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Qin Y, Tang C, Li J, Gong J. Liver cancer in China: the analysis of mortality and burden of disease trends from 2008 to 2021. BMC Cancer 2024; 24:594. [PMID: 38750424 PMCID: PMC11097423 DOI: 10.1186/s12885-024-12334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Liver cancer is one of the most common cancers in China. To understand the basic death situation and disease burden change trend, we analyze the death information of liver cancer among Chinese residents from 2008 to 2021. METHODS Data was collected from the Cause-of-Death Surveillance dataset of the National Cause-of-Death Surveillance System from 2008 to 2021. Excel 2016 was used for data entry and to calculate the Crude Mortality Rate (CMR), Age-Standardized Mortality Rate (ASMR), Potential Years of Life Lost (PYLL), and Potential Years of Life Lost Rate (PYLLR). SPSS 25.0 was used to statistically analyze CMR, ASMR, PYLL, and other indicators. Annual percent change (APC) and average APC(AAPC) was used for trend analysis and tested by t tests. Joinpoint 4.9.1.0 was used to calculate APC and AAPC. Age-Period-Cohort model was used to assess the effects of age, period, and birth cohort on liver cancer mortality. RESULTS From 2008 to 2021, 491,701 liver cancer deaths were reported in the National Disease Surveillance Points System. The ASMR of liver cancer in Chinese residents decreased from 27.58/100,000 in 2008 to 17.95/100,000 in 2021 at an average annual rate of 3.40% (t = -5.10, P < 0.001). The mortality rate was higher in males than in females (all P < 0.001) and higher in rural areas than in urban areas (all P < 0.001). The mortality rate of liver cancer varied significantly among eastern, central, and western China (all P < 0.001). The PYLLR of liver cancer in Chinese residents decreased from 2.89‰ in 2008 to 2.06‰ in 2021 at an average annual rate of 2.40% (t = -5.10, P < 0.001). Males had a lower PYLLR than females, decreasing at average annual rates of 2.20% (t = -5.40, P < 0.001) and 2.90% (t = -8.40, P < 0.001), respectively. Urban areas had a lower PYLLR than rural areas, decreasing at average annual rate of 3.30% (t = -4.00, P < 0.001) and 2.50% (t = -11.60, P < 0.001), respectively. Eastern, central, and western China decreased at average annual rates of 3.40%, 2.30%, and 2.10%, respectively (t = -7.80, -3.60, -7.10, P < 0.001 for all). The risk of China liver cancer mortality increased with age, decreased with birth cohort. CONCLUSIONS The mortality and disease burdens of liver cancer in China decreased yearly and were higher in males and in people living in rural areas, with significant differences among those living in eastern, central, and western China.
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Affiliation(s)
- Yajun Qin
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Changlin Tang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Jinhao Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Jianping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China.
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Ma ZR, Lin KQ, Guo H, Yang KY, Cao M, Song X, Jia HM, Hu YH, Yan YZ. Fatal, non-fatal burden of cancer in the elderly in China, 2005-2016: a nationwide registry-based study. BMC Public Health 2023; 23:877. [PMID: 37173657 PMCID: PMC10176703 DOI: 10.1186/s12889-023-15686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 04/16/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND As populations age, cancer burden becomes increasingly conspicuous. This study quantified the cancer burden of the elderly (≥ 60 years) in China, based on the China Cancer Registry Annual Report to provide epidemiological evidence for cancer prevention and control. METHODS Data on cancer cases and deaths among the elderly aged ≥ 60 years were collected from the China Cancer Registry Annual Report, 2008-2019. Potential years of life lost (PYLL) and disability-adjusted life years (DALY) were calculated to analyze fatalities and the non-fatal burden. The time trend was analyzed using the Joinpoint model. RESULTS From 2005 to 2016, the PYLL rate of cancer in the elderly was stable between 45.34‰ and 47.62‰, but the DALY rate for cancer decreased at an average annual rate of 1.18% (95% CI: 0.84-1.52%). The non-fatal cancer burden in the rural elderly was higher than that of the urban elderly. Lung, gastric, liver, esophageal, and colorectal cancers were the main cancers causing the cancer burden in the elderly, and accounted for 74.3% of DALYs. The DALY rate of lung cancer in females in the 60-64 age group increased (annual percentage change [APC] = 1.14%, 95% CI: 0.10-1.82%). Female breast cancer was one of the top five cancers in the 60-64 age group, with DALY rates that also increased (APC = 2.17%, 95% CI: 1.35-3.01%). With increasing age, the burden of liver cancer decreased, while that of colorectal cancer rose. CONCLUSIONS From 2005 to 2016, the cancer burden in the elderly in China decreased, mainly reflected in the non-fatal burden. Female breast and liver cancer were a more serious burden in the younger elderly, while colorectal cancer burden was mainly observed in the older elderly.
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Affiliation(s)
- Zhen-Rong Ma
- Department of Preventive Medicine, Medical College, Shihezi University, 129 Bei Er Road, Shihezi, 832002, China
| | - Kang-Qian Lin
- Department of Preventive Medicine, Medical College, Shihezi University, 129 Bei Er Road, Shihezi, 832002, China
| | - Hong Guo
- Department of Preventive Medicine, Medical College, Shihezi University, 129 Bei Er Road, Shihezi, 832002, China
| | - Kai-Yue Yang
- Department of Preventive Medicine, Medical College, Shihezi University, 129 Bei Er Road, Shihezi, 832002, China
| | - Miao Cao
- Department of Preventive Medicine, Medical College, Shihezi University, 129 Bei Er Road, Shihezi, 832002, China
| | - Xi Song
- Department of Preventive Medicine, Medical College, Shihezi University, 129 Bei Er Road, Shihezi, 832002, China
| | - Huai-Miao Jia
- Shihezi Municipal Center for Disease Control and Prevention, Shihezi, 832002, China
- Key Laboratory for Prevention and Control of Crucial Emerging Infectious Diseases and Public Health Security of The Xinjiang Production and Construction Corps, Xinjiang Production and Construction Corps, Shihezi, China
| | - Yun-Hua Hu
- Department of Preventive Medicine, Medical College, Shihezi University, 129 Bei Er Road, Shihezi, 832002, China
- Key Laboratory for Prevention and Control of Crucial Emerging Infectious Diseases and Public Health Security of The Xinjiang Production and Construction Corps, Xinjiang Production and Construction Corps, Shihezi, China
| | - Yi-Zhong Yan
- Department of Preventive Medicine, Medical College, Shihezi University, 129 Bei Er Road, Shihezi, 832002, China.
- Key Laboratory for Prevention and Control of Crucial Emerging Infectious Diseases and Public Health Security of The Xinjiang Production and Construction Corps, Xinjiang Production and Construction Corps, Shihezi, China.
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Kaur A, Wang S, Kumar A. Impact of racial disparities on potential years of life lost due to gynecologic cancer in the United States: Trends from 1975 to 2017 based on SEER database. Gynecol Oncol 2023; 170:266-272. [PMID: 36738485 DOI: 10.1016/j.ygyno.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION We assessed potential years of life lost (PYLL) in women secondary to gynecologic cancers (cervical, uterine, ovarian, vaginal, vulvar, and other) in the United States from 1975 to 2017 using SEER database. We also highlight racial disparities and economic costs of mortality from gynecologic malignancies. METHODS PYLL up to and including age 75 years were calculated [75 - (age at diagnosis + overall survival)] after stratifying for tumor site. Subgroup comparison was done using nonparametric method Kruskal-Wallis H with post-hoc analysis. Linear regression model was used to calculate every five-year incremental trends. Productivity losses were calculated using mortality data multiplied by age-adjusted estimated total lifetime productivity. RESULTS Total 304,995 patients were included with 1,472,152.67 PYLL from 1975 to 2017. Median PYLL for cervical cancer (12.58 years) was higher than other gynecologic malignancies (0.83, 6.00, 0.67 and - 0.25 years respectively for uterine, ovarian, vaginal and vulvar cancers). The median PYLL for Non-Hispanic White (NHW) population was lower than women from other racial groups for uterine, ovarian and vulvar cancers. From 1975 to 2017, median PYLL trend in the entire cohort showed a steady increment (p < 0.001, B1 = 1.65 years). Most rapid rise was noted in cervical cancer (p < 0.001, B1 = 2.68 years) and Hispanic population (p < 0.001, B1 = 1.92). Total productivity loss was $79 billion during 1975-2017 with maximum loss seen in uterine cancer and NHW population. CONCLUSION Ours is the first study to analyze PYLL in gynecologic malignancies and estimate productivity losses due to premature deaths. Data shows a clear trend pointing towards racial and ethnic disparities.
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Affiliation(s)
- Anahat Kaur
- Department of Hematology and Medical Oncology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, United States of America.
| | - Shuai Wang
- Department of Hematology and Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States of America
| | - Abhishek Kumar
- Department of Hematology and Medical Oncology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, United States of America
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Liu J, Cao H, Zhang Y, Chen H. Potential years of life lost due to PM 2.5-bound toxic metal exposure: Spatial patterns across 60 cities in China. Sci Total Environ 2022; 812:152593. [PMID: 34953837 DOI: 10.1016/j.scitotenv.2021.152593] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 05/17/2023]
Abstract
To clarify the spatial patterns of disease burden caused by toxic metals in fine particulate matter (PM2.5) across China, annual concentration levels of typical toxic metals in PM2.5 over 60 cities of China were retrieved. Then, potential years of life lost (PYLL) attributable to toxic metal (As, Cd, Cr (VI), Mn, and Ni) exposure was calculated from health risk assessments and lifetable estimates. The results show that Cr(VI) and As were the most polluted metals and greatly exceeded the recommended annual values in the National Ambient Air Quality Standard of China. PYLL for each death (mean ± standard deviation) of 19.8 ± 4.5 years was observed for lung cancer, followed closely by COPD and pneumonia. Furthermore, the PYLL rate (years per 100,000 people) attributable to exposure to these toxic metals was 457 (male: 505, female: 402) years for different cities; therein, Cr(VI) contributed the highest PYLL among these toxic metals, with a proportion of 72.7% (male: 75.3%, female: 69.5%), followed by As of 16.4% (male: 13.8%, female: 19.8%). The concentration level and PYLL both showed large spatial variability, of which the top-ranking cities were observed to be affected by well-developed metal-related industries and coal-powered industrial sectors.
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Affiliation(s)
- Jianwei Liu
- College of Resources and Environmental Sciences, Henan Agricultural University, Zhengzhou 450002, China.
| | - Hongbin Cao
- Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China
| | - Yali Zhang
- College of Resources and Environmental Sciences, Henan Agricultural University, Zhengzhou 450002, China
| | - Hui Chen
- College of Resources and Environmental Sciences, Henan Agricultural University, Zhengzhou 450002, China
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Ugarte MP, Achilleos S, Quattrocchi A, Gabel J, Kolokotroni O, Constantinou C, Nicolaou N, Rodriguez-Llanes JM, Huang Q, Verstiuk O, Pidmurniak N, Tao JW, Burström B, Klepac P, Erzen I, Chong M, Barron M, Hagen TP, Kalmatayeva Z, Davletov K, Zucker I, Kaufman Z, Kereselidze M, Kandelaki L, Le Meur N, Goldsmith L, Critchley JA, Pinilla MA, Jaramillo GI, Teixeira D, Goméz LF, Lobato J, Araújo C, Cuthbertson J, Bennett CM, Polemitis A, Charalambous A, Demetriou CA. Premature mortality attributable to COVID-19: potential years of life lost in 17 countries around the world, January-August 2020. BMC Public Health 2022; 22:54. [PMID: 35000578 PMCID: PMC8743065 DOI: 10.1186/s12889-021-12377-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Understanding the impact of the burden of COVID-19 is key to successfully navigating the COVID-19 pandemic. As part of a larger investigation on COVID-19 mortality impact, this study aims to estimate the Potential Years of Life Lost (PYLL) in 17 countries and territories across the world (Australia, Brazil, Cape Verde, Colombia, Cyprus, France, Georgia, Israel, Kazakhstan, Peru, Norway, England & Wales, Scotland, Slovenia, Sweden, Ukraine, and the United States [USA]). METHODS Age- and sex-specific COVID-19 death numbers from primary national sources were collected by an international research consortium. The study period was established based on the availability of data from the inception of the pandemic to the end of August 2020. The PYLL for each country were computed using 80 years as the maximum life expectancy. RESULTS As of August 2020, 442,677 (range: 18-185,083) deaths attributed to COVID-19 were recorded in 17 countries which translated to 4,210,654 (range: 112-1,554,225) PYLL. The average PYLL per death was 8.7 years, with substantial variation ranging from 2.7 years in Australia to 19.3 PYLL in Ukraine. North and South American countries as well as England & Wales, Scotland and Sweden experienced the highest PYLL per 100,000 population; whereas Australia, Slovenia and Georgia experienced the lowest. Overall, males experienced higher PYLL rate and higher PYLL per death than females. In most countries, most of the PYLL were observed for people aged over 60 or 65 years, irrespective of sex. Yet, Brazil, Cape Verde, Colombia, Israel, Peru, Scotland, Ukraine, and the USA concentrated most PYLL in younger age groups. CONCLUSIONS Our results highlight the role of PYLL as a tool to understand the impact of COVID-19 on demographic groups within and across countries, guiding preventive measures to protect these groups under the ongoing pandemic. Continuous monitoring of PYLL is therefore needed to better understand the burden of COVID-19 in terms of premature mortality.
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Affiliation(s)
| | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
| | - Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - John Gabel
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Ourania Kolokotroni
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicoletta Nicolaou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Qian Huang
- South Carolina Center for Rural and Primary Healthcare, Department of Geography, University of South Carolina, Columbia, USA
| | - Olesia Verstiuk
- Faculty of Medicine 2, Bogomolets National Medical University, Kyiv, Ukraine
| | - Nataliia Pidmurniak
- Faculty of Medicine 2, Bogomolets National Medical University, Kyiv, Ukraine
| | - Jennifer Wenjing Tao
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Petra Klepac
- Department Communicable Diseases, National Institute of Public Health, Ljubljana, Slovenia
| | - Ivan Erzen
- Public Health School, National Institute of Public Health, Ljubljana, Slovenia
| | - Mario Chong
- Facultad de Ingenieria, Universidad del Pacifico, Lima, Peru
| | - Manuel Barron
- Departamento de Economia, Universidad del Pacifico, Lima, Peru
| | - Terje P Hagen
- Department of Health Management and Economics, University of Oslo, Oslo, Norway
| | - Zhanna Kalmatayeva
- Faculty of Medicine, Al Farabi Kazakh National University, Almaty, Kazakhstan
| | - Kairat Davletov
- Health Research Institute, Al Farabi Kazakh National University, Almaty, Kazakhstan
| | - Inbar Zucker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Zalman Kaufman
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Maia Kereselidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Levan Kandelaki
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nolwenn Le Meur
- University of Rennes, EHESP, REPERES - EA 7449, F-35000, Rennes, France
| | - Lucy Goldsmith
- Population Health Research Institute and Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
| | | | | | | | - Lara Ferrero Goméz
- Department of Nature, Life and Environment Sciences, Jean Piaget University of Cape Verde, Praia, Cape Verde
| | - Jackeline Lobato
- Department of Epidemiology and Biostatistics, Institute of Collective Health (ISC), Fluminense Federal University, Niterói, Brazil
| | - Carolina Araújo
- Graduate Public Health Program, Institute of Studies in Collective Health (IESC), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joseph Cuthbertson
- Monash University Disaster Resilience Initiative, Monash University, Melbourne, Australia
| | | | | | | | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
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Abstract
The burden of an epidemic is often characterized by death counts, but this can be misleading as it fails to acknowledge the age of the deceased patients. Years of life lost is therefore widely used as a more relevant metric, however, such calculations in the context of COVID-19 are all biased upwards: patients dying from COVID-19 are typically multimorbid, having far worse life expectation than the general population. These questions are quantitatively investigated using a unique Hungarian dataset that contains individual patient level data on comorbidities for all COVID-19 deaths in the country. To account for the comorbidities of the patients, a parametric survival model using 11 important long-term conditions was used to estimate a more realistic years of life lost. As of 12 May, 2021, Hungary reported a total of 27,837 deaths from COVID-19 in patients above 50 years of age. The usual calculation indicates 10.5 years of life lost for each death, which decreases to 9.2 years per death after adjusting for 11 comorbidities. The expected number of years lost implied by the life table, reflecting the mortality of a developed country just before the pandemic is 11.1 years. The years of life lost due to COVID-19 in Hungary is therefore 12% or 1.3 years per death lower when accounting for the comorbidities and is below its expected value, but how this should be interpreted is still a matter of debate. Further research is warranted on how to optimally integrate this information into epidemiologic risk assessments during a pandemic.
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Affiliation(s)
- Tamás Ferenci
- Physiological Controls Research Center, Obuda University, Bécsi út 96/b, 1034, Budapest, Hungary. .,Department of Statistics, Corvinus University of Budapest, Budapest, Hungary.
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Mitra AK, Payton M, Kabir N, Whitehead A, Ragland KN, Brown A. Potential Years of Life Lost Due to COVID-19 in the United States, Italy, and Germany: An Old Formula with Newer Ideas. Int J Environ Res Public Health 2020; 17:E4392. [PMID: 32570888 PMCID: PMC7345973 DOI: 10.3390/ijerph17124392] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023]
Abstract
Today, the world is facing the challenge of a major pandemic due to COVID-19, which has caused more than 6.1 million cases of infection and nearly 370,000 deaths so far. Most of the deaths from the disease are clustered in the older population, but the young and children are not spared. In this context, there is a critical need to revisit the formula for calculating potential years of life lost (PYLL). Data on age-specific deaths due to COVID-19 in three countries, including the United States (US), Italy, and Germany, were evaluated. New York State, as a significant outlier within the US, was also included. PYLLs in the US were five times as high as those of Italy. Compared with Germany, PYLLs in Italy were 4 times higher, and the rates in the US were 23, 25, and 18 times higher when using upper age limits of 70, 75, and 80, respectively. Standardized PYLLs in New York were 2 times as high as the rates in Italy, and 7 to 9 times as high as PYLLs in Germany. The revised formula of PYLL, using an upper limit of age 80, is recommended to accurately measure premature deaths due to a major disastrous disease such as COVID-19.
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Affiliation(s)
- Amal K. Mitra
- Department of Epidemiology and Biostatistics, Jackson State University, School of Public Health, Jackson, MS 39213, USA; (M.P.); (N.K.); (A.W.); (K.N.R.); (A.B.)
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Watkins J, Wulaningsih W, Da Zhou C, Marshall DC, Sylianteng GDC, Dela Rosa PG, Miguel VA, Raine R, King LP, Maruthappu M. Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ Open 2017; 7:e017722. [PMID: 29141897 PMCID: PMC5719267 DOI: 10.1136/bmjopen-2017-017722] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/10/2017] [Accepted: 08/24/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Since 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates. METHODS We collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011-2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends. RESULTS Spending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65-6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, we found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths. CONCLUSIONS Spending constraints, especially PES, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers.
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Affiliation(s)
- Johnathan Watkins
- Institute for Mathematical and Molecular Biomedicine, King’s College London, London, UK
- PILAR Research and Education, Cambridge, UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, Cambridge, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | | | - Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Guia D C Sylianteng
- PILAR Research and Education, Cambridge, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Phyllis G Dela Rosa
- PILAR Research and Education, Cambridge, UK
- University of the Philippines Manila, Manila, Philippines
| | - Viveka A Miguel
- PILAR Research and Education, Cambridge, UK
- University of the Philippines Diliman, Quezon City, Philippines
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Lawrence P King
- Department of Sociology, University of Cambridge, Cambridge, UK
| | - Mahiben Maruthappu
- Department of Applied Health Research, University College London, London, UK
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Abstract
BACKGROUND Schistosoma mansoni infection is generally asymptomatic at the initial stage. However, patients left untreated can develop severe, potentially fatal clinical disease. In Brazil, S. mansoni transmission occurs in 19 states and, despite the contribution of infection to the cycle of poverty and disease, the economic impact of severe cases is unclear. Our objectives were to estimate the epidemiological burden and the costs of severe stages of S. mansoni in Brazil in 2010. METHODS We conducted an epidemiologic descriptive study and a partial economic evaluation of cost-of-illness. The study population was identified from records of notifications, hospitalizations and deaths related to S. mansoni in the respective information systems. RESULTS The mortality rate for S. mansoni was 0.3 deaths per 100 000 population, which represented 1.1% of the deaths in Brazil from infectious diseases listed in Chapter I of the International Statistical Classification of Disease and Related Health Problems, 10(th) revision (ICD 10), and almost 9.0% of deaths from infection diseases in the state of Pernambuco. We calculated 6419 potential years of life lost (PYLL) to S. mansoni. The costs estimated within the public health sector totaled R$889 049.58 (US$495 016.47) and the costs of productivity losses reached R$ 35 725 332.72 (US$ 19 891 590.86) in terms of salaries lost as a result of premature death or absence from work. The cost-of-illness related to S. mansoni in Brazil was R$ 36 614 382.30 (US$ 20 386 627.12). CONCLUSION The severe cases of S. mansoni disease still occurring in Brazil have an important epidemiologic and economic impact, representing a significant loss for society. The development of severe cases of a neglected parasitic disease that is preventable and responsive to primary healthcare intervention should be considered an expression of inequity. Our findings provide important evidence to support the strengthening of public health measures and investment to reduce poverty-related diseases in Brazil today.
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