Educational differences in life expectancy over five decades among the oldest old in Norway

Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study

BACKGROUND

Health inequalities are often assessed in terms of life expectancy or health-related quality of life (HRQoL). Few studies combine both aspects into quality-adjusted life expectancy (QALE) to derive comprehensive estimates of lifetime health inequality. Furthermore, little is known about the sensitivity of estimated inequalities in QALE to different sources of HRQoL information. This study assesses inequalities in QALE by educational attainment in Norway using two different measures of HRQoL.

METHODS

We combine full population life tables from Statistics Norway with survey data from the Tromsø study, a representative sample of the Norwegian population aged ≥ 40. HRQoL is measured using the EQ-5D-5L and EQ-VAS instruments. Life expectancy and QALE at 40 years of age are calculated using the Sullivan-Chiang method and are stratified by educational attainment. Inequality is measured as the absolute and relative gap between individuals with lowest (i.e. primary school) and highest (university degree 4 + years) educational attainment.

RESULTS

People with the highest educational attainment can expect to live longer lives (men: + 17.9% (95%CI: 16.4 to 19.5%), women: + 13.0% (95%CI: 10.6 to 15.5%)) and have higher QALE (men: + 22.4% (95%CI: 20.4 to 24.4%), women: + 18.3% (95%CI: 15.2 to 21.6%); measured using EQ-5D-5L) than individuals with primary school education. Relative inequality is larger when HRQoL is measured using EQ-VAS.

CONCLUSION

Health inequalities by educational attainment become wider when measured in QALE rather than LE, and the degree of this widening is larger when measuring HRQoL by EQ-VAS than by EQ-5D-5L. We find a sizable educational gradient in lifetime health in Norway, one of the most developed and egalitarian societies in the world. Our estimates provide a benchmark against which other countries can be compared.

Can Sex Differences in Old Age Disabilities be Attributed to Socioeconomic Conditions? Evidence from a Mapping Review of the Literature

Old age disabilities are more common among women than men, and adverse socioeconomic conditions are associated with a higher prevalence of disabilities among older adults. The goal of this study was to complete a mapping review of the available evidence assessing the extent to which the observed sex differences in older adults’ disabilities can be attributed to sex differences in socioeconomic status. We searched three databases for articles published between 2009 and 2019, and after screening and looking at eligibility criteria, 6 articles were included in the review. For those studies that did not directly analyse the contribution of socioeconomic conditions, we used the ‘difference method’ to estimate the proportion of the sex gap in disabilities among older adults that could be attributed to socioeconomic conditions. Our review demonstrated that women generally have a higher prevalence of disabilities than men. In several studies, these differences could be partly attributed to sex differences in the distribution of socioeconomic conditions. We also find great elasticity in the magnitude of both the sex gap in disabilities and in the proportion that could be attributed to differences in socioeconomic conditions.

Future trends of life expectancy by education in the Netherlands

Background

National projections of life expectancy are made periodically by statistical offices or actuarial societies in Europe and are widely used, amongst others for reforms of pension systems. However, these projections may not provide a good estimate of the future trends in life expectancy of different social-economic groups. The objective of this study is to provide insight in future trends in life expectancies for low, mid and high educated men and women living in the Netherlands.

Methods

We used a three-layer Li and Lee model with data from neighboring countries to complement Dutch time series.

Results

Our results point at further increases of life expectancy between age 35 and 85 and of remaining life expectancy at age 35 and age 65, for all education groups in the Netherlands. The projected increase in life expectancy is slightly larger among the high educated than among the low educated. Life expectancy of low educated women, particularly between age 35 and 85, shows the smallest projected increase. Our results also suggest that inequalities in life expectancies between high and low educated will be similar or slightly increasing between 2018 and 2048. We see no indication of a decline in inequality between the life expectancy of the low and high educated.

Conclusions

The educational inequalities in life expectancy are expected to persist or slightly increase for both men and women. The persistence and possible increase of inequalities in life expectancy between the educational groups may cause equity concerns of increases in pension age that are equal among all socio-economic groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13275-w.

Life-course income trajectories of men and women in Norway: implications for self-rated health in later life

BACKGROUND

Socioeconomic inequalities in health are well-established, but studies addressing lagged effects of income or of fluctuations in income over the life course are relatively rare. The current study aims to (i) identify and describe life-course income trajectories for men and women who are currently in later life; and (ii) assess the association of income trajectories with self-rated health in older adults.

METHODS

The study sample consisted of 1625 men and 1634 women born between 1937 and 1955 who participated in the third wave of the Norwegian Life course, Ageing and Generation Study. Latent class growth analyses were used to estimate dominant income trajectories from ages 30 through 62 in men and women. Stepwise logistic regression analyses were specified to analyze the association of income trajectories with self-rated health in later life.

RESULTS

Four trajectories in women and three trajectories in men were estimated as dominant patterns of income over the life course. Differences in the level of income were considerable at age 30 and accumulated over time. Continued exposure to low income showed statistically significant higher odds for poor self-rated health in older men and women. This association remained significant after taking differences in educational attainment, working life, family formation and accumulated wealth into account.

CONCLUSION

The findings suggested remarkable rigidity in income groups that had formed by age 30. A significant share of men and women remain mired in relatively low-income status across the life course with negative implications for health in later life.

Changes in socioeconomic differentials in old age life expectancy in four Nordic countries: the impact of educational expansion and education-specific mortality

Overall progress in life expectancy (LE) depends increasingly on survival in older ages. The birth cohorts now reaching old age have experienced considerable educational expansion, which is a driving force for the social change and social inequality. Thus, this study examines changes in old age LE by educational attainment in the Nordic countries and aims to find out to what extent the change in national LEs is attributable to education-specific mortality and the shifting educational composition. We used national register data comprising total 65 + populations in Denmark, Finland, Norway and Sweden to create period life tables stratified by five-year age groups (65-90 +), sex and educational attainment. Difference in LE between 2001 and 2015 was decomposed into the contributions of mortality changes within each educational group and changes in educational composition. Increasing LE at all ages and in all educational groups coincided with persistent and growing educational inequalities in all countries. Most of the gains in LE at age 65 could be attributed to decreased mortality (63-90%), especially among those with low education, the largest educational group in most countries. The proportion of the increase in LE attributable to improved education was 10-37%, with the highest contributions recorded for women in Norway and Sweden. The rising educational levels in the Nordic countries still carry potential for further gains in national LEs. However, the educational expansion has contributed to uneven gains in LE between education groups, which poses a risk for the future increase of inequalities in LE.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00698-y.

Oral health complications in Brazilian and French diabetic older people: A comparative study

INTRODUCTION

Diabetes mellitus (DM) is a risk factor for periodontitis for over 40 years and novel evidence suggests that periodontitis has an impact on glycemic control in patients with diabetes. This study aimed to compare oral health complications in diabetic older patients from Brazil and France.

METHODS

This cross-sectional study included 120 patients aged 65 and over diagnosed with type 2 diabetes. Sixty patients were admitted to a center for diabetes and hypertension care in Brazil and 60 patients were admitted to the Rouen University hospital. Dental conditions were assessed through the decayed, missing and filled teeth index and periodontal condition was assessed using the Community Periodontal Index. The significance threshold was p < 0.05.

RESULTS

Decayed teeth differed statistically between the groups (p = 0.001). The French group presented more tooth mobility, gingival recession and furcation involvement (p < 0.001). Tooth brushing frequency differed significantly between the groups (p < 0.030). The main cause of missing teeth was periodontitis in the French group and caries and periodontitis in the Brazilian group (p < 0.001). Statistical significance was found for use of fixed upper (p = 0.013) and lower (p = 0.013) dentures in the French group. The French group needed upper denture rehabilitation (p = 0.010) while the Brazilian group needed lower denture rehabilitation (p = 0.003).

CONCLUSION

Edentulism was prevalent in diabetic older people in both countries. However, the French participants presented with better oral health.

Socio-Economic Inequalities in Life Expectancy and Health Expectancy at Age 50 and over in European Countries

Abstract Based on the demographic ageing, many European governments have modified the statutory retirement age. However, in general, life expectancy (LE) and health expectancy (HE) are not uniformly distributed, being both lower among the least advantaged groups. Thus, a systematic search and review of the literature has been conducted to identify socioeconomic inequalities in LE and HE at age 50 and over in European countries. Twenty-nine studies were included in the review. Across Europe, people in a more advantaged position can expect to live longer, more years in good health and less in bad health, and therefore a lower percentage of their lives in bad health. Zusammenfassung: Sozioökonomische Ungleichheiten in der Lebens- und Gesundheitserwartung im Alter von 50 und älter in Europäischen Ländern. Erkenntnisse für die Debatte der Rentenpolitik Vor dem Hintergrund der demographischen Alterung haben viele europäische Regierungen das Renteneintrittsalter modifiziert. Allerdings sind Lebensund Gesundheitserwartungen nicht gleichmäßig verteilt, sondern sind in benachteiligten Bevölkerungsgruppen niedriger. Um sozioökonomische Ungleichheiten in der Lebens- und Gesundheitserwartung von Individuen im Alter von 50 Jahren und älter zu betrachten, wurde eine systematische Suche und Begutachtung der Literatur in den europäischen Ländern durchgeführt. Es wurden 29 Studien in der Begutachtung miteinbezogen. Es zeigt sich, dass Individuen in vorteilhaften Positionen erwarten können länger zu leben, länger gesund zu sein und weniger häufig einen schlechten Gesundheitszustand aufweisen, was der Grund dafür ist, dass sie auch einen geringeren Anteil ihrer Lebenszeit in schlechter Gesundheit verbringen.

Paternal characteristics associated with maternal periconceptional use of folic acid supplementation

Background

Maternal predictors of folic acid (FA) supplementation use to reduce offspring risk of neural tube defects are well known, while paternal determinants for maternal FA use are less known. Such knowledge is important to increase women’s compliance to recommended periconceptional FA use.

Methods

In a nation-wide study of 683,785 births registered in the Medical Birth Registry of Norway during 1999–2010, the associations between paternal characteristics (age, education, occupation, country of origin) and maternal FA use were estimated by relative risks (RR) with 95% confidence intervals (CI), using log-binomial regression.

Results

Maternal FA use before and during pregnancy (adequate FA use) was found in 16% of the births. The association between paternal age and adequate FA use was inversely U-shaped; adjusted RRs for adequate FA use were 0.35 (95% CI 0.28–0.43) and 0.72 (95% CI 0.71–0.74) for paternal age < 20 and ≥ 40 years, respectively, comparing age 30–34 years. Compulsory education (1–9 years) among fathers was compared to tertiary education; the RR was 0.69 (95% CI 0.68–0.71) for adequate FA use. The lower risk of adequate FA use for paternal compulsory education was present in all categories of maternal education. Occupation classes other than “Higher professionals” were associated with decreased risk of adequate FA use, compared with the reference “Lower professionals”. RR for adequate FA use was 0.58 (95% CI 0.56–0.60) comparing fathers from “Low/middle-income countries” with fathers born in Norway.

Conclusion

Adequate FA use in the periconceptional period was lower when fathers were younger or older than 30–34 years, had shorter education, had manual or self-employed occupations, or originated from low/middle-income countries. Partners may contribute to increase women’s use of periconceptional FA supplementation.

Does the Association of Comorbidity with 1-Year Mortality After Hip Fracture Differ According to Gender? The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)

BACKGROUND/OBJECTIVES

Excess mortality after hip fracture is higher in men than in women. The objective was to study whether comorbidity differs in men and women with hip fracture and to what degree differences in comorbidity according to gender may explain the higher excess mortality in men.

DESIGN

Population-based matched cohort covering the population aged 50 and older in Norway.

SETTING

Specialist healthcare (individuals with hip fracture) and general population (controls).

PARTICIPANTS

All individuals with hip fracture aged 50 and older from 2005 to 2008 (n = 32,175) and individuals without hip fracture matched 3:1 to those with hip fracture on gender, age, and county of residence (n = 96,410).

MEASUREMENTS

Comorbid diagnoses were recorded during the hospital stay. Relative and absolute excess 1-year mortality in individuals with hip fracture according to gender and Charlson Comorbidity Index (CCI) were investigated using Cox regression and linear regression, respectively.

RESULTS

Despite lower age (mean 78.7 vs 81.7), men had higher comorbidity than women. Compared with controls, women (hazard ratio (HR) = 6.5, 95% confidence interval (CI) = 6.2-6.9) and men (HR = 7.8, 95% CI = 7.3-8.3) with a CCI of 2 or greater were more likely to die. Women with a CCI of 2 or greater had an estimated 1-year risk of dying of 44%, and controls had an 11% risk; men with a CCI of 2 or greater had an estimated risk of dying of 53%, and controls had a 12% risk. Men were twice as likely as women to die within 1 year (HR = 2.0, 95% CI = 1.9-2.1). When adjusting for comorbidity, the difference was only slightly smaller (HR = 1.8, 95% CI = 1.7-1.8).

CONCLUSION

Men had greater comorbidity than women, but this did not explain the difference according to gender in excess mortality after hip fracture. Men who fracture a hip are an especially vulnerable subpopulation, even when there is no apparent comorbidity, and warrant special attention in follow-up and care.

Decennial trends and inequalities in healthy life expectancy: The HUNT Study, Norway

AIMS

Norway is experiencing a rising life expectancy combined with an increasing dependency ratio - the ratio of those outside over those within the working force. To provide data relevant for future health policy we wanted to study trends in total and healthy life expectancy in a Norwegian population over three decades (1980s, 1990s and 2000s), both overall and across gender and educational groups.

METHODS

Data were obtained from the HUNT Study, and the Norwegian Educational Database. We calculated total life expectancy and used the Sullivan method to calculate healthy life expectancies based on self-rated health and self-reported longstanding limiting illness. The change in health expectancies was decomposed into mortality and disability effects.

RESULTS

During three consecutive decades we found an increase in life expectancy for 30-year-olds (~7 years) and expected lifetime in self-rated good health (~6 years), but time without longstanding limiting illness increased less (1.5 years). Women could expect to live longer than men, but the extra life years for females were spent in poor self-rated health and with longstanding limiting illness. Differences in total life expectancy between educational groups decreased, whereas differences in expected lifetime in self-rated good health and lifetime without longstanding limiting illness increased.

CONCLUSIONS

The increase in total life expectancy was accompanied by an increasing number of years spent in good self-rated health but more years with longstanding limiting illness. This suggests increasing health care needs for people with chronic diseases, given an increasing number of elderly. Socioeconomic health inequalities remain a challenge for increasing pensioning age.

Supplemental folic acid in pregnancy and childhood cancer risk

BACKGROUND

We investigated the association between supplemental folic acid in pregnancy and childhood cancer in a nation-wide study of 687 406 live births in Norway, 1999-2010, and 799 children diagnosed later with cancer.

METHODS

Adjusted hazard ratios (HRs) compared cancer risk in children by approximated periconceptional folic acid levels (folic acid tablets and multivitamins (0.6 mg), only folic acid (0.4 mg), only multivitamins (0.2 mg)) and cancer risk in unexposed.

RESULTS

Any folic acid levels were not associated with leukemia (e.g., high-level folic acid HR 1.25; 95% CI 0.89-1.76, PTrend 0.20), lymphoma (HR 0.96; 95% CI 0.42-2.21, PTrend 0.51), central nervous system tumours (HR 0.68; 95% CI 0.42-1.10, PTrend 0.32), neuroblastoma (HR 1.05; 95% CI 0.53-2.06, PTrend 0.85), Wilms' tumour (HR 1.16; 95% CI 0.52-2.58, PTrend 0.76), or soft-tissue tumours (HR 0.77; 95% CI 0.34-1.75, PTrend 0.90).

CONCLUSIONS

Folic acid supplementation was not associated with risk of major childhood cancers.

Four Decades of Educational Inequalities in Hospitalization and Mortality among Older Swedes

BACKGROUND

The inverse association between education and mortality has grown stronger the last decades in many countries. During the same period, gains in life expectancy have been concentrated to older ages; still, old-age mortality is seldom the focus of attention when analyzing trends in the education-mortality gradient. It is further unknown if increased educational inequalities in mortality are preceded by increased inequalities in morbidity of which hospitalization may be a proxy.

METHODS

Using administrative population registers from 1971 and onwards, education-specific annual changes in the risk of death and hospital admission were estimated with complimentary log-log models. These risk changes were supplemented by estimations of the ages at which 25, 50, and 75% of the population had been hospitalized or died (after age 60).

RESULTS

The mortality decline among older people increasingly benefitted the well-educated over the less well-educated. This inequality increase was larger for the younger old, and among men. Educational inequalities in the age of a first hospital admission generally followed the development of growing gaps, but at a slower pace than mortality and inequalities did not increase among the oldest individuals.

CONCLUSIONS

Education continues to be a significant predictor of health and longevity into old age. That the increase in educational inequalities is greater for mortality than for hospital admissions (our proxy of overall morbidity) may reflect that well-educated individuals gradually have obtained more possibilities or resources to survive a disease than less well-educated individuals have the last four decades.