[Risk factors of atherosclerosis in relation to the life expectancy of today and life prospects of tomorrow].
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Hypertension, quality of life and functional status: the concept of active life expectancy.
Mortality rates and measures of life expectancy are widely used to compare and monitor health within populations. However, there is a need to add dimensions of population health other than survival. An alternative measure, 'active life expectancy', is a way of quantifying the functional health of older adult populations and, in part, measuring quality of life. Life-table techniques are used to define the expected duration of well-being. Instead of death, the end-point of active life expectancy is loss of independence in activities of daily living. Initial studies showed that active life expectancy decreased with age, from 10 years to 4.7 years and 2.9 years, respectively, for people entering the age intervals 65-69, 80-84 and 85 years and over. Since cardiovascular disease is the major cause of disability in the older adult population, measures of active life expectancy can provide improved information about functional independence and dependence. Life tables with estimates of active life expectancy can be used as a basis for determining the needs of age cohorts of people with hypertension and other conditions.
Activities of Daily Living↗
Estimating increment-decrement life tables with multiple covariates from panel data: the case of active life expectancy.
A fundamental limitation of current multistate life table methodology-evident in recent estimates of active life expectancy for the elderly-is the inability to estimate tables from data on small longitudinal panels in the presence of multiple covariates (such as sex, race, and socioeconomic status). This paper presents an approach to such an estimation based on an isomorphism between the structure of the stochastic model underlying a conventional specification of the increment-decrement life table and that of Markov panel regression models for simple state spaces. We argue that Markov panel regression procedures can be used to provide smoothed or graduated group-specific estimates of transition probabilities that are more stable across short age intervals than those computed directly from sample data. We then join these estimates with increment-decrement life table methods to compute group-specific total, active, and dependent life expectancy estimates. To illustrate the methods, we describe an empirical application to the estimation of such life expectancies specific to sex, race, and education (years of school completed) for a longitudinal panel of elderly persons. We find that education extends both total life expectancy and active life expectancy. Education thus may serve as a powerful social protective mechanism delaying the onset of health problems at older ages.
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The influence of some factors on the non-homogeneity in adult male life expectancy in the Slovak Republic.
Life expectancy of males in the Slovak Republic, a small postcommunist country in Central Europe, is among the lowest in Europe due to the extremely high mortality rate in middle-aged men. The relation between male life expectancy at age 20 and several variables (i.e. ethnic structure, educational status, religious belief and economic activity) was analysed by simple regressions and by multifactorial methods in all 38 districts of Slovakia. Significant negative associations were found between male life expectancy at age 20 and ethnic structure (i.e. percent of Hungarian population), economic activity (percent of men employed in agriculture) and educational status (percent of men having only a basic education). In multifactorial analysis educational status and ethnic structure entered the model. The most dramatic health decline occurred in agricultural southern districts with high percentage of Hungarian minority and with high percentage of men with the lowest educational status. Lifestyle probably presents the background of these relations, but there is a lack of reliable data from the individual districts for a more profound analysis. More sophisticated epidemiological research projects are important for the formulation of a public health strategy in Slovakia.
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Changes in U.S. life expectancy.
In 1993 the expectation of life in the United States apparently declined slightly. Newborns could expect, on average, to live 75.4 years; for baby boys the figure was 72.0 years and for girls 78.7 years. Each of these values represents a decline of 0.3 years from the 1992 provisional expectancies prepared by the National Center for Health Statistics, and results in average future lifetime returning to the 1990-91 level. Last year's decrease in life expectation was primarily brought about by the considerable rise in the absolute number of deaths and the corresponding increase in mortality rates. Indications are that mortality increased from all major forms of death as well as from AIDS. It is estimated that there were 2,260,000 deaths in 1993 compared with the provisional count of 2,177,000 in 1992 and the final figure of 2,169,518 in 1991. Notwithstanding, projections indicate that expectation of life will continue to rise into the foreseeable future although occasional small declines are likely such as that reported for 1993.
Adolescent↗
[Life expectancy in Norway--an international perspective].
Contrasts in life expectancy among countries are an important input for defining targets for the health service and for setting priorities for disease prevention and health promotion. In this article, the trend in life expectancy in Norway is compared with the trend in a selection of other OECD countries. Standardised measures of life expectancy were collected from WHO and OECD statistics. In 1960 Norwegians ranged among the top three countries as regards life expectancy for both women and men. In 1990 Norwegians ranged tenth for women and ninth for men. Life expectancy was two years shorter for Norwegian than for Japanese women in 1990, corresponding to a 20% surplus mortality throughout life. Similar differences were found for men. If Japanese age specific death rates are applied to the Norwegian population, this corresponds to a reduction of 9,600 deaths this year. The relatively unfavourable trend in life expectancy in Norway relative to other OECD countries raises concern, and should be considered when designing the future health policy.
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Impact of HIV/AIDS on life expectancy in the United States.
OBJECTIVES: The potential gains in life expectancy of the US population by the partial and total elimination of deaths from HIV/AIDS were compared with that of deaths from heart disease and malignant neoplasms. METHODS: The data from the 1992 advanced mortality report and detailed information provided by the National Center for Health Statistics were analysed by using the partial multiple decrement life-table technique. RESULTS: For the total population of the United States in 1992, the gains in future life expectancy through the elimination of deaths from HIV/AIDS, heart disease and malignant neoplasms were 0.34, 3.25 and 3.21 years, respectively. The gains in life expectancy in those of working age 15-64 years) through the elimination of deaths from these three causes of deaths were 0.20, 0.40 and 0.55 years, respectively. Race/sex-specific calculations indicate that the total elimination of deaths from HIV/AIDS, heart disease and malignant neoplasms in white men of working age resulted in increased life expectancy of 0.28, 0.54 and 0.53, respectively, whereas the corresponding figures for black men were 0.82, 0.90 and 0.76 years, respectively. Although the impact of the elimination of the other causes remained relatively stable from 1987 to 1992, the potential gains in life expectancy for black men of working age by eliminating HIV/AIDS rose from 0.36 years in 1987 to 0.82 years in 1992. For the total US population of working age, the elimination of HIV/AIDS deaths resulted in increased life expectancy similar to that observed for a 50% reduction of heart disease or malignant neoplasms, whereas among black men of working age, the increased years of life expectancy from the elimination of HIV/AIDS deaths were virtually the same as those observed for the elimination of heart disease or malignant neoplasms. CONCLUSIONS: The potential gains in life expectancy by reduction of deaths from heart disease and malignant neoplasms are more heavily influenced by increasing years after the working ages (15-64 years), whereas the potential gains in life expectancy by reducing deaths from HIV/AIDS make a greater contribution to those of working age. Hence, in terms of the economic costs and benefits, these results indicate that in evaluating policy issues regarding allocation of research funds, studies of life expectancy are far more important than the simple approach which allocates funds on the basis of the number of deaths due to various diseases.
Acquired Immunodeficiency Syndrome↗
What happened to life expectancy in Spain in the 1980s?
BACKGROUND: Life expectancy at birth in Spain improved between 1972 and 1982, by 2.5 years for males and 3.2 years for females. This slowed considerably in the following decade, with increases of only 0.5 and 1.7 years respectively. OBJECTIVE: To determine the causes of death that have been responsible for the failure by Spain to maintain in the 1980s and 1990s the rate of improvement in life expectancy seen during the 1970s. DESIGN: Data from WHO mortality tapes grouped in a series of clinically meaningful categories were used to calculate the contribution of each category, in five year age groups, to the changing life expectancy at birth in the two periods. SETTING: Spain. RESULTS: The trend in life expectancy at birth in Spain over this 20 year period can be considered to have two components, both with important consequences for public health policy. Underlying trends include a steady negative contribution from respiratory cancer in men and a reduction in cardiovascular disease. More recent trends include a considerable deterioration in deaths among young adults, most notably from accidents and, possibly, AIDS. CONCLUSION: The failure to maintain the rate of earlier gains in life expectancy in Spain can be attributed largely to a few conditions, although these may indicate less obvious underlying problems. These findings have important consequences for prioritising public health policies.
Accidents↗
Healthy life expectancy: evaluation of global indicator of change in population health.
OBJECTIVE: To review and evaluate the usefulness of healthy life expectancy as a global indicator of changes in a population's health. DESIGN: Review of all known studies to date from the United States, mainland Europe, Canada, and the United Kingdom that have used Sullivan's method of calculating disability free life expectancy. MAIN OUTCOME MEASURES: Life expectancy and disability free life expectancy. RESULTS: Over the past decade the average healthy life expectancy was 60 years for men and 64 for women, with the proportion of years of disability ranging from 11% to 21% in men and from 14% to 24% in women. At the age of 65 men could expect eight years of disability free life and women 10, with the life expectancy being respectively 14 and 19 years. The difference between the wealthiest and poorest income quintiles was 6.3 years in life expectancy and 14.3 in disability free life expectancy for men and 2.8 and 7.6 respectively for women. These results suggest that disparities in health are greater between social groups than between the sexes. Diseases affect mortality and morbidity differently. The order of importance for affecting life expectancy was circulatory disease, cancer, and accidents and for disability free life expectancy, circulatory disease, locomotor disorders, and respiratory disorders. CONCLUSIONS: Healthy life expectancy is a valuable index for the appreciation of changes in both the physical and the mental health states of the general population, for allocating resources, and for measuring the success of political programmes. Future calculations should also take into account the probability of recovery and thus extend the applicability of the indicator to populations in poor health rather than focusing on the well population.
Age Factors↗
Measuring and explaining the change in life expectancies.
A set of new indices for interpreting change in life expectancies, as well as a technique for explaining change in life expectancies by change in mortality at each age group are presented in the paper. The indices, as well as the new technique for explaining the differences in life expectancies, have been tested and examples using United States life tables are presented. The technique for explaining life expectancy differentials can be used for analyzing change in mortality or mortality differentials by sex, ethnicity, region, or any other subpopulations. The technique can be applied to life expectancies at birth or temporary life expectancies between any desirable ages.
Actuarial Analysis↗
Life and death in Hawaii: ethnic variations in life expectancy and mortality, 1980 and 1990.
Life expectancy in Hawaii is among the highest in the nation. Past research, however, found significant ethnic differences in longevity. This study presents life expectancy estimations for 1980 and 1990, along with ethnic differences in mortality rates for specific causes of death. The findings suggest that ethnic differences continue, with Chinese and Japanese having the longest life expectancy and Native Hawaiians having the shortest.
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[Effect of change in the occupational structure on extending life expectancy in Germany--a cohort analysis].
Life expectancy in Germany has increased considerably during the 20th century. Simultaneously a considerable change in occupational structure has occurred. Keeping the occupational impact on mortality in mind, the question arises as to what extent the mortality decrease can be contributed to changes in occupation. Based on cohort data this question is analysed with the result that a considerable impact on life expectancy is confirmed. The impact of changes in occupational structure on life expectancy is greater for men than for women. This can be explained by the fact that men benefit from the improvements of general living conditions associated with occupational status, as well as from improved working conditions.
Accidents, Occupational↗
Dementia-free life expectancy among elderly Japanese.
A 3-year prospective cohort study was conducted to estimate the life expectancy free of dementia (dementia-free life expectancy) in a representative sample of older persons living in an urban Japanese community. For the persons aged 65 years and older, who were not demented at the baseline survey in 1988, mortality and incidence rates of dementia were calculated. At the age of 65 years, males showed a total life expectancy of 18 years, including 16 years free of dementia, and females showed a total life expectancy of 23 years, including 18 years without dementia. At 65 years, the dementia-free life expectancy represented 89% of the total life expectancy for males and 79% for females. Total life expectancy and dementia-free life expectancy were longer among females than among males. However, the life-years with dementia were longer among females. This result would be attributable to a higher incidence of dementia and a lower mortality among females.
Age Distribution↗
Life expectancy of Swedish haemophiliacs, 1831-1980.
Life expectancy of Swedish haemophiliacs has been estimated for the period 1831-1980. The data were derived from 948 haemophiliacs of whom 580 survived throughout 1980. Applying standard demographic techniques, median life expectancy of patients with severe haemophilia was found to have increased fivefold, from a mere 11 years during the period 1831-1920 to 56.8 years during 1961-80. The corresponding estimates for patients with moderate haemophilia were 27.5 and 71.5 years, respectively. The limited data on patients with mild haemophilia did not indicate any significant improvements in mortality. From the beginning of this century to 1980 median life expectancy for Swedish males increased from 61.7 years to 75.6 years, an increase of 23%. Analysing the last 12 years of the study (1969-80), death rates for patients with severe haemophilia below the age of 45 were not much different from those of Swedish males in the population as a whole. The investigation implies that the mortality of haemophiliacs in Sweden is approaching that of the total male population.
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Estimated gain in life expectancy. A simple tool to select optimal reperfusion treatment in individual patients with evolving myocardial infarction.
Currently several modes of reperfusion therapy for acute myocardial infarction are available. Streptokinase, accelerated alteplase and direct angioplasty are the most frequently used. These options are increasingly effective, but are also increasingly complex and costly. Since, unfortunately, physicians are often restricted by budget limitations, choices must be made in clinical practice to provide optimal therapy to individual patients. In order to guide such decision making, we developed a model to predict the expected benefit of therapy in terms of gain in life expectancy. Patients' life expectancy will decrease after infarction. Part of this loss can be prevented by early reperfusion therapy. The clinical benefit of therapy ranges from negligible gain in patients with small infarcts treated relatively late to an expected gain of more than 2 years in patients with extensive infarction treated within 3 h of onset of symptoms. The expected benefits are presented in a set of tables and depend on age, previous infarction, estimated infarct size, treatment delay and intracranial bleeding risk. With the help of these table, resources will be allocated in such a manner that patients who will benefit the most will receive the most effective therapy. Patients with similar expected treatment benefit will be offered the same mode of therapy. Future life years were discounted at 5% per year. The arbitrary thresholds currently applied for decision making at the Thoraxcenter are: no reperfusion therapy when the estimated gain in discounted life expectancy was < 1 month, streptokinase for 1-4 months and accelerated alteplase for a gain > or = 5 months. Direct angioplasty is recommended in patients with an estimated gain > or = 12 months, and in patients with an increased risk of intracranial bleeding. In this way, approximately 80% of our patients will be treated with thrombolytics (40% streptokinase and 40% accelerated alteplase), while in 10% direct angioplasty will be initiated. Patients with small infarcts presenting late will not receive reperfusion therapy. These threshold values have been chosen arbitrarily, and different thresholds may be selected in other centres. However, the developed model would guarantee that treatment decisions are made in a consistent manner, to provide optimal therapy for patients with evolving myocardial infarction, in spite of limited resources.
Adolescent↗
Life expectancy in four U.S. racial/ethnic populations: 1990.
Previous estimates of life expectancy in the United States have not corrected for biases in population and mortality data, and no study has examined life expectancy in U.S. Asian/Pacific Islander and American Indian populations. We used information on population undercounts by race/ethnicity in the census and on misclassification of race/ethnicity on death certificates to calculate life expectancy for black, white, American Indian, and Asian men and women in the United States in 1990. Correction for undercount and misclassification had little effect on life expectancy estimates for whites, but it substantially decreased estimates for American Indians and Asians. Asian men had life expectancies of 82.0 years and Asian women 85.8 years--the highest life expectancies reported for any population in the world and beyond the limit predicted by some current theories.
Adolescent↗
The life expectancy of profoundly handicapped people with mental retardation.
BACKGROUND: The life expectancy of people with mental retardation is shorter than that of the general population. Exact estimates of the length of survival for mentally retarded persons at especially high risk are not available, however. METHODS: We collected data on mortality and other factors for 99,543 persons with developmental disabilities, including mental retardation, who received services from the California Department of Developmental Services between March 1984 and October 1987. Three subgroups were selected on the basis of the four characteristics identified in previous studies as the best predictors of mortality among mentally retarded people (deficits in cognitive function, limitations on mobility, incontinence, and inability to eat without assistance). In all three subgroups, the subjects had severe deficits in cognitive function and were incontinent; the subjects in subgroup 1 (n = 1550) were immobile and required tube feeding; those in subgroup 2 (n = 4513) were immobile but could eat with assistance; those in subgroup 3 (n = 997) were mobile (but not ambulatory) and could eat with assistance. Life tables were generated for each of the three subgroups. RESULTS: Immobile subjects were found to have a much shorter life expectancy than those who could move about. Those who also required tube feeding (subgroup 1) had a very short life expectancy (i.e., four to five additional years). Those who could eat if fed by others (subgroup 2) had an average life expectancy of approximately eight additional years. In contrast, those who were mobile though not ambulatory (subgroup 3) had a life expectancy of about 23 additional years. CONCLUSIONS: Severe mental retardation is associated with a decrease in life expectancy, particularly for those who were immobile.
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Total and occupationally active life expectancies in relation to social class and marital status in men classified as healthy at 20 in Finland.
STUDY OBJECTIVE: To study differences in total life expectancy and in occupationally active life expectancy in relation to social class and marital status in men classified as healthy as young adults. DESIGN: Historical cohort study. SETTING: Finland. PARTICIPANTS: Altogether 1662 men classified as completely healthy at the time of induction to military service (mean birth year 1923), who had been selected as referents for a study of former athletes. Mean follow up time was 46 years. MEASUREMENTS: Vital status was determined by follow up through local parish data up to 1990. Mortality data were obtained from the Cause of Death bureau of the Central Statistical Office of Finland. Occurrence of work disability was assessed from nationwide disability pension register data. Mean total life expectancy and mean occupationally active life expectancy (end points disability pension or death before age 65 years) were estimated. Social class was based on the major lifetime occupation, while marital status was classified as "never married" or "ever married" at the end of follow up. MAIN RESULTS: Mean total life expectancy was highest among executives and managers (73.2 (95% confidence interval (CI): 70.3, 76.1) years), next highest in clerical (white collar) workers (72.0 (70.0, 74.1) years), and lowest in unskilled blue collar workers (63.65 (61.1, 66.2) years). Skilled workers and farmers were intermediate. For the occupationally active life expectancy estimates, a similar gradient was observed: highest for executives (61.9 (60.7, 63.1) years) and lowest for the unskilled (52.2 (50.2, 54.2) years). The ratio of occupationally active life expectancy to total life expectancy was highest for executives (85%) and lowest for farmers (81%) and unskilled workers (82%). CONCLUSIONS: The social class gradient known to exist for mortality is also present for occupational disability. Social class and marital status differences in mortality are already evident in early adulthood and continue into old age. Those with the highest life expectancy also have the largest proportion of their life span free of occupationally incapacitating disability.
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