Is gender equality associated with a longer healthier life? Ecological evidence from 27 European countries

BACKGROUND

The association between gender equality and higher life expectancies has been described. Yet, little is known about its association with healthy life expectancy (HLE), or which domains are consistently associated with longer and healthier lives. We aimed to study the association between country-level gender equality, its domains and subdomains, with life expectancy and HLE in Europe, from 2013 to 2019.

METHODS

We combined life and HLE estimates from Eurostat with the Gender Equality Index and its 'work', 'knowledge', 'money', 'time' and 'power' domains and respective subdomains, for 27 European countries. Associations were estimated using panel data regression analyses adjusted for Gross Domestic Product, healthcare expenditure and Gini coefficient.

RESULTS

Higher life and healthy life expectancies were found in country years with higher gender equality, both for men and women. Associations were particularly consistent for the 'work' (βHLE-men = 0.59; βHLE-women = 0.59; P < 0.05) and 'power' domains (βHLE-men = 0.09; βHLE-women = 0.12, P < 0.01), especially for the 'work participation', 'political' and 'economic power' subdomains.

CONCLUSION

These results point to a country-level association between gender equality and life and healthy life expectancies, suggesting that gender disparities in 'work participation' and 'political' and 'economic power' play a role in the health of women and men through their aging course.

Research on the healthy life expectancy of older adult individuals in China based on intrinsic capacity health standards and social stratification analysis

Background

Based on the health standard of intrinsic capacity, this paper conducts an empirical study on the healthy life expectancy of older adult individuals aged 60 and older in China and analyzes the health inequities associated with different social characteristics to provide a reference for improving care for the older adult in China.

Methods

Data from the China Health and Retirement Longitudinal Study from 2011 to 2015 were used to evaluate the intrinsic capacity level of older adult individuals, and the multistate life table method was used to measure the healthy life expectancy of older adult individuals in China with the help of IMaCH software. Based on the theory of social stratification, the health inequality between older adult individuals in different social classes was analyzed in three dimensions: residence, income and education level.

Results

The calculation results show that the average life expectancy of the older adult in China at age 60 is 21.07 years, the healthy life expectancy is 16.89 years, and the healthy life expectancy accounts for 80.2% of the average life expectancy. The healthy life expectancy of older adult individuals with different social characteristics in China shows significant differences, and the healthy life expectancy of older adult individuals who are male, live in urban environments, have high levels of education and have middle- to high-income levels is significantly better than that of older adult individuals who are female, live in rural areas, have low levels of education and income.

Conclusion

Healthy life expectancy measured by intrinsic capacity as the health standard has a certain reference value, which reflects the overall health level of older adult individuals in China and expands the transformation and multidimensional understanding of the healthy thinking of older adult individuals in China. The analysis by social stratification reflects the large health inequities that exist in the older adult population in China.

Relationship between physical activity and locomotive syndrome among young and middle-aged Japanese workers

OBJECTIVES

This study aimed to examine the relationship between physical activity (PA) and locomotive syndrome (LS) among young and middle-aged Japanese workers.

METHODS

This cross-sectional study included 335 participants from a company in Kumamoto, Japan. LS was evaluated using the 25-question Geriatric Locomotive Function Scale (GLFS-25); a GLFS-25 score ≥7 was defined as LS. Weekly PA was measured using the International Physical Activity Questionnaire. Work-related PA (time spent sitting, standing, walking, and strenuous work per day) and sedentary breaks were measured using a Work-related Physical Activity Questionnaire. Screen usage (television [TV], smartphones, tablets, and personal computers) during leisure time was recorded. The association between PA and LS was examined using a multivariate logistic regression analysis adjusted for age, sex, body mass index, history of musculoskeletal disorders, cancer, stroke, occupation, employment type, work time, shift system, employment status, and body pain.

RESULTS

A total of 149 participants had LS. Fewer sedentary breaks during work (>70-minute intervals, odds ratio [OR] = 2.96; prolonged sitting, OR = 4.12) and longer TV viewing time (≥180 minutes, OR = 3.02) were significantly associated with LS. In contrast, moderate PA (OR = 0.75) was significantly associated with a lower risk of LS.

CONCLUSIONS

Fewer sedentary breaks during work and longer TV viewing time could increase the risk of LS in young and middle-aged Japanese workers.

Associations of Lower-Limb Phase Angle with Locomotion and Motor Function in Japanese Community-Dwelling Older Adults

Whole-body phase angle (PhA) is associated with motor function and geriatric diseases. However, it was unclear which parts of the upper- or lower-limb PhA were involved. This study investigated the differences in the PhA of the upper and lower extremities and their relationships with frailty, locomotive syndrome indices, and motor function in community-dwelling older adult participants. This study was a cross-sectional observational study. In 69 community-dwelling older adults, the PhA at each measurement site (whole body, upper limbs, and lower limbs), motor function, Kihon Checklist (KCL), and 25-Geriatric Locomotive Function Scale (GLFS-25) were measured. This study examined differences in each PhA and its relationship with motor function and geriatric diseases. Multiple regression analysis was performed using GLFS-25 as the dependent variable and sex and lower-limb PhA as independent variables. In this cohort (mean age: 72.3 ± 5.7 years; 18 males and 51 females), lower-limb PhA was significantly lower than upper-limb PhA. Unlike other PhAs, lower-limb PhA was related to grip strength, TUG, F/w, and GLFS-25. Multiple regression analysis showed that the lower-limb PhA was independently related to GLFS-25. Cellular health of the lower extremity is associated with gait, standing function, and indicators of locomotive syndrome.

A Gender Differentiated Analysis of Healthy Life Expectancy in South Asia: The Role of Greenhouse Gas Emission

The sluggish progress concerning SDG-9 and SDG 13 has made South Asia an epicentre of household and ambient greenhouse gases emissions. Furthermore, the regional progress concerning attainment of SDG-3 is considerably low. The major research objectives are twofold. First, to explore the impact of GHGs emissions from agriculture, transportation, and manufacturing sector on disaggregated life expectancy. Second, to examine the mitigating impact of renewable energy use, trade integration, and human capital development for practice policy recommendations. These research objectives are realized by employing recently advanced cross-sectional auto regressive distributed lag (CS-ARDL) model on panel data of five South Asian countries such as Bangladesh, India, Pakistan, Nepal, and Sri Lanka from 1990 to 2019. The estimation outcome reveals that the emissions from transportation, manufacturing, and agricultural sectors significantly deteriorate healthy life expectancy of male and female healthy life expectancy in South Asia with different intensity. Especially, we find that long-run impact of GHG is more profound on male healthy life expectancy than female life expectancy. The result further shows that renewable energy and human capital substantially improve healthy life expectancy, whereas the effects of trade integration are insignificant. The finding of moderating variables shows that renewable energy, human capital development, and trade integration have high potential to reduce GHGs emissions. The findings of this study urge South Asia for investments in human capital development and renewable energy along with fostering regional integration to decrease GHG and improve healthy life expectancy.

[Association between social participation and frailty among older adults: A longitudinal study from Japan Gerontological Evaluation Study]

Objective　In Japan, measures to prevent frailty among older adults have been implemented. Promotion of social participation is a key measure, but few longitudinal studies have examined the relationship between the types and number of social participation and frailty onset. In this study, we aimed to clarify the relationship between the types and number of social participation and frailty onset using longitudinal data from a large sample of older adults in municipalities in Japan.Methods　We used the 2016 and 2019 panel survey data from the Japan Gerontological Evaluation Study (JAGES). The analysis included 59,545 individuals from 28 municipalities who responded to the JAGES survey in both 2016 (at baseline) and 2019 (at follow-up). We excluded individuals who were dependent on activities of daily living at baseline and non-responders, and those who were frail or with no information about frailty. The dependent variable was frailty onset (≥8 out of 25 points on the basic checklist) at follow-up, and the independent variables were the types and number of types of social participation at baseline. We included 11 variables as potential confounders. We used multiple imputations to complete the missing values and used modified Poisson regression to examine the association between social participation and risk of frailty onset.Results　Of the 59,545 participants, 6,431 (10.8%) were frail onset at follow-up. After multiple imputations (minimum 64,212, maximum 64,287), the risk of frailty onset at follow-up was lower for eight types of social participation, excluding senior citizens' clubs, (nursing care [risk ratio; 0.91], paid work [0.90], volunteer groups [0.87], neighborhood associations [0.87], learning or cultural groups [0.87], activities intended to teach skills or pass experiences to others [0.85], hobby groups [0.81], and sports groups or clubs [0.80]; P<0.05), than no social participation. Additionally, individuals who participated in more types of social participation were at a lower risk of frailty than those with no social participation (P for trend <0.001).Conclusions　The risk of frailty onset was lower among individuals who participated in eight types of social participation at baseline and among those who participated in more types of social participation than those with no social participation. The results suggest that social participation is a useful measure to prevent frailty for extending healthy life expectancy.

Exploration of the Relationships between Men's Healthy Life Expectancy in Japan and Regional Variables by Integrating Statistical Learning Methods

A quantitative understanding of the relationship between comprehensive health levels, such as healthy life expectancy and their related factors, through a highly explanatory model is important in both health research and health policy making. In this study, we developed a regression model that combines multiple linear regression and a random forest model, exploring the relationship between men's healthy life expectancy in Japan and regional variables from open sources at the city level as an illustrative case. Optimization of node-splitting in each decision tree was based on the total mean-squared error of multiple regression models in binary-split child nodes. Variations of standardized partial regression coefficients for each city were obtained as the ensemble of multiple trees and visualized on scatter plots. By considering them, interaction terms with piecewise linear functions were exploratorily introduced into a final multiple regression model. The plots showed that the relationship between the healthy life expectancy and the explanatory variables could differ depending on the cities' characteristics. The procedure implemented here was suggested as a useful exploratory method for flexibly implementing interactions in multiple regression models while maintaining interpretability.

Impact of access to childhood health services on healthy life expectancy of the older population

Background

Life course theory provides new perspectives on the impact of early experiences on health in old age, where unfortunate childhood experiences can alter an individual's health trajectory. This study aims to calculate the healthy life expectancy of the older population in China under different childhood experiences, and to explore the influence of childhood medical and health services on the health level of older adults.

Methods

Differences in healthy life expectancy of the older population under different childhood experiences were analyzed using the multi-state life table method to calculate the healthy life expectancy by sex and place of birth, based on the cohort data of Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018.

Results

The probability of the transition risk from health to non-health gradually increased with age, while the probability of the transition risk from non-health to health decreased with age; In both urban and rural areas, on the probability of the transition risk from health to non-health, the older adults who were able to receive timely medical and health services in childhood were lower than those who failed to receive medical services in time (Z = -5.833, P < 0.05), but the probability of the transition risk from non-health to health was the opposite (Z = -5.334, P < 0.05); The probability of the transition risk from health to death is also higher in older adults who were unable to receive timely medical care in childhood (Z = -5.88, P < 0.05); The healthy life expectancy and its proportion in the remaining life expectancy of older people who received medical and health services in time during childhood were significantly higher than those of their peers (Z = -5.88, P < 0.05).

Conclusions

The lack of medical services in childhood has a negative effect on the health of older adults. The healthy life expectancy and its proportion of remaining life expectancy were higher for rural older adults than for urban older adults under the same health care conditions in childhood; the health benefits of good access to health care environment or conditions in childhood were greater for rural older females.

A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001-20

This study examines two decades of change in social inequalities in life and health expectancy among older adults in Australia, one of the few countries that escaped an economic recession during the global financial crisis. We compare adults aged 45+ across three measures of individual socio-economic position-education, occupation, and household wealth-and use multistate life tables to estimate total life expectancy (TLE) and life expectancy free of limiting long-term illness (LLTI-free LE) based on 20 waves of the Household, Income and Labour Dynamics in Australia Survey (2001-20). Our findings highlight substantial social disparities in both TLE and LLTI-free LE in Australia. Grouping individuals by household wealth shows striking differentials in LLTI-free LE. We observe widening social disparities in healthy longevity over time by all three measures of socio-economic position. This diverging trend in healthy longevity is troubling against the backdrop of widening income and wealth inequalities in Australia.

Fast walking and physical activity are independent contributors to improved physical function

BACKGROUND AND OBJECTIVES

To clarify whether the presence or absence of fast walking and habitual physical activity are independently associated with the incidence of functional disability.

METHODS

This historical cohort study was comprised of 9,652 (4,412 men, mean age 65 years) individuals aged 39-98 years without functional disability at baseline. Functional disability was determined based on the Japanese long-term care insurance system, which specified requirements for assistance in the activities of daily living. The impact of fast walking and habitual physical activity on the incidence of functional disability was analysed by Cox proportional hazards models.

RESULTS

The follow-up period was a median of 3.7 years during which 165 patients were newly certified as having functional disability. In the multivariate analysis, baseline age in 5-year increments (hazard ratio 2.42 [95% confidence interval 2.18-2.69]), no habitual physical activity (1.56 [1.07-2.27]), and not fast walking (1.89 [1.32-2.69]) significantly increased the risk of functional disability after adjustment for covariates. The stratified analysis showed that compared with physical activity (+), the impact of physical activity (-) on the incidence of functional disability was observed in those aged ≥75 years regardless of fast walking (+). Fast walking (-) significantly increased the risk of disability compared with fast walking (+) in those aged <75 years regardless of a physical activity habit.

CONCLUSION

In Japanese, slow walking speed and lack of a physical activity habit were shown to be independent risk factors for incident functional disability, with their impact differing according to age.

Relationship between Dietary Patterns and Subjectively Measured Physical Activity in Japanese Individuals 85 Years and Older: A Cross-Sectional Study

High-quality diets and regular physical activity (PA) are considered healthy behaviors (HBs). HBs are associated with many health outcomes and are expected to improve quality of life. Although implementing HBs is important, the relationship between dietary patterns (DPs) and PA has not been well investigated, especially among those aged ≥ 85. This study used data from the Tokyo Oldest Old survey on Total Health study to examine the relationship between DPs and PA in a cross-sectional study. The dietary survey used the brief self-administered diet history questionnaire to estimate the intake of 58 foods. After energy adjustment, principal component analysis was performed to identify major DPs. A validated questionnaire was used to evaluate PA, and linear regression analysis was used to investigate the association between DPs and PA, considering confounders. A total of 519 participants were included. Three major DPs (‘Various plant foods’, ‘Fish and mushrooms’, ‘Cooked rice and miso soup’) were identified. ‘Various plant foods’ was similar to DPs previously named ‘Healthy’ or ‘Prudent’, and its trend was positively associated with higher PA. This study observed the implementation of HBs even among those aged ≥ 85, suggesting that a trend toward a healthier diet is associated with higher PA.

[The social economic aspects of disability resulted from diseases of peripheral nervous system]

The diseases of peripheral nervous system (PNS diseases) are diagnosed in 48%-72% of workers in various branches of economy. They made up more than half of all occupational diseases and are the main cause of labor ability and of high level of disability able-bodied population. The purpose of the study is to assess social economic importance of disability because of PNS diseases of able-bodied population in the Republic of Bashkortostan. It is established that in 2014-2018 about 107 individuals of able-bodied age for the first time became disabled because of PNS diseases. The average annual level of individuals of able-bodied age with for the first time established disabilities because of PNS diseases made up to 0.1 cases per 10 thousand of population. Among the disabled 69.0 ± 5.4% are males. The disability rate in males (0.142o/ooo) is twice higher than in females (0.063o/ooo). The average age of the disabled is 48.7 ± 5.7 years. In the structure of disability dominate lumbosacral radiculopathy (50.9%), polyneuropathy of upper (15.3%) and lower (13.5%) extremities. In average, the disability develops in 11.3 years prior to age of 60 years and on 3.8-5.5 years earlier than in case of other diseases. The disability because of PNS diseases shortens healthy life expectancy by 16.0% in males and by 17.8% in females. Annual economic losses come to more than 26 million rubles of non-produced production. The disability because of PNS consists significant social economic problem of society and requires increased attention to prevention, early diagnostics, treatment, improvement of quality of medical social expertise, rehabilitation and habilitation.

Population-level impact of adverse early life conditions on adult healthy life expectancy in low- and middle-income countries

Evidence from theories of Developmental Origins of Health and Disease (DOHaD) suggests that experiencing adverse early life conditions subsequently leads to detrimental adult health outcomes. The bulk of empirical DOHaD literature does not consider the nature and magnitude of the impact of adverse early life conditions at the population level. In particular, it ignores the distortion of age and cohort patterns of adult health and mortality and the increased load of chronic illness and disability that ensues. In this paper, we use a microsimulation model combined with empirical estimates of incidence and prevalence of obesity, type 2 diabetes, and associated disability in low- and middle-income countries to assess the magnitude of delayed effects on adult healthy life expectancy and on compression (or expansion) of morbidity at older ages. The main goal is to determine if, in what ways, and to what extent delayed effects due to early conditions can influence cohorts' chronic illness and disability profiles.

Population-level impact of adverse early life conditions on adult healthy life expectancy in low- and middle-income countries

Evidence from theories of Developmental Origins of Health and Disease (DOHaD) suggests that experiencing adverse early life conditions subsequently leads to detrimental adult health outcomes. The bulk of empirical DOHaD literature does not consider the nature and magnitude of the impact of adverse early life conditions at the population level. In particular, it ignores the distortion of age and cohort patterns of adult health and mortality and the increased load of chronic illness and disability that ensues. In this paper, we use a microsimulation model combined with empirical estimates of incidence and prevalence of obesity, type 2 diabetes, and associated disability in low- and middle-income countries to assess the magnitude of delayed effects on adult healthy life expectancy and on compression (or expansion) of morbidity at older ages. The main goal is to determine if, in what ways, and to what extent delayed effects due to early conditions can influence cohorts' chronic illness and disability profiles.

Association between the Mediterranean Diet Score and Healthy Life Expectancy: A Global Comparative Study

OBJECTIVES

Extending healthy life expectancy (HALE), defined as the average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury, is a common topic worldwide. This study aims to clarify the relationships between the Mediterranean diet score (MDS) and life expectancy (LE) and HALE globally using publicly available international data.

SETTING

Analyses were conducted on 130 countries with populations of 1 million or more for which all data were available. Individual countries were scored from 0 to 9 to indicate adherence to the Mediterranean diet according to the MDS scoring method. The supply of vegetables, legumes, fruits and nuts, cereals, fish, and olive oil per 1,000 kcal per country was calculated based on the Food and Agriculture Organization Corporate Statistical Database, with a score of 1 for above the median and 0 for below. The same method was used to calculate scores of presumed detrimental components (meat and dairy), with consumption below the median given a value of 1, and consumption above the median given a value of 0. For ethanol, a score of 1 was given for 10g to 50 g of consumption. We investigated the cross-sectional associations between the MDS and LE and HALE at birth in 2009, and the longitudinal associations between the MDS in 2009 and LE and HALE between 2009 and 2019, controlling for covariates at baseline using linear mixed models.

RESULTS

In the cross-sectional analysis, the MDS was significantly positively associated with LE (β=0.906 [95% confidence interval, 0.065-1.747], p=0.037) and HALE (β=0.875 [0.207-1.544], p=0.011) after controlling for all covariates. The longitudinal analysis also revealed significantly positive associations between the MDS and LE (0.621 [0.063-1.178], p=0.030) and HALE (0.694 [0.227-1.161], p=0.004) after controlling for all covariates.

CONCLUSION

The present study, based on an analysis using 10 years of international data, showed that countries with a higher MDS showed a positive association with HALE.

[Healthy life expectancy of people over age 65: results of the Russian epidemiological study EVCALIPT.]

Population health is an important indicator of the general well-being of the population, and it has it's practical significance, as it determines the costs of providing care, social and medical assistance for the elderly. The study presents an assessment of healthy life expectancy indicators of people over age 65 based on the results of the Russian epidemiological study EVCALIPT and a comparison of this results with data from other surveys in Russia and European countries.

Tap Test Can Predict Cognitive Improvement in Patients With iNPH-Results From the Multicenter Prospective Studies SINPHONI-1 and -2

Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively. Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR). Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort. Conclusion: CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention. Clinical Trial Registration: SINPHONI-1 (ClinicalTrials.gov, no. NCT00221091), first posted: September 22, 2005. SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.

Novel approaches to pharmacological management of type 2 diabetes in Japan

INTRODUCTION

Newly developed anti-diabetic medications have had multiple activities, beyond a blood glucose-lowering effect. Current drugs for treating type 2 diabetes mellitus (T2DM) are based on the use of gastrointestinal hormones. Representative incretin preparations, such as those with glucagon-like peptide (GLP)-1 or gastric inhibitory polypeptide (GIP) activity, aim to provide new means of controlling blood glucose levels, body weight, and lipid metabolism.

AREA COVERED

In this manuscript, the pathophysiology of T2DM and the activities and characteristics of novel diabetic drugs are reviewed in the context of the Japanese population. This review also highlights the need for novel medicines to overcome the accompanying challenges. Finally, the author provides the reader with their expert perspectives.

EXPERT OPINION

The incidence of T2DM has been increasing in the aging of Japanese society. In older people, medical development should focus on safety, easier self-administration, and the relief of caregiver burden in terms of continuous administration. In the young, the focus should be on effectiveness, with a particular emphasis on the protection of organs, increasing the ease of adherence, and safety. Novel medicines will need to push the envelope in these areas.

Non-Hispanic Whites, 2000-2010

OBJECTIVES

To examine changes in Healthy Life Expectancy (HLE) against the backdrop of rising mortality among less-educated white Americans during the first decade of the twenty-first century.

METHODS

This study documented changes in HLE by education among U.S. non-Hispanic whites, using data from the U.S. Multiple Cause of Death public-use files, the Integrated Public Use Microdata Sample (IPUMS) of the 2000 Census and the 2010 American Community Survey, and the Health and Retirement Study (HRS). Changes in HLE were decomposed into contributions from: (i) change in age-specific mortality rates; and (ii) change in disability prevalence, measured via Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL).

RESULTS

Between 2000 and 2010, HLE significantly decreased for white men and women with less than 12 years of schooling. In contrast, HLE increased among college-educated white men and women. Declines or stagnation in HLE among less-educated whites reflected increases in disability prevalence over the study period, whereas improvements among the college educated reflected decreases in both age-specific mortality rates and disability prevalence at older ages.

DISCUSSION

Differences in HLE between education groups increased among non-Hispanic whites from 2000 to 2010. In fact, education-based differences in HLE were larger than differences in total life expectancy. Thus, the lives of less-educated whites were not only shorter, on average, compared with their college-educated counterparts, but they were also more burdened with disability.

Inequality in life expectancies across Europe and the US

We use harmonized household panel data from Europe and the US and a three-state survival model to provide comparable measurements of education and gender inequalities in total, healthy, and unhealthy life expectancies at age 50. Common across countries, the education advantage in total life expectancy is larger for males but the education advantage in (fewer) unhealthy years is larger for females. Counterfactual decompositions show that these results arise because the education advantage in conditional survival rates is relatively more important for males, while the education advantage in better health transitions is relatively more important for females. Across countries, the US stands out with the largest education gradient in healthy life expectancy.

Multi-State Analysis of the Impact of Childhood Starvation on the Healthy Life Expectancy of the Elderly in China

Background: Child malnutrition is not only common in developing countries but also an important issue faced by developed countries. This study aimed to explore the influence and degree of childhood starvation on the health of the elderly, which provides a reference for formulating health-related policies under the concept of full lifecycle health. Methods: Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2008, 2011, and 2014, this study took a total of 13,185 elderly people aged 65-99 years as the target population. By IMaCH software, with gender and income level as the control variables, the average life expectancy and healthy life expectancy of the elderly were measured. The x2test was used to explore the differences in the socioeconomic status of elderly people with or without starvation in childhood. Statistical differences between average life expectancy and healthy life expectancy were analyzed by rank tests. Results: (1) The results showed that there was a statistically significant difference in age, gender, residency, education level, and income level between the groups with or without starvation (P < 0.05). (2) Transition probabilities in health-disability, health-death, and disability-death all showed an upward trend with age (P < 0.05), where the elderly who experienced starvation in childhood were higher than those without such an experience (P < 0.05). However, the probability of disability-health recovery showed a downward trend with age (P < 0.05), in which the elderly who experienced starvation in childhood were lower than those without starvation (P < 0.05). (3) For the elderly who experienced starvation in childhood, the health indicators of the average life expectancy, healthy life expectancy, and healthy life expectancy proportion accounted for the remaining life were lower than those of the elderly without childhood starvation (P < 0.05). Conclusions: The average life expectancy and healthy life expectancy of the elderly with childhood starvation are lower than those without childhood starvation. It shows that the negative impact of childhood starvation on health through the life course till old age has a persistent negative cumulative effect on the quantity and quality of life. Therefore, it is important to pay attention to the nutritional status of children in poor families from the perspective of social policymaking.

Multidimensional healthy life expectancy of the older population in China

Research on healthy life expectancy (HLE) that considers cognitive impairment has been inadequate, particularly in the context of less developed countries. Using data from the China Health and Retirement Longitudinal Study, our study fills this research gap by computing active life expectancy (ALE), cognitive-impairment-free life expectancy (CIFLE), and active and cognitive-impairment-free life expectancy (ACIFLE) for China's older population, using multistate life tables. Results show that at age 60, the three life expectancies were 19.4 years (ALE), 9.5 years (CIFLE), and 8.8 years (ACIFLE) during the period 2011-13. HLE exhibits significant differentials by sex, urban/rural residence, educational level, marital status, and health status at age 60. Among China's older people, males and those living in urban areas experience higher CIFLE, and those who live with a spouse, are more educated, and are healthy at age 60 expect more years in good health according to all three HLE measures.Supplementary material for this article is available at: https://doi.org/10.1080/00324728.2021.1914854.

[Changes in trends of diseases requiring long-term care in an aging community]

Objectives　The purpose of this study was to identify the changes in trends of leading diseases that require long-term care within a 5-year period in an area with a rapidly growing aging population.Methods　Data were obtained from newly registered primary insured individuals for long-term care insurance in Sapporo Minami Ward. There were 2,538 participants in FY2018 and 4,089 in FY2013 and FY2014.　Disorders diagnosed by a primary doctor were categorized into groups using a long-term care questionnaire survey from the Comprehensive Survey of Living Conditions. The difference in the frequency of diseases between the survey years was examined using a chi-square test.Results　In men, there was no significant change in the frequency of diseases that require long-term care within the 5-year period. In women, the frequency of cerebrovascular diseases significantly reduced (7.8% for FY2013 and 2014 vs. 5.6% for FY2018; P=0.008) and fractures and falls significantly increased (9.5% vs. 13.8%; P=0.001).　Regarding the diseases in the severe-level category of long-term care insurance, malignancy was the most frequent disorder in men, followed by stroke. In women, the frequency of fractures and falls increased (10.5% vs. 17.7%; P=0.002) and subsequently became the most frequently occurring disorder. Similarly, the frequency of fractures and falls increased significantly (9.2% vs. 12.5%; P=0.004) in the mild-level long-term care insurance category.Conclusion　For women, fractures and falls increased within the 5-year period, indicating the need to introduce a prompt preventive program. Lifestyle-related diseases such as malignancy and cerebrovascular diseases have become the main reason for shortening a healthy lifespan. This finding highlights the importance of preventing lifestyle-related diseases.

Depression and Anxiety-Free Life Expectancy by Sex and Urban-Rural Areas in Jiangxi, China in 2013 and 2018

Objective: To quantitatively estimate life expectancy (LE) and depression and anxiety-free life expectancy (DAFLE) for the years 2013 and 2018 in Jiangxi Province, China, by sex and urban–rural areas. Additionally, to compare the discrepancy of DAFLE/LE of different sexes and urban-rural areas over various years. Methods: Based on the summary of the health statistics of Jiangxi Province in 2013 and 2018 and the results of the 5th and 6th National Health Service Surveys in Jiangxi Province, the model life table is used to estimate the age-specific mortality rate by sex and urban–rural areas. Sullivan’s method was used to calculate DAFLE. Results: Data from 2013 indicate that those aged 15 can expect to live 56.20 years without depression and anxiety for men and 59.67 years without depression and anxiety for women. Compared to 2013, DAFLE had not fluctuated significantly in 2018. The proportion of life expectancy without depression and anxiety (DAFLE/LE) declined between 2013 and 2018. DAFLE/LE in urban areas was higher than in rural areas. Men had higher DAFLE/LE than women. From 2013 to 2018, the DAFLE aged 15 decreased by 0.18 years for urban men and decreased by 0.52 years for urban women, rural areas also decreased to varying degrees. Conclusions: Even if women had a longer life span than men, they would spend more time with depression or anxiety. DAFLE did not increase with the increase in LE from 2013 to 2018, suggesting an absolute expansion of the burden, especially in rural areas. Depression and anxiety health services in Jiangxi, China will face more serious obstacles and challenges, which may lead to more disability. This requires more attention and more effective measures from the public, medical departments and the government.

The Significant Association between Health Examination Results and Population Health: A Cross-Sectional Ecological Study Using a Nation-Wide Health Checkup Database in Japan

In Japan, population health with life expectancy (LE) and healthy life expectancy (HALE) as indicators varies across the 47 prefectures (administrative regions). This study investigates how health examination results, including attitude toward improving life habits, are associated with population health. The association between health checkup variables and summary population health outcomes (i.e., life expectancy and healthy life expectancy) was investigated using a cross-sectional ecological design with prefectures as the unit of analysis. The medical records, aggregated by prefecture, gender, and age in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan, were used as health checkup variables. Body weight, blood pressure, liver enzymes, drinking habits, smoking habits, diabetes, serum lipids, and answers to questions regarding attitude toward improving health habits were significantly correlated to population health outcomes. Multiple regression analysis also revealed significant influence of these variables on population health. This study highlights that health examination results, including attitude toward improving health habits, are positively associated with population health. Consequently, implementing measures to improve health habits in response to the examination results could help the population maintain a healthy life.

Current status and issues concerning Health Japan 21 (second term)

The national health promotion program, Health Japan 21 (second term), began in 2013. This program has set 5 basic goals: to extend healthy life expectancy and reduce health disparity, to prevent noncommunicable disease, to improve function for social life, to establish a social environment for health, and to improve lifestyle. To achieve these goals, Health Japan 21 (second term) set 53 targets for the period between 2013 and 2022. At the interim evaluation in 2018, only 21 of the 53 targets were judged likely to be achieved by 2022. In addition, 18 targets were judged as unchanged, and 1 target was judged to be deteriorating. Thus, to achieve the goals of Health Japan 21 (second term), further efforts to strengthen health promotion programs across Japan are needed.

History of nutrition policy in Japan

Why has Japan become the longest-lived country in the world? The longevity is often attributed to Japan's economic growth, but Japan experienced an extended life expectancy prior to achieving such economic growth. During and after the Second World War when the General Headquarters of the Supreme Commander for the Allied Powers was occupying Japan, the welfare administration system was drastically reformed, resulting in dramatic improvements in the hygiene status, which led to an increase in the average life expectancy in Japan. Here, this background is reviewed, along with an explanation of how Japan has become the world's longest-lived country.

Predictors of (in)efficiencies of Healthcare Expenditure Among the Leading Asian Economies - Comparison of OECD and Non-OECD Nations

Purpose

The goal of this study was to assess the effectiveness of healthcare spending among the leading Asian economies.

Methods

We have selected a total of nine Asian nations, based on the strength of their economic output and long-term real GDP growth rates. The OECD members included Japan and the Republic of Korea, while the seven non-OECD nations were China, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand. Healthcare systems efficiency was analyzed over the period 1996–2017. To assess the effectiveness of healthcare expenditure of each group of countries, the two-way fixed effects model (country- and year effects) was used.

Results

Quality of governance and current health expenditure determine healthcare system performance. Population density and urbanization are positively associated with a healthy life expectancy in the non-OECD Asian countries. In this group, unsafe water drinking has a statistically negative effect on healthy life expectancy. Interestingly, only per capita consumption of carbohydrates is significantly linked with healthy life expectancy. In these non-OECD Asian countries, unsafe water drinking and per capita carbon dioxide emissions increase infant mortality. There is a strong negative association between GDP per capita and infant mortality in both sub-samples, although its impact is far larger in the OECD group. In Japan and South Korea, unemployment is negatively associated with infant mortality.

Conclusion

Japan outperforms other countries from the sample in major healthcare performance indicators, while South Korea is ranked second. The only exception is per capita carbon dioxide emissions, which have maximal values in the Republic of Korea and Japan. Non-OECD nations’ outcomes were led by China, as the largest economy. This group was characterized with substantial improvement in efficiency of health spending since the middle of the 1990s. Yet, progress was noted with remarkable heterogeneity within the group.

Occupational Exposures Associated with Life Expectancy without and with Disability

Policies to extend working lives often do not take into account potentially important health inequalities arising from differences in occupational exposures. Little is known about which occupational exposures are associated with these inequalities. This study aims to examine differences in life expectancy without and with disability by occupational exposures. Longitudinal data (1992–2016) on disability and physical and psychosocial work demands and resources of 2513 (former) workers aged ≥55 years participating in the Longitudinal Aging Study Amsterdam were used. Gender specific life expectancies without and with disability by occupational exposures were calculated using multistate survival models. Women aged 55 years with high physical work demands had a lower life expectancy without disability than those with low exposure (1.02–1.57 years), whereas there was no difference for men. Men and women with high psychosocial work demands and resources had a longer life expectancy without disability than those with low exposure (1.19–2.14 years). Life expectancy with disability did not significantly differ across occupational exposures. Workers with higher psychosocial demands and resources and lower physical demands can expect to live more disability-free years. Information on occupational exposure helps to identify workers at risk for lower life expectancy, especially without disability, who may need specific support regarding their work environment.

Associations Between Healthcare Resources and Healthy Life Expectancy: A Descriptive Study across Secondary Medical Areas in Japan

Japan has the highest life expectancy in the world. However, this does not guarantee an improved quality of life. There is a gap between life expectancy and healthy life expectancy. This study aimed to reveal the features of healthy life expectancy across all secondary medical areas (n = 344) in Japan and examine the relationship among healthcare resources, life expectancy, and healthy life expectancy at birth. Data were collected from Japan’s population registry and long-term insurance records. Differences in healthy life expectancy by gender were calculated using the Sullivan method. Maps of healthy life expectancy were drawn up. Descriptive statistics and correlation analysis were used for analysis. The findings revealed significant regional disparities. The number of doctors and therapists, support clinics for home healthcare facilities and home-visit treatments, and dentistry expenditure per capita were positively correlated with life expectancy and healthy life expectancy (correlation coefficients > 0.2). They also revealed gender differences. Despite controlling for population density, inequalities in healthy life expectancy were observed, highlighting the need to promote social policies to reduce regional disparities. Japanese policymakers should consider optimal levels of health resources to improve life expectancy and healthy life expectancy. The geographical distribution of healthcare resources should also be reconstituted.

Living longer but not necessarily healthier: The joint progress of health and mortality in the working-age population of England

Despite improvements in life expectancy, there is uncertainty on whether the increase in years of healthy life expectancy has kept pace. In this paper we explore whether there is empirical support for the expansion of morbidity hypothesis in the population aged 25-64 living in England. Nationally representative cohorts born between 1945 and 1980 are constructed from repeated annual cross-sections of the Health Survey for England, 1991-2014. Later-born cohorts at a given age have the same or higher prevalence of self-reported bad general health and long-term illness, self-reported high blood pressure (in men), self-reported and objectively-measured diabetes, circulatory illnesses, clinical hypertension, and overweight BMI. We also find that healthy life expectancies (in the sense of absence of each of these problems) at age 25 have increased at a slower pace than life expectancy between 1993 and 2013. Our findings lend support to the expansion of morbidity hypothesis and point to increased future demand for specific healthcare services at younger ages.

Healthy Life Expectancies by the Effects of Hypertension and Diabetes for the Middle Aged and Over in Taiwan

(1) Introduction: This study aims to investigate the disparity in the healthy life expectancy of the elderly with hypertension and diabetes mellitus. (2) Materials and Methods: This study used survey data collected in five waves (1996, 1999, 2003, 2007, and 2011) of the “Taiwan Longitudinal Study on Aging” (TLSA) to estimate the life expectancy and healthy life expectancy of different age groups. The activities of daily living, the health condition of hypertension and diabetes and the survival statuses of these cases were analyzed by the IMaCh (Interpolated Markov Chain) and logistic regression model. (3) Results: As regards the elderly between age 50 and 60 with hypertension and diabetes, women with hypertension only exhibited the longest life expectancy, and the healthy life expectancy and the percentage of remaining life with no functional incapacity were 33.74 years and 87.11%, respectively. In contrast, men with diabetes only showed the shortest life expectancy, and the healthy life expectancy and the percentage of remaining life with no functional incapacity were 22.51 years and 93.16%, respectively. We also found that people with diabetes showed a lower percentage of remaining life with no functional incapacity. (4) Conclusions: We suggest that policymakers should pay special attention to publicizing the importance of health control behavior in order to decrease the risk of suffering diseases and to improve the elderly’s quality of life.

Educational Inequalities in Life and Healthy Life Expectancies among the 50-Plus in Spain

This study computes educational inequalities in life expectancy (LE), healthy life expectancy (HLE), and unhealthy life expectancy (ULE) by gender and education level in Spain in 2012. Death registrations and vital status by level of education were obtained from Spain’s National Institute of Statistics. Health prevalences were estimated from the National Health Survey for Spain. We used Sullivan’s method to compute HLE, ULE, and the proportion of time lived with health problems. Our results reveal that Spanish women live longer than men in all education groups, but a higher proportion of women report poor health. We detect substantial differences in unhealthy life by gender and education, with higher effect for women and for those with low levels of education. Poor self-perceived health shows the largest educational gradient; chronic diseases present the lowest. This is the first work that provides evidence on health inequalities by education level in Spain. Our findings seem to be in line with reports of the smaller social inequalities experienced in Southern Europe and highlight the importance of education level on extending the proportion of years spent in good health in a Mediterranean country.

Ageism, Healthy Life Expectancy and Population Ageing: How Are They Related?

Evidence shows that ageism negatively impacts the health of older adults. However, estimates of its prevalence are lacking. This study aimed to estimate the global prevalence of ageism towards older adults and to explore possible explanatory factors. Data were included from 57 countries that took part in Wave 6 of the World Values Survey. Multilevel Latent Class Analysis was performed to identify distinct classes of individuals and countries. Individuals were classified as having high, moderate or low ageist attitudes; and countries as being highly, moderately or minimally ageist, by aggregating individual responses. Individual-level (age, sex, education and wealth) and contextual-level factors (healthy life expectancy, population health status and proportion of the population aged over 60 years) were examined as potential explanatory factors in multinomial logistic regression. From the 83,034 participants included, 44%, 32% and 24% were classified as having low, moderate and high ageist attitudes, respectively. From the 57 countries, 34 were classified as moderately or highly ageist. The likelihood of an individual or a country being ageist was significantly reduced by increases in healthy life expectancy and the proportion of older people within a country. Certain personal characteristics—younger age, being male and having lower education—were significantly associated with an increased probability of an individual having high ageist attitudes. At least one in every two people included in this study had moderate or high ageist attitudes. Despite the issue’s magnitude and negative health impacts, ageism remains a neglected global health issue.

[Multidisciplinary Approach to Aging]

Age-related decreases of various physiological functions have significant influence on activities of daily living (ADL) and QOL in elderly populations. Mechanisms of aging are currently the focus of many researchers in a wide range of studies. Researchers are trying to find novel ways to attenuate or delay aging in humans as well as to develop interventions for age-associated diseases. In this review, we briefly discuss the need for a multidisciplinary approach in aging research.

Self-Rated Healthy Life Expectancy Changes in Jiangxi Province of China by Gender and Urban-Rural Differences, 2013-2018

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.

Healthy Life Expectancy in 2010 for Native Hawaiian, White, Filipino, Japanese, and Chinese Americans Living in Hawai'i

Healthy life expectancy (HALE) varies substantially among countries, regions, and race/ethnicities. Utilizing the Sullivan method, this article examines HALE for Native Hawaiian, White, Filipino, Japanese, and Chinese Americans living in Hawai'i, the United States. HALE varies by sex and race/ethnicity. The HALE at birth in 2010 for females was 78.3, 77.8, 74.2, 73.7, and 62.6 years in contrast to life expectancy of 90, 88, 88.1, 83.4, and 79.4 for Chinese, Japanese, Filipino Americans, White, and Native Hawaiians, respectively. In the same order, HALE at birth for males was 73.0, 71.6, 72.3 70.7, and 60.7 years, compared with life expectancy of 85.3, 81.2, 80.8, 78.3, and 73.9. The gaps in HALE between Native Hawaiians and the longest living Chinese Americans were 15.7 years for females and 12.3 years for males. Our results highlight sex and racial/ethnic disparities in HALE, which can inform program and policy development.

Background Risk Factors Associated with Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus: A Nationwide Hospital-Based Survey in Japan

Background:

Patients with idiopathic normal-pressure hydrocephalus (iNPH) are typically older adults with multiple comorbidities that are associated with a reduction in the efficacy of iNPH treatment via cerebrospinal fluid (CSF) shunt placement.

Objective:

The present study aimed to investigate the effectiveness of CSF shunt for iNPH using data from a nationwide epidemiological survey in Japan.

Methods:

We examined 1,423 patients (581 women) aged ≥60 years (median age [25%–75%]: 77 [73–80] years) who were diagnosed with iNPH following a hospital visit in 2012. Patients who experienced an improvement of at least one modified Rankin Scale (mRS) grade after the CSF shunt were classified as “improvement” while the remaining patients were classified as “non-improvement.” The efficacy of the shunt intervention (n = 842) was analyzed using a binomial logistic regression analysis.

Results:

An analysis of risk factors associated with shunt placement in patients with mRS grade 2 revealed an association between comorbid chronic ischemic lesions (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11–4.67; p = 0.025) and cervical spondylosis (OR, 3.62; 95% CI, 1.15–11.34; p = 0.027). Patients with mRS grade 3 at study entry had an association with comorbid Alzheimer’s disease (OR, 3.02; 95% CI, 1.44–6.31; p = 0.003).

Conclusions:

The results presented here showed that any age-related risk is minimal and should not be cause for rejection of surgical treatment options. Clinical decisions regarding CSF shunt should be individualized to each patient, with adequate consideration of the relative risks and benefits, including maximizing a healthy life expectancy.

Traditional Japanese Diet Score - Association with Obesity, Incidence of Ischemic Heart Disease, and Healthy Life Expectancy in a Global Comparative Study

OBJECTIVES

We created a Traditional Japanese Diet Score (TJDS), and to clarify the relationship between TJDS and obesity, ischemic heart disease (IHD), and healthy life expectancy (HALE).

DESIGN

Ecological study.

SETTING

Food (g/day/capita) and energy (kcal/day/capita) supply was determined using the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characteristic traditional Japanese foods (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, eggs, and seaweeds; food components rarely used in the Japanese diet: wheat, milk, and red meat) was divided as tertiles (beneficial food components: -1, 0, 1; rarely used food components: 1, 0, -1). Obesity rate was determined using the World Health Organization database. Incidence of IHD, HALE and smoking rate were determined using the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 database. Gross domestic product per capita, percentage of population > 65 years old, and health expenditure were determined using the World Bank database. Education years were obtained from the United Nations Educational, Scientific and Cultural Organization Institute for Statistics. Associations between TJDS and obesity, IHD and HALE were examined in 132 countries with a population of 1 million or greater using a general linear model controlled for co-variables.

RESULTS

TJDS was distributed from -6 to 7. TJDS was inversely correlated to obesity (β±SE; -0.70±0.19, p<0.001), IHD (-19.4±4.3, p<0.001), and positively correlated to HALE (0.40±0.14, p<0.01).

CONCLUSIONS

TJDS is a good indicator of a healthy diet, and applies to preventing obesity, IHD and extending HALE.

The Influence of Universal Health Coverage on Life Expectancy at Birth (LEAB) and Healthy Life Expectancy (HALE): A Multi-Country Cross-Sectional Study

Background: There are substantial differences in long term health outcomes across countries, particularly in terms of both life expectancy at birth (LEAB) and healthy life expectancy (HALE). Socio-economic status, disease prevention approaches, life style and health financing systems all influence long-term health goals such as life expectancy. Within this context, universal health coverage (UHC) is expected to influence life expectancy as a comprehensive health policy. The aim of the study is to investigate this relationship between Universal Health Coverage (UHC) and life expectancy. Method: A multi-country cross-sectional study was performed drawing on different sources of data (World Health Organization, UNDP-Education and World Bank) from 193 UN member countries, applying administrative record linkage theory. Descriptive statistics, t-tests, Pearson correlations, hierarchical linear regressions were utilized as appropriate. Result: Global average healthy life years was shown to be 61.34 ± 8.40 and life expectancy at birth was 70.00 ± 9.3. Standardized coefficients from regression analysis found UHC (0.34), child vaccination (Diphtheria Pertussis Tetanus-3: 0.17) and sanitation coverage (0.31) were associated with significantly increased life expectancy at birth. In contrast, population growth was associated with a decrease (0.29). Likewise, unit increases in child vaccination (DPT 3), sanitation and UHC would increase healthy life expectancy considerably (0.18, 0.31, and 0.40 respectively), whereas the same for population growth reduces healthy life expectancy by 0.28. Conclusion: Universal Health Coverage (UHC) is a comprehensive health system approach that facilitates a wide range of health services and significantly improves the life expectancy at birth and healthy life expectancy. This study suggests that specific programs to achieve UHC should be considered for countries that have not seen sufficient gains in life expectancy as part of the wider push to achieve the Sustainable Development Goal (SDG).

Satisfaction with dietary life affects oral health-related quality of life and subjective well-being in very elderly people

Age-related deterioration in physical and oral health reduces healthy life expectancy and is thus an important problem for very elderly people. We investigated the effects of satisfaction with dietary life (SDL) in everyday life on oral health-related quality of life (OHRQoL) and subjective well-being and examined associations between these factors. We evaluated 426 elders aged 85 years or older. All participants completed a questionnaire that inquired about age, gender, drinking status, body mass index, cognitive function, disability, and comorbidities, among other covariates. Oral, physical, and mental health conditions were also examined. Associations of questionnaire results for SDL with items on subjective well-being (Philadelphia Geriatric Center Morale Scale [PGC] and World Health Organization-5 [WHO-5]) and OHRQoL (Geriatric Oral Health Assessment Index [GOHAI]) were confirmed with multiple logistic regression analysis. In a multivariate model adjusted for various confounders, participants with self-reported "enjoyable" SDL had significantly lower risks for having the lowest scores on the GOHAI, PGC, and WHO-5 (odds ratio [OR] = 0.460, 95% confidence interval [CI] = 0.277-0.762; OR = 0.589, 95% CI = 0.348-0.996; and OR = 0.452, 95% CI = 0.263-0.775, respectively). These associations remained after further adjustment for number of teeth.

A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States

OBJECTIVE

This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States.

METHOD

This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables.

RESULTS

Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles.

DISCUSSION

Japan's compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States.

Towards a postponement of activities of daily living dependence and mobility limitations: Trends in healthy life years in old age in Sweden

AIMS

To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980-2011 using the health indicators activities of daily living (ADL) and mobility limitations within the framework of the postponement, compression and expansion theories.

METHODS

Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Surveys of Living Conditions, conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE and a decomposition into mortality and disability effects was made.

RESULTS

Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980-1985 to 2006-2011. HLE65 calculated according to ADL and mobility limitations increased more rapidly than LE65 for both men and women ( p<0.05).

CONCLUSIONS

Our results for trends in the Swedish LE65 and HLE65, computed on the basis of ADL and mobility limitations and using the Swedish Surveys of Living Conditions study, are in line with the postponement hypothesis and there is also a tendency for compression. Thus the years with ADL dependence and mobility limitations are postponed to a higher age and the numbers of these years have decreased.

Decennial trends and inequalities in healthy life expectancy: The HUNT Study, Norway

AIMS

Norway is experiencing a rising life expectancy combined with an increasing dependency ratio - the ratio of those outside over those within the working force. To provide data relevant for future health policy we wanted to study trends in total and healthy life expectancy in a Norwegian population over three decades (1980s, 1990s and 2000s), both overall and across gender and educational groups.

METHODS

Data were obtained from the HUNT Study, and the Norwegian Educational Database. We calculated total life expectancy and used the Sullivan method to calculate healthy life expectancies based on self-rated health and self-reported longstanding limiting illness. The change in health expectancies was decomposed into mortality and disability effects.

RESULTS

During three consecutive decades we found an increase in life expectancy for 30-year-olds (~7 years) and expected lifetime in self-rated good health (~6 years), but time without longstanding limiting illness increased less (1.5 years). Women could expect to live longer than men, but the extra life years for females were spent in poor self-rated health and with longstanding limiting illness. Differences in total life expectancy between educational groups decreased, whereas differences in expected lifetime in self-rated good health and lifetime without longstanding limiting illness increased.

CONCLUSIONS

The increase in total life expectancy was accompanied by an increasing number of years spent in good self-rated health but more years with longstanding limiting illness. This suggests increasing health care needs for people with chronic diseases, given an increasing number of elderly. Socioeconomic health inequalities remain a challenge for increasing pensioning age.

Describing the population health burden of depression: health-adjusted life expectancy by depression status in Canada

INTRODUCTION

Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL) on the overall population. Health-adjusted life expectancy (HALE) is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population.

METHODS

We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS) participants 20 years and older (n = 12 373) were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007-2009). The Canadian Community Health Survey (2009/10) provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex.

RESULTS

For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2-43.8) compared to 57.0 years (95% CI: 56.8-57.2) for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5-41.5) for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6-54.0) for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The 14.8 fewer years of HALE observed for men with depression equated to a 13.0-year HRQOL gap and a 1.8-year mortality gap.

CONCLUSION

The population of adult men and women with depression in Canada had substantially lower healthy life expectancy than those without depression. Much of this gap is explained by lower levels of HRQOL, but premature mortality also plays a role.

A Framework for Monitoring Progress Using Summary Measures of Health

OBJECTIVE

Initiatives designed to monitor health typically incorporate numerous specific measures of health and the health system to assess improvements, or lack thereof, for policy and program purposes. The addition of summary measures provides overarching information which is essential for determining whether the goals of such initiatives are met.

METHOD

Summary measures are identified that relate to the individual indicators but that also reflect movement in the various parts of the system.

RESULTS

A hierarchical framework that is conceptually consistent and which utilizes a succinct number of summary measures incorporating indicators of functioning and participation is proposed.

DISCUSSION

While a large set of individual indicators can be useful for monitoring progress, these individual indicators do not provide an overall evaluation of health, defined broadly, at the population level. A hierarchical framework consisting of summary measures is important for monitoring the success of health improvement initiatives.

Smoking, physical inactivity and obesity as predictors of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study

Background: Smoking, physical inactivity and obesity are modifiable risk factors for morbidity and mortality. The aim of this study was to examine the extent to which the co-occurrence of these behaviour-related risk factors predict healthy life expectancy and chronic disease-free life expectancy in four European cohort studies.

Methods: Data were drawn from repeated waves of four cohort studies in England, Finland, France and Sweden. Smoking status, physical inactivity and obesity (body mass index ≥30 kg/m²) were examined separately and in combination. Health expectancy was estimated by using two health indicators: suboptimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years.

Results: Compared with men and women with at least two behaviour-related risk factors, those with no behaviour-related risk factors could expect to live on average8 years longer in good health and 6 years longer free of chronic diseases between ages 50 and 75. Having any single risk factor was also associated with reduction in healthy years. No consistent differences between cohorts were observed.

Conclusions: Data from four European countries show that persons with individual and co-occurring behaviour-related risk factors have shorter healthy life expectancy and shorter chronic disease-free life expectancy. Population level reductions in smoking, physical inactivity and obesity could increase life-years lived in good health.

Inequalities in healthy life expectancy between ethnic groups in England and Wales in 2001

OBJECTIVES

We aim to develop robust estimates of disability-free life expectancy (DFLE) and healthy life expectancy (HLE) for ethnic groups in England and Wales in 2001 and to examine observed variations across ethnic groups.

DESIGN

DFLE and HLE by age and gender for five-year age groups were computed for 16 ethnic groups by combining the 2001 Census data on ethnicity, self-reported limiting long-term illness and self-rated health using mortality by ethnic group estimated by two methods: the Standardised Illness Ratio (SIR) method and the Geographically Weighted Method (GWM).

RESULTS

The SIR and GWM methods differed somewhat in their estimates of life expectancy (LE) at birth but produced very similar estimates of DFLE and HLE by ethnic group. For the more conservative method (GWM), the range in DFLE at birth was 10.5 years for men and 11.9 years for women, double that in LE. DFLE at birth was highest for Chinese men (64.7 years, 95% CI 64.0-65.3) and women (67.0 years, 95% CI 66.4-67.6). Over half of the ethnic minority groups (men: 10; women: 9) had significantly lower DFLE at birth than White British men (61.7 years, 95% CI 61.7-61.7) or women (64.1 years, 95% CI 64.1-64.2), mostly the Black, Asian and mixed ethnic groups. The lowest DFLE observed was for Bangladeshi men (54.3 years, 95% CI 53.7-54.8) and Pakistani women (55.1 years, 95% CI 54.8-55.4). Notable were Indian women whose LE was similar to White British women but who had 4.3 years less disability-free (95% CI 4.0-4.6).

CONCLUSIONS

Inequalities in DFLE between ethnic groups are large and exceed those in LE. Moreover, certain ethnic groups have a larger burden of disability that does not seem to be associated with shorter LE. With the increasing population of the non-White British community, it is essential to be able to identify the ethnic groups at higher risk of disability, in order to target appropriate interventions.

Socioeconomic status, comorbidity, activity limitation, and healthy life expectancy in older men and women: a 6-year follow-up study in Japan

This study aimed to explore the structural contributions of socioeconomic status (SES), comorbidity, and activity limitation to the healthy life expectancy (HALE) of Japanese suburban elderly. A questionnaire survey was distributed to all residents aged 65 years and older in Tama City, Tokyo, in 2001; a follow-up study was conducted in 2004; and individual vital status data from the municipal residents' registry were tracked until 2007. In all, 7,905 respondents were included for analysis. Data analysis was performed by structural equation modeling (SEM). The data were well fit by the models, and HALE was found to be well explained by SES, comorbidity, and activity limitation (R (2) = .59 for men and R (2) = .71 for women). In conclusion, elderly people with higher SES were more likely to live longer with good self-rated health, via living with less chronic diseases and better performance in daily living activities, especially for elderly women.

Cross-national disparities in sex differences in life expectancy with and without frailty

BACKGROUND

with continued ageing, levels of frailty are an increasing concern. Women live longer than men, but how life expectancies (LE) with frailty differ between men and women and whether sex differences are the same for all European countries is unknown.

OBJECTIVE

to compare sex differences in LE in phenotypic frailty categories and disability at age ≥50 between European countries.

DESIGN

the Survey of Health, Ageing and Retirement in Europe (SHARE).

SUBJECTS

a total of 50,351 people aged ≥50 from SHARE wave 4 (included countries: Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Hungary, Italy, the Netherlands, Poland, Portugal, Slovenia, Spain, Sweden).

METHODS

the SHARE Frailty Instrument for Primary Care and the Global Activity Limitation Indicator were combined to define four phenotypic frailty and disability categories: robust, pre-frail, frail and severely limited. LEs with each state by sex and country were calculated using Sullivan's method.

RESULTS

at age 70, the LE robust ranged from 4.1 to 10.4 years (men) and 3.0 to 8.9 years (women), LE pre-frail from 0.8-3.1 years (men) and 2.2-5.5 years (women), LE frail from 0.1-1.8 years (men) and 0.4-5.5 years (women) and LE with severe activity limitation from 1.9 to 4.4 years (men) and 2.9 to 7.5 years (women). At all ages and both sexes the fewest years were spent frail.

CONCLUSIONS

this study is the first to compare differences in LE in frailty categories across European countries. In most European countries, years spent robust (free of frailty or limitation) are significantly less for women than men, perhaps due to socio-economic as well as biological factors.