Total Life Expectancy Research Articles

Disability and its impact on life expectancy: heterogeneity across Mexican states

BackgroundThe percentage of the world’s population with disabilities is estimated to be 16%, although its distribution and intensity varies within nations. We aim to disentangle the degree and types of disabilities, estimate the years spent with more severe disabilities, and analyze their distribution across states and between sexes in Mexico.MethodsThe Mexican Census of 2020 includes information on disabilities, which allows the study of its national distribution. We used life tables and the Sullivan method to calculate the number of years spent with disability (NYSD) and its percentage with respect to life expectancy for each state and each sex.ResultsIn Mexico, the population with disabilities is estimated to be 16.5%. Of this total, 69% have milder disabilities, while the remaining 31% have more severe disabilities. At age eighteen, there is a higher NYSD from more severe disabilities for females with 5.67 years (95% CI 5.66 to 5.69) as opposed to males with 3.66 years (95% CI 3.65 to 3.67). Across states, a more homogeneous distribution with lower NYSD is observed for men (between 2.44 and 5.69 years) than for women (4.14 and 8.08 years). A north-south division can also be observed, with particularly notorious disadvantages among coastal states, which is more distinctive among women.ConclusionsThis study shows that comparing the number of years spent with disability and the total life expectancy between subpopulations is essential for monitoring the well-being of aging populations, guiding policy decisions, and promoting a society that values and supports all individuals, regardless of their abilities.

Childhood and adult socioeconomic status influence on late-life healthy longevity: evidence from the Chinese longitudinal healthy longevity survey.

Older people in low- and middle-income countries are more susceptible to the impact of childhood experiences. This study comprehensively examines how childhood socioeconomic status (SES) and adult SES collectively influence late-life healthy longevity from a life course perspective, providing insights for shaping health-related policies. This study analyzed data from the Chinese Longitudinal Healthy Longevity Survey (1998-2018) with 37,264 individuals aged 65 and above. Using R software, we applied continuous-time multi-state models incorporating the Rockwood frailty index with 38 indicators to assess participants' health. Childhood SES or life course SES trajectories were core explanatory variables, while age and gender were controlled. Multinomial regression estimated annual transition probabilities between different states, and the multi-state life table method calculated total and frailty-specific life expectancy (LE). (1) Social mobility among older people in China showed an upward trend from childhood to adulthood. (2) Transition probabilities for robust-frailty, robust-dead, and frailty-dead increased with age, while frailty-robust decreased. Transition probabilities and LE varied across different childhood SES (low, medium, high) or life-course SES trajectory categories (low-low, low-medium, low-high, medium-low, medium-medium, medium-high, high-low, high-medium, high-high), with probabilities of robust-frailty, robust-dead, and frailty-dead decreasing sequentially across different categories, and frailty-robust increasing sequentially across different categories. Total LE, robust LE, and robust LE proportion increased sequentially across different categories, while frailty LE decreased sequentially across different categories. (3) Women had higher total LE and frailty incidence, but lower recovery rate, mortality risk, robust LE, and robust LE proportion compared to men. Favorable childhood SES and lifelong accumulation of SES advantages protect against frailty morbidity, improve recovery rate, reduce mortality risk, and increase total LE, robust LE, and robust LE proportion. High childhood SES has a stronger protective effect than high adult SES, indicating the lasting impact of childhood conditions on healthy longevity. Systematic interventions in education, food supply, and medical accessibility for children from impoverished families are crucial.

The Impact of the Approach to Accounting for Age and Sex in Economic Models on Predicted Quality-Adjusted Life-Years.

The method used to model general population mortality estimates in cohort models can make a meaningful difference in appraisals; particularly in scenarios involving potentially curative treatments where a prior National Institute for Health and Care Excellence (NICE) appraisal demonstrated that this assumption alone could make a difference of ~£10,000 to the incremental cost-effectiveness ratio. Our objective was to evaluate the impact of different methods for calculating general population mortality estimates on the predicted total quality-adjusted life expectancy (QALE) as well as absolute and proportional quality-adjusted life year (QALY) shortfall calculations. We employed three distinct methods for deriving general population mortality estimates: firstly, utilizing the population mean age at baseline; secondly, modelling the distribution of mean age at baseline by fitting a parametric distribution to patient-level data sourced from the Health Survey for England (HSE); and thirdly, modelling the empirical age distribution. Subsequently, we simulated patient age distributions to explore the effects of mean starting age and variance levels on the predicted QALE and applicable severity modifiers. Provided sample code in R and Visual Basic for Applications (VBA) facilitates the utilization of individual patient age and sex data to generate weighted average survival and health-related quality of life (utility) outputs. We observed differences of up to 10.4% (equivalent to a difference of 1.01 QALYs in quality-adjusted life-expectancy) between methods using the HSE dataset. In our simulation study, increasing variance in baseline age diminished the accuracy of predictions relying solely on mean age estimation. Differences of -0.30 to 2.24 QALYs were found at a standard deviation of 20%; commonly observed in trials. For potentially curative treatments this would represent a difference in economically justifiable price of -£4,500-+£33,600 at a cost-effectiveness threshold of £30,000 per QALY for a treatment with a 50% cure rate. For lower baseline ages, the population mean method tended to overestimate QALE, whereas for higher baseline ages, it tended to underestimate QALE compared with individual patient age-based approaches. The severity modifier assigned did not vary, however, apart from simulations with means at the extremes of the age distribution or with very high variance. Our analysis underscores the necessity of accounting for the distribution of mean age at baseline, as failure to do so can lead to inaccurate QALE estimates, thereby affecting calculations of incremental costs and QALYs in models, which base survival and quality of life predictions on general population expectations. We would recommend that patient age and sex distribution should be accounted for when incorporating general population mortality in economic models. Provided sufficient sample size, utilizing the observed empirical distribution for the expected population in clinical practice is likely to yield the most accurate results. However, in the absence of patient-level data, selecting a suitable parametric distribution is recommended.

Number of Teeth and Dementia-free Life Expectancy: A 10-Year Follow-Up Study from the Japan Gerontological Evaluation Study

ObjectivesPrevious studies have reported that tooth loss is associated with an increased risk of dementia; however, few have explored the association between number of teeth and dementia-free and total life expectancies. We investigated whether having more teeth is associated with longer dementia-free and total life expectancies. DesignA 10-year follow-up prospective cohort study from 2010 to 2020. Setting and ParticipantsFunctionally independent older adults aged ≥65 years living in 9 municipalities in Japan. MethodsThe exposure was the number of teeth (≥20, 10–19, 1–9, and 0). Dementia onset and mortality within the 10-year follow-up were used as the outcome. Dementia-free and total life expectancies according to the number of teeth were derived from multistate modeling estimates. ResultsA total of 44,083 participants were included (men: 46.8%). The mean age was 73.7 years [standard deviation (SD) = 6.0]. During follow-up, 17.3% and 21.4% of the participants experienced the onset of dementia and death, respectively. Having fewer teeth was associated with dementia [hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.07–1.22, 10–19 teeth; HR, 1.15; 95% CI, 1.08–1.22, 1–9 teeth; HR, 1.13; 95% CI, 1.05–1.21, 0 teeth] and death (HR, 1.13; 95% CI, 1.05–1.22, 10–19 teeth; HR, 1.27; 95% CI, 1.19–1.37, 1–9 teeth; HR, 1.47; 95% CI, 1.36–1.59, 0 teeth) compared with having ≥20 teeth. Dementia-free life expectancies at the age of 65 years were 16.43 years and 18.88 years with ≥20 teeth, and 14.40 years and 17.12 years with 0 teeth for men and women, respectively. The total life expectancies at the age of 65 were 17.84 years and 22.03 years with ≥20 teeth, and 15.42 years and 19.79 years with 0 teeth for men and women, respectively. Conclusions and ImplicationsHaving more teeth was associated with longer dementia-free and total life expectancies.

Total life expectancy and disability-free life expectancy and differences attributable to cigarettes’ smoking among Chinese middle-aged and older adults

ObjectivesMiddle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China.MethodsData were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011–2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment.ResultsAt baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education.ConclusionNever smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

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.

The gender paradox in health-impaired lifetime-end of amyth?

Women live longer than men, but they spend more life years with health-impairment. This article examines the extent to which this gender paradox can be explained by two factors: the "mortality effect," which results from the higher life expectancy of women, and "differential item functioning" (DIF), which refers to gender differences in reporting behavior. Impaired life expectancy at age50 is calculated for the health indicators general health, limitations, and chronic morbidity using the Sullivan method. Data on health prevalence are obtained from the 2012 survey "Gesundheit in Deutschland aktuell" (GEDA), data on mortality is taken from the Human Mortality Database. The gender difference in impaired life expectancy is decomposed into the mortality effect and the health effect. The latter is finally adjusted for DIF effects on the basis of vignettes from the 2004 SHARE survey. The gender paradox can be resolved not only partially but completely for all three health indicators considered by the mortality effect and DIF. After taking these two factors into account, the gender difference in impaired life expectancy reverses from higher values for women to higher values for men. The causes of the gender paradox are highly complex and the differences between women and men in total and impaired life expectancy are not necessarily going into contradictory directions. The extent of women's higher impaired life expectancy depends decisively on the underlying health indicator and is largely explained by the mortality effect.

Abstract 48: Racial and Ethnic Disparities in Cardiovascular Multimorbidity Progression Among Older United States Adults

Introduction: There is a knowledge gap in the potential unequal burden and progression of cardiovascular multimorbidity. Understanding the progression of cardiovascular multimorbidity and recognizing racial and ethnic disparities are needed to develop effective strategies to achieve health equity. Our objective is to investigate racial and ethnic disparities in the development and progression of cardiovascular multimorbidity among older adults in the United States and estimate relative life expectancies among patients with severe multimorbidity. Hypothesis: We hypothesized that life expectancy among older adults with severe cardiovascular multimorbidity is inversely related to the number of comorbid conditions and varies by race and ethnicity. Methods: Repeated cross-sectional cohort study of inpatient, outpatient, and carrier claims for a 5% nationwide Medicare sample. We included Medicare beneficiaries aged 65 or older enrolled in Medicare Fee-For-Service program from 2010 to 2020 and living in the continental United States. Multistate life table models were employed to estimate cardiovascular disease (CVD) progression and total life expectancies from ages 65 to 85 years. Progression probabilities and life expectancies were adjusted for age, non-cardiovascular comorbidities, and Medicaid dual eligibility. A microsimulation approach was utilized to derive life tables, and bootstrapping was used to estimate variability. The primary outcome was the development and progression of cardiovascular multimorbidity, defined by the number of major cardiovascular conditions (atrial fibrillation, acute myocardial infarction, heart failure, stroke, and chronic ischemic heart disease). Comorbidities were assessed using validated algorithms based on diagnostic codes billed over a 1-year lookback period, and beneficiaries were followed forward from their index date. Results: Of 2,189,633 beneficiaries, the median age was 69, median follow-up duration was 6 years. The cohort mainly consisted of individuals who are Non-Hispanic White (84.4%, n=1,848,410), followed by individuals who are Non-Hispanic Black (8.2%, n=179,694) and individuals from other racial or ethnic groups (7.4%, n=161,529. Non-Hispanic Black beneficiaries had higher odds of multimorbidity progression compared to Non-Hispanic White beneficiaries. Specifically, those initially with one CVD had elevated odds of developing multiple severe CVDs (OR range: 1.02-1.09). Furthermore, they generally had higher odds of progressing to a greater burden of CVD multimorbidity (OR range: 1.00-1.25). Conclusions: These findings suggest persistent racial and ethnic disparities in cardiovascular multimorbidity progression, identifying a potentially important target for the promotion of health equity.

Abstract P304: Sex Differences for the Progression of Cardiovascular Multimorbidity in Older Adults in the United States

Introduction: Understanding the progression of cardiovascular multimorbidity and recognizing differences are needed to develop effective strategies to improve health outcomes. There is a knowledge gap in the potential unequal burden and progression of cardiovascular multimorbidity. Our objective is to investigate sex differences in the progression of cardiovascular multimorbidity among older adults in the US and estimate relative life expectancies among patients with severe multimorbidity. Hypothesis: We hypothesized that life expectancy among older adults with severe cardiovascular multimorbidity is inversely related to the number of comorbid conditions and progresses more acutely in males. Methods: Repeated cross-sectional cohort study of inpatient, outpatient, and carrier claims for a 5% nationwide Medicare sample. We included Medicare beneficiaries aged 65 or older enrolled in Medicare Fee-For-Service program from 2010 to 2020 and living in the continental US. Multistate life table models were employed to estimate cardiovascular disease (CVD) progression and total life expectancies from ages 65 to 85 years. Progression probabilities and life expectancies were adjusted for age, non-cardiovascular comorbidities, and Medicaid dual eligibility. A microsimulation approach was utilized to derive life tables, and bootstrapping was used to estimate variability. The primary outcome was the development and progression of cardiovascular multimorbidity, defined by the number of major cardiovascular conditions (atrial fibrillation, acute myocardial infarction, heart failure, stroke, and chronic ischemic heart disease). Comorbidities were assessed using validated algorithms based on diagnostic codes billed over a 1-year lookback period, and beneficiaries were followed forward from their index date. Results: Of 2,189,633 beneficiaries, the median age was 69, median follow-up was 5 years, and 55.9% were female. For male beneficiaries, odds of developing cardiovascular comorbidities were significantly higher than for females, with odds ratios ranging from 1.20 (95% CI 1.19-1.21) for one CVD to 1.97 (95% CI 1.88-2.06) for 1 or more of the 4 CVD comorbidities. Men with 1 CVD at baseline had significant odds of developing 2 (OR: 1.10, 95% CI 1.09-1.11) and four CVDs (OR: 1.29, 95% CI 1.24-1.34), as well as a significant mortality risk (OR: 1.19, 95% CI 1.18-1.21). However, for men with 4 CVDs, the odds of progressing to 5 were not significant (OR: 1.00, 95% CI 0.97-1.04). Across levels of baseline multimorbidity, male beneficiaries had significantly elevated mortality risks compared to females, with the highest risk for those with no baseline CVD (OR: 1.50, 95% CI 1.48-1.52). Conclusions: These findings suggest persistent sex differences in cardiovascular multimorbidity progression, identifying a potentially important target for the improvement of health outcomes.

Ethnic differences in disability-free life expectancy and disabled life expectancy in older adults in Chile

BackgroundAlthough about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown.ObjectiveTo estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile.MethodDisability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan’s method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile.ResultsNon-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively).ConclusionsThis is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.

Association of healthy lifestyle with life expectancy free of five major disabilities in Chinese older adults.

Whether and to what extent multiple healthy lifestyles affect the longevity of people with disabilities, including those in basic activities of daily living, mobility, vision, hearing and cognition, is crucial to policymakers. We aimed to determine the impact of combined lifestyles on life expectancy (LE) lived with and without five disabilities. We recruited participants (n = 15 121 from the China Longitudinal Healthy Longevity Survey between 2008 and 2018. Healthy lifestyle levels were estimated from six factors: smoking, drinking, physical exercise, diet, cognitive activity, and sleep, which we categorised as favourable and unfavourable using the latent class growth mixture model throughout the follow-up period. We used Multi-state Markov models to assess the different disability stages of LE. Of the total LE at age 65, older adults with a favourable lifestyle spent 59.60% (disability-free LE (DFLE) = 10.24 years) without five disabilities in combination, whereas those with unfavourable lifestyle spent 56.74% (DFLE = 7.28 years). Furthermore, the percentage of DFLE was 64.98 (7.71 years) and 68.38 (9.91 years) in males with unfavourable and favourable lifestyle levels, respectively, and 47.92 (6.62 years) and 55.12 (10.30 years) for females. Compared to older adults with low socioeconomic status (SES) and unfavourable lifestyle level, those with lower SES and favourable lifestyle level had more 3.77 years of DFLE, those with higher SES and unfavourable lifestyle level had more 1.94 years, as well as those with higher SES and favourable lifestyle level had more 5.10 years at age 65. Corresponding associations were found separately for each of the five individual disabilities. A favourable lifestyle level was associated with longer total LE along with a higher proportion of DFLE and may contribute to narrowing socioeconomic health inequalities. Policymakers should develop lifestyle interventions and scale up rehabilitation services in primary care, thereby delaying disabilities to later ages, especially in low- and middle-income countries.

Multistate survival modelling of multimorbidity and transitions across health needs states and death in an ageing population

BackgroundUnmet health needs have the potential to capture health inequality. Nevertheless, the course of healthcare needs fulfilment, and the role of multimorbidity in this process remains unclear. This study assessed...

ETHNIC DIFFERENCES IN HEALTHY LIFE EXPECTANCY IN CHILE

Abstract Socioeconomic and sex differences in life expectancy (total and healthy) in Chile have been well established. However, the existence of ethnic differences in population longevity is unknown. Thus, we estimate total, healthy, and unhealthy life expectancy among Mapuche (largest indigenous group) and non-Mapuche older adults (≥60 years) in Chile. We estimated abbreviated mortality tables (using indirect demographic methods) and with the EDES health prevalence we applied Sullivan’s method. Disability was defined as the unhealthy state, evaluated through the methodology suggested by Albala et al. (2004). Results show that at age 60 the Mapuche have a life expectancy 7 years lower (26.4 vs. 18.9 years respectively). Although differences diminish with age, Mapuches always have lower total life expectancy. In addition, we detected that the proportion of disability-free life years is higher for non-Mapuche (1.5, 2.0 and 3.7 times higher at 60, 75 and 90 years respectively). In contrast, Mapuches expect to live a higher fraction of their life with disability compared to non-Mapuche (e.g., 84.1% vs. 62.9% at age 80). This is the first study addressing inequities in healthy life expectancy between the Mapuche ethnic group and non Mapuche population, reflected in lower life expectancy, lower healthy life expectancy and higher disabled life expectancy in Mapuche when compared with no Mapuche population.

SELF-REPORTED VERSUS DIAGNOSIS-BASED DISEASED LIFE EXPECTANCY AMONG OLDER COLOMBIANS

Abstract The number of older adults in Colombia will soon double and it is essential to understand the disease burden in this population. Disease prevalence is often estimated from medical diagnoses, which can underestimate disease in populations with less health care access and low health literacy. We compare differences in diseased life expectancy (DLE) using self-reported vs. measured markers for diabetes and hypertension using data from the 2015 health and wellbeing survey of older adults in Colombia (SABE-Col), a nationally representative survey of Colombians ages 60+. Respondents reported whether they had ever been told by a doctor that they had either diabetes or hypertension. Using direct measures of glucose and blood pressure and clinical cut-points, we determined which respondents were considered to have diabetes or hypertension. We used the Sullivan method to estimate life expectancy with and without disease. Data from self-reports alone generally suggest lower DLE than from both self-reported and measured disease statuses. At age 60, women have a total life expectancy of 20.56 years. We find a lower DLE for hypertension using self-reported data (12.66 years) than measured (13.24 years). Conversely, reported diabetes is similar (4.18 years) to the measured (4.28 years) DLE. Men, at age 60, have a total life expectancy of 18.04 years. DLE for hypertension using self-reports is lower (8.78 years) than measured (9.61 years). Similarly, DLE for diabetes is lower for self-report (2.98 years) than measured (3.04). Our findings show the burden of disease in this rapidly aging population.

Cardiovascular health and life expectancy with and without cardiovascular disease in the middle-aged and elderly Chinese population

BackgroundHigh cardiovascular health (CVH) was associated with lower risk of cardiovascular disease (CVD) and longer life expectancy. However, whether life years lived without CVD could increase faster than or at least at the same pace as total lifespan remains unknown. We aimed to explore the associations of CVH status with total life expectancy and life years lived with and without CVD among middle-aged and elderly men and women.MethodsWe included 65,587 participants aged ≥ 45 years from Kailuan study, who were recruited during June 2006 to October 2007. CVH was scored and classified (low [0–49 points], moderate [50–79 points] and high [80–100 points]) with Life’s Essential 8, incorporating evaluations of health behaviors and factors. All-cause mortality and incident non-fatal CVD were recorded from baseline to December 31, 2020. The multi-state life table was adopted to explore the associations of CVH status with total life expectancy and life years lived with and without CVD.ResultsSix thousand fifty eight cases of incident non-fatal CVD and 10,580 cases of deaths were identified. Men aged 45 years with low, moderate, and high CVH had a life expectancy of 33.0, 36.5 and 38.5 years, of which 7.8 (23.6%), 6.0 (16.3%) and 3.7 years (9.6%) were spent with CVD. For women, the corresponding life expectancy was 36.6, 43.6 and 48.6 years, and the remaining life years lived with CVD were 7.8 (21.3%), 6.0 (13.7%) and 4.5 years (9.3%), respectively. The benefits of high CVH were persistent across lifespan from age 45 to 85 years and consistent when CVH was evaluated with health behaviors and factors alone.ConclusionsHigh CVH compared with low CVH was associated with longer total life expectancy and fewer years spent with CVD, indicating that promoting CVH is of great importance for CVD prevention and healthy ageing in China.

Association of healthy sleep patterns with risk of mortality and life expectancy at age of 30 years: a population-based cohort study.

The importance of sleep on cardiovascular health has been increasingly acknowledged. However, the effect of combined sleep behaviors on life expectancy remains understudied. To investigate the association between sleep patterns with total and cause-specific mortality and life expectancy, using a nationally representative sample of US adults. Population-based cohort study. This cohort study included 172 321 adults aged 18 years or older in the National Health Interview Survey (2013-18) with linkage to the National Death Index records up to 31 December 2019. The life expectancy at the age of 30 years by the number of low-risk sleep scores was estimated using a flexible parametric survival model. During a median follow-up of 4.3 years, of the 172 321 adults (50.9% women; mean [SE] age, 46.98 [0.10] years), 8681 individuals died. The adjusted hazard ratios (95% confidence intervals [CI]) of participants with five vs. 0-1 low-risk sleep factors for all-cause, cardiovascular, and cancer mortality were 0.70 (0.63-0.77), 0.79 (0.67-0.93) and 0.81 (0.66-0.98), respectively. Nearly 8% (population attributable fraction 7.9%, 95% CI: 5.5-10.4) of mortality in this cohort could be attributed to suboptimal sleep patterns. When compared to those with 0-1 low-risk sleep factors, life expectancy at the age of 30 years for individuals with all five low-risk sleep factors was 4.7 (95% CI: 2.7-6.7) years greater for men and 2.4 (95% CI: 0.4-4.4) years greater for women. Our findings suggest that greater adherence to a low-risk sleep pattern may lead to significant gains in life expectancy among US adults.

Statistical modeling and estimating number of healthy life years lost and healthy life expectancy in India, 2000-2019.

In this study, our objective is to propose various models to estimate healthy life year lost (HLYL) and healthy life expectancy (HLE) in India. The HLYL and HLE were estimated and further these estimates were compared with the direct life table method and the World Health Organization (WHO) method. From the mortality perspective, we have developed a log-logistic model for estimating the parameter (bx), which is characterized by HLYL. The results were compared with other models, such as the Gompertz and Weibull model. Here, we have also obtained the HLE by subtracting HLYL from the total life expectancy. The result shows an increasing trend of HLYL among the male, female, and the total population in India. From the log-logistic model, the HLYL was estimated as 8.79 years, 8.36 years, and 9.38 years for the total, male, and female populations, respectively, in India during 2019.

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.

How long were older people expected to live with or without sarcopenia? Multistate modeling of a national cohort study.

Sarcopenia is well known to be associated with mortality, but there is a lack of evidence on the estimates of life expectancy (LE) for sarcopenia in China. This study aims to estimate total life expectancy (TLE) and sarcopenia-specific LE in community-dwelling older Chinese adults with and without sarcopenia. This study included participants aged 60 years and older who enrolled in the cohort in 2011 and 2013 and at least completed one follow-up until 2015 as part of the China Health and Retirement Longitudinal Study (CHARLS). The criteria for defining sarcopenia were based on the guidelines established by the Asian Working Group on Sarcopenia in 2019. TLE and sarcopenia-specific LE were estimated for the total population and subgroups using continuous-time multistate modeling. A total of 6,029 participants (49.2% women) with an average age of 68.4 (SD: 6.56) years were included in the study. The baseline prevalence of sarcopenia and possible sarcopenia was 19.5 and 44.9%, respectively. We observed that sarcopenia stages naturally deteriorated to worse stages (including death, by 24.4%) and returned to better stages (17.1%) during a median follow-up of 3.92 years (IQR: 2.00 ~ 4.00). The average TLE at the age of 60 was 20.9 [95% CI: 20.2-21.5] years (22.1 [95% CI: 19.6-24.6] for non-sarcopenic older adults, 20.9 [95% CI: 19.5-22.3] for possible sarcopenic, and 18.7 [95% CI: 16.4-21.1] for sarcopenic). Men, former and current smokers, and those living in northwest China had less TLE. Sarcopenic older adults, those with lower education, those who are unmarried, those with agriculture hukou, and those living in rural and northwest China were expected to live fewer years with non-sarcopenia. Sarcopenic older people, men, those with agriculture hukou, and those living in rural and southwest China were expected to live more years with sarcopenia. The results improved our understanding of the relationship between sarcopenia and life expectancy. We suggested that targeted strategies should be considered in high-risk populations and underdeveloped regions to prevent sarcopenia and improve non-sarcopenic life years for the older population.

A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001–20

This study examines two decades of change in social inequalities in life and health expectancy among older adults in Australia, one of the few countries that escaped an economic recession during the global financial crisis. We compare adults aged 45+ across three measures of individual socio-economic position—education, occupation, and household wealth—and use multistate life tables to estimate total life expectancy (TLE) and life expectancy free of limiting long-term illness (LLTI-free LE) based on 20 waves of the Household, Income and Labour Dynamics in Australia Survey (2001–20). Our findings highlight substantial social disparities in both TLE and LLTI-free LE in Australia. Grouping individuals by household wealth shows striking differentials in LLTI-free LE. We observe widening social disparities in healthy longevity over time by all three measures of socio-economic position. This diverging trend in healthy longevity is troubling against the backdrop of widening income and wealth inequalities in Australia.