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Cai J, Hu W, Yang Y, Chen S, Si A, Zhang Y, Jing H, Gong L, Liu S, Mi B, Ma J, Yan H, Chen F. Healthy life expectancy for 202 countries up to 2030: Projections with a Bayesian model ensemble. J Glob Health 2023; 13:04185. [PMID: 38146817 PMCID: PMC10750449 DOI: 10.7189/jogh.13.04185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Background Healthy life expectancy (HLE) projections are required for optimising social and health service management in the future. Existing studies on the topic were usually conducted by selecting a single model for analysis. We thus aimed to use an ensembled model to project the future HLE for 202 countries/region. Methods We obtained data on age-sex-specific HLE and the sociodemographic index (SDI) level of 202 countries from 1990 to 2019 from the Global Burden of Disease (GBD) database and used a probabilistic Bayesian model comprised of 21 forecasting models to predict their HLE in 2030. Results In general, HLE is projected to increase in all 202 countries, with the least probability of 82.4% for women and 81.0% for men. Most of the countries with the lowest projected HLE would be located in Africa. Women in Singapore have the highest projected HLE in 2030, with a 94.5% probability of higher than 75.2 years, which is the highest HLE in 2019 across countries. Maldives, Kuwait, and China are projected to have a probability of 49.3%, 41.2% and 31.6% to be the new entries of the top ten countries with the highest HLE for females compared with 2019. Men in Singapore are projected to have the highest HLE at birth in 2030, with a 93.4% probability of higher than 75.2 years. Peru and Maldives have a probability of 48.7% and 35.3% being new top ten countries in male's HLE. The female advantage in HLE will shrink by 2030 in 117 countries, especially in most of the high SDI and European countries. Conclusions HLE will likely continue to increase in most countries and regions worldwide in the future. More attention needs to be paid to combatting obesity, chronic diseases, and specific infectious diseases, especially in African and some Pacific Island countries. Although gender gaps may not be fully bridged, HLE could partially mitigate and even eliminate them through economic development and improvements in health care.
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Affiliation(s)
- Jiaxin Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Weiwei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yuhui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Shiyu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Aima Si
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yuxiang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Hui Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Lingmin Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Sitong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jiaojiao Ma
- Department of Neurology, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Fangyao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Radiology, First Affiliate Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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CUTLER DAVIDM, GHOSH KAUSHIK, MESSER KASSANDRAL, RAGHUNATHAN TRIVELLORE, ROSEN ALLISONB, STEWART SUSANT. A Satellite Account for Health in the United States. THE AMERICAN ECONOMIC REVIEW 2022; 112:494-533. [PMID: 35529584 PMCID: PMC9070842 DOI: 10.1257/aer.20201480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This paper develops a satellite account for the US health sector and measures productivity growth in health care for the elderly population between 1999 and 2012. We measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions. Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5% per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes.
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Affiliation(s)
- DAVID M. CUTLER
- Harvard University and NBER, 1805 Cambridge Street, Cambridge, MA 02138
| | - KAUSHIK GHOSH
- National Bureau of Economic Research, 1050 Massachusetts Avenue, Cambridge, MA 02138
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Liu Z, Zheng H, Wu Y, Wang S, Liu Y, Hu S. Self-Rated Healthy Life Expectancy Changes in Jiangxi Province of China by Gender and Urban-Rural Differences, 2013-2018. Front Public Health 2020; 8:596249. [PMID: 33569369 PMCID: PMC7868547 DOI: 10.3389/fpubh.2020.596249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Globalization has brought about rapid economic and technological development, and life expectancy (LE) is constantly increasing. However, it is not clear whether an increase in LE will result in an increase in healthy life expectancy (HLE). This study evaluates trends in the self-rated healthy life expectancy (SRHLE) of residents aged 15 and older in Jiangxi Province of China from 2013 to 2018 and analyzes gender differences and urban-rural differences. This study provides a basis for the formulation of relevant public health policies. Methods: Based on two National Health Services Survey databases of Jiangxi in 2013 and 2018 as well as infant mortality rates and under-5 mortality rates from the Health Commission of Jiangxi, the Sullivan method was used to calculate SRHLE. The changes in SRHLE were decomposed into health and mortality effects using the decomposition method. Results: SRHLE decreased from 56.55 to 55.54 years and from 60.00 to 57.87 years for men and women aged 15 from 2013 to 2018, respectively. The SRHLE of women aged 15 was 3.45 and 2.34 years longer than that of men in 2013 and 2018, respectively. The SRHLE of urban men aged 15 was 2.9 and 4.46 years longer than that of rural men in 2013 and 2018, respectively, and that of urban women aged 15 was 3.28 and 5.57 years longer than that of rural women. Conclusions: The decreased SRHLE indicated that the self-rated health (SRH) status of residents in Jiangxi has worsened, and it provided evidence for the expansion of morbidity, mainly due to the increased prevalence of chronic diseases and the improvement in residents' health awareness. Policy efforts are necessary to control the increased morbidity of chronic diseases and reduce gender and urban-rural differences in the quantity and quality of years lived.
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Affiliation(s)
- Zhitao Liu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Huilie Zheng
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Yuhang Wu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Shengwei Wang
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Yong Liu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Songbo Hu
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
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Highfill T, Bernstein E. Using disability adjusted life years to value the treatment of thirty chronic conditions in the U.S. from 1987 to 2010: a proof of concept. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2019; 19:449-466. [PMID: 30963361 DOI: 10.1007/s10754-019-09266-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
Health care spending in the U.S. grew two trillion dollars from 1987 to 2010, a 400% increase, but our understanding of the value of that increase is limited. In this paper we estimate the net value of spending for thirty chronic diseases between 1987 and 2010 by assigning a monetary value to changes in health outcomes and relating it to the costs of treating each disease. Changes in health outcomes are measured using a newly-available time series of disability adjusted life years (DALYs) data from the Institute for Health Metrics and Evaluation. Spending on treatments are determined using health care expenditure data from nationally representative surveys. We find the net value of treatment has grown substantially for several diseases. Overall, 20 of the 30 chronic conditions studied experienced an increase in health outcomes over the period, with 8 of those 20 showing a decrease in per-patient spending. Our estimates of net value of health spending using DALYs data are simple to apply and results are generally consistent with previous estimates which usually involve onerous data collection methods to study a single disease. The DALYs data have potential to be a useful, low-cost way to measure changes in health outcomes. However, challenges remain in using DALYs data to accurately measure the changing value of health care spending on the treatment of disease.
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Affiliation(s)
- Tina Highfill
- Department of Commerce, US Bureau of Economic Analysis, 4600 Silver Hill Rd., Suitland, MD, 20746, USA.
| | - Elizabeth Bernstein
- Department of Commerce, US Bureau of Economic Analysis, 4600 Silver Hill Rd., Suitland, MD, 20746, USA
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de la Fuente J, Caballero FF, Sánchez-Niubó A, Panagiotakos DB, Prina AM, Arndt H, Haro JM, Chatterji S, Ayuso-Mateos JL. Determinants of Health Trajectories in England and the United States: An Approach to Identify Different Patterns of Healthy Aging. J Gerontol A Biol Sci Med Sci 2019; 73:1512-1518. [PMID: 29346518 DOI: 10.1093/gerona/gly006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Indexed: 12/31/2022] Open
Abstract
Background Aging is a multidimensional process with a remarkable interindividual variability. This study is focused on identifying groups of population with similar aging patterns, and to define the health trajectories of these groups. Sociodemographic and health determinants of these trajectories are also identified. Methods Data from the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) were used. A set of self-reported health items and measured tests were used to generate a latent health metric by means of a Bayesian multilevel IRT model, assessing the ability of the metric to predict mortality. Then, a Growth Mixture Model (GMM) was conducted in each study to identify latent classes and assess health trajectories. Kaplan-Meier survival curves were obtained for each class and a multinomial logistic regression was used to identify determinants of these trajectories. Results The health score generated showed an adequate ability to predict mortality over 10 years in ELSA (AUC = 0.74; 95% CI: 0.72, 0.75) and HRS (AUC = 0.74; 95% CI: 0.73, 0.75). By means of GMM, four latent classes were identified in ELSA and five in HRS. Chronic conditions, no qualification and low level of household wealth were associated to the classes which showed a higher mortality in both studies. Conclusion The method based on the creation of a common metric of health and the use of GMM to identify similar patterns of aging, allows for the comparison of trajectories of health across longitudinal surveys. Multimorbidity, educational level, and household wealth could be considered as determinants associated to these trajectories.
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Affiliation(s)
| | - Francisco Félix Caballero
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain.,CIBER of Mental Health, Madrid, Spain.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | | | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - A Matthew Prina
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | | | - Josep Maria Haro
- CIBER of Mental Health, Madrid, Spain.,Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain.,CIBER of Mental Health, Madrid, Spain.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
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6
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Jia H, Lubetkin EI. Dose-response effect of smoking status on quality-adjusted life years among U.S. adults aged 65 years and older. J Public Health (Oxf) 2019; 39:e194-e201. [PMID: 27613764 DOI: 10.1093/pubmed/fdw096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/01/2016] [Indexed: 12/20/2022] Open
Abstract
Background To estimate the impact of smoking on quality-adjusted life years (QALY) for US adults aged 65 years and older. Methods Using the 2003-08 National Health and Nutrition Examination Survey Linked Mortality File, we estimated the mean QALY throughout the remaining lifetime by participants' smoking status as well as smoking intensity and time since cessation. Results Never, former and current smokers had a mean QALY of 16.1, 12.7 and 7.3 years, respectively. Among current smokers, those who started smoking before age 18 had fewer QALYs than those who started at or after age 18 (6.0 and 8.5 years, respectively) and those smoking ≥20 cigarettes per day had fewer QALYs than those smoking <20 cigarettes per day (6.6 and 8.1 years, respectively). QALYs also declined with a longer duration of smoking and a shorter time since cessation. The potential gains if a person quit smoking would be 5.4 QALYs, and the gains would increase with a longer time since quitting as well as quitting at a younger age. Conclusions This study demonstrated the dose-response effect of smoking status on QALY. The results indicate the health benefits of tobacco cessation at any age and sizeable losses for former or current smokers.
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Affiliation(s)
- Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, New York, NY, USA
| | - Erica I Lubetkin
- Department of Community Health and Social Medicine, CUNY Medical School, New York, NY, USA
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Gray JP, Arlinghaus KR, Johnston CA. The Potential Contribution of Current Health Care Zeitgeists to the Success of Health and Wellness Coaches. Am J Lifestyle Med 2019; 12:456-458. [PMID: 30783397 DOI: 10.1177/1559827618792496] [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: 11/17/2022] Open
Abstract
Chronic disease is challenging to treat because treatment often requires lifestyle behavior changes. In recent years the use of health and wellness coaches (HWC) has emerged as a way to support patients making behavioral changes. The use of HWCs has resulted in improved management of chronic disease for many patients. The success of HWCs is often thought to be due to the extended care they provide and the behavioral modification techniques they promote such as goal setting and self-monitoring. This article describes how HWC's conformity to the current health care zeitgeist of personalized, holistic care may be another reason for their success.
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Affiliation(s)
- Jon P Gray
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | | | - Craig A Johnston
- Department of Health and Human Performance, University of Houston, Houston, Texas
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8
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Kaskie B, Carr D, Ewen H. Defining doctoral gerontologists: Who are they and how are they contributing to the field of gerontology? GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:418-432. [PMID: 28350249 DOI: 10.1080/02701960.2017.1311880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
More than 300 individuals have earned doctoral degrees in gerontology since 1993, yet little is known about their training, professional placement, and contributions to the field. Given this lack of information, the authors sought to define the emerging mass of doctoral gerontologists. In this study, the authors analyzed results from the 2014 Gerontology Education Longitudinal Study survey sample of 84 individuals who earned a doctoral degree in gerontology between 1993 and 2013. Results revealed doctoral gerontologists completed training requirements that were consistent across eight programs offering doctorates in gerontology. The authors also found doctoral gerontologists have been successful in securing jobs in academic and nonacademic organizations, creating gerontological knowledge, and translating their work into other fields. The authors concluded by considering how the successful integration of doctoral gerontologists might continue, and they propose directions for future research.
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Affiliation(s)
- Brian Kaskie
- a College of Public Health , The University of Iowa , Iowa City , Iowa, USA
| | - Dawn Carr
- b Department of Sociology , Florida State University , Tallahassee , Florida , USA
| | - Heidi Ewen
- c Institute of Gerontology , University of Georgia , Athens , Georgia , USA
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9
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Taksler GB. Evaluating the best approach to treatment of aortic stenosis: The jury is still out. J Thorac Cardiovasc Surg 2018; 155:1989-1990. [DOI: 10.1016/j.jtcvs.2017.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
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The Effects of College on Weight: Examining the "Freshman 15" Myth and Other Effects of College Over the Life Cycle. Demography 2017; 54:311-336. [PMID: 27928734 DOI: 10.1007/s13524-016-0530-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examines the effects of college on weight over much of the life cycle. I compare weights for college students with their weights before and after college and with the weights of noncollege peers using data from the National Longitudinal Survey of Youth (NLSY). I also examine the longer-term effects of college measured almost three decades later. I find that college freshmen gain substantially less than the 15 pounds rumored to be typical for freshmen. Using difference models, individual-specific fixed-effects models, and instrumental variables models to control for various sources of potential bias, I find that freshman year college attendance is estimated to cause only about a one-pound increase. Supplemental results show that those from lower socioeconomic backgrounds gain more weight during the freshman college year. Longer term, having a college education consistently decreases weight. These negative effects have faded over the last 20 years, and they diminish as respondents approach middle age. These trends are more prevalent for whites and Hispanics than for blacks.
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Tate LM, Tsai PF, Rettiganti M, Landes RD, Lefler LL, Bryant-Moore K. Examining Exercise in Older Adults Using the Theory of Planned Behavior and Temporal Discounting. Res Gerontol Nurs 2017; 10:252-259. [PMID: 29156065 DOI: 10.3928/19404921-20171013-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/29/2017] [Indexed: 11/20/2022]
Abstract
Exercise is one of the most important health behaviors to reduce and prevent the severity of many chronic diseases. The purpose of the current study was to determine if adding temporal discounting (TD) would affect the predictability of the Theory of Planned Behavior (TPB) in exercising among older adults. One hundred thirty-seven older adults were recruited from 11 churches in rural Arkansas using a cross-sectional design. Information regarding participants' exercise behavior, constructs of the TPB, TD rates, and demographics was collected. Path analysis was used to examine the relationships between and among each of the concepts of the TPB and TD. TD was not a significant predictor (p = 0.413) for exercise behavior after adjusting for intention. Adding TD to the existing TPB did not significantly affect the predictability of the model negatively or positively. [Res Gerontol Nurs. 2017; 10(6):252-259.].
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12
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Steensma C, Loukine L, Choi BC. Evaluating compression or expansion of morbidity in Canada: trends in life expectancy and health-adjusted life expectancy from 1994 to 2010. Health Promot Chronic Dis Prev Can 2017; 37:68-76. [PMID: 28273034 PMCID: PMC5602161 DOI: 10.24095/hpcdp.37.3.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The objective of this study was to investigate whether morbidity in Canada, at the national and provincial levels, is compressing or expanding by tracking trends in life expectancy (LE) and health-adjusted life expectancy (HALE) from 1994 to 2010. "Compression" refers to a decrease in the proportion of life spent in an unhealthy state over time. It happens when HALE increases faster than LE. "Expansion" refers to an increase in the proportion of life spent in an unhealthy state that happens when HALE is stable or increases more slowly than LE. METHODS We estimated LE using mortality and population data from Statistics Canada. We took health-related quality of life (i.e. morbidity) data used to calculate HALE from the National Population Health Survey (1994-1999) and the Canadian Community Health Survey (2000-2010). We built abridged life tables for seven time intervals, covering the period 1994 to 2010 and corresponding to the year of each available survey cycle, for females and males, and for each of the 10 Canadian provinces. National and provincial trends were assessed at birth, and at ages 20 years and 65 years. RESULTS We observed an overall average annual increase in HALE that was statistically significant in both Canadian females and males at each of the three ages assessed, with the exception of females at birth. At birth, HALE increased an average of 0.2% (p = .08) and 0.3% (p < .001) annually for females and males respectively over the 1994 to 2010 period. At the national level for all three age groups, we observed a statistically non-significant average annual increase in the proportion of life spent in an unhealthy state, with the exception of men at age 65, who experienced a non-significant decrease. At the provincial level at birth, we observed a significant increase in proportion of life spent in an unhealthy state for Newfoundland and Labrador (NL) and Prince Edward Island (PEI). CONCLUSION Our study did not detect a clear overall trend in compression or expansion of morbidity from 1994 to 2010 at the national level in Canada. However, our results suggested an expansion of morbidity in NL and PEI. Our study indicates the importance of continued tracking of the secular trends of life expectancy and HALE in Canada in order to verify the presence of compression or expansion of morbidity. Further study should be undertaken to understand what is driving the observed expansion of morbidity in NL and in PEI.
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Affiliation(s)
- Colin Steensma
- Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Lidia Loukine
- Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - Bernard C Choi
- Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
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Cao B. Future healthy life expectancy among older adults in the US: a forecast based on cohort smoking and obesity history. Popul Health Metr 2016; 14:23. [PMID: 27408607 PMCID: PMC4941025 DOI: 10.1186/s12963-016-0092-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 06/23/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In the past three decades, the elderly population in the United States experienced increase in life expectancy (LE) and disability-free life expectancy (LE(ND)), but decrease in life expectancy with disability (LE(D)). Smoking and obesity are two major risk factors that had negative impacts on these trends. While smoking prevalence continues to decline in recent decades, obesity prevalence has been growing and is currently at a high level. This study aims to forecast the healthy life expectancy for older adults aged 55 to 85 in the US from 2011 to 2040, in relation to their smoking and obesity history. METHODS First, population-level mortality data from the Human Mortality Database (HMD) and individual-level disability data from the US National Health Interview Survey (NHIS) were used to estimate the transition rates between different health states from 1982 to 2010, using a multi-state life table (MSLT) model. Second, the estimated transition rates were fitted and projected up to 2040, using a modified Lee-Carter model that incorporates cohort smoking and obesity history from NHIS. RESULTS Mortality and morbidity for both sexes will continue to decline in the next decades. Relative to 2010, men are expected to have 3.2 years gain in LE(ND) and 0.8 years loss in LE(D). For women, there will be 1.8 years gain in LE(ND) and 0.8 years loss in LE(D). By 2040, men and women are expected to spend respectively 80 % and 75 % of their remaining life expectancy between 55 and 85 disability-free. CONCLUSIONS Smoking and obesity have independent negative impacts on both the survival and disability of the US older population in the coming decades, and are responsible for the present and future gender disparity in mortality and morbidity. Overall, the US older population is expected to enjoy sustained health improvements and compression of disability, largely due to decline in smoking.
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Affiliation(s)
- Bochen Cao
- Population Studies Center, University of Pennsylvania, McNeil Building, 3718 Locust Walk, Philadelphia, PA 19104 USA
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Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, Lloyd-Sherlock P, Epping-Jordan JE, Peeters GMEEG, Mahanani WR, Thiyagarajan JA, Chatterji S. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2016; 387:2145-2154. [PMID: 26520231 PMCID: PMC4848186 DOI: 10.1016/s0140-6736(15)00516-4] [Citation(s) in RCA: 1279] [Impact Index Per Article: 159.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.
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Affiliation(s)
- John R Beard
- Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Alana Officer
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | | | - Ritu Sadana
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Anne Margriet Pot
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Wahyu Retno Mahanani
- Health statistics and information systems, World Health Organization, Geneva, Switzerland
| | | | - Somnath Chatterji
- Health statistics and information systems, World Health Organization, Geneva, Switzerland
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Freedman VA, Wolf DA, Spillman BC. Disability-Free Life Expectancy Over 30 Years: A Growing Female Disadvantage in the US Population. Am J Public Health 2016; 106:1079-85. [PMID: 26985619 DOI: 10.2105/ajph.2016.303089] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine changes in active life expectancy in the United States over 30 years for older men and women (aged ≥ 65 years). METHODS We used the 1982 and 2004 National Long Term Care Survey and the 2011 National Health and Aging Trends Study to estimate age-specific mortality and disability rates, the overall chances of survival and of surviving without disability, and years of active life for men and women. RESULTS For older men, longevity has increased, disability has been postponed to older ages, disability prevalence has fallen, and the percentage of remaining life spent active has increased. However, for older women, small longevity increases have been accompanied by even smaller postponements in disability, a reversal of a downward trend in moderate disability, and stagnation of active life as a percentage of life expectancy. As a consequence, older women no longer live more active years than men, despite their longer lives. CONCLUSIONS Neither a compression nor expansion of late-life disability is inevitable. Public health measures directed at older women to postpone disability may be needed to offset impending long-term care pressures related to population aging.
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Affiliation(s)
- Vicki A Freedman
- Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Douglas A. Wolf is with the Aging Studies Institute, Syracuse University, Syracuse, NY. Brenda C. Spillman is with the Health Policy Center at the Urban Institute, Washington, DC
| | - Douglas A Wolf
- Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Douglas A. Wolf is with the Aging Studies Institute, Syracuse University, Syracuse, NY. Brenda C. Spillman is with the Health Policy Center at the Urban Institute, Washington, DC
| | - Brenda C Spillman
- Vicki A. Freedman is with the Institute for Social Research, University of Michigan, Ann Arbor. Douglas A. Wolf is with the Aging Studies Institute, Syracuse University, Syracuse, NY. Brenda C. Spillman is with the Health Policy Center at the Urban Institute, Washington, DC
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Jia H, Lubetkin EI. Impact of nine chronic conditions for US adults aged 65 years and older: an application of a hybrid estimator of quality-adjusted life years throughout remainder of lifetime. Qual Life Res 2016; 25:1921-9. [PMID: 26781442 DOI: 10.1007/s11136-016-1226-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To estimate quality-adjusted life years (QALY) loss due to each of the following nine chronic conditions-depression, diabetes mellitus, hypertension, heart disease, stroke, emphysema, asthma, arthritis, and cancer. METHODS We ascertained respondents' health-related quality of life scores and mortality status from the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES) with mortality follow-up data through December 31, 2011. We included respondents aged 65 years and older (n = 2380). A hybrid estimator was used to calculate QALY from two parts: QALY during the follow-up period and QALY beyond the follow-up period. We calculated QALY by each of the nine chronic conditions. RESULTS For persons aged 65 and older, QALY throughout the reminder of lifetime was 12.3 years. After adjusting for age- and sex-related differences, depression had an associated 8.2 years of QALY loss; diabetes, 5.6 years; hypertension, 2.5 years; heart disease, 5.4 years; stroke, 6.4 years; emphysema, 8.0 years; asthma, 4.8 years; arthritis, 0.3 years; and cancer, 2.5 years. Compared to persons without any chronic conditions, persons with one condition had an associated 4.7 years of QALY loss; persons with two conditions, 7.9 years; and persons with three or more conditions, 10.8 years. CONCLUSIONS This study presents a QALY estimator for respondents in the NHANES-Linked Mortality File and demonstrates the utility of this method to other follow-up data. Continued application of our method would enable the burden of disease to be compared for a range of health conditions and risk factors in the ongoing effort to improve population health.
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Affiliation(s)
- Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, USA.
| | - Erica I Lubetkin
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY Medical School, New York, NY, 10031, USA
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Tate LM, Tsai PF, Landes RD, Rettiganti M, Lefler LL. Temporal discounting rates and their relation to exercise behavior in older adults. Physiol Behav 2015; 152:295-9. [PMID: 26440317 DOI: 10.1016/j.physbeh.2015.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/25/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED As our nation's population ages, the rates of chronic illness and disability are expected to increase significantly. Despite the knowledge that exercise may prevent chronic disease and promote health among older adults, many still are inactive. Factors related to exercise behaviors have been explored in recent years. However, temporal discounting is a motivational concept that has not been explored in regard to exercise in older adults. Temporal discounting is a decision making process by which an individual chooses a smaller more immediate reward over a larger delayed reward. The aim of this study was to determine if temporal discounting rates vary between exercising and non-exercising older adults. DESIGN This study used cross-sectional survey of 137 older adults living in the community. Older adults were recruited from 11 rural Arkansas churches. The Kirby delay-discounting Monetary Choice Questionnaire was used to collect discounting rates and then bivariate analysis was performed to compare temporal discounting rate between the exercisers and non-exercisers. Finally, multivariate analysis was used to compare discounting rate controlling for other covariates. RESULTS The results indicated that exercising older adults display lower temporal discounting rates than non-exercising older adults. After controlling for education, exercisers still have lower temporal discounting rates than non-exercisers (p<0.001). CONCLUSIONS AND IMPLICATIONS These findings are important as several chronic health conditions relate to lack of exercise especially in older adults. This research suggests that if we can find appropriate incentives for discounting individuals, some type of immediate reward, then potentially we can design programs to engage and retain older adults in exercise.
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Affiliation(s)
- Linda M Tate
- University of Arkansas for Medical Sciences, United States.
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Nesson ET, Robinson JJ. An information theory based framework for the measurement of population health. ECONOMICS AND HUMAN BIOLOGY 2015; 17:86-103. [PMID: 25792258 DOI: 10.1016/j.ehb.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/28/2015] [Accepted: 01/31/2015] [Indexed: 06/04/2023]
Abstract
This paper proposes a new framework for the measurement of population health and the ranking of the health of different geographies. Since population health is a latent variable, studies which measure and rank the health of different geographies must aggregate observable health attributes into one summary measure. We show that the methods used in nearly all the literature to date implicitly assume that all attributes are infinitely substitutable. Our method, based on the measurement of multidimensional welfare and inequality, minimizes the entropic distance between the summary measure of population health and the distribution of the underlying attributes. This summary function coincides with the constant elasticity of substitution and Cobb-Douglas production functions and naturally allows different assumptions regarding attribute substitutability or complementarity. To compare methodologies, we examine a well-known ranking of the population health of U.S. states, America's Health Rankings. We find that states' rankings are somewhat sensitive to changes in the weight given to each attribute, but very sensitive to changes in aggregation methodology. Our results have broad implications for well-known health rankings such as the 2000 World Health Report, as well as other measurements of population and individual health levels and the measurement and decomposition of health inequality.
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Affiliation(s)
- Erik T Nesson
- Department of Economics, Miller College of Business, Ball State University, Muncie, IN, United States.
| | - Joshua J Robinson
- Department of Marketing, Industrial Distribution, and Economics, Collat School of Business, University of Alabama at Birmingham, Birmingham, AL, United States.
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Comparison of trends in US health-related quality of life over the 2000s using the SF-6D, HALex, EQ-5D, and EQ-5D visual analog scale versus a broader set of symptoms and impairments. Med Care 2015; 52:1010-6. [PMID: 25014733 DOI: 10.1097/mlr.0000000000000181] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A number of instruments have been developed to measure health-related quality of life (HRQoL), differing in the health domains covered and their scoring. Although few such measures have been consistently included in US national health surveys over time, the surveys have included data on a broad range of symptoms and impairments, which enables the tracking of population health trends. OBJECTIVES To compare trends in HRQoL as measured using existing instruments versus using a broader range of symptoms and impairments collected in multiple years of nationally representative data. DATA AND MEASURES Data were from the 2000-2010 Medical Expenditure Panel Survey, which is nationally representative of the noninstitutionalized US population. Level of and trends in HRQoL derived from a broad range of survey symptoms and impairments (SSI) was compared with HRQoL from the SF-6D, the HALex, and, between 2000 and 2003, the EuroQol-5D (EQ-5D) and EQ-5D Visual Analog Scale. RESULTS Trends in HRQoL were similar using different measures. The SSI scores correlated 0.66-0.80 with scores from other measures and mean SSI scores were between those of other measures. Scores from all HRQoL measures declined similarly with increasing age and with the presence of comorbid conditions. CONCLUSIONS Measuring HRQoL using a broader range of symptoms and impairments than those in a single instrument yields population health trends similar to those from other measures while making maximum use of existing data and providing rich detail on the factors underlying change.
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Das SK, Rahman A, Chisti MJ, Ahmed S, Malek MA, Salam MA, Bardhan PK, Faruque ASG. Changing patient population in Dhaka Hospital and Matlab Hospital of icddr,b. Trop Med Int Health 2013; 19:240-3. [DOI: 10.1111/tmi.12231] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- S. K. Das
- International Centre for Diarrhoeal Disease Research, Bangladesh; Dhaka Bangladesh
| | - A. Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh; Dhaka Bangladesh
| | - M. J. Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh; Dhaka Bangladesh
| | - S. Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh; Dhaka Bangladesh
| | - M. A. Malek
- International Centre for Diarrhoeal Disease Research, Bangladesh; Dhaka Bangladesh
| | - M. A. Salam
- International Centre for Diarrhoeal Disease Research, Bangladesh; Dhaka Bangladesh
| | - P. K. Bardhan
- International Centre for Diarrhoeal Disease Research, Bangladesh; Dhaka Bangladesh
| | - A. S. G. Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh; Dhaka Bangladesh
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