Project description:Background:An adequate forecasting model of mortality that allows an analysis of different population changes is a topic of interest for countries in demographic transition. Phenomena such as the reduction of mortality, ageing, and the increase in life expectancy are extremely useful in the planning of public policies that seek to promote the economic and social development of countries. To our knowledge, this paper is one of the first to evaluate the performance of mortality forecasting models applied to abridged life tables. Objective:Select a mortality model that best describes and forecasts the characteristics of mortality in Colombia when only abridged life tables are available. Data and method:We used Colombian abridged life tables for the period 1973-2005 with data from the Latin American Human Mortality Database. Different mortality models to deal with modeling and forecasting probability of death are presented in this study. For the comparison of mortality models, two criteria were analyzed: graphical residuals analysis and the hold-out method to evaluate the predictive performance of the models, applying different goodness of fit measures. Results:Only three models did not have convergence problems: Lee-Carter (LC), Lee-Carter with two terms (LC2), and Age-Period-Cohort (APC) models. All models fit better for women, the improvement of LC2 on LC is mostly for central ages for men, and the APC model's fit is worse than the other two. The analysis of the standardized deviance residuals allows us to deduce that the models that reasonably fit the Colombian mortality data are LC and LC2. The major residuals correspond to children's ages and later ages for both sexes. Conclusion:The LC and LC2 models present better goodness of fit, identifying the principal characteristics of mortality for Colombia.Mortality forecasting from abridged life tables by sex has clear added value for studying differences between developing countries and convergence/divergence of demographic changes.

Project description:ImportanceAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease; understanding ALS risk factors is a critical public health issue.ObjectivesTo evaluate the incidence of and mortality from ALS in National Football League (NFL) athletes and to describe characteristics associated with ALS within this cohort.Design, setting, and participantsThis population-based cohort study included all 19 423 NFL athletes who debuted between 1960 and 2019 and played 1 or more professional game. It was conducted between October 3, 2020, and July 19, 2021.ExposureParticipation in the NFL, including playing 1 or more professional games.Main outcomes and measuresCases of ALS and death information were identified based on public records from NFL statistics aggregators, news reports, obituaries, and National Death Index results. The standardized incidence ratio and the standardized mortality ratio were calculated based on data acquired from surveillance studies of ALS accounting for age, sex, and race. Secondary analyses examined the association of body mass index, NFL career duration, race, birth location, and markers of fame, using a nested case-control design, matching athletes with ALS to athletes without ALS, by NFL debut year.ResultsA total of 19 423 male former and current NFL players (age range, 23-78 years) were included in this cohort study and were followed up for a cumulative 493 168 years (mean [SD] follow-up, 30.6 [13.7] years). Thirty-eight players received a diagnosis of ALS, and 28 died during the study time frame, representing a significantly higher incidence of ALS diagnosis (standardized incidence ratio, 3.59; 95% CI, 2.58-4.93) and mortality (standardized mortality ratio, 3.94; 95% CI, 2.62-5.69) among NFL players compared with the US male population, adjusting for age and race. Among NFL athletes, nested-case-control analyses found that those who received a diagnosis of ALS had significantly longer careers (mean [SD] duration, 7.0 [3.9] years) than athletes without ALS (mean [SD] duration, 4.5 [3.6] years; odds ratio, 1.2; 95% CI, 1.1-1.3). There were no differences in ALS status based on proxies of NFL fame, body mass index, position played, birth location, or race.Conclusions and relevanceThe age-, sex-, and race-adjusted incidence of and mortality from ALS among all NFL players who debuted between 1960 and 2019 were nearly 4 times as high as those of the general population. Athletes with a diagnosis of ALS had longer NFL careers than those without ALS, suggesting an association between NFL duration of play and ALS. The identification of these risk factors for ALS helps to inform the study of pathophysiological mechanisms responsible for this fatal neurodegenerative disease.

Project description:ImportanceStudies of the longevity of professional American football players have demonstrated lower mortality relative to the general population but they may have been susceptible to selection bias.ObjectiveTo examine the association between career participation in professional American football and mortality risk in retirement.Design, setting, and participantsRetrospective cohort study involving 3812 retired US National Football League (NFL) players who debuted in the NFL between 1982 and 1992, including regular NFL players (n = 2933) and NFL "replacement players" (n = 879) who were temporarily hired to play during a 3-game league-wide player strike in 1987. Follow-up ended on December 31, 2016.ExposuresNFL participation as a career player or as a replacement player.Main outcomes and measuresThe primary outcome was all-cause mortality by December 31, 2016. Cox proportional hazards models were estimated to compare the observed number of years from age 22 years until death (or censoring), adjusted for birth year, body mass index, height, and position played. Information on player death and cause of death was ascertained from a search of the National Death Index and web-based sources.ResultsOf the 3812 men included in this study (mean [SD] age at first NFL activity, 23.4 [1.5] years), there were 2933 career NFL players (median NFL tenure, 5 seasons [interquartile range {IQR}, 2-8]; median follow-up, 30 years [IQR, 27-33]) and 879 replacement players (median NFL tenure, 1 season [IQR, 1-1]; median follow-up, 31 years [IQR, 30-33]). At the end of follow-up, 144 NFL players (4.9%) and 37 replacement players (4.2%) were deceased (adjusted absolute risk difference, 1.0% [95% CI, -0.7% to 2.7%]; P = .25). The adjusted mortality hazard ratio for NFL players relative to replacements was 1.38 (95% CI, 0.95 to 1.99; P = .09). Among career NFL players, the most common causes of death were cardiometabolic disease (n = 51; 35.4%), transportation injuries (n = 20; 13.9%), unintentional injuries (n = 15; 10.4%), and neoplasms (n = 15; 10.4%). Among NFL replacement players, the leading causes of death were cardiometabolic diseases (n = 19; 51.4%), self-harm and interpersonal violence (n = 5; 13.5%), and neoplasms (n = 4; 10.8%).Conclusions and relevanceAmong NFL football players who began their careers between 1982 and 1992, career participation in the NFL, compared with limited NFL exposure obtained primarily as an NFL replacement player during a league-wide strike, was not associated with a statistically significant difference in long-term all-cause mortality. Given the small number of events, analysis of longer periods of follow-up may be informative.

Dataset Information

Hospital mortality league tables.

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Hospital mortality league tables.

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