Trends in life expectancy: did the gap between the healthy and the ill widen or close?
Trends in life expectancy: did the gap between the healthy and the ill widen or close?
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DOI：
10.1186/s12916-020-01514-z
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发表时间：
2020-03-20
期刊：
影响因子：
9.3
通讯作者：
Modig, Karin
中科院分区：
文献类型：
--
作者：
Meyer, Anna C.;Drefahl, Sven;Modig, Karin
背景 在过去的几十年里，大多数高收入国家的预期寿命持续增长。先前的研究表明，预期寿命的提高主要是由健康分布高端的进步推动的，而部分人口则落后了。本研究利用瑞典全体人口的数据，旨在研究有常见疾病史的亚组人群相对于普通人群的预期寿命发展情况。方法 对 1998 年至 2017 年间每年有疾病史的个人以及瑞典总人口的 65 岁剩余预期寿命进行了估计。我们将人群亚组定义为有心肌梗塞、缺血性或出血性中风、髋部骨折、结肠癌、乳腺癌或肺癌病史的个体。我们进一步区分了不同的教育水平和查尔森合并症指数分数。结果 有心肌梗塞、缺血性或出血性中风以及结肠癌或乳腺癌病史的男性和女性的预期寿命延长幅度高于一般人群。然而，有髋部骨折或肺癌病史的人与普通人群之间的预期寿命差距一直在扩大。教育和合并症影响了死亡率水平，但没有改变有疾病史的个体的预期寿命增长率。在有疾病史的个体中，女性预期寿命的优势不如一般人群那么明显。结论 许多有疾病史的亚人群的预期寿命比一般人群增长得更快，但仍处于较低水平。无论合并症或教育水平如何，预期寿命均有所改善。这些发现表明，总体预期寿命的提高不仅仅反映了健康人生存率的提高或疾病发病的延迟。
Background During the past decades, life expectancy has continued to increase in most high-income countries. Previous research suggests that improvements in life expectancy have primarily been driven by advances at the upper end of the health distribution, while parts of the population have lagged behind. Using data from the entire Swedish population, this study aims to examine the life expectancy development among subgroups of individuals with a history of common diseases relative to that of the general population. Methods The remaining life expectancy at age 65 was estimated for each year in 1998-2017 among individuals with a history of disease, and for the total Swedish population. We defined population subgroups as individuals with a history of myocardial infarction, ischemic or hemorrhagic stroke, hip fracture, or colon, breast, or lung cancer. We further distinguished between different educational levels and Charlson comorbidity index scores. Results Life expectancy gains have been larger for men and women with a history of myocardial infarction, ischemic or hemorrhagic stroke, and colon or breast cancer than for the general population. The life expectancy gap between individuals with a history of hip fracture or lung cancer and the general population has, however, been growing. Education and comorbidity have affected mortality levels, but have not altered the rate of increase in life expectancy among individuals with disease history. The female advantage in life expectancy was less pronounced among individuals with disease history than among the general population. Conclusions Life expectancy has increased faster in many subpopulations with a history of disease than in the general population, while still remaining at lower levels. Improvements in life expectancy have been observed regardless of comorbidity or educational level. These findings suggest that the rise in overall life expectancy reflects more than just improved survival among the healthy or the delayed onset of disease.