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PubMed1996

Estimating life expectancy using an age-cohort model in Taiwan.

OBJECTIVES: Life expectation is a valuable summary index in public health and actuarial science. The life expectancies published in the vital statistics, however, are derived from the "current" rather than from the "cohort" life table. The former is based on a strong assumption of constant mortality in the population, whereas the latter calls for a recording of the mortality experience of a group of individuals, which is often an impossible task. Thus, a method of calculating cohort life expectancy without actual follow up is much needed. METHODS: Estimation of cohort life expectancy was based on an age-cohort model. Mortality data for the male population in Taiwan from 1951 to 1990 are used to illustrate the methodology. RESULTS: The increment of life expectancy over time in Taiwan is actually steeper than was previously thought using the current life table technique. CONCLUSIONS: The method is easy to implement and the data required are the usual age and period cross classified mortality data. It warrants further investigation.

Adolescent↗
PubMed2006

The effect of age and chronic illness on life expectancy after a diagnosis of colorectal cancer: implications for screening.

BACKGROUND: Older adults with shorter life expectancies may receive less benefit from colorectal cancer screening than younger, healthier patients. OBJECTIVE: To determine the degree to which life expectancy after diagnosis of an early-stage cancer varies according to age or coexisting chronic illness. DESIGN: Retrospective cohort study. SETTING: Population-based cancer registry with linked administrative claims data. PATIENTS: Patients 67 years of age or older who received a diagnosis of colorectal cancer from 1993 through 1999. MEASUREMENTS: Chronic conditions were identified by searching Medicare claims. Using a life-table approach, the authors quantified the degree to which life expectancy associated with each cancer stage at diagnosis varied with patient age, sex, and burden of chronic conditions. RESULTS: The final study sample consisted of 35 755 patients. After accounting for cancer stage at diagnosis, the authors found that life expectancy was strongly related to both age and the burden of chronic illness. Among men who received a diagnosis of stage I cancer at 67 years of age, life expectancy decreased from 19.1 years (95% CI, 17.8 to 20.5 years) for patients with no chronic conditions to 12.4 years (CI, 11.4 to 13.5 years) for those with 1 or 2 conditions and 7.6 years (CI, 6.1 to 9.4 years) for those with 3 or more conditions. A similar trend was noted among female counterparts, with life expectancy decreasing from approximately 23 years to 16 years and 7 years for the 3 chronic condition groups, respectively. For men and women 81 years of age with no chronic illnesses, life expectancy after stage I cancer diagnosis was 10.3 years (CI, 9.2 to 11.9 years) and 13.8 years (CI, 12.3 to 15.3 years), respectively. LIMITATIONS: Administrative claims may not identify all chronic conditions. Life expectancy estimates at the population level are averages and, therefore, may not accurately predict the life expectancy of individual patients. CONCLUSIONS: Coexisting chronic illness is associated with a substantial reduction in life expectancy after diagnosis of early-stage colorectal cancer. Physicians should consider this when deciding whether to screen older persons.

Age Factors↗
PubMed2001

Okinawa: an exception to the social gradient of life expectancy in Japan.

This paper examines why the social gradient of life expectancy does not apply in Japan when Okinawa is considered. The social gradient thesis links differences in longevity to social rank, with people and populations in higher status hierarchical positions having lower mortality and longer life expectancies than those beneath them in the social scale. Japan has been cited as a major example of this thesis in that Japanese life expectancy improved dramatically as Japan rose to the top echelon of nations in economic rank in the late 20th century. Thus it follows that Japan's most affluent and leading prefectures should be the major catalysts behind the nation's rise in life expectancy as well to the number one position in the world. However, this is not the case as life expectancy in Okinawa, Japan's poorest prefecture, exceeds that of Japan as a whole. We find that the social gradient of life expectancy does not apply at the prefectural level and question its validity for geographical areas. We suggest that healthy lifestyles, especially diet and the social support of family and friends, are more important than sense of hierarchy for longevity in Okinawa.

Aged↗
PubMed1999

Trends in dementia-free life expectancy among elderly members of a large health maintenance organization.

BACKGROUND: This study examined the secular trends of life expectancy without dementia among elderly American members of a health maintenance organization, and observed if an increased life expectancy is accompanied by an increase in the duration of life with dementia. METHODS: The data derived from two chronological 9-year prospective cohort studies of members of the Kaiser Permanente Medical Care Program of Northern California. The first and second cohorts included 2,702 and 2,926 people aged > or =65 years free from dementia at baseline. Life expectancy without dementia or dementia-free life expectancy (DemFLE) is defined as the average number of years a person is expected to live without dementia. Total life expectancy is equal to the sum of DemFLE and life expectancy with dementia. Estimations of DemFLE were based on mortality data and incidence of dementia, using double-decrement life tables. RESULTS: Between the first and second cohorts, all-cause mortality rates declined, while the incidence of dementia remained constant in both men and women. Among the males, total life expectancy increased at a higher rate than DemFLE. Consequently, the duration of life with dementia was extended in the second cohort. Conversely, among the females DemFLE increased at a higher rate than total life expectancy, thus the duration of life with dementia decreased in the second cohort. The median age of dementia onset was postponed by 2-3 years in the second cohort for females, and did not show any specific difference between the two cohorts in males. CONCLUSION: The trends of health expectancies suggest an extension of the duration of life with dementia for males and a compression of dementia for females. A decreased incidence of risk factors for dementia among females in the second cohort such as stroke may explain these trends.

Age Distribution↗
PubMed2006

Widening socioeconomic inequalities in US life expectancy, 1980-2000.

BACKGROUND: This study examines changes in the extent of inequalities in life expectancy at birth and other ages in the United States between 1980 and 2000 by gender and socioeconomic deprivation levels. METHODS: A factor-based deprivation index consisting of 11 education, occupation, wealth, income distribution, unemployment, poverty, and housing quality indicators was used to define deprivation deciles, which were then linked to the US mortality data at the county-level. Life expectancy estimates were developed by age, gender, and deprivation levels for three 3 year time periods: 1980-82, 1989-91, and 1998-2000. Inequalities in life expectancy were measured by the absolute difference between the least-deprived group and each of the other deprivation deciles. Slope indices of inequality for each gender and time period were calculated by regressing life expectancy estimates on deprivation levels using weighted least squares models. RESULTS: Those in less-deprived groups experienced a longer life expectancy at each age than their counterparts in more-deprived groups. In 1980-82, the overall life expectancy at birth was 2.8 years longer for the least-deprived group than for the most-deprived group (75.8 vs 73.0 years). By 1998-2000, the absolute difference in life expectancy at birth had increased to 4.5 years (79.2 vs 74.7 years). The inequality indices also showed a substantial widening of the deprivation gradient in life expectancy during the study period for both males and females. CONCLUSIONS: Between 1980 and 2000, those in higher socioeconomic groups experienced larger gains in life expectancy than those in more-deprived groups, contributing to the widening gap.

Educational Status↗
PubMed2001

Healthy life expectancy in 191 countries, 1999.

We describe here the methods used to produce the first estimates of healthy life expectancy (DALE) for 191 countries in 1999. These were based on estimates of the incidence, prevalence, and disability distributions for 109 disease and injury causes by age group, sex, and region of the world, and an analysis of 60 representative health surveys across the world. We used Sullivan's method to compute healthy life expectancy for men and women in each WHO member country. Japan had the highest average healthy life expectancy of 74.5 years at birth in 1999. The bottom ten countries are all in sub-Saharan Africa, where the HIV-AIDS epidemic is most prevalent, resulting in DALE at birth of less than 35 years. Years of healthy life lost due to disability represent 18% of total life expectancy in the bottom countries, and decreases to around 8% in the countries with the highest healthy life expectancies. Globally, the male-female gap is lower for DALE than for total life expectancy. Healthy life expectancy increases across countries at a faster rate than total life expectancy, suggesting that reductions in mortality are accompanied by reductions in disability. Although women live longer, they spend a greater amount of time with disability. As average levels of health expenditure per capita increase, healthy life expectancy increases at a greater rate than total life expectancy.

Adolescent↗
PubMed1995

Prognosis and life expectancy in chronic liver disease.

The aim of the present was to define prognosis and life expectancy in patients with chronic liver disease of different etiologies and to relate them to an age- and sex-matched normal population. After a follow-up of 15 years, life expectancy of 620 patients with chronic liver disease was retrospectively calculated and compared with an age- and sex-matched normal population. Among patients with cirrhosis, prognosis was dependent upon Child classification (P = 0.001). Patients with alcoholic cirrhosis and fatty liver disease were younger (P = 0.01) and had a lower life expectancy than patients with other causes of chronic liver disease (P = 0.004). Patients with hepatitis B and hepatitis C cirrhosis showed a comparable prognosis and a significantly lower life expectancy than the age- and sex-matched population. Cryptogenic and autoimmune liver diseases showed a comparable life expectancy but a significantly shorter life expectancy than the normal population. In patients with alpha 1-antitrypsin deficiency-associated cirrhosis, a high viral coinfection rate was found (P = 0.01). For patients with noncirrhotic hemochromatosis, prognosis was poorer than that for the age- and sex-matched population. In patients with asymptomatic primary biliary cirrhosis, chronic persistent hepatitis B, and alpha 1-antitrypsin deficiency without cirrhosis, life expectancy was equal to that of the normal population. Prognosis and life expectancy in chronic liver disease depend on stage, cause, and symptoms of chronic liver disease; age; and possibilities of treatment. In patients with hereditary liver disease, additional viral infection of alcohol abuse lead to a significant deterioration of life expectancy. Patients with alcoholic chronic liver disease have the poorest prognosis.

Autoimmune Diseases↗
PubMed1998

The use of the Gompertz function to relate changes in life expectancy to the standardized mortality ratio.

BACKGROUND: Change in life expectancy may be more readily appreciated by a lay person as a measure of risk than the standardized mortality ratio (SMR). METHODS: The linear increase in the logarithm of the age-specific mortality rates with age (the Gompertz function) is used to deduce formulae connecting SMR with change in life expectancy. Their validity is checked by a comparison between the 1992 and 1952 mortality data for England and Wales, and between smokers and non-smokers in the American Cancer Society's second Cancer Prevention Study. RESULTS: It is shown that the Gompertz function is a good fit to mortality data for England and Wales from age 30 years upwards. Changes in life expectancy at ages 15, 25, 45 and 65 are presented for values of SMR from 0.5 to 3. A very simple formula connecting the two is valid at ages 15 and 25, and provides a reasonable approximation at age 45. CONCLUSIONS: The Gompertz relationship can be used to calculate the change in life expectancy corresponding to a particular SMR over a greater range than have previous methods, and, although subject to some uncertainties, can provide a quick method of judging the change in life expectancy that is associated with a given SMR value.

Adolescent↗
PubMed2003

Trends in the association between average income, poverty and income inequality and life expectancy in Spain.

In this paper, we study the relation between life expectancy and both average income and measures of income inequality in 1980 and 1990, using the 17 Spanish regions as units of analysis. Average income was measured as average total income per household. The indicators of income inequality used were three measures of relative poverty-the percentage of households with total income less than 25%, 40% and 50% of the average total household income-the Gini index and the Atkinson indices with parameters alpha=1, 1.5 and 2. Pearson and partial correlation coefficients were used to evaluate the association between average income and measures of income inequality and life expectancy. None of the correlation coefficients for the association between life expectancy and average household income was significant for men. The association between life expectancy and average household income in women, adjusted for any of the measures of income inequality, was significant in 1980, although this association decreased or disappeared in 1990 after adjusting for measures of poverty. In both men and women, the partial correlation coefficients between life expectancy and the measures of relative income adjusted for average income were positive in 1980 and negative in 1990, although none of them was significant. The results with regard to women confirm the hypothesis that life expectancy in the developed countries has become more dissociated from average income level and more associated with income inequality. The absence of a relation in men in 1990 may be due to the large impact of premature mortality from AIDS in regions with the highest average total income per household and/or smallest income inequality.

Female↗
PubMed1991

Cross-sectional estimates of active life expectancy for the U.S. elderly and oldest-old populations.

Estimates are made of active life expectancy for the U.S. elderly and oldest-old populations using data from the 1982 and 1984 National Long Term Care Surveys. In the calculation of active life expectancy a multivariate analysis of 27 measures of functioning was used to define scores to decompose total life expectancy by type and level of disability. These analyses showed significant differences in active life expectancy for males and females. Though a higher proportion of male life expectancy at age 65 was "active," females had larger absolute amounts of active life expectancy. By age 85, in contrast, males had a higher absolute amount of active life expectancy. In addition, calculations were performed with the disability associated with cognitive impairment eliminated in order to illustrate the sensitivity of active life expectancy to changes in morbidity.

Activities of Daily Living↗
PubMed1983

Gains in life expectancies if heart disease and stroke were eliminated among Caucasians, Filipinos and Japanese in Hawaii.

Life tables were constructed based on all deaths in Hawaii occurring between 1968-1972 for Caucasians, Filipinos and Japanese. Gains in life expectancies to be attained if coronary heart disease (CHD) and cerebrovascular accidents (CVA) were eliminated were presented by sex and ethnic group. The expectation of life at birth for both males and females is greatest for Japanese, followed by Filipinos and then Caucasians. The gain in life expectancy by eliminating CHD would not benefit Caucasians while Filipinos would benefit the most from the elimination of CVA. For all ethnic groups and both sexes, the gain in expectation of life due to the elimination of CHD is more than were CVA eliminated as a cause of death.

Actuarial Analysis↗
PubMed1998

Life expectancy of persons with chronic disabilities.

The life expectancy is an important summary measure of an individual's prognosis for survival. The life table is the preferred method for computing life expectancies, but it is not always feasible. We show that for several chronic disabilities, the logarithms of the age-specific mortality ratios (relative to the general population) decline linearly with age, reaching parity at age 85 or older. This, combined with a standard modeling of an individual's current mortality rate, yields a set of age-specific mortality rates that can be used to produce a "customized" life table. The life expectancy is then immediately available. In a series of empirical comparisons the method performed better than an assumption of constant excess death rate (EDR), and much better than one of constant mortality ratio (MR). The method may be useful for a variety of non-progressive disabilities, such as cerebral palsy and injuries of the brain or spinal cord.

Adolescent↗
PubMed2001

Influence of homicide on racial disparity in life expectancy--United States, 1998.

Life expectancy (LE) is an important indicator of the health of populations. Since the early 1900s, when estimates of LE began to be tabulated in the United States, the LE of blacks has been lower than that of whites (1). Homicide, which disproportionately affects blacks, particularly young males, contributes to this difference in LE. To examine the associations between homicide, LE, and race, CDC analyzed 1998 mortality files from the National Center for Health Statistics (NCHS). This report summarizes the results of that analysis, which indicate, that in 1998, the LE for blacks was approximately 6 years shorter than for whites and that, after heart disease and cancer, homicide was the next largest contributor to the 6-year discrepancy. Violence prevention strategies (e.g., programs for youth offenders) have been implemented for the general population. More research is needed to determine an approach to target the male black population and to reduce LE disparity.

Black or African American↗
PubMed1996

Dementia-free life expectancy (DemFLE) in The Netherlands.

To gain an insight into the burden of dementia in an aging society, life expectancy with dementia and its counterpart dementia-free life expectancy (DemFLE) in The Netherlands are presented. Sullivan's method was used to calculate DemFLE. For elderly living either independently or in homes for the elderly prevalence figures on dementia were obtained from the Rotterdam Elderly Study (RES; n = 7528); for elderly in nursing homes the SIG Nursing home Information System was used. Conforming to other authors only the prevalence data on moderate and severe dementia as diagnosed with DSM-III-R criteria are used. The prevalence of mild dementia was not taken into account. At 65 years DemFLE for men is 14.0 years, that is 96.4% of the total life expectancy (14.5 years at this age). At age 90, DemFLE for men is 2.5 years, equal to 77.5% of the total life expectancy (3.3 years). For women DemFLE at age 65 is 17.7 years, that is 93.2% of their life expectancy (19.0 years), and at the age of 90, DemFLE for women is 2.8 years, equal to 74.7% of their remaining life expectancy (3.8 years). The absolute number of years with dementia remains relatively constant with increasing age. About 20-25% of these years with dementia are spent in nursing homes, the other 75-80% living independently. At each age compared with men women have both a higher DemFLE and a higher expectancy of years with dementia. The percentage of life expectancy without dementia however, is always lower for women, because of their higher total life expectancy. This indicates that the burden of dementia in absolute and relative terms is higher for women. Most years with dementia are spent at home, indicating that the burden of dementia rests mainly on the shoulders of informal caregivers.

Aged↗
PubMed2006

Estimation of reduced life expectancy from serious occupational injuries in Taiwan.

This study assesses the loss of life expectancy and potential working life in Taiwan, between 1986 and 2000, from various types of occupational accidents resulting in mortality or permanent disability. The databases on occupational mortality and permanent disability were obtained from the Bureau of Labor Insurance, with this information then being linked to national death registry data to construct the survival function. A Monte Carlo simulation method was subsequently used to extrapolate the survival rate for up to 600 months, to derive the life expectancy for different types of occupational accidents leading to permanent disability (n=81,249). Based upon the life table for each calendar year, the life expectancy lost by age-gender cohort was also estimated for cases of mortality (n=20,001). In those cases resulting in permanent occupational disability, variations in the expected years of life lost (EYLL) were demonstrated by different occupational injuries, ranging from 7.4 to 13.6 years per case. The overall EYLL through permanent occupational disability is found to be almost identical to that of occupational mortality, with a ratio of 1.04:1. We conclude that permanent disability resulting from occupational injuries has a significant impact on society as a whole.

Accidents, Occupational↗
PubMed2003

Disability-free life expectancy of elderly people in a population undergoing demographic and epidemiologic transition.

BACKGROUND: the major purpose of health and social policy in old age is to increase quality of life of elderly people. In many demographically developing countries, life expectancy is increasing very rapidly, but little information is available on survival free of disability. OBJECTIVES: to determine prevalence and severity of disability among the elderly population and to compare disability-free life expectancy and self-care life expectancy among different age groups and between men and women. DESIGN: a cross-sectional multi-stage random sample survey and routine life tables for Thailand. SETTING: national population of Thailand. SUBJECTS: 4,048 elderly subjects aged 60+ years. RESULTS: prevalence rates (95% CI) of long-term disability and dependency in self-care activities of daily living were 19% (95% CI 17.8, 20.2) and 6.9% (6.1, 7.7) respectively. Rates of disabilities increased with age and women were more disabled than men. The life expectancy and disability-free life expectancy at age 60 for men were 20.3 years and 16.4 years, and for women were 23.9 years and 18.2 years respectively. Self-care life expectancies at age 60, calculated from the prevalence of needing help with basic self-care activities, were 18.6 years and 21.3 years for men and women respectively. Women spent proportionately more of their longer life expectancy in a disabled state than men. Men and women can, respectively, expect that 19% and 24% of their life expectancy at age 60 will be spent in a disabled state, but may expect only about 10% of their life expectancy to be spent unable to manage basic self-care activities of daily living. CONCLUSION: long-term disability is common in old age, affecting a quarter of people over 60 years. However, self-care problems are much less common and suggest that the social and health care consequences of demographic transitions are over-estimated by use of simple questions about limiting long-standing disability. Self-care life expectancy provides a useful monitoring tool for censuses and national disability surveys.

Age Factors↗
PubMedDate not supplied

A cross-national analysis on determinants of life-expectancy in Africa.

The authors estimate and compare life expectancy for 28 African countries in 1984 and 1987, and relate the length of life to selected socioeconomic variables. "The objective of the study is...to identify some determinants of life expectancy and achieve some understanding of their underlying structures so as to make it possible to know those that can be manipulated by policy in order to increase the life expectancy in Africa." Data are from published UN sources.

Africa↗
PubMed1999

Thrombosis-free survival and life expectancy in 187 consecutive patients with essential thrombocythemia.

A total of 187 consecutive patients with essential thrombocythemia (ET) were diagnosed and followed by our Hematology Department in the period October 1980-November 1994. The overall follow-up was 773 patient-years. Thrombosis-free survival and overall survival were calculated for the whole cohort; the same parameters were then calculated after arbitrary division of the cohort into two groups, according to the median age at diagnosis (55 years). Fifty percent of the patients had at least one thrombotic episode within 9 years after diagnosis. The thrombosis-free survival curves calculated for patients younger or older than 55 years at diagnosis were comparable. About 85% of the patients were alive 10 years after diagnosis. The survival curves for patients younger and older than 55 years at diagnosis were not significantly different in the observation period, and the observed mortality (seven patients) among patients younger than 55 years at diagnosis was significantly higher than expected (1.68 cases). The relative risk of death was four times greater (SMR = 4.17, 95% C.I. 1.6-8.6, p<0.01) than for healthy, age-matched people living in the same area. Age at diagnosis, smoking, sex, hypercholesterolemia, peak number of platelets, hypertension, and diabetes were not significant prognostic cardiovascular risk factors in our cohort. In conclusion, our data show that ET has to be considered a serious disease that significantly decreases both quality of life (expected life without thrombosis) and life expectancy for younger patients.

Cohort Studies↗