Comparison of three small-area mortality metrics according to urbanity in Korea: the standardized mortality ratio, comparative mortality figure, and life expectancy

Background: This study aimed to compare three small-area level mortality metrics according to urbanity in Korea: the standardized mortality ratio (SMR), comparative mortality figure (CMF), and life expectancy (LE) by urbanity.Methods: We utilized the National Health Information Database to obtain annual small-area level age-specific numbers of population and deaths in Korea between 2013 and 2017. First, differences in the SMR by urbanity were examined, assuming the same age-specific mortality rates in all small-areas. Second, we explored the differences in ranking obtained using the three metrics (SMR, CMF, and LE). Third, the ratio of CMF to SMR by population was analyzed according to urbanity.Results: We found that the age-specific population distributions in urbanized areas were similar, but rural areas had a relatively old population structure. The age-specific mortality ratio also differed by urbanity. Assuming the same rate of age-specific mortality across all small-areas, we found that comparable median values in all areas. However, areas with a high SMR showed a strong predominance of metropolitan areas. The ranking by SMR differed markedly from the rankings by CMF and LE, especially in areas of high mortality, while the latter two metrics did not differ notably. The ratio of CMF to SMR showed larger variations in small-areas in rural areas, particularly in those with small populations, than in metropolitan and urban areas.Conclusions: In a comparison of multiple SMRs, bias could exist if the study areas have large differences in population structure. The use of CMF or LE should be considered for comparisons if it is possible to acquire age-specific mortality data for each small-area.

Comparison of three small-area mortality metrics according to urbanity in Korea: the standardized mortality ratio, comparative mortality figure, and life expectancy

Background: This study aimed to compare three small-area level mortality metrics according to urbanity in Korea: the standardized mortality ratio (SMR), comparative mortality figure (CMF), and life expectancy (LE) by urbanity.Methods: We utilized the National Health Information Database to obtain annual age-specific numbers of population and deaths for all neighborhood-level areas in Korea between 2013 and 2017. First, differences in the SMR by urbanity were examined, assuming the same age-specific mortality rates in all neighborhoods. Second, we explored the differences in ranking obtained using the three metrics (SMR, CMF, and LE). Third, the ratio of CMF to SMR by population was analyzed according to urbanity.Results: We found that the age-specific population distributions in urbanized areas were similar, but rural areas had a relatively old population structure. The age-specific mortality ratio also differed by urbanity. Assuming the same rate of age-specific mortality across all neighborhoods, we found that comparable median values in all areas. However, areas with a high SMR showed a strong predominance of metropolitan areas. The ranking by SMR differed markedly from the rankings by CMF and LE, especially in areas of high mortality, while the latter two metrics did not differ notably. The ratio of CMF to SMR showed larger variations in neighborhoods in rural areas, particularly in those with small populations, than in metropolitan and urban areas.Conclusions: In a comparison of multiple SMRs, bias could exist if the study areas have large differences in population structure. The use of CMF or LE should be considered for comparisons if it is possible to acquire age-specific mortality data for each neighborhood.

Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study

There is a paucity of data on incidence, prevalence and mortality associated with non-cystic fibrosis bronchiectasis.Using the Clinical Practice Research Datalink for participants registered between January 1, 2004 and December 31, 2013, we determined incidence, prevalence and mortality associated with bronchiectasis in the UK and investigated changes over time.The incidence and point prevalence of bronchiectasis increased yearly during the study period. Across all age groups, the incidence in women increased from 21.2 per 100 000 person-years in 2004 to 35.2 per 100 000 person-years in 2013 and in men from 18.2 per 100 000 person-years in 2004 to 26.9 per 100 000 person-years in 2013. The point prevalence in women increased from 350.5 per 100 000 in 2004 to 566.1 per 100 000 in 2013 and in men from 301.2 per 100 000 in 2004 to 485.5 per 100 000 in 2013. Comparing morality rates in women and men with bronchiectasis in England and Wales (n=11 862) with mortality rates in the general population from Office of National Statistics data showed that in women the age-adjusted mortality rate for the bronchiectasis population was 1437.7 per 100 000 and for the general population 635.9 per 100 000 (comparative mortality figure of 2.26). In men, the age-adjusted mortality rate for the bronchiectasis population was 1914.6 per 100 000 and for the general population 895.2 per 100 000 (comparative mortality figure of 2.14).Bronchiectasis is surprisingly common and is increasing in incidence and prevalence in the UK, particularly in older age groups. Bronchiectasis is associated with a markedly increased mortality.

Factors Affecting the Results of Allogeneic Hematopoietic Stem Cell Transplantation in Hematologic Malignancies

130 patients who were unsuitable for conventional-intensity conditioning underwent RI-HSCT after 100 mg/m2 melphalan (+ 50 mg/kg cyclophosphamide if no prior autograft). GVHD prophylaxis comprised cyclosporine (HLA-matched siblings) or tacrolimus (all others) and MMF. Table 1: Patient characteristics Age (y) 19–71 (median 55) Male 55% Refractory disease 57% ECOG performance status 0 34% 1 48% 2 14% 3 4% Diagnosis Lymphoma 42% Leukemia 36% Myeloma 22% Donor Matched sibling 49% Mismatched sibling 2% Matched unrelated 33% Mismatched unrelated 15% Donor age (y) 21–71 (median 44; 45% >45) Male donor 65% Prior autograft 45% Refractory disease, HLA mismatch, donor age >45, elevated creatinine, low DLCO, thrombocytopenia, male donor, poor performance status, and low albumin affected OS adversely in univariate analysis. The following factors affected outcome independently: Table 2: Cox analysis Adverse variable Relative risk P TRM HLA mismatch 4.78 0.0003 Performance status 2–3 3.07 0.044 Relapse Donor age >45 y 2.0 0.012 Male donor 1.98 0.026 Refractory disease 1.84 0.05 EFS Performance status 2–3 0.48 0.022 HLA mismatch 0.53 0.023 Refractory disease 0.55 0.016 Male donor 0.61 0.039 Donor age >45 y 0.63 0.034 OS Performance status 2–3 0.44 0.025 HLA mismatch 0.31 0.0001 Refractory disease 0.49 0.007 Donor age >45 y 0.55 0.012 High LDH 0.53 0.007 Platelets <100 0.58 0.021 These prognostic factors were similar to those found on studying the first 63 patients in this series (Mehta et al. Bone Marrow Transplant 2006) –with the additional emergence of HLA mismatch and thrombocytopenia which were significant in univariate but not multivariate analysis then. These data suggest that RI-HSCT is useful for some patients with hematologic malignancies who are ineligible for conventional-intensity HSCT. However, alternative HSCT techniques or non-HSCT options are needed for high-risk patients. Figure 1 shows the effect of the number of adverse prognostic factors on the cumulative incidence of relapse and transplant-related mortality. Figure 1. shows the effect of the number of adverse prognostic factors on the cumulative incidence of relapse and transplant-related mortality. Figure 2 shows the effect of the number of adverse prognostic factors on survival. Figure 2. shows the effect of the number of adverse prognostic factors on survival.

Escape from Catastrophe: The Saami’s Experience with Smallpox in Eighteenth- and Early-Nineteenth-Century Sweden

This article, which deals with the Saami’s experience with smallpox in the three northern Swedish parishes of Jokkmokk, Gällivare, and Enontekis during the latter half of the eighteenth century and the first decades of the nineteenth century, focuses on these epidemiologic questions: (1) Why were the Saami—a native people living in northern Norway, Sweden, Finland, and Russia—not affected by smallpox until this period? (2) What happened once smallpox was introduced into the area? (3) Did the Saami’s experience with smallpox differ from that of the rest of the Swedish population? (4) If so, what were the most important differences? (5) And how are they to be explained? Finding the answers to these questions requires considering whether smallpox inevitably resulted from the number of susceptible people and whether the disease affected other aspects of demography besides mortality (Figure 1).