Comparing Estimates of Fall-Related Mortality Incidence Among Older Adults in the United States

AbstractBackgroundFalls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally representative cohort with those from a national vital record database and identified correlates of fall-related mortality.MethodsCause-of-death data from the National Death Index (NDI; 1999–2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of U.S. older adults (N = 20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the Centers for Disease Control and Prevention (CDC) vital record data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths.ResultsThe overall incidence rate of fall-related mortality was greater in HRS–NDI data (51.6 deaths per 100,000; 95% confidence interval: 42.04, 63.37) compared with CDC data (42.00 deaths per 100,000; 95% confidence interval: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults aged 85 years and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality.ConclusionIncidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital record estimates.

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Longer Residence in the United States is Associated With More Physical Function Limitations in African Immigrant Older Adults

Journal of Applied Gerontology ◽

10.1177/0733464820977608 ◽

2020 ◽

pp. 073346482097760

Author(s):

Manka Nkimbeng ◽

Yvonne Commodore-Mensah ◽

Jacqueline L. Angel ◽

Karen Bandeen-Roche ◽

Roland J. Thorpe ◽

...

Keyword(s):

United States ◽

Older Adults ◽

Confidence Interval ◽

Physical Function ◽

Racial Discrimination ◽

African Immigrants ◽

The United States ◽

African Immigrant ◽

High Discrimination ◽

The Mean

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years ( SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years ( b = −2.62, 95% confidence interval [CI] = [–5.01, –0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations ( b = −2.51, 95% CI = [–4.91, –0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

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Esophageal Adenocarcinoma: Opportunities for Targeted Prevention in Ohio

Clinical Medicine Insights Gastroenterology ◽

10.1177/1179552218791170 ◽

2018 ◽

Vol 11 ◽

pp. 117955221879117 ◽

Cited By ~ 1

Author(s):

Julie A Stephens ◽

James L Fisher ◽

Jessica L Krok-Schoen ◽

Ryan D Baltic ◽

Holly L Sobotka ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Risk Factor ◽

Cigarette Smoking ◽

Esophageal Adenocarcinoma ◽

Surveillance System ◽

The United States ◽

Incidence Rates ◽

Targeted Prevention ◽

Care Providers

Objective: The incidence of esophageal adenocarcinoma, one of the most lethal gastroenterological diseases, has been increasing since the 1960s. Prevention of esophageal adenocarcinoma is important because no early detection screening programs have been shown to reduce mortality. Obesity, gastroesophageal reflux disease, and tobacco smoking are risk factors for esophageal adenocarcinoma. Due to the high prevalence in Ohio of obesity (32.6%) and cigarette smoking (21.0%), this study sought to identify trends and patterns of these risk factors and esophageal adenocarcinoma in Ohio as compared with the United States. Methods: Data from the Ohio Cancer Incidence Surveillance System, Surveillance Epidemiology and End Results Program (SEER), and Behavioral Risk Factor Surveillance System were used. Incidence rates overall, by demographics and by county, as well as trends in incidence of esophageal adenocarcinoma and the percent of esophageal adenocarcinoma among esophageal cancers were examined. Trends in obesity and cigarette smoking in Ohio, and the prevalence of each by county, were reported. Results: There was an increasing trend in esophageal adenocarcinoma incidence in Ohio. Ohio’s average annual esophageal adenocarcinoma incidence rate was higher than the SEER rate overall and for each sex, race, and age group in 2009 to 2013. There was also an increasing prevalence of obesity in Ohio. Although the prevalence of cigarette smoking has been stable, it was high in Ohio compared with the United States. Conclusions: Health care providers and researchers should be aware of the esophageal adenocarcinoma incidence rates and risk factor patterns and tailor interventions for areas and populations at higher risk.

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AIDS-related Burkitt lymphoma in the United States: what do age and CD4 lymphocyte patterns tell us about etiology and/or biology?

Blood ◽

10.1182/blood-2010-03-275917 ◽

2010 ◽

Vol 116 (25) ◽

pp. 5600-5604 ◽

Cited By ~ 68

Author(s):

Mercy Guech-Ongey ◽

Edgar P. Simard ◽

William F. Anderson ◽

Eric A. Engels ◽

Kishor Bhatia ◽

...

Keyword(s):

United States ◽

Incidence Rate ◽

Burkitt Lymphoma ◽

Rate Ratio ◽

Hiv Transmission ◽

Incidence Rate Ratio ◽

The United States ◽

Incidence Rates ◽

Cd4 Lymphocyte ◽

Cd4 Lymphocytes

Abstract Trimodal or bimodal age-specific incidence rates for Burkitt lymphoma (BL) were observed in the United States general population, but the role of immunosuppression could not be excluded. Incidence rates, rate ratios, and 95% confidence intervals for BL and other non-Hodgkin lymphoma (NHL), by age and CD4 lymphocyte count categories, were estimated using Poisson regression models using data from the United States HIV/AIDS Cancer Match study (1980-2005). BL incidence was 22 cases per 100 000 person-years and 586 for non-BL NHL. Adjusted BL incidence rate ratio among males was 1.6× that among females and among non-Hispanic blacks, 0.4× that among non-Hispanic whites, but unrelated to HIV-transmission category. Non-BL NHL incidence increased from childhood to adulthood; in contrast, 2 age-specific incidence peaks during the pediatric and adult/geriatric years were observed for BL. Non-BL NHL incidence rose steadily with decreasing CD4 lymphocyte counts; in contrast, BL incidence was lowest among people with ≤ 50 CD4 lymphocytes/μL versus those with ≥ 250 CD4 lymphocytes/μL (incidence rate ratio 0.3 [95% confidence interval = 0.2-0.6]). The bimodal peaks for BL, in contrast to non-BL NHL, suggest effects of noncumulative risk factors at different ages. Underascertainment or biological reasons may account for BL deficit at low CD4 lymphocyte counts.

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Newly incident cannabis use in the United States, 2002–2011: a regional and state level benchmark

PeerJ ◽

10.7717/peerj.3616 ◽

2017 ◽

Vol 5 ◽

pp. e3616 ◽

Cited By ~ 1

Author(s):

Jacob P. Leinweber ◽

Hui G. Cheng ◽

Catalina Lopez-Quintero ◽

James C. Anthony

Keyword(s):

United States ◽

Incidence Rate ◽

Meta Analysis ◽

State Level ◽

The United States ◽

Incidence Rates ◽

Cannabis Use ◽

Border Region ◽

Community Residents ◽

Mexico Border

BackgroundCannabis use and cannabis regulatory policies recently re-surfaced as noteworthy global research and social media topics, including claims that Mexicans have been sending cannabis and other drug supplies through a porous border into the United States. These circumstances prompted us to conduct an epidemiological test of whether the states bordering Mexico had exceptionally large cannabis incidence rates for 2002–2011. The resulting range of cannabis incidence rates disclosed here can serve as 2002–2011 benchmark values against which estimates from later years can be compared.MethodsThe population under study is 12-to-24-year-old non-institutionalized civilian community residents of the US, sampled and assessed with confidential audio computer-assisted self-interviews (ACASI) during National Surveys on Drug Use and Health, 2002–2011 (aggregaten ∼ 420,000) for which public use datasets were available. We estimated state-specific cannabis incidence rates based on independent replication sample surveys across these years, and derived meta-analysis estimates for 10 pre-specified regions, including the Mexico border region.ResultsFrom meta-analysis, the estimated annual incidence rate for cannabis use in the Mexico Border Region is 5% (95% CI [4%–7%]), which is not an exceptional value relative to the overall US estimate of 6% (95% CI [5%–6%]). Geographically quite distant from Mexico and from states of the western US with liberalized cannabis policies, the North Atlantic Region population has the numerically largest incidence estimate at 7% (95% CI [6%–8%]), while the Gulf of Mexico Border Region population has the lowest incidence rate at 5% (95% CI [4%–6%]). Within the set of state-specific estimates, Vermont’s and Utah’s populations have the largest and smallest incidence rates, respectively (VT: 9%; 95% CI [8%–10%]; UT: 3%; 95% CI [3%–4%]).DiscussionBased on this study’s estimates, among 12-to-24-year-old US community residents, an estimated 6% start to use cannabis each year (roughly one in 16). Relatively minor variation in region-wise and state-level estimates is seen, although Vermont and Utah might be exceptional. As of 2011, proximity to Mexico, to Canada, and to the western states with liberalized policies apparently has induced little variation in cannabis incidence rates. Our primary intent was to create a set of benchmark estimates for state-specific and region-specific population incidence rates for cannabis use, using meta-analysis based on independent US survey replications. Public health officials and policy analysts now can use these benchmark estimates from 2002–2011 for planning, and in comparisons with newer estimates.

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1470. Epidemiology of Invasive Pneumococcal Disease (IPD) Following 18 years of Pneumococcal Conjugate Vaccine (PCV) Use in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1651 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S736-S737

Author(s):

Tamara Pilishvili ◽

Ryan Gierke ◽

Monica M Farley ◽

William Schaffner ◽

Ann Thomas ◽

...

Keyword(s):

United States ◽

Older Adults ◽

Genome Sequencing ◽

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

The United States ◽

Census Bureau ◽

Incidence Rates ◽

Whole Genome ◽

Vaccine Type

Abstract Background PCVs have been recommended for U.S. children since 2000. A 7-valent vaccine (PCV7) was introduced in 2000. This was replaced by a 13-valent vaccine (PCV13) in 2010. PCV13 was also recommended for adults aged ≥ 65 years in August 2014. We evaluated PCV impact on IPD. Methods IPD cases (isolation of pneumococcus from sterile sites) were identified through CDC’s Active Bacterial Core surveillance during 1998-2018. Isolates were serotyped by Quellung or whole genome sequencing and classified as PCV13-type and non-vaccine-type (NVT). Incidence rates (cases/100,000) were calculated using U.S. Census Bureau population denominators. Results From 1998 through 2018, overall IPD rates among children aged < 5 years decreased by 93% (from 95 to 7 cases/100,000). PCV13-type IPD decreased by 98% (from 88 to 2 cases/100,000). Among adults aged ≥ 65 years, overall IPD rates decreased by 60% (from 61 to 25 cases/100,000). PCV13-type IPD rates declined 86% (from 46 to 7 cases/100,000). Declines were most dramatic in the years following PCV7 introduction, with additional declines after PCV13 introduction in children (Figures 1 and 2). Serotypes 3, 19A, and 19F caused most of the remaining PCV13-type IPD. NVT IPD rates did not change significantly among children. Among adults aged 50-64 years, NVT IPD increased by 83% (from 6 to 12 cases/100,000) (p< 0.01). Among adults aged ≥ 65 years, NVT IPD increased by 22% (from 15 to 18 cases/100,000) (p< 0.01). The most common NVTs in 2018 were 22F (10% of all IPD), 9N (7%) and 15A (5%). Among children, the proportion of cases with meningitis increased from 5% to 14% (p< 0.01), and the proportion with pneumonia/empyema increased from 17% to 31% (p< 0.01). Among adults, the proportion of cases with meningitis did not change (3%), while the proportion with pneumonia/empyema increased from 72% to 76% (p=0.01). Figure 1: Incidence of invasive pneumococcal disease among children aged < 5 years, 1998-2018 Figure 2: Incidence of invasive pneumococcal disease among adults aged ≥ 65 years, 1998-2018 Conclusion Overall IPD incidence among children and adults decreased following PCV introduction for children, driven primarily by reductions in PCV-type IPD. NVT IPD increased in older adults, but these increases did not eliminate reductions from PCV13-type IPD. Disclosures Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)

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Social Isolation and Hospitalization Risk Factors Among Community-Dwelling Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.314 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 95-95

Author(s):

J Mary Louise Pomeroy ◽

Gilbert Gimm

Keyword(s):

United States ◽

Risk Factors ◽

Older Adults ◽

Social Isolation ◽

The United States ◽

Community Dwelling ◽

Psychosocial Risk ◽

Depression And Anxiety ◽

Socially Isolated ◽

Community Dwelling Older Adults

Abstract PURPOSE: This study examines psychosocial risk factors associated with hospitalization among community-dwelling older adults in the United States. METHODS: Using two waves of the National Health and Aging Trends Study from 2011 and 2015, we conducted descriptive and multivariate analyses of individual-level data from a nationally representative sample of 8,003 Medicare beneficiaries ages 65 and older. Associations between hospitalization and risk factors including social isolation, depression, and anxiety were assessed. Covariates included gender, race/ethnicity, age, region, insurance type, falls, and comorbidities. RESULTS: Overall, about 20.9% of older adults reported a hospitalization within the past year and 22.2% were socially isolated. The odds of hospitalization were higher for socially isolated adults (OR 1.17; p = .02), for depressed adults (OR 1.25; p = .01), and for individuals with anxiety (OR 1.25; p = .02). Individuals living in the Western region had lower odds of hospitalization (OR 0.71; p = .001), whereas men (OR 1.13; p = .03), those requiring assistance with activities of daily living (OR 1.48; p < .001), and those having one (OR 1.41; p = .03) or more (OR 3.05; p < .001) chronic health conditions had higher odds of hospitalization. CONCLUSION: Social isolation, depression, and anxiety represent significant psychosocial risk factors for hospitalization among community-dwelling older adults in the United States. Efforts to reduce health care costs and improve health outcomes for older adults should explore ways to strengthen social integration and improve mental health.

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Incidence and Risk Factors for Invasive Pneumococcal Disease and Community-acquired Pneumonia in Human Immunodeficiency Virus–Infected Individuals in a High-income Setting

Clinical Infectious Diseases ◽

10.1093/cid/ciz728 ◽

2019 ◽

Vol 71 (1) ◽

pp. 41-50 ◽

Cited By ~ 1

Author(s):

Hannah M Garcia Garrido ◽

Anne M R Mak ◽

Ferdinand W N M Wit ◽

Gino W M Wong ◽

Mirjam J Knol ◽

...

Keyword(s):

Risk Factors ◽

Human Immunodeficiency Virus ◽

General Population ◽

Confidence Interval ◽

Incidence Rate ◽

Pneumococcal Disease ◽

Incidence Rates ◽

Community Acquired Pneumonia ◽

Cd4 Counts ◽

Immunodeficiency Virus

Abstract Background Although people living with human immunodeficiency virus (PLWH) are at increased risk of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP), it is unclear whether this remains the case in the setting of early initiation of combination antiretroviral therapy (cART), at high CD4 cell counts. This is important, as pneumococcal vaccination coverage in PLWH is low in Europe and the United States, despite longstanding international recommendations. Methods We identified all CAP and IPD cases between 2008 and 2017 in a cohort of PLWH in a Dutch HIV referral center. We calculated incidence rates stratified by CD4 count and cART status and conducted a case-control study to identify risk factors for CAP in PLWH receiving cART. Results Incidence rates of IPD and CAP in PLWH were 111 and 1529 per 100 000 patient-years of follow-up (PYFU). Although IPD and CAP occurred more frequently in patients with CD4 counts <500 cells/μL (incidence rate ratio [IRR], 6.1 [95% confidence interval, 2.2–17] and IRR, 2.4 [95% confidence interval, 1.9–3.0]), the incidence rate in patients with CD4 counts >500 cells/μL remained higher compared with the general population (946 vs 188 per 100 000 PYFU). All IPD isolates were vaccine serotypes. Risk factors for CAP were older age, CD4 counts <500 cells/μL, smoking, drug use, and chronic obstructive pulmonary disease. Conclusions The incidence of IPD and CAP among PLWH remains higher compared with the general population, even in those who are virally suppressed and have high CD4 counts. With all serotyped IPD isolates covered by pneumococcal vaccines, our study provides additional argumentation against the poor current adherence to international recommendations to vaccinate PLWH.

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149 Falls in the United States: Magnitude, Risk, Disparities, and Solutions

Age and Ageing ◽

10.1093/ageing/afz164.149 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv34-iv39

Author(s):

Matthew Lee Smith ◽

Edgar Vieira ◽

Angelica Herrera-Venson ◽

Kathleen Cameron

Keyword(s):

United States ◽

Older Adults ◽

Older Adult ◽

Fall Prevention ◽

Prevention Programs ◽

The United States ◽

Incidence Rates ◽

Gis Mapping ◽

Isolated Populations ◽

National Network

Abstract In the United States, falls incidence rates remain steady among older adults (those age 65 years and older), which highlights the need for effective interventions to prevent falls and manage fall-related risks. Falls are the leading cause of unintentional injury and injury-related disability and deaths among older adults (29,668 deaths, 61.6/100,000, in the US in 2016), and the rate of fall-related deaths among older adults increased 31% from 2007 to 2016. In the United States, an older adult goes to an emergency room due to a fall every 11 seconds (3 million visits per year), and an older adult dies from a fall-related injury every 19 minutes. In response to this issue, the Administration for Community Living (ACL) and other governmental agencies have dedicated large sums of funding to initiate and support fall prevention and management efforts in clinical and community settings. As part of the solution, ACL supported 40 grantees to deliver eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) from 2010-2016. During that time, this ongoing initiative has reached 45,812 participants in 22 states by delivering 3,755 workshops. The majority of workshops were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). This presentation will use geographic information system (GIS) mapping to geospatially depict the dissemination of these programs as well as highlights their impact on fall-related outcomes. Additionally, models of clinical and community collaboration for fall prevention will be described, which shows the importance of leveraged resources, seamless referral systems, and timely feedback channels. Further, policy initiatives and a national network of state-based fall prevention coalitions will be described to coordinate and integrate efforts across clinical, community, corporate, and academic settings. Lastly, strategies will be shared to diversify the delivery infrastructure for fall prevention programs and incorporate technological options for isolated populations and those without access to preventive services.

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Future of Cancer Incidence in the United States: Burdens Upon an Aging, Changing Nation

Journal of Clinical Oncology ◽

10.1200/jco.2008.20.8983 ◽

2009 ◽

Vol 27 (17) ◽

pp. 2758-2765 ◽

Cited By ~ 983

Author(s):

Benjamin D. Smith ◽

Grace L. Smith ◽

Arti Hurria ◽

Gabriel N. Hortobagyi ◽

Thomas A. Buchholz

Keyword(s):

United States ◽

Older Adults ◽

Cancer Incidence ◽

The United States ◽

Census Bureau ◽

Incidence Rates ◽

Population Projections ◽

Demographic Changes ◽

Younger Adults ◽

The Impact

Purpose By 2030, the United States' population will increase to approximately 365 million, including 72 million older adults (age ≥ 65 years) and 157 million minority individuals. Although cancer incidence varies by age and race, the impact of demographic changes on cancer incidence has not been fully characterized. We sought to estimate the number of cancer patients diagnosed in the United States through 2030 by age and race. Methods Current demographic-specific cancer incidence rates were calculated using the Surveillance Epidemiology and End Results database. Population projections from the Census Bureau were used to project future cancer incidence through 2030. Results From 2010 to 2030, the total projected cancer incidence will increase by approximately 45%, from 1.6 million in 2010 to 2.3 million in 2030. This increase is driven by cancer diagnosed in older adults and minorities. A 67% increase in cancer incidence is anticipated for older adults, compared with an 11% increase for younger adults. A 99% increase is anticipated for minorities, compared with a 31% increase for whites. From 2010 to 2030, the percentage of all cancers diagnosed in older adults will increase from 61% to 70%, and the percentage of all cancers diagnosed in minorities will increase from 21% to 28%. Conclusion Demographic changes in the United States will result in a marked increase in the number of cancer diagnoses over the next 20 years. Continued efforts are needed to improve cancer care for older adults and minorities.

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Hip Fracture-Related Mortality among Older Adults in the United States: Analysis of the CDC WONDER Multiple Cause of Death Data, 1999–2013

Epidemiology Research International ◽

10.1155/2016/8970259 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Carlos H. Orces

Keyword(s):

United States ◽

Older Adults ◽

Hip Fracture ◽

Cause Of Death ◽

The United States ◽

Mortality Rates ◽

Online Data ◽

Annual Percent Change ◽

Death Record ◽

Related Mortality

Objectives. To examine trends in hip fracture-related mortality among older adults in the United States between 1999 and 2013. Material and Methods. The Wide-Ranging Online Data for Epidemiological Research system was used to identify adults aged 65 years and older with a diagnosis of hip fracture reported in their multiple cause of death record. Joinpoint regression analyses were performed to estimate the average annual percent change in hip fracture-related mortality rates by selected characteristics. Results. A total of 204,254 older decedents listed a diagnosis of hip fracture on their death record. After age adjustment, hip fracture mortality rates decreased by −2.3% (95% CI, −2.7%, and −1.8%) in men and −1.5% (95% CI, −1.9%, and −1.1%) in women. Similarly, the proportion of in-hospital hip fracture deaths decreased annually by −2.1% (95% CI, −2.6%, and −1.5%). Of relevance, the proportion of cardiovascular diseases reported as the underlying cause of death decreased on average by −4.8% (95% CI, −5.5%, and −4.1%). Conclusions. Hip fracture-related mortality decreased among older adults in the United States. Downward trends in hip fracture-related mortality were predominantly attributed to decreased deaths among men and during hospitalization. Moreover, improvements in survival of hip fracture patients with greater number of comorbidities may have accounted for the present findings.

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