Ongoing improvement in long-term survival of patients with Hodgkin disease at all ages and recent catch-up of older patients

Since the breakthroughs in combination chemotherapy of patients with Hodgkin disease (HD) starting in the 1960s, prognosis of patients has been rising steadily. Trends in long-term survival of patients with HD on the population level should therefore be monitored in an as timely as possible manner. We assessed trends in age specific 5- and 10-year relative survival of patients with HD in the United States from 1980-1984 to 2000-2004 from the 1973-2004 database of the Surveillance, Epidemiology, and End Results (SEER) Program. Period analysis was used to disclose recent developments with minimum delay. Overall, 5-year relative survival steadily increased from 73.5% to 85.2% (+11.7 percentage units), and 10-year relative survival increased from 62.1% to 80.1% (+18.0 percentage units) between 1980-1984 and 2000-2004, according to period analysis. The increase was particularly pronounced for patients aged 45 to 59 years and 60 years and older (increases in 10-year relative survival by 24.8 and 23.3 percentage points, respectively). Nevertheless, a strong age gradient persisted, with 10-year relative survival of 92.7%, 88.7%, 84.9%, 76.2%, and 44.9% in patients aged 15 to 24 years, 25 to 34 years, 35 to 44 years, 45 to 54 years, and 60 years and older, respectively, in 2000-2004. Our period analysis discloses ongoing, major improvement in long-term survival of patients with HD in recent years, particularly among older patients.     

Inequalities in health at older ages: a longitudinal investigation of the onset of illness and survival effects in England

Background: previous studies have suggested a decline in therelationship between socioeconomic circumstances and healthor functioning in later life, but this may be due to survivaleffects. Objective: to examine whether wealth gradients in the incidenceof illness decline with age, and, if so, whether this declineis explained by differential mortality. Methods: the study included participants in the first two wavesof the English Longitudinal Study of Ageing (ELSA), a largenational longitudinal study of the population aged 50+ in England,who reported good health, no functional impairment, or no heartdisease at baseline. Wealth inequalities in onset of illnessover 2 years were examined across age groups, with and withoutthe inclusion of mortality. Outcome measures were functionalimpairment, heart disease, self-reported health, and all-causemortality (in conjunction with self-reported health and disability)or circulatory-related mortality (in relation to heart disease). Results: wealth predicted onset of functional impairment equallyacross age groups. For self-reported health and heart disease,wealth gradients in the onset of illness declined with age.Selective mortality contributed to this decline in the oldestage groups. Conclusions: socioeconomic inequality in developing new healthproblems persist into old age for certain illnesses, particularlyfunctional impairment, but not for heart disease. Selectivemortality explains only some of the decline in health inequalitieswith age.     

HIV prevalence and sexual behaviour at older ages in rural Malawi

Research on HIV infection and sexual behaviour in sub-Saharan Africa typically focuses on individuals aged 15-49 years under the assumption that both become less relevant for older individuals. We test this assumption using data from rural Malawi to compare sexual behaviour and HIV infection for individuals aged 15-49 with individuals aged 50-64 and 65 and over years. Although general declines with age were observed, levels of sexual activity and HIV remained considerable: 26.7% and 73.8% of women and men aged 65+ reported having sex in the last year, respectively; men's average number of sexual partners remained above one; and HIV prevalence is significantly higher for men aged 50-64 (8.9%) than men aged 15-49 (4.1%). We conclude that older populations are relevant to studies of sexual behaviour and HIV risk. Their importance is likely to increase as access to antiretrovirals in Africa increases. We recommend inclusion of adults aged over 49 years in African HIV/AIDS research and prevention efforts.     

Work at older ages in Japan: variation by gender and employment status

OBJECTIVES: This study describes the correlates of labor force participation among Japanese men and women aged 60-85 and examines differences by gender and employment status. METHODS: Using four waves of data collected from a national sample of older Japanese between 1990 and 1999, we estimate multinomial logistic regression models for three measures of labor force participation (current labor force status, labor force exit, and labor force re-entry) as a function of individual and family characteristics measured 3 years earlier. RESULTS: Labor force participation is significantly associated with socioeconomic status, longest occupation, and family structure. The strength and nature of these relationships differ markedly for men and women and for wage employment and self-employment. DISCUSSION: The emphasis on life course experiences and work-family interdependence characterizing recent research on retirement in the United States is clearly relevant in Japan as well. To better understand later-life labor force participation in Japan, subsequent research should incorporate more direct measures of life course experiences and family relationships and attempt to make explicit cross-national comparisons of these relationships.     

A mortality cost of virginity at older ages in female Mediterranean fruit flies

Mortality rates were measured over the lifetime of 65,000 female Mediterranean fruit flies, Ceratitis capitata, maintained in either all-female (virgin) cages or cages with equal initial numbers of males, to determine the effect of sexual activity and mating on the mortality trajectory of females at older ages. Although a greater fraction of females maintained in all-female (virgin) cages survived to older ages, the life expectancy of the surviving virgins was less than the life expectancy of surviving non-virgins at older ages. This was due to a mortality crossover where virgin flies experience lower mortality than mated flies from eclosion to Day 20 but higher mortality thereafter. These results suggest that there are two consequences of mating--a short-term mortality increase (cost) and a longer term mortality decrease (benefit).     

Long-term exposure to income inequality: implications for physical functioning at older ages

The ‘inequality hypothesis’ proposes that higher levels of societal income inequality have a direct negative causal effect on health. Support for this hypothesis has been mixed; particularly among older people. However, most previous studies have not accounted for people’s exposure to inequality over the long-term. We aimed to address this problem by examining the implications of long-term inequality exposure for older people’s physical health. Data on individual health and covariates were drawn from three large, comparable surveys of older people, covering 16 countries: the English Longitudinal Study of Ageing, the Survey of Health and Retirement in Europe and the U.S. Health and Retirement Study. Historical inequality information was derived from the Standardised World Income Inequality Database. We used multilevel regression methods to model the association between long-term average inequality and three measures of physical functioning: grip strength, lung function and self-reported activity limitation. Exposure to higher average long-term levels of inequality was significantly negatively related to objectively measured grip strength and lung function, but unrelated to self-reported limitations (although increasing inequality over time was positively related to self-reported limitations). The grip strength and lung function associations were partially explained by between-country differences in height, and in the latter case this factor may fully account for the apparent effect of inequality. We discuss implications of these results for the inequality hypothesis.     

Labor force participation at older ages in the Western Pacific: A microeconomic analysis

Retirement has become a very important stage of life for persons in developed countries. Life expectancy for those over age 60 has increased markedly. Rising real income and the institution of broad based social security systems have encouraged older workers to leave the labor force at younger ages. p]Reductions in older age mortality have also affected the less developed regions. Increases in the number of older persons, coupled with continuing high fertility, have increased the size of the working age population through both large entry cohorts and longevity of current workers. The capacity of the economy to absorb this growth is severely limited. As a result, labor force decisions by older individuals will be of increasing importance.This study provides new evidence on labor force decisions in four developing countries in the Western Pacific: Fiji, the Republic of Korea, Malaysia, and the Philippines. A uniform survey sponsored by the World Health Organization in the four countries of persons aged 60 and over is employed to estimate the determinants of work decisions.     

Prevalence of autoantibody-negative diabetes is not rare at all ages and increases with older age and obesity

OBJECTIVE: A significant percentage of nonautoimmune forms of diabetes presents among children in all age groups, with a remarkable increase with age. DESIGN: From October 1992 to October 2004, a total of 859 children less than 18 yr of age were newly diagnosed with diabetes at the Barbara Davis Center for Childhood Diabetes and had blood samples obtained within 2 wk of disease onset for analysis of antiislet autoantibodies to glutamic acid decarboxylase-65, insulinoma-associated antigen-2, insulin, and islet cell autoantibodies. The relationship of autoantibody positivity with human leukocyte antigen (HLA) class II, body mass index (BMI), glycosylated hemoglobin, age, and ethnicity was analyzed. RESULTS: Overall 19% (159 of 859) of these children with newly diagnosed diabetes were negative for all autoantibodies, and autoantibody negativity was significantly increased with age (P < 0.01). The Hispanic and Black subjects had significantly increased autoantibody negativity among older children with higher BMI than White subjects. The patients with the highest risk HLA genotype, DR3-DQ2/DR4-DQ8, were significantly less autoantibody negative (P = 0.001), whereas the HLA-protective allele, DQB1*0602, was significantly increased among the autoantibody-negative patients (P < 0.0001). Insulin autoantibodies were dramatically age dependent and were inversely correlated with age in both prevalence (P < 0.0001) and levels (P < 0.0001). Autoantibody positivity was inversely correlated with both BMI and age using multivariate analysis (P < 0.0001 and P = 0.0078, respectively). CONCLUSIONS: A significant percentage of children newly diagnosed with diabetes are negative for all antiislet autoantibodies with a marked increase in obesity-associated autoantibody-negative diabetes after age 10, suggesting diabetes heterogeneity at all ages.     

Daily dialysis and survival rates of vascular access

A major cause of morbidity for haemodialysis patients is vascular access failure and/or occlusion. It is commonly believed that increased frequency of dialysis sessions, among other factors, might lead to higher rates of fistula complications. To evaluate if patients on daily haemodialysis carry a higher risk of vascular access occlusion, we examined the raw incidence rate of access occlusion and the survival function of native vascular access in patients undergoing daily dialysis (DD ‐ N. =24) as compared to patients on standard three times a week haemodialysis (TWD‐N. =198). The number of thrombotic events in the first group was 2 (8%) whereas in the second group we observed 76 (38%) access problems (8%) (p<0.008). The mean vascular access survival before occlusion was 1307 days in TWD and 1388 days in DD. Our data clearly shows that daily dialysis should not be considered a risk factor for access occlusion.     

Trends in rates of onset of and recovery from disability at older ages: 1982-1994

OBJECTIVES: Although there is substantial evidence of declining prevalence of disability among the older population during the late 1980s and 1990s, evidence on trends in the underlying dynamics of disability is lacking. For this study, we estimated models of transitions between discrete disability and vital states that incorporated simple linear time trends. METHODS: We analyzed data from the 1982-1994 interviews of the New Haven Established Populations for Epidemiologic Studies of the Elderly study and used three alternative measures of disability status. We estimated separate models of disability prevalence and disability transitions by gender. RESULTS: Eleven of 12 estimated trends in transition rates were statistically significant. For men and women, and for three alternative disability indicators, we found downward trends in rates of both onset of and recovery from disability among people aged 75 and older. We did not find any consistent pattern of trends in disability among those aging into the 75 and older group during this period. DISCUSSION: Our findings are consistent with declining population-level disability prevalence only if any downward trend in onset outweighs the downward trend in recovery. These findings are also consistent with a trend toward more severe disability problems among the disabled population.     

Mammography use, breast cancer stage at diagnosis, and survival among older women

BACKGROUND: Women age 65 years and older account for most newly diagnosed breast cancers and deaths from breast cancer. Yet, older women are least likely to undergo mammography, perhaps because mammography's value is less well demonstrated in older women. OBJECTIVE: To investigate the relationship between prior mammography use, cancer stage at diagnosis, and breast cancer mortality among older women with breast cancer. DESIGN: Retrospective cohort study using the Linked Medicare-Tumor Registry Database. SETTING: Population-based data from three geographic areas included in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. PARTICIPANTS: Women aged 67 and older diagnosed with a first primary breast cancer, from 1987 to 1993, residing in Connecticut, metropolitan Atlanta, Georgia, or Seattle-Puget Sound, Washington. MEASUREMENTS: Medicare claims were reviewed and women were classified according to their mammography use during the 2 years before diagnosis: nonusers (no prior mammograms), regular users (at least two mammograms at least 10 months apart), or peri-diagnosis users (only mammogram(s) within 3 months before diagnosis). Mammography utilization was linked with SEER data to determine stage at diagnosis and cause of death. Our main outcome variables were (1) stage at diagnosis, classified as early (in situ/Stage I) or late (Stage II or greater), and (2) breast cancer mortality, measured from diagnosis until death from breast cancer or end of the follow-up period (December 31, 1994). RESULTS: Older women who were nonusers of mammography were diagnosed with breast cancer at Stage II or greater more often than regular users (adjusted odds ratio (OR), 3.12; 95% confidence interval (CI), 2.74-3.58). This association was present within each age group studied. Nonusers of mammography were at significantly greater risk of dying from their breast cancer than regular users for all women (adjusted hazard ratio (HR), 3.38; 95% CI, 2.65-4.32) and for women within each age group. Even assuming a lead time of 1.25 years, nonusers of mammography continued to be at increased risk of dying from breast cancer. Our findings remained significant for all women and for the two youngest age groups (67-74 years, 75-85 years), although the benefit was no longer statistically significant for the oldest women (85 years and older). CONCLUSIONS: Older women who undergo regular mammography are diagnosed with an earlier stage of disease and are less likely to die from their disease. These data support the use of regular mammography in older women and suggest that mammography can reduce breast cancer mortality in older women, even for women age 85 and older.     

Living kidney donors ages 70 and older: recipient and donor outcomes

Summary

Background and objectives

The profound organ shortage has resulted in longer waiting times and increased mortality for those awaiting kidney transplantation. Consequently, patients are turning to older living donors. It is unclear if an upper age limit for donation should exist, both in terms of recipient and donor outcomes.

Design, setting, participants, & measurements

In the United States, 219 healthy adults aged ≥70 have donated kidneys at 80 of 279 transplant centers. Competing risks models with matched controls were used to study the independent association between older donor age and allograft survival, accounting for the competing risk of recipient mortality as well as other transplant factors.

Results

Among recipients of older live donor allografts, graft loss was significantly higher than matched 50-to 59-year-old live donor allografts (subhazard ratio [SHR] 1.62, 95% confidence interval [CI] 1.16 to 2.28, P = 0.005) but similar to matched nonextended criteria 50-to 59-year-old deceased donor allografts (SHR 1.19, 95% CI 0.87 to 1.63, P = 0.3). Mortality among living kidney donors aged ≥70 was no higher than healthy matched controls drawn from the NHANES-III cohort; in fact, mortality was lower, probably reflecting higher selectivity among older live donors than could be captured in National Health and Nutrition Examination Survey III (NHANES-III; HR 0.37, 95% CI 0.21 to 0.65, P < 0.001).

Conclusions

These findings support living donation among older adults but highlight the advantages of finding a younger donor, particularly for younger recipients.     

Pet ownership and survival of European older adults

With pet ownership on the rise, millions of individuals are exposed to this environmental exposure. Although the subject has been largely studied, more evidence is needed to clarify the potential association of pet ownership with human health. The aim of this research is to study the potential association of pet exposure (any pet, cat, dog, bird, fish) with all-cause, cardiovascular and cancer mortality of older (≥ 50 years) European residents. To this end, a total of 23,274 participants from the Survey of Health Ageing and Retirement in Europe (SHARE) were employed (median follow-up 119 months). All-cause mortality (5163 events), as well as cardiovascular (CVD) (1832 events), and cancer mortality (1346 events) were examined using Cox Proportional Hazards models for their relation with pet exposure at baseline. Stratified analyses were also performed by gender and for single or multi-person households. No significant association was observed for any of the pets with all-cause mortality on the whole sample and the fully adjusted models. In stratified analyses, bird exposure significantly increased the risk of all-cause mortality in women [Hazard Ratio (HR)=1.23; 95% CI 1.04–1.44] as well as women living alone (HR=1.38; 95% CI 1.02–1.85). Cause-specific models revealed an increased risk of death for women bird owners for causes other than cancer and CVD (HR=1.40; 95% CI 1.05–1.99). In conclusion, bird ownership may be negatively associated with survival of older women in Europe.     

Productive activities and psychological well-being among older adults

OBJECTIVES: The purpose of this study was to test whether paid work and formal volunteering reduce the rate of mental health decline in later life. METHODS: Using four waves of Health and Retirement Study data collected from a sample of 7,830 individuals aged 55 to 66, I estimated growth curve models to assess the effects of productive activities on mental health trajectories. The analytical strategy took into account selection processes when examining the beneficial effects of activities. The analyses also formally attended to the sample attrition problem inherent in longitudinal studies. RESULTS: The results indicated that activity participants generally had better mental health at the beginning of the study. Full-time employment and low-level volunteering had independent protective effects against decline in psychological well-being. Joint participants of both productive activities enjoyed a slower rate of mental health decline than single-activity participants. DISCUSSION: The results are consistent with activity theory and further confirm the role accumulation perspective. The finding that full-time work combined with low-level volunteering is protective of mental health reveals the complementary effect of volunteering to formal employment. Methodological and theoretical implications are discussed.