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19世纪末和20世纪初出生在美国等高收入国家的人群来说，晚出生的人群确实比早出生的人群寿命更长，健康状况也更好。然而，对于二战后出生的人群来说，更长的寿命和更好的健康状况之间的联系似乎不那么直接。在联合王国，较晚出生的战后人群在同年龄阶段的身体和心理健康状况较差的比例高于较早出生的人群。大多数关于健康预期寿命近期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驱动健康预期在队列之间差异的机制的能力，因为它们不能反映任何真实个体的生活经验。来自纵向研究的数据可以帮助我们更好地理解是什么导致了健康预期的代际差异，使我们能够观察个人在一生中如何经历不同的健康状态。本博士学位的目的是利用来自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的最新趋势的理解，特别强调联合王国。该项目将评估自第二次世界大战以来出生的连续几代人的发病年龄是如何变化的，以及随着成年早期和中期人群进入老年，这些变化对社会和人口健康可能意味着什么。它还将通过利用来自医疗保健系统的生物标志物和相关管理数据，探索健康预期寿命的队列之间差异在多大程度上是由“客观上”更差的健康状况造成的，以及在21世纪，人们对健康的看法和期望的变化可能在多大程度上推动了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.