Age at death, the return of an old metric whose importance is growing

Physical Activity, Physical Fitness and Energy Intake Predict All-Cause Mortality and Age at Death in Extinct Cohorts of Middle-Aged Men Followed-Up for 61 Years

Objective: Working physical activity, physical fitness and energy intake were studied for their effect on all-cause mortality and age at death in residential cohorts followed-up for 61 years. Material and Methods: There were two residential cohorts of middle-aged men examined in 1960 with a total of 1712 subjects, and three indexes were measured, i.e., physical activity by a questionnaire (three classes-sedentary, moderate, vigorous: Phyac), physical fitness, estimated by combining arm circumference, heart rate, and vital capacity by Principal Component Analysis, whose score was divided into three tertile classes (low, intermediate, and high: Fitscore), and energy intake in Kcalories, estimated by dietary history divided into three tertile classes (low, intermediate, high: Calories), plus five traditional cardiovascular risk factors (age, cigarette smoking, body mass index, systolic blood pressure, and serum cholesterol). Cox models were used to predict all-cause mortality as a function of those adjusted indexes. Multiple linear regression models were used to predict age at death as a function of the same co-variates and a larger number of them. At the 61-year follow-up, 1708 men had died. Results: There were large correlations across the three indexes. Prediction of all-cause mortality showed the independent and complementary roles of the three indexes to all be statistically significant and all protective for their highest levels. However, the Fitness score outperformed the role of Phyac, while the role of Calories was unexpectedly strong. The same outcome was found when predicting age at death, even in the presence of 25 covariates representing risk factors, personal characteristics, and prevalent major diseases. Conclusions: Working physical activity, a score of physical fitness and energy intake, seems directly related to lower all-cause mortality and to higher age at death, thus suggesting a large part of independence.

From a Few Cardiovascular Risk Factors to the Prediction of Age at Death: The Shifting Interests of Cardiovascular Epidemiologists

We describe the changing research interests and goals of the responsible investigators of the Italian Rural Areas (IRA) of the Seven Countries Study of cardiovascular diseases (CVD) during a period of 60 years, dealing with a cohort of middle-aged men. Our initial interest was to discover the basic risk factors of coronary heart disease (CHD). Subsequently, the same problem was tackled regarding stroke and heart diseases of uncertain etiology. Later on, cancer deaths also became an end-point for which risk factors were investigated. The long duration of the study and the fact that CVD and cancer fatalities already cover 70% of all-cause mortality prompted the idea to focus on all-cause mortality, and particularly on age-at-death when the follow-up period reached 61 years together with the extinction of the cohort. At that point, a larger number of risk factors measured at baseline, including those which were unable to predict CVD, became the determinants of all-cause mortality and age-at-death, a metric that summarizes the life-span of health and disease. This study is supported by the presentation of data derived from published papers.

Continued increasing social inequality in mortality in Denmark - a nationwide register-based follow-up on previous mortality studies

OBJECTIVE

Social inequality in mortality has increased in many countries worldwide and does not appear to be levelling off. Denmark is no exception, and the latest developments are presented in this short communication.

METHODS

Trends in life expectancy and changes in the shape of the age-at-death distribution are calculated from nationwide register data on income and education linked to mortality data.

RESULTS

Since 1987, the difference in life expectancy between the lowest and highest income quartiles has increased by 5.4 years for men and by 2.0 years for women. The difference in life expectancy (at age 30) between education groups has also increased. The latest developments indicate a decline in life expectancy for men and women in the lowest income quartile and with the shortest education.

CONCLUSIONS

Reducing social inequality in health and mortality has been on the agenda for successive Danish governments for more than 20 years, but social inequality in life expectancy is still increasing.

Development and Validation of a Lifespan Prediction Model in Chinese Adults Aged 65 Years or Older

OBJECTIVES

Previous studies investigated factors associated with mortality. Nevertheless, evidence is limited regarding the determinants of lifespan. We aimed to develop and validate a lifespan prediction model based on the most important predictors.

DESIGN

A prospective cohort study.

SETTING AND PARTICIPANTS

A total of 23,892 community-living adults aged 65 years or older with confirmed death records between 1998 and 2018 from 23 provinces in China.

METHODS

Information including demographic characteristics, lifestyle, functional health, and prevalence of diseases was collected. The risk prediction model was generated using multivariate linear regression, incorporating the most important predictors identified by the Lasso selection method. We used 1000 bootstrap resampling for the internal validation. The model performance was assessed by adjusted R2, root mean square error (RMSE), mean absolute error (MAE), and intraclass correlation coefficient (ICC).

RESULTS

Twenty-one predictors were included in the final lifespan prediction model. Older adults with longer lifespans were characterized by older age at baseline, female, minority race, living in rural areas, married, with healthier lifestyles and more leisure engagement, better functional status, and absence of diseases. The predicted lifespans were highly consistent with observed lifespans, with an adjusted R2 of 0.893. RMSE was 2.86 (95% CI 2.84-2.88) and MAE was 2.18 (95% CI 2.16-2.20) years. The ICC between observed and predicted lifespans was 0.971 (95% CI 0.971-0.971).

CONCLUSIONS AND IMPLICATIONS

The lifespan prediction model was validated with good performance, the web-based prediction tool can be easily applied in practical use as it relies on all easily accessible variables.

Focus on age at death in field epidemiology

Age at death (AD) is an old metric recently re-evaluated for the study of longevity and mainly used in demography. Developed experience using AD in field epidemiology is summarized with cohorts followed-up for variable periods of time, frequently until extinction or close to extinction, a must to correctly adopt this metric. For practical purposes, a small number of examples is reported condensing previously published results to highlight various aspects of the problem. AD became the alternative of overall death rates when comparing cohorts reaching extinction or near extinction. AD was useful to characterize different causes of death in order to describe their natural history and possible etiology. With the use of multiple linear regression, a large number of possible determinants of AD were identified and some combinations of them resulted in large estimated differences in AD of 10 years or more across individuals. AD is a powerful tool to study population samples followed-up until extinction or near extinction. It allows to compare the life-long experience of different populations, to compare the role of different causes of death and to study the determinants of AD that are conditioning longevity.

Gender differences in lung cancer epidemiology - do Austrian male lung cancer patients still die earlier in life?

Objective

Previous analyses reported an unexpected decline of mean age of death of Austrian male lung cancer patients until 1996 and a subsequent turnaround of this epidemiological trend after the mid-1990s until 2007. In light of ongoing changes in smoking behavior of men and women, this study aims to investigate the development of mean age of death from lung cancer in Austria during the past three decades.

Materials and methods

This study used data about the annual mean age of death from lung cancer, including malignant neoplasm of trachea, bronchus and lung, between 1992 and 2021 obtained from Statistics Austria, Federal Institution under Public Law. One-way analysis of variance (ANOVA) and independent samples t-tests were applied to explore any significant differences of mean values in the course of time as well as between men and women.

Results

Overall, mean age of death of male lung cancer patients increased consistently throughout the observed time periods, whereas women did not show any statistically significant change in the last decades.

Conclusion

Possible reasons for the reported epidemiological development are discussed in this article. Research and Public Health measures should increasingly focus on smoking behaviors of female adolescents.

The effect of pharmaceutical innovation on longevity: Evidence from the U.S. and 26 high-income countries

This study examines the impact that pharmaceutical innovation, which accounts for most private biomedical research expenditure, has had on longevity. We perform two types of two-way fixed-effects analyses, which control for the effects of many potentially confounding variables. First, we analyze long-run (2006-2018) changes in longevity associated with different diseases in a single country: the U.S. Then, we analyze relative longevity levels associated with different diseases in 26 high-income countries during a single time period (2006-2016). The measure of longevity we analyze, mean age at time of death, is strongly positively correlated across countries with life expectancy at birth. The measure of pharmaceutical innovation we use is the mean vintage (year of initial world launch) of the drugs used to treat each disease in each country. Changes in the vintage distribution of drugs are due to both entry of new drugs and exit of old drugs. Our analysis of U.S. data indicates that the diseases for which there were larger increases in drug vintage tended to have larger increases in the longevity of Americans of all races and both sexes. In other words, the lower the mean age of the drugs, the higher the mean age at death. We test, and are unable to reject, the "parallel trends" hypothesis. We estimate that the 2006-2018 increase in drug vintage increased the mean age at death of Americans by about 6 months (66% of the observed increase). Controlling for sex, race, and education has only a small effect on the estimate of the vintage coefficient. The estimates indicate that drug vintage did not have a significant effect on the mean age at death of decedents with less than 9 years of education. Drug vintage had a positive and significant effect on the mean age at death of decedents with at least 9 years of education, and a larger effect on the mean age at death of decedents with at least 13 years of education. The finding that pharmaceutical innovation has a larger effect on the longevity of people with more education is consistent with previous evidence that more educated people are more likely to use newer drugs. Our analysis of data on 26 high-income countries indicates that the higher the vintage of drugs available to treat a disease in a country, the higher mean age at death was, controlling for fixed disease and country effects. The increase in drug vintage is estimated to have increased mean age at death in the 26 countries by 1.23 years between 2006 and 2016-73% of the observed increase. We obtain estimates of the cost of pharmaceutical innovation-its impact on drug expenditure-as well as estimates of an important benefit of pharmaceutical innovation-the number of life-years gained from it-and of their ratio, i.e., the incremental cost-effectiveness ratio. Estimates of the cost per life-year gained for the U.S. and the 26 countries are $35,817 and $13,904, respectively. Both figures are well below per capita GDP in the respective regions, suggesting that, overall, pharmaceutical innovation was highly cost-effective.

Age at death in elderly cohorts of four European countries of the Seven Countries Study: the role of comorbidities

PURPOSE

To study age at death (AD) in elderly men as a function of risk factors and morbid conditions in a 25-year follow-up.

MATERIALS AND METHODS

Men enrolled in the Seven Countries Study belonging to 8 cohorts in 4 European countries (Finland, The Netherlands, Italy and Serbia) were examined between 1984 and 1989 (aged 65-84 years) with measurement of some cardiovascular risk factors and recording of a few major morbid conditions. AD was measured after 25-year follow-up and used in multiple linear regression (MLR) models as dependent variable; while, risk factors and morbid conditions had the role of independent variables.

RESULTS

Out of 2457 men, 2290 died during 25-year follow-up. Overall mean AD was of 82.0 years and slightly different across cohorts, the lowest being recorded in Finland. Age at entry examination and HDL cholesterol were directly associated with AD; while, blood pressure, heart rate, smoking habits and morbid conditions (major cardiovascular diseases, either independently or combined together with diabetes, chronic bronchitis, cancer and silent ECG abnormalities) were inversely related to AD. Body mass index had a parabolic relation with AD with longer survival for levels around 24 units; while, total serum cholesterol was not related to AD. However, only three independent variables were statistically significant when tested in each individual country (age, heart rate and stroke). In a MLR model, where a comorbidity score was entered as independent variable (everything else being equal), the presence of 1 morbid condition was associated with a reduced AD by 1.87 years that increased up to 6.39 years when 4 morbid conditions were present.

CONCLUSION

AD seems a valuable indicator of all-cause mortality when the study population has reached or approached the extinction.

The Joint Impact of Age at Death and Dementia on Long-Term Care Use in the Last Years of Life: Changes From 1996 to 2013 in Finland

Welfare states increasingly rely on aging in place policies and have cut back on institutional long-term care (LTC) provision. Simultaneously, the major determinants of LTC use, that is, dementia and living to very old age, are increasing. We investigated how increasing longevity and concomitant dementia were associated with changes in round-the-clock LTC use in the last 5 years of life between 1996 and 2013. Retrospective data drawn from national registers included all those who died aged 70+ in 2007 and 2013, plus a 40% random sample from 2001 (N = 86,554). A generalized estimating equations (GEE) were used to estimate the association of dementia and age with LTC use during three study periods 1996-2001, 2002-2007, and 2008-2013. Between the study periods, the total number of days spent in LTC increased by around 2 months. Higher ages at death and the increased number of persons with dementia contributed to this increase. The group of the most frequent LTC users, that is, people aged 90+ with or without dementia, grew the most in size, yet their LTC use decreased. The implications of very old age and concomitant dementia for care needs must be acknowledged to guarantee an adequate quantity and quality of care.