Gap In Life Expectancy Research Articles

Can more CVD prevention increase life expectancy in Germany? Analysis with European data 2000-2019

Abstract Background Life expectancy (LE) in Europe is increasing since long - while mortality from cardiovascular diseases (CVD) declines, attributed to advances in therapy and prevention. Whether this is still applies the last 20 years is unclear. Recently, Germany’s low LE compared to other Western European countries (2019: 81.3 yrs; Spain: 84, Italy 83.6) was seen as result of high CVD mortality due to insufficient prevention. This led to the establishment of the German Federal Institute for Prevention and Education in Medicine, aimed at reducing CVD and -in the long term - narrowing the gap in LE. We explore whether data on CVD mortality and morbidity support this idea. Methods With data from OECD, WHO and IHME (GBD 2021), we calculated the mean annual change in LE and in age-standardised mortality (ASM) for CVD for 2000-2019 for European countries by sex. We estimated the linear association (adj R²) between the mean annual change in LE and ASM for CVD for West- and East-Europe, and -country-specific- between incidence and ASM from CVD. Results For 2000-2019, mean annual change in LE was lower in West- than in East-Europe: 0.25 yrs vs. 0.30 in men and 0.17 vs 0.22 in women; for ASM in CVD, it was about half as large: -6.6/100.000 vs. -11.1 for men and -4.1 vs. -8.0 for women. Similarly, the adj R² for the association between mean annual change in LE and in ASM for CVD was lower in West- compared to East-Europe: 0.43 vs. 0.24 in men and 0.21 vs. no association (adj R² -0.01) in women. Courses of CVD incidence were heterogeneous (linearly or wave-shaped in- or decreasing, stable or u-shaped). In Germany, it decreased wave-shaped, with an adj R² for linear association with ASM for CVD of 0.79 in women and 0.63 in men. The association between LE and ASM for CVD is low in West-European countries. Even if amplified prevention lowers CVD mortality, a positive effect on LE is questionable. Differences in LE are stable since long. Non-morbidity related factors might decisively effect LE. Key messages • Life expectancy in Europe-and it’s mean annual change since 2000 is not associated with age-standardised CVD mortality in women, and only moderate in men in West-Europe, in contrast to East-Europe. • Course of CVD incidence is country-specific and very heterogeneous and reveals no overall association with CVD mortality rates.

What works to reduce regional health inequalities? A case of East vs West Germany post reunification

Abstract Regional inequalities in mortality are rising across the globe. The case of German reunification offers a unique opportunity to explore how such inequalities can be reduced, or even eliminated: following reunification, a long-standing life expectancy gap between East and West Germany was closed for women and markedly reduced for men in a period of less than 15 years. Drawing from theory on health inequalities, we investigate the contribution of material, behavioural and psychosocial factors likely related to the narrowing of the life expectancy gap between East and West Germany following reunification. We used regional data from official national statistics covering the period 1994-2020 for 15 regions in East and West Germany. Using fixed-effects models with an interaction term for regions in the East, we investigated whether within-region changes in key hypothesised factors (social security expenditure, healthcare improvements, changes in alcohol consumption, and life satisfaction), have had differential impacts on life expectancy at birth and at 65 years. We find that increases in social security benefits in the East following reunification has been the most important factor for lowering inequalities between the two parts of Germany: for every standard deviation increase in social security benefits, life expectancy at birth increased by an additional 0.20 [0.07,0.33] years for males and by 0.15 [-0.01,0.31] years for females in East relative to West Germany. We find the protective effect of social security benefits also for women at 65 years (additional 0.14 years [0.006,0.268]) but not for men. Overall, our findings suggest that increasing social security expenditure could be an effective policy-based tool for reducing health disparities across regions with different levels of economic development. This provides additional support for the relevance of the materialist hypothesis and the political economy of root causes of health inequalities. Key messages • Our findings suggest that increasing social security expenditure could be an effective policy-based tool for reducing regional health disparities. • We find support for the materialist and political economy approaches to explaining health inequalities.

An effective approach to tackling complex health policy challenges. Using a clinical microsystems approach and rethinking codesign

That people with serious mental illness have poor physical health and face a significant life expectancy gap compared with the general population is well known. Despite considerable policy focus in some countries, the gap in life expectancy remains. Tackling complex and persistent health problems such as this requires a systems-based approach, recognising the complexity of interacting components and their effects on the problem and on each other and applying collaborative analysis, design and implementation by those with knowledge of and expertise in the problem and the context. This paper describes the methods used to develop the Australian Being Equally Well National Policy Roadmap for better physical health care and longer lives for people with severe mental illness. Whilst recognising that high rates of physical health comorbidities are caused by many factors including lifestyle, access to high-quality healthcare and medication side effects, the work was focused on what could be done within Australian primary care to improve the physical health of this cohort. A Clinical Microsystem Approach was applied to synthesise clinical evidence with professional and lived experience, and an innovative policy development process was established, creating trust across all system levels. Participants with different kinds of knowledge and experience worked in discrete groups according to their professional or expert role whilst also being supported to participate in an intensive cross-collaboration. The potential value of this methodology for tackling other complex problems in health policy is discussed.

The black-white lifetime earnings gap

The average white male born in 1900 earned 2.6 times more labor income over their lifetime than the average Black male. This gap is nearly twice as large as the more commonly studied cross-sectional Black-white earnings gap because 48% of Black males born in 1900 died before the age of 30 as compared to just 26% of white males. We calibrate a model of optimal consumption in a world with mortality risk to data describing the life-cycle earnings and survival probabilities of Black and white males born between 1900 and 1970. We find that convergence in Black and white mortality rates led to a 50% reduction in Black-white welfare gaps between the 1900 and 1920 birth cohorts, even as cross-sectional Black-white income gaps for those cohorts remained relatively constant. However, the Black-white welfare gap stagnated for the 1920 to 1970 birth cohorts as gaps in Black-white life expectancy and income remained stable and large.

Individual-Level Exposure to Residential Redlining in 1940 and Mortality Risk.

Historic redlining, the practice by the Home Owners' Loan Corporation (HOLC) of systematically denying credit to borrowers in neighborhoods that were inhabited by primarily African American individuals, has been associated with poor community outcomes, but the association with individual risk of death is not clear. To examine if exposure to residential redlining practices by HOLC in 1940 is associated with increased risk of death later in life. The study linked individuals who resided within HOLC-graded neighborhoods (defined as Census Enumeration Districts) in 1940 with administrative death records data. The study estimated hazard ratios as well as age-specific life expectancy gaps (at age 55, 65, and 75 years) for HOLC grading exposure. This was done using methods that adapted standard parametric survival analysis to data with limited mortality coverage windows and incomplete observations of survivors. The analysis sample consisted of 961 719 individual-level observations across 13 912 enumeration districts within 30 of the largest US cities (based on 1940 population counts) across 23 states. Data were analyzed between December 1, 2023, and September 4, 2024. The exposure was HOLC grade based on historic HOLC maps, with A representing "best" or creditworthy areas; B, "still desirable"; C, "definitely declining"; and D, "hazardous" areas not worthy of credit (ie, redlined), and the main outcome was age at death from the Social Security Numident file. The 961 719-person individual sample had a mean (SD) age of 19.26 (9.26) years in 1940 and a mean (SD) age at death of 76.83 (9.22) years. In a model adjusted for sex (52.48% female; 47.52% male), race and ethnicity (7.36% African American; 92.64% White), and latent place effects, a 1-unit lower HOLC grade was associated with an 8% (hazard ratio, 1.08 [95% CI, 1.07-1.09]) increased risk of death. At age 65 years, these hazard differentials translated into an estimated life expectancy gap of -0.49 (95% CI, -0.56 to -0.43) years for each 1-unit decrease of the HOLC grade. This study found that individuals who resided within redlined neighborhoods in 1940 had lower life expectancy later in life than individuals who resided within other HOLC-graded areas.

The urban-rural gap in older Americans' healthy life expectancy.

Estimate health-quality-adjusted life expectancy (QALE) for Americans nearing retirement age and assess rural-urban disparities in QALE. We used a dynamic microsimulation model based on Health and Retirement Study data to estimate the quantity and health quality of expected future life years for rural and urban Americans ages 59-60 in 2014-2020. Cohort life expectancy at age 60 (LE) for urban and rural men was 22.9 and 20.9, respectively; for urban and rural women, LE was 25.6 and 25.0, respectively. Adjusting future life years to quality-adjusted life years, QALE was 17.5versus 15.7 for urban versus rural men, and 19.3versus 18.7 for women. Compared to a cohort in 1994-2000, the urban-rural QALE gap in 2014-2020 grew substantially for men; changes for women were smaller. Average QALE masked heterogeneity by race/ethnicity, education, and Census region. Counterfactual scenarios suggested eliminating smoking and managing obesity and prevalent heart conditions would be particularly beneficial for increasing rural QALE and reducing the urban-rural gap. Expected health quality, in addition to longevity, is an important factor when assessing rural disparities in older Americans' future life outcomes. Current chronic disease disparities are expected to translate to a widening urban-rural gap in QALE, particularly for men. Interventions earlier in life may be needed to fully address disparities in QALE at older ages.

Deciphering the Sex gap in global life expectancy: the impact of female-specific cancers 1990-2019.

Females live longer than males, which results in a sex gap in life expectancy. This study examines the contribution of female cancers to this differential by world region and country 1990-2019 with special focus to the 15-69 age group. Cause-specific mortality data for 30 cancers, including four female-specific cancers from 238 countries and territories was retrieved from the Global Burden of Disease Study 2019. Using life table techniques and demographic decomposition analysis, we estimated the contribution of cancer deaths to the sex gap in life expectancy by age and calendar period. At ages 15-69, females had a higher life expectancy than males in 2019. Countries with the largest sex gaps or the largest female advantage in life expectancy were in Eastern Europe and Northern Asia, Latin America and Southern Africa. In contrast, countries with the smallest sex gaps were mainly located in Northern Africa, Northern America, and Northern Europe. The contribution of female-specific cancers to sex gaps in life expectancy were largely negative, ranging from -0.15 years in the Western Pacific to -0.26 years in the Eastern Mediterranean Region, implying that the disproportionately higher premature cancer mortality among females contributed to a reduction in the female life expectancy advantage. Female-specific cancers are important determinants of sex gaps in life expectancy. Their negative impact on life expectancy at working and reproductive age groups has far-reaching consequences for society. Increasing the availability and access to prevention, screening, timely diagnosis, and effective treatment can reduce this gap.

Faltering mortality improvements at young-middle ages in high-income English-speaking countries.

Before the COVID-19 pandemic, stagnating life expectancy trends were reported in some high-income countries (HICs). Despite previous evidence from country-specific studies, there is a lack of comparative research that provides a broader perspective and challenges existing assumptions. This study aims to examine longevity trends and patterns in six English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom, United States) by combining period and cohort perspectives and to compare them with other HICs. Using data from the Human Mortality and World Health Organization Mortality Databases, we estimated partial life expectancy, lifespan inequality and cohort survival differences for 1970-2021, as well as the contribution of causes of death to the gap in life expectancy between English-speaking countries and the average for other HICs in 2017-19. In the pre-pandemic period, the increase in life expectancy slowed in all English-speaking countries, except Ireland, mainly due to stagnating or rising mortality at young-middle ages. Relative to other HICs, those born in Anglophone countries since the 1970s experienced relative survival disadvantage, largely attributable to injuries (mainly suicides) and substance-related mortality (mainly poisonings). In contrast, older cohorts enjoyed advantages for females in Australia and Canada and for males in all English-speaking countries except the United States. Although future gains in life expectancy in wealthy societies will increasingly depend on reducing mortality at older ages, adverse health trends at younger ages are a cause for concern. This emerging and avoidable threat to health equity in English-speaking countries should be the focus of further research and policy action.

Trends in life expectancy and life disparity in Turkiye before and during the Covid-19 period

Objective: This descriptive study examines Turkiye's life expectancy trends from 2013 to 2022, encompassing the COVID-19 period. Methods: This study used the Turkish Statistical Institute (TURKSTAT) cause of death data and explored trends in life expectancy and life disparity by using the line-integral decomposition model. Results: According to results, before the pandemic, increased male life expectancy and reduced disparity resulted from improved outcomes in unintentional injuries and malignant neoplasms during adulthood. Female life expectancy gains were driven by declining cardiovascular diseases in old age. However, during COVID-19, males experienced a greater loss of life expectancy than females in youth and adulthood, while females faced higher mortality rates in old age than males. The pandemic has exacerbated the female-male gap in life expectancy and disparity, with all causes of death increasing except for an improvement in malignant neoplasms among males. Conclusion: The study suggests prioritizing policies that address the health challenges faced by elderly females and young/adult males to mitigate the pandemic's impact on public health.

The Influence of Gender Inequality on Economic Growth in Riau Province 2012-2021

The purpose of this study was to determine whether the average length of schooling, life expectancy, and labor force participation rates affect economic growth with productivity levels as intervening variables in Riau Province in 2012-2021. The data used in this study was secondary data, which is a combination of time series and cross-section. The analytical method used in this study was multiple linear regression analysis using theory and data related to research. The results showed that the average length of schooling for boys had a negative and insignificant effect on economic growth in Riau Province. Meanwhile, the average length of schooling for women has a negative and insignificant effect on economic growth in Riau Province. From the results of the partial test, it can be concluded that the average length of schooling does not show gender inequality. Directly, the life expectancy for men has a negative and insignificant effect on economic growth in Riau Province. Meanwhile, life expectancy for women has a positive and insignificant effect on economic growth in Riau Province. From the results of the partial test, it can be concluded that there is gender inequality in life expectancy. Directly, the labor force participation rate for men has a negative and insignificant effect on economic growth in Riau Province. Meanwhile, the labor force participation rate for women has a negative and insignificant effect on economic growth in Riau Province. From the results of the partial test, it can be concluded that there is no gender inequality in the labor force participation rate. Indirectly, through the level of productivity, the average length of schooling for men has a positive and insignificant effect on economic growth in Riau Province. Meanwhile, the average length of schooling for women has a positive and insignificant effect on economic growth in Riau Province. From the results of the Sobel test, it was concluded that the average length of schooling does not have a relation to gender inequality. Indirectly, through the level of productivity, the life expectancy rate for men has a positive and insignificant effect on economic growth in Riau Province. Meanwhile, life expectancy for women has a negative and insignificant effect on economic growth in Riau Province. From the results of the Sobel test, it was concluded that there is a gender gap in life expectancy. Indirectly, through the level of productivity, the labor force participation rate for men has a negative and insignificant effect on economic growth in Riau Province. Meanwhile, the labor force participation rate for women has a positive and insignificant effect on economic growth in Riau Province. From the results of the Sobel test, it can be concluded that there is a gender imbalance in the labor force participation rate. The results of this study were influenced by gender inequality in terms of education, health, and employment which are categorized as experiencing low inequality so that they do not have much impact on economic growth in Riau Province. From the education side, as seen from the average length of schooling, it has no effect on economic growth in Riau Province, as well as from a health perspective, the high life expectancy rate does not have a serious impact on economic growth in Riau Province. Keywords: Gender Inequality; Productivity; Economic Growth

Educational inequalities in deaths of despair in 14 OECD countries: a cross-sectional observational study

BackgroundDeaths of despair are a key contributor to stagnating life expectancy in the USA, especially among those without a university-level education, but these findings have not been compared internationally.MethodsMortality and...

Decomposing the gaps in healthy and unhealthy life expectancies between Indigenous and non-Indigenous Australians: a burden of disease and injury study

BackgroundThe gaps in healthy life expectancy (HLE) between Indigenous and non-Indigenous Australians are significant. Detailed and accurate information is required to develop strategies that will close these health disparities. This paper aims to quantify and compare the causes and their relative contributions to the life expectancy (LE) gaps between the Indigenous and non-Indigenous population in the Northern Territory (NT), Australia.MethodsThe age-cause decomposition was used to analyse the differences in HLE and unhealthy life expectancy (ULE), where LE = HLE + ULE. The data was sourced from the burden of disease and injury study in the NT between 2014 and 2018.ResultsIn 2014–2018, the HLE at birth in the NT Indigenous population was estimated at 43.3 years in males and 41.4 years in females, 26.5 and 33.5 years shorter than the non-Indigenous population. This gap approximately doubled the LE gap (14.0 years in males, 16.6 years in females) at birth. In contrast to LE and HLE, ULE at birth was longer in the Indigenous than non-Indigenous population. The leading causes of the ULE gap at birth were endocrine conditions (explaining 2.9–4.4 years, 23–26%), followed by mental conditions in males and musculoskeletal conditions in females (1.92 and 1.94 years, 15% and 12% respectively), markedly different from the causes of the LE gap (cardiovascular disease, cancers and unintentional injury).ConclusionsThe ULE estimates offer valuable insights into the patterns of morbidity particularly useful in terms of primary and secondary prevention.

New Zealand's world-first smokefree legislation 'goes up in smoke': A setback in ending the tobacco epidemic

For several decades, Aotearoa New Zealand has maintained a relatively strict regulatory approach towards tobacco. In response to the significant impact of tobacco-related illnesses, many countries worldwide have worked to enhance tobacco control measures. These efforts include introducing plain tobacco packaging with graphic health warnings, improving access to smoking cessation services and offering supportive treatments for tobacco dependence. In December 2022, New Zealand enacted world-leading tobacco control legislation aimed at leading the nation towards a 'smokefree' future by 2025, a future where the smoking prevalence falls below 5 percent across all population groups. To achieve this goal, revolutionary measures were needed. These measures included denicotinising cigarettes, reducing the number of tobacco retail outlets, and implementing a generational ban on smoked products. Despite receiving support from academics, clinicians, leaders of local indigenous communities, and the general public, the sixth National-led coalition government remained resolute in repealing the law and did so through parliamentary urgency on 27 February 2024. The reversal of this health policy is anticipated to result in thousands of lives lost and widen life expectancy gaps between indigenous and non-indigenous populations. This decision, driven by political agenda objectives and interference from the tobacco industry, has not only impeded New Zealand's progress but also weakened global efforts in tobacco control.

Enhancing Disability Nursing Practice in Australia: Addressing Educational Preparedness.

People with intellectual disabilities (IDs) face significant health challenges, including poor outcomes, limited access to health care, and a 26-year life expectancy gap compared with the general population. This highlights the need for improved public health and social policies to enhance the quality of care in hospital and community settings. An integrated literature review was conducted to examine the state of disability nursing practice in Australia following the implementation of the National Disability Insurance Support (NDIS) scheme. The review included English-language studies published from 2010 to 2023. Systematic searches in five databases resulted in a final sample of 28 studies. The data were then thematically analysed, and the following three themes emerged: Workforce development and professional standards, hospital experience and support needs of individuals with IDs, and nursing curriculum and ID. Study findings suggest that nurses lack preparation for effective health communication with individuals with IDs and their families. Evidence is insufficient to guide nursing practice and policies in ID care. Varying understandings of practice standards exist among nurses. Nursing curriculums in Australia fail to adequately prepare students to manage the unique needs of individuals with IDs, perpetuating the high mortality rates in this population. Specialised nursing practice areas are vital for meeting the complex needs of individuals with IDs. Reintroducing a disability nursing specialty and integrating dedicated study units and clinical placements in undergraduate programmes are recommended steps to improve care outcomes and support the overall well-being of this population.

Contributions of causes of death to differentials in life expectancy by internal migrant status in the Netherlands. A population register based study, 2015–2019

Important health differences exist in the context of international migration and residential mobility. Less is known about health differences regarding the medium-distance level of internal migration. This study examines life expectancy gaps between internal movers and stayers in the Netherlands and their underlying processes by assessing the contribution of different causes of death by age and sex. It uses individually-linked death counts and population exposures extracted from population registers, covering the native Dutch population aged 10+ from 2015 to 2019. The pooled data were disaggregated by causes-of-death group (neurodegenerative diseases, cardiovascular diseases, lifestyle-related mortality, external causes, and other causes), internal migrant status (movers and stayers, based on past 10-year residence in the 40 NUTS-3 [Nomenclature of Territorial Units for Statistics, level 3] regions), age, and sex. Comparing movers and stayers, we computed life expectancy at age 10 (e10), age- and cause-specific mortality risks, and applied decomposition methods to assess contributions of causes of death to e10 gaps. In the Netherlands in 2015–2019, e10 was lower for movers between NUTS-3 regions than stayers (males: 2.49 years; females: 3.51 years), due to excess mortality for movers at most ages. Movers only had a lower mortality than stayers at younger working ages (males: ages 20–44; females: ages 20–34). Mortality from neurodegenerative diseases and cardiovascular diseases were the largest contributors to the e10 gap, especially at ages 75+ and for females. Mortality from lifestyle-related and external causes of death contributed less, with the largest contributions for females aged 75–89 and males aged 45–69. The lower e10 of movers in the Netherlands is likely explained by health selection effects–in particular care-related moves as coping behaviour–rather than by causal effects through risk accumulation. Research focusing on regional or spatial heterogeneity of the mover-stayer health gap would be insightful to further understand these processes.

Nutrition Education in Psychiatry Residency Programs: A Call to Action

The burden of disease attributable to mental health is expected to rise in the coming decades. Poor nutritional status is considered a modifiable risk factor for general mental health. In fact, nutrition interventions are now accepted as a core strategy in mental healthcare to combat physical health inequalities and life-expectancy gap in people with certain psychiatric disorders. However, most psychiatrists are not familiar with evidence for the potential therapeutic benefits of diet in psychiatric illness, and this may be related to sparse nutrition education for physicians. Thus, there is a need to integrate nutritional management in psychiatric practice, but there is a gap in medical education that would support this practice. Here, we discuss evidence for and challenges in 1) assessing diet quality in psychiatric illness, 2) recommending improvements in diet quality and specific dietary patterns in psychiatric illness, and 3) recommending dietary supplements in psychiatric illness. This discussion serves as a call to develop nutrition curricula within psychiatry residency programs.

Selective Reduction of Socioeconomic Disparities in the Experimental Tobacco Marketplace: Effects of Cigarette and E-cigarette Flavor Restrictions.

Cigarette smoking accounts for >30% of the socioeconomic gap in life expectancy. Flavored restrictions claim to promote equity; however, no previous studies have compared the effect of cigarette and e-cigarette flavor restrictions among individuals who smoke with lower and higher socioeconomic status (SES). In a between-group within-subject design, individuals with lower (n = 155) and higher (n = 125) SES completed hypothetical purchasing trials in the experimental tobacco marketplace (ETM). Conditions were presented in a 2 × 2 factorial design (cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted) with increasing cigarette prices across trials. Results show (1) SES differences in cigarette, e-cigarette, and NRT purchases under unrestricted policies, with lower SES showing higher cigarette demand and lower e-cigarette and NRT substitution than higher SES, (2) cigarette restrictions decreased cigarette and increased NRT purchases among lower SES, but no significant changes among higher SES, (3) decreased SES differences in cigarette demand under cigarette restrictions, but persistence under e-cigarette restrictions or their combination, (4) persistence of SES differences in e-cigarette purchases when all restrictions were enforced, and (5) waning of SES differences in NRT purchasing under all restrictions. Flavor restrictions differentially affected individuals based on SES. Within-group comparisons demonstrated restrictions significantly impacted lower SES, but not higher SES. Between-group comparisons showed SES differences in cigarette purchasing decreased under cigarette restrictions, but persisted under e-cigarette-restrictions or their combination. Additionally, SES differences in NRT substitution decreased under flavor restrictions. These findings highlight the utility of the ETM to investigate SES disparities. With increasing trends of socioeconomic differences in smoking prevalence and cessation rates, smoking-related health disparities are expected to continue to widen. Restricting menthol flavor in cigarettes while enhancing the availability and affordability of NRT have the potential to alleviate SES disparities in tobacco use, therefore, positively impacting health equity. However, this effect may depend on flavor availability in other tobacco products.

Assessing life expectancy disparities in Chicago with a deep dive into green space

BackgroundFew studies have examined the association between green space and life expectancy, and only one study has looked at that data for small areas in the United States. These studies have found a positive association between green space and life expectancy. This study investigates the association between green space and small-area life expectancy in Chicago, a city in the United States with distinct environmental and socioeconomic characteristics and the largest U.S. life expectancy gap between neighborhoods. MethodsWe conducted a spatial analysis using the green space metrics of normalized difference vegetation index (NDVI), park access, and tree canopy. Additionally, we included 18 lifestyle, environmental, and social covariates. Diagnostic analytics included multiple linear regression, Moran I test for spatial dependence, and principal component analysis with CAR Gaussian model. We performed a simulation to predict life expectancy gain if NDVI was brought to median levels. ResultsOur study revealed that after adjusting for covariates and spatial dependence (Moran I test p = 0.012) with a CAR Gaussian model, NDVI (credible interval = 0.292-0.894) demonstrated significance at a 5 % level, while tree canopy (credible interval = -0.404-0.109) and park access (credible interval = -0.258-0.161) did not. Excluding non-significant variables (tree canopy and park access) from the CAR Gaussian model, the median effect of NDVI on life expectancy was 0.491 (95 % credible interval: 0.24–0.718). Projecting this effect to tracts below the median NDVI predicted a gain of 476,000 years of life expectancy for Chicago residents. ConclusionThis study provides evidence that green space and LE are positively correlated, suggesting the potential to increase green space to address current LE gaps. Future research should investigate the mechanisms by which green space correlates to lifespan.

The association between disability and mortality: a mixed-methods study

Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities. We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374. Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ2=0·28, I2=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types. Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health. National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.

Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in Germany, 2003–21: an ecological study

Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in Germany, 2003–21: an ecological study