Normalized lifespan inequality: disentangling the longevity–lifespan variability nexus

Previous studies have documented a historically strong and negative association between countries’ life expectancy (i.e., average longevity) and length-of-life inequality (i.e., variability in ages at death). The relationship between both variables might be partially explained by life expectancy increasing at a faster pace than maximal length of life, a phenomenon that mechanically compresses the age-at-death distribution and has not been taken into consideration in previous studies. In this paper, we propose a new approach to lifespan inequality measurement that accounts for the (uncertainly) bounded nature of length-of-life. Applying the new approach to the countries of the Human Mortality Database, we observe that the decline in overall lifespan variability typically associated with increases in longevity seems to stop and even reverse at higher levels of life expectancy. This suggests the emergence of worrying ethical dilemmas, whereby higher achievements in longevity would only be possible at the expense of higher lifespan variability.

On the measurement of healthy lifespan inequality

Background Current measures to monitor population health include indicators of (i) average length-of-life (life expectancy), (ii) average length-of-life spent in good health (health expectancy), and (iii) variability in length-of-life (lifespan inequality). What is lacking is an indicator measuring the extent to which healthy lifespans are unequally distributed across individuals (the so-called ‘healthy lifespan inequality’ indicators). Methods We combine information on age-specific survival with the prevalence of functional limitation or disability in Spain (2014–2017) by sex and level of education to estimate age-at-disability onset distributions. Age-, sex- and education-specific prevalence rates of adult individuals’ daily activities limitations were based on the GALI index derived from Spanish National Health Surveys held in 2014 and 2017. We measured inequality using the Gini index. Results In contemporary Spain, education differences in health expectancy are substantial and greatly exceed differences in life expectancy. The female advantage in life expectancy disappears when considering health expectancy indicators, both overall and across education groups. The highly educated exhibit lower levels of lifespan inequality, and lifespan inequality is systematically higher among men. Our new healthy lifespan inequality indicators suggest that the variability in the ages at which physical daily activity limitations start are substantially larger than the variability in the ages at which individuals die. Healthy lifespan inequality tends to decrease with increasing educational attainment, both for women and for men. The variability in ages at which physical limitations start is slightly higher for women than for men. Conclusions The suggested indicators uncover new layers of health inequality that are not traceable with currently existing approaches. Low-educated individuals tend to not only die earlier and spend a shorter portion of their lives in good health than their highly educated counterparts, but also face greater variation in the eventual time of death and in the age at which they cease enjoying good health—a multiple burden of inequality that should be taken into consideration when evaluating the performance of public health systems and in the elaboration of realistic working-life extension plans and the design of equitable pension reforms.

The Cross-sectional Average Inequality in Lifespan (CAL†): A Lifespan Variation Measure That Reflects the Mortality Histories of Cohorts

Lifespan variation is a key metric of mortality that describes both individual uncertainty about the length of life and heterogeneity in population health. We propose a novel and timely lifespan variation measure, which we call the cross-sectional average inequality in lifespan, or CAL†. This new index provides an alternative perspective on the analysis of lifespan inequality by combining the mortality histories of all cohorts present in a cross-sectional approach. We demonstrate how differences in the CAL† measure can be decomposed between populations by age and cohort to explore the compression or expansion of mortality in a cohort perspective. We apply these new methods using data from 10 low-mortality countries or regions from 1879 to 2013. CAL† reveals greater uncertainty in the timing of death than the period life table–based indices of variation indicate. Also, country rankings of lifespan inequality vary considerably between period and cross-sectional measures. These differences raise intriguing questions as to which temporal dimension is the most relevant to individuals when considering the uncertainty in the timing of death in planning their life courses.

Who Wants to Live Forever? Astrological Methods for Calculating Lifespan in Western Culture and Perspectives on Determinism in Astrology

The calculation of an individual’s life span has been a constant presence in premodern astrological practice. It was used by physicians to calculate the expected life of a patient or to ascertain if an illness was likely to be fatal. On a personal level, this knowledge could also offer a means of control over one’s life and, more importantly, a way to prepare their access to a rewarding afterlife. This article contains an overview of determinism in astrology and a brief survey of the main methodologies used to determine the length of life, exploring their history, primary sources, and variations from antiquity to the early modern period. Although it discusses to some extent the chief methods for determining the lifespan, an in-depth study of the techniques, with all their details and discrepancies is out of its scope. The goal is to correlate the astrological practice with different perspectives on determinism and free will.

Progesterone Receptor Antagonists – A Novel Treatment for Severe Hyponatremia from the Endocrine Paraneoplastic Syndrome

Hyponatremia related to ectopic secretion of cancer cells of argininevasopressin (AVP) or atrial natriuretic peptide (ANP) is most commonlycaused by small cell lung cancer. The ideal treatment would be one thatnot only corrects the hyponatremia, especially if it is life threatening, butat the same time causes regression of the cancer, and thus improves bothquality and length of life. As one is waiting for chemotherapy, surgery,or radiotherapy to decrease the cancer burden, tolvaptan has been usedto correct the hyponatremia to improve symptoms or prevent death.Mifepristone, a progesterone receptor modulator/antagonist has been usedto treat various cancers. The oral 200mg tablet was given to an 80-year-oldwoman who developed sudden extensive lung cancer with a serum sodiumof 118 mmol/L. She refused chemotherapy but agreed to take mifepristone.The hyponatremia was completely corrected (145 mmol/L) within onemonth of treatment. She was in complete remission for 5 years and diednot from lung cancer, but an acute myocardial infarction. Mifepristonemay serve the purpose to not only quickly correct hyponatremia when itis related to an endocrine paraneoplastic syndrome, but also to provideimproved quality and length of life.

Advance care planning in multiple sclerosis: reflections of a palliative care physician

Multiple sclerosis (MS) has a long illness trajectory punctuated by serious acute events, with a later stage that is often accompanied by cognitive impairment. There is ample time for advance care planning (ACP) discussions. While there is much to be learned about the optimal way to approach ACP for people living with MS, it is possible to approach these discussions sensitively at all stages of the condition. However, as such voluntary discussions currently lie outside usual practice, people living with MS are denied the opportunities to consider the effect future medical treatments may have on their quality and length of life. How can clinicians assist in planning for a ‘good life’ and a ‘good death’?

The Path Forward

Factors interfering with market-based alignment of drug prices and value make explicit value assessment necessary. The widely used quality-adjusted life year serves as a starting point because it accounts for both quality and length of life. Cost estimates could improve by accounting for drug price changes accompanying the loss of market exclusivity. Consistent use of a societal perspective when relevant would also improve value assessments. Prices should sometimes reflect government contributions to development, although such adjustments make the most sense when government facilitates late-stage research. The Institute for Clinical and Economic Review, a private group with a leading role in US value assessment, should make its analyses transparent and defer to payers regarding judgements about value. Finally, payers should embrace value-based pricing. They may not always get the lowest prices, but aligning price and value will mean society expends its resources efficiently and improves the population’s overall health.