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Wilkie RZ, Ho JY. Life expectancy and geographic variation in mortality: an observational comparison study of six high-income Anglophone countries. BMJ Open 2024; 14:e079365. [PMID: 39138004 DOI: 10.1136/bmjopen-2023-079365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To compare life expectancy levels and within-country geographic variation in life expectancy across six high-income Anglophone countries between 1990 and 2018. DESIGN Demographic analysis using aggregated mortality data. SETTING Six high-income Anglophone countries (USA, UK, Canada, Australia, Ireland and New Zealand), by sex, including an analysis of subnational geographic inequality in mortality within each country. POPULATION Data come from the Human Mortality Database, the WHO Mortality Database and the vital statistics agencies of six high-income Anglophone countries. MAIN OUTCOME MEASURES Life expectancy at birth and age 65; age and cause of death contributions to life expectancy differences between countries; index of dissimilarity for within-country geographic variation in mortality. RESULTS Among six high-income Anglophone countries, Australia is the clear best performer in life expectancy at birth, leading its peer countries by 1.26-3.95 years for women and by 0.97-4.88 years for men in 2018. While Australians experience lower mortality across the age range, most of their life expectancy advantage accrues between ages 45 and 84. Australia performs particularly well in terms of mortality from external causes (including drug- and alcohol-related deaths), screenable/treatable cancers, cardiovascular disease and influenza/pneumonia and other respiratory diseases compared with other countries. Considering life expectancy differences across geographic regions within each country, Australia tends to experience the lowest levels of inequality, while Ireland, New Zealand and the USA tend to experience the highest levels. CONCLUSIONS Australia has achieved the highest life expectancy among Anglophone countries and tends to rank well in international comparisons of life expectancy overall. It serves as a potential model for lower-performing countries to follow to reduce premature mortality and inequalities in life expectancy.
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Affiliation(s)
- Rachel Z Wilkie
- Spatial Sciences Institute, University of Southern California, Los Angeles, California, USA
| | - Jessica Y Ho
- Department of Sociology and Population Research Institute, The Pennsylvania State University, University Park, Pennsylvania, USA
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Hendi AS. Where Does the Black-White Life Expectancy Gap Come From? The Deadly Consequences of Residential Segregation. POPULATION AND DEVELOPMENT REVIEW 2024; 50:403-436. [PMID: 39035023 PMCID: PMC11258794 DOI: 10.1111/padr.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
The disparity in life expectancy between white and black Americans exceeds five years for men and three years for women. While prior research has investigated the roles of healthcare, health behaviors, biological risk, socioeconomic status, and life course effects on black mortality, the literature on the geographic origins of the gap is more limited. This study examines how the black-white life expectancy gap varies across counties and how much of the national gap is attributable to within-county racial inequality versus differences between counties. The estimates suggest that over 90% of the national gap can be attributed to within-county factors. Using a quasi-experimental research design, I find that black-white residential segregation increases the gap by approximately 16 years for men and five years for women. The segregation effect loads heavily on causes of death associated with access to and quality of healthcare; safety and violence; and public health measures. Residential segregation does not appear to operate through health behaviors or individual-level factors, but instead acts primarily through institutional mechanisms. Efforts to address racial disparities in mortality should focus on reducing racial residential segregation or reducing inequalities in the mechanisms through which residential segregation acts: public services, employment opportunities, and community resources.
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Affiliation(s)
- Arun S Hendi
- Office of Population Research and Department of Sociology, Princeton School of Public and International Affairs, Princeton University
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Pandey S, Hajizadeh M, Kiadaliri A. The contributions of avoidable causes of death to gender gap in life expectancy and life disparity in the US and Canada: 2001-2019. Soc Sci Med 2024; 347:116751. [PMID: 38484458 DOI: 10.1016/j.socscimed.2024.116751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/05/2024] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES This study measures public health policies' and healthcare system's influence, by assessing the contributions of avoidable deaths, on the gender gaps in life expectancy and disparity (GGLD and GGLD, respectively) in the United States (US) and Canada from 2001 to 2019. METHODS To estimate the GGLE and GGLD, we retrieved age- and sex-specific causes of death from the World Health Organization's mortality database. By employing the continuous-change model, we decomposed the GGLE and GGLD by age and cause of death for each year and over time using females as the reference group. RESULTS In Canada and the US, the GGLE (GGLD) narrowed (increased) by 0.9 (0.2) and 0.2 (0.3) years, respectively. Largest contributor to the GGLE was non-avoidable deaths in Canada and preventable deaths in the US. Preventable deaths had the largest contributions to the GGLD in both countries. Ischemic heart disease contributed to the narrowing GGLE/GGLD in both countries. Conversely, treatable causes of death increased the GGLE/GGLD in both countries. In Canada, "treatable & preventable" as well as preventable causes of death narrowed the GGLE while opposite was seen in the US. While lung cancer contributed to the narrowing GGLE/GGLD, drug-related death contributed to the widening GGLE/GGLD in both countries. Injury-related deaths contributed to the narrowing GGLE/GGLD in Canada but not in the US. The contributions of avoidable causes of death to the GGLE declined in the age groups 55-74 in Canada and 70-74 in the US, whereas the GGLE widened for ages 25-34 in the US. CONCLUSION Canada experienced larger reduction in the GGLE compared to the US attributed mainly to preventable causes of death. To narrow the GGLE and GGLD, the US needs to address injury deaths. Urgent interventions are required for drug-related death in both countries, particularly among males aged 15-44 years.
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Affiliation(s)
- Sujita Pandey
- School of Health Administration, Dalhousie University, Halifax, Canada
| | | | - Ali Kiadaliri
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopaedics, Lund University, Sweden; Centre for Economic Demography, Lund University, Lund, Sweden.
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Holmes DR, Farb A, Dib N, Jacques L, Rowe S, DeMaria A, King S, Zuckerman B. The medical device development ecosystem: Current regulatory state and challenges for future development: A review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 60:95-101. [PMID: 37778922 DOI: 10.1016/j.carrev.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/08/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND/PURPOSE There has been increasing emphasis on the development of new technology to mitigate unmet clinical needs in cardiovascular disease. This emphasis results in part from recognition that many devices, although being initially developed in the United States, were studied, and then eventually approved abroad before being returned to the U.S. for clinical application. The FDA (Food and Drug Administration) guidance document on Early Feasibility Studies (EFS) and then the 21st Century Cures Act from 2013 to 2016 focused on these issues. MATERIALS/METHODS There are multiple components of medical device translational pathways to be considered in continuing to reach the goal of providing early access to safe and effective products to the U.S. POPULATION This review article documents the various stages from early idea innovation to device design and iteration to clinical testing and then potential approval and application in the wide clinical practice of cardiovascular health care. RESULTS The CDRH (Centers for Devices and Radiological Health) has focused on key components including EFS, Breakthrough Devices Program, Total Product Life Cycle, the Unique Device Identification Program, the establishment of a Digital Health Center of Excellence, and leveraging Collaborative Communities. Each of these initiatives focuses on improving the Medical Device Development Ecosystem. CONCLUSIONS Major changes in device translational research have improved the device research climate in the United States. Goals remain including increased training and education for constituencies aspiring to work in the field of device development and regulation as part of a continuous health care learning system.
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Affiliation(s)
- David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Andrew Farb
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, United States of America
| | - Nabil Dib
- International Society for Cardiovascular Translational Research (ISCTR), Phoenix, Arizona and Dignity Health, Mercy Gilbert Medical Center, Phoenix, AZ, United States of America
| | - Louis Jacques
- ADVI Health, Washington, DC, United States of America
| | - Stanton Rowe
- NXT Biomedical, Irvine, CA, United States of America
| | - Anthony DeMaria
- Sulpizio Cardiovascular Center, University of California San Diego School of Medicine, San Diego, CA, United States of America
| | - Spencer King
- Emory University School of Medicine, Atlanta, GA, United States of America
| | - Bram Zuckerman
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, United States of America
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Dowd JB, Doniec K, Zhang L, Tilstra A. US exceptionalism? International trends in midlife mortality. Int J Epidemiol 2024; 53:dyae024. [PMID: 38508869 PMCID: PMC10954513 DOI: 10.1093/ije/dyae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/29/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64 years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. METHODS We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64 years) age-standardized death rates across 15 major cause-of-death categories. RESULTS US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54 year and in Canada, Poland and Sweden among for those aged 25-44 years. CONCLUSIONS The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.
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Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Katarzyna Doniec
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
| | - Luyin Zhang
- Office of Population Research, Princeton University, Princeton, USA
| | - Andrea Tilstra
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
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Ho JY, Hendi AS. Inequalities in life expectancy and cardiometabolic disease mortality across and within high-income countries. Cell Metab 2024; 36:224-228. [PMID: 38325335 PMCID: PMC10866299 DOI: 10.1016/j.cmet.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 02/09/2024]
Abstract
Cardiometabolic disease is a leading cause of death and plays a key role in recent life expectancy trends worldwide. We highlight inequalities in cardiometabolic disease mortality across sex, race/ethnicity, geographic region, and urbanicity within the United States, as well as across high-income countries.
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Affiliation(s)
- Jessica Y Ho
- Department of Sociology and Criminology and Population Research Institute, Pennsylvania State University, University Park, PA, USA.
| | - Arun S Hendi
- Office of Population Research and Department of Sociology, School of Public and International Affairs, Princeton University, Princeton, NJ, USA.
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Abrams LR, Myrskylä M, Mehta NK. Reply to Polizzi and Dowd: Within-country counterfactual reveals importance of retirement age mortality in addition to established concern about working ages. Proc Natl Acad Sci U S A 2024; 121:e2320028121. [PMID: 38227670 PMCID: PMC10823162 DOI: 10.1073/pnas.2320028121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Affiliation(s)
- Leah R. Abrams
- Department of Community Health, Tufts University, Medford, MA02155
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock18057, Germany
- Population Research Unit, University of Helsinki, Helsinki00014, Finland
- Max Planck–University of Helsinki Center for Social Inequalities in Population Health, Rostock18057, Germany
| | - Neil K. Mehta
- Department of Epidemiology, University of Texas Medical Branch, Galveston, TX77555
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Abrams LR, Myrskylä M, Mehta NK. The "double jeopardy" of midlife and old age mortality trends in the United States. Proc Natl Acad Sci U S A 2023; 120:e2308360120. [PMID: 37812715 PMCID: PMC10589701 DOI: 10.1073/pnas.2308360120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023] Open
Abstract
Since 2010, US life expectancy growth has stagnated. Much research on US mortality has focused on working-age adults given adverse trends in drug overdose deaths, other external causes of death, and cardiometabolic deaths in midlife. We show that the adverse mortality trend at retirement ages (65+ y) has in fact been more consequential to the US life expectancy stagnation since 2010, as well as excess deaths and years of life lost in 2019, than adverse mortality trends at working ages. These results reveal that the United States is experiencing a "double jeopardy" that is driven by both mid-life and older-age mortality trends, but more so by older-age mortality. Understanding and addressing the causes behind the worsening mortality trend in older ages will be essential to returning to the pace of life expectancy improvements that the United States had experienced for decades.
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Affiliation(s)
- Leah R. Abrams
- Department of Community Health, Tufts University, Medford, MA 02155
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock 18057, Germany
- Population Research Unit, University of Helsinki, Helsinki 00014, Finland
- Max Planck – University of Helsinki Center for Social Inequalities in Population Health, Rostock18057, Germany
| | - Neil K. Mehta
- Department of Epidemiology, University of Texas Medical Branch, Galveston, TX77555
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Simoes EJ, Ramos LR. The Role of Healthy Diet and Lifestyle in Centenarians. Nutrients 2023; 15:4293. [PMID: 37836577 PMCID: PMC10574171 DOI: 10.3390/nu15194293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Life expectancy at birth (hereafter, life expectancy) and longevity are established indicators of population health [...].
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Affiliation(s)
- Eduardo J. Simoes
- Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Luiz R. Ramos
- Department of Preventive Medicine, Federal University of Sao Paulo, São Paulo 04024-002, Brazil;
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