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


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


§  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


§  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


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


Age80Japanwomen

Francewomen

UKwomen

USAwomen

Japanmen

Francemen

UKmen

USAmen


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


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


Source: US Centers for Disease Control

Prevalence of obesity (BMI > 30), age 50+

0

5

10

15

20

25

30

35

40


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


Picture: Colourbox


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).


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?


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.


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


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



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


USA 2000–2006 Activity limitation 0.9 0.5 0.7 0.8 0.3 0.3




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


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



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


Change in dementia prevalence over time.

Wu et al, 2015 Dementia in Western Europe: epidemiological evidence and implications for policy making, The Lancet


!! 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?


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.


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.


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


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


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


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?


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.


Centenarians

Will increases in life expectancy be accompanied by increases in life extension or are we seeing a compression of longevity after 100?


Centenarians


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


Source: Christiansen et al Lancet 2009


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?


Bio-Technology


Therapeutic cell type

Skin Cell

Reprogramming

Stem Cells

Picture: Time (left) Paul J Fairchild, Dunn School of Pathology (right)

Human


The Challenge……

Thechallengeinallregionsishowtosustainand

enhancewell-beingacrossanindividual’slife,while

atthesamePmereducingtheinequaliPeswithin

eachgeneraPon,andensuringanequitable

reallocaPonofresourcesbetweenthegeneraPons.


www.ageing.ox.ac.uk


Picture: Nasir Hamid/Oxford University

longevity, life expectancy and healthy life expectancy...2017/01/01 · change (years) in life...

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