Regional differences in healthy life expectancy in The Netherlands

BACKGROUND: Healthy life expectancy has mainly been studied at the level of healthcare systems rather than at regional level within healthcare systems. In this article, healthy life expectancy at birth and at 65 years of age for men and women in the Netherlands has been described, and factors related to these regional variations have been explored. METHODS: Ecological study of 27 healthcare regions (hospital catchment areas). Life expectancy and healthy life expectancy were calculated using 1995 mortality data and pooled health interview survey data (1992-1997) from Statistics Netherlands. RESULTS: Healthy life expectancy shows a regional pattern, slightly different from that found in life expectancy and self-reported health. The regional distribution of male and female healthy life expectancy is different, especially at 65 years. Healthy life expectancy of women aged 65 years is independent of their total life expectancy. Social conditions and lifestyle differences between regions are negatively associated with healthy life expectancy in Dutch regions. Healthcare supply variables show no clear relationship. CONCLUSION: Although the Netherlands is a small, homogeneous country, substantial differences were found in healthy life expectancy.     

Dementia-free life expectancy (DemFLE) in The Netherlands

To gain an insight into the burden of dementia in an aging society, life expectancy with dementia and its counterpart dementia-free life expectancy (DemFLE) in The Netherlands are presented. Sullivan's method was used to calculate DemFLE. For elderly living either independently or in homes for the elderly prevalence figures on dementia were obtained from the Rotterdam Elderly Study (RES; n = 7528); for elderly in nursing homes the SIG Nursing home Information System was used. Conforming to other authors only the prevalence data on moderate and severe dementia as diagnosed with DSM-III-R criteria are used. The prevalence of mild dementia was not taken into account. At 65 years DemFLE for men is 14.0 years, that is 96.4% of the total life expectancy (14.5 years at this age). At age 90, DemFLE for men is 2.5 years, equal to 77.5% of the total life expectancy (3.3 years). For women DemFLE at age 65 is 17.7 years, that is 93.2% of their life expectancy (19.0 years), and at the age of 90, DemFLE for women is 2.8 years, equal to 74.7% of their remaining life expectancy (3.8 years). The absolute number of years with dementia remains relatively constant with increasing age. About 20–25% of these years with dementia are spent in nursing homes, the other 75–80% living independently. At each age compared with men women have both a higher DemFLE and a higher expectancy of years with dementia. The percentage of life expectancy without dementia however, is always lower for women, because of their higher total life expectancy. This indicates that the burden of dementia in absolute and relative terms is higher for women. Most years with dementia are spent at home, indicating that the burden of dementia rests mainly on the shoulders of informal caregivers.     

Mortality pattern and life expectancy of Seventh-Day Adventists in the Netherlands

The mortality pattern of Seventh-Day Adventists (SDAs) in the Netherlands was assessed during a ten-year study period, 1968-1977. Of 522 deceased SDAs the causes of death of 482 could be ascertained. Standardized Mortality Ratios (SMR) for total mortality (SMR = 0,45), cancer (SMR = 0,50) and cardiovascular diseases (SMR = 0,41) as well as for various subgroups differed significantly from the total Dutch population. Mean age at death as well as life-expectation at baptism were significantly higher in SDAs, both in males and females, as compared with Dutch males and females. A health survey among a sample of the total SDA population and a group of 'friend' controls' was done in order to try to explain the differences in mortality pattern and life expectancy. It is concluded that evidence was found for the thesis that abstinence from cigarette smoking is the main factor explaining the low mortality from ischaemic heart diseases among SDAs, while presumably an appropriate (prudent) diet confers additional benefit for example on colon cancer mortality.     

Women's empowerment and life expectancy at birth in Mexico]

OBJECTIVES: To assess the effect of women's empowerment (WE) on life expectancy at birth (LEB) in the federative states of Mexico and to compare the results of measuring WE with various compound indicators that reflect, to a greater or lesser degree, an individual or population focus.METHODS: This was an ecological study conducted in Mexico's 32 federative states. We estimated the correlations between overall and sex-specific LEB on the one hand, and a measure of gender empowerment (MGE), the index of women's ability to make decisions within the household (WADH), the index of women's autonomy (IWA), income inequality, certain aspects of the physical environment, the proportion of the population who spoke an indigenous language, and the net migratory rate on the other. By using robust regressions, we studied the effect on LEB of MGE, IWA, and WADH, after mutually adjusting for other independent variables.RESULTS: A very strong inverse correlation (-0.93) was found between overall LEB and factors of the physical environment linked to population vulnerability and biodiversity. Significant direct and inverse correlations were also found between LEB on the one hand and WADH, IWA, net migratory rate, the percentage of the population that spoke an indigenous language, and the Gini coefficient on the other. Multiple robust regressions showed inverse associations between MGE and LEB in women (beta: -1.44; 95% confidence interval [95% CI]: -2.71 to -0.17). WAI was positively associated with LEB in men (beta: 0.88; 95% CI: 0.01 to 1.75) and women (beta: 0.66; 95% CI: 0.03 to 1.30).CONCLUSION: The use of MGE as a surrogate for WE failed to reveal a positive effect of WE on LEB in Mexico. It is necessary to review the components that make up MGE and the relevance of using such a measure in different contexts. WAI showed a greater association with LEB and its effect was greater among men. This indicator made it possible to measure WE in Mexico and its use is recommended, as long as there are no other indicators available for capturing more effectively all the components that affect WE.     

Impact of diabetes mellitus on life expectancy and health-adjusted life expectancy in Canada

ABSTRACT: The objectives of this study were to estimate life expectancy (LE) and health-adjusted life expectancy (HALE) for Canadians with and without diabetes and to evaluate the impact of diabetes on population health using administrative and survey data.Mortality data from the Canadian Chronic Disease Surveillance System (2004 to 2006) and Health Utilities Index data from the Canadian Community Health Survey (2000 to 2005) were used. Life table analysis was applied to calculate LE, HALE, and their confidence intervals using the Chiang and the adapted Sullivan methods.LE and HALE were significantly lower among people with diabetes than for people without the disease. LE and HALE for females without diabetes were 85.0 and 73.3?years, respectively (males: 80.2 and 70.9?years). Diabetes was associated with a loss of LE and HALE of 6.0?years and 5.8?years, respectively, for females, and 5.0?years and 5.3?years, respectively, for males, living with diabetes at 55?years of age. The overall gains in LE and HALE after the hypothetical elimination of prevalent diagnosed diabetes cases in the population were 1.4?years and 1.2?years, respectively, for females, and 1.3?years for both LE and HALE for males.The results of the study confirm that diabetes is an important disease burden in Canada impacting the female and male populations differently. The methods can be used to calculate LE and HALE for other chronic conditions, providing useful information for public health researchers and policymakers.     

Physio-social activities and active life expectancy, life expectancy in Japanese elderly]

PURPOSE: Incidence of loss of activity and death in elderly people living at home were investigated to attempt to determine their relationship to physio-social activities in elderly. METHOD: This longitudinal study of life expectancy and active life expectancies is a thirty-six months follow up study. Loss of activities were classified as follows: Long term (over six months) treatment at home, long term (over six months) admission to hospital or intermediate institute for the elderly, admission to nursing home, and death. Subjects were persons living at home in Ogi, Saga prefecture, aged 70 years or older not requiring help in active daily living (ambulating, bathing, dressing, discharging, eating). RESULTS: 6,274 (male = 2,383, female = 3,891) subjects were followed for thirty six months, and 178 people experienced long term treatment at home, 310 people had long term admission to a hospital or intermediate institute for elderly, 28 people were admitted to a nursing home and 449 people experienced death. The main results were as follows: (1) From the Cox proportional hazards model using the likelihood-ratio method of survival and active life loss, significant hazard ratios for reduction active life expectancy for male were found for age, disability score for ADL, speech disorder, inconvenient bathroom design, with attention to health, and daily activity were associated with extension of active life expectancy. Age, disability score for ADL, speech disorder, inconvenient bathroom design were associated with reduced life expecting, while, attention to health, choosing to undergo regular health examinations, and daily were associated with increased activity in life expectancy. (2) Hazard ratios for reduction active life expectancy for females were age, disability score for ADL, defect of memory deficits, inconvenient design for hallway and stairs. Participating in health examinations, Purpose in life were associated with life expectancy increase. For females were age, disability score for ADL, speech disorder, inconvenient design of bathroom were associated with decrease in life expectancy, while having a person in life was associated with increase in life expectancy. DISCUSSION: Relationship between physio-social activities in elderly is a significant factor in many studies on elderly health. This study suggests that age, disability score for ADL, inconvenient for housing design, active health behavior, daily activities, and Losing a sense of worth in living, affect active life expectancy and life expectancy.     

上海市居民期望寿命与健康期望寿命的差异分析

目的:分析不同年龄、性别的上海市居民期望寿命和健康期望寿命的差异。方法:分析比较上海市和全球长寿国家/地区期望寿命的变化趋势;利用全球疾病负担研究建立的疾病和健康结局的失能权重,应用Sullivan法测算上海市居民健康期望寿命,并分析不同年龄、性别人群的健康寿命损失。结果:近40年,上海市期望寿命增长了10.86岁,2...     

The influence of chronic diseases and poor working conditions in working life expectancy across educational levels among older employees in The Netherlands

ObjectivesThis study aims to estimate the influence of chronic diseases and poor working conditions – across educational levels – on working life expectancy (WLE) and working years lost (WYL) in the Dutch workforce after age 50.MethodsInformation on demographics, chronic diseases, and working conditions from 11 800 Dutch workers aged 50–66 years participating in the Study on Transitions in Employment, Ability and Motivation (STREAM) from 2010/2015 was enriched with monthly information on employment status from Statistics Netherlands up to 2018. In a multistate model, transitions were calculated between paid employment and involuntary exit (disability benefits, unemployment) and voluntary exit (economic inactivity, early retirement) to estimate the impact of education, chronic diseases, and working conditions on WLE and WYL between age 50 and 66.ResultsWorkers with a chronic disease (up to 1.01 years) or unfavorable working conditions (up to 0.63 years) had more WYL due to involuntary pathways than workers with no chronic disease or favorable working conditions. The differences in WYL between workers with and without a chronic disease were slightly higher among workers with a lower education level (male: 0.85, female: 1.01 years) compared to workers with a high educational level (male: 0.72, female: 0.82 years). Given the higher prevalence of chronic diseases and unfavorable working conditions, WYL among lower educated workers were higher than among higher educated workers.ConclusionsThe presence of a chronic disease or unfavorable working conditions, more prevalent among lower educated workers, contribute substantially to WYL among older workers. This will increase educational inequalities in working careers.     

Dementia-free life expectancy in Australia

Abstract: Dementia-free life expectancy is a synthetic indicator of an important aspect of mental health which may have considerable use in public health decision making. Dementia expectancies were derived from senile dementia prevalence rates in Australia in 1991–1992 in conjunction with national life tables using Sullivan's method. Dementia-free life expectancy for Australian women aged 70 years was found to be 14 years within a total life expectancy of 15 years, and 11 years for men within a total life expectancy of 12 years. Between 70 and 85 years there is a constant average expectation of about one year of life expectancy with dementia. The age at which the largest number of persons with dementia is found is 82 years. Australians appear to have very similar dementia-free life expectancies to those reported in the European studies, with small differences probably due to sampling variation or to differences in case-finding methods.     

Dementia-free life expectancy in Belgium

To monitor the influence of dementia on the health of the populationthe concept of Dementia-Free Life Expectancy (DemFLE) was introduced.The DemFLE was estimated using Sullivan's method on the dataof the ERDA study 1991 (Epidemiology Research on Dementia, Antwerp,Belgium). At the age of 65 years, elderly people in Belgiumhad a life expectancy of 16.4 years, a DemFLE of 15.3 years,and 1.1 years with at least moderate dementia. In absolute yearsthe life expectancy with dementia remained constant beyond theage of 65: it was about 1.7 years for women, 0.7 years for men.The proportion of the remaining life that will be lived in ademented state increased with age: 4% and 9% in men and womenat age 65, but 20% and 30% at the age of 85. The results confirmdementia as an important public health problem in the elderly.     

Social gradient in life expectancy and health expectancy in Denmark

Objectives: Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels.Methods: Health interview data were combined with life table figures using Sullivans method.     

Social gradient in life expectancy and health expectancy in Denmark

Summary Objectives: Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels.Methods: Health interview data were combined with life table figures using Sullivans method.Results: Life expectancy was 4.3 years longer for 30-year-old men with a high educational level than for those with a low level. At age 30, the proportion of expected lifetime in self-rated good health was 67.7%, 76.1% and 82.3% for men with a low, medium and high educational level, respectively. Among women, life expectancy differed by 2.7 years between low and high educational level, and the proportion of expected lifetime in self-rated good health was 62.5% at the low and 80.5% at the high educational level.Conclusions: Educational level and life expectancy are clearly related. The social gradient in terms of health expectancy is even greater than that in terms of life expectancy.     

北京市城乡老年人预期寿命和健康预期寿命比较

目的 了解北京市老年人预期寿命(LE)、健康预期寿命(ALE)及健康预期寿命比值(ALE/LE)的地区性差异,分析高血压对不同地区老年人生命质量的影响。方法样本来自“北京市老龄化多维纵向研究”,研究对象为北京市城区（宣武区）、农村（大兴区和怀柔区）≥60岁老年人群,2004年基线调查1847人,2007年随访,由调访员入户调查不同地区人群的文化程度、职业及年龄构成,以能否独立完成日常生活活动认定功能健康与否,同时进行高血压病史的调查和现场测量血压,应用多状态寿命表IMaCH软件计算各个年龄段不同地区（城市及农村）的LE、ALE及ALE/LE,分析高血压对于不同地区老年人上述指标的影响。结果研究显示北京市老年人的文化程度、职业构成存在地域差异,农村老年人文化程度低（文盲占66.2％）,体力劳动比重高(占95.5％),与城市老年人的差异有统计学意义;农村地区各年龄组LE、ALE均低于城市,ALE/LE农村则高于城市,女性各年龄组城乡差距较男性明显;农村女性各年龄段正常血压组ALE高于城市,而高血压组则低于城市（以60～岁年龄组为例,正常血压农村女性ALE为24.61±2.08,城市女性为20.56±1.92;高血压农村女性ALE为16.34±1.15,城市女性为18.47±3.78）,强调了高血压对农村老年女性生命质量的影响。结论北京市老年人的LE、ALE、ALE/LE存在城乡差异,女性城乡差距更大,高血压则增加了城乡差距,降低了农村老年人的生活质量。提示了地域因素对于老年人生活质量的影响,强调了高血压防治的意义。     

1990-2015年中国分省期望寿命和健康期望寿命分析

目的 分析中国及各省期望寿命和健康期望寿命现状及其变化情况。方法 利用2015年全球疾病负担研究结果,对2015年中国居民与全球主要国家期望寿命和健康期望寿命进行比较;分析全国及各省期望寿命和健康期望寿命的差异和1990-2015年全国及各省期望寿命和健康期望寿命的变化幅度。结果 2015年中国居民的期望寿命为76.2岁,健康期望寿命为68.0岁,分别比全球平均水平高出4.4岁和5.2岁。2015年中国人均期望寿命和健康期望寿命,女性均高于男性。我国期望寿命和健康期望寿命较高的省份有上海、北京、香港、澳门、浙江、江苏、天津和广东等东部发达省份,较低的省份有西藏、青海、贵州、新疆和云南等西部省份。1990-2015年,中国居民期望寿命和健康期望寿命均呈上升趋势,期望寿命增加了9.5岁,健康期望寿命增加了8.4岁。全国及各省期望寿命增加的岁数均高于健康期望寿命增加的岁数。结论 1990-2015年中国居民的期望寿命和健康期望寿命有了较大程度的提高,但各省之间差异较大。     

The life expectancy of nonsmoking men and women

The pronounced difference in life expectancy between men and women in the United States and other industrialized countries has been attributed to a variety of causes, among them, differential rates of cigarette smoking. A study was undertaken to eliminate the confounding factors of imprecision in the taking of smoking histories and exaggeration of early traumatic deaths in life expectancy calculations. Survey data were collected on the lifetime smoking habits of adults in Erie County, Pa., as of 1972-74. In the survey interviews, careful distinctions were made between respondents who had formerly smoked and respondents who had never smoked. The survey data were combined with data collected from surviving relatives about the smoking habits of people who had died in Erie County during the years 1972-74. After deaths attributable to traumatic causes (accidents, suicides, and homicides) were removed, life tables were calculated for male and female nonsmokers over age 30. The resulting life expectancy figures for nonsmoking men and women of parallel age were virtually identical. Thus, differential rates of cigarette smoking are apparently the overwhelming cause for the male-female longevity difference. Actuarial tables should be divided by smoking behavior to reflect this finding. The results of the study suggest that the present longevity difference between men and women will disappear.     

The GAME estimate of reduced life expectancy.

The Declining Exponential Approximation of Life Expectancy (DEALE) is a simple method of estimating the impact of excess mortality on life expectancy, but it can lead to considerable bias due to the implicit constant baseline and excess mortality rates. This article presents a new method that does not use constant mortality rates. The variability of the baseline mortality is modeled using gamma (GA) distributions. Excess mortality rates are modeled using mixed-exponential (ME) distributions, which is appropriate if the excess mortality rate is nonincreasing, convex, and smooth. The new gamma mixed-exponential (GAME) estimate is convenient enough to replace the DEALE in formal decision analyses. The error from assuming gamma distributions for the Dutch baseline mortality was shown to be less than 2 months and typically about 1 month. Therefore, the GAME estimate is accurate enough to replace more elaborate methods, provided the mixed-exponential model is an appropriate model for the excess mortality.     

Age at menopause, cause-specific mortality and total life expectancy

BACKGROUND: A later menopause has been associated with a decreased cardiovascular risk but with an increased risk for breast and endometrial cancer. The net effect on mortality is unclear. We determined the association of age at menopause with longevity and with the balance between cardiovascular and cancer mortality. METHODS: We analyzed data from a breast cancer screening cohort comprising 12,134 postmenopausal women followed for an average of 17 years. We used Cox proportional hazards models and life tables to calculate the life expectancy of an average Dutch woman at age 50. RESULTS: During 204,024 person-years, there were 2607 deaths, of which 963 were due to cardiovascular diseases and 812 due to cancer. Ischemic heart disease risk decreased with a later menopause (hazard ratio [HR] = 0.98 per year; 95% confidence interval = 0.96-0.99), but the risk of fatal uterine or ovarian cancer increased (1.07 per year; 1.01-1.12). A later menopause was associated with longer overall survival; HR for total mortality was 0.98 per year (0.97-0.99). Life expectancy in women with menopause after age 55 was 2.0 years longer than those with menopause before age 40. Adjustment for potential confounders did not materially change the results. CONCLUSIONS: Age-adjusted mortality is reduced 2% with each increasing year of age at menopause. In particular, ischemic heart disease mortality is 2% lower. Although the risk of death from uterine or ovarian cancer is increased by 5%, the net effect of a later menopause is an increased lifespan.