Trends in life expectancy: did the gap between the healthy and the ill widen or close?

Anna C Meyer,Mats Lambe,Karin Modig,Sven Drefahl,Anders Ahlbom

doi:10.1186/s12916-020-01514-z

Anna C Meyer, Mats Lambe + Show 3 more

Open Access

https://doi.org/10.1186/s12916-020-01514-z

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Abstract

BackgroundDuring the past decades, life expectancy has continued to increase in most high-income countries. Previous research suggests that improvements in life expectancy have primarily been driven by advances at the upper end of the health distribution, while parts of the population have lagged behind. Using data from the entire Swedish population, this study aims to examine the life expectancy development among subgroups of individuals with a history of common diseases relative to that of the general population.MethodsThe remaining life expectancy at age 65 was estimated for each year in 1998–2017 among individuals with a history of disease, and for the total Swedish population. We defined population subgroups as individuals with a history of myocardial infarction, ischemic or hemorrhagic stroke, hip fracture, or colon, breast, or lung cancer. We further distinguished between different educational levels and Charlson comorbidity index scores.ResultsLife expectancy gains have been larger for men and women with a history of myocardial infarction, ischemic or hemorrhagic stroke, and colon or breast cancer than for the general population. The life expectancy gap between individuals with a history of hip fracture or lung cancer and the general population has, however, been growing. Education and comorbidity have affected mortality levels, but have not altered the rate of increase in life expectancy among individuals with disease history. The female advantage in life expectancy was less pronounced among individuals with disease history than among the general population.ConclusionsLife expectancy has increased faster in many subpopulations with a history of disease than in the general population, while still remaining at lower levels. Improvements in life expectancy have been observed regardless of comorbidity or educational level. These findings suggest that the rise in overall life expectancy reflects more than just improved survival among the healthy or the delayed onset of disease.

Highlights

During the past decades, life expectancy has continued to increase in most high-income countries
By using register data covering the total Swedish population, our aim is to examine whether the remaining life expectancy of men and women who have experienced common and severe diseases has improved at a pace similar to that of the general population
The date and cause of each death were retrieved from the Cause of Death Register, and disease diagnoses were obtained from the National Patient Register (NPR) or the Cancer Register

Summary

Introduction

Life expectancy has continued to increase in most high-income countries. Human life expectancy has increased by more than 2 years per decade during the past century in Sweden as well as many other high-income countries [1, 2]. The question of whether the increase in life expectancy has occurred at a similar pace across population groups has been investigated in a number of studies. In such studies, the focus has often been on the specific question of. We calculate the remaining life expectancy among population groups with a history of common and severe diseases and examine how it has developed over time. We compare these trends to the development of life expectancy in the total population

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