Explore the vast range of titles available.

The association between birth cohort and subsequent mortality has been of interest especially following publication of studies around 1930 of cohorts born up to the latter part of the nineteenth century, particularly for England and Wales. Updated results are presented for this population, together with those for two other cohorts, twentieth-century Japanese and British populations born about 1930, which have been identified as having particularly clear-cut birth cohort patterns, and which are used to underpin incorporation of cohort effects in both British official and actuarial mortality forecasts. Graphical methods used to identify cohort patterns are discussed. A number of limitations and difficulties are identified that mean that the conclusions about the predominance of cohort effects are less robust than often assumed. It is argued that alternative explanations should be considered and that the concentration on birth cohorts with particularly advantaged patterns may distort research priorities.

The risk of conversion from a first demyelinating event to MS was lower with minocycline than with placebo over 6 months but not over 24 months. Changes of demyelination on MRI favored minocycline over placebo. Adverse events were more frequent with minocycline. After a first focal clinical demyelinating event (also called a clinically isolated syndrome), the risk of conversion to multiple sclerosis is high. Minocycline is a tetracycline antibiotic agent that has immune-modulating properties; preliminary data have shown activity of minocycline in patients with multiple sclerosis. 1 – 4 Minocycline has a good safety profile, 5 although rash, headache, dizziness, and photosensitivity are common side effects. Pseudotumor cerebri and hypersensitivity syndromes are rare but serious complications, and hyperpigmentation may occur with long-term use. Antibiotic resistance is infrequently associated with minocycline therapy. 6 In one small clinical trial involving patients with relapsing–remitting multiple sclerosis, minocycline therapy reduced . . .

This comparative-effectiveness trial assessed clinical outcomes in patients with advanced heart failure who were not candidates for cardiac transplantation and who had a continuous-flow left ventricular assist device as compared with a pulsatile-flow device. The continuous-flow device resulted in better clinical outcomes, but it has not yet been approved by the Food and Drug Administration. This comparative-effectiveness trial assessed clinical outcomes in patients with advanced heart failure who had a continuous-flow left ventricular assist device as compared with a pulsatile-flow device. The continuous-flow device resulted in better clinical outcomes. Medical and electrical therapies for systolic heart failure have improved outcomes and altered the natural history of the disease. 1 – 9 However, heart failure commonly progresses and becomes refractory to current treatments. Continuous intravenous inotropic support may improve clinical status in the short term but results in a survival rate at 1 year of only 10 to 30%. 10 , 11 Cardiac transplantation is available for only a minority of patients, because of a lack of suitable donor hearts. The paucity of effective therapies for advanced heart failure led to the evaluation of mechanical circulatory-support devices as permanent therapy. To date, only two . . .

An electrocardiographic pattern of early repolarization (elevation of the QRS–ST junction) is generally believed to be benign. In this study, however, researchers found that among case subjects with idiopathic ventricular fibrillation, the prevalence of early repolarization was significantly increased, as compared with that among control subjects. These findings will lead to a reconsideration of the clinical significance of early repolarization. Researchers found that among case subjects with idiopathic ventricular fibrillation, the prevalence of early repolarization was significantly increased. These findings will lead to a reconsideration of the clinical significance of early repolarization. Sudden cardiac arrest remains a major public health problem that accounts for approximately 350,000 deaths annually in the United States. Despite advances in emergency medical systems, only 3 to 10% of patients who have an out-of-hospital cardiac arrest are successfully resuscitated. The majority of such sudden cardiac arrests are caused by ventricular tachyarrhythmias, which occur in persons without structural heart disease in 6 to 14% of cases. 1 , 2 Some of the latter cases are related to well-recognized electrocardiographic abnormalities that affect ventricular repolarization (e.g., long or short QT intervals or the Brugada syndrome), whereas other cases, in which there are . . .

Government intervention in insurance markets is ubiquitous and the theoretical basis for such intervention, based on classic work from the 1970s, has been the problem of adverse selection. Over the last decade, empirical work on selection in insurance markets has gained considerable momentum. This research finds that adverse selection exists in some insurance markets but not in others. And it has uncovered examples of markets that exhibit “advantageous selection”—a phenomenon not considered by the original theory, and one that has different consequences for equilibrium insurance allocation and optimal public policy than the classical case of adverse selection. Advantageous selection arises when the individuals who are willing to pay the most for insurance are those who are the most risk averse (and so have the lowest expected cost). Indeed, it is natural to think that in many instances individuals who value insurance more may also take action to lower their expected costs: drive more carefully, invest in preventive health care, and so on. Researchers have taken steps toward estimating the welfare consequences of detected selection and of potential public policy interventions. In this essay, we present a graphical framework for analyzing both theoretical and empirical work on selection in insurance markets. This graphical approach provides both a useful and intuitive depiction of the basic theory of selection and its implications for welfare and public policy, as well as a lens through which one can understand the ideas and limitations of existing empirical work on this topic.

Abstract Background The mortality effects of COVID-19 are a critical aspect of the disease’s impact. Years of life lost (YLLs) can provide greater insight than the number of deaths by conveying the shortfall in life expectancy and thus the age profile of the decedents. Methods We employed data regarding COVID-19 deaths in the USA by jurisdiction, gender and age group for the period 1 February 2020 through 11 July 2020. We used actuarial life expectancy tables by gender and age to estimate YLLs. Results We estimated roughly 1.2 million YLLs due to COVID-19 deaths. The YLLs for the top six jurisdictions exceeded those for the remaining 43. On a per-capita basis, female YLLs were generally higher than male YLLs throughout the country. Conclusions Our estimates offer new insight into the effects of COVID-19. Our findings of heterogenous rates of YLLs by geography and gender highlight variation in the magnitude of the pandemic’s effects that may inform effective policy responses.

At a minimum, high-quality health care is care that does not harm patients, particularly through medical errors. The first step in reducing the large number of harmful medical errors that occur today is to analyze them. We used an actuarial approach to measure the frequency and costs of measurable US medical errors, identified through medical claims data. This method focuses on the analysis of comparative rates of illness, using mathematical models to assess the risk of occurrence and to project costs to the total population. We estimate that the annual cost of measurable medical errors that harm patients was $17.1 billion in 2008. Pressure ulcers were the most common measurable medical error, followed by postoperative infections and by postlaminectomy syndrome, a condition characterized by persistent pain following back surgery. A total of ten types of errors account for more than two-thirds of the total cost of errors, and these errors should be the first targets of prevention efforts. [PUBLICATION ABSTRACT]

Quality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs) are commonly used in cost-effectiveness analysis (CEA) to measure health benefits. We sought to quantify and explain differences between QALY- and DALY-based cost-effectiveness ratios, and explore whether using one versus the other would materially affect conclusions about an intervention's cost-effectiveness. We identified CEAs using both QALYs and DALYs from the Tufts Medical Center CEA Registry and Global Health CEA Registry, with a supplemental search to ensure comprehensive literature coverage. We calculated absolute and relative differences between the QALY- and DALY-based ratios, and compared ratios to common benchmarks (e.g., 1× gross domestic product per capita). We converted reported costs into US dollars. Among eleven published CEAs reporting both QALYs and DALYs, seven focused on pharmaceuticals and infectious disease, and five were conducted in high-income countries. Four studies concluded that the intervention was \"dominant\" (cost-saving). Among the QALY- and DALY-based ratios reported from the remaining seven studies, absolute differences ranged from approximately $2 to $15,000 per unit of benefit, and relative differences from 6-120 percent, but most differences were modest in comparison with the ratio value itself. The values assigned to utility and disability weights explained most observed differences. In comparison with cost-effectiveness thresholds, conclusions were consistent regardless of the ratio type in ten of eleven cases. Our results suggest that although QALY- and DALY-based ratios for the same intervention can differ, differences tend to be modest and do not materially affect comparisons to common cost-effectiveness thresholds.

The concept of actuarial senescence (defined here as the increase in mortality hazards with age) is often confounded with life span duration, which obscures the relative role of age-dependent and age-independent processes in shaping the variation in life span. We use the opportunity afforded by the Species360 database, a collection of individual life span records in captivity, to analyze age-specific mortality patterns in relation to variation in life span. We report evidence of actuarial senescence across 96 mammal species. We identify the life stage (juvenile, prime-age, or senescent) that contributes the most to the observed variation in life span across species. Actuarial senescence only accounted for 35%-50% of the variance in life span across species, depending on the body mass category. We computed the sensitivity and elasticity of life span to five parameters that represent the three stages of the age-specific mortality curve-namely, the duration of the juvenile stage, the mean juvenile mortality, the prime-age (i.e., minimum) adult mortality, the age at the onset of actuarial senescence, and the rate of actuarial senescence. Next, we computed the between-species variance in these five parameters. Combining the two steps, we computed the relative contribution of each of the five parameters to the variance in life span across species. Variation in life span was increasingly driven by the intensity of actuarial senescence and decreasingly driven by prime-age adult mortality from small to large species because of changes in the elasticity of life span to these parameters, even if all the adult survival parameters consistently exhibited a canalization pattern of weaker variability among long-lived species than among short-lived ones. Our work unambiguously demonstrates that life span cannot be used to measure the strength of actuarial senescence, because a substantial and variable proportion of life span variation across mammals is not related to actuarial senescence metrics.

Population aging is creating serious challenges for the sustainability of China’s pension system. To mitigate the adverse impact of the demographic shift, China has recently introduced fertility and retirement policy reforms. The research presented in this paper primarily evaluates the impacts of recent reforms on the financial sustainability of China’s Urban Employees’ Pension Plan (UEPP). By using the Leslie matrix and actuarial models, the financial sustainability of the UEPP from 2019 to 2070 is projected and evaluated under a set of assumed policy reform scenarios. The results indicate that an imbalance in the pension fund would occur in the early 2020s and then expand under existing policies. Fertility adjustment, retirement delay, or combination reforms would not fundamentally solve this financial crisis in the long term. When 100% of couples have a second child and the retirement age is increased to 65, the current and accumulated pension deficits would drop by 50.05–67.56% and 35.88–54.23% between 2040 and 2070, respectively. Supplementary policy measures should be designed to encourage childbearing and retirement delay, including family support policies and top-designed pension system reform policies.