Changing effect of the numerator–denominator bias in unlinked data on mortality differentials by education: evidence from Estonia, 2000–2015

BackgroundThis study highlights changing disagreement between census and death record information in the reporting of the education of the deceased and shows how these reporting differences influence a range of mortality inequality estimates.MethodsThis study uses a census-linked mortality data set for Estonia for the periods 2000–2003 and 2012–2015. The information on the education of the deceased was drawn from both the censuses and death records. Range-type, Gini-type and regression-based measures were applied to measure absolute and relative mortality inequality according to the two types of data on the education of the deceased.ResultsThe study found a small effect of the numerator–denominator bias on unlinked mortality estimates for the period 2000–2003. The effect of this bias became sizeable in the period 2012–2015: in high education group, mortality was overestimated by 23–28%, whereas the middle education group showed notable underestimation of mortality. The same effect was small for the lowest education group. These biases led to substantial distortions in range-type inequality measures, whereas unlinked and linked Gini-type measures showed somewhat closer agreement.ConclusionsThe changing distortions in the unlinked estimates reported in this study warn that this type of evidence cannot be readily used for monitoring changes in mortality inequalities.

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Local mortality estimates during the COVID-19 pandemic in Italy

Journal of Population Economics ◽

10.1007/s00148-021-00857-y ◽

2021 ◽

Author(s):

Augusto Cerqua ◽

Roberta Di Stefano ◽

Marco Letta ◽

Sara Miccoli

Keyword(s):

Machine Learning ◽

Excess Mortality ◽

Control Method ◽

Local Level ◽

Supervised Machine Learning ◽

Machine Learning Techniques ◽

Mortality Data ◽

Official Method ◽

Learning Techniques ◽

Mortality Estimates

AbstractEstimates of the real death toll of the COVID-19 pandemic have proven to be problematic in many countries, Italy being no exception. Mortality estimates at the local level are even more uncertain as they require stringent conditions, such as granularity and accuracy of the data at hand, which are rarely met. The “official” approach adopted by public institutions to estimate the “excess mortality” during the pandemic draws on a comparison between observed all-cause mortality data for 2020 and averages of mortality figures in the past years for the same period. In this paper, we apply the recently developed machine learning control method to build a more realistic counterfactual scenario of mortality in the absence of COVID-19. We demonstrate that supervised machine learning techniques outperform the official method by substantially improving the prediction accuracy of the local mortality in “ordinary” years, especially in small- and medium-sized municipalities. We then apply the best-performing algorithms to derive estimates of local excess mortality for the period between February and September 2020. Such estimates allow us to provide insights about the demographic evolution of the first wave of the pandemic throughout the country. To help improve diagnostic and monitoring efforts, our dataset is freely available to the research community.

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Disaggregation of official demographic projections in sub-groups by education level: the neglected “composition effect” in the future path of life expectancy

Genus ◽

10.1186/s41118-020-00113-3 ◽

2021 ◽

Vol 77 (1) ◽

Author(s):

Sergio Ginebri ◽

Carlo Lallo

Keyword(s):

High Education ◽

Life Expectancy ◽

Education Level ◽

Retirement Age ◽

Composition Effect ◽

Education Group ◽

Population Forecasts ◽

Low Education ◽

Mortality Differential ◽

Education Groups

AbstractWe developed an innovative method to break down official population forecasts by educational level. The mortality rates of the high education group and low education group were projected using an iterative procedure, whose starting point was the life tables by education level for Italy, based on the year 2012. We provide a set of different scenarios on the convergence/divergence of the mortality differential between the high and low education groups. In each scenario, the demographic size and the life expectancy of the two sub-groups were projected annually over the period 2018–2065. We compared the life expectancy paths in the whole population and in the sub-groups. We found that in all of our projections, population life expectancy converges to the life expectancy of the high education group. We call this feature of our outcomes the “composition effect”, and we show how highly persistent it is, even in scenarios where the mortality differential between social groups is assumed to decrease over time. In a midway scenario, where the mortality differential is assumed to follow an intermediate path between complete disappearance in year 2065 and stability at the 2012 level, and in all the scenarios with a milder convergence hypothesis, our “composition effect” prevails over the effect of convergence for men and women. For instance, assuming stability in the mortality differential, we estimated a life expectancy increase at age 65 of 2.9 and 2.6 years for men, and 3.2 and 3.1 for women, in the low and high education groups, respectively, over the whole projection period. Over the same period, Italian official projections estimate an increase of 3.7 years in life expectancy at age 65 for the whole population. Our results have relevant implications for retirement and ageing policies, in particular for those European countries that have linked statutory retirement age to variations in population life expectancies. In all the scenarios where the composition effect is not offset by a strong convergence of mortality differentials, we show that the statutory retirement age increases faster than the group-specific life expectancies, and this finding implies that the expected time spent in retirement will shrink for the whole population. This potential future outcome seems to be an unintended consequence of the indexation rule.

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The biological effect of cage design corrected for reductions in spray penetration

Journal of Plant Protection Research ◽

10.2478/jppr-2014-0059 ◽

2014 ◽

Vol 54 (4) ◽

pp. 395-400 ◽

Cited By ~ 2

Author(s):

Bradley Keith Fritz ◽

Wesley Clint Hoffmann ◽

Jane Annalise Sara Bonds ◽

Keith Haas ◽

Zbigniew Czaczyk

Keyword(s):

Wind Tunnel ◽

Biological Effect ◽

Conversion Factor ◽

Mortality Data ◽

Data Set ◽

Spray Penetration ◽

Mosquito Mortality ◽

Insect Mortality ◽

Group Variation ◽

Penetration Data

Abstract In-field measures of physical spray concentration do not tend to correlate well with caged insect mortality data. This is partly due to the reduced penetration of the spray into the cage. Spray penetration is hindered by the structure of the cage. Wind tunnel studies were conducted to investigate the accuracy of those calculations developed to correct for filtration levels in caged mosquito bioassays. Zenivex E20 (Etofenprox) was applied at rates ranging from an LD10 to an LD90. Three cage types were used, each with different penetration levels. The dose approaching the cage was converted to the dose entering the cage using cage penetration data from previous research. The penetration conversion factor returned a data set that directly correlated dose with mosquito mortality (R2 = = 0.918). The mortality percent was a function of the dose within the cage. The mesh type acted as a regulator. Although the conversion factor was effective, the differences between cages was not always significant due to within-group variation.

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Births to Teens Older and Younger Than 17 Years in San Bernardino County and California

Californian Journal of Health Promotion ◽

10.32398/cjhp.v2i2.1730 ◽

2004 ◽

Vol 2 (2) ◽

pp. 20-27

Author(s):

Kofi Adade Boafo ◽

Bruce Smith ◽

Naomi N Modeste ◽

Thomas J Prendergast, Jr

Keyword(s):

Infant Mortality ◽

Very Low Birth Weight ◽

Age Groups ◽

Mortality Rates ◽

Teen Mothers ◽

Mortality Data ◽

San Bernardino County ◽

Low Birth Weight Infants ◽

Data Set ◽

San Bernardino

Objective: The purpose of this cohort, descriptive study was to attempt to understand the variables associated with discordant infant mortality among teenagers 17-19 years old whose infants demonstrated higher mortality than infants of teenagers who were younger than 17 years old in San Bernardino County, California. The intent was to elicit further research and/or define appropriate interventions for teen mothers within the age range 17-19 years. Methods: Data was abstracted from an electronic infant mortality data set, the State of California Birth Cohort File in which birth records from San Bernardino County for the period 1989 through 1993 were matched with mortality records. Results: The data showed that infants of white teens within the 17-19 age groups were more likely to have higher infant mortality rates when compared to their younger peers. Infant mortality rates among offspring of Hispanic and black teenage mothers showed no discrepancy between the two groups nor between county and state rates. Conclusions: Further study is needed to answer why infants of white teen mothers in the 17-19 age groups have higher mortality rates. There is also a need to review the services rendered to pregnant and parenting adolescents in San Bernardino County. In addition, very low birth weight infants were much more likely to die when born to older teens than when born to younger teens.

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Maternal Prenatal Anthropometry, High Education and Cesarean Delivery as Risk Factors for Low Gestational Age in Iran

Open Medicine Journal ◽

10.2174/1874220301603010077 ◽

2019 ◽

Vol 6 (1) ◽

pp. 77-82

Author(s):

Sorayya Kheirouri ◽

Mohammad Alizadeh ◽

Parvin Sarbakhsh

Keyword(s):

Risk Factors ◽

High Education ◽

Preterm Birth ◽

Cesarean Delivery ◽

Gestational Age ◽

Economic Status ◽

Cross Sectional ◽

Data Set ◽

Pregnancy Weight ◽

High Bmi

Background: Preterm birth is an important contributor to the global burden of disease. Evidence indicating that maternal health, nutritional and socioeconomic status may contribute to preterm birth. Objective: This cross-sectional study was conducted to describe the contribution of prenatal maternal factors on low gestational age, and to assess newborns anthropometric measurements regarding gestational age. Methods: Data of mothers delivering a singleton live infant (n= 759) and their newborns (n= 755) during the two years up to August 2014 were collected. Data were collected from the data set of eight public health centers which were chosen from different administrative regions of Tabriz city and were analyzed. Differences between the groups were assessed by Student’s t-test or one- way analysis of variance (ANOVA). Multiple linear regression was used to estimate the association between gestational age and variables studied. Results: Incidence of preterm birth was 2.1%. Percentage of infants with low birth weight and Head Circumference (HC) under 34 cm was significantly higher in the preterm group. Mean gestational age was lower in mothers with cesarean delivery, high education, high economic status, high BMI, pre-pregnancy weight ≥ 65 kg and medical problem. Gestational age was inversely associated with maternal pre-pregnancy weight ≥ 65 kg (B= -0.20, p= 0.02), high BMI (B= -0.33, p= 0.01), high education (B= -0.47, p= 0.002) and cesarean delivery (B= -0.74, p< 0.001). Conclusion: The results indicate that maternal anthropometric characteristics, education and type of delivery are associated with gestational age. Explorating potentially modifiable risk factors for unfavorable gestational age and integrating them into intervention efforts may ameliorate adverse birth outcomes.

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Syrian Civil War: a systematic review of trauma casualty epidemiology

BMJ Military Health ◽

10.1136/jramc-2019-001304 ◽

2020 ◽

pp. jramc-2019-001304

Author(s):

Joshua McIntyre

Keyword(s):

Civil War ◽

Mortality Rate ◽

Marked Change ◽

Future Research ◽

Common Mechanism ◽

Mortality Data ◽

Mechanism Of Injury ◽

Eligibility Criteria ◽

Data Set ◽

Syrian Civil War

BackgroundThe Syrian Civil War has caused over 400 000 traumatic deaths. Understanding the nature of war casualties is crucial to deliver healthcare improvement. Historic regional conflicts and Syrian mortality data have been characterised by blast injuries. The aim of this novel review is to assess the trauma epidemiology of Syrian Civil War casualties from the perspective of healthcare facilities.MethodsThis review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Studies addressing Syria, trauma and war were investigated. Eligibility criteria included being conducted from a healthcare facility, published in English and peer reviewed. The outcomes were demography, mechanism of injury and anatomical injury site.Results38 papers satisfied the eligibility criteria. 13 842 casualties were reported across the entire data set. Casualties were 88.8% male (n=4035 of 4544). Children contributed to 16.1% of cases (n=398 of 2469). Mortality rate was 8.6% (n=412 of 4774). Gunshot wound was the most common mechanism of injury representing 66.3% (n=7825 of 11799). Head injury was the most common injured site at 26.6% (n=719 of 2701).ConclusionsThis conflict has a distinct trauma profile compared with regional modern wars. The prevalence of gunshot wounds represents a marked change in mechanism of injury. This may be related to higher mortality rate and proportion of head injuries identified. This review cannot correlate mechanism of injury, demographics or injuries sustained to outcomes. The quality of data from the included studies lacked standardisation; future research and consistent reporting tools are required to enable further analysis.

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Influence of Department Volume on Survival for Ovarian Cancer: Results From a Prospective Quality Assurance Program of the Austrian Association for Gynecologic Oncology

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e31819915cb ◽

2009 ◽

Vol 19 (1) ◽

pp. 94-102 ◽

Cited By ~ 36

Author(s):

Christian Marth ◽

Sonja Hiebl ◽

Willi Oberaigner ◽

Raimund Winter ◽

Sepp Leodolter ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Quality Assurance ◽

Residual Disease ◽

Gynecologic Oncology ◽

Quality Assurance Program ◽

Birth Date ◽

Mortality Data ◽

Data Set ◽

Department Volume

Objective:The Austrian Association for Gynecologic Oncology initiated in 1998 a prospective quality assurance program for patients with ovarian cancer. The aim of this study was to evaluate factors predicting overall survival especially under consideration of department volume.Methods:All Austrian gynecological departments were invited to participate in the quality assurance program. A questionnaire was sent out that included birth date, histology, date of diagnosis, stage, and basic information on primary treatment. Description of comorbidity was not requested. Patient life status was assessed in a passive way. We did record linkage between each patient's name and birth date and the official mortality data set collected by Statistics Austria. No data were available on progression-free survival. Patients treated between January 1, 1999 and December 31, 2004 were included in the analysis. Mortality dates were available to December 31, 2006. Data were analyzed by means of classical statistical methods. Cut-off point for departments was 24 patients per year.Results:A total of 1948 patients were evaluable. Approximately 75% of them were treated at institutions with fewer than 24 new patients per year. Patient characteristics were grossly similar for both department types. Multivariate analysis confirmed established prognostic factors such as International Federation of Gynecologists and Obstetricians (FIGO) stage, lymphadenectomy, age, grading, and residual disease. In addition, we found small departments (<24 patients per year) to have a negative effect on overall survival (hazards ratio, 1.38: 95% confidence interval, 1.2-1.7; and P < 0.001).Conclusions:The results indicate that in Austria, rules prescribing minimum department case load can further improve survival for patients with ovarian cancer.

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Causes of Death Data in the Global Burden of Disease Estimates for Ischemic and Hemorrhagic Stroke

Neuroepidemiology ◽

10.1159/000441084 ◽

2015 ◽

Vol 45 (3) ◽

pp. 152-160 ◽

Cited By ~ 18

Author(s):

Thomas Truelsen ◽

Lars-Henrik Krarup ◽

Helle K. Iversen ◽

George A. Mensah ◽

Valery L. Feigin ◽

...

Keyword(s):

Literature Review ◽

Burden Of Disease ◽

Causes Of Death ◽

Hemorrhagic Stroke ◽

Age Groups ◽

Global Burden Of Disease ◽

Mortality Data ◽

Global Burden ◽

Stroke Mortality ◽

Mortality Estimates

Background: Stroke mortality estimates in the Global Burden of Disease (GBD) study are based on routine mortality statistics and redistribution of ill-defined codes that cannot be a cause of death, the so-called ‘garbage codes' (GCs). This study describes the contribution of these codes to stroke mortality estimates. Methods: All available mortality data were compiled and non-specific cause codes were redistributed based on literature review and statistical methods. Ill-defined codes were redistributed to their specific cause of disease by age, sex, country and year. The reassignment was done based on the International Classification of Diseases and the pathology behind each code by checking multiple causes of death and literature review. Results: Unspecified stroke and primary and secondary hypertension are leading contributing ‘GCs' to stroke mortality estimates for hemorrhagic stroke (HS) and ischemic stroke (IS). There were marked differences in the fraction of death assigned to IS and HS for unspecified stroke and hypertension between GBD regions and between age groups. Conclusions: A large proportion of stroke fatalities are derived from the redistribution of ‘unspecified stroke' and ‘hypertension' with marked regional differences. Future advancements in stroke certification, data collections and statistical analyses may improve the estimation of the global stroke burden.

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Global, regional and national burden of bladder cancer and its attributable risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019

BMJ Global Health ◽

10.1136/bmjgh-2020-004128 ◽

2021 ◽

Vol 6 (11) ◽

pp. e004128

Author(s):

Saeid Safiri ◽

Ali-Asghar Kolahi ◽

Mohsen Naghavi

Keyword(s):

Risk Factors ◽

Bladder Cancer ◽

Death Rate ◽

Attributable Risk ◽

Mortality Data ◽

Years Of Life Lost ◽

Death Rates ◽

Life Years ◽

Incident Cases ◽

Mortality Estimates

IntroductionThe current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from 1990 to 2019, by age, sex and sociodemographic index (SDI; a composite measure of sociodemographic factors).MethodsVarious data sources from different countries, including vital registration and cancer registries were used to generate estimates. Mortality data and incidence data transformed to mortality estimates using the mortality to incidence ratio (MIR) were used in a cause of death ensemble model to estimate mortality. Mortality estimates were divided by the MIR to produce incidence estimates. Prevalence was calculated using incidence and MIR-based survival estimates. Age-specific mortality and standardised life expectancy were used to estimate years of life lost (YLLs). Prevalence was multiplied by disability weights to estimate years lived with disability (YLDs), while disability-adjusted life years (DALYs) are the sum of the YLLs and YLDs. All estimates were presented as counts and age-standardised rates per 100 000 population.ResultsGlobally, there were 524 000 bladder cancer incident cases (95% uncertainty interval 476 000 to 569 000) and 229 000 bladder cancer deaths (211 000 to 243 000) in 2019. Age-standardised death rate decreased by 15.7% (8.6 to 21.0), during the period 1990–2019. Bladder cancer accounted for 4.39 million (4.09 to 4.70) DALYs in 2019, and the age-standardised DALY rate decreased significantly by 18.6% (11.2 to 24.3) during the period 1990–2019. In 2019, Monaco had the highest age-standardised incidence rate (31.9 cases (23.3 to 56.9) per 100 000), while Lebanon had the highest age-standardised death rate (10.4 (8.1 to 13.7)). Cabo Verde had the highest increase in age-standardised incidence (284.2% (214.1 to 362.8)) and death rates (190.3% (139.3 to 251.1)) between 1990 and 2019. In 2019, the global age-standardised incidence and death rates were higher among males than females, across all age groups and peaked in the 95+ age group. Globally, 36.8% (28.5 to 44.0) of bladder cancer DALYs were attributable to smoking, more so in males than females (43.7% (34.0 to 51.8) vs 15.2% (10.9 to 19.4)). In addition, 9.1% (1.9 to 19.6) of the DALYs were attributable to elevated fasting plasma glucose (FPG) (males 9.3% (1.6 to 20.9); females 8.4% (1.6 to 19.1)).ConclusionsThere was considerable variation in the burden of bladder cancer between countries during the period 1990–2019. Although there was a clear global decrease in the age-standardised death, and DALY rates, some countries experienced an increase in these rates. National policy makers should learn from these differences, and allocate resources for preventative measures, based on their country-specific estimates. In addition, smoking and elevated FPG play an important role in the burden of bladder cancer and need to be addressed with prevention programmes.

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Education-related inequalities in cause-specific mortality: First estimates for Australia using individual-level linked census and mortality data

10.1101/2020.09.21.20193516 ◽

2020 ◽

Author(s):

Jennifer Welsh ◽

Grace Joshy ◽

Lauren Morgan ◽

Kay Soga ◽

Hsei-Di Law ◽

...

Keyword(s):

High Education ◽

Causes Of Death ◽

Negative Binomial ◽

International Comparisons ◽

Negative Binomial Regression ◽

Medical Intervention ◽

Mortality Data ◽

Individual Level ◽

Specific Mortality ◽

Inequalities In Mortality

Background: Socioeconomic inequalities in mortality are evident in all high-income countries and ongoing monitoring is recommended using linked census-mortality data. Using such data, we provide first estimates of education-related inequalities in cause-specific mortality in Australia, suitable for international comparisons. Methods: Using Australian Census (2016) linked to 13-months of Death Registrations data (2016-17), we estimated relative rates (RR) and rate differences (RD, per100 000 person-years), comparing rates in low (no qualifications) and intermediate (secondary school) with high education (tertiary), for individual causes of death (among those 25-84y) and grouped according to preventability (25-74y), separately by sex and age group, adjusting for age, using negative binomial regression. Results: Among 13.9M people contributing 14 452 732 person-years, 84 743 deaths occurred. We observed inequalities in most causes of death for each age-sex group. Among men aged 25-44y, absolute and relative inequalities (low versus high education) were largest for injuries, e.g. transport accidents (RR=10.1 [95%CI: 5.4-18.7], RD=21.1 [15.9-26.3]). Among those aged 45-64y, inequalities were greatest for chronic diseases, e.g. lung cancer (men RR=6.6 [4.9-8.9], RD=55.6 [51.1-60.1]) and ischaemic heart disease (women RR=5.8 [3.7-9.1], RD=19.2 [17.0-21.5]), with similar patterns for people aged 65-84y. When grouped according to preventability, inequalities were large for causes amenable to behaviour change and medical intervention for all ages and causes amenable to injury prevention among young men. Conclusions: Australian education-related inequalities in mortality are substantial, generally higher than international estimates, and related to preventability. Findings highlight opportunities to reduce them and the potential to improve the health of the population.

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