Improvements in Life Expectancy: Past, Present and Future

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Improvements in Life Expectancy Past, Present
and Future
John R. Iacovino, M.D., F.A.C.P. Medical Director
/ Senior Consultant
Consistency Accuracy Professionalism
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Overview

• Mortality Improvements By Period
• 1900 to 1940
• 1940 to 1960
• 1960 /1980 to 2000
• 2000 and forward
• The Aging Process
• Effect of Eliminating Cancer and Heart Disease on
  Life Expectancy

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Source Centers for Disease Control and
Prevention, National Center for Health Statistics
(US)
4
Future life expectancy can be calculated for any
starting age
US Vital Statistics 2004
5
Life expectancy at birth 1900 to 2000
79
74
Source U.S. Vital Statistics, 2004
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Mortality Improvements.
Cutler and Meara, Sept 2001, Changes in the Age
Distribution of Mortality Over the 20th Century
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Phase 1 1900 to 1940 Life expectancy increased
16 years

• Decline in infant deaths contributed 4 ½ years
• Decline in childhood mortality contributed 4 ½
  years
• Decline in young adult mortality contributed 3 ½
  years
• Other improvements contributed 3 ½ years

Cutler and Meara, Sept 2001, Changes in the Age
Distribution of Mortality Over the 20th Century
8
Phase 1 1900 to 1940 Explanations for declining
death rate

• In 1900, infections accounted for 32 of all
  deaths. By 1940, infections were only 8 of
  deaths.
• Deaths from pneumonia and influenza fell 2.4
  annually between 1900 and 1940
• Deaths from TB fell 3 to 6 annuallyand fell by
  50 after anti-TB drugs were introduced.
• Deaths from vaccine preventable diseases fell 3
  to 6 annually.

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Phase 1 1900 to 1940 Classic public health
improvements for whole society

• Sanitation and safe drinking water
• Refrigeration and safe food
• Better housing
• Better quality air

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Phase 1 1900 to 1940 On the downside, heart
disease and cancer increased

• Heart disease rose from 22 in 1900 to 44 of all
  deaths in 1940.
• Cancer deaths rose from 5 in 1900 to 11 of all
  deaths in 1940.

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Phase 2 1940 to 1960 Life expectancy increased
6.4 years

• Infections as a cause of death declined faster
  between 1940 and 1960 than in the first 40 years
  of the century.
• Much of this decline was due to medical care new
  diagnostic tests and medications

Cutler and Meara, Sept 2001, Changes in the Age
Distribution of Mortality Over the 20th Century
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Phase 3 1960 to 1990

• By 1960, infectious disease mortality is already
  so low that their further decreases do not
  materially impact life expectancy.
• Decline in infant mortality adds only 1 ¼ years
• Decline in deaths in those over age 45 added 3 ½
  years.

Cutler and Meara, Sept 2001, Changes in the Age
Distribution of Mortality Over the 20th Century
13
Phase 3 1960-1990

• Virtually all of the mortality gain since 1965 is
  due to decrease in cardiovascular mortality.
• Since 1965, cardiovascular disease mortality
  begins to decline at about 2 per year

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Major reasons for CV declinewhich has the
greatest impact?

• Technology (coronary care units, angiography,
  coronary interventions, etc.)
• 1967 First bypass
• 1977 First angioplasty
• Pharmaceutical gains (BP and cholesterol meds,
  post heart attack protocols)
• Behavioral life style interventions (better diet,
  more exercise, less smoking)

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Phase 4 1981 to 2000

• Cardiovascular mortality fell by 54
• Smoking fell by 35
• Population total cholesterol fell 4.2
• Introduction of statins
• Population BP fell 7.7
• Note the gain despite increasing obesity and
  inactivity at the same time. An even greater
  future opportunity.
• Unal,B, Am J. Pub Health, 2005 Jan95(1) 103-108

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Phase 4 1981 to 2000

• The improvements in cardiovascular risk-factors
  account for four times more life-years gained
  than did all of cardiovascular treatments for
  known disease.
• Diet
• Exercise
• Smoking
• Unal,B, Am J. Pub Health, 2005 Jan95(1)
  103-108

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Phase 5 2000 forward Life expectancy is
increasing, but

• Americans lag behind the rest of the world.
• America ranks about 30th in life expectancy
• U.S. LE 81 years
• Japan / China 84 years - 1
• Swaziland 33 years - last
• Immigrants to the US live 3 years longer than
  their American born relatives.

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Phase 5 2000 forwardContinuing and future
challenges

• Smoking
• Obesity
• Inactivity

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Trends in Cigarette Smoking Prevalence () by
Gender, Adults 18 and Older, US, 1965-2002
Redesign of survey in 1997 may affect trends.
Source National Health Interview Survey,
1965-2002, National Center for Health Statitics,
Centers for Disease Control and Prevention, 2004.
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Phase 5 2000 forwardRecent health loses -
Obesity rises

• 15 of Americans were obese in 1976-80, but up to
  31 in 1999-2000
• Between 1988 and 2002, percent of overweight
  adults climbed from 56 to 65 and percent of
  obese adults went from 23 to 30.
• Normal BMI 18.5 24.9
• Overweight BMI 25 29.9
• Obese BMI 30 and greater

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Opportunities for improvement Trends in
Overweight Prevalence (), Children and
Adolescents, by Age Group, US, 1971-2002
Overweight is defined as at or above the 95th
percentile for body mass index by age and sex
based on reference data. Source National Health
and Nutrition Examination Survey, 1971-1974,
1976-1980, 1988-1994, 1999-2002, National Center
for Health Statistics, Centers for Disease
Control and Prevention, 2002, 2004.
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Phase 5 2000 forward Diabetes increasing

• In 1997, 5.1 of Americans had diabetes, in 2002,
  the number was 6.5.
• 12 million Americans now have type 2 diabetes
• Exercise can prevent and/or delay onset of
  diabetes
• On average diabetes decreases life expectancy by
  about one third

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Value of Preventive Life Style

• A 35-year-old who burns 2,000 calories through
  exercise each week gains, on average, more than
  six years of life expectancy.
• Inverse relationship between cardiovascular
  fitness and coronary heart disease and all-cause
  mortality in healthy men and women
• Increase in 1 MET higher level of maximal aerobic
  capacity resulted in a 14 decrease in the
  history of coronary heart disease and/or
  all-cause mortality
• Fitness is better correlated with mortality
  improvement than simple physical activity

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Decline in elderly mortality is accelerating

• Between 1900 and 1940, mortality in the elderly
  (over age 65) declined to only 0.3 per year.
• Between 1960 and 1990, mortality in the elderly
  declined 1.1 per year.

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Who lives the longest?

• Best socio-economic class and education
• Best genes
• Best medical care and risk factor reduction

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Years of Life Remaining at Age 65
19
15
Source U.S. Vital Statistics, 2004
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Years of Life Remaining at Age 85
6.5
5.8
Source U.S. Vital Statistics, 2004
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Aging Process Causes

• Free radicals
• Antioxidants
• Mutations
• DNA repair failure
• Waste product accumulation
• Telomere shortening

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Telomeres

• Long chains of DNA at the ends of chromosomes
• Protect the integrity of the chromosome
• Shorten at the end of each cell division

Exercise Physiology, Brown, Miller and Eason
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http//science.nasa.gov/headlines/y2006/images/tel
omeres/caps.gif
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The Future Are telomeres the best life
expectancy calculator?

• Aging process
• Probably genetically preprogrammed
• We lose the ability to repair aging organs
• Damage increases as we age
• Hayflict Limit on life expectancy
• Life style and behaviors profoundly affect the
  genetic profile

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Hayflict Limit

• Cells divide freely to a predetermined number of
  divisions
• Then cell division enters a senescence phase
• Each division produces a telomere shortening
• This creates a ticking back of the genetic inner
  clock for each subsequent cell division-Replicativ
  e Senescence
• Stress Induced Premature Senescence

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Telomeres

• The length of the telomere may determine
  longevity
• Progeria
• Very short telomeres
• Cancer Cells
• Produce an enzyme that prevents shortening cell
  immortality

Exercise Physiology, Brown, Miller and Eason
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Effect of Disease Elimination on Life Expectancy

• Correlations
• Positive elimination correlation
• Eliminating cancer or heart disease renders death
  from other causes in the future more probable
• Independent elimination correlation
• Eliminating cancer or heart disease has no effect
  on the probability of death from other causes
• Negative elimination correlation
• Eliminating cancer or heart disease renders death
  from other causes in future years less probable

Source Centers for Disease Control and
Prevention, National Center for Health Statistics
(US)
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Source Centers for Disease Control and
Prevention, National Center for Health Statistics
(US) US Population Decennial Life Table 1989-1991
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Source Centers for Disease Control and
Prevention, National Center for Health Statistics
(US) US Population Decennial Life Table 1989-1991
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