Achieving national health objectives: the impact on life expectancy and on healthy life expectancy

Our study quantifies the impact of achieving specific Healthy People 2010 targets and of eliminating racial/ethnic health disparities on summary measures of health. We used life table methods to calculate gains in life expectancy and healthy life expectancy that would result from achievement of Healthy People 2010 objectives or of current mortality rates in the Asian/Pacific Islander (API) population. Attainment of Healthy People 2010 mortality targets would increase life expectancy by 2.8 years, and reduction of population wide mortality rates to current API rates would add 4.1 years. Healthy life expectancy would increase by 5.8 years if Healthy People 2010 mortality and assumed morbidity targets were attained and by 8.1 years if API mortality and activity limitation rates were attained. Achievement of specific Healthy People 2010 targets would produce significant increases in longevity and health, and elimination of racial/ethnic health disparities could result in even larger gains.     

Measuring the impact of HIV/AIDS, heart disease and malignant neoplasms on life expectancy in the USA from 1987 to 2000

OBJECTIVES: Quantifying the impact of a disease on society is an important issue for setting priorities for better allocation of healthcare resources and for evaluating the effectiveness of prevention and control of the disease. STUDY DESIGN: The potential gains in life expectancy due to the elimination of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), heart disease and malignant neoplasms were compared for the US population by age and ethnicity from 1987 to 2000. METHODS: The potential gain in life expectancy after hypothetical elimination of cause-specific deaths is an effective indicator of measuring the impact of a disease on a population. Official age-specific mortality rates, by ethnicity, due to HIV/AIDS, heart disease and malignant neoplasms of the US population from the National Center for Health Statistics were used, and multiple decremental life tables were constructed to find the corresponding potential gains in life expectancy. RESULTS: The potential gains in life expectancy for the US population at birth by complete elimination of HIV/AIDS, heart disease and malignant neoplasms were 0.14, 3.71 and 3.06 years in 1987, respectively. In 1995, the potential gain in life expectancy due to the elimination of HIV/AIDS increased from 0.14 years in 1987 and achieved its highest value (0.41 years), whereas the elimination of heart disease and malignant neoplasms led to potential gains in life expectancy of 3.05 and 3.10 years, respectively. Since 1995, the potential gains in life expectancy at birth by eliminating deaths from HIV/AIDS and heart disease have decreased to 0.13 and 2.67 years, respectively, in 2000. However, the potential gain in life expectancy due to elimination of malignant neoplasms remained relatively stable (3.01 years in 2000). It is well known that HIV/AIDS tends to have a greater impact on people of working age, whereas heart disease and malignant neoplasms have a greater impact on people over 65 years of age. To measure the impact of these diseases on life expectancy in people of working age, a partial multiple decremental life table was constructed and the potential gains in life expectancy were computed by partial or complete elimination of various causes of death during the working years. shows the impact on life expectancy of the US working-age population by eliminating deaths from HIV/AIDS, heart disease and malignant neoplasms by race and sex groups. CONCLUSIONS: Since 1995, there has been a rapid reduction in the burden of HIV/AIDS on the life expectancy for the US population, especially for black males of working age. These results could provide useful information when evaluating public health improvements and allocating resources for future disease control programmes.     

Contributions of mortality changes by age group and selected causes of death to the increase in Japanese life expectancy at birth from 1950 to 2000

The purpose of this study is to analyze contributions of mortality change by age group and selected causes of death to the increase in life expectancy at birth from 1950 to 2000 in Japan, which has the longest longevity in the world. Using mortality data from Japanese vital statistics from 1950 to 2000, we analyzed contributions of mortality change by age group and selected causes of death to the increase in life expectancy at birth by the method of decomposition of changes and calculated age-adjusted death rates for selected causes of death. Gastroenteritis, tuberculosis and pneumonia largely contributed to an increase in life expectancy in childhood and in the young in the 1950s and 1960s. The largest contributing disease changed from tuberculosis and pneumonia in earlier decades to cerebrovascular diseases in the 1970s. The largest contributing age group also shifted to older age groups. Age-adjusted death rate for cerebrovascular diseases in 2000 was one fifth of the 1965 level. Cerebrovascular diseases contributed to an increase in life expectancy at birth of 2.9years in males and 3.1 years in females from 1970 to 2000. In the 1990s, the largest contributing age group, both among males and among females, was the 75–84 age group. Of the selected causes of death, heart diseases other than ischemic heart disease became the largest contributor to the increase in life expectancy at birth. Unlike cerebrovascular diseases, cancer and ischemic heart disease contributed little to change in life expectancy at birth over the past 50years. In conclusion, although mortality from ischemic heart disease has not increased since 1970 and remained low compared with levels in western countries, mortality from cerebrovascular diseases has dramatically decreased since the mid-1960s in Japan. This gave Japan the longest life expectancy at birth in the world. It is necessary to study future trends in life expectancy at birth in Japan.     

Epidemiologic indicators of health status to guide health care management decision making

Health objectives, developed by the United States Department of Health and Human Services, were published recently in the document entitled Healthy People 2000: National Health Promotion and Disease Prevention Objectives. They were developed to guide national and local health policy toward actions to increase the health of the nation. To effectively apply these objectives locally, epidemiologists and health planners must work together. Through collaboration, the Healthy People 2000 objectives can be prioritized to guide health policy and planning on a regional basis. The purpose of this study was to assess certain health status indicators in southwestern Pennsylvania to determine whether it was likely that the year 2000 targets would be met if trends from the past 20 years were to continue. The following mortality rates were analyzed: heart disease, homicide, breast cancer, colon cancer, lung cancer, suicide, motor vehicle accidents, work-related injury, and infant mortality. In addition, incidence of the following diseases was evaluated against the year 2000 targets: gonorrhea, primary and secondary syphilis, measles, tuberculosis, and AIDS. By employing epidemiological principles and considering strategic planning needs, it is possible to prioritize some of the health care needs in local areas for the next decade.     

Results of two methods to determine health expectancy in The Netherlands in 1981-1985.

Health expectancy is a measure providing summarizing information on mortality on one hand and morbidity and/or disability on the other hand. In this article health expectancy is determined with two approaches: method 1 leads to life expectancy free of disability at birth and at other ages; method 2 leads to life expectancy in good health. Results of the various calculations show that according to method 1 life expectancy free of disability at birth for men in the Netherlands was 58.8 years and for women 57.3 years (based on data from the period 1981-1985). Results of method 2 are different from method 1; life expectancy in good health for men was 58.9 years and for women 60.7 years. Results of both methods are compared with studies which have been carried out in other countries. The comparison shows that method 1 leads to results which deviate from the other studies while results of method 2 are to a large extent similar to the other studies. Reasons are given which explain why the results of method 1 deviate from the other studies. In spite of the fact that the two methods lead to different outcomes, the conclusion is drawn that the difference in health expectancy between men and women is much smaller than the difference in total life expectancy between men and women. The difference in total life expectancy by sex in the period 1981-1985 was 6.7 years.     

Estimating the value of disability-free life expectancy for western countries in the last decade. How can this new health status indicator be used?

Disability-free life expectancy (DFLE) is an indicator of the mean duration of life in good health, based on the measurement of mortality combined with the measurement of disability. To date, some experimental calculations have been carried out mainly in Canada, England, France, the Netherlands and the United States of America. Taking these studies as a whole, disability-free life expectancy in the last decade can be estimated at about 59 years for men and about 63 years for women. The share of years of disability within life expectancy ranges from 11% to 27%. The calculations show that women suffer disability for a greater part of their life expectancy than men. The calculations also reveal social inequalities in health. Health authorities in Western countries are showing increasing interest in this indicator today. The main points in its favour are its simplicity in practice, its usefulness for determining objectives, allocating resources, measuring the success or failure of health policies, assessing current needs and defining future scenarios.     

Toward health for all in the European region of the WHO. Survey of progress accomplished. II. Preliminary conditions: demographic and health status

A review of recent progress towards the regional targets set for health for all by the Member States of the European Region of WHO, as regards preliminary conditions for health, and for indicators of mortality, morbidity and disability. Life expectancy, infant and maternal mortality, and mortality from ischaemic heart disease and from traffic accidents show an improvement, as does the incidence of several infectious diseases, but the situation has worsened or stagnated as regards suicide and cancer, and there is a lack of information on disability and chronic morbidity. Despite some progress, the goal of equity in health is still very far from being attained.     

What targets for international development policies are appropriate for improving health in Russia?

BACKGROUND: The OECD countries and the United Nations have agreed to co-ordinate their work around a series of International Development Targets. The targets for health are based on improvements in infant, child and maternal mortality. Progress towards these goals will be used to assess the effectiveness of development policies. OBJECTIVES: To assess the potential impact of achievement of the International Development Targets on health in Russia, and to identify possible alternatives that may be more relevant to transition countries. DESIGN: The study covered the population of the Russian Federation from 1995-99.The effects of reducing infant, child and maternal mortality on Russian life expectancy at birth were modelled using construction of life tables. Three scenarios were modelled, reducing rates to those of the best performing regions in Russia, those required to achieve the International Development Targets and current UK rates. The results were compared with the effect on life expectancy at birth of policies to reduce adult mortality in different ways. RESULTS: Achieving the International Development Targets for infant, child and maternal mortality (66.7 and 75% reductions) will contribute very little to improving life expectancy in Russia (0.96 years). In contrast, even a 20% reduction in adult mortality would give rise to an increase in male life expectancy at birth of 1.86 years. CONCLUSION: Targets for health improvement in transition countries such as Russia should take account of adult mortality as well as the indicators contained in the International Development Targets.     

Life cycle of maternal health and child health

This editorial presents data on maternal and child health and mortality in India. Since 1946, government health recommendations have recognized the high rate of mortality affecting women and children as well as the extent of malnutrition and disease they suffer. The Eighth Five-Year Plan has set specific goals for the years 2000 in terms of the infant, under age five years, and maternal mortality rate; the crude birth and death rates; life expectancy; elimination of poliomyelitis and neonatal tetanus; immunization coverage; and delivery by trained attendant. A discussion of recent data reveals that only slow declines have occurred in neonatal mortality and that a significantly higher age specific death rate for 0-4 years exists in rural than in urban areas. Malnutrition is shown to affect nearly half of all children and to contribute to 60% of all child deaths. Irrational drug use is also a major health problem. The family planning program has been burdened with targets and has focused on sterilization in women over age 35. This approach has had little effect on the birth rate. Tabulation of the relationship between birth rate, infant mortality rate, and marriage age shows the importance of marriage age. A table also illustrates the percentage of births by type of attendant in rural and urban areas. The low status of women is seen as contributing to the problem, with females having a higher death rate than males until age 35. While these statistics are pessimistic, some organizations are producing excellent work in an effort to solve these problems.     

用时间序列模型预测2015年浙江妇幼人口的健康水平

目的预测2015年浙江妇幼人口的健康水平,针对影响健康的危险因素,采取有效的干预措施和卫生策略,为浙江省卫生事业发展“十二五”健康战略计划…提供理论依据。方法采用时间序列回归分析方法,综合2000一2010年浙江各家医院监测的几个主要指标：人均期望寿命、人口出生率、婴儿死亡率、5岁以下儿童死亡率和孕产妇死亡率数据建立预测模型,经统计学检验和评价后再进行预测。结果分别获得了2015年各指标的回归模型和预测值,人均期望寿命、人口出生率采用复合曲线回归拟合法：人均期望寿命将为78．24岁,其95％可信区间为77．59—78．89岁;出生率为10．25‰、其95％可信区间为7．59‰～10．63‰;人口自然增长率5．50‰,其95％可信区间为3．15‰～6．68‰。婴儿死亡率、5岁以下儿童死亡率和孕产妇死亡率,采用对数曲线回归法：婴儿死亡率将为5．52‰,其95％可信区间为4．02％e～5．31‰。5岁以下儿童死亡率为7．41‰,其95％可信区间为4．53‰～7．95‰;孕产妇死亡率5．90／10万,其95％可信区间为1．17／10万～8．53／10万。各预测方程模型的决定系数R2、方差齐：陛检验F值,因素及常量回归系数值,各指标的界值P均〈0．05,有显著的统计学差异。结论预测方法、结果可信可行,浙江卫生事业管理井然有序;妇幼卫生健康管理,能预期完成浙江卫生“十二五”健康战略规划。     

High cardiovascular mortality in Russia cannot be explained by the classical risk factors. The Arkhangelsk study 2000

Since the beginning of the 1990s the public health situation in Russia has been characterized by an extremely high mortality and a significant reduction in life expectancy. Cardiovascular diseases remained the major cause of death. Only a few large population studies were conducted in Russia during this period. A total of 1968 men and 1737 women aged 18–75 years participated in a health survey in Arkhangelsk, Russia, over the period 1999–2000. Investigation included assessment of classic cardiovascular risk factors (family history, smoking, blood pressure, and blood lipids) along with general health variables. The paper presents sex specific data on risk factors for coronary heart disease. Though the cardiovascular mortality is high in Russia, the calculated risk for coronary heart disease (the Framingham risk score and the Norwegian risk score) was lower in all age groups of men and women in Arkhangelsk compared with studies from the Western Europe and USA. Our data suggest that high cardiovascular mortality in Russia may be driven not only by the classic risk factors for coronary heart disease.     

The impact of the major causes of death on life expectancy in Italy

BACKGROUND: This study aims to evaluate the contribution of the reduction in major cardiovascular diseases (CVD), malignant neoplasms (MN), accidents and AIDS mortality to the gains in life expectancy observed during the decade 1985-1994, as well as to calculate and compare the potential gains due to the partial or total elimination of these causes. METHODS: Mortality data from the Italian Mortality Data Base were analysed by the method of decomposition of changes in life expectancy and the partial multiple decrement life table technique. RESULTS: In Italy, considering the decade 1985-1994, the gain in life expectancy at birth was 2.27 years for men and 2.16 for women. The major contribution to this increase was the reduction in CVD mortality followed by fewer deaths from accidents and MN. Conversely, AIDS caused a loss in the length of life of adults. Major potential gains in life expectancy at birth could be obtained by the elimination or even partial reduction of CVD and MN mortality. When working life (15-64 years) is considered, the relative importance of the causes changes. The elimination of accidents and AIDS would result in increased life expectancy longer than that associated with a 50% reduction in CVD. CONCLUSIONS: The findings of this study provide useful information which could contribute to a more effective allocation of resources for research activity and public health programmes.     

Bridging the gap in life expectancy of the aborigines in Taiwan

BACKGROUND: Similar to the general population in Taiwan, the health of aborigines has steadily improved over the last 30 years, but the gap remains wide, especially in males, despite an infusion of substantial medical resources. The objectives of this study are to quantify the contribution of major causes of death to the gap in life expectancy and to propose initiatives to bridge the health gap between aborigines and the general population. METHODS: This study included residents (slightly over 200000) from 30 'aboriginal townships' in Taiwan. The gap in life expectancy between aborigines and the general population was analysed by decomposing these gaps according to major causes of deaths. This analysis quantifies the contribution of different causes of deaths to the gap in life expectancy between the two populations. RESULTS: The overall mortality of aborigines in these townships was approximately 70% higher than the respective male and female general populations over the past 30 years. Mortality from infectious disease, cirrhosis of the liver, accidents, and suicide are substantially higher than the general population. The gap in life expectancy at birth in males was 8.5 years during 1971-1973, increasing to 13.5 years by 1998-2000, however, the gap in females remained relatively stable (8.0 years and 8.4 years, respectively). Of the 13.5-year difference in life expectancy in males, the differential mortality from diseases of the digestive system (mainly due to cirrhosis of the liver), accidents (from both motor vehicle and non-motor vehicle accidents), and infectious and parasitic disease contributed half (50%) of the gap in life expectancy. In females, the above primarily preventable causes of deaths accounted for 41% of the life expectancy gap. CONCLUSIONS: Based on the findings of this study, we suggest that future focus should be in the area of primary prevention in order to reduce the incidence of infectious and parasitic diseases, liver cirrhosis, and accidents.     

辽宁省城乡居民30年间出生期望寿命差异分析

目的 分析30年间辽宁省城乡居民出生期望寿命的变化及主要疾病死亡率对期望寿命年代差异的影响.方法 应用简略寿命表法、期望寿命差异的年龄分解和死因分解法分析辽宁省城乡居民1973-1975年和2004-2005年的死亡数据,以死亡率变化对出生期望寿命年代差异的贡献值及百分比为分析指标.结果 30年间辽宁省城市、农村居民期望寿命分别增加了4.68岁和4.91岁,女性增幅显著大于男性.0～4岁和55～74岁组人群死亡率下降对城乡居民期望寿命增加的贡献比例最大,男性为76.27%和82.81%,女性为58.76%和62.13%.呼吸系统疾病和传染病是对期望寿命年代差异贡献最大的两类疾病;呼吸系统疾病死亡率下降对不同人群期望寿命增加的贡献比例为62.20%(城市女性)～85.39%(农村男性),传染病的贡献比为16.70%(城市女性)～36.26%(农村男性).城乡居民心脏病死亡率、农村居民脑血管病和恶性肿瘤死亡率的增加对期望寿命年代差异的贡献率为负值.结论 呼吸系统疾病和传染病是影响30年间辽宁省城乡居民期望寿命差异的主要疾病,提高慢性非传染性疾病的防治水平是进一步提高居民期望寿命的关键.

Abstract：

Objective To analyze the impact of mortality by age and causes of death on life expectancy at birth among residents of Liaoning province.Methods The study included mortality data of urban and rural residents in two periods (1973-1975 and 2004-2005).Both Abridged Life Table and Arriaga method were used to calculate and to decompose life expectancy changes by age and causes of death.Results From 1975-2005,the life expectancy increased by 4.68 years in urban residents and 4.91 for rural residents with a higher increment among females than males.Most part of the increase (76.27% and 82.81% for urban and rural male,58.76% and 62.13% for urban and rural female) in life expectancy within the last 30 years could be explained by the decrease of mortality in the populations at age 0-4 and 55-74.Diseases related to respiratory system and infectious disease were contributing the most to the gap in life expectancy between the two periods.Mortality of heart disease was a negative contributor to the changes in life expectancy among both rural and urban residents while the mortalities of cerebro-vascular diseases and malignant tumors were the negative contributors for rural residents.Conclusion The increase of life expectancy in the last 30 years was mainly resulted from the decrease of mortality on both respiratory and infectious diseases.Control of chronic diseases is the key point to increase the life expectancy among the residents of Liaoning province.     

Social group and mortality in Finland

Morality rates for various social groups within the population of Finland were compared, using 179 919 death certificates for the period 1969-72. Morality was generally lowest in the highest social groups and highest among unskilled workers. Male mortality from coronary heart disease was also high among lower salaried employees. In the less developed area of northern Finland, female mortality from coronary heart disease and vascular lesions of the central nervous system was highest among the agricultural population. Cancer of the breast, cancer of the intestine, and suicides among women were apparently concentrated in the higher classes. Life table analysis showed that the social group differences in life expectancy at birth could be as great as 7.2 years. It is considered indispensable for a national health policy to improve on the recording of occupational data and to give regularly the occupation of the deceased when publishing mortality rates.     

Social group and mortality in Finland.

Morality rates for various social groups within the population of Finland were compared, using 179 919 death certificates for the period 1969-72. Morality was generally lowest in the highest social groups and highest among unskilled workers. Male mortality from coronary heart disease was also high among lower salaried employees. In the less developed area of northern Finland, female mortality from coronary heart disease and vascular lesions of the central nervous system was highest among the agricultural population. Cancer of the breast, cancer of the intestine, and suicides among women were apparently concentrated in the higher classes. Life table analysis showed that the social group differences in life expectancy at birth could be as great as 7.2 years. It is considered indispensable for a national health policy to improve on the recording of occupational data and to give regularly the occupation of the deceased when publishing mortality rates.     

A review of the evidence concerning the impact of medical measures on recent mortality and morbidity in the United States

Because it still is widely believed that one deadly disease after another is being eliminated, or diminished, largely because of medical interventions, there is little commitment to social change and even resistance to a reordering of national priorities. In this article we examine the contribution of medical measures to recent mortality changes in coronary heart disease, cancer, and stroke, which together account for two-thirds of total U.S. mortality and consume the vast majority of available resources. Morbidity changes are also examined and found to be not declining in a manner congruent with mortality and, in fact, increasing for some subgroups. Using a combined measure of mortality and morbidity (the probability of a life free of disability), it is demonstrated that although overall life expectancy has increased over several decades, most of this increase is in years of disability. Our late 20th century approach to the emerging AIDS pandemic (the frantic search for a "magic bullet"--either a treatment or a vaccine) belies any suggestion that the arguments and data presented concerning the modest contribution of medical measures are now passé.     

中国居民2013年酒精归因死亡及对期望寿命影响的分析

目的 分析2013年中国居民饮酒归因死亡和期望寿命损失情况。方法 利用2013年中国居民死因监测和中国慢性病及其危险因素监测数据,通过计算人群归因分值估计饮酒造成的死亡及其对期望寿命的影响。结果 2013年中国居民饮酒导致死亡人数为38.12万,同时避免了7.65万人死亡。饮酒导致死亡最多的为出血性脑卒中（9.71万）、肝癌（8.82万）、肝硬化（6.14万）和食道癌（4.87万）,避免了6.85万缺血性心脏病、0.49万缺血性脑卒中和0.31万糖尿病可能造成的死亡。饮酒给我国居民造成0.43岁的预期寿命损失。若避免饮酒,西部地区居民获益最多,期望寿命能增加0.52岁,高于东部和中部地区（0.12岁）;农村地区人群期望寿命增加0.48岁,高于城市地区（0.31岁）。结论 尽管饮酒对降低缺血性心脏病和脑卒中以及糖尿病死亡具有一定的保护作用,但总体而言,饮酒仍然是影响中国居民死亡和期望寿命损失的重要危险因素,有必要针对过量饮酒带来的健康问题提出应对措施。     

The impact of changes in age-related and cause-related mortality on life expectancy at birth in the State of Santa Catarina, Brazil, in the 1990s

This study aimed to analyze the impact of changes in age-related and cause-related mortality on life expectancy at birth in the State of Santa Catarina, Brazil, in the 1990s. Data were obtained from the Mortality Information System (SIM) for the three-year periods 1989/1990/1991 and 1998/1999/2000. Infant mortality rates and specific mortality rates for individuals > or = 1 year of age were calculated by gender and cause of death. The Pollard method was used to disaggregate the contributions by mortality from different causes and in different ages to life expectancy at birth. The age groups that contributed the most to the increase in life expectancy at birth were 0-1 year and > or = 70 years. The causes of death that most contributed to this increase were chronic non-communicable diseases, such as cardiovascular diseases, in the age brackets above 35 years, and neonatal diseases in the < 1-year bracket. Finally, there were a high proportion of deaths from ill-defined causes, indicating that the true cause-related mortality structure in the State is still unknown.     

中国肢体残疾人口预期寿命研究

目的 估算中国肢体残疾人口预期寿命.方法 基于2007-2010年监测肢体残疾人口平均死亡率,使用生命表方法 估算不同特征人口预期寿命及其标准误(s-x).结果 (1)肢体残疾人口女性预期寿命高于男性,女性和男性0岁预期寿命分别是63岁(s-x=2.6)和55岁(s-x=3.1);(2)35～50岁人口预期寿命城镇高于农村;(3)轻度肢体残疾人口预期寿命高于重度残疾人口,0岁预期寿命分别为62.5岁(s-x=2.4)和42岁(s-x=5.4);(4)肢体残疾人口预期寿命低于中国普通人群,男性和女性0岁预期寿命差距分别为17.1岁和12.7岁.结论 中国肢体残疾人口死亡水平较高,需要采取措施提高其预期寿命.

Abstract：

Objective To estimate the life expectancy of persons with physical disabilities in China based on data related to representative national disability.Methods Life table technique was used to estimate the life expectancy and its standard error by various characteristics on the basis of average mortality rates from the monitoring cases during 2007-2010.Results (1)Females were expected to live longer than males.The life expectancy at birth for females was 63 years with standard error(SE)=2.6 while for males it was 55 years(SE=3.1).(2)Persons aged 35-50 in urban areas had higher life expectancy than those in rural areas.(3)Life expectancy of persons with mild disability [62.5 years(SE=2.4)] was higher than that of persons with severe disability[42 years(SE=5.4)].(4)Life expectancies of persons with physical disability were much lower than that of the Chinese general population.Gaps of male and female life expectancy at birth were 17.1 years and 12.7 years,respectively.Conclusion Persons with physical disability had higher mortality and actions should be taken to improve their life expectancy,accordingly.