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PubMed1976

The life table. A method for analyzing longitudinal studies.

The life table is presented as the method of choice for analyzing data from longitudinal studies in which the outcome under study occurs randomly and in which patients are followed up varying lengths of time. We discuss the superiority of the life table to methods typically used, the calculation of its entries, and some of the clinical uses that can be made of its results. The method is applied to follow-up data on manic-depressive patients maintained with prophylactic lithium carbonate or with control regimens, and it is shown to disclose mathematical regularities in the parameters of longitudinal course.

Adult↗
PubMed1997

How good is Sullivan's method for monitoring changes in population health expectancies?

STUDY OBJECTIVE: To compare health expectancies calculated by Sullivan's method and the multistate life table method in order to identify the magnitude of the bias in Sullivan's method and assess how seriously this limits its use for monitoring population health expectancies. DESIGN: A simulation model was used to compare health expectancies calculated using Sullivan's method and the multistate life table method under various scenarios for the evolution of disability over time in populations. The simulation model was based on abridged cohort life tables using data on French mortality from 1825-90 and disability prevalence data from the 1982 French health survey. MAIN RESULTS: The Sullivan method could not detect a sudden change in disability transition rates, but the simulations suggested that it provides a good estimate of the true multistate value if there are smooth and relatively regular changes in disability prevalence over the longer term. When disability incidence rates are increasing or decreasing smoothly over time, the absolute bias in the Sullivan estimate of disability free life expectancy is relatively constant with age. The relative bias thus increases at older ages as disability free life expectancy decreases. CONCLUSIONS: The difference between the estimates produced by the two methods was small for realistic scenarios for the evolution of population health and Sullivan's method is thus generally acceptable for monitoring relatively smooth long term trends in health expectancies for populations.

Adolescent↗
PubMed1998

Causes of declining life expectancy in Russia.

CONTEXT: Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. OBJECTIVE: To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. DESIGN: Mortality and natality data from the vital statistics systems of Russia and the United States. SETTING: Russia, 1990-1994. POPULATION: Entire population of Russia. MAIN OUTCOME VARIABLES: Mortality rates, life expectancy, and contribution to change in life expectancy. METHODS: Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. RESULTS: Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. CONCLUSION: The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.

Adolescent↗
PubMed1998

Conditional survival estimates in 34,963 patients with invasive carcinoma of the colon.

PURPOSE: We report colon cancer survival rates that are conditioned on patients having already survived one or more years after diagnosis. These rates have more meaning clinically, because they consider those patients who have already survived a given period of time after treatment. METHODS: The life table method was used to compute conditional survival rates, using population-based data obtained from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. Patients were diagnosed between 1983 and 1987 and followed up through 1994. Relative and observed survival rates are considered. RESULTS: Survival rates up to ten years after diagnosis are reported by stage of disease, gender, and race for colon cancer patients who survived from one to five years after diagnosis. Survival rates are also reported by lymph node involvement. CONCLUSIONS: Five-year and ten-year survival in colon cancer patients having already survived between one and five years after diagnosis continues to be influenced significantly by stage and race.

Adult↗
PubMed1986

Differential mortality in Turkana agriculturalists and pastoralists.

Nomadic pastoral populations appear to have much lower rates of growth than the otherwise very high growth rates now characteristic of populations in developing nations. Because dramatic declines in infant mortality have been a primary contributor to increased population growth rates in these countries, it has been assumed that nomadic pastoral populations are still characterized by high levels of mortality in the first few years of life. Few studies, however, have been undertaken to estimate demographic parameters for nomadic pastoral populations, and even fewer of a comparative nature have been undertaken to document the impact of subsistence strategy on demographic processes. This study compares indirect childhood mortality estimates for Turkana nomadic pastoralists with childhood mortality in a settled agricultural group within the same population and finds that pastoralists have substantially higher levels of mortality. Based on the childhood mortality estimates, model life tables are selected for pastoral and agricultural groups from which values for mean life expectancy and infant mortality are estimated and compared. Recent improvements in primary health care for the settled agricultural group are ruled out as being an important cause of their lower mortality levels, and some aspects of life-style associated with subsistence strategy are discussed as likely determinants of the mortality differences.

Adolescent↗
PubMed1993

Analysis of birth intervals in India's Uttar Pradesh and Kerala States.

Life tables of birth intervals and median birth intervals in two Indian states, Uttar Pradesh and Kerala, were computed for several subgroups of the study population. Multivariate hazards modelling technique was used to examine the net effect of each of the variables studied. The results show a substantial effect of socioeconomic variables in child-spacing after controlling for the major intermediate variables.

Adolescent↗
PubMed1998

Sterilisation of married couples: husband versus wife sterilisation.

Sterilisation has been increasing in the United States in recent decades. Using the National Survey of Families and Households, this paper examines sterilisation among married couples using event history techniques, viewing husband and wife sterilisation as competing risks. Wives are more likely to experience sterilisation and at shorter durations of marriage. Number of children has a curvilinear effect on sterilisation, increasing and then decreasing its likelihood. Wives who are older than their husbands are more likely to get sterilised themselves. Black and Hispanic husbands are more likely to undergo sterilisation.

Adult↗
PubMedDate not supplied

Effects of gender, birth order, and other correlates on childhood mortality in China.

Using data from the 1988 Two-Per-Thousand Survey of Fertility and Birth Control, this paper examines the effects of gender, birth order, and other correlates of childhood mortality in China. Controlling for family-level factors, childhood mortality is found to be associated with the child's gender and birth order. Among firstborn children the difference between male and female childhood mortality is not statistically significant, but among others, female children between ages 1 and 5 experience higher mortality than male children. Childhood mortality is slightly higher for children who have older brothers only than for those who have older sisters only, and it is highest for those who have both older brothers and sisters. Other factors affecting childhood mortality in China include mortality of older siblings, birth interval, urban/rural residence, mother's level of education, and mother's occupation. All interactive effects between gender and family-level characteristics are found to be statistically insignificant.

Birth Intervals↗
PubMedDate not supplied

The marriage squeeze and the rise in informal marriage in Brazil.

Around the world, populations have experienced shortages of one sex or the other at marriageable ages, as a result of mortality declines. The solutions to this problem vary with the cultural context. Declines in the spousal age difference and increases in dowry payments (India) and polygamy (Africa) are two adjustments to a disequilibrium in the marriage market. We hypothesize that in Brazil the marriage market finds its balance by "recycling" men through highly unstable informal unions. Using census and 1984 survey data, we establish the relationship between a marriage squeeze and the increase in informal marriage. Census data and a competing-risks analysis of marriage choice provide evidence that a marriage squeeze has affected both the chances of marrying at all and the type of marriage entered.

Adolescent↗
PubMed1988

The infant mortality rate, life expectancy at birth, and a linear index of mortality as measures of general health status.

The infant mortality rate is not a good indicator of overall mortality or health status. Based on new empirical life tables from the UN Population Division, it can only predict life expectancy with 95% confidence to within a 14-year range. Two infant mortality rates must be nearly 80 units apart to be 95% confident that life expectancy in the two communities is different. Life expectancy itself is not an ideal general measure of mortality, because it implicitly weights deaths at different ages in an inconsistent fashion. A measure of potential years of life lost is preferable because it is ethically more consistent.

Adolescent↗
PubMed1978

A fetal-infant life table based on single births in Norway, 1967--1973.

The study is based on 440,452 single births occurring in Norway, 1967--1973, with known gestational age. The information was collected through a notification system known as "Medical Registration of Births," covering all births occurring in Norway, and the data are made available through the Medical Birth Registry of Norway, which allows for linkage between births and infant deaths. The life table describes the experience of women still pregnant at a gestational age of 16 completed weeks, and states for each subsequent week the number of pregnancy terminations, the outcome, and the number of women still pregnant. Seven outcomes of pregnancy are considered: fetal death prior to labor, fetal death during labor, death within 24 hours, death 1--6 days, death 7--27 days, death 28 days--1 year, and survival of one year or more. The data in the life table provide information on the probability of pregnancy termination in each week of gestation (after 16 completed weeks), and the probabilities of the various outcomes. The fetal-infant life table is considered as an extension of descriptive perinatal statistics and is of value in monitoring health changes and in comparing perinatal mortality between populations. It also provides information on time of pregnancy termination and outcome, which has some clinical applications.

Adult↗