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PubMed2000

Life expectancy benefits of cancer screening in the end-stage renal disease population.

Health maintenance includes secondary prevention through cancer screening. There are no established guidelines for cancer screening patients with end-stage renal disease (ESRD). Using an established method of estimating life expectancy, published literature on cancer screening, and information from databases on mortality and malignancy (US Renal Data System 1997 Annual Data Report and the SEER Cancer and Statistical Review, 1973-1994), a "real-time life expectancy calculator" was developed to guide the primary help provider in making informed decisions on the benefits of cancer screening in individual patients. Potential days of life saved by each screening method can be calculated using the difference in life expectancy per the DEALE (declining exponential approximation of life expectancy) method with and without cancer screening. Using two sets of assumptions (one to enhance any bias toward support for screening and one to limit this bias), a range of potential days of life saved with screening for breast and colon cancer can be calculated in individual patients with ESRD. In breast cancer, for example, a 50-year-old black woman with ESRD and multiple risk factors would have 41 to 291 potential days of life saved with screening. A 60-year-old white woman with ESRD and diabetes mellitus (DM) would have only 1 to 16 days of life saved. This life expectancy calculator can guide the primary health care provider in making clinical decisions concerning screening in the ESRD population. In addition to assisting in patient education, the calculator can be updated as new information becomes available regarding relative risk, treatment, and mortality.

Breast Neoplasms↗
PubMed2004

Social gradient in life expectancy and health expectancy in Denmark.

OBJECTIVES: Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels. METHODS: Health interview data were combined with life table figures using Sullivan's method. RESULTS: Life expectancy was 4.3 years longer for 30-year-old men with a high educational level than for those with a low level. At age 30, the proportion of expected lifetime in self-rated good health was 67.7%, 76.1% and 82.3% for men with a low, medium and high educational level, respectively. Among women, life expectancy differed by 2.7 years between low and high educational level, and the proportion of expected lifetime in self-rated good health was 62.5% at the low and 80.5% at the high educational level. CONCLUSIONS: Educational level and life expectancy are clearly related. The social gradient in terms of health expectancy is even greater than that in terms of life expectancy.

Adolescent↗
PubMed1997

The East-West life expectancy gap: differences in mortality from conditions amenable to medical intervention.

BACKGROUND: Although mortality from conditions amenable to medical intervention has frequently been shown to be higher in the countries of Central and Eastern Europe (CCEE) than in the countries of Western Europe (CWE), the contribution of these mortality differences to the East-West gap in life expectancy is unknown. We have determined the contribution of mortality from nine amenable causes to differences in temporary life expectancy from birth to age 75 (TLE0-75) between 12 CCEE and the average TLE0-75 for CWE in ca. 1988. DATA AND METHODS: Population and mortality data were extracted from publications of the World Health Organization. Chiang's method was used for constructing abridged life tables, and Arriaga's method was used for decomposition by cause of death of the differences in TLE0-75 between each of the CCEE and the average for CWE. RESULTS: Differences in TLE0-75 between CCEE and the average for CWE ranged between 1.25 and 6.29 years in men, and between 1.09 and 3.44 years in women. After exclusion of early neonatal deaths, for which data were not available in all CCEE, amenable causes accounted for between 11% and 50% of the difference in TLE0-75 in men, and between 24% and 59% in women. The results for countries where data on early neonatal deaths were available show that inclusion of this category generally raises these estimates substantially. The contribution of conditions amenable to medical intervention to the East-West life expectancy gap is of the same order of magnitude as that of cardiovascular diseases, and much larger than that of neoplasms, respiratory diseases or external causes. CONCLUSION: Although the contribution of conditions amenable to medical intervention should not be taken as a direct estimate of the contribution of medical care to the East-West life expectancy gap, these results suggest that reducing differences in the effectiveness of medical care may be more important for narrowing the life expectancy gap than has hitherto been assumed.

Adolescent↗
PubMed2001

Where there are no data: what has happened to life expectancy in Georgia since 1990?

In recent years there has been a considerable increase in understanding of changes in mortality in Russia and some other former Soviet republics. However, the situation in the republics of the Caucasus remains poorly understood. Information on Georgia is especially fragmentary as a fifth of the country remains outside government control, there has been large scale migration since 1991, and the introduction of fees for vital registration has compromised the quality of official statistics. The aim of the study is to produce plausible estimates for life expectancy in Georgia for the period 1990-1998 and thus to assess whether Georgia has undergone changes similar to other former Soviet republics in the post-independence period. Four models were used to construct life tables. Model 1 used officially published statistics on deaths and population. Model 2 applied new estimates of population derived from household surveys to the observed deaths. Model 3 adjusted model 2 for under-registration at extremes of life, with parameter estimates derived from a survey of infant mortality and comparison of observed rates with Coale-Demeny standard life tables. Model 4 arose following inspection of death rates by cause that revealed implausible discontinuities in cancer mortality rates and involved applying the estimates of under-registration that this finding implied to model 3. The four models produce quite different estimates of life expectancy, differing by 7.8 y for men and 6.8 y for women by 1998. In any of the models, however, Georgia does not appear to have experienced the marked deterioration in life expectancy seen in Russia following the transition to independence. Importantly, Georgia had also not experienced a marked improvement in life expectancy during the 1985 Soviet anti-alcohol campaign, again unlike other Soviet republics.Official statistics substantially over-estimate life expectancy at birth in Georgia. Despite undergoing a civil war, life expectancy in Georgia has been less affected by the transition than has Russia and the overall trends in mortality since the mid 1980s suggest that this may be because alcohol has played a smaller role in these changes than it did in Russia.

Aged↗
PubMed1994

Life expectancy following dietary modification or smoking cessation. Estimating the benefits of a prudent lifestyle.

OBJECTIVE: To evaluate the maximum benefits of dietary modification or smoking cessation to the life expectancy of North American adults. DESIGN: Using a computer model, we estimated the change in life expectancy for men and women following risk factor modification. We then estimated the total number of adults who would be targeted by national guidelines and the total person-years of life that would be saved. PATIENTS: Men and women aged 30 to 74 years who were free of coronary heart disease. INTERVENTIONS: Smoking cessation or serum cholesterol-reducing diets with 8% to 10% saturated fat and 240 to 300 mg of daily cholesterol, respectively. RESULTS: On average, dietary modification would reduce serum cholesterol levels from 0.45 mmol/L (17.4 mg/dL) to 0.75 mmol/L (29.1 mg/dL) in men and 0.12 mmol/L (4.6 mg/dL) to 0.55 mmol/L (21.4 mg/dL) in women, thereby increasing life expectancy by 0.03 to 0.4 year and 0.01 to 0.16 year, respectively. Smoking cessation would increase life expectancy from 2.59 to 4.43 years among men and from 2.6 to 3.68 years among women. Among adult Canadians, dietary modification would save 373,000 to 683,000 person-years of life. The majority of these benefits would occur among men who start dieting at ages 30 to 59 years. Smoking cessation would add more than 4 million person-years of life to the Canadian population. The relative impact of either intervention among American adults would be similar to these Canadian estimates. CONCLUSIONS: Younger men, aged 30 to 59 years, might live slightly longer after dietary change, but among women and older men the average benefits would be negligible. The benefits of smoking cessation are more uniform across age and sex and are substantially greater than those predicted for dietary change.

Adult↗
PubMed1994

Life expectancy in children with cerebral palsy.

OBJECTIVE: To determine life expectancy of children with cerebral palsy. DESIGN: Cohort analysis, by means of register compiled from multiple sources of ascertainment, of all children with cerebral palsy born during 1966-84 to mothers resident in Mersey region. Status of children was determined by flagging through NHS central register. SUBJECTS: 1258 subjects with idiopathic cerebral palsy, of whom 1251 were traced and included in analysis. MAIN OUTCOME MEASURES: Effect of functional ability (ambulation, manual dexterity, and mental ability), sex, birth weight, and gestational age on survival. RESULTS: 20 year survival for whole cohort was 89.3% for females and 86.9% for males. For subjects with no severe functional disabilities 20 year survival was 99% (95% confidence interval 98% to 100%), while subjects severely disabled in all three functional groups had 20 year survival of 50% (42% to 58%). Subjects with birth weight < or = 2500 g had 20 year survival of 92% (89% to 95%), while those with birth weight > 2500 g had survival of 87% (84% to 89%). Subjects with gestational age of > 37 weeks had 20 year survival of 93% (91% to 96%), while those with gestational age > or = 37 weeks had survival of 85% (83% to 88%). Birth weight and gestational age were less predictive of survival than functional disability. Best statistical model used gestational age and number of severe functional disabilities as predictors. CONCLUSIONS: Life expectancy of this cohort of children with cerebral palsy was greater than has been suggested in some previous studies. This has important implications for social, educational, and health services.

Birth Weight↗
PubMed1993

Increased life expectancy of world class male athletes.

Reliable data are scanty on the incidence of chronic diseases and life expectancy (LE) of highly trained athletes. We therefore studied Finnish male world class athletes to estimate the LE of athletes. Finnish team members in the Olympic games, World or European championships or intercountry competitions during 1920-1965 in track and field athletics, cross-country skiing, soccer, ice hockey, basketball, boxing, wrestling, weight lifting, and shooting were included (N = 2613 men). The reference cohort, 1712 men, was selected from the Finnish Defence Forces conscription register matched on age and area of residence. All referents were classified completely healthy at the time of induction to military service. The stratified Kaplan-Meier product limit method and the Cox proportional hazards model were used to estimate the life expectancies and the mortality odds ratios (OR) and their confidence limits. The mean LE adjusted for occupational group, marital status, and the age at entry to the cohort (and its 95% confidence limits) was in endurance sports (long distance running and cross-country skiing) 75.6 (73.6, 77.5) yr; in team games (soccer, ice hockey, basketball, as well as jumpers and short-distance runners from track and field (73.9 (72.7, 75.1) yr; in power sports (boxing, wrestling, weight lifting, and throwers from field athletics) 71.5 (70.4, 72.2) yr; and in the reference group 69.9 (69.0, 70.9) yr. The increased mean life expectancies were mainly explained by decreased cardiovascular mortality (endurance sports mortality odds ratio OR = 0.49 (95% CL 0.26, 0.93), team sports OR = 0.61 (0.41, 0.92) compared with referents). For maximum life span no differences between the groups were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cohort Studies↗
PubMed2005

Increasing socio-economic inequalities in life expectancy and QALYs in Sweden 1980-1997.

The aim of this study was to estimate the change in socio-economic differences in life expectancy and in quality-adjusted life years (QALYs), for men and women at different ages, in Sweden 1980 to 1997. We used data from the Swedish Survey of Living Conditions (the ULF survey), which is linked to mortality data, to estimate the life expectancy in different socio-economic groups in 1980 and 1997 (n=100 868). Health state scores were obtained by mapping responses to selected ULF survey interview questions into the generic health-related quality of life measure EQ-5D, using the UK EQ-5D index tariff (n=34 447). For 20-year-old men the difference in life expectancy between the highest (higher non-manual) and the lowest socio-economic group (unskilled manual) was 2.11 years in 1980 and 3.79 years in 1997. The corresponding figures for 20-year-old women were 1.56 in 1980 and 2.15 in 1997. The difference in QALYs between the highest and the lowest socio-economic group increased from 5.76 QALYs in 1980 to 7.06 QALYs in 1997 for 20-year-old men, and from 4.14 QALYs in 1980 to 5.66 QALYs in 1997 for 20-year-old women. The widening socio-economic inequalities over time were more stable for men than for women. We conclude that our results suggest that the socio-economic inequality in health has increased between 1980 and 1997 in Sweden.

Adolescent↗
PubMedDate not supplied

Narrowing sex differentials in life expectancy in the industrialized world: early 1970's to early 1990's.

Between the early 1970's and 1990's, twelve industrialized nations experienced for the first time a narrowing of their sex differences in life expectancy at age zero. In another set of countries, the differential has not yet reached a stage of convergence, although in some of these nations the female advantage appears to be increasing at a slower pace than ever before. We discuss the demographic and epidemiologic conditions for this new and largely unanticipated trend, as well as its applied and theoretical implications in the context of the following questions: (1) Is the observed change a function of males' faster pace of gains in life expectancy since the early 1970s? (2) What is the relationship between country differences in socioeconomic development (as measured by GNP) and the degree of convergence in the sex gap in average length of life? (3) What is the degree of association between temporal change in age-sex specific death rates and change in the sex gap in life expectancy over the twenty-year interval between the early 1970s and early 1990s? Our results indicate that where some convergence has taken place, in relation to women, men have experienced more rapid gains in survival; the higher a nation's level of social and economic development, the greater the amount of convergence in male and female life expectancies. The most pronounced age-specific association with the changing sex gap in longevity is that of ages 25-59, where the greater reductions in male mortality, as compared to that for females, contributed to a significant portion of the observed convergence in life expectancy across industrialized nations.

Adolescent↗
PubMed2003

Healthy life expectancy: comparison of OECD countries in 2001.

OBJECTIVES: To compare average levels of population health for Australia and other OECD countries in 2001. METHODS: Healthy life expectancies (HALE) for OECD countries for 2001 are based on analysis of mortality data for OECD countries, country-specific estimates of health state prevalences for 135 causes from the Global Burden of Disease 2000 study, and an analysis of 34 health surveys in 28 OECD countries, using novel methods to improve the comparability of self-report data. RESULTS: HALE at birth ranges from a low of 59.8 years for Turkey to a high of 73.6 years in Japan in 2001. Australia ranks fourth among OECD countries at 71.6 years with a 95% uncertainty interval of 70.9 to 72.8 years, ahead of New Zealand in 13th place at 70.3 years. The equivalent 'lost' healthy years at birth range from around 10 years in OECD countries with lowest life expectancies to around eight years in those with high life expectancies at birth. There is a statistically significant association between higher levels of health expenditure and higher healthy life expectancy across OECD countries, although causal inferences require more sophisticated analyses of the health system and non-health system determinants of levels of health. CONCLUSIONS: The new methods used in the WHO Multi-Country Household Survey Study have increased the comparability of self-report data across OECD countries, a major step forward in the use of self-reported data on health. Building on this experience, WHO is developing improved health status measurement techniques for a World Health Survey to be carried out in 2002/03.

Aged↗
PubMedDate not supplied

Prostate biopsies in men with limited life expectancy.

CONTEXT: Authorities discourage prostate screening in men who are likely to die from causes other than prostate cancer. PRACTICE PATTERN EXAMINED: Use of prostate biopsy-a proxy for screening-in men aged 65 and older with limited life expectancy (i.e., estimated to be less than 10 years). DATA SOURCE: Five percent samples of Part A (hospital) and Part B (physician) Medicare claims for 1993 through 1997. RESULTS: 22% of all Medicare beneficiaries who underwent a prostate biopsy had a limited life expectancy, corresponding to a rate of 1420 biopsies per 100,000. This rate did not change significantly between 1993 and 1997. For men with a life expectancy greater than 10 years, the biopsy rate was 2,360 per 100,000. Among men with limited life expectancy, in the year following the biopsy, 1.6% had radical prostatectomy and 2.3% had external-beam radiation. Thirty-nine percent were hospitalized. CONCLUSION: A substantial proportion of prostate biopsies are being performed in men with a life expectancy of less than 10 years. These men are unlikely to benefit from the biopsy or subsequent treatment.

Aged↗
PubMed2001

Life expectancies for individuals with psychiatric diagnoses.

The aim of the study was to estimate life expectancies in different diagnostic groups for individuals treated as inpatients at Swedish psychiatric clinics. All individuals, older than 18 y and alive on the first of January 1983, who had been registered in the National Hospital Discharge Registry by a psychiatric clinic in 1978-82, were monitored for mortality during 1983 by using the National Cause of Death Registry. The study group consisted of 91 385 men and 77 217 women. The patients were divided into nine diagnostic groups according to the principal diagnosis registered at the latest discharge. Actuarial mathematics was used to construct life expectancy tables, which present the number of years expected to live, by gender and diagnostic group. Expectancies of life were significantly shortened for both genders and in all nine diagnostic groups (with one exception). Mental disorders in general are life shortening. This fact should be recognised in community health when setting health priorities. It should also be addressed in curricula as well as in treatment and preventive programmes.

Adult↗
PubMed2002

[Relative risk of death and life expectancy in low cardiovascular risk population].

OBJECTIVE: To assess the relationship between low cardiovascular disease (CVD) risk and the mortalities of coronary heart disease (CHD), stroke, cancer and all causes as well as life expectancy in Chinese population. METHODS: CVD risk factors were surveyed in 1982 approximately 1985 for 30 thousand male and female participants aged 35 approximately 59 from 10 Chinese population groups including 3 groups of factory workers, 6 groups of farmers and 1 group of fishermen according a uniform protocol with standardized methods. Follow-up was carried out up to 1999 approximately 2000 and the causes of death were all documented. Low cardiovascular risk was defined as: SBP/DBP < 120/80 mm Hg without anti-hypertensive medication 2 weeks before the baseline survey, serum total cholesterol < 5.17 mmol/L, BMI > 18.5 but < 24 kg/m(2) and no smoking at baseline survey. Mortality rates of CHD and stroke, cancer and all causes the participants with low CVD risk were compared with the rest of the cohort and difference in life expectancy was estimated. RESULTS: Out of the whole cohort of 30 560 participants, 24 900 with complete data were available for the present analysis. Among these, 4 542 participants (18.2%) were defined as low CVD risk group, including 959 (7.7%) men and 3 583 (28.9%) women. During a follow-up of 15.2 years on average, 243 deaths including 6 CHD, 15 stroke and 117 cancer deaths took place in low risk group, while 2 383 deaths including 182 CHD, 333 stroke, and 934 cancer deaths occurred in rest of the cohort. Cox proportional hazards model adjusted for age showed that the relative risks of death of CHD, stroke, cancer and all causes in low risk group were 0.51 (95% CI: 0.19 approximately 1.37), 0.30 (95% CI: 0.11 approximately 0.81), 0.86 (95% CI: 0.62 approximately 1.19) and 0.77 (95% CI: 0.62 approximately 0.96) for men and 0.11 (95% CI: 0.03 approximately 0.45), 0.31 (95% CI: 0.17 approximately 0.58), 0.84 (95% CI: 0.66 approximately 1.10) and 0.67 (95% CI: 0.56 approximately 0.79) for women, respectively. Life expectancy was 2.6 years longer for men and 4.0 years longer for women in the low risk group. CONCLUSION: The mortality rates of CVD and all causes were lower and life expectancy was longer in the participants with low CVD risk. Keeping low risk profile may not only prevent from having CVD but also extend life expectancy.

Adult↗
PubMed2005

Healthy life expectancy for selected race and gender subgroups: the case of Tennessee.

OBJECTIVE: To analyze healthy life expectancy (HLE) for major racial and gender subgroups, based on the diverse population of Tennessee and compared with the United States. MATERIALS AND METHODS: We use life table methodology and the HLE calculation model of the National Center for Health Statistics (NCHS), using two databases for 2001: NCHS National Vital Statistics Reports life tables and CDC Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS: For Tennessee, although average total life expectancy (TLE) is 73.6 years at birth, only 61.1 years of "good" health are expected. Substantial racial and gender differences are found in both TLEs and HLEs with black males having the lowest and white females the highest. Although females have longer TLE, they spend more years in an unhealthy state than males. CONCLUSIONS: The findings raise new challenges for researchers and health policy makers for accomplishing the dual goals of longer life expectancy and elimination of health disparities among population subgroups.

Adolescent↗
PubMed1988

The current differential in black and white life expectancy.

The 1980 National Center for Health Statistics life tables for the U.S. black and white populations reveal a difference in life expectancy of 7 years between black and white males and 6 years between black and white females. Using cause-substituted life tables, we show that a number of causes of death contribute to the difference. The largest contributors are cardiovascular disease for both sexes and homicide and cancer for males.

Adolescent↗
PubMed1987

[Changes in life expectancy of Koreans due to reduction in leading causes of death in 1985].

"This study examines potential gains in life expectancy of Korean males and females in 1985 when the three leading causes of death are totally eliminated. The greatest increase in life expectancy of Korean males would result from the elimination of malignant neoplasms (2.2 years at birth), whereas the life expectancy of Korean females would be lengthened the most (2.4 years) by elimination of cerebrovascular diseases. The implications of the results can provide useful information for the evaluation of the public health programs and health planning policy for [the Republic of Korea] in the future." (SUMMARY IN ENG)

Asia↗
PubMed2005

Trends in disability and disability-free life expectancy among elderly people in Spain: 1986-1999.

BACKGROUND: This paper examines recent trends in the prevalence of disability and disability-free life expectancy in the population aged 65 years and older in Spain. METHODS: Data were drawn from two National Disability, Impairment and Handicap Surveys conducted in 1986 and 1999. Only severe disability was studied, and disabilities overcome through use of external technical aids were included. RESULTS: In the period 1986--1999, a relative annual decline of 3.7% in overall disability was observed for men. The decline was somewhat less marked in women, participants aged 75 years and older, and those with the lowest educational level. In men, there was a relative annual decline of just over 3% in walking and hearing disabilities, of under 1% in seeing and cognitive disabilities, and a slight rise in self-care disability. Trends among women were similar, though self-care disability rose by 1.78%. In the period 1986--1999, total and disability-free life expectancy rose across all age groups in both sexes. Among men aged 65 years, the proportion of life expectancy with disability fell from 42.1% in 1986 to 21.6% in 1999; the comparable figures for women were 49.8% in 1986 and 30.6% in 1999. Indeed, a reduction in life expectancy with disability was observed even among persons aged 80 years and older. CONCLUSION: From 1986 through 1999, prevalence of severe disability among Spanish elderly persons decreased substantially, and the duration of life with disability was compressed between a later onset and the time of death. Among women, however, self-care disability--the type of disability requiring most social resources for its attention--underwent a sharp rise.

Aged↗
PubMed1997

Life expectancy, economic inequality, homicide, and reproductive timing in Chicago neighbourhoods.

In comparisons among Chicago neighbourhoods, homicide rates in 1988-93 varied more than 100-fold, while male life expectancy at birth ranged from 54 to 77 years, even with effects of homicide mortality removed. This "cause deleted" life expectancy was highly correlated with homicide rates; a measure of economic inequality added significant additional prediction, whereas median household income did not. Deaths from internal causes (diseases) show similar age patterns, despite different absolute levels, in the best and worst neighbourhoods, whereas deaths from external causes (homicide, accident, suicide) do not. As life expectancy declines across neighbourhoods, women reproduce earlier; by age 30, however, neighbourhood no longer affects age specific fertility. These results support the hypothesis that life expectancy itself may be a psychologically salient determinant of risk taking and the timing of life transitions.

Adult↗