Understanding the Economic Consequences of Shifting Trends in Population Health

The public economic burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy – with a concomitant decrease in the public-sector’s annuity burden – but these savings may be offset by worsening functional status, which increases health care spending, reduces labor supply, and increases public assistance. Using a microsimulation approach, we quantify the competing public-finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures (including Social Security and income assistance). Together, the reduction in smoking and the rise in obesity have increased net public-sector liabilities by $430bn, or approximately 4% of the current debt burden. Larger effects are observed for specific public programs: annual spending is 10% higher in the Medicaid program, and 7% higher for Medicare.disability, health care costs, social security, microsimulation

Swiss teenagers, AIDS and sexually transmitted diseases: presentation and evaluation of a preventive exhibition

As part of a larger school-based health program for Swiss apprentices and students, an AIDS and sexually transmitted disease (STD) prevention exhibition was offered to 7000 boys and girls aged 15-19. Its objectives were: (1) to reinforce their knowledge of STD and AIDS transmission and prevention, and (2) to modify their attitudes and behavior regarding (a) the decision whether, when and how to have sex and (b) the use of condoms. The exhibition consisted of six posters, reviewed by specially-trained teachers and nurses. Condoms were presented in an amusing way and were freely available. A case control follow-up survey was carried out 12 weeks later in two random samples: 798 subjects from an experimental school and 600 subjects from a control school completed an anonymous multiple-choice questionnaire. Of the respondents, 69% were sexually active, and among this group, 76% of the boys and 59% of the girls had used a condom at least once but only 15% used them regularly. As regards knowledge, both groups reached high levels (75-97% of right answers); the group exposed to the exhibition scored higher for only two items (P < 0.05). Significantly more teenagers in the experimental group said they had handled condoms or had condoms with them ‘just in case ...'. This evaluation shows that an AIDS and STD prevention exhibition for teenagers may be both feasible and effective. However, future intervention programs should include practical interpersonal counseling on topics such as mutual trust, contraception issues, and the purchase and use of condom

Le thon : enjeux et stratégies pour l'océan Indien

Le développement de la pêche thonière industrielle dans l'océan Indien sud-ouest et particulièrement de l'activité des flottilles étrangères a un impact économique important sur l'économie des pays de la Commission de l'océan Indien qui autorisent l'exploitation des ressources thonières dans leurs eaux. Le document analyse particulièrement, et en apportant des données originales, la situation dans les pays de la zone et particulièrement pour les Seychelles, pays clé du système en raison de sa situation géographique. L'analyse porte sur l'historique, l'état actuel de la réglementation et des flottilles autorisées, les licences, les accords de pêche en cours, la gestion à terme des droits d'accès et les conditions futures d'octroi des licences de pêche. (Résumé d'auteur

International Differences in Longevity and Health and Their Economic Consequences

In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.disability, mortality, international comparisons, microsimulation

Bayesian Non-Exhaustive Classification A Case Study: Online Name Disambiguation using Temporal Record Streams

The name entity disambiguation task aims to partition the records of multiple real-life persons so that each partition contains records pertaining to a unique person. Most of the existing solutions for this task operate in a batch mode, where all records to be disambiguated are initially available to the algorithm. However, more realistic settings require that the name disambiguation task be performed in an online fashion, in addition to, being able to identify records of new ambiguous entities having no preexisting records. In this work, we propose a Bayesian non-exhaustive classification framework for solving online name disambiguation task. Our proposed method uses a Dirichlet process prior with a Normal * Normal * Inverse Wishart data model which enables identification of new ambiguous entities who have no records in the training data. For online classification, we use one sweep Gibbs sampler which is very efficient and effective. As a case study we consider bibliographic data in a temporal stream format and disambiguate authors by partitioning their papers into homogeneous groups. Our experimental results demonstrate that the proposed method is better than existing methods for performing online name disambiguation task.Comment: to appear in CIKM 201

International Differences in Longevity and Health and their Economic Consequences

In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.disability, mortality, international comparisons, microsimulation

Patterns of Tumor Necrosis Factor Inhibitor (TNFi) Biosimilar Use Across United States Rheumatology Practices.

ObjectiveIt is unclear if biosimilars of biologics for inflammatory arthritis are realizing their promise to increase competition and improve accessibility. This study evaluates biosimilar tumor necrosis factor inhibitor (TNFi) utilization across rheumatology practices in the United States and compares whether patients initiating biosimilars remain on these treatments at least as long as new initiators of bio-originators.MethodsWe identified a cohort of patients initiating a TNFi biosimilar between January 2017 and September 2018 from an electronic health record registry containing data from 218 rheumatology practices and over 1 million rheumatology patients in the United States. We also identified a cohort of patients who initiated the bio-originator TNFi during the same period. We calculated the proportion of biosimilar prescriptions compared with other TNFi's and compared persistence on these therapies, adjusting for age, sex, diagnoses codes, and insurance type.ResultsWe identified 909 patients prescribed the biosimilar infliximab-dyyb, the only biosimilar prescribed, and 4413 patients with a new prescription for the bio-originator infliximab. Biosimilar patients tended to be older, have a diagnosis code for rheumatoid arthritis, and covered by Medicare insurance. Over the study period, biosimilar prescriptions reached a maximum of 3.5% of all TNFi prescriptions. Patients persisted on the biosimilar at least as long as the bio-originator infliximab (hazard ratio [HR] 0.83, P = 0.07).ConclusionThe uptake of biosimilars in the United States remains low despite persistence on infliximab-dyyb being similar to the infliximab bio-originator. These results add to clinical studies that should provide greater confidence to patients and physicians regarding biosimilar use