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Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis.

ABSTRACT: This study assessed trends in social inequalities in tooth loss in the United Kingdom between 1988 and 2009. Data from 20,126 adults who participated in the latest three national Adult Dental Health Surveys in England, Wales and Northern Ireland were used. Social class was determined using the 6-point Registrar General's Social Class. Three indicators of tooth loss were analysed; the proportion of edentate people among all adults and the number of teeth and the proportion with functional dentition (defined as having 20+ teeth) among dentate adults. Trends were modelled within an age, period and cohort framework using partial least squares regression (PLSR). Confidence intervals for PLSR estimates were obtained using non-parametric bootstrapping. The Slope and Relative Index of Inequality (SII and RII) were used to quantify social inequalities in tooth loss. Between 1988 and 2009, absolute inequalities in total tooth loss narrowed (SII changed from -28.4% to -15.3%) while relative inequalities widened (RII from 6.21 to 20.9) in the whole population. On the other hand, absolute and relative social inequality in tooth loss remained fairly stable over time among dentate adults. There was an absolute difference of 2.5-2.9 in number of teeth and 22-26% in the proportion with functional dentition between the lowest and highest social classes. In relative terms, the highest social class had 10-11% more teeth and 25-28% higher probability of having functional dentition than the lowest social class. The findings show pervasive inequalities in tooth loss by social class among British adults despite marked improvements in tooth retention in recent years and generations. In the whole adult population, absolute inequalities in tooth loss have narrowed while relative inequalities have increased steadily. Among dentate adults, absolute and relative inequalities in number of teeth and proportion of people with functional dentition have remained significant but unchanged over time.

SUBMITTER: Bernabe E

PROVIDER: S-EPMC4126783 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Project description:ImportanceMerkel cell carcinoma is an aggressive, cutaneous, neuroendocrine cancer that is increasing in incidence. Understanding why the incidence of Merkel cell carcinoma is increasing through underlying factors, such as age effects, calendar period of diagnosis effects, and birth cohort effects, can help guide resource allocation and design of screening programs.ObjectivesTo evaluate the associations of patient age, calendar period of diagnosis, and birth cohort with the increasing incidence of Merkel cell carcinoma and to provide new incidence projections to 2030.Design, setting, and participantsA cross-sectional retrospective study with age-period-cohort analysis and incidence projection modeling using data from the Surveillance, Epidemiology, and End Results Program database of 9 registries from 1987 to 2016 was conducted among 3720 patients with Merkel cell carcinoma. Statistical analysis was conducted from October 20, 2019, to July 29, 2020.ExposuresAge effects (ie, physiology), period of diagnosis effects (ie, changes in diagnostics and clinical awareness), and birth cohort effects (ie, environmental risk factors) over time were assessed.Main outcomes and measuresIncidence rates of Merkel cell carcinoma.ResultsAmong the 3720 patients in the study (2200 male patients [59.1%]; median age, 77 years [interquartile range, 68-84 years]), during the period from 2012 to 2016, the age-adjusted Merkel cell carcinoma incidence rate was 0.66 per 100 000 (95% CI, 0.62-0.70), which represented a 3.5-times (95% CI, 3.0-4.2) increase from 1987 to 1991. The incidence of Merkel cell carcinoma increased with patient age across calendar periods and birth cohorts; the highest incidence rate was observed for those aged 85 years or older, with an age-adjusted rate from 2012 to 2016 of 14.6 per 100 000 for men and 5.5 per 100 000 for women. Although the birth cohort effect has continued to increase over time, the calendar period of diagnosis effect has started to plateau. It is projected that there will be 3023 new cases of Merkel cell carcinoma in 2020 and 5130 new cases in 2030, increased from an estimated 1933 cases in 2010.Conclusions and relevanceThe slowing down of the period effect (ie, changes in diagnostics and awareness) found in this longitudinal cohort study suggests that part of the initial increased incidence of Merkel cell carcinoma was associated with increased detection. However, the projected increase in incidence rate is likely associated with the aging population and increasing risk factor exposure in more recent birth cohorts.

Project description:This study used nationwide hip fracture data from Denmark and Sweden during 1987-2010 to examine effects of (birth) cohort and period. We found that time trends, cohort, and period effects were different in the two countries. Results also indicated that hip fracture rates may increase in the not so far future.IntroductionThe reasons for the downturn in hip fracture rates remain largely unclear but circumstances earlier in life seem important.MethodsWe ascertained hip fractures in the populations ?50 years in Denmark and Sweden in national discharge registers. Country- and sex-specific age-period-cohort (APC) effects during 1987-2010 were evaluated by log-likelihood estimates in Poisson regression models presented as incidence rate ratios (IRR).ResultsThere were 399,596 hip fractures in SE and 248,773 in DK. Age-standardized hip fracture rate was stable in SE men but decreased in SE women and in DK. Combined period + cohort effects were generally stronger in SE than DK and in women than men. IRR per period ranged from 1.05 to 1.30 in SE and 0.95 to 1.21 in DK. IRR per birth cohort ranged from 1.07 to 3.13 in SE and 0.77 to 1.67 in DK. Relative period effects decreased with successive period in SE and described a convex curve in DK. Relative cohort effects increased with successive birth cohort in both countries but with lower risks for DK women and men and SE women born around the 1930s (age 75-86 years today and responsible for most hip fractures) partly explaining the recent downturn. Men and women born thereafter however seem to have a higher hip fracture risk, and we expect a reversal of the present decline in rates, with increasing hip fracture rates in both Denmark and Sweden during the upcoming decade.ConclusionsTime trends, cohort, and period effects were different in SE and DK. This may reflect differences in general health as evident in known differences in life expectancy, healthcare organization, and prevention such as use of anti-osteoporosis drugs. Analyses indicate that hip fracture rates may increase in the not so far future.

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Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis.

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