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PubMedDate not supplied

Mixed life expectancy changes.

Life expectancy for the U.S. total population was essentially unchanged in 1995 from the prior year. However, analysis by sex reveals that males experienced longevity enhancements across the age spectrum. In fact, average remaining future lifetime for men established new record highs or remained at peak levels at every age. In 1995 expectation of life at birth was 75.7 years for the total population, 72.4 years for boys and 78.8 years for girls. At individual ages, women's average remaining lifetime has hardly changed since 1990, whereas men under age 75 have gained around 0.5 years between 1990 and 1995. In 1995 the infant mortality rate established another all-time low, namely 7.6 per 1,000 live births; this marks the 33rd consecutive year of annual declines.

Adolescent↗
PubMed1996

[Sex differential in life expectancy at birth in Japan: (2) trends in sex differential in life expectancy at birth from 1920 to 1990].

Sex differentials in life expectancy at birth in Japan are analyzed for the period 1920 to 1990. The results show that there was a general increase in differences in mortality by sex over time. "The sex differential in age-specific death rate in 0-4 year age group (particularly age 0) explained most of the sex differential in life expectancy at birth before 1947. After 1950, the age group of 60-79 played a major role in the sex differential in life expectancy at birth. It is noteworthy that female mortality exceeded male mortality in age groups of 2-41 before 1930. Consequently, excess of female mortality reduced the sex differential in life expectancy at birth at that period. As for the sex differential in mortality rates by causes of death, tuberculosis, pregnancy and childbirth related disease exerted a great influence...before 1940. Recently, malignant neoplasms, heart diseases, cerebrovascular diseases, and accidents [have] become leading contributors to the sex differentials in life expectancy at birth." (SUMMARY IN ENG)

Age Factors↗
PubMed2005

The female gender has a positive effect on survival independent of background life expectancy following surgical resection of primary non-small cell lung cancer: a study of absolute and relative survival over 15 years.

Surgical resection is the treatment of choice for non-advanced lung cancer, but is encumbered with an overall relative poor long time prognosis. The purpose of this study was to examine if long time survival for patients operated for non-small cell lung cancer have changed over a 15 years period. We retrospectively studied hospital records of the 351 patients operated, with the intention to cure, for a primary non-small cell carcinoma (NSCLC) in our department between 1 January 1988 and 31 December 2002. Preoperative clinical variables were noted together with variables allowing staging based on pathological examination. Absolute survival and survival relative to expected was studied for the whole group using uni- and multivariate Cox analyses. Early 30 days mortality was 2.0%. The 5-year absolute and relative survivals for all patients were 46.3% and 52.6%, respectively. After 10 years corresponding values were 32.9% and 44.6%. At the end of the study, the 15-year absolute survival was 27.8% with a relative survival of 46.2%. Univariate analysis revealed that age, gender, nodular stage, tumour size, p-stage, type of resection, time of operation and additional cardiovascular disease at the time of operation significantly influenced survival. Multivariate analysis for all patients revealed that low age, female gender, low nodular stage, and operation late in the study period were significant prognostic factors predicting improved survival. When including a population based age- and gender-adjusted median expected life time for every patient as a predictor for survival, only female gender and low nodular stage were additional significant and independent positive prognostic factors.

Adult↗
PubMed1990

A predictive model for life expectancy curves.

Life expectancy curves have a characteristic ominous shape that has fascinated scientists for centuries. Medawar was the first to explain this shape, specifically the steeply rising proneness of an average individual to die as a function of age, in evolutionary terms. The idea was that the "selective value" of the individual decreases as it has triggered other individuals taking its place (and carrying its genes) into existence. We demonstrate that this idea can be turned into a quantitative model. The resulting 4-parameter function reproduces well two well-known life expectancy curves from the first half of this century. Moreover, the easily interpretable parameters (3 of the 4) seem intuitively reasonable.

Female↗
PubMedDate not supplied

Impact of survival probability, life expectancy, quality of life and patient preferences on do-not-attempt-resuscitation orders in a hospital. Resuscitation Committee.

Consensus exists that a do-not-attempt-resuscitation order (DNAR) is appropriate if a resuscitation attempt is futile. Less agreement exists when this point is reached. We investigated the influence of three major considerations for in-hospital DNAR orders: expected survival probability after resuscitation, prospects of the patients' current condition without a cardiac arrest and the patients' autonomous decision not to want resuscitation. We calculated an expected survival probability according to two multi-morbidity prediction scores for each patient, assuming the event of cardiac arrest. The prospects of the current condition without a cardiac arrest was estimated by the patients' physician, in terms of life expectancy and quality of life (level of dependency after discharge and pain). The patients' preference was documented from the medical records. A total of 470 patients were included in the study. Fifty-eight patients (12%) had a DNAR-order, 11 of these patients (19%) wanted no resuscitation. The patients' prospects (life expectancy, dependency after discharge), and age proved to be independently associated with the presence of a DNAR order. The odds ratio (OR) for the presence of a DNAR order was 37 (CL 14-107) for an estimated life expectancy less than 3 months, 13 (CL 4-41) for a life in a nursing home and four (CL 2-12) for an age of 80 years and older. Expected survival probability after resuscitation and pain were not independently associated with a DNAR order. We conclude that resuscitation is considered futile on the basis of the patients' age and prospects without cardiac arrest and that the impact of expected survival probability on these decisions is small.

Aged↗
PubMed2005

Societal discounting of health effects in cost-effectiveness analyses: the influence of life expectancy.

BACKGROUND: Increasing life expectancy and decreasing marginal valuation of additional QALYs over time may serve as a basis for discounting future health effects from a societal perspective. Therefore, we tested the hypothesis that societal time preference for health is related to perceived future life expectancy. METHODS: A sample of 223 people from the general population prioritised healthcare programmes with differential timing of health benefits and costs from a societal perspective. Furthermore, we asked respondents to estimate future life expectancy. RESULTS: The relationship between future life expectancy and time preference for health is ambiguous. We observed that people who expected a higher future life expectancy elicited higher discount rates for health effects than those with lower life expectancy growth expectations for all four time periods (5, 10, 20 and 40 years into the future), but the differences were never significant. On average, providing explicit information on growth in life expectancy did significantly alter discount rates in the expected direction but, on an individual level, the results were rather inconsistent. We observed a significantly stronger time preference (i.e. higher discount rates) for health effects than for costs. As commonly observed, discount rates for health and money decreased with time delay following a hyperbolic function. CONCLUSION: Our data indicate that it is troublesome to elicit societal discount rates empirically, especially rates that are in line with the theoretical arguments on societal discounting. The influence of life expectancy remains ambiguous, but there seems to be at least some positive relationship between growth in life expectancy and discount rates that deserves additional attention.

Attitude to Health↗
PubMed2004

[Life expectancy, potential years of life lost (PYLL), and avoidable mortality in an East/West comparison].

The dynamics of convergence between East and West Germany in the life-prolonging process continued undiminished from 1990 until 2001. The regional differences in premature and avoidable mortality were clearly reduced, both between East and West and between the individual federal states. In the East and in the West there was an increase in life expectancy in all age groups and for both sexes, whereby the increase in life expectancy was considerably greater in East Germany and in all of the East German federal states. Also, the standardized potential years of life lost before the age of 65 decreased more intensively in East Germany. The women in East Germany achieved a lower premature mortality due to illness in the year 2001 than those in West Germany. In the initial year of 1990, the years of life lost were 27.2% greater. Unnatural premature mortality (especially due to accidents) was also relatively high in East Germany in the year 2001, but it is clearly being reduced. The avoidable mortality has been more than cut in half in all East German federal states since 1990. An almost complete alignment between East and West in regard to avoidable mortality was achieved in the year 2001. The phase of economic stagnation that can be observed in East Germany since 1997 has up to now not led to a worsening in the constitutive health references presented above.

Adolescent↗
PubMed2005

Life expectancy--a commentary on this life table variable.

In 1992, I wrote an article on a method of modifying the Decennial US Life Table to accommodate any pattern of excess mortality expressed in terms of excess death rate (EDR), for the specific purpose of calculating the reduced life expectancy, e. I believe this was the first article published in the Journal of Insurance Medicine (JIM) that dealt specifically with life expectancy as an index of survival and risk appraisal, never used in the classification of extra mortality risk in applicants for life insurance. In this commentary, I discuss the 1989-91 US Decennial Life Table in detail. I link the subject matter of the 1992 article with several more recent articles that also focus on the utility of life expectancy in underwriting structured settlement annuities and preparing reports on life expectancy for an attorney in a tort case. A few references are given for further reading on life table methodology and its use in the most accurate estimate of life expectancy, given the inherent limitations of the life table and the limited duration of follow-up studies.

Adolescent↗
PubMed2006

Adjusting for dependent comorbidity in the calculation of healthy life expectancy.

BACKGROUND: Healthy life expectancy--sometimes called health-adjusted life expectancy (HALE)--is a form of health expectancy indicator that extends measures of life expectancy to account for the distribution of health states in the population. The World Health Organization has estimated healthy life expectancy for 192 WHO Member States using information from health interview surveys and from the Global Burden of Disease Study. The latter estimates loss of health by cause, age and sex for populations. Summation of prevalent years lived with disability (PYLD) across all causes would result in overestimation of the severity of the population average health state because of comorbidity between conditions. Earlier HALE calculations made adjustments for independent comorbidity in adding PYLD across causes. This paper presents a method for adjusting for dependent comorbidity using available empirical data. METHODS: Data from five large national health surveys were analysed by age and sex to estimate "dependent comorbidity" factors for pairs of conditions. These factors were defined as the ratio of the prevalence of people with both conditions to the product of the two total prevalences for each of the conditions. The resulting dependent comorbidity factors were used for all Member States to adjust for dependent comorbidity in summation of PYLD across all causes and in the calculation of HALE. A sensitivity analysis was also carried out for order effects in the proposed calculation method. RESULTS: There was surprising consistency in the dependent comorbidity factors across the five surveys. The improved estimation of dependent comorbidity resulted in reductions in total PYLD per capita ranging from a few per cent in younger adult ages to around 8% in the oldest age group (80 years and over) in developed countries and up to 15% in the oldest age group in the least developed countries. The effect of the dependent comorbidity adjustment on estimated healthy life expectancies is small for some regions (high income countries, Eastern Europe, Western Pacific) and ranges from an increase of 0.5 to 1.5 years for countries in Latin America, South East Asia and Sub-Saharan Africa. CONCLUSION: The available evidence suggests that dependent comorbidity is important, and that adjustment for it makes a significant difference to resulting HALE estimates for some regions of the world. Given the data limitations, we recommend a normative adjustment based on the available evidence, and applied consistently across all countries.

Journal Article↗
PubMed2006

Cerebral palsy life expectancy.

The life expectancy of people who have perinatally acquired cerebral palsy can be similar to that of the general population, or it can be reduced substantially. The most important factors that are associated with reduced survival are disabilities of motor, cognitive, or visual functions. Prematurity and low birth weight are associated with lower rates of disability, and better survival. A 2-year-old who has severe cerebral palsy has about a 40% chance of living to age 20, in contrast to a child who has mild cerebral palsy, for whom the chance is 99%. Cerebral palsy, respiratory diseases, epilepsy, and congenital malformation are the most commonly recorded causes of early death.

Birth Weight↗
PubMed2005

The Jewish-Arab divide in life expectancy in Israel.

Life expectancy at birth in Israel in 2001 was 77.7 years for males and 81.6 years for females among Jews, and 74.5 and 77.8 years for males and females, respectively, among Israeli Arabs. In spite of vast improvements in health conditions of the two populations since Israel's statehood in 1948, persistent disparities in life expectancy between the two groups have challenged the Israeli socialized health care system. These disparities are influenced primarily by differences between the two population groups in infant and child mortality rates. This early study suggests that the distribution of life expectancy across localities in Israel reflects the distribution of those localities' socio-economic condition index (not including health and medical care), and the distribution of medical services. The positive association between life expectancy and the index is pronounced, however, only within the Jewish population but not among Arabs. While there may be no significant difference in life expectancy among Jews and Arabs living in poorer communities, there are fewer Arabs living in relatively affluent communities. Thus, persistent higher concentration of poverty among Arabs than among Jews has sufficed to maintain the gap in life expectancy between them. In addition, however, there are population-specific effects: wealth and education are more protective among Jews than among Arabs, while medical services are more protective among Arabs.

Adolescent↗
PubMed2006

Physical activity and life expectancy with and without diabetes: life table analysis of the Framingham Heart Study.

OBJECTIVE: Physical activity is associated with a reduced risk of developing diabetes and with reduced mortality among diabetic patients. However, the effects of physical activity on the number of years lived with and without diabetes are unclear. Our aim is to calculate the differences in life expectancy with and without type 2 diabetes associated with different levels of physical activity. RESEARCH DESIGN AND METHODS: Using data from the Framingham Heart Study, we constructed multistate life tables starting at age 50 years for men and women. Transition rates by level of physical activity were derived for three transitions: nondiabetic to death, nondiabetic to diabetes, and diabetes to death. We used hazard ratios associated with different physical activity levels after adjustment for age, sex, and potential confounders. RESULTS: For men and women with moderate physical activity, life expectancy without diabetes at age 50 years was 2.3 (95% CI 1.2-3.4) years longer than for subjects in the low physical activity group. For men and women with high physical activity, these differences were 4.2 (2.9-5.5) and 4.0 (2.8-5.1) years, respectively. Life expectancy with diabetes was 0.5 (-1.0 to 0.0) and 0.6 (-1.1 to -0.1) years less for moderately active men and women compared with their sedentary counterparts. For high activity, these differences were 0.1 (-0.7 to 0.5) and 0.2 (-0.8 to 0.3) years, respectively. CONCLUSIONS: Moderately and highly active people have a longer total life expectancy and live more years free of diabetes than their sedentary counterparts but do not spend more years with diabetes.

Adult↗