Past, Present, and Future of Healthy Life Expectancy

"The light at the end of the tunnel". Discharge experience of older patients with chronic diseases: A multi-centre qualitative study

AIM

To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge.

DESIGN

Multi-centre descriptive qualitative study.

METHODS

Semi-structured interviews were conducted with older patients with chronic diseases discharged from two Italian university hospitals, between March 2017 and October 2019. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Several strategies were used to ensure the credibility, dependability, confirmability, authenticity and transferability of the findings. The study was reported in accordance with Standards for Reporting Qualitative Research and Consolidated criteria for reporting qualitative research.

RESULTS

Sixty-five patients participated in the study. Six main categories emerged: feelings, need for information, time of fragility, need for support, need for trusting relationships, and home as a caring place.

CONCLUSION

Older patients with chronic diseases are patients who require quality discharge planning with a patient-centred care vision. Healthcare professionals should intervene more extensively and deeply in the discharge process, balancing the patients' perception of their needs against organizational priorities and the wish to return home with that of not being abandoned.

IMPACT

Discharge from hospital remains an area of concern as older people have varying degrees of met and unmet needs during and following hospital discharge. Discharge is characterized by conflicting feelings of patients, who need information and support of healthcare professionals through trusting and continuous relationships. Understanding the experience of discharge is essential to support older patients with chronic diseases, considering that discharge from hospital is not an end point of care but a stage of the process involving care transition. The reframing of discharge as another transition point is crucial for healthcare professionals, who will be responsible for making their patients fit for discharge by preparing them to manage their chronic condition at home.

Personalised nutrition for older adults: design challenges, SME barriers, and options and competencies for innovation

Personalised nutrition (PN) products and services have the potential to enhance the health and quality of life of older adults. However, PN innovation is challenging and requires specific competencies and supportive collaborations. This paper reports findings from a Collective Intelligence Scenario-Based Design session conducted with PN experts as part of the Horizon 2020 project INCluSilver, which aims to support the development of products, services, and systems that improve the health and quality of life of older adults through innovation in PN. Experts identified challenges to the design of PN products and services and barriers that small and medium enterprises (SMEs) face when innovating PN products and services for older adults. Options to address these barriers were generated and specific SME competencies supporting PN innovation were identified. This study provides a useful framework for understanding the challenges, opportunities, and key competencies needed to innovate PN products and services for older adults.

The Impact of Smoking and Obesity on Disability-Free Life Expectancy in Older Australians

BACKGROUND

Smoking and obesity are 2 modifiable risk factors for disability. We examine the impact of smoking and obesity on disability-free life expectancy (DFLE) at older ages, using 2 levels of disability.

METHOD

We used the DYNOPTA dataset, derived by harmonizing and pooling risk factors and disability outcomes from 5 Australian longitudinal aging studies. We defined mobility disability as inability to walk 1 km, and more severe (activities of daily living [ADL]) disability by the inability to dress or bathe. Mortality data for the analytic sample (N = 20 401; 81.2% women) were obtained from Government Records via data linkage. We estimated sex-specific total life expectancy, DFLE, and years spent with disability by Interpolated Markov Chain (IMaCh) software for each combination of smoking (never vs ever), obesity (body mass index ≥30 vs 18.5 to <30), and education (left school age 14 or younger vs age 15 or older).

RESULTS

Compared to those without either risk factor, high educated nonobese smokers at age 65 lived shorter lives (men and women: 2.5 years) and fewer years free of mobility disability (men: 2.1 years; women: 2.0 years), with similar results for ADL disability. Obesity had the largest effect on mobility disability in women; high educated obese nonsmoking women lived 1.3 years less than nonsmoking, not obese women but had 5.1 years fewer free of mobility disability and 3.2 fewer free of ADL disability. Differences between risk factor groups were similar for the low educated.

CONCLUSIONS

Our findings suggest eliminating obesity would lead to an absolute reduction of disability, particularly in women.

Pet Ownership Patterns and Successful Aging Outcomes in Community Dwelling Older Adults

Introduction: Diminishing cognitive and physical functions, worsening psychological symptoms, and increased mortality risk and morbidity typically accompany aging. The aging population's health needs will continue to increase as the proportion of the population aged > 50 years increases. Pet ownership (PO) has been linked to better health outcomes in older adults, particularly those with chronic conditions. Much of the evidence is weak. Little is known about PO patterns as people age or the contribution of PO to successful aging in community-dwelling older adults. This study examines PO patterns among healthy community-dwelling older adults and the relationship of PO to cognitive and physical functions and psychological status. Methods: Participants in the Baltimore Longitudinal Study of Aging (> 50 years old, N = 378) completed a battery of cognitive, physical function, and psychological tests, as well as a PO questionnaire. Descriptive and non-parametric or general/generalized linear model analyses were conducted for separate outcomes. Results: Most participants (82%) had kept pets and 24% have pets: 14% dogs, 12% cats, 3% other pets. The most frequent reasons for having pets included enjoyment (80%) and companionship (66%). Most owners had kept the pet they had the longest for over 10 years (70%). PO was lower in older decades (p < 0.001). Pet owners were more likely to live in single-family homes and reside with others (p = 0.001) than non-owners. Controlling for age, PO was associated independently with better cognitive function (verbal leaning/memory p = 0.041), dog ownership predicted better physical function (daily energy expenditure, p = 0.018), and cat ownership predicted better cognitive functioning (verbal learning/memory, p = 0.035). Many older adults who did not own pets (37%) had regular contact with pets, which was also related to health outcomes. Conclusion: PO is lower at older ages, which mirrors the general pattern of poorer cognitive and physical function, and psychological status at older ages. PO and regular contact with pets (including PO) are associated with better cognitive status compared with those who did not own pets or had no regular contact with pets independent of age. Dog ownership was related to better physical function. Longitudinal analysis is required to evaluate the association of PO and/or regular contact with maintenance of health status over time.

Physical activity, a modulator of aging through effects on telomere biology

Aging is a complex process that is not well understood but involves finite changes at the genetic and epigenetic level. Physical activity is a well-documented modulator of the physiological process of aging. It has been suggested that the beneficial health effects of regular exercise are at least partly mediated through its effects on telomeres and associated regulatory pathways. Telomeres, the region of repetitive nucleotide sequences functioning as a "cap" at the chromosomal ends, play an important role to protect genomic DNA from degradation. Telomeres of dividing cells progressively shorten with age. Leucocyte telomere length (TL) has been associated with age-related diseases. Epidemiologic evidence indicates a strong relationship between physical activity and TL. In addition, TL has also been shown to predict all-cause and cardiovascular mortality. Experimental studies support a functional link between aerobic exercise and telomere preservation through activation of telomerase, an enzyme that adds nucleotides to the telomeric ends. However, unresolved questions regarding exercise modalities, pathomechanistic aspects and analytical issues limit the interpretability of available data. This review provides an overview about the current knowledge in the area of telomere biology, aging and physical activity. Finally, the capabilities and limitations of available analytical methods are addressed.

Association between obesity status and successful aging among older people in China: evidence from CHARLS

Background

The paper aimed to examine the association between obesity status and successful aging among elderly adults in China and further find gender differences in the effect of components of successful aging on obesity status.

Methods

The data came from the follow-up survey(2015) of China Health and Retirement Longitudinal Study (CHARLS) and 4019 dwellers age 60 and over are included. Obesity status were defined by the body mass index (BMI) according to Chinese criteria. Successful aging was defined following Rowe and Kahn’s multidimensional model. Multivariable logistic regression was used to estimate the relationship between obesity status and successful aging.

Results

The rate of successful aging in men and women was 18.87 and 9.48% respectively. For BMI, the proportion of population with underweight, overweight and obesity in men was 10.29, 23.04 and 29.63% respectively and that in women was 1.40, 11.69 and 9.47%. Men with obesity (OR = 1.587 95% CI 1.087 ~ 2.316) has an positive relationship with successful aging than normal weight men; Women with underweight (OR = 0.197 95% CI 0.058 ~ 0.824) has an negative relationship with successful aging than normal weight women; Meanwhile, no matter men and women, the relationship between obesity status and successful aging were not significant among oldest adults(≥75 years).

Conclusion

Obesity status was significantly association with successful aging in young older adults (60-74 years), and the components of successful aging differently were related with the obesity status of male and female.

Rethinking morbidity compression

Studies of morbidity compression routinely report the average number of years spent in an unhealthy state but do not report variation in age at morbidity onset. Variation was highlighted by Fries (1980) as crucial for identifying disease postponement. Using incidence of first hospitalization after age 60, as one working example, we estimate variation in morbidity onset over a 27-year period in Denmark. Annual estimates of first hospitalization and the population at risk for 1987 to 2014 were identified using population-based registers. Sex-specific life tables were constructed, and the average age, the threshold age, and the coefficient of variation in age at first hospitalization were calculated. On average, first admissions lasting two or more days shifted towards older ages between 1987 and 2014. The average age at hospitalization increased from 67.8 years (95% CI 67.7-67.9) to 69.5 years (95% CI 69.4-69.6) in men, and 69.1 (95% CI 69.1-69.2) to 70.5 years (95% CI 70.4-70.6) in women. Variation in age at first admission increased slightly as the coefficient of variation increased from 9.1 (95% CI 9.0-9.1) to 9.9% (95% CI 9.8-10.0) among men, and from 10.3% (95% CI 10.2-10.4) to 10.6% (95% CI 10.5-10.6) among women. Our results suggest populations are ageing with better health today than in the past, but experience increasing diversity in healthy ageing. Pensions, social care, and health services will have to adapt to increasingly heterogeneous ageing populations, a phenomenon that average measures of morbidity do not capture.

Disability-free life expectancy and life expectancy in good self-rated health in Chile: Gender differences and compression of morbidity between 2009 and 2016

Background

Chile has one of the highest life expectancies at 60 years in South America. This study was aimed to determine healthy life expectancies among Chilean older people, according to self-rated health and disability, and to explore gender differences.

Methods

Data from the National Survey of Health (2009 and 2016) were used to estimate prevalence of less than good self-rated health and disability among people aged 60 years and above. Health expectancies were calculated with the Sullivan method.

Results

In both years, women expected to live a lower proportion of their life expectancy in good self-rated health (54.5% [95% CI 50.0–58.8] for men and 37.6% [95% CI 34.3–40.8] for women in 2009; 46.1% [95% CI 42.6–49.7] for men and 38.5% [95% CI 35.6–41.4] for women in 2016). Life expectancy in less than good self-rated health increased for men (9.4 years [95% CI 8.4–10.3] in 2009; 11.5 years [95% CI 10.7–12.2]). Women expected to live a lower proportion of their remaining life without disabilities (65.3% [95% CI 61.2–69.4] for men and 44.9% [95% CI 41.9–47.9] for women in 2009; 71.9% [95% CI 68.7–75.0] for men and 61.1% [95% CI 58.5–63.8] for women in 2016). In 2016, disability-free life expectancy increased among women, but they still had a higher life expectancy with mild disability (2.8 years [95% CI 2.3–3.4] for men and 6.0 years [95% CI 5.4–6.7] for women).

Conclusions

Women expected to spend more years in less than good self-rated health and disabled. There was an expansion of life expectancy in less than good SRH among men and a compression of disability in both sexes. The high proportion of years expected to be lived in less than good self-rated health and gender differences in disability-free life expectancy of older adults should be addressed by public health policies in Chile.

The Impact of Population Aging and Public Health Support on EU Labor Markets

Population aging and public health expenditure mainly dedicated to older dependent persons present major challenges for the European Union (EU) Member States, with profound implications for their economies and labor markets. Sustainable economic development relies on a well-balanced workforce of young and older people. As this balance shifts in favor of older people, productivity tends to suffer, on the one hand, and the older group demands more from health services, on the other hand. These requisites tend to manifest differently within developed and developing EU countries. This research aimed to assess population aging impacts on labor market coordinates (employment rate, labor productivity), in the framework of several health dimensions (namely, health government expenditure, hospital services, healthy life years, perceived health) and other economic and social factors. The analytical approach consisted of applying structural equation models, Gaussian graphical models, and macroeconometric models (robust regression and panel corrected standard errors) to EU panel data for the years 1995–2017. The results show significant dissimilarities between developed and developing EU countries, suggesting the need for specific policies and strategies for the labor market integration of older people, jointly with public health expenditure, with implications for EU labor market performance.

Parallel Progress in Perceived Age and Life Expectancy

BACKGROUND

Human life expectancy continues to rise in most populations. This rise not only leads to longer lives but also is accompanied by improved health at a given age, that is, recent cohorts show a reduction of biological age for a given chronological age. Despite or even because of the diversity of biomarkers of aging, an accurate quantification of a general shift in biological age across time has been challenging.

METHODS

Here, we compared age perception of facial images taken in 2001 over a decade and related these changes in age perception to changes in life expectancy.

RESULTS

We show that age perception changes substantially across time and parallels the progress in life expectancy. In 2012, people aged more than 70 years needed to look 2.3 years younger to be rated the same age as in 2002.

CONCLUSIONS

Our results suggest that age perception reflects the past life events better than predicts future length of life, that is, it is written in your face how much you have aged so far. We draw this conclusion as age perception among elderly individuals paralleled changes in life expectancy at birth but not changes in remaining life expectancies. We suggest that changes in age perception should be explored for younger age classes to inform on aging processes, including whether aging is delayed or slowed with increasing life expectancy.

Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study

BACKGROUND

This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study.

METHODS

We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years.

RESULTS

The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke.

DISCUSSION

While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive.

Discovering markers of healthy aging: a prospective study in a Danish male birth cohort

There is a pressing need to identify markers of cognitive and neural decline in healthy late-midlife participants. We explored the relationship between cross-sectional structural brain-imaging derived phenotypes (IDPs) and cognitive ability, demographic, health and lifestyle factors (non-IDPs). Participants were recruited from the 1953 Danish Male Birth Cohort (N=193). Applying an extreme group design, members were selected in 2 groups based on cognitive change between IQ at age ~20y (IQ-20) and age ~57y (IQ-57). Subjects showing the highest (n=95) and lowest (n=98) change were selected (at age ~57) for assessments on multiple IDPs and non-IDPs. We investigated the relationship between 453 IDPs and 70 non-IDPs through pairwise correlation and multivariate canonical correlation analysis (CCA) models. Significant pairwise associations included positive associations between IQ-20 and gray-matter volume of the temporal pole. CCA identified a richer pattern - a single "positive-negative" mode of population co-variation coupling individual cross-subject variations in IDPs to an extensive range of non-IDP measures (r = 0.75, P_corrected < 0.01). Specifically, this mode linked higher cognitive performance, positive early-life social factors, and mental health to a larger brain volume of several brain structures, overall volume, and microstructural properties of some white matter tracts. Interestingly, both statistical models identified IQ-20 and gray-matter volume of the temporal pole as important contributors to the inter-individual variation observed. The converging patterns provide novel insight into the importance of early adulthood intelligence as a significant marker of late-midlife neural decline and motivates additional study.

MicroRNAs as modulators of longevity and the aging process

MicroRNAs (miRNAs) are short, non-coding RNAs that post-transcriptionally repress translation or induce mRNA degradation of target transcripts through sequence-specific binding. miRNAs target hundreds of transcripts to regulate diverse biological pathways and processes, including aging. Many microRNAs are differentially expressed during aging, generating interest in their use as aging biomarkers and roles as regulators of the aging process. In the invertebrates Caenorhabditis elegans and Drosophila, a number of miRNAs have been found to both positive and negatively modulate longevity through canonical aging pathways. Recent studies have also shown that miRNAs regulate age-associated processes and pathologies in a diverse array of mammalian tissues, including brain, heart, bone, and muscle. The review will present an overview of these studies, highlighting the role of individual miRNAs as biomarkers of aging and regulators of longevity and tissue-specific aging processes.

Comparison of cognitive and physical functioning of Europeans in 2004-05 and 2013

Background

Adult mortality has been postponed over time to increasingly high ages. However, evidence on past and current health trends has been mixed, and little is known about European disability trends.

Methods

In a cross-sectional setting, we compared cognitive and physical functioning in same-aged Europeans aged 50+ between 2004–05 (wave 1; n = 18 757) and 2013 (wave 5 refresher respondents; n = 16 696), sourced from the Survey of Health, Ageing and Retirement in Europe (SHARE).

Results

People in 2013 had better cognitive function compared with same-aged persons in 2004–05, with an average difference of approximately one-third standard deviation. The same level of cognitive function in 2004–05 at age 50 was found in 2013 for people who were 8 years older. There was an improvement in cognitive function in all European regions. Mean grip strength showed an improvement in Northern Europe of 1.00 kg [95% confidence interval (CI) 0.65; 1.35] and in Southern Europe of 1.68 kg (95% CI 1.14; 2.22), whereas a decrease was found in Central Europe (-0.80 kg; 95% CI −1.16; −0.44). We found no overall differences in activities of daily living (ADL), but small improvements in instrumental activities of daily living (IADL) in Northern and Southern Europe, with an improvement in both ADL and IADL from age 70 in Northern Europe.

Conclusions

Our results indicate that later-born Europeans have substantially better cognitive functioning than earlier-born cohorts. For physical functioning, improvements were less clear, but for Northern Europe there was an improvement in ADL and IADL in the oldest age groups.

Proactive interception and care of Frailty and Multimorbidity in older persons: the experience of the European Innovation Partnership on Active and Healthy Ageing and the response of Parma Local Health Trust and Lab through European Projects

According to the 2018 European Union Ageing Report, the demographic profile of the European population is projected to be older. Aging cannot be considered a homogeneous process, and only in certain cases is “successful”, with maintained functional ability, which is determined by intrinsic capacity, the environment, and their interaction. When intrinsic capacity is lost, elders with chronic diseases develop frailty, a condition with high-risk of disability. Old-age dependency-ratio is projected to increase from 29.6% to 51.2% in the EU in 2070: thus, the need of new approaches targeting the prevention of disability. Numerous studies are conducted in the European Innovation Partnership on Active and Healthy Ageing and addressing identification, treatment, coordination and integration of care in frail older subjects. SUNFRAIL is aimed at developing a model, good practices and tools to improve the identification, prevention and care of frailty and management of multimorbidity. SPRINTT is testing the effectiveness of a multi-component treatment able to treat frailty and sarcopenia. VIGOUR, a project aimed at strengthening integrated-care in different contexts of European Countries, verifies enablers and obstacles encountered in the real world by these good practices. Through the creation of Parma-Lab and Frailty-Team in the Academic-Hospital of Parma combined with the contribution of Parma Health-Trust in the “Community Health-Centers”, the Projects were translated into Health Services Arena. This response bridging European Studies and clinical practice, aims to early detecting and caring 75-year older citizens with frailty and multimorbidity, living in the community, not institutionalized and at risk of hospitalization and mobility ADL-disability. (www.actabiomedica.it)

Global Burden of Disease and the Impact of Mental and Addictive Disorders

PURPOSE OF REVIEW

This contribution reviews the newest empirical evidence regarding the burden of mental and addictive disorders and weighs their importance for global health in the first decades of the twenty-first century.

RECENT FINDINGS

Mental and addictive disorders affected more than 1 billion people globally in 2016. They caused 7% of all global burden of disease as measured in DALYs and 19% of all years lived with disability. Depression was associated with most DALYs for both sexes, with higher rates in women as all other internalizing disorders, whereas other disorders such as substance use disorders had higher rates in men. Mental and addictive disorders affect a significant portion of the global population with high burden, in particular in high- and upper-middle-income countries. The relative share of these disorders has increased in the past decades, in part due to stigma and lack of treatment. Future research needs to better analyze the role of mental and addictive disorders in shifts of life expectancy.

Effect of Peer Group Education on the Quality of Life of Elderly Individuals with Diabetes: A Randomized Clinical Trial

Background:

Considering the important role of education and the benefits of peer education in increasing patients' independence in self-care, as well as the socio-economic benefit of using peer education, the present study was conducted to assess the effect of peer education on the quality of life (QOL) of elderly people with diabetes.

Materials and Methods:

This clinical trial was conducted with 44 diabetic people aged over 65 years in selected health centers of Isfahan, Iran, in 2014. After preparing the peer group, 8 educational sessions were held for the participants of the groups by their peers (intervention group) and by the researcher (control group). The Diabetes Quality-of-Life (DQOL) measure was used to assess their QOL before, immediately after, and 1 month after the intervention.

Results:

The difference between the groups in terms of the total quality of life score immediately after the intervention was significant (t = 8.63; p = 0.001). The results showed that the QOL score in the dimensions of worries about diabetes effects (t = 12.13, p = 0.042), impact of diabetes treatment, (t = 8.63, p = 0.001), and satisfaction with diabetes treatment (t = 11.33, p = 0.001) was significantly different in the groups immediately after the intervention.

Conclusions:

Peer education increased the QOL of patients with diabetes, with significantly better results than the researcher training group immediately after the training. Thus, this method can be used to improve the QOL of the aged population.

Obesity May Accelerate the Aging Process

Lines of evidence from several studies have shown that increases in life expectancy are now accompanied by increased disability rate. The expanded lifespan of the aging population imposes a challenge on the continuous increase of chronic disease. The prevalence of overweight and obesity is increasing at an alarming rate in many parts of the world. Further to increasing the onset of metabolic imbalances, obesity leads to reduced life span and affects cellular and molecular processes in a fashion resembling aging. Nine key hallmarks of the aging process have been proposed. In this review, we will review these hallmarks and discuss pathophysiological changes that occur with obesity, that are similar to or contribute to those that occur during aging. We present and discuss the idea that obesity, in addition to having disease-specific effects, may accelerate the rate of aging affecting all aspects of physiology and thus shortening life span and health span.

Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.

METHODS

We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.

FINDINGS

Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2).

INTERPRETATION

With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health.

FUNDING

Bill & Melinda Gates Foundation.

A Model of Evolutionary Selection: The Cardiovascular Protective Function of the Longevity Associated Variant of BPIFB4

Evolutionary forces select genetic variants that allow adaptation to environmental stresses. The genomes of centenarian populations could recapitulate the evolutionary adaptation model and reveal the secrets of disease resistance shown by these individuals. Indeed, longevity phenotype is supposed to have a genetic background able to survive or escape to age-related diseases. Among these, cardiovascular diseases (CVDs) are the most lethal and their major risk factor is aging and the associated frailty status. One example of genetic evolution revealed by the study of centenarians genome is the four missense Single Nucleotide Polymorphisms (SNPs) haplotype in bactericidal/permeability-increasing fold-containing family B, member 4 (BPIFB4) locus that is enriched in long living individuals: the longevity associated variant (LAV). Indeed, LAV-BPIFB4 is able to improve endothelial function and revascularization through the increase of endothelial nitric oxide synthase (eNOS) dependent nitric oxide production. This review recapitulates the beneficial effects of LAV-BPIFB4 and its therapeutic potential for the treatment of CVDs.

A Hypothesis: Moderate Consumption of Alcohol Contributes to Lower Prevalence of Type 2 Diabetes Due to the Scavenging of Alpha-Dicarbonyls by Dietary Polyphenols

The world is experiencing an epidemic of type-2-diabetes mellitus (T2DM). This has led to increased morbidity and mortality, explosive growth in health care budgets, and an even greater adverse, if indirect, impact on societies and economies of affected countries. While genetic susceptibility to T2DM is a major determinant of its prevalence, changes in lifestyles also play a role. One such change has been a transition from traditional diets characterized by low caloric and high nutrient density to calorie-rich but nutrient-poor Western diets. Given this, one solution to the epidemic of T2DM would be to abandon Western diets and revert to traditional eating patterns. However, traditional diets cannot provide enough calories for the increasing global population, so transition from traditional to Western foodstuffs appears to be irreversible. Consequently, the only practical solution to problems caused by these changes is to modify Western diets, possibly by supplementing them with functional foods containing nutrients that would compensate for these dietary deficits. I present in this study a hypothesis to explain why shifts from traditional to Western diets have been so problematic and to suggest nutrients that may counteract these adverse effects. I postulate that the components of traditional diets that may compensate for deficiencies of Westerns diets are scavengers of reactive α-dicarbonyls produced as unavoidable by-products of glucose and lipid metabolism. Most important among these scavengers are some plant secondary metabolites: polyphenols, phlorotannins, and carotenoids. They are found in alcoholic beverages and are abundant in seasonings, cocoa, coffee, tea, whole grains, pigmented vegetables, fruits, and berries.

Assessment of the role of ageing and non-ageing factors in death from non-communicable diseases based on a cumulative frequency model

To quantify the effects of ageing and non-ageing factors, a characterization of the effects of ageing, genetic, and exogenous variables on 12 major non-communicable diseases was evaluated using a model assessing cumulative frequency of death and survival by age group from dead and surviving populations based on mortality statistics. Indices (0–1) of the roles of ageing (ARD), genetics (GRD) and exogenous (ERD) variables in deaths due to disease were established, and the sum of ARD, GRD and ERD was 1 (value of each indices was <1). Results showed that ageing plays an important role in death from chronic disease; exogenous factors may contribute more to the pattern of chronic disease than genetic factors (ARD, GRC and ERD were 0.818, 0.058 and 0.124 respectively for all non-communicable diseases). In descending order, ERD for non-communicable diseases were breast cancer, leukaemia, cancer of the cervix uteri and uterus, liver cancer, nephritis and nephropathy, stomach cancer, lung cancer, diabetes, cerebrovascular disease, coronary heart disease, COPD, and Alzheimer’s disease, while a smaller ERD indicated a tendency of natural death. An understanding of the aforementioned complex relationships of specific non-communicable diseases will be beneficial in designing primary prevention measures for non-communicable diseases in China.

Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study

BACKGROUND

While many studies have shown associations between obesity and increased risk of morbidity and mortality, little comparable information is available on how body mass index (BMI) impacts health expectancy. We examined associations of BMI with healthy and chronic disease-free life expectancy in four European cohort studies.

METHODS

Data were drawn from repeated waves of cohort studies in England, Finland, France and Sweden. BMI was categorized into four groups from normal weight (18.5-24.9 kg m^-2) to obesity class II (⩾35 kg m^-2). Health expectancy was estimated with two health indicators: sub-optimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years for each BMI category.

RESULTS

The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. The proportion of life between ages 50 and 75 years without chronic diseases decreased from 62 and 65% in normal weight men and women and to 29 and 36% in men and women with class II obesity, respectively. This corresponds to an average 9 more years without chronic diseases in normal weight men and 7 more years in normal weight women between ages 50 and 75 years compared to class II obese men and women. No consistent differences were observed between cohorts.

CONCLUSIONS

Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations.