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PubMed1997

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.

Adult↗
PubMedDate not supplied

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↗
PubMed2002

[Disorders requiring nursing care and the period before recognized as needing nursing care (active life expectancy) in relation to nursing care insurance].

PURPOSE: To measure the state of health of the elderly population, active and dependent life expectancies were calculated based on the number of people needing nursing care. For this purpose, active life expectancy was defined as the period before nursing care was recognized by insurers as being required. Moreover, to cast light on disorders requiring nursing care, age-adjusted nursing time needed for different ailments per ten thousand elderly population was calculated. SUBJECTS AND METHODS: Subjects were those 65 years or over living in Taihaku-ku, Sendai City, recognized as needing nursing care by nursing care insurers. The period before being recognized as needing nursing care was calculated using the Sullivan method, and termed the active life expectancy. Dependent life expectancy = life expectancy - active life expectancy. The number of those needing nursing care caused by each disorder diagnosed by attending physicians, was also age-adjusted by the reference population and multiplied by the nursing time needed for each level of nursing, resulting in the age-adjusted nursing time needed per ten thousand elderly population. RESULTS: Those recognized as needing nursing care were 7.5% (7.7% after age adjustment) of the male elderly population, and 12.5% of the female population (10.7% after age adjustment). For men, the active life expectancy was 16.1 years for the age of 65, 9.2 years for 75 and 4.4 years for 85, while the dependent one was 2.0-2.1 years for all ages. For women, the active life expectancy was 19.3 years for the age of 65, 11.1 years for 75 and 4.8 years for 85, while the dependent one was 4.6-5.3 years. The age-adjusted nursing time needed per ten thousand elderly population was 874 hours for men and 1,125 hours for women: of the time 51% was for men with cerebrovascular disease (40% for cerebral infarction), 11% for men with dementia; 37% for women with cerebrovascular disease (26% for cerebral infarction), 20% for women with skeletal diseases, 18% for women with dementia. CONCLUSIONS: The active life expectancy for women is longer than for men, by 3.7 years for the age of 65, by 2.3 years for 75 and by 0.5 years for 85. The dependent life expectancy for women is also longer than for men, by 3.2 years for the ages of 65 and 75 and by 2.6 years for 85. Thus, nursing prevention is an urgent issue, especially for women. The disorders requiring particularly long age-adjusted nursing time are carebrovascular disease (particularly cerebral infarction), dementia and skeletal disorders (particularly among women).

Age Factors↗
PubMed2004

Evaluation of methodologies for small area life expectancy estimation.

STUDY OBJECTIVE: To evaluate methods for calculating life expectancy in small areas, for example, English electoral wards. DESIGN: The Monte Carlo method was used to simulate the distribution of life expectancy (and its standard error) estimates for 10 alternative life table models. The models were combinations of Chiang or Silcocks methodology, 5 or 10 year age intervals, and a final age interval of 85+, 90+, or 95+. SETTING: A hypothetical small area experiencing the population age structure and age specific mortality rates of English men 1998-2000. PARTICIPANTS: Routine mortality and population statistics for England. MAIN RESULTS: Silcocks and Chiang based models gave similar estimates of life expectancy and its standard error. For all models, life expectancy was increasingly overestimated as the simulated population size decreased. The degree of overestimation depended largely on the final age interval chosen. Life expectancy estimates of small populations are normally distributed. The standard error estimates are normally distributed for large populations but become increasingly skewed as the population size decreases. Substitution methods to compensate for the effect of zero death counts on the standard error estimate did not improve the estimate. CONCLUSIONS: It is recommended that a population years at risk of 5000 is a reasonable point above which life expectancy calculations can be performed with reasonable confidence. Implications are discussed. Within the UK, the Chiang methodology and a five year life table to 85+ is recommended, with no adjustments to age specific death counts of zero.

Aged↗
PubMed1996

[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.

Adult↗
PubMed2005

[The remarkable rise in life expectancy and how it will affect medicine].

Life expectancy has increased at a steady pace in industrialized countries over the last 160 years. A slowdown is not evident: Since 1950 the number of people celebrating their 100th birthdays has at least doubled each decade. This increase in survival is the result of economic developments, social improvements and advances in medicine. Although the belief that old-age mortality is intractable remains widespread, life expectancy is not approaching a limit. Rather, the evidence suggests that ageing is plastic and that survival can be extended by various genetic changes and non-genetic interactions. Increases in life expectancy are largely attributed to improvements in old-age survival. It is a reasonable scenario that life expectancy will rise further in coming decades, supported by advances in the prevention, diagnosis and treatment of age-related diseases. If the trend continues, life expectancy in Germany will rise to over 90 years in the first half of this century. Many official forecasts, however, have assumed lower figures which can have severe consequences both for public and private decision making.

Aged↗
PubMed1997

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↗
PubMed1997

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↗
PubMed2003

Life expectancy for children with cerebral palsy and mental retardation: implications for life care planning.

OBJECTIVES: Physicians may be asked by attorneys or other patient advocates to help plan for the long-term needs of children with cerebral palsy (CP) and developmental disability (DD). The first step in such planning is to thoroughly examine the literature dealing with life expectancy in these populations. This review paper comprehensively reviews the literature relating to survival in children with cerebral palsy and developmental disability. STUDY SELECTION: A Medline data search was completed using the terms cerebral palsy, life expectancy, survival, as well as other pertinent terms. Further articles were gleaned from bibliographies of pertinent literature. DATA SYNTHESIS: Certain key disabilities can be used to accurately predict life expectancy in children with cerebral palsy and mental retardation. These include: (1) presence and severity of mental retardation, (2) inability to speak intelligible words, (3) inability to recognize voices, (4) inability to interact with peers, (4) severity of physical disability, (5) use of tube feeding, (6) incontinence, and (7) presence and severity of seizures. CONCLUSIONS: Literature review definitively shows that children with CP and DD have a diminished life expectancy, which can be assessed based on simple clinical examination findings.

Cerebral Palsy↗
PubMed1991

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↗
PubMed1984

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↗
PubMed1999

How Fast Can the Racial Gap in Life Expectancy Between Whites and Blacks Be Eliminated?

BACKGROUND: The racial gap in life expectancy between whites and blacks fluctuated from 7.6 to 5.7 years from 1970-1996, but the causes of this gap and the years required to eliminate it remain unclear. This paper analyzes the leading causes of death and how they contribute to the racial gap in life expectancy, and estimates the number of years required to eliminate this gap. METHODS: Standard abridged life table methods and life table partitioning techniques were used to estimate the total and the cause-specific racial gap in life expectancy. Cause-specific mortality rates by age, sex, and race in the United States from 1970-1996 were obtained from the Centers for Disease Control and Prevention. The predictions of years needed to eliminate the racial gap in life expectancy are based on international and domestic trends in life expectancy improvement. RESULTS: The racial gap in life expectancy declined before 1982, increased from 1982 to 1989, and slowly declined after 1989. In 1996, about 54% and 62% of the racial gap was attributable to cancer, heart disease, homicide, and HIV for females and males, respectively. If blacks could experience substantial improvement in life expectancy, the current racial gap in life expectancy could be eliminated in about 40 years. CONCLUSIONS: The goal of eliminating the racial gap in life expectancy is a critical national priority. Differences in life expectancy are the result of multiple health and socioeconomic determinants, which will require multiple intervention strategies. The time it will take to reduce the overall gap will depend on the speed of reduction of the leading cause-specific mortality differences, which will require intensified efforts in both prevention and treatment.

Journal Article↗
PubMed2000

Lack of improvement of life expectancy at advanced ages in The Netherlands.

BACKGROUND: Several countries have reported an increase in life expectancy at advanced ages. This paper analyses recent changes in life expectancy at age 60 and 85 in The Netherlands, a low mortality country with reliable mortality data. METHODS: We used data on the population and the number of deaths by age, sex and underlying cause of death for 1970-1994. Life expectancy at age 60 and 85 was estimated using standard life-table techniques. The contribution of different ages and causes of death to the change in life expectancy during the 1970s (1970/74-1980/84) and the 1980s (1980/84-1990/94) were estimated with a decomposition technique developed by Arriaga. RESULTS: Life expectancy at age 60 increased in the 1970s and 1980s, whereas life expectancy at age 85 decreased (men) and stagnated (women) in the 1980s, and has decreased in both sexes since 1985/89. The decomposition by age showed that constant mortality rates in women aged 85-89, and increasing mortality rates at ages 85+ (men) and 90+ (women) have caused this lack of increase in life expectancy. The decomposition by cause of death showed that smaller mortality reductions from other cardiovascular and cerebrovascular diseases, which contributed most to the increase in life expectancy at age 85 in the 1970s, and mortality increases from, amongst others, chronic obstructive pulmonary disease (COPD), mental disorders and diabetes mellitus produced the decrease (men) and plateau (women) in life expectancy at age 85. CONCLUSIONS: Life expectancy at advanced ages stopped increasing during the 1980s in The Netherlands due to mortality increases at ages 85+ (men) and 90+ (women). Cause-specific trends suggest that, in addition to (past) smoking behaviour in men, changes in the distribution of morbidity and frailty in the population might have contributed to this stagnation.

Age Distribution↗
PubMed2000

Life expectancy as an indicator of environmental health.

Whether or not life expectancy at birth is related to the quality of life as expressed by global economical, environmental and nutritional measures is the primarily studied question in this article. Two models, set of independent variables and multivariate analysis was performed. An attempt to estimate the role of studied variables in overall life expectancy was done, too. A descriptive, ecological study design was used. The population of 156 countries have been taken into account, using data from published databases [7, 9]. Access to safe drinking water, per capita gross domestic product, literacy, calories available as percentage of needs and per capita public health expenditures were taken as exposure, and compared with life expectancy at birth. A linear regression model was used to estimate the role of different exposures on life expectancy at birth. A correlation matrix for all variables and life expectancy at birth is presented in the article. Literacy and access to safe drinking water are statistically significant variables (p < 0.001) also after fitting a linear regression model. The correlation coefficient for the linear model was 0.8823 (R2 = 0.7784). Shares of years of life from overall life expectancy attributed to studied variables were 28.06, 9.42, 2.04 and 1.93% for literacy, access to safe drinking water, GDP and calories available as percentage of needs, respectively.

Educational Status↗
PubMed2003

Health, life expectancy, and health care spending among the elderly.

BACKGROUND: Life expectancy among the elderly has been improving for many decades, and there is evidence that health among the elderly is also improving. We estimated the relation of health status at 70 years of age to life expectancy and to cumulative health care expenditures from the age of 70 until death. METHODS: Using the 1992-1998 Medicare Current Beneficiary Survey, we classified persons' health according to functional status and whether or not they were institutionalized and according to self-reported health. We used multistate life-table methods and microsimulation to estimate life expectancy for persons in various states of health. We linked annual health care expenditures with transitions between health states. RESULTS: Elderly persons in better health had a longer life expectancy than those in poorer health but had similar cumulative health care expenditures until death. A person with no functional limitation at 70 years of age had a life expectancy of 14.3 years and expected cumulative health care expenditures of about 136,000 dollars (in 1998 dollars); a person with a limitation in at least one activity of daily living had a life expectancy of 11.6 years and expected cumulative expenditures of about 145,000 dollars. Expenditures varied little according to self-reported health at the age of 70. Persons who were institutionalized at the age of 70 had cumulative expenditures that were much higher than those for persons who were not institutionalized. CONCLUSIONS: The expected cumulative health expenditures for healthier elderly persons, despite their greater longevity, were similar to those for less healthy persons. Health-promotion efforts aimed at persons under 65 years of age may improve the health and longevity of the elderly without increasing health expenditures.

Activities of Daily Living↗
PubMed1996

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.

Asian↗
PubMedDate not supplied

Life expectancy without chronic morbidity: trends in gender and socioeconomic disparities.

OBJECTIVE: Life expectancy without chronic morbidity, or morbidity-free life expectancy (MFLE), was calculated to measure changes in population health status between 1989 and 2000 on the basis of gender and socioeconomic status. METHODS: Sullivan's method was used to calculate morbidity-free life expectancy. Prevalence rates for chronic morbidity were derived from the Netherlands Continuous Health Interview Survey. Four socioeconomic groups were distinguished on the basis of educational level. RESULTS: Between 1989 and 2000, total life expectancy increased for males and females and for all socioeconomic groups. Morbidity-free life expectancy decreased significantly for males (from 54.7 years to 53.9 years) and females (from 55.3 years to 51.0 years). The gap between males and females in MFLE has reversed, from 0.6 years in favor of females in 1989 to 2.9 years in favor of males in 2000. The gap between the upper and lower classes seems to have narrowed (for males from 11 years to 8.5 years and for females from 4.7 years to 4.0 years). CONCLUSIONS: The results indicate that morbidity-free life expectancy is falling for males and females and in all socioeconomic groups. Part of this decrease could be attributed to earlier diagnosis of chronic diseases. A widening gap in MFLE was observed between males and females in favor of males. The gap between the upper and lower socioeconomic groups seems to be narrowing.

Aged↗
PubMed1993

[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↗