Abstract
Subjective well-being is associated with reduced mortality, but it is not clear whether additional time is spent in good health or with chronic disease and disability. To evaluate the associations between affective well-being, total life expectancy, and life expectancy free of disability and chronic disease. This survey study used data on 9761 participants from the English Longitudinal Study of Ageing who were followed up for a maximum of 10 years (mean [SD] follow-up, 6 [3.7] years). Discrete-time multistate life table models were used to estimate total life expectancy and life expectancy free of disability or chronic disease. Data were collected between March 2002 and March 2013 and analyzed from December 2018 to April 2019. Analyses were adjusted for wealth and cohabiting status. The main outcome was life expectancy free of disability and chronic disease. Affective well-being was assessed at baseline as a combination of enjoyment of life and the lack of significant depressive symptoms. Disability was measured in terms of impaired activities of daily living and instrumental activities of daily living, and chronic disease as the occurrence of 6 serious illnesses. Data were analyzed from 9761 participants (5297 [54%] female; mean [SD] age at baseline, 64 [9.9] years). High affective well-being was associated with longer life expectancy and with longer disability-free and chronic disease-free life expectancies. For example, a woman aged 50 years who reported high affective well-being could expect to live 6 years longer than a woman of similar age with low well-being; 31.4 of her remaining years (95% CI, 30.5-31.9 years) would be likely to be free of disability, compared with 20.8 years (95% CI, 20.1-22.1 years) for a woman with low affective well-being. A man aged 50 years with high affective well-being could expect to live 20.8 years (95% CI, 18.7-22.4 years) without chronic disease, compared with 11.4 years (95% CI, 8.5-14.6 years) for a man reporting low well-being. Similar patterns were observed at the ages of 60, 70, and 80 years. This study suggests that people who report high levels of subjective well-being live longer and also healthier lives than those with lower well-being. These findings add weight to endeavors to promote the subjective well-being of older people.
Highlights
Subjective well-being (SWB) has emerged as an important issue in health research and practice over recent decades and includes experiences of affective well-being such as happiness and enjoyment of life, evaluative well-being related to life satisfaction, and eudemonic well-being, involving judgements of life having meaning and purpose.[1]
High affective well-being was associated with longer life expectancy and with longer disability-free and chronic disease–free life expectancies
A man aged 50 years with high affective well-being could expect to live 20.8 years without chronic disease, compared with 11.4 years for a man reporting low well-being
Summary
Subjective well-being (SWB) has emerged as an important issue in health research and practice over recent decades and includes experiences of affective well-being such as happiness and enjoyment of life, evaluative well-being related to life satisfaction, and eudemonic well-being, involving judgements of life having meaning and purpose.[1]. Health expectancy provides estimates of how many years of future life are likely to be spent in good health and has been applied to issues such as socioeconomic deprivation, lifestyle, and obesity.[14,15,16] Here, we estimate life expectancy and healthy life expectancy, defined as years free of disability and serious chronic illness, in association with affective well-being. We measured affective well-being as enjoyment of life coupled with low levels of depressive symptoms, as both aspects of well-being have previously been shown to be associated with mortality in the English Longitudinal Study of Ageing (ELSA).[17,18,19] We hypothesized that individuals reporting high enjoyment and no depression would live longer lives with less disability and chronic disease than those experiencing low enjoyment of life and depressive symptoms. Because of well-established differences in affective well-being between men and women,[20] and higher life expectancy in women compared with men, we report our results by sex
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