Thursday, April 12, 2018

Framing Americans' Years of Living Lost


A very comprehensive analysis of disease incident rates was just published in the Journal of the American Medical Association by The US Burden of Disease Collaborators:
The US Burden of Disease Collaborators. The State of US Health, 1990-2016Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018;319(14):1444–1472. doi:10.1001/jama.2018.0158 https://jamanetwork.com/journals/jama/fullarticle/2678018?alert=article
Below I review the data collection and results. These are directly quoted:

DATA USED FOR ANALYSIS 


· Systematic analysis of published studies and available data sources providing information on prevalence, incidence, remission, and excess mortality, such as the National Health and Nutrition Examination Surveys, state inpatient databases, the National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, Medical Expenditure Panel Survey, National Comorbidity Survey, National Epidemiological Survey on Alcohol and Related Conditions,National Survey on Drug Use and Health, US Department of Agriculture Continuing Survey of Food Intakes,Marketscan,NationalHealth Interview Survey, Behavioral Risk Factor Surveillance System, and the Centers for Disease Control and Prevention Disease Surveillance Reports.

· Hospital inpatient data were extracted and used for this analysis.

· Outpatient encounter data were available for the United States through aggregate data derived from a database of claims information for US private and public insurance schemes for the years 2000, 2010, and 2012.

RESULTS (YLL: Years of Living Lost ) p. 1447 

US Mortality and YLLs Table 1 lists the 25 leading causes of death and premature mortality from 1990 to 2016. Ischemic heart disease (IHD); cancer of the trachea, bronchus, and lung; chronic obstructive pulmonary disease; Alzheimer disease and other dementias; and cancer of the colon and rectumwere the 5 leading causes of death.

Despite a 50.7% decline in age-standardized mortality and a 50.4% decline in age-standardized YLLs, IHD remained the leading cause of death and premature mortality. There was an increase in age standardized mortality and in age-standardized YLLs from 1990 for chronic obstructive pulmonary disease (13.8% for deaths and 4.6% for YLLs) and for Alzheimer disease and other dementias (11.6% for deaths and 5.5% forYLLs).

There was a decrease in age standardized mortality and in age-standardized YLLs for colon and rectal cancer (29.6% for deaths and 27.9% for YLLs) and for breast cancer (32.6% for deaths and 36.0% forYLLs).

Deaths from endocrine, metabolic, blood, and immune disorders increased by 89.1%, and YLLs increased by 60.3% from 1990 to 2016 (an increase in rank from 37 in2010 to22 in2016).

Other notable findings seen in Table 1 are declines in deaths from self-harm by firearm (13.2%) and physical violence by firearm (28.5%) but an increase in self-harm by other means (16.9%). P. 1447

EXPLANATORY FRAMEWORK


Diet, tobacco use, and high systolic blood pressure were the leading causes of deaths while tobacco use, high body mass index, and diet were the leading risk factors P. 1449

MAJIA'S DISCUSSION

This study is a very useful snapshot of mortality and risk in the US. Risk for death and measured vitality at birth were both very clearly linked to geographical locales. The obvious lesson from the increased risk in places such as West Virginia is that social-welfare programs in states such as California and Minnesota save lives.

But more generally I find one limitation of this otherwise impressive study. That limitation derives from the truncated approach to "environmental" risk adopted in the analysis of results.

Although diet, tobacco use, and high systolic blood pressure (itself a symptom of some underlying conditions) are clearly important lifestyle risk factors, there was no discussion at all of environmental risk factors.

One environmental risk factor that has been very clearly linked to human health is "dirty air":
Emily Underwood (2017, Janaury 26). The Polluted Brain: Evidence Builds that Dirty Air Causes Alzheimers, Dementia. Science Magazine, http://www.sciencemag.org/news/2017/01/brain-pollution-evidence-builds-dirty-air-causes-alzheimer-s-dementia 
Weisskopf, M. G., Kioumourtzoglou, M.-A., & Roberts, A. L. (2015). Air Pollution and Autism Spectrum Disorders: Causal or Confounded? Current Environmental Health Reports, 2(4), 430–439. http://doi.org/10.1007/s40572-015-0073-9
There is strong evidence that dirty air harms the human brain, especially during early development but also across the lifespan.

The harms acquired from dirty air across the lifespan might drive susceptibility to neurological diseases in later adulthood, even as measures of many common pollutants (albeit not ozone) actually decline (http://www.berkeleywellness.com/healthy-community/environmental-health/article/air-pollution-getting-worse-or-better ).

Why don't the JAMA researchers mention dirty air as a possible explanation for the rise of Alzheimer's disease and pulmonary obstruction?

Why do they only mention individualized, lifestyle factors, such as smoking, when other environmental factors may be as important?

Smoking rates, for example, have gone down substantially in the US so it seems unlikely that increased incidents of pulmonary obstruction and Alzheimers could be explained by that particular lifestyle habit alone:
CDC Trends in Current Cigarette Smoking Among High School Students and Adults, United States, 1965–2014. https://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking/index.htm

I believe that framing of increased disease incident primarily in relation to individualized lifestyle choices has unfortunate political effects as it marginalizes environmental hazards over which we could execute better control if we were truly motivated to protect and secure life.

20 comments:

  1. Air quality has improved dramatically in the USA over the same time period owing to reduced emissions and the Clean Air Act. Let's hope changes in the EPA do not lead air quality to diminish. The environment was in a particularly sad state in the 70's and 80's but there have been some success stories. Air Quality is one. Data can be found here showing these improving trends over time relevant to the health study you consider https://www.epa.gov/air-trends/air-quality-national-summary

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    1. It is true that by many measures air pollutants have dropped (as I note specifically above), but when you consider exposure across a lifetime of 70 plus years, the improvements over the last 30 years probably aren't evident yet in neurological diseases stats.

      Meanwhile, we are exposed to new chemicals whose levels aren't as carefully monitored, such as exposure to fracking chemicals in air, water and food.

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    2. Please go and read/consult the data. You state "even as measures of many common pollutants (albeit not ozone) actually decline". O3 (ozone) has dropped more than 30% over this period. https://www.epa.gov/air-trends/ozone-trends The trends go in the wrong direction to explain increases in the incidence of disease. The experts who study such things consider atmospheric pollution as a causal agent. Dirty air is a problem but not likely behind the increase in incidence of these diseases. Your opinions seem to be informed by a lack of understanding of the data. Regards.

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    3. You missed my point about cumulative lifetime impacts and exposures not measured

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    4. E.g. Long term impacts from particulates
      https://jamanetwork.com/journals/jama/fullarticle/194704

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    5. Also trends for ozone are regionally variable. In the southwest the trend is for higher levels
      https://www.sciencedirect.com/science/article/pii/S135223100500097X

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    6. I stand corrected about O3 declines across the USA as there is clearly regional variability. But the study you summarize here and accuse the experts of ignoring things like environmental factors (i.e., air pollution) as a determinant of health...they don't ignore them. The impact of PM2.5 on health has been understood for a long time. These experts know that. In the paper you link to they find that air pollution is 10th most important factor leading to lost days "he results of GBD 2016 have shown that occupational risks and air pollution were the 9th and 10th leading causes for DALYs. Although the findings show reductions in attributable burden from 1990 to 2016, occupational risks still account for 948.75 DALYS per 100 000 persons, and air pollution accounts for 584.97 DALYs per 100 000 persons—large numbers in the United States. Indeed, renewed efforts to reduce the burden of environmental and occupational risks are needed to ensure continued progress in reducing their effect on health in the United States."

      So, again, I'm not sure why you think these things are ignored or why you seem convinced that the experts in this field are in some way incompetent.

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    7. It is quite positive that the study shows that trends are toward better health in the USA.

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    8. Not for better health of the brain.

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    9. Which is unlikely to be due to environmental factors. "Mortality reversals in 21 states for adults ages 20 to 55 years are strongly linked to the burden of substance use disorders, cirrhosis, and self-harm, and this study shows that the trends for some of these conditions differ considerably across different states. "

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    10. Those are environmental factors. And they are only the 'lifestyle' type.

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  2. Really? Is that my old buddy Jay Cullen, famous for testing the wrong things and covering up the devastation of Fukushima and the now obvious destruction of the Pacific Food chain?

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    1. This comment has been removed by a blog administrator.

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    2. Besse davis reactors oñ verge of meltdown

      ONE FIRSTENERGY NUCLEAR PLANT RIDDLED WITH NEAR-MISS ACCIDENTS: DAVIS-BESSE IN OHIO
      Let’s start with the Davis-Besse nuclear plant near Toledo, Ohio. It would be a relief for everyone if that old plant closes down early. Kevin tells us Davis-Besse is a twin to Three Mile Island reactors. There was an accident, like a precursor to TMI, at Davis-Besse about 18 months before TMI Unit 2 had a 50% melt down. But the operators of Davis-Besse kept it secret, so no lesson was learned that could have possibly prevented the TMI accident.

      In 2002, the “hole in head” fiasco at D-B came within 3/16 inch of breaching the reactor, and was again kept secret, then lied about, and finally received millions of dollars in fines. Kamps says the company told the insurance company one thing, admitted differently to federal regulators, and were caught by the insurance company. It more bad behavior from a company with tremendous responsibility to avoid mass damage to the region and beyond.


      https://www.ecoshock.org/2018/04/the-terror-will-cost-you-extra.html


      .

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  3. Study in Utah, shows that brief exposure to pollution particles, causes infection in children.
    Repepeated insults, take their toll, on children and adulta.
    Http://fox13now.com/2018/04/13/brief-exposure-to-air-pollution-particles-triggers-childhood-lung-infections-study-conducted-in-utah-finds/amp/


    Trace elements, like arsenic. Like radium, radon, and other radionuclides, in air pollution, are not closely monitored or studied for long term mortality.

    There is also the occurence, of clouds with high alpha particulates, like this one in Las Angeles, in 2015

    https://www.enviroreporter.com/2015/06/alpha-radiation-clouds-los-angeles-air/









    https://www.enviroreporter.com/2015/06/alpha-radiation-clouds-los-angeles-air/

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  4. Fascism consolidation in America, started with Eisenhower. 

    Eisenhower surrounded himself with military blood suckers, and deep swamp ceatures, as trump has. The saying attributed him, about fearing the military complex, was a cover for him bringing fascism and the military-industrial complex in full bore .

    Eisenhower's presidency was an incubation chamber for creeps like Richard Nixon.

    NIXON AND HIS CRONIES WANTED TO BUILD 1000 NUCLEAR REACTORS IN AMERICA BY 2000.

    Eisenhower was responsible, for radioactively contaminating the west and most openair bomb testing in Nevada. When he started, as president, there were less than a thousand nuclear warheads, when his presidency ended, there were thousands.
    Real fascism, in america was boiling in america, under Eisenhower. THE JOHN birch society, a koch favorite, the serial killer loving ayn rand, promoting her unique brand of hate and fascism, fascist think tanks, the deep state,. Nazi war crimnal-coddling was there.
    Look at the nazi Banderas's, whom neocons reinstalled, in the Ukraine. They were harbored by british and american intelligence, till the time was right.

    The Vietnam war was a prelude, to the  creeping fascism in America. It was the prelude, to the real goal of the Mic, deep state, and oligarchs ( that were resurgent from the great depression), that is a neoliberal imperialist order, and expoitation/raping, pollution of america, of americans. 

    Americans have not been free, since the Nuclear security state under Eisenhower, unleashed the radionuclide mess, that is now all over america and the world.

    Many feel, that the assassination of JFK was the fascist coup that is America, today! The pretend game of far-right and right is becoming unmasked. Millions, have become desperate, in the second great depression, after 2008. A depression and economic displacement that is far from resolved.

    The Vietnam war, was a prelude to the ugliness that america and, america with  trump, have come to. The lies, the propaganda, the brainwashing, the now constantly changing, revisionist history.
    Vietnam was an ugly prelude, to what is happening in america now.

    1 % own more than 50 % of the country.  During the the last great depression, 50 % of the people were displaced by foreclosures and thieves consolidating what was left of the wrecked economy, from the criminal-casino stock market game. It is worse now. Intervention was necessary, in the last great depression, it is now. Like the last great depression, 1% control and own more than 50% of america. When that much  is owned, like in the game of monopoly, people cannot afford rent or health care in america. The nuclearists and corporations have destroyed the health of many americans, by poisoning everything with chemical and radioactive filth from fracking, from the military, from pesticides..............

    Cop shootings are off the rail in America.

    America is involved in many conflicts, around the world.

    Homelessness and dispossession, are at an all-time high in America! Now there are about 10 million, in America. What crappy healthcare, there was in america, is being torn to shreds in America by Republicans. 

    If you get cancer in America, you are just as likely to become despatarate and homeless, as not.

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  5. Trump, and his wave of ultra right-wing thugs, are pushing america to the the edge. They are cutting, already lousey food programs, health programs, housing programs, environmental monitoring programs, to the bone, in this time of massive desperation.

    80 % of America lives paycheck, to paycheck. The other 20 % , who are the core of the republican party, in America, brag about, how much they hate the poor.


    There were never any homeless in Durango, co. Now there are many. The town of Durango, Colorado is trying to make the homeless in the tiny town,  stay on a nuclear waste dump, just outside of town. Steinbeck could not have framed a more despicable, desperate situation.

    https://durangoherald.com/articles/217353

    Christofascist dominionists and blatant fascists, have the foothold in America  now! Welcome to the new world/disorder. The dogs are set loose with Trump. It may not appear to be blatant fascism. It is worse.
    The Dept of Homeland Security is going to monitor journalists and websites in America now. They are consolidating totalitarianism.

    The phoney isolationist, trump, is now a war preaident. It does not get any worse.

    Trump fascists and racists, have provoked and killed in America. What is next?

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  6. From the Nuclear “Buchenwald touch” (Hamilton’s words in 1950) to Nuclear Extermination….
    13 FridayApr 2018
    Posted by miningawareness in Uncategorized≈ Leave a oactivity,Radionuclides,radium girls, x-rays
    Mining Awareness +

    In 1950 Dr. Joseph Hamilton, a Manhattan Project physician involved with human plutonium injections, on unknowing victims, from 1945 to 1947, advised using chimpanzees rather than humans, for total body irradiation experiments, because “If this is to be done in humans, I feel that those concerned in the Atomic Energy Commission would be subject to considerable criticism, as admittedly this would have a little of the Buchenwald touch.” Cited in
    “Advisory Committee on Human Radiation Experiments Final Report,” October 1995, p. 377 (archive.org)

    800 more words

    https://miningawareness.wordpress.com/2018/04/13/from-the-nuclear-buchenwald-touch-hamiltons-words-in-1950-to-nuclear-extermination-2/



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  7. No Magic Bullet Against The Explosive Power and Toxicity of Radionuclides

    Finding a “magic bullet” which will cure the damage done by this high power radiation, especially in the context of a contaminated environment, is more impossible than hoping to heal the anti-Nazi German women in the picture below, or other victims.
    Bones of anti-Nazi German women still are in the crematoriums in the German concentration camp at Weimar, Germany

    No sane person sits in a burning house with the hope that doctors can cure the burns, the tissue damage, induced by the fire. When people self-immolate, and set themselves afire in protest, it is to commit suicide. And, yet we are led to believe that there will be some magic bullet, magic cure for the damage done by nuclear ionizing radiation, which damages tissue, cells and even our very DNA, both externally and internally

    https://miningawareness.wordpress.com/2014/04/15/from-the-nuclear-buchenwald-touch-hamiltons-words-in-1950-to-nuclear-extermination/


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  8. http://www.ibtimes.com/political-capital/betsy-devos-invested-military-tech-contractor-run-son-law-while-brother-shaped

    The worst war crimes, corrumption, murder possible. The sub-human trump and its things, starve americans, fire teachers, dismantle public schools, put people in the streets, while corrupt de vos, corrupt murserer, war criminal-murderer prince genocide innocents. Betsy De vos, erik Primce and family make a killing doing it. The worst darkness possible.
    Kushner got a billion dollar loan for his debt-sunken 666 park avenue property, from saudi connections, after meeting with saudi princes as an agent of the United States under his father in law and boss, the insane bastard, fuko the clown, donald trump. Try to visualize how much of your tax money was wasted mirdering innocent civilians, children in syria. Meanwhile there are millions of homeless and starving americans, and most of the rest barely making it in this fuking chemical and radioactive sewer .fuko the evil clown makes it a million times worse.

    ReplyDelete