Impact of opioid overdoses on US life expectancy and years of life lost, by demographic group and stimulant co-involvement: a mortality data analysis from 2019 to 2022.

Background: The United States' opioid crisis is worsening, with the number of deaths reaching 81,806 in 2022 after more than tripling over the past decade. This study aimed to comprehensively characterize changes in burden of opioid overdose mortality in terms of life expectancy reduction and years of life lost between 2019 and 2022, including differential burden across demographic groups and the contribution of polysubstance use. Methods: Using life tables and counts for all-cause and opioid overdose deaths from the National Center for Health Statistics, we constructed cause-eliminated life tables to estimate mortality by age in the absence of opioid-related deaths. We calculated the loss in life expectancy at birth (LLE) and total years of life lost (YLL) due to opioid overdose deaths by state of residency, sex, racial/ethnic group, and co-involvement of cocaine and psychostimulants. Findings: Opioid-related deaths in the US led to an estimated 3.1 million years of life lost in 2022 (38 years per death), compared to 2.0 million years lost in 2019. Relative to a scenario with no opioid mortality, we estimate that opioid-related deaths reduced life expectancy nationally by 0.67 years in 2022 vs 0.52 years in 2019. This LLE worsened in all racial/ethnic groups during the study period: 0.76 y-0.96 y for white men, 0.36 y-0.55 y for white women, 0.59 y-1.1 y for Black men, 0.27 y-0.53 y for Black women, 0.31 y-0.82 y for Hispanic men, 0.19 y-0.31 y for Hispanic women, 0.62 y-1.5 y for American Indian/Alaska Native (AI/AN) men, 0.43 y-1 y for AI/AN women, 0.09 y-0.2 y for Asian men, and 0.08 y-0.13 y for Asian women. Nearly all states experienced an increase in years of life lost (YLL) per capita from 2019 to 2022, with YLL more than doubling in 16 states. Cocaine or psychostimulants with abuse potential (incl. methamphetamines) were involved in half of all deaths and years of life lost in 2022, with substantial variation in the predominant drug class by state and racial/ethnic group. Interpretation: The burden of opioid-related mortality increased dramatically in the US between 2019 and 2022, coinciding with the period of the COVID-19 pandemic and the associated disruptions to social, economic, and health systems. Opioid overdose deaths are an important contributor to decreasing US life expectancy, and Black, Hispanic, and Native Americans now experience mortality burdens approaching or exceeding white Americans. Funding: None.

Analyses of academician cohorts generate biased pandemic excess death estimates.

OBJECTIVE: Death data from cohorts of academicians have been used to estimate pandemic excess deaths. We aimed to evaluate the validity of this approach. STUDY DESIGN AND SETTING: Data were analyzed from living and deceased member lists from Mainland China, UK and Greece academies; and Nobel laureates (and US subset thereof). Samples of early elected academicians were probed for unrecorded deaths; datasets overtly missing deaths were excluded from further analyses. Actuarial risks were compared against the general population in the same country in respective age strata. Relative incidence risk increases in death in active pandemic periods were compared to population-wide pandemic excess death estimates for the same country. RESULTS: Royal Society and Academy of Athens datasets overtly missed deaths. Prepandemic death rates were 4- to 12-fold lower in the Chinese Academy of Engineering (CAE) vs respective age strata of the Mainland China population. A +158% relative increase in death risk was seen in CAE data during the first 12-month of wide viral spread. Both increases (+34% in British Academy) and decreases (-27% in US Nobel laureates) in death rates occurred in pandemic (2020-22) vs prepandemic (2017-19) years; point estimates were far from known excess deaths in the respective countries (+6% and +14%, respectively). Published excess death estimates for urban-dwelling Mainland China selectively analyzed CAE that had double the pandemic death rates than another Chinese academy (Chinese Academy of Sciences). CONCLUSION: Missingness, lack of representativeness, large uncertainty, and selective analysis reporting make data from academy rosters unreliable for estimating general population excess deaths.

Sublethal effects of a spiromesifen and abamectin combination on Tetranychus urticae (Acari: Tetranychidae) and its predators Phytoseiulus persimilis and Amblyseius swirskii (Acari: Phytoseiiidae).

The two-spotted spider mite, Tetranychus urticae Koch (TSSM), is an important cosmopolitan pest of agricultural crops that is often managed in greenhouses by augmentation of predatory mites in combination with acaricides. Here we examined the transgenerational effects of low lethal concentrations of a widely-used acaricide, Oberon Speed® (a combination of spiromesifen and abamectin), on the life history traits and population growth of T. urticae and two of its predators, Phytoseiulus persimilis Athias-Henriot and Amblyseius swirskii Athias-Henriot (Acari: Phytoseiidae). The concentrations employed corresponded to the LC10, LC20 and LC30 values estimated for TSSM protonymphs 48 h post-exposure in a topical bioassay, which yielded an LC50 value of 207.2 ppm. Parental exposure of TSSM to all three low concentrations increased the total developmental time of progeny; both the LC20 and LC30 treatments reduced adult longevity and number of oviposition days, but only the LC30 treatment increased the preoviposition period. Similarly, both the LC20 and LC30 treatments significantly reduced life table parameters (r, R0, λ, and GRR), and increased generation time (T) and population doubling time (DT). Although maternal exposure to the acaricide had various impacts on progeny life history, A. swirskii was less affected than P. persimilis, suggesting the former species would be more compatible for integration with Oberon Speed® for control of T. urticae in greenhouse vegetable production.

Are We Adding Pain-Free Years to Life? A Test of Compression Versus Expansion of Morbidity.

BACKGROUND: There has been debate regarding whether increases in longevity result in longer and healthier lives or more disease and suffering. To address the issue, this paper uses health expectancy methods and tests an expansion versus compression of morbidity with respect to pain. METHODS: Data are from 1993 to 2018 Health and Retirement Study. Pain is categorized as no pain, non-limiting and limiting pain. Multistate life tables examine 77,996 wave-to-wave transitions across pain states or death using the Stochastic Population Analysis for Complex Events program. Results are presented as expected absolute and relative years of life for 70-, 80- and 90-year-old males and females. Confidence intervals assess significance of differences over time. Population- and status-based results are presented. RESULTS: For those 70 and 80 years old, relative and absolute life with non-limiting and limiting pain increased substantially for males and females, and despite variability on a wave-to-wave basis, results generally confirm an expanding pain morbidity trend. Results do not vary by baseline status, indicating those already in pain are just as likely to experience expansion of morbidity as those pain-free at baseline. Results are different for 90-year-olds who have not experienced expanding pain morbidity and do not show an increase in life expectancy. CONCLUSIONS: Findings are consistent with extant literature indicating increasing pain prevalence among older Americans and portend a need for attention on pain-coping resources, therapies, and prevention strategies.

Biology and life table parameters of Paralobesia viteana (Lepidoptera: Tortricidae), grown on different grape cultivars.

The grape berry moth, Paralobesia viteana (Clemens), is an important pest of cultivated grapes in eastern North America. Damage is caused directly by larval feeding of grape clusters and indirectly by increasing fruit susceptibility to fungal and bacterial pathogens. Despite the impact of grape berry moth on grapes being widely recognized, there is a lack of understanding of the influence that different grape cultivars may have on grape berry moth development, reproduction, and population dynamics. In this study, we constructed age-stage 2-sex life tables for grape berry moth fed on 5 grape cultivars: Concord, Niagara, Riesling, Chambourcin, and Vidal, to examine the effects of diet on insect population development, survival, reproduction, and demographic parameters such as net reproductive rate, intrinsic rate of increase, finite rate of increase, and mean generation time. Our findings reveal that grape cultivar significantly influenced the neonate wandering period, larval developmental time, adult and female longevity, pupal weight, adult preoviposition period, oviposition period, mean generation time, age-stage-specific life expectancy, and reproductive value of P. viteana. However, diet type did not affect grape berry moth total fecundity or other demographic parameters. The highest female reproductive value was observed at 30-40 days of age, indicating that control tactics implemented during this time frame would have the greatest impact on reducing population increase. This study provides critical information on the effects of different grape cultivars on grape berry moth development, reproduction, and demography. These insights could lead to the development of management strategies that improve pest control and reduce economic losses in vineyards.

The role of car tyres in the ecology of Aedes aegypti mosquitoes in Ghana.

Aedes aegypti is an important vector of arboviral diseases including dengue and yellow fever. Despite the wide distribution of this mosquito species, there are limited data on the ecology of Ae. aegypti in Ghana. In this study, we report on the oviposition preference and the larval life tables of Ae. aegypti mosquitoes in Accra, Ghana. The oviposition preference of the mosquitoes to three habitat types (car tyres, drums and bowls) was measured by setting up ovitraps. We recorded the presence and abundance of larvae every 3 days. Two-hour-old Ae. aegypti larvae were introduced and raised in three habitat types to undertake larval life tables. The number of surviving larvae at each developmental stage was recorded daily until they emerged as adults. Car tyres showed a higher abundance of Ae. aegypti larvae (52.3%) than drums (32.5%) and bowls (15.1%) (ANOVA, F(2,159) = 18.79, P < 0.001). The mean development time of Ae. aegypti larvae was significantly lower in car tyres (7 ± 1 days) compared to that of bowls (9 ± 0.0 days) and drums (12.6 ± 1.5 days) (P = 0.024). The differences in pupation rates and emergence rates were not significant across the habitat types; however, the highest pupation rate was observed in bowls (0.92 ± 0.17) and the emergence rate was highest in tyres (0.84 ± 0.10). The proportion of first-instar larvae that survived to emergence was significantly higher in car tyres (0.84 ± 0.10) compared to that of bowls (0.72 ± 0.20) and drums (0.62 ± 0.20) (P = 0.009). No mortalities were observed after 9 days in car tyres, 10 days in bowls and 15 days in drums. The results confirm that discarded car tyres were the preferred habitat choice for the oviposition of gravid female Ae. aegypti mosquitoes and provide the best habitat conditions for larval development and survival. These findings are necessary for understanding the ecology of Ae. aegypti to develop appropriate strategies for their control in Ghana.

CRISPR/Cas9-Mediated Knockout of the PxJHBP Gene Resulted in Increased Susceptibility to Bt Cry1Ac Protoxin and Reduced Lifespan and Spawning Rates in Plutella xylostella.

Juvenile hormone binding protein (JHBP) is a key regulator of JH signaling, and crosstalk between JH and 20-hydroxyecdysone (20E) can activate and fine-tune the mitogen-activated protein kinase cascade, leading to resistance to insecticidal proteins from Bacillis thuringiensis (Bt). However, the involvement of JHBP in the Bt Cry1Ac resistance of Plutella xylostella remains unclear. Here, we cloned a full-length cDNA encoding JHBP, and quantitative real-time PCR (qPCR) analysis showed that the expression of the PxJHBP gene in the midgut of the Cry1Ac-susceptible strain was significantly higher than that of the Cry1Ac-resistant strain. Furthermore, CRISPR/Cas9-mediated knockout of the PxJHBP gene significantly increased Cry1Ac susceptibility, resulting in a significantly shorter lifespan and reduced fertility. These results demonstrate that PxJHBP plays a critical role in the resistance to Cry1Ac protoxin and in the regulation of physiological metabolic processes associated with reproduction in adult females, providing valuable insights to improve management strategies of P. xylostella.

Intergenerational Effects of Sublethal Lambda-Cyhalothrin Exposure on Aphis gossypii Glover (Hemiptera: Aphididae) Reproduction and Development.

Aphis gossypii Glover, a widespread insect, presents a substantial danger to global agriculture. Lambda-cyhalothrin is a pyrethroid insecticide that has been widely studied for its effects on arthropods. Studies have reported that sublethal doses of insecticides can produce various consequences on arthropod reproduction. Hence, the objective of this research was to examine the potential effects of a sublethal dose of lambda-cyhalothrin (LC30, 1.15 mg/L) on A. gossypii, for which we created life tables and conducted qPCR analysis. Adult longevity, fecundity, net reproductive rate (R0), body length, width, weight, and the expression of vitellogenin (Vg) and vitellogenin receptor (VgR) genes were not significantly altered by lambda-cyhalothrin treatment at LC30 concentration in the F0 generation of A. gossypii adults. The intrinsic rate of increase (r) and finite rates of increase (λ) decreased significantly, while the mean generation time (T) increased. In addition, Vg and VgR gene expression levels were significantly higher in the F1 and F2 generations, whereas body length, width, and weight were notably reduced. The developmental duration, longevity, r, and λ did not differ significantly from those of the control group. Thus, the sublethal and intergenerational stimulatory effects of lambda-cyhalothrin were observed in A. gossypii, and the alterations in Vg and VgR in A. gossypii were strongly associated with sublethal effects. The results of this research offer valuable knowledge regarding the indirect impacts of lambda-cyhalothrin on A. gossypii, which can be utilized as a theoretical foundation for the prudent utilization of insecticides to combat this pest and devise strategies for managing resistance.

Age- and cause-specific contributions to increase in life expectancy at birth in Korea, 2000-2019: a descriptive study.

BACKGROUND: Korea's life expectancy at birth has consistently increased in the 21st century. This study compared the age and cause-specific contribution to the increase in life expectancy at birth in Korea before and after 2010. METHODS: The population and death numbers by year, sex, 5-year age group, and cause of death from 2000 to 2019 were acquired. Life expectancy at birth was calculated using an abridged life table by sex and year. The annual age-standardized and age-specific mortality by cause of death was also estimated. Lastly, the age and cause-specific contribution to the increase in life expectancy at birth in the two periods were compared using a stepwise replacement algorithm. RESULTS: Life expectancy at birth in Korea increased consistently from 2010 to 2019, though slightly slower than from 2000 to 2009. The cause-specific mortality and life expectancy decomposition analysis showed a significant decrease in mortality in chronic diseases, such as neoplasms and diseases of the circulatory system, in the middle and old-aged groups. External causes, such as transport injuries and suicide, mortality in younger age groups also increased life expectancy. However, mortality from diseases of the respiratory system increased in the very old age group during 2010-2019. CONCLUSIONS: Life expectancy at birth in Korea continued to increase mainly due to decreased mortality from chronic diseases and external causes during the study period. However, the aging of the population structure increased vulnerability to respiratory diseases. The factors behind the higher death rate from respiratory disease should be studied in the future.

Using Relative Survival to Estimate the Burden of Kidney Failure.

RATIONALE & OBJECTIVE: Estimates of mortality from kidney failure are misleading because the mortality from kidney failure is inseparable from the mortality attributed to comorbid conditions. We sought to develop an alternative method to reduce the bias in estimating mortality due to kidney failure using life table methods. STUDY DESIGN: Longitudinal cohort study. SETTING & PARTICIPANTS: Using data from the US Renal Data System and the Medicare 5% sample, we identified an incident cohort of patients, age 66+, who first had kidney failure in 2009 and a similar general population cohort without kidney failure. EXPOSURE: Kidney failure. OUTCOME: Death. ANALYTICAL APPROACH: We created comorbidity, age, sex, race, and year-specific life tables to estimate relative survival of patients with incident kidney failure and to attain an estimate of excess kidney failure-related deaths. Estimates were compared with those based on standard life tables (not adjusted for comorbidity). RESULTS: The analysis included 31,944 adults with kidney failure with a mean age of 77±7 years. The 5-year relative survival was 31% using standard life tables (adjusted for age, sex, race, and year) versus 36% using life tables also adjusted for comorbidities. Compared with other chronic diseases, patients with kidney failure have among the lowest relative survival. Patients with incident kidney failure ages 66-70 and 76-80 have a survival comparable to adults without kidney failure roughly 86-90 and 91-95 years old, respectively. LIMITATIONS: Relative survival estimates can be improved by narrowing the specificity of the covariates collected (eg, disease severity and ethnicity). CONCLUSIONS: Estimates of survival relative to a matched general population partition the mortality due to kidney failure from other causes of death. Results highlight the immense burden of kidney failure on mortality and the importance of disease prevention efforts among older adults. PLAIN-LANGUAGE SUMMARY: Estimates of death due to kidney failure can be misleading because death information from kidney failure is intertwined with death due to aging and other chronic diseases. Life tables are an old method, commonly used by actuaries and demographers to describe the life expectancy of a population. We developed life tables specific to a patient's age, sex, year, race, and comorbidity. Survival is derived from the life tables as the percentage of patients who are still alive in a specified period. By comparing survival of patients with kidney failure to the survival of people from the general population, we estimate that patients with kidney failure have one-third the chance of survival in 5 years compared with people with similar demographics and comorbidity but without kidney failure. The importance of this measure is that it provides a quantifiable estimate of the immense mortality burden of kidney failure.

Impacto directo e indirecto del COVID-19 en la esperanza de vida al nacer de Chile en el año 2020 / Direct and indirect impact of COVID-19 on life expectancy at birth in Chile in 2020 / Impacto direto e indireto da COVID-19 na expectativa de vida ao nascer no Chile em 2020

Resumen: El artículo muestra el impacto directo e indirecto del COVID-19 en la esperanza de vida de Chile durante el año 2020, utilizando las estadísticas de defunciones definitivas publicadas en marzo del año 2023. Para ello, se estimó una mortalidad contrafactual para año 2020 sin el COVID-19, siguiendo el patrón de mortalidad según causas de muerte desde 1997 a 2019, se elaboraron tablas de mortalidad para calcular la esperanza de vida para los años 2015 a 2020 y para el año 2020 estimado, y luego se descompuso la diferencia entre la esperanza de vida esperada y observada del año 2020 según grupos de edad y causas de muerte. La esperanza de vida del año 2020 quiebra la tendencia a su aumento entre 2015 y 2019, mostrando un retroceso, en hombres y en mujeres, con respecto al año 2019, de 1,32 y 0,75 años respectivamente. Con respecto al año 2020 estimado, la esperanza de vida del 2020 observado es 1,51 años menor en hombres y 0,92 en mujeres, pero el impacto directo del COVID-19 en pérdida de esperanza de vida fue mayor, 1,89 para los hombres y 1,5 para las mujeres, concentrándose en las edades entre los 60 y 84 años en hombres y entre 60 y 89 años en mujeres. El impacto directo negativo del COVID-19 a la esperanza de vida en parte fue contrarrestado por impactos indirectos positivos significativos en dos grupos de causas de muerte, las enfermedades del sistema respiratorio y las enfermedades infecciosas y parasitarias. El estudio muestra la necesidad de distinguir los impactos directos e indirectos del COVID-19, por la incidencia que pueden tener en la salud pública cuando el COVID-19 baje su intensidad y se eliminen las restricciones de movilidad.

Abstract: This article shows the direct and indirect impacts of COVID-19 on life expectancy in Chile in 2020, based on mortality statistics published in March 2023. To this end, a counterfactual mortality was estimated for 2020 without COVID-19; based on the pattern of mortality by cause of death from 1997 to 2019, mortality charts were created to calculate life expectancy from 2015 to 2020 and an estimation for 2020, and the difference between expected and observed life expectancy in 2020 was then separated by age group and cause of death. Life expectancy in 2020 interrupted the upward trend from 2015 to 2019, showing a decline of 1.32 years in men and 0.75 years in women compared to 2019. Compared to the estimated 2020, life expectancy was 1.51 years lower in men and 0.92 years lower in women, but the direct impact of COVID-19 on the decrease in life expectancy was greater (1.89 for men and 1.5 for women) in the 60-84 age group in men and the 60-89 age group in women. The direct negative impact of COVID-19 on life expectancy was partially mitigated by significant positive indirect impacts on two groups of causes of death: diseases of the respiratory system and infectious and parasitic diseases. This study shows the need to differentiate direct and indirect impacts of COVID-19, due to the implications for public health when the intensity of COVID-19 decreases and mobility restrictions are suspended.

Resumo: Este artigo apresenta os impactos direto e indireto da COVID-19 na expectativa de vida no Chile em 2020 a partir de estatísticas de mortalidade publicadas em março de 2023. Para tanto, foi estimada uma mortalidade contrafactual para 2020 sem a COVID-19; a partir do padrão de mortalidade por causa de morte de 1997 a 2019, foram criadas tabelas de mortalidade para calcular a expectativa de vida para o período de 2015 a 2020 e para o ano estimado de 2020 e, em seguida, a diferença entre a expectativa de vida esperada e observada em 2020 foi separada por faixa etária e causa de morte. A expectativa de vida em 2020 interrompe a tendência de aumento entre 2015 e 2019, mostrando um declínio com relação a 2019 de 1,32 ano nos homens e 0,75 ano nas mulheres. Com relação ao ano estimado de 2020, a expectativa de vida observada é 1,51 ano menor nos homens e 0,92 nas mulheres, mas o impacto direto da COVID-19 na diminuição da expectativa de vida foi maior (1,89 para homens e 1,5 para mulheres), concentrando-se nas idades entre 60 e 84 anos nos homens e entre 60 e 89 anos nas mulheres. O impacto direto negativo da COVID-19 na expectativa de vida foi parcialmente atenuado por impactos indiretos positivos significativos em dois grupos de causas de morte: doenças do sistema respiratório e doenças infecciosas e parasitárias. Este estudo mostra a necessidade de diferenciar impactos diretos e indiretos da COVID-19, devido às implicações para a saúde pública quando a intensidade da COVID-19 diminuir e as restrições de mobilidade forem suspensas.

Trypanosoma cruzi infection in dogs along the US-Mexico border: R0 changes with vector species composition.

Infection with Trypanosoma cruzi, etiological agent of Chagas disease, is common in US government working dogs along the US-Mexico border. This 3145 km long border comprises four states: Texas (TX), New Mexico (NM), Arizona (AZ) and California (CA) with diverse ecosystems and several triatomine (a.k.a., kissing bug) species, primary vectors of T. cruzi in this region. The kissing bug (Heteroptera: Reduviidae) community ranging from CA to TX includes Triatoma protracta (Uhler), Triatoma recurva (Stål) and Triatoma rubida (Uhler) and becomes dominated by Triatoma gerstaeckeri Stål in TX. Here, we ask if T. cruzi infection dynamics in dogs varies along this border region, potentially reflecting changes in vector species and their vectorial capacity. Using reversible catalytic models of infection, where seropositivity can be lost, we estimated an R0 (Estimate ± S.E.) of 1.192 ± 0.084 for TX and NM. In contrast, seropositivity decayed to zero as dogs aged in AZ and CA. These results suggest that dogs are likely infected by T. cruzi during their training in western TX, with a force of infection large enough for keeping R0 above 1, i.e., the disease endemically established, in TX and NM. In AZ and CA, a lower force of infection, probably associated with different vector species communities and associated vectorial capacity and/or different lineages of T. cruzi, results in dogs decreasing their seropositivity with age.

Life expectancy and healthy life expectancy of Korean registered disabled by disability type in 2014-2018: Korea National Rehabilitation Center database.

BACKGROUND: Conducting a distinct comparison between the life expectancy (LE) and healthy life expectancy (HALE) of people with disabilities (PWDs) and the general population is necessary due to the various environmental and health conditions they encounter. Therefore, this study aimed to develop the life table for PWDs and calculate those of LE and HALE based on sex, severity, and disability types among the registered Korean PWDs. METHODS: We used aggregated data of registered PWDs from the Korea National Rehabilitation Center database between 2014 and 2018. Overall, 345,595 deaths were included among 12,627,428 registered PWDs. First, we calculated the LE for total PWDs and non-disabled people using a standard life table, extending the old age mortality among nine models. Subsequently, we calculated the LE for each type of disability using the relationship between the mortality of total PWDs and those of each type of disability. Finally, HALE was calculated using the Sullivan method for three types as follows: disability-free and perceived health (PH) using the National Survey, and hospitalized for ≥ 7 days using the Korea National Health Insurance System (NHIS) database. RESULTS: The calculated LE/HALE-NHIS (years) at registration in males and females were 81.32/73.32 and 87.38/75.58, 68.54/58.98 and 71.43/59.24, 73.87/65.43 and 78.25/67.51, and 61.53/50.48 and 62.41/49.72 years among non-disabled, total PWDs, mild disabled, and severe disabled, respectively. LE/HALE-NHIS was lowest and highest in respiratory dysfunction and hearing disabilities, respectively. CONCLUSIONS: Males with disabilities had shorter LE and HALE at registration than females, except for those with severe disabilities, and there were variabilities in the LE based on the disability types.

Validation of a Multivariate Prediction Model of the Clinical Progression of Alzheimer's Disease in a Community-Dwelling Multiethnic Cohort.

BACKGROUND: The major aims of the three Predictors Studies have been to further our understanding of Alzheimer's disease (AD) progression sufficiently to predict the length of time from disease onset to major disease outcomes in individual patients with AD. OBJECTIVES: To validate a longitudinal Grade of Membership (L-GoM) prediction algorithm developed using clinic-based, mainly white patients from the Predictors 2 Study in a statistically representative community-based sample of Hispanic (N = 211) and non-Hispanic (N = 62) older adults (with 60 males and 213 females) from the Predictors 3 Study and extend the algorithm to mild cognitive impairment (MCI). METHODS: The L-GoM model was applied to data collected at the initial Predictors 3 visit for 150 subjects with AD and 123 with MCI. Participants were followed annually for up to seven years. Observed rates of survival and need for full-time care (FTC) were compared to those predicted by the algorithm. RESULTS: Initial MCI/AD severity in Predictors 3 was substantially higher than among clinic-based AD patients enrolled at the specialized Alzheimer's centers in Predictors 2. The observed survival and need for FTC followed the L-GoM model trajectories in individuals with MCI or AD, except for N = 32 subjects who were initially diagnosed with AD but reverted to a non-AD diagnosis on follow-up. CONCLUSION: These findings indicate that the L-GoM model is applicable to community-dwelling, multiethnic older adults with AD. They extend the use of the model to the prediction of outcomes for MCI. They also justify release of our L-GoM calculator at this time.

Different health systems - Different mortality outcomes? Regional disparities in avoidable mortality across German-speaking Europe, 1992-2019.

BACKGROUND: Evaluating the impact of health systems on premature mortality across different countries is a very challenging task, as it is hardly possible to disentangle it from the influence of contextual factors such as cultural differences. In this respect, the German-speaking area in Central Europe (Austria, Germany, South Tyrol and large parts of Switzerland) represents a unique 'natural experiment' setting: While being exposed to different health policies, they share a similar culture and language. METHODS: To assess the impact of different health systems on mortality differentials across the German-speaking area, we relied on the concept of avoidable mortality. Based on official mortality statistics, we aggregated causes of death below age 75 that are either 1) amenable to health care or 2) avoidable through primary prevention. We calculated standardised death rates and constructed cause-deleted life tables for 9 Austrian, 96 German, 1 Italian and 5 Swiss regions from 1992 to 2019, harmonised according to the current territorial borders. RESULTS: There are strong north-south and east-west gradients in amenable and preventable mortality across the studied regions to the advantage of the southwest. However, the Swiss regions still show significantly lower mortality levels than the neighbouring regions in southern Germany. Eliminating avoidable deaths from the life tables reduces spatial inequality in life expectancy in 2017/2019 by 30% for men and 28% for women. CONCLUSIONS: The efficiency of health policies in assuring timely and adequate health care and in preventing risk-relevant behaviour has room for improvement in all German regions, especially in the north, west and east, and in eastern Austria as well.

Wheat as a new host for potato aphid Macrosiphum euphorbiae Thomas (Hemiptera: Aphididae) and construction of its age-stage two-sex life tables.

Wheat (Triticum aestivum L.) is the major global staple food crop that meets the food security demands of various nations across the continents. The recent reduction in wheat production is attributed to several biotic and abiotic factors especially, temperature and rainfall patterns, and pest occurrence. Among insect pests, aphid species are emerging as new pests of economic importance in India and elsewhere. The present investigation identified a new association of Macrosiphum euphorbiae Thomas with the wheat crop. Life table parameters were studied for M. euphorbiae and Rhopalosiphum padi fed on wheat foliage. The total nymphal duration and life cycle duration, respectively, of R. padi (4.76 ± 0.54 and 9.71 ± 1.38 days) and M. euphorbiae (5.84 ± 0.69 and 9.96 ± 1.31 days) were significantly different for these species. The fecundity of the two aphid species was 23.95 ± 8.67 and 11.6 ± 4.10 progeny/female, respectively. Age-specific survival rate (lx), age-specific fecundity (fx), and population age-specific fecundity (mx) were higher in R. Padi compared to M. euphorbiae. Reproductive value (Vxj) was high in R. padi and the duration of reproduction was less, while these parameters showed an opposite trend in M. euphorbiae. The gross reproduction rate (GRR) was found higher in R. Padi (29.17 offspring/adult lifetime) compared to M. euphorbiae (19.58 offspring/adult lifetime). The M. euphorbiae being a pest of solanaceous crops seems to have shifted to a new host, i.e., wheat. This new adaptation strategy to survive for long periods on a wheat crop might pose a serious threat to wheat crop cultivation in near future.

Flexible transition timing in discrete-time multistate life tables using Markov chains with rewards.

Discrete-time multistate life tables are attractive because they are easier to understand and apply in comparison with their continuous-time counterparts. While such models are based on a discrete time grid, it is often useful to calculate derived magnitudes (e.g. state occupation times), under assumptions which posit that transitions take place at other times, such as mid-period. Unfortunately, currently available models allow very few choices about transition timing. We propose the use of Markov chains with rewards as a general way of incorporating information on the timing of transitions into the model. We illustrate the usefulness of rewards-based multistate life tables by estimating working life expectancies using different retirement transition timings. We also demonstrate that for the single-state case, the rewards approach matches traditional life-table methods exactly. Finally, we provide code to replicate all results from the paper plus R and Stata packages for general use of the method proposed.

A censored quantile regression approach for relative survival analysis: Relative survival quantile regression.

We propose a censored quantile regression model for the analysis of relative survival data. We create a hybrid data set consisting of the study observations and counterpart randomly sampled pseudopopulation observations imputed from population life tables that adjust for expected mortality. We then fit a censored quantile regression model to the hybrid data incorporating demographic variables (e.g., age, biologic sex, calendar time) corresponding to the population life tables of demographically-similar individuals, a population versus study covariate, and its interactions with the variables of interest. These latter variables can be interpreted as relative survival parameters that depict the differences in failure quantiles between the study participants and their population counterparts.

A new cure model that corrects for increased risk of non-cancer death: analysis of reliability and robustness, and application to real-life data.

BACKGROUND: Non-cancer mortality in cancer patients may be higher than overall mortality in the general population due to a combination of factors, such as long-term adverse effects of treatments, and genetic, environmental or lifestyle-related factors. If so, conventional indicators may underestimate net survival and cure fraction. Our aim was to propose and evaluate a mixture cure survival model that takes into account the increased risk of non-cancer death for cancer patients. METHODS: We assessed the performance of a corrected mixture cure survival model derived from a conventional mixture cure model to estimate the cure fraction, the survival of uncured patients, and the increased risk of non-cancer death in two settings of net survival estimation, grouped life-table data and individual patients' data. We measured the model's performance in terms of bias, standard deviation of the estimates and coverage rate, using an extensive simulation study. This study included reliability assessments through violation of some of the model's assumptions. We also applied the models to colon cancer data from the FRANCIM network. RESULTS: When the assumptions were satisfied, the corrected cure model provided unbiased estimates of parameters expressing the increased risk of non-cancer death, the cure fraction, and net survival in uncured patients. No major difference was found when the model was applied to individual or grouped data. The absolute bias was < 1% for all parameters, while coverage ranged from 89 to 97%. When some of the assumptions were violated, parameter estimates appeared more robust when obtained from grouped than from individual data. As expected, the uncorrected cure model performed poorly and underestimated net survival and cure fractions in the simulation study. When applied to colon cancer real-life data, cure fractions estimated using the proposed model were higher than those in the conventional model, e.g. 5% higher in males at age 60 (57% vs. 52%). CONCLUSIONS: The present analysis supports the use of the corrected mixture cure model, with the inclusion of increased risk of non-cancer death for cancer patients to provide better estimates of indicators based on cancer survival. These are important to public health decision-making; they improve patients' awareness and facilitate their return to normal life.

Correcting for heterogeneity and non-comparability bias in multicenter clinical trials with a rescaled random-effect excess hazard model.

In the presence of competing causes of event occurrence (e.g., death), the interest might not only be in the overall survival but also in the so-called net survival, that is, the hypothetical survival that would be observed if the disease under study were the only possible cause of death. Net survival estimation is commonly based on the excess hazard approach in which the hazard rate of individuals is assumed to be the sum of a disease-specific and expected hazard rate, supposed to be correctly approximated by the mortality rates obtained from general population life tables. However, this assumption might not be realistic if the study participants are not comparable with the general population. Also, the hierarchical structure of the data can induces a correlation between the outcomes of individuals coming from the same clusters (e.g., hospital, registry). We proposed an excess hazard model that corrects simultaneously for these two sources of bias, instead of dealing with them independently as before. We assessed the performance of this new model and compared it with three similar models, using extensive simulation study, as well as an application to breast cancer data from a multicenter clinical trial. The new model performed better than the others in terms of bias, root mean square error, and empirical coverage rate. The proposed approach might be useful to account simultaneously for the hierarchical structure of the data and the non-comparability bias in studies such as long-term multicenter clinical trials, when there is interest in the estimation of net survival.