Slower increase in life expectancy in Australia than in other high income countries: the contributions of age and cause of death

A scoping review of adult NCD-relevant phenotypes measured in today's large child cohort studies

BACKGROUND

Child cohort studies are important resources that can inform strategies to prevent adult noncommunicable diseases (NCDs). Technological advances now enable direct measurement of NCD-relevant phenotypes at large scale. Across contemporary large child cohorts, we aimed to provide the first comprehensive map of NCD-relevant phenotype measurement and gaps.

METHODS

We included cohorts with >8000 child participants that were recruiting in whole or part after 2010 and measuring phenotypes relevant to ten high-burden NCDs. Our database and gray literature search identified 15 cohort studies for inclusion. Details on phenotype measurement (methods, age, location) are presented in an online, searchable inventory.

RESULTS

All 15 cohorts measure body size or composition. Most cohorts measure aspects of cardiovascular health (n = 10) and neurocognition (n = 9). Fewer measure musculoskeletal phenotypes (n = 6), pulmonary function (n = 6), vision (n = 6) and glucose (n = 4). Only two cohorts measure hearing or kidney function.

CONCLUSIONS

Today's childhood cohorts are not measuring some phenotypes important to global burden of disease, notably kidney function and hearing. Given the rarity of very large contemporary child cohorts, cross-cohort coordination will be required if all major NCD precursors are to be adequately represented for future benefit.

IMPACT

This scoping review provides a comprehensive overview of NCD-relevant phenotype measurement across large, modern child cohort studies. This review has identified measurement gaps in important areas that may obviate steps to prevent and detect NCDs with high global disease burden. Findings may inform planning of collaborative projects and future data collection to address measurement gaps for greatest future benefit.

Faltering mortality improvements at young-middle ages in high-income English-speaking countries

BACKGROUND

Before the COVID-19 pandemic, stagnating life expectancy trends were reported in some high-income countries (HICs). Despite previous evidence from country-specific studies, there is a lack of comparative research that provides a broader perspective and challenges existing assumptions. This study aims to examine longevity trends and patterns in six English-speaking countries (Australia, Canada, Ireland, New Zealand, United Kingdom, United States) by combining period and cohort perspectives and to compare them with other HICs.

METHODS

Using data from the Human Mortality and World Health Organization Mortality Databases, we estimated partial life expectancy, lifespan inequality and cohort survival differences for 1970-2021, as well as the contribution of causes of death to the gap in life expectancy between English-speaking countries and the average for other HICs in 2017-19.

RESULTS

In the pre-pandemic period, the increase in life expectancy slowed in all English-speaking countries, except Ireland, mainly due to stagnating or rising mortality at young-middle ages. Relative to other HICs, those born in Anglophone countries since the 1970s experienced relative survival disadvantage, largely attributable to injuries (mainly suicides) and substance-related mortality (mainly poisonings). In contrast, older cohorts enjoyed advantages for females in Australia and Canada and for males in all English-speaking countries except the United States.

CONCLUSIONS

Although future gains in life expectancy in wealthy societies will increasingly depend on reducing mortality at older ages, adverse health trends at younger ages are a cause for concern. This emerging and avoidable threat to health equity in English-speaking countries should be the focus of further research and policy action.

A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001-20

This study examines two decades of change in social inequalities in life and health expectancy among older adults in Australia, one of the few countries that escaped an economic recession during the global financial crisis. We compare adults aged 45+ across three measures of individual socio-economic position-education, occupation, and household wealth-and use multistate life tables to estimate total life expectancy (TLE) and life expectancy free of limiting long-term illness (LLTI-free LE) based on 20 waves of the Household, Income and Labour Dynamics in Australia Survey (2001-20). Our findings highlight substantial social disparities in both TLE and LLTI-free LE in Australia. Grouping individuals by household wealth shows striking differentials in LLTI-free LE. We observe widening social disparities in healthy longevity over time by all three measures of socio-economic position. This diverging trend in healthy longevity is troubling against the backdrop of widening income and wealth inequalities in Australia.

Age- and cause-specific contributions to increase in life expectancy at birth in Korea, 2000-2019: a descriptive study

BACKGROUND

Korea's life expectancy at birth has consistently increased in the 21st century. This study compared the age and cause-specific contribution to the increase in life expectancy at birth in Korea before and after 2010.

METHODS

The population and death numbers by year, sex, 5-year age group, and cause of death from 2000 to 2019 were acquired. Life expectancy at birth was calculated using an abridged life table by sex and year. The annual age-standardized and age-specific mortality by cause of death was also estimated. Lastly, the age and cause-specific contribution to the increase in life expectancy at birth in the two periods were compared using a stepwise replacement algorithm.

RESULTS

Life expectancy at birth in Korea increased consistently from 2010 to 2019, though slightly slower than from 2000 to 2009. The cause-specific mortality and life expectancy decomposition analysis showed a significant decrease in mortality in chronic diseases, such as neoplasms and diseases of the circulatory system, in the middle and old-aged groups. External causes, such as transport injuries and suicide, mortality in younger age groups also increased life expectancy. However, mortality from diseases of the respiratory system increased in the very old age group during 2010-2019.

CONCLUSIONS

Life expectancy at birth in Korea continued to increase mainly due to decreased mortality from chronic diseases and external causes during the study period. However, the aging of the population structure increased vulnerability to respiratory diseases. The factors behind the higher death rate from respiratory disease should be studied in the future.

The burden and trend of diseases and their risk factors in Australia, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

A comprehensive understanding of temporal trends in the disease burden in Australia is lacking, and these trends are required to inform health service planning and improve population health. We explored the burden and trends of diseases and their risk factors in Australia from 1990 to 2019 through a comprehensive analysis of the Global Burden of Disease Study (GBD) 2019.

METHODS

In this systematic analysis for GBD 2019, we estimated all-cause mortality using the standardised GBD methodology. Data sources included primarily vital registration systems with additional data from sample registrations, censuses, surveys, surveillance, registries, and verbal autopsies. A composite measure of health loss caused by fatal and non-fatal disease burden (disability-adjusted life-years [DALYs]) was calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). Comparisons between Australia and 14 other high-income countries were made.

FINDINGS

Life expectancy at birth in Australia improved from 77·0 years (95% uncertainty interval [UI] 76·9-77·1) in 1990 to 82·9 years (82·7-83·1) in 2019. Between 1990 and 2019, the age-standardised death rate decreased from 637·7 deaths (95% UI 634·1-641·3) to 389·2 deaths (381·4-397·6) per 100 000 population. In 2019, non-communicable diseases remained the major cause of mortality in Australia, accounting for 90·9% (95% UI 90·4-91·9) of total deaths, followed by injuries (5·7%, 5·3-6·1) and communicable, maternal, neonatal, and nutritional diseases (3·3%, 2·9-3·7). Ischaemic heart disease, self-harm, tracheal, bronchus, and lung cancer, stroke, and colorectal cancer were the leading causes of YLLs. The leading causes of YLDs were low back pain, depressive disorders, other musculoskeletal diseases, falls, and anxiety disorders. The leading risk factors for DALYs were high BMI, smoking, high blood pressure, high fasting plasma glucose, and drug use. Between 1990 and 2019, all-cause DALYs decreased by 24·6% (95% UI 21·5-28·1). Relative to similar countries, Australia's ranking improved for age-standardised death rates and life expectancy at birth but not for YLDs and YLLs between 1990 and 2019.

INTERPRETATION

An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing.

FUNDING

Bill & Melinda Gates Foundation.

An egalitarian society? Widening inequalities in premature mortality from non-communicable diseases in Australia, 2006-16

BACKGROUND

The recent slowdown in life expectancy increase in Australia has occurred concurrently with widening socioeconomic and geographical inequalities in all-cause mortality risk. We analysed whether, and to what extent, mortality inequalities among specific non-communicable diseases (NCDs) in Australia at ages 35-74 years widened during 2006-16.

METHODS

Registered deaths that occurred during 2006-16 in Australia were analysed. Inequalities were measured by area socioeconomic quintile [ranging from Q1 (lowest) to Q5 (highest)] and remoteness (major cities, inner regional, outer regional/remote/very remote). Age-standardized death rates (ASDR) for 35-74 years were calculated and smoothed over time.

RESULTS

NCD mortality inequalities by area socioeconomic quintile widened; the ratio of Q1 to Q5 ASDR for males increased from 1.96 [95% confidence interval (CI) 1.91-2.01] in 2011 to 2.08 (2.03-2.13) in 2016, and for females from 1.78 (1.73-1.84) to 1.96 (1.90-2.02). Moreover, Q1 NCD ASDRs did not clearly decline from 2011 to 2016. CVD mortality inequalities were wider than for all NCDs. There were particularly large increases in smoking-related mortality inequalities. In 2016, mortality inequalities were especially high for chronic respiratory diseases, alcohol-related causes and diabetes. NCD mortality rates outside major cities were higher than within major cities, and these differences widened during 2006-16. Higher mortality rates in inner regional areas than in major cities were explained by socioeconomic factors.

CONCLUSIONS

Widening of inequalities in premature mortality rates is a major public health issue in Australia in the context of slowing mortality decline. Inequalities are partly explained by major risk factors for CVDs and NCDs: being overweight or obese, lack of exercise, poor diet and smoking. There is a need for urgent policy responses that consider socioeconomic disadvantage.

Trends in life expectancy and healthy life years at birth and age 65 in the UK, 2008-2016, and other countries of the EU28: An observational cross-sectional study

Background

As society ages, promoting the health of the extra years of life is of paramount importance for health, social care and pension provision. Increases in life expectancy in the UK and elsewhere have slowed in recent years, but the reasons for this are unclear. No formal comparison of trends in healthy life years between the UK and the other countries of the EU28 in recent times has been published. These countries are geographically proximate, and share many social, cultural and demographic properties, making them interesting and useful comparators, especially as the UK prepared to leave the European Union in 2020.

Methods

We calculated sex-specific healthy life years (HLY), unhealthy life years (ULY), mild and severe ULY at birth and age 65 using life tables and age-specific prevalence of activity limitation amongst the EU28 between 2008 and 2016 from EuroHex. Trends in life expectancy, HLY, ULY and proportion of life spent healthy (HLY%) were compared. We then decomposed HLY temporal changes into relative effects of changes in healthy life and mortality, by age group.

Findings

Life expectancy at birth, and age 65, in the UK were increasing rapidly in 2008 but slowed around 2011. Germany, Portugal and France showed evidence of a similar slowing. HLY at birth in the UK decreased, whereas it increased in most EU28 countries. The UK experienced a period of absolute expansion of unhealthy life in both sexes. The reduction in HLY at birth in the UK was mainly attributable to increases in unhealthy life in younger age groups.

Interpretation

The UK's performance relative to the other countries of the EU28 was poor after 2011, combining static life expectancy and reductions in healthy life years. These trends suggest that the UK government's Ageing Society Grand Challenge (to increase the healthy life expectancy by five years by 2035) will be difficult to attain.

Funding

National Institute for Health Research (NIHR) Policy Research Programme conducted through the NIHR Older People and Frailty Policy Research Unit, PR-PRU-1217-21502. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Considerations in Planning Physical Activity for Older Adults in Hot Climates: A Narrative Review

Regular physical activity has multiple health benefits for both the prevention and management of disease, including for older adults. However, additional precautions are needed with ageing given physiological changes and the increasing prevalence of comorbidities. Hot ambient temperatures increase the risks of exercise at any age, but are particularly important given thermoregulatory changes in older people. This narrative review informs planning of physical activity programs for older people living in rural areas with very hot climates for a period of the year. A multi-database search of peer-reviewed literature was undertaken with attention to its relevance to Australia, starting with definitions and standard advice in relation to physical activity programming and the incremental limitations imposed by age, rurality, and extreme heat. The enablers of and barriers to increasing physical activities in older adults and how they can be modified for those living in extreme hot climates is described. We describe multiple considerations in program design to improve safety, adherence and sustaining physical activity, including supervision, simple instructions, provision of reminders, social support, encouraging self-efficacy. Group-based activities may be preferred by some and can accommodate special populations, cultural considerations. Risk management is an important consideration and recommendations are provided to assist program planning.

New Perspective on Why Women Live Longer Than Men: An Exploration of Power, Gender, Social Determinants, and Capitals

BACKGROUND

Women live longer than men, even though many of the recognised social determinants of health are worse for women than men. No existing explanations account fully for these differences in life expectancy, although they do highlight the complexity and interaction of biological, social and health service factors.

METHODS

this paper is an exploratory explanation of gendered life expectancy difference (GLED) using a novel combination of epidemiological and sociological methods. We present the global picture of GLED. We then utilise a secondary data comparative case analysis offering explanations for GLED in Australia and Ethiopia. We combine a social determinant of health lens with Bourdieu's concepts of capitals (economic, cultural, symbolic and social).

RESULTS

we confirmed continuing GLED in all countries ranging from less than a year to over 11 years. The Australian and Ethiopian cases demonstrated the complex factors underpinning this difference, highlighting similarities and differences in socioeconomic and cultural factors and how they are gendered within and between the countries. Bourdieu's capitals enabled us to partially explain GLED and to develop a conceptual model of causal pathways.

CONCLUSION

we demonstrate the value of combing a SDH and Bourdieu's capital lens to investigate GLED. We proposed a theoretical framework to guide future research.

Mortality in Tonga over three triennia, 2010-2018

BACKGROUND

Tonga is a South Pacific Island country with a population of 100,651 (2016 Census). This study examines Tongan infant mortality rates (IMR), under-five mortality rates (U5MR), adult mortality and life expectancy (LE) at birth from 2010 to 2018 using a recent collation of empirical mortality data over the past decade for comparison with other previously published mortality estimates.

METHODS

Routinely collected mortality data for 2010-2018 from the Ministry of Health, national (Vaiola) hospital, community nursing reports, and the Civil Registry, were consolidated by deterministic and probabilistic linkage of individual death records. Completeness of empirical mortality reporting was assessed by capture-recapture analysis. The reconciled data were aggregated into triennia to reduce stochastic variation, and used to estimate IMR and U5MR (per 1000 live births), adult mortality (15-59, 15-34, 35-59, and 15-64 years), and LE at birth, employing the hypothetical cohort method (with statistical testing). Mortality trends and differences were assessed by Poisson regression. Mortality findings were compared with published national and international agency estimates.

RESULTS

Over the three triennia in 2010-2018, levels varied minimally for IMR (12-14) and U5MR (15-19) per 1000 births (both ns, p > 0.05), and also for male LE at birth of 64-65 years, and female LE at birth 69-70 years. Cumulated risks of adult mortality were significantly higher in men than women; period mortality increases in 15-59-year women from 18 to 21% were significant (p < 0.05). Estimated completeness of the reconciled data was > 95%. International agencies reported generally comparable estimates of IMR and U5MR, with varying uncertainty intervals; but they reported significantly lower adult mortality and higher LE than the empirical estimates from this study.

CONCLUSIONS

Life expectancy in Tonga over 2010-2018 has remained relatively low and static, with low IMR and U5MR, indicating the substantial impact from premature adult mortality. This analysis of empirical data (> 95% complete) indicates lower LE and higher premature adult mortality than previously reported by international agencies using indirect and modelled methods. Continued integration of mortality recording and data systems in Tonga is important for improving the completeness and accuracy of mortality estimation for local health monitoring and planning.

Pharmaceutical opioids utilisation by dose, formulation, and socioeconomic status in Queensland, Australia: a population study over 22 years

Background Prescription opioids are a central aspect of pain management and as the prevalence of pain is increasing so is the rate of use of prescription opioids. Increased opioid prescriptions increases the risk of deaths and morbidity. Objective To (a) describe the 22-year trend of prescription opioid dispensing in Queensland, (b) examine the effect of opioid dose, formulation and socioeconomic status on the number of prescriptions dispensed. Design/setting Retrospective analysis of data from the Monitoring of Drugs of Dependence system of the Monitored Medicines Unit of Queensland Health, Australia. Participants Queensland residents (3.3 million) from 18 years old dispensed 18.8 million opioid prescriptions from January 1997 to December 2018. Results Opioid prescriptions dispensed annually increased to over two million in 2018 from about 150,000 prescriptions in 1997. The number of prescriptions for modified-release formulations dispensed annually was three times higher compared to the immediate-release formulations. Oxycodone accounted for over 60% of prescriptions for pharmaceutical opioids since 2013. There was an increase in the number of prescriptions dispensed as socioeconomic status decreased and modified-release opioid formulations positively affects the pattern of dispensing. The highest increase in number of prescriptions dispensed (for all opioids) was observed among the high socioeconomic status (IRR = 1.25, 95% CI 1.25, 1.26). The disparities in the annual number of prescriptions across dose categories are wider in the modified-release than the immediate-release formulations. Conclusion The dispensing of opioids increased significantly in Queensland. There was a positive relationship between the increased dispensing of opioids and locations of lower socioeconomic status.

The role of overweight and obesity in adverse cardiovascular disease mortality trends: an analysis of multiple cause of death data from Australia and the USA

BACKGROUND

In recent years, there have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35-74 years) in the USA and Australia. Following long-term declines, rates in the USA are now increasing while falls in Australia have slowed rapidly. These two countries also have the highest adult obesity prevalence of high-income countries. This study investigates the role of overweight and obesity in their recent CVD mortality trends by using multiple cause of death (MCOD) data-direct individual-level evidence from death certificates-and linking the findings to cohort lifetime obesity prevalence.

METHODS

We identified overweight- and obesity-related mortality as any CVD reported on the death certificate (CVD MCOD) with one or more of diabetes, chronic kidney disease, obesity, lipidemias or hypertensive heart disease (DKOLH-CVD), causes strongly associated with overweight and obesity. DKOLH-CVD comprises 50% of US and 40% of Australian CVD MCOD mortality. Trends in premature age-standardized death rates were compared between DKOLH-CVD and other CVD MCOD deaths (non-DKOLH-CVD). Deaths from 2000 to 2017 in the USA and 2006-2016 in Australia were analyzed. Trends in in age-specific DKOLH-CVD death rates were related to cohort relative lifetime obesity prevalence.

RESULTS

Each country's DKOLH-CVD mortality rate rose by 3% per annum in the most recent year, but previous declines had reversed more rapidly in Australia. Non-DKOLH-CVD mortality in the USA increased in 2017 after declining strongly in the early 2000s, but in Australia it has continued declining in stark contrast to DKOLH-CVD. There were larger increases in DKOLH-CVD mortality rates at successively younger ages, strongly related with higher relative lifetime obesity prevalence in younger cohorts.

CONCLUSIONS

The increase in DKOLH-CVD mortality in each country suggests that overweight and obesity has likely been a key driver of the recent slowdown or reversal of CVD mortality decline in both countries. The larger recent increases in DKOLH-CVD mortality and higher lifetime obesity prevalence in younger age groups are very concerning and are likely to adversely impact CVD mortality trends and hence life expectancy in future. MCOD data is a valuable but underutilized source of data to track important mortality trends.

Who? What? Where? A snapshot of Nuclear Medicine Research Presentations from recent ANZSNM conferences in Australia and New Zealand

OBJECTIVES

The aims of this study were to: 1) discover location (by city) of contributors to poster and oral presentations at recent ANZSNM conferences; 2) determine the nuclear medicine themes most commonly explored; 3) establish institutions producing the highest number of oral and poster abstracts and 4) determine publication rates of conference abstracts to full papers from recent ANZSNM conferences.

METHODS

Retrospective analysis of abstracts published in the Internal Medicine Journal Special Issues 2014-2019 identified 614 abstracts. Invited plenary speaker abstracts were excluded. Descriptive statistics were used in data analysis. Conference abstracts were analysed using the following criteria: poster or oral presentation, author/s, city location, hospital and subject matter. Themes defined by the ANZSNM conference committee for abstract submission were: cardiology, oncology, neurology, therapy, renal/urology, gastrointestinal, paediatrics, musculoskeletal, infection/inflammation, technology, physics, radiation safety, radiopharmacy/radiochemistry, education, or general. Retrospective analysis of 555 conference abstracts (excluding New Zealand and International, 59 abstracts) using Google Scholar, Pubmed and Google databases was undertaken. Abstract titles, key words, institutions and/or authors' names were used to find peer-reviewed papers. Identified papers were authenticated through either open access, publicly available author information or Monash University's library access. Published paper citations were also recorded (up to 1st July 2019).

RESULTS

Analysis of 614 abstracts 2014 - 2019 was performed. Over five years, the average number of poster abstracts was 67.8 and oral 55.0. Sydney submitted the highest number of poster abstracts, while Melbourne the highest number of oral abstracts. Most popular abstract theme was oncology for both poster and oral abstracts. Publications found had in excess of 1250 citations.One hundred and one publications from one hundred and seven conference presentations were identified, distributed across sixty journals. Conference presentation to full publication rate was 18.2%; excluding 2019 conference abstracts the rate was 21.5%.

CONCLUSION

Publishing research findings is a challenging process. A retrospective analysis of research presented at recent ANZSNM conferences by abstract content was undertaken, with conference presentation to full publication rate found to be at the lower end of reported literature findings.