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PubMed1997

Likely gains in life expectancy of patients with coronary artery disease treated with HMG-CoA reductase inhibitors, as predicted by a decision analysis model.

OBJECTIVE: To estimate the likely gains in life expectancy of patients with coronary artery disease treated with HMG-CoA reductase inhibitors based on published reports and the results of the 4S and the West of Scotland Study. DESIGN: Decision analysis. MAIN OUTCOME: Four likely scenarios of the effect of treatment with HMG-CoA reductase inhibitors on the life expectancy of medically and surgically managed coronary artery disease were modelled. RESULTS: Regardless of the scenario, treatment with HMG-CoA reductase inhibitors was estimated to provide a gain in life expectancy for medically managed patients of all ages with coronary artery disease, ranging from 4.6 to 10.1 quality adjusted life years (QALYs) for a 40 year old with three vessel disease (depending on the scenario assumed), to 0.2 QALYs for a 80 year old with two vessel disease. These gains were always greater than those predicted after bypass alone. If the use of HMG-CoA reductase inhibitors produces the same reduction in cardiac mortality after bypass as it does in medically managed patients it will increase the benefits of operation except for patients with two vessel disease over 70 years of age. Conversely, if HMG-CoA reductase inhibitors do not influence the course of coronary artery disease after bypass, the benefits of operation over medical treatment with HMG-CoA reductase inhibitors are either reduced or lost completely, ranging from a loss of -5.6 QALYs for a 40 year old with two vessel disease to a gain of 1.5 QALYs for 55 to 60 year old patients with left main stem disease. CONCLUSION: Although their effect on the progression of coronary artery disease after bypass must be defined, it is probable that HMG-CoA reductase inhibitors will produce considerable gains in life expectancy for patients with coronary artery disease.

Acyl Coenzyme A↗

PubMed2006

Life expectancy and productivity loss among narcotics addicts thirty-three years after index treatment.

This study computed the life expectancy of a cohort of male narcotics addicts followed for 33 years and assessed the productivity lost as a result of premature mortality. The future life expectancy was constructed for the narcotics addicts and for a comparable cohort from the general U.S. population. The average future life expectancy of the cohort was 18.84 years compared to 33.48 years for comparable U.S. males (t = 49.49, p < .00001). As a result of this premature mortality, the estimated monetary value of lost productivity was greater than 174 million dollars. The lives of heroin addicts were severely truncated at productive ages resulting in a loss of potential productivity that increases social and economic burdens.

Adult↗

PubMed2004

An update on the impact of HIV/AIDS on life expectancy in the United States.

We used the potential gains in life expectancy to quantify the impact of eliminating HIV/AIDS,heart disease and malignant neoplasms on the life expectancy of the population of the USA from 1987 to 1999 by race and sex groups. We previously reported the results from 1987 to 1992,with a focus on the year 1992. This report gives an update to 1999, showing the impact of improvements in the care and treatment of HIV/AIDS in recent years.

Acquired Immunodeficiency Syndrome↗

PubMed2004

An economic analysis of life expectancy by gender with application to the United States.

This paper presents an economic model to explain the behavior of life expectancy of both sexes. It explicitly examines the relationship between the gender gap in life expectancy and the gender gap in pay. It shows that as the latter narrows over the course of economic development, the former may initially expand but will eventually shrink. Simulation results from our model accord with the behavior of life expectancy for both sexes since the 1940s in the United States.

Female↗

PubMed1999

[Corneal arcus and life expectancy].

In 1964-66, the authors completed the comprehensive medical screening of 1412 persons. Apart from the indicators of health state they also recorded their social and cultural parameters. The diagnoses they registered included AC, which has been covered in literature in rather contradicting ways. They found no data concerning survival; as analysing such a correlation is only possible within the frame-work of a several-decade follow-up study. By the end of the follow-up stage (31:12:1994), after 30 years, 1375 persons had died. Their death certificates and--if there were any--necropsy records have been processed and thoroughly analysed. They examined the occurrence of AC, life duration and survival probability--all in correlation with age, gender, constitution, certain diseases (hypertonia, ostheoarthrosis) and diagnoses at death (ischaemic heart diseases, acute myocardiac infarction, cerebrovascular diseases). They point it out that the occurrence of AC is significantly higher among males, but it increases in strong correlation with age in both sexes. Those who had AC were found to be older at the time of death, but it doesn't mean that AC correlates with better life expectancy--it means that AC occurs at older age. The survival probability of men over 75 was better than that of women. On the whole, AC is unfavourable concerning life expectancy, but the later it occurs, the less it can be used as an indicator of life expectancy. It was found that greater average weight correlated with longer average life duration, while among females the more a person weighed, the less frequent AC became. It was true for each weight group that those with AC had worse life expectancy. Altogether those with no AC were found to suffer from hypertonia significantly more frequently. The life expectancy of those with both AC and hypertonia, however, was always worse than those with hypertonia only, regardless of age and the type of hypertonia. Generally women are in a more favourable position, but in the 'serious' and 'very serious' hypertonia groups there is practically no difference in the survival of the two sexes. The authors have also found that AC has a significant negative prognostical value concerning survival and correlation with ostheoarthrosis, ischaemic heart diseases and cerebrovascular diseases. The correlation of AC with acute myocardiac infarction could not be proved convincingly.

Aged↗

PubMedDate not supplied

[Mortality among young people and its impact on life expectancy in Andalusia during 1980-1992].

BACKGROUND: From the middle eighties, mortality in the age group 15 to 39 years in Andalusia has experienced an important increase; the object of this work is to analyse mortality in this age group, in order to discover the causes which have brought about this increase in mortality and to assess its impact on life expectancy in the eighties. METHODS: Using the mortality data and the population of Andalusia from 1980 to 1992, specific rates have been calculated, both for mortality by age and cause as well as those adjusted for age. To quantify the impact of the causes of death with respect to life expectancy development, the Pollard method was used. RESULTS: There was a relative increase in the mortality of Andalusian young people between the three-yearly periods 1980-1982 and 1990-1992. The causes contributing to this increase, amongst the male population, were: Aids with an excess of 825 deaths, 575 in traffic accidents, 155 suicides and 147 deaths from drug overdoses. These same causes of death led to total losses of 0.46% years in the gain of life expectancy. Amongst women, on the other hand, the causes of death maintained relatively stable rates, with an almost imperceptible effect on life expectancy at birth. CONCLUSIONS: The increase in mortality in the 15-40 age group for causes mentioned previously, is an almost exclusive phenomenon amongst young Andalusian men. This produced a slow-down in any gain in life expectancy during the eighties.

Adolescent↗

PubMed1993

Gender life expectancy and alcohol: an international perspective.

This research determined the alcoholism-related and other correlates of the discrepancy between life expectancy in females and males using information for 161 different countries. The variables that correlated most highly with female minus male life expectancy were per capita alcohol consumption, cirrhosis of the liver deaths per capita, and overall life expectancy. Greater gender discrepancy was also found in non-Moslem countries and in countries with greater per capita income and less infant mortality. Public health implications are discussed.

Adult↗

PubMed2001

[Contribution of disability-free life expectancy indicators to the study of social inequities in health].

In looking at increases in disability-free life expectancy we examine the scope and evolution of social inequalities in health. As early as the end of the 18th century, Moheau had already emphasised the differences in life expectancy according to profession but it wasn't until much later that official statistics could confirm them. Despite the growing concern related to this phenomenon, the data are lacking for tracking its evolution and understanding its causes. The indicators of disability-free life expectancy that we established for socio-professional groups allowed us to respond to certain outstanding questions. The results of this study are summarised in this article. They serve to re-open the debate around the problems involved in measuring social inequalities and their place in public health.

Adult↗

PubMed2006

Life expectancy of elderly and very elderly patients with chronic heart failure.

INTRODUCTION: The survival of patients with chronic heart failure is typically reported as a comparison of different groups of patients using the hazard ratio from a Cox proportional hazards analysis. The absolute survival is generally neglected. Furthermore, attention is often focused on relatively young patients although chronic heart failure largely affects older patients. The present study was undertaken to determine the life expectancy (a measure of absolute survival) of older patients with chronic heart failure. METHODS: Patients >75 years with chronic heart failure caused by impaired left ventricular systolic function who attended an outpatient clinic were included in the study. Follow-up commenced on August 1, 1993, and continued until September 30, 2005, when vital status was ascertained. Mean survival time was calculated as a measure of life expectancy. RESULTS: There were 210 patients included in the study. Male patients of mean age 80 years had a life expectancy of 3.9 years (95% CI 3.2-4.5), compared with that of 7 years for men in the general population of the same age. For female patients of mean age 80 years, the life expectancy was 4.5 years (95% CI 3.6-5.7), compared with 8.5 years for the general population of women of the same age. CONCLUSION: The presence of chronic heart failure in older patients results in an approximately 50% reduction in life expectancy.

Age Factors↗

PubMed2005

The impact of obesity on active life expectancy in older American men and women.

PURPOSE: The purpose of this article is to estimate the effect of obesity on both the length of life and length of nondisabled life for older Americans. DESIGN AND METHODS: Using data from the first 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, this article develops estimates of total, active, and disabled life expectancy for obese and nonobese older men and women. We used the Interpolation of Markov Chains (IMaCh) method to estimate the average number of years obese and nonobese older persons can expect to live with and without activity of daily living (ADL) disability. RESULTS: Our findings indicate that obesity has little effect on life expectancy in adults aged 70 years and older. However, the obese are more likely to become disabled. This means that obese older adults live both more years and a higher proportion of their remaining lives disabled. IMPLICATIONS: The lack of significant differences in life expectancy by obesity status among the old suggests that obesity-related death is less of a concern than disability in this age range. Given steady increases in obesity among Americans at all ages, future disability rates may be higher than anticipated among older U.S. adults. In order to reduce disability among future cohorts of older adults, more research is needed on the causes and treatment of obesity and evaluations done on interventions to accomplish and maintain weight loss.

Activities of Daily Living↗

PubMed1997

Age, subjective life expectancy, and the sense of control: the horizon hypothesis.

This article reports a test of the horizon hypothesis, which states that greater subjective life expectancy increases the sense of control over one's own life and in part accounts for the negative association between age and the sense of control. Results of a U.S. survey of 2,029 respondents aged 18 and older (934 aged 50 and older) support the hypothesis. Subjective life expectancy has a significant positive association with the sense of control that does not vanish with adjustment for race, sex, education, income, widowhood, inability to work because of a disability, physical impairment, and physical fitness. Adjustment for subjective life expectancy explains the part of the negative association between age and the sense of control that remains after adjustment for education and physical impairment. Adjusting the three factors together explains 93.1 percent of the total association between age and the sense of control, and renders the remaining association insignificant.

Aged↗

PubMedDate not supplied

Using life expectancy to communicate benefits of health care programs in contingent valuation studies.

BACKGROUND: There is growing interest in the use of contingent valuation (CV) to estimate the monetary value of health program benefits. Ideally, CV could be used to value a specific shift in survival curve. However, a shift in survival curve may prove too complex for widespread use in CV instruments. To facilitate the use of CV in valuing longevity benefits, researchers need alternative summary measures that describe the longevity benefit in a single number that is more readily communicated in a CV context. METHODS: The authors compare 2 methods for communicating longevity benefits in a CV survey. Random subsamples of respondents valued a longevity benefit expressed either as a continuing reduction in annual mortality risk or as a gain in life expectancy. To compare the validity of the alternative descriptions, the authors evaluate willingness to pay (WTP) estimates for consistency with theoretical predictions. RESULTS: It is found that WTP for a longevity benefit is sensitive to the framing of the benefit, with respondents expressing higher WTP for the benefit expressed as a life expectancy gain. The life expectancy format performs better than the risk reduction format in one important regard-sensitivity to scope of the benefit-and no worse than the risk reduction format in other regards. CONCLUSION: Expressing longevity benefits in terms of life expectancy appears to hold promise as a method for enhancing the validity of economic evaluation of health care programs.

Adult↗

PubMed2001

Change in male and female life expectancy by social class: decomposition by age and cause of death in Finland 1971-95.

STUDY OBJECTIVE: To quantify the contribution of different causes of death and age groups for trends in life expectancy for two major social classes. DESIGN AND SETTING: Prospective study of mortality in Finland among all over 35 year old men and women. Baseline social class (manual/non-manual) was from the 1970, 1975, 1980, 1985 and 1990 census records, and follow up was by computerised record linkage to death certificates for 1971-1995. MAIN RESULTS: From the early 1970s to the early 1990s life expectancy at age 35 increased by about five and four years among Finnish men and women respectively, with largest gains among 55-74 year old men and 65-84 year old women. Life expectancy increase was 5.1 years among non-manual and 3.8 years among manual men; corresponding figures for women were 3.6 and 3.0 years. In the 1980s, when differences in life expectancy increased most rapidly, decline in cardiovascular disease mortality was more rapid in the non-manual than the manual class. Furthermore, increasing mortality for alcohol associated causes, "other diseases", and accidents and violence were most prominent in the manual class. CONCLUSIONS: Explanations of increasing social inequalities in mortality that are based on one underlying factor are difficult to reconcile with the variability in the cause specific trends in social inequalities in mortality. The contribution of older ages to social inequalities in mortality should be more widely recognised.

Adult↗

PubMed1993

Effect of age-specific mortality on the average life expectancy in Bulgaria.

Using a concise method, we estimated the effect of mortality in specific age groups on the average life expectancy in Bulgaria. The method enables the calculation of the index from all causes of death as well as hypothetically, eliminating the mortality of the age groups involved in the study: under 1 year of age, 1 to 14-year-olds, 15 to 59-year-olds, and 60-year-olds and over 60. The detailed dynamic analysis of the influence of these four age groups mortality showed that the decrease in child mortality influenced positively the average life expectancy making it rise. This was especially clearly seen in the period until the mid-1960s. In the late 1960s the influence of the child mortality became insignificant and the major reserve for increasing the average life expectancy remained the decrease in active-life mortality.

Adolescent↗

PubMed1992

Molecular aging of lens crystallins and the life expectancy of the animal. Age-related protein structural changes studied in situ by Raman spectroscopy.

In order to investigate the relationship of molecular aging of lens crystallins to an animal's life expectancy or to the type of the lens, Raman spectra have been measured in situ for rabbit and guinea-pig lens nuclei at various stages of aging; these spectra have been compared with those of rat and mouse lens nuclei previously reported. Lens aging results in pronounced differences among the Raman spectra of the lens nuclei of the four species. It is shown that the rates of dehydration, inter- and intramolecular disulfide bond formation, and microenvironmental changes in the tryptophan residues of lens crystallins are different among the four species. Much faster changes occur for rat and mouse, which have a shorter life expectancy (2 years) and give rise to hard lens nuclei while slower changes occur for rabbit and guinea-pig, which have a longer life expectancy (5-7 years), and give soft lens nuclei. In addition, the Raman data reveal, for all the species investigated, that there are correlations among the rates of the dehydration, the inter- and intramolecular disulfide bond formation, and the microenvironmental changes in the tryptophan residues. Therefore, there seems to be a common mechanism for molecular aging of lens crystallins among the four species, although the rate of the molecular aging strongly depends upon the life expectancy of the animal and the type of the lens. The most important factor determining the rate of the molecular aging is probably the dehydration which decreases free water in the lens nucleus.

Aging↗

PubMed1997

Lost life expectancy rate: an application to environmental levels of radiation.

The risk index Lost Life Expectancy Rate (LLER) provides a unitless number (time of life expectancy lost per time exposed) describing the risk from exposure to a given hazard or from partaking in a given activity. Simple equations to calculate the LLER from radiation-induced cancers caused by an exposure to low-level radiation were derived using the relative risk models developed by the Nuclear Regulatory Commission (upper bound estimate), the United Nations Scientific Committee on the Effects of Atomic Radiation-1988, and the National Academy of Science's Committee on the Biological Effects of Ionizing Radiation (BEIR V). Estimates of the LLER to an average person from a continuous exposure to 0.1 microSv h(-1) based on these models, respectively, are 5.5 x 10(-4), 9.5 x 10(-4), and 9.4 x 10(-4). These values compare to LLERs of 0.015 from occupational accidents, 0.25 from being an automobile passenger, and 2.0 from cigarette smoking. Factors effecting LLER from radiation exposures examined in this work include dose rate, age, sex, race and smoking status.

Environmental Exposure↗

PubMed2000

Cognitive impairment and syndromal depression in estimates of active life expectancy: the 13-year follow-up of the Baltimore Epidemiologic Catchment Area sample.

OBJECTIVE: Our hypothesis was that including cognitive status and syndromal depression in specifying functional impairment would result in significant differences in estimates of active life expectancy from specifications that included only standard functional measures (such as activities of daily living). METHOD: The subjects were the 3481 continuing participants of the Baltimore Epidemiologic Catchment Area Program. Interviews included criterion-based diagnosis of depression, assessment of cognitive status and standard survey questions on function. RESULTS: Estimates of active life expectancy decreased from 9.8 years to 8.9 years at age 65 years for men, and from 10 years to 8.4 years at age 65 years for women, when the definition of active life expectancy included measures of cognitive impairment and syndromal depression. CONCLUSION: Measurements of active life expectancy tend to ignore dependencies related to psychological causes, and should move beyond mere enumeration of activities of daily living and instrumental activities of daily living.

Adolescent↗

PubMed1996

Fertility of populations as a function of the attained level of life expectancy in the course of human evolution.

"¿Aging societies' with increasing life expectancies of the average of all their members are facts in modern history that are disputed by nobody. What is disputed by the most renowned names in demography, however, is that aging populations are a consequence of the fall in mortality and thus the increase in life expectancy. It is claimed that the [principal] reason for ¿aging' is to be found in a drop in fertility. In this sense today's demographers regard as a standard result: ¿Variations in fertility are of more significance for the age structure of populations than variations in mortality'. In the following paper this thesis, which is based on a neo-Malthusian interpretation of the role of fertility in the demographic process, will be questioned."

Birth Rate↗