The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting
The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting
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DOI：
10.1016/s0140-6736(15)60296-3
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发表时间：
2015-07-11
期刊：
影响因子：
168.9
通讯作者：
Ezzati, Majid
中科院分区：
文献类型：
--
作者：
Bennett, James E.;Li, Guangquan;Ezzati, Majid
规划养老金和保健及社会服务的背景需要预测未来的死亡率和预期寿命。对一个国家内所有国家以下单位的一致预测是非常罕见的。我们的目标是预测英格兰和威尔士地区的死亡率和预期寿命。方法我们开发了贝叶斯时空模型，用于在当地小区域水平预测特定年龄段的死亡率和预期寿命。这些模型包括与年龄、出生队列、时间和空间相关的死亡率的组成部分。我们使用了1981年至2012年国家统计局的地理编码死亡率和人口数据，以及误差最小的模型，预测了英格兰和威尔士376个区中375个区到2030年的年龄死亡率和预期寿命。我们通过隐瞒最近的数据来衡量模型的表现，并将预测与隐瞒的数据进行比较。2012年，英格兰和威尔士的出生时预期寿命男性为79.5岁(95%可信区间79.5-79.6)，女性为83.3岁(83.3-83.4)。地区预期寿命男性为75.2岁(74.9-75.6)至83.4岁(82.1-84.8)，女性为80.2岁(79.8-80.5)至87.3岁(86.0-88.8)。1981至2012年间，男性预期寿命增加了8.2岁，女性增加了6.0岁，男女之间的差距从6.0岁缩小到3.8岁。2030年全国人均预期寿命预计将达到男性85.7岁(84.2-87.4)岁，女性87.6岁(86.7-88.9岁)，女性优势进一步缩小至1.9岁。到2030年，各区男性预期寿命将达到或超过81.4岁，女性预期寿命将达到或超过84.5岁。各地区的寿命不平等，即地区预期寿命的第一个百分位数和第99个百分位数之间的差异，自1981年以来一直在上升，预计到2030年，男性将稳定上升到8.3岁(6.8-9.7岁)，女性将达到8.3岁(7.1-9.4岁)。目前的预测低估了预期寿命的增长，特别是男性的预期寿命，因此需要为英格兰和威尔士的老年人提供更好的医疗和社会服务和养老金。需要卫生和社会政策来遏制日益扩大的预期寿命不平等，帮助贫困地区赶上寿命增长，并避免所谓的健康和寿命方面的巨大差异。
Background To plan for pensions and health and social services, future mortality and life expectancy need to be forecast. Consistent forecasts for all subnational units within a country are very rare. Our aim was to forecast mortality and life expectancy for England and Wales' districts.Methods We developed Bayesian spatiotemporal models for forecasting of age-specific mortality and life expectancy at a local, small-area level. The models included components that accounted for mortality in relation to age, birth cohort, time, and space. We used geocoded mortality and population data between 1981 and 2012 from the Office for National Statistics together with the model with the smallest error to forecast age-specific death rates and life expectancy to 2030 for 375 of England and Wales' 376 districts. We measured model performance by withholding recent data and comparing forecasts with this withheld data.Findings Life expectancy at birth in England and Wales was 79.5 years (95% credible interval 79.5-79.6) for men and 83.3 years (83.3-83.4) for women in 2012. District life expectancies ranged between 75.2 years (74.9-75.6) and 83.4 years (82.1-84.8) for men and between 80.2 years (79.8-80.5) and 87.3 years (86.0-88.8) for women. Between 1981 and 2012, life expectancy increased by 8.2 years for men and 6.0 years for women, closing the female-male gap from 6.0 to 3.8 years. National life expectancy in 2030 is expected to reach 85.7 (84.2-87.4) years for men and 87.6 (86.7-88.9) years for women, further reducing the female advantage to 1.9 years. Life expectancy will reach or surpass 81.4 years for men and reach or surpass 84.5 years for women in every district by 2030. Longevity inequality across districts, measured as the difference between the 1st and 99th percentiles of district life expectancies, has risen since 1981, and is forecast to rise steadily to 8.3 years (6.8-9.7) for men and 8.3 years (7.1-9.4) for women by 2030.Interpretation Present forecasts underestimate the expected rise in life expectancy, especially for men, and hence the need to provide improved health and social services and pensions for elderly people in England and Wales. Health and social policies are needed to curb widening life expectancy inequalities, help deprived districts catch up in longevity gains, and avoid a so-called grand divergence in health and longevity.