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Bramajo O, Zueras P, Rentería E, Permanyer I. Decomposition of life expectancy differentials with (and without) conditions by educational attainment for major groups of causes in contemporary Spain: where is the advantage? GENUS 2024; 80:11. [PMID: 39027674 PMCID: PMC11252180 DOI: 10.1186/s41118-024-00220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Healthy life expectancy is higher among individuals with higher socioeconomic standing. However, it is unclear whether such advantage is attributable to longer (i.e., mortality advantage) or to healthier (morbidity advantage) lifespans across different health conditions. Objective Estimate the contribution of mortality and morbidity components in differences in condition-free life expectancies (CFLE) and life expectancy with conditions (LEWC) for five major groups of conditions by sex and educational attainment, instead of using a global indicator of morbidity. Methods Using the Sullivan Method, we computed remaining life expectancies at age 40 and 65, CFLE, and LEWC and applied a stepwise decomposition technique, using national health surveys along with mortality data, in a cross-sectional analysis. Results An educational gradient was present in almost all conditions, with different intensities. For females, morbidity was the main contributor to educational differences in health expectancies, but mainly in the older age groups. For males, the drivers behind higher health expectancies for high-educated males were evenly distributed across mortality and morbidity between ages 40 and 65, but after that, the mortality gradient vanished between high-educated and middle-educated individuals. Discussion The changing contribution of the mortality and morbidity gradient for different conditions across age-groups brings evidence to adequately plan health policies to mitigate health gaps and improve quality of life of the populations in a lower social standing.
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Affiliation(s)
- Octavio Bramajo
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Centre d’Estudis Demogràfics, Bellaterra, Spain
- University of Texas Medical Branch, Galveston, USA
| | - Pilar Zueras
- Centre d’Estudis Demogràfics, Bellaterra, Spain
- Institute for Social and Economic Research, University of Essex, Essex, UK
| | | | - Iñaki Permanyer
- Centre d’Estudis Demogràfics, Bellaterra, Spain
- ICREA-Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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Gbessemehlan A, Cambois E, Brouard N, Letenneur L, Amieva H, Pérès K. Differences between subjective and disability health expectancies across ages in older adults. Sci Rep 2024; 14:14731. [PMID: 38926481 PMCID: PMC11208525 DOI: 10.1038/s41598-024-65416-3] [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: 10/17/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
Health expectancies (HEs) have become a key indicator for monitoring healthy aging. So far, they have mainly been calculated based on functional rather than subjective health measures. Yet, by integrating several dimensions (medical, social, and cultural), subjective health is also an important measure of an older person's health status. In this study, we first estimated HEs using self-rated health (SRH), by age and sex. Second, we compared these results to those obtained when using a disability measure. We used pooled data from three prospective population-based cohorts including adults aged 65 years and over, living in Southwestern France (N = 4468). SRH was assessed using a single question and disability was measured using the Lawton scale. Healthy/Unhealthy Life Expectancies (HLE/UHLE) and Disability/Disability-Free Life Expectancies (DLE/DFLE) were estimated using the Interpolated Markov Chain program (IMaCh), separately in men and women. Women lived longer than men, with similar HLE but longer UHLE at all ages. The proportion of HLE in total LE decreased with age for both sexes and for women, it became smaller than the proportion of UHLE from age 73 onward. In both sexes, while the DLE was shorter than the UHLE in the youngest, a reversal was observed with advancing age. This change occurred earlier in women. Our study supports that SRH and disability showed different aging patterns, with sex and age differences. From a public health perspective, SRH and disability indicators appeared not interchangeable as they uncovered complementary but different information on the needs of aging people.
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Affiliation(s)
- Antoine Gbessemehlan
- University of Bordeaux, INSERM, UMR 1219, Bordeaux Population Health Research Center, 146 Rue Léo Saignat, 33076, Bordeaux, France.
| | | | - Nicolas Brouard
- National Institute of Demographic Studies (INED), Paris, France
| | - Luc Letenneur
- University of Bordeaux, INSERM, UMR 1219, Bordeaux Population Health Research Center, 146 Rue Léo Saignat, 33076, Bordeaux, France
| | - Hélène Amieva
- University of Bordeaux, INSERM, UMR 1219, Bordeaux Population Health Research Center, 146 Rue Léo Saignat, 33076, Bordeaux, France
| | - Karine Pérès
- University of Bordeaux, INSERM, UMR 1219, Bordeaux Population Health Research Center, 146 Rue Léo Saignat, 33076, Bordeaux, France
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Spijker JJA, Rentería E. Shifts in Chronic Disease Patterns Among Spanish Older Adults With Multimorbidity Between 2006 and 2017. Int J Public Health 2023; 68:1606259. [PMID: 37920847 PMCID: PMC10618995 DOI: 10.3389/ijph.2023.1606259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Objectives: To investigate changes in multimorbidity patterns among Spanish older adults. Methods: Data come from the Spanish National Health Survey (ENSE) for individuals aged 60-89 years (2006: n = 9,758; 2017: n = 8,535). Prevalence rates and relative risks of 20 chronic conditions are estimated for the multimorbidity (3+ chronic conditions) sample, along with observed-to-expected prevalence of three-way disease combinations. Principal component and cluster analyses identify multimorbidity patterns and track temporal changes. Results: Overall, multimorbidity remained stable [2006: 59.6% (95% CI: 58.7%-60.6%); 2017: 60.3% (CI: 59.3%-61.3%)], except at older ages. Women exhibited higher multimorbidity prevalence, but sex differences declined by five percentage points. Low-high education differences widened by three percentage points. In 2017 most individuals living with multimorbidity experienced hypertension (63.4%), osteoarthrosis (62.4%) and chronic back pain (55.9%). These chronic conditions also dominate the most common triadic combinations. Multimorbid men also saw increases in cholesterol and diabetes. Conclusion: Multimorbidity trends and the most common combination of diseases can help plan healthcare for an ageing population. Sex and socioeconomic differences pose additional public health challenges as women and deprived populations tend to have more health complexities.
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Li Y, Li X, Wang W, Guo R, Huang X. Spatiotemporal evolution and characteristics of worldwide life expectancy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:87145-87157. [PMID: 37418193 DOI: 10.1007/s11356-023-28330-1] [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: 09/07/2022] [Accepted: 06/14/2023] [Indexed: 07/08/2023]
Abstract
Exploring global differences in life expectancy can facilitate the development of strategies to narrow regional disparities. However, few researchers have systematically examined patterns in the evolution of worldwide life expectancy over a long time period. Spatial differences among 181 countries in 4 types of worldwide life expectancy patterns from 1990 to 2019 were investigated via geographic information system (GIS) analysis. The aggregation characteristics of the spatiotemporal evolution of life expectancy were revealed by local indicators of spatial association. The analysis employed spatiotemporal sequence-based kernel density estimation and explored the differences in life expectancy among regions with the Theil index. We found that the global life expectancy progress rate shows upward then downward patterns over the last 30 years. Female have higher rates of spatiotemporal progression in life expectancy than male, with less internal variation and a wider spatial aggregation. The global spatial and temporal autocorrelation of life expectancy shows a weakening trend. The difference in life expectancy between male and female is reflected in both intrinsic causes of biological differences and extrinsic causes such as environment and lifestyle habits. Investment in education pulls apart differences in life expectancy over long time series. These results provide scientific guidelines for obtaining the highest possible level of health in countries around the world.
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Affiliation(s)
- Yaxing Li
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China
- College of Design and Engineering, National University of Singapore, Singapore, 119077, Singapore
| | - Xiaoming Li
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China
- Shenzhen Key Laboratory of Spatial Smart Sensing and Services & MNR Technology Innovation Center of Territorial & Spatial Big Data & Guangdong-Hong Kong-Macau Joint Laboratory for Smart Cities, Shenzhen, 518060, China
| | - Weixi Wang
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China
- Shenzhen Key Laboratory of Spatial Smart Sensing and Services & MNR Technology Innovation Center of Territorial & Spatial Big Data & Guangdong-Hong Kong-Macau Joint Laboratory for Smart Cities, Shenzhen, 518060, China
| | - Renzhong Guo
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China.
- Shenzhen Key Laboratory of Spatial Smart Sensing and Services & MNR Technology Innovation Center of Territorial & Spatial Big Data & Guangdong-Hong Kong-Macau Joint Laboratory for Smart Cities, Shenzhen, 518060, China.
| | - Xiaojin Huang
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China
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Jiang H, Zhou J, Xia M, Li G, Di J, Mao F, Yu L, Cai Y, Wang Z, Xiong Y, Tong Y, Yin J, Chen Y, Jiang Q, Zhou Y. Life expectancy and healthy life expectancy of patients with advanced schistosomiasis in Hunan Province, China. Infect Dis Poverty 2023; 12:4. [PMID: 36709305 PMCID: PMC9883924 DOI: 10.1186/s40249-023-01053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Few studies have investigated the change in life expectancy (LE) and the healthy lifespan among patients with advanced schistosomiasis. This study was to evaluate the LE and healthy life expectancy (HLE) for patients and assess the mechanism responsible for the LE inequality. METHODS We utilized data from a dynamic advanced schistosomiasis cohort (10,362 patients) for the period from January 2008 to December 2019 in Hunan Province, China, to calculate the LEs of patients, and made a comparison with that of general population (19,642 schistosomiasis-free individuals) in the schistosomiasis endemic areas. LEs were estimated from 15 years of age by constructing period life tables. Arriaga's decomposition method was applied to quantify the influence of the age structure on the difference in LE. HLE for advanced schistosomiasis patients was calculated by using Sullivan method with age-specific disability weight. The LE and HLE were calculated for both males and females to perform further analyses on gender gap. RESULTS The estimated LE for advanced schistosomiasis patients aged 15-19 was 49.51 years (48.86 years for males and 51.07 years for females), which was 20.14 years lower compared with general population (69.65 years), and the LE gap between patients and general population decreased with age. The largest age-specific mortality contribution to the gap (32.06%) occurred at age 80-84 years. Women had a lower LE and HLE than men at age ≥ 60 years (both gender gaps in LE and HLE < 0). For advanced schistosomiasis patients, the gender gap in LE was largely attributed to the difference in mortality among those under the age of 55; the age-specific mortality in women exerted positive influence on the gap at age 25-64 and 75-79 years, with the contribution rate ranging from 0.59% to 57.02%, and made the negative contribution at other age groups. CONCLUSIONS The LE of advanced schistosomiasis patients was still much lower compared with general population. Strengthened prevention strategies and targeted treatments are needed to reduce morbidity and mortality due to advanced schistosomiasis, especially for younger population and elderly female patients.
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Affiliation(s)
- Honglin Jiang
- grid.8547.e0000 0001 0125 2443Fudan University School of Public Health, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Fudan University Center for Tropical Disease Research, Building 8, 130 Dong’an Road, Shanghai, 200032 China
| | - Jie Zhou
- Hunan Institute for Schistosomiasis Control, Jin’e Middle Road, Yueyang, 414021 Hunan China
| | - Meng Xia
- Hunan Institute for Schistosomiasis Control, Jin’e Middle Road, Yueyang, 414021 Hunan China
| | - Guangping Li
- Hunan Institute for Schistosomiasis Control, Jin’e Middle Road, Yueyang, 414021 Hunan China
| | - Jie Di
- Yueyang Vocational and Technical College, Xueyuan Road, Yueyang, 414000 Hunan China
| | - Feng Mao
- Yueyang Vocational and Technical College, Xueyuan Road, Yueyang, 414000 Hunan China
| | - Liangqing Yu
- Hunan Institute Xiangyue Hospital, Jin’e Middle Road, Yueyang, 414022 Hunan China
| | - Yu Cai
- Hunan Institute for Schistosomiasis Control, Jin’e Middle Road, Yueyang, 414021 Hunan China
| | - Zhengzhong Wang
- grid.8547.e0000 0001 0125 2443Fudan University School of Public Health, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Fudan University Center for Tropical Disease Research, Building 8, 130 Dong’an Road, Shanghai, 200032 China
| | - Ying Xiong
- grid.8547.e0000 0001 0125 2443Fudan University School of Public Health, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Fudan University Center for Tropical Disease Research, Building 8, 130 Dong’an Road, Shanghai, 200032 China
| | - Yixin Tong
- grid.8547.e0000 0001 0125 2443Fudan University School of Public Health, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Fudan University Center for Tropical Disease Research, Building 8, 130 Dong’an Road, Shanghai, 200032 China
| | - Jiangfan Yin
- grid.8547.e0000 0001 0125 2443Fudan University School of Public Health, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Fudan University Center for Tropical Disease Research, Building 8, 130 Dong’an Road, Shanghai, 200032 China
| | - Yue Chen
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3 Canada
| | - Qingwu Jiang
- grid.8547.e0000 0001 0125 2443Fudan University School of Public Health, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Fudan University Center for Tropical Disease Research, Building 8, 130 Dong’an Road, Shanghai, 200032 China
| | - Yibiao Zhou
- grid.8547.e0000 0001 0125 2443Fudan University School of Public Health, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong’an Road, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Fudan University Center for Tropical Disease Research, Building 8, 130 Dong’an Road, Shanghai, 200032 China
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Bartoll-Roca X, Rodríguez-Sanz M, Sánchez-Ledesma E, Pérez K, Borrell C. Inequalities in life expectancy by educational level and its decomposition in Barcelona, 2004-2018. GACETA SANITARIA 2022; 36:520-525. [PMID: 35337685 DOI: 10.1016/j.gaceta.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyse the gap in life expectancy by educational level in the city of Barcelona from 2004 to 2018 and to decompose this gap by age and causes of death. METHOD We computed abridged life tables at the age of 25 years by sex from 2004 to 2018 using standard methods. Educational level was categorised in two groups (lower secondary or less vs. upper secondary or higher education). The life expectancy gap was further decomposed by age and by causes of death based in Arriaga's method in 5-year age blocks up to the age of ≥ 90 years and broad causes of death using ICD-10 codes. RESULTS The life expectancy gap at 25 years by educational level oscillated without trend at around 3.08 years for men and 1.93 years for women. Decomposition by age showed a favourable significant shift in the contribution to this gap from young to older ages for men, with few changes for women. Decomposition by causes of death showed that the diseases concentrating the largest share of the contribution were neoplasms and respiratory and circulatory disease. There was a significant downward trend in external causes for men and in infectious diseases for both men and women but a significant upward trend for respiratory disease for both sexes. CONCLUSIONS The stability of the life expectancy gap by educational level during the period analysed resulted from a combination of divergent trends by age and causes of death among high and low educational levels.
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Affiliation(s)
- Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Cièncias Experimentales i de la Salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Katherine Pérez
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Cièncias Experimentales i de la Salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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Solé-Auró A, Zueras P, Lozano M, Rentería E. Gender Gap in Unhealthy Life Expectancy: The Role of Education Among Adults Aged 45. Int J Public Health 2022; 67:1604946. [PMID: 36090830 PMCID: PMC9459479 DOI: 10.3389/ijph.2022.1604946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This paper examines the gender gap in unhealthy life expectancy across education levels and age in Spain to understand the extent to which the gender paradox exists over education and across ages. Methods: Death registrations and vital status were taken from the Spanish Statistical Office, while the three health measures (chronic conditions, bad-self rated health and cognitive impairment) from the 2019 European Health Interview Survey. We used Sullivan's method to compute unhealthy life expectancy by education level. We computed the gender and the education ratios of the proportion of unhealthy life years in each health measure by education and age. Results: At almost all ages and all education levels, women significantly lived longer but in poorer health than men. Marked gender differences are seen across most age-groups, particularly among the low educated. We detected greater health inequalities by education level for women (confirming the gender paradox) and a health gradient due to aging and across the health measures charting the disablement process. Conclusion: The new education distribution might improve the unhealthy life expectancy and might reduce the gender gap in the number of years spent in poor health.
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Affiliation(s)
- Aïda Solé-Auró
- Department of Political and Social Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Pilar Zueras
- Center for Demographic Studies, Autonomous University of Barcelona, Barcelona, Spain
- Institute for Social and Economic Research, Colchester, United Kingdom
| | - Mariona Lozano
- Center for Demographic Studies, Autonomous University of Barcelona, Barcelona, Spain
| | - Elisenda Rentería
- Center for Demographic Studies, Autonomous University of Barcelona, Barcelona, Spain
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Mortality and life expectancy trends in Spain by pension income level for male pensioners in the general regime retiring at the statutory age, 2005-2018. Int J Equity Health 2022; 21:96. [PMID: 35836221 PMCID: PMC9281150 DOI: 10.1186/s12939-022-01697-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Research has generally found a significant inverse relationship in mortality risk across socioeconomic (SE) groups. This paper focuses on Spain, a country for which there continues to be very little evidence available concerning retirement pensioners. We draw on the Continuous Sample of Working Lives (CSWL) to investigate disparities in SE mortality among retired men aged 65 and above over the longest possible period covered by this data source: 2005–2018. We use the initial pension income (PI) level as our single indicator of the SE status of the retired population. Methods The mortality gradient by income is quantified in two ways: via an indicator referred to as “relative mortality”, and by estimating changes in total life expectancy (LE) by PI level at ages 65 and 75 over time. We show that, should the information provided by the relative mortality ratio not be completely clear, a second indicator needs to be introduced to give a broad picture of the true extent of inequality in mortality. Results The first indicator reveals that, for the period covered and for all age groups, the differences in death rates across PI levels widens over time. At older age groups, these differences across PI levels diminish. The second indicator shows that disparities in LE at ages 65 and 75 between pensioners in the lowest and highest income groups are relatively small, although slightly higher than previously reported for Spain. This gap in LE widens over time, from 1.49 to 2.54 years and from 0.71 to 1.40 years respectively for pensioners aged 65 and 75. These differences are statistically significant. Conclusions Along with other behavioral and structural aspects, a combination of factors such as the design of the pension system, the universality and quality of the health system, and high levels of family support could explain why LE inequalities for retired Spanish men are relatively small. To establish the reasons for this increased inequality in LE, more research needs to be carried out. An analysis of all Spanish social security records instead of just a sample would provide us with more information.
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Rentería E, Zueras P. Macro-level factors explaining inequalities in expected years lived free of and with chronic conditions across Spanish regions and over time (2006–2019). SSM Popul Health 2022; 19:101152. [PMID: 35865801 PMCID: PMC9293933 DOI: 10.1016/j.ssmph.2022.101152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/27/2022] Open
Abstract
Life expectancy has long been associated with macro-level factors, including health expenditures, but little research has focused on the relationship with morbidity measures. This paper examines the relationship between the expected years lived free of and with chronic conditions (YLFCC and YLCC) at age 50 and macroeconomic and social factors including, for the first time, several indicators of public health expenditure. We calculate YLFCC and YLCC for Spanish regions using the Sullivan method over a long period of time (2006–2019). Spain is a good case study due to two reasons. First, its national health system is decentralized among regional administrations since 2002. Second, the financial crisis of 2008 led to public health cuts in 2010–2014 that each region handled differently. We use fixed-effects models to assess the relationship between changes in macro-level regional indicators (socioeconomic factors, healthcare resources, health behavior and public health expenditures) with YLFCC and YLCC across regions and over time. Results show that socioeconomic levels, public health expenditure, healthcare resources and health behaviors are associated with years lived free of and with chronic conditions when analyzing them independently. However, in the global model including all these dimensions only public health expenditure is associated with both YLFCC and YLCC for men and women, showing that a higher level of expenditures is correlated with more YLFCC and less YLCC. Therefore, regional authorities need to pay special attention to the level of investments on health services, as they are clearly associated with a better quality of living of the middle age and older population. Regional and gender differences exist in expected years lived with chronic diseases in Spain. The 2008 economic crisis relates with an increase in years lived with bad health. More expenditure in public health relates with more years lived free of chronic conditions and less years lived with. Socioeconomic and behavioral factors have different effects on years lived free of and with chronic conditions by sex.
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Affiliation(s)
- Elisenda Rentería
- Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
- Corresponding author.
| | - Pilar Zueras
- Centre d’Estudis Demogràfics, Carrer de Ca n’Altayó, Edifici E2, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
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Szwarcwald CL, Almeida WDSD, Souza Júnior PRBD, Rodrigues JM, Romero DE. Socio-spatial inequalities in healthy life expectancy in the elderly, Brazil, 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00124421. [PMID: 35544919 DOI: 10.1590/0102-311x00124421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022] Open
Abstract
The growth in longevity in Brazil has drawn attention to more useful population health measures to complement mortality. In this paper, we investigate socio-spatial differences in life expectancy and healthy life expectancy based on information from the Brazilian National Health Survey (PNS), 2013 and 2019. A three-stage cluster sampling with stratification of the primary sampling units and random selection in all stages was used in both PNS editions. Healthy life expectancy was estimated by Sullivan's method by sex, age, and Federated Units (UF). Severe limitations to at least one noncommunicable chronic disease (NCD) or poor self-rated health were used to define the unhealthy state. Inequality indicators and a Principal Component analysis were used to investigate socio-spatial inequalities. From 2013 to 2019, both life expectancy and healthy life expectancy increased. The analysis by UF show larger disparities in healthy life expectancy than in life expectancy, with healthy life expectancy at age 60 varying from 13.6 to 19.9 years, in 2013, and from 14.9 to 20.1, in 2019. Healthy life expectancy in the wealthiest quintile was 20% longer than for those living in the poorest quintile. Wide socio-spatial disparities were found with the worst indicators in the UF located in the North and Northeast regions, whether considering poverty concentration or health care utilization. The socio-spatial inequalities demonstrated the excess burden of poor health experienced by older adults living in the less developed UF. The development of strategies at subnational levels is essential not only to provide equal access to health care but also to reduce risk exposures and support prevention policies for adoption of health behaviors.
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Affiliation(s)
- Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Jéssica Muzy Rodrigues
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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11
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Siegel A, Schug JF, Rieger MA. Social Determinants of Remaining Life Expectancy at Age 60: A District-Level Analysis in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1530. [PMID: 35162553 PMCID: PMC8835464 DOI: 10.3390/ijerph19031530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
Remaining life expectancy at age 60 (in short: RLE) is an important indicator of the health status of a population's elders. Until now, RLE has not been thoroughly investigated at the district level in Germany. In this study we analyzed, based on recent publicly available data (2015-2017), and for men and women separately, how large the RLE differences were in Germany across the 401 districts. Furthermore, we examined a wide range of potential social determinants in terms of their bivariate and multivariate (i.e., partial) impact on men's and women's RLE. Men's district-level RLE ranged between 19.89 and 24.32 years, women's district-level RLE between 23.67 and 27.16 years. The best single predictor both for men's and women's RLE at district level was 'proportion of employees with academic degree' with standardized partial regression coefficients of 0.42 (men) and 0.51 (women). Second and third in rank were classic economic predictors, such as 'household income' (men), 'proportion of elder with financial elder support' (women), and 'unemployment' (men and women). Indicators expressing the availability of medical services and staffing levels of nursing homes and services had at best a marginal partial impact. This study contributes to the growing body of evidence that a population's educational level is a decisive determinant of population health resp. life expectancy in contemporary industrialized societies.
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Affiliation(s)
- Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany
| | - Jonas F Schug
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstr. 27, 72074 Tübingen, Germany
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12
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Pérez-Salamero González JM, Regúlez-Castillo M, Vidal-Meliá C. Differences in Life Expectancy Between Self-Employed Workers and Paid Employees when Retirement Pensioners: Evidence from Spanish Social Security Records. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2021; 37:697-725. [PMID: 34421450 DOI: 10.1007/s10680-021-09585-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
The aim of this paper is to examine differences in life expectancy (LE) between self-employed (SE) and paid employee (PE) workers when they become retirement pensioners, looking at levels of pension income using administrative data from Spanish social security records. We draw on the Continuous Sample of Working Lives (CSWL) to quantify changes in total life expectancy at age 65 (LE65) among retired men over the longest possible period covered by this data source: 2005-2018. These changes are broken down by pension regime and initial pension income level for three periods. The literature presents mixed evidence, even for the same country-for Japan and Italy, for example-with some studies pointing to higher life expectancy for SE than for PE retirement pensioners while others argue the opposite. In Spain, LE65 is slightly higher for the SE than for PE workers when retirement pensioners. For 2005-2010, a gap in life expectancy of 0.23 years between SE and PE retirement pensioners is observed. This widens to 0.55 years for 2014-2018. A similar trend can be seen if pension income groups are considered. For 2005-2010, the gap in LE65 between pensioners in the lowest and highest income groups is 1.20 years. This widens over time and reaches 1.51 years for 2014-2018. Although these differences are relatively small, they are statistically significant. According to our research, the implications for policy on social security are evident: differences in life expectancy by socioeconomic status and pension regime should be taken into account for a variety of issues involving social security schemes. These include establishing the age of eligibility for retirement pensions and early access to benefits, computing the annuity factors used to determine initial retirement benefits and valuing the liabilities taken on for retirement pensioners.
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Affiliation(s)
| | - Marta Regúlez-Castillo
- Department of Quantitative Methods, University of the Basque Country (UPV/EHU), Avda Lehendakari Aguirre 84, 48015 Bilbao, Spain
| | - Carlos Vidal-Meliá
- Department of Financial Economics and Actuarial Science, University of Valencia, Avenida de Los Naranjos S.N., 46022 Valencia, Spain.,Instituto Complutense de Análisis Económico, Complutense University of Madrid, Madrid, Spain.,Centre of Excellence in Population Ageing Research (CEPAR), UNSW, Sydney, Australia
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13
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Lozano M, Solé-Auró A. Happiness and life expectancy by main occupational position among older workers: Who will live longer and happy? SSM Popul Health 2021; 13:100735. [PMID: 33511266 PMCID: PMC7815996 DOI: 10.1016/j.ssmph.2021.100735] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 12/02/2022] Open
Abstract
Current concerns about aging populations are being translated into legislations to postpone the statutory age at retirement. However, if this is done without considering inequalities in longevity across occupational groups, some may face higher vulnerabilities than others. We examine differences in life expectancy and happiness by occupational position for the Spanish population aged 50 and over. We use happiness as a measure of subjective wellbeing, and compute life expectancy and happy life expectancy by sex and main occupation. Age-specific death rates are calculated using administrative data, and happiness prevalence comes from the European Social Survey. We show that both men and women in managerial positions were advantaged in terms of life expectancy, but only men record more years with happiness. In addition, women in routine jobs were the ones who could expect to live shorter and unhappier. Postponing the statutory age at retirement without considering these differences could be detrimental to women's wellbeing and health.
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Affiliation(s)
- Mariona Lozano
- Centre D'Estudis Demogràfics, Universitat Autònoma de Barcelona, C/ Ca N'Altayó, E2, 08193, Bellaterra, Spain
| | - Aïda Solé-Auró
- DemoSoc Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, C/ Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain
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14
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Michel JP, Goldberg J. Education, Healthy Ageing and Vaccine Literacy. J Nutr Health Aging 2021; 25:698-701. [PMID: 33949640 PMCID: PMC8040006 DOI: 10.1007/s12603-021-1627-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
Importance and Objective: The Covid pandemic is a timely opportunity to try to broaden our understanding of the links between education and health literacy and explore the vaccine-decision process with a view to identifying interventions that will positively influence vaccine uptake. EVIDENCE Health and vaccine literacy encompass people's knowledge, motivation, and competence to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion. FINDINGS Appropriate vaccine communication, which depends greatly on personal and contextual determinants, as well as on societal and environmental circumstances, is essential to reassure people about vaccine efficacy, safety, and possible side effects. However, vaccine confidence is not solely a question of trust in the vaccine's efficacy, safety. and individual protective benefit of vaccination. It also encompasses the mechanism(s) of vaccine activity, immunization schedules, organization and trust in the healthcare system that promotes and delivers the vaccines, and at what costs. When healthcare professionals as science brokers of vaccine knowledge attempt to increase vaccine knowledge and confidence, they must adjust their communication to the educational or health literacy level of their intended audience. Even if their messages are apparently clear and simple, they absolutely need to verify that they are properly understood. RELEVANCE Specific vaccine communication training appears essential to increase vaccine communication skills among healthcare providers. Moreover, further randomized controlled studies are warranted to improve vaccine empowerment among different populations, from a variety of educational backgrounds.
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Affiliation(s)
- J-P Michel
- Jean-Pierre Michel, Honorary professor of Medicine, Medical University of Geneva, Switzerland, + 41 79 77 83 742 ,
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15
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Stephan AJ, Schwettmann L, Meisinger C, Ladwig KH, Linkohr B, Thorand B, Schulz H, Peters A, Grill E. Living longer but less healthy: The female disadvantage in health expectancy. Results from the KORA-Age study. Exp Gerontol 2020; 145:111196. [PMID: 33310150 DOI: 10.1016/j.exger.2020.111196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We explored the male-female health-survival paradox in the context of health expectancy (HE) at age 65 and thereafter, using three different morbidity measures and different severity cut-offs with and without adjustments for the share of nursing home residents. METHODS HE at ages 65, 70, 75, 80, and 85 was estimated with the Sullivan method, linking morbidity prevalence from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study to 2016 Bavarian mortality data. Morbidity measures comprised deficit accumulation (Frailty Index, FI, cut-offs 0.08 and 0.25), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI, cut-off >0) and participation (Global Activity Limitation Indicator, GALI, "limited" vs "not limited"). RESULTS Morbidity data were available for 4083 participants (52.7% female). HE was lower in women than in men at all ages. Differences in morbidity prevalence, absolute HE, and health proportions of life expectancy (relative HE) increased with age for FI ≥ 0.25 and GALI, but not for HAQ-DI > 0 and FI > 0.08. Accounting for the share of nursing home residents resulted in a slight reduction of HE estimates but had no impact on estimated sex differences. CONCLUSIONS In HE at age 65 and thereafter, women's health disadvantage was larger than their life expectancy advantage over men.
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Affiliation(s)
- Anna-Janina Stephan
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T Augsburg, Augsburg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany
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Comparative Dynamics of Individual Ageing among the Investigative Type of Professionals Living in Russia and Russian Migrants to the EU Countries. Eur J Investig Health Psychol Educ 2020; 10:749-762. [PMID: 34542509 PMCID: PMC8314298 DOI: 10.3390/ejihpe10030055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/22/2022] Open
Abstract
The goal of this study was to uncover the influence of professional activity, migration, and gender on dynamics of subjective age and ageing biomarkers. We examined the representatives of investigative types of professions (ITP), 30–75 years old in Russia, (101/62 women), and Russian migrants to the European Union, (101/56 women). ITPs appeared to be ageing slower than statistical standards; men age faster than women; the pre-retirement group (51–65 years old) showed acceleration of relative biological ageing in the Russian sample (women +4.5 years, men +10.7 years) against the EU sample, suggesting a boost of pre-retirement stress in Russia; subjectively, Russian people (51–65 years old) feel close to their chronological age, while EU people perceive themselves far below their calendar age (men—lower by 20.4, women—lower by 10.9 years). The subjective ageing depends on the country of residence, while biological ageing depends on occupation, gender, and negative expectations of retirement.
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