Cancer Morbidity Trends and Regional Differences in England - a Bayesian Analysis

Reliable modelling of the dynamics of cancer morbidity risk is important, not least due to its significant impact on healthcare and related policies. We identify morbidity trends and regional differences in England for all-cancer and type-specific incidence between 1981 and 2016. We use Bayesian modelling to estimate cancer morbidity incidence at various age, year, gender, and region levels. Our analysis shows increasing trends in most rates and marked regional variations that also appear to intensify through time in most cases. All-cancer rates have increased significantly, with the highest increase in East, North West and North East. The absolute difference between the rates in the highest- and lowest-incidence region, per 100,000 people, has widened from 39 (95% CI 33-45) to 86 (78-94) for females, and from 94 (85-104) to 116 (105-127) for males. Lung cancer incidence for females has shown the highest increase in Yorkshire and the Humber, while for males it has declined in all regions with the highest decrease in London. The gap between the highest- and lowest-incidence region for females has widened from 47 (42-51) to 94 (88-100). Temporal change in in bowel cancer risk is less manifested, with regional heterogeneity also declining. Prostate cancer incidence has increased with the highest increase in London, and the regional gap has expanded from 33 (30-36) to 76 (69-83). For breast cancer incidence the highest increase has occurred in North East, while the regional variation shows a less discernible increase. The analysis reveals that there are important regional differences in the incidence of all-type and type-specific cancers, and that most of these regional differences become more pronounced over time. A significant increase in regional variation has been demonstrated for most types of cancer examined here, except for bowel cancer where differences have narrowed

The effect of the COVID-19 health disruptions on breast cancer mortality for older women: A semi-Markov modelling approach

We propose a methodology to quantify the impact on breast cancer mortality of diagnostic delays caused by public health measures introduced as a response to the COVID-19 pandemic. These measures affected cancer pathways by halting cancer screening, delaying diagnostic tests, and reducing the numbers of patients starting treatment. We introduce a semi-Markov model, to quantify the impact of the pandemic based on publicly available population data for women age 65{89 years in England and relevant medical literature. We quantify age-specific excess deaths, for a period up to 5 years, along with years of life expectancy lost and change in cancer mortality by cancer stage. Our analysis suggests a 3-6% increase in breast cancer deaths, corresponding to more than 40 extra deaths, per 100,000 women, after age 65 years old over 5 years, and a 4-6% increase in registrations of advanced (Stage 4) breast cancer. Our modelling approach exhibits consistent results in sensitivity analyses, providing a model that can account for changes in breast cancer diagnostic and treatment services

Insurance pricing for breast cancer under different multiple state models

In this paper we consider pricing of insurance contracts for breast cancer risk based on three multiple state models. Using population data in England and data from the medical literature, we calibrate a collection of semi-Markov and Markov models. Considering an industry-based Markov model as a baseline model, we demonstrate the strengths of a more detailed model while showing the importance of accounting for duration dependence in transition rates. We quantify age-specific cancer incidence and cancer survival by stage along with type-specific mortality rates based on the semi-Markov model which accounts for unobserved breast cancer cases and progression through breast cancer stages. Using the developed models, we obtain actuarial net premiums for a specialised critical illness and life insurance product. Our analysis shows that the semi-Markov model leads to results aligned with empirical evidence. Our findings point out the importance of accounting for the time spent with diagnosed or undiagnosed pre-metastatic breast cancer in actuarial applications

Modelling frontier mortality using Bayesian generalised additive models

Mortality rates differ across countries and years, and the country with the lowest observed mortality has changed over time. However, the classic Science paper by Oeppen and Vaupel(2002)identified a persistent linear trend over time in maximum national life expectancy. Inthis article, we look to exploit similar regularities in age-specific mortality by considering for any given year a hypothetical mortality ‘frontier’, which we define as the lower limit of the force of mortality at each age across all countries. Change in this frontier reflects incremental advances across the wide range of social, institutional and scientific dimensions that influence mortality. We jointly estimate frontier mortality as well as mortality rates for individual countries. Generalised additive models are used to estimate a smooth set of baseline frontier mortality rates and mortality improvements, and country-level mortality is modelled as a set of smooth, positive deviations from this, forcing the mortality estimates for individual countries to lie above the frontier. This model is fitted to data for a selection of countries from the Human Mortality Database (2019). The efficacy of the model in forecasting over a ten-year horizon is compared to a similar model fitted to each country separately

Smoothing mortality data: the English life table, 2010-12

We describe the most recent statistical methodology used to produce the 17th English Life Table, covering the period 2010–2012. Crude mortality rates are smoothed, or graduated, by using a combination of a generalized additive model and low dimensional parametric models. The approach to graduation acknowledges uncertainty, particularly in the highest age groups, by model averaging, using a simplified version of a full Bayesian analysis

Joint modelling of male and female mortality rates using adaptive P-splines

Raw mortality data often exhibit irregular patterns due to randomness. Graduation refers to the act of smoothing crude mortality rates. In this paper, we propose a flexible and robust methodology for graduating mortality rates using adaptive P-splines. Since the observed data at high ages are often sparse and unreliable, we use an exponentially increasing penalty. We use mortality data of England and Wales and model male and female mortality rates jointly by means of penalties, achieving borrowing of information between the two sexes.</p

Forecasting of cohort fertility under a hierarchical Bayesian approach

Fertility projections are a key determinant of population forecasts, which are widely used by government policy makers and planners. In keeping with the recent literature, we propose an intuitive and transparent hierarchical Bayesian model to forecast cohort fertility. Using Hamiltonian Monte Carlo methods and a data set from the human fertility database, we obtain fertility forecasts for 30 countries. We use scoring rules to assess the predictive accuracy of the forecasts quantitatively; these indicate that our model predicts with an accuracy comparable with that of the best-performing models in the current literature overall, with stronger performance for countries without a recent structural shift. Our findings support the position of hierarchical Bayesian modelling at the forefront of population forecasting methods.</p

Socioeconomic disparities in cancer incidence and mortality in England and the impact of age-at-diagnosis on cancer mortality

Background: we identify socioeconomic disparities by region in cancer morbidity and mortality in England for all-cancer and type-specific cancers, and use incidence data to quantify the impact of cancer diagnosis delays on cancer deaths between 2001–2016.Methods and findings: we obtain population cancer morbidity and mortality rates at various age, year, gender, deprivation, and region levels based on a Bayesian approach. A significant increase in type-specific cancer deaths, which can also vary among regions, is shown as a result of delay in cancer diagnoses. Our analysis suggests increase of 7.75% (7.42% to 8.25%) in female lung cancer mortality in London, as an impact of 12-month delay in cancer diagnosis, and a 3.39% (3.29% to 3.48%) increase in male lung cancer mortality across all regions. The same delay can cause a 23.56% (23.09% to 24.30%) increase in male bowel cancer mortality. Furthermore, for all-cancer mortality, the highest increase in deprivation gap happened in the East Midlands, from 199 (186 to 212) in 2001, to 239 (224 to 252) in 2016 for males, and from 114 (107 to 121) to 163 (155 to 171) for females. Also, for female lung cancer, the deprivation gap has widened with the highest change in the North West, e.g. for incidence from 180 (172 to 188) to 272 (261 to 282), whereas it has narrowed for prostate cancer incidence with the biggest reduction in the South West from 165 (139 to 190) in 2001 to 95 (72 to 117) in 2016.Conclusions: the analysis reveals considerable disparities in all-cancer and some type-specific cancers with respect to socioeconomic status. Furthermore, a significant increase in cancer deaths is shown as a result of delays in cancer diagnoses which can be linked to concerns about the effect of delay in cancer screening and diagnosis during the COVID-19 pandemic. Public health interventions at regional and deprivation level can contribute to prevention of cancer deaths

Joint modelling of male and female mortality rates using adaptive P-splines

Raw mortality data often exhibit irregular patterns due to randomness. Graduation refers to the act of smoothing crude mortality rates. In this paper, we propose a flexible and robust methodology for graduating mortality rates using adaptive P-splines. Since the observed data at high ages are often sparse and unreliable, we use an exponentially increasing penalty. We use mortality data of England and Wales and model male and female mortality rates jointly by means of penalties, achieving borrowing of information between the two sexes