377Smoking, blood pressure, and body mass index to estimate healthy life expectancy: NIPPON DATA90

Background Healthy life expectancy (HLE) is an important measure of an ageing society. We estimated HLE based on combinations of smoking, blood pressure (BP), and body mass index (BMI) in the Japanese population using a multistate life table. Methods A nationwide cohort study of Japan was performed using NIPPON DATA90 (N = 6,676) with the Katz Activities of Daily Living Index as the HLE endpoint. Combinations of smoking (non-smokers and smokers), BP (2018 ESC/ESH Guidelines classification), and BMI (underweight, normal, and overweight) were developed, and the group-specific HLEs were calculated using a multistate life table. Results At age 65, smokers had shorter HLE than non-smokers for all BMI and BP groups. The HLE of men who were overweight, hypertensive (Grade 2 or 3), and smokers was 14.05 years (95% confidence interval: 15.77-21.36); in contrast, the HLE of men who were normal weight, normotensive, and non-smokers was 19.04 years (16.46-21.61). Among all BMI and smoking status groups, HLE decreased linearly as BP increased regardless of sex. The HLE distribution showed a slight inverted U-shape as BMI increased in both sexes. Conclusions This study showed that HLE at age 65 was considerably shorter in smokers and individuals with higher BP. Furthermore, both underweight and overweight had modest effects on HLE at age 65. Key messages HLE was considerably shorter in smokers and individuals with higher BP. In addition, both underweight and overweight had modest effects on HLE.

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.

Children’s Financial Dependence on Mothers: Propensity and Duration

Over 40 percent of American children rely primarily on their mothers’ earnings for financial support in cross-sectional surveys. Yet these data understate mothers’ role as their family’s primary earner. Using longitudinal Survey of Income and Program Participation panels beginning in 2014, we create multistate life table estimates of mothers’ duration as primary earner as well as single-decrement life table estimates of their chance of ever being the primary earner over the first 18 years of motherhood. Using a threshold of 60 percent of household earnings to determine primary earning status, mothers average 4.19 years as their families’ primary earner in the 18 years following first birth. Mothers with some college but no degree spent the most years as primary earners, about 5.09 years on average, as did mothers with nonmarital first births, about 5.69 years. Around 70 percent of American mothers can reasonably expect to be their household’s primary earner at some point during their first 18 years of motherhood.

Hearing and Cognitively Impaired Life Expectancies in the United States

As the population ages, increased prevalence of cognitive and sensory impairments may pose growing public health challenges. Among the nine modifiable risk factors for dementia, the highest percentage (9%) of dementia cases are attributed to hearing impairment. While much research has examined the relationship between hearing impairment and cognition, almost none has translated these relationships into a meaningful, life course metric: how many years of life individuals can expect to live with both impairments and how hearing impairment affects years lived with cognitive impairment. Our study fills this gap by using Bayesian multistate life table methods applied to nine waves of the Health and Retirement Study (1998-2014) to estimate years of life to be spent (1) with/without hearing and cognitive impairment, and (2) with/without cognitive impairment, conditional on having versus not having hearing impairment. Preliminary results for aim 1 reveal that at age 50, individuals will live 18.9 (18.7-19.2) years healthy, 4.3 (4.2-4.5) years hearing impaired but cognitively intact, 4.2 (4.0-4.3) years hearing unimpaired but cognitively impaired, and 2.3 (2.2-2.6) years with both impairments. Women will spend more years healthy, hearing unimpaired but cognitively impaired, or with both impairments; men will spend more years hearing impaired but cognitively intact. People with more education will spend more years hearing impaired but cognitively intact; people with less education will spend more years hearing unimpaired but cognitively impaired or with both impairments. Our study is one of the first to investigate the implications of hearing impairment for years of cognitively impaired life.

Vision and Hearing Impairments in Relation to Disability-Free Life Expectancy in People From England and the United States

Both hearing and vision impairments are some of the most common deficits experienced by older adults. We examined the impact of self-reported vision and hearing impairments on disability-free life expectancy (DFLE). We used harmonized data from the Gateway to Global Aging Data from the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA). We used discrete-time multistate life table models to estimate disability-free life expectancy by sex, age and country. In both countries and at all ages either vision or hearing impairment was associated with shorter DFLE compared to those who reported no impairments. Reporting both vision and hearing impairments reduced DFLE. For example, at the age of 50, men and women with both vision and hearing impairments could expect to live up to 12 fewer years free from disability compared with men and women with no impairments, similar results were found in both countries.

Multistate life tables using Stata

The mslt command calculates the functions of a multistate life table and plots a graph of conditional and unconditional life expectancies by time. The command provides linear and exponential solutions to estimate the number of individuals, transitions, probabilities, person-years, and years of life in a given cohort and state of occupancy. The input data are time-specific transition rates (or survivorship proportions) between nonabsorbing and at most one absorbing state. In addition to the mean age at transfer between states, mslt calculates the following summary measures: the mean age, the probability of dying, the average duration, and the proportion of life spent in a specific state.

Impact of tax and tobacco-free generation on health-adjusted life years in the Solomon Islands: a multistate life table simulation

ObjectiveTo estimate health-adjusted life years (HALY) gained in the Solomon Islands for the 2016 population over the remainder of their lives, for three interventions: hypothetical eradication of cigarettes; 25% annual tax increases to 2025 such that tax represents 70% of sales price of tobacco; and a tobacco-free generation (TFG).DesignWe adapted an existing multistate life table model, using Global Burden of Disease (GBD) and other data inputs, including diseases contributing >5% of the GBD estimated disability-adjusted life years lost in the Solomon Islands in 2016. Tax effects used price increases and price elasticities to change cigarette smoking prevalence. The TFG was modelled by no uptake of smoking among those 20 years and under after 2016.ResultsUnder business as usual (BAU) smoking prevalence decreased over time, and decreased faster under the tax intervention (especially for younger ages). For example, for 20-year-old males the best estimated prevalence in 2036 was 22.9% under BAU, reducing to 14.2% under increased tax. Eradicating tobacco in 2016 would achieve 1510 undiscounted HALYs per 1000 people alive in 2016, over the remainder of their lives. The tax intervention would achieve 370 HALYs per 1000 (24.5% of potential health gain), and the TFG 798 HALYs per 1000 people (52.5%). By time horizon, 10.5% of the HALY gains from tax and 8.0% from TFG occur from 2016 to 2036, and the remainder at least 20 years into the future.ConclusionThis study quantified the potential of two tobacco control policies over maximum health gains achievable through tobacco eradication in the Solomon Islands.