Lack of improvement of life expectancy at advanced ages in The Netherlands

BACKGROUND: Several countries have reported an increase in life expectancy at advanced ages. This paper analyses recent changes in life expectancy at age 60 and 85 in The Netherlands, a low mortality country with reliable mortality data. METHODS: We used data on the population and the number of deaths by age, sex and underlying cause of death for 1970-1994. Life expectancy at age 60 and 85 was estimated using standard life-table techniques. The contribution of different ages and causes of death to the change in life expectancy during the 1970s (1970/74-1980/84) and the 1980s (1980/84-1990/94) were estimated with a decomposition technique developed by Arriaga. RESULTS: Life expectancy at age 60 increased in the 1970s and 1980s, whereas life expectancy at age 85 decreased (men) and stagnated (women) in the 1980s, and has decreased in both sexes since 1985/89. The decomposition by age showed that constant mortality rates in women aged 85-89, and increasing mortality rates at ages 85+ (men) and 90+ (women) have caused this lack of increase in life expectancy. The decomposition by cause of death showed that smaller mortality reductions from other cardiovascular and cerebrovascular diseases, which contributed most to the increase in life expectancy at age 85 in the 1970s, and mortality increases from, amongst others, chronic obstructive pulmonary disease (COPD), mental disorders and diabetes mellitus produced the decrease (men) and plateau (women) in life expectancy at age 85. CONCLUSIONS: Life expectancy at advanced ages stopped increasing during the 1980s in The Netherlands due to mortality increases at ages 85+ (men) and 90+ (women). Cause-specific trends suggest that, in addition to (past) smoking behaviour in men, changes in the distribution of morbidity and frailty in the population might have contributed to this stagnation

Compression or expansion of morbidity? A life-table approach

Changes in incidence, progression and l'ecovery of morbidity and related disability have important consequences for mortality, and, vice versa, changes in modality have important consequences for morbidity. The inter· play of changes in mortality and morbidity determines whether population health is improving 01' deteriorating. A deterioration or an improvement in the health status of the population has far reaching consequences. A deterioration in population health affects the lives of indivieluals and has implications for society as a whole, for instance in terms of population (health) service needs and social security. The subject of this thesis is the association between mortality and morbidity and its implications for population health. We will examine which conditions are necessary for longer life to be associated with better health. To this end we will assess which changes in underlying patterns of mortality and morbidity will produce a reduction in years with disability ('absolute compression of morbidity') andior a reduction of the proportion of life with elisability ('relative compression of morbidity')

The longevity risk of the Dutch Actuarial Association’s projection model

Accurate assessment of the risk that arises from further increases in life expectancy is crucial for the financial sector, in particular for pension funds and life insurance companies. The Dutch Actuarial Association presented a revised projection model in 2010, while in the same year two fundamentally different approaches were published by other institutions. This situation invites study of the consequences that the choice of projection model has on estimates of future life expectancy, which is the purpose of this paper. We firstly compare the three approaches against theoretical findings in the international literature. Secondly, we compare their outcomes in terms of period and cohort survival. In addition, we estimate the impact of each model on the present value of future pension payments. Our results indicate that, even in the short term, remarkable differences in life expectancy occur that also translate into different pension values. The literature review suggests that there is currently no blueprint for mortality projections; that calls for the application of various approaches to discount the uncertainty of the individual models. Instead of relying on extrapolation methods only, the pension sector should also take expert-driven forecasts into account as well as approaches that model causal influences on mortality. The model of the Actuarial Association could be improved by taking cohort influences into account as well as the estimate of uncertainty bounds around the outcome measure. Also, the consistency of the projection in terms of the age and gender dimensions but also other countries should be enhanced

Compressie van morbiditeit: een veelbelovende benadering om de maatschappelijke consequenties van vergrijzing te verlichten?

There is an urgent need for strategies that alleviate the societal consequences of population ageing. A possible strategy is aiming for compression of morbidity. Some of the initial conditions for a compression of morbidity have been invalidated. The life expectancy has shown a much stronger increase than was expected and the modal age at death has exceeded the age of 85. Trend studies have found no consistent evidence for a compression of morbidity. At the department of Public Health, we aim at identifying entry-points for a compression. For example, an analysis was performed on potential contributions of changes in exposure to life style factors (smoking, hypertension, physical inactivity and overweight/obesity) to compression of cardiovascular disease, using multi-state life tables with data from the Framingham Heart Study. It was shown that smoking and physical inactivity increased the incidence of cardiovascular disease, as well as mortality with and without cardiovascular disease. Hypertension and overweight mainly increased the incidence of cardiovascular disease. Interventions on the latter risk factors will therefore increase the life expectancy, but will also result in a compression of morbidity. For policymakers and researchers it is important to find a mix of interventions that lead to a comparable overall effect

Forecasting differences in life expectancy by education

Forecasts of life expectancy (LE) have fuelled debates about the sustainability and dependability of pension and healthcare systems. O

The case for action on socioeconomic differences in overweight and obesity among Australian adults: modelling the disease burden and healthcare co

Objective: We aimed to quantify the extent to which socioeconomic differences in body mass index (BMI) drive avoidable deaths, incident disease cases and healthcare costs. Methods: We used population attributable fractions to quantify the annual burden of disease attributable to socioeconomic differences in BMI for Australian adults aged 20 to <85 years in 2016, stratified by quintiles of an area-level indicator of socioeconomic disadvantage (SocioEconomic Index For Areas Indicator of Relative Socioeconomic Disadvantage; SEIFA) and BMI (normal weight, overweight, obese). We estimated direct healthcare costs using annual estimates per person per BMI category. Results: We attributed $AU1.06 billion in direct healthcare costs to socioeconomic differences in BMI in 2016. The greatest number (proportion) of cases and deaths attributable to socioeconomic differences in BMI was observed for type 2 diabetes among women (8,602 total cases [16%], with 3,471 cases [22%] in the most disadvantaged quintile [SEIFA 1]) and all-cause mortality among men (2027 total deaths [4%], with 815 deaths [6%] in SEIFA 1). Conclusions: Socioeconomic differences in BMI substantially contribute to avoidable deaths, disease cases and direct healthcare costs in Australia. Implications for public health: Population-level policies to reduce socioeconomic differences in overweight and obesity must be identified and implemented

Educational inequalities in Global Activity Limitation Indicator disability in 28 European Countries: Does the choice of survey matter?

Objectives: To assess the sensitivity of prevalence and inequality estimates of Global Activity Limitation Indicator (GALI) to the choice of

The influence of health care spending on life expectancy

Health care expenditures and life expectancy have both been rising in many countries, including in the Netherlands. However, it is unclear to what extent increased health care spending caused the increase in life expectancy. Establishing a causal link between health care expenditures and mortality is difficult for several reasons. In medicine, randomized clinical trials are the gold standard to demonstrate causality and thereby the effectiveness of clinical interventions. However, data from randomized trials are not available to estimate the influence of health care spending on life expectanc

Substituting polyunsaturated fat for saturated fat: A health impact assessment of a fat tax in seven European countries

There is evidence that replacing saturated fat (SFA) with polyunsaturated fat (PUFA) lowers ischemic heart disease (IHD). In order to improve the population’s diet, the World Health Organization has called for the taxation of foods that are high in SFA. We aimed to assess the potential health gains of a European fat tax by applying the SFA intake reduction that has been observed under the Danish fat tax to six other European countries. For each country, we created a fat tax scenario with a decreased SFA intake and a corresponding increase in PUFA. We compared this fat tax scenario to a reference scenario with no change in SFA intake, and to a guideline scenario with a population-wide SFA intake in line with dietary recommendations. We used DYNAMO-HIA to dynamically project the policy-attributable IHD cases of these three scenarios 10 years into the future. A fat tax would reduce prevalent IHD cases by a minimum of 500 and 300 among males and females in Denmark, respectively, up to a maximum of 5,600 and 4,000 among males and females in the UK. Thereby, the prevented IHD cases under a fat tax scenario would correspond to between 11.0% (in females in the Netherlands) and 29.5% (in females in Italy) of the prevented IHD cases under a guideline scenario, which represents the maximum preventable disease burden. Henceforth, our quantification of beneficial health impacts makes the case for the policy debate on fat taxes

Adult obesity and the burden of disability throughout life

OBJECTIVE: To analyze the prevalence of disability throughout life and life expectancy free of disability, associated with obesity at ages 30 to 49 years. RESEARCH METHODS AND PROCEDURES: We used 46 and 20 years of mortality follow-up, respectively, for 3521 Original and 3013 Offspring Framingham Heart Study participants 30 to 49 years and classified as normal weight, overweight, or obese at baseline. Disability measures were available between 36 and 46 years of follow-up for 1352 Original participants and at 20 years of follow-up for 2268 Offspring participants. We measured the odds of disability in the Original cohort after 46 years follow-up, and we estimated life expectancy with and without disability from age 50. Two disability measures were used, one representing limitations with mobility only and the second representing limitations with activities of daily living (ADL). RESULTS: Obesity at ages 30 to 49 years was associated with a 2.01-fold increase in the odds of ADL limitations 46 years later. Nonsmoking adults who were obese between 30 and 49 years lived 5.70 (95% confidence interval, 4.11 to 7.35) (men) and 5.02 (95% confidence interval, 3.36 to 6.61) (women) fewer years free of ADL limitations from age 50 than their normal-weight counterparts. There was no significant difference in the total number of years lived with disability throughout life between those obese or normal weight, due to both higher disability prevalence and higher mortality in the obese population. DISCUSSION: Obesity in adulthood is associated with an increased risk of disability throughout life and a reduction in the length of time spent free of disability, but no substantial change in the length of time spent with disability