Ageing in the South-East Asian region

The increasing trend in the aging population of countries in the South-East Asia Region (SEAR) transforms these countries from "mature societies" to "aging societies.? The elderly population in this region would be increasing from 18.1% in 1995 to 21.4% of the world elderly population in 2025. Since women have a longer life expectancy than men, the proportion of elderly women in the region would increase to 13.2% by 2025, while the proportion of elderly men would be 11.6%. In SEAR, 11.8 million people reportedly suffered from blindness in 1998; 50-80% of these cases are caused by cataract, which is most common in those aged 60 years and above. Although the aged is one of the most vulnerable population groups, little attention is given to geriatric care. Health services in many countries still focus largely on communicable diseases, maternal care, and child care, rather than on the enormous needs of the elderly population. Care of the elderly should be a priority of the primary health care system, focusing on the promotion of a healthy old-age lifestyle and prevention of behaviors that are hazardous to health.     

World mortality 1950-2000: divergence replaces convergence from the late 1980s

OBJECTIVE: We sought to investigate to what extent worldwide improvements in mortality over the past 50 years have been accompanied by convergence in the mortality experience of the world's population. METHODS: We have adopted a novel approach to the objective measurement of global mortality convergence. The global mortality distribution at a point in time is quantified using a dispersion measure of mortality (DMM). Trends in the DMM indicate global mortality convergence and divergence. The analysis uses United Nations data for 1950-2000 for all 152 countries with populations of at least 1 million in 2000 (99.7% of the world's population in 2000). FINDINGS: The DMM for life expectancy at birth declined until the late 1980s but has since increased, signalling a shift from global convergence to divergence in life expectancy at birth. In contrast, the DMM for infant mortality indicates continued convergence since 1950. CONCLUSION: The switch in the late 1980s from the global convergence of life expectancy at birth to divergence indicates that progress in reducing mortality differences between many populations is now more than offset by the scale of reversals in adult mortality in others. Global progress needs to be judged on whether mortality convergence can be re-established and indeed accelerated.     

2008-2014年桂林市城区居民期望寿命趋势分析

目的 了解桂林市城区居民期望寿命的现状,并探讨影响居民期望寿命的主要原因。方法 利用SPSS 20.0软件及桂林市2008-2014年的死亡数据绘制各年份寿命表,计算其期望寿命;同时分析影响期望寿命的前5位死因,并计算去死因后的期望寿命。结果 桂林市城区居民在2008-2014年里,期望寿命逐年下降,且以2011年为转折点,2011年为下降的最低点,之后呈现小幅度的上升。2008年为85.51岁,之后稍有上升,2014年为81.38岁,7年间共下降了4.13岁。男性期望寿命低于女性。去除循环系统疾病后可增加期望寿命3.97～6.49岁;去除呼吸系统疾病可增加期望寿命3.38～6.22岁;去除其他异常所见类可增加期望寿命1.07～2.06岁;去除肿瘤可增加期望寿命0.52～1.05岁;去除损伤与中毒可增加期望寿命0.27～0.40岁。结论 桂林市城区居民期望寿命呈现逐年下降趋势;针对不同性别,居民的疾病防控重点应有所不同。     

Preventing child unintentional injury deaths: prioritising the response to the New Zealand Child and Adolescent Injury Report Card

Objective: To develop recommendations for child unintentional injury prevention by comparing New Zealand's child unintentional injury mortality and injury prevention policies with those of European countries. Methods: Unintentional child injury death rates based on external cause of injury were calculated and ranked. NZ's score for each of the 12 domains (based on external causes of injury) from the New Zealand Child and Adolescent Report Card was compared to European scoring. Policy priorities are identified by domains where mortality makes up a high proportion of overall child unintentional injury mortality (high burden of injury) and where report card score for that domain is low in comparison to other countries (under‐utilisation of effective interventions). Results: Death as a motor vehicle occupant accounts for 49% of all child unintentional injury deaths, followed by pedestrian (10%) and drowning deaths (8%). The overall score for the 12 policy domains of the NZ Report Card ranks NZ as 15^th among the 25 European countries. There are important policy and legislative actions which NZ has not implemented. Conclusions: A number of evidence‐based injury prevention policy and legislative actions are available that could target areas of greatest childhood injury mortality in NZ. Implications: A set of injury prevention policy and legislation priorities are presented which, if implemented, would result in a significant reduction in the injury mortality and morbidity rates of NZ children.     

Global comparative assessments of life expectancy: the impact of migration with reference to Australia

OBJECTIVE: To investigate the effect of immigration on life expectancy in Australia for the period from 1981 to 2003, and to compare life expectancy of the Australian-born population with that of other countries in the Organisation for Economic Cooperation and Development (OECD). METHODS: Standard life-table methods using age-specific all-cause mortality and population data from 1981 to 2003 were used to calculate life expectancy at birth (e0) for the total Australian population (including migrants) and for people born in Australia (excluding migrants). Mean differences in life expectancy for each sex were compared using paired t-tests. Rankings of life expectancy among OECD countries were reassessed, and rank changes measured using the Wilcoxon signed rank test. FINDINGS: Life expectancy of males and females was significantly lower in the Australian-born group than in the total Australian population. During 1981 to 2003, there was a mean difference in life expectancy of 0.41 years (95% confidence interval, CI: 0.37-0.44; t(17) = 27.0; P < 0.0001) in males and 0.29 years (95% CI: 0.26-0.31; t(17) = 27.6; P < 0.0001) in females between the Australian-born and the total population. After excluding migrant groups, Australia no longer ranked among the top five OECD countries with the highest life expectancy in the two most recent years examined. CONCLUSION: While Australia has one of the highest life expectancies in the industrialized world, this is partly attributable to immigration of populations with low rates of mortality. This effect needs to be considered in international comparative assessments of mortality levels.     

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。     

2011年长春市居民死亡原因调查分析

目的了解长春市全死因监测点死因分布特点,计算长春市5城区居民期望寿命以及重要死因对期望寿命的影响,为慢性病的预防、控制提供依据。方法利用死亡率、构成比及期望寿命对2011年五城区居民死亡资料进行统计分析。结果 2011年5城区居民总死亡率5.23‰,男性高于女性。前5位死因依次是心脏病、恶性肿瘤、脑血管病、呼吸系统疾病及其他疾病,占总死因的83.43%。本市5城区居民期望寿命78.56岁,女性期望寿命高于男性。如果去除主要死因,长春市期望寿命将有提高。结论慢性病在总死亡中所占比例最高,是目前危害本市居民健康的主要疾病和死因,预防和控制慢性病是当务之急。     

Standardized mortality ratio and life expectancy: a comparative study of Chinese mortality

BACKGROUND: Various models have been proposed for rapid conversion of the standardized mortality ratio (SMR) to life expectancy using data from developed countries. METHODS: We compared two methods for converting the SMR to life expectancy using mortality data from the largest developing country, China. RESULTS: The first model, using the Gompertz function, does not provide a good fit to the life expectancy and SMR of China. The regression lines derived from the second, a log-linear model using parameters estimated from the US white population are not a good fit to Chinese males and older females. However, if the parameters in the log-linear model are estimated using Chinese mortality data, the resultant regression lines fit the data reasonably well. CONCLUSION: The relationship between life expectancy and SMR based on mortality data from developed countries may not be valid for developing countries. Based on our empirical study, separate estimates of the coefficients of the model are required for developing countries.     

The challenges of injuries and trauma in Pakistan: An opportunity for concerted action

Injuries and trauma are a major cause of mortality and morbidity in low and middle income countries (LMICs). In Pakistan, a low income South Asian developing country, they are among the top ten contributors to disease burden and causes of disabilities, with the majority of the burden falling on younger people in the population. This burden of injuries comes with a high social and economic cost. Several distal and proximal determinants, such as poverty, political instability, frequent natural disasters, and the lack of legislation and enforcement of preventive measures, make the Pakistani population susceptible to injuries. Historically, there has been a low level of investment in the prevention of injuries in Pakistan. Data is limited and while a public sector surveillance project has been initiated in one major urban centre, the major sources of information on injuries have been police and hospital records. Given the cost-effectiveness of injury prevention programs and their success in other LMICs, it is essential that the public sector invest in injury prevention through improving national policies and creating a strong evidence-based strategy while collaborating with the private sector to promote injury prevention and mobilizing people to engage in these programs.     

中国2010-2015年呼吸系统疾病死亡的预期寿命差异分析

  目的   分析我国2010年-2015年呼吸系统疾病死亡率变化对预期寿命影响的年龄、地区差异。   方法   本文数据来源于国家统计局2010年-2015年人口普查结果, 以及国家卫生健康委统计信息中心和中国疾病预防控制中心公布的《中国死因监测数据集》, 应用简略寿命表、Arriaga分解法计算不同年龄组和不同地区的呼吸系统疾病死亡率变化对预期寿命增量的贡献值和百分比。   结果   2010年-2015年, 我国呼吸系统疾病死亡率有所下降。2010和2015年因呼吸系统疾病减少的寿命分别为2.0岁和1.6岁, 呼吸系统疾病死亡率降低对预期寿命增量的贡献分别为, 东部地区15.4%, 中部12.5%, 西部55.6%。从年龄维度分析, 0~5岁、70岁以上年龄组死亡率的下降对提升预期寿命贡献最大。   结论   2010年-2015年全国因呼吸系统疾病减少的寿命降幅为20.0%, 具有明显的区域差异; 从疾病别维度分析, 慢性下呼吸道疾病对预期寿命的影响最大, 但对预期寿命的增加贡献较小; 肺炎对预期寿命的增加有贡献, 其中0~10岁人群肺炎的改善促进预期寿命增长。     

2016年重庆市伤害死亡特征及疾病负担分析

目的 分析2016年重庆市居民伤害死亡特征及疾病负担,为开展伤害防控工作提供建议。方法 对2016年重庆市全人群死因监测数据按常住地址提取伤害死亡个案(ICD-10:V01-V99,W00-W99,X00-X99,Y00-Y98),采用SPSS19.0统计分析死亡率、期望寿命、期望寿命损失年、潜在寿命损失年、平均潜在寿命损失年等指标。结果 2016年全市共报告伤害死亡15 761例,伤害死亡率为52.90/10万,男性伤害死亡率(70.49/10万)高于女性(34.72/10万);农村伤害死亡率(60.79/10万)高于城市(32.31/10万),5岁以下、5~14岁、15~64岁、65岁及以上年龄组伤害死亡率分别为23.42/10万、17.29/10万、42.98/10万、148.42/10万。伤害死亡前5位的依次是交通事故(15.98/10万)、跌倒(13.17/10万)、自杀(6.61/10万)、淹溺(5.09/10万)、意外的机械性窒息(3.47/10万)。5岁以下与5~14岁年龄组第1位的伤害死因是淹溺、15~64岁年龄组是交通事故、65岁及以上年龄组是跌倒。伤害导致的期望寿命损失年数为1.23岁,平均潜在寿命损失年为25.32岁。结论 重庆市居民伤害死亡率较高,疾病负担重,应加强伤害的预防控制工作。     

陕西省≥25岁居民血压升高导致的归因死亡和期望寿命损失研究

目的分析2015年陕西省≥25岁居民由于血压升高造成的归因死亡和期望寿命损失,为制定相关防治措施提供科学依据。方法收集2015年陕西省慢性病及其危险因素监测数据、死因监测数据和2015年全球疾病负担(GBD)资料,计算陕西省分性别、城乡的≥25岁居民中血压升高导致死亡的人群归因分值(PAF),估计由于血压升高导致的归因死亡和期望寿命损失。采用Excel 2016和SPSS 25.0软件进行统计分析。结果陕西省≥25岁居民收缩压(SBP)的平均水平为(136.41±21.96)mm Hg,且男性略低于女性、城市略低于农村。在全死因死亡中,陕西省≥25岁居民血压升高导致死亡的PAF为32.19%,其中男性为29.22%,女性为36.33%,城市为31.19%,农村为33.63%。血压升高导致的归因死亡数为10558例,归因死亡率为198.36/10万,其中归因死亡数男性大于女性、城市大于农村,归因死亡率男性高于女性、城市低于农村。由血压升高导致的死亡占心脑血管疾病全部死亡的58.20%,占慢性肾病死亡的52.58%。血压升高导致疾病死亡数最多的前3种疾病分别是缺血性心脏病(3969例)、出血性脑卒中(3290例)和缺血性脑卒中(1925例)。去除血压升高的影响后,陕西省≥25岁居民期望寿命提高4.53岁,其中女性(4.98岁)高于男性(4.14岁),农村(5.14岁)高于城市(3.99岁)。结论陕西省居民血压升高对死亡和期望寿命造成的影响较为严重,尤其是女性和农村居民,应加强高血压的预防与控制措施。     

中国的死亡率进度效应与去进度效应平均预期寿命

目的：介绍死亡率进度效应，其也是高估中国人口平均预期寿命的不可忽略的因素之一，说明去进度效应平均预期寿命是衡量人口寿命水平和健康水平变动趋势的更佳指标。方法：采用1994-2016年中国的死亡数据，以John Bongaarts和Griffith Feeney提出的三步估计策略，考察了中国的去进度效应平均预期寿命。结果与结论：（1）与常规预期寿命指标相比，去进度效应平均预期寿命呈更加平稳增长的趋势，女性的平均预期寿命及其增长速度均高于男性；（2）中国1994-2016年平均预期寿命的进度效应在2~5岁之间波动，平均在2.5岁以上，明显高于已有研究所涉及欧美国家的进度效应，表明中国死亡率下降速度更快；（3）就"六普"而言，进度效应会造成常规平均预期寿命高估寿命水平，男性、女性和两性合计人口的幅度分别为2.43岁、2.63岁和2.57岁，去进度效应预期寿命或许可以更好地测度中国人口的寿命水平及其变化趋势。     

National health objectives for the year 2000: the demographic impact of health promotion and disease prevention.

BACKGROUND. The national objectives in Healthy People 2000, drafted by health professionals aware of currently available public health interventions, represent a wealth of information about near-term future mortality and morbidity. METHODS. Life table methods were used to calculate the impact of projected changes in mortality and activity limitation rates on life expectancy and expected disability years. RESULTS. Meeting the mortality objectives would increase life expectancy at birth by 1.5 to 2.1 years, raising life expectancy to 76.6 to 77.2 years. In addition, meeting the target for disability from chronic conditions would increase the number of years of life without activity limitations from 66.8 years to 69.3-69.7 years. If the targets for coronary heart disease and unintentional injury were changed to reflect recent trends, a greater improvement in life expectancy at birth would be achieved: from 1.8 to 2.7 years to 76.9 to 77.8 years. CONCLUSION. Meeting the targets would have an important demographic impact. Including changes in the coronary heart disease and injuries targets, life expectancy in the year 2000 would be above the middle of the ranges used in current Census Bureau projections.     

Life expectancies in the United Kingdom and Japan

BACKGROUND: Compared with other developed countries, the United Kingdom has exhibited less of an increase in life expectancy over the past 30 years. METHODS: We compared the chronological changes in the age-adjusted mortality rates (AMRs) from all causes or major causes, and in life expectancy in the United Kingdom and Japan between 1970 and 1997. RESULTS: In both 1970 and 1997 the AMRs for most major causes were higher in the United Kingdom than in Japan; the difference in the AMR between countries was smaller in 1970 than in 1997. The difference in the AMR from all causes between the United Kingdom and Japan in 1997 was mainly due to differences in the AMR for heart diseases. The trend for an increasing difference over time between the United Kingdom and Japan in the AMR from all causes was due to the decreased rate of AMR from heart diseases from 1970 to 1997 in the United Kingdom being lower than those from cerebrovascular diseases in same period in Japan. CONCLUSIONS: These data suggest that mortality rates could be reduced by a change in focus of the National Health Service toward an emphasis on primary rather than secondary prevention and associated clinical interventions. The greatest priority should be placed on reducing the incidence of heart disease by aggressively improving primary prevention.     

2014年遵义市居民期望寿命和去死因期望寿命分析

目的 分析遵义市居民期望寿命,了解主要死因对遵义市居民期望寿命的影响,为制定疾病预防和控制策略提供科学依据。方法 收集2014年遵义市死因监测点数据和漏报数据,运用简略寿命表和去死因简略寿命表,计算期望寿命、去死因期望寿命、寿命损失年数和损失率等指标。结果 2014年遵义市死因监测点居民期望寿命为75.76岁,男性和女性依次为73.41岁和78.43岁,女性期望寿命比男性高5.02岁。去除循环系统疾病、肿瘤、呼吸系统疾病、损伤与中毒、消化系统疾病前5位死因后,人均期望寿命可依次增加6.66、2.03、1.97、1.35和0.40岁,男性期望寿命增幅与全人群一致,女性期望寿命顺位与全人群略有差别,呼吸系统疾病居第2位。去除脑血管病、心脏病、恶性肿瘤和慢性下呼吸道疾病后,期望寿命分别增长2.80岁、2.31岁、0.92岁、0.87岁。结论 遵义市居民期望寿命值有待进一步提高,重点应加强心脑血管疾病、恶性肿瘤以及慢性下呼吸道疾病等慢性非传染性疾病的防治工作。     

Measuring health inequalities between genders and age groups with realization of potential life years (RePLY)

OBJECTIVE: We propose a new method to measure health inequalities caused by conditions amenable to policy intervention and use this to identify health differences between sexes and age groups. METHODS: The lowest observed mortality rates are used as a proxy of unavoidable mortality risks to develop a new measure of health outcome - realization of potential life years (RePLY). The RePLY distribution is used to measure avoidable health inequalities between sex and age groups respectively. FINDINGS: Using RePLY we find that even those countries with very high life expectancy at birth can have substantial health inequalities across different age groups. Also, gender inequality is more pronounced among those aged < 30. Among countries with a life expectancy < 60 years, there is a much larger prevalence of gender inequality against females; countries with life expectancy > 60 years have comparable numbers of cases of inequality among females and males. Finally, high avoidable health inequality is associated with low average income, high income inequality and high population fractionalization. CONCLUSION: It is important to distinguish between unavoidable and avoidable mortality when measuring health outcomes and their distribution in society. The proposed new measure (RePLY) enables policy-makers to focus on age-sex groups with low realization of potential life years and thus high avoidable mortality risks.     

Left behind: widening disparities for males and females in US county life expectancy, 1985–2010

Background

The United States spends more than any other country on health care. The poor relative performance of the US compared to other high-income countries has attracted attention and raised questions about the performance of the US health system. An important dimension to poor national performance is the large disparities in life expectancy.

Methods

We applied a mixed effects Poisson statistical model and Gaussian Process Regression to estimate age-specific mortality rates for US counties from 1985 to 2010. We generated uncertainty distributions for life expectancy at each age using standard simulation methods.

Results

Female life expectancy in the United States increased from 78.0 years in 1985 to 80.9 years in 2010, while male life expectancy increased from 71.0 years in 1985 to 76.3 years in 2010. The gap between female and male life expectancy in the United States was 7.0 years in 1985, narrowing to 4.6 years in 2010. For males at the county level, the highest life expectancy steadily increased from 75.5 in 1985 to 81.7 in 2010, while the lowest life expectancy remained under 65. For females at the county level, the highest life expectancy increased from 81.1 to 85.0, and the lowest life expectancy remained around 73. For male life expectancy at the county level, there have been three phases in the evolution of inequality: a period of rising inequality from 1985 to 1993, a period of stable inequality from 1993 to 2002, and rising inequality from 2002 to 2010. For females, in contrast, inequality has steadily increased during the 25-year period. Compared to only 154 counties where male life expectancy remained stagnant or declined, 1,405 out of 3,143 counties (45%) have seen no significant change or a significant decline in female life expectancy from 1985 to 2010. In all time periods, the lowest county-level life expectancies are seen in the South, the Mississippi basin, West Virginia, Kentucky, and selected counties with large Native American populations.

Conclusions

The reduction in the number of counties where female life expectancy at birth is declining in the most recent period is welcome news. However, the widening disparities between counties and the slow rate of increase compared to other countries should be viewed as a call for action. An increased focus on factors affecting health outcomes, morbidity, and mortality such as socioeconomic factors, difficulty of access to and poor quality of health care, and behavioral, environmental, and metabolic risk factors is urgently required.

     

盐城市2009-2018年居民全死因死亡与减寿分析

目的 分析2009-2018年10年期间盐城市居民死因及其对寿命的影响等,为制定疾病预防控制措施提供依据。方法 分析2009-2018年盐城市居民死亡资料,计算粗死亡率、标化死亡率、去死因期望寿命和潜在寿命损失年指标。结果 2009-2018年10年盐城市居民平均粗死亡率、标化死亡率分别为661.65/10万、359.41/10万。男女第1位死因为恶性肿瘤（262.91/10万、162.74/10万）、第2位为脑血管病（135.78/10万、148.50/10万）、第3位为呼吸系统疾病（103.68/10万、99.27/10万）、第4位为心脏病（76.52/10万、86.60/10万）、第5位为损伤和中毒（67.80/10万、38.81/10万）。对期望寿命影响最大的是恶性肿瘤和脑血管疾病,去除后寿命分别增加了3.94岁、2.97岁。结论 恶性肿瘤、脑血管疾病、呼吸系统疾病、心脏病、损伤和中毒等慢性疾病是影响健康导致死亡的主要因素。慢性病的预防控制和管理是将来疾控工作的重点,提示要加强慢性病的危险因素调查研究,大力开展健康教育和健康促进工作,从而提高居民的期望寿命和健康水平。     

2010年成都市户籍人口主要死因

目的分析居民死因顺位、减寿顺位居前列的死亡原因在城乡、性别的分布差异。方法利用2010年成都市死因监测资料,和成都市公安局公布的同期户籍人口数,编制寿命表和去死因寿命表,采用直接标化法计算城乡、性别标化死亡率后,比较其差异。结果居民死因顺位前5位、减寿前5位、去死因期望寿命增加最多前5位疾病是恶性肿瘤、呼吸系统疾病、脑血管病、心脏病和损伤和中毒。恶性肿瘤以肺癌、肝癌、胃癌为首,死亡率男性高于女性,肺癌死亡率城市高于农村,肝癌、胃癌死亡率农村高于城市。慢性下呼吸道疾病、脑血管病死亡率都是农村高于城市,男性高于女性。心脏病死亡率城市高于农村,男性高于女性。损伤和中毒死亡率男性高于女性,农村高于城市,在顺位和构成上农村和城市、男性和女性有差异。结论成都市居民影响期望寿命的主要疾病为恶性肿瘤、呼吸系统疾病、脑血管病、心脏病和损伤和中毒,不同地区和性别人群应对不同的重点疾病采取的措施,降低死亡率,提高期望寿命。