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PubMed2004

Trends in disability-free life expectancy.

PURPOSE: To assess trends in Disability-Free Life Expectancy, in life expectancy with disabilities according to levels of severity and in Disability-Adjusted Life Expectancy in the Netherlands between 1989 and 2000. METHOD: The disability-free life expectancy, a composite population health status measure, was calculated with data on long-term disability. Weights reflecting the impact of disability on personal functioning were assigned to different levels of severity of disability, in order to calculate a Disability-Adjusted Life Expectancy and to define cut-off points, in order to distinguish between levels of severity. RESULTS: At an aggregated level, for both males and females at the ages of 16 and of 65 years, an increase in years with disabilities and a decline in disability-free life expectancy were observed. These trends were mainly caused by a rise in the number of years with mild disabilities, with the number of years with moderate and severe disabilities decreasing. The combined changes have resulted in an increase in the Disability-Adjusted Life Expectancy. CONCLUSION: Trends in disability-free life expectancy and in years with disabilities provide support for a scenario of dynamic equilibrium. The number of years with moderate and severe disabilities has reduced, resulting in an increase in the number of years with minor disabilities. Further research should focus on the underlying causes of the increase of years with minor disabilities.

Adolescent↗
PubMed1995

Virally induced arteriosclerosis: increased life expectancy?

The average human life expectancy has been increasing constantly since first observed in Roman Times (particularly during our century). This is usually believed to be related to such 'environmental' factors as sanitation and housing and to medical intervention. Data obtained from Vital Statistics of the United States supported the idea that these explanations are insufficient. Studies on persons who had died from conditions associated with advanced stages of arteriosclerosis (ischemic heart disease, cerebrospinal disease) showed the highest life expectancy. The inflammatory nature of arteriosclerosis and studies (by others) indicating 'protective' effects suggested that the developmental stages of arteriosclerosis (in contrast to the final stages) promote increased life expectancy. Inasmuch as certain viruses (especially the human herpes virus) are involved in the development of arteriosclerosis and because nearly everybody gets infected during childhood, this virus may be a factor in the increase of life expectancy. The work on symbiosis and on hormesis has established the fact that small amounts of parasites are often associated with beneficial effects for both the host and the parasites. All of this is in line with evolutionary expectations.

Animals↗
PubMedDate not supplied

Record high U.S. life expectancy.

In 1996 life expectancy in the United States rose to a record high of 75.9 years for all persons combined. A new peak was also recorded among newborn boys--72.8 years--while average future lifetime for infant girls increased to 79.0 years--0.1 year shy of the 1992 record of 79.1 years. In recent years longevity gains among males have outpaced those for females, with the result that the sex differential in longevity at birth in favor of females has narrowed considerably. In 1996 newborn girls could anticipate living 6.2 years longer than boys--the gap was 6.8 years in 1992 and 7.0 years in 1990. Projections indicate that the trend in longevity improvements in favor of males will continue. As a consequence, the sex differential gap in average future lifetime is anticipated to diminish to 4.6 years by 2050.

Adolescent↗
PubMed2006

Assessing the state of population health by age-adjusted life expectancies.

OBJECTIVES: A gain in life expectancy of a population is commonly interpreted as an effect of improved health care. After the reunion of Germany in 1990 life expectancy at birth grew extremely in the new federal states. Within one decade after reunion the new federal states had a gain in life expectancy of about five years while the gain in the old federal states was only about two years. METHODS: It has been widely argued that this phenomenon is caused by an obviously improved public health service and environmental protection or even by an increased social status in the new federal states. On the other hand, the median population age grew rapidly in the new federal states, caused by a dramatic reduction of the birth rate as well as a high emigration rate of young people. Using real time series for three selected federal states and for the total Federal Republic of Germany, it is derived that most of the gain in life expectancy is explained by population ageing. RESULTS: An elementary probabilistic procedure is proposed allowing for estimating the amount in life expectancy not attributable to population ageing. CONCLUSIONS: The age-adjusted life expectancy can be regarded as an unbiased measure of a populations' state of health that stays comparable both over time and across countries.

Germany↗
PubMed2001

Life expectancy, comorbidity and quality of life: the treatment equation in the older cancer patients.

With ageing, function preservation and maintenance of quality of life represent a major goal in an increasing proportion of patients. Life expectancy is a function of age, comorbidity, disability and cancer type and stage. Decision-making involves a delicate balance among all these factors, evaluation of treatment related complications of the overall effects of cancer and cancer treatment on the patients' quality of life. Despite several instruments for the assessment of quality of life being validated, none have been calibrated to the special requirements of the older patients. The structured interview administered by a trained clinician represents a standard approach for geriatric research and even for clinical practice because of the frailty of the older population. The combination of this approach with the self-administered questionnaire appears the most effective way to minimise missing data in collecting information for patients unable to complete the form.

Aged↗
PubMed1997

Life expectancy, comorbidity, and quality of life. A framework of reference for medical decisions.

The treatment of cancer in the elderly can benefit from increasingly sophisticated methods that measure a patient's quality of life. These measures are both general and cancer specific and herald a new and enlightened approach to patient care. The care of the older patient must be seen in light of what is known about life expectancy, the outcome of treatment, an awareness of comorbidity, and the importance of informed consent and respect for the values and preferences of the individual patient. This article reviews the growing literature on quality of life research in cancer patients.

Aged↗
PubMed1986

[Life expectancy of diabetics].

The disease-specific life expectancy of diabetics is significant for the organisation of medical care. The investigations show that the disease-specific expectation of life of diabetics from the beginning of the disease is considerably more insignificant in comparison to the further life expectancy of the population in the younger and middle age groups. Only with increasing age of onset the life expectations of diabetics draw towards those of the population. Thus the lower life expectancy of the diabetics of younger age groups from the beginning of the disease now as ever may point to a higher risk in comparison to the disease population at the decline of life.

Aged↗
PubMed2004

Global patterns of healthy life expectancy in the year 2002.

BACKGROUND: Healthy life expectancy--sometimes called health-adjusted life expectancy (HALE)--is a form of health expectancy indicator that extends measures of life expectancy to account for the distribution of health states in the population. The World Health Organization reports on healthy life expectancy for 192 WHO Member States. This paper describes variation in average levels of population health across these countries and by sex for the year 2002. METHODS: Mortality was analysed for 192 countries and disability from 135 causes assessed for 17 regions of the world. Health surveys in 61 countries were analyzed using new methods to improve the comparability of self-report data. RESULTS: Healthy life expectancy at birth ranged from 40 years for males in Africa to over 70 years for females in developed countries in 2002. The equivalent "lost" healthy years ranged from 15% of total life expectancy at birth in Africa to 8-9% in developed countries. CONCLUSION: People living in poor countries not only face lower life expectancies than those in richer countries but also live a higher proportion of their lives in poor health.

Cross-Cultural Comparison↗
PubMed1978

The effect of a reduction in leading causes of death: potential gains in life expectancy.

The potential gains in total expectation of life and in the working life ages among the United States population are examined when the three leading causes of death are totally or partially eliminated. The impressive gains theoretically achieved by total elimination do not hold up under the more realistic assumption of partial elimination or reduction. The number of years gained by a new-born child, with a 30 per cent reduction in major cardiovascular diseases would be 1.98 years, for malignant neoplasms 0.71 years, and for motor vehicle accidents 0.21 years. Application of the same reduction to the working ages, 15 to 70 years, results in a gain of 0.43, 0.26, and 0.14 years, respectively for the three leading causes of death. Even with a scientific break-through in combating these causes of death, it appears that future gains in life expectancies for the working ages will not be spectacular. The implication of the results in relation to the current debate on the national health care policy is noted.

Accidents, Traffic↗
PubMed2000

[Life expectancy in health: major indicators of health in a population].

The concepts of life expectation, life expectation without disability, are explained. Their importance for defining a health policy and a healthcare policy is emphasized. A concrete example is given: the inequalities in life expectancy without disability follow the same pattern as the inequalities in mortality.

Adolescent↗
PubMed1999

[Current life expectancy in Chile].

An increased life expectancy is associated to a nation's progress. Life expectancy at birth is 78 years in developed countries, 72 in Latin America, 70 in China, 63 in Eastern Europe and 51 in Africa. Chile is the Latin American country with the higher increment in life expectancy, reaching 75 years at birth, during the period 1990-95. A higher life expectancy is not always an advantage. People over 60 years old may survive with a burden of chronic diseases or physical and mental disability. The higher health care needs of the increasing population of elderly people is raising the costs of health care in modern nations.

Chile↗
PubMed2001

Life expectancy as a summary of mortality in a population: statistical considerations and suitability for use by health authorities.

OBJECTIVE: To investigate the sampling distribution and usefulness of expectation of life in comparisons of mortality at health district level or below. DESIGN: Derivation of a formula for the variance of the expectation of life, confirmation of the result and generation of the sampling distribution by Monte Carlo simulation; comparison of expectation of life with standardised mortality ratio (SMR) and other summary indices of mortality. SETTING: A health district in Trent Region, England. SUBJECTS: Routinely available mortality statistics at electoral ward level and above. MAIN RESULTS: Given reasonable and simple assumptions the sampling distribution of the expectation of life is approximately normal. Expectation of life shows a high negative correlation with SMR even if the oldest age band for the SMR is open ended. CONCLUSIONS: Where sampling error is an issue, inference concerning differences in mortality rates between populations can be based on expectation of life, which is better for illustrative purposes than SMR. The formula for the variance of the expectation of life is more complex however. If the final age band is open ended, its lower bound should be as high as possible to avoid misleading results caused by hidden differences in age structure.

Age Factors↗
PubMed1994

Dementia-free life expectancy in Australia.

Dementia-free life expectancy is a synthetic indicator of an important aspect of mental health which may have considerable use in public health decision making. Dementia expectancies were derived from senile dementia prevalence rates in Australia in 1991-1992 in conjunction with national life tables using Sullivan's method. Dementia-free life expectancy for Australian women aged 70 years was found to be 14 years within a total life expectancy of 15 years, and 11 years for men within a total life expectancy of 12 years. Between 70 and 85 years there is a constant average expectation of about one year of life expectancy with dementia. The age at which the largest number of persons with dementia is found is 82 years. Australians appear to have very similar dementia-free life expectancies to those reported in the European studies, with small differences probably due to sampling variation or to differences in case-finding methods.

Age Factors↗
PubMed2001

[Antihypertensive therapy and improved life expectancy without cerebrovascular accident or coronary artery disease].

The absolute benefit from antihypertensive therapy increases with the baseline risk. However, age is a major determinant of cardiovascular risk, so it is important to express therapeutic efficacy with indices for which age is not a confounder. With this aim we explored the expected gain in life expectancy without cardiovascular events according to age at the initiation of the treatment. The treatment effect estimated from the INDANA meta-analysis, was applied to the cardiovascular risk of a French hypertensive population, simulated from national vital statistics. The gain in life expectancy was estimated from the area between survival curves without events. The treatment effect varied according three different hypotheses: increasing, decreasing or constant effect. When assuming a constant treatment effect, our results show a 29 month gain without stroke for a man who began his treatment at 40 years, and 15 months if hypertension is screened and treatment initiated at 75 years. The gains without coronary heart disease are respectively of 11 and 6 months. The variation of treatment effect over time could have a major impact on the treatment benefit. The gain in life expectancy without events is a relevant decision tool, completing usefully the absolute benefit, since it takes into account the influence of age.

Adult↗
PubMed2006

Measuring inequalities in health: the case for healthy life expectancy.

OBJECTIVE: To evaluate healthy life expectancy (HLE) as a measure of health inequalities by comparing geographical and area-based deprivation-related inequalities in healthy and total life expectancy (TLE). DESIGN: Life table analysis based on ecological cross-sectional data. SETTING AND POPULATION: Council area quarters and postcode sector-based deprivation fifths in Scotland. MAIN OUTCOME MEASURES: Expectation of life in good self-assessed general health, or free from limiting long-term illness, and TLE, for females and males at birth. RESULTS: Women in Scotland have a life expectation of 70.3 years in good health, 61.6 years free from limiting long-term illness, and a TLE of 78.9 years. Comparable figures for men are 66.3, 58.6 and 73.5 years. TLE and HLE decrease with increasing area deprivation. Differences are substantially wider for HLE. A 4.7-year difference is seen in TLE between women living in the most and least deprived fifth of areas. The difference in HLE is 10.7 years in good health and 11.6 years free from limiting long-term illness. The degree of deprivation-related inequality in HLE is 2.5 times wider for women and 1.8 times wider for men than in TLE. CONCLUSIONS: Differences in TLE underestimate health inequalities substantially. By including morbidity and mortality, HLE reflects the excess burden of ill health experienced by disadvantaged populations better. Inequalities in length of life and health status during life should be taken into account while monitoring inequalities in population health.

Adolescent↗
PubMed2002

Life expectancy and quality of life in adult patients with congenital heart disease.

The survival and quality of life of patients with congenital heart disease have significantly improved in the last 20 years. This is due to more effective medical and surgical care. The new community of grown-up congenital heart patients consists of a few natural survivors with trivial congenital lesions or very rare complex cardiac abnormalities which are naturally compensated, and of more than 75% of patients who had been submitted to cardiac surgery during infancy or childhood. Clinical follow-up is however mandatory for many of them with scheduled times and types of exams to control the effects of sequelae and late complications, and to prevent deterioration and premature death because cardiac surgery may not have resulted in normality. Moreover, these patients have many needs and even more, many questions. Not giving a correct answer to each specific question reduces the entity of surgical success.

Adult↗
PubMed1996

Occupational handicap-free life expectancy in Bulgaria 1976-1992 based on the data of the medical expert commissions.

This article presents health expectancy calculations from Bulgaria for 1976-1992. The calculations are based on mortality statistics and data from a national information system from the Expert Medical Commissions on Working Capacity about loss of working capacity. Following internationally accepted terminology, the most appropriate term for the health expectancies presented here is "occupational handicap-free life expectancy' (OHFLE). Life expectancies were calculated as partial life expectancies from ages 16 to 59. Health expectancy calculations followed Sullivan's cross-sectional method with age and sex specific prevalence data on occupational handicap. Around 1985 a three- to four-fold increase in these prevalences occurred. The distribution of occupational handicaps over sexes, age groups and severity levels, however, remained fairly constant. The results show a decrease both in partial life expectancy within the age range 16-59 and in OHFLE at the age of 16 for men. For women a more or less stable partial life expectancy and a decrease in OHFLE at the age of 16 was found around 1985. The introduction of more incentives for people who successfully registered probably caused the decrease around 1985. Major social changes may have acted as confounding factors for the fluctuations after 1985. On the other hand the findings may reflect real changes in population health due to an increasing incidence in some major disease categories. The nation-wide system for assessment and registration of health related working incapacity has proved a useful source for an attempt to calculate OHFLE. Given uncertainties about the population health underlying these changes in OHFLE, however, it is recommended that health interview and health examination surveys should be considered as alternative routes for achieving a more comprehensive picture of population health in Bulgaria.

Adolescent↗