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INDEPTH model life tables for Sub-Saharan Africa
\"Model life tables provide ways of deriving accurate mortality schedules or predicting future trends from scanty data. In settings where accurate data are unavailable, these provide invaluable tools for estimating mortality conditions among populations. Constructing model life tables requires the availability of accurate empirical life tables that depict the different patterns of age-specific risks of death in the populations covered. Starting in the early 1960s, a number of field-based research stations were established to collect longitudinal data on births, deaths and migrations, covering some geographic areas in sub-Saharan Africa and Asia. In the late 1990s, these research sites teamed up to form an international network, INDEPTH.
Site-specific Solid Cancer Mortality After Exposure to Ionizing Radiation: A Cohort Study of Workers (INWORKS)
BACKGROUND:There is considerable scientific interest in associations between protracted low-dose exposure to ionizing radiation and the occurrence of specific types of cancer.
METHODS:Associations between ionizing radiation and site-specific solid cancer mortality were examined among 308,297 nuclear workers employed in France, the United Kingdom, and the United States. Workers were monitored for external radiation exposure and follow-up encompassed 8.2 million person-years. Radiation–mortality associations were estimated using a maximum-likelihood method and using a Markov chain Monte Carlo method, the latter used to fit a hierarchical regression model to stabilize estimates of association.
RESULTS:The analysis included 17,957 deaths attributable to solid cancer, the most common being lung, prostate, and colon cancer. Using a maximum-likelihood method to quantify associations between radiation dose- and site-specific cancer, we obtained positive point estimates for oral, esophagus, stomach, colon, rectum, pancreas, peritoneum, larynx, lung, pleura, bone and connective tissue, skin, ovary, testis, and thyroid cancer; in addition, we obtained negative point estimates for cancer of the liver and gallbladder, prostate, bladder, kidney, and brain. Most of these estimated coefficients exhibited substantial imprecision. Employing a hierarchical model for stabilization had little impact on the estimated associations for the most commonly observed outcomes, but for less frequent cancer types, the stabilized estimates tended to take less extreme values and have greater precision than estimates obtained without such stabilization.
CONCLUSIONS:The results provide further evidence regarding associations between low-dose radiation exposure and cancer.
Journal Article
Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000
Summary Background Information about the distribution of causes of and time trends for child mortality should be periodically updated. We report the latest estimates of causes of child mortality in 2010 with time trends since 2000. Methods Updated total numbers of deaths in children aged 0–27 days and 1–59 months were applied to the corresponding country-specific distribution of deaths by cause. We did the following to derive the number of deaths in children aged 1–59 months: we used vital registration data for countries with an adequate vital registration system; we applied a multinomial logistic regression model to vital registration data for low-mortality countries without adequate vital registration; we used a similar multinomial logistic regression with verbal autopsy data for high-mortality countries; for India and China, we developed national models. We aggregated country results to generate regional and global estimates. Findings Of 7·6 million deaths in children younger than 5 years in 2010, 64·0% (4·879 million) were attributable to infectious causes and 40·3% (3·072 million) occurred in neonates. Preterm birth complications (14·1%; 1·078 million, uncertainty range [UR] 0·916–1·325), intrapartum-related complications (9·4%; 0·717 million, 0·610–0·876), and sepsis or meningitis (5·2%; 0·393 million, 0·252–0·552) were the leading causes of neonatal death. In older children, pneumonia (14·1%; 1·071 million, 0·977–1·176), diarrhoea (9·9%; 0·751 million, 0·538–1·031), and malaria (7·4%; 0·564 million, 0·432–0·709) claimed the most lives. Despite tremendous efforts to identify relevant data, the causes of only 2·7% (0·205 million) of deaths in children younger than 5 years were medically certified in 2010. Between 2000 and 2010, the global burden of deaths in children younger than 5 years decreased by 2 million, of which pneumonia, measles, and diarrhoea contributed the most to the overall reduction (0·451 million [0·339–0·547], 0·363 million [0·283–0·419], and 0·359 million [0·215–0·476], respectively). However, only tetanus, measles, AIDS, and malaria (in Africa) decreased at an annual rate sufficient to attain the Millennium Development Goal 4. Interpretation Child survival strategies should direct resources toward the leading causes of child mortality, with attention focusing on infectious and neonatal causes. More rapid decreases from 2010–15 will need accelerated reduction for the most common causes of death, notably pneumonia and preterm birth complications. Continued efforts to gather high-quality data and enhance estimation methods are essential for the improvement of future estimates. Funding The Bill & Melinda Gates Foundation.
Journal Article
Cognitive and behavioural markers improve survival prediction in progressive supranuclear palsy
The pathology of Progressive Supranuclear Palsy (PSP) causes Richardson’s syndrome (RS) and variant clinical phenotypes, with differential cognitive, behavioural and motor deficits. Survival is 3-4 years from diagnosis. The PSP Rating Scale (PSPRS) is prognostically informative, but the impact of cognitive and behavioural changes on survival is less clear. We test univariate and multivariate models of survival to determine the best clinically-applicable model for all-cause mortality.The MDS 2017 criteria were used to phenotype patients at the Cambridge Centre for Parkinson-plus (UK). Univariate and multivariate logistic regression models assessed the relationship between survival and clinicalvariables(PSPRS, MMSE, Addenbrooke’s Cognitive Examination,Cambridge Behavioural Inventory).335 people (male=56%, age 71.4±7.2 years) were identified with possible, probable or definite PSP. RS and variant groups had similar disease severity at baseline assessment (p=0.6) and survival (p=0.2). For 3-year mortality, PSPRS was the most reliable single predictor (AUC=0.68). Age, sex and PSPRS improved the model(AUC=0.71), but over all models Akaike’s Information Criterion identified the best model for RS to include PSPRS, CBI and MMSE(AUC=0.79, p=0.01). CBI and MMSE also improved the model for var- iant-PSP(PSPRS, CBI and MMSE AUC=0.89 vs 0.73, p=0.01).Inclusion of cognitive and behavioural measures improves the prediction of mortality in PSP.
Journal Article
NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4
The Sustainable Development Goal (SDG) target 3.4 is to reduce premature mortality from non-communicable diseases (NCDs) by a third by 2030 relative to 2015 levels, and to promote mental health and wellbeing. We used data on cause-specific mortality to characterise the risk and trends in NCD mortality in each country and evaluate combinations of reductions in NCD causes of death that can achieve SDG target 3.4. Among NCDs, ischaemic heart disease is responsible for the highest risk of premature death in more than half of all countries for women, and more than three-quarters for men. However, stroke, other cardiovascular diseases, and some cancers are associated with a similar risk, and in many countries, a higher risk of premature death than ischaemic heart disease. Although premature mortality from NCDs is declining in most countries, for most the pace of change is too slow to achieve SDG target 3.4. To investigate the options available to each country for achieving SDG target 3.4, we considered different scenarios, each representing a combination of fast (annual rate achieved by the tenth best performing percentile of all countries) and average (median of all countries) declines in risk of premature death from NCDs. Pathways analysis shows that every country has options for achieving SDG target 3.4. No country could achieve the target by addressing a single disease. In at least half the countries, achieving the target requires improvements in the rate of decline in at least five causes for women and in at least seven causes for men to the same rate achieved by the tenth best performing percentile of all countries. Tobacco and alcohol control and effective health-system interventions—including hypertension and diabetes treatment; primary and secondary cardiovascular disease prevention in high-risk individuals; low-dose inhaled corticosteroids and bronchodilators for asthma and chronic obstructive pulmonary disease; treatment of acute cardiovascular diseases, diabetes complications, and exacerbations of asthma and chronic obstructive pulmonary disease; and effective cancer screening and treatment—will reduce NCD causes of death necessary to achieve SDG target 3.4 in most countries.
Journal Article
