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

Genus ◽  
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.

Diagnostic accuracy of CERAD total score in a Colombian cohort with mild cognitive impairment and Alzheimer's disease affected by E280A mutation on presenilin-1 gene

2015 ◽  
Vol 28 (3) ◽  
pp. 503-510 ◽  
Author(s):  
Daniel Camilo Aguirre-Acevedo ◽  
Fabian Jaimes-Barragán ◽  
Eliana Henao ◽  
Victoria Tirado ◽  
Claudia Muñoz ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
High Education ◽  
Mild Cognitive Impairment ◽  
Diagnostic Accuracy ◽  
Education Level ◽  
Presenilin 1 ◽  
Education Group ◽  
Low Education

ABSTRACTBackground:This study aimed to determine Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychological Assessment Battery total score diagnostic accuracy in the diagnosis of mild cognitive impairment (MCI) and dementia in familial Alzheimer's disease (FAD) with E280A mutation on presenilin-1 gene (PSEN1).Methods:A cross-sectional study was conducted in a cohort of PSEN1 E280A carriers and non-carriers assessed between January 1995 and February 2013. During the first neuropsychological assessment, 76 were having dementia, 46 had MCI, and 1,576 were asymptomatic. CERAD cut-off points were established for MCI and dementia using a Receiver Operating Characteristics (ROC) analysis, and were further analyzed according to education level in two groups: low education level (eight years or less), and high education level (over eight years).Results:The area under curve–ROC CERAD total score for dementia was 0.994 (95% CI = 0.989–0.999), and that for MCI was 0.862 (95% CI = 0.816–0.908). The dementia diagnosis cut-off point for the low education group was 54, (98.4% sensitivity, 92.6% specificity), and that for the high education group was 67 (100% sensitivity, 94.1% specificity). The MCI diagnosis cut-off point for the low education group was 66 (91.2% sensitivity, 56.4% specificity), and that for the high education group was 72 (91.7% sensitivity, 76.3% specificity).Conclusions:The CERAD total score is a useful screening tool for dementia and MCI in a population at risk of FAD.

scholarly journals Changing Educational Gradients in Life Expectancy With and Without Disease Among U.S. Older Adults From 2000 to 2010

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 505-505
Author(s):  
Matthew Farina ◽  
Phillip Cantu ◽  
Mark Hayward
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Chronic Diseases ◽  
Population Aging ◽  
Good Health ◽  
Vital Statistics ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
Education Group ◽  
Education Groups

Abstract Recent research has documented increasing education inequality in life expectancy among U.S. adults; however, much is unknown about other health status changes. The objective of study is to assess how healthy and unhealthy life expectancies, as classified by common chronic diseases, has changed for older adults across education groups. Data come from the Health and Retirement Study and National Vital Statistics. We created prevalence-based life tables using the Sullivan method to assess sex-specific life expectancies for stroke, heart disease, cancer, and arthritis by education group. In general, unhealthy life expectancy increased with each condition across education groups. However, the increases in unhealthy life expectancy varied greatly. While stroke increased by half a year across education groups, life expectancy with diabetes increased by 3 to 4 years. In contrast, the evidence for healthy life expectancy provides mixed results. Across chronic diseases, healthy life expectancy decreased by 1 to 3 years for respondents without a 4-year degree. Conversely, healthy life expectancy increased for the college educated by .5 to 3 years. While previous research shows increases in life expectancy for the most educated, trends in life expectancy with chronic conditions is less positive: not all additional years are in lived in good health. In addition to documenting life expectancy changes across education groups, research assessing health of older adults should consider the changing inequality across a variety of health conditions, which will have broad implications for population aging and policy intervention.

scholarly journals Education Level as a Predictor of Survival in Patients with Multiple Myeloma

2020 ◽  
Author(s):  
Limei Xu ◽  
Xiuju Wang ◽  
Xueyi Pan ◽  
Xiaotao Wang ◽  
Qing Wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Education ◽  
Rural Areas ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Education Level ◽  
Low Education ◽  
Education Levels ◽  
Better Than

Abstract Background: Disparities in multiple myeloma (MM) prognosis based on sociodemographic factors may exist. We investigated whether education level at diagnosis influenced Chinese MM patient outcomes.Methods: We performed a multicenter retrospective analysis of data from 773 MM patients across 9 centers in China from 2006 to 2019. Sociodemographic and clinical factors at diagnosis and treatment regimens were recorded, and univariate and multivariate analyses were performed.Results: Overall, 69.2% of patients had low education levels. Patients with low education levels differed from those with high education levels in that they were more likely to be older, and a higher proportion lived in rural areas, were unemployed, had lower annual incomes and lacked insurance. Additionally, compared to patients with high education levels, patients with low education levels had a higher proportion of international staging system (ISS) stage III classification and elevated lactate dehydrogenase (LDH) levels and underwent transplantation less often. Patients with high education levels had a median progression-free survival (PFS) of 67.50 (95% confidence interval (CI): 51.66-83.39) months, which was better than that of patients with low education levels (30.60 months, 95% CI: 27.38-33.82, p<0.001). Similarly, patients with high education levels had a median overall survival (OS) of 122.27 (95% CI: 117.05-127.49) months, which was also better than that of patients with low education levels (58.83 months, 95% CI: 48.87-62.79, p<0.001). In the multivariable analysis, patients with high education levels had lower relapse rates and higher survival rates than did those with low education level in terms of PFS and OS (hazard ratio (HR)=0.50 [95% CI: 0.34-0.72], p<0.001; HR=0.32 [0.19-0.56], p<0.001, respectively).Conclusions: Low education levels may independently predict poor survival in MM patients in China.

scholarly journals Education Level as a Predictor of Survival in Patients with Multiple Myeloma

2020 ◽  
Author(s):  
Limei Xu ◽  
Xiuju Wang ◽  
Xueyi Pan ◽  
Xiaotao Wang ◽  
Qing Wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Education ◽  
Rural Areas ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Staging System ◽  
Education Level ◽  
Rank Test ◽  
Low Education ◽  
Education Levels

Abstract Background Disparities in multiple myeloma (MM) prognosis based on sociodemographic factors may exist. We investigated whether education level at diagnosis influenced Chinese MM patient outcomes.Methods We performed a multicenter retrospective analysis of data from 773 MM patients across 9 centers in China from 2006 to 2019. Sociodemographic and clinical factors at diagnosis and treatment regimens were recorded, and univariate and multivariate analyses were performed. Results Overall, 69.21% of patients had low education levels. Patients with low education levels differed from those with high education levels in that they were more likely to be older, and a higher proportion lived in rural areas, were unemployed, had lower annual incomes and lacked insurance. Additionally, compared to patients with high education levels, patients with low education levels had a higher proportion of international staging system (ISS) stage III classification and elevated lactate dehydrogenase (LDH) levels and underwent transplantation less often. Patients with high education levels had better progression-free survival (PFS) and overall survival (OS) than did patients with low education levels (67.50±8.10 versus 30.60±1.64 months; 122.27±0 versus 55.83±3.55 months, log-rank test, p<0.001; respectively). In the multivariable analysis, patients with high education levels had lower relapse and mortality rates than did those with low education level in terms of PFS and OS (hazard ratio (HR)=0.50 [95% confidence interval (CI): 0.34-0.72], p<0.001; HR=0.31 [0.18-0.53], p<0.001, respectively). Conclusions Low education levels may independently predict poor survival in MM patients in China. To reduce healthcare disparities for universal healthcare reform, it is critical to improve citizens’ education levels.

Education Exerts Different Effects on Cognition in Individuals with Subjective Cognitive Decline and Cognitive Impairment: A Population-Based Study

2020 ◽  
pp. 1-9
Author(s):  
Guanqun Chen ◽  
Mingyan Zhao ◽  
Kun Yang ◽  
Hua Lin ◽  
Chunlei Han ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
High Education ◽  
Cognitive Decline ◽  
Educational Level ◽  
Population Based ◽  
Education Level ◽  
Subjective Cognitive Decline ◽  
Population Based Study ◽  
Low Education ◽  
Positive Effect

Background: Education plays a potential important effect on the prevalence and incidence of dementia. However, most of the evidence based on convenience sampling. Objective: To explore effects of education on cognition in individuals with subjective cognitive decline (SCD) and cognitive impairment (CI) from a population-based study. Methods: We examined the effect of education on cognition among individuals with SCD (n = 451) and CI (n = 280) from a population-based study. A series of neuropsychological tests of memory, executive, language, and general cognitive function were used to assess the participants. Results: Multiple regression analyses revealed that education has a positive effect on cognition in both SCD and CI group in the population-based research. Further stratification study showed that the beneficial effect of education remains in the SCD group regardless of the education level, especially in the SCD participants with a low education level. However, that effect of education exists in the CI group with a low education level and disappears in the high education level. Conclusion: These results from a population-based sample suggest that high educational attainment may delay cognitive decline in the individuals with SCD regardless of high or low educational level, and high education only predicts cognition in those in the low educational level in CI group.

scholarly journals Inequalities in Life Expectancy by Education and Its Changes in Lithuania during 2001–2014

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 245
Author(s):  
Olga Mesceriakova-Veliuliene ◽  
Ramune Kalediene ◽  
Skirmante Sauliune ◽  
Gvidas Urbonas
Keyword(s):  
Secondary Education ◽  
Life Expectancy ◽  
Educational Background ◽  
Post Secondary Education ◽  
Level Of Education ◽  
Post Secondary ◽  
Education Group ◽  
Males And Females ◽  
Education Groups

Background and Objectives: Reduction of health inequalities is a highly important task in public health policies worldwide. In Lithuania, inequalities in life expectancy (LE) by education level are among the greatest, compared to other European countries. However, studies on inequalities in LE by level of education over a long-term period are quite scarce in Lithuania. The aim of the study was to analyze inequalities in life expectancy by education and its changes in Lithuania during 2001–2014. Materials and Methods: Information on deaths (in population aged ≥30 years) was obtained from Statistics Lithuania. Life expectancy at age 30 (LE30) and 95% confidence intervals (CIs) were calculated using life tables. Inequalities in LE30 were assessed using rate differences. Joinpoint regression analysis was used to assess the trends and inequalities of LE30 during 2001–2014. Results: During 2001–2014, LE30 in males and females with post-secondary education was higher than in those with up-to-secondary education (p < 0.05). Among males and females, LE30 increased in both education groups, except for males with up-to-secondary education. Among individuals with post-secondary education, LE30 started increasing earlier and more quickly than in those with up-to-secondary education. Over the analyzed period, greater differences in LE30 between post-secondary and up-to-secondary education groups were found among males. Differences in LE30 due to different educational background were statistically significantly, increasing across the sexes with a more rapid increase for females than for males. During 2001 and 2014, the highest number of years of LE30 lost in both education groups was due to cardiovascular diseases. Conclusions: Throughout the period of 2001–2014, life expectancy in Lithuania in the post-secondary education group was statistically significantly longer and was increasing more rapidly compared to the up-to secondary education group. Inequalities in life expectancy by level of education significantly increased among both males and females.

Premorbid Educational Attainment and Long-Term Motor Prognosis in Parkinson’s Disease

2021 ◽  
pp. 1-8
Author(s):  
Seong Ho Jeong ◽  
Seok Jong Chung ◽  
Han Soo Yoo ◽  
Jin Ho Jung ◽  
Kyoungwon Baik ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
High Education ◽  
Educational Attainment ◽  
Linear Mixed Model ◽  
De Novo ◽  
Freezing Of Gait ◽  
Education Group ◽  
Low Education

Background: Premorbid educational attainment is a well-known proxy of reserve, not only with regard to cognition, but also to motor symptoms. Objective: In the present study, we investigated the relationship between educational attainment and long-term motor prognosis in patients with Parkinson’s disease (PD). Methods: We analyzed 466 patients with de novo PD without dementia who underwent dopamine transporter (DAT) scans and were followed up more than 2 years. Patients were divided into three groups: low education (years-of-education ≤6, n = 125), intermediate education (6 <years-of-education <  12, n = 108), and high education (years-of-education ≥12, n = 233). The effects of educational attainment on the development of levodopa-induced dyskinesia (LID), wearing-off, and freezing-of-gait, and longitudinal increase in levodopa-equivalent doses (LEDs) were assessed. Results: Multiple regression analysis showed that higher education was associated with milder parkinsonian symptoms after adjusting for DAT availability in the posterior putamen. Survival analysis showed that the rate of LID was significantly lower in the high education group than in the low education group (HR = 0.565, p = 0.010). A linear mixed model showed that the high education group had lower LED than the low education group until a period of 30 months; however, this difference in LED was not observed thereafter. Conclusion: The present study demonstrated that premorbid educational attainment has protective effects on the development of LID in patients with PD and has sparing effects on LED during the early treatment period. These results suggest that high educational attainment has a beneficial effect on motor outcomes in patients with PD.

Abstract P306: Combined Impact Of Income And Education On All-Cause And Cardiovascular Mortality In Men And Women. Prospective Results From The Moli-Sani Study.

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Marialaura Bonaccio ◽  
Augusto Di Castelnuovo ◽  
Simona Costanzo ◽  
Mariarosaria Persichillo ◽  
Maria Benedetta Donati ◽  
...  
Keyword(s):  
High Education ◽  
Low Income ◽  
Cardiovascular Mortality ◽  
Reference Group ◽  
High Income ◽  
Men And Women ◽  
Education Group ◽  
Low Education ◽  
Combined Impact ◽  
Overall Mortality

Background: Education and income have been reportedly associated with mortality but their combined impact has not been extensively investigated. This study aims at evaluating the combined impact of income and education on overall and cardiovascular mortality in men and women. Methods: A prospective cohort study on a large sample of individuals (N=20,600, age ≥35) free from cardiovascular or cancer disease randomly enrolled in the Moli-sani study. The cohort was followed-up for overall mortality for 6.8 years (median 4.3 years). Education was considered as low (≤8 years of study) or high (>8 years). Low income group was defined as gross income ≤25,000euros/year while high income category included subjects reporting >25,000euro/years. A four-level variable was constructed to account for the combination of the two measurements: a) low income and low education group (reference group); b) high income and low education; c) low income and high education; d) high income and high education group. Hazard ratios were calculated using Cox-proportional hazard models. Results: During follow-up, 354 all-cause deaths occurred, 61 from cardiovascular causes. In a fully adjusted model, income, but not education, was significantly associated with a reduction of overall mortality. However, the group having both high income and high education levels showed a reduced risk of 54%(HR=0.46; 95CI: 0.32-0.66) compared to the reference group. Cardiovascular mortality was also reduced by 63%. Analyses stratified by sex showed that the highest combination of income and education had a stronger impact on overall mortality among women (HR=0.27; 95CI: 0.10-0.79) than among men (HR=0.50; 95CI:0.34-0.76). Conclusions: The combination of high education and high income is associated with a consistent significant reduction of either overall or cardiovascular mortality. The protective effect of the combination is apparent in both genders but is stronger in women than in men.

A Novel Computational Proxy for Characterizing Cognitive Reserve in Alzheimer’s Disease

2020 ◽  
Vol 78 (3) ◽  
pp. 1217-1228
Author(s):  
Ying Zhang ◽  
Yajing Hao ◽  
Lang Li ◽  
Kai Xia ◽  
Guorong Wu ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
High Education ◽  
Statistical Model ◽  
Socioeconomic Factors ◽  
Cognitive Reserve ◽  
Demographic Data ◽  
Education Group ◽  
Low Education ◽  
And Gender

Background: Although the abnormal depositions of amyloid plaques and neurofibrillary tangles are the hallmark of Alzheimer’s disease (AD), converging evidence shows that the individual’s neurodegeneration trajectory is regulated by the brain’s capability to maintain normal cognition. Objective: The concept of cognitive reserve has been introduced into the field of neuroscience, acting as a moderating factor for explaining the paradoxical relationship between the burden of AD pathology and the clinical outcome. It is of high demand to quantify the degree of conceptual cognitive reserve on an individual basis. Methods: We propose a novel statistical model to quantify an individual’s cognitive reserve against neuropathological burdens, where the predictors include demographic data (such as age and gender), socioeconomic factors (such as education and occupation), cerebrospinal fluid biomarkers, and AD-related polygenetic risk score. We conceptualize cognitive reserve as a joint product of AD pathology and socioeconomic factors where their interaction manifests a significant role in counteracting the progression of AD in our statistical model. Results: We apply our statistical models to re-investigate the moderated neurodegeneration trajectory by considering cognitive reserve, where we have discovered that 1) high education individuals have significantly higher reserve against the neuropathology than the low education group; however, 2) the cognitive decline in the high education group is significantly faster than low education individuals after the level of pathological burden increases beyond the tipping point. Conclusion: We propose a computational proxy of cognitive reserve that can be used in clinical routine to assess the progression of AD.

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