Impact of diagnostic accuracy on the estimation of excess mortality from incidence and prevalence: simulation study and application to diabetes in German men

Aggregated data about the prevalence and incidence of chronic conditions is becoming more and more available. We recently proposed a method to estimate the age-specific excess mortality in chronic conditions from aggregated age-specific prevalence and incidence data. Previous works showed that in age groups below 50 years, estimates from this method were unstable or implausible. In this article, we examine how limited diagnostic accuracy in terms of sensitivity and specificity affects the estimates. We use a simulation study with two settings, a low and a high prevalence setting, and assess the relative importance of sensitivity and specificity. It turns out that in both settings, specificity, especially in the younger age groups, dominates the quality of the estimated excess mortality. The findings are applied to aggregated claims data comprising the diagnoses of diabetes from about 35 million men in the German Statutory Health Insurance. Key finding is that specificity in the lower age groups (<50 years) can be derived without knowing the sensitivity. The false-positive ratio in the claims data increases linearly from 0.5 per mil at age 25 to 2 per mil at age 50. As a conclusion, our findings stress the importance of considering diagnostic accuracy when estimating excess mortality from aggregated data using the method to estimate excess mortality. Especially the specificity in the younger age-groups should be carefully taken into account.

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Diagnostic accuracy of ultrasonography with laparoscopy for assessment of benign adnexal masses

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20196035 ◽

2019 ◽

Vol 9 (1) ◽

pp. 283

Author(s):

Vinita Sarbhai ◽

Medha Yadav

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Ovarian Cyst ◽

Imaging Modality ◽

Age Groups ◽

Serous Cystadenoma ◽

Histopathological Diagnosis ◽

Adnexal Masses ◽

Adnexal Pathology ◽

Rule Out

Background: Adnexal masses are one of the most common pathologies among women of all age groups. Objective of this study was to assess efficacy of ultrasonography in diagnosing adnexal pathology, rule out malignancy and its comparison with laparoscopy and pathology results.Methods: A total 32 women with benign adnexal mass were evaluated by clinical examination, ultrasonography and laparoscopy. Findings of ultrasound were compared with laparoscopy and histopathology reports and diagnostic accuracy was calculated.Results: Sensitivity of USG in diagnosing simple ovarian cyst is 20% and specificity is 88.9% while laparoscopy has sensitivity of 100% and specificity of 94.4%. USG versus laparoscopy has sensitivity of 50% versus 100% and specificity of 94.1% versus 100% in diagnosing endometrioma. Sensitivity of USG in diagnosing dermoid cyst is 66.7% and specificity is 95% while laparoscopy has both sensitivity and specificity of 100%. USG and laparoscopy, both have 100% sensitivity and specificity in diagnosing ectopic pregnancy, para-ovarian cyst and TO abscess. Benign serous cystadenoma is a histopathological diagnosis and is missed by both laparoscopy and ultrasonography.Conclusions: Ultrasonography should be the primary imaging modality used to identify and characterize adnexal masses, as it is readily available, and noninvasive.

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Excess Mortality Associated With COVID-19 by Demographic Group: Evidence From Florida and Ohio

Public Health Reports ◽

10.1177/00333549211041550 ◽

2021 ◽

pp. 003335492110415

Author(s):

Troy Quast ◽

Ross Andel

Keyword(s):

Excess Mortality ◽

Prediction Interval ◽

National Level ◽

Age Groups ◽

Black Population ◽

Infection Rates ◽

Black Adults ◽

Demographic Groups ◽

Younger Age ◽

Excess Deaths

Objective COVID-19 mortality varies across demographic groups at the national level, but little is known about potential differences in COVID-19 mortality across states. The objective of this study was to estimate the number of all-cause excess deaths associated with COVID-19 in Florida and Ohio overall and by sex, age, and race. Methods We calculated the number of weekly and cumulative excess deaths among adults aged ≥20 from March 15 through December 5, 2020, in Florida and Ohio as the observed number of deaths less the expected number of deaths, adjusted for population, secular trends, and seasonality. We based our estimates on death certificate data from the previous 10 years. Results The results were based on ratios of observed-to-expected deaths. The ratios were 1.17 (95% prediction interval, 1.14-1.21) in Florida and 1.15 (95% prediction interval, 1.11-1.19) in Ohio. Although the largest number of excess deaths occurred in the oldest age groups, in both states the ratios of observed-to-expected deaths were highest among adults aged 20-49 (1.21; 95% prediction interval, 1.11-1.32). The ratio of observed-to-expected deaths for the Black population was especially elevated in Florida. Conclusions Although excess deaths were largely concentrated among older cohorts, the high ratios of observed-to-expected deaths among younger age groups indicate widespread effects of COVID-19. The high levels of observed-to-expected deaths among Black adults may reflect in part disparities in infection rates, preexisting conditions, and access to care. The finding of high excess deaths among Black adults deserves further attention.

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Errata ao artigo “Estimativa do Excesso de Mortalidade Durante a Pandemia COVID-19: Dados Preliminares Portugueses”, publicado em Acta Med Port 2020 Jun;33(6):376-383

Acta Médica Portuguesa ◽

10.20344/amp.14041 ◽

2020 ◽

Vol 33 (6) ◽

pp. 450

Author(s):

Paulo Jorge Nogueira ◽

Miguel De Araújo Nobre ◽

Paulo Jorge Nicola ◽

Cristina Furtado ◽

António Vaz Carneiro

Keyword(s):

Protective Effect ◽

Excess Mortality ◽

Age Groups ◽

Older Age ◽

Younger Age ◽

Summer Holiday ◽

Overall Mortality

Article published with errors: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13928On page 376, in Abstract, paragraph Results, where it reads: ”Despite the inherent uncertainty, it is safe to assume an observed excess mortality of 2400 to 4000 deaths. Excess mortality was associated with older age groups (over age 65).”It should read: “An excess mortality of 2400 to 4000 deaths was observed. Excess mortality was associated with older age groups (over age 65).”On page 376, in Abstract, paragraph Conclusion, where it reads: ”The excess mortality occurred between March 1 and April 22 was 3 to 5 fold higher than what can be explained by the official COVID-19 deaths.”It should read: “Despite the inherent uncertainty, the excess mortality occurred between March 1 and April 22 could be 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths.”On page 376, in Resumo, paragraph Conclusão, where it reads: “Da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril foi 3 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.”It should read: “Apesar da incerteza inerente, da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril poderá ter sido 3,5 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.”On page 377, last line of the first paragraph, where it reads: “If the lockdown had some protective effect on overall mortality, like summer holiday months seem to have, these effects may be observed some, if not all, age groups.”It should read: “If the lockdown had some protective effect on overall mortality, like summer holiday months seem to have, these effects may be observed in all age groups.”On page 377, section Results, third paragraph, last sentence where it reads: “Mortality in the younger age groups was, on average, below the proposed baselines, as hypothesized.”It should read: “Mortality in the younger age groups was, on average, lower than the proposed baselines as theorized.”On page 382, section Conclusion, last sentence, where it reads: “Overall, these results point towards an excess mortality that is associated with and that is 3 to 5-fold higher than the official COVID-19 mortality.” It should read: “Overall, these results point towards an excess mortality that is associated with and that could be 3.5- to 5-fold higher than the official COVID-19 mortality.” Artigo publicado com erros: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13928Na página 376, no Abstract, parágrafo Results, onde se lê: “Despite the inherent uncertainty, it is safe to assume an observed excess mortality of 2400 to 4000 deaths. Excess mortality was associated with older age groups (over age 65).”Deverá ler-se: “An excess mortality of 2400 to 4000 deaths was observed. Excess mortality was associated with older age groups (over age 65).”Na página 376, no Abstract, parágrafo Conclusion, onde se lê: “The excess mortality occurred between March 1 and April 22 was 3 to 5 fold higher than what can be explained by the official COVID-19 deaths."Deverá ler-se: “Despite the inherent uncertainty, the excess mortality occurred between March 1 and April 22 could be 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths.”Na página 376, no Resumo, parágrafo Conclusão, onde se lê: “Da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril foi 3 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.”Deverá ler-se: “Apesar da incerteza inerente, da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril poderá ter sido 3,5 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.”Na página 377, na última linha do primeiro parágrafo, onde se lê: “If the lockdown had some protective effect on overall mortality, like summer holiday months seem to have, these effects may be observed some, if not all, age groups.”Deverá ler-se: “If the lockdown had some protective effect onoverall mortality, like summer holiday months seem to have, these effects may be observed in all age groups.”Na página 377, secção Resultados, terceiro parágrafo última frase, onde se lê: “Mortality in the younger age groups was, on average, below the proposed baselines, as hypothesized.”Deverá ler-se: “Mortality in the younger age groups was, on average, lower than the proposed baselines as theorized.”Na página 382, secção Conclusion, última frase, onde se lê: “Overall, these results point towards an excess mortality that is associated with and that is 3 to 5-fold higher than the official COVID-19 mortality.”Deverá ler-se: “Overall, these results point towards an excess mortality that is associated with and that could be 3.5- to 5-fold higher than the official COVID-19 mortality.”

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Mortality Studies in Unskilled and Semi-Skilled Workers in Denmark

Scandinavian Journal of Social Medicine ◽

10.1177/140349488201000302 ◽

1982 ◽

Vol 10 (3) ◽

pp. 77-80 ◽

Cited By ~ 1

Author(s):

Elsebeth Lynge ◽

Bernard Jeune

Keyword(s):

Excess Mortality ◽

Census Data ◽

Age Groups ◽

Skilled Workers ◽

Younger Age

Results from two Danish studies on mortality among male unskilled and semi-skilled workers are compared. The first study is based on union data, the second study on census data. Apparently conflicting results are found to be identical after making adjustment for differences in the study populations and standard populations. The male unskilled and semi-skilled workers have an excess mortality in the younger age groups which decreases with increasing age.

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Frailty differences across population characteristics associated with health inequality: a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA)

BMJ Open ◽

10.1136/bmjopen-2020-047945 ◽

2021 ◽

Vol 11 (7) ◽

pp. e047945

Author(s):

Lauren E Griffith ◽

Parminder Raina ◽

David Kanters ◽

David Hogan ◽

Christopher Patterson ◽

...

Keyword(s):

Longitudinal Study ◽

Health Inequalities ◽

Cognitive Deficits ◽

Chronic Conditions ◽

Age Groups ◽

Baseline Data ◽

Population Characteristics ◽

Cognitive Domain ◽

Cross Sectional ◽

Younger Age

ObjectiveTo evaluate the pattern of frailty across several of social stratifiers associated with health inequalities.Design, setting and participantsCross-sectional baseline data on 51 338 community-living women and men aged 45–85 years from the population-based Canadian Longitudinal Study on Aging (collected from September 2011 to May 2015) were used in this study.Primary outcomes and measuresA Frailty Index (FI) was constructed using self-reported chronic conditions, psychological function and cognitive status and physical functioning variables. Social stratifiers were chosen based on the Pan-Canadian Health Inequalities Reporting Initiative, reflecting key health inequalities in Canada. Unadjusted and adjusted FIs and domain-specific FIs (based on chronic conditions, physical function, psychological/cognitive deficits) were examined across population strata.ResultsThe overall mean FI was 0.13±0.08. It increased with age and was higher in women than men. Higher mean FIs were found among study participants with low income (0.20±0.10), who did not complete secondary education (0.17±0.09) or had low perceived social standing (0.18±0.10). Values did not differ by Canadian province of residence or urban/rural status. After simultaneously adjusting for population characteristics and other covariates, income explained the most heterogeneity in frailty, especially in younger age groups; similar patterns were found for men and women. The average frailty for people aged 45–54 in the lowest income group was greater than that for those aged 75–85 years. The heterogeneity in the FI among income groups was greatest for the psychological/cognitive domain.ConclusionsOur results suggest that especially in the younger age groups, psychological/cognitive deficits are most highly associated with both overall frailty levels and the gradient in frailty associated with income. If this is predictive of later increases in the other two domains (and overall frailty), it raises the question whether targeting mental health factors earlier in life might be an effective approach to mitigating frailty.

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Possible Relationship of Elderly Suicide Rates with Unemployment in Society: A Cross-National Study

Psychological Reports ◽

10.2466/pr0.102.2.398-400 ◽

2008 ◽

Vol 102 (2) ◽

pp. 398-400 ◽

Cited By ~ 11

Author(s):

Ajit Shah

Keyword(s):

Age Groups ◽

National Study ◽

Aggregated Data ◽

Suicide Rates ◽

Younger Age ◽

Elderly Suicide ◽

Cross National Study ◽

Relationship Of ◽

The Relationship ◽

Cross National

Analyses of individual and aggregated data have yielded an association between suicide and unemployment, particularly for men in younger age groups. Examination of the relationship of elderly suicide rates with measures of unemployment in a cross-national study of 27 countries did not produce any statistically significant association between these two variables. Also, the magnitude of the actual correlations was small. One reason for low magnitude of correlations may be better welfare systems in the studied countries which mainly reported medium and high income.

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Pooling European all-cause mortality: methodology and findings for the seasons 2008/2009 to 2010/2011

Epidemiology and Infection ◽

10.1017/s0950268812002580 ◽

2012 ◽

Vol 141 (9) ◽

pp. 1996-2010 ◽

Cited By ~ 11

Author(s):

J. NIELSEN ◽

A. MAZICK ◽

N. ANDREWS ◽

M. DETSIS ◽

T. M. FENECH ◽

...

Keyword(s):

Influenza A ◽

Excess Mortality ◽

National Level ◽

Age Groups ◽

Pooled Analysis ◽

European Countries ◽

Younger Age ◽

Influenza A H1n1 ◽

All Cause Mortality ◽

Fertile Women

SUMMARYSeveral European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the ‘summarized’ approach, data across countries were summarized and analysed as one overall country. In the ‘stratified’ approach, heterogeneities between countries were taken into account. Pooling using the ‘stratified’ approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe.

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Excess Deaths associated with the COVID-19 Pandemic in Ukraine in 2020

10.1101/2021.09.28.21264266 ◽

2021 ◽

Author(s):

Neil K. Mehta ◽

Ihor Honchar ◽

Olena Doroshenko ◽

Igor Brovchenko ◽

Khrystyna Pak ◽

...

Keyword(s):

Excess Mortality ◽

Age Groups ◽

European Countries ◽

List Type ◽

Younger Age ◽

Influenza Activity ◽

Expected Mortality ◽

The Impact ◽

Excess Deaths

AbstractCOVID-19 related mortality has been understudied in Ukraine. As part of a World Bank project, we estimated excess mortality in Ukraine during 2020. Data on all deaths registered in government-controlled Ukraine from 2016-2020 (N=2,946,505) were utilized. We predicted deaths in 2020 by five-year age groups, sex, and month and calculated the number of deaths that deviated from expected levels (excess deaths). We compared excess deaths with the number of recorded COVID-19 deaths on death certificates and with published estimates for 30 European countries. We estimated 38,095 excess deaths in 2020 (6% of all deaths). Death rates were above expected levels in February and from June-December and lower in January and March-May. From June-December, we estimated 52,124 excess deaths with a peak in November (16,891 deaths). COVID-19 recorded deaths were approximately one-third of excess deaths in June-December (18,959 vs. 52,124). Higher than expected mortality was detected for all age groups 40-44 years and above and for those ages 0-4, 15-19, and 20-24. Ukraine’s excess mortality was about average compared to 30 other European countries. Excess deaths may be attributed directly to SARS-COV2 infection or indirectly to death causes associated with social and economic upheavals resulting in from the pandemic. Lower than expected mortality during the early part of 2020 is consistent with low influenza activity and reductions in deaths from restricted movement. Further studies are required to examine the causes of death that have contributed to positive excess mortality, particularly among younger aged groups.Key MessagesUkraine has experienced sizeable changes in its recent demography and the impact of the COVID-19 pandemic on the country’s aggregate mortality patterns is understudiedBased on recent death trends, we found that Ukraine experienced lower than expected mortality during the early part of 2020 and consistently higher than expected mortality from June-December with peak levels occurring in NovemberPositive excess mortality was observed for all age groups beginning at ages 40-44 as well as some younger age groups.

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Fall-related injury among people with arthritis, a concern among different age groups!

Journal of Epidemiological Research ◽

10.5430/jer.v4n1p8 ◽

2017 ◽

Vol 4 (1) ◽

pp. 8

Author(s):

Diana C. Sanchez-Ramirez ◽

Allyson Jones ◽

Don Voaklander

Keyword(s):

Older Adults ◽

Community Health ◽

Age Groups ◽

Canadian Community Health Survey ◽

Aggregated Data ◽

Broken Bones ◽

Younger Age ◽

Community Health Survey ◽

Main Activity ◽

Type Of Injury

Background and objectives: The association between arthritis and falls has been study mainly in older adults, and information about fall-related injuries and arthritis in younger population is scarce. In addition, there is a gap of knowledge about the activities and types of injury associated with falls among people with arthritis in different age groups. The aims of the study were: 1) to explore the association between arthritis and fall-related injury among different age groups, and 2) to compare the main activity associated with fall-related injury and the type of injury resulted from falls between age groups in people with arthritis.Methods: This study used aggregated data from the Canadian Community Health Survey for the years 2001, 2003, 2005, 2009/2010 and 2013/2014.Results: People with arthritis were significantly more likely to report fall-related injuries than people without arthritis across all age groups. Younger people (12-19 years) were over six times more likely to fall when practicing sports, whereas all adults were more likely to slip/trip/stumble while walking. As a result of the falls, older adults (65 and over) were more likely to have broken bones and other kind of injuries (i.e., bruises, cuts, etc.), while all younger age groups reported more strains/sprains.Conclusion: Fall-related injury is a concern across all age groups in people with arthritis, and not only among older adults. In addition, the activities performed when the fall occurred and the type of injuries resulted from the falls were different between age groups. These findings contribute to reduce the gap of knowledge about fall-related injuries among people with arthritis in different age groups.

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