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OBJECTIVE: To assess the usefulness of the general framework of the smoking epidemic. METHODS: We use lung cancer mortality as an indicator for smoking intensity and employ an age-cohort model to accommodate the long-lasting and cumulative effects. RESULTS: Dutch males have higher risks than Danish males, but the risks for the younger cohorts have been declining faster in the Netherlands than in Denmark. Danish women have about twice the risk of Dutch women, and in both countries the risks for the younger cohorts are increasing. The smoking epidemic began at about the same time in Denmark and the Netherlands. Dutch males, however, seem to have smoked more but to have given up smoking more quickly than Danish males. Danish females were quicker to take up smoking than Dutch females. CONCLUSIONS: Within the general framework of the smoking epidemic, differences in timing and levels can produce large differences between countries. For the purposes of assessing smoking-related risks, including projections, the smoking epidemic framework therefore has to be tailored to each study population.

OBJECTIVE: To explore the usefulness of incidence-prevalence-mortality (IPM) models in improving estimates of disease epidemiology. METHODS: Two artificial and four empirical data sets (for breast, prostate, colorectal, and stomach cancer) were employed in IPM models. FINDINGS: The internally consistent artificial data sets could be reproduced virtually identically by the models. Our estimates often differed considerably from the empirical data sets, especially for breast and prostate cancer and for older ages. Only for stomach cancer did the estimates approximate to the data, except at older ages. CONCLUSION: There is evidence that the discrepancies between model estimates and observations are caused both by data inaccuracies and past trends in incidence or mortality. Because IPM models cannot distinguish these effects, their use in improving disease estimates becomes complicated. Expert opinion is indispensable in assessing whether the use of these models improves data quality or, inappropriately, removes the effect of trends.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.04.018 Byline: Johan J. Polder (a), Jan J. Barendregt (b), Hans van Oers (a) Keywords: Health expenditure; Ageing; Last year of life; Longevity; Causes of death; Cost projection; The Netherlands Abstract: Health expenditure depends heavily on age. Common wisdom is that the age pattern is dominated by costs in the last year of life. Knowledge about these costs is important for the debate on the future development of health expenditure. According to the 'red herring' argument traditional projection methods overestimate the influence of ageing because improvements in life expectancy will postpone rather than raise health expenditure. This paper has four objectives: (1) to estimate health care costs in the last year of life in the Netherlands; (2) to describe age patterns and differences between causes of death for men and women; (3) to compare cost profiles of decedents and survivors; and (4) to use these figures in projections of future health expenditure. We used health insurance data of 2.1 million persons (13% of the Dutch population), linked at the individual level with data on the use of home care and nursing homes and causes of death in 1999. On average, health care costs amounted to 1100 Euro per person. Costs per decedent were 13.5 times higher and approximated 14,906 Euro in the last year of life. Most costs related to hospital care (54%) and nursing home care (19%). Among the major causes of death, costs were highest for cancer (19,000 Euro) and lowest for myocardial infarctions (8068 Euro). Between the other causes of death, however, cost differences were rather limited. On average costs for the younger decedents were higher than for people who died at higher ages. Ten per cent of total health expenditure was associated with the health care use of people in their last year of life. Increasing longevity will result in higher costs because people live longer. The decline of costs in the last year of life with increasing age will have a moderate lowering effect. Our projection demonstrated a 10% decline in the growth rate of future health expenditure compared to conventional projection methods. Author Affiliation: (a) RIVM, Bilthoven, The Netherlands (b) School of Population Health, University of Queensland, Australia

Objective To explore the usefulness of incidence-prevalence-mortality (IPM) models in improving estimates of disease epidemiology. Methods Two artificial and four empirical data sets (for breast, prostate, colorectal, and stomach cancer) were employed in IPM models. Findings The internally consistent artificial data sets could be reproduced virtually identically by the models. Our estimates often differed considerably from the empirical data sets, especially for breast and prostate cancer and for older ages. Only for stomach cancer did the estimates approximate to the data, except at older ages. Conclusion There is evidence that the discrepancies between model estimates and observations are caused both by data inaccuracies and past trends in incidence or mortality. Because IPM models cannot distinguish these effects, their use in improving disease estimates becomes complicated. Expert opinion is indispensable in assessing whether the use of these models improves data quality or, inappropriately, removes the effect of trends. Keywords Epidemiologic research design; Models, Theoretical; Incidence; Prevalence; Mortality; Reproducibility of results; Neoplasms/epidemiology; Breast neoplasms/epidemiology; Prostatic neoplasms/epidemiology; Colorectal neoplasms/epidemiology; Stomach neoplasms/epidemiology; Netherlands (source: MeSH, NLM). Mots cles Projet d'etude epidemiologique; Modele theorique; Incidence; Prevalence; Mortality; Reproducibility des resultats; Tumeurs/epidemiologie; Tumeur sein/epidemiologie; Tumeur prostate/epidemiologie; Tumeur colorectale/epidemiologie; Tumeur estomac/epidemiologie; Pays-Bas (source: MeSH INSERM). Palabras clave Diseno de investigaciones epidemiologicas; Modelos teoricos; Incidencia; Prevalencia; Mortalidad; Reproducibilidad de resultados; Neoplasmas/epidemiologia; Neoplasmas de la mama/epidemiologia; Neoplasmas de la prostata/epidemiologia; Neoplasmas colorrectales/epidemiologia; Neoplasmas gastricos/epidemiologia; Paises Bajos (fuente: DeCS, BIREME)., Voir page 620 le resume en francias. En la pagina 621 figura un resumen en espanol. Introduction Quantitative descriptions of disease epidemiology, such as incidence, prevalence and mortality, by age [...]