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

预期寿命的增加是否意味着健康状况不佳的时间减少？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，晚出生的人群似乎比早出生的人群寿命更长，健康状况更好。然而，对于第二次世界大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。在联合王国，战后出生较晚的同龄人与出生较早的同龄人相比，身心健康状况不佳的发生率更高。大多数关于健康预期寿命近期趋势的研究使用了从横截面数据构建的伪队列。这可能会限制我们理解导致健康预期队列间差异的机制的能力，因为它们并不反映任何真实的个体的生活经验。来自纵向研究的数据可以帮助我们更好地了解是什么驱动了健康预期的代际差异，使我们能够观察个体如何在一生中通过不同的健康状态取得进展。这个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，特别强调英国。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如何变化，以及这些变化对社会和人口健康的意义，因为早期和中期的成年人达到老年。它还将探索健康预期寿命的队列间差异在多大程度上是由于“客观”健康状况恶化，通过利用生物标志物和医疗保健系统的相关管理数据，以及改变对21世纪健康的看法和期望可能会推动多少。

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.