Transcript Life expectancy

Life expectancy
Jean-François Boivin
8 October 2010
1
Life expectancy
Table. Age-specific mortality rates by age, Quebec 1996
Age
Male
Female
All ages
7.5
6.7
<1
5.1
4.2
1-4
0.3
0.3
5-9
0.2
0.1
10-14
0.2
0.2
15-19
0.9
0.3
20-24
1.1
0.3
25-29
1.1
0.4
30-34
1.2
0.5
35-39
1.7
0.8
40-44
2.3
1.4
45-49
3.0
2.1
50-54
5.1
3.1
55-59
8.7
4.7
60-64
14.5
7.7
65-69
24.8
12.5
70-74
40.1
20.3
75-79
59.8
33.8
80-84
97.8
58.4
85-89
143.4
99.9
90+
208.8
184.0
Source: Statistics Canada, Vital Statistics compendium, 1996
Age-standardized
8.4
5.2
How can we summarize in one number a series of age-specific mortality rates?
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A period of life table gives an overview
of the present mortality experience of a
population and shows projections of
future mortality experience. The term
life expectancy refers to the number of
years that a person is expected to live,
at any particular year. With respect to a
year of interest (e.g. 2000), a period life
table enables us to project the future
life expectancy of persons born during
the year as well as the remaining life
expectancy of persons who have
attained a certain age.
Friis and Sellers, 4th edition, page 290.
3
x
=
All ages: Total person years = 7,686,810
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Mortality Rates
Males, Canada
10 to 15 to 20 to 30 to 35 to 40 to 45 to 50 to
1 to 4 5 to 9 14
19
24
34
39
44
49
54
years years years years years years years years years years
<1
year
55 to
59
years
60 to
64
years
65 to
69
years
70 to
74
years
75 to
79
years
1991
6.9
0.4
0.2
0.3
0.9
1.2
1.3
1.6
2.1
3.4
5.5
9.4
15.6
25.2
38.8
62.8
1992
6.8
0.3
0.2
0.2
0.8
1.1
1.4
1.7
2.2
3.2
5.3
9.3
15.3
23.9
38.1
61.3
1993
6.9
0.4
0.2
0.2
0.8
1
1.4
1.8
2.3
3.4
5.3
9.1
14.7
24.4
38.7
62
1994
6.9
0.4
0.2
0.2
0.8
1
1.3
1.7
2.3
3.1
5.1
8.7
14.9
23.8
37.6
60.8
1995
6.7
0.3
0.2
0.2
0.8
1.1
1.4
1.7
2.2
3.2
5.2
8.4
14.2
23.5
37.3
60.4
1996
6.1
0.3
0.2
0.2
0.7
1
1.3
1.6
2.2
3
5
8.2
13.8
23
37.4
58.2
1997
6
0.3
0.2
0.2
0.8
1
1.1
1.4
2
2.9
4.8
8.1
13.4
22.2
35.9
58.1
1998
5.7
0.3
0.1
0.2
0.7
1
1.1
1.4
1.9
2.9
4.5
7.8
12.8
21.9
35.5
57.5
1999
5.7
0.3
0.2
0.2
0.7
0.9
1.1
1.3
2
2.9
4.4
7.6
12.5
21
34.5
56.2
2000
5.9
0.2
0.1
0.2
0.7
0.9
1
1.3
1.9
2.8
4.4
7.5
12.4
20.2
33.1
53.8
2001
5.8
0.3
0.1
0.2
0.7
0.9
1
1.2
1.8
2.8
4.4
7.2
12
19.3
31.7
52
2002
5.8
0.2
0.1
0.2
0.6
0.8
0.9
1.2
1.8
2.8
4.4
7.1
11.7
19.3
30.5
50.7
2003
5.7
0.2
0.1
0.2
0.6
0.9
0.9
1.3
1.8
2.8
4.4
6.9
11.5
18.2
30.4
49.6
2004
5.5
0.2
0.1
0.1
0.6
0.8
0.9
1.2
1.7
2.7
4.3
6.8
11.3
17.7
28.8
47.7
2005
5.9
0.2
0.1
0.2
0.6
0.8
0.9
1.2
1.8
2.7
4.2
6.7
10.8
17.3
28.1
46
2006
5.4
0.2
0.1
0.1
0.6
0.8
0.9
1.1
1.7
2.7
4.2
6.4
10.5
16.4
26.5
43.9
2007
5.5
0.2
0.1
0.2
0.6
0.8
0.8
1.2
1.6
2.6
4.2
6.6
10.2
16.5
26.7
44
5
6
7
8
9
There are additional ways to
describe the mortality experience of
the population. One measure,
which takes into account the effect
of premature death caused by
diseases, is known as years of
potential life lost (YPLL). For
example, we might assume that the
average person lives until age 65. If
an individual succumbs at age 60,
that person has lost five years of
life. PLL is computed by summing
years of life lost for each individual
in a population such as the United
States for a specific cause of
mortality.
Friis and Sellers, page 290.
10
11
Another measure is disabilityadjusted life years (DALYs), which
adds the time a person has a
disability to the time lost to early
death. Thus, one DALY indicates
one year of life lost to the
combination of disability and
early mortality.
Friis and Sellers.
12
13
tuberculosis
Tubercle bacillus
identified
Chemotherapy
BCG vaccination
Source: McKeown, 1976. Reproduced by kind permission of the publisher.
Beaglehole et al. 1993
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The epidemiologic transition
A theory of the epidemiology
of population change
Omran AR. Milbank Memorial Fund Quaterly 1971; 49: 509-538
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This theory provides a …
description and explanation … of
the “demographic transition", the
spectacular decline firstly of
death rates and then of birth
rates which has been observed in
all currently industrialised
countries.”
Journal of Epidemiology and Community Health 1994; 48:
329-332
16
In the epidemiological transition theory, the
historical development of mortality over time is
characterised by three phases: the "age of
pestilence and famine", the "age of receding
pandemics"; and the "age of degenerative and
man-made diseases". It is the transition from a
cause of death pattern dominated by infectious
diseases with very high mortality, especially at
younger ages, to a pattern dominated by chronic
diseases and injuries with lower mortality, mostly
peaking at older ages, that is seen to be
responsible for the tremendous increase in life
expectancy.
Journal of Epidemiology and Community Health 1994; 48: 329-33
17
18
In countries in western Europe and
northern America the shift started early and
took approximately 100 years. This was
called the "western" or "classical model" of
the epidemiologic transition. In a number of
other countries, notably Japan and eastern
Europe, the transition started later but
proceeded much more quickly (the so
called "accelerated model"). Finally, in many
third world countries the transition started
even later and, unlike that in currently
industrialised countries, has not yet been
completed (the "delayed" or "contemporary
model").
Journal of Epidemiology and Community Health 1994; 48: 329-33
19
20
“Omran attributed the decline of
mortality to a complex of factors closely
linked to "modernisation". For the
western model, socioeconomic progress,
leading to a rise in living standards, was
presumed to be a very important
contributing factor, whereas for the
accelerated and delayed models, public
health and medical technologies were
considered relatively more important.”
Journal of Epidemiology and Community Health 1994; 48: 329-332
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Leading factors determining the
epidemiologic transition:
•
•
•
•
•
•
Public health
Medicine
Wealth and income
Nutrition
Behaviour
Education
Riley (2001), p 56
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Public health
•
•
•
•
•
•
suppression of waterborne disease
study of disease problems of poverty
disease surveillance and control
mass vaccination
insect control
purposeful application of medical,
social, and scientific knowledge to the
control of hazard,
• etc.
Riley, page 77
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Medicine
24
25
26
Wealth, income, and
economic development
27
28
29
Literacy and education
30
31
Revisiting Omran
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The shift from acute infectious and deficiency diseases to
chronic noncommunicable diseases is not a simple
transition but a complex and dynamic epidemiological
process, with some diseases disappearing and others
appearing or reemerging. The unabated pandemic of
childhood and adulthood obesity and concomitant
comorbidities are affecting both rich and poor nations,
while infectious diseases remain an important public
health problem, particularly in developing countries.
34
Emerging and Reemerging Disease
A recent review (3) suggested that 175 human
pathogens (12% of those known) were emerging or
reemerging and that 37 pathogens have been
recognized since 1973, including rotavirus, Ebola
virus, HIV-1 and HIV-2, and most recently, Nipah
virus. Among the infectious vectorborne diseases,
dengue, dengue hemorrhagic fever, yellow fever,
plague, malaria, leishmaniasis, rodent-borne viruses,
and arboviruses are persisting, and sometimes
reemerging, with serious threats to human health.
For example, malaria, which is the foremost vectorborne disease worldwide, continues to worsen in
many areas, and there are now an estimated 300
million to 500 million cases of malaria worldwide
each year with 2 million to 4 million deaths.
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Improving the health status of poor populations
requires a twin approach. Not only are infectious
diseases still common, but chronic diseases,
including tobacco-related diseases, are on the
rise.
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Remeasuring aging
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