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PubMed2002

The ten-year rule revisited: accuracy of clinicians' estimates of life expectancy in patients with localized prostate cancer.

OBJECTIVES: To determine the accuracy of clinicians' predictions of life expectancy in patients with localized prostate cancer, when provided with information about age and comorbidity, and to determine whether life expectancy estimates predict the choice of initial treatment. METHODS: A survey was sent by facsimile to 191 Canadian urologists and radiation oncologists asking them to estimate the life expectancy and choose the initial therapy (radical prostatectomy, radiation, or watchful waiting) for 18 patient scenarios: two prostate cancer scenarios, each with three ages and three levels of comorbidity. RESULTS: Life expectancy estimates were accurate within 1 year of the projections of a Markov model for 31% of the clinicians' responses and accurate within 3 years for 67% of the responses. The average prediction error ranged from 2.4 to 5.2 years. The life expectancy was correctly estimated as being greater than or less than 10 years in 82% of responses. Ten years was the minimal life expectancy for recommending surgery and within the range (5 to 15 years) in which radiation was recommended. CONCLUSIONS: Clinicians can use age and comorbidity to predict the life expectancy of patients with localized prostate cancer with a modest degree of overall accuracy, but with sufficient accuracy to use the "10-year rule." Life expectancy estimates are strongly associated with treatment choice. The appropriateness of the 10-year rule remains to be determined.

Age Factors↗
PubMed1994

Black/white life expectancy differences and sociodemographics: Arkansas and the U.S.

Life expectancy data by race and gender for Arkansas show whites having longer average life expectancies at birth than blacks. Racial differences in life expectancy have been found to be due to higher mortality rates for blacks due to their tendency to fall into high-risk groups. Cause-specific mortality rates by race and gender for Arkansans 25 years and older were calculated for the ten leading causes of death in the state. Blacks in Arkansas had higher mortality rates than whites for each major cause of death except pulmonary diseases and suicide.

Black or African American↗
PubMed2003

Blood pressure lowering and life expectancy based on a Markov model of cardiovascular events.

The life expectancy benefits of antihypertensive treatment, based on both systolic and diastolic blood pressure reduction, was estimated with a cardiovascular disease event Markov model with prospective data from 57 573 men and women. Seven patient states were defined, including (1) no cardiovascular disease, (2) stroke, (3) myocardial infarction, (4) revascularization, (5) history of cardiovascular disease, (6) noncardiovascular disease death, and (7) cardiovascular death. Risk functions were developed from gender-specific multivariate Cox proportional hazards models for primary events and age-, smoking-, and diabetes-adjusted models for secondary events. At baseline we assumed (1) hypothetical pretreatment blood pressures of 160/95 or 150/90 mm Hg; (2) strategies A and B lower blood pressure by 20/13 and 13/8 mm Hg, respectively; and (3) baseline age of 35 years. For subjects initially at 160/95 mm Hg, those with antihypertensive treatment, antihypertensive treatment and diabetes, or antihypertensive treatment, diabetes, and currently smoking had corresponding gains in life expectancy of 2.43, 2.80, and 2.43 years for Strategy A. An initial blood pressure of 150/90 mm Hg resulted in similar gains. Compared with Strategy B, with blood pressure reductions of 13/8 mm Hg, Strategy A provided additional gains in life expectancy of 0.84, 0.99, and 0.87 years for those with antihypertensive treatment, antihypertensive treatment and diabetes, or antihypertensive treatment, diabetes, and currently smoking. The initial blood pressure level did not affect the magnitude of life expectancy gains for equivalent blood pressure reductions. Greater gains in life expectancy among hypertensive and diabetic women suggest that blood pressure lowering may yield greater benefits in selected subgroups.

Adult↗
PubMed1989

Bounds on life expectancy for the Rayleigh and Weibull distributions.

Bounds are presented for the life expectancy or the mean residual life of an individual whose lifetime is a random variable X following a Rayleigh distribution or more generally a Weibull distribution. Simple transformations of the variables give inequalities on the Mills' ratio and the incomplete gamma functions. Some numerical computations are also reported to compare the lower and upper bounds with the exact value of the life expectancy function for several values of the parameter. When the lifetime follows a Gompertz distribution, the problem becomes complicated, and it has not been possible to construct bounds on the life expectancy function. The importance of the Gompertz distribution in the dynamics of normal and tumor growth and in the embryonic and postnatal growth of birds and mammals is demonstrated, and life expectancy is evaluated by numerical methods for a number of parameter values.

Animals↗
PubMed2001

The effect of arthritis on working life expectancy.

OBJECTIVE: To measure the effect of arthritis and musculoskeletal conditions on working life expectancy. METHODS: Cross sectional data from the 1994 Canadian National Population Health Survey (NPHS) were used to calculate and compare the working life expectancy of individuals who reported "arthritis or rheumatism" with that of the general population. Age and sex-specific workforce participation rates were calculated for the population reporting arthritis or rheumatism as a chronic condition, excluding back pain, and for the entire population surveyed. Age and sex-specific population figures and mortality data were obtained from annual estimates produced by Statistics Canada. Working life expectancy was estimated by constructing multiple-decrement life tables for the total and for the arthritis and rheumatism populations. RESULTS: The NPHS surveyed 22,000 households, yielding a sample size of 58,439 individuals. The percentage of the population aged 15 to 65 yrs who reported having arthritis or rheumatism was 8.9%. The percentage of persons employed for each group was reduced compared to the total population, by 3 to 23%. Working life expectancy of individuals with arthritis or rheumatism was reduced by 4.19 +/- 0.02 yrs (mean +/- SE) for men and 3.12 +/- 0.01 yrs for women at age 15 (p < 0.001 for both), with a persistent reduction through all age groups. Working life expectancy of men at age 15 was 37.42 +/- 0.01 yrs for the population with arthritis or rheumatism compared to 41.62 +/- 0.01 yrs for the total population; for women it was 31.06 +/- 0.01 and 34.19 +/- 0.001 yrs for both groups, respectively. CONCLUSION: The working life expectancy of people with arthritis and musculoskeletal conditions is significantly reduced compared to the general Canadian population.

Adolescent↗
PubMed2000

The impact of colorectal cancer screening on life expectancy.

METHODS: The purpose of this study was to assess the effect of screening for colorectal cancer on life expectancy and estimate the number of colonoscopies needed per life year saved. The declining exponential approximation of life expectancy was used to calculate the effect of colorectal cancer screening on expected remaining lifetime. The annual number of deaths from colorectal cancer and the size of the population were obtained from the vital statistics of the United States. Published reports were consulted to determine the decrease in mortality from colorectal cancer achieved by fecal occult blood testing, screening sigmoidoscopy or colonoscopy. A Markov chain analysis was used to determine the endoscopic resources required to screen and survey the entire population of U.S. residents age 50 years until death or age 85 years. RESULTS: Colorectal cancer decreases the life expectancy of U.S. residents aged 50 to 54 years by 292 days and those aged 70 to 74 years by 70 days. Screening with fecal occult blood tests extends expected lifetime of the 2 age groups by 51 and 12 days, respectively, whereas screening with sigmoidoscopy leads to increases of 86 and 21 days. Colonoscopic screening increases expected lifetime by 170 and 41 days, respectively. The number of colonoscopies needed to save 1 year of expected life ranges from 2.9 to 6.0, depending on the type of screening regimen used. CONCLUSIONS: The extension of life through screening colonoscopy is two or three times longer than the extension achieved through flexible sigmoidoscopy or fecal occult blood test, respectively. Although a large number of colonoscopies are required to screen the U.S. population, relatively few colonoscopies need to be invested per year of life expectancy saved.

Aged↗
PubMed2005

Has the relation between income inequality and life expectancy disappeared? Evidence from Italy and top industrialised countries.

OBJECTIVE: To investigate the relation between income inequality and life expectancy in Italy and across wealthy nations. DESIGN AND SETTING: Measure correlation between income inequality and life expectancy at birth within Italy and across the top 21 wealthy countries. Pearson correlation coefficients were calculated to study these relations. Multivariate linear regression was used to measure the association between income inequality and life expectancy at birth adjusting for per capita income, education, and/or per capita gross domestic product. DATA SOURCES: Data on the Gini coefficient (income inequality), life expectancy at birth, per capita income, and educational attainment for Italy came from the surveys on Italian household on income and wealth 1995-2000 and the National Institute of Statistics information system. Data for industrialised nations were taken from the United Nations Development Program's human development indicators database 2003. RESULTS: In Italy, income inequality (beta = -0.433; p<0.001) and educational attainment (beta = 0.306; p<0.001) were independently associated with life expectancy, but per capita income was not (beta = 0.121; p>0.05). In cross national analyses, income inequality had a strong negative correlation with life expectancy at birth (r = -0.864; p<0.001). CONCLUSIONS: In Italy, a country where health care and education are universally available, and with a strong social safety net, income inequality had an independent and more powerful effect on life expectancy at birth than did per capita income and educational attainment. Italy had a moderately high degree of income inequality and an average life expectancy compared with other wealthy countries. The cross national analyses showed that the relation between income inequality and population health has not disappeared.

Adult↗
PubMed1997

[Preliminary analysis of healthy life expectancy in some urban residents].

Healthy life expectancy in some urban residents was analyzed with fundamental principles of Sullivan's method and mortality data in our residents and some data from national health service survey conducted in 1993 to assess their quality of life. Results showed that proportion of healthy to total life expectancy accounted for more in males than in females and in medium-sized and small cities than in large ones, and decreased with increase of age. It suggests that quality of life in some of our urban residents lowered with increase of age, was worse in women than in men and lower in large cities than in mediumsized and small ones.

China↗
PubMed2000

Healthy life expectancy of Thai elderly: did it improve during the soap-bubble economic period?

Healthy life expectancy (HLE) of Thai elderly was studied to clarify the health benefit for the elderly population in Thailand during the soap-bubble economic period by comparing their HLE and life expectancy (LE) in 1986 and 1995. The information on the perceived health status of Thai elderly, aged 60 and over, from two national surveys in 1986 and 1995 and the life tables of correspondent years were used for calculating healthy life expectancy. Both life expectancy (LE) and healthy life expectancy (HLE) of Thai elderly have markedly increased between 1986 and 1995. Regardless of sex, the HLE-LE ratios of nearly all age groups increased from 1986 to 1995. This suggests that the unhealthy life duration had been compressed. Women spend more years than men both active and inactive at every age; however, the proportion of life that is expected to be active is less for women. In conclusion, health and well-being of Thai elderly population significantly improved during the soap-bubble economic period (1989-1996) of Thailand.

Aged↗
PubMed2006

Life expectancy of adult liver allograft recipients in the UK.

BACKGROUND: Liver transplantation is a very successful therapy for those with end stage disease. Although there are numerous data on patient and graft survival after liver transplantation, life expectancy and possible loss of life (compared with a normal matched population) in those who survive remains unknown. AIMS: To assess the life expectancy and life years lost of adult liver allograft recipients, compared with an age and sex matched UK population to provide patients with more information and to improve the use of a scarce resource. METHODS: Using the National Transplant Database held by UK Transplant, on over 3600 adult liver allograft recipients transplanted between 1985 and 2003, we analysed survival of all adults who survived more than six months after transplantation and compared survival after transplantation with national age and sex matched controls to assess life years lost. RESULTS: Estimated median survival time of the analysis cohort of 2702 adult liver allograft recipients was 22.2 years (95% confidence interval 19.3-25.6), with an estimated loss of seven life years compared with an age and sex matched population. CONCLUSIONS: Overall, female recipients have a longer life expectancy and lose fewer life years than male recipients. While younger recipients have a longer life expectancy, they also lose more life years. Those transplanted for cancer, hepatitis C virus infection, and alcoholic liver disease had the greatest loss of life years.

Adolescent↗
PubMed2002

Life expectancy in the province of Halland, Sweden, 1911-50: the progress of public health in a long-living population.

BACKGROUND: Life expectancy in Sweden is currently one of the longest in the world. The population of Halland has the longest life expectancy in Sweden. AIM: Life expectancy in the province of Halland and Sweden as a whole during 1911-50 was studied and the findings are discussed in the light of local historical data. METHOD: A trend analysis of risk ratio of death and life expectancy for Halland and Sweden was done for the period 1911-50 with regard to calendar year, age, and sex using a Poisson model. RESULTS: The risk ratio between Halland and Sweden was 0.83 for 1911 and 0.76 for 1950. The risk ratio of death for women was lower compared with men and this difference increased over time. At the start of the study period life expectancy for men and women was higher in Halland (58.5 and 60.1 years, respectively) compared with Sweden (54.7 and 56.4 years, respectively) with a difference of approximately 3.8 years. At the end of the study period this difference in life expectancy for men and women in Halland (71.3 and 72.3 years, respectively) and the nation (68.0 and 69.2 years, respectively) had decreased to approximately 3.3 years. CONCLUSION: The long life expectancy seen in Halland today can be traced back to the early twentieth century. The starting point for this development seems to be a lower infant mortality in Halland compared with Sweden as a nation during the 1880-90. The basis for this might have been a greater increase of food production during the whole nineteenth century as well as other socioeconomic characteristics of Halland compared with the rest of the country.

Aged↗
PubMed2006

Estimates of life expectancy by adolescents and young adults with congenital heart disease.

OBJECTIVES: This study sought to determine what adolescents and young adults with moderate to complex congenital heart disease (CHD) believe their life span to be and to examine correlates of their beliefs. BACKGROUND: Patients with moderate to complex CHD have a shortened life expectancy. Patients' perceptions of their life expectancy have not been examined. METHODS: Young adults and older adolescents with moderate or complex CHD (n = 296) estimated their own life expectancy and that of healthy peers, and rated their health status and risk of CHD complications. Adults with CHD discussed reasons for life expectancy ratings in an interview. RESULTS: Patients with CHD expected to live to age 75 +/- 11 years, only 4 years less than their healthy peers. Over 85% of patients expected to live longer than our estimates of their life expectancy. Poorer health status and higher perceived risk of CHD complications related to shorter perceived life expectancy. Young adults lacked awareness and understanding of CHD-specific risks, and their life expectancy perceptions often related to risk factors for coronary artery disease. CONCLUSIONS: Patients with moderate to complex CHD expect to live almost as long as their healthy peers. For most patients, this is unlikely. The implications of these beliefs on health behaviors and life choices are unknown, but should be examined. Nevertheless, patients need accurate information delivered in a sensitive manner to make informed life choices regarding education, careers, and family.

Adolescent↗
PubMed1991

[Prognosis and life expectancy in multiple sclerosis].

Prognosis and life expectancy of patients with multiple sclerosis can be judged according to disability state, to duration and course of the disease on the basis of regular examinations. Assuming that life expectancy is reduced--collectively--by 10 to 15 years, it should be possible to find some form of life insurance for patients with multiple sclerosis also.

Disability Evaluation↗
PubMed2006

Life expectancy and mortality differences between populations on Croatian islands and the mainland.

AIM: To examine the differences in life expectancy and mortality between the populations on Croatian islands and the mainland, and among the islands themselves. METHOD: Data on population size and mortality collected in Croatia in 2001 were analyzed by life table and standardized mortality rates. RESULTS: Life expectancy at birth (95% confidence interval) of the population on Croatian islands was 76.4 yr (75.7-77.1) which was significantly higher than life expectancy at birth of general Croatian population which was 73.8 yr (73.5-73.9) or mainland Croatian population which was 73.7 yr (73.6-73.8). Island population had higher life expectancy until the age of 80 and again in the oldest age group, 95+. More than 10% of inhabited islands in Croatia had life expectancy at birth over 80 years. Two inhabited islands, Ilovik (Kvarner islands) and Lopud (South Dalmatian islands), had one of the highest life expectancy at birth recorded in the literature, with 95.0 and 90.6 years respectively. Mortality rates on islands were significantly lower for age groups 50-64 and 65-79 years, and this difference persisted for all island groups compared with general Croatian population. CONCLUSION: Residents of Croatian islands had a higher life expectancy than general or mainland Croatian population. Life expectancy at birth on Croatian islands was lower than in other European Mediterranean countries, but it resembles that in the neighboring Slovenia, and it is considerably higher than in central and eastern Europe and Balkan countries.

Aged↗
PubMed2001

Trends in healthy life expectancy in the United States, 1970-1990: gender, racial, and educational differences.

This paper examines healthy life expectancy by gender and education for whites and African Americans in the United States at three dates: 1970, 1980 and 1990. There are large racial and educational differences in healthy life expectancy at each date and differences by education in healthy life expectancy are even larger than differences in total life expectancy. Large racial differences exist in healthy life expectancy at lower levels of education. Educational differences in healthy life expectancy have been increasing over time because of widening differentials in both mortality and morbidity. In the last decade, a compression of morbidity has begun among those of higher educational status; those of lower status are still experiencing expansion of morbidity.

Adult↗
PubMed2006

Analysis of air pollution mortality in terms of life expectancy changes: relation between time series, intervention, and cohort studies.

BACKGROUND: Information on life expectancy change is of great concern for policy makers, as evidenced by the discussions of the so-called "harvesting" issue (i.e. the question being, how large a loss each death corresponds to in the mortality results of time series studies). METHODS: Whereas most epidemiological studies of air pollution mortality have been formulated in terms of mortality risk, this paper shows that a formulation in terms of life expectancy change is mathematically equivalent, but offers several advantages: it automatically takes into account the constraint that everybody dies exactly once, regardless of pollution; it provides a unified framework for time series, intervention studies and cohort studies; and in time series and intervention studies, it yields the life expectancy change directly as a time integral of the observed mortality rate. RESULTS: Results are presented for life expectancy change in time series studies. Determination of the corresponding total number of attributable deaths (as opposed to the number of observed deaths) is shown to be problematic. The time variation of mortality after a change in exposure is shown to depend on the processes by which the body can repair air pollution damage, in particular on their time constants. Hypothetical results are presented for repair models that are plausible in view of the available intervention studies of air pollution and of smoking cessation. If these repair models can also be assumed for acute effects, the results of cohort studies are compatible with those of time series. CONCLUSION: The proposed life expectancy framework provides information on the life expectancy change in time series studies, and it clarifies the relation between the results of time series, intervention, and cohort studies.

Air Pollutants↗
PubMed1999

Independent life expectancy in New Zealand, 1996-97.

The objective of this article is to describe independent life expectancy (ILE) in New Zealand in 1996-97, including variations in this indicator between age, gender and ethnic groups. ILE is defined as the number of years a person can expect to live without any self-reported functional limitation requiring the assistance of another person or a complex assistive device. ILE is a positive measure of health. Its complement, expectation of life with dependency (LED), is also a useful indicator. Together, ILE and LED add up to total life expectancy (LE). The contribution to ILE from disability and mortality at each age is analysed in this article. The elasticity of ILE to changes in mortality and to changes in disability is also investigated. Finally, the burden of injury is estimated by calculating the potential gain in ILE that would result were injury-related disability and mortality to be eliminated.

Activities of Daily Living↗
PubMed2005

Geographical variation in life expectancy at birth in England and Wales is largely explained by deprivation.

STUDY OBJECTIVE: To describe the population mortality profile of England and Wales by deprivation and in each government office region (GOR) during 1998, and to quantify the influence of geography and deprivation in determining life expectancy. DESIGN: Construction of life tables describing age specific mortality rates and life expectancy at birth from death registrations and estimated population counts. Life tables were created for (a) quintiles of income deprivation based on the income domain score of the index of multiple deprivation 2000, (b) each GOR and Wales, and (c) every combination of deprivation and geography. SETTING: England and Wales.PATIENTS/ PARTICIPANTS: Residents of England and Wales, 1998. MAIN RESULTS: Life expectancy at birth varies with deprivation quintile and is highest in the most affluent groups. The differences are mainly attributable to differences in mortality rates under 75 years of age. Regional life expectancies display a clear north-south gradient. Linear regression analysis shows that deprivation explains most of the geographical variation in life expectancy. CONCLUSIONS: Geographical patterns of life expectancy identified within these data for England and Wales in 1998 are mainly attributable to variations in deprivation status as defined by the IMD 2000 income domain score.

Adolescent↗