Yasuhiko Saito

Trends in healthy life expectancy in the united states, 1970-1990 : gender, racial, and educational differences

This paper examines healthy life expectancy by gender and education for whites and African Americans in the United States at three dates: 1970, 1980 and 1990. There are large racial and educational differences in healthy life expectancy at each date and differences by education in healthy life expectancy are even larger than differences in total life expectancy. Large racial differences exist in healthy life expectancy at lower levels of education. Educational differences in healthy life expectancy have been increasing over time because of widening differentials in both mortality and morbidity. In the last decade, a compression of morbidity has begun among those of higher educational status; those of lower status are still experiencing expansion of morbidity.

Trends in Disability-Free Life Expectancy in the United States, 1970-90

This article provides estimates of active life expectancy defined as disability-free life expectancy for [U.S.] males and females for three dates: 1970 1980 and 1990. Increases in life expectancy during the 1980s were concentrated in years without disability. This contrasts with the preceding decade during which almost all of the increase in life expectancy was in disabled years. Recent increases in both total life expectancy and disability-free life expectancy have been greater for males than for females. The primary reason for the increase in disability-free life during the 1980s is a decrease in the proportion of the population who are disabled among those in their late 50s and their 60s. (EXCERPT) (SUMMARY IN FRE AND SPA)

Change in Disability-Free Life Expectancy for Americans 70 Years Old and Older

In this article, we examine changes in life expectancy free of disability using longitudinal data collected from 1984 through 2000 from two cohorts who composed the Longitudinal Studies of Aging I and II. Life expectancies with and without ADL and/or IADL disability are calculated using a Markov-based multistate life table approach. At age 70, disability-free life expectancy increased over a 10-year period by 0.6 of a year in the later cohort, which was the same as the increase in total life expectancy, both increases marginally statistically significant. The average length of expected life with IADL and ADL disability did not change. Changes in disability-free life expectancy resulted from decreases in disability incidence and increases in the incidence of recovery from disability across the two survey cohorts. Age-specific mortality among the ADL disabled declined significantly in the later cohort after age 80. Mortality for the IADL disabled and the nondisabled did not change significantly. Those with ADL disability at age 70 experienced substantial increases in both total life expectancy and disability-free life expectancy. These results indicate the importance of efforts both to prevent and delay disability and to promote recovery from disability for increasing life expectancy without disability. Results also indicate that while reductions in incidence and increases in recovery work to decrease population prevalence of disability, declining mortality among the disabled has been a force toward increasing disability prevalence.

The emergence of extremely old people: the case of Japan.

It is acknowledged today that the number of oldest old persons, nonagenarians and centenarians, is increasing rapidly. Analysis of data from Japan, where female life expectancy at birth approaches the assumed limit of 85 years, can provide unique information on whether the rate of these demographic changes is accelerating. Adjusted for the size of the birth cohorts, the centenarian doubling time (CDT i.e. the number of years needed to double the number of centenarians), halved in 29 years. Moreover death rates at 100 years and above show a clear decrease if we exclude males at age 105 and over.

Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US.

The present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific.

Preference changes among American youth: family work and goods aspirations 1976-86.

This article examines trends and differentials by sex in both absolute and relative preferences among American young adults from 1976 to 1986. If one considers marriage and family formation preferences alone the desires of American youth to marry and have children changed very little over this period. When one shifts from absolute to relative preferences desires for goods for oneself have increased substantially and for leisure and goods for ones children moderately. Considered in this context the stability in marriage and family preferences implies a shift in relative preferences against children. This is a revised version of a paper originally presented at the 1990 Annual Meeting of the Population Association of America (see Population Index Vol. 56 No. 3 Fall 1990 p. 420). (SUMMARY IN FRE AND SPA) (EXCERPT)

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents

BackgroundSelf-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea.MethodsCross-sectional data were drawn from large surveys of older respondents (≥ 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH.ResultsSRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations.ConclusionsWe conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.

The relationship between longevity and healthy life expectancy

What is the relationship between longevity and health? Health expectancies were developed more than 30 years ago specifically to answer this question. It may therefore be the time to try to answer this question, though it is worth noting that the question implies a unidirectional relationship. Almost no one questions the positive association between health and longevity. It is expected that healthy, robust people will live, on average, longer than frail people. This heterogeneity in terms of robustness/frailty may explain the shape of the mortality trajectory with age, ie. the oldest old seem to follow a lower mortality schedule (Vaupel et al, 1979). On the other hand, many people wonder about the relationship between longevity and health. Are we living longer because we are in better health? Are we living longer in good health? Or are we merely surviving longer whatever our health status? In other words, can we live in good health as long as we can survive? And this is exactly the purpose of health expectancies: monitoring how long people live in various health statuses (Sanders, 1964; Sullivan, 1971; Robine et al, 2003a).

Are There Education Differentials in Disability and Mortality Transitions and Active Life Expectancy Among Japanese Older Adults? Findings From a 10-Year Prospective Cohort Study

OBJECTIVES To investigate the robust education-health association found in Western developed nations in the Japanese context. We examined disability and mortality transitions and computed active life expectancy (ALE) by educational attainment for a cohort of Japanese adults aged 65+ years. METHOD Nationally representative data from the Nihon University Japanese Longitudinal Study of Aging over a 10-year period in Japan (1999, 2001, 2003, 2006, and 2009) were used (N = 4,968). Disability was measured by difficulties in performing daily activities. A multistate life table method was employed using an interpolated Markov chain approach. RESULTS There is little effect of education on disability and mortality transitions. Except for transiting from an active to inactive state (disability incidence), the other health transitions, including to mortality, are not statistically significant. ALE computations show that Japanese men and women with more education can expect more years of remaining life and active life. DISCUSSION The robust education-health relationship found in Western societies does not seem applicable in Japan. We discuss the casual mechanisms addressed in the literature in relation to Japans relatively egalitarian society and specific characteristics.

Centenarians Today: New Insights on Selection from the 5-COOP Study

The number of oldest old grew tremendously over the past few decades. However, recent studies have disclosed that the pace of increase strongly varies among countries. The present study aims to specify the level of mortality selection among the nonagenarians and centenarians living currently in five low mortality countries, Denmark, France, Japan, Switzerland, and Sweden, part of the 5-Country Oldest Old Project (5-COOP). All data come from the Human Mortality Database, except for the number of centenarians living in Japan. We disclosed three levels of mortality selection, a milder level in Japan, a stronger level in Denmark and Sweden and an intermediary level in France and Switzerland. These divergences offer an opportunity to study the existence of a trade-off between the level of mortality selection and the functional health status of the oldest old survivors which will be seized by the 5-COOP project.