Multistate Life Table Analyses Research Articles

Länger gesund im Beruf? Trends in den Lebensjahren frei von Herz-Kreislauf- und Muskel-Skelett-Erkrankungen in GKV-Daten für die Erwerbstätigen- und Allgemeinbevölkerung

ZusammenfassungHintergrundUnsere Studie fokussiert auf die Entwicklung der erkrankungsfreien Lebensjahre in Bezug auf 2 Erkrankungsgruppen mit hoher Public-Health-Relevanz: Muskel-Skelett- (MSE) und Herz-Kreislauf-Erkrankungen (HKE). Vor dem Hintergrund der steigenden Lebensarbeitszeit wird die Entwicklung der erkrankungsfreien Jahre der Bevölkerung im erwerbsfähigen Alter und der Erwerbstätigen verglichen und Unterschiede zwischen den Berufsgruppen beleuchtet.MethodenDie Studie basiert auf den Daten der AOK Niedersachsen (N = 2.001.225). Die Erkrankungsfälle werden anhand der Diagnosedaten ermittelt. Die erwarteten Jahre frei von MSE und HKE werden mit Multistate-Life-Table-Analysen für 3 Perioden zwischen 2006 und 2018 berechnet. Die Berufsgruppe wird über den Berufsschlüssel definiert und in 3 Gruppen unterteilt: 1) Un- und Angelernte, 2) Fachkräfte und Spezialisten, 3) Hochqualifizierte.ErgebnisseDie Lebensjahre frei von MSE nahmen in der Allgemeinbevölkerung und unter den Erwerbstätigen deutlich ab. Die stärkste Verringerung zeigte sich in der höherqualifizierten Berufsgruppe. Die Lebensjahre frei von HKE stiegen in der Allgemeinbevölkerung im Zeitverlauf. Die Zunahmen waren unter den Erwerbstätigen geringer, sie wurden nur bei Männern in un- und angelernter Tätigkeit verzeichnet.DiskussionDie Studie zeigt, dass sich die erkrankungsfreien Jahre unter den Erwerbstätigen teilweise schlechter als in der Allgemeinbevölkerung entwickelten. Für die untersuchten Erkrankungsgruppen MSE und HKE bestehen deutliche Ungleichheiten zwischen den Berufsgruppen, die sich im Zeitverlauf etwas verringerten. Die Ungleichheiten und die Abnahme der Jahre frei von MSE belegen die hohe Public-Health-Relevanz und den Bedarf an Präventionsmaßnahmen zur Vermeidung von HKE und MSE im erwerbsfähigen Alter.

Neighborhood Environments and Healthy Life Expectancy in Older Adults: A 6-year Longitudinal Cohort Study Based on Data from the Japan Gerontological Evaluation Study.

A well-established association exists between health and neighborhood land use patterns, including parks, roads, and other physical environments, also called the built environment. Previous studies have demonstrated that the built environment influences health, particularly among older populations, because the scope of activities in such populations is limited. Herein, we investigated the association between specific neighborhood environments and the healthy life expectancy of older individuals. Data at two time points (2013 and 2019) from the Japan Gerontological Evaluation Study were used in this study. The study comprised a sample of 8,956 residents aged ≥65 years who were not certified for long-term care. Information on the presence or absence of eight types of neighborhood environments was collected using a questionnaire. A multistate life table analysis was conducted to determine the association between perceived neighborhood environments and healthy life expectancy. Significant differences were observed in the "parks and sidewalks suitable for exercise and walking" category. The group that perceived "parks and sidewalks suitable for exercise and walking" had an approximately 1.2-year longer healthy life expectancy than the group that did not perceive such parks and sidewalks. In addition, individuals who lived within walking distance of a park were more physically active than those who did not. Safe, walkable neighborhoods with excellent parks may encourage physical activity among older adults and extend their healthy lifespan. Future research is warranted to identify the underlying mechanisms.

Cognitive life expectancy by educational attainment in Mexican adults aged 60 and older.

To estimate cognitively healthy life expectancy (CHLE), cognitive impairment life expectancy (CILE), and dementia life expectancy (DLE) in Mexican adults aged 60 and older stratified by educational attainment. The data were obtained from Waves 1 (2001) to 5 (2018) of the Mexican Health and Aging Study. The life expectancy was estimated using a multistate life table analysis. CHLE at age 60 increased with higher educational attainment and ranged from 17.9 to 24.4 years in female participants, and 17.2 to 21.3 in male participants. The CILE and DLE decreased with greater educational attainment. The CILE ranged from 0.7 to 2.8 years in female participants and 0.7 to 2.6 in male participants. Older adults in Mexico with higher education live more years with good cognitive health and fewer years with cognitive impairment and dementia. Education has a stronger effect on the length of cognitively healthy life expectancies than on total life expectancies.

결혼의향 변화에 대한 다상태 생명표 분석

결혼의향 변화에 대한 다상태 생명표 분석

Estimating trends in working life expectancy based on health insurance data from Germany – Challenges and advantages

Against the backdrop of population aging and growing strain on pension systems, monitoring the development of Working Life Expectancy (WLE) is vital to assess whether the policies taken are effective. This is the first study investigating time trends and educational inequalities in WLE based on German health insurance data. The analyses are based on the data of the AOK Lower Saxony (N = 3,347,912) covering three time periods (2006-08, 2011-13, and 2016-18). WLE is defined as years spent in the labor force (i.e. in employment and unemployment) and was calculated for each age between 18 and 69 years for the three periods to depict changes over time using multistate life table analysis. Educational inequalities in 2011-13 are reported for two educational levels (8–11 years and 12–13 years of schooling). WLE increased in both sexes with increases being stronger among women. This holds irrespective of whether WLE at age 18 (35.8–38.3 years in men, 27.5–34.0 years in women) or the older working-age (e.g. at age 50 10.2–11.7 years in men, 7.8–10.5 years in men) is considered. Among women at all ages and men from their mid-20s onwards, WLE was higher among higher-educated individuals. Inequalities were most pronounced among women (e.g. Δ3.1 years in women, Δ1.3 years in men at age 50). The study supports previous research indicating that measures to extend working life are effective, but that noticeable inequalities in WLE exist. Health insurance data represent a valuable source for such research that has so far remained untapped. The data provide a suitable basis to investigate trends and inequalities in WLE. Future research should build on the strengths of the data by broadening the research towards a more comprehensive analysis of the development of WLE from a health perspective.

Proximity to mother over the life course in the United States: Overall patterns and racial differences

Background: The spatial distance between children and parents substantially influences their lives, yet empirical evidence on life course patterns of child–parent proximity is sparse. Objective: The goal of this study is to identify salient features of child–parent spatial distance across the life course and explain differences by race in these features in the United States. Methods: Using the Panel Study of Income Dynamics, this study examines the spatial distance between residential locations of children and their mothers over 47 years (166,098 person-year observations). Point-in-time, dynamic, and multi-state life table analyses of spatial distance are conducted using location measured at the block level. Differences between Black and White people are assessed, examining various explanatory factors, including life course events. Results: Living very close is common across the life course, with 25% of life-years during ages 18–54 spent within five miles of, but not with, one’s mother. Children who are Black are much more likely than children who are White to live close to their mother if she is alive, but mothers of Black children are much less likely to be alive, especially when children are middle-aged. Observed sociodemographic characteristics of the child and mother account for a substantial share – and in some cases all – of the racial differences. Conclusions: Very close residential proximity to one’s mother beyond coresidence is common across the life course even in the geographically large United States. Racial differences in mortality affect differences between Black and White people in family spatial availability. Contribution: This study provides the first national estimates of intergenerational proximity over the life course in the United States, and hence a basis for further research.

Transitions of disability, disability-free life expectancy and health insurance among adults aged 50 and older in Mexico: a multistate life table analysis

ObjectivesTo analyse the transitions of disability onset and recovery, estimate life expectancy (LE) with and without disability and explore the relation between insurance and disability patterns in the population aged...

Compression, expansion, or maybe both? Growing inequalities in lung cancer in Germany.

BackgroundLung Cancer (LC) is one of the most common malign diseases worldwide. So far, it is unclear if the development of LC incidence and mortality leads to morbidity compression or expansion and whether these developments differ by socioeconomic characteristics. This study analyses time trends in social and gender inequalities in life years with and without LC in Germany.MethodsThe study is based on data of a large German statutory health insurance provider (N = 2,511,790). Incidence and mortality risks were estimated from multistate survival models. Trends in life years with and without LC were analysed using multistate life table analyses. All analyses were performed separately for gender, time period (2006–2009 and 2014–2017), and income group (<60% and ≥60% of the German average income).ResultsAmong men, declining LC incidence rates resulted in gains of life years free of LC and declining LC- affected life years and led to a relative compression, which was strongest in men with higher incomes. Among women, a clear increase in life years with LC led to an expansion of the lifespan affected by LC. This expansion was mainly driven by increasing incidence rates in women with low incomes. Overall, income inequalities in LC increased in both genders.ConclusionsOur analyses reveal that developments in the length of life affected by LC differed substantially by gender and income and led to widening health inequalities over time. Public health efforts should mainly focus on vulnerable groups to reduce the persisting social inequalities in LC.

A Multistate Life Table Analysis of Union Regimes in the United States: Trends and Racial Differentials, 1970-2002.

We estimate trends and racial differentials in marriage, cohabitation, union formation and dissolution (union regimes) for the period 1970-2002 in the United States. These estimates are based on an innovative application of multistate life table analysis to pooled survey data. Our analysis demonstrates (1) a dramatic increase in the lifetime proportions of transitions from never-married, divorced or widowed to cohabiting; (2) a substantial decrease in the stability of cohabiting unions; (3) a dramatic increase in mean ages at cohabiting after divorce and widowhood; (4) a substantial decrease in direct transition from never-married to married; (5) a significant decrease in the overall lifetime proportion of ever marrying and re-marrying in the 1970s to 1980s but a relatively stable pattern in the 1990s to 2000-2002; and (6) a substantial decrease in the lifetime proportion of transition from cohabiting to marriage. We also present, for the first time, comparable evidence on differentials in union regimes between four racial groups.

Higher education delays and shortens cognitive impairment. A multistate life table analysis of the US Health and Retirement Study

Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992–2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.

Estimates of the Incidence, Prevalence, Duration, Intensity, and Cost of Chronic Disability Among the U.S. Elderly

The objective of this paper is to estimate the burden of chronic disability on the U.S. elderly population, using unisex and sex-specific measures of long-term care (LTC) service use, intensity, and costs. Multistate life-table analysis was performed of adjacent rounds of the National Long-Term Care Survey (NLTCS) from 1984, 1989, and 1994, using criteria introduced in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 to stratify the disabled population according to level of disability based on ADL and cognitive impairment criteria. Rates of transition to and from nondisabled to disabled states and from all states to death were computed and analyzed for differences by age and sex. Rates of service use, intensity, and costs were computed conditional on age and sex. It was found that approximately 20% of the residual life expectancy at age 65 for males and 30% for females were spent in a state of chronic disability. For both sexes, the years of chronic disability above age 65 were split evenly between mild/moderate and severe disability. The expected costs of purchased LTC services were $59,000 (includes home/community care and institutional care, in constant 2000 dollars), with substantial sex differences: $29,000 for males versus $82,000 for females. For both sexes, the overwhelming majority (92%) of the LTC costs were incurred during episodes of severe disability, with the remaining (8%) incurred during episodes of mild/moderate disability. Residual lifetime unpaid home/community care averaged 3,200 hours for males and 4,000 hours for females, with approximately one-third of those hours incurred during episodes of mild/moderate disability. The criteria for identifying severely disabled persons introduced by HIPAA effectively targeted the high-cost disabled subpopulation. This group accounted for the overwhelming majority of purchased LTC services, and a large majority of unpaid LTC services, over age 65. Sex differences in expected per capita lifetime LTC costs were substantial, with females outspending males 2.8 to 1.

The Effect of Risk Factors on the Duration of Cognitive Impairment: A Multistate Life Table Analysis of the U.S. Health and Retirement Survey

Objectives: Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assessed the duration of cognitive impairment by BMI, smoking and levels of education.Methods: Multistate life tables estimated the duration of cognitive impairment. Regression models determine the age specific transition probabilities to disease and death in a both genders and three races of the US population from the Health and Retirement Survey (HRS), 1992-2004. Exposures are self-reported BMI, smoking and education, outcome is cognitive functioning determined by the Telephone Interview Cognitive Screen (TICS).Results: At age 55, white men and women may expect to live respectively 1.7 (1.5; 1.9) and 2.7 (2.4; 2.9) years with cognitive impairment. Black non-Hispanic males and females live 3.7 [2.8,4.6] and 3.7 [3.0,4.5] years longer with cognitive impairment than whites. BMI makes no difference. (Ever) smoking decreases duration of cognitive impairment among men and women with respectively 0.7 [0.3,1.2] and 0.9 [0.5,1.3] years compared to never smokers. Highly educated men and women expect to live respectively 1.1 [0.7,1.4] and 1.9 [1.4,2.4] years with cognitive impairment, lowly educated men and women 2.7 [2.2,3.1] and 3.8 [3.3,4.3] years with cognitive impairment.Discussion: Our findings confirm the brain reserve hypothesis. While life extension increases the duration of dementia, higher levels of education compress this cognitive disability. Large differences by race remain after controlling for risk factors.

Patterns in trouble sleeping among women at mid-life: results from a British prospective cohort study

Background:Although trouble sleeping is a common problem among women at mid-life, patterns in trouble sleeping relating to social and health-related risk factors are unclear. This analysis describes the dynamics of...

Age at first sex: understanding recent trends in African demographic surveys

Objectives: To describe recent trends in age at first sex in African countries, identifying and making due allowances for a variety of common reporting errors. Methods: Demographic and Health Surveys...

Rising Educational Levels Contribute to Compression of Morbidity. A Multi-State Life Table Analysis of the Netherlands 1995-2015

Objective: This paper assesses whether the future rise in educational levels of theelderly may not only increase life expectancy (LE) but also at the same timecontribute to a reduction in life expectancy with disability (LED).Methods: For each educational level, LE and LED were estimated from multi-statelife tables with a disabled and non-disabled state. Basic transition rates wereestimated from regression analysis of data of a Dutch longitudinal study. The resultsper educational level were aggregated to the total population for the years 1995,2005 and 2015.Results: In 1995, men in the highest educational level had a 0.9 years longerLE and a 5.4 years shorter LED than men in the lowest level. Differences amongwomen were larger (2.0 and 8.3 years). Due to rising educational levels between1995 and 2015, LE for the total male population would increase by 0.2 years whileLED would decrease by 0.5 years. A larger effect was observed for women(0.2 and 1.5 years).Conclusion: Rising educational levels of the elderly are likely to contribute to acompression of morbidity over the next decades, especially among women.

Marital status behaviour of women in the former Soviet Republics.

This paper uses the most recent data and life table analysis to describe the marital behavior of women in the republics of the former USSR. For the first time a multistate life table analysis was used to describe the marital careers of women from all the 15 republics. In the near future, such a comparative analysis will no longer be possible due to the unavailability of statistical data, especially in some of the Asian states. The analysis shows that despite 70 years of influence by Soviet ideology and lifestyle, the institution of marriage was little subject to rapid change, and retained its traditions for each culture and its ethnic features. Marriage was a universal institution in the former USSR. The majority of the women in all of the former republics entered marriage at least once. The mean age at first marriage varies from 20.5 in Moldavia to 22.8 in Azerbaijan. The proportion of marriages that end in divorce differs from 16% in Georgia to 41% in Latvia. On average more than 30% of divorced women remarry in Latvia and Ukraine and less than 5% in Georgia.

Multistate life table with duration dependence: an application to Hungarian female marital history.

"Building on recent developments in multistate demography, and using data from the 1984 Hungarian microcensus, this paper analyzes the impact that the introduction of duration-specific transitions has on the results of a multistate life table analysis of marital dissolution. The results show that the inclusion of duration has its greatest impact on the distribution of the stationary population between ages 25 and 35." (SUMMARY IN FRE)

Nonparametric inference procedures for multistate life table analysis.

Recent generalizations of the classical single state life table procedures to the multistate case provide the means to analyze simultaneously the mobility and mortality experience of 1 or more cohorts. This paper examines fairly general nonparametric combinatorial matrix procedures, known as quadratic assignment, as an analysis technic of various transitional patterns commonly generated by cohorts over the life cycle course. To some degree, the output from a multistate life table analysis suggests inference procedures. In his discussion of multstate life table construction features, the author focuses on the matrix formulation of the problem. He then presents several examples of the proposed nonparametric procedures. Data for the mobility and life expectancies at birth matrices come from the 458 member Cayo Santiago rhesus monkey colony. The author's matrix combinatorial approach to hypotheses testing may prove to be a useful inferential strategy in several multidimensional demographic areas.