Increasing life expectancy in Germany: quantitative contributions from changes in age- and disease-specific mortality

Forecasting the mortality burden of coronary heart disease and stroke in Germany: National trends and regional inequalities

BACKGROUND

The decline of cardiovascular disease (CVD) mortality has slowed in many countries, including Germany. We examined the implications of this trend for future coronary heart disease (CHD) and stroke mortality in Germany considering persistent mortality inequalities between former East and West Germany.

METHODS

We retrieved demographic and mortality data from 1991 to 2019 from the German Federal Statistical Office. Using a Bayesian age-period-cohort framework, we projected CHD and stroke mortality from 2019 to 2035, stratified by sex and German region. We decomposed annual changes in deaths into three components (mortality rates, population age structure and population size) and assessed regional inequalities with age-sex-standardized mortality ratios.

RESULTS

We confirmed that declines of CVD mortality rates in Germany will likely stagnate. From 2019 to 2035, we projected fewer annual CHD deaths (114,600 to 103,500 [95%-credible interval: 81,700; 134,000]) and an increase in stroke deaths (51,300 to 53,700 [41,400; 72,000]). Decomposing past and projected mortality, we showed that population ageing was and is offset by declining mortality rates. This likely reverses after 2030 leading to increased CVD deaths thereafter. Inequalities between East and West declined substantially since 1991 and are projected to stabilize for CHD but narrow for stroke.

CONCLUSIONS

CVD deaths in Germany likely keep declining until 2030, but may increase thereafter due to population ageing if the reduction in mortality rates slows further. East-West mortality inequalities for CHD remain stable but may converge for stroke. Underlying risk factor trends need to be monitored and addressed by public health policy.

The temporal trend of cause-specific mortality: comparing Estonia and Lithuania, 2001 - 2019

BACKGROUND

Despite being two Baltic countries with similar histories, Estonia and Lithuania have diverged in life expectancy trends in recent years. We investigated this divergence by comparing cause-specific mortality trends.

METHODS

We obtained yearly mortality data for individuals 20 + years of age from 2001-2019 (19 years worth of data) through Statistics Lithuania, the Lithuanian Institute for Hygiene, and the National Institute for Health Development (Estonia). Using ICD-10 codes, we analyzed all-cause mortality rates and created eight major disease categories: ischemic heart disease, cerebrovascular disease, all other cardiovascular disease, cancers (neoplasms), digestive diseases, self-harm and interpersonal violence, unintentional injuries and related conditions, and other mortality (deaths per 100,000 population). We used joinpoint regression analysis, and analyzed the proportional contribution of each category to all-cause mortality.

RESULTS

There was a steeper decline in all-cause mortality in Estonia (average annual percent change, AAPC = -2.55%, 95% CI: [-2.91%, -2.20%], P < .001) as compared to Lithuania (AAPC = -1.26%, 95% CI: [-2.18%, -0.57%], P = .001). For ischemic heart disease mortality Estonia exhibited a relatively larger decline over the 19-year period (AAPC = -6.61%, 95% CI: [-7.02%, -6.21%], P < .001) as compared to Lithuania (AAPC = -2.23%, 95% CI: [-3.40%, -1.04%], P < .001).

CONCLUSION

Estonia and Lithuania showed distinct mortality trends and distributions of major disease categories. Our findings highlight the role of ischemic heart disease mortality. Differences in public health care, management and prevention of ischemic heart disease, alcohol control policies may explain these differences.

On assessing excess mortality in Germany during the COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) is associated with a very high number of casualties in the general population. Assessing the exact magnitude of this number is a non-trivial problem, as relying only on officially reported COVID-19 associated fatalities runs the risk of incurring in several kinds of biases. One of the ways to approach the issue is to compare overall mortality during the pandemic with expected mortality computed using the observed mortality figures of previous years. In this paper, we build on existing methodology and propose two ways to compute expected as well as excess mortality, namely at the weekly and at the yearly level. Particular focus is put on the role of age, which plays a central part in both COVID-19-associated and overall mortality. We illustrate our methods by making use of age-stratified mortality data from the years 2016 to 2020 in Germany to compute age group-specific excess mortality during the COVID-19 pandemic in 2020.

Decreasing Non-bladder-cancer Mortality After Radical Cystectomy

Life expectancy is increasing in many parts of the world. Using proportional hazard models for competing risks, we investigated whether this increase has changed outcomes after radical cystectomy in a sample of 1419 consecutive patients treated between 1993 and 2018. During the observation period, the mean age and the proportion of patients with American Society of Anesthesiologists physical status class 3 or 4 increased, whereas the proportion of patients with heart disease decreased. Competing mortality (causes other than bladder cancer) decreased in all subgroups (hazard ratios [HRs] per year ranged from 0.931 to 0.963) and after controlling for increasing age (HRs ranged from 1.018 to 1.081). In an optimal model resulting from an analysis including age (HR per year 1.048, 95% confidence interval [CI] 1.027–1.070; p < 0.0001), comorbidity, tumor-related variables, body mass index, (neoadjuvant and adjuvant) chemotherapy and smoking status, the HR per increment for year of surgery was 0.928 (95% CI 0.886–0.973; p = 0.0019). The effect of year of surgery was greater than the decrease in competing mortality that may be expected with increasing life expectancy (4 yr for females, 6 yr for males).

Patient summary

In a review of data for 1993–2018, we found that death from other causes after removal of the bladder (radical cystectomy) for bladder cancer decreased over time. This decreasing trend might increase the age limit at which bladder cancer patients can benefit from radical cystectomy in the future.

Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a multi-institutional comparative study

Background

The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions.

Methods

A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at (P < 0.05). All reported P values are two-sided.

Results

A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time (P < .0001), catheterization period (P < .001), hospital stay (P < .0001), and overall complications rate (P = .023).

Conclusions

The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.

Cardiovascular disease trends in Nepal - An analysis of global burden of disease data 2017

Cardiovascular diseases (CVDs) are the leading cause of disease burden globally, disproportionately affecting low and middle-income countries. The continued scarcity of literature on CVDs burden in Nepal has thwarted efforts to develop population-specific prevention and management strategies. This article reports the burden of CVDs in Nepal including, prevalence, incidence, and disability basis as well as trends over the past two decades by age and gender. We used the Institute of Health Metrics and Evaluation's Global Burden of Diseases database on cardiovascular disease from Nepal to describe the most recent data available (2017) and trends by age, gender and year from 1990 to 2017. Data are presented as percentages or as rates per 100,000 population. In 2017, CVDs contributed to 26·9% of total deaths and 12·8% of total DALYs in Nepal. Ischemic heart disease was the predominant CVDs, contributing 16·4% to total deaths and 7·5% to total DALYs. Cardiovascular disease incidence and mortality rates have increased from 1990 to 2017, with the burden greater among males and among older age groups. The leading risk factors for CVDs were determined to be high systolic blood pressure, high low density lipoprotein cholesterol, smoking, air pollution, a diet low in whole grains, and a diet low in fruit. CVDs are a major public health problem in Nepal contributing to the high DALYs with unacceptable numbers of premature deaths. There is an urgent need to address the increasing burden of CVDs and their associated risk factors, particularly high blood pressure, body mass index and unhealthy diet.

Patterns and changes in life expectancy in China, 1990-2016

Objective

To achieve the goal of “healthy China 2030”, reasonable health policies must be developed based on the changes of death spectrum. We aim to investigate the temporal patterns of life expectancy (LE) and age/cause-specific contributions from 1990 to 2016.

Methods

Joinpoint regression model was used with Arriaga’s decomposition method.

Results

LE in China has reached to 76.3 years in 2016 with an increase of 9.44 years from 1990. From 1990 to 2002, a remarkable reduction in infant mortality accounted for an increase of 1.27 years (35.39%) to LE which mainly resulted from diarrhea, lower respiratory, and other common infectious diseases (1.00 years, 27.79%). After 2002, those aged 65+ years contributed most to increased LE and the most prominent causes included cardiovascular diseases (0.67 years, 23.36%), chronic respiratory diseases (0.54 years, 18.76%) and neoplasms (0.39 years, 13.44%). Moreover, the effects of transport injuries changed from negative to positive. After 2007, contributions of transport and unintentional injuries increased especially for males. And for females contributions of cardiovascular diseases sharply increased LE by 1.17 years (32.26%).

Conclusion

More attention should be paid to cardiovascular diseases, chronic respiratory diseases and neoplasms which were mainly attributed to the increase of LE, especially for males and elderly population.

Socioeconomic development and life expectancy relationship: evidence from the EU accession candidate countries

This paper investigates the effect of the socioeconomic development on life expectancy at birth as an indicator of mortality or longevity in five EU accession candidate countries (Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, and Albania). Using aggregate time series pool data on an annual level from UN and World Bank databases for the period 1990–2017 and Full Information Maximum Likelihood model, it was found that this connection between the socioeconomic conditions and life expectancy at birth is a prerequisite for longer life in all these five countries. Our dependent variable was the life expectancy at birth, and the background exploratory variables for the socioeconomic development were GDP per capita and infant mortality rate. The main results are that higher values of GDP per capita and lower values of infant mortality levels lead to higher life expectancy at birth suggesting that longevity of people in these five countries is increasing. These results are supported by our theoretical background and research framework hypotheses.

[Demographic perspective on the concept of the tailored approach in surgery : Analysis of the quality of life exemplified by inguinal hernia repair]

INTRODUCTION

The constant increase in life expectancy for over 170 years is one of the biggest achievements of modern society. In Germany the probability of an 80-year-old person becoming 100 years old has increased by a factor of 20 since the 1950s. This fact has various implications for the clinical routine and therapeutic guidelines. In addition to the quantitative factors (e.g. complications, recurrence rate), the quality of life (QoL) as a patient-centered subjective factor should be taken into consideration in the treatment options for hernia repair. To compare heterogeneous cohorts of patients regarding the QoL, a standardization based on representative reference values is absolutely essential.

MATERIAL AND METHODS

The study was based on data from the follow-up of 310 patients who underwent inguinal hernia repair at the surgery department of the University Hospital Rostock. The preoperative clinical examination of the patients and a questionnaire were supplemented by a postal follow-up survey postoperatively at a median of 20 months (follow-up rate 66%). Patient pain level was assessed by a visual analogue scale (VAS) and health-unspecific QoL by the EQ-5D questionnaire. Standardization of the EQ-5D was based on a survey on a normative German reference population.

RESULTS

Analysis of the patients in the various treatment arms showed significant differences in age composition and health states (American Society of Anesthesologists, ASA scores) of the patient cohorts. A comparison of the QoL between the two mesh-based procedures, the transabdominal preperitoneal (TAPP) procedure and the Lichtenstein procedure, showed that complete recovery is possible after 6 months. A slight decrease in the QoL of the Lichtenstein cohort patients was ascertainable, which can be explained by the method and the higher age of the group. Taking the differences in age of the two groups into account led to a change of the QoL outcome.

CONCLUSION

The concept of QoL is currently becoming increasingly more important in the assessment of treatment procedures. When comparing several therapeutic procedures, a standardization must be undertaken to take the heterogeneity of patient cohorts into consideration. Analogous to the relative survival in cancer epidemiology, the measured QoL scores should be put in the relationship to the age and sex-specific reference of the general population in order to demonstrate the actual effect of the disease in question and its treatment.

Mortality pattern trends and disparities among Chinese from 2004 to 2016

BACKGROUND

With the changes in environmental, medical technique, population structure and national health projects, human mortality rates have undergone great changes all over the world. According to "World Health Statistics 2016: Monitoring Health for the SDGs (Sustainable Development Goals)", we can draw a globally vision about life expectancy and cause of death; also, significant inequality still persists within and among countries. This study was designed to research into the trend of mortality pattern in China, evaluate the disparities of age-specific and disease-specific mortality rates between male and female, and provides a scientific basis for further prevention strategies and policies design.

METHODS

Data from the Chinese Disease Surveillance Points system were used to calculate crude and age-adjusted death rates, annual percent changes (APC) for men and women during 2004 to 2016. Age-standardized mortality rates (ASMR) were performed through the direct method with the World Health Organization's World Standard Population. APC, according to log linear model, was adopted to describe the mortality rate trend. The χ2 test was used to compare differences between age-specific and cause-specific mortality rates of men and women. Data analysis and figures were completed by R software.

RESULTS

The mortality rates of men and women have decreased significantly (P < 0.05) during 2004-2016, and the APC were1.98 and 2.45%, respectively. In 2016, the crude mortality rate (CMR) and ASMR in all causes of death were 658.50 and 490.28 per 100,000 per year, respectively. The 5 leading causes of death were malignant neoplasm, cerebrovascular disease, heart disease, COPD, and accidental injury. The mortality rates of men were higher than that of women in all age groups.

CONCLUSIONS

There are severe health gaps and disparities between male and female, and the chronic non-communicable diseases continue to be a serious health threat to Chinese residents.

Understanding the Increase in Life Expectancy in Hong Kong: Contributions of Changes in Age- and Cause-Specific Mortality

To assess the mechanism responsible for the improvement in life expectancy in Hong Kong over the past several decades, Arriaga’s decomposition method was applied to quantify the influence of the age structure and the leading causes of death on the increase in life expectancy in Hong Kong from 1986 to 2015. Our results showed that, during the observed period, the major contribution to the improvement in life expectancy in Hong Kong was attributable to the older population for both males and females. Contributions of malignant neoplasms in the period of 1986–1995, 1996–2005 and 2006–2015 were 0.613, 0.279 and 0.887 years in males and 0.391, 0.312 and 0.226 years in females, respectively. For circulatory diseases, the corresponding figures were 1.452, 0.202 and 0.832 years in males and 0.675, 0.192 and 1.069 years in females, with the largest contribution also shifting to older ages. However, these positive contributions were partly offset by the negative contribution of pneumonia, especially among those at advanced ages. Furthermore, although the impact was limited, attention should also be paid to the prevalence of some chronic diseases among the younger age groups in recent years.

Potential gains in health-adjusted life expectancy from reducing four main non-communicable diseases among Chinese elderly

BACKGROUND

To estimate the potential gains in health-adjusted life expectancy (HALE) after hypothetical elimination of four non-communicable diseases (NCDs) among Chinese elderly from 1990 to 2016, including cardiovascular diseases (CVD), cancers, chronic respiratory diseases (CRD) and diabetes mellitus (DM).

METHODS

Based on data from Global Burden of Disease 2016, we generated life table by gender using Sullivan method to calculate HALE. Disease-deleted method was used to calculate cause-elimination HALE, after hypothetical elimination of specific diseases.

RESULTS

From 1990 to 2016, HALE increased for all age groups. After hypothetic eliminating the four main NCDs, potential gain in HALE by CVD, DM and cancers increased while by CRD decreased from 1990 to 2016 for both genders. Among four main NCDs, potential gain in HALE after eliminating CVD was largest and increased most for both genders. Although elimination of DM led to the smallest gain in HALE, the increasing speed of gain in HALE by DM was faster than that by CVD and cancers from 1990 to 2016.

CONCLUSIONS

This study highlights the potential gains in HALE of NCDs among Chinese elderly from 1990 to 2016. HALE of Chinese elderly could further increase from the reduction of NCDs. Control measures and targeted prevention should be carried out.

Trends in gender differences in health at working ages among West and East Germans

Before 1990, Germany was divided for more than 40 years. While divided, significant mortality disparities between the populations of East and West Germany emerged. In the years following reunification, East German mortality improved considerably, eventually converging with West German levels. In this study, we explore changes in the gender differences in health at ages 20–59 across the eastern and western regions of Germany using data from the German Socio-Economic Panel (SOEP) for the 1990–2013 period. We apply random-effects linear regressions to the SOEP data to identify trends in health, measured as self-assessed health satisfaction, after German reunification.

The findings indicate that women were substantially less satisfied with their health than men in both West and East Germany, but that the gender gap was larger in East Germany than in West Germany. Furthermore, the results show that respondents’ satisfaction with their health decreased over time, and that the decline was steeper among men – and particularly among East German men – than among women. Thus, the initial male advantage in health in East and West Germany in the years immediately after reunification diminished over time, and even reversed to become a female advantage in East Germany. One interpretation of this finding is that stress-inducing post-reunification changes in the political and social landscape of East Germany had lasting damaging consequences for men’s health.

Ongoing risky health behaviors and high levels of economic insecurity due to unemployment could have had long-lasting effects on the health of the working-aged population. A partial explanation for our finding that health declined more sharply among East German men than among their female counterparts could be that women have better compensatory mechanisms than men for dealing with psychosocial stress.

Changes in Life Expectancy From 2006 to 2015 in Suzhou, East China: Contributions of Age- and Cause-Specific Mortality

This study was designed to estimate the contribution of age- and disease-specific mortality, particularly that attributable to chronic noncommunicable diseases and at-birth life expectancy (LE) in Suzhou, East China, between 2006 and 2015. In total, data on 427 290 deaths were analyzed. From 2006 to 2015, the at-birth LE increased from 78.92 years to 82.87 years in Suzhou. A decrease in all-cause age-specific death rates contributed to an increase of 1.98 years. The decreased death rates attributable to noncommunicable diseases including cerebrovascular diseases, cancer, heart disease, and respiratory diseases resulted in an increased LE of 1.37 years, which was particularly pronounced among people aged 65 years and older. However, the prevalence of cancer in those aged 45 to 74 years, particularly gastric, liver, and esophageal cancers, contributed the most to the increase in LE. These data may be useful for public health communications.

Understanding the rapid increase in life expectancy in shanghai, China: a population-based retrospective analysis

Background

Life expectancy at birth (LE) is a comprehensive measure that accounts for age-specific death rates in a population. Shanghai has ranked first in LE in China mainland for decades. Understanding the reasons behind its sustained gain in LE provides a good reflection of many other cities in China. The aim of this study is intended to explore temporal trend in age- and cause-specific gains in LE in Shanghai and the probable reasons lay behind.

Methods

Joinpoint regression was applied to evaluate temporal trend in LE and the long time span was then divided accordingly. Contributions to change in LE (1973–2015) were decomposed by age and cause at corresponding periods.

Results

LE in Shanghai could be divided into four phases ie., descent (1973–1976), recovery (1976–1998), rapid rise (1998–2004) and slow rise (2004–2015). The growing LE was mainly attributed to reductions in mortality from the elderly populations and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers (stomach, liver and esophageal cancer).

Conclusions

The four-decade sustained gain in LE in Shanghai is due to the reductions in mortality from the elderly and chronic diseases such as cerebrovascular disease, chronic lower respiratory disease, and gastrointestinal cancers. Further growth momentum still comes from the elderly population.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5112-7) contains supplementary material, which is available to authorized users.

Estimating the contribution of mortality selection to the East-West German mortality convergence

Background

Before German reunification, old-age mortality was considerably higher in East Germany than West Germany but converged quickly afterward. Previous studies attributed this rapid catch-up to improved living conditions. We add to this discussion by quantifying for the first time the impact of mortality selection.

Methods

We use a gamma-Gompertz mortality model to estimate the contribution of selection to the East–West German mortality convergence before and after reunification.

Results

We find that, compared to the West, frailer East Germans died earlier due to deteriorating mortality conditions leading to converging mortality rates for women and men already over age 70 before 1990. After 1990, the selection of frailer individuals played only a minor role in closing the East–west German mortality gap. However, our study suggests that, after reunification, old-age mortality improved quickly because the more robust population in the East benefitted greatly from ameliorating external factors such as health care and better living standards.

Conclusion

Our results from a natural experiment show that selection of frail individuals plays an important role in population-level mortality dynamics. In the case of the German reunification, East German old-age mortality already converged before 1990 because of stronger selection pressure.

Surgical treatment of pelvic ring fractures in the elderly now and then: a pelvic registry study

BACKGROUND

With the demographic change, the treatment of elderly patients has become a major issue for health systems worldwide.

AIMS

The aim of this study was to analyze the change in the rate of surgical treatment of pelvic ring fractures in patients with an age of ≥60 years over a 22-year period depending on fracture type, age and sex.

METHODS

Data of 5665 patients with an age of ≥60 years, who were treated for pelvic ring fractures from 1991 to 2013 in one of 31 hospitals participating in the German Pelvic Trauma Registry, were included. The registry is divided into four time periods: t ₁ = 1991-1993, t ₂ = 1997-2000, t ₃ = 2001-2008 and t ₄ = 2009-2013. Data had been collected prospectively and was analyzed retrospectively, stratified for age and sex of the patients as well as type of fracture and mode of therapy (surgical vs. conservative).

RESULTS

There was a significant increase (p < 0.05) in the overall rate of surgical treatment. Nonetheless, during all time periods patients with an age of >70 years were significantly less frequently surgically treated compared to 60- to 70-year-olds. Regardless of the fracture type, the rate of surgical treatment was significantly higher (p < 0.05) in male compared to female patients during t ₁. While this difference persisted for type A and type B fractures, the frequency of surgical treatment of type C fractures approximated in males and females.

CONCLUSIONS

The present data indicate that the rate of surgical treatment of pelvic ring fractures in elderly patients has significantly increased over the 22-year period. Nonetheless, older patients (>70 years) as well as female patients are still less frequently surgically treated.

'I shouldn't have had to push and fight': health care experiences of persons with dementia and their caregivers in primary care

OBJECTIVES

Most persons with dementia (PWD) receive the majority of their care from primary care providers (PCPs). A number of challenges have been identified with providing quality dementia care in primary care from the perspective of PCP. However, less is known of the primary care health care experience (HCE) of PWD and their caregivers. We examined the primary care HCE of PWD and their caregivers in Ontario, Canada.

METHODS

Participants were recruited through local Alzheimer Society chapter support groups. A semi-structured interview guide was developed. Focus groups were audio recorded, transcribed verbatim, anonymized, and then reviewed and coded for themes independently by two study authors. Thematic analysis was conducted to identify major themes and a model proposing the common components of a perceived positive HCE was created.

RESULTS

Five focus groups were conducted across urban and rural settings. Each focus group included both PWD and their caregivers and a total of eight PWD and 21 caregivers participated. Four main themes emerged from the analysis: communication, caregiver as manager, system navigation, ease of access. The model for positive HCE included: an informed patient/caregiver; supported patient/caregiver; strong PCP-patient/caregiver relationship; an accessible provider; a knowledgeable provider; and strong communication by the provider.

CONCLUSION

The HCE of PWD and their caregivers is complex and a number of factors which are potentially modifiable by PCP may improve the HCE for the growing number of PWD in primary care. Understanding these experiences may help to identify strategies to improve care and patient and provider experiences.

Ganhos em expectativa de vida ao nascer no Brasil nos anos 2000: impacto das variações da mortalidade por idade e causas de morte

Resumo A expectativa de vida ao nascer é um indicador sintético de mortalidade que reflete as condições gerais de vida de uma população. A variação da mortalidade por idade e causas gera mudanças não explícitas na análise simples do indicador. A aplicação de um método que decomponha a variação da expectativa de vida pode ajudar a melhor entender o fenômeno. O objetivo deste estudo foi mensurar a contribuição dos grupos etários e causas de morte na variação da expectativa de vida ao nascer de homens e mulheres, a partir da aplicação do método de decomposição de Pollard aos dados brasileiros de 2000 e 2010. Foram utilizadas as tábuas de mortalidade disponibilizadas pelo Instituto Brasileiro de Geografia e Estatística e os dados de óbitos do Sistema de Informações sobre Mortalidade. Os resultados mostram que o grupo etário que mais contribuiu para o aumento da expectativa de vida foi o dos menores de 1 ano de idade. Dentre as causas definidas, as doenças cardiovasculares foram as responsáveis pelo maior acréscimo à média de anos de vida dos brasileiros.

Changes in physical functioning among men and women aged 50-79 years in Germany: an analysis of National Health Interview and Examination Surveys, 1997-1999 and 2008-2011

Background

This study examines changes in physical functioning among adults aged 50-79 years in Germany based on data from two German National Health Interview and Examination Surveys conducted in 1997–1999 (GNHIES98) and 2008–2011 (DEGS1).

Methods

Using cross-sectional data from the two surveys (GNHIES98, n = 2884 and DEGS1, n = 3732), we examined changes in self-reported physical functioning scores (Short Form-36 physical functioning subscale (SF-36 PF)) by sex and age groups (50–64 and 65–79 years). Covariables included educational level, living alone, nine chronic diseases, polypharmacy (≥5 prescribed medicines), body mass index, sports activity, smoking and alcohol consumption. Multimorbidity was defined as ≥2 chronic diseases. Multivariable models were fitted to examine consistency of changes in physical functioning among certain subgroups and to assess changes in mean SF-36 PF scores, adjusting for changes in covariables between surveys.

Results

Mean physical functioning increased among adults aged 50–79 years between surveys in unadjusted analyses, but this change was not as marked among men aged 65–79 years who experienced rising obesity (20.6 to 31.5%, p = 0.004) and diabetes (13.0 to 20.0%, p = 0.014). Prevalence of multimorbidity and polypharmacy use increased among men and women aged 65–79 years. In sex and age specific multivariable analyses, changes in physical functioning over time were consistent across subgroups. Gains in physical functioning were explained by improved education, lower body mass index and improved health-related behaviours (smoking, alcohol consumption, sports activity) in women, but less so among men.

Conclusions

Physical functioning improved in Germany among adults aged 50–79 years. Improvements in the population 65–79 years were less evident among men than women, despite increases in multimorbidity prevalence among both sexes. Changes in health behaviours over time differed between sexes and help explain variations in physical functioning. Targeted health behaviour interventions are indicated from this study.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0377-0) contains supplementary material, which is available to authorized users.

Changes in life expectancy 1950-2010: contributions from age- and disease-specific mortality in selected countries

Background

Changes of life expectancy over time serve as an interesting public health indicator for medical, social and economic developments within populations. The aim of this study was to quantify changes of life expectancy between 1950 and 2010 and relate these to main causes of death.

Methods

Pollard’s actuarial method of decomposing life expectancy was applied to compare the contributions of different age- and disease-groups on life expectancy in 5-year intervals.

Results

From the 1960 to 70s on, declines in cardiovascular disease (CVD) mortality play an increasing role in improving life expectancy in many developed countries. During the past decades gains in life expectancy in these countries were mainly observed in age groups ≥65 years. A further consistent pattern was that life expectancy increases were stronger in men than in women, although life expectancy is still higher in women. In Japan, an accelerated epidemiologic transition in causes of death was found, with the highest increases between 1950 and 1955. Short-term declines and subsequent gains in life expectancy were observed in Eastern Europe and the former states of the Union of Soviet Socialist Republics (USSR), reflecting the changes of the political system.

Conclusions

Changes of life years estimated with the decomposing method can be directly interpreted and may therefore be useful in public health communication. The development within specific countries is highly sensitive to changes in the political, social and public health environment.

Electronic supplementary material

The online version of this article (doi:10.1186/s12963-016-0089-x) contains supplementary material, which is available to authorized users.

Exploring the Life Expectancy Increase in Poland in the Context of CVD Mortality Fall: The Risk Assessment Bottom-Up Approach, From Health Outcome to Policies

Life expectancy at birth is considered the best mortality-based summary indicator of the health status of the population and is useful for measuring long-term health changes. The objective of this article was to present the concept of the bottom-up policy risk assessment approach, developed to identify challenges involved in analyzing risk factor reduction policies and in assessing how the related health indicators have changed over time. This article focuses on the reasons of the significant life expectancy prolongation in Poland over the past 2 decades, thus includes policy context. The methodology details a bottom-up risk assessment approach, a chain of relations between the health outcome, risk factors, and health policy, based on Risk Assessment From Policy to Impact Dimension project guidance. A decline in cardiovascular disease mortality was a key factor that followed life expectancy prolongation. Among basic factors, tobacco and alcohol consumption, diet, physical activity, and new treatment technologies were identified. Poor health outcomes of the Polish population at the beginning of 1990s highlighted the need of the implementation of various health promotion programs, legal acts, and more effective public health policies. Evidence-based public health policy needs translating scientific research into policy and practice. The bottom-up case study template can be one of the focal tools in this process. Accountability for the health impact of policies and programs and legitimization of the decisions of policy makers has become one of the key questions nowadays in European countries' decision-making process and in EU public health strategy.

Geriatrics in medical students' curricula: questionnaire-based analysis

BACKGROUND

Demographic development is accompanied by an increasingly aging society. Concerning medical education, the treatment of older people as well as the scientific research and exploration of ageing aspects in the coming years need to be considered. Aim of the study was to ascertain medical students' knowledge, interest, and attitudes regarding older patients and geriatric medicine.

METHODS

Each participant completed a self-designed questionnaire. This questionnaire was based on three validated internationally recognised questionnaires ("Facts on Aging Quiz--FAQ", "Expectations Regarding Aging--ERA" and the "Aging Semantic Differential--ASD"). The inquiry and survey were performed at the beginning of the summer term in 2012 at the University of Regensburg Medical School.

RESULTS

A total of n = 184/253 (72.7%) students participated in this survey. The results of the FAQ 25+ showed that respondents were able to answer an average of M = 20.4 of 36 questions (56.7%) correctly (Median, Md = 21; SD ±6.1). The personal attitudes and expectations of ageing averaged M = 41.2 points on the Likert-scale that ranged from 0 to 100 (Md = 40.4; SD ±13.7). Respondents' attitudes towards the elderly (ASD 24) averaged M = 3.5 points on the Likert-scale (range 1-7, Md 3.6, SD ±0.8).

CONCLUSIONS

In our investigation, medical students' knowledge of ageing was comparable to previous surveys. Attitudes and expectations of ageing were more positive compared to previous studies. Overall, medical students expect markedly high cognitive capacities towards older people that can actively prevent cognitive impairment. However, medical students' personal interest in medicine of ageing and older people seems to be rather slight.

The effect of soybean-derived phosphatidylserine on cognitive performance in elderly with subjective memory complaints: a pilot study

OBJECTIVE

To evaluate the efficacy and safety of soybean-derived phosphatidylserine (SB-PS) (300 mg/day) in improving cognitive performance in elderly with memory complaints, following a short duration of 12 weeks' SB-PS administration.

METHODS

SB-PS was administered daily for 12 weeks to 30 elderly volunteers with memory complaints (age range 50-90 years). Cognitive performance was determined by a computerized test battery and by the Rey Auditory Verbal Learning Test (Rey-AVLT). Physical examination and blood safety parameters were part of the extensive safety analysis of PS that was performed.

RESULTS

The computerized test results showed that SB-PS supplementation significantly increased the following cognitive parameters: memory recognition (P = 0.004), memory recall (P = 0.006), executive functions (P = 0.004), and mental flexibility (P = 0.01). The Rey-AVLT indicated that, following SB-PS administration, total learning and immediate recall improved significantly (P = 0.013 and P = 0.007, respectively). Unexpected results from the safety tests suggested that SB-PS significantly reduces both systolic (P = 0.043) and diastolic (P = 0.003) blood pressure. SB-PS consumption was well tolerated and no serious adverse events were reported during the study.

CONCLUSION

This exploratory study demonstrates that SB-PS may have favorable effects on cognitive function in elderly with memory complaints. In addition, the study suggests that SB-PS is safe for human consumption and may serve as a safe alternative to phosphatidylserine extracted from bovine cortex. These results encourage further extended studies in order to establish the safety and efficacy of SB-PS treatment.

Measuring the burden of chronic diseases in Korea in 2007

OBJECTIVES

This study was performed to measure the burden of disease from premature death and disability for chronic diseases in Korea in 2007.

STUDY DESIGN

Chronic diseases were defined using the WHO definitions. Disability-adjusted life years (DALY) were used to analyse insurance claim data.

METHODS

This was a population-based study and included the total population of Korea. DALYs were used to analyse insurance claim data. Years of life lost (YLL) and years lost to disability (YLD) were measured in terms of incidence rate and number of deaths. DALYs were aggregated to YLL and YLD. To ensure code validity, only patients who had visited a tertiary hospital or a clinic three or more times for the same disease were included.

RESULTS

Cerebrovascular disease was the leading contributor to the chronic disease burden, with a value of 907.4, followed by diabetes mellitus (899), ischaemic heart disease (710), cirrhosis of the liver (616.5), chronic obstructive pulmonary disease (512.9), asthma (503.1), hypertensive heart disease (407.5), stomach cancer (356) and peptic ulcer disease (292.5). As these results demonstrate, the highest ranked diseases were cardio-cerebrovascular or related diseases, as well as the fact that hypertension, diabetes mellitus and related complications, which are associated diseases, have became increasingly severe problems. And the rural areas have a higher burden of disease than metropolitan cities. According to difference in social status, Medicaid 2 group has more burden of disease than other groups.

CONCLUSIONS

It has been possible to present evidence regarding the burden of diseases and the relatively high risk of cardio-cerebrovascular disease. If the various types of cancer were combined and then the calculating tool applied, the burden would likely be greater than that of cardio-cerebrovascular disease. However, based on DALY, ischaemic heart disease demonstrated a remarkable increase compared to the rate in the previous study based on 2002 data. Underprivileged people in particular have been struggling - with chronic diseases.

von Willebrand's disease: a report from a meeting in the Åland islands

von Willebrand's disease (VWD) is probably the most common bleeding disorder, with some studies indicating that up to 1% of the population may have the condition. Over recent years interest in VWD has fallen compared to that of haemophilia, partly the result of focus on blood-borne diseases such as HIV and hepatitis. Now the time has come to revisit VWD, and in view of this some 60 international physicians with clinical and scientific interest in VWD met over 4 days in 2010 in the Åland islands to discuss state-of-the-art issues in the disease. The Åland islands are where Erik von Willebrand had first observed a bleeding disorder in a number of members of a family from Föglö, and 2010 was also the 140th anniversary of his birth. This report summarizes the main papers presented at the symposium; topics ranged from genetics and biochemistry through to classification of VWD, pharmacokinetics and laboratory assays used in the diagnosis of the disease, inhibitors, treatment guidelines in different age groups including the elderly who often have comorbid conditions that present challenges, and prophylaxis. Other topics included managing surgeries in patients with VWD and the role of FVIII in VWF replacement, a controversial subject.

[National health target "healthy ageing". Medical, psychosocial and nursing care for elderly people]

What kind of health targets should be pursued concerning the health care of elderly people? What kind of activities should be implemented to ensure good health care with regard to future challenges? The Association for the Continuous Development of the National Health Target Process, health-targets.de, deals with these issues under the new national health target "Healthy Ageing". We develop concrete objectives and proposals for practical implementation in the areas of "outpatient and inpatient care", "nursing" and "rehabilitation in old age". health-targets.de supports a common health target process and initiates interventions in the field of health care for elderly people.

[Development of mortality and morbidity of vascular diseases: variations between coronary heart disease and stroke]

INTRODUCTION

Cardiovascular diseases represent a central challenge for our health care system because of their individual and societal consequences. The manuscript compares the current development of mortality and morbidity of coronary heart disease and stroke in Germany.

RESULTS

Coronary heart diseases are one of the leading causes of death and one of the major causes for adult disability. In Germany the average life expectancy has increased by more then 2 years per decade within recent years. The greatest contribution to the increase in life expectancy between 1980 and 2002 in Germany was attributed in previous studies to the decline in mortality rates of cardiovascular diseases; for example in Germany 134,648 persons died in 2008 from coronary heart disease (ICD-10 I20-I25) and 63,060 persons from stroke (ICD-10 I60-I64) compared to 178,759 persons and 90,241 persons in 1998, respectively. Statistical models from other countries estimated that the decrease in coronary heart disease mortality is attributed by about 40% to better treatment and by about 60% to changes in risk factors in the population. Comparable data for stroke are lacking.

CONCLUSION

Despite the substantial knowledge on cardiovascular diseases in Germany a continuous and timely documentation of their determinants, time trends of risk factors and impact regarding mortality and morbidity is compulsory to assess the effectiveness of initiated population health measures and to identify future options for improving prevention and treatment of cardiovascular diseases in Germany.

Esperança de vida ao nascer: impacto das variações na mortalidade por idade e causas de morte no Município de Campinas, São Paulo, Brasil

O objetivo do estudo foi examinar o impacto das mudanças na mortalidade por idades e causas de morte sobre o aumento da esperança de vida ao nascer no Município de Campinas, São Paulo, Brasil, entre 1991, 2000 e 2005. Foram construídas tábuas de vida. O método de Pollard foi aplicado para estimar as contribuições das idades e causas de morte na variação da longevidade. O grupo etário de 0-1 ano foi o que mais contribuiu com o aumento da vida média masculina (31,1%) e feminina (22,9%) em 1991/2000. Entre 2000 e 2005, as idades de 15-44 anos responderam por 79% do ganho masculino. A maior contribuição entre 1991 e 2000 foi gerada pelas doenças cardiovasculares (66,1% entre os homens e 43,5% entre as mulheres). As causas externas subtraíram 1,1 ano entre os homens. Entre 2000 e 2005, com a queda da mortalidade por estas causas, a esperança de vida masculina aumentou em 2,3 anos. As neoplasias provocaram redução de 0,11 ano para homens e 0,15 ano para mulheres. Estes resultados podem auxiliar na orientação de políticas públicas de saúde para redução da mortalidade e aumento da esperança de vida ao nascer.

Questionnaire-based evaluation of everyday competence in older adults

BACKGROUND

Gerontological research aims at understanding factors that are crucial for mediating "successful aging". This term denotes the absence of significant disease and disabilities, maintenance of high levels of physical and cognitive function, and preservation of social and productive activities. Preservation of an active lifestyle is considered an effective means through which everyday competence can be attained. In this context, it is crucial to obtain ratings of modern day older adults' everyday competence by means of appropriate assessments. Here, we introduce the Everyday Competence Questionnaire (ECQ), designed to assess healthy older adults' everyday competence.

METHODS

The ECQ includes 17 items, covering housekeeping, leisure activities, sports, daily routines, manual skills, subjective well-being, and general linguistic usage. The ECQ was administered to a population of 158 healthy subjects aged 60-91 years, who were divided into groups on the basis of their physical activity. These groups were community-dwelling subjects, those living independently and having a sedentary lifestyle, those living independently but characterized by a general lifestyle without any noteworthy physical activity, and those living independently and exercising regularly. Age, gender, and education levels were balanced between the groups.

RESULTS

Using the ECQ, we could identify and distinguish different everyday competence levels between the groups tested: Subjects characterized by an active lifestyle outperformed all other groups. Subjects characterized by a general lifestyle showed higher everyday competence than those with a sedentary lifestyle or subjects who needed care. Furthermore, the ECQ data showed a significant positive correlation between individual physical activity and everyday competence.

CONCLUSION

The ECQ is a novel tool for the questionnaire-based evaluation of everyday competence among healthy subjects. By including leisure activities, it considers the changed living conditions of modern-day older adults.

Are gaps in disability free life expectancies diminishing in Italy?

This paper studies gender differences in disability free life expectancy (DFLE), taking into account mortality and disability contributions. After analysing the types of disability that account for such differences, it goes on to examine temporal variability and age contributions to mortality and disability variation. The method used is an extension of Arriaga's model proposed by Nusselder. In 2005, disability free life expectancy at age 30 was 46.23 years for men and 48.74 years for women, with a gender difference of 2.51 years. Decomposing this difference we find that the mortality effect is 3.70 years, while the disability effect is negative and equal to -1.19 years. Ten years earlier, in 1994, DFLE at age 30 was 43.24 years for men and 46.55 years for women, with a difference between genders of 3.32 years. This broke down to a mortality effect of 4.33 years and a disability effect of -1.02 years. In conclusion, the gap in DFLE between men and women is narrowing, thanks to the more rapid drop in mortality rates in men. With respect to disabilities women are disadvantaged, although the difference (in both total disability and different types of disability) has been almost stable in recent years.

Understanding the rapid increase in life expectancy in South Korea

OBJECTIVES

We assessed life expectancy increases in the past several decades in South Korea by age and specific causes of death.

METHODS

We applied Arriaga's decomposition method to life table data (1970-2005) and mortality statistics (1983-2005) to estimate age- and cause-specific contributions to changes in life expectancy.

RESULTS

Reductions in infant mortality made the largest age-group contribution to the life expectancy increase. Reductions in cardiovascular diseases (particularly stroke and hypertensive diseases) contributed most to longer life expectancy between 1983 and 2005 (30% in males and 28% in females). Lower rates of stomach cancer, liver disease, tuberculosis, and external-cause mortality accounted for 30% of the male and 20% of the female increase in longevity. However, higher mortality from ischemic heart disease, lung and bronchial cancer, colorectal cancer, breast cancer, diabetes, and suicide offset gains by 10% in both genders.

CONCLUSIONS

Rapid increases in life expectancy in South Korea were mostly achieved by reductions in infant mortality and in diseases related to infections and blood pressure.

Older smokers' motivation and attempts to quit smoking: epidemiological insight into the question of lifestyle versus addiction

BACKGROUND

Much media attention currently focuses on demands from the organized medical profession in Germany for an altered legal framework regarding remuneration for smoking-cessation interventions. With this development, the question whether smoking is an autonomously chosen lifestyle or, alternatively, an addiction constituting a disease in its own right has once again come to the fore of public debate.

METHODS

In a population-based study in the German state of Saarland, 10,000 persons aged 50 to 74 were questioned about their health-related behavior and medical history. The frequency of attempts to quit smoking, and of the motivation to do so, was analyzed in relation to the total number of smokers in the survey and was stratified with respect to existing illnesses whose cardiovascular risk potential is exacerbated by smoking.

RESULTS

Among 1528 persons who were smokers at the beginning of the study, 76% (95% confidence interval [CI]: 73.7%-78.0%) reported having tried to quit at least once. Among smokers with existing high-risk conditions, this figure was higher, reaching 89% (CI: 83.1%-93.0%) in smokers with known cardiovascular disease. Only 11% of the smokers were content with their smoking behavior; 30% said they wanted to cut down, and 59% said they wanted to quit smoking entirely.

CONCLUSIONS

Most older smokers in Germany would like to quit smoking and have tried to do so repeatedly without success. In particular, high-risk patients with comorbidities, whose number will further increase as the population ages, are highly motivated to quit smoking and would derive major benefit from effective assistance with smoking cessation. The description of smoking as an autonomously chosen lifestyle appears cynical and deserves to be vigorously rejected.

Neurotrophic factors in Alzheimer's disease: role of axonal transport

Neurotrophic factors (NTF) are small, versatile proteins that maintain survival and function to specific neuronal populations. In general, the axonal transport of NTF is important as not all of them are synthesized at the site of its action. Nerve growth factor (NGF), for instance, is produced in the neocortex and the hippocampus and then retrogradely transported to the cholinergic neurons of the basal forebrain. Neurodegenerative dementias like Alzheimer’s disease (AD) are linked to deficits in axonal transport. Furthermore, they are also associated with imbalanced distribution and dysregulation of NTF. In particular, brain-derived neurotrophic factor (BDNF) plays a crucial role in cognition, learning and memory formation by modulating synaptic plasticity and is, therefore, a critical molecule in dementia and neurodegenerative diseases. Here, we review the changes of NTF expression and distribution (NGF, BDNF, neurotrophin-3, neurotrophin-4/5 and fibroblast growth factor-2) and their receptors [tropomyosin-related kinase (Trk)A, TrkB, TrkC and p75^NTR] in AD and AD models. In addition, we focus on the interaction with neuropathological hallmarks Tau/neurofibrillary tangle and amyloid-β (Abeta)/amyloid plaque pathology and their influence on axonal transport processes in order to unify AD-specific cholinergic degeneration and Tau and Abeta misfolding through NTF pathophysiology.