Average Life Expectancy For Men Research Articles

Демографическая бездна или закономерность? К проблеме управления численностью населения (на примере регионов РФ и мира)

A different correlation has been established for different regions of the South of the Russian Federation of the following demographic factors: life expectancy, the ratio of births to deaths, the average life expectancy of men and women, their difference in age, as well as per capita gross regional product. For a world population of about 5 billion people and 51 states of the world, a single natural relationship has been established between an increase in average life expectancy and a decrease in the ratio of the number of births and deaths, regardless of the level of socio-economic development of the regions. The problem of population management in regions and states of different socio-economic levels is associated with the need to solve exclusively socio-economic problems, including in the direction of reducing the difference in the average life expectancy of men and women. Harmonization of the steady state of demographic dynamics is established at the points of the ratio of births and deaths near the golden numbers: 0.618, 1.618, 2.618.

1240 Life Expectancy of Octogenarians Following EVAR

Abstract Background The aim of elective Abdominal Aortic Aneurysm (AAA) repair is to prevent premature death from rupture. The Endovascular Aneurysm Repair (EVAR) 2 trial showed that patients with AAA who are not fit for open repair do not benefit in terms of life-expectancy from EVAR. In our region, the average life expectancy for men is above the national average but controversy remains when offering octogenarians expensive procedures with the aim of prolonging life. This study aimed to quantify the life-expectancy following an EVAR between octogenarians and younger patients. Method A retrospective review was performed of the electronic notes of all patients receiving EVAR at our unit between October 2009 to October 2019. Survival post EVAR was compared between the octogenarian group and the younger patient group. A survival analysis was undertaken using the SPSS software to calculate a Kaplan-Meier curve. Results 294 patients received EVAR between 2009-2019. Patients were between ages 45 and 89 (Median: 75); 87.4% were male. 169 patients died during follow up (n = 64 ≥80 years, n = 105 <80 years). Time of death post-EVAR in octogenarians (average age 82.91 years) ranged between 0 - 131 months, whilst those under 80 years (average age 71.77 years) ranged between 1 - 152 months. Log rank (Mantel-Cox) analysis demonstrated statistical significance (p = 0.017). Median years post-EVAR for ≥80 years was 3.02 - 4.98 and <80 years was 5.12 - 6.87. Conclusions Octogenarians undergoing EVAR have a shorter life-expectancy compared to those under 80 years of age. This should be considered when discussing elective options with patients and their relatives.

106 Life expectancy of octogenarians following EVAR

Abstract Background The aim of elective Abdominal Aortic Aneurysm (AAA) repair is to prevent premature death from rupture. The Endovascular Aneurysm Repair (EVAR) 2 trial showed that patients with AAA who are not fit for open repair do not benefit in terms of life-expectancy from EVAR. In our region, the average life expectancy for men is above the national average but controversy remains when offering octogenarians expensive procedures with the aim of prolonging life. This study aimed to quantify the life-expectancy following an EVAR between octogenarians and younger patients. Methods A retrospective review was performed of the electronic notes of all patients receiving EVAR at our unit between October 2009 to October2019. Survival post EVAR was compared between the octogenarian group and the younger patient group. A survival analysis was undertaken using SPSS software to calculate a Kaplan-Meier curve. Results 294 patients received EVAR between 2009-2019. Patients were between ages 45 and 89 (Median 75); 87.4% were male. 169 patients died during follow up (n=64 ≥80 years, n=105 <80 years). Time of death post-EVAR in octogenarians (average age 82.91 years) ranged between 0- 131 months, whilst those under 80 years (average age 71.77 years) ranged between 1-152 months. Log rank (Mantel-Cox) analysis demonstrated statistical significance (p=0.017). Median years post-EVAR for ≥80 years was 3.02-4.98 and <80 years was 5.12 – 6.87. Conclusion Octogenarians undergoing EVAR have a shorter life-expectancy compared to those under 80 years of age. This should be taken into account when discussing elective options with patients and their relatives.

German Index of Socioeconomic Deprivation (GISD): Revision, update and applications.

Regional deprivation indices enable researchers to analyse associations between socioeconomic disadvantages and health outcomes even if the health data of interest does not include information on the individuals' socioeconomic position. This article introduces the recent revision of the German Index of Socioeconomic Deprivation (GISD) and presents associations with life expectancy as well as age-standardised cardiovascular mortality rates and cancer incidences as applications. The GISD measures the level of socioeconomic deprivation using administrative data of education, employment, and income situations at the district and municipality level from the INKAR database. The indicators are weighted via principal component analyses. The regional distribution is depicted cartographically, regional level associations with health outcomes are presented. The principal component analysis indicates medium to high correlations of the indicators with the index subdimensions. Correlation analyses show that in districts with the lowest deprivation, the average life expectancy of men is approximately six years longer (up to three years longer for women) than for those from districts with the highest deprivation. A similar social gradient is observed for cardiovascular mortality and lung cancer incidence. The GISD provides a valuable tool to analyse socioeconomic inequalities in health conditions, diseases, and their determinants at the regional level.

Jämställdhet och mäns medellivslängd

The average life expectancy of men in Sweden has rapidly approached that of women over the past twenty years. Deaths related to the consumption of alcohol and tobacco as well as to suicide have decreased among both sexes. However, this means that more men than women are being saved to live longer lives, since these causes of death are more common among men than women. Surprisingly, the relatively strong status of women in Swedish society may be an important factor underlying the levelling out of the gender differences in average life expectancy. As women's entry into the labour märket during the 1960s and 1970s resulted in an expansion of women's life space into previously male domains, this has also resulted in men's increased engagement with child care and household work during the 1980s and 1990s. The fact that men have taken on a more concrete responsibility for child care may in turn have significance for attitudes towards taking risks in traffic and the over-consumption of alcohol and smoking, both among men and in society in general. An overall greater impact by women's views on which societal issues should receive high priority is perhaps of even more importance. For example, the relatively prominent position of women in society led to early priority being given to child safety issues. All in all, this means that we have a society where health risks are viewed from a more "feminine" perspective than was previously the case, and that both women and men adopt more pronounced attitudes towards safety and care, which influences trends in health. This article shows that gender differences in average life expectancy are caused by factors that are highly sensitive to social change. There is no reason to mystify the fact that women live longer than men by attributing it to something inaccessible in women's biological nature. There is a great and still undeveloped potential in the study of how gender differences in average life expectancy arise/exist that can lead to new perspectives in our knowledge about the determinants of public health. Improved public health is one of many arguments for a more gender equal society.

EVALUATION OF THE QUALITY OF LIFE IN THE POPULATION OF THE REGION BY THE MULTI-DIMENSIONAL ANALYSIS

Introduction. The methodology of studying the quality of life is one of the intensively developed scientific directions. The aim of the work is to assess the quality of life in the population of the region on the basis of multidimensional mathematical analysis of a wide range of environmental factors and living conditions. Material and methods. The study was conducted on the example of the Irkutsk region. In order to establish the features of the formation of the quality of life under the influence of a wide range of environmental factors, methods of multivariate factor analysis have been used. At the first stage, the principal components analysis was applied. At the next stage, the analysis of the relationship between the eigenvalues of the main components and the index of the average life expectancy was carried out with the correlation-regression analysis. Results. The most significant indices were established to positively characterize the improvement of the quality of life in the population of the region as follows: housing security and accessibility of housing, income, marriage and fertility rates, the level of pensions, the health system’s supply of human resources. Indices mostly reflecting the negative impact of the habitat on the quality of life are: the prevalence of syphilis, alcoholism, tuberculosis; number of abortions; the score of the migration outflow of the population; levels of poverty and unemployment; the level of water pollution; the score of social environment criminality; provision of the population with a bed fund, etc. There was an increase in the quality of life in the population of the region, accompanied by an increase in the average life expectancy of men and women in 1999-2014. Discussion. The applied methodology is used in epidemiological and ecological studies by domestic and foreign authors. In studies with similar objects and subject of research, but using other methods of factor analysis, similar results were obtained. Conclusion. The main vector of changes in the quality of life in the population of the region was the strongest clear correlation with individual socio-economic and demographic indices; the strongest inverse correlation was noted with the incidence rates of socially conditioned diseases, criminality, poverty, health system resources, etc.

Life expectancy and poverty

Life expectancy and poverty

The Northern Italian Diet Compared to the Mediterranean Diet: Prevalence Rates of Obesity and Diabetes

I am writing in response to your recent articles on the conference proceedings of the World Congress on Nutrition and obesity prevention. I wish to call attention to the data on the prevalence of obesity in Italy, which are some of the lowest in the Western world, and which seem to be relatively stable [1]. The table 1 below shows that the northern part of Italy had significantly lower prevalence of overweight and obesity in 2007 than the southern part of Italy [2]. The Northern Italian diet differs significantly from the Mediterranean diet of the southern part of Italy, being richer in calories, animal fats and meat products than the typical Mediterranean diet. It also uses butter more often than olive oil as a condiment. For years the Mediterranean diet has been portrayed as one of the healthiest. The concept of the Mediterranean diet reflected “food patterns typical of Crete, much of the rest of Greece, and Southern Italy in the early 1960s” [3]. American biochemist Ancel Keys had first originated the concept of the Mediterranean diet after discovering a high proportion of centenarians in the Cilento area of Southern Italy [4]. However, according to the World Health Organization, Greece only ranked 24th among world countries in 2015 with respect to life expectancy with an average life expectancy for men of 78.3 years and for women of 83.6 years, behind Germany and the United Kingdom. Like many Western countries, Greece is also experiencing an obesity epidemic [5]. With particular regards to type 2 diabetes mellitus, Northern Italy has a very low prevalence of the condition (3.2%), lower than that of Southern Italy (6.3%) [6]. The Mediterranean diet has even been proclaimed an intangible cultural heritage by Unesco in 2013 (Inscription: 8.COM 8.10), supposedly for its great health benefits. The American College of Cardiology promotes the Mediterranean diet on its website claiming that it lowers the risk of diabetes. However, analysis of the available data does not support this conclusion. The table 2 below lists the diabetes type 2 prevalence rates of several countries and of Northern and Southern Italy: as it will be apparent some “Mediterranean” countries(including Greece) have higher prevalence rates than the United States. I therefore feel that we are giving the wrong advice to the public: to follow a “Mediterranean” diet.

Investments in fixed assets and human capital: Two interconnected drivers of socioeconomic growth

This paper highlights the great importance of increasing the share of the knowledge economy in the GDP, which is currently 13% in Russia, compared to 30% in Western Europe and the United States. The accelerated growth in the fixed asset and investment in the knowledge economy at levels of 20–25% and 20%, respectively, by 2020 have been justified. Attention is drawn to the inadequately low, declining level of investment in healthcare in Russia, the GDP share of which is twice as low as in 25 developed countries and 1.5 times lower than in 30 developing countries, which is reflected in the increased mortality rate. The WHO data on the average life expectancy of men has been analyzed; it amounts to only 58.7 years, which is below the age of retirement in Russia. In developed countries, the average life expectancy of men is 13–14 years higher. It has been concluded that, in order to tackle the long-term challenges in human capital, it is necessary to boost labor productivity and increase wages by reducing the groundless differentiation of the population’s income to the level of Western European countries.

High-Intensity Focused Ultrasound for the Treatment of Prostate Cancer: A Review.

Over the past 25 years, the average life expectancy for men has increased almost 4 years, and the age of prostate cancer detection has decreased an average of 10 years with diagnosis increasingly made at early-stage disease where curative therapy is possible. These changing trends in the age and extent of malignancy at diagnosis have revealed limitations in conventional curative therapies for prostate cancer, including a significant risk of aggressive cancer recurrence, and the risk of long-term genitourinary morbidity and its detrimental impact on patient's quality of life (QOL). Greater awareness of the shortcomings in radical prostatectomy, external radiotherapy, and brachytherapy has prompted the search for alternative curative therapies that offer comparable rates of cancer control and less treatment-related morbidity to better preserve QOL. High-intensity focused ultrasound (HIFU) possesses characteristics that make it an attractive curative therapy option. HIFU is a noninvasive approach that uses precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urologic oncology, HIFU is used clinically in the treatment of prostate cancer and is under experimental investigation for therapeutic use in multiple malignancies. Clinical research on HIFU therapy for localized prostate cancer began in the 1990s, and there have now been ∼65,000 prostate cancer patients treated with HIFU, predominantly with the Ablatherm (EDAP TMS, Lyon, France) device. Neoadjuvant transurethral resection of the prostate has been combined with HIFU since 2000 to reduce prostate size, facilitate tissue destruction, and to minimize side effects. Advances in imaging technologies are expected to further improve the already superior efficacy and morbidity outcomes, and ongoing investigation of HIFU as a focal therapy in salvage and palliative indications is serving to expand the role of HIFU as a highly versatile noninvasive therapy for prostate cancer.

Comments on the history of medical–biological studies of aging, the birth of scientific gerontology

Recent books (Immunity. How Elie Metchnikoff changed the course of modern medicine and Expectations of Life) reviewed the important contribution of Metchnikoff to the emergence of gerontology as a new branch of biomedical sciences. Here, we insist on Metchnikoff's contribution and pivotal role in the emergence of nutrition as a science and its importance for health and longevity. The discovery of phagocytosis by Metchnikoff and of its evolutionary ancestry are at the origin of the emergence of cellular immunity as an independent science besides humoral immunity. The longevity of Metchnikoff (71years) at a time when average life expectancy of men did hardly pass 50years certainly contributed to the acceptance of his teachings. The recent increase of the senior population in most advanced countries is a good opportunity to review the contributions of nutrition to longevity.

Introduction to Special National Longitudinal Surveys Issue

ThisspecialissueoftheJournalofMarriageand Family celebrates 50 years of the National Longitudinal Surveys. In 1964, Professor Herbert Parnes wrote a proposal for a five-year longitudinal study to interview men approaching retirement age to describe their employment patterns as they neared the completion of their careers and to ascertain their plans for retirement. Thus began the first U.S. National Longitudinal Survey (NLS): the NLS Cohort of Older Men. The first interview took place on April 11, 1966, and in the 50 years since, seven different longitudinal surveys that make up the National Longitudinal Surveys have collectively interviewed close to 54,000 respondents with approximately 730,000 interviews.The NLS Older Men's cohort consisted of 5,020 men born between 1906 and 1921 who were between ages 45 and 59 and living in the United States when first interviewed in 1966. They were therefore born during a span of years when the first traffic light was introduced into the United States and average life expectancy for men was around 48 years, and it was a time of new innovations with expanding railways and early airplanes. These men ended up being interviewed 13 times during the next 24 years rather than 5, with a final interview occurring in 1990 when they were 71 to 83 years old.In the following year, 1967, a sample of 5,083 Mature Women born between 1922 and 1937 was drawn to study the return of women to the labor force as their children grew up and to investigate how women balanced the roles of homemaker, mother, and labor force participant. These women were born during a 15-year span when the Equal Rights Amendment was first introduced in the U.S. Senate, sliced bread was launched, Wall Street crashed, the Mickey Mouse comic strip debuted, and the Empire State Building opened in New York City. A total of 22 surveys were undertaken with these women, with their first interview at ages 30 to 44 and their last interview in 2003 at ages 63 to 77.Two cohorts of younger people were also initiated around the same time. Started in 1966 was the Young Men's cohort, which consisted of 5,225 males born between 1941 and 1952 who were ages 14 to 24 when first interviewed. This was a sample intended to chronicle the employment patterns of men transitioning from school and making initial career and job decisions that would impact their employment in the decades to follow. Twelve interviews were conducted between 1966 and 1981 when the study ended. Originated 2 years later in 1968 was the Young Women's cohort, which was made up of 5,159 females also ages 14 to 24 as they were completing school, making career and job decisions, and starting families. Twenty-two interviews were undertaken with this cohort, which ended in 2003. To place them in historical context, members of these two cohorts were born during years when M&Ms and slinky toys were created, Mount Rushmore was completed, Korea was divided into North and South, the United Nations and UNICEF were founded, Polaroid cameras were invented, the State of Israel was founded, the first organ transplant was undertaken, and color television was introduced. We hope that we may be able to reinterview members of both of these younger cohorts in the future.Then there are the three cohorts that are still ongoing. The first is the 1979 National Longitudinal Survey of Youth (NLSY79), which comprised a sample of 12,686 men and women born between 1957 and 1964 who were selected to replicate the NLS of Young Women and Young Men cohorts and designed to help researchers and policy makers evaluate the expanded employment and training programs for youths legislated by the 1977 amendments to the Comprehensive Employment and Training Act. These late baby boomers were born during the years when Alaska and Hawaii became the final two U.S. states admitted to the union, hula hoops became a national fad, and John Glenn became the first American to orbit the Earth.Originally there were oversamples of Blacks, Hispanics, poor Whites, and military youth in the NLSY79, although most military oversample cases and the economically disadvantaged non-Black, non-Hispanic oversample had to be dropped later on due to a lack of funds. …

Epididymal Sparing Bilateral Simple Orchiectomy: Cost-Effectiveness and Aesthetic Preservation for Men with Metastatic Prostate Cancer

IntroductionIn the last 2 decades medical androgen deprivation therapy has replaced surgical castration for the treatment of metastatic prostate cancer. We assessed costs and patient satisfaction associated with epididymal sparing bilateral simple orchiectomy in an underinsured, immigrant population. MethodsWe performed epididymal sparing bilateral simple orchiectomy in patients with metastatic prostate cancer between January 2003 and September 2014 at our institution. Procedures were performed in the operating room with the patient under general anesthesia and later under conscious sedation. Associated material and facility costs were calculated and compared to costs of androgen deprivation therapy with leuprolide or degarelix. Medication costs were calculated using wholesale acquisition costs. Patient satisfaction and body image perception were evaluated using a survey questionnaire. ResultsA total of 108 orchiectomies were performed in the operating room and 12 in the outpatient unit. The total cost of bilateral simple orchiectomy in the operating room was $4,118. By performing orchiectomy in the outpatient unit we reduced the cost to $2,101. The cost of orchiectomy in the operating room is the equivalent of 4 months of leuprolide and 7.8 months of degarelix. When performed in the outpatient clinic the cost of bilateral simple orchiectomy is equivalent to 2.1 months of leuprolide and 4 months of degarelix. Overall 95% of participants surveyed were pleased with the surgical results. ConclusionsThe average life expectancy of men with metastatic prostate cancer is 30 months and, thus, a onetime surgical cost offers significant cost savings. Further cost reductions are achieved by performing bilateral simple orchiectomy in the outpatient setting. By sparing the epididymis, patients are left with a sense of testicular preservation. Epididymal sparing bilateral simple orchiectomy is a cost-effective and cosmetically acceptable method of androgen deprivation therapy for patients with metastatic prostate cancer.

Improvements in life expectancy among Australians due to reductions in smoking: Results from a risk percentiles approach.

BackgroundTobacco smoking is a major burden on the Australian population in terms of health, social and economic costs. Because of this, in 2008, all Australian Governments agreed to set targets to reduce prevalence of smoking to 10 % by 2018 and subsequently introduced several very strong anti-smoking measures. On this backdrop, we estimated in 2012-13 the impact of several scenarios related to reduction of smoking prevalence to 10 % across the entire Australian population and for below specific ages, on improving life expectancy.MethodsUsing the risk percentiles method the Australian Diabetes, Obesity and Lifestyle (AUSDIAB) baseline survey and the Australian Bureau of Statistics (ABS) age-sex specific death counts were analyzed.ResultsAmongst men the gains in life expectancy associated with 10 % smoking prevalence are generally greater than those of women with average life expectancy for men increasing by 0.11 to 0.41 years, and for women by 0.12 to 0.29 years. These are at best 54 % and 49 % for men and women of the gains achieved by complete smoking cessation. The gains plateau for interventions targeting those <70 and <80 years. Amongst smokers the potential gains are much greater, with an increase in average life expectancy amongst men smokers of 0.43 to 2.08 years, and 0.73 to 2.05 years amongst women smokers. These are at best 46 % and 38 % for men and women smokers of the gains achieved by complete smoking cessation.ConclusionThe estimated optimum gain in life expectancy is consistent with potentially moderate gains which occur when both men and women below 60 years are targeted to reduce smoking prevalence to 10 %.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2750-5) contains supplementary material, which is available to authorized users.

Ageing and Learning Disability: putting older people with learning disabilities on the map

Ageing and Learning Disability: putting older people with learning disabilities on the map

The Life Expectancy of People with Intellectual Disabilities in Germany.

This study presents age group-specific mortality rates and the average life expectancy of people with intellectual disabilities in Germany. For two samples from Westphalia-Lippe and Baden-Wuerttemberg, person-related data for the years 2007-2009 were analysed. Age group-specific mortality rates were estimated by exponential regression analyses. The average life expectancy of men with intellectual disabilities was 70.9 years in Westphalia-Lippe and 65.3 years in the Baden-Wuerttemberg sample. Women with intellectual disabilities reached a life expectancy of 72.8 years in the Westphalian sample and 69.9 years in Baden-Wuerttemberg. The mortality tables, the crude mortality rates and the standardized mortality rates according to the WHO standard population are reported. Comparing the results with other international studies, the trend of increasing life expectancies of people with intellectual disabilities is confirmed. People with intellectual disabilities still have a lower average life expectancy than the general population, partly due to subgroups with low life expectancies.

Living longer, working longer: the need for a comprehensive approach to labour market reform in response to demographic changes.

Increases in life expectancy over the last decades have been among the most salient reflections of changes in the quality of life in the developed world. In Germany, in 1990, the average life expectancy for men and women was, respectively, 72 and 79, while in Italy men could expect to live 74 years and women 80. By 2012, these numbers changed by about 6 years for men and 4 years for women in Germany and by 6 and 5 years in Italy. Substantial increases in life expectancy have been recorded in all EU countries, from Portugal to Estonia and from Cyprus to Norway. This growth reflects unequivocal success of medicine and health care provision and fundamental changes in the quality of life and lifestyle, and offers new opportunities for the growing groups of older populations. However, when set against very low birth rates and low levels of economic growth, the increases have also called into question the financial sustainability of social security and public health care systems, and the potential generosity of welfare support for large groups of the population. It has long been recognised that increases in life expectancy, and the slower but equally important growth of healthy life expectancy, must be matched by adaptations of eligibility for public retirement pensions and by extended labour market activity. Continued economic development requires that increased proportions of the 50, 60 and 70 year olds be involved in the labour market, and that living longer be accompanied by working longer. There seems to be broad agreement that the process of extending working lives needs to involve all of the key stakeholders, i.e. both workers and their employers with an important supportive role of the government in areas of potential market failures. It also requires a comprehensive approach that combines labour market and retirement policies with tax policy and public health and welfare reforms. The demographic changes that are occurring before our very eyes offer new opportunities for older individuals, insofar as many of them continue to enjoy healthy and active lives. At the same time these changes also present substantial challenges for many individuals who find themselves faced with new requirements at the workplace and difficult choices concerning care duties for older family members or support expectations among younger generations. It seems clear that as the proportion of the 50? in the population grows, it becomes ever more important to understand the mechanisms which affect the quality of life of these groups of the population and which drive individual decisions in different areas of life, including activity in the labour market. Fortunately, as new survey and administrative data on older populations become available at national and international levels, researchers can examine the causes behind observed variation in different outcomes and they can address increasing number of key questions of academic and policy relevance. The labour market activity of older people is the focus of the special section in this issue of the European Journal of Ageing, with each of the four articles in the section making its contribution to the current debate on increasing working lives. As argued by Sonnet et al. (2014), for example, this debate, apart from reforming retirement systems, has to address such areas as rewarding work, changing employer practises and improving employability of workers. The four papers in the special section fit well within this framework. Dal Bianco et al. (2014) and Achdut et al. (2014) examine different factors behind retirement Responsible editor: H. Litwin.

The Aged and the Ageing: Profiles and Perspectives

As the average life expectancy of men in this world increase with time, the proportion of the aged population also increases simultaneously. The population of the elderly in the world which was 205 million in 1950 is expected to reach one billion by 2020; 70% of that population would be living in developing countries including India. The ageing process is characterized by retarded thinking, impaired memory, diminished enthusiasm and distorted sleep patterns.

Do Women Live Longer or Do Men Die Earlier? Reflections on the Causes of Sex Differences in Life Expectancy

Background: Although many different factors have been identified to contribute to excess male mortality, it is still unclear which path of the complex cause-effect chain is the decisive driver of the life expectancy gap between women and men. Objective: The question behind this study is whether these sex differences are caused primarily by factors leading to low female mortality or rather by factors causing high male mortality. We hypothesise that they are to a large extent caused by specific subpopulations of men with particularly high mortality levels that decrease the average life expectancy of men. Methods: To test this hypothesis, we investigate in a meta-analysis the variability in mortality (VM) in women and men - defined as the range of death rates prevailing among subpopulations - in empirical studies analysing specific phenomena of mortality differentials. We used the data of 72 empirical studies, including 146 total effects (TE) and 1,718 single effects (SE) for 21 different risk factors. Results: In 85% of TE and three quarters of SE the VM was higher in men than in women, taking into account men's higher overall mortality. The corresponding figures for the direct differences in the VM between women and men are 92 and 82%, respectively. Cases with higher female VM are rare exceptions and appear in particular in the highest age groups. Conclusions: We find support for our hypothesis that the disproportionate high mortality levels of specific male subpopulations are the central cause of the current extent of sex differences in life expectancy. Thus, public health programmes should be targeted toward these disadvantaged subpopulations among men which seem to be related primarily to socioeconomic characteristics.

Life Expectancies of South African Adults Starting Antiretroviral Treatment: Collaborative Analysis of Cohort Studies

Few estimates exist of the life expectancy of HIV-positive adults receiving antiretroviral treatment (ART) in low- and middle-income countries. We aimed to estimate the life expectancy of patients starting ART in South Africa and compare it with that of HIV-negative adults. Data were collected from six South African ART cohorts. Analysis was restricted to 37,740 HIV-positive adults starting ART for the first time. Estimates of mortality were obtained by linking patient records to the national population register. Relative survival models were used to estimate the excess mortality attributable to HIV by age, for different baseline CD4 categories and different durations. Non-HIV mortality was estimated using a South African demographic model. The average life expectancy of men starting ART varied between 27.6 y (95% CI: 25.2-30.2) at age 20 y and 10.1 y (95% CI: 9.3-10.8) at age 60 y, while estimates for women at the same ages were substantially higher, at 36.8 y (95% CI: 34.0-39.7) and 14.4 y (95% CI: 13.3-15.3), respectively. The life expectancy of a 20-y-old woman was 43.1 y (95% CI: 40.1-46.0) if her baseline CD4 count was ≥ 200 cells/µl, compared to 29.5 y (95% CI: 26.2-33.0) if her baseline CD4 count was <50 cells/µl. Life expectancies of patients with baseline CD4 counts ≥ 200 cells/µl were between 70% and 86% of those in HIV-negative adults of the same age and sex, and life expectancies were increased by 15%-20% in patients who had survived 2 y after starting ART. However, the analysis was limited by a lack of mortality data at longer durations. South African HIV-positive adults can have a near-normal life expectancy, provided that they start ART before their CD4 count drops below 200 cells/µl. These findings demonstrate that the near-normal life expectancies of HIV-positive individuals receiving ART in high-income countries can apply to low- and middle-income countries as well. Please see later in the article for the Editors' Summary.