Longevity, life expectancy and healthy life expectancy...2017/01/01 · Change (years) in life...
Transcript of Longevity, life expectancy and healthy life expectancy...2017/01/01 · Change (years) in life...
Professor Sarah Harper University of Oxford
IARU
Unviersity of Tokyo
2016年 12月 20日
Longevity, life expectancy and healthy life expectancy
Oxford Institute of Population Ageing
Worlds 1st Super- centenarion
Geert Adriaans Boomgaard
Oxford Institute of Population Ageing
Worlds 1st Super- centenarion FOUGHT WITH NAPOLEAN…. Geert Adriaans Boomgaard 21 September 1788 Groningen, Netherlands 3 February 1899 110 years 135 days Record male life until 1966
Oxford Institute of Population Ageing
§ Jeanne Calment of France, who died in 1997 aged 122 years, 164 days, had the longest human lifespan documented.
§ The oldest verified man ever recorded is Jiroemon Kimura of Japan, who died in 2013 aged 116 years and 54 days
Oxford Institute of Population Ageing
§ Will increases in both life expectancy and in life extension or
longevity continue? § will there be an increase in average years lived by humans and also
maximum years attained by a human being?
§ Will life expectancy increase in line with life extension? § will we all enjoy the benefits of longevity or will it be for a few?
§ Will increases in life expectancy be accompanied by increases in life extension or are we seeing a compression of longevity after 100?
§ will the predicted increases in centenarians over the coming century be accompanied by increases in super-centenarians?
§ Will advances in life expectancy be matched by advances in healthy life expectancy?
Life expectancy, selected OECD countries, men and women, birth
Source:OECD
72
74
76
78
80
82
84
86
88
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Remainingyearsoflife
Birth
Japanwomen
Francewomen
UKwomen
USAwomen
Japanmen
Francemen
UKmen
USAmen
Life expectancy, selected OECD countries, men and women, age 65
Source:OECD
15
16
17
18
19
20
21
22
23
24
25
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Remainingyearsoflife
Age65
Japanwomen
Francewomen
UKwomen
USAwomen
Japanmen
Francemen
UKmen
USAmen
Life expectancy, selected OECD countries, men and women, age 80
Source:OECD
6
7
8
9
10
11
12
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Remainingyearsoflife
Age80Japanwomen
Francewomen
UKwomen
USAwomen
Japanmen
Francemen
UKmen
USAmen
Oxford Institute of Population Ageing
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0 10 20 30 40 50 60 70 80 90 100 110 Age
Pro
porti
on s
urvi
ving
1851 1871 1891
1911 1931 1951
Proportion of persons surviving to successive ages
1971 1991 2011
Source: ONS / Oxford Institute of Population Ageing
Oxford Institute of Population Ageing
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
1911 1921 1931 1941 1951 1961 1971 1981 1991
Deat
hs p
er m
illion
adult
s
!"#$%&'"() *$(+,-./'-0)
1."%$-() 1,-%23./'-0)
UK Male Mortality 1911-2005
Source: ONS / Oxford Institute of Population Ageing
Oxford Institute of Population Ageing
Source: US Centers for Disease Control
Prevalence of obesity (BMI > 30), age 50+
0
5
10
15
20
25
30
35
40
Oxford Institute of Population Ageing
Effect of Obesity on Female Life Expectancy at age 50 at age 50 at age 50
0 0.2 0.4 0.6 0.8
1 1.2 1.4 1.6 1.8
US France Italy Netherlands Spain Denmark Canada England
PSC Mehta/Chang
PSC: 41% of female gap Mehta/Chang: 22% of female gap
Expectancy at age 50 at age 50 PSC: 41% of female gap at age 50 PSC: 41% of female gap at age 50 PSC: 41% of female gap at age 50 PSC: 41% of female gap at age 50
Source: Prospective Studies Collaboration (PSC); Mehta and Chang (2010)
from Preston and Stokes “Is the High Level of Obesity in the United States Related to Its Low Life Expectancy?” 2010
Mehta/Chang: 22% of female Mehta/Chang: 22% of female gap gap
Oxford Institute of Population Ageing
Picture: Colourbox
Oxford Institute of Population Ageing
Public Health
Age 55 Reduced LE Increased DY Obesity 1.4 5.9 Smoking 4 3.8 Alcohol 3 3.1
(Klijs et al., 2011a).
Oxford Institute of Population Ageing
Will increases in both life expectancy and in life extension or longevity continue?
will there be an increase in average years lived by humans and also maximum years attained by a human being?
Will life expectancy increase in line with life extension? will we all enjoy the benefits of longevity or will it be for a few? The Inequality question
Will increases in life expectancy be accompanied by increases in life extension or are we seeing a compression of longevity after 100?
!! Will advances in life expectancy be matched by advances in healthy life expectancy?
Oxford Institute of Population Ageing
Will advances in life expectancy be matched by advances in healthy life expectancy? Relationship of life expectancy healthy life expectancy: Compression of morbidity: HLE increasing faster than LE expectancy - extra years of life are healthy ones Expansion of morbidity: HLE not pacing LE - extra years of life are unhealthy ones. Modern drivers of longevity (science and technology) enabling those with frailty to live longer. Dynamic equilibrium: DLE increasing but severity of ill health is reducing. Pushing back onset of frailty but maintaining that state for longer.
Oxford Institute of Population Ageing
Data – problematic Lack of harmonisation of health measures reduces comparisons § The Global Burden of Disease programme - estimate
healthy life expectancy for 187 countries worldwide - Disability Adjusted Life Years (DALY) (Chris Murry)
§ EU healthy life years (HLY), a DFLE
§ Global Activity Limitation Indicator (GALI) “Participation restriction”: World Health Organization International Classification of Functioning, Disability and Health.
(Van Oyen et al., 2006; Berger et al., 2015)
Change (years) over time period Birth Age 65 Age 85 Period Measure of ill health LE HE LE HE LE HE Men Japan 1995–2004 Activity limitation 2.3 1.2 1.7 0.8
1995–2004 ADL limitation 2.3 2.0 1.7 1.3 2005–2009 Care needs 0.8 0.2 0.4 0.1 1995–2004 Less than good health 1.7 −0.7 1.0 −0.3
Switzerland 2008–2012 Activity limitation 0.8 2.9 0.4 1.4 −0.1 0.8
2008–2012 Less than good health 0.4 0.5 −0.1 0.7
UK 2001–2010 Disability 2.7 3.6 2.1 1.7 0.7 0.4
2001–2010 Less than good health 2.7 3.5 2.1 1.2 0.7 0.3
USA 2000–2006 Activity limitation 1.0 0.7 1.0 1.0 0.3 0.3 Women
Japan 1995–2004 Activity limitation 1.7 0.8 2.3 0.8
1995–2004 ADL limitation 1.7 1.7 2.3 1.2 2005–2009 Care needs 0.8 0.5 0.6 0.4
1995–2004 Less than good health 2.4 −0.7 1.4 −0.4
Switzerland 2008–2012 Activity limitation 0.3 3.0 0.1 1.4 −0.2 −0.2
2008–2012 Less than good health 0.1 0.6 −0.2 −0.6
UK 2001–2010 Disability 2.0 1.9 1.7 0.8 0.6 0.1
2001–2010 Less than good health 2.0 3.7 1.7 1.3 0.6 0.6
USA 2000–2006 Activity limitation 0.9 0.5 0.7 0.8 0.3 0.3
Changes (years) in life expectancy (LE) and health expectancies (HE) at birth, age 65 and age 85 based on different measures of ill health, Japan, Switzerland, UK and USA, men and women
Source: Hashimoto et al., 2010 (Japan); European Health and Life Expectancy Information System (Switzerland); Office for National Statistics (UK); Molla and Madans, 2010 (USA).
Change (years) over time period Birth Age 65 Age 85 Period Measure of ill health LE HE LE HE LE HE Men Japan 1995–2004 Activity limitation 2.3 1.2 1.7 0.8 1995–2004 ADL limitation 2.3 2.0 1.7 1.3 2005–2009 Care needs 0.8 0.2 0.4 0.1
1995–2004 Less than good health 1.7 −0.7 1.0 −0.3
Changes (years) in life expectancy (LE) and health expectancies (HE) at birth, age 65 and age 85 based on different measures of ill health, Japan, Switzerland, UK and USA, men and women
Source: Hashimoto et al., 2010 (Japan); European Health and Life Expectancy Information System (Switzerland); Office for National Statistics (UK); Molla and Madans, 2010 (USA).
Change (years) over time period Birth Age 65 Age 85
Period Measure of ill health
LE HE LE HE LE HE
Men
Japan 1995–2004
Activity limitation
2.3 1.2 1.7 0.8
1995–2004
ADL limitation
2.3
2.0
1.7
1.3
2005–2009
Care needs
0.8
0.2
0.4
0.1
1995–2004
Less than good health
1.7
−0.7
1.0
−0.3
2001–2010 Less than good health 2.0 3.7 1.7 1.3 0.6 0.6
USA 2000–2006 Activity limitation 0.9 0.5 0.7 0.8 0.3 0.3
Changes (years) in life expectancy (LE) and health expectancies (HE) at birth, age 65 and age 85 based on different measures of ill health, Japan, Switzerland, UK and USA, men and women
Source: Hashimoto et al., 2010 (Japan); European Health and Life Expectancy Information System (Switzerland); Office for National Statistics (UK); Molla and Madans, 2010 (USA).
Oxford Institute of Population Ageing
High correlation between life expectancy and healthy life expectancy for men in EU25+ countries
10
12
14
16
18
20
0 2 4 6 8 10 12 14 16 18
CC=0.64
Life Expectancy at 65
Healthy life expectancy at 65
Iceland France
Eurostat 2009 data
Birth Age 65 Age 85 LE HLY LE HLY LE HLY
Men Italy 1.4 - 1.0 -1.8 0.5 0.2
France 1.5 −0.5 1.2 0.5 0.9 0.4
Poland 1.4 -2.7 0.8 -1.7 0.5 0.1
Denmark 1.2 -6.1 0.9 -1.4 0.3 -0.2
Hungary
2.0 4.1 0.8 0.3 0.7 0.02
EU27 1.6 0.7 1.1 0.1 0.7 1.5
Women Italy 1.1 - 1.0 -3.1 0.9 0.5
France 1.5 −1.2 1.4 0.1 1.4 1.7
Poland 1.4 -4.6 1.0 -2.7 0.9 -0.1
Denmark 0.9 -7 0.6 -1.2 0.2 -0.3
Hungary 1.4 4.3 1.0 0.9 0.6 -0.1
EU27 1.4 0.1 1.0 0 0.8 -
Change (years) in life expectancy (LE) and healthy life years (HLY) at birth, age 65 and age 85 between 2005 and 2010, men and women, selected EU countries.
Source: European Health and Life Expectancy Information System
Life expectancy (LE) and healthy life years (HLY), selected EU countries and regions, men at Age 65
0
5
10
15
20
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Rem
aini
ng y
ears
of l
ife
Age 65
EU (27) LE
Denmark LE
France LE
Italy LE
Hungary LE
Poland LE
EU (27) HLY
Denmark HLY
France HLY
Italy HLY
Hungary HLY
Poland HLY
Source: European Health and Life Expectancy Information System
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Rem
aini
ng y
ears
of l
ife
Age 85
EU (27) LE
Denmark LE
France LE
Italy LE
Hungary LE
Poland LE
EU (27) HLY
Denmark HLY
France HLY
Italy HLY
Hungary HLY
Poland HLY
Life expectancy (LE) and healthy life years (HLY), selected EU countries and regions, men at Age 85
Source: European Health and Life Expectancy Information System
Oxford Institute of Population Ageing
Three scenarios for changing relationship between life expectancy at 65 and disability-free life expectancy between 2006 and 2026 in the UK. Percentages refer to proportion of remaining life expectancy that is disability-free. It decreases in all scenarios.
19.5
16.7
18.5
16.7
18.8
16.7
2.9
1.8
3.1
1.8
3
1.8
0 5 10 15 20 25
Ageing only
Poorer health
Improving health
90%
86%
86%
87%
90%
90%
Source: C Jagger, R Matthews. 2008 findings from ESRC IMAP 2030 project
2006
2006
2006
2026
2026
2026
Life years without disability Life years with disability
Oxford Institute of Population Ageing
Change in dementia prevalence over time.
Wu et al, 2015 Dementia in Western Europe: epidemiological evidence and implications for policy making, The Lancet
Oxford Institute of Population Ageing
!! Will increases in both life expectancy and in life extension or
longevity continue? !! will there be an increase in average years lived by humans and also
maximum years attained by a human being?
!! Will life expectancy increase in line with life extension? !! will we all enjoy the benefits of longevity or will it be for a few? The Inequality question
!! Will increases in life expectancy be accompanied by increases in life extension or are we seeing a compression of longevity after 100?
!! Will advances in life expectancy be matched by advances in healthy life expectancy?
Oxford Institute of Population Ageing
The inequality question ….. It was originally thought that social class differentials in mortality were to be understood mainly in terms of poverty measures: inadequate nutrition, overcrowded living conditions, poor sanitation and personal hygiene, and hazardous working conditions. Now evident that despite the considerable improvements in the standard of living of the lower socio-economic groups, there is still a large gap in LE and larger (increasing) in HLE Social gradient in mortality risk: lower income groups within a society have a higher mortality rate, despite being well above the poverty line.
Oxford Institute of Population Ageing
Inequalities and Life Course ‘ § Foetal origins hypothesis’, which links impaired foetal growth
with increased risk of cardiovascular mortality.
§ There is also a clear relationship between marital status and mortality risk: married people tend to have better health and to live longer than never-married people, who in turn do somewhat better than the divorced or widowed.
§ Most recently social class, unemployment and education were found to be strongly related to variation in LE and DFLE at birth but were less influential in explaining variations at age 85.
Oxford Institute of Population Ageing
Inequality in Mortality
Club Vita UK data set: 2 million Occupational Pension Records
Rate ratios for age-standardised mortality rates for different socioeconomic and retirement categories
(deaths per 100,000 pop)
Regional distribution of factors associated with high mortality in men and womena (percentages)
Comparison of life expectancy top and bottom salary quintiles for different regions
Comparison of life expectancy top and bottom Carstairs quintiles for different regions
DevianceAnalysis
Oxford Institute of Population Ageing
Differential longevity
Comparison of UK life expectancies from age 65
Low High Difference Men 12.0 23.0 11.0 years
Low income High income Ill health retiree Normal health retiree Unhealthy lifestyle Healthy lifestyle
Source: Oxford Institute of Population Ageing
Comparison of UK life expectancies from age 65
Low High Difference Men 12.0 23.0 11.0 years
Low income High income Ill health retiree Normal health retiree Unhealthy lifestyle Healthy lifestyle
Oxford Institute of Population Ageing
Proportion of 65 year old men expected to survive to each older age
Source: Oxford Institute of Population Ageing Source: Oxford Institute of Population Ageing
100
75
50
25
0
65 75 85 95 Age
% probability of reaching age x
Unhealthy lifestyle, ill health retiree, poor Healthy lifestyle, normal health retiree, rich ‘Average’ individual
Impact of different factors on longevity
4.6
4
1.8
0.7
12
0 5 10 15 20 25
if he also had a healthy lifestyle
if he also had a high income
if he retired in normal health
if he did a non-manual job
Manual employee, poor, unhealthy lifestyle, ill health retiree
Remaining Expectancy from age 65
Oxford Institute of Population Ageing
Will increases in both life expectancy and in life extension or longevity continue?
will there be an increase in average years lived by humans and also maximum years attained by a human being?
Will life expectancy increase in line with life extension? will we all enjoy the benefits of longevity or will it be for a few? The Inequality question
!! Will increases in life expectancy be accompanied by increases in life extension or are we seeing a compression of longevity after 100?
Will advances in life expectancy be matched by advances in healthy life expectancy?
Oxford Institute of Population Ageing
Determinants of the shape of mortality and morbidity in 21st Century § Healthy Living § Disease Prevention and Cure § Regenerative medicine § Age-Retardation. Key Question How much life expectancy can we expect to gain without the intensive application of scientific medicine?
Estimate the impact on life expectancy of delaying the onset of what we know to be age-related diseases rather than eliminating them altogether.
Oxford Institute of Population Ageing
Centenarians
Will increases in life expectancy be accompanied by increases in life extension or are we seeing a compression of longevity after 100?
Oxford Institute of Population Ageing
Centenarians
Oxford Institute of Population Ageing
Source: Oxford Institute of Population Ageing Statistics
2010 2020 2030 2040 2050 2060 2070 2080
Centenarians Projected number of centenarians in the USA
6m
5m
4m
3m
2m
1m
>1m
Oxford Institute of Population Ageing
Source: Christiansen et al Lancet 2009
Oxford Institute of Population Ageing
Determinants of the shape of mortality and morbidity in 21st Century § Healthy Living § Disease Prevention and Cure § Regenerative medicine § Age-Retardation. Key Question How much life expectancy can we expect to gain with the intensive application of scientific medicine?
Oxford Institute of Population Ageing
Bio-Technology
Oxford Institute of Population Ageing
Therapeutic cell type
Skin Cell
Reprogramming
Stem Cells
Picture: Time (left) Paul J Fairchild, Dunn School of Pathology (right)
Human
Oxford Institute of Population Ageing
Oxford Institute of Population Ageing
The Challenge……
Thechallengeinallregionsishowtosustainand
enhancewell-beingacrossanindividual’slife,while
atthesamePmereducingtheinequaliPeswithin
eachgeneraPon,andensuringanequitable
reallocaPonofresourcesbetweenthegeneraPons.
Oxford Institute of Population Ageing
www.ageing.ox.ac.uk
Oxford Institute of Population Ageing
Picture: Nasir Hamid/Oxford University