Transitions of disability, disability-free life expectancy and health insurance among adults aged 50 and older in Mexico: a multistate life table analysis

ObjectivesTo analyse the transitions of disability onset and recovery, estimate life expectancy (LE) with and without disability and explore the relation between insurance and disability patterns in the population aged 50+ in Mexico.DesignMultistate life table analysis of data from a longitudinal cohort survey.SettingData came from the Mexican Health and Aging Study, a longitudinal and representative survey of older adults in Mexico.Participants10 651 individuals aged 50+ interviewed in 2012 and 2015, including those who died between waves.Primary and secondary outcome measuresDisability is measured using the activities of daily living (ADL) scale. Transition rates between disability free, ADL disabled and death were employed to estimate total life expectancy (TLE) and disability-free life expectancy (DFLE).Results46% of the individuals who reported an ADL limitation in 2012 recover from disability by 2015. TLE at age 60 for people without ADL limitations is 30 years (95% CI 28.9 to 31), out of which 4.7 years (95% CI 4.1 to 5.4) are lived with ADL limitations, while TLE at age 60 in the initially disabled is 18.7 years (95% CI 17.3 to 20), with 9.4 years (95% CI 8.4 to 10.3) lived with disability. DFLE at age 60 in people with social security is 24.2 years (95% CI 23.3 to 25.2), in people with public insurance is 24.6 years (95% CI 23.7 to 25.4) and in uninsured people is 26.9 years (95% CI 25.9 to 27.9).ConclusionsIn Mexico, a substantial proportion of ADL disabled individuals recover from disability. Nevertheless, initially disabled individuals have a considerably lower DFLE regardless of age when compared with initially active individuals. There appeared to be no differences in terms of disability and LEs between the individuals with social security and public insurance.

Effect of Different Plants on the Growth and Reproduction of Thrips flavus (Thysanoptera: Thripidae)

Host plants play an important role in affecting insect development and reproduction. Understanding the host plant preferences is important for pest control. Thrips flavus Schrank (Thysanoptera: Thripidae) is a worldwide phytophagous pest in Palearctic Asian and European countries. We used a life table analysis to study the development duration, population parameters, and population growth of T. flavus on five plant species, including Solanum melongena (Solanaceae), Capsicum annuum (Solanaceae), Glycine max (Leguminosae), Brassica rapa var. glabra (Cruciferae), and Cucumis sativus (Cucurbitaceae). The results showed that T. flavus can survive and reproduce on Cu. sativus and G. max, which were two potentially suitable host plants. T. flavus preferred to oviposit on Cu. sativus with a shorter duration of development (17.8 days) at 25 °C. Therefore, the host plant was an important factor influencing the development and fecundity of T. flavus populations. These results will improve our understanding of the population dynamics of T. flavus and facilitate the development of more scientific and efficient measures to control thrips.

Continuation Rates of the 52-mg Levonorgestrel-releasing Intrauterine System according to the Primary Reason for its Use

Objective To evaluate whether continuation rates with the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone. Methods A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis. Results Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group. Conclusion The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.

Estimation of the Distribution of Duration of Breastfeeding from Cross-Sectional Data: Some Methodological Issue

Background: Duration of breastfeeding is an important health indicator of mother and child. There are various indirect epidemiological methods available to estimate the duration of breastfeeding from cross sectional data. Objective: To estimate the distribution of duration of breastfeeding at national level cross sectional data and compare various available technique. The impact of the sampling frame (ascertain of the individual understudy) is also evaluated. Method: National Family Health Survey (NFHS-IV) data is used. Duration of breastfeeding of only those children who were born before 60 months from survey date were included in the study. The technique of Current Status Data, Life Table Analysis, and Kaplan Meier (KM) estimator is applied to assess the distribution of duration of breastfeeding. Result: The mean estimate is 32.84, 33.14 and 33.64 months by Kaplan Maier Estimator, Current Status Data and Life Table Analysis respectively. The Current Status and Life Table method are better than Kaplan Meier Estimator as it is doesn’t based on recall data and heaping present in the data. Conclusion: One must be very cautions while estimating the various epidemiological parameters from cross section data set. The assumptions of the methodology as per data available should be evaluate. If such data is not available, the available methodology may be modified. Regression analysis based on Current Status data technique may be used to assess the impact of various clinical and epidemiological factors (such as nutrition of mother, health status of mother etc.) on duration of breastfeeding

Ethnic Disparities in Stillbirth Risk in Yunnan, China: A Prospective Cohort Study, 2010-2018

Background: Racial and ethnic disparities in stillbirth risk had been documented in most western countries, but it remains unknown in China. This study was to determine whether exist ethnic disparities in stillbirth risk in mainland China. Methods: Data came from 217,070 pregnancies of Yunnan China during 2010-2018 year. The Han majority and other four main minorities including Yi, Dai, Miao, Hani were investigated in the analysis. The stillbirth hazards were estimated by life-table analysis. The excess stillbirth risk (ESR) was computed for Chinese minorities in multiple logistic regression. Results: Compared with other four minorities, women in Han majority were more likely to more educated, less multiparous, and less occupied in agriculture. The pattern of stillbirth hazard of Dai women across different gestation intervals were found to be different from other ethnic groups, especially in 20-23 weeks with 3.2 times higher than Han women. The ESR of the Dai, Hani, Miao, and Yi were 45.05%, 18.70%, -4.17% and 12.28%, respectively. Adjusted for maternal age, education, parity and other general risk factors, the ethnic disparity still persisted between Dai women and Han women. Adjusted for preterm birth further (gestation age <37 weeks) can reduce 19.39% ESR of Dai women and made the disparity insignificant. Maternal diseases and congenital anomalies explained little for ethnic disparities.Conclusions: We identified the ethnic disparity in stillbirth risk between Dai women and Han women. General risk factors including sociodemographic factors and maternal diseases explained little. Considerable ethnic disparities can be attributed to preterm birth.

Secular trends of sustained remission in rheumatoid arthritis, a nationwide study in Sweden

Objectives The aim of this study of patients with RA in Sweden was to investigate secular trends in achieving sustained remission (SR), i.e. DAS28 <2.6 on at least two consecutive occasions and lasting for at least 6 months. Methods All adult RA patients registered in the Swedish Rheumatology Quality register through 2012, with at least three registered visits were eligible, a total of 29 084 patients. Year of symptom onset ranged from 1955, but for parts of the analysis only patients with symptom onset between 1994 and 2009 were studied. In total, 95% of patients fulfilled the ACR 1987 classification criteria for RA. Odds of reaching SR for each decade compared with the one before were calculated with logistic regression and individual years of symptom onset were compared with life table analysis. Results Of patients with symptom onset in the 1980s, 1990s and 2000s, 35.0, 43.0 and 45.6% reached SR, respectively (P < 0.001 for each increment), and the odds of SR were higher in every decade compared with the one before. The hazard ratio for reaching SR was 1.15 (95% CI 1.14, 1.15) for each year from 1994 to 2009 compared with the year before. Five years after symptom onset in 2009, 45.3% of patients had reached SR compared with 15.9% in 1999. Conclusion There is a clear secular trend towards increased incidence of SR in patients with RA in Sweden. This trend most likely reflects earlier diagnosis and treatment start, and adherence to national and international guidelines recommending the treat to target approach.