in life expectancy between socioeconomic groups are one of the main challenges for health policy, and their reduction over time is an important policy objective.

METHODS

Observational study using routinely registered data on mortality around 2011 and 2016 by sex, age, educational attainment level, and cause of death in 13 member countries of the Organization for Economic Cooperation and Development (OECD). The main outcome measures are life expectancy by education at the ages of 25 and 65 in 2011 and 2016.

RESULTS

Between 2011 and 2016, the life expectancy gap has increased by 0·2 years among men and 0·3 years among women from 13 available countries. The United States recorded one the largest increases in the absolute life expectancy gap, 1·3 years for women and 1·1 years for men respectively.

CONCLUSION

Inequality in longevity has increased in over half of the countries surveyed and starkly so in the United States in a context of deteriorating health.

TRIAL REGISTRATION

Not applicable.

The socioeconomic distribution of life expectancy and healthy life expectancy in Chile

BACKGROUND

Life expectancy (LE) has usually been used as a metric to monitor population health. In the last few years, metrics such as Quality-Adjusted-Life-Expectancy (QALE) and Health-Adjusted-Life- Expectancy (HALE) have gained popularity in health research, given their capacity to capture health related quality of life, providing a more comprehensive approach to the health concept. We aimed to estimate the distribution of the LE, QALEs and HALEs across Socioeconomic Status in the Chilean population.

METHODS

Based on life tables constructed using Chiang II´s method, we estimated the LE of the population in Chile by age strata. Probabilities of dying were estimated from mortality data obtained from national registries. Then, life tables were stratified into five socioeconomic quintiles, based on age-adjusted years of education (pre-school, early years to year 1, primary level, secondary level, technical or university). Quality weights (utilities) were estimated for age strata and SES, using the National Health Survey (ENS 2017). Utilities were calculated using the EQ-5D data of the ENS 2017 and the validated value set for Chile. We applied Sullivan´s method to adjust years lived and convert them into QALEs and HALEs.

RESULTS

LE at birth for Chile was estimated in 80.4 years, which is consistent with demographic national data. QALE and HALE at birth were 69.8 and 62.4 respectively. Men are expected to live 6.1% less than women. However, this trend is reversed when looking at QALEs and HALEs, indicating the concentration of higher morbidity in women compared to men. The distribution of all these metrics across SES showed a clear gradient in favour of a better-off population-based on education quintiles. The absolute and relative gaps between the lowest and highest quintile were 15.24 years and 1.21 for LE; 18.57 HALYs and 1.38 for HALEs; and 21.92 QALYs and 1.41 for QALEs. More pronounced gradients and higher gaps were observed at younger age intervals.

CONCLUSION

The distribution of LE, QALE and HALEs in Chile shows a clear gradient favouring better-off populations that decreases over people´s lives. Differences in LE favouring women contrast with differences in HALEs and QALEs which favour men, suggesting the need of implementing gender-focused policies to address the case-mix complexity. The magnitude of inequalities is greater than in other high-income countries and can be explained by structural social inequalities and inequalities in access to healthcare.

Which risk factors significantly influence the outcome of traumatic brain injured patients with alcohol use disorder?

PURPOSE

Every year, approximately 10 million people worldwide suffer a traumatic brain injury that leads to hospitalization or mortality. Chronic and acute alcohol intoxication increase the risk of developing traumatic brain injury. Alcohol use disorder (AUD) as a predictor of outcome in neurosurgical patients and the definition of risk factors have been sparsely addressed so far. This study aims to improve the understanding of the effects of alcohol use disorder in the context of neurosurgical therapy.

METHODS

This study included patients admitted to Münster University Hospital with a traumatic brain injury and alcohol use disorder from January 1, 2010, to December 31, 2018. Univariate and multivariate analyses were performed to identify risk factors for a poorer outcome, assessed by the Glasgow Outcome Score.

RESULTS

Of the 197 patients included, 156 (79%) were male, and 41 (21%) were female, with a median age of 49 years (IQR 38-58 years). In multivariate analyses, age (p < 0.001), the occurrence of a new neurologic deficit (p < 0.001), the development of hydrocephalus (p = 0.005), and CT-graphic midline shift due to intracerebral hemorrhage (p = 0.008) emerged as significant predictors of a worse outcome (GOS 1-3). In addition, the level of blood alcohol concentration correlated significantly with the occurrence of seizures (p = 0.009).

CONCLUSIONS

Early identification of risk factors in patients with alcohol use disorder and traumatic brain injury is crucial to improve the outcome. In this regard, the occurrence of hydrocephalus or seizures during the inpatient stay should be considered as cause of neurological deterioration in this patient group.

Intrinsic and environmental basis of aging: A narrative review

Longevity has been a topic of interest since the beginnings of humanity, yet its aetiology and precise mechanisms remain to be elucidated. Aging is currently viewed as a physiological phenomenon characterized by the gradual degeneration of organic physiology and morphology due to the passage of time where both external and internal stimuli intervene. The influence of intrinsic factors, such as progressive telomere shortening, genome instability due to mutation buildup, the direct or indirect actions of age-related genes, and marked changes in epigenetic, metabolic, and mitochondrial patterns constitute a big part of its underlying endogenous mechanisms. On the other hand, several psychosocial and demographic factors, such as diet, physical activity, smoking, and drinking habits, may have an even more significant impact on shaping the aging process. Consequentially, implementing dietary and exercise patterns has been proposed as the most viable alternative strategy for attenuating the most typical degenerative aging changes, thus increasing the likelihood of prolonging lifespan and achieving successful aging.

The underwhelming German life expectancy

This article contributes to the discussion on the determinants of diverging life expectancy in high-income countries, with a focus on Germany. To date, much of this discourse has centered around the social determinants of health, issues of healthcare equity, poverty and income inequality, and new epidemics of opioids and violence. Yet despite doing well on all of these metrics and having numerous advantages such as comparatively strong economic performance, generous social security, and an equitable and well-resourced health care system, Germany has been a long-time life expectancy laggard among the high-income countries. Using aggregated population-level mortality data for Germany and selected six high-income countries (Switzerland, France, Japan, Spain, the United Kingdom, and the United States) from the Human Mortality Database and WHO Mortality Database, we find that the German longevity shortfall is mainly explained by a longstanding disadvantage in survival among older adults and adults nearing statutory retirement age, which mainly stems from sustained excess cardiovascular disease mortality, even when compared to other laggard countries such as the US and the UK. Patchy contextual data suggests that the unfavorable pattern of cardiovascular mortality may be driven by underperforming primary care and disease prevention. More systematic and representative data on risk factors are needed to strengthen the evidence base on the determinants of the controversial and long-standing health gap between more successful countries and Germany. The German example calls for broader narratives of population health that embed the variety of epidemiological challenges populations face around the globe.

Trends in Mortality From Poisonings, Firearms, and All Other Injuries by Intent in the US, 1999-2020

Importance

Although deaths due to external causes are a leading cause of mortality in the US, trends over time by intent and demographic characteristics remain poorly understood.

Objective

To examine national trends in mortality rates due to external causes from 1999 to 2020 by intent (homicide, suicide, unintentional, and undetermined) and demographic characteristics. External causes were defined as poisonings (eg, drug overdose), firearms, and all other injuries, including motor vehicle injuries and falls. Given the repercussions of the COVID-19 pandemic, US death rates for 2019 and 2020 were also compared.

Design, Setting, and Participants

Serial cross-sectional study using national death certificate data obtained from the National Center for Health Statistics and including all external causes of 3 813 894 deaths among individuals aged 20 years or older from January 1, 1999, to December 31, 2020. Data analysis was conducted from January 20, 2022, to February 5, 2023.

Exposures

Age, sex, and race and ethnicity.

Main Outcomes and Measures

Trends in age-standardized mortality rates and average annual percentage change (AAPC) in rates calculated by intent (suicide, homicide, unintentional, and undetermined), age, sex, and race and ethnicity for each external cause.

Results

Between 1999 and 2020, there were 3 813 894 deaths due to external causes in the US. From 1999 to 2020, poisoning death rates increased annually (AAPC, 7.0%; 95% CI, 5.4%-8.7%). From 2014 to 2020, poisoning death rates increased the most among men (APC, 10.8%; 95% CI, 7.7%-14.0%). During the study period, poisoning death rates increased in all the racial and ethnic groups examined; the most rapid increase was among American Indian and Alaska Native individuals (AAPC, 9.2%; 95% CI, 7.4%-10.9%). During the study period, death rates for unintentional poisoning had the most rapid rate of increase (AAPC, 8.1%; 95% CI, 7.4%-8.9%). From 1999 to 2020, firearm death rates increased (AAPC, 1.1%; 95% CI, 0.7%-1.5%). From 2013 to 2020, firearm mortality increased by an average of 4.7% annually (95% CI, 2.9%-6.5%) among individuals aged 20 to 39 years. From 2014 to 2020, mortality from firearm homicides increased by an average of 6.9% annually (95% CI, 3.5%-10.4%). From 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, and homicide due to firearms and all other injuries.

Conclusions and Relevance

Results of this cross-sectional study suggest that from 1999 to 2020, death rates due to poisonings, firearms, and all other injuries increased substantially in the US. The rapid increase in deaths due to unintentional poisonings and firearm homicides is a national emergency that requires urgent public health interventions at the local and national levels.

Comparing Life Expectancy Determinants between Saudi Arabia and United Arab Emirates from 1980-2020

Despite marked advancements, life expectancy (LE) growth in Saudi Arabia and the United Arab Emirates (UAE) has remained stagnant compared to other developed nations. This study aims to investigate the significant correlation between macroeconomic (ME), sociodemographic (SD), and health status and resources (HSR) factors and LE to formulate an explanatory model for Saudi Arabia and the UAE-a previously unexplored area. Utilizing an ecological, retrospective, time-series study design, we delved into secondary data on SD, ME, and HSR factors and LE of the populations of the UAE and Saudi Arabia spanning three decades (1980-2020). We employed partial least squares-structural equation modeling for statistical analysis. Our analysis revealed significant direct impacts of HSR factors on LE for Saudi Arabia (β = 0.958, p < 0.001) and the UAE (β = 0.716, p < 0.001). Furthermore, we discerned a notable indirect influence of ME factors on LE, mediated through SD and HSR factors for Saudi Arabia (β = 0.507, p < 0.001) and the UAE (β = 0.509, p < 0.001), along with a considerable indirect effect of SD factors on LE through HSR (Saudi: β = 0.529, p < 0.001; UAE: β = 0.711, p < 0.001). This study underscores the mediating role of a nexus of ME-SD-HSR factors on LE in Saudi Arabia and the UAE. Consequently, these findings signal an imperative need for holistic policy interventions addressing ME, SD, and HSR factors, aiming to alter health behaviors and improve LE projections for Saudi Arabia and the UAE in the long run.

Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys

BACKGROUND

Previously improving UK mortality trends stalled around 2012, with evidence implicating economic policy as the cause. This paper examines whether trends in psychological distress across three population surveys show similar trends.

METHODS

We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire) from Understanding Society (Great Britain, 1991-2019), Scottish Health Survey (SHeS, 1995-2019) and Health Survey for England (HSE, 2003-2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify breakpoints after 2010.

RESULTS

Psychological distress was higher in Understanding Society than in SHeS or HSE. There was slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of a worsening in psychological distress across surveys. Prevalence worsened notably among those aged 16-34 years after 2010 (all three surveys), and aged 35-64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared with the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall.

CONCLUSION

Psychological distress worsened among working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread mental health crisis that predates the COVID-19 pandemic.

A global perspective on the intrinsic dimensionality of COVID-19 data

We develop a novel global perspective of the complexity of the relationships between three COVID-19 datasets, the standardised per-capita growth rate of COVID-19 cases and deaths, and the Oxford Coronavirus Government Response Tracker COVID-19 Stringency Index (CSI) which is a measure describing a country's stringency of lockdown policies. We use a state-of-the-art heterogeneous intrinsic dimension estimator implemented as a Bayesian mixture model, called Hidalgo. Our findings suggest that these highly popular COVID-19 statistics may project onto two low-dimensional manifolds without significant information loss, suggesting that COVID-19 data dynamics are generated from a latent mechanism characterised by a few important variables. The low dimensionality imply a strong dependency among the standardised growth rates of cases and deaths per capita and the CSI for countries over 2020-2021. Importantly, we identify spatial autocorrelation in the intrinsic dimension distribution worldwide. The results show how high-income countries are more prone to lie on low-dimensional manifolds, likely arising from aging populations, comorbidities, and increased per capita mortality burden from COVID-19. Finally, the temporal stratification of the dataset allows the examination of the intrinsic dimension at a more granular level throughout the pandemic.

Transcranial Electromagnetic Wave Treatment: A Fountain of Healthy Longevity?

Most diseases of older age have as their common denominator a dysfunctional immune system, wherein a low, chronic level of inflammation is present due to an imbalance of pro-inflammatory cytokines over anti-inflammatory cytokines that develops during aging ("inflamm-aging"). A gerotherapeutic that can restore the immune balance to that shared by young/middle-aged adults and many centenarians could reduce the risk of those age-related diseases and increase healthy longevity. In this perspectives paper, we discuss potential longevity interventions that are being evaluated and compare them to a novel gerotherapeutic currently being evaluated in humans-Transcranial Electromagnetic Wave Treatment (TEMT). TEMT is provided non-invasively and safety through a novel bioengineered medical device-the MemorEM-that allows for near complete mobility during in-home treatments. Daily TEMT to mild/moderate Alzheimer's Disease (AD) patients over a 2-month period rebalanced 11 of 12 cytokines in blood back to that of normal aged adults. A very similar TEMT-induced rebalancing of cytokines occurred in the CSF/brain for essentially all seven measurable cytokines. Overall inflammation in both blood and brain was dramatically reduced by TEMT over a 14-27 month period, as measured by C-Reactive Protein. In these same AD patients, a reversal of cognitive impairment was observed at 2 months into treatment, while cognitive decline was stopped over a 2½ year period of TEMT. Since most age-related diseases have the commonality of immune imbalance, it is reasonable to postulate that TEMT could rebalance the immune system in many age-related diseases as it appears to do in AD. We propose that TEMT has the potential to reduce the risk/severity of age-related diseases by rejuvenating the immune system to a younger age, resulting in reduced brain/body inflammation and a substantial increase in healthy longevity.

Effects of giving psychologists prescriptive authority: Evidence from a natural experiment in the United States

BACKGROUND

Suicide is the tenth leading cause of death in the U.S. Six states have granted psychologists prescriptive authority to address shortages in the provision of behavioral and mental health care services to increase provider access to pharmacological interventions using psychotropic medications.

METHODS

This study estimates the impact of expanding scope of practice for specifically trained psychologists to include pharmacological interventions on mortality by self-inflicted injury in the U.S. by using the implementation of prescriptive authority for psychologists in New Mexico and Louisiana as a natural experiment using a staggered different-in-difference estimation. Additional robustness tests are conducted to identify heterogenous treatment effects, observe sensitivity of our results for Medicaid expansion, and to compare other forms of mortality that should not have been affected by psychologist prescriptive authority.

RESULTS

Mortality resulting from self-inflicted injury decreased by 5 to 7 percentage points in New Mexico and Louisiana following prescriptive authority expansions for psychologists. The effect is statistically significant for males, white populations, individuals who are married or single, and for people between the ages of 35 and 55.

CONCLUSIONS

In the U.S., expanding scope of practice for specifically trained psychologists to include prescriptive authority may help address poor mental health care outcomes, such as suicides. Similar policy expansions may be useful for other countries where referral from a psychologist and prescription assignment from a psychiatrist are separated.

Determinants of life expectancy at birth: a longitudinal study on OECD countries

This paper analyses the influence of several determinants on life expectancy at birth in 36 OECD countries over the 1999-2018 period. We utilized a cross-country fixed-effects multiple regression analysis with year and country dummies and used dynamic models, backward stepwise selection, and Arellano-Bond estimators to treat potential endogeneity issues. The results show the influence of per capita health-care expenditure, incidence of out-of-pocket expenditure, physician density, hospital bed density, social spending, GDP level, participation ratio to labour, prevalence of chronic respiratory diseases, temperature, and total size of the population on life expectancy at birth. In line with previous studies, this analysis confirms the relevance of both health care expenditure and health care system (physicians and hospital beds in our analysis) in influencing a country's population life expectancy. It also outlines the importance of other factors related to population behaviour and social spending jointly considered on this outcome. Policy makers should carefully consider these mutual influences when allocating public funds, particularly after the COVID-19 pandemic period.

Improved accuracy and precision of fat-suppressed isotropic 3D T2 mapping MRI of the knee with dictionary fitting and patch-based denoising

PURPOSE

To develop an isotropic three-dimensional (3D) T2 mapping technique for the quantitative assessment of the composition of knee cartilage with high accuracy and precision.

METHODS

A T2-prepared water-selective isotropic 3D gradient-echo pulse sequence was used to generate four images at 3 T. These were used for three T2 map reconstructions: standard images with an analytical T2 fit (AnT2Fit); standard images with a dictionary-based T2 fit (DictT2Fit); and patch-based-denoised images with a dictionary-based T2 fit (DenDictT2Fit). The accuracy of the three techniques was first optimized in a phantom study against spin-echo imaging, after which knee cartilage T2 values and coefficients of variation (CoV) were assessed in ten subjects in order to establish accuracy and precision in vivo. Data given as mean ± standard deviation.

RESULTS

After optimization in the phantom, whole-knee cartilage T2 values of the healthy volunteers were 26.6 ± 1.6 ms (AnT2Fit), 42.8 ± 1.8 ms (DictT2Fit, p < 0.001 versus AnT2Fit), and 40.4 ± 1.7 ms (DenDictT2Fit, p = 0.009 versus DictT2Fit). The whole-knee T2 CoV reduced from 51.5% ± 5.6% to 30.5 ± 2.4 and finally to 13.1 ± 1.3%, respectively (p < 0.001 between all). The DictT2Fit improved the data reconstruction time: 48.7 ± 11.3 min (AnT2Fit) versus 7.3 ± 0.7 min (DictT2Fit, p < 0.001). Very small focal lesions were observed in maps generated with DenDictT2Fit.

CONCLUSIONS

Improved accuracy and precision for isotropic 3D T2 mapping of knee cartilage were demonstrated by using patch-based image denoising and dictionary-based reconstruction.

KEY POINTS

• Dictionary T2 fitting improves the accuracy of three-dimensional (3D) knee T2 mapping. • Patch-based denoising results in high precision in 3D knee T2 mapping. • Isotropic 3D knee T2 mapping enables the visualization of small anatomical details.

Cardiovascular Health and Life Expectancy Among Adults in the United States

BACKGROUND

Cardiovascular disease may be the main reason for stagnant growth in life expectancy in the United States since 2010. The American Heart Association recently released an updated algorithm for evaluating cardiovascular health (CVH)-Life's Essential 8 (LE8) score. We aimed to quantify the associations of CVH levels, estimated by the LE8 score, with life expectancy in a nationally representative sample of US adults.

METHODS

We included 23 003 nonpregnant, noninstitutionalized participants aged 20 to 79 years who participated in the National Health and Nutrition Examination Survey from 2005 to 2018 and whose mortality was identified through linkage to the National Death Index through December 31, 2019. The overall CVH was evaluated by the LE8 score (range, 0-100), as well as the score for each component of diet, physical activity, tobacco/nicotine exposure, sleep duration, body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure. Life table method was used to estimate life expectancy by levels of the CVH.

RESULTS

During a median of 7.8 years of follow-up, 1359 total deaths occurred. The estimated life expectancy at age 50 years was 27.3 years (95% CI, 26.1-28.4), 32.9 years (95% CI, 32.3-33.4), and 36.2 years (95% CI, 34.2-38.2) in participants with low (LE8 score <50), moderate (50≤ LE8 score <80), and high (LE8 score ≥80) CVH, respectively. Equivalently, participants with high CVH had an average 8.9 (95% CI, 6.2-11.5) more years of life expectancy at age 50 years compared with those with low CVH. On average, 42.6% of the gained life expectancy at age 50 years from adhering to high CVH was attributable to reduced cardiovascular disease death. Similarly significant associations of CVH with life expectancy were observed in men and women, respectively. Similarly significant associations of CVH with life expectancy were observed in White participants and Black participants but not in Mexican participants.

CONCLUSIONS

Adhering to a high CVH, defined as the LE8 score, is related to a considerably increased life expectancy in US adults, but more research needs to be done in other races and ethnicities (eg, Hispanic and Asian).

Although in shortage, nursing workforce is still a significant contributor to life expectancy at birth

OBJECTIVES

Previous studies have not fully reported the strength and independency of the correlation of nursing workforce to life expectancy. This study advances that nursing workforce is a major independent contributor to life expectancy at birth (LEB) globally and regionally.

DESIGN

A cross-sectional study was conducted at population level.

SAMPLE

Ecological data were extracted from the United Nations agencies for 215 populations. Each population is considered a research subject.

MEASUREMENTS

The correlation between nursing workforce and LEB was analyzed with scatter plots, bivariate correlation, partial correlation, and multiple linear regression analyses, Analysis of Variance post hoc and independent T-test. Economic affluence, urban lifestyle and obesity were included as the potential confounders in this study.

INTERVENTION

Not applicable RESULTS: Nursing workforce correlated to LEB and this relationship remained regardless of the competition of economic affluence, urbanization, and obesity. Second to economic affluence, nursing workforce showed the greatest influence on LEB. In total, 64.50% of LEB was explained in this study. Nursing workforce was a determinant of regional variations of LEB.

CONCLUSIONS

Nursing workforce may be a significant contributor to LEB globally and regionally. This contribution was independent of the potential confounding effects of economic affluence, urbanization, and obesity.

Effect of lifestyle interventions on carotid arterial structure - The DR's EXTRA study

No lifestyle-based interventions with medium-term duration on carotid atherosclerotic have been performed so far. We aimed to investigate whether guideline-based dietary and physical activity interventions slow the progression of atherosclerotic changes in the general elderly population. 1410 Finnish men and women from a representative population sample were randomly assigned to one of six groups in the four-year intervention study: 1) reference, 2) aerobic training, 3) resistance training, 4) Nordic Diet, 5) aerobic training + Nordic Diet, 6) resistance training + Nordic Diet. The primary outcome was mean common carotid artery intima-media thickness (cIMT). The lumen diameter of the common carotid artery (cLD) was also analyzed. 567 men and 565 women aged 57 to 78 years were included. None of the intervention groups significantly slowed cIMT progression compared to the reference group. A subgroup analysis showed that men in the diet group had significantly smaller cIMT progression than in the reference group (-0.078 mm, 95% CI: -0.146 to -0.009, p = 0.02) and no significant increase in cIMT (p = 0.23). No other group showed a slowed cIMT progression. Among guideline-based lifestyle interventions, only diet leads to a significantly smaller progression of cIMT in older men of a representative population sample. No other lifestyle intervention contributed to a slowing of the progression of structural carotid markers. It must be questioned whether the guideline-based recommendations for a lifestyle change that were in place until recently are adequate to decelerate the atherosclerotic process.

Cause-of-Death Diversity From a Multiple-Cause Perspective in the United States

Cause-of-death diversity captures the variability of deaths across causes and is an important marker of heterogeneity in a population's health. We contribute to the debate of cause-of-death diversity dynamics by following a novel multiple causes of death (MCOD) approach and applying it to the U.S. context between 2003 and 2018 and across education groups. Results show that cause-of-death diversity increased over this period, especially up to 2012. These trends were mainly driven by increases in the groups aged 65 years or more. The inclusion of MCOD resulted in higher increases in cause-of-death diversity over time compared with merely using underlying causes of death, except for the 85 or more age group, where no difference was observed for males and a reverted gradient was observed for females. Results by educational attainment reveal lower diversity among the highest educated groups and widening differences across groups from around 2012 onward. The clear educational gradient observed at ages 30-64 diminished at older ages. The observed increases in cause-of-death diversity should be monitored to better understand mortality dynamics in aging populations. Our new MCOD diversity measures suggest that traditional approaches relying on single causes of death might be underestimating cause-of-death diversity dynamics, particularly for males.

Multi-country clustering-based forecasting of healthy life expectancy

Healthy life expectancy (HLE) is an indicator that measures the number of years individuals at a given age are expected to live free of disease or disability. HLE forecasting is essential for planning the provision of health care to elderly populations and appropriately pricing Long Term Care insurance products. In this paper, we propose a methodology that simultaneously forecasts HLE for groups of countries and allows for investigating similarities in their HLE patterns. We firstly apply a functional data clustering to the multivariate time series of HLE at birth of different countries for the years 1990-2019 provided by the Global Burden of Disease Study. Three clusters are identified for both genders. Then, we carry out the HLE simultaneous forecasting of the populations within each cluster by a multivariate random walk with drift. Numerical results and the statistical significance of the parameters of the identified multivariate processes are shown. Demographic evidences on the different evolution of HLE between countries are commented.