Healthy longevity in the 21st century: Leveraging longitudinal microdata to explore macro trends in healthy life expectancy

预期寿命的延长是否意味着健康状况不佳的时间会减少？对于出生在19世纪末和20世纪初的美国等高收入国家的人来说，出生较晚的人似乎确实比出生较早的人活得更长，健康状况也更好。然而，对于二战后出生的人群来说，长寿和更好的健康之间的联系似乎不那么直接。在英国，与较早出生的战后同龄人相比，较晚出生的战后同龄人身心健康状况较差的比例更高。大多数关于健康预期寿命最新趋势的研究使用的是由横断面数据构建的伪队列。这可能会限制我们理解推动队列间健康预期差异的机制的能力，因为它们不反映任何真实个体的生活经验。来自纵向研究的数据有助于更好地理解是什么导致了健康预期寿命的代际差异，使我们能够观察个人在一生中如何在不同的健康状态中进步。本博士学位的目的是利用一系列队列研究的纵向微观数据，以提高我们对高收入国家健康预期寿命最近趋势的理解，特别是英国。该项目将评估自第二次世界大战以来出生的几代人中疾病发病年龄的变化，以及这些变化可能对社会和人口健康意味着什么，因为成年早期和中期的人群达到了较高的年龄。它还将通过利用来自医疗保健系统的生物标记物和相关管理数据，探索队列之间的健康预期寿命差异在多大程度上是由于健康状况的客观恶化造成的，以及对21世纪健康意味着什么的看法和预期的变化可能会在多大程度上推动健康预期寿命的变化。

Does increasing life expectancy mean fewer years spent in poor health? For cohorts born in the late 19th and early 20th centuries in high-income countries like the United States, later-born cohorts did appear to live longer and to live longer in better health than earlier-born cohorts. However, for cohorts born since the Second World War, the connection between longer lives and better health appears less straight-forward. In the United Kingdom, later-born post-war cohorts have a higher prevalence of poor physical and mental health at the same age compared to earlier-born cohorts. Most studies on recent trends on healthy life expectancy use pseudo-cohorts constructed from cross-sectional data. This can limit our ability to understand the mechanisms driving between-cohort differences in health expectancies since they do not reflect the lived experience of any real set of individuals. Data from longitudinal studies could help to better understand what is driving inter-generational differences in health expectancies, allowing us to observe how individuals progress through different health states throughout their lives.The aim of this PhD is to leverage longitudinal micro-data from a series of cohort studies to improve our understanding of recent trends in healthy life expectancy in high-income countries, with a special emphasis on the United Kingdom. The project will assess how the age of onset of disease has changed across successive generations born since the Second World War, and what these changes might mean for society and population health as cohorts in early and mid-adulthood reach older ages. It will also explore the extent to which between-cohort differences in healthy life expectancy result from 'objectively' worse health, by leveraging biomarker and linked administrative data from the healthcare system, and how much might be driven by changing perceptions and expectations of what it means to be healthy in the 21st century.