Trends in disability-free life expectancy at age 50 years in Australia between 2001 and 2011 by social disadvantage

Is 70 the new 60? A longitudinal analysis of cohort trends inintrinsic capacity in England and China

To understand how the health of older adults today compares to that of previous generations, we estimated intrinsic capacity and subdomains of cognitive, locomotor, sensory, psychological and vitality capacities in participants of the English Longitudinal Study on Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS). We applied multilevel growth curve models to examine change over time and cohort trends. We found that more recent cohorts entered older ages with higher levels of capacity, and their subsequent age-related declines were somewhat compressed compared to earlier cohorts. These improvements in capacity were large, with the greatest gains being in the most recent cohorts. For example, a 68-year-old ELSA participant born in 1950 had higher capacity than a 62-year-old born just 10 years earlier. Trends were similar for men and women, and findings were generally consistent across English and Chinese cohorts.

Multilevel joint frailty model for hierarchically clustered binary and survival data

Hierarchical data arise when observations are clustered into groups. Multilevel models are practically useful in these settings, but these models are elusive in the context of hierarchical data with mixed multivariate outcomes. In this article, we consider binary and survival outcomes and assume the hierarchical structure is induced by clustering of both outcomes within patients and clustering of patients within hospitals which frequently occur in multicenter studies. We introduce a multilevel joint frailty model that analyzes the outcomes simultaneously to jointly estimate their regression parameters and explicitly model within-patient correlation between the outcomes and within-hospital correlation separately for each outcome. Estimation is facilitated by a computationally efficient residual maximum likelihood method that further predicts cluster-specific frailties for both outcomes and circumvents the formidable challenges induced by multidimensional integration that complicates the underlying likelihood. The performance of the model and estimation procedure is investigated via extensive simulation studies. The practical utility of the model is illustrated through simultaneous modeling of disease-free survival and binary endpoint of platelet recovery in a multicenter allogeneic bone marrow transplantation dataset that motivates this study.

Educational disparities in disability-free life expectancy across Europe: A focus on the East-West gaps from a gender perspective

Education plays a crucial role in shaping the health outcomes of adults. This study examines the relationship between educational attainment and health across Europe. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we estimate educational inequalities in disability-free life expectancy (DFLE) by gender in seven Western European (2004-2019) and three Central and Eastern European (CEE) (2010-2019) countries. We exploit a novel approach that combines the Sullivan method and multivariate life tables to calculate DFLE using SHARE data. We find that educational differences in DFLE favoring the better-educated exist in both CEE and Western European countries, but also that the differences across countries are more pronounced among the low-educated. While the absolute gaps in DFLE between low- and high-educated individuals in CEE and Western European countries are similar, the educational disparities in DFLE impose a more significant burden on the CEE populations due to their overall lower life expectancy. Educational inequalities are larger among women than among men in CEE countries, while the results for Western European countries are mixed. Our findings further highlight the important role of the institutional context in mitigating or exacerbating educational inequalities in health.

Gender, education, and cohort differences in healthy working life expectancy at age 50 years in Australia: a longitudinal analysis

BACKGROUND

We aimed to estimate healthy working life expectancy (HWLE) at age 50 years by gender, cohort, and level of education in Australia.

METHODS

We analysed data from two nationally representative cohorts in the Household Income and Labour Dynamics in Australia survey. Each cohort was followed up annually from 2001 to 2010 and from 2011 to 2020. Poor health was defined by a self-reported, limiting, long-term health condition. Work was defined by current employment status. HWLEs were estimated with Interpolated Markov Chain multi-state modelling.

FINDINGS

We included data from 4951 participants in the cohort from 2001 to 2010 (2605 [53%] women and 2346 [47%] men; age range 50-100 years) and 6589 participants in the cohort from 2011 to 2020 (3518 [53%] women and 3071 [47%] men; age range 50-100 years). Baseline characteristics were similar between groups. Working life expectancy increased over time for all groups, regardless of gender or educational attainment. However, health expectancies only increased for men and people of either gender with higher education. Years working in good health at age 50 years for men were 9·9 years in 2001 (95% CI 9·3-10·4) and 10·8 years (10·4-11·3) in 2011. The corresponding HWLEs for women were 7·9 years (7·3-8·5) and 9·0 years (8·5-9·6). For people with low education level, HWLE was 7·9 years (7·3-8·5) in 2001 and 8·4 years (7·9-8·9) in 2011, and for those with high education level, HWLE rose from 9·6 years in 2001 (9·1-10·1) to 10·5 years in 2011 (10·2-10·9). Across all groups, there were at least 2·5 years working in poor health and 6·7 years not working in good health.

INTERPRETATION

Increases in length of working life have not been accompanied by similar gains in healthy life expectancy for women or people of any gender with low education, and it is not unusual for workers older than 50 years to work with long-term health limitations. Strategies to achieve longer working lives should address life-course inequalities in health and encourage businesses and organisations to recruit, train, and retain mature-age workers.

FUNDING

Australian Research Council.

Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries

Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data ( N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.