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PubMed2004

Life expectancy in Germany until 2050.

The expected demographic shifts-already having commenced in many countries-have their origin primarily in decreasing birth rates and increased life expectancy. This paper will show possible development paths for life expectancy at birth up until the year 2050. We will distinguish between traditional period life tables and cohort life tables, the latter leading to more realistic values for life expectancy. It will be shown that a marked increase in life expectancy up to over 90 years is to be expected.

Aged↗
PubMed2002

Influence of death from circulatory diseases on life expectancy at birth in Japan.

This study aims to evaluate the contribution of the change in circulatory diseases mortality to the life expectancy at birth observed during the years 1955-1995 in Japan. We used data on the population and the number of deaths by cause, age, and sex in 1955, 1965, 1975, 1985, and 1995. The contribution of different ages and causes of death to the change in life expectancy were examined with the method developed by Pollard. We found that the reduction in circulatory diseases mortality contributed to the improvements in life expectancy for both sexes during the decade 1975-1985. Much of this was due to the decrease in cerebrovascular disease. In the years 1985-1995, however, the contribution of cerebrovascular disease decreased in both sexes, while that of heart disease grew to become the largest of any single condition. By age, the contribution of all circulatory diseases increased among the elderly in recent years. The contribution of the change in circulatory diseases mortality to the life expectancy at birth has increased in recent years but seems to have reached a plateau. The weight against improvements in life expectancy in middle-aged people has shown little change, so that reducing the mortality rate in middle-aged people is now a major issue.

Adolescent↗
PubMed1997

Decision analysis--effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations.

BACKGROUND: Women with BRCA1 or BRCA2 mutations have an increased risk of breast cancer and ovarian cancer. Prophylactic mastectomy and oophorectomy are often considered as ways of reducing these risks, but the effect of the procedures on life expectancy has not been established. METHODS: In a decision analysis, we compared prophylactic mastectomy and prophylactic oophorectomy with no prophylactic surgery among women who carry mutations in the BRCA1 or BRCA2 gene. We used available data about the incidence of cancer, the prognosis for women with cancer, and the efficacy of prophylactic mastectomy and oophorectomy in preventing breast and ovarian cancer to estimate the effects of these interventions on life expectancy among women with different levels of risk of cancer. RESULTS: We calculated that, on average, 30-year-old women who carry BRCA1 or BRCA2 mutations gain from 2.9 to 5.3 years of life expectancy from prophylactic mastectomy and from 0.3 to 1.7 years of life expectancy from prophylactic oophorectomy, depending on their cumulative risk of cancer. Gains in life expectancy decline with age at the time of prophylactic surgery and are minimal for 60-year-old women. Among 30-year-old women, oophorectomy may be delayed 10 years with little loss of life expectancy. CONCLUSIONS: On the basis of a range of estimates of the incidence of cancer, prognosis, and efficacy of prophylactic surgery, our model suggests that prophylactic mastectomy provides substantial gains in life expectancy and prophylactic oophorectomy more limited gains for young women with BRCA1 or BRCA2 mutations.

Adult↗
PubMed2006

Immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma: beneficial effect on local control without additional negative impact on pituitary function and life expectancy.

PURPOSE: To demonstrate the benefit of immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma (NFA) in perspective to the need for hormonal substitution and life expectancy. METHODS AND MATERIALS: Retrospective cohort analysis of 122 patients, operated for NFA between 1979 and 1998. Recurrence was defined as regrowth on computed tomography or magnetic resonance imaging. The occurrence of hormonal deficiencies was defined as the starting date of hormonal substitution therapy. RESULTS: Seventy-six patients had residual NFA after surgery and received immediate postoperative radiotherapy (Group 1); three patients developed a recurrence, resulting in a 95% local control rate at 10 years. Twenty-eight patients had residual NFA after surgery, but were followed by a wait-and-see policy (Group 2). Sixteen developed a recurrence, resulting in a local control rate of 49% at 5 years and 22% at 10 years (p < 0.001 compared with Group 1). There were no differences between Group 1 and 2 regarding the need for substitution with thyroid hormone, glucocorticoids, and sex hormones before first surgery, directly after surgery and at end of follow-up. There were no differences in hormone substitution free survival between Group 1 and Group 2 during the study period after first surgery. Life expectancy was similar in Group 1 and 2, and their median life expectancy did not differ from median life expectancy in the general population. CONCLUSIONS: Immediate postoperative radiotherapy provides a marked improvement of local control among patients with residual NFA compared with surgery alone, without an additional deleterious effect on pituitary function and life expectancy.

Adenoma↗
PubMed2001

Social inequalities in disability-free life expectancy in the French male population, 1980-1991.

We calculate aggregate indicators of population health for occupational groups to gauge changes in health disparities during the 1980-1991 period. The study is based on the experiences of French adult men in three major occupational classes: managers, manual workers, and an intermediary occupational group. Life table models show that managers have longer life expectancy and disability-free life expectancy (DFLE) than manual workers, and a shorter life expectancy with disability. The concurrent increases in life expectancy and DFLE during the period maintained the occupational disparities in health; the years lived with disability, however, declined for all groups, as for the entire French population.

Adult↗
PubMed2000

The social gradient in life expectancy: the contrary case of Okinawa in Japan.

This paper examines the social gradient theory of health and life expectancy presented by Evans and his colleagues [Evans, R.G., Barer, M.L. and Marmor, T.R. (Eds.), 1994. Why are some People Healthy and others not? The Determinants of Health of Populations. Aldine de Gruyter, New York]. They maintain that social hierarchy is the determining factor in the health of large populations largely because it promotes differences in stress or the ability to cope with stress. For example, as Japan has risen to the top ranks of the economic hierarchy of nations in the late 20th century, Japanese life expectancy improved dramatically. Evans [Evans, R.G., 1994. Introduction. In: Evans, R., Barer, M., Marmor T. (Eds.), Why are some People Healthy and others not? The Determinants of Health of Populations. Aldine de Gruyter, New York, pp. 3-26.] notes that something lies behind this rapid increase in longevity and the major change was the hierarchical position of Japan relative to the rest of the world. However, we reviewed life expectancy data within Japan and found that Okinawans traditionally rank at the top in health and life expectancy and at the bottom in socioeconomic indicators. We find that the social gradient thesis does not apply in Japan and suggest that what is more important for health are health lifestyles, especially diet and social support. More research is needed to assess the validity of the social gradient thesis if it is to be used on a cross-national basis.

Aged↗
PubMed2005

There and back again: the impact of adult HIV prevalence on national life expectancies.

Worldwide we have seen dramatic increases in HIV prevalence and decreases in life expectancy over the last decade. The aim of this study was to determine the association between HIV prevalence and life expectancy. A strong negative association between adult HIV prevalence and life expectancy was observed for 137 countries. Because high adult HIV prevalence poses the greatest threat to countries with limited health resources, our study supports increased efforts to provide antiretrovirals in these countries.

Adult↗
PubMed1986

Past and future life expectancy increases at later ages: their implications for the linkage of chronic morbidity, disability, and mortality.

Recently life expectancy increases have been noted at advanced ages in the United States. This means a more rapid growth of the elderly U.S. population in general, and of the "oldest-old" population in particular. Thus it is of considerable social and health policy interest to forecast the direction and magnitude of future changes in life expectancy at later ages and the changes in the prevalence of health and disability at later ages consequent to the increases in life expectancy. In the analysis, several prior efforts to predict life expectancy changes using standard demographic techniques are reviewed and reasons for the limitations of such efforts suggested. Results show that mortality changes at advanced ages have very different relations to risk factors than at earlier ages. The analysis also shows that linking morbidity, disability, and mortality in a complete projection of population health changes will require the extension of standard demographic methodologies to utilize information from multiple data sources.

Adult↗
PubMed1982

A convenient approximation of life expectancy (the "DEALE"). II. Use in medical decision-making.

We show how to use a bedside approximation of life expectancy in quantitative decision-making. This method, the declining exponential approximation of life expectancy (DEALE), enables the physician to collate various survival data with information on morbidity to determine a quality-adjusted expected survival for a potential management plan. The keystone in the DEALE approach is the approximation of survival by a simple exponential function. This approximation makes it possible to translate data from various literature sources (life expectancy tables, five-year survival rates, survival curves, median survival) into a single, unified mortality scale. In this paper, we use the DEALE method to obtain approximations of quality-adjusted life expectancy and illustrate the application of the method in a quantitative analysis of a clinical decision.

Aged↗
PubMed2005

Socioeconomic status differentials in life and active life expectancy among older adults in Beijing.

PURPOSE: The study compares life and active life expectancy estimates across indicators of socioeconomic status (SES) for a cohort of older adults in the Beijing municipality. Our aim is to determine if associations found are consistent across indicators and with those typically observed in the Western industrialized countries. METHOD: A multistate life table method is used to estimate expected years of total and active life, defined as life spent without limitation in functions necessary for performing daily tasks. RESULTS: We find that men of higher status experience advantages with respect to life and active life expectancies. Among women, only active life expectancy is significantly higher for those of higher status, but the difference by income is not statistically significant. With respect to the proportion of life spent in an active state, both men and women of higher status benefit in comparison to their lower status counterparts. Finally, we find that disparities by SES generally increase with age. CONCLUSIONS: Despite several inconsistencies across SES indicators by gender, findings generally confirm inequalities within a society that is organized very differently socially, economically, and politically from the West.

Activities of Daily Living↗
PubMed1999

The impact of the major causes of death on life expectancy in Italy.

BACKGROUND: This study aims to evaluate the contribution of the reduction in major cardiovascular diseases (CVD), malignant neoplasms (MN), accidents and AIDS mortality to the gains in life expectancy observed during the decade 1985-1994, as well as to calculate and compare the potential gains due to the partial or total elimination of these causes. METHODS: Mortality data from the Italian Mortality Data Base were analysed by the method of decomposition of changes in life expectancy and the partial multiple decrement life table technique. RESULTS: In Italy, considering the decade 1985-1994, the gain in life expectancy at birth was 2.27 years for men and 2.16 for women. The major contribution to this increase was the reduction in CVD mortality followed by fewer deaths from accidents and MN. Conversely, AIDS caused a loss in the length of life of adults. Major potential gains in life expectancy at birth could be obtained by the elimination or even partial reduction of CVD and MN mortality. When working life (15-64 years) is considered, the relative importance of the causes changes. The elimination of accidents and AIDS would result in increased life expectancy longer than that associated with a 50% reduction in CVD. CONCLUSIONS: The findings of this study provide useful information which could contribute to a more effective allocation of resources for research activity and public health programmes.

Accidents↗
PubMedDate not supplied

Self-rated life expectancy as a predictor of mortality: evidence from the HRS and AHEAD surveys.

BACKGROUND: An extensive literature has demonstrated that self-ratings of health predict mortality, even after controlling for more objective measures of health, health habits and sociodemographic characteristics. We examine the role of a related concept, self-rated life expectancy, in predicting mortality. OBJECTIVE: To assess whether self-rated life expectancy predicts mortality after controlling for measures of health, self-rated health, and sociodemographic characteristics. METHODS: Using data from the 1992 Health and Retirement Survey (HRS), the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, and the second Tracker file (2.0), Cox proportional hazard models were estimated to assess whether self-rated life expectancy predicts mortality, after adjusting for self-rated health and several potential confounders that might otherwise explain this relationship. The AHEAD sample included 2,102 men and 3,160 women. During the 2 years of follow-up, 9% (n = 185) of the men died and 5% (n = 166) of the women died. The HRS sample was comprised of 4,090 men and 4,885 women. Four percent (n = 164) of the men died and 2% (n = 99) of the women died in the 3 years of follow-up. RESULTS: In the older, AHEAD sample, both self-rated life expectancy (p < 0.01) and self-rated health (p < 0.05) predicted mortality for both men and women, even when the two measures were included in the model together. In the younger, HRS sample, self-rated life expectancy was not significantly associated with mortality when self-rated health was included in the model. CONCLUSION: Our findings suggest that, although self-rated life expectancy and self-rated health may be conceptually related, they have independent empirical effects on mortality.

Aged↗
PubMed2001

[Active life expectancy: factors influencing regional and gender differences].

Active life expectancy (ALE) is defined as an expected duration to be spent with a certain level of physical/mental function. The objectives of this article are to indicate ALE values based on our prospective observation, and to discuss factors influencing regional and gender differences in ALE values. We estimated ALE without disability in basic activities of daily living (ADL) on a 5% random sample (n = 3,459) of the residents aged 65 years and over in Sendai City between 1988 and 1991. At the age 65, ALE was 14.7 years for men and 17.7 years for women. ALE occupied 91% of the total life expectancy for men and 87% for women. As compared with the reports for the American elderly, ALE was longer in Sendai than in the United States. The duration to be spent with disability was shorter among the subjects in Sendai. We estimated ALEs in three functional areas: basic ADL, instrumental ADL, and mobility, on all the residents aged 65 years and over (n = 3,590) at Wakuya Town between 1994 and 1996. For both sexes, ALE in IADL was shorter than those in basic ADL and mobility. The development and progression of disability were different between sexes: men experienced disability at a younger age and progressed at a faster rate than women.

Activities of Daily Living↗
PubMed1990

Life expectancy in Canada--an overview.

At 73 years for men and more than 80 years for women, Canada's life expectancy at birth compares favourably with other developed countries; Japan currently leads the world with 75.6 years for men and 81.4 years for women. In 1920-1922, fewer than six out of ten Canadians could expect to survive to their 65th birthday; by 1985-1987, this had risen to eight out of ten. At the oldest ages, the increases in survival are even more striking. In 1920-1922, just over one in ten Canadians could expect to reach their 85th birthday; by 1985-1987, this had increased to more than three out of ten. Since the 1920s, life expectancy has been higher in the Western provinces and lower in Atlantic Canada and Quebec. In 1950-1952, for example, a person born in Saskatchewan could expect to live four years longer than a person born in Quebec. By 1985-1987, this difference had been reduced to just over one year. Women have made much greater gains in life expectancy than men. In 1920-1922, women had an advantage in life expectancy over men of less than two years; by 1970-1972, this had more than tripled to seven years. Married men and women have a distinct advantage in longevity over other marital status categories. Married men may expect to live over eight years longer than never-married men, and more than ten years longer than widowed men. Married women can expect to live three years longer than never-married women, and four years longer than women who are either divorced or widowed. As of 1986, a boy born in highest-income quintile area in urban Canada can expect to live almost six years longer than a boy born in a lowest-income quintile area. For girls, the difference is almost two years. However, this socio-economic differential narrowed from 1971 to 1986.

Aged↗
PubMed2004

Bridging the gap in life expectancy of the aborigines in Taiwan.

BACKGROUND: Similar to the general population in Taiwan, the health of aborigines has steadily improved over the last 30 years, but the gap remains wide, especially in males, despite an infusion of substantial medical resources. The objectives of this study are to quantify the contribution of major causes of death to the gap in life expectancy and to propose initiatives to bridge the health gap between aborigines and the general population. METHODS: This study included residents (slightly over 200000) from 30 'aboriginal townships' in Taiwan. The gap in life expectancy between aborigines and the general population was analysed by decomposing these gaps according to major causes of deaths. This analysis quantifies the contribution of different causes of deaths to the gap in life expectancy between the two populations. RESULTS: The overall mortality of aborigines in these townships was approximately 70% higher than the respective male and female general populations over the past 30 years. Mortality from infectious disease, cirrhosis of the liver, accidents, and suicide are substantially higher than the general population. The gap in life expectancy at birth in males was 8.5 years during 1971-1973, increasing to 13.5 years by 1998-2000, however, the gap in females remained relatively stable (8.0 years and 8.4 years, respectively). Of the 13.5-year difference in life expectancy in males, the differential mortality from diseases of the digestive system (mainly due to cirrhosis of the liver), accidents (from both motor vehicle and non-motor vehicle accidents), and infectious and parasitic disease contributed half (50%) of the gap in life expectancy. In females, the above primarily preventable causes of deaths accounted for 41% of the life expectancy gap. CONCLUSIONS: Based on the findings of this study, we suggest that future focus should be in the area of primary prevention in order to reduce the incidence of infectious and parasitic diseases, liver cirrhosis, and accidents.

Accidents↗
PubMed2001

Compression or expansion of morbidity? Trends in healthy-life expectancy in the elderly Austrian population between 1978 and 1998.

The aim of our study is to test the theories of compression or expansion of morbidity on the basis of data on the elderly population of Austria. Our data come from four microcensus surveys for the years 1978, 1983, 1991, and 1998. We use self-perceived health ratings to calculate healthy-life expectancy for the elderly population aged 60-89. Because our data are based on four cross-sectional surveys, we devote the first part of the paper to the consequences of possible sampling and non-sampling errors in our analysis of time trends. We come to the conclusion that, although the absolute number of years lived in good health may be overestimated, the time trend in healthy-life expectancy over the 20 years most probably is unbiased. The second part of the paper describes trends in healthy-life expectancy for the Austrian population. Our results suggest that both healthy-life expectancy and the ratio of healthy years to life expectancy increased between 1978 and 1998. Thus, in Austria ill health seems to be more and more compressed into the later years of life. Contrary to Fries's hypothesis, however, life expectancy does not seem to be approaching a maximum average life span in Austria, as mortality rates at older ages have been continuously decreasing over the last 20 years.

Aged↗
PubMed2003

Gender differentials in life expectancy in Italy.

OBJECTIVE: To analyze the gender differential in life expectancy in Italy from 1970 to 1997, to determine which ages and causes of death mostly influenced its trend. METHODS: Pollard method was used to explain which ages and which pathologies give the highest contribution to the gender differential. RESULTS: A slight reduction of the gender differential has been observed since 1980. The olds and very olds became the most relevant contributors to the differential. Cardiovascular diseases were the principal contributing causes of death until 1980 and Cancer replaced them afterwards. CONCLUSION: Relatively recent adoption of unhealthy life styles by women together with an opposite process run by young men towards healthier behaviour, seem to be at the basis of the slight reduction of the gender differential in life expectancy observed since 1980.

Cause of Death↗
PubMed1976

A technique for estimating life expectancy with crude vital rates.

This paper describes a method of estimating life expectancy at birth on the basis of crude vital rates. The method is derived from stable population theory and it furnishes good estimates insofar as the current crude vital rates of a population are close to its intrinsic rates. This condition is generally met in closed populations which have not experienced sharp movements in fertility. The method is useful for estimating life expectancy in developing nations with good sample registration systems but for which information on age is of poor quality. It is also useful for estimating the movement of life expectancy in certain European nations in the period prior to regular census taking. There are a number of nations and regions in Europe for which long series of birth and death rates are available but for which census age counts are widely spaced.

Birth Rate↗