Browsing by Subject "Life expectancy"

Now showing 1 - 4 of 4
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    A Modified Tumor-Node-Metastasis Classification for Primary Operable Colorectal Cancer
    (Oxford University Press, 2020-10-16) Zhang, Chundong; Mei, Zubing; Pei, Junpeng; Abe, Masanobu; Zeng, Xiantao; Huang, Qiao; Nishiyama, Kazuhiro; Akimoto, Naohiko; Haruki, Koichiro; Nan, Hongmei; Meyerhardt, Jeffrey A.; Zhang, Rui; Li, Xinxiang; Ogino, Shuji; Ugai, Tomotaka; Community and Global Health, School of Public Health
    Background: The American Joint Committee on Cancer (AJCC) 8th tumor-node-metastasis (TNM) classification for colorectal cancer (CRC) has limited ability to predict prognosis. Methods: We included 45 379 eligible stage I-III CRC patients from the Surveillance, Epidemiology, and End Results Program. Patients were randomly assigned individually to a training (n = 31 772) or an internal validation cohort (n = 13 607). External validation was performed in 10 902 additional patients. Patients were divided according to T and N stage permutations. Survival analyses were conducted by a Cox proportional hazard model and Kaplan-Meier analysis, with T1N0 as the reference. Area under receiver operating characteristic curve and Akaike information criteria were applied for prognostic discrimination and model fitting, respectively. Clinical benefits were further assessed by decision curve analyses. Results: We created a modified TNM (mTNM) classification: stages I (T1-2N0-1a); IIA (T1N1b, T2N1b, T3N0); IIB (T1-2N2a-2b, T3N1a-1b, T4aN0); IIC (T3N2a, T4aN1a-2a, T4bN0); IIIA (T3N2b, T4bN1a); IIIB (T4aN2b, T4bN1b); and IIIC (T4bN2a-2b). In the internal validation cohort, compared with the AJCC 8th TNM classification, the mTNM classification showed superior prognostic discrimination (area under receiver operating characteristic curve = 0.675 vs 0.667, respectively; 2-sided P < .001) and better model fitting (Akaike information criteria = 70 937 vs 71 238, respectively). Similar findings were obtained in the external validation cohort. Decision curve analyses revealed that the mTNM had superior net benefits over the AJCC 8th TNM classification in the internal and external validation cohorts. Conclusions: The mTNM classification provides better prognostic discrimination than AJCC 8th TNM classification, with good applicability in various populations and settings, to help better stratify stage I-III CRC patients into prognostic groups.
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    Declaring racism a public health crisis brings more attention to solving long-ignored racial gaps in health
    (The Conversation US, Inc., 2021-04-22) Halverson, Paul K.; Health Policy and Management, Richard M. Fairbanks School of Public Health
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    Non-Response to Population Aging in Sub-Saharan Africa: A Survey of Gerontology Scholars
    (Oxford University Press, 2021) Adamek, Margaret; Kotecho, Messay; Chane, Samson; Gebeyaw, Getachew; School of Social Work
    Life expectancy is increasing globally, with the biggest gains expected in sub-Saharan Africa. In fact, most of the population growth globally in the next few decades will occur in sub-Saharan Africa. Using an online survey we investigated the perspectives of gerontology scholars on the challenges of aging in sub-Saharan Africa as well as the assets of elders. Respondents (n=72) from 17 countries, primarily in Africa, and representing 16 disciplines, identified the top issues facing African elders as: poverty, lack of trained professionals, food insecurity, disability/health issues, and long-term care. Older adults’ unique strengths were noted as indigenous knowledge systems, being holders of cultural heritage, and their contributions to development. Respondents’ biggest concerns about older adults in sub-Saharan Africa were the lack of government attention to aging issues (63%) and a lack of social services targeted to elders’ needs (57%). Government funding (77.8%) and international partnerships (38.9%) were noted as resources needed to support aging research in sub-Saharan Africa. The response or non-response of governments in sub-Saharan Africa will determine whether the growing number of older adults will increasingly experience unmet needs and whether their assets will be considered in development efforts. Establishing professional networks of gerontology scholars in the region will help to document the challenges faced by elders, to plan for the coming demographic shift, and to empower elders to thrive as valued community members.
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    Worlds Further Apart: The Widening Gap in Life Expectancy among Communities of the Indianapolis Metropolitan Area
    (IU Richard M. Fairbanks School of Public Health; The Polis Center at IUPUI, 2021-08) Weathers, T; Kiehl, NT; Colbert, JT; Nowlin, M; Comer, KF; Staten, LK
    Indianapolis metro area residents are a diverse group of people. What we have in common is that many of our best and worst days have been lived within this larger community. We may recall warm summer hours in our favorite park, a day spent at “the track,” or taking the kids to the Children’s Museum. We may also remember days spent at the bedside of a sick family member in an area hospital or places of tragic loss. Year after year, we build our lives within the Indianapolis metro area. In this way, our lives are linked by a shared community. However, in the neighborhoods we each call home, our daily lives are often vastly different. For some, getting groceries means lugging plastic sacks onto the IndyGo bus after waiting on a patch of worn grass. For others, grocery shopping is a quick drive to one of three favorite options, and the farmer’s market is a weekend routine for fresh produce. Some kids go to school with laptops and fresh smelling pages of new textbooks, while others have worn books and no internet access. Playing outside with friends in one neighborhood builds fitness and friendships, while in another playing outside triggers an asthma attack because of all the car exhaust along the busy roadway. Place differences add up over the days of our lives to affect our health and length of life. The children of one neighborhood have the same biological capacity for a long and healthy life as do the children of any other neighborhood, but where they live and grow and learn often unfairly cuts short their opportunities and their life. In our updated analysis of 104 ZIP Codes in the metro area (2014-2018), we identified the northern suburb of Fishers as our longest living community and just 17 miles away, within the Indianapolis city limits, is the shortest living community within the metro area. Though only 17 miles of distance separate them, their life expectancy is worlds apart. As the White River winds its way through the metro area, flowing northeast to southwest, it connects us as a larger community across time and space. The history of central Indiana is rooted in access to this shared life-supporting resource, where tribes, then towns and cities grew along its banks. Following the winding path of the White River, we see a pattern in life expectancy that also plays out throughout the metro area (See Life Expectancy Mapped Along the White River, 2014-2018, on next page). Life expectancy is lowest in places within the urban core of Indianapolis and also on the outer periphery of the metro area (red), while highest life expectancy is found in the suburban transitions from the city (green). Similar to our earlier findings residents of the longest-living community are living years longer than the U.S. average with a life expectancy comparable to the top high-income countries of the world.1 Residents of the shortest living community are living only as long as U.S. residents lived on average more than six decades ago, and the gap has widened. There is no genetic reason for this inequity. These data compel us to put equity at the forefront in addressing the economic and social policies and structures driving this unfairness. Inequity, in life and health, “saps the strength of the whole society.”2