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PubMedDate not supplied

[Mortality in Sardinia: table of survival and potential years of life lost].

Mortality rates have often been used to measure levels of health in a population. The "PYLL indicator" and the "life expectancy with zero mortality for one cause" give high weights to early deaths. In this paper we use these tools to evaluate the impact of five different causes of death (cardiov. dis., neoplasms, respirat. dis., accidents, digestive s. dis.). The rate of PYLL per 1000 population is given by [formula: see text] where Di delta = number of deaths between ages i and i+1; P = number of persons between ages i and i+1; w = age limit. The probability of death in the interval i - i + 1 is qi = ni Di/Pi/1 + 0.5 . ni Di/Pi where ni = number of years in the interval; Pi = population; Di . delta = number dying The probability of survival is pi = 1 - qi. The probability of death if the risk delta is eliminated is qi . delta = 1 - pi (Di delta-Di)/Di The probability of survival until age i is poi = II pi and, if the risk delta is eliminated, poi . delta = II pi . delta. The expectation of life at birth is eo = 0.5 . ni + poi . 0.5 (ni - 1 + ni) + po omega (0.5 . n omega-1 + P omega/D omega) and, if the risk is eliminated, eo . delta = 0.5 . n i + poi . delta . 0.5 (ni - 1 + ni) + po omega . delta (0.5 . n omega - 1 + P omega/(D omega - D omega . delta) Life expectancy gives high weights to early deaths, but the weights are less noticeable than when we use the PYLL indicator. In this paper we calculate the life expectancy with zero mortality for one cause and PYLL before ages 65, 75 and 85. When mortality rates (or number of deaths) are used to study mortality, cardiovascular diseases, neoplasms and respiratory s. disease are the three leading categories. When the probability of survival is concerned, respiratory diseases play the most important role until age 5, accidents until age 60, neoplasms until age 65, cardiovascular diseases in the elderly population.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2004

Impact of preoperative staging and chemoradiation versus postoperative chemoradiation on outcome in patients with rectal cancer: a decision analysis.

BACKGROUND: Although radical resection and postoperative chemoradiation have been the standard therapy for patients with rectal cancer, preoperative staging by local imaging and chemoradiation are widely used. We used a decision analysis to compare the two strategies for rectal cancer management. METHODS: We developed a decision model to compare survival outcomes after postoperative chemoradiation versus preoperative staging and chemoradiation in patients aged 70 years with resectable rectal cancer. In the postoperative chemoradiation strategy, patients undergo radical resection and receive postoperative chemoradiation. In the preoperative staging and chemoradiation strategy, patients with locally advanced cancer receive preoperative chemoradiation and radical resection, whereas those with amenable localized tumors undergo local excision. The cohorts of patients were entered into a Markov model incorporating age-adjusted and disease-specific mortality. Outcomes were evaluated by modeling 5-year disease-specific survival for preoperative chemoradiation as less than, equal to, or greater than that of postoperative chemoradiation. Base-case probabilities were derived from published data; the Surveillance, Epidemiology, and End Results (SEER) Program database; and U.S. Life Tables. One-way and two-way sensitivity analyses were performed. The outcome measures were life expectancy and quality-adjusted life expectancy. RESULTS: Life expectancy and quality-adjusted life expectancy were 9.72 and 8.72 years, respectively, in the postoperative chemoradiation strategy. In the preoperative staging and chemoradiation strategy, life expectancy was 9.36, 9.72, and 10.09 years and quality-adjusted life expectancy was 8.71, 9.04, and 9.37 years when 5-year disease-specific survival was less than, equal to, or greater than that of postoperative chemoradiation, respectively. The decision model was sensitive to differences in the long-term toxicity of pre- and postoperative chemoradiation. When the 5-year disease-specific survival for patients after pre- or postoperative chemoradiation was equal, the decision model was sensitive to surgical mortality and to the probability of residual lymph node disease after local excision. CONCLUSION: If efficacy and toxicity after preoperative chemoradiation are equal to or better than that after postoperative chemoradiation in patients with locally advanced rectal cancer, then preoperative staging to select patients appropriate for preoperative chemoradiation is beneficial.

Adult↗
PubMed2000

[Increased clinical and economic advantages using PROSIT (proteinuria screening and intervention) in type 2 diabetic patients].

BACKGROUND AND OBJECTIVE: Even though there are simple and cost-effective means for the early diagnosis of diabetic nephropathy, only a small proportion of diabetics in Germany is regularly tests for microalbuminuria. On the basis of evidence-based knowledge and of international guidelines the PROSIT project (proteinuria screening and intervention) aims to make good this deficiency in the German Federal Republic by introducing nephropathy screening and a structured intervention to improve blood sugar and blood pressure regulation, optimizing lipid metabolism and nutritional intake. It was the aim of this study to assess with a computer-aided diabetes model the clinical value and cost-effectiveness of such an intervention. PATIENTS AND METHODS: From data collected for 589 diabetics who participated in the PROSIT project, the short-time effects after one year on HbA1c, systolic blood pressure and lipid levels were obtained and cost-effectiveness compared with that of standard care. Life expectancy, life-time costs to be met by health insurance and event frequency of the diabetic nephropathy stages were calculated with a Markov model for type 2 diabetics. RESULTS: PROSIT improved individual life expectancy by 0.23 years with reduction of life-time costs by DM 9,772 (ca. $4,900). The cumulative incidence of microalbuminuria was lowered by 30.5%, that of terminal renal failure by 55.9%. Even after discounting the results (i.e. the inclusion of time preference for cost and benefit) and stepwise changes of all variables by +/- 10%, PROSIT remained the more cost-effective variant. CONCLUSION: From a health economy viewpoint PROSIT is superior to standard management. Early recognition of albuminuria and the introduction of a multifactorial treatment strategy make it possible to delay progression to terminal renal failure. In addition to its clinical benefits, prevention of dialysis and transplantation would reduce the annual savings of the health care system by several billion DM.

Albuminuria↗
PubMed1996

Density-dependent processes in the transmission of human onchocerciasis: relationship between microfilarial intake and mortality of the simuliid vector.

In order to construct an analytical model of onchocerciasis transmission, it is necessary to elucidate the functional relationships of the various population rate processes taking place within the human and vector hosts. Two previous papers have explored the evidence for density-dependent regulation in relation to microfilarial intake by, and larval development within, the Simulium host. This paper investigates the survivorship of wild-caught blackfly samples fed on subjects with different intensities of Onchocerca volvulus microfilarial infection. Analyses were based on data for Guatemalan S. ochraceum s.l. (possessing a well-developed cibarial armature), West African S. damnosum s.l. (forest species), and South Venezuelan S. guianense (the latter two lacking a toothed cibarium). The mean survival times of samples of the 3 species, kept under laboratory conditions, decreased as parasite intake increased, the rate of mortality being dependent on the fly's age (measured as time post-feeding) and on the worm load acquired. An empirical, time-dependent hazard function was fitted to observed death rates/fly/day which rose very shortly after engorgement, declined subsequently, and rose again throughout the extrinsic incubation period of the parasite. The parameters of this hazard model were all positively correlated with the density of microfilariae in the bloodmeal. Expressions of survivorship and life-expectancy as explicit functions of time post-feeding and mean parasite intake were derived. The average expectation of life at engorgement for uninfected flies in the laboratory was estimated to be around 1 week for both, armed and unarmed blackflies. Residual life-expectancy decreased with time post-feeding and microfilarial load in both categories of vectors. This decline (resulting from age- and parasite-dependent mortality rates) was much more pronounced in those species lacking a toothed fore-gut. Whilst a fraction of heavily infected S. ochraceum was able to survive the latent period of the parasite, being therefore potentially capable of transmitting the infection, equivalent worm loads in S. guianense resulted in a drastic reduction of the expectation of infective life. These results provide additional evidence to support the hypothesis that, in the case of intrinsically susceptible vectors, unarmed simuliids are more efficient at low microfilarial loads, when the transmission rate from human to vector host is higher, and parasite-induced fly mortality is negligible. The opposite takes place in armed flies, which perform poorly at low parasite burdens and better at heavier loads, with little parasite-induced vector death.

Animals↗
PubMed1985

Elective hysterectomy. Benefits, risks, and costs.

This study evaluated the effect of hysterectomy or hysterectomy and bilateral salpingo-oophorectomy (hysterectomy and oophorectomy) versus alternative medical management on life expectancy, quality of life, and direct medical costs. Using techniques of decision analysis and available data on sequelae, it was found that gains in life expectancy and quality of life can be expected when women ages 30-60 undergo hysterectomy for benign neoplasm, disorders of menstruation, acquired abnormal anatomy, cervical disease, or endometriosis, owing primarily to prevention of reproductive tract cancers, which outweighs the impact of operative mortality. However, women who have relatively high operative risk or low expected cancer risks, beyond thresholds estimated in sensitivity analyses, suffer losses in life expectancy. Women younger than 35 not treated with replacement estrogens following hysterectomy and oophorectomy can expect net losses in life expectancy with surgical intervention due to increased risks of heart disease and osteoporosis. For women in the reproductive years who wish to preserve their potential to bear children, sterilization may be an unacceptable consequence of elective hysterectomy in the quality of life.

Adult↗
PubMedDate not supplied

Longevity gains continue.

1990 was an excellent year for life expectancy. Average future lifetime for both infant boys and girls rose to all-time highs. However, the gender gap in expectation of life at birth widened for the first time in more than a decade. The increase may be a statistical aberration or, more likely, a reflection of the growing mortality toll from AIDS, especially among males. If so, then the outlook is for widening longevity gaps between the sexes. On the other hand, there was more good news, as the infant mortality rate decreased dramatically, falling to a record low. Also encouraging is the continued, if somewhat unsteady, long-term trend toward gradual narrowing of the white/non-white/black life expectancy differentials.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Changes in longevity by state.

The latest state data just released from the National Center for Health Statistics reveal that men and women living in Hawaii can expect, on the average, to live longer than those residing in any other state. During 1989-91 expectation of life at birth for all residents of the United States was 71.8 for boys and 78.8 for girls. In Hawaii, however, average future lifetime for newborn boys was 75.4 years and 81.3 for girls. For infant boys, the states that followed in rank order were Utah, Minnesota and North Dakota. Among baby girls, the leading states were North Dakota, Minnesota, South Dakota and Iowa. On the other hand, the District of Columbia, on average, experienced the least favorable longevity. For each sex, geographic longevity disparities diminish with advance in age. Yet, for almost the entire age range, Hawaii still remained the state with the best longevity outlook. Among the next most desirable areas, the rankings shifted positions, somewhat. Even so, North Dakota, Minnesota and Utah usually recorded the highest state life expectancies. These same states also ranked best during 1979-81. Between 1979-81 and 1989-91, on a state-by-state basis, life expectancy gains generally were larger among men than among women.

Adolescent↗
PubMed2002

[Healthy aging: the Swiss experience].

The quantitative importance of ageing both in developed or in developing countries raised the subtle question of the quality of life of the ageing person. Precise definitions of life expectancy, healthy life expectancy and quality of life are presented. Then, presentation of the results of two cross-sectional studies performed with the same methodology at a 15-year time interval in French-speaking Switzerland illustrates compression of morbidity theory, with increased longevity, increased good perception of health and increased quality of life. Moreover, quantitative data concerning the longevity impact of hospital geriatric care are presented from Geneva. The 4-year survival rate of over 85 year old women, discharged from the hospital for acute care, reached 48%. Explanations of these outstanding medical progresses on longevity and socio-economical challenges of extreme ageing are discussed in the world context.

Aged↗
PubMed2005

Cost-effectiveness analysis of strategies introducing FDG-PET into the mediastinal staging of non-small-cell lung cancer from the French healthcare system perspective.

AIM: To determine the most cost-effective strategy using PET for mediastinal staging of potentially operable non-small-cell lung cancer (NSCLC). METHODS: Four decision strategies based on French NSCLC work-up practices for the selection of potential surgical candidates were compared, comprising CT only, PET for negative CT, PET for all with anatomical CT, and CT and PET for all cases. The medical literature was surveyed to obtain values for all variables of interest. Costs were assessed with reimbursements from the French healthcare insurance for the year 1999. Expected cost and life expectancy were calculated for all possible outcomes of each strategy. Sensitivity analysis was performed to determine the effects of changing variables on the expected cost and life expectancy. RESULTS: Compared with the CT only strategy, CT and PET for all resulted in a relative reduction of 70% of surgery for persons with mediastinal lymph node metastasis. PET for all with anatomical CT was shown to be a cost-effective alternative to the CT only, with life expectancy increased by 0.10 years and expected cost savings of 61 euros. This strategy was more favourable than PET for negative CT. Overall, sensitivity analyses showed the robustness of the results. CONCLUSION: The introduction of thoracic PET for NSCLC staging is potentially cost-effective in France. Further clinical investigation might help to validate this result.

Aged↗
PubMed1997

Cost-effectiveness of cytomegalovirus (CMV) disease prevention in patients with AIDS: oral ganciclovir and CMV polymerase chain reaction testing.

OBJECTIVE: To perform a cost-effectiveness analysis of strategies to prevent cytomegalovirus (CMV) disease. METHOD: Markov model and published data. PATIENTS: Hypothetical HIV-infected patients with CD4 cell counts < or = 50 x 10(6)/l and positive CMV serologies. INTERVENTIONS: Oral ganciclovir daily versus plasma CMV DNA polymerase chain reaction (PCR) testing every 3 months with oral ganciclovir for patients with positive tests. OUTCOME MEASURES: The number of CMV disease cases prevented by the interventions, life expectancy, disease-free life expectancy, and the cost to extend life by 1 year. RESULTS: Oral ganciclovir preventive therapy reduces the lifetime number of CMV disease cases by 50 per 1000 cohort, extends life expectancy by 5 days and disease-free life expectancy by 18 days, and costs US$ 1,762,517 per year of life extended. Periodic PCR testing reduces the lifetime number of CMV disease cases by eight per 1000 cohort, extends life expectancy by 1 day and disease-free life expectancy by 3 days, and costs US$ 495,158 per year of life extended. The prevention strategies could be acceptably cost effective only under a combination of optimistic assumptions and reduced costs. CONCLUSIONS: Oral ganciclovir preventive therapy and periodic plasma testing for CMV PCR with oral ganciclovir for those with positive tests result in small benefits at great cost. They are not cost-effective prevention strategies for persons with advanced HIV infection and positive CMV serologies.

AIDS-Related Opportunistic Infections↗
PubMed2004

Linkages between biodiversity loss and human health: a global indicator analysis.

The association between health and biodiversity loss was explored by means of regression analysis on a global scale, with control for confounding by socio-economic developments. For this we selected indicators of human health (life expectancy, disability adjusted life expectancy, infant mortality rate and percentage low-birthweight babies), biodiversity (percentage threatened species, current forest as a percentage of original forest, percentage of land highly disturbed by man) and socio-economic development (health expenditure as percentage of GNP, percentage one-year olds immunized, illiteracy rate, GNP per capita and development grade) on a country level. After controlling for relevant socio-economic confounders, both current forest as a percentage of original forest and the percentage of land highly disturbed by human activities had no relationship with one of the health indicators. The logarithm of the percentage threatened species, showed a positive association with life expectancy and disability adjusted life expectancy. The present study was not able to provide any empirical proof of a negative association between loss of biodiversity and human health at the global scale. This does not mean, however, that no such relationship exists, because there may be several reasons for our findings, like possible non-linearity of the relationship, lack of suitable indicators, non-randomness in the sample of countries and the limitations of regression analysis in proving causality.

Adolescent↗
PubMed1999

United States life tables, 1997.

The life tables in this report are current life tables for the United States based on age-specific death rates in 1997. Beginning with 1997 mortality data, complete U.S. life tables were constructed using a new methodology that replaces the abridged life table methodology used previously. The methodology is similar to that used in the decennial life tables. Also, life expectancy and other life table values are shown for ages 85 to 100 years for the first time as part of the annual U.S. life tables. Data used to prepare these life tables are 1997 final mortality statistics; July 1, 1997, population estimates; and data from the Medicare program. Presented are complete life tables by age, race, and sex. In 1997 the overall expectation of life at birth was 76.5 years, an increase of 0.4 years compared with life expectancy in 1996. Life expectancy increased from 1996 to 1997 for each of the four race-sex groups for which life expectancy is reported. Life expectancy increased for black males by 1.1 year (from 66.1 to 67.2), for black females by 0.5 year (from 74.2 to 74.7), for white males by 0.4 year (from 73.9 to 74.3), and for white females by 0.2 year (from 79.7 to 79.9).

Adolescent↗
PubMed1997

Health expectancy by level of education in Finland.

Using the method first presented by Sullivan, the article presents results on health expectancy by level of education and gender in the late 1980s in Finland. The life tables by level of education cover the years 1986-90. Indicators of disability and poor health were based on three variables from the nationwide 1986 Survey on Living Conditions (N = 12,057): limiting long-standing illness, functional disability or poor self-perceived health. Two cutting points indicating different levels of severity of disability or poor health were used for each measure, giving six dichotomous indicators. Disability-free life expectancy and life expectancy with disability were found to depend strongly on the indicator of disability, but the patterns of differences both between genders and between educational categories were largely independent of the indicators used. Life expectancy as well as disability-free life expectancy showed a systematic relationship with level of education: the higher the level of education, the higher the life expectancy and disability-free life expectancy. The differences between educational categories in disability-free life expectancy were markedly larger than in total life expectancy. Life expectancy with disability was shortest among the more educated and longest among the less educated. Due to the higher life expectancy and the higher prevalence of disability among women, life expectancy with disability was longer among women than men according to all indicators.

Adult↗
PubMed2005

Long-term clinical and cost outcomes of treatment with biphasic insulin aspart 30/70 versus insulin glargine in insulin naïve type 2 diabetes patients: cost-effectiveness analysis in the UK setting.

OBJECTIVES: To evaluate the long-term clinical and cost outcomes associated with biphasic insulin aspart 30/70 (BIAsp 30/70, premixed 30% soluble and 70% protaminated insulin aspart in one injection) compared to insulin glargine treatment in insulin-naïve type 2 diabetes patients failing oral antidiabetic agents in the UK, based on findings recently reported from the INITIATE clinical trial. METHODS: The CORE Diabetes Model, a published, peer-reviewed and validated model of diabetes, was used to evaluate life expectancy, quality-adjusted life expectancy, cumulative incidence of complications and direct medical costs over patient lifetimes. The model simulates the range of diabetic complications and disease progression within a series of sub-models (cardiovascular disease, neuropathy, renal and eye disease) based on published data. Baseline cohort characteristics (54.5% male, mean age 52.45 years, mean diabetes duration 9 years, mean HbA(1c) 9.77%) and treatment effects were based on INITIATE. Costs were derived from published UK sources. The analysis was run over a 35-year time horizon (patient lifetime) from a third party payer perspective. Costs and clinical benefits were discounted at 3.5% per annum. Sensitivity analyses were performed. RESULTS: BIAsp 30/70 was associated with projected improvements in discounted life expectancy (0.19 +/- 0.20 years) and quality-adjusted life expectancy (0.19 +/- 0.14 quality-adjusted life years [QALYs]), as well as a reduced incidence of retinopathy and nephropathy complications, versus glargine. Total lifetime direct costs were 1319 pounds higher with BIAsp 30/70 than with glargine leading to an incremental cost-effectiveness ratio of 6951 pounds per QALY gained. CONCLUSIONS: This study is the first to address the long-term health economic implications of treating type 2 diabetes patients failing oral anti-diabetics with a biphasic insulin mix versus long-acting insulin. Our projections indicate that improved HbA1c levels with BIAsp 30/70 treatment are associated with improvements in life expectancy and quality-adjusted life expectancy, and that BIAsp 30/70 represents excellent value for money compared to insulin glargine in the UK.

Adult↗