scholarly journals Health expectancy and the problem of substitute morbidity

1997 ◽  
Vol 352 (1363) ◽  
pp. 1819-1827 ◽  
Author(s):  
Harry P. A. Van De Water
Keyword(s):  
Life Expectancy ◽  
Population Health ◽  
Dynamic Equilibrium ◽  
Morbidity And Mortality ◽  
Health Expectancy ◽  
Past Century ◽  
Potential Health ◽  
Policy Problem ◽  
Intervention Trials ◽  
Data Collections

During the past century, the developed world has not only witnessed a dramatic increase in life expectancy (ageing), but also a concomitant rise in chronic disease and disability. Consequently, the tension between ‘living longer’ on the one hand and health–related ‘quality of life’ on the other has become an increasingly important health policy problem. The paper deals with two consequences of this so–called epidemiological transition in population health. The first one concerns the question of how— given the impressive changes, population health can be measured in an adequate and policy relevant present–day fashion. The second one is the so–called phenomenon of ‘substitute morbidity and mortality’: more and more acute fatal diseases are replaced by non–fatal delayed degenerative diseases like dementia and arthritis. How the phenomenon of substitute morbidity and mortality affects the development of population health is illustrated with the epidemiological transitions, worldwide shifts in the main causes of death, assumptions used in models, adverse consequences of medical technologies and some results from intervention trials. Substitute morbidity and mortality may thwart our disease–specific expectations of interventions and asks for a shift to a ‘total population health’ perspective when judging potential health gains of interventions. Better understanding of the dynamics that underly the changes in population health is necessary. Implications for data collections are more emphasis on morbidity data and their relation with mortality, more longitudinal studies, stricter requirements for intervention trials and more use of modelling as a tool. A final recommendation is the promotion of integrative measures of population health. For the latter several results are presented suggesting that, although the amount of morbidity and disability is growing with an increasing life expectancy, this is mild unhealthiness in particular. This finding supports the ‘dynamic equilibrium’ theory. In absolute numbers, however, the burden of disease will continue to increase with further ageing of the population.

Health in a ‘post-transition’ Australia: adding years to life or life to years?

2014 ◽  
Vol 38 (1) ◽  
pp. 1 ◽  
Author(s):  
Stephen J. Begg
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Life Expectancy ◽  
Life Course ◽  
Morbidity And Mortality ◽  
Health Expectancy ◽  
Average Life Span ◽  
Mortality And Morbidity ◽  
The Difference ◽  
The Life Course

Objective To explore the likely impact of future trajectories of morbidity and mortality in Australia. Methods Estimates of mortality and morbidity were obtained from a previous assessment of Australia’s health from 1993 to 2003, including projections to 2023. Outcomes of interest were the difference between life expectancy (LE0) and health-adjusted life expectancy (i.e. absolute lost health expectancy (ALHE0)), ALHE0 as a proportion of LE0 and the partitioning of changes in ALHE0 into additive contributions from changes in age- and cause-specific mortality and morbidity. Results Actual and projected trajectories of mortality and morbidity resulted in an expansion of ALHE0 of 1.22 years between 1993 and 2023, which was equivalent to a relative expansion of 0.7% in morbidity over the life course. Most (93.8%) of this expansion was accounted for by cardiovascular disease, diabetes and cancer; of these, the only unfavourable trend of any note was increasing morbidity from diabetes. Conclusions Time spent with morbidity will most likely increase in terms of numbers of years lived and as a proportion of the average life span. This conclusion is based on the expectation that gains in LE0 will continue to exceed gains in ALHE0, and has important implications for public policy. What is known about the topic? Although the aging of Australia’s population as a result of declining birth and death rates is well understood, its relationship with levels of morbidity is not always fully appreciated. This is most noticeable in the policy discourse on primary prevention, in which such activities are sometimes portrayed as having unrealised potential with respect to alleviating growth in health service demand. What does this paper add? This paper sheds new light on these relationships by exploring the likely impact of future trajectories of both morbidity and mortality within an additive partitioning framework. The results suggest a modest expansion of morbidity over the life course, most of which is accounted for by only three causes. In two of these (cardiovascular disease and cancer), the underlying trends in both mortality and morbidity have been favourable for some time due, at least in part, to success in primary prevention. What are the implications for practitioners? Although there may be good arguments in favour of a greater focus on primary prevention as currently practiced, reducing overall demand for health services is unlikely to be one of them. To make such an argument valid, policy makers should consider shifting their attention to the effectiveness of primary prevention as it relates to causes other than cardiovascular disease and cancer, particularly those with a predominantly non-fatal impact, such as diabetes and degenerative diseases of old age.

scholarly journals Dietary nitrate and population health: a narrative review of the translational potential of existing laboratory studies

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Oliver M. Shannon ◽  
Chris Easton ◽  
Anthony I. Shepherd ◽  
Mario Siervo ◽  
Stephen J. Bailey ◽  
...  
Keyword(s):  
Population Health ◽  
Leafy Vegetables ◽  
Future Research ◽  
Research Approach ◽  
Valuable Insight ◽  
Main Body ◽  
Laboratory Studies ◽  
Potential Health ◽  
Health Promoting

Abstract Background Dietary inorganic nitrate (NO3−) is a polyatomic ion, which is present in large quantities in green leafy vegetables and beetroot, and has attracted considerable attention in recent years as a potential health-promoting dietary compound. Numerous small, well-controlled laboratory studies have reported beneficial health effects of inorganic NO3− consumption on blood pressure, endothelial function, cerebrovascular blood flow, cognitive function, and exercise performance. Translating the findings from small laboratory studies into ‘real-world’ applications requires careful consideration. Main body This article provides a brief overview of the existing empirical evidence basis for the purported health-promoting effects of dietary NO3− consumption. Key areas for future research are then proposed to evaluate whether promising findings observed in small animal and human laboratory studies can effectively translate into clinically relevant improvements in population health. These proposals include: 1) conducting large-scale, longer duration trials with hard clinical endpoints (e.g. cardiovascular disease incidence); 2) exploring the feasibility and acceptability of different strategies to facilitate a prolonged increase in dietary NO3− intake; 3) exploitation of existing cohort studies to explore associations between NO3− intake and health outcomes, a research approach allowing larger samples sizes and longer duration follow up than is feasible in randomised controlled trials; 4) identifying factors which might account for individual differences in the response to inorganic NO3− (e.g. sex, genetics, habitual diet) and could assist with targeted/personalised nutritional interventions; 5) exploring the influence of oral health and medication on the therapeutic potential of NO3− supplementation; and 6) examining potential risk of adverse events with long term high- NO3− diets. Conclusion The salutary effects of dietary NO3− are well established in small, well-controlled laboratory studies. Much less is known about the feasibility and efficacy of long-term dietary NO3− enrichment for promoting health, and the factors which might explain the variable responsiveness to dietary NO3− supplementation between individuals. Future research focussing on the translation of laboratory data will provide valuable insight into the potential applications of dietary NO3− supplementation to improve population health.

scholarly journals Using population health surveys to provide information on access to and use of quality primary health care

2006 ◽  
Vol 30 (4) ◽  
pp. 485 ◽  
Author(s):  
Elizabeth J Comino ◽  
Oshana Hermiz ◽  
Jeff Flack ◽  
Elizabeth Harris ◽  
Gawaine Powell Davies ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Population Health ◽  
Health Survey ◽  
Health Surveys ◽  
Diabetes Management ◽  
Relevant Information ◽  
Population Based ◽  
Primary Health ◽  
Data Collections

Objective: Currently, primary health care (PHC) is under-represented in health statistics due to the lack of a comprehensive PHC data collection. This research explores the utility of population health surveys to address questions relating to access to and use of PHC, using diabetes as an example. Methods: Drawing on published material relating to diabetes management, we developed a conceptual framework of access to and use of quality PHC. Using this framework we examined three recent population-based health surveys ? the 2001 National Health Survey, 2002?03 NSW Health Survey, and AusDiab ? to identify relevant information collection. Results: We identified seven domains comprising aspects of quality PHC for people with diabetes. For each domain we proposed associated indicators. In critiquing the three population health surveys in relation to these indicators, we identified strengths and weaknesses of the data collections. Conclusion: This approach could inform the development of questions and extension of population health surveys to provide a better understanding of access to and use of quality PHC in Australia. The additional information would complement other data collections with a communitybased perspective and contribute to the develop- ment of PHC policy.

scholarly journals Social Inequality and the Future of US Life Expectancy

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Iliya Gutin ◽  
Robert A. Hummer
Keyword(s):  
United States ◽  
Life Expectancy ◽  
Social Inequality ◽  
Population Health ◽  
The United States ◽  
Annual Review ◽  
Publication Date ◽  
The Social ◽  
The Future ◽  
Extreme Longevity

Despite decades of progress, the future of life expectancy in the United States is uncertain due to widening socioeconomic disparities in mortality, continued disparities in mortality across racial/ethnic groups, and an increase in extrinsic causes of death. These trends prompt us to scrutinize life expectancy in a high-income but enormously unequal society like the United States, where social factors determine who is most able to maximize their biological lifespan. After reviewing evidence for biodemographic perspectives on life expectancy, the uneven diffusion of health-enhancing innovations throughout the population, and the changing nature of threats to population health, we argue that sociology is optimally positioned to lead discourse on the future of life expectancy. Given recent trends, sociologists should emphasize the importance of the social determinants of life expectancy, redirecting research focus away from extending extreme longevity and toward research on social inequality with the goal of improving population health for all. Expected final online publication date for the Annual Review of Sociology, Volume 47 is July 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Autocratisation and universal health coverage: synthetic control study

BMJ ◽  
2020 ◽  
pp. m4040 ◽  
Author(s):  
Simon Wigley ◽  
Joseph L Dieleman ◽  
Tara Templin ◽  
John Everett Mumford ◽  
Thomas J Bollyky
Keyword(s):  
Life Expectancy ◽  
Confidence Interval ◽  
Population Health ◽  
Universal Health Coverage ◽  
Freedom Of Expression ◽  
Synthetic Control ◽  
Health Coverage ◽  
Effective Coverage ◽  
Per Capita ◽  
Universal Health

Abstract Objective To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress toward universal health coverage (UHC). Design Synthetic control analysis. Setting and country selection Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. Main outcome measures HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. Results Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. Conclusions Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations.

scholarly journals An Alternative Mathematical Modeling Approach to Estimating a Reference Life Expectancy

2019 ◽  
Vol 4 (1) ◽  
pp. 238146831881476 ◽  
Author(s):  
Elizabeth R. Stevens ◽  
Qinlian Zhou ◽  
Glen B. Taksler ◽  
Kimberly A. Nucifora ◽  
Marc Gourevitch ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Life Expectancy ◽  
White Women ◽  
Policy Decision ◽  
The United States ◽  
Population Characteristics ◽  
Potential Health ◽  
Health Gains ◽  
Health Policy Decision

Background. Reference life expectancies inform frequently used health metrics, which play an integral role in determining resource allocation and health policy decision making. Existing reference life expectancies are not able to account for variation in geographies, populations, and disease states. Using a computer simulation, we developed a reference life expectancy estimation that considers competing causes of mortality, and is tailored to population characteristics. Methods. We developed a Monte Carlo microsimulation model that explicitly represented the top causes of US mortality in 2014 and the risk factors associated with their onset. The microsimulation follows a birth cohort of hypothetical individuals resembling the population of the United States. To estimate a reference life expectancy, we compared current circumstances with an idealized scenario in which all modifiable risk factors were eliminated and adherence to evidence-based therapies was perfect. We compared estimations of years of potential years life lost with alternative approaches. Results. In the idealized scenario, we estimated that overall life expectancy in the United States would increase by 5.9 years to 84.7 years. Life expectancy for men would increase from 76.4 years to 82.5 years, and life expectancy for women would increase from 81.3 years to 86.8 years. Using age-75 truncation to estimate potential years life lost compared to using the idealized life expectancy underestimated potential health gains overall (38%), disproportionately underestimated potential health gains for women (by 70%) compared to men (by 40%), and disproportionately underestimated the importance of heart disease for white women and black men. Conclusion. Mathematical simulations can be used to estimate an idealized reference life expectancy among a population to better inform and assess progress toward targets to improve population health.

scholarly journals Equity and length of lifespan are not the same

2016 ◽  
Vol 113 (30) ◽  
pp. 8420-8423 ◽  
Author(s):  
Benjamin Seligman ◽  
Gabi Greenberg ◽  
Shripad Tuljapurkar
Keyword(s):  
Life Expectancy ◽  
Health Equity ◽  
Causes Of Death ◽  
The United States ◽  
Past Century ◽  
The Past ◽  
The United Kingdom ◽  
Mortality Improvement ◽  
Over Time ◽  
Age Of Death

Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.

Death at the End of the 20th Century: Individual Processes and Developmental Tasks in Old Age

2002 ◽  
Vol 54 (4) ◽  
pp. 315-333 ◽  
Author(s):  
Christina Röcke ◽  
Katie E. Cherry
Keyword(s):  
Life Expectancy ◽  
Old Age ◽  
Personal Experience ◽  
Public Awareness ◽  
Developmental Tasks ◽  
Past Century ◽  
Research Practice ◽  
The Past ◽  
And Coping ◽  
The Impact

In this article, we address the topic of death from historic and contemporary perspectives. In the first section, we describe the changes in life expectancy, personal experience, and public awareness of death that have occurred over the past century. In the next section, we examine the impact these changes have had on the mastery of the two developmental tasks in adulthood, acceptance of one's own mortality and coping with the death of a spouse. We describe select findings from the literature on attitudes, fear or acceptance of death, and grief processes. Implications for research, practice, and social change are considered.

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