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PubMed2003

Age of ovary determines remaining life expectancy in old ovariectomized mice.

We investigated the capacity of young ovaries, transplanted into old ovariectomized CBA mice, to improve remaining life expectancy of the hosts. Donor females were sexually mature 2-month-olds; recipients were prepubertally ovariectomized at 3 weeks and received transplants at 5, 8 or 11 months of age. Relative to ovariectomized control females, life expectancy at 11 months was increased by 60% in 11-month recipient females and by 40% relative to intact control females. Only 20% of the 11-month transplant females died in the 300-day period following ovarian transplantation, whereas nearly 65% of the ovariectomized control females died during this same period. The 11-month-old recipient females resumed oestrus and continued to cycle up to several months beyond the age of control female reproductive senescence. Across the three recipient age groups, transplantation of young ovaries increased life expectancy in proportion to the relative youth of the ovary. Our results relate to recent findings on the gonadal input upon aging in Caenorhabditis elegans and may suggest how the mammalian gonad, including that of humans, could regulate aging and determine longevity.

Age Factors↗
PubMed2005

The AIDS epidemic in the city of Copenhagen, Denmark: potential years of life lost and impact on life expectancy.

AIMS: This study seeks to describe the impact of AIDS on the city of Copenhagen by estimating potential years of life lost (PYLL) before the age of 65 years and to estimate the impact of AIDS deaths on life expectancy for males and females. METHODS: All AIDS cases reported to the national AIDS surveillance register for residents in the city of Copenhagen in the period 1983-98 were included. For comparative purposes data were obtained on six other causes of death: accidents, suicide, lung cancer, ischaemic heart disease, testicular cancer, and breast cancer. RESULTS: Overall, deaths from AIDS accounted for 8% of all PYLL in men and showed an increasing tendency from 1983 to 1991, when it became the leading cause of PYLL. AIDS had most impact in men in the age group 25-44 years and accounted for 29% of all PYLL in this group at the peak in 1993, decreasing significantly after the introduction of anti-retroviral treatments to 5% of PYLL in 1998. Other leading causes of PYLL, accidents and suicide, also showed a decreasing tendency over the years, but of a much smaller magnitude than AIDS. The impact of AIDS in women was more modest. In the entire study period suicide, accidents, and breast cancer were the leading causes of PYLL in women. It was shown that AIDS deaths at the top of the epidemic in 1991-95 were responsible for a loss of 0.76 years in life expectancy for men and 0.08 years for women. CONCLUSIONS: AIDS has had a considerable impact on potential years of life lost. A significant decline in AIDS deaths has been seen since 1995 with an effect on life expectancy for men in the city of Copenhagen.

Acquired Immunodeficiency Syndrome↗
PubMed2006

[The impact of changes in age-related and cause-related mortality on life expectancy at birth in the State of Santa Catarina, Brazil, in the 1990s].

This study aimed to analyze the impact of changes in age-related and cause-related mortality on life expectancy at birth in the State of Santa Catarina, Brazil, in the 1990s. Data were obtained from the Mortality Information System (SIM) for the three-year periods 1989/1990/1991 and 1998/1999/2000. Infant mortality rates and specific mortality rates for individuals > or = 1 year of age were calculated by gender and cause of death. The Pollard method was used to disaggregate the contributions by mortality from different causes and in different ages to life expectancy at birth. The age groups that contributed the most to the increase in life expectancy at birth were 0-1 year and > or = 70 years. The causes of death that most contributed to this increase were chronic non-communicable diseases, such as cardiovascular diseases, in the age brackets above 35 years, and neonatal diseases in the < 1-year bracket. Finally, there were a high proportion of deaths from ill-defined causes, indicating that the true cause-related mortality structure in the State is still unknown.

Adolescent↗
PubMed1988

Potential gains in life expectancy of Kuwaiti nationals through partial and complete elimination of infectious and parasitic disease mortality.

This study attempts to estimate potential gains in life expectancy in 1984 through partial and complete elimination of infectious and parasitic diseases among Kuwaiti nationals. For deriving these estimates, a multiple decrement life table approach was applied. The results of the study show that complete elimination of infectious and parasitic disease mortality would further add 0.45 years to the life expectancy at birth of Kuwaiti males and 0.54 yr to that of Kuwaiti females. A partial reduction by 50% would result in gains of just one-half of the years gained through complete elimination of these causes. Also, as partial reduction is increased from 10% to 90%, the gains in life expectancy at birth would go up from 0.04 yr to 0.40 yr in the case of Kuwaiti males and 0.06 to 0.48 yr for Kuwaiti females.

Age Factors↗
PubMed2004

A new method for correcting under-estimation of disabled life expectancy and an application to the Chinese oldest-old.

This article demonstrates that disabled life expectancies that are based on conventional multistate life-table methods are significantly underestimated because of the assumption of no changes in functional status between age x and death. We present a new method to correct the bias and apply it to data from a longitudinal survey of about 9,000 oldest-old Chinese aged 80-105 collected in 1998 and 2000. In our application, the age trajectories of disability (activities of daily living--ADL), status-specific death rates, and the probabilities of transitions between ADL states of the oldest-old were investigated for the first time in a developing country. In this article, we report estimates of bias-corrected disabled and active life expectancies of the Chinese oldest-old and demonstrate patterns of large differences associated with initial status, gender, and advances in ages. Using combined information on ADL disabilities and length of having been bedridden before dying, we analyze gender and age patterns of the extent of morbidity before dying among the oldest-old and their implications for debates on the hypothesis of compression of morbidity.

Activities of Daily Living↗
PubMed1993

Forecasts of active life expectancy: policy and fiscal implications.

Age-related changes in functional status can be summarized by active life expectancy (ALE) measures. ALE is useful in assessing efforts to improve function and in determining a population's service needs. ALE disaggregates total life expectancy (TLE) into components representing degree and type of impairment. We illustrate the calculation of two ALE measures and their relations to health inputs and service use. First, scores are calculated from 27 measures of function for persons 65 and over, as reported in the National Long Term Care Survey (NLTCS). The scores are then used to calculate the two ALE measures. Results are compared to ALE calculated from the 1982, 1984, and 1989 NLTCS.

Activities of Daily Living↗
PubMed2002

The contribution of medical care to changing life expectancy in Germany and Poland.

This paper assesses the impact of medical care on changes in mortality in east Germany and Poland before and after the political transition, with west Germany included for comparison. Building upon Rutstein's concept of unnecessary untimely deaths, we calculated the contribution of conditions considered responsive to medical care or health policy to changes in life expectancy between birth and age 75 [e(0-75)] for the periods 1980/1983-1988 and 1991/1992-1996/1997. Temporary life expectancy, between birth and age 75, has been consistently higher in west Germany, intermediate in east Germany and lowest in Poland. Although improving in all three regions between the early 1980s and the late 1990s, the pace of change differed between countries, resulting in a temporary widening of an initial east-west gap by the late 1980s and early 1990s. In the 1980s, in east Germany, 50-60% of the improvement was attributable to declining mortality from conditions responsive to medical care (west Germany: 30-40%). A net positive effect was also observed in Poland, although counterbalanced by deterioration in ischaemic heart disease mortality.In the former communist countries, improvements attributable to medical care in the 1980s were due, largely, to declining infant mortality. In the 1990s, they benefited also adults, specifically those aged 35+ in Poland and 55+ in Germany. A persisting east-west gap in temporary life expectancy in Germany was due, largely, to higher mortality from avoidable conditions in the east, with causes responsive to health policy contributing about half, and medical care 16% (men) to 24% (women) to the differential in 1997. The findings indicate that changes in the health care system related to the political transition were associated with improvements in life expectancy in east Germany and, to a lesser extent, in Poland. Also, differences in the quality of medical care as assessed by the concept of "unnecessary untimely deaths" appear to contribute to a persisting east-west health gap. Especially in Poland and the former German Democratic Republic there remains potential for further progress that would narrow the health gap with the west.

Adolescent↗
PubMed1988

Diet, mortality and life expectancy: a cross national analysis.

"There are numerous reasons why mortality and life expectancy vary between countries. Epidemiological studies seem to indicate that dietary variations may be among them. A sample of 51 countries studied with data from the International Comparisons Project and other sources, shows that after controlling for nutrient intake, consumption of medical goods and services, income distribution, weather, and literacy, countries with more meat and poultry in their diet have lower life expectancies after age five. The results for infant mortality and child death between one and five indicate that a more animal-intensive diet may be actually beneficial, especially if fish consumption is increased and meat and poultry consumption reduced."

Demography↗
PubMed2003

Active life expectancy in people with and without diabetes.

BACKGROUND: The aim of the study was to investigate the feasibility of monitoring older people's health by measuring active life expectancy among older people with and without diabetes using routinely collected primary care data. METHODS: The study comprised the first five rounds of a routine health assessment of those aged 75 years and over belonging to a large Midlands general practice (list size 32,500). A nurse carried out the health assessments in the participant's home. Being active was defined as the ability to perform (without difficulty, help or use of aids) at least six of seven activities of daily living (ADLs). Mortality data were collected through the practice register together with regular linkage to information from the Office for National Statistics. Period health expectancies were calculated for those known or found to be diabetic through the health assessments and for non-diabetic individuals. RESULTS: Calculation of active life expectancies (ALE) was based on 2,474 persons (212 with and 2,262 without diabetes). At all ages, people with diabetes had lower life expectancy and spent fewer years active. The proportion of remaining life spent active was, however, similar for both groups at younger ages, but by age 85 years people with diabetes spent only 32 per cent of remaining life active compared with 42 per cent for those without diabetes. CONCLUSION: Annual health assessments of the over-75s in primary care together with linkage to mortality data provide a feasible method of monitoring older people's health, particularly for subgroups at greater risk of disability. At Strategic Health Authority or Primary Care Trust level these methods can monitor health needs, highlight health inequalities and evaluate intervention strategies.

Activities of Daily Living↗
PubMed2006

Estimating health-adjusted life expectancy conditional on risk factors: results for smoking and obesity.

BACKGROUND: Smoking and obesity are risk factors causing a large burden of disease. To help formulate and prioritize among smoking and obesity prevention activities, estimations of health-adjusted life expectancy (HALE) for cohorts that differ solely in their lifestyle (e.g. smoking vs. non smoking) can provide valuable information. Furthermore, in combination with estimates of life expectancy (LE), it can be tested whether prevention of obesity and smoking results in compression of morbidity. METHODS: Using a dynamic population model that calculates the incidence of chronic disease conditional on epidemiological risk factors, we estimated LE and HALE at age 20 for a cohort of smokers with a normal weight (BMI < 25), a cohort of non-smoking obese people (BMI>30) and a cohort of 'healthy living' people (i.e. non smoking with a BMI < 25). Health state valuations for the different cohorts were calculated using the estimated disease prevalence rates in combination with data from the Dutch Burden of Disease study. Health state valuations are multiplied with life years to estimate HALE. Absolute compression of morbidity is defined as a reduction in unhealthy life expectancy (LE-HALE) and relative compression as a reduction in the proportion of life lived in good health (LE-HALE)/LE. RESULTS: Estimates of HALE are highest for a 'healthy living' cohort (54.8 years for men and 55.4 years for women at age 20). Differences in HALE compared to 'healthy living' men at age 20 are 7.8 and 4.6 for respectively smoking and obese men. Differences in HALE compared to 'healthy living' women at age 20 are 6.0 and 4.5 for respectively smoking and obese women. Unhealthy life expectancy is about equal for all cohorts, meaning that successful prevention would not result in absolute compression of morbidity. Sensitivity analyses demonstrate that although estimates of LE and HALE are sensitive to changes in disease epidemiology, differences in LE and HALE between the different cohorts are fairly robust. In most cases, elimination of smoking or obesity does not result in absolute compression of morbidity but slightly increases the part of life lived in good health. CONCLUSION: Differences in HALE between smoking, obese and 'healthy living' cohorts are substantial and similar to differences in LE. However, our results do not indicate that substantial compression of morbidity is to be expected as a result of successful smoking or obesity prevention.

Journal Article↗
PubMed1985

Recalled life expectancy information, phase of illness and hope in cancer patients.

In this study two research questions were addressed: What is the relationship between recalled life expectancy information and hope in cancer patients? What effect does phase of illness have on the level of hope in cancer patients? A scale to measure hope was developed, used, and evaluated. In 55 cancer patients, an analysis of variance showed a significant main effect on hope for recalled life expectancy; difference in level of hope was found in cancer patients at different phases of illness. The findings indicated that individuals having no recollection of receiving information regarding their prognosis were more hopeful. The results have implications for determining what, how much, when, and how to communicate life expectancy information to patients who have cancer or other life-threatening illnesses.

Adult↗
PubMed1995

Life expectancy of ventilator-dependent persons with spinal cord injuries.

OBJECTIVE: The purpose of this study is to estimate age-specific life expectancies for ventilator-dependent persons with spinal cord injury (SCI). DESIGN: Nonconcurrent prospective study. SETTING: Federally designated model SCI care systems. PATIENTS: The study included all 435 persons admitted to a model SCI care system between 1973 and 1992 who survived at least 24 h postinjury and who were either ventilator dependent at rehabilitation discharge or who died prior to discharge while still ventilator dependent. INTERVENTION: None. OUTCOME MEASURES: Standardized mortality ratio (SMR), life expectancy, and causes of death. RESULTS: The overall 1-year survival rate was 25.4%, while the 15-year survival rate was 16.8%. Among those who survived the first year, cumulative survival over the next 14 years was 61.4%. The mortality rate for persons injured since 1980 was reduced by 60% compared with persons injured between 1973 and 1979. Among year 1 survivors, the subsequent mortality rate was reduced by 39% for persons injured between 1980 and 1985, and 91% for persons injured since 1986, relative to persons injured between 1973 and 1979. The leading cause of death was respiratory complications, particularly pneumonia. CONCLUSIONS: With the development of improved methods of prevention and management of respiratory complications in this population, life expectancies should continue to improve. As a result, additional attention should be focused on enhancing the quality of life for these individuals.

Adolescent↗
PubMed1994

Dementia-free life expectancy in France.

OBJECTIVES: Increasing concern with the quality of gains in life years has led to the development of a new synthetic indicator of population health:health expectancy. Until now, calculations have been made for physical disabilities only. A first estimate of mental health expectancy is presented: dementia-free life expectancy. METHODS: Sullivan's method was used to calculate dementia-free life expectancy for a random representative sample of 4134 persons over 65 years of age in the Bordeaux region of France. The diagnosis of senile dementia was made in two stages, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. RESULTS: At 65 years of age, a person's dementia-free life expectancy is 16.9 years within a total life-expectancy of 17.7 years; it decreases with age in parallel with the decrease in total life expectancy so that life expectancy with dementia stays constant at 0.8 years. Although dementia prevalence increases with age, if the prevalence is adjusted for mortality, the largest number of persons with dementia are in their early eighties. At each age women have a higher dementia-free life expectancy. CONCLUSIONS: Trends in dementia-free life expectancy are similar to those found in disability-free life expectancy. Because the dementia prevalence rates used in this estimate resemble a general model derived from meta-analysis, it can be assumed that similar results will be found in other Western countries with similar mortality rates.

Aged↗
PubMed1988

The infant mortality rate, life expectancy at birth, and a linear index of mortality as measures of general health status.

The infant mortality rate is not a good indicator of overall mortality or health status. Based on new empirical life tables from the UN Population Division, it can only predict life expectancy with 95% confidence to within a 14-year range. Two infant mortality rates must be nearly 80 units apart to be 95% confident that life expectancy in the two communities is different. Life expectancy itself is not an ideal general measure of mortality, because it implicitly weights deaths at different ages in an inconsistent fashion. A measure of potential years of life lost is preferable because it is ethically more consistent.

Adolescent↗
PubMed2006

[Income differences in health and life expectancy--cross-sectional and longitudinal findings of the German Socio-Economic Panel (GSOEP)].

Income is an important determinant of individual standards of living and participation in social life. Data from the German Socio-Economic Panel shows that the level of income also affects a person's health and life expectancy. People's self-assessment of their health and health-related quality of life follow a distribution pattern which can be described as a gradient: the lower the income, the more frequent the impairments to subjective health. Life expectancy statistics also reflect income differences, primarily due to premature deaths among lower-income groups. Clues for explaining income-related differences in health and life expectancy can be found in the results on health-related behaviour and use of the medical system: people in the lower income groups smoke more frequently, are slaker in sports and are less likely to go to a doctor when their health is impaired. Furthermore, work environment and job-specific influences, stress burdens and reactions, social comparison processes and disease-induced processes of declining social mobility and social exclusion are discussed as possible explanations.

Adolescent↗
PubMed2002

Life expectancy and mortality differences between migrant groups living in Amsterdam, The Netherlands.

There is an apparent contradiction between the high level of morbidity and the low level of mortality observed in certain groups of migrants living in Europe. This observation should have some consequences for health policy development and the targeting of resources in a city like Amsterdam. In this paper a number of hypotheses to explain the low mortality in migrant groups are discussed. An analysis is made of mortality in Amsterdam using data from the civil registry as to mortality according to age, sex and nationality group of the deceased. Standard demographic techniques such as the standardised mortality ratio (SMR) and life table analysis were employed. Life table analysis shows that life expectancy in Amsterdam is lowest among residents of Dutch descent (73.3 yr for males and 79.1 yr for females) and highest among those of Mediterranean origin (77.6 yr for males and 86.1 yr for females). This appears to contradict previous research based on the SMR, which showed high mortality in migrant groups. To find the cause of this contradiction, the SMR and risk ratios by age are studied. The conclusion of this paper is that on the basis of life table analysis it appears that some immigrant groups living in Amsterdam have a remarkably high life expectancy. Since the SMR is sensitive to demographic differences between groups compared, questions can be raised about previous studies using the SMR. It has been suggested that the high life expectancy in migrant groups is not really caused by good health but by 'spurious' phenomena, such as problems in mortality registration. However, in view of the available data it seems likely that some migrant groups do in fact have high life expectancy, although the morbidity in these groups can be quite high. These findings should inform health-related policy.

Adolescent↗