Increase In Female Life Expectancy Research Articles

Gender parity at scale: Examining correlations of country-level female participation in education and work with measures of men's and women's survival

BackgroundPast research has demonstrated the relationship between women's educational levels and other measures of social development with maternal and child health outcomes. This study examines the relationship between gender parity in education and work, achieved through greater female participation in both spheres, with survival in both women and men. MethodsUtilizing cross-sectional indicators from United Nations agencies, we constructed global indices of gender parity in education and work for international comparison. Multivariable regression was performed to assess relationships between gender parity index scores and national mortality rates or life expectancy indicators. FindingsGender parity in both arenas was significantly associated with improved health outcomes after controlling for country health expenditures and other characteristics. A 10% higher country educational parity index score was associated with 59·5 fewer maternal deaths per 100 000 live births, a 2·1-year increase in female life expectancy, and almost a 1-year increase in male life expectancy at birth. Similarly, a 10% higher work parity index score was significantly associated with 14·6 fewer maternal deaths per 100 000 live births and a 0·9-year increase in female life expectancy at birth, with no deleterious relationship to male life expectancy. InterpretationThis study extends past research by examining actionable areas of gender equality and their impact on both male and female survival. While longitudinal research is needed to examine both causality and mechanisms, our findings suggest longevity gains for both women and men, and for all children through reduced maternal mortality, where greater parity in school and work is exhibited. FundingNo funding source directly supported the work in this manuscript. We are deeply indebted to the Conrad N Hilton Foundation for its support of Adva Gadoth as a Hilton Scholar.

Climbing a long hill: pelvic floor surgery and the need for geriatric urogynecology

The topic of geriatric urogynecology is receiving much attention lately as a public health priority because of the global increase in female life expectancy and the significant risk of associated pelvic floor dysfunctions. Statistics from the USA project that in 2050, 25 % of the population will be >60 years and that those >85 will increase from a population of 1.9 % in 2010 to 4.3 % in 2050 [1]. The urogynecological community should thus expect to face a worldwide and progressively growing demand from patients seeking care for pelvic floor dysfunctions. One study predicted >50 % increased demand for urogynecological services over the next 40 years [2]. The changing female demographics is accompanied by a considerable interest in the contemporary literature to standardize the indications, techniques, and outcomes of surgical treatment of pelvic floor dysfunctions. Only a few reports appreciate that increasing age of our female population is an intrinsic biological variable interfering with the standardization process [3]. Women aged >80 years undergoing urogynecological surgery have a 13.6 higher risk of postoperative death than their younger counterparts. In the majority of cases, the cause of death is not directly related to the procedure [4]. Despite the obvious need for operative intervention among these elderly women and the strong evidence for the inherent morbidity and mortality of this treatment option, there is scarce urogynecological data on the risks and specific perioperative management in this patient group. Ageing influences lower urinary tract symptoms (LUTS), pelvic floor function, and perioperative and postoperative courses. The higher postoperative morbidity rate is also an important factor that is often overlooked in most surgical studies. Main concerns when treating elderly women are:

Gewonnene Lebensjahre

In Germany life expectancy is continuously increasing. Differently to the increases in the nineteenth century, which were mainly driven by decreasing mortality from infectious diseases, the recent rise in life expectancy is the result of a mortality decline in all major groups of causes of death. Contrary to mortality, the incidence and prevalence of a large number of diseases, in particular cancer and cardiovascular diseases (CVD), is rising. However, this increase is mainly the result of changes in the population's age structure, differences in lifestyle, improvements in diagnostic techniques, and increasing prevention. Age-standardized death rates and survival rates indicate significant improvements in most of the diseases over the last decades. Important exceptions are cancer of the lung and bronchia for females as well as mental diseases for both sexes. Therefore, these diseases will grow in importance for public health measures in the next decades. A major potential for a further increase in female life expectancy lies in the reduction of CVD mortality. In contrast, decreases in mortality due to various types of cancer, diseases of the respiratory system, and diseases of the digestive system in addition to CVD mortality may lead to a significant rise in male life expectancy. Although declining mortality is strongly linked to an increase in the prevalence of multi-morbidity and the number of years with disability, it is also paralleled by an increase in healthy life years.

Physiology and effects of the menopause

The menopause, caused by ovarian failure, is natural part of female ageing. Most women will experience a spontaneous menopause around 52 years in the western world. Some women become menopausal because of surgical removal of their ovaries or as a result of treatment for other disease such as chemotherapy or radiotherapy. A menopause before the age of 45 years is considered premature and these women may need closer supervised care and support. Women often report changes in menstrual pattern and a woman is considered postmenopausal following 1 year of amenorrhoea. Checking follicle-stimulating hormone levels can sometimes be helpful to confirm diagnosis in women following hysterectomy or with unexplained amenorrhoea. Each woman has a unique and individual menopause experience. Many women experience vasomotor symptoms and sometimes psychological symptoms in the perimenopause and in a minority of women, these can continue for many years. With the increase in female life expectancy over the past century, the long term consequences of the menopause, such as cardiovascular disease and osteoporosis, are significant because of the distress and dependence to ageing women and the resulting burden on the social and health services.

Sex steroids impact on female sexuality: peripheral and central effects

The increase in female life expectancy during the past century has meant that women now live one-third of their lives beyond cessation of their ovarian function. This evolution in demography has increased the need for the development of new therapeutical strategies to promote successful aging, defined as low probability of disease, high cognitive and physical capacity and active engagement in life. The growth, differentiation, normal physiology and aging of the CNS are all recognized to be influenced by gonadal steroid hormones. Steroids arriving from the gonads via the circulation modulate brain function, affecting gender differentiation and sexually differentiated behavioural responses, but also the ability of the brain to process, store and retrieve sensory information. Sex steroids (estrogen, androgen) play a pivotal neuroactive role during the “organizational/developmental” phase, mainly in the fetal-neonatal period, when participated to the formation of neuronal circuits, as well as during the aging process when it has been demonstrated to directly affect synapse density and remodelling, suggesting a physiopathological role for sex steroids in the modulation and perception of measure of quality of life, cognitive function and development of neurovegetative disease. In postmenopause as well as during ageing process, neurotransmitters, neuropeptides and neurosteroids undergo important changes as a consequence of the failure of gonadal and adrenal hormone production, bringing on specific symptoms due to CNS derangement. Hot flushes, sweat, obesity and hypertension are consequences of the neuroendocrine changes in the hypothalamus. Mood changes, anxiety, depression, insomnia, headaches/migraine, sexual dysfunction are related to postmenopausal alterations of sovrahypothalamic areas. Because changes in the aging nervous system are subtle, it may be possible to reverse them and to improve cognitive and sexual behavioural performance by pharmacological treatments. Though a large attention has been given to the study of postmenopause and to the options in hormone replacement treatment (estrogens and progestins), relative attention and awareness has been focused on the activity of endogenous or exogenous androgens in women. In fact the middle age of women life is characterized by the coexistence of menopause and adrenopause that sometimes both partecipate to create the androgen-deficiency syndrome. Thus, much more interested have been launched to the study of androgen role in the modulation of brain function in term of sexuality, mood, cognition and neuroaging process. The presentation summarize the neuroactive effect of estrogen and androgen in the female body and in particular in female brain with particular regard to their impact of measure of quality of life and sexuality.

Pharmaceutical Expenditures as a Correlate of Population Health in Industrialized Nations

In recent years, healthcare spending has outpaced economic growth in developed countries, with pharmaceutical expenditures being a key driver of this trend. While a significant number of studies investigating the effect of healthcare resource productivity on health status have been done, only a few have disaggregated pharmaceutical expenditures from total healthcare expenditures. To assess the independent association between pharmaceutical expenditures and health outcomes in 14 industrialized countries. We used data from the Organisation for Economic Co-operation and Development to construct a panel data set covering the years from 1985 to 2001. These data contain information on pharmaceutical expenditures, other healthcare expenditures, environmental health determinants, lifestyle health determinants, potential years of life lost, and life expectancy at ages 65 and 80 years across 14 industrialized nations. We estimated the relationship between pharmaceutical expenditures and potential years of life lost and life expectancy at ages 65 and 80 years for both males and females, using nonlinear fixed-effects regression models that corrected for serial correlation. All explanatory variables were lagged by 5 years to account for their cumulative effect on population health outcomes. Pharmaceutical expenditures proved to be a robust correlate of health outcomes from 1985 to 2001 in this sample of nations, when controlling for the effects of other variables likely to impact population health outcomes. Our estimates imply that a 10% increase in pharmaceutical expenditures during these years was associated with a 0.3% (95% CI 0.1% to 0.5%; approximately 21 days) increase in female life expectancy at age 65 years (p < 0.05), while a similar increase was associated with a 0.4% (95% CI 0.1 to 0.7; approximately 24 days) increase in male life expectancy at age 65 years (p < 0.05) and a 0.5% increase (95% CI 0.03 to 1.0; approximately 14 days) at age 80 years (p < 0.05). Our results suggest that significant, but small, marginal gains in population health outcomes were associated with increased pharmaceutical expenditures in developed nations during the period studied.

Ageing of the female pelvic floor: towards treatment a la carte of the “geripause”

The study of menopause and female ageing “geripause” is receiving much attention lately from the health care community for three main reasons [1–3]. The first is the global increase in female life expectancy as a result of improved health awareness and services with continuing reduction of adult mortality, progressive transition from high to low fertility, and recent socioeconomic affluence in most countries. This unprecedented demographic change, which started in the developed world in the 19th century and more recently in developing countries, allowed women to experience menopausal manifestations during approximately one third of their lifespan and reach the geripause. Secondly, the process of medicalization within the broader context of the dominance of health as a cultural preoccupation in recent societies and women’s motivation by personal concerns and cultural forces to take more control of the effects of menopause and/or ageing on their bodies has resulted in increasing use of female sex hormones as a replacement therapy. Finally, there is a growing public and medical concern about the serious adverse effects of estrogen/progestin replacement therapy in old postmenopausal “geripausal” women that had been recently reported in the Women’s Health Initiative Trial. This is accompanied by considerable interest in the contemporary biomedical literature, in particular, about the prevalence, detrimental effects, and management of support-related pelvic floor dysfunction (pelvic organ prolapse, urinary incontinence, and fecal incontinence) in the geripausal population. There seems to be no consensus, however, whether the exact underlying mechanism is normative ageing, falling circulating estrogen levels caused by menopausal ovarian failure, or a combination of both factors [3–9]. It is widely believed that estrogen deprivation at the climacteric is primarily responsible for support-related pelvic floor dysfunction in geripausal women. This assumption is based on the detection of estrogen receptors in the components of continence-maintaining and supportive pelvic floor structures in premenopausal women and experimental animals [3–6]. In turn, estrogen replacement had been extensively used to prevent or restore the decline in pelvic floor support and/or deterioration of urinary and fecal control after the menopause but without critical analysis of the long-term cure rates or evidence-based improvement in clinical outcome after treatment in most studies [7]. Paradoxically, a recent meta-analysis and a Int Urogynecol J (2008) 19:455–458 DOI 10.1007/s00192-008-0576-0

Hormone replacement Up-to-date. Hormone replacement therapy and brain function

Estrogen has its receptor in the brain and affects the nervous system in various ways. To date, it has been paid attention whether the cognitive function and the risk of depression change due to estrogen deficiency and also whether these changes respond to hormone replacement therapy (HRT). The increase in female life expectancy accelerates the prevalence of dementia like Alzheimer Disease, so the efficacy of HRT in the cognitive function got the public attention. On the contrary, a series of large-scale randomized controlled trials (Women's Health Initiative Memory Study: WHIMS) in aged 65 years or older women showed HRT increases the risk of dementia. However, certain studies indicate HRT may have beneficial effect on dementia when being started earlier. Therefore direct application of the result of WHIMS for the climacteric women is still controversial.

The health expectancies of older Australians

Health expectancies of the states ‘Disability-free’ and ‘Disabled’ are estimated for Australian females and males aged 60 and over, both by cohort from 1980 and current for survey years 1981, 1988, 1993 and 1998. Modifications of recently developed logistic regression techniques are used rather than the standard 1971 method due to Sullivan. Results from the three later surveys are broadly similar and differ in important respects from those of the 1981 survey. Based on the last three surveys our estimates support the view that, depending on age, two-thirds or more of the increase in female life expectancy over the decade 1988–1998 is spent in the Disabled state. The situation is worse for elderly men, for whom all of the increased years of expected life are estimated to be spent in the Disabled state. The findings do not support rectangularization of the survival curve or Disability-free survival curve.