Health in a ‘post-transition’ Australia: adding years to life or life to years?

2014 ◽  
Vol 38 (1) ◽  
pp. 1 ◽  
Author(s):  
Stephen J. Begg
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Life Expectancy ◽  
Life Course ◽  
Morbidity And Mortality ◽  
Health Expectancy ◽  
Average Life Span ◽  
Mortality And Morbidity ◽  
The Difference ◽  
The Life Course

Objective To explore the likely impact of future trajectories of morbidity and mortality in Australia. Methods Estimates of mortality and morbidity were obtained from a previous assessment of Australia’s health from 1993 to 2003, including projections to 2023. Outcomes of interest were the difference between life expectancy (LE0) and health-adjusted life expectancy (i.e. absolute lost health expectancy (ALHE0)), ALHE0 as a proportion of LE0 and the partitioning of changes in ALHE0 into additive contributions from changes in age- and cause-specific mortality and morbidity. Results Actual and projected trajectories of mortality and morbidity resulted in an expansion of ALHE0 of 1.22 years between 1993 and 2023, which was equivalent to a relative expansion of 0.7% in morbidity over the life course. Most (93.8%) of this expansion was accounted for by cardiovascular disease, diabetes and cancer; of these, the only unfavourable trend of any note was increasing morbidity from diabetes. Conclusions Time spent with morbidity will most likely increase in terms of numbers of years lived and as a proportion of the average life span. This conclusion is based on the expectation that gains in LE0 will continue to exceed gains in ALHE0, and has important implications for public policy. What is known about the topic? Although the aging of Australia’s population as a result of declining birth and death rates is well understood, its relationship with levels of morbidity is not always fully appreciated. This is most noticeable in the policy discourse on primary prevention, in which such activities are sometimes portrayed as having unrealised potential with respect to alleviating growth in health service demand. What does this paper add? This paper sheds new light on these relationships by exploring the likely impact of future trajectories of both morbidity and mortality within an additive partitioning framework. The results suggest a modest expansion of morbidity over the life course, most of which is accounted for by only three causes. In two of these (cardiovascular disease and cancer), the underlying trends in both mortality and morbidity have been favourable for some time due, at least in part, to success in primary prevention. What are the implications for practitioners? Although there may be good arguments in favour of a greater focus on primary prevention as currently practiced, reducing overall demand for health services is unlikely to be one of them. To make such an argument valid, policy makers should consider shifting their attention to the effectiveness of primary prevention as it relates to causes other than cardiovascular disease and cancer, particularly those with a predominantly non-fatal impact, such as diabetes and degenerative diseases of old age.

Abstract 14677: Distribution of 10- and 30-year Predicted Risks for Atherosclerotic Cardiovascular Disease in the United States: NHANES 2015 to 2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nilay S Shah ◽  
Hongyan Ning ◽  
Amanda Perak ◽  
Norrina B Allen ◽  
John T Wilkins ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Life Course ◽  
Risk Model ◽  
The United States ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Aged ◽  
Ascvd Risk ◽  
The Life Course ◽  
Predicted Risk

Introduction: Premature fatal cardiovascular disease rates have plateaued in the US. Identifying population distributions of short- and long-term predicted risk for atherosclerotic cardiovascular disease (ASCVD) can inform interventions and policy to improve cardiovascular health over the life course. Methods: Among nonpregnant participants age 30-59 years without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10 year (10Y) and 30 year (30Y) predicted ASCVD risk were assigned using the Pooled Cohort Equations and a 30-year competing risk model, respectively. Intermediate/high 10Y risk was defined as ≥7.5%, and high 30Y risk was chosen a priori as ≥20%, based on 2019 guideline levels for risk stratification. Participants were combined into low 10Y/low 30Y, low 10Y/high 30Y, and intermediate/high 10Y categories. We calculated and compared risk distributions overall and across race-sex, age, body mass index (BMI), and education using chi-square tests. Results: In 1495 NHANES participants age 30-59 years (representing 53,022,413 Americans), median 10Y risk was 2.3% and 30Y risk was 15.5%. Approximately 12% of individuals were already estimated to have intermediate/high 10Y risk. Of those at low 10Y risk, 30% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, BMI, and education (P<0.01, Figure ). Black males more frequently had high 10Y risk compared with other race-sex groups. Older individuals, those with BMI ≥30 kg/m 2 , and with ≤high school education had a higher frequency of low 10Y/high 30Y risk. Conclusions: More than one-third of middle-aged U.S. adults have elevated short- or long-term predicted risk for ASCVD. While the majority of middle-aged US adults are at low 10Y risk, a large proportion among this subgroup are at high 30Y ASCVD risk, indicating a substantial need for enhanced clinical and population level prevention earlier in the life course.

scholarly journals KEEPING THINGS, BUT ONLY FOR A WHILE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
David J Ekerdt
Keyword(s):  
Older Adults ◽  
Material Culture ◽  
Life Course ◽  
Long Run ◽  
Museum Objects ◽  
Entire World ◽  
The Difference ◽  
Aging Adults ◽  
The Life Course

Abstract The life course is accomplished by material culture held as a convoy of possessions, but also sustained by public affordances and amenities that include the artifacts and artworks to be found in museums. In both places—household and museum—objects come and go, but there is mainly keeping. The difference lies in the capacity to keep things indefinitely: it is virtue for museums but a predicament for households of aging adults. Museums model ideals of permanence and responsibility toward things, ideals that, in the long run, households can only faintly attain. For older adults and for gerontologists, preservation is the wrong lesson to take away from the galleries. Rather, what we can learn there is how single, selected things can show, in a thoughtful way, an entire world of ideas and universe of meaning. No need to keep it all—and forever—but we can honor things while we can. ​

Prevention of Premature Mortality Among Patients with Schizophrenia: The Need for Primary Prevention Efforts in Cardiovascular Disease

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S10) ◽  
pp. 9-10 ◽  
Author(s):  
Charles H. Hennekens
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Primary Prevention ◽  
General Population ◽  
Life Expectancy ◽  
Premature Mortality ◽  
The United States ◽  
Average Life ◽  
Average Life Expectancy ◽  
United States Today

Patients with schizophrenia have a markedly reduced lifespan compared with the general population. In the United States today, patients with schizophrenia have an average life expectancy of ∼61 years, about 20% lower than that of the general population, in which life expectancy is ∼76 years.

scholarly journals Health expectancy and the problem of substitute morbidity

1997 ◽  
Vol 352 (1363) ◽  
pp. 1819-1827 ◽  
Author(s):  
Harry P. A. Van De Water
Keyword(s):  
Life Expectancy ◽  
Population Health ◽  
Dynamic Equilibrium ◽  
Morbidity And Mortality ◽  
Health Expectancy ◽  
Past Century ◽  
Potential Health ◽  
Policy Problem ◽  
Intervention Trials ◽  
Data Collections

During the past century, the developed world has not only witnessed a dramatic increase in life expectancy (ageing), but also a concomitant rise in chronic disease and disability. Consequently, the tension between ‘living longer’ on the one hand and health–related ‘quality of life’ on the other has become an increasingly important health policy problem. The paper deals with two consequences of this so–called epidemiological transition in population health. The first one concerns the question of how— given the impressive changes, population health can be measured in an adequate and policy relevant present–day fashion. The second one is the so–called phenomenon of ‘substitute morbidity and mortality’: more and more acute fatal diseases are replaced by non–fatal delayed degenerative diseases like dementia and arthritis. How the phenomenon of substitute morbidity and mortality affects the development of population health is illustrated with the epidemiological transitions, worldwide shifts in the main causes of death, assumptions used in models, adverse consequences of medical technologies and some results from intervention trials. Substitute morbidity and mortality may thwart our disease–specific expectations of interventions and asks for a shift to a ‘total population health’ perspective when judging potential health gains of interventions. Better understanding of the dynamics that underly the changes in population health is necessary. Implications for data collections are more emphasis on morbidity data and their relation with mortality, more longitudinal studies, stricter requirements for intervention trials and more use of modelling as a tool. A final recommendation is the promotion of integrative measures of population health. For the latter several results are presented suggesting that, although the amount of morbidity and disability is growing with an increasing life expectancy, this is mild unhealthiness in particular. This finding supports the ‘dynamic equilibrium’ theory. In absolute numbers, however, the burden of disease will continue to increase with further ageing of the population.

scholarly journals Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention?

2017 ◽  
Vol 211 (4) ◽  
pp. 194-197 ◽  
Author(s):  
Athif Ilyas ◽  
Edward Chesney ◽  
Rashmi Patel
Keyword(s):  
Cardiovascular Disease ◽  
Mental Illness ◽  
Primary Prevention ◽  
Life Expectancy ◽  
Physical Health ◽  
Serious Mental Illness ◽  
Health Monitoring ◽  
Prevention Strategies ◽  
Everyday Clinical Practice ◽  
Exercise Interventions

SummaryPeople with serious mental illness have a reduced life expectancy that is partly attributable to increased cardiovascular disease. One approach to address this is regular physical health monitoring. However, physical health monitoring is poorly implemented in everyday clinical practice and there is little evidence to suggest that it improves physical health. We argue that greater emphasis should be placed on primary prevention strategies such as assertive smoking cessation, dietary and exercise interventions and more judicious psychotropic prescribing.

scholarly journals Primary prevention of cardiovascular disease: Updated review of contemporary guidance and literature

2020 ◽  
Vol 9 ◽  
pp. 204800402094932
Author(s):  
Jack Stewart ◽  
Katherine Addy ◽  
Sarah Campbell ◽  
Peter Wilkinson
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Healthcare Providers ◽  
Lipid Lowering ◽  
Treatment Modalities ◽  
Ageing Population ◽  
Mortality And Morbidity ◽  
Important Target ◽  
Previous Iteration ◽  
Prevention Of Cardiovascular Disease

Cardiovascular disease remains a substantial concern in terms of global mortality and morbidity, while prevalence of cardiovascular disease is increasing as treatment modalities improve survival. With an ageing population and increasing costs of chronic medical care, primary prevention of cardiovascular disease is an important target for healthcare providers. Since the previous iteration of this paper, new international guidelines have been produced regarding hypertension and lipid lowering therapies, whilst there is a growing body of evidence and new therapies emerging in other areas of lifestyle and pharmacotherapeutic intervention. This review outlines emerging evidence in the field and compares and contrasts contemporary recommendations from European and American guidelines.

scholarly journals Life course traumas, phenotypic aging, and cardiovascular disease: retrospective analysis of 104,939 UKB participants

2021 ◽  
Author(s):  
Xingqi Cao ◽  
Jingyun Zhang ◽  
Chao Ma ◽  
Xueqin Li ◽  
Chia-Ling Kuo ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Life Course ◽  
Cardiovascular Health ◽  
Logistic Models ◽  
Traumatic Experiences ◽  
Mediation Analyses ◽  
The Uk ◽  
Childhood Traumas ◽  
The Life Course ◽  
Mental Health Questionnaire

Background: While childhood and adulthood traumatic experiences have been linked to subsequent cardiovascular disease (CVD), the relationship between life course traumas and CVD and the underpinning pathways are poorly understood. This study aimed to: (1) examine the associations of childhood, adulthood, and lifetime traumas with CVD; (2) examine the associations between diverse life course traumatic profiles and CVD; and (3) examine the extent to which Phenotypic Age (PhenoAge), a well-developed phenotypic aging measure, mediates these associations. Methods: We included 104,939 participants from the UK Biobank who completed the 2016 online mental health questionnaire. CVD outcomes including ischemic heart disease, myocardial infarction, and stroke were ascertained. Childhood, adulthood, and lifetime traumas were categorized into three subgroups (mild, moderate, and severe), respectively. Four life course traumatic profiles were defined as non-severe traumas across life course, non-severe childhood and severe adulthood traumas, severe childhood and non-severe adulthood traumas, and severe traumas across life course based on both childhood and adulthood traumas. PhenoAge was measured using an equation previously developed. Multivariable logistic models and formal mediation analyses were performed. Results: Of 104,939 participants, 7,398 (7.0%) were diagnosed with CVD. Subgroups of childhood, adulthood, and lifetime traumas were associated with CVD, respectively. Furthermore, life course traumatic profiles were significantly associated with CVD. For instance, compared with subgroups experiencing non-severe traumas across life course, those who experienced non-severe childhood and severe adulthood traumas, severe childhood and non-severe adulthood traumas, and severe traumas across life course had higher odd of CVD, with odds ratios of 1.07 (95% confidence interval [CI]: 1.00, 1.15), 1.17 (95% CI: 1.09, 1.25), and 1.33 (95% CI: 1.24, 1.43), respectively. Formal mediation analyses suggested that PhenoAge partially mediated the above associations. For instance, PhenoAge mediated 5.8% of increased CVD events in subgroups who experienced severe childhood traumas, relative to those experiencing mild childhood traumas. Conclusions: Childhood, adulthood, and lifetime traumas, as well as diverse life course traumatic profiles, were associated with CVD. Furthermore, phenotypic aging partially mediated these associations. These findings suggest a potential pathway from life course traumas to CVD through phenotypic aging, and underscore the importance of policy programs targeting traumatic events over the life course in ameliorating inequalities in cardiovascular health.

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