Tempo effects may distort the interpretation of trends in life expectancy

Objectives: Recently, a new interpretation problem of trends in period life expectancy has been discussed in the demographic literature. The so-called tempo effects arise if large numbers of deaths are suddenly postponed. In such conditions, the life table inflates longevity gains in the population because it weights avoided deaths with the full remaining life expectancy. This article explains how such effects occur and indicates their relevance using an illustrative example. Study Design and Setting: Data of East and West Germany from the Human Mortality Database for the years 1990-2009 were used. We simulated a scenario that contrasts the observed life expectancy in West and East Germany with an alternative one based on the assumption of short-term postponements of deaths. Results: Our example demonstrates that if tempo effects have distorted changes in life expectancy, the pace of improvement in underlying mortality conditions could be over- and underestimated. Conclusion: We recommend that the assumptions of the life table, in this case about the remaining life expectancy of avoided deaths, are carefully evaluated in all applications. Interdisciplinary efforts to develop models to detect and quantify tempo effects from life expectancy calculations should be put on the research agenda. (C) 2014 Elsevier Inc. All rights reserved

Unfair Utilities and First Steps Towards Improving Them

Many fairness criteria constrain the policy or choice of predictors. In this work, we propose a different framework for thinking about fairness: Instead of constraining the policy or choice of predictors, we consider which utility a policy is optimizing for. We define value of information fairness and propose to not use utilities that do not satisfy this criterion. We describe how to modify a utility to satisfy this fairness criterion and discuss the consequences this might have on the corresponding optimal policies.Comment: 20 page

Späte Mutterschaft als medizinischer Risikofaktor?: Der Einfluss des Alters der Mutter auf das Risiko der Frühgeburt

Das steigende mittlere Alter bei Geburt wird in der medizinischen Forschung als wichtiger Risikofaktor für die Gesundheit der Neugeborenen erachtet, die über den Indikator Frühgeburt bestimmt werden kann. Die vorliegende Analyse eines Kollektivs von insgesamt 1391 Geburten von Müttern im SOEP, konnte in einem multivariaten Design zeigen, dass der Einfluss des biologischen Alters tatsächlich stark von der Bildung moderiert wird. So hat ein mittlerer Bildungsgrad bereits eine stark protektive Wirkung für das mit dem Alter steigende Risiko auf eine Frühgeburt. Die Ergebnisse bestätigen die Hypothese, nach der im Lebenslauf kumulative Bildungsprozesse einen gegenläufigen Einfluss zu gleichzeitigen Alterungsprozessen ausüben können.Older primigravida, preterm births, SOEP, Germany, longitudinal

Can patiromer allow for intensified renin-angiotensin-aldosterone system blockade with losartan and spironolactone leading to decreased albuminuria in patients with chronic kidney disease, albuminuria and hyperkalaemia?:An open-label randomised controlled trial: MorphCKD

INTRODUCTION: Chronic kidney disease (CKD) is associated with significantly increased morbidity and mortality. No specific treatment of the underlying condition is available for the majority of patients, but ACE-inhibitors (ACE-I) and angiotensin II-receptor blockers (ARB) slows progression in albuminuric CKD. Adding a mineralocorticoid receptor-antagonist (MRA) like spironolactone has an additive effect. However, renin–angiotensin–aldosterone system (RAAS)-blockade increases the risk of hyperkalaemia which is exacerbated by the presence of CKD. Thus, hyperkalaemia may prevent optimal use of RAAS-blockade in some patients. This project hypothesises that adding a potassium binder (patiromer) allows for improved RAAS-blockade including the use of MRA, thereby reducing albuminuria in patients with albuminuric CKD where full treatment is limited by hyperkalaemia. If successful, the study may lead to improved treatment of this subgroup of patients with CKD. Furthermore, the study will examine the feasibility of potassium binders in patients with CKD. METHODS AND ANALYSIS: An open-label, randomised controlled trial including 140 patients with estimated glomerular filtration rate (eGFR) 25–60 mL/min/1.73 m(2), a urinary albumin/creatinine ratio (UACR) >500 mg/g (or 200 mg/g if diabetes mellitus) and a current or two previous plasma-potassium >4.5 mmol/L. Patients who develop hyperkaliaemia >5.5 mmol/L during a run-in phase, in which RAAS-blockade is intesified with the possible addition of spironolactone, are randomised to 12-month treatment with maximal tolerated ACE-I/ARB and spironolactone with or without patiromer. The primary endpoint is the difference in UACR measured at randomisation and 12 months compared between the two groups. Secondary endpoints include CKD progression, episodes of hyperkalaemia, blood pressure, eGFR, markers of cardiovascular disease, diet and quality of life. ETHICS AND DISSEMINATION: This study is approved by The Central Denmark Region Committees on Health Research Ethics (REFNO 1-10-72-110-20) and is registered in the EudraCT database (REFNO 2020-001595-15). Results will be presented in peer-reviewed journals, at meetings and at international conferences

Forecasting differences in life expectancy by education

Forecasts of life expectancy (LE) have fuelled debates about the sustainability and dependability of pension and healthcare systems. O

Monitoring of German Fertility: Estimation of Monthly and Yearly Total Fertility Rates on the Basis of Preliminary Monthly Data

Dieser Beitrag stellt eine Methode zur Schätzung von Indikatoren der Geburtenhäufigkeit vor für den Fall, dass keine aktuelle und kurzfristige Geburtenstatistik verfügbar ist. Für Deutschland schlagen wir einen Satz einfacher Methoden vor, der die Errechnung der monatlichen (mTFR) und der jährlichen zusammengefassten Geburtenziffern (TFR) auf der Grundlage vorläufiger Monatsdaten, einschließlich eines Konfidenzintervalls, ermöglicht. Die Methode zur Schätzung der aktuellsten Geburtenziffern lässt sich dann anwenden, wenn keine Angaben zur Altersstruktur und zur Anzahl der Frauen im Gebäralter vorliegen. Die in diesem Beitrag vorgestellten Methoden eignen sich zur Berechnung monatlicher Geburts-indikatoren, wobei minimale Anforderungen an die Datenqualität und den statistischen Aufwand gestellt werden. Darüber hinaus regen wir einen Ansatz an, der die jährliche TFR auf der Grundlage der vorläufigen monatlichen Angaben des ersten Halbjahres vorausberechnet.This paper introduces a set of methods for estimating fertility indicators in the absence of recent and short-term birth statistics. For Germany, we propose a set of straightforward methods that allow for the computation of monthly and yearly total fertility rates (mTFR) on the basis of preliminary monthly data, including a confidence interval. The method for estimating most current fertility rates can be applied when no information on the age structure and the number of women exposed to childbearing is available. The methods introduced in this study are useful for calculating monthly birth indicators, with minimal requirements for data quality and statistical effort. In addition, we suggest an approach for projecting the yearly TFR based on preliminary monthly information up to June

Order specific fertility rates for Germany: Estimates from Perinatal Statistics for the period 2001-2008

Until 2008, Germany’s vital statistics did not include information on the biological order of each birth. This resulted in a dearth of important demographic indicators, such as the mean age at fi rst birth and the level of childlessness. Researchers have tried to fill this gap by generating order-specifi c birth rates from survey data, and by combining survey data with vital statistics. This paper takes a different approach by using Perinatal Statistics to generate birth order-specific fertility rates for the period 2001 to 2008. Perinatal Statistics includes information on births that took place in German hospitals. Out-of-hospital births, which account for about 2 % of all births, are not included in the Perinatal Statistics. In a sensitivity analysis, we show how robust our estimates are to the inclusion of out-of-hospital births. Our general assessment is that the Perinatal Statistics is a valuable source for generating order-specific fertility rates, regardless of whether out-of-hospital births are included

Deer Behavior Affects Density Estimates With Camera Traps, but Is Outwighted by Spatial Variability

Density is a key trait of populations and an essential parameter in ecological research, wildlife conservation and management. Several models have been developed to estimate population density based on camera trapping data, including the random encounter model (REM) and camera trap distance sampling (CTDS). Both models need to account for variation in animal behavior that depends, for example, on the species and sex of the animals along with temporally varying environmental factors. We examined whether the density estimates of REM and CTDS can be improved for Europe’s most numerous deer species, by adjusting the behavior-related model parameters per species and accounting for differences in movement speeds between sexes, seasons, and years. Our results showed that bias through inadequate consideration of animal behavior was exceeded by the uncertainty of the density estimates, which was mainly influenced by variation in the number of independent observations between camera trap locations. The neglection of seasonal and annual differences in movement speed estimates for REM overestimated densities of red deer in autumn and spring by ca. 14%. This GPS telemetry-derived parameter was found to be most problematic for roe deer females in summer and spring when movement behavior was characterized by small-scale displacements relative to the intervals of the GPS fixes. In CTDS, density estimates of red deer improved foremost through the consideration of behavioral reactions to the camera traps (avoiding bias of max. 19%), while species-specific delays between photos had a larger effect for roe deer. In general, the applicability of both REM and CTDS would profit profoundly from improvements in their precision along with the reduction in bias achieved by exploiting the available information on animal behavior in the camera trap data.Deer Behavior Affects Density Estimates With Camera Traps, but Is Outwighted by Spatial VariabilitypublishedVersio

Spatial variation in red deer density in a transboundary forest ecosystem

Forests in Europe are exposed to increasingly frequent and severe disturbances. The resulting changes in the structure and composition of forests can have profound consequences for the wildlife inhabiting them. Moreover, wildlife populations in Europe are often subjected to differential management regimes as they regularly extend across multiple national and administrative borders. The red deer Cervus elaphus population in the Bohemian Forest Ecosystem, straddling the Czech-German border, has experienced forest disturbances, primarily caused by windfalls and bark beetle Ips typographus outbreaks during the past decades. To adapt local management strategies to the changing environmental conditions and to coordinate them across the international border, reliable estimates of red deer density and abundance are highly sought-after by policymakers, wildlife managers, and stakeholders. Covering a 1081-km2 study area, we conducted a transnational non-invasive DNA sampling study in 2018 that yielded 1578 genotyped DNA samples from 1120 individual red deer. Using spatial capture-recapture models, we estimated total and jurisdiction-specific abundance of red deer throughout the ecosystem and quantified the role of forest disturbance and differential management strategies in shaping spatial heterogeneity in red deer density. We hypothesised that (a) forest disturbances provide favourable habitat conditions (e.g., forage and cover), and (b) contrasting red deer management regimes in different jurisdictions create a differential risk landscape, ultimately shaping density distributions. Overall, we estimated that 2851 red deer (95% Credible Interval = 2609–3119) resided in the study area during the sampling period, with a relatively even overall sex ratio (1406 females, 95% CI = 1229–1612 and 1445 males, 95% CI = 1288–1626). The average red deer density was higher in Czechia (3.5 km−2, 95% CI = 1.2–12.3) compared to Germany (2 km−2, 95% CI = 0.2–11). The effect of forest disturbances on red deer density was context-dependent. Forest disturbances had a positive effect on red deer density at higher elevations and a negative effect at lower elevations, which could be explained by partial migration and its drivers in this population. Density of red deer was generally higher in management units where hunting is prohibited. In addition, we found that sex ratios differed between administrative units and were more balanced in the non-intervention zones. Our results show that the effect of forest disturbances on wild ungulates is modulated by additional factors, such as elevation and ungulate management practices. Overall density patterns and sex ratios suggested strong gradients in density between administrative units. With climate change increasing the severity and frequency of forest disturbances, population-level monitoring and management are becoming increasingly important, especially for wide-ranging species as both wildlife and global change transcend administrative boundaries.publishedVersio

Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P=0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P=0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19months (95 CI, 15-25months). Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor