Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Life Expectancy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,801 records · Page 100Linked to original sources
PubMed2001

The national financial adjustment policy and the equalisation of health levels among prefectures.

STUDY OBJECTIVES: The objectives of this study were to examine (1) trends concerning financial assistance from the national government to local governments, (2) trends regarding death rates and life expectancies among prefectures, and (3) the effect of the national financial adjustment policy in equalising both the revenues of local governments and variations in the health levels among prefectures in terms of death rates and life expectancies. DESIGN: The study analysed prefectural income, the amount of national taxes collected, financial assistance from the national government to local governments, and age adjusted death rates and life expectancies of all of the prefectures in Japan during the period from 1965 through 1995. MAIN RESULTS: (1) Under the financial adjustment policy, financial assistance from the national government to the local governments, which consists of the sum of the local allocation tax and treasury disbursements, increased from 1831 billion yen in 1965 to 31 116 billion yen in 1995. (2) During the same period, the age adjusted death rate per 100 000 people decreased from 1168.9 (1965) to 545.3 (1995). The range of variation in the age adjusted death rate among prefectures diminished as the coefficient of variation of the death rate declined from 0.060 in 1965 to 0.043 in 1995. (3) There was a significant statistical correlation between higher prefectural incomes and lower mortality rates during from 1965 until 1975 (p < 0.05), whereas this correlation was indistinct in the 1980s and has not been observed since 1990. (4) The relative health level of Tokyo has declined in terms of its ranking among all the prefectures with regard to life expectancy, from being the best in 1965 to below average in 1995. CONCLUSIONS: The national financial adjustment policy to balance the revenues of local governments has increased the health levels of rural prefectures. It is probable that the policy reduced the disparity in death rates and life expectancies among prefectures throughout the country. However, the policy has precluded the nation's capital city from applying its economic resources as local government expenditures to deal with the megacity issues affecting health.

Financial Support↗
PubMed1995

Life table analysis of the United States' Year 2000 mortality objectives.

BACKGROUND: The US Year 2000 mortality objectives are model standards cast as targeted changes in age-adjusted cause-specific death rates. This research centred on the projected impact of such changes on life expectancy and the mortality toll for each sex. METHODS: A computer simulation was conducted using single decrement, multiple decrement and cause-elimination life table techniques, together with a decomposition procedure. RESULTS: Male and female life expectancy at birth was projected to increase by 1.71 and 1.51 years, respectively, between the designated 1987 baseline and 2000. The leading beneficiaries would be those aged 65 and older, followed by those aged 45-64, and infants. Declines in coronary heart disease, stroke and injury death rates would most influence the projected life expectancy changes, irrespective of sex. Approximately 782,000 male deaths and 730,000 female deaths would be averted under Year 2000 assumptions. CONCLUSIONS: Life expectancy would be a useful summary measure to incorporate into official evaluations of the Year 2000 mortality objectives. Targeting of excess male mortality in the US and other highly industrialized nations is recommended.

Adolescent↗
PubMed1989

Health outcome models for policy analysis.

The increasing therapeutic options in health care have created new dilemmas because resources to pay for the new technologies are limited. Cost/effectiveness and cost/utility models are required in order to evaluate the return on the invested dollar for various health care technologies. The problem is that different technologies are often evaluated using very different outcome units. The alternatives may range from liver transplantation to rehabilitation to preventive care. This article presents an overview of a general health policy model that expresses the benefits of all programs in a common unit known as the well-year--defined as the equivalent of 1 completely well year of life. The model uses two data sources: life expectancy and health-related quality of life during years prior to death. The quality-of-life component considers behavioral scales for mobility, physical activity, social activity, and symptoms. These dimensions are weighted by utility or preference to create a single scale that ranges from 0 (for death) for 1.0 (for optimum health). The model also considers duration of stay in each health state. Because all providers in health care attempt to extend life expectancy and improve quality of life, very different approaches in health care can be evaluated against one another. Preliminary analyses suggest that some behavioral interventions compete favorably with traditional medical and surgical treatments in terms of cost/well-year of life production. Various applications of the model are discussed.

Behavior Therapy↗
PubMed1985

Survival in trisomy 18. Life tables for use in genetic counselling and clinical paediatrics.

Clinical management of neonates with Trisomy 18 depends on a knowledge of life expectancy. True estimates of potential life span are required for genetic counselling purposes when parents interpret the genetic threat, not only in terms of the mathematical odds involved, but also in terms of the quality and length of life of an affected infant, should such be born. This paper reports the findings from a study to generate life tables for Trisomy 18. This study is a total population study over 10 years based on a primary population of 2.2 million. Forty-eight cases of Trisomy 18 were identified, five at amniocentesis. Four of the 43 clinical cases (9%) were mosaics. The median life expectancy for live-born infants was five days (range one hour to 18 months). Mean age at death was 48 days. Life tables, by sex and by sub-types (associated congenital abnormalities) are presented. The annual incidence is 14 per 100,000 total births, with a prevalence estimate of 0.06 per 100,000 total population.

Chromosomes, Human, 4-5↗
PubMed2007

Visual screening for malignant melanoma: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost-effectiveness of various melanoma screening strategies proposed in the United States. DESIGN: We developed a computer simulation Markov model to evaluate alternative melanoma screening strategies. PARTICIPANTS: Hypothetical cohort of the general population and siblings of patients with melanoma. Intervention We considered the following 4 strategies: background screening only, and screening 1 time, every 2 years, and annually, all beginning at age 50 years. Prevalence, incidence, and mortality data were taken from the Surveillance, Epidemiology, and End Results Program. Sibling risk, recurrence rates, and treatment costs were taken from the literature. MAIN OUTCOME MEASURES: Outcomes included life expectancy, quality-adjusted life expectancy, and lifetime costs. Cost-effectiveness ratios were in dollars per quality-adjusted life year (US dollars/QALY) gained. RESULTS: In the general population, screening 1 time, every 2 years, and annually saved 1.6, 4.4, and 5.2 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of US dollars 10,100/QALY, US dollars 80,700/QALY, and US dollars 586,800/QALY, respectively. In siblings of patients with melanoma (relative risk, 2.24 compared with the general population), 1-time, every-2-years, and annual screenings saved 3.6, 9.8, and 11.4 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of US dollars 4000/QALY, US dollars 35,500/QALY, and US dollars 257,800/QALY, respectively. In higher risk siblings of patients with melanoma (relative risk, 5.56), screening was more cost-effective. Results were most sensitive to screening cost, melanoma progression rate, and specificity of visual screening. CONCLUSIONS: One-time melanoma screening of the general population older than 50 years is very cost-effective compared with other cancer screening programs in the United States. Screening every 2 years in siblings of patients with melanoma is also cost-effective.

Boston↗
PubMed1999

Decision analysis on alternative treatment strategies for favorable-prognosis, early-stage Hodgkin's disease.

PURPOSE: To compare the therapeutic outcomes of various treatment strategies in early-stage, favorable-prognosis Hodgkin's disease (HD) using methods of decision analysis. METHODS: We constructed a decision-analytic model to determine the life expectancy and quality-adjusted life expectancy for a hypothetical cohort of clinically or pathologically staged 25-year-old patients with early-stage, favorable-prognosis HD treated with varying degrees of initial therapy. Markov models were used to simulate the lifetime clinical course of patients, and baseline probability estimates were derived from published study results. RESULTS: Among patients with pathologic stage (PS) I to II, mantle and para-aortic (MPA) radiotherapy was favored over combined-modality therapy (CMT), mantle radiotherapy, and chemotherapy by 1.18, 1.33, and 1.55 years, respectively. For patients with clinical stage (CS) I to II, the treatment options of MPA-splenic radiotherapy, CMT, and chemotherapy yielded similar survival outcomes. Sensitivity analysis showed that the decision between CMT and MPA-splenic radiotherapy was highly influenced by the precise values of the estimates of treatment efficacy and long-term morbidity, the quality-of-life value assigned to the postsplenic irradiation state, and the time discount value used in the model. Probabilistic sensitivity analysis demonstrated that even if future studies doubled the precision of the estimates of the treatment-related variables, it would be impossible to demonstrate the superiority of one treatment over the other. CONCLUSION: Our model predicted that on average, MPA radiotherapy was clearly the preferred treatment for PS I to II patients. For CS I to II patients the treatment decision is a toss-up between MPA-splenic radiotherapy and CMT, emphasizing the importance of patient preference exploration and shared decision making between patient and physician when choosing between treatments.

Child↗
PubMed2003

Decision analysis of hormone replacement therapy after the Women's Health Initiative.

OBJECTIVES: The purpose of this study was to estimate the quality-adjusted life expectancy with and without hormone replacement therapy. STUDY DESIGN: We compared the quality-adjusted life expectancy with and without combination hormone replacement therapy in three cohorts of women with menopausal symptoms over a 20-year period using a Markov decision-analysis model. Women were either at high or low risk for breast cancer and coronary heart disease or at high risk for osteoporosis. RESULTS: Hormone replacement therapy decreases life expectancy slightly compared with no hormone replacement therapy if menopausal symptoms are not considered. However, if relief from menopausal symptoms is considered and the usefulness of life with symptoms is worth <0.996 compared with life without symptoms, then 5 years of hormone replacement therapy provides equivalent quality-adjusted life-years. CONCLUSION: Combination hormone replacement therapy decreases life expectancy if quality of life with menopausal symptoms is not considered. However, the benefit of hormone replacement therapy can exceed the risk for women with menopausal symptoms.

Decision Support Techniques↗
PubMed1995

Mortality analyses of the 1990 Singapore population: I. General life tables.

General life tables for the 1990 Singapore resident population are given in this paper. Analyses were carried out separately for males and females for all ethnic groups as well as for Chinese, Malays and Indians. Average fractions of the last age interval lived were used to give a more precise derivation of the life table death rates from their corresponding age-specific death rates. The results show that in 1990, Singapore males had achieved a life expectancy at birth of 73.7 years while the females had attained a level of 78.6 years. These levels were comparable to those of many developed countries. Other interesting features include higher differentials in the life expectancies between sexes among the Chinese and the Indians taking over the Malays for second placing in terms of life expectancy at birth for both sexes. As a result, the Indians registered a 12% gain in life expectancy at birth for males for the decade 1980 to 1990, compared to only 7.1% for Chinese and 4.4% for Malays as well as nearly 10% for females compared to only 6.2% for Chinese and 6.3% for Malays. A subsequent paper will highlight the results of multiple-decrement life table analyses which will summarise the mortality of the 1990 Singapore resident population for various component causes of death rather than for all causes combined.

Adolescent↗
PubMed1998

Short-course prophylaxis against tuberculosis in HIV-infected persons. A decision and cost-effectiveness analysis.

BACKGROUND: Isoniazid prophylaxis for 12 months effectively prevents tuberculosis in HIV-infected persons and may decrease the incidence of other HIV-related disease and mortality. Recent clinical trials have found that some short-course regimens also effectively prevent tuberculosis. OBJECTIVE: To compare the benefits, risks, and cost-effectiveness of isoniazid prophylaxis and short-course prophylaxis regimens. DESIGN: Decision and cost-effectiveness analysis. SETTING: United States. PATIENTS: Hypothetical patients who are HIV-infected and have CD4 counts of 200 cells/mm3 or less and positive results on tuberculin skin tests. INTERVENTIONS: Isoniazid prophylaxis lasting 12 months and six short-course prophylaxis regimens of isoniazid, rifampin, and pyrazinamide alone or in combination. MEASUREMENTS: 5-year survival rate, life expectancy, lifetime incidence of tuberculosis, and cost per quality-adjusted life-year saved. RESULTS: Compared with no prophylaxis, the 12-month isoniazid regimen increased 5-year survival rates by 9% and life expectancy by 8.7 months, decreased incidence of tuberculosis by 27%, and saved 4 medical care dollars for every 1 spent on prophylaxis. Regimens of isoniazid for 6 months, isoniazid and rifampin for 3 months, and rifampin and pyrazinamide for 2 months had similar results: 6.2- to 8.6-month increases in life expectancy, 19% to 26% reductions in incidence of tuberculosis, and 1 to 7 medical care dollars saved for every 1 spent on prophylaxis. A 3-month regimen of isoniazid, rifampin, and pyrazinamide resulted in fewer clinical benefits and was the only regimen tested that did not save medical care dollars. CONCLUSIONS: Prophylaxis decreases the incidence of tuberculosis and increases life expectancy for HIV-infected patients. Some regimens save medical care dollars, and some short-course regimens have clinical and economic benefits similar to those of the 12-month isoniazid regimen. Short-course prophylaxis is a reasonable alternative to the 12-month isoniazid regimen.

AIDS-Related Opportunistic Infections↗
PubMed2006

[Palliative bypass surgery].

Impaired intestinal passage considerably reduces quality of life irrespective of the underlying condition. Limited life expectancy and increased operative risk of advanced malignant disease add particular weight to this issue. The indication for operative therapy results from carefully weighing individual incapacity and potential gain vs operative risk and life expectancy. Exactly because life expectancy is quite limited, selection of an effective, low-risk procedure is of utmost importance to benefit the patient.

Constriction, Pathologic↗
PubMed1995

Surgery of unruptured, asymptomatic aneurysms: a decision analysis.

BACKGROUND: Asymptomatic cerebral aneurysms are diagnosed more frequently since the advent of computed tomography and magnetic resonance imaging. Their management is currently empirical. We have used decision analysis to place it on a more analytical basis. METHODS: Decision analysis was used to determine the benefit in years of survival free of sequelae resulting from elective surgery of unruptured aneurysms over natural history. We took 2% as the annual rate of rupture (r), 73% as the risk of death or disability with rupture (M), and 6.5% for the average risk of elective surgery (S). Benefit was calculated from the equation L([1-(1-r)L]M/2-S) [1] for life expectancy (L) corresponding to each quinquennial age group from age 15 to 100 years. Sensitivity analysis was performed to take into account increasing risk of elective surgery based on the size, and accessibility of the aneurysm, and variable risks of rupture and outcome. RESULTS: A gain of at least one year of survival free of neurological sequelae is achieved by surgery compared to natural history for patients whose life expectancy is 19.5 years, corresponding to age 63.5 years for males and 68 years for females. The life expectancy at which a benefit accrues is longer (the patient is younger) for larger, less accessible aneurysms, for lower rates of rupture, and for lesser risks of death or disability from rupture. CONCLUSIONS: Elective surgery of unruptured asymptomatic aneurysms achieves an increased survival over the natural history of at least one year free of neurological sequelae in patients whose life expectancy is 19.5 years or more, using our baseline assumptions. Using equation [1], the corresponding life expectancy producing this benefit can be calculated to account for the increased surgical risk of large, poorly accessible aneurysms and for factors affecting natural history.

Adolescent↗
PubMed2000

Mammography screening for older women with and without cognitive impairment.

No upper age limit exists for Medicare benefits for mammography screening, but benefits for women older than age 75 remain unclear. From a clinical perspective, it would be useful to know if there is an upper age limit for women beyond which screening for breast cancer will not extend life. Using a decision-analysis model, the author examined the utility of screening using cohorts of women age 75 to 79, 80 to 84, and 85 and older, with and without cognitive impairment. The analysis evaluated different scenarios of the benefit of biennial screening versus no screening for women who had no prior screening and women who had participated in a regular screening program. Screening increased Quality Adjusted Life Years (QALYs) at all ages. Marginal savings in life expectancy adjusted for quality of life for women with no prior screening ranged from 43.5 days for healthy 75 to 79-year-old women to 25.9 days for women older than age 85. Among cognitively impaired women who were never screened, savings ranged from 20 to 5.5 days for the three age cohorts. Biennial screening among women who had been screened continuously resulted in substantially smaller life expectancy savings, from 3.3 days for healthy individuals age 75 to 79 to less than 1 day for women older than age 85. Cost effectiveness analysis indicated the reduction in costs associated with managing recurrent disease gained by early diagnosis with mammography was greatest among the population with no prior screening. Although the increase in QALYs was consistently lower for cognitively impaired women than for their healthy counterparts, the presence of cognitive impairment did not alter the finding that screening increased QALYs.

Age Factors↗
PubMed2004

Quality of death: assessing the importance placed on end-of-life treatment in the intensive-care unit.

CONTEXT: The value of good end-of-life (EOL) care could be underestimated if its effects are assessed using the standard metric of quality-adjusted survival, especially if the time horizon is limited to the duration of the EOL care. This issue is particularly problematic in the intensive-care unit (ICU) where death is frequent, care is difficult, and costs are high. OBJECTIVES: The objectives of this study were to test whether people would trade healthy life expectancy for better EOL care, to understand how much life expectancy they would trade relative to domains of good care, and to determine the association of respondent characteristics to time traded. DESIGN AND SUBJECTS: We used a computerized survey instrument describing hypothetical patient experiences in the ICU used to assess attitudes of a general population sample (n = 104) recruited in Pittsburgh, Pennsylvania. MEASURES: We used life expectancy traded (from a baseline of 80 healthy years followed by a 1-month fatal ICU stay) for improving ICU care in 4 domains: pain and discomfort, daily surroundings, treatment decisions, and family support. RESULTS: Three fourths of respondents (n = 78) were prepared to shorten healthy life for better EOL care. Median time traded in individual domains ranged from 7.2 to 7.7 months overall and 9.6 to 11.4 months when restricted to those willing to trade. Median time traded for improvement in all domains was 8.3 months overall and 24.0 months by those willing to trade. In multivariable analyses, respondents who were older, nonwhite, or had children traded significantly less time, whereas those who did not perceive the ICU to be a caring environment traded more time. CONCLUSIONS: Good EOL care is highly valued, both in terms of medical and nonmedical domains, as suggested by previous work and confirmed by our data showing respondents trading quantities of healthy life several times longer than the duration of the EOL period itself. The considerable interperson variation highlights the importance of soliciting individual preferences about EOL care.

Adult↗
PubMed1984

[Autoaggressive behavior of the mentally retarded--results of a survey].

An initial mail survey in Sweden has shown that, roughly, at least 4 percent of all mentally retarded persons display self-abusive behaviour. Those concerned usually are severely or profoundly mentally retarded, and the autoaggressive behaviour occurs very frequently, in most instances daily. Almost three quarters of self-abusing retarded persons live in institutional settings, such as special hospitals or residential homes for the mentally retarded. The age distribution found in the self-abusing population deviates substantially from the expected distribution. Life expectancy seems reduced. Gender-specific differences have not been found. A social-psychological care approach (empathy, improved life conditions, meaningful activities, systematic behavioural modification) may have an alleviating, or even remedial, influence.

Adolescent↗
PubMed1987

Factors affecting the longevity of total Japanese population.

To clarify the relative importance of social life factors in longevity by age and sex, the authors analyzed the effects of 8 social life factors on life expectancy at birth and at ages 20, 40 and 65 years for males and females in 46 Japanese prefectures. The analysis was conducted twice at five-year intervals during the period of rapid urbanization using stepwise regression analysis after classification of twenty-two variables by factor analysis. The results indicated that urban residence was the major factor for life expectancy at birth for males and females and at ages 20 and 40 years for males; whereas proportions of old and young persons in the population were essential factors for life expectancy at age 40 years for females and at age 65 years for males and females. In addition, in males, proportions of old and young persons in the population also positively affected life expectancy at birth and at age 20 years; employment and high income factor positively affected life expectancy at birth and at ages 20 and 40 years. Unique position of Japan in comparison with Western countries regarding social life factors for longevity is discussed in the light of these findings.

Adult↗
PubMed2002

Patterns of active life among older women: differences within and between groups.

This study examines the distribution of total, unimpaired, and impaired life for several groups of older women defined by race, education, and marital history. Using data from the 1984-1990 Longitudinal Study of Aging, we model transitions among functional statuses using discrete-time Markov chains, and use microsimulation to produce summary indices of active life. Remaining years of life and the proportion of remaining years with disability vary substantially, both within each group of women studied and between pairs of groups. Of all groups studied, never-married, more-educated white women live the longest, healthiest lives. Ever-married nonwhite women with low education have the shortest life expectancy, and experience the most disability. Our findings show that life expectancy is an incomplete indicator of the time women, in particular sub-groups, can expect to live with and without impairment. These findings highlight the heterogeneity of disability processes and life expectancy for older women.

Activities of Daily Living↗
PubMed2006

Counting the costs of overweight and obesity: modeling clinical and cost outcomes.

OBJECTIVE: To quantify changes in clinical and cost outcomes associated with increasing levels of body mass index (BMI) in a US setting. RESEARCH METHODS AND PROCEDURES: A semi-Markov model was developed to project and compare life expectancy (LE), quality-adjusted life expectancy (QALE) and direct medical costs associated with distinct levels of BMI in simulated adult cohorts over a lifetime horizon. Cohort definitions included age (20-65 years), gender, race, and BMI (24-45 kg m(-2)). Cohorts were exclusively male or female and either Caucasian or African-American. Mortality rates were adjusted according to these factors using published data. BMI progression over time was modeled. BMI-dependent US direct medical costs were derived from published sources and inflated to year 2004 values. A third party reimbursement perspective was taken. QALE and costs were discounted at 3% per annum. RESULTS: In young Caucasian cohorts LE decreased as BMI increased. However, in older Caucasian cohorts the BMI associated with greatest longevity was higher than 25 kg m(-2). A similar pattern was observed in young adult African-American cohorts. A survival paradox was projected in older African-American cohorts, with some BMI levels in the obese category associated with greatest longevity. QALE in all four race/gender cohorts followed similar patterns to LE. Sensitivity analyses demonstrated that simulating BMI progression over time had an important impact on results. Direct costs in all four cohorts increased with BMI, with a few exceptions. CONCLUSIONS: Optimal BMI, in terms of longevity, varied between race/gender cohorts and within these cohorts, according to age, contributing to the debate over what BMI level or distribution should be considered ideal in terms of mortality risk. Simulating BMI progression over time had a substantial impact on health outcomes and should be modeled in future health economic analyses of overweight and obesity.

Adult↗
PubMed1996

Nutrition and ageing at the population level.

There are important differences in the expectation of life between countries where infectious diseases were for the greater part eradicated and other countries. Whereas in Japan one man in the age class of 55 to 64 years dies, about three men of the same age die in Hungary and 3,7 men in the Russian Federation. The death rate is significantly lower in all countries for women than for men. A highly significant linear relation exists between the log mortality owing to all causes and age. The slope of this equation is considered as the expression of the ageing of a population, to which it is inversely proportional. This is explained by the fact that the human race possesses a maximal age that differs very little from one country to another. This can be proved mathematically. Significant relations exist as well between the slope as between the intercept of the equation of log mortality from all causes and of age, due to the consumption of saturated fat (the latter increases the mortality) or the proportions in the consumption of polyunsaturated and of saturated fat by different populations (P/S and U/S ratio's). There is also a very significant correlation between log total mortality for cancer and log age. After adjusting the intake of saturated fat, the differences of cancer-mortality between the countries are no longer significant in men and the significance decreases strongly in women. Our conclusion is that food is the most important determinant of life expectancy between and within the populations.

Aged↗

Refine your search to explore more results.