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Moryson W, Stawińska-Witoszyńska B. Excess Mortality of Males Due to Chronic Obstructive Pulmonary Disease (COPD) in Poland. Healthcare (Basel) 2024; 12:437. [PMID: 38391812 PMCID: PMC10887559 DOI: 10.3390/healthcare12040437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
At present, female life expectancy exceeds male life expectancy almost worldwide. However, numerous studies indicate that this disparity is gradually decreasing. In Poland, the gender gap in life expectancy peaked in 1991 when it amounted to 9.2 years. Since then, a narrowing of the gap has been observed, reaching 8 years in 2021. Decreasing differences in life expectancy between men and women in Poland were mainly the result of a reduction in mortality due to ischaemic heart disease, cerebrovascular disease, and a number of malignancies.Less attention has been paid to chronic obstructive pulmonary disease (COPD) although it is the third leading cause of death worldwide. This paper includes an analysis of mortality due to chronic obstructive pulmonary disease COPD. The male excess mortality was calculated as the ratio of mortality rates in the male population scaled up to the corresponding rates in the female population using both crude and standardised detailed mortality rates. The Joinpoint model was used to determine time trends. It was shown that from 2008 to 2021, the excess mortality of men due to COPD in Poland decreased by 3.3% per year from 2.4 to 1.7 when using crude coefficients, while when standardised coefficients were applied, it decreased significantly by 3.9% per year from 3.8 to 2.4. The decrease in the excess mortality of men in Poland was due to a simultaneous decrease in mortality in the population in general; however, a greater decrease was observed in the male population. The mortality of men and women, and, at the same time, the excess mortality of men caused by COPD in Poland decreased faster in the period studied than in other European countries.
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Affiliation(s)
- Waclaw Moryson
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, Rokietnicka 4, 60-806 Poznan, Poland
| | - Barbara Stawińska-Witoszyńska
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, Rokietnicka 4, 60-806 Poznan, Poland
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Atance D, Claramunt MM, Varea X, Aburto JM. Convergence and divergence in mortality: A global study from 1990 to 2030. PLoS One 2024; 19:e0295842. [PMID: 38232060 DOI: 10.1371/journal.pone.0295842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
An empirical question that has motivated demographers is whether there is convergence or divergence in mortality/longevity around the world. The epidemiological transition is the starting point for studying a global process of mortality convergence. This manuscript aims to provide an update on the concept of mortality convergence/divergence. We perform a comprehensive examination of nine different mortality indicators from a global perspective using clustering methods in the period 1990-2030. In addition, we include analyses of projections to provide insights into prospective trajectories of convergence clubs, a dimension unexplored in previous work. The results indicate that mortality convergence clubs of 194 countries by sex resemble the configuration of continents. These five clubs show a common steady upward trend in longevity indicators, accompanied by a progressive reduction in disparities between sexes and between groups of countries. Furthermore, this paper shows insights into the historical evolution of the convergence clubs in the period 1990-2020 and expands their scope to include projections of their expected future evolution in 2030.
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Affiliation(s)
- David Atance
- Departamento de Economía y Dirección de Empresas, Universidad de Alcalá, Madrid, Spain
| | - M Mercè Claramunt
- Departamento de Matemática Económica, Financiera y Actuarial, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Varea
- Departamento de Matemática Económica, Financiera y Actuarial, Universitat de Barcelona, Barcelona, Spain
| | - Jose Manuel Aburto
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of Oxford, Oxford, United Kingdom
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3
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Marroig A. Transitions across states with and without difficulties in performing activities of daily living and death: a longitudinal comparison of ten European countries. Eur J Ageing 2023; 20:18. [PMID: 37202643 DOI: 10.1007/s10433-023-00763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Ageing has been related to the onset of disability and dependency in older adults. There is a need to better understand the disability and dependency trajectories of older adults and their relationship with socio-demographic characteristics and institutional or cultural context. This study analyses the role of age, sex, education and self-perceived health in disability, dependency and death transitions, addressing the heterogeneity across European countries and inconsistencies when using different measures of disability. Multi-state models were adjusted to evaluate the role of risk and protective factors in the transitions to disability, dependency and death. Difficulties in performing activities of daily living (ADLs) assess disability and dependency states. Data were from the Survey of Health, Ageing and Retirement in Europe conducted in 2004-2013, considering individuals aged 65 and older at baseline from Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden and Switzerland. The results showed that transitions to disability and dependency varied with age, sex, education and self-perceived health. The probability of transition to disability and dependency states increases until the age of 70 for all countries. However, there was heterogeneity in the disability and dependency trajectories with ageing between men and women. In most countries, women live with difficulties and may need help for longer than men. Care policies should consider sex differences to decrease the burden of care of informal caregivers, particularly in countries where care systems are absent or partially developed and a high level of family obligations to care needs exist.
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Affiliation(s)
- Alejandra Marroig
- Instituto de Estadística, Universidad de la República, Montevideo, Uruguay.
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4
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Are Skeletal Muscle Changes during Prolonged Space Flights Similar to Those Experienced by Frail and Sarcopenic Older Adults? LIFE (BASEL, SWITZERLAND) 2022; 12:life12122139. [PMID: 36556504 PMCID: PMC9781047 DOI: 10.3390/life12122139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Microgravity exposure causes several physiological and psychosocial alterations that challenge astronauts' health during space flight. Notably, many of these changes are mostly related to physical inactivity influencing different functional systems and organ biology, in particular the musculoskeletal system, dramatically resulting in aging-like phenotypes, such as those occurring in older persons on Earth. In this sense, sarcopenia, a syndrome characterized by the loss in muscle mass and strength due to skeletal muscle unloading, is undoubtedly one of the most critical aging-like adverse effects of microgravity and a prevalent problem in the geriatric population, still awaiting effective countermeasures. Therefore, there is an urgent demand to identify clinically relevant biological markers and to underline molecular mechanisms behind these effects that are still poorly understood. From this perspective, a lesson from Geroscience may help tailor interventions to counteract the adverse effects of microgravity. For instance, decades of studies in the field have demonstrated that in the older people, the clinical picture of sarcopenia remarkably overlaps (from a clinical and biological point of view) with that of frailty, primarily when referred to the physical function domain. Based on this premise, here we provide a deeper understanding of the biological mechanisms of sarcopenia and frailty, which in aging are often considered together, and how these converge with those observed in astronauts after space flight.
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Silva JMM, da Silva Freitas JLG, Nóbrega JCL, Medeiros JB, Simões RFM, Olinda R, de Ferreira Santos JL, de Oliveira Duarte YA, Zatz M, Matheson D, Santos S, Menezes TN. Regional differences regarding the occurrence of falls and associated factors in two populations of Brazilian longevous people. BMC Geriatr 2022; 22:931. [DOI: 10.1186/s12877-022-03630-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
Few studies have explored regional asymmetries and their implications for health policies regarding episodes of falls among the population of ≥80 years old in continental and developing countries like Brazil with deep inequalities and sociocultural differences.
Objective
To evaluate the occurrence of falls and their association with functional capacity and nutritional status in the longest oldest-old living in two municipalities in the Northeast and Southeast of Brazil.
Methods
This is a cross-sectional study, with primary data collection in which were included in the research seniors aged 80 years or more, of both sexes, belonging to two Brazilian municipalities of discrepant socioeconomic aspects. The dependent variable was the occurrence of falls in the last year. The independent variables were grouped into demographic aspects, functional capacity and nutritional status. To identify variables that contribute to the occurrence of falls, the multiple logistic regression model, adopts a significance level of 5%.
Results
The sample was composed of 415 oldest-old adults. From the total, 32.3% reported having fallen in the last year, 24.7% in Brejo dos Santos and 37.8% in São Paulo. Among the former population, the mean value of walking speed for those who had falls was 0.27 m/s and for those who had no occurrence of falls was 0.33 m/s; and, among the seniors from São Paulo, the mean values were 0.51 m/s and 0.58 m/s, respectively. Significant correlations between walking speed and falls were verified for both populations, showing that the lower the walking speed, the higher the predisposition to falls. In the final regression model, the occurrence of falls was associated with moderate balance (OR = 5.28; CI: 1.11–25.18) among the longevous people Brejo dos Santos and with very poor functional performance (OR = 16.09; CI:1.46–177.06) among those from São Paulo.
Conclusion
The results pointed out a lower prevalence of falls in longevous people from Brejo dos Santos than in those from São Paulo and differences regarding the associated factors, showing heterogeneity between the two populations; indicating the need for public policies and effective programmes aimed at preventing falls based on the maintenance or increase of functional capacity.
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Feraldi A, Zarulli V. Patterns in age and cause of death contribution to the sex gap in life expectancy: a comparison among ten countries. GENUS 2022. [DOI: 10.1186/s41118-022-00171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractWomen live longer than men and the absolute difference between male and female mortality risk reaches its maximum at old ages. We decomposed the sex gap in life expectancy and investigated the changes over time of the profile of the age–cause specific contributions with indicators of location, magnitude and dispersion in ten countries. Data were retrieved from the Human Cause-of-Death Database. The decomposition analyses revealed that neoplasm, heart diseases and external causes were the main drivers of the gender gap. We also find two main patterns in the development of age-specific contributions. With mortality delay, regarding neoplasm-related mortality and heart disease-related mortality, the shift (i.e., movement of the modal age at contribution towards older ages) and compression (i.e., dispersion concentrated on a shorter age interval) of the survival advantage of women over a narrower age range reveal that men are gradually improving their survival. This might be linked to improvements in survival, diagnosis and access to treatment, at least to those ages no longer affected by the most significant differences.
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Zhao E, Crimmins EM. Mortality and morbidity in ageing men: Biology, Lifestyle and Environment. Rev Endocr Metab Disord 2022; 23:1285-1304. [PMID: 35697963 PMCID: PMC9748037 DOI: 10.1007/s11154-022-09737-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 01/11/2023]
Abstract
Males live shorter lives than women in all countries. The universality of shorter male life expectancy is a 21st Century phenomena. It occurs with the decline in infectious diseases and the rise in cardiovascular diseases accounting for mortality. Male/female differences in morbidity are not as succinctly characterized. Men have a higher prevalence of lethal diseases, which is linked to their lower life expectancy. Women have more non-lethal conditions such as depression and arthritis; which may also be linked in part to longer survival. Men have better physical functioning and less disability which is partly explained by gender differences in diseases and also by their greater strength, size, and stamina. Gender differences in risk factors for disease have changed over time with the prevalence and treatment of risk as well as differential behavior by gender. Examination of what are seen as basic molecular and cellular measures related to aging indicates men age faster than women; however, even these basic biological measures result from a combination of biology, behavior, and social factors.
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Affiliation(s)
- Erfei Zhao
- Davis School of Gerontology, University of Southern California, 90089-0191 Los Angeles, CA United States
| | - Eileen M. Crimmins
- Davis School of Gerontology, University of Southern California, 90089-0191 Los Angeles, CA United States
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8
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Fors S, Illinca S, Jull J, Kadi S, P Phillips S, Rodrigues R, Vafaei A, Zolyomi E, Rehnberg J. Cohort-specific disability trajectories among older women and men in Europe 2004-2017. Eur J Ageing 2022; 19:1111-1119. [PMID: 36692740 PMCID: PMC9729672 DOI: 10.1007/s10433-022-00684-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 01/26/2023] Open
Abstract
As the population of Europe grows older, one crucial issue is how the incidence and prevalence of disabilities are developing over time in the older population. In this study, we compare cohort-specific disability trajectories in old age across subsequent birth cohorts in Europe, during the period 2004-2017.We used data from seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Mixed effects logistic regression models were used to model trajectories of accumulation of ADL limitations for subsequent birth cohorts of older women and men in different European regions. The results showed that there were sex differences in ADL and IADL limitations in all regions for most cohorts. Women reported more limitations than men, particularly in Eastern and Southern rather than Northern and Western Europe. Among men in Eastern, Northern and Western Europe, later born cohorts reported more disabilities than did earlier born birth cohorts at the same ages. Similar patterns were observed for women in Northern and Western Europe. In contrast, the risk of disabilities was lower in later born cohorts than in earlier born birth cohorts among women in Eastern Europe. Overall, results from this study suggest that disability trajectories in different cohorts of men and women were by and large similar across Europe. The trajectories varied more depending on sex, age and region than depending on cohort.
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Affiliation(s)
- Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Tomtebodavägen 18A, 171 65, Solna, Stockholm, Sweden.
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.
| | - Stefania Illinca
- European Center for Social Welfare Policy and Research, Vienna, Austria
| | - Janet Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Selma Kadi
- European Center for Social Welfare Policy and Research, Vienna, Austria
| | - Susan P Phillips
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Ricardo Rodrigues
- European Center for Social Welfare Policy and Research, Vienna, Austria
| | - Afshin Vafaei
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Eszter Zolyomi
- European Center for Social Welfare Policy and Research, Vienna, Austria
| | - Johan Rehnberg
- Aging Research Center, Karolinska Institutet and Stockholm University, Tomtebodavägen 18A, 171 65, Solna, Stockholm, Sweden
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9
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Wennberg AM, Ebeling M, Ek S, Meyer A, Ding M, Talbäck M, Modig K. Trends in Frailty Between 1990 and 2020 in Sweden Among 75-, 85-, and 95-Year-Old Women and Men: A Nationwide Study from Sweden. J Gerontol A Biol Sci Med Sci 2022; 78:342-348. [PMID: 36190806 PMCID: PMC9951059 DOI: 10.1093/gerona/glac210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aging is the primary risk factor for frailty, which is defined as an inability to respond to acute or chronic stressors. Individuals are living longer with greater multimorbidity, but there is a paucity of evidence examining frailty across birth cohorts and ages. METHODS We investigated frailty prevalence and its association with mortality at ages 75, 85, and 95 in the 1895-1945 birth cohorts in Sweden with data from population registries. Frailty was assessed with the Hospital Frailty Risk Score (HFRS). RESULTS We observed that frailty increased with increasing age and that it has become more common in more recent birth cohorts. At age 75, the percent frail in the Total Population Register increased from 1.1% to 4.6% from birth cohorts 1915-1945, corresponding to calendar years 1990-2020. At age 85, the percentage of frail increased from 3.5% to 11.5% from birth cohorts 1905-1935, and at age 95 from birth cohorts 1895-1925, from 4.7% to 18.7%. Our results show that the increase was primarily driven by an increase in the distribution of individuals with scores in the highest quartile of HFRS, while the bottom 3 quartiles remained relatively stable across birth cohorts. Women accounted for a greater distribution of the overall population and frail population, though these disparities decreased over time. Despite increasing levels of frailty, the relationship between frailty and mortality did not change over time, nor did it differ by sex. CONCLUSION Increased frailty with improved survival points to a chronic condition that could be intervened upon.
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Affiliation(s)
- Alexandra M Wennberg
- Address correspondence to: Alexandra M. Wennberg, PhD, Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77 Stockholm, Sweden. E-mail:
| | - Marcus Ebeling
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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10
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Sex differences in longevity are relative, not independent. Behav Brain Sci 2022; 45:e150. [PMID: 35875961 DOI: 10.1017/s0140525x22000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
I ask three questions related to the claims made within the staying alive theory (SAT): Is survival more fitness-enhancing for females than for males? Does the historical record on sex differences in mortality support the SAT? Is it possible to talk about "independent selective pressures on both male and female traits" when all we have are sex/gender comparisons?
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Li J, Hui X, Lu Z, Ren X, Yan W, Yan P, Yao L, Yang K. PROTOCOL: The association between marital transitions and physical and mental health in late life: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1252. [PMID: 36911347 PMCID: PMC9175064 DOI: 10.1002/cl2.1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: What is the association between marital transitions and physical health among people older than 60? What is the association between marital transitions and mental health among people older than 60? What is the role of gender, age, and education on the association between marital transitions and health among people older than 60? What is the influence of geographical region, housing, neighborhood, and social support on the association between marital transitions and health status among people older than 60?
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Affiliation(s)
- Jing Li
- School of Public Health, Evidence‐based Social Sciences Research Center, Health Technology Assessment CenterLanzhou UniversityLanzhouChina
| | - Xu Hui
- School of Public Health, Evidence‐based Social Sciences Research Center, Health Technology Assessment CenterLanzhou UniversityLanzhouChina
| | - Zhenxing Lu
- Institute of Medical ResearchNorthwestern Polytechnical UniversityXi'anChina
| | - Xiaocao Ren
- Clinical Medical CollegeLanzhou UniversityLanzhouChina
| | - Wenlong Yan
- Clinical Medical CollegeLanzhou UniversityLanzhouChina
| | - Peijing Yan
- School of Public Health, Evidence‐based Social Sciences Research Center, Health Technology Assessment CenterLanzhou UniversityLanzhouChina
| | - Liang Yao
- Department of Health Research Methodology, Evidence and ImpactMcMaster UniversityHamiltonCanada
| | - Kehu Yang
- School of Public Health, Evidence‐based Social Sciences Research Center, Health Technology Assessment CenterLanzhou UniversityLanzhouChina
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12
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Wu J, KC S, Luy M. The Gender Gap in Life Expectancy in Urban and Rural China, 2013–2018. Front Public Health 2022; 10:749238. [PMID: 35223719 PMCID: PMC8873095 DOI: 10.3389/fpubh.2022.749238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/03/2022] [Indexed: 12/28/2022] Open
Abstract
BackgroundGender differences in mortality are embedded within mortality transitions. Rural residents generally lag behind their urban counterparts in the transitions. The study objective is to identify major causes of death that drive gender differences in mortality in urban and rural China.MethodsWe use age-, gender-, urban-rural- and cause-specific mortality data (2013–2018) derived from the national mortality surveillance system that covered about 24% of the Chinese population. We apply Arriaga's method to decompose age- and cause-specific contributions to the gender gap in life expectancy at birth. Analyses are stratified by urban-rural residence.ResultsWomen had a higher life expectancy at birth than men in both urban and rural areas. Cancers, cardiovascular disease, external causes, and respiratory disease accounted for more than 90% of the gender gap in both areas during 2013–2018. In urban areas, the gender gap decreased from 5.17 years in 2013–2015 to 4.98 years in 2016–2018. In rural areas, the gender gap stayed rather constant (2013–2015: 5.68 years; 2016–2018: 5.65 years). Traffic accidents, among external causes, contributed the most to decreasing the gender gap (urban: −0.07 years; rural: −0.10 years), especially in the 0–44 age group. However, the decrease in the gender gap was counteracted by an increase in the gender gap attributable to ischemic heart disease (urban: +0.05 years; rural: +0.08 years) and lung cancer (urban: +0.02 years; rural: +0.05 years) in older age groups. The gender gap attributable either to cerebrovascular disease or to chronic lower respiratory disease decreased in urban areas but increased in rural areas.ConclusionsThe urban-rural variations in the cause-specific contributions to the gender gap in China suggest the necessity of implementing urban-rural-specific interventions to improve population health and health equity.
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Affiliation(s)
- Jinjing Wu
- Asian Demographic Research Institute, Shanghai University, Shanghai, China
| | - Samir KC
- Asian Demographic Research Institute, Shanghai University, Shanghai, China
- International Institute for Applied Systems Analysis (IIASA), Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Laxenburg, Austria
- *Correspondence: Samir KC
| | - Marc Luy
- Vienna Institute of Demography (OeAW), Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
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Fernandez OE, Beltrán-Sánchez H. Life span inequality as a function of the moments of the deaths distribution: Connections and insights. PLoS One 2022; 17:e0262869. [PMID: 35100280 PMCID: PMC8803175 DOI: 10.1371/journal.pone.0262869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
Recent work has unearthed many empirical regularities in mortality trends, including the inverse correlation between life expectancy and life span inequality, and the compression of mortality into older age ranges. These regularities have furnished important insights into the dynamics of mortality by describing, in demographic terms, how different attributes of the life table deaths distribution interrelate and change over time. However, though empirical evidence suggests that the demographically-meaningful metrics these regularities involve (e.g., life span disparity and life table entropy) are correlated to the moments of the deaths distribution (e.g., variance), the broader theoretical connections between life span inequality and the moments of the deaths distribution have yet to be elucidated. In this article we establish such connections and leverage them to furnish new insights into mortality dynamics. We prove theoretical results linking life span disparity and life table entropy to the central moments of the deaths distribution, and use these results to empirically link statistical measures of variation of the deaths distribution (e.g., variance, index of dispersion) to life span disparity and life table entropy. We validate these results via empirical analyses using data from the Human Mortality Database and extract from them several new insights into mortality shifting and compression in human populations.
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Affiliation(s)
- Oscar E Fernandez
- Department of Mathematics, Wellesley College, Wellesley, MA, United States of America
| | - Hiram Beltrán-Sánchez
- Department of Community Health Sciences, UCLA Fielding School of Public Health, and California Center for Population Research, Los Angeles, California, United States of America
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Gender differences in time to first hospital admission at age 60 in Denmark, 1995-2014. Eur J Ageing 2021; 18:443-451. [PMID: 34786008 PMCID: PMC8563932 DOI: 10.1007/s10433-021-00614-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 10/26/2022] Open
Abstract
Women have consistently lower mortality rates than men at all ages and with respect to most causes. However, gender differences regarding hospital admission rates are more mixed, varying across ages and causes. A number of intuitive metrics have previously been used to explore changes in hospital admissions over time, but have not explicitly quantified the gender gap or estimated the cumulative contribution from cause-specific admission rates. Using register data for the total Danish population between 1995 and 2014, we estimated the time to first hospital admission for Danish men and women aged 60. This is an intuitive population-level metric with the same interpretive and mathematical properties as period life expectancy. Using a decomposition approach, we were able to quantify the cumulative contributions from eight causes of hospital admission to the gender gap in time to first hospital admission. Between 1995 and 2014, time to first admission increased for both, men (7.6 to 9.4 years) and women (8.3 to 10.3 years). However, the magnitude of gender differences in time to first admission remained relatively stable within this time period (0.7 years in 1995, 0.9 years in 2014). After age 60, Danish men had consistently higher rates of admission for cardiovascular conditions and neoplasms, but lower rates of admission for injuries, musculoskeletal disorders, and sex-specific causes. Although admission rates for both genders have generally declined over the last decades, the same major causes of admission accounted for the gender gap. Persistent gender differences in causes of admission are, therefore, important to consider when planning the delivery of health care in times of population ageing. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-021-00614-w.
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15
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Reid N, Weerasekera S, Hubbard RE, Gordon EH. Frailty in ethnic minority women. Maturitas 2021; 152:26-31. [PMID: 34674805 DOI: 10.1016/j.maturitas.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
In majority populations in high- and middle-income countries, women live longer yet experience higher levels of frailty than men of the same age. It is unclear whether this 'sex-frailty paradox' is present in ethnic minority populations. In this narrative review, we explore biological, behavioural and social factors associated with mortality, morbidity and frailty in women, particularly ethnic minority women. We ascertain that natural menopause occurs earlier in women of particular ethnicities. Ethnic minority women (living in high-income countries) have more children and higher rates of chronic disease and disability, all of which are associated with frailty. In some ethnic minorities, women are less likely to engage in deleterious health behaviours such as smoking and alcohol consumption. However, in others the reverse is true. Women from migrant ethnic minorities tend to have lower levels of physical activity. With time, they can also adopt adverse behavioural patterns of the majority population. Although the evidence is sparse, sex differences in health reporting and social assets, as well as gender roles, are likely to contribute to sex differences in frailty in ethnic minorities. Overall, ethnic minority women are a particularly vulnerable group, but the majority of risk factors for frailty appear to be mutable rather than fixed. Future research may examine interventions that target frailty in different races and ethnicities at individual, population and global levels.
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Affiliation(s)
- Natasha Reid
- Faculty of Medicine, The University of Queensland, Queensland, Australia.
| | - Shavini Weerasekera
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia; School of Medicine, Griffith University, Queensland, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia
| | - Emily H Gordon
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia
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16
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Hossin MZ. The male disadvantage in life expectancy: can we close the gender gap? Int Health 2021; 13:482-484. [PMID: 33533409 PMCID: PMC7928849 DOI: 10.1093/inthealth/ihaa106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/07/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023] Open
Abstract
Men are usually considered to be the stronger sex. However, when it comes to health, they are evidently weaker than their female counterparts. In almost all countries around the world, men consistently live shorter lives than women. The gender gap in longevity has once again been evident during the ongoing coronavirus disease 2019 (COVID-19) pandemic, which kills men disproportionately. Drawing on the relevant scientific literature and updated information, this article aimed to provide useful insights into the biological and social mechanisms that potentially underlie the gender gap in life expectancy.
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Affiliation(s)
- Muhammad Zakir Hossin
- Department of Global Public Health, Karolinska Institute, SE-171 77, Stockholm, Sweden.,Department of General Education, Eastern University, Dhaka, Bangladesh
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17
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Baum F, Musolino C, Gesesew HA, Popay J. New Perspective on Why Women Live Longer Than Men: An Exploration of Power, Gender, Social Determinants, and Capitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E661. [PMID: 33466763 PMCID: PMC7829786 DOI: 10.3390/ijerph18020661] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/03/2021] [Accepted: 01/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women live longer than men, even though many of the recognised social determinants of health are worse for women than men. No existing explanations account fully for these differences in life expectancy, although they do highlight the complexity and interaction of biological, social and health service factors. METHODS this paper is an exploratory explanation of gendered life expectancy difference (GLED) using a novel combination of epidemiological and sociological methods. We present the global picture of GLED. We then utilise a secondary data comparative case analysis offering explanations for GLED in Australia and Ethiopia. We combine a social determinant of health lens with Bourdieu's concepts of capitals (economic, cultural, symbolic and social). RESULTS we confirmed continuing GLED in all countries ranging from less than a year to over 11 years. The Australian and Ethiopian cases demonstrated the complex factors underpinning this difference, highlighting similarities and differences in socioeconomic and cultural factors and how they are gendered within and between the countries. Bourdieu's capitals enabled us to partially explain GLED and to develop a conceptual model of causal pathways. CONCLUSION we demonstrate the value of combing a SDH and Bourdieu's capital lens to investigate GLED. We proposed a theoretical framework to guide future research.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society & Equity, Flinders University, Adelaide 5042, Australia;
| | - Connie Musolino
- Southgate Institute for Health, Society & Equity, Flinders University, Adelaide 5042, Australia;
| | - Hailay Abrha Gesesew
- College of Medicine and Public Health, Flinders University, Adelaide 5048, Australia;
- Epidemiology, School of Health Sciences, Mekelle University, Mekelle 231, Ethiopia
| | - Jennie Popay
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster LA1 4YW, UK;
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18
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Schacht R, Macfarlan SJ, Meeks H, Cervantes PL, Morales F. Male survival advantage on the Baja California peninsula. Biol Lett 2020; 16:20200600. [PMID: 33142089 PMCID: PMC7728671 DOI: 10.1098/rsbl.2020.0600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A consistent finding from contemporary Western societies is that women outlive men. However, what is unclear is whether sex differences in survival are constant across varying socio-ecological conditions. We test the universality of the female survival advantage with mortality data from a nineteenth century population in the Baja California peninsula of Mexico. When examined simply, we find evidence for a male-biased survival advantage. However, results from Cox regression clearly show the importance of age intervals for variable survival patterns by sex. Our key findings are that males: (i) experience significantly lower mortality risk than females during the ages 15-30 (RR = 0.69), (ii) are at a significantly increased risk of dying in the 61+ category (RR = 1.30) and (iii) do not experience significantly different mortality risk at any other age interval (0-14, 31-45, 46-60). We interpret our results to stem from differing intrinsic and extrinsic risk factors for sex-biased mortality across age intervals, highlighting the relevance of a lifecourse approach to the study of survival advantage. Ultimately, our results make clear the need to more broadly consider variability in mortality risk factors across time and place to allow for a clearer understanding of human survival differences.
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Affiliation(s)
- Ryan Schacht
- Department of Anthropology, East Carolina University, Greenville, NC, USA
| | - Shane J Macfarlan
- Department of , University of Utah, Salt Lake City, Utah, USA.,Center for Latin American Studies, University of Utah, Salt Lake City, Utah, USA.,Global Change and Sustainability Center, University of Utah, Salt Lake City, Utah, USA
| | - Huong Meeks
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Fernando Morales
- Eccles School of Business, University of Utah, Salt Lake City, Utah, USA
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19
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Arosio B, Guerini FR, Costa AS, Dicitore A, Ferri E, Mari D, Torresani E, Clerici M, Cesari M, Vitale G. Vitamin D Receptor Polymorphisms in Sex-Frailty Paradox. Nutrients 2020; 12:nu12092714. [PMID: 32899460 PMCID: PMC7551757 DOI: 10.3390/nu12092714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
The “male-female health-survival paradox” evidences that the survival advantage observed in women is linked to higher rates of disability and poor health status compared to men, a phenomenon also called the “sex-frailty paradox”. The depletion of vitamin D seems to play a role in the fragilization of old persons, and genetic polymorphisms of the vitamin D receptor (VDR) gene seem to be involved in regulating the vitamin D pathway. This study correlated the VDR gene polymorphisms (FokI, ApaI, BsmiI, and TaqI) with frailty, computed by frailty index (FI), in 202 persons (127 women and 75 men, aged from 60 to 116 years), aiming to capture the involvement of vitamin D in the sex-frailty paradox. The results showed slightly higher FI (p = 0.05), lower levels of 25(OH)D (p = 0.04), and higher levels of parathyroid hormone PTH (p = 0.002) and phosphorus (p < 0.001) in women than in men. Interestingly, the ApaI minor allele (Aa + aa) showed a significant positive association with FI (p = 0.03) and a negative association with inorganic phosphorus values (p = 0.04) compared to AA genotype only in women, regardless of age. The exact mechanism and the causal role that, in old women, links ApaI polymorphism with frailty are still unclear. However, we could speculate that a specific genetic profiling, other than 25(OH)D levels, play a role in the sex-frailty paradox.
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Affiliation(s)
- Beatrice Arosio
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.A.); (E.F.); (M.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
| | - Franca Rosa Guerini
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (A.S.C.); (M.C.)
- Correspondence: ; Tel.: +39-02-4030-8376; Fax: +39-02-4030-8438
| | - Andrea Saul Costa
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (A.S.C.); (M.C.)
| | - Alessandra Dicitore
- Laboratorio Sperimentale di Ricerche di Neuroendocrinologia Geriatrica ed Oncologica, Istituto Auxologico Italiano, IRCCS, 20095 Cusano Milanino, Italy; (A.D.); (D.M.)
| | - Evelyn Ferri
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.A.); (E.F.); (M.C.)
| | - Daniela Mari
- Laboratorio Sperimentale di Ricerche di Neuroendocrinologia Geriatrica ed Oncologica, Istituto Auxologico Italiano, IRCCS, 20095 Cusano Milanino, Italy; (A.D.); (D.M.)
| | - Erminio Torresani
- Laboratorio Analisi Cliniche Centro di Ricerche e Tecnologie Biomediche, Istituto Auxologico Italiano, IRCCS, 20095 Cusano Milanino, Italy;
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (A.S.C.); (M.C.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (B.A.); (E.F.); (M.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
| | - Giovanni Vitale
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Laboratorio Sperimentale di Ricerche di Neuroendocrinologia Geriatrica ed Oncologica, Istituto Auxologico Italiano, IRCCS, 20095 Cusano Milanino, Italy; (A.D.); (D.M.)
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20
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Shaw BA, Dahlberg L, Nilsen C, Agahi N. Trends in the Mortality Risk of Living Alone during Old Age in Sweden, 1992-2011. J Aging Health 2020; 32:1399-1408. [PMID: 32571127 DOI: 10.1177/0898264320930452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives: This study investigates the association between living alone and mortality over a recent 19-year period (1992-2011). Method: Data from a repeated cross-sectional, nationally representative (Sweden) study of adults ages 77 and older are analyzed in relation to 3-year mortality. Results: Findings suggest that the mortality risk associated with living alone during old age increased between 1992 and 2011 (p = .076). A small increase in the mean age of those living alone is partly responsible for the strengthening over time of this association. Throughout this time period, older adults living alone consistently reported poorer mobility and psychological health, less financial security, fewer social contacts, and more loneliness than older adults living with others. Discussion: Older adults living alone are more vulnerable than those living with others, and their mortality risk has increased. They may have unique service needs that should be considered in policies aiming to support aging in place.
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Affiliation(s)
- Benjamin A Shaw
- University at Albany (State University of New York), Rensselaer, NY, USA
| | - Lena Dahlberg
- Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Dalarna University, Falun, Sweden
| | - Charlotta Nilsen
- Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Neda Agahi
- Karolinska Institutet and Stockholm University, Stockholm, Sweden
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21
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Abstract
Evolutionary theories of senescence, such as the ‘disposable soma’ theory, propose that natural selection trades late survival for early fecundity. ‘Frailty’, a multidimensional measure of health status, may help to better define the long-term consequences of reproduction. We examined the relationship between parity and later life frailty (as measured by the Frailty Index) in a sample of 3,534 adults aged 65 years and older who participated in the English Longitudinal Study of Ageing. We found that the most parous adults were the most frail and that the parity-frailty relationship was similar for both sexes. Whilst this study provided some evidence for a ‘parity-frailty trade-off’, there was little support for our hypothesis that the physiological costs of childbearing influence later life frailty. Rather, behavioural and social factors associated with rearing many children may have contributed to the development of frailty in both sexes.
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22
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Chen H, Zhou Y, Sun L, Chen Y, Qu X, Chen H, Rajbhandari-Thapa J, Xiao S. Non-communicable diseases are key to further narrow gender gap in life expectancy in Shanghai, China. BMC Public Health 2020; 20:839. [PMID: 32493253 PMCID: PMC7268263 DOI: 10.1186/s12889-020-08932-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background To address change in the gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change over time. Methods The temporal trend in GGLE was evaluated using retrospective demographic analysis with Joinpoint regression. Causes of death were coded in accordance with the International Classification of Diseases and mapped with the Global Burden of Disease (GBD) cause list. The life table technique and decomposition method were used to express changes in GGLE. Results The trend of GGLE in Shanghai experienced two phases, i.e., a decrease from 8.4 to 4.2 years in the descent phase (1973–1999) and a fluctuation between 4.0 and 4.9 years in the plateau phase (1999–2018). The reduced age-specific mortality rates tended to concentrate to a narrower age range, from age 0–9 and above 30 years in the descent phase to age above 55 years in the plateau phase. Gastroesophageal and liver cancer, communicable, chronic respiratory, and digestive diseases were once the major contributors to narrow GGLE in the descent phase. While, importance should be attached to a widening effect on GGLE by lung cancer, cardiovascular diseases, other neoplasms like colorectal and pancreatic cancer, and diabetes in the recent plateau phase. Conclusions Non-communicable diseases (NCDs) have made GGLE enter a plateau phase from a descent phase in Shanghai, China. Public efforts to reduce excess mortalities for male NCDs, cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes in particular and health policies focused on the middle-aged and elderly population might further narrow GGLE. This will also ensure improvements in health and health equity in Shanghai China.
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Affiliation(s)
- Hanyi Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Yi Zhou
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Lianghong Sun
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Yichen Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Xiaobin Qu
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Hua Chen
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China.,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | | | - Shaotan Xiao
- Department of Science Research and Information Management, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, 200136, China. .,Fudan University Pudong Institute of Preventive Medicine, Shanghai, China.
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23
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Kalseth J, Halvorsen T. Health and care service utilisation and cost over the life-span: a descriptive analysis of population data. BMC Health Serv Res 2020; 20:435. [PMID: 32429985 PMCID: PMC7236310 DOI: 10.1186/s12913-020-05295-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Current demographic changes affect both the level and composition of health and care needs in the population. The aim of this study was to estimate utilisation and cost for a comprehensive range of health and care services by age and gender to provide an in-depth picture of the life-span pattern of service needs and related costs. METHODS Data on service use in 2010 for the entire population in Norway were collected from four high-quality national registers. Cost for different services were calculated combining data on service utilisation from the registries and estimates of unit cost. Data on cost and users were aggregated within four healthcare services and seven long-term care services subtypes. Per capita cost by age and gender was decomposed into user rates and cost per user for each of the eleven services. RESULTS Half of the population is under 40 years of age, but only a quarter of the health and care cost is used on this age group. The age-group of 65 or older, on the other hand, represent only 15% of the population, but is responsible for almost half of the total cost. Healthcare cost dominates in ages under 80 and mental health services dominates in adolescents and young adults. Use of other healthcare services are high in middle aged and elderly but decreases for the oldest old. Use of care services and in particular institutional care increases in old age. Healthcare cost per user follows roughly the same age pattern as user rates, whereas user cost for care services typically are either relatively stable or decrease with age among adults. Gender differences in the age pattern of health and care costs are also revealed and discussed. CONCLUSION The type of services used, and the related cost, show a clear life-span as well as gender pattern. Hence, population aging and narrowing gender-gap in longivety calls for high policy awarness on changing health and care needs. Our study also underscores the need for an attentive and pro-active stance towards the high service prevalence and high cost of mental health care in our upcoming generations.
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Affiliation(s)
- Jorid Kalseth
- Department of Health Research, SINTEF Digital, P.O. Box 4760, Sluppen, NO-7465 Trondheim, Norway
| | - Thomas Halvorsen
- Department of Health Research, SINTEF Digital, P.O. Box 4760, Sluppen, NO-7465 Trondheim, Norway
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24
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An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities. J Nurs Meas 2020; 28:73-94. [PMID: 32295856 DOI: 10.1891/jnm-d-18-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The Health Risk Screening Tool (HRST) is a 22-item instrument specifically designed to assess the health risk of persons with developmental disabilities. The predictive validity of the HRST was investigated by examining its ability to predict mortality. METHODS The sample consisted of 12,582 people with an intellectual or developmental disability residing in Georgia (U.S.). Data were analyzed using survival analysis (Kaplan-Meier estimate and Cox regression) and a binary logistic regression. RESULTS All models supported the prognostic value of the six-level health risk classification. The Kaplan-Meier procedure showed clear separation among functions. The Cox proportional hazard regression revealed that hazard is inversely related to the health risk level, even after controlling for potential confounding by gender, ethnicity, and race. CONCLUSIONS The HRST can predict mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity.
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25
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Wensink M, Alvarez JA, Rizzi S, Janssen F, Lindahl-Jacobsen R. Progression of the smoking epidemic in high-income regions and its effects on male-female survival differences: a cohort-by-age analysis of 17 countries. BMC Public Health 2020; 20:39. [PMID: 31924192 PMCID: PMC6954612 DOI: 10.1186/s12889-020-8148-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Of all lifestyle behaviours, smoking caused the most deaths in the last century. Because of the time lag between the act of smoking and dying from smoking, and because males generally take up smoking before females do, male and female smoking epidemiology often follows a typical double wave pattern dubbed the 'smoking epidemic'. How are male and female deaths from this epidemic differentially progressing in high-income regions on a cohort-by-age basis? How have they affected male-female survival differences? METHODS We used data for the period 1950-2015 from the WHO Mortality Database and the Human Mortality Database on three geographic regions that have progressed most into the smoking epidemic: high-income North America, high-income Europe and high-income Oceania. We examined changes in smoking-attributable mortality fractions as estimated by the Preston-Glei-Wilmoth method by age (ages 50-85) across birth cohorts 1870-1965. We used these to trace sex differences with and without smoking-attributable mortality in period life expectancy between ages 50 and 85. RESULTS In all three high-income regions, smoking explained up to 50% of sex differences in period life expectancy between ages 50 and 85 over the study period. These sex differences have declined since at least 1980, driven by smoking-attributable mortality, which tended to decline in males and increase in females overall. Thus, there was a convergence between sexes across recent cohorts. While smoking-attributable mortality was still increasing for older female cohorts, it was declining for females in the more recent cohorts in the US and Europe, as well as for males in all three regions. CONCLUSIONS The smoking epidemic contributed substantially to the male-female survival gap and to the recent narrowing of that gap in high-income North America, high-income Europe and high-income Oceania. The precipitous decline in smoking-attributable mortality in recent cohorts bodes somewhat hopeful. Yet, smoking-attributable mortality remains high, and therefore cause for concern.
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Affiliation(s)
- Maarten Wensink
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark.
- Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Jesús-Adrián Alvarez
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Silvia Rizzi
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Fanny Janssen
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands
| | - Rune Lindahl-Jacobsen
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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26
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Abstract
Frailty describes an individual's vulnerability to adverse health outcomes and is a useful construct that assists health professionals to understand the heterogeneity of the ageing population. While the pathophysiological pathways that lead to frailty are not well defined, an individual's sex appears to be a key factor influencing the ageing trajectory. Compared with age-matched men, women tend to have poorer health status (ie, they are more frail) but longer life expectancy (ie, they are more resilient). It seems likely that a combination of biological, behavioural and social factors underpin this male-female health-survival paradox. Randomised controlled trial data for frailty interventions in older adults are emerging, with multicomponent programs incorporating exercise and nutrition-based strategies showing promise. Pharmaceutical and other innovative therapeutic strategies for frailty are highly anticipated. Sex differences in the effectiveness of frailty interventions have not been addressed in the research literature to date. In the future, successful interventions may target many (if not all) biopsychosocial domains, with careful consideration of issues relevant to each sex.
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Affiliation(s)
- Emily H Gordon
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Ruth E Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
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27
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Jiao K, Liu M, Xu M. Age and cohort trajectories of gender inequality in health among elderly people in China. J Women Aging 2019; 33:247-267. [PMID: 31800377 DOI: 10.1080/08952841.2019.1686325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using a multistate model, this article examines gender gap and its trend in health transition, life expectancy (LE), and active life expectancy (ALE) in different age groups and birth cohorts. The transition rate from life independence/disability to death for elderly women is lower than for elderly men. However, their disability rate is higher. The gender gap in LE, ALE, and DLE (disabled life expectancy) declines as age increases. In successive birth cohorts, men's LE increases more, and gender gaps in LE and ALE decrease over time. In the future, gender issues should be considered for health-care policy to provide nursing care for elderly women in China.
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Affiliation(s)
- Kaishan Jiao
- Department of Sociology, Minzu University of China, Beijing, China
| | - Meng Liu
- School of Law and Politics, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Mengjia Xu
- Department of Economics, Claremont Graduate University, Claremont, California, USA
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28
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Yokota RTC, Nusselder WJ, Robine JM, Tafforeau J, Renard F, Deboosere P, Van Oyen H. Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008. Eur J Public Health 2019; 29:82-87. [PMID: 29917065 DOI: 10.1093/eurpub/cky105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We aimed to investigate the contribution of chronic conditions to gender differences in disability-free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008. Methods Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED. Results Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross-sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic respiratory diseases. Conclusion To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.
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Affiliation(s)
- Renata T C Yokota
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Jean-Marie Robine
- Mécanismes moléculaires dans les démences neurodégénératives, French Institute of Health and Medical Research (INSERM), Montpellier, France.,Centre de recherche médecine, sciences, santé, santé mentale, société (Cermes3), École Pratique des Hautes Études, Paris, France
| | - Jean Tafforeau
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Françoise Renard
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Van Oyen
- Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
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High mortality following distal femur fractures: a cohort study including three hundred and two distal femur fractures. INTERNATIONAL ORTHOPAEDICS 2019; 44:173-177. [DOI: 10.1007/s00264-019-04343-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/01/2019] [Indexed: 02/07/2023]
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Gordon EH, Hubbard RE. Do sex differences in chronic disease underpin the sex-frailty paradox? Mech Ageing Dev 2019; 179:44-50. [PMID: 30825457 DOI: 10.1016/j.mad.2019.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 12/21/2022]
Abstract
The 'male-female health-survival paradox' is a well-described clinical phenomenon. More recently, it has been conceptualized as a 'sex-frailty paradox': females may be considered to be more frail (because they have poorer health status) but also less frail (because they are less vulnerable to death) than males of the same age. Here, we review potential biological, behavioral and social mechanisms underpinning sex differences in morbidity, mortality and frailty before considering the question at the center of the sex paradox - why is it that females are able to tolerate poor health better than males? We explore, in detail, a frequently cited explanation for the sex paradox that centers on sex differences in chronic disease and conclude by presenting a new approach to this old hypothesis.
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Affiliation(s)
- E H Gordon
- Centre for Health Services Research, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - R E Hubbard
- Centre for Health Services Research, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
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Bergeron-Boucher MP, Canudas-Romo V, Pascariu M, Lindahl-Jacobsen R. Modeling and forecasting sex differences in mortality: a sex-ratio approach. GENUS 2018; 74:20. [PMID: 30595608 PMCID: PMC6280850 DOI: 10.1186/s41118-018-0044-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
Female and male life expectancies have converged in most industrialized societies in recent decades. To achieve coherent forecasts between females and males, this convergence needs to be considered when forecasting sex-specific mortality. We introduce a model forecasting a matrix of the age-specific death rates of sex ratio, decomposed into two age profiles and time indices-before and after age 45-using principal component analysis. Our model allows visualization of both age structure and general level over time of sex differences in mortality for these two age groups. Based on a prior forecast for females, we successfully forecast male mortality convergence with female mortality. The usefulness of the developed model is illustrated by its comparison with other coherent and independent models in an out-of-sample forecast evaluation for 18 countries. The results show that the new proposal outperformed the other models for most countries.
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Affiliation(s)
| | | | - Marius Pascariu
- 1Center on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- 1Center on Population Dynamics, University of Southern Denmark, Odense, Denmark.,Department of Epidemiology and Biostatistics, University of Southern Denmark, Institute of Public Health, Odense, Denmark
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Sundberg L, Agahi N, Fritzell J, Fors S. Why is the gender gap in life expectancy decreasing? The impact of age- and cause-specific mortality in Sweden 1997-2014. Int J Public Health 2018; 63:673-681. [PMID: 29654335 PMCID: PMC6015620 DOI: 10.1007/s00038-018-1097-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To enhance the understanding of the current increase in life expectancy and decreasing gender gap in life expectancy. METHODS We obtained data on underlying cause of death from the National Board of Health and Welfare in Sweden for 1997 and 2014 and used Arriaga's method to decompose life expectancy by age group and 24 causes of death. RESULTS Decreased mortality from ischemic heart disease had the largest impact on the increased life expectancy of both men and women and on the decreased gender gap in life expectancy. Increased mortality from Alzheimer's disease negatively influenced overall life expectancy, but because of higher female mortality, it also served to decrease the gender gap in life expectancy. The impact of other causes of death, particularly smoking-related causes, decreased in men but increased in women, also reducing the gap in life expectancy. CONCLUSIONS This study shows that a focus on overall changes in life expectancies may hide important differences in age- and cause-specific mortality. It also emphasizes the importance of addressing modifiable lifestyle factors to reduce avoidable mortality.
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Affiliation(s)
- Louise Sundberg
- Aging Research Center, Karolinska Institute and Stockholm University, Gävlegatan 16, 13330, Stockholm, Sweden.
| | - Neda Agahi
- Aging Research Center, Karolinska Institute and Stockholm University, Gävlegatan 16, 13330, Stockholm, Sweden
| | - Johan Fritzell
- Aging Research Center, Karolinska Institute and Stockholm University, Gävlegatan 16, 13330, Stockholm, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institute and Stockholm University, Gävlegatan 16, 13330, Stockholm, Sweden
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33
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Jørgensen TSH, Fors S, Nilsson CJ, Enroth L, Aaltonen M, Sundberg L, Brønnum-Hansen H, Strand BH, Chang M, Jylhä M. Ageing populations in the Nordic countries: Mortality and longevity from 1990 to 2014. Scand J Public Health 2018; 47:611-617. [PMID: 29886814 DOI: 10.1177/1403494818780024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: Cross-country comparisons of mortality and longevity patterns of Nordic populations could contribute with novel insights into the compositional changes of these populations. We investigated three metrics of population ageing: the proportion of the population aged 75+ and 90+ years, the proportion of birth cohorts reaching 75 and 90 years, and life expectancy (LE) at age 75 and 90 years in Sweden, Norway, Iceland, Denmark and Finland, in the period 1990-2014. Methods: Demographic information was collected from national statistical databases and the Human Mortality Database. Results: All metrics on population ageing increased during the study period, but there were some cross-country variations. Finland experienced a notably steep increase in the proportion of 75+ and 90+ year olds compared to the other countries. Regarding the proportion reaching old ages, the Finnish lagged behind from the beginning, but females decreased this difference. The Danes were more similar to the other countries at the beginning, but did not experience the same increase over time. Gender-specific LE at age 75 and 90 years was similar overall in the five countries. Conclusions: Developments in cross-country variation suggest that survival until old age has become more similar for Finnish females and more different for Danish males and females compared with the other countries in recent decades. This provides perspectives on the potential to improve longevity in Denmark and Finland. Similarities in LE in old age suggest that expected mortality in old age has been more similar throughout the study period.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen K, Denmark
| | - Stefan Fors
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Charlotte Juul Nilsson
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen K, Denmark
| | - Linda Enroth
- Faculty of Social Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland.,Institute for Advanced Social Research, University of Tampere, Finland
| | - Louise Sundberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Henrik Brønnum-Hansen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Bjørn Heine Strand
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health Oslo, Norway
| | - Milan Chang
- The Icelandic Gerontological Research Center, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland.,Faculty of Health Promotion, Sport and Leisure Studies University of Iceland, Reykjavík, Iceland
| | - Marja Jylhä
- Faculty of Social Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
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Abstract
Women live longer than men in nearly all populations today. Some research focuses on the biological origins of the female advantage; other research stresses the significance of social factors. We studied male–female survival differences in populations of slaves and populations exposed to severe famines and epidemics. We find that even when mortality was very high, women lived longer on average than men. Most of the female advantage was due to differences in mortality among infants: baby girls were able to survive harsh conditions better than baby boys. These results support the view that the female survival advantage is modulated by a complex interaction of biological environmental and social factors. Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors.
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Shaw BA, Fors S, Fritzell J, Lennartsoon C, Agahi N. Who Lives Alone During Old Age? Trends in the Social and Functional Disadvantages of Sweden's Solitary Living Older Adults. Res Aging 2017; 40:815-838. [PMID: 29241401 DOI: 10.1177/0164027517747120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study identifies specific social and functional disadvantages associated with living alone during old age in Sweden and assesses whether these associations have changed during recent decades. Data came from repeated cross-sectional surveys of Swedish adults aged 77+ during 1992-2014. Findings indicate that several types of disadvantage are consistently associated with the probability of living alone including financial insecurity and having never married for women and having never married and mobility impairment for men. Also for older men, low education has become an increasing strong determinant of living alone. These findings suggest that older adults who live alone are a subgroup that is particularly, and in some cases increasingly, vulnerable with respect to social and functional status. This has important policy implications related to addressing the needs of this growing subgroup as well as methodological implications for studies on the health effects of living alone.
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Affiliation(s)
- Benjamin A Shaw
- 1 Department of Health Policy, Management, and Behavior, Center for Social and Demographic Analysis, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Stefan Fors
- 2 Aging Research Center, Karolinska Institutet, Solna, Sweden
- 3 Aging Research Center, Stockholm University, Stockholm, Sweden
| | - Johan Fritzell
- 2 Aging Research Center, Karolinska Institutet, Solna, Sweden
- 3 Aging Research Center, Stockholm University, Stockholm, Sweden
| | - Carin Lennartsoon
- 2 Aging Research Center, Karolinska Institutet, Solna, Sweden
- 3 Aging Research Center, Stockholm University, Stockholm, Sweden
| | - Neda Agahi
- 2 Aging Research Center, Karolinska Institutet, Solna, Sweden
- 3 Aging Research Center, Stockholm University, Stockholm, Sweden
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García González JM, Grande R. [The changing sex differences in life expectancy in Spain (1980-2012): decomposition by age and cause]. GACETA SANITARIA 2017; 32:151-157. [PMID: 28529096 DOI: 10.1016/j.gaceta.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To calculate and analyse the contributions of changes in mortality by age groups and selected causes of death to sex differences in life expectancy at birth in Spain from 1980 to 2012. METHODS Cross-sectional study with three time points (1980, 1995, and 2012). We used data from Human Cause-of-Death Database and Human Mortality Database. We use a decomposition method of the differences in life expectancy and gender differences in life expectancy from changes in mortality by 5-year age groups and causes of death between women and men. RESULTS From 1980 to 1995, the lower mortality of women from 25 years old, and the differences in mortality by HIV/AIDS, lung cancer, and chronic obstructive pulmonary diseases contributed to the gap increase. From 1995 to 2012, greatest improvement in mortality of males under 74 years of age, and in improving male mortality from HIV/AIDS, acute myocardial infarction and traffic accidents contributed to the narrowing. CONCLUSIONS The difference in life expectancy at birth between men and women has decreased since 1995 due to a greater improvement in mortality from causes of death associated with risky behaviours and habits of the working age male population.
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Affiliation(s)
| | - Rafael Grande
- Departamento de Derecho del Estado y Sociología, Universidad de Málaga, Málaga, España
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Lagergren M, Johnell K, Schön P, Danielsson M. Towards a postponement of activities of daily living dependence and mobility limitations: Trends in healthy life years in old age in Sweden. Scand J Public Health 2017; 45:520-527. [PMID: 28381119 DOI: 10.1177/1403494817698287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980-2011 using the health indicators activities of daily living (ADL) and mobility limitations within the framework of the postponement, compression and expansion theories. METHODS Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Surveys of Living Conditions, conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE and a decomposition into mortality and disability effects was made. RESULTS Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980-1985 to 2006-2011. HLE65 calculated according to ADL and mobility limitations increased more rapidly than LE65 for both men and women ( p<0.05). CONCLUSIONS Our results for trends in the Swedish LE65 and HLE65, computed on the basis of ADL and mobility limitations and using the Swedish Surveys of Living Conditions study, are in line with the postponement hypothesis and there is also a tendency for compression. Thus the years with ADL dependence and mobility limitations are postponed to a higher age and the numbers of these years have decreased.
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Affiliation(s)
| | - Kristina Johnell
- 2 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.,3 Stockholm University, Stockholm Gerontology Research Center, Sweden
| | - Pär Schön
- 1 Stockholm Gerontology Research Center, Sweden
| | - Maria Danielsson
- 4 Center for Psychiatry Research, Karolinska Institutet, Sweden.,5 Stockholm County Council, Sweden
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Sundberg L, Agahi N, Fritzell J, Fors S. Trends in health expectancies among the oldest old in Sweden, 1992-2011. Eur J Public Health 2016; 26:1069-1074. [PMID: 27175003 DOI: 10.1093/eurpub/ckw066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Information on the extent to which older people's increasing life expectancy is characterized by good or poor health is important for policy and fiscal planning. This study explores trends in health expectancies among the oldest old in Sweden from 1992 to 2011. METHODS Cross-sectional health expectancy estimates at age 77 were obtained for 1992, 2002, 2004 and 2011 by Sullivan's method. Health expectancy was assessed by severe disability, mild disability and mobility problems. Changes in health expectancies were decomposed into the contributions attributed to changes of mortality rates, and changes in disability and mobility prevalence. Mortality data were obtained from Statistics Sweden and prevalence data from two nationally representative surveys, the Swedish Panel Study of Living Conditions of the Oldest Old and the Survey of Health, Ageing and Retirement in Europe. RESULTS Years free from severe disability, mild disability and mobility problems increased in both men and women. Decomposition analysis indicates that the increase was mainly driven by the change in health status rather than change in mortality. In relation to total life expectancy, the general patterns suggest that women had a compression of health problems and men an expansion. CONCLUSION Men's life expectancy increased more than women's; however, the increased life expectancy among men was mainly characterized by disability and mobility problems. The results suggest that the gender gap in health expectancy is decreasing.
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Affiliation(s)
- Louise Sundberg
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Johan Fritzell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Phillips SP, Hamberg K. Doubly blind: a systematic review of gender in randomised controlled trials. Glob Health Action 2016; 9:29597. [PMID: 27087576 PMCID: PMC4834361 DOI: 10.3402/gha.v9.29597] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/25/2016] [Accepted: 02/21/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although observational data show social characteristics such as gender or socio-economic status to be strong predictors of health, their impact is seldom investigated in randomised controlled studies (RCTs). OBJECTIVE & DESIGN Using a random sample of recent RCTs from high-impact journals, we examined how the most often recorded social characteristic, sex/gender, is considered in design, analysis, and interpretation. Of 712 RCTs published from September 2008 to 31 December 2013 in the Annals of Internal Medicine, British Medical Journal, Lancet, Canadian Medical Association Journal, or New England Journal of Medicine, we randomly selected 57 to analyse funding, methods, number of centres, documentation of social circumstances, inclusion/exclusion criteria, proportions of women/men, and reporting about sex/gender in analyses and discussion. RESULTS Participants' sex was recorded in most studies (52/57). Thirty-nine percent included men and women approximately equally. Overrepresentation of men in 43% of studies without explicit exclusions for women suggested interference in selection processes. The minority of studies that did analyse sex/gender differences (22%) did not discuss or reflect upon these, or dismissed significant findings. Two studies reinforced traditional beliefs about women's roles, finding no impact of breastfeeding on infant health but nevertheless reporting possible benefits. Questionable methods such as changing protocols mid-study, having undefined exclusion criteria, allowing local researchers to remove participants from studies, and suggesting possible benefit where none was found were evident, particularly in industry-funded research. CONCLUSIONS Social characteristics like sex/gender remain hidden from analyses and interpretation in RCTs, with loss of information and embedding of error all along the path from design to interpretation, and therefore, to uptake in clinical practice. Our results suggest that to broaden external validity, in particular, more refined trial designs and analyses that account for sex/gender and other social characteristics are needed.
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Affiliation(s)
- Susan P Phillips
- Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, Canada
- Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden;
| | - Katarina Hamberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
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Lagergren M, Johnell K, Schön P, Danielsson M. Healthy life years in old age: Swedish development 1980–2010 according to different health indicators. Scand J Public Health 2015; 44:55-61. [DOI: 10.1177/1403494815605195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
Abstract
Aims: To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980 and 2010 by using two different health indicators: self-rated health and the global activity limitation indicator (GALI). Methods: Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Survey of Living Conditions (SSLC), which have been conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE. A decomposition into mortality and disability effect has been made in accordance with the method devised by Nusselder. Results: Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980/85 to 2006/11. Regardless of which health measure investigated – self-rated health or GALI – HLE65 increased between the periods 1980/85 to 2006/2011 more rapidly than LE65 and as a consequence the years with bad self-rated health and years with activity limitations decreased. These increases as well as the decreases were significant ( p<0.05). Conclusions: The Swedish LE65 and HLE65 development, as judged by the SSLC study, are compatible with the postponement hypothesis and there is even a clear tendency for compression. Thus, the years with bad self-rated health and years with activity limitations are postponed to a higher age and the number of those years have decreased. From this respect, the Swedish development looks positive. The need of old age care in 2010 would have been much higher if it had been expansion – not postponement – of bad self-rated health and years with activity limitations during the time period.
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Affiliation(s)
| | - Kristina Johnell
- Stockholm Gerontology Research Centre, Sweden
- Aging Research Centre, Karolinska Institute and Stockholm University, Stockholm Gerontology Research Centre, Sweden
| | - Pär Schön
- Stockholm Gerontology Research Centre, Sweden
- Aging Research Centre, Karolinska Institute and Stockholm University, Stockholm Gerontology Research Centre, Sweden
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Abstract
Using historical data from 1,763 birth cohorts from 1800 to 1935 in 13 developed countries, we show that what is now seen as normal-a large excess of female life expectancy in adulthood-is a demographic phenomenon that emerged among people born in the late 1800s. We show that excess adult male mortality is clearly rooted in specific age groups, 50-70, and that the sex asymmetry emerged in cohorts born after 1880 when male:female mortality ratios increased by as much as 50% from a baseline of about 1.1. Heart disease is the main condition associated with increased excess male mortality for those born after 1900. We further show that smoking-attributable deaths account for about 30% of excess male mortality at ages 50-70 for cohorts born in 1900-1935. However, after accounting for smoking, substantial excess male mortality at ages 50-70 remained, particularly from cardiovascular disease. The greater male vulnerability to cardiovascular conditions emerged with the reduction in infectious mortality and changes in health-related behaviors.
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Kautzky-Willer A. Gendermedizin. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:1022-30. [DOI: 10.1007/s00103-014-2011-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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