Living healthier for longer: comparative effects of three heart-healthy behaviors on life expectancy with and without cardiovascular disease

Background: Non-smoking, having a normal weight and increased levels of physical activity are perhaps the three key factors for preventing cardiovascular disease (CVD). However, the relative effects of these factors on healthy longevity have not been well described. We aimed to calculate and compare the effects of non-smoking, normal weight and physical activity in middle-aged populations on life expectancy with and without cardiovascular disease. Methods: Using multi-state life tables and data from the Framingham Heart Study (n = 4634) we calculated the effects of three heart healthy behaviours among populations aged 50 years and over on life expectancy with and without cardiovascular disease. For the life table calculations, we used hazard ratios for 3 transitions (No CVD to CVD, no CVD to death, and CVD to death) by health behaviour category, and adjusted for age, sex, and potential confounders. Results: High levels of physical activity, never smoking (men), and normal weight were each associated with 20-40% lower risks of developing CVD as compared to low physical activity, current smoking and obesity, respectively. Never smoking and high levels of physical activity reduced the risks of dying in those with and without a history of CVD, but normal weight did not. Never-smoking was associated with the largest gains in total life expectancy (4.3 years, men, 4.1 years, women) and CVD-free life expectancy (3.8 and 3.4 years, respectively). High levels of physical activity and normal weight were associated with lesser gains in total life expectancy (3.5 years, men and 3.4 years, women, and 1.3 years, men and 1.0 year women, respectively), and slightly lesser gains in CVD-free life expectancy (3.0 years, men and 3.1 years, women, and 3.1 years men and 2.9 years women, respectively). Normal weight was the only behaviour associated with a reduction in the number of years lived with CVD (1.8 years, men and 1.9 years, women). Conclusions: Achieving high levels of physical activity, normal weight, and never smoking, are effective ways to prevent cardiovascular disease and to extend total life expectancy and the number of years lived free of CVD. Increasing the prevalence of normal weight could further reduce the time spent with CVD in the population

Differences in life expectancy between four Western countries and their Caribbean dependencies, 1980–2014

BackgroundIn the Caribbean, life expectancy in politically independent territories has increasingly diverged from that of territories that remained affiliated to their former colonizers. Because these affiliated territories differ in degree of political independence, they are not all governed in the same way. We assessed whether differences in life expectancy trends between Caribbean dependencies and their Western administrators were related to their degree of political independence, and which causes of death contributed to divergence or convergence in life expectancy.MethodsAnalysis of age-standardized death rates and decomposition of life expectancy differences between France, the Netherlands, UK, USA and their Caribbean dependencies by age and cause-of-death during the period 1980–2014.ResultsLife expectancy differences between Western countries and their dependencies have generally increased for men and narrowed for women, but trends have been much more favorable in the French- than in the Dutch-administered territories. The strongest contributions to widening gaps in life expectancy between Western countries and their dependencies were from mortality from cardiovascular diseases (ischemic heart disease) and external causes (homicide and traffic accidents).ConclusionDependencies with a stronger political affiliation to a Western country experienced more favorable life expectancy developments than dependencies that had more autonomy during the 1980–2014 period. The underlying mortality differences with Western countries are largely comparable among Caribbean territories but differ in magnitude, most notably for cardiovascular disease and external causes. This suggests that increases in a territory’s political autonomy impairs the diffusion of new knowledge and techniques, and/or reduces government’s effectiveness in implementing policies

Available energy of trapped electrons in Miller tokamak equilibria

Available energy (\AE{}), which quantifies the maximum amount of thermal energy that may be liberated and converted into instabilities and turbulence, has shown to be a useful metric for predicting saturated energy fluxes in trapped-electron-mode-driven turbulence. Here, we calculate and investigate the \AE{} in the analytical tokamak equilibria introduced by \citet{Miller1998NoncircularModel}. The \AE{} of trapped electrons reproduces various trends also observed in experiments; negative shear, increasing Shafranov shift, vertical elongation, and negative triangularity can all be stabilising, as indicated by a reduction in \AE{}, although it is strongly dependent on the chosen equilibrium. Comparing \AE{} with saturated energy flux estimates from the \textsc{tglf} model, we find fairly good correspondence, showcasing that \AE{} can be useful to predict trends. We go on to investigate \AE{} and find that negative triangularity is especially beneficial in vertically elongated configurations with positive shear or low gradients. We furthermore extract a gradient threshold-like quantity from \AE{} and find that it behaves similarly to gyrokinetic gradient thresholds: it tends to increase linearly with magnetic shear, and negative triangularity leads to an especially high threshold. We next optimise the device geometry for minimal \AE{} and find that the optimum is strongly dependent on equilibrium parameters, e.g. magnetic shear or pressure gradient. Investigating the competing effects of increasing the density gradient, the pressure gradient, and decreasing the shear, we find regimes that have steep gradients yet low \AE{}, and that such a regime is inaccessible in negative-triangularity tokamaks.Comment: 31 pages, 16 figure

The available energy of trapped electrons:a nonlinear measure for turbulent transport

A collisionless plasma possesses a certain amount of 'available energy', which is that part of the thermal energy that can be converted into kinetic energy of plasma motion and electromagnetic fluctuations. In this paper we present a calculation of the available energy carried by trapped electrons in a slender non-omnigenous flux tube of plasma. This quantity is compared with gyrokinetic simulations of the nonlinear saturated radial energy flux resulting from turbulence driven by collisionless trapped-electron modes in various stellarators and a tokamak. The numerical calculation of available energy is fast and shows a strong correlation with the turbulent energy fluxes found in the gyrokinetic simulations. Indeed, the energy flux is found to be proportional to the available energy to the power of approximately, which is what one would expect from a simple argument. We furthermore investigate how available energy is distributed across different bounce wells, and it is found that deeply trapped electrons typically contribute most to the available energy. Finally, we investigate the dependence of available energy on gradient strength, and we find important differences between weakly and strongly driven regimes for stellarators and tokamaks.</p

Trends in inequalities in disability in Europe between 2002 and 2017

Monitoring socioeconomic inequalities in population health is important in order to reduce them. We aim to determine if educational inequalities in Global Activity Limitation Indicator (GALI) disability have changed between 2002 and 2017 in Europe (26 countries). We used logistic regression to quantify the annual change in disability prevalence by education, as well as the annual change in prevalence difference and ratio, both for the pooled sample and each country, as reported in the European Union Statistics on Income and Living Conditions (EU-SILC) and the European Social Survey (ESS) for individuals aged 30–79 years. In EU-SILC, disability prevalence tended to decrease among the high educated. As a result, both the prevalence difference and the prevalence ratio between the low and high educated increased over time. There were no discernible trends in the ESS. However, there was substantial heterogeneity between countries in the magnitude and direction of these changes, but without clear geographical patterns and without consistency between surveys. Socioeconomic inequalities in disability appear to have increased over time in Europe between 2002 and 2017 as per EU-SILC, and have persisted as measured by the ESS. Efforts to further harmonise disability instruments in international surveys are important, and so are studies to better understand international differences in disability trends and inequalities.</p

The available energy of trapped electrons:a nonlinear measure for turbulent transport

A collisionless plasma possesses a certain amount of 'available energy', which is that part of the thermal energy that can be converted into kinetic energy of plasma motion and electromagnetic fluctuations. In this paper we present a calculation of the available energy carried by trapped electrons in a slender non-omnigenous flux tube of plasma. This quantity is compared with gyrokinetic simulations of the nonlinear saturated radial energy flux resulting from turbulence driven by collisionless trapped-electron modes in various stellarators and a tokamak. The numerical calculation of available energy is fast and shows a strong correlation with the turbulent energy fluxes found in the gyrokinetic simulations. Indeed, the energy flux is found to be proportional to the available energy to the power of approximately, which is what one would expect from a simple argument. We furthermore investigate how available energy is distributed across different bounce wells, and it is found that deeply trapped electrons typically contribute most to the available energy. Finally, we investigate the dependence of available energy on gradient strength, and we find important differences between weakly and strongly driven regimes for stellarators and tokamaks.</p