Increase In Life Expectancy Research Articles

Artificial intelligence in assessing progression of age-related macular degeneration

AbstractThe human population is steadily growing with increased life expectancy, impacting the prevalence of age-dependent diseases, including age-related macular degeneration (AMD). Health care systems are confronted with an increasing burden with rising patient numbers accompanied by ongoing developments of therapeutic approaches. Concurrent advances in imaging modalities provide eye care professionals with a large amount of data for each patient. Furthermore, with continuous progress in therapeutics, there is an unmet need for reliable structural and functional biomarkers in clinical trials and practice to optimize personalized patient care and evaluate individual responses to treatment. A fast and objective solution is Artificial intelligence (AI), which has revolutionized assessment of AMD in all disease stages. Reliable and validated AI-algorithms can aid to overcome the growing number of patients, visits and necessary treatments as well as maximize the benefits of multimodal imaging in clinical trials. Therefore, there are ongoing efforts to develop and validate automated algorithms to unlock more information from datasets allowing automated assessment of disease activity and disease progression. This review aims to present selected AI algorithms, their development, applications and challenges regarding assessment and prediction of AMD progression.

Predicting Mortality Rates and Longevity Using Cains -Blake-Dowd Model

Pension schemes and annuity providers frequently guarantee their retirement payouts until the retirees' deaths. As a result of longer life expectancies and declining rates of death in old age, trends in mortality and longevity have become evident. Academicians and actuaries have been forced to concentrate their research on mortality and longevity concerns in particular as a result of this. Instead of a provident fund, the new National Social Security Fund Act Number 45 of 2013 established a pension fund that is a requirement for every employee. Annuity service providers are exposed to the longevity risk when the scheme's participants retire. For pricing and reserving, appropriate modeling tools or projected life tables are required. In comparison to deterministic models, which were based on projected present values, stochastic models allow a variety of risk causes and components as well as pertinent effect on portfolio performance. The long term mean level of Longevity has become more uncertain exposing the annuity service providers such as assurance companies and states to the risk of uncertainty after retirement. Most industrialized countries' national security systems, pension plans, and annuity providers have revised their mortality tables to account for longevity risks due to decline mortality rates and rising life expectancy. Kenya is one of the developing nations that has seen a drop-in death rates and a rise in life expectancy recently. Since developing nations choose to take the longevity risk into account when pricing and reserving annuities because such long term mean level in mortality rates declines and increases life expectancy, particularly at retirement age, pose risks to annuity service providers and pension plans that has been pricing annuities based on mortality tables that do not take these trends into account. The stochastic aspect of mortality was ignored by earlier actuarial models used to estimate trends. The actuary will therefore likely be interested in knowing how the future mortality trend utilizing stochastic models affects annuity pricing and reserve. Demographers and actuaries have since employed a variety of stochastic methods to forecast mortality while examining a variety of stochastic model ranges. The CBD stochastic model, which was the first to take longer life expectancies into account, is now extensively used, and a number of expansions and adjustments have been suggested to stop the major characteristics of mortality intensity. The CBD model, developed by Andrew Cairn, David Blake, and Kevin Dowd, is being used in this study to fit mortality rates, forecast mortality trends, using least square method and then calculate projections for life expectancy. Regarding the longevity risk, we take into account the possibilities of computing annuity benefits by connecting the benefits to actual mortality and calculating the present value on annuities. The results of the study showed that, the CBD model can be used to forecast mortality rates where parameters estimating the CBD model are performed using the bivariate random walk (drift).

IMPLANTES DENTÁRIOS INSTALADOS EM PACIENTES PORTADORES DO VIRUS DA IMUNODEFICIENCIA HUMANA (HIV)

The Human Immunodeficiency Virus (HIV) compromises the immune system and, as it progresses, causes acquired immunodeficiency syndrome (AIDS), characterized by the emergence of opportunistic infections. Transmission occurs mainly through sexual contact or via blood and, in Brazil, between 1980 and 2022, more than 1 million cases of AIDS were recorded. Regarding implantology, patients with HIV face oral complications such as gingivitis and candidiasis, and although the impact of osseointegrated implants in these patients is not yet entirely clear, prior evaluation of bone health and conditions is essential. This research aims to describe the care in the osseointegration process in HIV-positive patients, investigating the possible complications and the importance of biosafety, in addition to highlighting the relevance of treatment to improve the quality of life of these patients. The methodology used was the bibliographic review, using articles published between 2012 and 2022 in Portuguese. Oral rehabilitation with dental implants in HIV-positive patients has gained importance due to the increase in life expectancy provided by antiretroviral therapy. These patients, with an improved quality of life, are looking for viable options to replace missing teeth, with dental implants being an attractive alternative. Although the literature on the topic is limited, the results indicate that the success rates of implants in patients with HIV are similar to those of healthy patients, as long as the treatment considers the immune status. However, specific care is needed, such as monitoring for possible complications resulting from the continuous use of antiretrovirals, which can cause liver and kidney problems. Additionally, strict biosafety protocols are essential to ensure the safety of patients and healthcare providers. Further research is recommended to clarify outstanding issues and improve pre- and postoperative care, providing more predictable outcomes and greater safety in treatment with osseointegrated implants.

The Strategies to Improve Primary Health Care Services: A Scoping Review

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran. Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022. Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers. Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

Mortality in patients older than 65years undergoing surgery for degenerative lumbar spine disease: a comparison with the general population.

The increased life expectancy and prevalence of spondylarthrosis have led to a growing frequency of spinal surgery in older people. This study aims to assess whether there is an excess mortality concerning that expected in the general population associated with surgical procedures performed in patients over 65years old for a degenerative disease of the lumbar spine. All patients aged 65years or older undergoing surgery at a single center between 2009 and 2019 for lumbar spine degenerative disease were included. Standardized mortality ratios (SMRs) were estimated to compare the mortality risk with the expected in the Spanish population for the same age, gender, and calendar-period. Multivariable Cox analysis was employed to determine risk factors of mortality. A total of 411 procedures were analyzed. The mean age was 72.6years old. SMR was 0.67 (CI 95% 0.54-0.84). That benefit was significant in women after gender stratification. Patients operated on between 65-84years old had a lower mortality rate than that expected for the general population. For patients aged 85 or older, the observed mortality was not different from that expected in the general population. Multivariable Cox analysis observed an association between higher mortality and the variables age, male, and Charlson comorbidity index score. Compared with the general population, patients over 65years old who underwent spinal surgery for degenerative disease of the lumbar spine experienced a reduction in mortality. This effect was particularly significant in women and patients aged 65-84years. Age, male gender, and Charlson comorbidity index score were associated with higher mortality risk.

Diabetes mellitus and comorbidities in elderly people from the Lugu community: A critical-reflective analysis

Ageing has a close relationship with chronic non-communicable diseases, such as diabetes mellitus and high blood pressure. These pathologies are often associated with changes in eating habits and promote crucial physiological changes which act silently in the long term in the elderly population. Due to the speed of urban development and technological advances, there has been an increase in the population's life expectancy. However, it is essential to know the socio-demographic profile and prevalent comorbidities of the elderly population, which can provide a reliable and broad database to enable the outline of strategies and the promotion of efficient health policies. In this sense, the purpose of this editorial is to contribute to the debate surrounding the article that analysed epidemiological data from the Lugu community. Diabetes mellitus, hypertension and cardiovascular pathologies and their comorbidities were the most prevalent conditions in this community. Such data could contribute to develop public policies constructively and assertively, allowing investments in the prevention and treatment of these pathologies.

Pharmacokinetics of Antiretroviral Drugs in Older People Living with HIV, Part II: Drugs Licensed Before 2005.

Advances in antiretroviral therapy led to an increase in life expectancy among people living with human immunodeficiency virus (HIV). As aging is characterized by several physiological changes that can influence pharmacokinetics (PK), this systematic review aims to describe the impact of aging on the PK of antiretrovirals (ARV) approved by the Food and Drug Administration (FDA) before 2005. Searches were performed in BVS, EMBASE, and PubMed databases for publications until June 2024. Peer-reviewed published studies were included if they met the following criteria: adults (≥ 18 years) living with HIV; reporting at least one PK parameter or plasma concentration of any ARV approved by the US FDA before 2005 and still used in the clinic: lamivudine (3TC), emtricitabine (FTC), tenofovir disoproxil fumarate (TDF), abacavir (ABC), zidovudine (ZDV), efavirenz (EFV), nevirapine (NVP), atazanavir (ATV), lopinavir (LPV), ritonavir (RTV), tipranavir (TPV), and fosamprenavir (FPV); PK parameters stratified per age group as young (aged 18-49 years) or older (age ≥ 50 years) adults; and manuscripts published in English, Portuguese, or Spanish. All studies were evaluated for risk of bias. The review protocol was registered in the PROSPERO database (registration no. CRD42023463092). Among 106 studies included, only 22 evaluated the PK of participants aged 50 years or older and only 5 studies compared the PK between young and older adults for ATV, RTV, EFV, and 3TC. Our analysis revealed an increase in minimal concentration (Cmin) values for LPV, RTV, and ATV in older adults. While increased values of the area under the curve (AUC) and maximum concentration (Cmax) were observed in older adults using ATV, 3TC, and FTC, no differences in PK were apparent between young and older adults for ABC and EFV, with no estimation possible for ZDV. Exposure to 3TC, TDF, FTC, ATV, LPV, and RTV increases with age, while exposure to ABC and EFV appears to be unaffected. Despite the large quantity of data on PK in young adults, there is still a gap in knowledge about the effects of aging on the PK of these ARVs.

Age-related testosterone decline: mechanisms and intervention strategies.

Contemporary societies exhibit delayed reproductive age and increased life expectancy. While the male reproductive system demonstrates relatively delayed aging compared to that of females, increasing age substantially impacts its function. A characteristic manifestation is age-induced testosterone decline. Testosterone, a crucial male sex hormone, plays pivotal roles in spermatogenesis and sexual function, and contributes significantly to metabolism, psychology, and cardiovascular health. Aging exerts profound effects on the hypothalamic-pituitary-gonadal axis and Leydig cells, precipitating testosterone reduction, which adversely affects male health. Exogenous testosterone supplementation can partially ameliorate age-related testosterone deficiency; however, its long-term safety remains contentious. Preserving endogenous testosterone production capacity during the aging process warrants further investigation as a potential intervention strategy.

Mountains and Waves: Fontan Circulation in Different Environmental Conditions.

As surgical options and medical care for patients with univentricular heart physiology continue to improve, leading to increased life expectancy and quality of life, a new population of Fontan patients is growing up with the desire to participate in leisure activities, including aquatic activities, high-altitude stays, and air travel. Due to significant data gaps and insufficient experience, current guidelines do not provide clear recommendations, leading to uncertainty and sometimes restrictive patient management. This review summarizes new insights and the current state of research on this subject and provides an overview of the long overdue change in policies toward less restrictive counseling for Fontan patients regarding swimming, diving, high-altitude stays, and air travel. The current review summarizes the physiologic impact of aquatic and high-altitude activities on the cardiovascular system and presents currently available data on this topic in Fontan patients. Patients with Fontan circulation in good clinical shape can tolerate activities in the water and in the mountains as well as air traveling without critical events. In order to be able to make general recommendations, further studies with larger numbers of cases must be carried out.

A systematic review on feature extraction methods and deep learning models for detection of cancerous lung nodules at an early stage -The Recent trends and challenges.

Lung cancer is one of the most common life-threatening worldwide cancers affecting both the male and female populations. The appearance of nodules in the scan image is an early indication of the development of cancer cells in the lung. The Low Dose Computed Tomography screening technique is used for the early detection of cancer nodules. Therefore, with more Computed Tomography (CT) lung profiles, an automated lung nodule analysis system can be utilized through image processing techniques and neural network algorithms. A CT image of the lung consists of many elements such as blood vessels, ribs, nodules, sternum, bronchi, and nodules. These nodules can be both benign and malignant, where the latter leads to lung cancer. Detecting them at an earlier stage can increase life expectancy by up to 5 to 10 years. To analyze only the nodules from the profile, respected features are calculated using image processing techniques. Based on the review, textural features were promising ones in medical image analysis and for solving computer vision problems. The significance of extracting the hidden features (textural) enables the higher performance of deep learning algorithms (DL) predominantly in medical imaging, which has resulted in improvement in accuracy in recent years. Earlier detection of cancerous lung nodules is possible through the combination of multi-featured extraction and classification techniques using image data. In this paper, we discussed the overview of lung cancer along with publicly available datasets for research purposes. The primary objective of the paper is to provide the importance of textural features when combined with different deep-learning models. It gives insights into their advantages, disadvantages, and limitations regarding possible research gaps. The paper compared the recent studies of deep learning models with and without feature extraction and concluded that DL models that include feature extraction were better than the others.

Physical activity and life expectancy: a life-table analysis

ObjectiveLow physical activity (PA) levels are associated with increased mortality. Improved measurement has resulted in stronger proven associations between PA and mortality, but this has not yet translated to improved...

Kinetic Recovery of the Patient with Gonarthrosis

Osteoarthritis of the knee, also known as gonarthrosis, is indeed a common and growing concern, particularly as factors like increased life expectancy and rising obesity rates contribute to its prevalence. A few key points to highlight from the statistics you've provided: About 13% of women and 10% of men over the age of 60 are diagnosed with gonarthrosis; The prevalence significantly rises in people over the age of 70, where it affects 40% of this population. This reflects the impact of aging on joint degeneration; Gonarthrosis is more common in women than men. While exact reasons aren't fully clear, hormonal factors, differences in joint anatomy, and possibly physical activity differences may play a role in this disparity; Despite radiographic evidence of osteoarthritis, only a portion of individuals’ experience symptoms. This emphasizes that structural joint changes don't always equate to pain or functional limitations; One study suggests that only 15% of patients with radiographic evidence of gonarthrosis have symptoms, indicating that many individuals may have osteoarthritis without knowing it; The overall incidence of symptomatic gonarthrosis is about 240 cases per 100,000 people per year, making it a significant public health issue. [4]

The psycho-social impact of cancer treatment on the caregivers of the patients

Objectives The incidence of cancer cases shows an increasing trend over the past two decades owing to several factors, such as increased life expectancy, aging population, behavioral, environmental, and occupational risk factors, and more. Consequently, a greater number of people are expected to take the role of principal caregivers in the near future. Cancer treatment can have a multifaceted impact on the quality of life and psychological well-being of not only the patients but also their families. Caregivers are expected and required to provide complex care and support for which they are neither prepared nor trained. The reports of feeling overwhelmed and stressed are high when the demands placed on them exceed their resources, resulting in a negative effect on the overall well-being of the caregivers, including the patients themselves. The impact covers a wide spectrum of emotional, physical, financial, social, cognitive, spiritual, and work-related effects. Material and Methods This is a cross-sectional study conducted (for over three months from May to July 2023) among the caregivers accompanying cancer patients attending a tertiary care hospital in a South Indian metropolitan city. All the adult caregivers of patients diagnosed with cancer at least two to six months before the time of the study were considered as the study population. A systematic random sample was applied to recruit a convenient sample of 150 caregivers, maintaining the enrollment of only one caregiver per patient. Sociodemographic details of the patients and their caregivers were collected. The Zarit Burden Interview (ZBI) based on a Likert scale was implemented to collect relevant data related to both the cancer patient and the family caregiver. Results Of the total 150 cancer patients, the most common type of cancer among the patients was head and neck (63, 42%), followed by cancers of the female reproductive system (44, 29.3%) and breast (24, 16%). Nearly 47% of caregivers were children of cancer patients, while 35.3% were spouses. Significantly higher burden scores on the “emotional strain” and “financial/physical strain” domains were observed among female caregivers. Higher burden scores on the “self-criticism” domain were independently associated with a shorter caregiver-patient contact time. Significantly higher burden scores on the “self-criticism” and “time/dependence” domains were observed among employed caregivers. Higher levels of burden on the “financial/physical strain” domain were reported by unemployed caregivers. Significantly higher burden scores on the “uncertainty” domain were observed among older caregivers and caregivers who were parents or spouses of the patients. Conclusion Caregiving impacts the physical, emotional, financial, and social aspects of the caregiver’s life. They adopt active coping strategies to overcome the impacts of caregiving. A majority of the caregivers experienced mild to moderate burden, while most scored low on quality of life. Attention to concerns and the psychological well-being of caregivers may improve the overall scenario.

Aging Well? Exploring Self-Reported Quality of Life in the Older Austrian Population Based on Repeated Cross-Sectional Data

ABSTRACT Increase in life expectancy around the world puts aging societies with all their challenges on the Global Public Health agenda. In Austria, additional years of life gained are not spent in good health, as healthy life expectancy is far below the European average. Using repeated cross-sectional data from three waves of the Austrian Health Interview Survey (2006, 2014 and 2019), including a total of 10,056 participants aged 65 years and above, this study examined the change in self-reported quality-of-life (QoL) over time and explored associated factors. QoL, estimated by domain scores of the WHOQOL-BREF questionnaire, increased over time but decreased with age in all survey waves. Observed mean scores were significantly higher in males than in females in all QoL domains except the social domain but sex differences disappeared in most domains in the multivariable regression analyses. Instead, factors associated with significantly higher QoL scores included younger age, higher socioeconomic status, living in Western Austria and having no chronic conditions. Statistically significant observed sex differences in QoL in the older-aged Austrian population disappeared when adjusting for income and education. Strategies and measures to increase financial capabilities may have a significant impact on QoL and well-being in this age group.

Populationwide Screening for Chronic Kidney Disease

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have changed clinical management of chronic kidney disease (CKD) and made populationwide screening for CKD a viable strategy. Optimal age of screening initiation has yet to be evaluated. To compare the clinical benefits, costs, and cost-effectiveness of population-wide CKD screening at different initiation ages and screening frequencies. This cost-effectiveness study used a previously published decision-analytic Markov cohort model that simulated progression of CKD among US adults from age 35 years and older and was calibrated to population-level data from the National Health and Nutrition Examination Survey (NHANES). Effectiveness of SGLT2 inhibitors was derived from the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial. Mortality, quality-of-life weights, and cost estimates were obtained from published cohort studies, randomized clinical trials, and US Centers for Medicare & Medicaid Services data. Analyses were performed from June 2023 through September 2024. One-time or periodic (every 10 or 5 years) screening for albuminuria, initiated at ages between 35 and 75 years, with and without addition of SGLT2 inhibitors to conventional CKD therapy (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers). Cumulative incidence of kidney failure requiring kidney replacement therapy (KRT); life years, quality-adjusted life years (QALYs), lifetime health care costs (2024 US currency), and incremental cost-effectiveness ratios discounted at 3% annually. For those aged 35 years, starting screening at age 55 years, and continuing every 5 years through age 75 years, combined with SGLT2 inhibitors, decreased the cumulative incidence of kidney failure requiring KRT from 2.4% to 1.9%, increased life expectancy by 0.13 years, and cost $128 400 per QALY gained. Although initiation of screening every 5 years at age 35 or 45 years yielded greater gains in population-wide health benefits, these strategies cost more than $200 000 per additional QALY gained. The comparative values of starting screening at different ages were sensitive to the cost and effectiveness of SGLT2 inhibitors; if SGLT2 inhibitor prices drop due to patent expirations, screening at age 55 years continued to be cost-effective even if SGLT2 inhibitor effectiveness were 30% lower than in the base case. This study found that, based on conventional benchmarks for cost-effectiveness in medicine, initiating population-wide CKD screening with SGLT2 inhibitors at age 55 years would be cost-effective.

Influence of saponin tauroside Sx1 on lifespan and expression of vitamin D receptors in the liver tissue of mice with influenza infection

Introduction. Respiratory infections, including influenza, are often accompanied by hepatitis in humans which pathogenesis is not fully understood. According to the available datan D deficiency is presumably a risk factor in the occurrence of acute respiratory viral infections due to its modulation of immune response. Recent studies indicate that several plant compounds can interact with vitamin D receptors (VDRs) and modulate the activity of VDRs. The biologically active components saponins have found widespread use in clinical practice due to their wide range of biological and pharmacological effects which mechanisms are still largely unclear.Aim. To study the effect of oral administration of saponin tauroside Sx1, obtained from Crimean ivy, on life expectancy and activation of vitamin D receptors in the liver of mice during experimental viral infection of varying severity.Materials and methods. The 11 subgroups were formed from male BALB/c mice, were used in the experiment depending on the infectious dose of influenza virus, 5 LD50 virus or 10 LD50 virus, respectively, including control. Saponin tauroside Sx1 was used as a corrector. Immunohistochemical studies were carried out automatically in a BOND-MAX immunohistainer (Leica, Germany). Primary rabbit polyclonal antibodies to the vitamin D receptor were used.Results and discussion. Due to the administration of tauroside Sx1 at a dose of 200 μg/mouse/day increases the average life expectancy of animals receiving saponin by 4.6 days. Reducing the infectious dose of IV from 10 LD50 to 5 LD50 also changed the onset of death of animals by 2 days in both groups. With different infectious doses of the virus, on the 10th day of the experiment in the subgroups, the expression of vitamin D receptors changes without correction. In subgroup 2V, the number of total positive cells was lower than the control group. Moreover, in the 2Vir subgroup, VDR expression was significantly higher than the control group.Conclusion. The saponin tauroside Sx1 at a dose of 200 µg/mouse/day has a fairly pronounced antiviral effect during experimental infection of mice with the influenza A/H1N1 virus, which is manifested by an increase in the average life expectancy of animals (for 4.6 days) and a decrease in the mortality rate during severe influenza infection, compared with the control group, where 100 % mortality was observed by the 14th day of the experiment. The introduction of saponin on the 4th day of the experiment in all subgroups reduces the total number of immune cells that intensively express VDR.

Exposing telomere length's impact on malnutrition risk among older adults residing in the community: Insights from cross-sectional data analysis.

Successful aging is associated with an increase in life expectancy. For a better understanding of the aging process, recognize the relationship between telomere length and nutritional status is a novel approach in geriatric science. Telomers shortening coincides with a decrease in life expectancy, and an increased risk of malnutrition-related diseases. The goal of this study was to investigate whether a shorter telomere length is associated with a greater likelihood of malnutrition in community-dwelling older adults. A cross-sectional study with a probabilistic sample of 448 older people aged 60 years old or over, and living in the urban area of an inland Brazilian municipality was conducted. The information was gathered in two stages: a) a personal interview was conducted to obtain sociodemographic, cognitive, and functional autonomy data. The Mini Nutritional Assessment was used to assess the risk of malnutrition. b) a blood sample was taken to proceed with the relative quantitative study of telomere length using real-time qPCR method. The differences between the groups were estimated using Pearson's v2 and Fisher's exact tests. In the data analysis, descriptive statistics and multiple logistic regression were applied. In 34.15% of the total sample, malnutrition was recognized as a risk factor. Older people with the shortest telomere length had more chances of getting malnutrition (OR = 1.63; IC:95% = 1.04-2.55) compared to those with longer telomeres, independent of age groups, family income, multimorbidity, cognitive decline, and depressive symptoms. The creation of clinical trials and the implementation of therapies to reduce the risk of malnutrition will be aided using the telomere length as an aging innovative biomarker, connected with nutritional status.

Progress Stalled? The Uncertain Future of Mortality in High‐Income Countries

AbstractSteady and significant improvements in life expectancy have been a bright spot for human progress for the last century or more. Recently, this success has shown signs of faltering in some high‐income countries, where mortality improvements have slowed or even reversed since the early 2010s. Combined with the large mortality shock of the COVID‐19 pandemic, guaranteed forward progress feels less certain. We review mortality trends in high‐income countries since 2000 through the COVID‐19 pandemic. While deteriorating mortality in the United States has received the most attention, countries including the United Kingdom, Canada, the Netherlands, Greece, and Germany are also seeing slowdowns. Before COVID‐19, these slowdowns largely reflected stalling improvements in cardiovascular disease mortality and increases in deaths from external causes in young and midlife for the worst‐performing countries. We discuss prospects for the future of mortality in high‐income countries, including lingering impacts of the COVID‐19 pandemic, challenges and opportunities related to the obesity epidemic, and emerging reasons for both optimism and pessimism. While biological limits to increased life expectancy may eventually dominate long‐term trends, human‐made social factors are currently holding many countries back from already achievable best‐practice life expectancy and will be key to near‐term improvements.

Life Expectancy and Politics of Public Education and Pension with Endogenous Fertility

Implications of increased life expectancy on parental fertility decisions and subsequent shifts in political influence between younger and older generations carry significant consequences for government policies concerning education and pension. This study introduces an overlapping generations growth model incorporating these effects, qualitatively indicating that increased life expectancy correlates with lower fertility rates, decreased education expenditure-GDP ratio, and increased pension benefit-GDP ratio. A model simulation evaluates the impact of the projected increase in life expectancy until 2100 on four country groups: synthetic rich OECD, synthetic rich OECD Europe, Japan, and the United States. The findings demonstrate similar trends as in the qualitative analysis, yet growth rates are projected to vary significantly across regions and countries due to differing life expectancy increases.

Quantifying the impact of disease severity changes on the burden of blindness: A global decomposition analysis.

Despite the significant impact of blindness on the affected individuals' quality of life, its burden has not been assessed according to temporal cause-specific changes in severity, impeding our ability to evaluate the impact of blindness on population health accurately. Therefore, we aimed to comprehensively quantify the changes in cause-specific blindness burden according to changes in disease severity for 18 causes of blindness. For this cross-sectional population-based study, we derived data on prevalence, disability-adjusted life-years (DALYs), and population size between 1990 and 2019 from the Global Burden of Disease 2019 study. Using the decomposition method, we attributed changes in total DALYs to population growth, population ageing, and changes in prevalence rate and disease severity between 1990 and each subsequent year globally, regionally, nationally, and by sex, cause, and sociodemographic index (SDI). The absolute and relative contributions to the variation in blindness-related DALYs between 1990 and each year from 1991 to 2019 then served as a measure of changes in disease severity. Changes in disease severity from 1990 to 2019 were associated with 15 165.11 DALYs in men and 20 639.32 DALYs in women. We observed disease severity increases in most countries/territories, with attributable DALY proportions ranging from -0.07% to 1.30% in men and from -0.06% to 1.73% in women. Notably, both attributable proportions and DALYs were greater in women than men. The largest increases in attributable DALYs were observed for cataracts, refraction disorders, and glaucoma globally; age-related macular degeneration in high-SDI countries; and trachoma and retinopathy of prematurity in lower-SDI countries. Growth in the burden of cause-specific blindness due to increased disease severity reflects the lag of healthy vision life behind increasing life expectancy, necessitating the implementation of preventive and long-term therapeutic measures focussed on improving visual outcomes.