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Years of Life Lost due to exposure: Causal concepts and empirical shortcomings.

ABSTRACT: Excess Years of Life Lost due to exposure is an important measure of health impact complementary to rate or risk statistics. I show that the total excess Years of Life Lost due to exposure can be estimated unbiasedly by calculating the corresponding excess Years of Potential Life Lost given conditions that describe study validity (like exchangeability of exposed and unexposed) and assuming that exposure is never preventive. I further demonstrate that the excess Years of Life Lost conditional on age at death cannot be estimated unbiasedly by a calculation of conditional excess Years of Potential Life Lost without adopting speculative causal models that cannot be tested empirically. Furthermore, I point out by example that the excess Years of Life Lost for a specific cause of death, like lung cancer, cannot be identified from epidemiologic data without assuming non-testable assumptions about the causal mechanism as to how exposure produces death. Hence, excess Years of Life Lost estimated from life tables or regression models, as presented by some authors for lung cancer or after stratification for age, are potentially biased. These points were already made by Robins and Greenland 1991 reasoning on an abstract level. In addition, I demonstrate by adequate life table examples designed to critically discuss the Years of Potential Life Lost analysis published by Park et al. 2002 that the potential biases involved may be fairly extreme. Although statistics conveying information about the advancement of disease onset are helpful in exposure impact analysis and especially worthwhile in exposure impact communication, I believe that attention should be drawn to the difficulties involved and that epidemiologists should always be aware of these conceptual limits of the Years of Potential Life Lost method when applying it as a regular tool in cohort analysis.

SUBMITTER: Morfeld P

PROVIDER: S-EPMC545055 | biostudies-literature | 2004 Dec

REPOSITORIES: biostudies-literature

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Years of Life Lost due to exposure: Causal concepts and empirical shortcomings.

Morfeld P P

Epidemiologic perspectives & innovations : EP+I 20041216 1

Excess Years of Life Lost due to exposure is an important measure of health impact complementary to rate or risk statistics. I show that the total excess Years of Life Lost due to exposure can be estimated unbiasedly by calculating the corresponding excess Years of Potential Life Lost given conditions that describe study validity (like exchangeability of exposed and unexposed) and assuming that exposure is never preventive. I further demonstrate that the excess Years of Life Lost conditional on ...[more]

PMID: 15601477

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Project description:PurposeAn evaluation of mortality due to infectious diseases in Poland in 1999-2012 and an analysis of standard expected years of life lost due to the above diseases.MethodsThe study material included a database created on the basis of 5,219,205 death certificates of Polish inhabitants, gathered between 1999 and 2012 and provided by the Central Statistical Office. Crude Death Rates (CDR), Standardized Death Rates (SDR) and Standard Expected Years of Life Lost (SEYLL) due to infectious and parasitic diseases were also evaluated in the study period as well as Standard Expected Years of Life Lost per living person (SEYLLp) and Standard Expected Years of Life Lost per dead person (SEYLLd). Time trends were evaluated with the application of joinpoint models and an annual percentage change in their values.ResultsDeath certificates report that 38,261 people died due to infectious diseases in Poland in the period 1999-2012, which made up 0.73% of the total number of deaths. SDR caused by these diseases decreased, particularly in the male group: Annual Percentage Change (APC = -1.05; 95% CI:-2.0 to -0.2; p<0.05). The most positive trends were observed in mortality caused by tuberculosis (A15-A19) (APC = -5.40; 95% CI:-6.3 to -4.5; p<0.05) and also meningitis, encephalitis, myelitis and encephalomyelitis (G03-G04) (APC = -3.42; 95% CI:-4.7 to -2.1; p<0.05). The most negative mortality trends were observed for intestinal infectious diseases (A00-A09) Annual Average Percentage Change (AAPC = 7.3; 95% CI:3.1 to 11.7; p<0.05). SDR substantially decreased in the first half of the study period, but then significantly increased in the second half. Infectious and parasitic diseases contributed to a loss of around 37,000 standard expected years of life in 1999 and more than 28,000 in 2012. During the study period, the SEYLLp index decreased from 9.59 to 7.39 per 10,000 population and the SEYLLd index decreased from 14.26 to 10.34 years (AAPC = 2.3; 95% CI:-2,9 to -1.7; p<0.05).ConclusionsDespite smaller numbers of deaths reported from infectious causes these diseases still represent a serious problem for Poland compared to countries in Western Europe.

Project description:BACKGROUND:The aim of the study was to evaluate trends of mortality and the number of years of life lost due to lung cancer in Poland, in the period 2000-2016. METHODS:The study material was 375,151 death certificates of all inhabitants of Poland who died in the period 2000-2016 due to lung cancer. In order to calculate the number of years of life lost, the authors used indices: SEYLLp (Standard Expected Years of Life Lost per living person), SEYLLd (per deaths), APC (Annual Percentage Change) and AAPC (Average Annual Percentage Change). RESULTS:The standardized death rate (SDR) due to lung cancer decreased in the analyzed period from 74.5 to 68.3 per 100,000 population (AAPC?=?-0.6%). The most rapid decrease was noted in the years 2008-2011 (APC?=?-2.2%). With regards to males, SDR decreased from 148.8 to 114.5 (AAPC?=?-1.7%), whereas in females, it increased from 25.7 to 37.6 (AAPC?=?2.3%). The SEYLLp index, calculated per 100,000 inhabitants, increased from 1189.9 in the year 2000 to 1250.5 in the year 2016. The trend and pace of changes fluctuated. In 2000-2008, the SEYLLp index was increasing at a pace of 0.7%. This growth was followed by a decrease at a pace of -1.2%, noted in 2008-2011. After the year 2011, the indices started to grow at an annual pace of 0.4%. AAPC in the whole study period was 0.3%. Increased mortality in females was responsible for the increase in the number of lost years of life. SEYLLp values in this sex group increased from 464.8 in the year 2000 to 774.7 in the year 2016 (APC?=?3.3%).With regards to males, SEYLLp values, calculated for 100,000 male population, decreased in the analyzed period from 1961.1 to 1758.3. CONCLUSIONS:Lung cancer still poses a serious epidemiological problem in Poland and the number of years of life lost due to this cause reflects social and economic implications of premature lung cancer-related mortality. There is a great need to educate, particularly women, and show effective ways of quitting smoking.

Project description:Aims/hypothesisType 2 diabetes can lead to reduced productivity during working age. We aimed to estimate productive life years lost associated with type 2 diabetes on the individual and population level in Germany in 2020 and 2040, while accounting for future trends in mortality.MethodsBased on a mathematical projection model, we estimated age- and sex-specific productivity losses associated with type 2 diabetes during working age (20-69 years) in Germany in 2020 and 2040. Productivity losses in terms of excess mortality (years of life lost, YLL) and reductions in labour force participation, presenteeism and absenteeism (years of productivity lost, YPL) were summed to calculate productivity-adjusted life years (PALY) lost. Input data for the projection were based on meta-analyses, representative population-based studies and population projections to account for future trends in mortality.ResultsCompared with a person without type 2 diabetes, mean PALY lost per person with type 2 diabetes in 2020 was 2.6 years (95% CI 2.3, 3.0). Of these 2.6 years, 0.4 (95% CI 0.3, 0.4) years were lost due to YLL and 2.3 (95% CI 1.9, 2.6) years were lost due to YPL. Age- and sex-specific results show that younger age groups and women are expected to lose more productive life years than older age groups and men. Population-wide estimates suggest that 4.60 (95% CI 4.58, 4.63) million people with prevalent type 2 diabetes in 2020 are expected to lose 12.06 (95% CI 10.42, 13.76) million PALY (1.62 million years due to YLL and 10.44 million years due to YPL). In 2040, individual-level PALY lost are projected to slightly decrease due to reductions in YLL. In contrast, population-wide PALY lost are projected to increase to 15.39 (95% CI 13.19, 17.64) million due to an increase in the number of people with type 2 diabetes to 5.45 (95% CI 5.41, 5.50) million.Conclusions/interpretationOn the population level, a substantial increase in productivity burden associated with type 2 diabetes was projected for Germany between 2020 and 2040. Efforts to reduce the incidence rate of type 2 diabetes and diabetes-related complications may attenuate this increase.

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Years of Life Lost due to exposure: Causal concepts and empirical shortcomings.

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Years of Life Lost due to exposure: Causal concepts and empirical shortcomings.

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