Study: Life expectancy increased as world addressed major killers, though poor pandemic management slowed progress

by Institute for Health Metrics and Evaluation

Credit: Unsplash/CC0 Public Domain

Global life expectancy increased by 6.2 years since 1990 according to a new study published in The Lancet. Over the past three decades, reductions in death from leading killers have fueled this progress, including diarrhea and lower respiratory infections, as well as stroke and ischemic heart disease.

11 april 2024--When the COVID-19 pandemic arrived in 2020, however, it derailed progress in many locations. This is the first study to compare deaths from COVID-19 to deaths from other causes globally.

Despite the challenges presented by the COVID-19 pandemic, the researchers found that the super-region of Southeast Asia, East Asia, and Oceania had the largest net gain in life expectancy between 1990 and 2021 (8.3 years), largely due to reductions in mortality from chronic respiratory diseases, stroke, lower respiratory infections, and cancer.

The super-region's strong management of the COVID-19 pandemic helped preserve these gains. South Asia had the second-largest net increase in life expectancy among super-regions between 1990 and 2021 (7.8 years), primarily thanks to steep declines in deaths from diarrheal diseases.

"Our study presents a nuanced picture of the world's health," said Dr. Liane Ong, co-first author of the study and a Lead Research Scientist at the Institute for Health Metrics and Evaluation (IHME). "On one hand, we see countries' monumental achievements in preventing deaths from diarrhea and stroke," she said. "At the same time, we see how much the COVID-19 pandemic has set us back."

The study also highlights how COVID-19 radically altered the top five causes of death for the first time in 30 years. COVID-19 displaced a long-dominant killer—stroke—to become the second-leading cause of death globally. The research presents updated estimates from the Global Burden of Disease Study (GBD) 2021.

The authors found that the super-regions where the COVID-19 pandemic hit hardest were Latin America and the Caribbean and sub-Saharan Africa, which lost the most years of life expectancy due to COVID-19 in 2021. While documenting the enormous loss of life caused by the COVID-19 pandemic, the researchers also pinpointed the reasons behind the improvements in life expectancy in every super-region.

Looking across different causes of death, the study reveals sharp drops in deaths from enteric diseases—a class of diseases that includes diarrhea and typhoid. These improvements increased life expectancy worldwide by 1.1 years between 1990 and 2021.

Reductions in deaths from lower respiratory infections added 0.9 years to global life expectancy during this period. Progress in preventing deaths from other causes also drove up life expectancy around the world, including stroke, neonatal disorders, ischemic heart disease, and cancer. For each disease, reductions in deaths were most pronounced between 1990 and 2019.

At the regional level, Eastern sub-Saharan Africa experienced the largest increase in life expectancy, which jumped by 10.7 years between 1990 and 2021. Control of diarrheal diseases was the leading force behind improvements in this region. East Asia had the second-largest gain in life expectancy; the region's success in slashing deaths from chronic obstructive pulmonary disease played a key role.

The GBD 2021 study measures mortality by cause of death and years of life lost at global, regional, national, and subnational levels. The analysis links specific causes of death to changes in life expectancy.

The study illuminates not only the diseases that have driven increases and decreases in life expectancy, but also looks at how patterns of disease have shifted across locations over time, presenting, as the authors write, an "opportunity to deepen our understanding of mortality-reduction strategies…[which] might reveal areas where successful public health interventions have been implemented."

GBD 2021 highlights places that have made huge strides in preventing deaths from major diseases and injuries. It also emphasizes how some of the most burdensome diseases are now concentrated in certain locations, underscoring opportunities for intervention. For example, in 2021, deaths from enteric diseases were largely concentrated in sub-Saharan Africa and South Asia.

For another disease, malaria, the researchers found that 90% of deaths occurred in an area inhabited by just 12% of the world's population in a stretch of land ranging from Western sub-Saharan Africa through Central Africa to Mozambique.

"We already know how to save children from dying from enteric infections including diarrheal diseases, and progress in fighting this disease has been tremendous," said Professor Mohsen Naghavi, the study's co-first author and the Director of Subnational Burden of Disease Estimation at IHME.

"Now, we need to focus on preventing and treating these diseases, strengthening and expanding immunization programs, and developing brand-new vaccines against E. coli, norovirus, and Shigella," he added.

In addition to providing new insights on COVID-19, the study reveals growing threats from non-communicable diseases, such as diabetes and kidney diseases, which are increasing in every country. The researchers also point to uneven progress against conditions such as ischemic heart disease, stroke, and cancer. High-income countries have driven down deaths from many types of non-communicable diseases, but many low-income countries have not.

"The global community must ensure that the lifesaving tools that have cut deaths from ischemic heart disease, stroke, and other non-communicable diseases in most high-income countries are available to people in all countries, even where resources are limited," said Eve Wool, senior author of the study and a Senior Research Manager at IHME.

More information: Mohsen Naghavi et al, Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021, The Lancet (2024). DOI: 10.1016/S0140-6736(24)00367-2 , www.thelancet.com/journals/lan … (24)00367-2/fulltext

Is 75 the new 65? Wealthy countries need to rethink what it means to be old

by Warren Sanderson And Sergei Scherbov, The Conversation

Living longer and loving it. Credit: oneinchpunch/shutterstock.com

In 1950, men and women at age 65 could expect to live about 11 years more on average.

12 april 2019--Today, that number has gone up to 17, and the United Nations forecasts that it will increase by about five more years by the end of the century.

One consequence of the increase in life expectancy is that the proportion of the population above age 65 has increased, too. In policy analyses and in the media, increases in these proportions are frequently taken to mean that the population will keep getting older. This is often interpreted as warning of a forthcoming crisis.

As researchers who study aging, we believe that it's better to think about older people not in terms of their chronological ages, but in terms of their remaining life expectancy.

In our study, published on Feb. 26, we explored the implications of this alternative view for assessing the likely future of population aging. We found that, using this new perspective, population aging in high-income countries will likely come to an end shortly after the middle of the century.

Age inflation

Sixty-five-year-olds today are not like 65-year-olds in 1900. Today's older people on average live longer, are healthier and score higher on cognitive tests.

There are two different ways that demographers can think about older people. They can define older people by the number of years they've already lived, or they can define older people based on how many more years they are expected to live. In our research, we subscribe to the second view.

Credit: The Conversation

We think about aging the way economists think about price inflation. Say US$75 today would buy the same amount as $65 in the past. In essence, $75 is the new $65, because $75 today and $65 in the past had the same purchasing power.

When we say that 75 is the new 65, we mean something similar – that 75-year-olds now have the same remaining life expectancy as 65-year-olds in the past. Adjusting age for changes in remaining life expectancy is called adjustment for "age inflation." It's just like adjusting the value of the dollar for changes in purchasing power.

Measuring future aging

In our study, we explored the future of population aging, measured with and without age inflation.

We wanted to understand whether population aging will come to an end in the foreseeable future, particularly in wealthier countries, where public concern about population aging is most acute. We looked at countries with a gross national income per capita at or above $4,000, including Barbados, Croatia, the U.S., China, Russia and South Africa.

Using the U.N.'s forecasts of population sizes and age structures, a computer program generated 1,000 random possible future populations for these countries.

We computed the likelihood that population aging would come to an end this century using two measures. First, we looked at the proportion of the the population above a certain age. The unadjusted measures uses a cutoff of 65. The adjusted measure uses an age that changes from year to year based on a remaining life expectancy of 15 years.

Second, we looked at the median age of the population: the age that divides the population into two equally sized groups.

Credit: The Conversation

We found that, when unadjusted measures are used, population aging generally continues through the end of the century. But, when adjusted measures are used, population aging generally comes to an end well before the end of the century.

When exactly will population aging end? It depends on whether you're looking at the adjusted proportion of people who are counted as old is used or the adjusted median age. By the second measure, in over 95% of our 1,000 simulated futures, populations stopped growing older by 2050.

Two views of aging and public policy

In 1950, the average monthly U.S. Social Security benefit was $29.

The people of 1950 could have envisioned two scenarios for future Social Security payments. In one future, the average monthly Social Security benefit would have stayed unadjusted for expected wage and price increases. In that scenario, the average monthly benefit would still be $29. In the second, Social Security benefits would be adjusted for expected wage increases and inflation.

Of course, although it is possible, no one would ever forecast future Social Security payments assuming a fixed dollar monthly payment. It's too unrealistic. Forecasts are always made using adjusted benefit levels.

In demography, however, forecasts of population aging are still often made on the basis of ages unadjusted for life expectancy change. We believe these are equally unrealistic.

For example, today in the U.S., people are not allowed to contribute to certain retirement savings plans after age 70 and a half. As life expectancy increases, an increasing proportion of the population may wish to continue contributing to their saving plans after age 70 and a half but be unable to do so.

As people continue to live longer, governments will need to rethink similar policies around health care, employment and more. Eventually, as conditions change, we worry that policies based on fixed chronological ages will become as dysfunctional as a $29 monthly Social Security benefit would be today.

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Provided by The Conversation 

Global life expectancy up 5.5 years since 2000: WHO

Credit: CC0 Public Domain

Global life expectancy grew by 5.5 years between 2000 and 2016, the World Health Organization said Thursday, warning though that unequal income and access to healthcare translates into far shorter lives for many.

05 april 2019--The UN health agency also stressed significant gender differences in life expectancy worldwide.

On average, a child born in 2016 can expect to live 72 years, up from 66.5 in 2000, according to the annual World Health Statistics report.

The first 16 years of the century saw dramatic drops in deaths among children under five, especially in sub-Saharan Africa, where progress has been made against malaria, measles and other communicable diseases, WHO said.

Life expectancy has also increased thanks to advances against HIV/AIDS, which ravaged much of Africa in the 1990s.

But despite progress in poorer countries, WHO said there remained significant life expectancy gaps between developed and developing nations.

People in low-income countries live 18 fewer years on average than those in high-income nations, statistics showed.

In Lesotho, for instance, people on average live to be just 52, or 53 in the Central African Republic 53 years of age, compared to over 83 for Switzerland and over 84 in Japan.

While most people who die in rich countries are old, nearly one in three deaths in poorer countries are children under five, WHO said.

'Shocking differences'

For the first time, WHO broke down its global health statistics by sex, clearly showing that females have better longevity prospects than males.

At birth, babies are more likely to be male than female, with some 73 million boys expected to be born this year, compared to 68 million girls, WHO said.

But due to greater biological frailty and riskier behaviours, mortality rates tend to be higher among boys and men, and the ratio shifts as the population ages.

At a global scale, girls born in 2016 are expected to live to the age of 74.2, while and boys on average will make it to 69.8 years, the report showed.

One reason why women appear to live longer is that they tend to be better about using available healthcare.

In countries facing HIV epidemics, for instance, women are far more likely to take HIV tests and access antiretroviral therapies than their male counterparts. Female TB patients are also more likely to seek treatment, WHO said.

It is therefore perhaps not surprising that the gap between men's and women's life expectancy is narrowest in places where women lack access to health services.

In low-income countries with scarcer services, one in 41 women die from maternal causes, compared to one in 3,300 women in high-income countries.

These are "shocking differences", WHO's head of data and analytics, Samira Asma, told reporters.

Overall, the statistics showed that life expectancy has risen in most countries, including significant jumps in places like Eritrea, where people on average are now expected to live 22 years longer than the 43 years predicted in 2000.

In Syria, meanwhile, which has been ravaged by eight years of conflict, life expectancy dropped by a decade, from 73 years in 2000 to 63.8 years in 2016.

People in the United States have meanwhile seen their life expectancy slip from 79 years in 2014 to 78.5 years two years later, the WHO numbers showed.

Asma said the drop was in part driven by the obesity epidemic.

STUDY: At what age do you feel 65?

by Institute for Health Metrics and Evaluation

Credit: CC0 Public Domain

A 30-year gap separates countries with the highest and lowest ages at which people experience the health problems of a 65-year-old, according to a new scientific study.

Researchers found 76-year-olds in Japan and 46-year-olds in Papua New Guinea have the same level of age-related health problems as an "average" person aged 65.

09 mar 2019--"These disparate findings show that increased life expectancy at older ages can either be an opportunity or a threat to the overall welfare of populations, depending on the aging-related health problems the population experiences regardless of chronological age." said Dr. Angela Y. Chang, lead author and postdoctoral fellow at the Center for Health Trends and Forecasts at the University of Washington. "Age-related health problems can lead to early retirement, a smaller workforce, and higher health spending. Government leaders and other stakeholders influencing health systems need to consider when people begin suffering the negative effects of aging."

These negative effects include impaired functions and loss of physical, mental, and cognitive abilities resulting from the 92 conditions analyzed, five of which are communicable and 81 non-communicable, along with six injuries.

The study, published yesterday in the international medical journal The Lancet Public Health, is the first of its kind, according to Chang, whose center is housed at the UW's Institute for Health Metrics and Evaluation. Where traditional metrics of aging examine increased longevity, this study explores both chronological age and the pace at which aging contributes to health deterioration. The study uses estimates from the Global Burden of Disease study (GBD).

Researchers measured "age-related disease burden" by aggregating all disability-adjusted life years (DALYs), a measurement of loss of healthy life, related to the 92 diseases. The findings cover 1990 to 2017 in 195 countries and territories. For example, in 2017, people in Papua New Guinea had the world's highest rate of age-related health problems with more than 500 DALYs per 1,000 adults, four times that of people in Switzerland with just over 100 DALYs per 1,000 adults.

The rate in the United States was 161.5 DALYs per 1,000, giving it a ranking of 53rd, between Algeria at 52nd with 161.0 DALYs per 1,000 and Iran at 54th with 164.8 DALYs per 1,000.

Using global average 65-year-olds as a reference group, Chang and other researchers also estimated the ages at which the population in each country experienced the same related burden rate. They found wide variation in how well or poorly people age. Ranked first, Japanese 76-year-olds experience the same aging burden as 46-year-olds in Papua New Guinea, which ranked last across 195 countries and territories. At 68.5 years, the United States ranked 54th, between Iran (69.0 years) and Antigua and Barbuda (68.4 years).

The study is entitled "Measuring population ageing: an analysis of the Global Burden of Disease Study 2017."

Additional findings include:

• Age-related disease burden rates decreased over time across all regions between 1990 and 2017, representing reductions in deaths and disease severity of age-related problems.
• In 2017, people in 108 countries experienced earlier accumulation of problems associated with aging, whereas those in 87 countries experienced slower onset of aging.
• Globally, the age-related diseases with the most deaths and DALYs were ischemic heart disease, brain hemorrhage, and chronic obstructive pulmonary disease (COPD).

Countries with highest equivalent age to global 65-year-olds in 2017:

1. Japan: 76.1 years

2. Switzerland: 76.1

3. France: 76.0

4. Singapore: 76.0

5. Kuwait: 75.3

6. South Korea: 75.1

7. Spain: 75.1

8. Italy: 74.8

9. Puerto Rico: 74.6

10. Peru: 74.3

Countries with lowest equivalent age to global 65-year-olds in 2017:

1. Papua New Guinea: 45.6 years

2. Marshall Islands: 51.0

3. Afghanistan: 51.6

4. Vanuatu: 52.2

5. Solomon Islands: 53.4

6. Central African Republic: 53.6

7. Lesotho: 53.6

8. Kiribati: 54.2

9. Guinea-Bissau: 54.5

10. Federated States of Micronesia: 55.0

Countries with lowest age-related burden rate in 2017:

1. Switzerland: 104.9 DALYs per 1,000 adults aged 25 or older

2. Singapore: 108.3

3. South Korea: 110.1

4. Japan: 110.6

5. Italy: 115.2

6. Kuwait: 118.2

7. Spain: 119.2

8. France: 119.3

9. Israel: 120.2

10. Sweden: 122.1

Countries with highest age-related burden rate in 2017:

1. Papua New Guinea: 506.6 DALYs per 1,000 adults aged 25 or older

2. Marshall Islands: 396.6

3. Vanuatu: 392.1

4. Afghanistan: 380.2

5. Solomon Islands: 368.0

6. Central African Republic: 364.6

7. Lesotho: 360.5

8. Kiribati: 347.5

9. Guinea-Bissau: 343.4

10. Eritrea: 325.7

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More information: Angela Y Chang et al, Measuring population ageing: an analysis of the Global Burden of Disease Study 2017, The Lancet Public Health (2019). DOI: 10.1016/S2468-2667(19)30019-2

The studies and additional information are available at http://www.healthdata.org

Provided by Institute for Health Metrics and Evaluation

Following five healthy lifestyle habits may increase life expectancy by decade or more

Credit: CC0 Public Domain

Maintaining five healthy habits—eating a healthy diet, exercising regularly, keeping a healthy body weight, not drinking too much alcohol, and not smoking—during adulthood may add more than a decade to life expectancy, according to a new study led by Harvard T.H. Chan School of Public Health.

01 may 2018--Researchers also found that U.S. women and men who maintained the healthiest lifestyles were 82% less likely to die from cardiovascular disease and 65% less likely to die from cancer when compared with those with the least healthy lifestyles over the course of the roughly 30-year study period.
The study is the first comprehensive analysis of the impact of adopting low-risk lifestyle factors on life expectancy in the U.S. It will be published online April 30, 2018 in Circulation.
Americans have a shorter average life expectancy—79.3 years—than almost all other high-income countries. The U.S. ranked 31st in the world for life expectancy in 2015. The new study aimed to quantify how much healthy lifestyle factors might be able to boost longevity in the U.S.
Harvard Chan researchers and colleagues looked at 34 years of data from 78,865 women and 27 years of data from 44,354 men participating in, respectively, the Nurses' Health Study and the Health Professionals Follow-up Study. The researchers looked at how five low-risk lifestyle factors—not smoking, low body mass index (18.5-24.9 kg/m²), at least 30 minutes or more per day of moderate to vigorous physical activity, moderate alcohol intake (for example, up to about one 5-ounce glass of wine per day for women, or up to two glasses for men), and a healthy diet—might impact mortality.
For study participants who didn't adopt any of the low-risk lifestyle factors, the researchers estimated that life expectancy at age 50 was 29 years for women and 25.5 years for men. But for those who adopted all five low-risk factors, life expectancy at age 50 was projected to be 43.1 years for women and 37.6 years for men. In other words, women who maintained all five healthy habits gained, on average, 14 years of life, and men who did so gained 12 years, compared with those who didn't maintain healthy habits.
Compared with those who didn't follow any of the healthy lifestyle habits, those who followed all five were 74% less likely to die during the study period. The researchers also found that there was a dose-response relationship between each individual healthy lifestyle behavior and a reduced risk of early death, and that the combination of all five healthy behaviors was linked with the most additional years of life.
"This study underscores the importance of following healthy lifestyle habits for improving longevity in the U.S. population," said Frank Hu, chair of the Department of Nutrition at Harvard Chan School and senior author of the study. "However, adherence to healthy lifestyle habits is very low. Therefore, public policies should put more emphasis on creating healthy food, built, and social environments to support and promote healthy diet and lifestyles."

More information: "The Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population," Yanping Li, An Pan, Dong D. Wang, Xiaoran Liu, Klodian Dhana, Oscar H. Franco, Stephen Kaptoge, Emanuele Di Angelantonio, Meir Stampfer, Walter C. Willett, Frank B. Hu, Circulation, April 30, 2018, DOI: 10.1161/CIRCULATIONAHA.117.032047


Provided by Harvard T.H. Chan School of Public Health

Education, not income, the best predictor of a long life

Curve showing the relationship between income and life expectancy in 1970, 1990 and 2010. Credit: Lutz/Kebede

Rising income and the subsequent improved standards of living have long been thought to be the most important factors contributing to a long and healthy life. However, new research from Wolfgang Lutz and Endale Kebede, from IIASA and the Vienna University of Economics and Business (WU) has shown that instead, the level of education a person has is a much better predictor of life expectancy.

20 april 2018--In 1975, Samuel Preston developed the Preston Curve, which plotted the GDP per person on the horizontal axis against life expectancy on the vertical axis. The curve shows a clear but flattening upward trend in life expectancy with increasing GDP. The curves also shift upwards over time which has been explained by better healthcare.
In 1985, John Caldwell and Pat Caldwell suggested instead that lowered mortality resulted from better female education. In their new paper, Lutz and Kebede used global data from 174 countries from 1970-2015 to test the two hypotheses. Whether income or education is more important for improving health and life expectancy is an important question for policymakers deciding where to direct funding.
Lutz and Kebede also plotted life expectancy against the mean years of schooling of the adult population. The curve created is much more linear, suggesting that education is a much better predictor. There is no upward shift of the curve requiring explanation by other factors. Data was subject to multivariate analyses to validate the findings. The same link was found when the curves were adjusted for child mortality.

Curve showing the relationship between education and life expectancy in 1970, 1990 and 2010 Credit: Lutz/Kebede

The researchers point out that better education leads to improved cognition and in turn to better choices for health-related behaviours. Recent decades have seen a shift in the disease burden from infectious to chronic diseases, the latter of which are largely lifestyle-related. As time goes on, the link between education and better health choices, and therefore life expectancy, will become even more apparent.
"This paper is more radical than previous analyses in terms of challenging the ubiquitous view that income and medical interventions are the main drivers of health. It even shows that the empirical association between income and health is largely spurious," says Lutz.
Previous lines of research at the Wittgenstein Centre, a collaboration between IIASA, WU and the Vienna Institute of Demography, have emphasised the importance of improving education for poverty eradication and economic growth, as well as the ability to adapt to climate change. These findings further back up the call for improved access to education.
The apparent link between health and income found by Preston can be explained by the fact that better education results in both better health and higher incomes.
"The findings matter for the entire global health research community, and they matter for everybody in global development and deciding on funding allocations for the different aspects of development," says Lutz, adding that funding quality education for all around the world should be a much higher priority.

More information: Wolfgang Lutz et al, Education and Health: Redrawing the Preston Curve, Population and Development Review (2018). DOI: 10.1111/padr.12141


Provided by International Institute for Applied Systems Analysis

Life expectancy diverges between England's wealthiest and poorest neighbourhoods

New research from the Longevity Science Panel (LSP) shows life expectancy diverging between England's wealthiest and poorest neighbourhoods since 2001. This widening gap in outcomes applies to children born today and to people already in older age.

21 feb 2018--A boy born in one of the most advantaged 20 percent of neighbourhoods in 2015 can now expect to outlive his counterpart, born in one of the least advantaged 20 percent of neighbourhoods, by 8.4 years. In 2001, that gap was 7.2 years. For girls, the difference has risen from 5 years to 5.8 years over the same period.
A sixty-year-old man living in the most advantaged 20 percent of neighbourhoods could expect to live 4.1 years longer than his counterpart from the least advantaged 20 percent in 2001, increasing to 5.0 years longer in 2015. A sixty-year-old women living in the most advantaged 20 percent of neighbourhoods could expect to live 3.1 years longer than her counterpart in the least advantaged 20 percent in 2001, increasing to 4.2 years longer in 2015.
Death rates for people aged 60-89 improved for all groups between 2001 and 2015. However, the improvement was greatest for the best-off. The most advantaged fifth of older men experienced a reduction in death rates of 32 percent, compared with 20 percent for the least advantaged fifth. Women in this age group experienced a 29 percent fall in death rates for the most advantaged fifth, and 11 percent for the least advantaged fifth.
Differing improvement rates meant that by 2015, men aged 60-89 from the least advantaged fifth of the country were 80 percent more likely to die in any given year than those from the most advantaged fifth. This figure has climbed from 52 percent in 2001. The equivalent figures for women are 44 percent in 2001 and 81 percent in 2015.
The LSP's analysis shows that, of the many factors comprising the Index of Multiple Deprivation, income levels have the most powerful influence over neighbourhood death rates.
Commenting on the research, LSP's Dame Karen Dunnell said:
"Dying earlier if you are poor is the most unfair outcome of all. So we should all be concerned about the growing divergence in rich-poor life expectancy. To reduce the risk of further widening, we need better understanding of the precise causes, followed by co-ordinated policy initiatives across health, work, welfare, pension and housing to improve outcomes for all."
Co-author, Professor Steve Haberman, Professor of Actuarial Sciences, Cass Business School said:
"Our main finding is that the socioeconomic gap in life expectancy in England has widened over the last 15 years. This has happened despite life expectancy increasing across all sections of the population—it is clear that some groups are being left behind. As the population ages, these inequalities are likely to increase further. To solve this problem, we will need better coordinated policies involving central and local government, civil society and the private sector."

More information: Life Expectancy: Is the Socio-Economic Gap Narrowing? www.longevitypanel.co.uk/viewp … nomic-gap-narrowing/


Provided by City University London

Global health: longer lives, more lifestyle disease

Credit: CC0 Public Domain

Life expectancy worldwide has jumped by a decade since 1980, rising in 2015 to 69 years for men and nearly 75 for women, according to a comprehensive overview of global health released Thursday.
These extra years came in large measure thanks to a sharp drop in deaths from communicable diseases, especially over the last decade, said the Global Burden of Disease report, published in The Lancet.

08 oct 2016--Despite population increases, combined mortality from HIV/AIDS and tuberculosis—both major killers—fell by more than a quarter, from 3.1 million in 2005 to 2.3 million in 2015.
Over this period, annual deaths due to diarrhoeal diseases decreased by 20 percent.
And malaria mortality plummeted by more than a third, from 1.2 million in 2005 to 730,000 last year.
During that decade, life expectancy went up in 188 of 195 countries and territories.
At the same time, however, non-communicable diseases of all kinds—ranging from cancers to heart disease and stroke—claimed more lives, with the death toll rising from 35 million in 2005 to 39 million in 2015.
"As we live longer, the burden of non-communicable diseases is rising—along with the attendant costs of treatment," Kevin Watkins, head of Save the Children UK, noted in a comment, also in The Lancet.
Many of the diseases on the rise are associated with ageing: cancers, coronary artery disease, cirrhosis of the liver and Alzheimer's, among others.
The paradox is that even as lifespans grow, more people are spending more time in ill health of living with disabilities, the 100-page study found.
Centralising the expertise of nearly 1,900 experts, the report—coordinated by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle—comes at the juncture between two major UN health initiatives.
The Millennium Development Goals (MDGs), set in 2000, set hard targets for reducing child and maternal mortality, and combatting key communicable diseases, by 2015.
A 15-year clock on a new set of Sustainable Development Goals (SDGs)—several of them health related—began running last year.
The report is intended as a benchmark for this new effort.
There have been other major health gains over the last quarter century.
The number of deaths of children under five, for example, dropped by more than 50 percent from 1990 to 2015, to 5.8 million.

National score cards

But that was still well short of the MDG calling for under-five mortality to be slashed by two-thirds.
Had that target been met, another 14 million children would have survived to see their fifth birthday.
There were exceptions to the generally positive trends, many stemming from conflict.
Since 2011, global deaths from war have risen massively due in large part to fighting in Syria, Yemen and Libya.
Male life expectancy in Syria has dropped more than 11 years since the civil war there began.
In 2015, the number of people displaced by armed conflict and disasters reached a record 65 million. Over half of the world's refugees are children.
The report also "graded" countries, indicating whether mortality levels from specific causes were lower or higher than expected, taking into account each nation's income and education levels, as well as fertility rates.
The United States, for example, scored very poorly on coronary heart disease, chronic obstructive pulmonary disease (COPD), and drug abuse.
Many Eastern European countries scored poorly on these, as well as alcohol abuse and stroke.
Western European and East Asian countries, generally speaking, scored highest.

New procedure uses the heart rate to estimate the life expectancy of infarct patients

After five years, persons with only minor arrhythmia (red graph) were five times more at risk of dying than people with higher breathing-related fluctuations. Credit: JACC

The heart rate may be an indicator of a person's life expectancy. A research team at the Technical University of Munich (TUM) has to this end analyzed an effect which at first seems paradoxical: Minor irregularities in the heartbeat are indicative of a healthy body. A clinical study confirmed a strong correlation between this phenomenon and the survival prospects of heart attack patients. The new methods of measurement may soon be applied in medical practice.

29 may 2016--A healthy person's heart will beat slightly faster upon inhalation and slow down again upon exhalation. The reason for this is that inhaling dampens an effect that will normally regulate the heart rate down to the at rest rate of approximately 60 beats per minute. This phenomenon is called respiratory sinus arrhythmia, which may be translated as a "breathing-induced irregularity in the sinus node, the bundle of nerve fibers controlling the heart beat".
The phenomenon has been known since the 19th century. A body weakened by a heart attack will show a clearly smaller difference between heart rates during the exhaling and inhaling cycles. Therefore, several attempts at using arrhythmia characteristics to draw conclusions about the life expectancy of patients were made in the past. Thus far, however, the data taken on its own yielded no conclusions as to the life expectancy of a patient. This, however, is precisely what the scientists working with Prof. Georg Schmidt, head of the Biosignal Processing team at the University Hospital Klinikum rechts der Isar, have now achieved.

Breathing cycle and heart rate: The decisive moment

Whilst in the majority of earlier studies the full breathing cycle was correlated to the heart rate, the TUM team now focused on exhaling and specifically on the moment when the heart rate would normally be reduced again. "With our approach, you might say we are surgically selecting the moment when the decisive events take place," says Georg Schmidt. In the analysis of the heart rate data, an algorithm Schmidt and his team proposed in an article published in theLancet in 2006 has proven useful. The method renders the respiratory sinus arrhythmia measurable by - to put it simply - extracting other sources of heart rhythm variation from the data collected over a certain period. The algorithm calculates an average from the data, which may then be graphed.
"Our method produces a far more specific picture of the functional condition of the body," says Dr. Daniel Sinnecker, primary author of the study. "There is no other method as yet to isolate the vagal function as specifically as this."The vagal function, i.e. the activity of the vagus nerve, is responsible, among other, for reducing the heart rate of healthy persons as described above. Although the vagus nerve affects many other bodily processes, its activity is not directly measurable.

More than 900 patients examined

Within the framework of the study, published in the Journal of the American College of Cardiology, breathing cycles and heart beat rhythms of close on 950 heart attack patients were measured shortly after a heart attack. The data was analyzed to find respiratory sinus arrhythmia. The test persons were re-examined every six months over a five-year period. The result: Heart attack patients with less pronounced arrhythmia had a higher risk of dying within the period of observation. Examined persons with only minor arrhythmia were five times more at risk of dying over the five-year period than people with higher breathing-related fluctuations.
Two further clinical studies are currently under way with TUM participation, examining the respiratory sinus arrhythmia in different groups of persons. One of the studies (EU-Cert-ICD) examines different treatment strategies in people with pacemakers, whilst the other (INVADE) monitors elderly people with and without heart disease. Schmidt and his team are confident that the results of these studies will confirm that their method, taken on its own, will be a reliable indicator of risk.

Everyday application imminent

The developers are confident that the new method may soon be widely deployed. "We are quite close to everyday application since, by and large, the development of the method is complete," says Georg Schmidt. The technical hurdles are few: Since it is no longer necessary these days to measure breathing rate in addition to heart beat, a modern ECG unit would basically suffice. "Even the general practitioner could therefore within ten minutes record sinus arrhythmic activity."
The method may be fruitfully applied in more than 80 percent of the cases, says Schmidt. Irrespective whether the examined patients had recently suffered a heart attack, it could be used in combination with other indicators to assess the health risk. Hidden risks may in this way be detected in some persons and possibly mitigated with an implantable defibrillator, for instance. "In addition to that, the cost of treatments could be reduced by avoiding unnecessary procedures," says Georg Schmidt.
A next step might be to apply this method to examine the efficacy of different strategies for treatment. Should a patient's characteristics improve in the course of treatment, it is likely that the applied therapy was appropriate.

More information: Daniel Sinnecker et al. Expiration-Triggered Sinus Arrhythmia Predicts Outcome in Survivors of Acute Myocardial Infarction, Journal of the American College of Cardiology (2016). DOI: 10.1016/j.jacc.2016.03.484


Provided by Technical University Munich

Life expectancy increases globally as death toll falls from major diseases

Credit: Bill Kuffrey/public domain

People are living much longer worldwide than they were two decades ago, as death rates from infectious diseases and cardiovascular disease have fallen, according to a new, first-ever journal publication of country-specific cause-of-death data for 188 countries.

18 dec 2014--Causes of death vary widely by country, but, at the global level, drug use disorders and chronic kidney disease account for some of the largest percent increases in premature deaths since 1990. Death rates from some cancers, including pancreatic cancer and kidney cancer, also increased. At the same time, countries have made great strides in reducing mortality from diseases such as measles and diarrhea, with 83% and 51% reductions, respectively, from 1990 to 2013.

Globally, three conditions - ischemic heart disease, stroke, and chronic obstructive pulmonary disease (COPD) - claimed the most lives in 2013, accounting for nearly 32% of all deaths.

Published in The Lancet on December 18, the study, "Global, regional, and national age-sex-specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013," was conducted by an international consortium of more than 700 researchers led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Compared to previous Global Burden of Disease (GBD) studies, researchers from more than 100 nations incorporated more country-level data as well as additional data on specific conditions. They also examined whether leading causes of death in lower-income countries are beginning to mirror those in higher-income countries. What they found is that even with big improvements in longevity in low-income countries, the types of health challenges faced by countries such as Bolivia, Nepal, and Niger are far different from those faced by countries such as the Japan, Spain, and the United States. The health challenges of many middle-income countries such as China or Brazil are also closer to those in the US.

The average age of death increased from 46.7 in 1990 to 59.3 in 2013, as a result of declining fertility and a demographic shift in the world's population to older ages. Partly because of global population growth, the number of deaths in both sexes for all ages combined increased from 47.5 million to 54.9 million.

The number of people dying from certain conditions, such as heart disease, has increased as population has increased, but decreases in age-specific mortality rates for these conditions is a sign of progress. Death rates from most cancers, including breast cancer, cervical cancer, and colon cancer, have decreased, but the reverse is true for pancreatic cancer, kidney cancer, and non-Hodgkin lymphoma.

"People today are less likely than their parents to die from certain conditions, but there are more people of older ages throughout the world," said IHME Director Dr. Christopher Murray. "This is an encouraging trend as people are living longer. We just need to make sure we are making the right health policy decisions today to prepare for the health challenges and associated costs that are coming."

Global life expectancy for both sexes increased from 65.3 years in 1990 to 71.5 years in 2013, and women made slightly greater gains than men. Female life expectancy at birth increased by 6.6 years and male life expectancy by 5.8 years. If trends seen over the past 23 years hold, by 2030 global female life expectancy will be 85.3 years and male life expectancy will be 78.1 years.

Disparities remain across age groups and countries. In all age groups except 80 and older, mortality has decreased more for women than men. Men aged 30-39 and over 80 showed some of the smallest declines in mortality. The gender gap in death rates for adults between the ages of 20 and 44 is widening, and HIV/AIDS, interpersonal violence, road injury, and maternal mortality are some of the key conditions responsible. For children under 5, diarrheal diseases, lower respiratory tract infections, neonatal disorders, and malaria are still among the leading causes of death.

Given the size of India's population in particular, and projections that it may soon become the world's most populous country, mortality trends there have global implications. In 2013, India accounted for 19%, or 10.2 million, of the world's deaths. The country has made great strides in reducing both child and adult mortality since 1990. The average yearly rates of decline in mortality have been 3.7% per year for children and 1.3% per year for adults. Between 1990 and 2013, life expectancy at birth increased from 57.3 years to 64.2 years for males and from 58.2 years to 68.5 years for females.

"It's very encouraging that adults and children in India are living longer and healthier lives," said Dr. Jeemon Panniyammakal of the Public Health Foundation of India and a co-author of the study. "But India's growing influence on global health means we must do more to address the diseases that kill people prematurely."

In other parts of the world, life expectancy gains in sub-Saharan Africa were mainly driven by reductions in deaths from diarrhea, lower respiratory tract infections, and neonatal disorders. Reductions in cardiovascular disease, some cancers, transport injuries, and chronic respiratory conditions have led to the longevity gains in high-income regions.

A variety of causes contributed to life expectancy declines globally. Diabetes, other endocrine disorders, and chronic kidney disease decreased life expectancy across many regions, including central Latin America; mental disorders had a negative impact in multiple regions, especially North America; intentional injuries reduced life expectancy in South Asia, the high-income countries of the Asia Pacific region, and southern sub-Saharan Africa. In Eastern Europe and Central Asia, cirrhosis took a toll on life expectancy. HIV/AIDS was a major cause of death in Southern sub-Saharan Africa and to a smaller extent in Western and Eastern sub-Saharan Africa.

"Almost a decade after HIV/AIDS peaked globally, this remains the leading cause of premature death in more than a dozen countries in sub-Saharan Africa," said Dr. Andre Kengne, of the South African Medical Research Council, and a co-author of the study. "As fewer young people die from childhood diseases we must do more to ensure that HIV/AIDS does not become a threat for people of all ages."

When looking at other causes of death, progress is seen in lower death rates despite increasing numbers of deaths. Some of the biggest increases in premature mortality since 1990 were seen for diabetes, HIV/AIDS, hypertensive heart disease, chronic kidney disease, and Alzheimer's disease. But for many disorders, including stomach cancer, Hodgkin's lymphoma, rheumatic heart disease, peptic ulcer disease, appendicitis, and schizophrenia, death rates have fallen by more than one-third since 1990.

Death rates for some cancers have fallen (lung by 9%, breast by 18%, and leukemia by 20%). Global age-standardized death rates also have fallen by more than one-fifth for ischemic heart disease and stroke.

Overall, global mortality rates increased significantly for very few diseases between 1990 and 2013.

Leading causes of death globally, with the number of deaths

2013

1. Ischemic heart disease (8,139,900)
2. Stroke (6,446,900)
3. Chronic obstructive pulmonary disease (2,931,200)
4. Pneumonia (2,652,600)
5. Alzheimer's disease (1,655,100)
6. Lung cancer (1,639,600)
7. Road injuries (1,395,800)
8. HIV/AIDS (1,341,000)
9. Diabetes (1,299,400)
10. Tuberculosis (1,290,300)

1990

1. Ischemic heart disease (5,737,500)
2. Stroke (4,584,800)
3. Pneumonia (3,420,700)
4. Diarrheal diseases (2,578,700)
5. Chronic obstructive pulmonary disease (2,421,300)
6. Tuberculosis (1,786,100)
7. Neonatal preterm birth complications (1,570,500)
8. Road injuries (1,058,400)
9. Lung cancer (1,050,000)
10. Malaria (888,100)

More information: The Lancet, www.thelancet.com/journals/lan… (14)61682-2/abstract

Provided by Institute for Health Metrics and Evaluation

Living longer, living healthier

A new study, conducted by David Cutler, the Otto Eckstein Professor of Applied Economics, shows that, even as life expectancy has increased over the past two decades, people have become increasingly healthier later in life.

05 aug 2013--"With the exception of the year or two just before death, people are healthier than they used to be," Cutler said. "Effectively, the period of time in which we're in poor health is being compressed until just before the end of life. So where we used to see people who are very, very sick for the final six or seven years of their life, that's now far less common. People are living to older ages and we are adding healthy years, not debilitated ones."

The study results are based on data collected between 1991 and 2009 from nearly 90,000 individuals who responded to the Medicare Current Beneficiary Survey (MCBS). Cutler reported these findings in work with Mary Beth Landrum of Harvard Medical School and Kaushik Ghosh of the National Bureau of Economic Research.

To understand whether people are becoming healthier, Cutler first had to answer a question that, at least initially, seemed impossible to solve: How far are people from death?

"There are two basic scenarios that people have proposed about the end of life," he said. "The first argues that what medical science is doing is turning us into light bulbs – that is, we work well until suddenly we die. This is also called the rectangularization of the life curve, and what it says is that we're going to have a fairly high quality of life until the very end.

"The other idea says life is a series of strokes, and medical care has simply gotten better at saving us," he continued. "So we can live longer because we've prevented death, but those years are not in very good health, and they are very expensive – we're going to be in wheelchairs, in and out of hospitals and in nursing homes."

While researchers have tried to tackle the question of which model is more accurate, different studies have produced competing results. One reason for the confusion, Cutler suggested, is that such efforts are simply looking at the wrong end of someone's life.

"Most of our surveys measure health at different ages, and then use a model to estimate how long people have to live," he said. "But the right way to do this is to measure health backwards from death, not forwards. We should start when someone dies, then go back a year and measure their health, then go back two years, three years, and so on."

The MCBS allows researchers to do just that, Cutler said, by linking survey responses to participants' Medicare records for the rest of their life, meaning researchers can calculate - in some cases to the day - exactly how far participants were from death when they answered the survey.

By comparing that data with survey responses on how well people were able to care for themselves – whether they were able to cook, clean, bathe themselves, dress themselves, walk and manage money – Cutler was able to determine how healthy people were relative to how close or far away they were from dying.

Going forward, Cutler hopes to unravel the reasons why some conditions are today less debilitating than in the past. Part of the change, he said, will certainly be chalked up to increased access and improvements to care, but there are a host of other factors that make answering the question "very very difficult."

"There seems to be a clear relationship between some conditions that are no longer as debilitating as they once were and areas of improvement in medicine," he said. "The most obvious is cardiovascular disease – there are many fewer heart attacks today than there used to be, because people are now taking cholesterol-lowering drugs, and recovery is much better from heart attacks and strokes than it used to be. A person who suffered a strokeused to be totally disabled, but now many will survive and live reasonable lives. People also rebound quite well from heart attacks."

What's more, he said, as standards of care have improved, so too has the public's knowledge of how to live healthier lives.

"People are much better educated about their health now," Cutler said. "People are taking steps to help prevent long-term cognitive decline. We don't have any way yet to slow down something like Alzheimer's or Parkinson's, but there is a lot we can do for other health problems."

Provided by Harvard University

World population gains more than a decade's life expectancy since 1970

In the first Global Burden of Disease Study 2010 paper, published in The Lancet, the authors present new estimates of life expectancy for the last four decades in 187 different countries. While overall life expectancy is increasing globally, the gap in life expectancy between countries with the highest and lowest life expectancies has remained similar since 1970.

17 dec 2012--The new estimates show that, globally, in 2010 a man's average life expectancy at birth had increased by 11.1 years (19.7%) since 1970, from 56.4 years in 1970, to 67.5 years in 2010. For women, life expectancy increased by 12.1 years (19.8%) during the same period, from 61.2 years in 1970, to 73.3 years in 2010.

Deaths in children under five years old have declined by almost 60% since 1970, from 16.4 million deaths in 1970 to 6.8 million in 2010. However, while overall life expectancy is increasing globally, the gap in life expectancy between countries with the highest and lowest life expectancies has remained similar since 1970, at around 32 – 47 years, even when significant mortality shocks such as the 1994 Rwanda genocide are discounted.

In 2010, Japanese women had the highest life expectancy at birth in the world, at 85.9 years; for men, Iceland had the highest life expectancy, at 80.0 years. Haiti had the lowest life expectancy at birth in 2010 for both men and women (32.5 and 43.6, respectively), largely due to the disastrous earthquake in January 2010. The largest overall gain in life expectancy since 1970 was in the Maldives, which saw an increase in male life expectancy of 54.4% since 1970 (from 50.2 to 77.5) and a 57.6% increase in women's life expectancy, from 51 in 1970, to 80.4 in 2010. Other countries which experienced gains in life expectancy greater than 20 years since 1970 were Bangladesh, Bhutan, Iran, and Peru.

Some countries in Central and Eastern sub-Saharan Africa also experienced substantial gains in life expectancy since 1990, with men in Angola undergoing a 31.9% increase in life expectancy (from 43.9 in 1990 to 57.9 in 2010), and an increase of 23.6% in women's life expectancy in the same period (from 51.7 in 1990 to 63.9 in 2010). Ethiopia and Rwanda also experienced substantial gains in life expectancy during this period.

Despite these encouraging figures, some countries have experienced substantial declines in life expectancy. Overall, men's life expectancy in Southern sub-Saharan Africa decreased by 1.3 years between 1970 and 2010, and women's life expectancy decreased by 0.9 years in the same period, with the decline attributed to the catastrophic HIV / AIDS epidemic. Lesotho experienced the second-largest decline in life expectancy 1970 – 2010, with men in 2010 living for 4.6 fewer years in 2010 compared to 1970, and women living for 6.4 fewer years in the same period. Belarus and Ukraine in Eastern Europe also underwent notable declines in life expectancy, thought to be due to high rates of alcohol-related deaths in these countries.

According to Assistant Professor Haidong Wang, of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and one of the study authors, "Because more children are now surviving to adulthood compared to earlier decades, health policy makers globally will need to pay much more attention to preventing deaths in young adults, aged 15 – 49, in coming years."

While most developed countries, and some developing countries such as China and Argentina, have experienced declining numbers of deaths in this age group since 1970, some high-income regions – including Albania, Greece, Israel, Lithuania, and Russia – have experienced increased numbers of deaths in this age group in the same period. In Botswana, South Africa, Zambia, and Zimbabwe, deaths in this age group have increased by more than 500% since 1970.

More information: www.thelancet.com/… n-of-disease

Provided by Lancet

The paradox of BMI and life expectancy

11 oct 2012—Although the medical cost to the community rises as more and more people become obese, there is little adverse association between being overweight and life expectancy, new research has confirmed.

The increasing rates of obesity and associated disability and illness mean greater financial costs for the community. This expenditure is partly why obesity may have little effect on life expectancy in the aged.

The Monash University-led collaborative study of over 110,000 people examined the effect of BMI (Body Mass Index, regarded as a measure of obesity) on life expectancy and the repercussions for health-care systems. The 12-year study included men and women across all age groups. 

The results of the research were recently published in the Asia Pacific Journal of Clinical Nutrition. The study also included researchers from the National Health Research Institutes, Taiwan and the National Defense Medical Centre, Taiwan.

Co-author, Emeritus Professor Mark Wahlqvist from Monash University's Department of Epidemiology and Preventive Medicine and the Monash Asia Institute, said the study drew attention to the growing need to recognise paradoxes with weight disorders in health care systems, both clinical and public health.

"We found that especially in the elderly, medical expenditure continues to rise with increasing BMI, but there was little relationship with how long a person lived," Professor Wahlqvist said.

One reason for this greater expenditure is that, with age, excess weight is increasingly accompanied by loss of muscle (sarcopenia) and bone (osteopenia or osteoporosis), with their own health consequences.

"The study showed that to maintain a favourable life expectancy for those who fall outside the desirable BMI range, more money is being spent," Professor Wahlqvist said.

BMI indicates a relationship between weight and height. The findings show that, if medical expenditure is to be reduced, people must maintain their BMI in the lower end of the desirable range between 18.5 and 24.

"To reduce the health burden, and the associated medical expenditure by both individuals and governments, it is important that people are encouraged to maintain a desirable BMI - and to do so by inexpensive exercise as well as diet," Professor Wahlqvist said.

"It also means greater government effort for the well-being of ageing communities is needed."

Professor Wahlqvist said that the economic impact for both individuals and society was a consequence not only of the health costs of obesity but also of the effects it had on independent living, workforce participation and livelihoods.

"Another difficulty to be actively addressed is that the socio-economically disadvantaged are at greater risk of obesity in the first place," Professor Wahlqvist said.

"In times of international financial crisis, vulnerability in the health system becomes more apparent. This can be seen in those countries in the euro-zone with demanding terms for debt alleviation, including cut-backs to health system funding."

More information: apjcn.nhri.org.tw/… _577_587.pdf

Provided by Monash University