Abstract
BackgroundLife expectancy is increasingly incorporated in evidence-based screening and treatment guidelines to facilitate patient-centered clinical decision-making. However, life expectancy estimates from standard life tables do not account for health status, an important prognostic factor for premature death. This study aims to address this research gap and develop life tables incorporating the health status of adults in the United States.MethodsData from the National Health Interview Survey (1986–2004) linked to mortality follow-up through to 2006 (age ≥ 40, n = 729,531) were used to develop life tables. The impact of self-rated health (excellent, very good, good, fair, poor) on survival was quantified in 5-year age groups, incorporating complex survey design and weights. Life expectancies were estimated by extrapolating the modeled survival probabilities.ResultsLife expectancies incorporating health status differed substantially from standard US life tables and by health status. Poor self-rated health more significantly affected the survival of younger compared to older individuals, resulting in substantial decreases in life expectancy. At age 40 years, hazards of dying for white men who reported poor vs. excellent health was 8.5 (95% CI: 7.0,10.3) times greater, resulting in a 23-year difference in life expectancy (poor vs. excellent: 22 vs. 45), while at age 80 years, the hazards ratio was 2.4 (95% CI: 2.1, 2.8) and life expectancy difference was 5 years (5 vs. 10). Relative to the US general population, life expectancies of adults (age < 65) with poor health were approximately 5–15 years shorter.ConclusionsConsiderable shortage in life expectancy due to poor self-rated health existed. The life table developed can be helpful by including a patient perspective on their health and be used in conjunction with other predictive models in clinical decision making, particularly for younger adults in poor health, for whom life tables including comorbid conditions are limited.
Highlights
Life expectancy is increasingly incorporated in evidence-based screening and treatment guidelines to facilitate patient-centered clinical decision-making
Life expectancy is the most common summary measure of mortality used to describe the overall health status of a population. It is increasingly incorporated in evidencebased screening and treatment guidelines to ensure that patients with limited life expectancy exposed to the potential harms of screening and treatment live long
The National Health Interview Survey (NHIS) is an annual in-person household survey of the civilian noninstitutionalized population of the United States conducted by the National Center for Health Statistics (NCHS)
Summary
Life expectancy is increasingly incorporated in evidence-based screening and treatment guidelines to facilitate patient-centered clinical decision-making. Previous studies have developed tools to estimate life expectancy using additional characteristics, such as comorbidities, [6,7,8,9,10] smoking status, [11] and socioeconomic factors [12,13,14]. Medicare claim data life tables by comorbidity status have only been calculated for the elderly population (65 years and older) based on the comorbidities that were treated and reimbursed. Little research has been conducted in the younger population, where individuals with high comorbidity burden or poor health status are likely to have a very different life expectancy than an average individual of the same age
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