Healthy Life Expectancy Research Articles

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.

Searching for Beauty and Health: Aging in Women, Nutrition, and the Secret in Telomeres.

Women typically outlive men, yet they often experience greater frailty and a higher incidence of chronic diseases as they age. By exploring the biological foundations of aging, with a particular focus on telomere dynamics, this manuscript aims to describe how dietary and lifestyle choices can significantly influence the aging process. The review comprehensively examines current research, underscoring the power of nutrition to counteract age-related changes, support healthy aging, and maintain vitality and beauty in women. The exploration of telomeres-the protective caps at the ends of chromosomes-reveals how they serve as markers of cellular aging and are potential targets for interventions aimed at enhancing women's longevity and quality of life. This study also emphasizes the importance of sex-specific approaches and precision medicine in understanding the unique health challenges women face as they age. By proposing targeted strategies, the review seeks to address these challenges, offering insights into preventive measures that can foster resilience, promote well-being, and extend healthy life expectancy in women. Ultimately, this work provides a sophisticated understanding of the aging process in women, highlighting the pivotal role of tailored interventions in preserving both health and beauty.

Using System Dynamics for Local Authority Public Health practice in England

A key function of local authority public health teams in England is to undertake a regular health needs assessment of their population. This involves forecasting, among other things, prevalence and incidence of long term conditions and health care service demand. Over the last few years, Kent County Council Public Health has adopted the use of system dynamics modelling (SDM) to not only do this but generate scenarios to simulate the impact of different interventions across different cohorts defined by age groups and diagnosable conditions. These include “no conditions” as well as understand the combined effects of different interventions, demographic changes and wider health determinants. Risk factors, such as smoking, diet and physical activity, were calculated using local linked data for the incidence of single conditions, progression toward complex needs and levels of morbidity including frailty. These were used to create the dynamics of the model. Incidence, prevalence and mortality for each cohort were projected over 25 years with “do nothing” and “Better Health” scenarios. The size of the “no conditions” cohort increased, and the other cohorts decreased in size. The impact of the interventions on life expectancy at birth and healthy life expectancy was significant. SDM heavily influenced local authority commissioning decisions for health improvement services redesign such as smoking cessation, weight management as well as other secondary prevention measures such as hypertension management and cardiovascular disease screening delivered by General Practice and other health service partners.

Does socioeconomic status modify how individuals perceive or describe their own health? An assessment of reporting heterogeneity in the Health Survey for England

BackgroundSelf-reported health (SRH) is widely used as a proxy for health status; it is a simple, holistic measure of health and has been associated with other health outcomes. However, variation...

Relationship between participation in projects of incentives to promote walking and healthy aging among the older population: A four-year longitudinal study

ObjectiveThis study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy. MethodsA total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into “non-participation,” “participation without uploading,” and “participation with uploading” groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation. ResultsA total of 440 participants (10.2 %) were included in the “participation with uploading” group and 206 (4.8 %) in the “participation without uploading” group. Compared with “non-participation,” the risk ratio was 0.77 (95 % confidence interval (CI): 0.59–0.99) for “participation with uploading” and 1.02 (95 % CI: 0.75–1.38) for “participation without uploading”. In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60–1.04) for the likelihood of functional decline. ConclusionsThe use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.

Association Between Frailty and Pelvic Organ Prolapse in Elderly Women: A Retrospective Study

Introduction and HypothesisThis study evaluated the association between pelvic organ prolapse (POP), frailty, and sarcopenia to explore how POP treatment can extend healthy life expectancy in elderly women.MethodsWe conducted a retrospective study of prospectively collected data, comparing women with mild POP (stages 0–II) with those with advanced POP (stages III and IV). The inclusion criteria for this study were women who visited the clinic with at least one symptom of pelvic floor dysfunction and underwent imaging studies between April 2020 and November 2022. Initially, 119 patients met these inclusion criteria. Patients were excluded if they had a history of previous POP treatment, did not respond to the study survey, or were lost to follow-up. After applying these exclusion criteria, 82 patients were included in the final analysis, of whom 65 underwent surgery (laparoscopic sacrocolpopexy, colpocleisis, tension-free vaginal tape, and native tissue repair). Assessments included POP Quantification, Kihon Checklist, Pelvic Organ Prolapse Quality of Life (P-QOL) questionnaire, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Incontinence Symptom Questionnaire (ICIQ-SF). Pelvic muscles were measured using MRI or CT. Immunohistochemical analysis of estrogen receptor alpha (ERα), estrogen receptor beta , and androgen receptor was performed on surgical specimens from 43 patients.ResultsThe median age of participants was 75 years. Of the 82 patients, 48 (58.5%) were classified as frail or pre-frail, and 22 (26.8%) exhibited motor impairment. Advanced POP (stages 3 and 4) was seen in 41 patients. These patients had more motor function impairments (advanced, 16; mild, 6; p = 0.01). Patients with advanced POP had poorer P-QOL, ICIQ-SF (median: 9.5 vs 4, p = 0.006) and OABSS (7 vs 4, p = 0.008) scores, and smaller pubococcygeus muscle diameter (2.5 vs 3 cm, p = 0.017). Postoperatively, significant improvements were seen in P-QOL (all domains except personal relationships: p < 0.001), total IPSS (11 vs 4, p < 0.001), OABSS (6 vs 5, p = 0.033), and ICIQ-SF scores (6 vs 2, p < 0.001). ERα expression was associated with preoperative frailty (r = −0.37, p = 0.014).ConclusionsAdvanced POP correlates with poorer QOL, worse urinary symptoms, and reduced pubococcygeus muscle diameter, consistent with sarcopenia, compared with mild POP.

Markers of healthcare: the scientific and legal environment of a medical university

The article notes and examines in detail the currently important healthcare tool that provides training for highly qualified personnel — research work carried out at a medical university. In May 2024, the decree of the President of the Russian Federation defines strategic goals for the development of the social sphere facing domestic healthcare and relating, in particular, to strengthening human health, increasing healthy life expectancy, timely disease prevention, and increasing the level of satisfaction of participants in a special military operation with conditions for medical rehabilitation. The analysis of the features of legal support of scientific personnel of medical universities involved in the training of highly qualified doctors who are called upon to directly solve the above tasks, possessing not only theoretical knowledge, but also having passed scientific and practical training.

Longer healthy life, but for how many? A stochastic analysis of healthy lifespan inequality

AbstractOver the past 150 years, life expectancy doubled and healthy life expectancy increased. Expectations reveal nothing about variability, so we present a stochastic analysis to investigate changes over time, age and gender of variation, among individuals, in healthy lifespan, for different levels of country income. To complement health-adjusted life expectancy (HALE) data from the Global Burden of Disease Study, we use a stochastic model to compute the standard deviation of healthy life (SDHL). The model is a finite-state absorbing Markov chain with rewards. It includes stochastic survival, mortality, and loss of good health status. An individual surviving from one age to the next gains, as a "reward," a year of good health. This method provides all the moments of healthy longevity. The mean healthy longevity is exactly the HALE. As a measure of variation, here we focus on the standard deviation of healthy longevity. From 1990 to 2019, HALE increased, with greater increases at younger ages. At the same time, SDHL at younger ages decreased and at older ages increased. The most significant changes at birth occurred in low- and lower-middle-income countries. High- and upper-middle-income countries saw notable increases at old ages. Women generally have longer HALE and higher SDHL, but the overall HALE increase was greater for men. The reduction in SDHL over time suggests that more individuals benefit from increased longevity, particularly in low-income countries closing the gap with high-income countries. However, improvements in healthy survival at older ages appear unevenly distributed among individuals in high-income countries.

Medication-based profiling of older orthopedic patients: a multicenter cross-sectional study

BackgroundManaging medication use in older orthopedic patients is imperative to extend their healthy life expectancy in an aging society. However, the actual situation regarding polypharmacy, the intake of potentially inappropriate medications (PIMs), and fall risk-increasing drugs (FRIDs) among older orthopedic patients is not well characterized. This study aimed to investigate the medication-based profiles of older orthopedic patients to highlight the critical points of concern.MethodsWe retrospectively reviewed the clinical data of consecutive patients aged ≥ 65 years who underwent orthopedic surgery at two acute care hospitals between April 2020 and March 2021. The cutoff number of prescribed drugs for polypharmacy was set at 6. According to the specified guidelines, 19 categories of drugs were identified as PIMs, and 10 categories were classified as FRIDs.ResultsA total of 995 older patients with orthopedic surgery were assessed, of which 57.4% were diagnosed with polypharmacy, 66.0% were receiving PIMs, and 41.7% were receiving FRIDs. The prevalence of FRID intake did not significantly differ among patients with degenerative spinal disease (n = 316), degenerative disease of extremities (n = 331), and fractures (n = 272). Compared with patients with degenerative disease of the extremities, the multivariable-adjusted prevalence ratios (PRs) of polypharmacy and PIM intake were significantly higher in patients with degenerative spinal disease (1.26 [confidence intervals (CI): 1.11–1.44] and 1.12 [CI: 1.00–1.25]), respectively. Use of antiemetic drugs (adjusted PR, 13.36; 95% CI: 3.14–56.81) and nonsteroidal anti-inflammatory drugs (adjusted PR, 1.37; 95% CI: 1.05–1.78) was significantly higher in patients with degenerative spinal disease. Among patients with degenerative spinal disease, the prevalence of antiemetic drug intake was 8.7% in lumbar spinal patients and 0% in cervical spinal patients.ConclusionsMore than half of the orthopedic patients in this study were affected by polypharmacy, and approximately two-thirds were prescribed some form of PIMs. Patients with degenerative spinal disease showed a significantly higher prevalence of polypharmacy and PIM use compared with other orthopedic diseases. Particular attention should be paid to the high frequency of antiemetic drugs and nonsteroidal anti-inflammatory drugs intake among patients with degenerative lumbar spine conditions.

The Multicenter STudy On a Precise algorithm for diagnosis of heart failure with preserved ejection fraction, STOP-HFPEF study: study protocol and design.

This study aims to develop a new heart failure with preserved ejection fraction (HFpEF) diagnostic algorithm tailored to Asian populations, addressing limitations of current diagnostic models. Existing HFpEF diagnostic algorithms primarily target patients with dyspnea and metabolic comorbidities, such as obesity, which are more prevalent in Western populations. However, in Asian countries, HFpEF cases are less frequently associated with obesity, leading to less prominent dyspnea and more noticeable symptoms such as fatigue. By incorporating exercise stress echocardiography and focusing on early-stage HFpEF, particularly in patients with symptoms beyond dyspnea, we seek to enable early diagnosis and intervention, ultimately extending healthy life expectancy and improving quality of life. The STOP-HFPEF (The Multicenter STudy On a Precise algorithm for diagnosis of Heart Failure with Preserved Ejection Fraction) study is a multicenter prospective observational investigation in Japan. Certified by the Japanese Society of Echocardiography, the study includes participants aged 20 and older who undergo exercise stress echocardiography. The primary goal is to develop a scoring model for diagnosing HFpEF in heart-failure stages A, B, and C. Secondary outcomes will assess the clinical utility of the new diagnostic score by comparing heart-failure incidence, cardiovascular events, and mortality rates.Study registration: Registered at the UMIN registry (UMIN000054565) on 1 July 2024.

Human rights health care measures reporting physical fitness test for ages 6 to 17 with 10-year follow-up

Purpose This study aims to compare the physical fitness test results of Japanese children in 2008 and 2018 to narrow the gap between life expectancy and healthy life expectancy and extend healthy life expectancy. In addition, this paper sought to explore the potential of implementing health education programs as a new social context to promote race equality and human rights in health and social care. Design/methodology/approach This study was conducted in 2008 and 2018 in Nagano Prefecture, Japan. Physical fitness tests related to growth and development were administered to participants aged 6–17 years. Findings Physical fitness measurements in 2018, specifically those for walking ability and endurance, were significantly inferior to those in 2008. In a gender-specific analysis, boys outperformed girls in muscle strength, muscle endurance, walking ability and endurance tests, while girls outperformed boys in the balance test. Research limitations/implications Most of the junior and senior high school students who participated in the EO test exceeded the upper limit of 120 s, suggesting that the load of the measurement method is low and improvement is necessary. In 2018, a large variation in 6M results was observed among participants, possibly due to the differences in the level of seriousness during the 6M test. Therefore, to ensure that junior and senior high school students properly perform the EO and 6M tests, it is necessary to devise an effective method of implementation, such as changing the physical fitness test load. Originality/value Mere health education is ineffective to address health inequalities. Addressing structural factors is essential to avoid unintended consequences such as increasing the gap between groups of people. However, one way to extend healthy life expectancy is to improve overall health, including differences in the health status of groups due to differences in region and socioeconomic status.

Healthy life expectancy with cardiovascular disease among Chinese rural population based on the prospective cohort study.

Limited research has explored the impact of cardiovascular disease (CVD) on healthy life expectancy (HLE) especially in resource-limited areas. This study aimed to investigate the association between CVD and HLE in Chinese rural population. This study included 11,994 participants aged 45 years and older from the baseline and follow-up surveys of the Henan rural cohort study. Healthy status was measured via a Visual Analogue Scale. The multistate Markov model was applied to estimate the association between CVD and transitions in health, unhealthiness and death. Gender-specific total life expectancy, HLE and unhealthy life expectancy were calculated by the multistate life table method. During a mean follow-up time of 3.85 (3.84-3.86) years, there were 588 deaths recorded. For individuals with CVD, the risk of switching from health to unhealthiness status was increased by 71% [hazard ratio (HR) = 1.71, 95% CI: 1.42-2.07], the chance of recovery was reduced by 30% (HR = 0.70, 95% CI: 0.60-0.82). Men aged 45 years without CVD could gain an extra 7.08 (4.15-10.01) years of HLE and lose 4.00 (1.60-6.40) years of unhealthy life expectancy compared to their peers with CVD, respectively. The corresponding estimates among women were 8.62 (5.55-11.68) years and 5.82 (2.59-9.04) years, respectively. This study indicated that CVD was significantly associated with poorer health status and lower HLE among Chinese rural population. It is an important public health policy to adopt targeted measures to reduce the CVD burden and enhance the quality of life and HLE in resource-limited areas.

An Investigation of Substances Influencing Adipocyte Function

Adipose tissue plays a central metabolic role in systemic energy metabolism via nutrient exchange and secretion of adipose-derived hormones and cytokines. Adipose tissue dysfunction increases the risk of developing conditions, including type 2 diabetes, coronary artery disease, stroke, and cancer, ultimately shortening healthy lifespan. Maintaining adipose tissue functions has recently garnered attention as a means to extend healthy life expectancy. We previously developed a T-cell activation-inhibitory assay, which facilitates efficient selection of candidate substances for extending healthy lifespan. Using this assay, we identified two candidate substances: Cynandione A (CA), a major component of Cynanchum wilfordii, and N-caffeoyltryptophan (NCT) found in coffee. This review summarizes recent findings regarding the effect of CA and NCT on adipocyte (the primary cells in adipose tissue) function, and their potential contribution to extending healthy life expectancy.

Natural activators of autophagy

Autophagy is the process by which cell contents, such as aggregated proteins, dysfunctional organelles, and cell structures, are sequestered by the autophagosome and delivered to lysosomes for degradation. As a process that allows the cell to get rid of non-functional components that tend to accumulate with age, autophagy has been associated with many human diseases. In this regard, the search for autophagy activators and the study of their mechanism of action is an important task for the treatment of many diseases, as well as for increasing healthy life expectancy. Plants are rich sources of autophagy activators, containing a large amount of polyphenolic compounds in their composition, which can be activators in their original form, or can be metabolized by the intestinal microbiota to active compounds. This review is devoted to plant-based autophagy activators with an emphasis on the sources of their production, mechanism of action, and application in various diseases. The review also describes companies commercializing natural autophagy activators.

Efficiency evaluation of 28 health systems by MCDA and DEA

BackgroundPolicymakers, who are constantly discussing growing health expenditures, should know whether the health system is efficient. We can provide them with such information through international health system efficiency evaluations. The main objectives of this study are: (a) to evaluate the efficiency of health systems in 28 developed countries by multiple-criteria decision analysis (MCDA) and data envelopment analysis (DEA) and (b) to identify reasonable benchmark countries for the Czech Republic, for which we collect information on the relative importance of health system inputs and outputs.MethodsWe used MCDA and DEA to evaluate the efficiency of the health systems of 28 developed countries. The models included four health system inputs (health expenditure as a relative share of GDP, the number of physicians, nurses, and hospital beds) and three health system outputs (life expectancy at birth, healthy life expectancy, and infant mortality rate). The sample covers 27 OECD countries and Russia, which is also included in the OECD database. To determine the input and output weights, we used a questionnaire sent to health policy experts in the Czech Republic.ResultsWe obtained subjective information on the relative importance of the health system inputs and outputs from 27 Czech health policy experts. We evaluated health system efficiency using four MCDA and two DEA models. According to the MCDA models, Turkey, Poland, and Israel were found to have efficient health systems. The Czech Republic ranked 16th, 19th, 15th, and 17th. The benchmark countries for the Czech Republic’s health system were Israel, Estonia, Luxembourg, Italy, the UK, Spain, Slovenia, and Canada. The DEA model with the constant returns to scale identified four technically efficient health systems: Turkey, the UK, Canada, and Sweden. The Czech Republic was found to be one of the worst-performing health systems. The DEA model with the variable returns to scale identified 15 technically efficient health systems. We found that efficiency results are quite robust. With two exceptions, the Spearman rank correlations between each pair of models were statistically significant at the 0.05 level.ConclusionsDuring the model formulation, we investigated the pitfalls of efficiency measurement in health care and used several practical solutions. We consider MCDA and DEA, above all, as exploratory methods, not methods providing definitive answers.

Personalized heart rate management through data-driven dynamic exercise control

Maximizing healthy life expectancy is essential for enhancing well-being. Optimal exercise intensity is crucial in promoting health and ensuring safe rehabilitation. Since heart rate is related to exercise intensity, the required exercise intensity is achieved by controlling the heart rate. This study aims to control heart rate during exercise by dynamically adjusting the load on a bicycle ergometer using a proportional-integral (PI) control. The choice of PI parameters is very important because the PI parameters significantly affect the performance of heart rate control. Since the dynamic characteristics of heart rate relative to work rate vary widely from subject to subject, the PI parameters for each subject must be determined individually. In this study, PI parameters are optimized directly from exercise data using a data-driven design approach. Thus, the proposed method does not require excessive exercise of the subject to model heart rate dynamics. Using the proposed method, the heart rate can be controlled to follow a designed reference model so that the heart rate is safely increased to the desired value. The quantitative evaluation of the control results of fifteen healthy volunteers confirmed that the proposed method improved the control error of the target heart rate trajectory by approximately 40%, regardless of gender or age. In addition, it was shown that control parameters from the exercise experiment also indicate that females are more likely than males to have an elevated heart rate at the same load.

Dietary characteristics of urban community-dwelling older adults with low muscle mass: the bunkyo health study: a cross-sectional study

BackgroundWith the aging of the population worldwide, extending healthy life expectancy is an urgent issue. Muscle mass has been reported to be associated with physical independence and longevity. This study aimed to investigate the characteristics of food intake in urban community-dwelling older adults with low muscle mass.MethodsThis cross-sectional study used baseline data from the Bunkyo Health Study, which included 1618 urban community-dwelling older adults aged 65–84 years. All participants underwent measurement of body composition using bioelectrical impedance analysis and evaluation of nutrient and food intake using the brief-type self-administered diet history questionnaire. Participants were stratified by sex and divided into robust or low skeletal muscle mass index (SMI) groups according to the Asian Working Group for Sarcopenia criteria to compare differences in nutrient and food intake.ResultsThe mean age and body mass index were 73.1 ± 5.4 years and 22.6 ± 3.1 kg/m2, respectively. The prevalence of low SMI was 31.1% in men and 43.3% in women. In men, all food intake, including total energy intake, was similar between the low SMI group and the robust group. In women, the low SMI group had less total energy intake, and consumed lower amounts of energy-producing nutrients (protein, fat, and carbohydrates), but there were only small differences in the intake of specific foods.ConclusionsThere were sex differences in food intake characteristics between urban community-dwelling older adults with low SMI and those who were robust. Advising women to increase their energy intake may be important in preventing muscle loss, and further research is needed in men.

Frailty and all-cause and cancer-related mortality in cancer patients: A prospective cohort study

PurposeTo evaluate the associations between frailty and all-cause and cancer-related mortality. Additionally, the objective is to compare the magnitude of these associations between older adults and younger adults. MethodsWe gathered baseline data from NHANES (1999–2018) and developed a cumulative index consisting of 39 items to evaluate frailty. The National Death Index database was utilized to track the survival status of individuals. The Cox regression model was employed to estimate the associations between frailty status and all-cause and cancer-related mortality. ResultsUltimately, 3398 cancer patients were included in the analysis, comprising 910 younger adults and 2488 older adults. Compared to non-frail patients, the elevated all-cause and cancer-related mortality among pre-frail patients was not statistically significant (HRs = 1.312, 95%CI: 0.956–1.800, P = 0.092; HRs = 1.462, 0.811–2.635, P = 0.207). However, a significant elevation of both all-cause and cancer-related mortality risk was observed among frail patients (HRs = 2.213, 1.617–3.030, P < 0.001; HRs = 2.463, 95%CI = 1.370–4.429, P = 0.003). Frailty individuals demonstrated a more pronounced association with the prediction of all-cause mortality in younger (HRs = 2.230, 1.073–4.634, P = 0.032) than in older adults (HRs = 2.090, 1.475–2.960, P < 0.001). Sensitivity analysis consistently revealed robust results. RCS plots suggested a progressively escalating dose-response correlation between frailty and both all-cause and cancer-related mortality risk. ConclusionsPre-frailty did not result in an increase in mortality risks compared to non-frailty. However, frailty caused a higher all-cause and cancer-related mortality risk than non-frailty. Identifying those at risk and implementing targeted interventions may contribute to extending healthy life expectancy, regardless of age.

Relationship between quantitative physical activity and deterioration of locomotive function: a cross-sectional study using baseline data from a cohort

BackgroundIn aged society, health policies aimed at extending healthy life expectancy are critical. Maintaining physical activity is essential to prevent the deterioration of body functions. Therefore, it is important to understand the physical activity levels of the target age group and to know the content and intensity of the required physical activity quantitatively. Especially we focused the role of non-exercise activity thermogenesis and sedentary time, which are emphasized more than the introduction of exercise in cases of obesity or diabetes.MethodsA total of 193 patients from 25 institutions were included. Participants underwent a locomotive syndrome risk test (stand-up test, 2-step test, and Geriatric Locomotive Function Scale-25 questionnaire) and were classified into three stages. Physical activity was quantitatively monitored for one week with 3-axial accelerometer. Physical activity was classified into three categories; (1) Sedentary behavior (0 ∼ ≤ 1.5 metabolic equivalents (METs)), (2) Light physical activity (LPA:1.6 ∼ 2.9 METs), and (3) Moderate to vigorous physical activity (MVPA: ≥3 METs). We investigated the relationship between physical activity, including the number of steps, and the stages after gender- and age- adjustment. We also investigated the relationship between social isolation using Lubben’s Social Network Scale (LSNS), as social isolation would lead to fewer opportunities to go out and less outdoor walking.ResultsComparison among the three stages showed significant difference for age (p = 0.007) and Body Mass Index (p < 0.001). After gender-and age-adjustment, there was a significant relation with a decrease in the number of steps (p = 0.002) and with MVPA. However, no relation was observed in sedentary time and LPA. LSNS did not show any statistically significant difference. Moderate to high-intensity physical activity and the number of steps is required for musculoskeletal disorders. The walking, not sedentary time, was associated to the locomotive stages, and this finding indicated the importance of lower extremity exercise.ConclusionsAdjusting for age and gender, the number of steps and moderate to vigorous activity levels were necessary to prevent worsening, and there was no effect of sedentary behavior. Merely reducing sedentary time may be inadequate for locomotive disorders. It is necessary to engage in work or exercise that moves lower extremities more actively.

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.