The analysis of mortality by the subject-years method

The observed mortality of a group of individuals often needs to be compared with that expected from the death rates of the national population, with allowance made for age and period. Expected deaths are usually calculated by the subject-years method (Case and Lea, 1955, British Journal of Preventive and Social Medicine 9, 62-72), in which each person is assumed at risk up to the date of the analysis, the date of death, or the date the person was lost to follow-up, whichever is first. Some of the properties of this method are described, including an approach based on likelihood. For this purpose the observed number of deaths may be treated as though it were a Poisson variable. The likelihood approach leads to a generalization to the cases where the groups have a factorial structure or where covariates are available for each individual. The calculations are readily carried out by use of GLIM or GENSTAT.     

A Cox regression model for the relative mortality and its application to diabetes mellitus survival data

A Cox-type regression model for the ratio between the mortality in a cohort and that in a reference population is introduced. By means of the model it is possible to include in the survival analysis both individual (possibly time-dependent) characteristics for the study cohort and changing trends in the mortality in the reference population. This is particularly relevant in long-term follow-up studies where there may be considerable changes in the mortality in the reference population. Estimation procedures in the model are discussed and large-sample properties of the estimators are outlined. The model is applied to the analysis of two sets of data concerning the survival among insulin-dependent diabetics in Denmark.     

The effect of growth pattern, sampling interval and number of size classes on benthic invertebrate production estimated by the size-frequency method

SUMMARY. 1. A hypothetical leech population with known initial density, initial weight, final weight and cohort production interval (CPI) was established. Production estimated by the size-frequency method for various growth patterns, mortalities, number of samples per CPI and number of size classes was compared with actual production estimated from daily growth and mortality by the increment-summation method. The population had either perfectly continuous reproduction or a perfectly synchronous cohort.
2. When size-classes were delimited in order to equalize the time spent in each size class, the deviations from actual production increased with decreasing number of size-classes and increasing mortality. For a population with perfectly continuous reproduction, production was only overestimated by 32% with an extreme mortality of 2.0% day⁻¹ and three size-classes. For a perfectly synchronous cohort, production was either underestimated or overestimated, depending on the first day of sampling. The deviations from actual production increased considerably with decreasing number of size-classes, increasing mortality and decreasing number of samples per CPI.
3. Differences between actual and assumed growth patterns may give underestimates or overestimates of more than one order of magnitude at high mortalities and few size-classes. It is concluded that knowing the actual growth pattern, the size frequency method will give realistic estimates of production in cases when normal cohort methods cannot be used. The estimate can be improved significantly by increasing the number of size classes and the number of samples per CPI.     

Twenty years of melanoma in Victoria,Queensland, and South Australia (1997 – 2016)

BackgroundGiven the high incidence of melanoma in Australia alongside high mortality with later stage disease, we investigated the populations and locations most at risk, to optimise public health activities in areas where intervention is most needed. This study examines trends and identifies significant prognostic factors and potential disparities in incidence, mortality and survival between population groups in Victoria, Queensland and South Australia.MethodsThe analysis includes data from the population-based cancer registries of the three states over a twenty-year period (1997–2016). Age-standardized and age-specific incidence rates were calculated, and long-term trends analysed using Joinpoint Regression. Five-year relative survival estimates for the study population were calculated using the cohort method and multivariable flexible parametric survival models were applied for each jurisdiction to calculate adjusted excess mortality hazard ratios for the key characteristics.ResultsThere were more males with melanoma than females in all the three states. Over 60% of the cases occurred in the 40–74 years age group. Most melanomas had a Breslow thickness less than or equal to 1.0 mm. For males, Victoria and Queensland had a statistically significant increasing trend whereas in South Australia there was a decreasing trend. For females, the incidence rate trend was stable in Victoria but significantly decreasing in South Australia. In Queensland there was an increasing and statistically significant trend from 2006 to 2016. Across all three states there was a reducing incidence rate in the youngest cohort, stabilizing incidence in the 40–59-year-old age group, and increasing in the oldest cohorts. Five-year relative survival decreased with increasing age and with Breslow thickness across all three jurisdictions. Males had between 43%− 46% excess mortality compared to females in all the three states. There was higher risk with increasing age and Breslow thickness, with the largest risk among the 75 + age group and those with a Breslow thickness of > 4 mm.ConclusionIt is the first time that data from these three registries has been analysed together in a uniform way, covering more than half of the Australian population. This study compares the epidemiology of melanoma across three states and provides a better understanding of trends and factors affecting outcome for Australians with melanoma. While there has been some improvement in aspects of incidence and mortality, this has not been evenly achieved across Australia.     

Comparison of confidence intervals for adjusted attributable risk estimates under multinomial sampling

The epidemiologic concept of the adjusted attributable risk is a useful approach to quantitatively describe the importance of risk factors on the population level. It measures the proportional reduction in disease probability when a risk factor is eliminated from the population, accounting for effects of confounding and effect-modification by nuisance variables. The computation of asymptotic variance estimates for estimates of the adjusted attributable risk is often done by applying the delta method. Investigations on the delta method have shown, however, that the delta method generally tends to underestimate the standard error, leading to biased confidence intervals. We compare confidence intervals for the adjusted attributable risk derived by applying computer intensive methods like the bootstrap or jackknife to confidence intervals based on asymptotic variance estimates using an extensive Monte Carlo simulation and within a real data example from a cohort study in cardiovascular disease epidemiology. Our results show that confidence intervals based on bootstrap and jackknife methods outperform intervals based on asymptotic theory. Best variants of computer intensive confidence intervals are indicated for different situations.     

Endemic disease in host populations with fully specified demography

This study explores the epidemiology of an aerogenically transmitted infectious disease following an S.I.R. pattern in a host population with completely specified age-specified maternity and mortality schedules. A fully age-structured demographic-epidemiologic model is developed, and its demographic and epidemiologic behaviour is explored in numerical studies. The impact of variations in host population demographic structure upon the effect of immunization programs is also studied.     

Modeling Exposure Intensity and Susceptibility-Latency Effect from Retrospective Cohort Data - Application to Lung Cancer Mortality in Blackfoot Disease Endemic Area in Taiwan

It is challenge in epidemiology to characterize the temperol aspect of exposure-disease association. The authors propose a stochastic model to deal with exposures that are time-dependent and exhibit susceptibility and latency effects. The model is applied to a retrospective cohort data on lung cancer mortality in the blackfoot disease endemic area in Taiwan. The authors compare the proposed model with the multistage model, the back-calculation model, the catalytic model, and the age-period-cohort models.     

Mortality from cardiovascular diseases in the Semipalatinsk historical cohort, 1960-1999, and its relationship to radiation exposure

The data on risk of mortality from cardiovascular disease due to radiation exposure at low or medium doses are inconsistent. This paper reports an analysis of the Semipalatinsk historical cohort exposed to radioactive fallout from nuclear testing in the vicinity of the Semipalatinsk Nuclear Test Site, Kazakhstan. The cohort study, which includes 19,545 persons of exposed and comparison villages in the Semipalatinsk region, had been set up in the 1960s and comprises 582,656 person-years of follow-up between 1960 and 1999. A dosimetric approach developed by the U.S. National Cancer Institute (NCI) has been used. Radiation dose estimates in this cohort range from 0 to 630 mGy (whole-body external). Overall, the exposed population showed a high mortality from cardiovascular disease. Rates of mortality from cardiovascular disease in the exposed group substantially exceeded those of the comparison group. Dose-response analyses were conducted for both the entire cohort and the exposed group only. A dose-response relationship that was found when analyzing the entire cohort could be explained completely by differences between the baseline rates in exposed and unexposed groups. When taking this difference into account, no statistically significant dose-response relationship for all cardiovascular disease, for heart disease, or for stroke was found. Our results suggest that within this population and at the level of doses estimated, there is no detectable risk of radiation-related mortality from cardiovascular disease.     

Exact Maximum Likelihood Estimates of Cox's Regression Parameters Based on Categorized Factorial Data

This paper describes how Cox's Proportional Hazards model may be used to analyze dichotomized factorial data obtained from a right-censored epidemiological study where time to response is of interest. Exact maximum likelihood estimates of the relative mortality rates are obtained for any number of prognostic factors, as well as their joint asymptotic sampling distribution. These rates represent excess mortality due to the various levels of the prognostic factors. The results are used to discuss the effect of the factors on the survival probability distribution of a cohort of industrial workers who have been exposed to a carcinogen. Kaplan-Meier estimates of the survival function of the internal control population are used to determine the expected number of deaths in the study population. This method differs from the usual lite-table procedure. Asymptotic tests are proposed for some simultaneous and conditional statistical hypotheses.     

An Assessment of the Annual Mortality Rate and Population Demographics Status in Birds Based on Ring-Recovery Data

A new method for assessing the annual mortality rate in bird populations is described. Ring recoveries from birds that died from various causes serve as the basis for such an assessment. The commonly accepted technique for such an assessment performed with the help of MARK software is laborious, yet fails to ensure a highly precise assessment. To calculate the mortality rate, we propose an exponential demographic model that is based on the geometric progression of a decrease in the annual numbers in some arbitrarily selected set of birds in a population. The equation of the model allows calculating the annual mortality rate of a bird population or even a species in a simple way, if the ringing data covers a vast area, for example, the territory of Russia. In addition, the proposed equation permits producing “a mortality pattern,” namely, to present a chart of interrelations between the theoretical and real rates of the decrease in numbers in a given cohort of birds. The interrelations between the theoretical and real annual mortality rates allow understanding the status of a bird population each year during a period of ringing and recovery collecting: this makes it possible to reveal the population trend about whether the population is stable or decreasing or increasing in numbers.     

Mortality among twins after age 6: fetal origins hypothesis versus twin method.

OBJECTIVE--To test the validity of the fetal origins hypothesis and the classic twin method. DESIGN--Follow up study of pairs of same sex twins in which both twins survived to age 6. SETTING--Denmark. SUBJECTS--8495 twin individuals born 1870-1900, followed through to 31 December 1991. MAIN OUTCOME MEASURES--Mortality calculated on a cohort basis. RESULTS--Mortality among twins and the general population was not significantly different except among females aged 60-89, in whom mortality among twins was 1.14 times (SE 0.03) higher than in the general population. Mortality among female dizygotic twins was 1.77 times (0.18) higher than among monozygotic twins at age 30-59. Otherwise, mortality for monozygotic and dizygotic twins did not consistently differ after age 6. CONCLUSION--According to the fetal origins hypothesis the risk of adult morbidity and mortality is heightened by retardation in intrauterine growth. Twins, and in particular monozygotic twins, experience growth retardation in utero. The findings in the present study suggest that the fetal origins hypothesis is not true for the retardation in intrauterine growth experienced by twins. Furthermore, the data are inconsistent with the underlying assumption of a recent claim that the classic twin method is invalid for studies of adult diseases. The present study is, however, based on the one third of all pairs of twins in which both twins survived to age 6. The possible impact of this selection can be evaluated in future studies of cohorts of younger twins with lower perinatal and infant mortality.     

The NAS-NRC Twin Registry of WWII military veteran twins. National Academy of Sciences-National Research Council.

The NAS-NRC Twin Registry is one of the oldest, national population based-twin registries in the United States. It consists of 15,924 white male twin pairs born in the years 1917-1927 (inclusive) both of whom served in the armed forces. The registry, which has been in operation more than 30 years, has collected data from a variety of sources. Records-based, computerized data have come largely from the Department of Veterans Affairs, and there have been three major epidemiologic questionnaires, undertaken roughly every 15 years. Classic twin studies on a variety of medical conditions were the early focus of the registry, which now has a strong focus on chronic disease epidemiology. Work on a DNA specimen bank has been proceeding slowly, but is now a top priority, due to the increasing force of mortality in this twin cohort.     

Population structure and ecology of a tropical rare rhizomatous species of teosinte Zea diploperennis (Gramineae).

One of the objectives of the Sierra de Manantlán Biosphere Reserve (Jalisco, México) is the conservation in situ of the teosinte Zea diploperennis Iltis, Doebley, Guzman & Pazzi. Zea diploperennis is perennial, shade intolerant and its 1-3 m shoots are architecturally similar to maize. Clonal growth is of the phalanx type. Genets are iteroparous (modules semelparous). The demography of seven module and genet populations was studied in seven sites representing three stages of old-field succession. Seven permanent one-meter-square plots were randomly established in each site. All genets initially present and those that became established during our study were mapped and labeled according to year of establishment. The magnitude of demographic fluctuations was greater in module populations. Genet population dynamics followed a seasonal rhythm with a maximum population size obtained at the onset of the rainy season. A relation was documented between percent annual mortality of a cohort and its age: the younger the cohort, the greater the mortality. This was a statistically significant relationship, Y = [sin(-0.288x + 1.657)]2 (r = 0.92, p < 0.01), where is proportion annual mortality of genets and is the age of the cohort. The maximum rates of genet mortality occurred during the rainy season when population densities were greatest. As a consequence, we postulate that competition occurs principally during the rainy season. Linear relationships were observed between rate of population increase of genets versus old-field successional stage and soil type. Those areas with poor soil (Ultisol), degraded soil or soils with similar physical characteristics could be rehabilitated by introducing Z. diploperennis. Such rehabilitation would achieve two distinct objectives, promote propagation of this rare endemic and reclaim areas that are susceptible to erosion and further degradation.     

Long-term mortality in patients with tuberculous meningitis: a Danish nationwide cohort study

Background

With high short-term mortality and substantial excess morbidity among survivors, tuberculous meningitis (TBM) is the most severe manifestation of extra-pulmonary tuberculosis (TB). The objective of this study was to assess the long-term mortality and causes of death in a TBM patient population compared to the background population.

Methods

A nationwide cohort study was conducted enrolling patients notified with TBM in Denmark from 1972–2008 and alive one year after TBM diagnosis. Data was extracted from national registries. From the background population we identified a control cohort of individuals matched on gender and date of birth. Kaplan-Meier survival curves and Cox regression analysis were used to estimate mortality rate ratios (MRR) and analyse causes of death.

Findings

A total of 55 TBM patients and 550 individuals from the background population were included in the study. Eighteen patients (32.7%) and 107 population controls (19.5%) died during the observation period. The overall MRR was 1.79 (95%CI: 1.09–2.95) for TBM patients compared to the population control cohort. TBM patients in the age group 31–60 years at time of diagnosis had the highest relative risk of death (MRR 2.68; 95%CI 1.34–5.34). The TBM patients had a higher risk of death due to infectious disease, but not from other causes of death.

Conclusion

Adult TBM patients have an almost two-fold increased long-term mortality and the excess mortality stems from infectious disease related causes of death.     

Mortality in babies with achondroplasia: Revisited

BACKGROUND: Natural history studies performed 30 years ago identifying higher mortality among children born with achondroplasia, a genetic dwarfing condition, resulted in clinical recommendations aimed at improving mortality in childhood. The objective of this study was to determine if mortality rates have changed over the past few decades. METHODS: Children born with achondroplasia during 1996 to 2003 were ascertained from the Texas Birth Defects Registry and matched with death certificate data from the Bureau of Vital Statistics through 2007. Infant and overall mortality rates, both crude and standardized to the 2005 (SMR₂₀₀₅) and 1975 (SMR₁₉₇₅) U.S. populations, were calculated. RESULTS: 106 children born with achondroplasia were identified. Four deaths were reported, with all occurring in the first year of life (mortality rate: 41.4 /1000 live‐births). Infant mortality was higher when standardized to the 2005 U.S. population (SMR₂₀₀₅:6.02, 95% CI:1.64–15.42) than the 1975 population (SMR₁₉₇₅:2.58, 95% CI:0.70–6.61). CONCLUSION: The higher SMR₂₀₀₅ compared with SMR₁₉₇₅, along with the fact that SMR₁₉₇₅ was nearly half that of a previous cohort reported 25 years ago (rate ratio: 0.53, 95% CI: 0.11–2.25), reflect a discrepancy in the changes in mortality in the overall population and in our cohort. Although an overall improvement in mortality, especially after the first year of life, is observed in our cohort, children with achondroplasia are still at a much higher risk of death compared with the general population. A longer follow‐up is needed to elucidate whether evaluation/intervention changes have resulted in significant improvement in long‐term survival among these patients. Birth Defects Research (Part A) 100:247–249, 2014. © 2014 Wiley Periodicals, Inc.     

Year of Birth Effects in the Historical Decline of Tuberculosis Mortality: A Reconsideration

Birth cohort patterns in mortality are often used to infer long-lasting impacts of early life conditions. One of the most widely accepted examples of a birth cohort effect is that of tuberculosis mortality before the late 1940s. However the evidential basis for claims of cohort-specific declines in tuberculosis mortality is very slight. Reanalysis of original or enhanced versions of datasets used previously to support claims of cohort effects in tuberculosis mortality indicated that: 1. where the initial decline in tuberculosis mortality occurred within the period of observation, onset of decline occurred simultaneously in many age groups, in a pattern indicative of ‘period’ not cohort-dependent effects. 2. there was little evidence of ‘proportional hazard’-type cohort patterns in tuberculosis mortality for any female population studied. Therefore any mechanisms proposed to underlie this type of cohort pattern in male mortality must be sex-specific. 3. sex ratios of tuberculosis mortality at older ages peaked in cohorts born around 1900, and resembled cohort sex ratios of lung cancer mortality. This analysis indicates that age-specific patterns in the decline in tuberculosis mortality before 1950 are unlikely to reflect improvements in early life conditions. The patterns observed are generally more consistent with the influence of factors that reduced mortality simultaneously in most age groups. Additional influences, possibly smoking habits, impeded the decline of tuberculosis in older adult males, and produced the sex-specific shifts in age distributions of mortality that were previously interpreted as evidence of cohort-dependent mortality decline.     

Demographic heterogeneity impacts density-dependent population dynamics

Among-individual variation in vital parameters such as birth and death rates that is unrelated to age, stage, sex, or environmental fluctuations is referred to as demographic heterogeneity. This kind of heterogeneity is prevalent in ecological populations, but is almost always left out of models. Demographic heterogeneity has been shown to affect demographic stochasticity in small populations and to increase growth rates for density-independent populations. The latter is due to ??cohort selection,?? where the most frail individuals die out first, lowering the cohort??s average mortality as it ages. The importance of cohort selection to population dynamics has only recently been recognized. We use a continuous-time model with density dependence, based on the logistic equation, to study the effects of demographic heterogeneity in mortality and reproduction. Reproductive heterogeneity is introduced in three ways: parent fertility, offspring viability, and parent?Coffspring correlation. We find that both the low-density growth rate and the equilibrium population size increase as the magnitude of mortality heterogeneity increases or as parent?Coffspring phenotypic correlation increases. Population dynamics are affected by complex interactions among the different types of heterogeneity, and trade-off scenarios are examined which can sometimes reverse the effect of increased heterogeneity. We show that there are a number of different homogeneous approximations to heterogeneous models, but all fail to capture important parts of the dynamics of the full model.     

Time series analysis supporting the hypothesis that enhanced cosmic radiation during germ cell formation can increase breast cancer mortality in germ cell cohorts

 Techniques from cancer epidemiology and time series analysis were used to explore the hypothesis that cosmic radiation can induce germ cell changes leading to increases in future breast cancer mortality. A birth cohort time series for female breast cancer mortality was obtained using a model-independent, age-period-cohort analysis on age-specific mortality data for 1940–1990. The birth cohort series contained several oscillatory components, which were isolated and compared to the corresponding frequency components of a cosmic ray surrogate time series – Greenland ice-core ¹⁰Be concentrations. A technique, referred to as component wave-train alignment, was used to show that the breast cancer and cosmic ray oscillations were phase-locked approx. 25 years before the time of birth. This is consistent with the time of germ cell formation, which occurs during the fetal development stage of the preceding generation. Evidence is presented that the observable oscillations in the birth cohort series were residues of oscillations of much larger amplitude in the germ cell cohort, which were attenuated by the effect of the broad maternal age distribution. It is predicted that a minimum of 50% of breast cancer risk is associated with germ cell damage by cosmic radiation (priming event), which leads to the development of individuals with a higher risk of breast cancer. It is proposed that the priming event, by preceding other steps of carcinogenesis, works in concert with risk factor exposure during life. The priming event is consistent with epigenetic changes such as imprinting. Received: 10 June 1996 / Revised: 4 December 1996 / Accepted: 19 December 1996