Vladimir Canudas-Romo

Three measures of longevity: time trends and record values.

This article examines the trend over time in the measures of “typical” longevity experienced by members of a population: life expectancy at birth, and the median and modal ages at death. The article also analyzes trends in record values observed for all three measures. The record life expectancy at birth increased from a level of 44 years in Sweden in 1840 to 82 years in Japan in 2005. The record median age at death shows increasing patterns similar to those observed in life expectancy at birth. However, the record modal age at death changes very little until the second half of the twentieth century: it moved from a plateau level, around age 80, to having a similar pace of increase as that observed for the mean and the median in most recent years. These findings explain the previously observed uninterrupted increase in the record life expectancy. The cause of this increase has changed over time from a dominance of child mortality reductions to a dominance of adult mortality reductions, which became evident by studying trends in the record modal age at death.

Multiple chronic conditions and life expectancy: a life table analysis

Background:The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy. Objective:We analyze life expectancy in Medicare beneficiaries by number of chronic conditions. Research Design:A retrospective cohort study using single-decrement period life tables. Subjects:Medicare fee-for-service beneficiaries (N=1,372,272) aged 67 and older as of January 1, 2008. Measures:Our primary outcome measure is life expectancy. We categorize study subjects by sex, race, selected chronic conditions (heart disease, cancer, chronic obstructive pulmonary disease, stroke, and Alzheimer disease), and number of comorbid conditions. Comorbidity was measured as a count of conditions collected by Chronic Conditions Warehouse and the Charlson Comorbidity Index. Results:Life expectancy decreases with each additional chronic condition. A 67-year-old individual with no chronic conditions will live on average 22.6 additional years. A 67-year-old individual with 5 chronic conditions and ≥10 chronic conditions will live 7.7 fewer years and 17.6 fewer years, respectively. The average marginal decline in life expectancy is 1.8 years with each additional chronic condition—ranging from 0.4 fewer years with the first condition to 2.6 fewer years with the sixth condition. These results are consistent by sex and race. We observe differences in life expectancy by selected conditions at 67, but these differences diminish with age and increasing numbers of comorbid conditions. Conclusions:Social Security and Medicare actuaries should account for the growing number of beneficiaries with multiple chronic conditions when determining population projections and trust fund solvency.

A flexible two-dimensional mortality model for use in indirect estimation

Mortality estimates for many populations are derived using model life tables, which describe typical age patterns of human mortality. We propose a new system of model life tables as a means of improving the quality and transparency of such estimates. A flexible two-dimensional model was fitted to a collection of life tables from the Human Mortality Database. The model can be used to estimate full life tables given one or two pieces of information: child mortality only, or child and adult mortality. Using life tables from a variety of sources, we have compared the performance of new and old methods. The new model outperforms the Coale–Demeny and UN model life tables. Estimation errors are similar to those produced by the modified Brass logit procedure. The proposed model is better suited to the practical needs of mortality estimation, since both input parameters are continuous yet the second one is optional.

Increased use of antidepressants and decreasing suicide rates: a population-based study using Danish register data

Objective: The objective of the present study was to examine if the change in the suicide rate is associated with individuals’ use of antidepressants as has been suggested by ecological studies. Design: Decomposition of suicide rates by antidepressant treatment group. Setting: Population-based record linkage. Participants: All individuals aged 50 years and older living in Denmark between 1 January 1996 and 31 December 2000 (N  =  2 100 808). Main outcome measures: Suicide rates are calculated according to current antidepressant treatment status (no treatment, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), other antidepressants). The change in the suicide rate during 1996–2000 was decomposed by treatment group. Results: Only one in five older adults dying by suicide was in treatment at the time of death. Whereas the male suicide rate declined by 9.7 suicides per 100 000, recipients of antidepressants contributed to the decline by 0.9 suicides. Women redeeming antidepressant prescriptions accounted for 0.4 suicides of the observed reduction of 3.3 per 100 000. The average suicide rates for men receiving TCA and SSRI were 153.3 and 169.0 per 100 000 person-years, respectively. Among older women, both TCA and SSRI users had an average suicide rate of 68.8 per 100 000 over the period examined. Conclusions: Just a small proportion of older adults dying by suicide were found to be in treatment with antidepressants at the time of death. Individuals in active treatment with antidepressants seem to account for 10% of the decline in the suicide rate. Nevertheless, suicides might be prevented by more effective treatment.

Timing effects on first marriage: Twentieth-century experience in England and Wales and the USA

Recent substantial declines in first marriage in Western countries have been accompanied by increases in the average age at first marriage. Since the period proportion ever marrying, PEM, is sensitive to cohort tempo changes, the recent fall in the PEM may simply reflect cohort delays in marriage. The importance of timing factors is examined in the light of twentieth-century experience of first marriage in England and Wales and the USA. Using a variant of the Timing Index developed in research on fertility, we measure cohort timing effects for marriage and calculate an adjusted PEM. After examining twentieth-century trends in nuptiality for men and women, we find substantial tempo effects on the period PEM. Adjusted PEM values show a real decline in marriage for cohorts, but that decline is considerably smaller than the one shown by the unadjusted figures. This is especially true for England and Wales, where the decline in marriage was much greater.

Mortality and Causes of Death in Patients With Osteogenesis Imperfecta: A Register-Based Nationwide Cohort Study

Osteogenesis imperfecta (OI) is a hereditary connective tissue disease that causes frequent fractures. Little is known about causes of death and length of survival in OI. The objective of this work was to calculate the risk and cause of death, and the median survival time in patients with OI. This study was a Danish nationwide, population‐based and register‐based cohort study. We used National Patient Register data from 1977 until 2013 with complete long‐term follow‐up. Participants comprised all patients registered with the diagnosis of OI from 1977 until 2013, and a reference population matched five to one to the OI cohort. We calculated hazard ratios for all‐cause mortality and subhazard ratios for cause‐specific mortality in a comparison of the OI cohort and the reference population. We also calculated all‐cause mortality hazard ratios for males, females, and age groups (0 to 17.99 years, 18.00 to 34.99 years, 35.00 to 54.99 years, 55.00 to 74.99 years, and >75 years). We identified 687 cases of OI (379 women) and included 3435 reference persons (1895 women). A total of 112 patients with OI and 257 persons in the reference population died during the observation period. The all‐cause mortality hazard ratio between the OI cohort and the reference population was 2.90. The median survival time for males with OI was 72.4 years, compared to 81.9 in the reference population. The median survival time for females with OI was 77.4 years, compared to 84.5 years in the reference population. Patients with OI had a higher risk of death from respiratory diseases, gastrointestinal diseases, and trauma. We were limited by the lack of clinical information about phenotype and genotype of the included patients. Patients with OI had a higher mortality rate throughout their life compared to the general population.

Remaining Life Expectancy With and Without Polypharmacy: A Register-Based Study of Swedes Aged 65 Years and Older

Objectives To investigate the remaining life expectancy with and without polypharmacy for Swedish women and men aged 65 years and older. Design Age-specific prevalence of polypharmacy from the nationwide Swedish Prescribed Drug Register (SPDR) combined with life tables from Statistics Sweden was used to calculate the survival function and remaining life expectancy with and without polypharmacy according to the Sullivan method. Setting Nationwide register-based study. Participants A total of 1,347,564 individuals aged 65 years and older who had been prescribed and dispensed a drug from July 1 to September 30, 2008. Measurements Polypharmacy was defined as the concurrent use of 5 or more drugs. Results At age 65 years, approximately 8 years of the 20 remaining years of life (41%) can be expected to be lived with polypharmacy. More than half of the remaining life expectancy will be spent with polypharmacy after the age of 75 years. Women had a longer life expectancy, but also lived more years with polypharmacy than men. Discussion Older women and men spend a considerable proportion of their lives with polypharmacy. Conclusion Given the negative health outcomes associated with polypharmacy, efforts should be made to reduce the number of years older adults spend with polypharmacy to minimize the risk of unwanted consequences.

Rise, stagnation, and rise of Danish women's life expectancy

Significance Life expectancy is the most commonly used measure of health status in a population. Life expectancy has increased rapidly in most western populations over the past two centuries. There has been an ongoing debate about the relative contribution of cohort and period effects on a nation’s life expectancy, but few concrete examples of strong cohort effects exist. In this study, we use demographic approaches to study cohort effects on the life expectancy of Danish women. We identify a clear-cut and strong cohort effect: the case of the interwar generations of Danish women. Health conditions change from year to year, with a general tendency in many countries for improvement. These conditions also change from one birth cohort to another: some generations suffer more adverse events in childhood, smoke more heavily, eat poorer diets, etc., than generations born earlier or later. Because it is difficult to disentangle period effects from cohort effects, demographers, epidemiologists, actuaries, and other population scientists often disagree about cohort effects’ relative importance. In particular, some advocate forecasts of life expectancy based on period trends; others favor forecasts that hinge on cohort differences. We use a combination of age decomposition and exchange of survival probabilities between countries to study the remarkable recent history of female life expectancy in Denmark, a saga of rising, stagnating, and now again rising lifespans. The gap between female life expectancy in Denmark vs. Sweden grew to 3.5 y in the period 1975–2000. When we assumed that Danish women born 1915–1945 had the same survival probabilities as Swedish women, the gap remained small and roughly constant. Hence, the lower Danish life expectancy is caused by these cohorts and is not attributable to period effects.

Cause-specific life-years lost in people with mental disorders: a nationwide, register-based cohort study

BACKGROUND People with mental disorders have higher mortality rates than the general population and more detailed estimates of mortality differences are needed to address this public health issue. We aimed to assess whether differences in cause-specific mortality between people with and without mental disorders have changed between 1995 and 2014 by quantifying life-years lost and assessing differences over time. METHODS Using a cohort design, we linked nationwide population data from the Danish Civil Registration System to information about hospital contacts from the Psychiatric Central Research Register and deaths from the Danish Cause of Death register. All linked data sources contained longitudinal information covering all individuals aged 15-94 years living in Denmark between 1995 and 2014. We assessed cause-specific mortality differences using rate ratios and average life-years lost. FINDINGS Between 1995 and 2014, 6 107 234 individuals (3 026 132 men and 3 081 102 women) aged 15-94 years were living in Denmark. The study population was observed over 89 216 177 person-years (men: 43 914 948; women 45 301 229). Cause-specific mortality rates were higher for people with mental disorders than those without (total mortality rate per 1000 person-years in men 27·1 vs 11·4, respectively, and in women 21·2 vs 11·0). When compared with individuals without mental disorders, men and women with mental disorders had 10·20 and 7·34 excess life-years lost, respectively. The largest cause-specific differences between those with and without mental disorders in terms of excess life-years lost were for respiratory diseases (men: 0·9; women: 1·4) and alcohol misuse (men: 2·8; women: 1·2). Between 1995 and 2014, we noted an increase in excess life-years lost for neoplasms (men: 0·7; women: 0·4), heart diseases (men: 1·2; women: 0·3), and respiratory diseases (men: 0·3; women: 0·2), and a decrease for suicide (men: -0·7; women: -0·5) and accidents (men: -0·9; women: -0·5). INTERPRETATION By applying a novel approach, more precise estimates of life-years lost were obtained. The increase in excess mortality due to medical diseases and disorders among people with mental disorders emphasises the need for future interventions to address these aspects as well as the continued high shares of excess mortality due to alcohol misuse, suicide, and accidents. FUNDING The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH).

Homicides In Mexico Reversed Life Expectancy Gains For Men And Slowed Them For Women, 2000–10

Life expectancy in Mexico increased for more than six decades but then stagnated in the period 2000-10. This decade was characterized by the enactment of a major health care reform-the implementation of the Seguro Popular de Salud (Popular Health Insurance), which was intended to provide coverage to the entire Mexican population-and by an unexpected increase in homicide mortality. We assessed the impact on life expectancy of conditions amenable to medical service-those sensitive to public health policies and changes in behaviors, homicide, and diabetes-by analyzing mortality trends at the state level. We found that life expectancy among males deteriorated from 2005 to 2010, compared to increases from 2000 to 2005. Females in most states experienced small gains in life expectancy between 2000 and 2010. The unprecedented rise in homicides after 2005 led to a reversal in life expectancy increases among males and a slowdown among females in most states in the first decade of the twenty-first century.