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PubMed2006

The changing relation between education and life expectancy in central and eastern Europe in the 1990s.

BACKGROUND: The political and social transition in central and eastern Europe has been generally associated with widening educational differences in life expectancy. However, interpretation of these findings is complicated because the size of educational categories within the population has also changed. It is therefore important to disentangle these two phenomena. SETTING: The Czech Republic, Estonia, the Russian Federation and, as a western European reference, Finland, in two periods, 1988-89 and 1998-99. METHODS: Life tables were calculated in three categories: university; secondary; and less than secondary education. Changes in life expectancy were decomposed into contributions of population composition and within-category mortality. RESULTS: In Finland and the Czech Republic improvements are seen in all educational groups, with only a slight widening of the educational differences. Over 80% of the total life expectancy increase is attributable to improved mortality within educational categories. In Estonia and Russia, less favourable overall trends coincide with a dramatic widening of the educational gap. A decrease in life expectancy in those with low and middle education has been compensated for, to a small degree in Russia but a greater extent in Estonia, by improvements among those with higher education and by the improved population composition. For highly educated Estonians, the gains were seen at all ages, the greatest at age > or =60 years. In Russia mortality increased in those <60 years although compensated for by improvements at older ages. CONCLUSIONS: Russia and Estonia exhibit much less equitable transitions compared with the Czech Republic. Analyses of trends in health inequalities should capture the changing population composition. In Russia and Estonia an improved educational structure prevented an even greater decline in life expectancy. The highly educated Estonians can potentially catalyse a wider health progress.

Adult↗
PubMed1993

Testing a new health indicator: using avoidable causes of death and life expectancy for Spain between 1975-1986.

The concept of avoidable cause of death serves as the basis for measuring the quality and diversity of a health care system. In this study the authors propose a new way to use this kind of mortality by combining with the concept of life expectancy to obtain what they call "life expectancy free of avoidable mortality" (LEFAM). This indicator was 76.9 in 1986 in Spain while life expectancy was 75.83. If these deaths were avoidable there would be a gain of 1.09 years per person born. There is an important difference between the would-be male gain of 1.76 years and the would-be female gain of 0.6. In the ecological study, LEFAM would better explain the year to year changes of the resources in the health sector, measured in terms of the human resources (R = 0.96), the hospital beds per thousand persons (R = -0.86), and would also increase the relation with other health indicators such as infant mortality rate (R = 0.98) and mortality rate (R = 0.59) as compared with life expectancy alone.

Adolescent↗
PubMed2005

[Factor analysis of attributive determinants for life expectancy and infant mortality rate with recipient country data in consideration of socioeconomic environment].

OBJECTIVE: From a financial viewpoint, it is important that international medical care and cooperation in recipient countries by NGOs or governments of donor countries, and health promotion carried out by recipient countries' governments, are carried out efficiently. In this paper, we performed analysis of factors that determine life expectancy and infant mortality rates in recipient countries, in consideration of the socioeconomic environment. METHODS: We used data from World Development Indicators 2002 and 2003, published by the World Bank, and Human Development Indicators 2002, published by the United Nations Development Programme. We analyzed 68 countries classified as middle and low income countries by the World Bank, because complete data for these countries were available. We used life expectancy and infant mortality rates as health indicators and did multiple regression analysis; with these indicators as dependent variables, and with socioeconomic environmental data as independent variables. Furthermore, we undertook multiple regression analysis after carrying out group divisions of the countries according to the numbers of refugees, birthrates, and expenditures on armaments. RESULTS: We ascertained the following points. 1) For improving health of people in recipient countries, it is important to secure safe drinking water, improve literacy, and increase income and the possibility of access to basic medicines. 2) For countries where there are a lot of refugees, it is important to increase the measles vaccine inoculation rate. 3) In countries where there are few refugees, life expectancy will be prolonged by as much as three years if the measles vaccine inoculation rate increases by just 10%. 4) In countries with a high armaments expenditure rate in proportion to GNI, it is important to secure access to sanitary toilet facilities. 5) Life expectancy in countries tends to shorten if life expectancy in their neighboring countries is short. 6) The rate of public health expenditures in proportion to GDP has no affect on health. 7) If the literacy rate rises 10%, life expectancy will be prolonged by about 1.2 years and the infant mortality rate will decrease about 6%. CONCLUSION: Though improvement of the socioeconomic environment is more effective for improving life expectancy and infant mortality rates in recipient countries than medical conditions, the effectiveness differs according to the number of refugees, the birthrate and expenditures on armaments.

Developing Countries↗
PubMed2001

Active and cognitive impairment-free life expectancies: results from the Melton Mowbray 75+ health checks.

OBJECTIVES: To estimate active and cognitive impairment-free life expectancy at older ages from longitudinal data collected during two consecutive rounds of health checks for patients aged > or =75 years. SETTING: A single, large general practice serving Melton Mowbray, Leicestershire, UK, and its surrounding area. OUTCOME MEASURES: active life expectancy was defined by independence in seven activities of daily living (mobility, transfer from bed, transfer from chair, bathing, feeding, dressing, using the toilet). Cognitive impairment was defined by a score of < or =7 on the information/orientation subtest of the Clifton Assessment Procedures of the Elderly. RESULTS: We assessed 1557 people aged > or =75 years at baseline. Active life expectancy at age 75 was 4.6 years for men and 3.1 years for women (50.5 and 29.2% of remaining life). Cognitive impairment-free life expectancy at age 75 was 8.4 years for men and 9.9 years for women (92.3 and 93.4% of remaining life). The proportion of active life decreased dramatically with age in both sexes: after the age of 87, almost all of remaining life was spent with some activity restriction. The proportion of life free from cognitive impairment, in comparison, decreased slowly in men and remained relatively constant in women at around 90%. CONCLUSIONS: The extra years lived by women over men appear to be spent with some form of activity restriction, although not all with cognitive impairment. Monitoring these trends over time will be important to ascertain whether we are exchanging longer life for poorer health.

Activities of Daily Living↗
PubMed1997

Comprehensive life table of computer-assisted predictive mathematical relationship between age and life expectancy, survival probability or death rate in US adults.

A microcomputer program in BASIC for predicting life expectancy by age in US adults was designed. Formulas used in this study were derived from the data reported by the National Center for Health Statistics. A comprehensive life table that shows the relationship between age and death rate, survival probability or life expectancy for each year between 25 and 85 years of age was obtained in this study, using a newly designed computer program for predicting life expectancy by age and the program for survival probability previously published by the author. The comprehensive life table may be useful for clinical evaluation of patients and further helpful for biomedical investigation and epidemiological evaluation of US adults.

Adult↗
PubMed2005

[Study on the active life expectancy of the elderly and its longitudinal transition in Beijing].

OBJECTIVE: Focus on the Active Life Expectancy (ALE) of elderly in Beijing and the transition in recent years. METHODS: A representative sample of 3257 elderly people who lived in the urban, suburban and rural communities in Beijing that had been followed up for 12 years. Their health and survival status had been surveyed every 2-3 years. Activity Daily Living scale (ADL), recommended by WHO was used to evaluate the physical function capability of the elderly. IMaCH 0.8 was used to estimate life expectancy (LE) and active life expectancy (ALE) for both periods while age, sex and rural/urban residence areas were adjusted. RESULTS: Longitudinally, data showed that the main characters remained unchange throughout the two periods including 1) LE, ALE, ALE/LE of elderly living in urban area were higher than those living in rural area; 2) LE seemed longer in women than men, but ALE/LE was less in women. The transition between two period showed that 1) LE increased modestly in all groups but less prominent in urban residents and in females; 2) ALE was not significantly changed in the rural elderly but declined markedly in women living in the urban area; 3) ALE/LE of the elderly declined in all groups, especially in urban and oldest old groups. CONCLUSION: In Beijing, elderly AL-E did not increase in parallel with the increase of LE while ALE/LE of the elderly declined significantly in recent years. In order to improve quality of life of the elderly and to increase their ALE, emphasis should be given to prevention of cardiovascular, cerebrovascular and other chronic diseases while reducing the occurrence of physical disability and strengthening on rehabilitation would be the basic health care measures.

Activities of Daily Living↗
PubMed2000

Life expectancy of people with intellectual disability: a 35-year follow-up study.

A 35-year follow-up study based on a nation-wide population study of the life expectancy of people with intellectual disability (ID) was undertaken. The study population consisted of a total of 60,969 person-years. A prospective cohort study with mortality follow-up for 35 years was used and the life expectancy of people with ID was calculated for different levels of intelligence. Proportional hazard models were used to assess the influence of level of intelligence and associated disorders on survival. People with mild ID did not have poorer life expectancy than the general population and subjects with mild ID did not have lower life expectancy in the first 3 decades of life. In cases with profound ID, the proportion of expected life lost was > 20% for almost all age groups. The female preponderance was manifested from the age of 60 years onwards, 25 years later than in the general population. Respectively, survival between sexes differed less. Epilepsy and/or hearing impairment increased the relative risk of death for all levels of ID. The prevalence of people with ID over 40 years was 0.4%. People with ID now live longer than previously expected, and the ageing of people with mild ID appears to be equal to that of the general population, posing new challenges to health care professionals.

Adolescent↗
PubMed2006

Self-rated life expectancy and lifetime socio-economic position: cross-sectional analysis of the British household panel survey.

BACKGROUND: The association between mortality risk and socio-economic position (SEP) across the lifecourse is established. This study investigates whether people's own ratings of their life expectancy are also associated with lifetime SEP. Health behaviour messages, which often emphasize the long-term benefits of behavioural change, may be received differently depending on people's perceptions of their life chances. METHODS: Cross-sectional analysis of 4780 adults aged 25-64 interviewed in the British Household Panel Survey in 2001. RESULTS: Just under a quarter of respondents did not think it likely they would live to 75 or older. People in lower SEPs were more likely to be pessimistic about their life expectancy. This applied across a number of socio-economic measures (father's social class, educational achievement, own social class, and household income). Eight socio-economic lifecourse pathways were compared. In comparison to those following the most advantaged pathway, those experiencing sustained socio-economic disadvantage were most likely to be pessimistic about their longevity, but those experiencing sustained upward mobility did not differ. Comparisons with measures of self-rated general health and limiting illness suggest that self-rated life expectancy is at least partially independent of current health status. CONCLUSIONS: This study shows that people's own perceptions of their life expectancy are associated with lifetime SEP. Self-rated life expectancy, in part, appears to reflect something over and above current health status and smoking behaviour. Given its ease of collection, it would be informative to include self-rated life expectancy in future studies.

Adult↗
PubMed2004

Life expectancy and prognostic factors for survival in patients with polycythemia vera and essential thrombocythemia.

PURPOSE: To assess life expectancy and prognostic factors for survival in patients with polycythemia vera and essential thrombocythemia. METHODS: The study sample consisted of 831 consecutive patients with polycythemia vera (n = 396; 4184 person-years of follow-up) or essential thrombocythemia (n = 435; 4304 person-years of follow-up). Mortality in each group was compared with the Italian population using the standardized mortality ratio (SMR) based on life expectancy data obtained from the Italian Institute of Statistics. RESULTS: The 15-year survival was 65% in patients with polycythemia and 73% in those with thrombocythemia. By Cox regression analysis, the independent predictors of death were a history of thrombosis for polycythemia (hazard ratio [HR] = 2.2; P = 0.0002) and thrombocythemia (HR = 2; P = 0.01), and male sex (HR = 1.8; P = 0.03) for thrombocythemia. Mortality compared with the general population was 1.6-fold higher (P <0.001) in patients with polycythemia but was not increased in those with thrombocythemia (SMR = 1; P = 0.8). CONCLUSION: Life expectancy of patients with polycythemia vera (especially if younger than 50 years) was reduced compared with the general population, whereas life expectancy of patients with essential thrombocythemia was not affected significantly by the disease, reflecting the more indolent nature of the proliferation. History of thrombosis was the main predictor of death in both diseases.

Female↗
PubMed2004

Effects of rofecoxib and naproxen on life expectancy among patients with rheumatoid arthritis: a decision analysis.

BACKGROUND: The VIOXX Gastrointestinal Outcomes Research (VIGOR) trial showed a 53% decrease in the risk of upper gastrointestinal toxicity and a fivefold increase in the risk of myocardial infarction for rofecoxib (a selective cyclooxygenase-2 inhibitor) compared with naproxen. We examined the effects of these competing adverse events on life expectancy in patients with rheumatoid arthritis. METHODS: We used decision analysis to compare the life expectancy of a cohort of rheumatoid arthritis patients taking naproxen versus a similar cohort taking rofecoxib, using data from the VIGOR trial. We incorporated the competing risks of upper gastrointestinal toxicity and myocardial infarction, as well as their long-term health consequences, on the basis of population-based studies. RESULTS: For 58-year-old women with rheumatoid arthritis (i.e., typical of participants in the VIGOR trial), naproxen was associated with a longer life expectancy than was rofecoxib (difference = 4.4 months). This difference was larger among 58-year-old men (7.8 months). The probability that naproxen is associated with a longer life expectancy than rofecoxib among 58-year-old patients was 92% for women and 98% for men. Life expectancy became the same between the two treatments when the risk of upper gastrointestinal toxicity was 70% higher or the risk of myocardial infarction was 40% lower than that of the base case among women, and when the risk of upper gastrointestinal toxicity was 4.4-fold higher or the risk of myocardial infarction was 70% lower among men. CONCLUSION: Our analysis suggests that the competing risks of upper gastrointestinal toxicity and myocardial infarction shown in the VIGOR trial would project a longer life expectancy with naproxen than rofecoxib among patients with rheumatoid arthritis, except in those at low risk of myocardial infarction or at high risk of upper gastrointestinal toxicity.

Aged↗
PubMed1988

Changing mortality patterns that led life expectancy in Japan to surpass Sweden's: 1972-1982.

Between 1972 and 1982, Japan caught up to and then surpassed Sweden as the country with the longest life expectancy. The contributions of different causes of death and age groups to life expectancy changes in males during this time period are examined in detail for these two countries. Even though cerebrovascular disease mortality rates remained lower in Sweden over the entire interval, the rapid gain made by Japan relative to Sweden for this cause of death was a prime factor in Japan's ending the period with a higher life expectancy. Important contributions to life expectancy improvement in Japan came from declining mortality rates in those aged 55 and older.

Adolescent↗
PubMed2006

PSA screening among elderly men with limited life expectancies.

CONTEXT: Most guidelines do not recommend prostate-specific antigen (PSA) screening in elderly men who have limited life expectancies because the known harms of screening outweigh potential benefits. However, there are no large-scale studies of actual PSA screening practices in elderly men, according to life expectancy. OBJECTIVE: To characterize the extent of PSA screening among elderly men, including those with limited life expectancies. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of 597 642 male veterans aged 70 years and older who were seen at 104 US Department of Veterans Affairs facilities during both 2002 and 2003, without a history of prostate cancer, elevated PSA, or prostate cancer symptoms. Charlson comorbidity scores were used to stratify men into 3 groups ranging from best health (score = 0) to worst health (score >or= 4). MAIN OUTCOME MEASURE: Receipt of PSA testing during 2003 was based on US Department of Veterans Affairs data and Medicare claims. RESULTS: In 2003, 56% of elderly men had a PSA test performed. Although PSA screening rates decreased with advancing age, within each 5-year age group the percentage of men who underwent a PSA test did not substantially decline with worsening health. For example, among men aged 85 years and older, 34% in best health had a PSA test compared with 36% in worst health. In multivariate analyses, many nonclinical factors, such as marital status and region of the country, had a greater effect on PSA screening than health, and screening rates exceeded 60% for some subgroups of men in worst health. CONCLUSIONS: Prostate-specific antigen screening rates among elderly veterans with limited life expectancies should be much lower than current practice given the known harms of screening. More attention to prognosis is needed when making screening PSA recommendations to elderly men.

Aged↗
PubMed1993

Estimated gains in life expectancy with use of postmenopausal estrogen therapy: a decision analysis.

BACKGROUND: Epidemiologic data are accumulating that suggest that postmenopausal estrogen therapy reduces the risk of developing coronary artery disease (CAD). Computer simulation by Markov analysis can be applied to current data to estimate the increase in life expectancy obtained from postmenopausal estrogen use and compare them with benefits from other therapies for CAD risk reduction. Decision-analysis techniques can also examine whether the benefits of unopposed estrogen regimens ever exceed those of combination therapy. METHODS: In our analysis, hypothetical cohorts of postmenopausal women age 50 and 65 years with intact uteri were assigned either to estrogen and progesterone therapy or unopposed estrogens. The subjects were also defined by risk category for CAD. Outcomes were measured in terms of life expectancy for treatment cohorts compared with identical untreated cohorts. RESULTS: Life expectancy benefits in combined therapy groups were found to be very substantial for all CAD risk categories. Cohorts who began therapy at age 50 years showed benefits ranging from 0.3 years of additional life for those at low risk of developing CAD to 2.3 years for those at high risk. Even though the addition of progestins may theoretically result in reduction of overall CAD benefits, impressive gains in life expectancy were still found even when a 40% reduction in estrogenic effect was considered. Overall, benefits were very favorable when compared with other accepted strategies for CAD risk reduction. Little additional benefit was found to justify use of unopposed estrogens given the potential added mortality from endometrial cancer. CONCLUSIONS: Substantial increases in life expectancy may result from postmenopausal estrogen therapy. These may be equal to or possibly greater than benefits from other well-recognized risk-reduction strategies. Little advantage in additional life expectancy is found to justify use of unopposed estrogens.

Aged↗
PubMed1995

Life expectancy at age 60--epidemiologic scenarios assuming delayed mortality for selected causes of death.

"The present analysis offers a projection of life expectancy at advanced ages in Austria for the year 2010. To estimate the gains in life expectancy the Simultaneous Multiple Cause-Delay (SIMCAD) method is used. This model takes into account the epidemiological concept of an additional delay in the onset of particular chronic-degenerative diseases. While the results of the SIMCAD method vary only slightly on the whole from the official projection of life expectancy at age 60, the similarity between the two projections decreases steadily with increasing age. The SIMCAD model predicts higher gains in life expectancy for the oldest age-groups of the population than do the official statistics." (SUMMARY IN FRE)

Adult↗
PubMed2002

Survival in a cohort of social services placements in nursing and residential homes: factors associated with life expectancy and mortality.

The aim of this study was to examine the life expectancy of elderly people in nursing and residential care over a 20-month period and its relationship to specific risk factors. Using a retrospective cohort design, data obtained on 1888 residents placed between 1 July 1997 and 30 April 1999 in residential, nursing and dual registered homes within Nottingham Health Authority boundaries were examined. Additional data on physical and mental disability at placement were available for 514 residents. Main outcome measures comprised survival rate overall, and in relation to gender, age, home type (nursing, residential or dual), source of placement (hospital or community) and various disability factors.One-year survival rates were: overall, 66%; nursing homes, 59%; dual homes, 58%; and residential homes 76%. Median survival in nursing homes was 541 days, but was not reached in residential homes. Male gender, admission to nursing or dual registered homes, placement from hospital, decreased mobility and increased age were associated with decreased life expectancy. Although no association was found between length of survival and level of cognitive function, lack of cognitive impairment was associated with lower survival. In conclusion, mortality is high in nursing, dual and residential homes where life expectancy has been shown to be associated with gender, home type, origin of placement and mobility. Rates of survival are related to higher comorbidity and disability. Important data for planning and assessing care needs can be yielded through the analysis of mortality data.

Aged↗
PubMed1994

Prescribing propensity: influence of life-expectancy gains and drug costs.

OBJECTIVE: To determine whether physician willingness to prescribe drugs for primary prevention of cardiovascular disease is influenced by information about the resultant life-expectancy gains (presented in one of two formats) and about drug costs. MATERIALS AND METHODS: Mailed survey (four versions randomly allocated) asking physicians to assess hypothetical preventive interventions with outcomes expressed either as averaged or as stratified gains in life expectancy (e.g., average gain of 15 weeks, versus 5% of treated patients gain 2 to 6 years, 10% gain up to 2 years, and 85% remain unchanged). Both costs and gains were varied to high and low values. The subjects rated their willingness to prescribe treatments on an 11-point scale from "strongly oppose" to "strongly favor." PARTICIPANTS: Internists randomly selected from two Canadian academic centers (n = 330). RESULTS: 231 usable responses were received (76% of the deliverable questionnaires). For low-yield scenarios typical of very effective primary prevention strategies, the physicians gave significantly higher ratings in response to stratified life-expectancy data than to equivalent averaged data (p < 0.0001). The same trend was not observed for high-yield scenarios (p = NS). The ratings were strongly influenced by cost: 34% of the physicians reversed their treatment decisions in response to a tenfold price increase. Despite this, the rankings of the treatments differed from those expected on the basis of cost-effectiveness criteria (p < 0.0001). CONCLUSIONS: Physician enthusiasm for a therapy designed to prolong life expectancy may be influenced by the format in which that life-expectancy gain is presented. Knowledge of drug cost also affects physicians' choices, but their greater focus on treatment effects causes their rankings to depart from those expected with cost-effectiveness criteria.

Attitude of Health Personnel↗
PubMed1991

Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic type 1 (insulin-dependent) diabetic patients.

The aim of our study was to evaluate the effects of haemodialysis, kidney transplantation and simultaneous kidney and pancreas transplantation on survival of diabetic subjects and on kidney function. 40 Type 1 (insulin-dependent) diabetic patients received a kidney transplantation: in 31 cases the kidney was transplanted simultaneously to a pancreas graft from the same donor (KP group), while in 9 cases the pancreas was not available (K group). 44 uraemic Type 1 (insulin-dependent) diabetic patients on dialysis and in waiting list for kidney transplantation, constituted the control group (HD group). Patient survival rate 1, 3 and 5 years following transplantation was better in KP group (93%, 89%, 89%, respectively) and in K group (88%, 88%, 73%, respectively) and in HD group (88%, 62%, 51%, respectively). Kidney graft survival at 1, 3 and 5 years post-transplant was better in KP group (93%, 72%, 72%, respectively) than in K group (76%, 61%, 31%, respectively). 1 year after transplantation, patients of the KP group who had lost the pancreas for technical reasons (thrombosis) were included in the K group so as to evaluate the effect of the transplanted pancreas on long-term patient and kidney survival. Patient survival rate in the KP group (17 patients) at 2 and 4 years was 100%, while at the same intervals it was 78% in the K group (13 patients). Kidney graft function rate at 2 and 4 years was 93% in the KP group (17 grafts) and 54% and 27% respectively in the K group (14 grafts).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Impact of long-term exposure to air particulate matter on life expectancy and survival rate of Shanghai residents.

OBJECTIVE: To evaluate the impact of long-term air particulate matter exposure on the life expectancy and survival rate of Shanghai residents. METHODS: Epidemiology--based exposure-response function was used for the calculation of attributable deaths to air particulate matter in Shanghai, and the effect of long-term exposure to particulate matter on life expectancy and survival rate was estimated using the life table of Shanghai residents in 1999. RESULTS: It was shown that in 1999, the long-term air particulate matter exposure caused 1.34-1.69 years reduction of life expectancy and a decrease of survival rate for each age group of Shanghai residents. CONCLUSION: The effect of long-term exposure to air particulate matter on life expectancy is substantial in Shanghai.

Adolescent↗