Cholesterol reduction and life expectancy.
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Adult↗
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[The relationship between the life table method and the formula for calculating life expectancy].
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Demography↗
[From alms to entitlements. A historical approach on private and public attitudes towards long life expectancies].
At all times in history, there have been people reaching a high age. However, long life expectancies as a--relatively seen--socially non-stratified phenomenon are of a very recent date. This essay identifies three different currents which have shaped the related massive development of population. First, there was what could be called the "democratization of long life expectancies", rooted in the steadily growing access to the fruits of medical and technical progress during the past centuries. Second, the state constantly took over from the private sector responsibilities to provide services for old people. Third and simultaneously, a commonly shared idea of entitlement to a period of retirement after the working career gained acceptance. These three currents are summarized in the essay under the heading of the development of "social rights". Until the end of the 19th century those rights were totally neglected. It was only under the impression of industrialization, the appearance of a strong labor movement, world economic crisis and the catastrophe of two world wars that a conscience for the social dimension of citizenship developed. The history of German social policies from Bismarck to the present day serves as a measurement for these developments towards social rights. In this respect, particular attention is paid to the "Grosse Rentenreform" of 1957, the breakthrough of the modern German welfare state.
Aged↗
Dependence and active life expectancy of the elderly population living in the central region of Thailand.
OBJECTIVE: To determine the prevalence and the independent socio-economic factors with respect to the dependence status of the Thai elderly population living in the central region and to calculate the active life expectancy (ALE) based on the results of this survey and abridged life tables for Thailand. DESIGN: A cross-sectional mulitistage random sampling survey. SETTING: Communities in the central region, Thailand. SUBJECTS: 723 elderly subjects. RESULTS: Mean age and its standard deviation (SD) of the 723 recruited subjects were 69.9 and 7.3 years, respectively. Forty three per cent of the subjects were men. Mean values (SD) of the BAI score and the CAI score were 18.78 (2.6) and 6.47 (2.4), respectively. Except for housework, elderly women had a higher prevalence rate of dependence on activities of daily living (ADL) compared with elderly men. Seven univariate factors of the BAI and the CAI were demonstrated. According to the multiple linear regression analysis by entering all univariate factors of the BAI and the CAI except "working status", independent factors of both the BAI (adjusted R2 = 0.051) and the CAI (adjusted R2 = 0.146) were age, sex and writing ability. The prevalence rate (95% confidence interval) of dependence regarding self-care activities of daily living was 5.9 per cent (4.2-7.6%). The rate of dependence increased with age. The female elderly were more dependent on self care than their male counterparts. Although the elderly women live longer than the elderly men, they spend more years in a severely dependent state. Findings on ratios between health and life expectancy demonstrate that Thai men spend more proportional time leading a healthy life than Thai women. CONCLUSION: Prevalence rates of dependence regarding activities of daily living among the Thai elderly living in the Central region were rather high showing the health of elderly women to be worse than that of elderly men. The elderly women spend more years in a severely dependent state although they live longer than the elderly men.
Activities of Daily Living↗
Increased intake of fruit and vegetables: estimation of impact in terms of life expectancy and healthcare costs.
OBJECTIVES: There is strong evidence that a high consumption of fruit and vegetables reduces the risk of developing many cancers. This study examined the economic consequences for the healthcare sector if people followed the recommendations and increased their intake of fruit and vegetables. DESIGN: A life table was used to describe a base case population with respect to life expectancy, cancer incidence and healthcare costs. Relative risks of cancer for a high versus a low intake of fruit and vegetables were obtained from the literature and were used to simulate populations with a higher intake of fruit and vegetables. The empirical data consist of a 20% sample of the Danish population that was followed from 1993 to 1997. Civil registration numbers were used to link various computerised registers, in order to describe each individual in the sample in terms of morbidity, mortality and healthcare costs. RESULTS: The average daily intake of fruit and vegetables was assumed to be approximately 250 g for the general Danish population. Simulated intakes of 400 g and 500 g increased the life expectancy by 0.8 and 1.3 years, respectively. In addition, it was estimated that 19% and 32% of the cancer incidence could be prevented. The aggregate healthcare costs remained stable, as the resources saved due to a lower cancer incidence were offset by healthcare costs imposed by the fact that healthy people live longer and require more healthcare. However, the variations across age groups and health sectors were substantial. DISCUSSION: The study adopted a healthcare sector perspective. Only costs from hospitalisation and primary care were included in the calculations. The costs of changing people's dietary habits, i.e. education, information and promotion as well as other costs that would be relevant from a societal perspective, have not been taken into account. Furthermore, the transition from one level of intake to another is not the focus of the analysis, although it might take decades to observe the full effect of the dietary changes. CONCLUSION: Empirical evidence suggests that a considerable fraction of all cancer incidences can be prevented by a higher intake of fruit and vegetables. That may result in improved public health (gain in life years) at no additional cost to the healthcare sector.
Adolescent↗
Absolute benefit, number needed to treat and gain in life expectancy: which efficacy indices for measuring the treatment benefit?
The absolute benefit (AB) is extensively used to summarize the results of clinical trials. As the AB depends directly on the patient's baseline risk, therapeutic decisions based on AB tend to favor patients at high risk. To evaluate the consequences of this decision's procedure for life-long therapy, we compare the AB with the gain in event-free life expectancy in a simulated hypertensive population. Our results show that the AB goes through a maximum and then declines as the duration of treatment increases. The amplitude of the variation of AB is independent of the baseline risks but the maximum is reached more quickly in the high-risk patients. Considering the gain in event-free life expectancy, low-risk patients benefit more than high-risk patients do, at the expense of a longer treatment exposure. The interpretation of the AB changes depending on follow-up.
Adult↗
Spouse-rated limitations and spouse-rated life expectancy as mortality predictors.
Survival analyses are used to examine the predictive value of spouse-rated limitations due to health problems and spouse-rated life expectancy for 3-year mortality in a communication sample of elderly Australian married couples, net of health status indicators, health behaviors, and sociodemographic factors. Tests for gender differences in the effects and for empirical overlap with self-ratings of health expectancy were also done. Findings show that both spouse-ratings are predictive of husbands' mortality, while for wives' mortality the parallel measures are not predictive in the adjusted model. Wives' rating are not substitutes for other health indicators or for self-ratings of health and life expectancy. The independent effect suggests that wives are more astute reporters or judges of their husbands' mortality risk for that wives' perceptions indicate tangible influences on husbands' health and mortality risk. Future analyses should be directed toward finding mechanisms linking spouse perceptions to health outcomes.
Aged↗
Life expectancy free of disability: a composite measure of population health status.
Access to disability data from a nationwide survey of New Zealanders provides the opportunity to estimate Life Expectancy Free of Disability (LEFD) for the non-institutional adult population. This measure of population health status combines mortality and morbidity data into a single index. The analysis is restricted to the 15-64 age range and results on partial life expectancy free of disability are presented for the key sociodemographic groups. The results conform to the international evidence and highlight the potential impact of disability as a component in a composite measure of population health status: although women live longer than men, almost all this apparent advantage in longevity is spent in some state of disablement; Maori are disadvantaged in comparison with non-Maori both in terms of longevity and in the proportion of the life span spent disability-free; and, social class comparisons show a decline in LEFD with declining social class that is steeper than the corresponding mortality gradient. Despite some technical difficulties and the strong requirements of the data, the LEFD measure has many potential applications in public health research and planning. In particular, it has the potential to direct research and policy towards the enhancement of the active years of life rather than just the postponement of mortality.
Adolescent↗
Essential thrombocythemia beyond the first decade: life expectancy, long-term complication rates, and prognostic factors.
OBJECTIVE: To describe the long-term natural history of essential thrombocythemia (ET) in terms of life expectancy, risk of disease transformation Into a more aggressive myeloid disorder, and prognostic factors for both survival and disease complications. PATIENTS AND METHODS: The study population consisted of a consecutive cohort of patients seen at the Mayo Clinic In Rochester, Minn, in whom a diagnosis of ET was established before 1992, thus allowing a minimum of 10 years of potential follow-up. The conventional criteria-based diagnosis was confirmed by bone marrow biopsy in all Instances. RESULTS: A total of 322 patients were studied (median age, 54 years; median follow-up, 13.6 years). With a median survival time of 18.9 years, survival in the first decade of disease was similar to that of the control population (risk ratio, 0.72; 95% confidence interval, 0.50-0.99) but became significantly worse thereafter (risk ratio, 2.21; 95% confidence Interval, 1.74-2.76). Multivariable analysis identified age at diagnosis of 60 years or older, leukocytosis, tobacco use, and diabetes mellitus as Independent predictors of poor survival. A 2-variable model based on an age cutoff of 60 years and leukocyte count of 15 x 10(9)/L resulted in 3 risk groups with significant difference in survival. In addition, age at diagnosis of 60 years or older, leukocytosis, and history of thrombosis were independent predictors of major thrombotic events. The risk of leukemic or any myeloid disease transformation was low in the first 10 years (1.4% and 9.1%, respectively) but increased substantially in the second (8.1% and 28.3%, respectively) and third (24.0% and 58.5%, respectively) decades of the disease. CONCLUSION: Life expectancy in patients with ET is significantly worse than that of the control population. Leukocytosis is identified as a novel independent risk factor for both inferior survival and thrombotic events.
Adolescent↗
Tying it all together: telomeres, sexual size dimorphism and the gender gap in life expectancy.
The classic explanation that women outlive men solely due to hormonal and lifestyle differences, does not withstand a critical analysis. In developed countries, the average gap in life expectancy between the sexes is 7 years. It has widened over the last decades, despite the trend of women copying the 'unhealthy' lifestyle of men. Estrogen levels in postmenopausal women are virtually identical to estrogen levels in males and can hardly explain the discrepancy. Furthermore, testosterone got its bad reputation from one study on mentally retarded men, which has to be interpreted with caution. However, sexual size dimorphism with men being the larger sex in conjunction with the limited replication potential of human somatic cells might account for higher mortality rates in males, especially at old age. The hypothesis, as presented here, is based on the well-known concept of a cellular mitotic clock, which was discovered by Leonard Hayflick almost half a century ago. The underlying counting mechanism, namely the gradual erosion of chromosome ends (telomeres) due to the end replication problem of linear DNA molecules, was first described by Alexey Olovnikov in 1971 and with minor modifications has become a widely accepted paradigm. In a recent Lancet study, an inverse correlation between mean telomere length and mortality in people has been found. In this and two other studies, it was confirmed that males do have shorter telomeres than females at the same age. This is almost certainly a consequence of men being usually taller than women, although nobody has done an investigation yet. Clearly, a larger body requires more cell doublings, especially due to the ongoing regeneration of tissues over a lifetime. Accordingly, the replicative history of male cells might be longer than that of female cells, resulting in the exhaustion of the regeneration potential and the early onset of age-associated diseases predominantly in large-bodied males. Inherited telomere length variation between unrelated individuals might have obscured a clear correlation between body height and mortality, leading to conflicting results in some studies. Finally, I propose that the secular height increase over the last decades, of about 2.5 cm per generation in the western world, has to be blamed for the widening of the gender gap in life expectancy.
Aging↗
The evaluation of short and long-term administration of drugs improving life expectancy in patients with myocardial infarction in a Hungarian county hospital.
OBJECTIVE: The patients after myocardial infarction could hope for a significant improvement in their life expectancy when complying with the principles of the secondary prevention. Today there is no doubt that the administration of ACE-inhibitors, beta-blockers, aspirin and statins decrease mortality in these patients. Although the clinicians are aware of the guidelines of Evidence Based Medicine, international and Hungarian surveys show that in their everyday application there is still much to improve. PATIENTS AND METHODS: The authors studied the therapy of 200 consecutive patients (115 men and 85 women) who suffered from acute myocardial infarction (either STAMI or NSTAMI) in 1999-2000 at the discharge from their internal medicine department with cardiological profile and 6 months later during outpatient check-up. Having these therapeutic data a special emphasise was given to the same group of drugs and their administration was investigated in patients suffering from acute coronary syndrome with elevated troponin-T levels in the year 2002. RESULTS: In the study of years 1999-2000 at the discharge 175 of 200 patients received ACE-inhibitor (87%), 121 (60%) beta-blocker, 180 (90%) antiplatelet and 102 (51%) statin therapy. At the time of the control performed 6 months later 85% of the patients were on ACE-inhibitor, 88% on beta-blocker, 77% on aspirin and 47% on statin therapy. In this high risk population during the 6 months control the LDL-cholesterol goal of 2.5 mmol/l was attained in the 17% of patients. In the survey performed in 2002 the use of beta-receptor blocker increased to 85%, antiplatelet drug and statin administration to 95% and 57%, respectively. CONCLUSIONS: Although the administration of drugs improving life expectancy in the authors' department is comparable with the published Hungarian and international data, effort to the widespread application of the ever growing principles of the Evidence Based Medicine and continuous self-control are essential.
Adrenergic beta-Antagonists↗
LIFE EXPECTATION of radiologists.
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Humans↗
A measure of mortality based on life expectancies.
"Two alternative measures of mortality have been proposed in this paper. These are (a) the average age of the stationary population, and (b) the area covered by the life expectancy function. The former has been shown to be equal to the average number of years remaining to be lived by the stationary population and as such can be used as a measure of mortality.... The usefulness of the latter is also obvious, based as it is on the values of the life expectancies at all ages instead of that at birth alone." The measures are estimated for seven selected countries.
Age Factors↗
Correlation between life expectancy, flightlessness and actomyosin adenosine triphosphatase activity in the housefly, Musca domestica.
The objective of this investigation was to determine if actomyosin ATPase activity in flight muscles is correlated with life expectancy of houseflies. All houseflies lose flying ability before death which permits the identification of shorter-lived flightless 'crawlers' from their longer-lived cohorts, the 'fliers'. Life expectancy of crawlers is about one-third shorter than that of the fliers. Flying performance of houseflies, as measured by the total duration of flying activity during 1 h periods, average duration of flights and the number of rest stops, was highest at 4 days of age and declined thereafter. Actomyosin ATPase activity was higher in the fliers than in the crawlers of the same age. Abolition of flight, by surgical removal of wings at 1 day of age, had no effect on the enzyme activity. Results are interpreted to suggest that actomyosin ATPase activity is correlated with physiological rather than chronological age of flies.
Adenosine Triphosphatases↗
Relationship between life expectancy, endogenous antioxidants and products of oxygen free radical reactions in the housefly, Musca domestica.
The general objective of this study was to identify biochemical correlates of life expectancy in the adult male housefly. All houseflies lose flying ability prior to death, whereby, in an aging population, shorter-lived flies can be identified as flightless 'crawlers' from their longer-lived cohorts, the 'fliers'; the average lifespan of crawlers is about one-third shorter than the fliers. Neither crawlers nor fliers exhibited any physical damage to their chemoreceptive tarsi, thereby ruling out starvation as a probable cause of death. Levels of antioxidant defenses (superoxide dismutase, catalase and glutathione) and products of oxygen free radical reactions (inorganic peroxides and thiobarbituric acid [TBA]-reactants) were compared between crawlers and fliers. The fliers showed higher superoxide dismutase and catalase activities and glutathione concentration than crawlers, whereas, the amount of inorganic peroxides (H2O2) and TBA-reactants was higher in the crawlers than in fliers. Results of this study demonstrate, for the first time, that longer life expectancy of organisms belonging to the same cohort group is associated with relatively higher levels of antioxidants and lower concentrations of products of oxygen free radical reactions.
Animals↗
[Impact of life expectancy on the clinical significance and curability of prostate cancer].
Theoretical projected prostate cancer volume at the time of expected death was determined based on patient age and index cancer volume at diagnosis, assumed cancer volume doubling time and life expectancy of Japanese male population. Clinically insignificant cancer in 104 prostatectomy specimens was found to occur at 4.8, 10.6, 15.4 and 26.9% for tumor doubling times of 2, 3, 4 and 6 years, respectively. Assuming a 2-year doubling time with clinically insignificant cancer excluded, only 36.4% of significant cancers could be considered potentially curable and with a 3-year doubling time, 32.3%. For 4- and 6-year doubling times, only 30.7% and 25.0% of the clinically significant cancers were potentially curable, respectively. Patient life expectancy and tumor doubling time significantly determine the outcome of treatment for prostate cancer especially in elderly males with higher risk of mortality.
Aged↗
Estimated event-free life expectancy after autograft aortic root replacement in adults.
BACKGROUND: Autograft aortic root replacement is an established therapeutic option for young adults with aortic valve disease. Unfortunately, most series are small with a limited follow-up. Meta-analysis and microsimulation modeling were used to predict long-term outcome based on currently available midterm data. METHODS: We combined our center's experience with autograft aortic root replacement in 85 adult patients in a meta-analysis with reported results of three other hospitals. The outcomes of this meta-analysis were entered in a microsimulation model, calculating (event-free) life expectancy after autograft aortic root replacement. RESULTS: The pooled results comprised 380 patients with a total follow-up of 1,077 patient-years. Mean age was 37 years (range 16 to 68 years). Male/female ratio was 2.7. Operative mortality was 2.6% (n = 10); during follow-up 6 more patients died. Linearized annual risk estimates were 0.5% for thromboembolism, 0.3% for endocarditis, and 0.4% for nonstructural valve failure. Structural autograft failure requiring reoperation occurred in 5 patients, and a Weibull function was constructed accordingly. Using this information, the microsimulation model predicted age- and gender-specific mean, reoperation-free, and event-free life expectancy. CONCLUSIONS: Based on current evidence the calculated average autograft-related reoperation-free life expectancy is 16 years. The combination of meta-analysis and microsimulation provides a promising and powerful tool for estimating long-term outcome after aortic valve replacement.
Adolescent↗
Gains in life expectancy after elimination of major causes of death: revised estimates taking into account the effect of competing causes.
BACKGROUND: It is generally acknowledged that conventional estimates of the potential number of life years to be gained by elimination of causes of death are too generous. This is because these estimates fail to take into account the fact that those who are saved from the cause are likely to have one or more other conditions ("competing" causes of death), which may increase their risks of dying. It is unknown to what extent this introduces bias in comparisons of life years to be gained between underlying causes of death. The purpose of the study was to assess this bias. DATA AND METHODS: A sample of 5975 death certificates from the Netherlands, 1990, was coded for the presence of diseases that, according to a set of explicit rules, could be regarded as potential causes of death "competing" with the underlying cause. Logistic regression analysis was used to quantify age and sex adjusted differences between four main underlying causes of death (neoplasms, cardiovascular diseases, respiratory diseases, all other diseases) in prevalence of the six most frequent competing causes of death (neoplasms, ischaemic heart disease, cerebrovascular disease, other cardiovascular diseases, chronic obstructive lung disease, all other diseases). These prevalence differences were then used to revise conventional calculations of gains in life expectancy, by taking them to indicate differences in risk of dying from these competing causes after the underlying cause has been eliminated. RESULTS: The prevalence of competing causes of death is relatively low among persons dying from neoplasms as the underlying cause, about average among persons dying from cardiovascular diseases, and relatively high among persons dying from respiratory diseases. Taking this into account results in substantial decreases of potential life years to be gained by elimination of cardiovascular diseases and respiratory diseases, relative to the number of years to be gained by elimination of neoplasms. Specifically, while according to the conventional calculations the gain in life expectancy by elimination of cardiovascular diseases exceeds that for neoplasms by more than one year, in the revised calculations the number of life years to be gained is approximately equal. CONCLUSIONS: Despite its limitations, mainly relating to reliance on death certificate data, this study suggests that conventional estimates of differences between underlying causes of death in life years to be gained by elimination are seriously biased by ignoring the effects of competing causes. Specifically, the relative impacts of eliminating cardiovascular diseases and respiratory diseases, as compared with eliminating neoplasms, seem to be overestimated. The implications are discussed.
Adolescent↗