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.

SourceResearch connectionFrom yearThrough year

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

At least 1,711 records · Page 95Linked to original sources

PubMed2004

Nutrition-related disease and death in Zhejiang Province?

In Zhejiang province economic development and changes in nutrition appear to have increased both life expectancy and nutrition-related chronic disease morbidity. Life expectancy is longer in urban populations than in rural and in both urban and rural females. From 1997 to 2002 urban females had an average life expectancy of 81.4 years. In 2002 the estimated incidence of ischaemic heart disease was higher in rural males and females whereas diabetes mellitus was higher in urban males and females. From 1990 to 2002 lung cancer had large increases in all groups, cancers of the oesophagus and stomach increased in rural males and females, and cancer of the large intestine increased 40 per cent in urban males. In 2002 deaths from cerebrovascular disease were much higher in rural males and females. Apart from differences in lifestyle factors between urban and rural, access to medical resources may also be relevant to the differences within the province in chronic disease rates and in life expectancy.

Adult↗

PubMed1986

Assessing the effect of mortality change in an age group on the expectation of life at birth.

"This article compares four procedures in assessing the effect of the change in mortality conditions in an age group between two periods on the expectation of life at birth. The differences and similarities are pointed out. The outcome of applying the different approaches on the difference in the expectation of life at birth of the life tables of Sweden for the periods 1901-10 and 1936-40 is also discussed."

Age Factors↗

PubMed1994

The effect of selected causes of death on the expectation of life at birth.

"This paper is an attempt to construct cause-deleted life tables [for Iraq]. Certain causes of death were selected to be deleted depending on the outcomes of a sample of 20,947 death certificates which represent 1 out of each 7 registered death events.... The paper reveals that the expectation of life is considerably affected by the hypothetical absence of these causes which leads to the importance of carrying out profound health studies concerning these selected causes of death." (SUMMARY IN ARA)

Asia↗

PubMedDate not supplied

Cost-effectiveness of positron emission tomography for the management of potentially operable non-small cell lung cancer in Quebec.

BACKGROUND: The potential benefits of positron emission tomography (PET) scanning stem from the fact that it can reduce the number of diagnostic examinations; particularly, the number of unnecessary thoracic surgeries. OBJECTIVE: To evaluate the economic impact and cost-effectiveness of PET scanning in the management of potentially operable non-small cell lung cancer in Quebec. METHODS: A decision tree was developed. Two strategies were compared: chest computed tomography (CT) alone or CT and whole-body PET. The various paths of each strategy were dependent on the numerous variables that were determined from a literature review. The costs and life expectancy were determined for each strategy under consideration. Life expectancy was calculated using the declining exponential approximation of life expectancy. Costs were obtained from the Quebec diagnosis-related group database and Quebec physician fee schedules. RESULTS: The mean cost of the CT strategy was US dollars 8,455 per patient compared with US dollars 9,723 for the PET strategy, for a cost differential of US dollars 1,268. The PET strategy extended life expectancy by slightly more than three months (0.27 years) compared with the survival of the CT strategy. The incremental cost-effectiveness ratio was US dollars 4,689. Considering the number of new cases and the prevalence of mediastinal metastases, the budget impact would be US dollars 8,613,693. CONCLUSION: The use of PET to detect local and distant metastases in non-small cell lung cancer is an intervention that would require an acceptable investment for each life-year gained.

Analysis of Variance↗

PubMed1995

The elimination of disease: a mixed blessing.

The increase in life expectancy that would result from the elimination of certain diseases and the resulting change in hospital utilization vary, depending on the disease. In some cases, life expectancy would rise and total days spent in hospital would decline, while in others, the gain in life expectancy would be accompanied by an increase in hospital days. For instance, if mental health disorders were eliminated, the increase in life expectancy at age 45 would be minimal: from 34.9 to 35.3 years, but time spent in hospital would decline from 168 to 151 days. By contrast, if diseases of the circulatory system were eliminated, life expectancy at age 45 would rise from 34.9 to 41.6 years, but time spent in hospital would also rise: from 168 to 209 days. Elimination of not only mental illnesses but also injuries and poisoning and diseases of the nervous system has the potential of both increasing life expectancy and reducing hospital use.

Aged↗

PubMed1988

Changes in the retirement process among older men in the United States: 1972-1980.

Recent changes in older men's retirement patterns are investigated for the United States. The results show that labor force incumbents, particularly those in secondary occupations, experienced increases in the volume of both retirement and reentry to the labor force. In addition, although working life expectancy remained relatively stable across occupations, men in secondary occupations spent increasingly greater portions of their work lives in postretirement jobs. Finally, large increases in nonworking life expectancy occurred because of substantial increases in life expectancy. In several occupations, however, declines in working life expectancy were major contributors to increases in nonworking life expectancy.

Actuarial Analysis↗

PubMed2004

Patients' preferences for the management of non-metastatic prostate cancer: discrete choice experiment.

OBJECTIVE: To establish which attributes of conservative treatments for prostate cancer are most important to men. DESIGN: Discrete choice experiment. SETTING: Two London hospitals. PARTICIPANTS: 129 men with non-metastatic prostate cancer, mean age 70 years; 69 of 118 (58%) with T stage 1 or 2 cancer at diagnosis. MAIN OUTCOME MEASURES: Men's preferences for, and trade-offs between, the attributes of diarrhoea, hot flushes, ability to maintain an erection, breast swelling or tenderness, physical energy, sex drive, life expectancy, and out of pocket expenses. RESULTS: The men's responses to changes in attributes were all statistically significant. When asked to assume a starting life expectancy of five years, the men were willing to make trade-offs between life expectancy and side effects. On average, they were most willing to give up life expectancy to avoid limitations in physical energy (mean three months) and least willing to trade life expectancy to avoid hot flushes (mean 0.6 months to move from a moderate to mild level or from mild to none). CONCLUSIONS: Men with prostate cancer are willing to participate in a relatively complex exercise that weighs up the advantages and disadvantages of various conservative treatments for their condition. They were willing to trade off some life expectancy to be relieved of the burden of troublesome side effects such as limitations in physical energy.

Aged↗

PubMedDate not supplied

[The estimation of the expectation of life in the case of truncation of the survivorship function at older ages: some considerations].

"A tentative approximation of the expectation of life at 60-65 years, for populations with defective demographic statistics, is explored and expounded on the basis of a recent Horiuchi and [Coale] paper." The method is applied to data for El Salvador, Mexico, Puerto Rico, and Peninsular Malaysia, and it is shown that the method can be used on actual data, although it requires some drastic rounding off. (summary in ENG, FRE)

Age Factors↗

PubMed1997

Monitored isoniazid prophylaxis for low-risk tuberculin reactors older than 35 years of age: a risk-benefit and cost-effectiveness analysis.

BACKGROUND: Isoniazid chemoprophylaxis effectively prevents the development of active infectious tuberculosis. Current guidelines recommend withholding this prophylaxis for low-risk tuberculin reactors older than 35 years of age because of the risk for fatal isoniazid-induced hepatitis. However, recent studies have shown that monitoring for hepatotoxicity can significantly reduce the risk for isoniazid-related death. OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of monitored isoniazid prophylaxis for low-risk tuberculin reactors older than 35 years of age. DESIGN: A Markov model was used to compare the health and economic outcomes of prescribing or withholding a course of prophylaxis for low-risk reactors 35, 50, or 70 years of age. Subsequent analyses evaluated costs and benefits when the effect of transmission of Mycobacterium tuberculosis to contacts was included. MEASUREMENTS: Probability of survival at 1 year, number needed to treat, life expectancy, and cost per year of life gained for individual persons and total population. RESULTS: Isoniazid prophylaxis increased the probability of survival at 1 year and for all subsequent years. For 35-year old, 50-year-old, and 70-year-old tuberculin reactors, life expectancy increased by 4.9 days, 4.7 days, and 3.1 days, respectively, and costs per person decreased by $101, $69, and $11, respectively. When the effect of secondary transmission to contacts was included, the gains in life expectancy per person receiving prophylaxis were 10.0 days for 35-year-old reactors, 9.0 days for 50-year-old reactors, and 6.0 days for 70-year-old reactors. Costs per person for these cohorts decreased by $259, $203, and $100, respectively. The magnitude of the benefit of isoniazid prophylaxis is moderately sensitive to the effect of isoniazid on quality of life. The hypothetical provision of isoniazid prophylaxis for all low-risk reactors older than 35 years of age in the U.S. population could prevent 35,176 deaths and save $2.11 billion. CONCLUSIONS: Monitored isoniazid prophylaxis reduces mortality rates and health care costs for low-risk tuberculin reactors older than 35 years of age, although reductions for individual patients are small. For the U.S. population, however, the potential health benefits and economic savings resulting from wider use of monitored isoniazid prophylaxis are substantial. We should consider expanding current recommendations to include prophylaxis for tuberculin reactors of all ages with no contraindications.

Adult↗

PubMedDate not supplied

Pretreatment evaluation of chronic hepatitis C: risks, benefits, and costs.

CONTEXT: Chronic hepatitis C (CHC) infection affects nearly 4 million people in the United States. Treatment with interferon alfa-2b has been limited by its cost and low likelihood of long-term response. OBJECTIVE: To examine the cost-effectiveness of alternative pretreatment management strategies for patients with CHC. DESIGN: Decision and cost-effectiveness analysis using a Markov model to examine prevalence of genotypes, viral load, and histological characteristics in relation to the sustained response rate with treatment. Data were based on a previously published decision model and a MEDLINE literature search for hepatitis C, biopsy, and liver from 1966 to 1996. PATIENTS: A hypothetical population of patients with CHC infection and elevated serum alanine aminotransferase level. INTERVENTIONS: Combinations of liver biopsy, genotyping, and quantitative viral load determination prior to a single 6-month course of interferon alfa-2b; empirical interferon treatment; and conservative management. MAIN OUTCOME MEASURES: Proportion of sustained responders, lifetime costs, life expectancy, and quality-adjusted life expectancy. RESULTS: Strategies involving hepatitis C virus (HCV) RNA testing had marginal cost-effectiveness ratios up to $4400 per discounted quality-adjusted life-year gained but would miss up to 36% of sustained responders. Empirical interferon treatment had a marginal cost-effectiveness ratio of $12400 per discounted quality-adjusted life-year gained and reached all potential sustained responders. Strategies involving liver biopsy were more expensive and would miss 6% of sustained responders and yield slightly lower life expectancies. CONCLUSIONS: Routine liver biopsy before treatment with interferon increases the cost of managing patients with CHC without improving health outcomes. Using quantitative HCV RNA testing to guide therapy misses some potential sustained responders. Empirical interferon treatment has a marginal cost-effectiveness ratio within the bounds of other commonly accepted therapies and misses none of the sustained responders.

Adult↗

PubMedDate not supplied

When should functional neuroimaging techniques be used in the diagnosis and management of Alzheimer's dementia? A decision analysis.

BACKGROUND: Functional neuroimaging, including positron emission tomography (PET), has been proposed for use in diagnosing Alzheimer's disease-related dementia (AD). OBJECTIVE: The objective of this study was identify the circumstances under which PET scanning for the diagnosis of AD maximizes health outcomes. METHODS: A Markov-model-based decision analysis was conducted using estimates derived from the literature on AD epidemiology, the accuracy of PET, and donepezil treatment efficacy. The target population for the analysis was assumed to be US men and women who either have mild AD or are asymptomatic but at an elevated risk of developing AD owing to disease in a first-degree relative (parent or sibling). The time horizon was the patient lifetime. We compared treatment 1) based on an American Academy of Neurology (AAN) clinical evaluation either alone; 2) in combination with PET scanning; or 3) empirically based on a family history. Outcomes measures were life expectancy, quality-adjusted life-years (QALYs), and (severe) dementia-free life expectancy (SDFLE). RESULTS: For both patient populations, treating all patients based on an AAN evaluation without further testing using PET resulted in the greatest gains in life expectancy, QALYs, and SDFLEs. PET-based testing was the second preferred strategy compared to no intervention. The rankings of the strategies were sensitive to severity of treatment complications: analyses of hypothetical treatments with the potential for severe complications indicated that testing was preferred if the treatment was effective but had moderate complications. CONCLUSIONS: These results suggest that current treatments, which are relatively benign and may slow progression of disease, should be offered to patients who are identified as having AD based solely on an AAN clinical evaluation. A clinical evaluation that includes functional neuroimaging based testing will be warranted, however, when new treatments that are effective at slowing disease progression but have the potential for moderate to severe complications become available.

Aged↗

PubMed2000

Disparities in health: common myths and uncommon truths.

A reappraisal of disparities by deprivation provides new and important information. NZDep96 is an area-based index of socioeconomic deprivation that uses nine variables measured in the 1996 census. The distribution of the Māori ethnic group is sharply skewed towards the most deprived deciles with only three percent in decile 1 and twenty-six percent residing in decile 10 meshblocks. More than half (56%) of Māori live in areas represented by the three most deprived deciles. This pattern is consistent within both sectors of the Māori ethnic group: sole Māori--those who give Māori as their only ethnicity and mixed Māori--those who give Māori as only one of their ethnicities. This is a 'distribution gap'. Within disparities analysis, there is also evidence of an 'outcome gap'. That is, the health outcomes of Māori are different from non-Māori, even after controlling for deprivation. For example, overseas data on life expectancy at birth have demonstrated social class gradients with lower life expectancy among manual workers and increasing life expectancy for trades-people, through to managerial and professional workers. This gradient is also evident in Aotearoa with life expectancy at birth decreasing as deprivation increases. A third dimension is evident in a review of disparities by deprivation,--a 'gradient gap'. This describes the relationship between ethnicity and increasing deprivation. It is as if the effect of increasing deprivation compounds risk for Māori whereas Pākehā do not seem subject to this effect. Analyses that foreground disparities have been portrayed as oppositional or secondary to Māori health development. In such frameworks where a disparity focus intersects with a development focus, the impression is given that the two are interconnected but move past each other in different directions. Our analysis promotes the disparities focus and the development focus as parallel reinforcing variables, each informing the other in the design and provision of services that have as their starting point, Māori needs. These services offer hope and opportunity for Māori but risk the vulnerability of special provision services (e.g. cuts in government expenditure). Furthermore the may delay the imperative of addressing the societal drivers that perpetuate disparities. This tension to engage in remedial reform is an important dilemma in Māori health development.

Censuses↗

PubMed1995

[Value of local radiotherapy in treatment of osseous metastases, pathological fractures and spinal cord compression].

Local radiotherapy plays an important and responsible role in the management of bone metastases. The valence will be described according to the different treatment objectives in the sense of pain relief, remineralization and cord decompression. Radiotherapy schedules, aimed at the relief pain, need to take into consideration life expectancy. Patients with a reduced life expectancy could have a good high chance of achieving pain relief with a single dose of 8 Gy. Patients with a solitary metastasis, patients with a longer life expectancy and patients with a pathological fracture should be treated with 'curative' irradiation doses, aimed at killing the maximum number of tumor cells. In addition to pain relief, remineralization is also an important treatment goal. Conventional radiotherapy with doses of 40-50 Gy resulted in pain relief in 70-100% and in remineralization in 60-80% of the patients. Remineralization could not be accelerated by short-course fractionation courses, but resulted in faster pain relief. Short-course fractionation schedules are not indicated as a 'standard' treatment in the vertebral column. Surgery is the treatment of choice for immediate cord decompression and stabilization of a pathological vertebral fracture. Radiotherapy alone could decrease neurological impairment and is suitable for patients with gradual onset and progression of symptoms, no spinal instability and lesions of the cauda equina.

Bone Neoplasms↗

PubMed2005

Pharmacogenetic testing in the clinical management of schizophrenia: a decision-analytic model.

Clinical application of pharmacogenetic testing has been proposed as a means of improving treatment outcomes in psychiatry. The identification of a putative genetic test for better clozapine response in schizophrenia offers an opportunity to evaluate the cost-effectiveness of such testing. The authors performed a cost-effectiveness analysis of a genetic test that may identify individuals with greater likelihood of responding to clozapine treatment. We modeled a target population of schizophrenia patients in an acute psychotic episode, using a lifetime time horizon and societal perspective. Outcome measures included life expectancy, quality-adjusted life expectancy, costs, and incremental cost-effectiveness. Effects of variations in testing parameters were also examined. For a 30-year-old with schizophrenia, applying the pharmacogenetic test and treating those predicted to respond to clozapine with clozapine-first cost US $47,705 per additional quality-adjusted life-year, compared with treating all patients with conventional agents and reserving clozapine for treatment-resistant patients. In 1-way sensitivity analyses, test sensitivity and cost had the greatest impact on the incremental cost-effectiveness. We conclude that pharmacogenetic tests may achieve utility in clinical psychiatry, although their cost-effectiveness depends on several clinical parameters. More consistent reporting of test parameters such as sensitivity and specificity would greatly facilitate assessment of future pharmacogenetic studies.

Antipsychotic Agents↗

PubMed2006

The value of medical spending in the United States, 1960-2000.

BACKGROUND: The increased use of medical therapies has led to increased medical costs. To provide insight into the value of this increased spending, we compared gains in life expectancy with the increased costs of care from 1960 through 2000. METHODS: We estimated life expectancy in 1960, 1970, 1980, 1990, and 2000 for four age groups. To control for the influence of nonmedical factors on survival, we assumed in our base-case analysis that 50 percent of the gains were due to medical care. We compared the adjusted increases in life expectancy with the lifetime cost of medical care in the same years. RESULTS: From 1960 through 2000, the life expectancy for newborns increased by 6.97 years, lifetime medical spending adjusted for inflation increased by approximately 69,000 dollars, and the cost per year of life gained was 19,900 dollars. The cost increased from 7,400 dollars per year of life gained in the 1970s to 36,300 dollars in the 1990s. The average cost per year of life gained in 1960-2000 was approximately 31,600 dollars at 15 years of age, 53,700 dollars at 45 years of age, and 84,700 dollars at 65 years of age. At 65 years of age, costs rose more rapidly than did life expectancy: the cost per year of life gained was 121,000 dollars between 1980 and 1990 and 145,000 dollars between 1990 and 2000. CONCLUSIONS: On average, the increases in medical spending since 1960 have provided reasonable value. However, the spending increases in medical care for the elderly since 1980 are associated with a high cost per year of life gained. The national focus on the rise in medical spending should be balanced by attention to the health benefits of this increased spending.

Adolescent↗

PubMed1998

Cost-effectiveness of FDG-PET for staging non-small cell lung cancer: a decision analysis.

BACKGROUND: Preliminary studies have shown that thoracic positron emission tomography (PET) is more accurate than thoracic computed tomography (CT) for the staging of non-small cell lung carcinoma. In the present study the cost-effectiveness, as measured by national Medicare reimbursed costs, and patient life expectancy are used to compare several thoracic PET-based strategies with a conventional thoracic CT-based strategy for preoperative staging. METHODS: Five decision strategies for selection of potential surgical candidates were compared; thoracic CT alone or four different strategies that use thoracic CT plus thoracic PET. The various paths of each strategy are dependent on numerous variables that were determined from a review of the medical literature. Life expectancy was calculated using the declining exponential approximation of life expectancy and reduced on the basis of procedural morbidity and mortality. Costs were based on national Medicare reimbursed costs. For all possible outcomes of each strategy, the expected cost and projected life expectancy were determined. The effects of changing one or more variables on the expected cost and life expectancy were studied using sensitivity analysis. RESULTS: A strategy that uses PET only after a negative CT study is shown to be a cost-effective alternative to the CT-alone strategy ($25,286 per life-year saved). CONCLUSIONS: These results show through rigorous decision tree analysis the potential cost-effectiveness of using thoracic PET in the management of non-small cell lung carcinoma. Greater use of thoracic PET for nonsmall cell lung carcinoma staging is warranted, and further clinical trials should help to validate the analytic results predicted from this study.

Carcinoma, Non-Small-Cell Lung↗

PubMed1998

Economic change, crime, and mortality crisis in Russia: regional analysis.

OBJECTIVE: To identify which aspects of socioeconomic change were associated with the steep decline in life expectancy in Russia between 1990 and 1994. DESIGN: Regression analysis of regional data, with percentage fall in male life expectancy as dependent variable and a range of socioeconomic measures reflecting transition, change in income, inequity, and social cohesion as independent variables. Determination of contribution of deaths from major causes and in each age group to changes in both male and female life expectancy at birth in regions with the smallest and largest declines. SETTING: Regions (oblasts) of European Russia (excluding Siberia and those in the Caucasus affected by the Chechen war). SUBJECTS: The population of European Russia. RESULTS: The fall in life expectancy at birth varied widely between regions, with declines for men and women highly correlated. The regions with the largest falls were predominantly urban, with high rates of labour turnover, large increases in recorded crime, and a higher average but unequal distribution of household income. For both men and women increasing rates of death between the ages of 30 and 60 years accounted for most of the fall in life expectancy, with the greatest contributions being from conditions directly or indirectly associated with heavy alcohol consumption. CONCLUSIONS: The decline in life expectancy in Russia in the 1990s cannot be attributed simply to impoverishment. Instead, the impact of social and economic transition, exacerbated by a lack of social cohesion, seems to have played a major part. The evidence that alcohol is an important proximate cause of premature death in Russia is strengthened.

Adolescent↗

PubMed2001

Decision analysis and its application in clinical medicine.

Decision analysis is increasingly used to address difficult medical problems. Case-by-case models designed for individual patients facing complex trade-offs in their medical care often help individual clinical decision making, but are expensive and time consuming. On the other hand, generic models addressing broad clinical questions that can be adapted from one patient to another, can often make valid projections about specific outcomes, such as life expectancy, quality-adjusted life expectancy, and cost-effectiveness issues, and represent a useful approach to clinical decision making.

Anticoagulants↗