Daily Papers

Whether the risk of death keeps climbing at extreme ages or levels off has divided researchers for a century. We show this conflict reflects a moving target. Using cohort data from twelve low-mortality populations, we find that mortality deceleration and plateau onset shift steadily later across cohorts born from the mid-19th to the early-20th century. The data support a plateau across the full cohort range, though evidence weakens for the youngest, incompletely observed cohorts. In these younger cohorts, deceleration begins near age 100, and the fitted plateau begins beyond age 108. Because past studies focused on different cohorts and fixed age ranges, they sampled different phases of the exact same shift. The mortality plateau has no fixed age: it has been rescheduled.

This paper presents a novel approach for modeling mortality rates above age 70 by proposing a mixture-based model. This model is compared to four other widely used models: the Beard, Gompertz, Makeham, and Perks models. Our model can capture the complex behavior of mortality rates at all ages, providing a more accurate representation of the data. To evaluate the performance of our model, we applied it to two countries with different data quality: Japan and Brazil. Our results show that the proposed model outperforms the other models in both countries, particularly in Japan where it obtained an absolute mean percentage error of less than 7%, while the other models presented values greater than 30%. This highlights the ability of our model to adapt to different data quality and country-specific mortality patterns. In summary, this paper presents a mixture-based model that captures the behavior of mortality rates at all ages and outperforms other widely used models in both high- and low-quality data settings. This model can improve mortality prediction and inform public health policy.

Age-specific mortality improvements are non-uniform, neither across ages nor across time. We propose a two-step procedure to estimate the rates of mortality improvement (RMI) in age-specific death rates (ASDR) at ages 85 and above for ten European countries from 1950 to 2019. In the first step, we smooth the raw death counts and estimate ASDR using four different methods: one parametric (gamma-Gompertz-Makeham), two non-parametric (P-splines and PCLM), and a novel Bayesian procedure to handle fluctuations resulting from ages with zero death counts. We compare the goodness of fit of the four smoothing methods and calculate the year-to-year ASDR differences according to the best-fitting one. We fit a piecewise linear function to these differences in the second step. The slope in each linear segment captures the average RMI in the respective year range. For each age, we calculate the goodness of fit in the last linear segment to assess how informative the estimated RMI of current mortality change is. The estimated rates of mortality improvement or deterioration (RMI) can be used to make short-term social, health, and social planning, as well as more precise mortality forecasts.

The Makeham term is a crucial element in mortality modeling, representing a constant additive hazard that addresses background mortality factors unrelated to aging. Widely used in mortality analysis, this term enables the capture of risks not linked to age-related decline. This paper aims to explore the relationship between Makeham mortality models and competing risk frameworks, investigating how Makeham models can be analyzed within the context of competing risks. It provides insights into the mathematical properties, interpretation, and applicability of Makeham models in modeling mortality risks associated with various causes of death. Additionally, it demonstrates that competing risk models can be represented as mixture models, enhancing understanding of mortality dynamics. The contribution lies in showing that Makeham mortality models, when represented as mixtures, offer a straightforward specification that can accommodate unobserved heterogeneity and distinguish between senescent and extrinsic mortality. By expressing Makeham models as a convex combination of probability distributions, the paper allows the estimation of premature mortality profiles, particularly at older ages, where most deaths are assumed to be senescent. It also facilitates the estimation of senescent mortality, which is crucial for studying the aging process.

Timely intensive care dictates survival, yet emergency infrastructure remains unevenly distributed across Sri Lanka. While pre-hospital services have expanded, the transition to definitive care remains a critical bottleneck. This study evaluates national emergency resilience by quantifying the gap between clinical demand and the availability of specialized resources across all 25 districts. Using the latest national epidemiological data and terrain-aware H3 hexagonal modeling, we analyzed accessibility for seven critical conditions based on spatial gaps, clinical need-gaps, lethality, coverage, and resource availability. Based on these metrics, unsupervised K-Means clustering was applied to categorize districts into four policy-actionable archetypes: Critical Structural Exclusion, Institutional Mirages, Operational Capacity Strain, and High-Resilience Benchmarks. Our study suggests that severe service deficits exist in the Northern and Eastern provinces, where spatial gaps exceed 70%, rendering the Golden Hour operationally impossible. Notably, specialist scarcity drives systemic pressure more than bed capacity; underserved regions effectively function as institutional mirages. This study suggests that improving accessibility by 25% in high-priority clusters would reduce the national need-gap by 9.65%, providing a roadmap for the strategic redistribution of specialists to ensure healthcare equity.

In this paper, we suggest a novel method for detecting mortality deceleration. We focus on the gamma-Gompertz frailty model and suggest the subtraction of a penalty in the log-likelihood function as an alternative to traditional likelihood inference and hypothesis testing. Over existing methods, our method offers advantages, such as avoiding the use of a p-value, hypothesis testing, and asymptotic distributions. We evaluate the performance of our approach by comparing it with traditional likelihood inference on both simulated and real mortality data. Results have shown that our approach is more accurate in detecting mortality deceleration and provides more reliable estimates of the underlying parameters. The proposed method is a significant contribution to the literature as it offers a powerful tool for analyzing mortality patterns.

\noindent The modal age at death is an increasingly used measure for understanding longevity and mortality patterns. However, existing estimation methods focus on point estimates, overlooking the inherent variability and uncertainty in mortality data. This study addresses this gap by introducing a probabilistic framework for estimating the probability distribution of the modal age at death. Using a multinomial model for age-specific death counts and leveraging a Gaussian approximation, our methodology captures variability while aligning with the discrete nature of mortality data. Empirical examples are based on mortality data from six different countries. By quantifying uncertainty around the modal age at death and improving robustness to data fluctuations, this approach offers valuable insights for demographic research and policy planning.

Addressing the imminent shortfall of 10 million health workers by 2030, predominantly in Low- and Middle-Income Countries (LMICs), this paper introduces an innovative approach that harnesses the power of Large Language Models (LLMs) integrated with machine translation models. This solution is engineered to meet the unique needs of Community Health Workers (CHWs), overcoming language barriers, cultural sensitivities, and the limited availability of medical dialog datasets. I have crafted a model that not only boasts superior translation capabilities but also undergoes rigorous fine-tuning on open-source datasets to ensure medical accuracy and is equipped with comprehensive safety features to counteract the risks of misinformation. Featuring a modular design, this approach is specifically structured for swift adaptation across various linguistic and cultural contexts, utilizing open-source components to significantly reduce healthcare operational costs. This strategic innovation markedly improves the accessibility and quality of healthcare services by providing CHWs with contextually appropriate medical knowledge and diagnostic tools. This paper highlights the transformative impact of this context-aware LLM, underscoring its crucial role in addressing the global healthcare workforce deficit and propelling forward healthcare outcomes in LMICs.

Epidemiologists aiming to model the dynamics of global events face a significant challenge in identifying the factors linked with anomalies such as disease outbreaks. In this paper, we present a novel method for identifying the most important development sectors sensitive to disease outbreaks by using global development indicators as markers. We use statistical methods to assess the causative linkages between these indicators and disease outbreaks, as well as to find the most often ranked indicators. We used data imputation techniques in addition to statistical analysis to convert raw real-world data sets into meaningful data for causal inference. The application of various algorithms for the detection of causal linkages between the indicators is the subject of this research. Despite the fact that disparities in governmental policies between countries account for differences in causal linkages, several indicators emerge as important determinants sensitive to disease outbreaks over the world in the 21st Century.

Medical coding translates clinical documentation into standardized codes for billing, research, and public health, but manual coding is time-consuming and error-prone. Existing automation efforts rely on small datasets that poorly represent real-world patient heterogeneity. We trained a language model on 5.8 million electronic health records from 1.8 million patients across nearly all specialties in Eastern Denmark (2006--2016) to predict ICD-10 codes from clinical notes, medications, and laboratory results. Evaluated on 270,000 held-out patients, the model achieved a micro F1 of 71.8% and a top-10 recall of 95.5%. Performance varied by specialty (F1: 53--91%), with higher scores in specialties with well-defined diagnostic criteria. Codes appearing predominantly as secondary diagnoses had markedly lower F1 scores. For three such codes (suicide-related behaviors, weight disorders, and hypertension), the model identified thousands of uncoded cases, of which 76-86% were confirmed valid upon manual review, suggesting systematic under-coding rather than model error. These findings suggest under-coding of secondary diagnoses in Eastern Denmark during this period, with potential implications for epidemiological research, public health surveillance, and understanding of multimorbidity. Similar time constraints and reimbursement structures in other healthcare systems suggest this may not be isolated to this dataset. The model can automate coding for approximately 50% of cases and provide accurate suggestions for most others, and may offer a practical solution to help capture missed secondary conditions.

Human aging is marked by a steady rise in the risk of dying with age-a process demographers call senescence. Over the past century, life expectancy has risen dramatically, but is this because we are aging slower, or simply starting it later? Vaupel hypothesizes that the pace at which individuals age may be constant, with gains in longevity coming from the delayed onset of senescence rather than its slowing down. We test this idea using a new framework that decomposes the pace of senescence into three components: a biological baseline, a long-term trend, and the cumulative impact of period shocks. Applying this to cohort mortality data above age 80 from 12 countries, we find that once period shocks are accounted for, there is no statistical evidence of a long-term trend, consistent with Vaupel's hypothesis. Analyses using lower starting ages yield the same qualitative conclusion. Rather than indicating a change in the process that drives senescence, these variations are consistent with echoes of shared historical events. These results suggest that while longevity has shifted, the rhythm of human aging may be conserved.

Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.

Sri Lanka has experienced a decade of progressive forest degradation and rising atmospheric pollution, yet district-level respiratory admissions have paradoxically declined, pointing to the confounding role of healthcare access. This study addresses that gap by constructing an 11-year (2014-2024) panel dataset across all 25 administrative districts, integrating satellite-derived vegetation indices, fire radiative power, pollutant concentrations (particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2)), carbon flux metrics and population-normalized respiratory admission rates. Two temporally validated XGBoost models were created for annual district-level respiratory rate (R^2 = 0.937) and monthly PM2.5 concentration (R^2 = 0.976) with generalization validated in 21 out of 25 districts (Mean Absolute Percentage Error (MAPE) <= 20%). Shapley Additive Explanations (SHAP) analysis established that cumulative air quality burden is the overwhelming driver of respiratory rate variance (80.1%), ahead of forest degradation (15.6%) and fire activity (4.3%). The Forest-Air-Health (FAH) Risk Index used these SHAP-derived weights to find the districts with the highest risk: Colombo (FAH = 0.802), Gampaha (0.708), and Kalutara (0.682). These findings present the inaugural evidence-based, district-level framework correlating environmental degradation with respiratory health in Sri Lanka, establishing a quantitative basis for focused public health and environmental policy.

Satellite imagery has emerged as an important tool to analyse demographic, health, and development indicators. While various deep learning models have been built for these tasks, each is specific to a particular problem, with few standard benchmarks available. We propose a new dataset pairing satellite imagery and high-quality survey data on child poverty to benchmark satellite feature representations. Our dataset consists of 33,608 images, each 10 km times 10 km, from 19 countries in Eastern and Southern Africa in the time period 1997-2022. As defined by UNICEF, multidimensional child poverty covers six dimensions and it can be calculated from the face-to-face Demographic and Health Surveys (DHS) Program . As part of the benchmark, we test spatial as well as temporal generalization, by testing on unseen locations, and on data after the training years. Using our dataset we benchmark multiple models, from low-level satellite imagery models such as MOSAIKS , to deep learning foundation models, which include both generic vision models such as Self-Distillation with no Labels (DINOv2) models and specific satellite imagery models such as SatMAE. We provide open source code for building the satellite dataset, obtaining ground truth data from DHS and running various models assessed in our work.

Dengue fever presents a substantial challenge in developing countries where sanitation infrastructure is inadequate. The absence of comprehensive healthcare systems exacerbates the severity of dengue infections, potentially leading to life-threatening circumstances. Rapid response to dengue outbreaks is also challenging due to limited information exchange and integration. While timely dengue outbreak forecasts have the potential to prevent such outbreaks, the majority of dengue prediction studies have predominantly relied on data that impose significant burdens on individual countries for collection. In this study, our aim is to improve health equity in resource-constrained countries by exploring the effectiveness of high-resolution satellite imagery as a nontraditional and readily accessible data source. By leveraging the wealth of publicly available and easily obtainable satellite imagery, we present a scalable satellite extraction framework based on Sentinel Hub, a cloud-based computing platform. Furthermore, we introduce DengueNet, an innovative architecture that combines Vision Transformer, Radiomics, and Long Short-term Memory to extract and integrate spatiotemporal features from satellite images. This enables dengue predictions on an epi-week basis. To evaluate the effectiveness of our proposed method, we conducted experiments on five municipalities in Colombia. We utilized a dataset comprising 780 high-resolution Sentinel-2 satellite images for training and evaluation. The performance of DengueNet was assessed using the mean absolute error (MAE) metric. Across the five municipalities, DengueNet achieved an average MAE of 43.92. Our findings strongly support the efficacy of satellite imagery as a valuable resource for dengue prediction, particularly in informing public health policies within countries where manually collected data is scarce and dengue virus prevalence is severe.

Breast cancer screening plays a pivotal role in early detection and subsequent effective management of the disease, impacting patient outcomes and survival rates. This study aims to assess breast cancer screening rates nationwide in the United States and investigate the impact of social determinants of health on these screening rates. Data on mammography screening at the census tract level for 2018 and 2020 were collected from the Behavioral Risk Factor Surveillance System. We developed a large dataset of social determinants of health, comprising 13 variables for 72337 census tracts. Spatial analysis employing Getis-Ord Gi statistics was used to identify clusters of high and low breast cancer screening rates. To evaluate the influence of these social determinants, we implemented a random forest model, with the aim of comparing its performance to linear regression and support vector machine models. The models were evaluated using R2 and root mean squared error metrics. Shapley Additive Explanations values were subsequently used to assess the significance of variables and direction of their influence. Geospatial analysis revealed elevated screening rates in the eastern and northern United States, while central and midwestern regions exhibited lower rates. The random forest model demonstrated superior performance, with an R2=64.53 and root mean squared error of 2.06 compared to linear regression and support vector machine models. Shapley Additive Explanations values indicated that the percentage of the Black population, the number of mammography facilities within a 10-mile radius, and the percentage of the population with at least a bachelor's degree were the most influential variables, all positively associated with mammography screening rates.

A growing literature argues that progress in human longevity is slowing, and that this slowdown may signal an approaching biological limit to lifespan. The argument rests on visible flattening of cumulative life expectancy records, evaluated through linear regressions or through comparisons of average gains across decades. These summaries, however, provide only weak evidence for slowing improvements, because they cannot distinguish a true from an apparent slowdown. An apparent slowdown may arise due to periods of low variance around unchanged mean annual gains. Applying a Bayesian change-point framework to annual gains, both at the best-practice frontier and separately for each record-holding country, we find no evidence that the expected annual gain has changed across nearly two centuries, but strong evidence that its variance has moved through distinct historical regimes, with progress most regular in recent decades. The recent flattening is consistent with a low-variance regime and provides little evidence for a decline in the underlying mean pace of improvement. Claims that the best-practice frontier signals a biological ceiling should therefore not rest on the recent bend in the cumulative record alone. The frontier is better read as an empirical benchmark, the highest country-specific survival achieved under observed historical conditions.

Background: This study aimed to evaluate and compare the performance of classical machine learning models (CMLs) and large language models (LLMs) in predicting mortality associated with COVID-19 by utilizing a high-dimensional tabular dataset. Materials and Methods: We analyzed data from 9,134 COVID-19 patients collected across four hospitals. Seven CML models, including XGBoost and random forest (RF), were trained and evaluated. The structured data was converted into text for zero-shot classification by eight LLMs, including GPT-4 and Mistral-7b. Additionally, Mistral-7b was fine-tuned using the QLoRA approach to enhance its predictive capabilities. Results: Among the CML models, XGBoost and RF achieved the highest accuracy, with F1 scores of 0.87 for internal validation and 0.83 for external validation. In the LLM category, GPT-4 was the top performer with an F1 score of 0.43. Fine-tuning Mistral-7b significantly improved its recall from 1% to 79%, resulting in an F1 score of 0.74, which was stable during external validation. Conclusion: While LLMs show moderate performance in zero-shot classification, fine-tuning can significantly enhance their effectiveness, potentially aligning them closer to CML models. However, CMLs still outperform LLMs in high-dimensional tabular data tasks.

Large language models (LLMs) are increasingly essential in processing natural languages, yet their application is frequently compromised by biases and inaccuracies originating in their training data. In this study, we introduce Cross-Care, the first benchmark framework dedicated to assessing biases and real world knowledge in LLMs, specifically focusing on the representation of disease prevalence across diverse demographic groups. We systematically evaluate how demographic biases embedded in pre-training corpora like ThePile influence the outputs of LLMs. We expose and quantify discrepancies by juxtaposing these biases against actual disease prevalences in various U.S. demographic groups. Our results highlight substantial misalignment between LLM representation of disease prevalence and real disease prevalence rates across demographic subgroups, indicating a pronounced risk of bias propagation and a lack of real-world grounding for medical applications of LLMs. Furthermore, we observe that various alignment methods minimally resolve inconsistencies in the models' representation of disease prevalence across different languages. For further exploration and analysis, we make all data and a data visualization tool available at: www.crosscare.net.

Subnational studies of aid effectiveness often rely on repeated cross-sections or nighttime lights, making it difficult to separate local treatment effects from baseline differences and potentially favoring infrastructure-heavy projects. We address these limitations by studying World Bank and Chinese development projects in Africa with a balanced panel of 2,166 DHS clusters across 35 countries from 2002 to 2013. Geocoded AidData projects are linked to satellite-imputed International Wealth Index estimates, a household-centered measure of material living standards. We compare a conventional two-way fixed effects (TWFE) event-study with the switcher--stayer estimator of de Chaisemartin and D'Haultfoeuille (dCdH), which avoids contaminated comparisons under staggered treatment timing. Pre-treatment diagnostics show that project placement is frequently selective: clusters that later receive projects often begin from weaker relative positions before treatment onset. Consequently, TWFE often implies larger post-treatment gains than the preferred staggered-treatment design supports. Under dCdH, the evidence becomes more selective and sector-specific. For the World Bank, positive evidence is strongest in Health, while Education shows positive but less cleanly identified gains. For China, Water Supply and Sanitation and Other Social Infrastructure and Services show positive associations with local wealth, although residual selection concerns remain. By contrast, Chinese Energy Generation and Supply appears strongly positive under TWFE but falls close to zero under dCdH. Overall, the results do not support a donor-wide claim that either the World Bank or China uniformly improves local wealth. Instead, estimated effects are concentrated in a limited set of donor--sector panels and depend strongly on how treatment timing, selection, and outcome measurement are handled.

One straightforward metric to evaluate a survival prediction model is based on the Mean Absolute Error (MAE) -- the average of the absolute difference between the time predicted by the model and the true event time, over all subjects. Unfortunately, this is challenging because, in practice, the test set includes (right) censored individuals, meaning we do not know when a censored individual actually experienced the event. In this paper, we explore various metrics to estimate MAE for survival datasets that include (many) censored individuals. Moreover, we introduce a novel and effective approach for generating realistic semi-synthetic survival datasets to facilitate the evaluation of metrics. Our findings, based on the analysis of the semi-synthetic datasets, reveal that our proposed metric (MAE using pseudo-observations) is able to rank models accurately based on their performance, and often closely matches the true MAE -- in particular, is better than several alternative methods.

Neonatal death is still a concerning reality for underdeveloped and even some developed countries. Worldwide data indicate that 26.693 babies out of 1,000 births die, according to Macro Trades. To reduce this number, early prediction of endangered babies is crucial. Such prediction enables the opportunity to take ample care of the child and mother so that early child death can be avoided. In this context, machine learning was used to determine whether a newborn baby is at risk. To train the predictive model, historical data of 1.4 million newborns was used. Machine learning and deep learning techniques such as logical regression, K-nearest neighbor, random forest classifier, extreme gradient boosting (XGBoost), convolutional neural network, and long short-term memory (LSTM) were implemented using the dataset to identify the most accurate model for predicting neonatal mortality. Among the machine learning algorithms, XGBoost and random forest classifier achieved the best accuracy with 94%, while among the deep learning models, LSTM delivered the highest accuracy with 99%. Therefore, using LSTM appears to be the most suitable approach to predict whether precautionary measures for a child are necessary.

According to the World Health Organization (WHO), suicide was the fourth leading cause of death in the world for individuals aged 15 to 29 in 2019. Given the rapid increase in mental health issues, providing psychological support is both crucial and urgent. In this paper: (1) we propose S\'olo Esc\'uchame, the first open-source Spanish emotional assistance chatbot, based on LLaMA-2-7b-Chat. (2) We introduced the HEAR (Hispanic Emotional Accompaniment Responses) dataset, compiled from multiple English sources translated into Spanish, as well as generic data generated using ChatGPT-3.5-Turbo. Finally, (3) we propose an evaluation metric based on two semi-automatic assessment methods. Our system outperforms a range of state-of-the-art models in providing psychological assistance in Spanish. Our models and datasets are publicly available to facilitate reproducibility.

A compartmental deterministic model that allows (1) immunity from two stages of infection and carriage, and (2) disease induced death, is used in studying the dynamics of meningitis epidemic process in a closed population. It allows for difference in the transmission rate of infection to a susceptible by a carrier and an infective. It is generalized to allow a proportion ({\phi}) of those susceptibles infected to progress directly to infectives in stage I. Both models are used in this study. The threshold conditions for the spread of carrier and infectives in stage I are derived for the two models. Sensitivity analysis is performed on the reproductive number derived from the next generation matrix. The case-carrier ratio profile for various parameters and threshold values are shown. So also are the graphs of the total number ever infected as influenced by {\epsilon} and {\phi}. The infection transmission rate (eta), the odds in favor of a carrier, over an infective, in transmitting an infection to a susceptible ({\epsilon}) and the carrier conversion rate ({\phi}) to an infective in stage I, are identified as key parameters that should be subject of attention for any control intervention strategy. The case-carrier ratio profiles provide evidence of a critical case-carrier ratio attained before the number of reported cases grows to an epidemic level. They also provide visual evidence of epidemiological context, in this case, epidemic incidence (in later part of dry season) and endemic incidence (during rainy season). Results from total proportion ever infected suggest that the model, in which {\phi}=0 obtained, can adequately represent, in essence, the generalized model for this study.