Abstract
BackgroundRecent improvements in life expectancy in many countries stem from reduced mortality from cardiovascular disease and cancer above the age of 60. This is the combined result of decreased incidence and improved survival among those with disease. The latter has led to a higher proportion in the population of people with a past history of disease. This is a group with higher mortality than the general population. How growing shares of persons with past history of disease and improved survival with disease have affected changes in life expectancy of the total population is the objective of this paper.MethodsUsing register data for the total Swedish population, we stratified the population based on whether individuals have been diagnosed with myocardial infarction, stroke, hip fracture, colon cancer, or breast cancer. Using a novel decomposition approach, we decomposed the changes in life expectancy at age 60 between 1994 and 2016 into contributions from improved survival with disease and from changes in proportion of people with past history of disease.ResultsImprovements in survival from disease resulted in gains of life expectancy for the total population. However, while the contributions to life expectancy improvements from myocardial infarction, stroke and breast cancer were substantial, the contributions from the other diseases were minor. These gains were counteracted, to various degrees, by the increasing proportion of people with raised mortality due to a past history of disease. For instance, the impact on life expectancy by improved survival from breast cancer was almost halved by the increasing share of females with a past history of breast cancer.ConclusionRising numbers of survivors of different diseases can slow the increase in life expectancy. This dynamic may represent the costs associated with successful treatment of diseases, and thus, a potential “failure of success.” This dynamic should be considered when assessing mortality and life expectancy trends. As populations are aging and disease survival continues to improve, this issue is likely to become even more important in the future.
Highlights
Recent improvements in life expectancy in many countries stem from reduced mortality from cardiovascular disease and cancer above the age of 60
This article aims to contribute to this topic by investigating how improved survival from major diseases has contributed to gains in general life expectancy in Sweden, and whether these gains have been offset by increases in the prevalence of the respective diseases
The proportion of person-years lived by long-term survivors increased between both years, while the proportion of recent cases declined for all diseases, except for colon cancer and breast cancer
Summary
Recent improvements in life expectancy in many countries stem from reduced mortality from cardiovascular disease and cancer above the age of 60 This is the combined result of decreased incidence and improved survival among those with disease. Survival after diagnosis has generally improved at a faster pace than disease incidence has come down This has led to growing proportions of persons with a past disease history, or in other words, the prevalence of many diseases has grown [11]. The prognosis for patients of various diseases has improved and led to higher survival chances, these individuals may face a higher mortality risk later on, at higher ages, than their disease-free counterparts This may potentially slow down the overall mortality improvement, or life expectancy increase in the population
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