Increasing inequalities in disability-free life expectancy among older adults in Sweden 2002–2014

Background: In an aging society with increasing old age life expectancy, it has become increasingly important to monitor the health development in the population. This paper combines information on mortality and disability and explores educational inequalities in disability-free life expectancy in the aging population in Sweden, and to what extent these inequalities have increased or decreased over time. Methods: A random sample of the Swedish population aged 77 years and above ( n=2895) provided information about disability in the population in the years 2002, 2004, 2011 and 2014. The prevalence of disability was assessed by five items of personal activities of daily living and incorporated in period life tables for the corresponding years, using the Sullivan method. The analyses were stratified by sex and educational attainment. Estimates at ages 77 and 85 years are presented. Results: Disability-free life expectancy at age 77 years increased more than total life expectancy for all except men with lower education. Women with higher education had a 2.7-year increase and women with lower education a 1.6-year increase. The corresponding numbers for men were 2.0 and 0.8 years. The educational gap in disability-free life expectancy increased by 1.2 years at age 77 years for both men and women. Conclusions: While most of the increase in life expectancy was years free from disability, men with lower education had an increase of years with disability. The educational differences prevailed and increased over the period as the gains in disability-free life expectancy were smaller among those with lower education.

Health expectancy indicators: what do they measure?

Background Health expectancy indicators aim at capturing the quality dimension of total life expectancy.; however, the underlying approach, definition of health, and information source differ considerably among the indicators available. Objective (1) Review the main concepts and approaches used to estimate health expectancy focusing on two widely used European health indicators: Health-Adjusted Life Expectancy (HALE) and Healthy Life Years (HLY); (2) identify underlying differences between the results yielded by these two indicators. Method Statistical differences between the HALE and HLY indicators by sex at ages 50, 60, and 70 were tested using pairwise and global Student´s t-tests and z-scores based on standard deviation. Data for 29 European countries were collected from the European Health Expectancy Monitoring Unit (EHEMU) information system and the World Health Organization (WHO) Global Burden of Disease Study 2016 (GBD 2016). Results The HALE indicator estimates were smoother across European countries compared with those of the HLY indicator, present a narrower sex gap in morbidity, higher z-scores compared with the average distribution across Europe, and results less sensitive to cross-national variations. Conclusion The HALE estimates indicate that morbidity is more compressed for both sexes, whereas the HLY estimates suggest that morbidity is more compressed for males but more expanded for females. These contrasting results demonstrate that health expectancy indicators should be interpreted with caution.

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 50+ in Mexico.DesignMultistate life table analysis of data from a longitudinal cohort survey.SettingData came from the Mexican Health and Aging Study, a longitudinal and representative survey of older adults in Mexico.Participants10 651 individuals aged 50+ interviewed in 2012 and 2015, including those who died between waves.Primary and secondary outcome measuresDisability is measured using the activities of daily living (ADL) scale. Transition rates between disability free, ADL disabled and death were employed to estimate total life expectancy (TLE) and disability-free life expectancy (DFLE).Results46% of the individuals who reported an ADL limitation in 2012 recover from disability by 2015. TLE at age 60 for people without ADL limitations is 30 years (95% CI 28.9 to 31), out of which 4.7 years (95% CI 4.1 to 5.4) are lived with ADL limitations, while TLE at age 60 in the initially disabled is 18.7 years (95% CI 17.3 to 20), with 9.4 years (95% CI 8.4 to 10.3) lived with disability. DFLE at age 60 in people with social security is 24.2 years (95% CI 23.3 to 25.2), in people with public insurance is 24.6 years (95% CI 23.7 to 25.4) and in uninsured people is 26.9 years (95% CI 25.9 to 27.9).ConclusionsIn Mexico, a substantial proportion of ADL disabled individuals recover from disability. Nevertheless, initially disabled individuals have a considerably lower DFLE regardless of age when compared with initially active individuals. There appeared to be no differences in terms of disability and LEs between the individuals with social security and public insurance.

PRELIMINARY EVALUATION OF THE EFFECTIVENESS OF HIFU-THERAPY IN PATIENTS WITH PANCREATIC CANCER

Purpose: to conduct a preliminary analysis of the safety and effectiveness of hifu-therapy with a lowenergy hifu-2001 device (shenzhen Huikang Medical apparatus Co., ltd) performed concurrently with chemotherapy in pancreatic cancer patients who are not suitable for surgery or chemoradiotherapy.Material and Method. The study included 24 pancreatic cancer patients who were treated at the Hertsen Moscow Oncology Research institute in the period from 2016 to 2019. There were 17 (71 %) women and 7 (29 %) men. The percentage of patients in the elderly group was 79 %. Stage iia pancreatic cancer was diagnosed in 3 (12.5 %) patients, stage ii in 5 (21 %) patients, stage iii in 9 (37.5 %) patients, and stage iv in 7 (29 %) patients. All patients received combination therapy, including systemic chemotherapy and hifu-therapy. Results. The most frequent adverse events of treatment were skin burns (n=6), with third-degree burns occurring in 2 (8.3 %) patients. Local sclerosis of subcutaneous adipose tissue was observed in 4 (17 %) patients; development of asymptomatic pancreatic pseudocysts in the area of hifu exposure was observed in 1 (4 %) patient. Pain control was achieved in 17 (85 %) patients, and local tumor control was achieved in 19 (79.2 %) patients. The follow-up time ranged from 5 to 30 months with a median time of 14.5 months. The median total life expectancy of patients was 16 months, and the median time to progression was 9 months. The overall 6-month survival rate was 100 %. The 1- and 1.5-year survival rates were 75.0 % and 41.7 %, respectively. The 2-year survival rate was 17.2 %. The 6-month and 1-year disease-free survival rates were 62.5 % and 12.5 %, respectively. Conclusion. The short- and long-term outcomes were consistent with those described in other studies, which indicated that a combination of systemic drug therapy and hifu-therapy is an appropriate approach for the treatment of patients with pancreatic cancer.

Telomere dynamics in the first year of life, but not later in life, predict lifespan in a wild bird

Telomeres are protective, nucleoprotein structures at the end of chromosomes that have been associated with lifespan across taxa. However, the extent to which these associations can be attributed to absolute length versus the rate of telomere shortening prior to sampling remains unresolved. In a longitudinal study, we examined the relationship between lifespan, telomere length and the rate of telomere shortening in wild, purple-crowned fairy-wrens (Malurus coronatus coronatus). To this end, we measured telomere length using qPCR in the blood of 59 individuals sampled as nestling and 4-14 months thereafter, and in 150 individuals sampled on average three times across adulthood. We applied within-subject centering analyses to simultaneously test for associations between lifespan and average telomere length and telomere shortening. We reveal that the rate of telomere shortening in the first year of life predicted lifespan, with individuals with faster shortening rates living less long. We also report a trend for an effect of telomere length in the first year of life on lifespan, independent of telomere shortening. In contrast, in adulthood neither telomere shortening, nor telomere length predicted lifespan, despite a considerably larger data set. Our results suggest that telomere length measured very early in life (during development) and longitudinal assessments of telomere shortening during the first year of life constitute more useful biomarkers of total life expectancy than either telomere length measured after development, or telomere shortening later in adulthood.

Trends in health expectancies: a systematic review of international evidence

ObjectivesA clear understanding of whether increases in longevity are spent in good health is necessary to support ageing, health and care-related policy.DesignWe conducted a systematic review to update and summarise evidence on trends in health expectancies, in Organisation for Economic Co-operation and Development (OECD) high-income countries.Data sourcesFour electronic databases (MEDLINE, 1946–19 September 2019; Embase 1980–2019 week 38; Scopus 1966–22 September 2019, Health Management Information Consortium, 1979–September 2019), and the UK Office for National Statistics website (November 2019).Eligibility criteriaEnglish language studies published from 2016 that reported trends in healthy, active and/or disability-free life expectancy in an OECD high-income country.Data extraction and synthesisRecords were screened independently by two researchers. Study quality was assessed using published criteria designed to identify sources of bias in studies reporting trends, and evidence summarised by narrative synthesis.FindingsTwenty-eight publications from 11 countries were included, covering periods from 6 to 40 years, between 1970 and 2017. In most countries, gains in healthy and disability-free life expectancy do not match the growth in total life expectancy. Exceptions were demonstrated for women in Sweden, where there were greater gains in disability-free years than life expectancy. Gains in healthy and disability-free life expectancy were greater for men than women in most countries except the USA (age 85), Japan (birth), Korea (age 65) and Sweden (age 77).ConclusionAn expansion of disability in later life is evident in a number of high-income countries, with implications for the sustainability of health and care systems. The recent COVID-19 pandemic may also impact health expectancies in the longer term.

US State Disparities in Life Expectancy, Disability-Free Life Expectancy, and Disabled Life Expectancy Among Adults Aged 25 to 89 Years

Objectives. To estimate total life expectancy (TLE), disability-free life expectancy (DFLE), and disabled life expectancy (DLE) by US state for women and men aged 25 to 89 years and examine the cross-state patterns. Methods. We used data from the 2013–2017 American Community Survey and the 2017 US Mortality Database to calculate state-specific TLE, DFLE, and DLE by gender for US adults and hypothetical worst- and best-case scenarios. Results. For men and women, DFLEs and DLEs varied widely by state. Among women, DFLE ranged from 45.8 years in West Virginia to 52.5 years in Hawaii, a 6.7-year gap. Men had a similar range. The gap in DLEs across states was 2.4 years for women and 1.6 years for men. The correlation among DFLE, DLE, and TLE was particularly strong in southern states. The South is doubly disadvantaged: residents have shorter lives and spend a greater proportion of those lives with disability. Conclusions. The stark variation in DFLE and DLE across states highlights the large health inequalities present today across the United States, which have significant implications for individuals’ well-being and US states’ financial costs and medical care burden.

Are Older Persons in China Living More Years in an Independent Living Arrangement? Estimates Using Multistate Life Tables

Adopting a multistate life table approach, this study estimates number of years the very old in China expect to live in an independent living arrangement (alone or with spouse only)—an estimate we term “independent living life expectancy” (ILLE)—as opposed to in coresidence with adult children or others. We also estimate how ILLE and proportion of total life expectancy (TLE) residing independently has changed over time. The backdrop for this study is a society experiencing both increasing longevity and social changes that influence the tendency to live in an independent living arrangement. The study concentrates on assessing whether changes in ILLE match or surpass gains in TLE experienced by oldest-old Chinese adults. Data are from the 2002–2014 Chinese Longitudinal Healthy Longevity Survey, and estimation is conducted using the Stochastic Population Analysis for Complex Events software. Results suggest that on balance, gains in ILLE are proportionately greater than gains in TLE, indicating an expansion of ILLE for most Chinese elders. Males, septuagenarian females, and disabled septuagenarians are the most likely to be living proportionately longer lives in an independent living arrangement. In contrast, extremely old (nonagenarian and centenarian) females and extremely old disabled individuals are least likely to have experienced dramatic changes in proportion of life residing independently. The findings imply some support for the hypothesis that given the maintenance of family solidarity in China, those in greatest need are least likely to encounter the most extreme changes toward independent living arrangements.

Neighborhood Disadvantage and Active, Disabled and Total Life Expectancy Among Community-living Older Persons

BackgroundNeighborhood disadvantage is a novel social determinant of health that could adversely affect the functional well-being and longevity of older persons. We evaluated whether estimates of active, disabled and total life expectancy differ on the basis of neighborhood disadvantage after accounting for individual-level socioeconomic characteristics and other prognostic factors.MethodsWe used data on 754 community-living older persons from South Central Connecticut, who completed monthly assessments of disability from 1998 to 2020. Scores on the area deprivation index were dichotomized at the 80th state percentile to distinguish neighborhoods that were disadvantaged (81-100) from those that were not (1-80).ResultsWithin 5-year age increments from 70 to 90, active and total life expectancy were consistently lower in participants from neighborhoods that were disadvantaged versus not disadvantaged, and these differences persisted and remained statistically significant after adjustment for individual-level race/ethnicity, education, income, and other prognostic factors. At age 70, adjusted estimates (95% CI) for active and total life expectancy (in years) were 12.3 (11.5-13.1) and 15.0 (13.8-16.1) in the disadvantaged group and 14.2 (13.5-14.7) and 16.7 (15.9-17.5) in the non-disadvantaged group. At each age, participants from disadvantaged neighborhoods spent a greater percentage of their projected remaining life disabled, relative to those from non-disadvantaged neighborhoods, with adjusted values (SE) ranging from 17.7 (0.8) vs. 15.3 (0.5) at age 70 to 55.0 (1.7) vs. 48.1 (1.3) at age 90.ConclusionsLiving in a disadvantaged neighborhood is associated with lower active and total life expectancy and a greater percentage of projected remaining life disabled.

Age of Migration and Cognitive Life Expectancies Among Older Latinos: Evidence From the Health and Retirement Study

This study used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively intact, cognitively impaired/no dementia (CIND), and dementia life expectancies by nativity, age of migration, and sex for older Latinos residing in the United States. Results show foreign-born Latinos, regardless of age of migration or sex, spend a greater number of years after age 50 with CIND compared to U.S.-born Latinos. Furthermore, we document an advantage in total life expectancy and cognitively intact life expectancy among mid-life immigrant men relative to their U.S.-born counterparts. The robust relationship between nativity, age of migration, and cognitive health suggests that the foreign-born may place particularly serious burdens on families and the government. This issue merits special attention in the development of community-based long-term care programs to appropriately target the specific needs of different subgroups of older Latinos who are entering into their last decades of life.