Managing Mortality Risk With Longevity Bonds When Mortality Rates Are Cointegrated

Summary. In 168 male diabetics aged 40-64 years participating in the Whitehall Study, ten-year age adjusted mortality rates were significantly higher than in non-diabetics for all causes, coronary heart disease, all cardiovascular disease and, in addition, causes other than cardiovascular. Mortality rates were not significantly related to known duration of the diabetes. The predictive effects of several major mortality risk factors were similar in diabetics and non-diabetics. Excess mortality rates in the diabetics could not be attributed to differences in levels of blood pressure or any other of the major risk factors measured. Key words: diabetics; mortality rates; risk factors; coronary heart disease. There are many studies documenting higher mortality rates - particularly from cardiovascular disease -in diabetics compared with age and sex matched diabetics from the same population (see Jarrett et al. (1982) for review). However, there is sparse information relating potential risk factors to subsequent mortality within a diabetic population, information which might help to explain the increased mortality risk and also suggest preventive therapeutic approaches. In the Whitehall Study, a number of established diabetics participated in the screening programme and data on mortality rates up to ten years after screening are available. We present here a comparison of diabetics and non-diabetics in terms of relative mortality rates and the influence of conventional risk factors as well as an analysis of the relationship between duration of diabetes and mortality risk.

Download Full-text

Estimates of mortality rates in people with diabetes and cardiovascular disease using administrative pharmaceutical data

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1166 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Shaun Purkiss ◽

Tessa Keegel ◽

Hassan Vally ◽

Dennis Wollersheim

Keyword(s):

Cardiovascular Disease ◽

Mortality Risk ◽

Age Groups ◽

Mortality Rates ◽

World Health ◽

Data Set ◽

Medication Discontinuation ◽

Disease Mortality ◽

Health Organization

BackgroundQuantifying the mortality risk for people with diabetes is challenging because of associated comorbidities. The recording of cause specific mortality from accompanying cardiovascular disease in death certificate notifications has been considered to underestimate the overall mortality risk in persons with diabetes. Main AimDevelop a technique to quantify mortality risk from pharmaceutical administrative data and apply it to persons diagnosed with diabetes, and associated cardiovascular disease and dyslipidaemia before death. MethodsPersons with diabetes, cardiovascular disease and dyslipidaemia were identified in a publicly available Australian Pharmaceutical data set using World Health Organization anatomic therapeutic codes assigned to medications received. Diabetes associated multi-morbidity cohorts were constructed and a proxy mortality (PM) event determined from medication and service discontinuation. Estimates of mortality rates were calculated from 2004 for 10 years and compared persons with diabetes alone and associated cardiovascular disease and dyslipidemia. ResultsThis study identified 346,201 individuals within the 2004 calendar year as having received treatments for diabetes (n=51,422), dyslipidaemia (n=169,323) and cardiovascular disease including hypertension (n=280,105). Follow up was 3.3 x 106 person-years. Overall crude PM was 26.1 per 1000 person-years. PM rates were highest in persons with cardiovascular disease and diabetes in combination (47.5 per 100 person years). Statin treatments significantly improved the mortality rates in all persons with diabetes and cardiovascular disease alone and in combination over age groups >44 years (p<.001). Age specific diabetes PM rates using pharmaceutical data correlated well with Australian data from the National Diabetes Service Scheme (r=0.82) ConclusionProxy mortality events calculated from medication discontinuation in persons with chronic conditions can provide an alternative method to estimate disease mortality rates. The technique also allows the assessment of mortality risk in persons with chronic disease multi-morbidity.

Download Full-text

THE STUDY OF RUSSIAN CIVILIAN AVIATION PILOTS’ MORTALITY

10.31089/978-5-6042929-2-1-2021-1-82-86 ◽

2021 ◽

Author(s):

I.V. Bukhtiyarov ◽

◽

E.V. Zibarev ◽

K.V. Betts

Keyword(s):

Working Conditions ◽

Mortality Risk ◽

Age Groups ◽

Mortality Rates ◽

Russian Population ◽

Standardized Mortality Ratio ◽

Long Term Effects ◽

Specific Mortality ◽

Aviation Pilots

Abstract. Introduction. The work of civilian aviation pilots is characterized by heavy psychological and emotional stress in combination with other occupational factors. Such complex of adverse working conditions appears to be a risk for functional and somatic disorders, which may subsequently be reflected in the causes and rates of mortality in the distant period. The aim of this work is to study the mortality of retired civilian aviation pilots. Methods. A prospective cohort epidemiological study of civilian aviation pilots’ mortality. The cohort included 4513 male civilian aviation pilots of Russia who completed their employment and received employment pension. The follow-up period was 10 years (01.01.2010-31.12.2019), with 22156.9 person-years obtained. The age-specific mortality rates were calculated for 5-year age groups, the mortality risk was assessed using standardized mortality ratio (SMR) with 95% confidence interval (95% CI). The comparison group was the male Russian population. Results. As of 31.12.2019, out of 4513 civilian aviation pilots, 150 people deceased (3.3%). The age-specific mortality rates in the retired pilots’ cohort were lower in all age groups compared to the male Russian population, except for the 35-39 age group. The all-cause mortality risk for civilian aviation pilots was significantly lower compared to the male Russian population, SMR=0.31 (95%CL 0.26-0.36). Conclusion. Further research is required to determine the long-term effects of working conditions on civilian aviation pilots’ health. The follow-up period for the pilots’ cohort should be increases to 20 years and more.

Download Full-text

Mortality by colon, lung, esophagus, prostate, cervix and breast cancers in Brazilian capitals, 2000 to 2015: a multilevel analysis

10.21203/rs.2.11916/v1 ◽

2019 ◽

Author(s):

NÁDIA CRISTINA PINHEIRO RODRIGUES ◽

Gisele O’Dwyer ◽

Mônica Kramer de Noronha Andrade ◽

Denise Leite Maia Monteiro ◽

Inês Reis Nascimento Reis ◽

...

Keyword(s):

Mortality Risk ◽

Cancer Mortality ◽

Fixed Effects ◽

Mortality Rates ◽

Lung Cancers ◽

Esophageal Cancers ◽

Risk Of Death ◽

Colon Cancers ◽

Significant Difference ◽

Risk Of Cancer

Abstract Background. In Brazil, cancer is the second most common cause of death, and the most incident types of cancer are prostate, breast, lung, colon and rectum. This study aimed to analyze the role of period, geographic and socio demographic factors in cancer-related mortality by prostate, breast, cervix, colon, lung and esophagus cancer in Brazilians capitals from 2000 to 2015. Methods. Data from 2005-2015 cancer mortality and resident population were collected from Information Technology Department of the Brazilian Unified Health System (DATASUS), the Brazilian Institute of Geography and Statistics (IBGE) and the Brazilian Mortality Information (SIM). State capitals were the study’s analytic units. A multilevel Poisson model was used to estimate the adjusted risk of cancer mortality (prostate, breast, cervix, colon, lung and esophageal cancers). The adjusted models included the following variables as fixed effects: age, Gross Domestic Product, region, year squared and year of death. Results. A statistically significant difference was found between mortality rates by gender for colon, lung and esophageal cancers. The highest mortality rates were observed in the older age group, especially for prostate and lung cancers, which values were higher than 100 deaths per 100,000. Comparing with those aged 40-59 years, men older than 59 years showed 47 times higher mortality risk for prostate cancer, 8-9 times higher for lung or colon cancers and four times higher for esophageal cancer. Compared with those aged 40-59 years, women older than 59 years old showed 5-7 times higher mortality risk for esophageal, lung or colon cancers and 2-3 times higher for breast or cervix cancers. Conclusions. Colon cancer mortality rate increased from 2000 to 2015 for both genders, while breast and lung cancers mortality increased over the period only for women. In both genders, the highest mortality risk for lung and esophageal cancers was observed in Southern capitals. Northern capitals had a lower risk of death by prostate and breast cancer and a higher risk of death by cervix cancer.

Download Full-text

Emphysematous cystitis: mortality, risk factors, and pathogens of a rare disease

Clinics and Practice ◽

10.4081/cp.2017.930 ◽

2017 ◽

Vol 7 (2) ◽

Cited By ~ 10

Author(s):

Andreas Schicho ◽

Christian Stroszczynski ◽

Philipp Wiggermann

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Mortality Rate ◽

Mortality Risk ◽

Conservative Management ◽

Mortality Rates ◽

Emphysematous Pyelonephritis ◽

Emphysematous Cystitis ◽

The Mean ◽

High Degree

Although high mortality rates have been reported for emphysematous pyelonephritis (EP), information on emphysematous cystitis (EC), which is less common, is sparse. Here, we report one new case of severe EC and 136 cases of EC that occurred between 2007 and 2016, and review information about the characteristics, diagnosis, treatment and mortality of these patients, and the pathogens found in these patients. The mean age of the 136 patients was 67.9±14.2 years. Concurrent emphysematous infections of other organs were found in 21 patients (15.4%), with emphysematous pyelonephritis being the most common of these infections. The primary pathogen identified was <em>Escherichia coli</em> (54.4%). Patients were mainly treated by conservative management that included antibiotics (n=105; 77.2%). Ten of the 136 patients with EC died, yielding a mortality rate of 7.4%. Despite the relatively low mortality rate of EC compared with that of EP, a high degree of suspicion must be maintained to facilitate successful and conservative management.

Download Full-text

Comparability of Mortality Estimates from Social Surveys and Vital Statistics Data in the United States

10.31235/osf.io/x9f5y ◽

2019 ◽

Author(s):

Dustin C Brown ◽

Joseph Lariscy ◽

Lucie Kalousova

Keyword(s):

Mortality Risk ◽

General Social Survey ◽

The United States ◽

Mortality Rates ◽

Vital Statistics ◽

National Death Index ◽

Social Survey ◽

Social Surveys ◽

Cox Proportional Hazard Models ◽

Mortality Estimates

Social surveys prospectively linked with death records provide invaluable opportunities for the study of the relationship between social and economic circumstances and mortality. Although survey-linked mortality files play a prominent role in U.S. health disparities research, it is unclear how well mortality estimates from these datasets align with one another and whether they are comparable with U.S. vital statistics data. We conduct the first study that systematically compares mortality estimates from several widely-used survey-linked mortality files and U.S. vital statistics data. Our results show that mortality rates and life expectancies from the National Health Interview Survey Linked Mortality Files, Health and Retirement Study, Americans’ Changing Lives study, and U.S. vital statistics data are similar. Mortality rates are slightly lower and life expectancies are slightly higher in these linked datasets relative to vital statistics data. Compared with vital statistics and other survey-linked datasets, General Social Survey-National Death Index life expectancy estimates are much lower at younger adult ages and much higher at older adult ages. Cox proportional hazard models regressing all-cause mortality risk on age, gender, race, educational attainment, and marital status conceal the issues with the General Social Survey-National Death Index that are observed in our comparison of absolute measures of mortality risk. We provide recommendations for researchers who use survey-linked mortality files.

Download Full-text

Predicting Outcome in Mechanically Ventilated Pediatric Patients

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-3400962 ◽

2019 ◽

Vol 09 (02) ◽

pp. 092-098

Author(s):

Selman Kesici ◽

Şenay Kenç ◽

Ayşe Filiz Yetimakman ◽

Benan Bayrakci

Keyword(s):

Respiratory Failure ◽

Mortality Risk ◽

Pediatric Patients ◽

Oxygenation Index ◽

Mortality Rates ◽

Mechanically Ventilated ◽

Risk Of Mortality ◽

Predicting Outcome ◽

Expected Mortality ◽

Pediatric Index Of Mortality

AbstractTo apply and determine whether standardized mortality scores are appropriate to predict the risk of mortality in mechanically ventilated pediatric patients, 150 patients were retrospectively evaluated. Pediatric risk of mortality (PRISM) III-24 and pediatric index of mortality (PIM)-2 scores were unable to discriminate survivors and nonsurvivors; the observed mortality rate was lower than expected mortality rates. Oxygenation index (OI) was calculated at 0, 12, 24, and 72 hours of ventilation. OI-12 and OI-72 were found to be higher in nonsurvivors. PRISM III-24 and PIM-2 scores failed to predict mortality risk in mechanically ventilated pediatric patients. OI can be used to predict degree of respiratory failure and mortality risk.

Download Full-text

Personalized estimation of one-year mortality risk after elective hip or knee arthroplasty for osteoarthritis

Bone and Joint Research ◽

10.1302/2046-3758.911.bjr-2020-0343.r1 ◽

2020 ◽

Vol 9 (11) ◽

pp. 808-820

Author(s):

Lea Trela-Larsen ◽

Gard Kroken ◽

Christoffer Bartz-Johannessen ◽

Adrian Sayers ◽

Parham Aram ◽

...

Keyword(s):

Knee Arthroplasty ◽

Mortality Risk ◽

Clinical Information ◽

Mortality Rates ◽

Joint Arthroplasty ◽

Individual Risk ◽

First Year ◽

Joint Registry ◽

Risk Of Death ◽

One Year

Aims To develop and validate patient-centred algorithms that estimate individual risk of death over the first year after elective joint arthroplasty surgery for osteoarthritis. Methods A total of 763,213 hip and knee joint arthroplasty episodes recorded in the National Joint Registry for England and Wales (NJR) and 105,407 episodes from the Norwegian Arthroplasty Register were used to model individual mortality risk over the first year after surgery using flexible parametric survival regression. Results The one-year mortality rates in the NJR were 10.8 and 8.9 per 1,000 patient-years after hip and knee arthroplasty, respectively. The Norwegian mortality rates were 9.1 and 6.0 per 1,000 patient-years, respectively. The strongest predictors of death in the final models were age, sex, body mass index, and American Society of Anesthesiologists grade. Exposure variables related to the intervention, with the exception of knee arthroplasty type, did not add discrimination over patient factors alone. Discrimination was good in both cohorts, with c-indices above 0.76 for the hip and above 0.70 for the knee. Time-dependent Brier scores indicated appropriate estimation of the mortality rate (≤ 0.01, all models). Conclusion Simple demographic and clinical information may be used to calculate an individualized estimation for one-year mortality risk after hip or knee arthroplasty ( https://jointcalc.shef.ac.uk ). These models may be used to provide patients with an estimate of the risk of mortality after joint arthroplasty. Cite this article: Bone Joint Res 2020;9(11):808–820.

Download Full-text

Variable annuities and aggregate mortality risk

National Institute Economic Review ◽

10.1177/002795011623700117 ◽

2016 ◽

Vol 237 ◽

pp. R55-R61 ◽

Cited By ~ 4

Author(s):

Martin Weale ◽

Justin van de Ven

Keyword(s):

Relative Risk ◽

Risk Aversion ◽

Mortality Risk ◽

Mortality Rates ◽

Risk Averse ◽

Actual Cost ◽

Relative Risk Aversion ◽

Variable Annuities ◽

Actual Mortality ◽

Specific Mortality

This paper explores the extent to which annuitants might be prepared to pay for protection against cohort-specific mortality risk, by comparing traditional indexed annuities with annuities whose payout rates are revised in response to differences between expected and actual mortality rates of the cohort in question. It finds that a man aged 65 with a coefficient of relative risk aversion of two would be prepared to pay 75p per £100 annuitised for protection against aggregate mortality risk while a man with risk aversion of twenty would be prepared to pay £5.75 per £100; studies put the actual cost at £2.70–£7 per £100, suggesting that unless annuitants are very risk averse it is likely that existing products tend to over-insure against cohort mortality risk.

Download Full-text

Derivation and Validation of Clinical Prediction Models for Rapid Risk Stratification for Time-Sensitive Management for Acute Heart Failure

Journal of Clinical Medicine ◽

10.3390/jcm9113394 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3394

Author(s):

Yasuyuki Shiraishi ◽

Shun Kohsaka ◽

Takayuki Abe ◽

Toshiyuki Nagai ◽

Ayumi Goda ◽

...

Keyword(s):

Heart Failure ◽

Risk Stratification ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Mortality Risk ◽

Mortality Rates ◽

Validation Dataset ◽

Stepwise Logistic Regression ◽

Early Presentation ◽

C Statistic

Early and rapid risk stratification of patients with acute heart failure (AHF) is crucial for appropriate patient triage and outcome improvements. We aimed to develop an easy-to-use, in-hospital mortality risk prediction tool based on data collected from AHF patients at their initial presentation. Consecutive patients’ data pertaining to 2006–2017 were extracted from the West Tokyo Heart Failure (WET-HF) and National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure (NaDEF) registries (n = 4351). Risk model development involved stepwise logistic regression analysis and prospective validation using data pertaining to 2014–2015 in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure Syndrome (REALITY-AHF) (n = 1682). The final model included data describing six in-hospital mortality risk predictors, namely, age, systolic blood pressure, blood urea nitrogen, serum sodium, albumin, and natriuretic peptide (SOB-ASAP score), available at the time of initial triage. The model showed excellent discrimination (c-statistic = 0.82) and good agreement between predicted and observed mortality rates. The model enabled the stratification of the mortality rates across sixths (from 14.5% to <1%). When assigned a point for each associated factor, the integer score’s discrimination was similar (c-statistic = 0.82) with good calibration across the patients with various risk profiles. The models’ performance was retained in the independent validation dataset. Promptly determining in-hospital mortality risks is achievable in the first few hours of presentation; they correlate strongly with mortality among AHF patients, potentially facilitating clinical decision-making.

Download Full-text